Biomedical subjects
Publications and source records attributed to H Steinhoff.
This paper is concerned with the aetiology, prophylaxis and treatment of the Mendelson-syndrome. It serves as a quick reference to anaesthesists and obstetricians who are faced with this problem and therefore helps them to decrease the maternal mortality resulting from regurgitation and aspiration of gastric juice.
In a cooperative study the examination results of CT and angiography of 756 patients with verified supratentorial tumors were compared. CT displayed the higher diagnostic accuracy. Temporobasal tumors cause diagnostic problems for both examination methods. The value of arteriography is still unquestioned because using this examination method the differential diagnosis of mass lesions can be considered largely secured.
Among 2,600 patients, examined by computerized tomography, 404 had brain tumours, which were gliomas in 150 cases. There were 73 glioblastomas. Examination was performed according to Ambrose's method using an intravenous injection of 1 ml 60% contrast medium per kg body weight. Thus 98% of all gliomas could be demonstrated. Glioblastomas are shown in three different forms: an annular type (55%), a nodular type (18%), and a combined type (27%). Perifocal oedema is found in 88% of glioblastomas. The oedema most frequently belongs to grade II or III. Differentialdiagnosis of gliomas, abscess, metastases and other tumours with central necrosis are discussed.
Based on findings obtained from 442 patients with various cerebral diseases by comparative evaluation of cerebral serial scintigraphy (cSS) and cranial axial compouted transmission tomography (T-CAT), a scheme is introduced which illustrates reasonable employment of cSS in combination with T-CAT in patients presumed to have (a) "intracranial tumor", (b) "cerebrovascular disease" or (c) "unspecific symptoms". Concerning group (a), T-CAT should primarily be employed; as to groups (b) and (c), cSS is recommended to be the first study.
Computer assisted tomography (CAT) data from 10 patients with histologically verified primary malignant lymphomas of the brain are reported. Studies both prior to and after contrast medium administration were done on nine patients. In all these patients, tumor nodules presented with slightly increased density in the precontrast scan and considerable contrast enhancement. The appearance of malignant lymphomas in the CAT scan may be similar to that of meningiomas. Pituitary adenoma, medulloblastoma, and metastasis of malignant melanoma may not be ruled out in a particular case from the CAT picture alone. Blurred margin of the tumor after contrast enhancement was found in half the patients. Diffusely growing malignant lymphomas produce low density areas in the CAT scan without contrast medium uptake.
In 215 cases of intracranial tumors with subsequent histological identification, computerized transaxial tomography (CTT), and cerebral serial scintigraphy (CSS) with [99mTc] pertechnetate were carried out to compare the efficiency of each method in detecting and classifying such tumors. With a tumor detection rate of 99%, CTT turned out to be superior to CSS (91%). On the other hand, CSS findings enhanced the CTT rate of correctly identified tumor types in meningiomas from 85 to 92% and in high-grade gliomas from 82 to 89%. In metastases, low-grade gliomas, and various other tumors, CSS supported CTT by confirming a number of these tumor types. Therefore, the most important use of CSS in intracranial tumors today is its role as a supplement to CTT in order to establish and confirm type-specific diagnoses.
The CT patterns of 295 glioblastomas examined with pre- and postcontrast scans using an EMI scanner Mark I (Matrix 160/160) have been reviewed and compared with the CT appearances of other brain tumors, metastases and abscesses. There is a great variety of CT patterns with glioblastomas. However, a garland-shaped CT appearance, representing a subgroup of ring-shaped lesions, seems to be most typical for glioblastomas since it was observed in 19% of ring-shaped glioblastomas but in only one out of 172 metastases and in no case of an astrocytoma grade II or an abscess in our series. The initial CT diagnosis, based on the CT finding, the patient's history and the clinical data, was correct in 69.8% of the glioblastomas, 41 recurrent glioblastomas included. In 12% of the cases the presence of a glioblastoma was within differential diagnosis. These results lead to the conclusion that in many cases additional diagnostic methods, such as serial scintigraphy and/or cerebral angiography, are required for a reliable differential diagnosis.
A thorough neurological diagnostic investigation was carried out in 112 patients with chronic headache existing for an average of 14 years, using a case history questionnaire we had designed for the purpose. Apart from the history and clinical examination, the program included X-ray negatives, angiography, computer tomography, sequence scanning, electroencephalogram and echoencephalogram. Migraine was the most common diagnosis (54.5%). Three cases in which admission to a ward was necessary for more detailed examination are described and demonstrated with reference to neuroradiological illustrative material.
Computed tomography (CT) has given us a new method for examining the orbit and its contents. The technique of examination is described, and the indications for the application of computed tomography in ophthalmology are considered: suspected orbital tumors, unilateral exophthalmos, pareses of the ocular muscles, traumatic lesions and malformations in the region of the orbit. The findings in 210 cases of orbital lesions examined in this study are reported and the differential diagnosis is discussed. Considerable improvement and greater accuracy in diagnosis have been achieved in the field of ophthalmology by using computed tomography. Early tumor visualization is possible without risk or discomfort to the patient.
