Biomedical subjects

Jens Nickel

Publications and source records attributed to Jens Nickel.

4 recordsLinked to original sources

PubMed2003

[Selective embolisation of posttraumatic intractable epistaxis].

Idiopathic or trauma-related nose-bleeds can in rare cases be an intractable clinical picture in which normal conservative measures fail. Further therapeutic options that can be applied are surgical vascular ligature or selective endovascular occlusion. We report on a patient who developed hemodynamically relevant epistaxis due to splanchnocranial injuries after falling from his bicycle. Spiral-CT showed a fracture of the posterior nasal septum and of the inferior nasal concha. Despite anterior and posterior nasal tamponade, anemia occurred requiring transfusion and resulting in the interdisciplinary decision to perform transcatheter embolization. Via a trans femoral incision, a 5 F Vitek catheter was introduced into the maxillary artery, and a tracker system was then advanced through the catheter supraselectively and placed in the peripheral branches of the vascular system of the sphenopalatine artery. Selective DSA clearly showed the source of bleeding to be the area supplying the sphenopalatine artery. Following documentation of the localization of bleeding, a total of six (3/30 mm) complex heliacal mini-coils were inserted. After intravascular occlusion of the sphenopalatine artery, bleeding completely stopped within a few minutes. This shows that supraselective embolization is an easily conducted, effective and low-complication method for the definitive treatment of severe posttraumatic nosebleeds, even in emergency situations.

Adolescent↗

PubMed2003

[Differential diagnosis of tailgut cyst in the case of a rectal carcinoma with presacral mass].

Cystic masses of various different origins and degrees of malignancy occur in the presacral space. Apart from benign, malignant and acute inflammatory masses, the benign lesions include a group of cystic structures to which the dysgenetic cysts belong. The tailgut cyst is a relatively rare type of gastrointestinal origin from this group. We present the case of a stenosing rectal carcinoma in which a presacral mass was additionally found, which did not get smaller compared to the rectal tumour during combined preoperative radiochemotherapy, with a lymphoma being suspected. After extirpation of the tumour, histopathological processing revealed a stenosing rectal carcinoma with an adjacent dysgenetic lesion--a tailgut cyst. Although dysgenetic lesions are rare as presacral masses, this must also be taken into account as a differential diagnosis in the various imaging procedures such as endosonography, CT and MRT when a rectal carcinoma is present.

Aged↗

PubMed2003

[Eagle syndrome: diagnostic imaging and therapy].

In the case of clinical symptoms such as dysphagia, foreign-body sensation and chronic neck or facial pain close to the ear, an Eagle syndrome should be considered in the differential diagnosis. Rational diagnostics and therapy are elucidated on the basis of four case reports. Four patients presented in the outpatients clinic with chronic complaints on chewing and a foreign-body sensation in the tonsil region. Upon specific palpation below the mandibular angle, pain radiating into the ear region intensified. In all patients, local anaesthesia with lidocaine only led to a temporary remission of symptoms. Imaging diagnostics then performed initially included cranial survey radiograms according to Clementschitsch as well as in the lateral ray path and an OPTG. An axial spiral-CT was then performed using the thin-layer technique with subsequent 3-D reconstruction. Therapy consisted of elective resection with a lateral external incision from the retromandibular. From a symptomatic point of view, the cranial survey radiograms and the OPTG revealed hypertrophic styloid processes. The geometrically corrected addition of the axial CT images produced an absolute length of 51-58 mm. The 3-D reconstruction made it possible to visualise the exact spatial orientation of the styloid processes. An ossification of the stylohyoid ligament could definitely be ruled out on the basis of the imaging procedures. After resection of the megastyloid, the patients were completely free of symptoms. Spiral-CT with subsequent 3-D reconstruction is the method of choice for exact determination of the localisation and size of a megastyloid, while cranial survey radiograms according to Clementschitsch and in the lateral ray path or an OPTG can provide initial information. The therapy of choice is considered to be resection of the megastyloid, whereby an external lateral incision has proved effective.

Adult↗

PubMed2002

[Diagnostic imaging and therapy of chondroblastoma].

The chondroblastoma is a rare lytic osseous lesion, which is typically to be found in the epiphyses of the long tubular bones. We present a case report with the differential diagnostic imaging and the surgical therapy of a chondroblastoma of the proximal tibial epiphysis. A 16-year-old male presented in the traumatological accident and emergency centre with knee pain of unclear origin that had been increasing for several months. He had no memory of any acute trauma. For further clarification, a conventional radiograph in two planes, a thin-layer CT, a multiplanar MRI before and after Gd-DTPA, and a bone scan were performed. The conventional radiological diagnostics show a smoothly circumscribed, osteolytic, eccentric lesion with marginal sclerosis, which not exceeds the epiphyseal seam of the proximal tibia. The thin-layer CT reveals an eccentric osteolysis, with a typical, narrow sclerotic seam and central calcifications. In the high-resolution MRI, the T2-weighted sequences show a locally limited, epiphyseal, lobulated lesion with a heterogeneous, in part raised signal. A further signal increase can be seen in the T1-weighted sequences after administration of Gd-DTPA. Perifocally, there is an epiphyseal edema and discrete (intraarticular fluid collection) fluid in the inner knee. In the skeletal scintigraphy, there is a strong focal and diffuse increased activity from the proximal, lateral tibial epiphysis. After the diagnosis had been rendered, curettage of the defect was performed and then, after histological confirmation of the diagnosis, completing spongiosaplasty was conducted. Taking into account the localisation and the patient's age, a virtually certain diagnosis can already be rendered using conventional imaging. A supplementary MRI or CT can be helpful for final clarification, while 3-phase skeletal scintigraphy is superfluous. The therapy of choice is curettage and subsequent filling of the defect with autologous spongiosa.

Adolescent↗