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Biomedical subjects

M Warmuth-Metz

Publications and source records attributed to M Warmuth-Metz.

At least 55 records · Page 3Linked to original sources
PubMed1997

Iatrogenic spinal epidural abscesses: early diagnosis essential for good outcome.

Spinal epidural abscess usually arises by hematogenous, lymphatic or venous spread. The frequent use of invasive procedures at the spinal cord such as epidural injections to produce analgesia has led to an increased incidence of iatrogenic abscesses. We describe 8 patients who developed iatrogenic spinal epidural abscesses after paravertebral or intragluteal punctures respectively intravenous catheters to produce analgesia. Deep paravertebral or intragluteal injections were the cause of abscess formation in five, a contaminated intravenous line in two and a peridural catheter in one case. Pain of the affected vertebral column and malaise were the leading symptoms and Staphylococcus aureus was isolated in all cases. Diagnosis was made by means of magnetic resonance (n = 7) or Computed tomography (n = 1). Outcome was excellent with early therapy consisting of laminectomy and/or antibiotic treatment in the six patients treated within two days of appearance of symptoms. Invasive procedures at the spinal cord can lead to iatrogenic spinal epidural abscesses. Physicians dealing with deep punctures and catheter procedures should be aware of early symptoms and signs of an epidural abscess, since early diagnosis and specific therapy are the most important factors for a good outcome.

Abscess↗
PubMed1997

Pleomorphic xanthoastrocytoma: report of six cases with special consideration of diagnostic and therapeutic pitfalls.

BACKGROUND: Pleomorphic xanthoastrocytoma (PXA) is a rare clinicopathologic entity that occurs typically in young patients. Improved neuroradiologic techniques, especially gadolinium-enhanced magnetic resonance imaging (MRI), reveal a characteristic tumor appearance. METHODS: We present six cases of PXA operated on with unusual clinical course, elucidating different clinical implications. RESULTS: Two patients showed subsequent progression into a malignant glioma, one case was a primary anaplastic PXA. The latter case had not previously been reported in the literature. Increased mitotic activity seems to indicate a worse clinical course; whereas focal infiltration of the brain does not necessarily lead to malignant transformation. CONCLUSIONS: Surgical removal is the treatment of choice. A consequent follow-up is mandatory in order to detect a potentially malignant recurrence as early as possible and to select patients who need additional therapy.

Adolescent↗
PubMed1996

Primary Ki-1-positive T-cell lymphoma of the brain--an aggressive subtype of lymphoma: case report and review of the literature.

BACKGROUND: By detection of the Ki-1 antigen, Stein (1985) defined a new entity of anaplastic large cell lymphoma [24]. Apart from our case, only four further cases of Ki-1 positive primary central nervous system lymphoma (PCNSL) have been reported in the literature to date. CASE REPORT: A 63-year-old man presented with two frontal and parietal mass lesions and one ring lesion on computed tomography scan. Clinically, no evidence of brain metastases or abscesses could be found. Immunohistochemical investigations of biopsy specimens revealed a large cell anaplastic T-cell lymphoma positive to Ki-1 antigen. In spite of all therapeutic efforts, the patient died less than 3 months after the onset of symptoms. DISCUSSION: In all cases the clinical course was very rapid, suggesting that Ki-1 positive PCNSL might form an aggressive subtype of lymphomas. Since the radiologic appearance was atypical and clinical diagnosis was not possible, diagnostic biopsy for immunohistochemical diagnosis should be performed.

Brain Neoplasms↗
PubMed1993

Intracranial neurothekeoma (nerve-sheath myxoma). Case report.

Neurothekeoma is a benign cutaneous nerve-sheath tumor. The authors describe the case of a 16-year-old girl with a parasellar neurothekeoma that was successfully removed. Magnetic resonance imaging with gadolinium administration revealed bright enhancement of the peripheral portions and nonhomogeneous uptake in the central areas, which corresponded histologically to the vascular capsule and the myxoid center. It was concluded that: 1) intracranial neurothekeoma does exist, and 2) surgical resection appears to be the definitive therapy.

