[Positive arthrography in pathological changes of medial connective structures in the knee joint].
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Biomedical subjects
Publications and source records attributed to J Grepl.
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Retrofemoral Baker's cysts are occasionally found in athletes; they occur as a result of a rupture in the dorsal part of the bursa semimembranosa gastrocnemia. The rupture itself may occur if there is increased pressure in joints or a considerable increase in the amount of synovial fluid. Ruptures can also occur if the joint wall is inadequately adapted and the synovial fluid fails to flow into the ventral joint spaces, as is possible due to certain movements in some sports. Active movement delays healing of the rupture of the capsule: the para-articular structures become encapsulated or, respectively, adhere to one another. Depending on the duration of the effusion and the amount of fluid, the pseudocyst may become pencil-shaped, spherical, cylindrical or rhomboid. It is, therefore, a traumatic pseudocyst, which occurs as a result of insufficient adaptation, principally in athletes of individuals whose occupation involves typical stresses on the knee joint.
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A subcutaneous metastase in the left forearm is detected by direct angiography of the A. brachialis 18 months after nephrectomy of the right kidney because of renal carcinoma. The angiography shows a solitary well defined tumor with pathological vascularisation. The pattern of vascularisation corresponds to the histological findings of the excised metastase.
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In inappropriately treated synovitides of the knee joint with shift towards a villonodular inversion, an inflammatory angiographic symptomatology may be expected which is different according to the seriousness of the illness including (1) local hyperaemia, (2) deviation of arteries, (3) morphologic and formative vascular inversions and (4) diffusion of the contrast material into synovitic conglomerates and (5) shunts. From these findings the stadia of synovitis may be evaluated, including the extent and place of the villonodular inversion in the clinically or arthrographically inaccessible sites. Differential-diagnostic contributions to the origin of the synovitis cannot be expected from angiography and biochemical as well as bacteriological methods (cultivation) remain necessary. Despite this, angiography has its supplementary value in all cases where an analysis of synovitis is impossible by other means and also in all cases, where the extent of the synovitic changes must be evaluated for an operative treatment.
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In 570 patients an examination of the subarachnoideal space was performed. In 77 of them oily contrast media, in 93 oxygen and in the remaining 400 patients different water-soluble contrast media were used, including Conray 60, Dimer X and Amipaque. Neurotoxic spinal complications occurred in 12 of the 400 patients investigated with hydrosoluble agents (i.e. in 3%). In one of them after investigation with Dimer X, intense cramps in the lower extremities caused a fracture of the femoral neck within a few hours after the investigation. In another patient, investigated with Amipaque, a psychotic reaction with amentia and paranoid symptoms developed, which disappeared completely after 4 days.
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The article describes the special features governing the assessment of angiographic findings in tumours of the nerve sheaths. Considerations of differential diagnosis, especially between neurinoma and neurofibroma, are discussed. Likewise, the problems of differential diagnosis of such tumours against neoplasms of the tissue of the soft parts, are also discussed. Angiography permits only a limited determination of the degree of malignancy of the neurinoma and neurofibroma. It is always mandatory to correlate these findings with the histological findings. However, angiography does seem to be justified as an additional examination technique, since it supplies fundamental pointers for surgery.