Biomedical subjects
Publications and source records attributed to H Häuser.
Medical progress in intensive care has led to a modification of management in diagnostic imaging. All radiological imaging methods are available for intensive care patients. Thus, it is necessary to correlate the risk of patient transport with diagnostic and therapeutic benefit. This article describes the currently available imaging methods for the chest, and radiological findings of the most frequent pathologies.
OBJECTIVE: To analyse common and divergent features of staff-related, equipmental and spatial/logistical concepts of three large trauma centers of highest health care level. METHODS: The health care mandate as well as the staff management, the organisational and the constructional-spacial structure of trauma room diagnostics and therapy of the trauma centers of the Universities of Leiden and Munich (Innenstadt) and the Zentralklinikum Augsberg are described. In particular the technical equipment and the process of the radiological diagnostic procedures in the trauma room are outlined. RESULTS: Staff availability and basic technical equipment of the trauma rooms are comparable between the three hospitals. Divergent concepts exist concerning the complexity of the initial radiologic examination protocols. Spacial connection and importance of computed tomography are also discussed controversially. Urgent interventional procedures are increasingly performed within the trauma room. Magnetic-resonance-tomography does not play a role in early care from multiple injured patients. CONCLUSION: Trauma centers have to meet certain personnel and technical prerequisites to guarantee a temporally optimised care for multiple injured patients. Differences between the three centers concerning the logistic sequence and the radiologic examination techniques used are mainly due to variable emphasis put on CT in the initial phase of patient care.
The diagnostic value of unenhanced helical computed tomography was investigated in a prospective study. In 53 patients (aged 35 to 82 years) with acute flank pain tomography was performed in addition to abdominal plain film and ultrasound examination. All 53 patients had a contraindication for intravenous administration of contrast medium. Ureteral calculi were either confirmed or excluded by retrograde ureteropyelography in 44 cases, in 9 patients by asservation of calculi and clinical follow-up. Helical computed tomography was able to precisely identify all of the 34 ureteral calculi, whereas abdominal plain films led to 6 false positive and 17 false negative findings. In 1 patient with retroperitoneal lymphoma (diagnosed by CT) false positive findings occurred. Unenhanced helical computed tomography reaches a distinctively increased diagnostic value (sensitivity 100%, specificity 95%, accuracy 97%) in the evaluation of acute flank pain as compared to conventional radiologic imaging and ultrasound. This non-invasive procedure is to be considered method of choice for patients with contraindications for the application of radiopaque material.
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PURPOSE: To evaluate prospectively whether and to what extent both thoracic computed tomography (Tx-CT) and supine X-ray of the chest (Rx-Tx) are able to show additional findings that are therapeutically relevant. PATIENTS AND METHODS: According to a fixed study protocol, we performed Rx-Tx and Tx-CT in 102 consecutive, haemodynamically stable polytrauma patients (mean age, 41.2 yrs; age range, 12-93 yrs). Findings of therapeutical relevance drawn from both Tx-CT and Rx-Tx, and urgent interventions indicated by an attending trauma team were documented on a standardized evaluation sheet immediately. Any change in the patient's management that is different from routine life-saving procedures, and any therapeutical intervention done in the emergency room or elsewhere (operating theatre, angiographic facility) were considered therapeutically relevant. RESULTS: Of 102 patients, 43 (42.2%) had a total of 51 therapeutically relevant findings. Rx-Tx alone yielded 23 relevant findings (45.1%) in 23 patients (22.5%). Of them, Tx-CT has shown additional important findings in 7 patients (30.4%). When Tx-CT alone is considered, it revealed 22 new findings of therapeutical relevance (43.2%) in 20 patients (46.5%). Altogether, Tx-CT was able to show 30 relevant findings in 27 patients, i.e., there was a therapeutical benefit for 26.5% of all polytrauma patients included. Most frequently, there was a need for chest-tube insertion (n = 29). CONCLUSIONS: Polytrauma patients if haemodynamically stable may profit from computed tomography of the chest when therapeutically relevant thoracic injuries are looked for or early therapeutical interventions are to be checked. However, chest X-ray should stay as a "front-line" screening method because of its superbly quick feasibility and availability.