Adolescent↗
PubMed1992

Desmoplastic supratentorial neuroepithelial tumours of infancy.

The clinicopathological features of two infants with desmoplastic supratentorial neuroepithelial tumours are described. The cases were similar to the 26 cases reported previously as desmoplastic infantile ganglioglioma and superficial cerebral astrocytoma attached to dura. Neuronal differentiation was absent on routine stains, but was immunohistochemically established. We review the literature and suggest classifying this clinicopathological entity by using a general designation such as desmoplastic supratentorial neuroepithelial tumours of infancy, a term which indicates the variability in the amount and lines of differentiation.

Astrocytoma↗
PubMed1992

Histiocytic tumor of Meckel's cave. An intracranial equivalent of juvenile xanthogranuloma of the skin.

We present the case of a 7-year-old boy who had a solitary mass within Meckel's cave that recurred 6 weeks after the initial resection. The histological, immunohistochemical, electron-microscopical, and molecular genetical features established the lesion's histiocytic nature. Our findings showed that it was closely related to juvenile xanthogranuloma, a benign lesion that usually occurs in the skin but has not yet been histologically confirmed in the brain. The present tumor is different from other intracranial histiocytic and xanthogranulomatous lesions.

Acid Phosphatase↗
PubMed1991

Do arachnoid cysts grow? A retrospective CT volumetric study.

The volumes of intracranial arachnoid cysts were measured in 136 CT scans of 86 patients. Absolute and relative cyst size was calculated. Left hemisphere and middle cranial fossa location prevailed. A slight negative correlation of relative cyst size with age (r = -0.21, NS) disappeared when analysis was restricted to the adult age group (greater than or equal to 20 years). After the sample was divided into two groups according to relative cyst size (cysts less than mean volume vs cysts greater than mean volume), small AC showed no correlation with age, while large AC correlated positively with age (r = 0.79, P less than 0.05). A subgroup of large AC appears to expand with time, while the majority of small AC remain unchanged.

Adolescent↗
PubMed1991

Diagnosis and monitoring of subarachnoid hemorrhage by transcranial color-coded real-time sonography.

Thirty-six patients with acute spontaneous subarachnoid hemorrhage (26 caused by rupture of an aneurysm) were examined by transcranial color-coded real-time sonography by using a 2.25-MHz ultrasound transducer. In 20 of these 26 patients (76%), the aneurysm could be identified by a characteristic abnormal blood flow pattern within the aneurysm in coronal and axial scanning planes by transcranial color-coded real-time sonography. Blood within the basal cisterns, on top of the tentorium, and within the ventricles and parenchyma was sonographically detected by increased echodensity in 75%. In addition, cerebrospinal fluid circulation disturbances and cerebral vasospasm were detected in two-dimensional B-mode images in 85% and 100%, respectively. In Doppler mode, intravascular blood flow velocity could be quantified. We conclude that transcranial color-coded real-time sonography, a new, noninvasive method for diagnosis and follow-up of patients with subarachnoid hemorrhage, allows detection of the primary vascular lesion and monitoring of complications.

Blood Flow Velocity↗
PubMed1990

[Lumbosacral nerve root avulsion. Diagnosis using computed tomography, magnetic resonance tomography and myelography].

Root lesions in the lumbo-sacral region are rare, compared with injuries of the roots of the brachial plexus. They occur almost exclusively in association with serious injuries of the pelvis. The present case, without pelvic injury, is a rarity. The appearances on myelography and CT are well known, but the findings on MRI are also described and the value of this non-invasive procedure is discussed.

Adult↗
PubMed1990

Maffucci's syndrome with bilateral cartilaginous tumors of the cerebellopontine angle.

Maffucci's syndrome is characterized by the combination of multiple enchondromas (Ollier's disease) and hemangiomatosis. These hemangiomas develop in the subcutaneous tissue and form red-blue tumors dispersed over the whole body. Intracranial involvement is rare, making a preoperative radiological diagnosis and differentiation from other tumors rather difficult. The radiological characteristics and successful removal of the intracranial part of a chondrosarcoma of the cerebellopontine angle in a case of Maffucci's syndrome are reported in this paper.

