[Diagnosis of carotid stenosis using radionuclide angiography and ultrasonic tomography].
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Biomedical subjects
Publications and source records attributed to K O Kagel.
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Micro-angiograms were performed between eight weeks and one year following osteotomies and pressure osteosyntheses in 34 dog tibiae. Seventeen animals also underwent lumbar sympathectomy. In more than half of the cases, vascularisation of the medulla was reduced by damage to the nutrient artery. Segmental connections could be demonstrated by means of transcortical anastomoses. Following sympathectomy, revascularisation was more marked as a result of numerous trans-osseus anastomoses. This, however, did not lead to improved healing; healing was worse after sympathectomy. Transcortical revascularisation and vessel growth along drill holes are of crucial significance.
Artificial embolisation of the renal artery or its branches was performed in 48 patients with renal carcinoma. Occlusion was effected by using Gelaspon or Ivalon sponges, metal spirals or a combination of both. This surgical intervention created favourable conditions for surgery. In about 80% of the patients pain occurred after embolisation, whereas more than half of them had fever or subfebrile temperatures. The use of Gelaspon sponge is recommended as the simplest and cheapest method of preoperative embolisation. To cut short the unpleasant effects of the postembolisation syndrome it appears to be best to operate 24 hours after embolisation.
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Case-report on an intracranial dermoid with reference to origin, symptoms, diagnostics, therapy and prognosis of that during the childhood rarely diagnosed tumor.
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The own animal experimental investigations served the clearing of the most favourable variant of the operative technique in dog including organ perfusion and microsurgery. The middle-term endocrinic effects of a segmental transplant of nearly 35% of the pancreas from the dog were defined and the regulation of the endocrinic function of the denervated transplant was analysed. The morphological transformations in the transplant show new aspects by the exclusion of immunologic events. The evidence of the function of the transplant in vivo was led by the absolute lack of insulin after extirpating the transplant.
In 50 mongrel dogs autogenous heterotopic transplantation of pancreatic segments was performed without duct ligation. Analyses of the endocrine function of the transplant up to 275 days yielded reduced glucose tolerance and simultaneously normoglycaemia as well as stimulation of insulin release following administration of glucose and no early reflex insulin incretion following oral glucose administration. The exocrine pancreas tissue disappeared nearly completely and inside big complexes of isles mitoses could be observed. The A:B-cell relation had changed. The reduction of the transplanted tissue mass to one third was also evident by angiography.
Liver tumours developed in two women during pregnancy which followed discontinuation of hormonal contraception. Liver cell adenoma developed in a secundipara, 24 years of age, and its rupture during puerperium led to death by bleeding, after surgical intervention had failed. Hepatocellular carcinoma was recorded from a secundipara, 22 years of age, and surgically treated, following premature delivery. Problems of diagnosis and the need for interdisciplinary cooperation are discussed and compared with literature data. The pathogenesis of liver tumours in the wake of exogenous hormone inflow and in the context of subsequent pregnancy is another topic of discussion.
The following phenomena are discussed as pathogenetic sequelae of an elongated and deformed A. basilaris: 1. Mechanical cerebral nerve disorders and complex infratentorial vascular syndromes. 2. Impressions of the bottom of the third ventricle by the terminal basilar or stenosing of the aquaeduct by its backward angulation. 3. Induction of an active hydrocephalus. 4. Displacement of the elongated basilar by an anterior herniation in the tentorial slot. 5. Complex conditions of a hydrocephalus development from an elevation of the a. basilaris, disorders of the dynamics of the spinal fluid and a relative stenosis of the aquaeductus. The term megadolichobasilar is reserved for the arteriosclerotically elongated and deformed basilar. One should speak of a basilar deformation in case of a distinct elevation of the terminal basilar artery in relation to the dorsum sellae level without a vascular deformation.
Complex radiologic examination comprises tomography and fistulography as well as arteriography and phlebography. This programme can be extended by intraarterial perfusion scintigraphy, 133Xe-muscle clearance as well as quantified bone scintigraphy using 99m-TC-diphonate.
A report is given on a case of bilateral carotid occlusion in which on one side a sufficient blood supply of the right hemisphere developed spontaneously via extra-intra-cranial anastomoses. On the opposite side, after proving an insufficient blood supply, an extraintracranial arterial bypass between the parietal branch of the A. temporalis superficialis and the cortical A. angularis was established micro-neurosurgically. The result was a reperfusion of the left aspect of the media and a clinical improvement of the neurological symptoms.
Extra-intercranial arterial vascular anastomosing is a surgical form of treatment in selected patients with ischemic cerebral diseases. For the demarkation of the indication for an operation and for the objectification of the functional results cerebrovascular radionuclide angiography was carried out in seven patients with cerebrovascular insufficiency before and after the bypass operation. The non-invasive method only requires an intravenous bolar radionuclide application. It permits a well reproducible appraisal of the regional cerebral blood flow. The best functional results of the shunt operation were observed in the radionuclide angiogram of patients with pronounced focal perfusion reductions. Functionally unsatisfactory results were obtained with low-degree diffuse perfusion reductions of one hemisphere. The results permit to derive criteria for the surgical indication.
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The author describes origin and course of the anterior falcial artery under physiological conditions. In the carotis communis arteriogram without using the subtraction technique it can be recognised in about one per cent of the cases. Of pathophysiological importance is a dilated anterior falcial artery serving as a collateral artery in occlusions of the carotis interna and as an affluent artery in falcial menigiomas, which is demonstrated in an example. The combination of an a. primitiva trigemini with a homolateral traumatic dural arteriovenous shunt and dilated anterior falcial artery is shown in another patient.