Biomedical subjects
Publications and source records attributed to U Mödder.
The article describes on the basis of the authors' own 12 cases the typical CT pattern of mucoceles of the paranasal sinuses--intrasinusoidal space-occupying growths with central density values of 20-25 HE, expansive displacement of the adjacent walls. Attention is drawn to the special factors due to the localization, which are different for various paranasal sinuses. Conventional tomography can be omitted in future.
Out of 59 cases of peritoneal carcinosis (PCA) diagnosed by either laparoscopy, laparotomy, or post mortem 50 cases (85%) could be recognised as such retrospectively by computerized tomography (CT). Beside diagnosing direct metastases one was able to show more subtle indirect signs such as alterations at the mesenterial root, greater omentum and in the pelvis. The accuracy of the CT in the diagnosis of PCA is discussed.
Where there is suspicion from the audiological and vestibular findings of an VIIIth nerve tumour, radiographs of the skull and of the petrous bones (Stenvers) should be obtained. This should be followed by computer tomography with intravenous contrast medium (a plain series can be omitted in these cases). A negative or indefinite scan should be followed by CT performed after air insufflation. Vertebral angiography is valuable as a pre-operative investigation for tumours larger than 3 cm. Ordinary tomography of the petrous bone in sagittal, lateral or stenvers projection or cisternography with air, oily or aqueous contrast medium need not be carried out.
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A group of 54 patients with nasopharyngeal carcinoma (NPC) has been classified according to the TNM-staging-systems of the UICC (International Union Against Cancer), DAG (German Work Group "Clinical Oncology"), J.H.C. Ho/Hong Kong and the 2nd International Symposium on NPC, Kyoto 1977. For several parameters the patients have been classified for AJC (American Joint Committee for Cancer Staging and End-Results-Reporting), too. Tumor extension to the base of the skull or pterygopalatine fossa can only be assessed by radiological techniques. Therefore 36 of the 54 patients have been examined for osseous lesions of these regions with both conventional and computerized tomography. New computed tomographs with high resolution power give better information about tumor involvement than conventional tomography. The value of X-ray methods for correct staging of NPC are demonstrated. A review of the results showed that the staging system of Ho is the most reliable of the staging systems. The other staging systems ie. UICC and DAG need considerable improvement before they can be recommended.
CT is--especially since the introduction of thin slice technique--the method of choice for the diagnosis of nasopharyngeal tumors. This method provides better results than the conventional film tomography in determining intracranial tumor extension, osseous destruction of the base of the skull, and involvement of the orbit. Tumor infiltration into the pterygoid fossa is also well seen by the third generation of CT. In particular CT scans are superior to conventional tomography in delineating tumor extension to the parapharyngeal and retromaxillary space as well as in recognition of cervical lymph node involvement.
Compared with ordinary CT, angio-CT in mild, moderate or severe pancreatitis provides better demonstration of parenchymatous necrosis and more accurate identification of the organ in the presence of oedema, necrosis or haemorrhage in the retroperitoneal space. Follow up observations of these changes assist in the choice of treatment, such as was not available previously.
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The ureterocele is a cystic ballooning of the terminal ureter into the bladder resulting from a congenital weakness of the wall of the lower ureter and a facultative concomitant stenosis of the ureteral orifice. This condition is more frequent in females. The cobra head with its surrounding halo is the most common finding on the excretory urogram in the simple adult ureterocele. In ectopic ureterocele which is principally encountered in children, the ureter terminates either at the bladder neck or in the proximal urethra. The urogram shows filling defect in the bladder which may extend into the female urethra. Ureteral duplication, dilatation of the upper urinary tract, vesico-ureteral reflux, chronic infection and ureteral stones are the most frequent additional findings and complications.
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Computer tomography of the adrenals was performed on 35 patients. Abnormal findings were noted in 19, histologically confirmed in 14. In the course of localization of endocrine processes, as well as in elucidating suspected tumours, a normal adrenal gland can be visualised by computer tomography in over 90% of instances, and lesions detected if greater than 0.5--1.0 cm in diameter. It should be used after all clinical and biochemical tests and conventional radiological measures have been employed, invasive angiography being reserved only for special problem cases.
Three hundred and five patients were examined by computer tomography and sonography. In 117 patients no abnormalities were found in the pancreas. The accuracy of computer tomography was 87%, of sonography 85%. In 41 patients the presence of a carcinoma of the pancreas was confirmed histologically. In this group the sensitivity of computer tomography was 83%, of sonography 85%. Thirty-four patients suffered from acute pancreatitis. In this group sensitivity of the two methods was equal at 79%. 113 patients had changes of chronic pancreatitis. Sensitivity of computer tomography was 84%, of sonography 70%. Computer tomography is better at demonstrating calcification in the pancreas. Atrophy of the pancreas cannot be diagnosed by sonography.
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First results of angio-computer tomography (CT) in the diagnosis of acute pancreatitis are reported. Angio-CT allows the display of changes occurring during hemorrhagic-necrotizing pancreatitis in a much more precise manner, than has been possible up to now. Enlargement of organs, changes of contours, exudation and hemorrhage into the retroperitoneal space can be diagnosed; after bolus injection of radio opaque viable and well perfused tissue may well be differentiated from necrotic tissue.
125 patients were subjected to computer tomography on account of suspected pancreatic disease. 48 patients were operated on--the computer tomography (CT) diagnosis was confirmed in 85.5% of the cases. Acute pancreatitis can be detected by CT if it is accompanied by an appropriate enlargement of the organ. Chronic pancreatitis can be recognized by deformations of the organ, calcifications or formation of pseudocysts. Pancreatic carcinoma is recognizable when it is larger than 3 cm accompanied by a change in the shape of the organ or if infiltration of neighboring structures has occurred. Computer tomography offers patients a safe, non-invasive method of performing follow-up examinations at short intervals.