Biomedical subjects
Publications and source records attributed to P Schepke.
A 70-year-old patient with a malignant fibrous histiocytoma, appearing as a pulsating tumor of the upper lateral neck is reported. Intraarterial digital subtraction angiography (IADSA) demonstrated a highly vascularised tumour with occlusion of the internal carotid artery.
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Until now fibromuscular dysplasia has only been described in centrally located arteries. We found this disease in the arteries of the palm. Because of the progressive course and the increasing pain the disease had to be treated surgically. After the necessary resection of the fibromuscular dysplastic aneurysm the vessel system of the palm can only be reconstructed by microsurgical interposition of a vein graft.
From 1978 to 1980 a total of 119 patients with carcinoma of the rectum were treated by abdominoperineal excision at Erlangen University Surgical Clinic. 66 of these patients were examined by CAT scan in a follow-up study. Local recurrence was found in nine patients. A radical second operation was useful in one case only. Our findings show, that only postoperative check-ups by CAT scan can detect new tumor growth at an early state. The prognostic groups used in Erlangen are helpful in defining the intervals for postoperative examinations by CAT scan.
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Eight cases of cavernous hemangioma of the liver are described and their sonographic, scintigraphic, computertomographic and angiographic findings are discussed. The angiographic diagnosis was the most reliable, especially when the computertomography was performed without using contrast medium for tissue enhancement. In cases of doubt laparatomy was necessary in order to maintain a histological diagnosis.
In 7 patients with bone and soft tissue sarcoma super-selective angiography with chemotherapy was performed. Both showed a low rate of complications. In 2 patients we saw a total and in 3 a subtotal tumor-regression. A residual tumor was eliminated after systemic chemotherapy. Beside the tumor vessels treated in the first session, we found other initially unimportant ones. These showed increased size during subsequent angiography and allowed further injection of chemotherapeutic agent into the residues of the tumor. We found that each part of the tumor has its own separate blood supply.
Incidental complete transsection of the hepato-duodenal ligament occurred in a 59-year-old female patient during gastric surgery. More than three hours later reconstruction of the portal vein, hepatic artery and common bile duct was started, performing end-to-end anastomoses in all cases. The time interval between transsection and restoration of blood flow was 225 minutes for the portal vein and 255 minutes for the right hepatic artery. The left hepatic artery could not be reconstructed. The postoperative course was unremarkable clinically, however, there was an extreme initial rise in the levels of SGOT, SGPT, LDH, and alpha-amylase, followed by a somewhat delayed jaundice with bilirubin levels above 10 mg/dl. In-hospital follow-up examinations were performed 6 and 13 month postoperatively. They revealed good clinical condition, patent blood vessels, slight displacement of the biliary anastomosis by scar tissue without functional stenosis and gradual normalisation of biochemical parameters. The left hepatic lobe became initially necrotic, later atrophic.
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The technique of ultrasound tomography was tested in nearly 200 patients at our institute and was compared to mammography; therefrom additional information was obtained for the differentiation of tumors, the site of which had been unfavorable to mammography. Differential diagnosis of solid tissues and cysts also is possible in this way, especially in voluminous breasts which are a difficult case for palpation examination. Ultrasound may be helpful, too, in localization for exact puncture. As the final images have shown, gray-scale technique offers new possibilities, mainly with the single-scan taking less time and having undoubtedly a better resolving power. In diagnostics of early cancer or carcinoma in situ, of which, naturally, palpation findings are not existent, the method is inferior to mammography and certainly not yet satisfying. Even in the case of a known early carcinoma, having been localized by means of a positive mammogram, no sonographic correlative can as yet be found. At present, ultrasonic diagnostics is insufficient as a sole method for examination of the female breast; the technique is evidently useful, however, in case of special problems.
A technique for renal angiography is described, which uses a special catheter and cardiac-phase-controlled injection of contrast; it provides maximal information with a reduction in the amount of contrast and the number of exposures required. This reduces the stress on the patient, as well as the radiation dose.
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