Biomedical subjects
Publications and source records attributed to J Freyschmidt.
A radiological check list in trauma of the thorax is presented that is oriented by means of topographic locations (thoracic wall, pleura, lung, mediastinal organs). Focus is on the specific features of lung contusion and lesions of the mediastinal organs with special reference to modern examination methods.
Twelve cases of subchondral synovial cysts (intra-osseous ganglion) have been seen and their clinical features, radiological findings and differential diagnosis are described. The lesion is a benign cystic tumour-like mass in the subchondral portion of a synovial joint. Our findings in respect of age, sex and localisation are compared with those of other authors. The aetiology and pathogenesis of the lesion is not completely understood. There is an increased incidence in middle life and joints with high dynamic and static stress are favoured, particularly in the lower extremities. Chronic stress or microtrauma, causing damage to the involved joint, therefore appears to be a plausible explanation.
The primary clinical, laboratory, and radiological findings of 116 patients with plasmacytoma were analysed and correlated. Skeletal findings could be seen on the radiograms of 105 of 116 patients (= 90.5%): All of the five patients with solitary plasmacytoma and 96 of 111 patients with multiple myeloma showed osteolyses; four of 111 patients with multiple myeloma showed sole osteoporosis. The leading clinical symptom was skeletal pain; whenever the pain was located in the spine skeletal findings were evident. Paraproteinaemia turned out to be the most important laboratory finding. Its proportion depended on the grade of radiological findings.
We have compared the value of MRI with conventional radiography and CT in 40 predominantly sclerotic skeletal lesions. We have found that sclerosis and other changes in the bone structure can be demonstrated by MRI in much the same way as with conventional radiography and CT. Using high resolution surface coils, it is possible to demonstrate small areas of new bone formation such as periosteal new bone or the calcification within the nidus of an osteoid osteoma. MRI is particularly appropriate if it is necessary to show soft tissue changes within an area of sclerosis, which may be responsible for the new bone formation and which may be masked on radiographs and CT by the surrounding sclerosis.
In a period from 1984 to 1986 (T-scan was used as acute diagnostic in 74 polytraumatized patients. The patients were brought by emergency car or helicopter during or shortly after shock treatment directly to the computerized tomography. In all patients several regions of the body (head, thorax, abdomen, extremities) were examined in the (T-scan. Nearly two third of the patients (n = 58) were examined because of an uncertain abdominal trauma. In 27 of these patients pathological results were found, which have been followed by immediate laparotomy. Besides the high efficiency one more advantage of the method is its non-invasivity.
Eighty-eight patients with possible ankylosing spondylitis (AS) were selected for this followup study. They showed normal or at most suspicious radiographic findings of the sacroiliac joints. After 5 years' followup, 24, and after 10 years 32 patients (59% of the 54 finally available, 36% of the 88 original patients) had definite AS. In 12 individuals, AS could be excluded. Of the 10 remaining patients, 6 still had possible, and 4 had undifferentiated spondyloarthropathy. A comparison between HLA-B27 positive and negative patients showed a significantly increased frequency of definite AS or possible and undifferentiated spondyloarthropathy (p less than 0.05) in the group of HLA-B27 positive patients. The development of AS was characterized by a prolonged course: radiological sacroiliitis became evident after at least 9 +/- 6 years, radiological signs of spinal involvement after 11 +/- 6 years mean disease duration. After 18 +/- 6 years 25 (78%) of 32 patients with AS still maintained good or sufficient functional capacity, indicating a good functional prognosis in the great majority of the patients.
Stress fractures result from bone stress in a rhythmical, repeated and subthreshold manner. Fatigue fractures and insufficiency fractures are considered. In the present paper clinical and radiological findings in stress fractures and problems of differential diagnosis are discussed. Typical locations and forms of manifestation are presented.
Of 88 selected patients with possible ankylosing spondylitis (AS) 54 (61%) participated in two phases of a 10 years' follow-up study. Thirty-two (59%) developed definite AS according to the New York criteria, 10 (19%) had possible/undifferentiated seronegative spondylarthropathy (SSA) and 12 patients had other diagnoses. Only 3 (9%) of 35 patients with sacroiliitis did not fulfill the New York criteria for definite AS until the last examination. Sacroiliitis and radiological spinal signs of AS appeared rather late above a mean age of 40 years and after a mean disease duration of more than 10 years. After 18 years mean disease duration 25 (78%) of 32 AS patients had good or sufficient functional capacity indicating an overall good functional prognosis. HLA B27 typing proved to be useful in patients with possible early AS: 29 (71%) of 41 B27 positive and 3 (23%) of 13 B27 negative patients developed definite AS (p less than 0.005). A combination of the B27 test with data of the history, clinical, laboratory, and radiological examination proposed as early diagnostic criteria detected patients with the outcome diagnosis of definite AS with even higher significance (p less than 0.001). These criteria were also useful in the identification of patients with possible or undifferentiated SSA. The recently recognized entity of undifferentiated SSA should only be diagnosed after long term follow-up.
Explore the source record for details and available documents.
Aside from the classical trias of symptoms, Bourneville-Pringle's syndrome shows a lot of other alterations concerning the inner organs. These changes being much more important for the further prognosis are illustrated, and the diagnostic procedure is demonstrated.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Primary bone tumours in ribs are less common than tumour-like lesions. The most common solitary primary bone tumour in ribs is the chondrosarcoma (about 35%). This is followed with about the same frequency (10 to 14%) by Ewing's sarcoma, malignant lymphoma, chondroma and osteo-chondromas. The clinical features and radiological appearances of the more common tumours and tumour-like lesions in the ribs are described, and their differential diagnosis is discussed.
Explore the source record for details and available documents.
The present paper presents the clinical and radiological findings from a retrospective study of 18 children suffering from histiocytosis with skeletal involvement (20 lesions) treated between 1971 and 1983. The different forms of manifestation on the skull, vertebral column, and long bones are described and problems of differential diagnosis discussed. Possible forms of therapy are considered.
Two cases of primary misdiagnosis of a posttraumatic false aneurysm are reported. In the first case a twenty-year-old patient was hospitalized under the diagnosis of a malignant soft tissue tumor five weeks after a kick against the right distal thigh. Diagnostic procedures performed in our clinic, however, led to the expectation of a false aneurysm of the femoral artery, caused by perforation of the wall of the vessel by an osteochondroma. Intraoperative findings confirmed this and led to the supposition of a connection with the mechanical trauma. The postoperative course was uneventful. The second case had a similar history. Prophylactic excision of osteochondromas in areas with increased risk of perforation, as in the region of the femoropopliteal junction, is recommended.
In the spectrum of the fibroosseous bone tumours the ossifying fibroma of the bone (OF) is situated as a not yet clearly defined entity with many names. The present paper deals with the question wether a term innovation brings elucidation to clinical management. Therefore 811 previously published and 16 additional cases have been analysed with respect to their clinical and radiological behavior. In addition a simplificated histological reclassification was performed on 284 well documented literature cases. It was found that there are no great differences between these tumours according to their localisation, their clinical behavior, and their prognosis. All tumours of this group are suitable to different categories of histological maturation of the same tumour best called "ossifying fibroma".
Between August 1980 and June 1982, 12 left-sided proximal subclavian stenoses were dilated with balloon catheters. The dilatation was successful in all patients. Differences in blood pressure in the arm could be demonstrated subsequently. Recurrences occurred in two patients after seven and eleven months. Follow-up of nine patients up to 24 months showed them to be symptom-free.