OBJECTIVE: The diagnostic value of unenhanced helical computed tomography (CT) for the evaluation of acute flank pain is investigated in a prospective study. PATIENTS AND METHODS: In 125 patients aged 18-86 years, we performed unenhanced helical CT in addition to abdominal plain film, abdominal ultrasound and urinalysis as a diagnostic measure for acute flank pain. Ureteral calculi were confirmed or, respectively, excluded by retrograde ureteropyelography in 80 cases. In the other cases, diagnosis was verified by clinical course and/or stone asservation. RESULTS: In 91 of 125 patients the flank pain was caused by a ureteral calculus. In 67 of 91 patients with urolithiasis, stones could be collected for analysis. Helical CT was able to precisely identify 90 ureteral calculi. Abdominal plain films led to 8 false-positive and 48 false-negative findings. Thus, sensitivity of plain radiography, ultrasound and urinalysis was 47, 11 and 84% with a specificity 76, 97 and 32%, respectively. CONCLUSIONS: Unenhanced helical CT reaches a distinctively increased diagnostic value (sensitivity 99%, specificity 97%) in the evaluation of acute flank pain as compared to plain radiography, ultrasound and urinalysis.
BACKGROUND: In a substantial number of mainly diabetic patients isolated crural arterial lesions are found to be the underlying cause for severe ischaemic foot lesions. Without revascularisation, patients with this specific occlusion pattern will inevitably face major amputation. To attain limb salvage in this setting, since the early eighties short vein grafts were used to bypass the occluded infrapopliteal arteries. More recently, percutaneous transluminal angioplasty (PTA) was also attempted to avoid limb loss in selected patients. PATIENTS AND METHODS: Since May 1986 in 125 patients 130 autologous bypass grafts from the BK-popliteal artery or the proximal tibioperoneal arteries to malleolar vessels were performed in the presence of extended crural arterial occlusions and critical foot ischaemia (rest pain 3, tissue loss 127). In another series in 89 limbs (rest pain 5, tissue loss 84) of 84 patients PTA was done to treat 168 focal stenoses of > 50% diameter reduction and 11 short occlusions in a total of 135 crural arteries. RESULTS: Using life-table analysis, primary and secondary cumulative patency rates for short vein grafts with distal graft origin were 90% and 98% at 30 days, 76% and 83% at one year and 46% and 49% at seven years, respectively. The corresponding limb salvage rates amounted to 95%, 80% and 63%. Initial complete or partial technical success after PTA of crural arteries could be obtained in 93%: The limb salvage rates achieved were 95% at 30 days, 82% at one year and 63% at six years. CONCLUSION: Our results suggest that--depending on the extent of lesions--both short vein grafts as well as PTA are successful complementary treatment modalities to avoid limb loss in predominantly diabetic patients with infrapopliteal artery disease and critical ischaemia.
This article describes the CT-guided osteosynthesis of calcaneus fractures. This procedure is minimal invasive and offers the opportunity to reduce and to stabilize such fractures very exactly under intraoperative CT-controll only by stab-incisions. A running study will define the ranking of this method.
UNLABELLED: With a prospective assessment of 140 emergency-room patients, we registered the conventional radiological examinations (CR), ultrasound (US) and computer tomographies (CT), including the duration of the examinations, transportation and diagnostic free time. RESULTS: CR: 98.6% (average 8.5 radiographs per patient), US 78.6%, CT 67.8%. DURATION: CR average 20.3 min (range 1-80 min), US average 6.5 min (range 2-15 min), CT average 16.9 min (range 12-135 min). The entire time spent in the primary diagnostic work-up, including CT: average 79.4 min (only CR and US average 49.1 min). Diagnostic free time, including CT: average 31.9 min, without CT average 19.2 min. Time for transportation and repositioning: average 14.5 min. When a CT is indicated, the radiological diagnostic work-up will increase as a result of waiting and transportation. The patient also suffers because of more repositioning procedures.
The management of multiple trauma patients has improved recently. Surgeons' education, preclinical rescue structures, initial clinical survey and therapeutic strategies, as well as diagnostic imaging, have progressed. Plain film imaging is increasingly being abandoned in favor of CT. Fast imaging techniques (spiral CT) have led to the inclusion of CT in the primary survey. To minimize the risk to the patient during prolonged diagnostic time, algorithms have to be defined concerning structures, emergency room equipment and quality. Basics, state of the art and suggestions concerning management of multiple trauma patients are presented and discussed from the radiologist's point of view.
In Europe ultrasonography has displaced diagnostic peritoneal lavage (DPL) in the primary survey of polytraumatized patients with suspected abdominal trauma. Hemodynamically unstable patients who are brought to the emergency room with blunt abdominal trauma will go directly to the operating room after a rapid ultrasonography examination with evidence of hemoperitoneum. In hemodynamically stable patients, in addition to ultrasonography, computed tomography can be done. This is especially efficient if evaluation with sonography is not completely possible or shows little pathology (e.g. small amounts of hemoperitoneum).