Adult↗
PubMed1990

[Computed tomography of soft tissue tumors of the hand and the forearm].

Computed tomography was carried out in 32 patients with clinically equivocal soft-tissue lesions of the hand (24 times) and forearm (8 times). The CT scans were performed with the patients in standard positions; thin slices and zoom technique were used. All soft-tissue tumors were correctly diagnosed with regard to localization, size and infiltration of the surrounding tissue. The histological diagnosis was correct in tendon-sheath proliferations, deposits caused by metabolic disorders, epithelial and ganglion cysts, hemangiomas, lipomas and in one schwannoma. A malignancy was suspected and was proven to be correct in two cases. False-positive diagnoses of a malignant soft-tissue tumor were made in one case of an aggressive fibromatosis, in a rapidly progressive, ossifying myositis, and three times in the presence of postoperative scar tissue following the resection of a sarcoma. Finally, a case of proliferative myositis regarded as semimalignant was underrated by CT. The hand surgeon considered CT diagnostics to be very helpful in planning operations in an anatomically complex organ such as the hand.

Adolescent↗
PubMed1990

CT morphology of benign median nerve tumors. Report of three cases and a review.

Computed tomography (CT) was performed in 3 patients with benign tumors of the median nerve, histologically confirmed as neurilemmoma, fibrolipoma and hemangioma. The neurilemmoma showed a ring-shaped contrast enhancement. The fibrolipoma presented with areas of solid soft tissue and areas of fat. The hemangioma was a solid tumor with a lacunar, vascular contrast enhancement. According to our experience and to the previous literature CT gives useful information regarding the anatomic location, size, and relationship of peripheral nerve sheath tumors to surrounding structures, and may help to differentiate between various tumor types.

Adolescent↗
PubMed1989

[Diagnostic evaluation of full x-ray pictures and computed tomography of bone tumors of the spine].

The conventional radiographs and CT examinations of 112 patients with primary and secondary bone tumours of the spine have been compared. Two hundred and sixty-eight vertebrae were shown to be involved, using CT; conventional radiographs showed correctly in 88% an involvement of the vertebral bone and in 66% of the different parts of the vertebrae. Of the intraspinal and paravertebral tumour extensions shown by CT, only 23% and 33% respectively were correctly diagnosed by plain radiography. Only 51% of the vertebrae showing a reduction in height on conventional radiographs could be diagnosed on horizontal CT cuts. The type of lesion could be diagnosed in only very few cases by either method.

Evaluation Studies as Topic↗
PubMed1989

[Computerized tomography of the hand: examination technic, normal anatomy, indications].

The results of 480 computed tomograms carried out in the hand are presented. The digital slice imaging technique shows following advantages: a) Imaging of the complex carpus without superimposition giving a better understanding of carpal biomechanics. b) Anatomically exact imaging of the soft tissues determined by density analysis. In the following states relevant information can be obtained by CT of the hand: 1. Posttraumatic states of the carpus such as scaphoid non-union, lunato-malacia in stages I and II, complex fracture dislocations, and carpal instabilities; 2. cystic transformation of the bone; 3. non-idiopathic CTS; 4. clinically unequivocal soft-tissue masses. In our institution conventional tomography has been largely replaced by carpal CT within a progressive diagnostic programme. Today CT is the best method for imaging soft-tissue masses of the hand.

Carpal Bones↗
PubMed1988

[Computed tomography in the diagnosis of injuries of the posterior pelvic girdle].

Sixty-two patients who had suffered trauma to the posterior part of the pelvis were examined by CT and conventional methods; the latter showed abnormalities in only 70%. This part of the body is involved particularly frequently in the case of high velocity injuries. An obvious fracture of the ventral part of the pelvis, with or without ligamentous injury, is an indication for performing CT in order to clarify the situation and to evaluate the stability of the pelvis.

Fractures, Bone↗