The increasing use of cranial computed tomography (CT) in the diagnosis of cerebral tumours has suggested that the place of cerebral serial scintigraphy (CSS) with 99mTc pertechnitate needs to be re-assessed. For this purpose 190 patients with 200 intracranial tumours were examined by both methods. Of the 155 histologically confirmed tumours, 87% could be diagnosed by CSS, and 99% with CT. Amongst the total of 190 patients, CSS was correct in 90%, and CT in 99%. Correct tumour diagnosis of meningiomas was 84% for both methods, and for glioblastomas, 83% for both methods. Combining the two methods, however, produced 92% accuracy with meningiomas, and 90% of glioblastomas could be correctly classified. Gliomas of Grade I/II had an accuracy of 39% for CSS (52% for CT), for metastases 50% for CSS (80% for CT) and in the group "various tumours" 19% for CSS (41% for CT). Computed tomography will have to be carried out in future on all patients suspected of having a primary tumour and before any neuro-surgical intervention. The main task of CSS remains as a screening procedure for intracranial space-occupying lesions and to increase the accuracy of diagnosis. CSS is also valuable as an indication for the use of contrast during CT. In some cases this isotope method may increase the type specific diagnosis of CT.
This paper decribes the results of the CT teams of the University Clinics Berlin, Mainz and Munich. 1658 patients with cerebral tumors have been examined so far (EMI Scanner Mark I, Matrix 160/160) revealing a diagnostic accuracy of 98.4%. The findings of various kinds of tumors (306 glioblastomas, 255 astrocytomas and oligodendrogliomas, 248 meningiomas, 212 metastases, 200 pituitary adenomas and craniopharyngeomas) are discussed and illustrated by typical images. Differential diagnostic problems and the importance of additional neuroradiological procedures are discussed.
CT findings of 46 patients with operatively confirmed chronic subdural hematomas are reviewed. The analysis of the EMI scans resulted in three different types of CT findings. Type 1 is characterized by decreased attenuation of the hematoma contents compared to brain tissue. The hematoma is visualized as a lens-shaped low density area between the skull and the surface of the brain. Type 2 apart from low density areas contains zones of increased attenuation due to recent bleeding into a watery chronic subdural hematoma. In many cases sedimentation causes a well-defined horizontal borderline between the thin fluid parts in the anterior portion and the blood debris in the posterior portion of the hematoma sac. Type 3 shows the same average absorption values as normal brain tissue, a direct visualization is not possible. However , the presence of a midline displacement in combination with ventricular compression and absence of a circumscript lesion even after contrast enhancement, allows the diagnosis of a unilateral chronic subdural hematoma in these cases too. Bilateral chronic subdural hematomas may cause considerable diagnostic difficulties if only one or none of the hematomas is visualized. A relatively small midline displacement points to a second bleeding on the opposite side. Most frequent were hematomas of type 1 (37%), type 2 and 3 could be observed in 30,5% resp. 32,5% of cases respectively.
Cranial computerized tomography (CCT) has opened new dimensions in the diagnosis of neuropediatric disorders. The results of this new method are comparable to gross neuropathology. Thereby it is often possible to avoid further invasive neuroradiological investigations. This is especially true of pneumoencephalography which, according to the present state of CCT, is no longer indicated. Optimal diagnostic results can be achieved only if the patients is cooperative and does not move his head during the scanning procedure. Therefore in infants general anaesthesia is necessary. Sedation alone has proved to be not sufficient. The numerous new findings gained by CCT cover nearly all types of intracranial lesions. First of all the direct visualization of brain tumours in their relations to the surrounding structures, the surprising findings in inflammatory diseases of the brain, and the impressive demonstration of brain anomalies make CCT superior to all conventional neuroradiological investigations. Only for planning a surgical intervention and in vascular disorders angiography remains irreplacable.
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The value of regional cerebral blood flow measurement for the microneurosurgical treatment of cerebral ischemia is outlined. Preoperatively, this method is of great value for the selection of suitable candidates for this operation. Postoperatively, the effect of the extraintracranial arterial bypass on the ischemic brain may be quantitatively assessed. The practical management of flow measurements in these patients is discussed.
In 37 patients with intracranial tumros, regional cerebral blood flow was measured. The typical abnormalities are described and an attempt is made to correlate the blood flow with the histologic type of tumor. Moreover, the deranged cerebral vasomotor responses are demonstrated when the flow is measured during functional tests. The practical value of the method in patients with brain tumors is discussed.
Extracranial intracranial arterial anastomosis is gaining acceptance as a form of treatment in selected cases with ischemic cerebrovascular disease. To establish indications for this operation and to provide an objective assessment of postoperative results, regional cerebral blood flow (rCBF) studies were performed in 110 patients with cerebrovascular insufficiency considered for extra-intracranial bypass surgery. The 133Xe intracarotid injection method with 16 externally placed detectors was used for measuring rCBF. Postoperatively, rCBF was measured in 40 patients. From these results our present criteria for surgery have evolved. The probability of a good postoperative result is best in patients who showed focal cerebral ischemia or a moderate general reduction of CBF with an additional ischemic focus. The operation is contraindicated in patients with either normal or severely reduced CBF values (less than 60% of normal).
Clinical results of an extra-intracranial arterial bypass (EIAB) procedure for cerebral ischemia are assessed in 65 patients. The 5-year-study suggests that the EIAB procedure has a protective effect against further clinically significant cerebrovascular accidents in properly selected patients. Correlation with angiography and regional cerebral blood flow (rCBF) studies are discussed. It is felt that rCBF measurements offer the best diagnostic test to determine which patients are suitable for surgery by revealing if an ischemic or relative ischemic focus is present. The surgical procedure is contraindicated in acute cerebral ischemia and when the rCBF study reveals general reduction of cerebral blood flow as opposed to a localized ischemic focus.