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We treated foot ulcerations in diabetics with limb-threatening ischemia using percutaneous balloon dilatation (44) and popliteodistal vein grafts (94). After revascularization, we observed in 12% an increase in the infection which necessitated major amputation despite open bypass or successful dilatation. A diabetic local immunodeficiency leads to cellular and humoral alterations which may cause severe tissue damage although the perfusion has been improved.
PURPOSE: Retrospective analysis of the results after infrapopliteal PTA of isolated crural limb artery stenoses in patients with critical crural limb ischaemia. PATIENTS AND METHODS: Between 1989 and 1994 70 infrapopliteal dilatations of isolated crural limb artery stenoses in 44 patients (47 PTA procedures) were done with small diameter balloon catheters. 45 patients were stage IV according to Fontaine's classification, two patients were stage III. No patient had a relevant obstruction up to the popliteal artery. Follow up ranged from 1-50 months (mean 13.3 months). RESULTS: A technical success with a residual stenosis below 30% compared to the original vessel diameter was achieved in 80% of patients (n = 56). The cumulative limb-salvage rate was 76.6% after 6 to 36 months after PTA. RESULTS: In patients with chronical critical crural limb ischaemia PTA of isolated crural limb artery stenoses is an efficient therapy modality for limb-salvage. In many cases PTA is the last alternative method to amputation surgery if there is no sufficient distal vessel for a bypass.
At the University ENT Clinic Frankfurt 105 patients with zygomatic fractures were treated from 1980 until 1986: 45 were treated with a maxillary sinus stent, part of them in combination with wire osteosynthesis, miniplate osteosynthesis was performed in 30 patients, some fractures seemed stable after reposition without fixation. The zygomatic fractures are classified into 3 types requiring different surgical treatments. Comparing the long term results of these methods with the pre- and postoperative radiological and functional data, patients with type 2 and 3 fractures do better with miniplate osteosynthesis than with the other treatments. In combination with an orbital floor fracture, the degree of enophthalmus is more severe in those patients where fractures were only repositioned without fixation.
The detection of early micrometastasis or disseminated single tumor cells poses a problem for conventional diagnosis procedures. Using a panel of monoclonal antibodies against cytokeratin and the 17-1A epithelial antigen we identified immunocytochemically tumor cells in bone marrow of patients with breast cancer (n = 155) and colorectal cancer (n = 57) at the time of surgery of the primary tumor. Monoclonal antibody CK2, recognizing the human cytokeratin component 18 in simple epithelia, appeared to be the most suitable reagent because of its negative reaction with bone marrow samples of the noncarcinoma patients (n = 75). Its specificity was further demonstrated in a double-marker staining procedure using an anti-leukocyte common antigen monoclonal antibody (T200) as counterstain. A comparative analysis showed that immunocytology was clearly superior to conventional cytology (n = 212) and histology (n = 39). In 9.5-20.5% of patients without distant metastasis, tumor cells could be detected in bone marrow. We found a significant correlation between tumor cells in bone marrow and conventional risk factors, such as distant metastasis or lymph node involvement. In a first approach toward immunotherapy we demonstrated in 3 patients that infused monoclonal antibody 17-1A can label single tumor cells in bone marrow in vivo. We then used this approach to follow up 7 patients undergoing 17-1A therapy in an adjuvant clinical trial.
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The effect on histological changes of the stomach mucosa of 50 male and 50 female Wistar-rats was tested after a constant application of antacidum which was given up to 12 weeks. After 8 weeks the number of agryophile endocrine-active G-cells in the antrum has doubled; then it hardly increased any more during the last period of the experiment. In the corpus mucosa an increase of argyrophile cells could be noticed at the end of the experiment. The relation of the various cell populations of the specific corpus glands shifted a little in favour of the parietal cells. This resulted in a 10 per cent increase of the parictal cells and an equal decrease of the chief cells. The mucoid superficial cells did not show any significant changes just as much as the thickness of the mucosa in all three regions of the stomach did not alter during the total lenght of the experiment. Statistically significant differences between a low dose (1 ml/die) and a high dose (2 ml/die) could not be ascertained. The hyperplasia of argyrophile cells of the corpus is seen in correlation with the hyperplasia of the G-cells respectively the increased release of gastrin, because somatostatin produces a generally inhibitory effect, especially on the release of gastrin.