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Biomedical subjects

W Gross-Fengels

Publications and source records attributed to W Gross-Fengels.

At least 55 records · Page 3Linked to original sources
PubMed1991

[The differential diagnosis of malignant soft tissue tumors: pyomyositis].

The case of a seven-year-old boy with an enlarging woody-hard mass in the upper thigh is described and the related literature is reviewed. In absence of conclusive signs of inflammation on both clinical and radiological findings a malignant soft tissue tumour was initially suspected. On operation the mass was found to contain multiple loculated abscesses, and turned out to be a subacute staphylococcal myositis (pyomyositis). Such lesions are quite common in subtropical and tropical climates, and a review of the literature indicates that the incidence of this formerly rare entity is increasing in temperate climates. A variety of factors play a role in pathogenesis, and a history of previous aseptic trauma can be found in about 50% of all cases. The most frequent location is the proximal lower limb or buttock. The clinical history and physical findings are often non-specific. Plain radiographs are non-diagnostic; ultrasound, CT and/or MRI may in some cases be equivocal and angiography sometimes is even misleading. It is important to keep this differential diagnosis in mind, especially in children.

Angiography, Digital Subtraction↗
PubMed1990

MRI of the knee region in leukemic children. Part I. Initial pattern in patients with untreated disease.

The results of MRI studies performed on the medullary cavity in the knee region of 15 children with leukemia and 5 healthy children are reported. By the age of a few years the signal intensities and the relaxation times of bone marrow begin to resemble fat. Early leukemic infiltration can therefore be more easily recognised in the knee region than in the spine using simple T1 weighted Spin-Echo images. We observed an abnormal signal pattern in all our patients which fell into three groups: (a) diffuse uniform (b) diffuse non-uniform and (c) patchy. We have not been able to correlate these into age, sex or the risk factor determined by clinical or laboratory methods. The diffuse patterns seem to dominate in cases of ALL, the patchy forms in AML. No correlation could be found between the blast levels established by the iliac crest biopsy and the results of MRI.

Adolescent↗
PubMed1990

MRI of the knee region in leukemic children. Part II. Follow up: responder, non-responder, relapse.

Part II demonstrates the results of MRI follow up studies of 23 children with leukemia. Differentiation between leukemic cells and normal hematopoiesis by MRI is impossible. The state of disease can only be determined together with bone marrow biopsy. Clinical remission precedes the normalization of bone marrow signal by weeks. In non-responders, however, cytological findings and MRI findings seem to correlate at the same time. During therapy, areas of osteonecrosis may develop. They do not necessarily contradict continuing complete remission. But this does not affect the prognosis and complete remission is still a possibility. Diagnosis of relapse by MRI is only possible in correlation with studies during the different states of disease especially at clinical remission.

Adolescent↗
PubMed1990

Symptoms, diagnosis, and therapy of primary sarcomas of the pulmonary artery.

Primary sarcoma of the pulmonary artery is a rare tumor which must be considered in differential diagnosis of pulmonary embolism. The data of the 93 cases published up to now is evaluated synoptically after a report on a primary sarcoma of the pulmonary artery. Modern diagnostic imaging methods (pulmonary DSA, perfusion scintigraphy, echocardiography, computer tomography, nuclear magnetic resonance tomography) may corroborate the suspicion of a sarcoma of the pulmonary artery. With a median survival time of 1.5 months, the prognosis of patients with primary sarcomas of the pulmonary artery must be regarded extremely poor. After tumor excision, the median survival time of the patients could be prolonged (statistically significant; p less than 0.01) to ten months. The significance of adjuvant chemotherapy and/or radiotherapy cannot be appraised at present.

Diagnosis, Differential↗
PubMed1990

[Bone marrow metastases of neuroblastoma: MRT in comparison with bone marrow cytology and mIBG scintigraphy].

Thirteen MRT investigations of the knee region of nine children with neuroblastoma stage IV/III were performed in order to demonstrate bone-marrow metastases. The MRT-findings were correlated with bone-marrow cytology, immunofluorescence, and mIBG-scintigraphy. MRT showed a high sensitivity in demonstrating bone-marrow abnormalities, although bone-marrow aspiration and mIBG-scintigraphy will still be needed to make a specific diagnosis. On the other hand, signs of bone-marrow involvement in MRT investigations without positive findings in bone-marrow cytology and mIBG-scintigraphy may be the first evidence of bone-marrow metastases.

3-Iodobenzylguanidine↗
PubMed1990

[Intracranial hemorrhages in the magnetic resonance tomogram. Studies on sensitivity, on the development of hematomas and on the determination of the cause of the hemorrhage].

One hundred and forty-six intracranial hematomas in 129 patients were examined by MRI (136 examinations) and CT (147 examinations). Even using a high field MR system (1.5 T) and gradient-echo sequences, CT was the more sensitive method during the acute phase (46% compared with 93%). During the sub-acute phase, MR was superior to CT (97% compared with 58%), as it was in the chronic phase (93% compared with 17%). Petechial bleedings and discreet foci of contusion could only be demonstrated by MRI. Moreover, MRI showed evidence of residues from hemorrhage (signal reduction due to hemosiderin deposition) long after CT has become normal. Analyses of MRI images allows one to date the bleed and to distinguish between a) the formation of clot in a haemorrhagic cavity, b) bleeding into the tissues and c) a liquefying hematoma. Bearing in mind this classification, the localisation of the hematoma and the clinical findings mostly allow it is possible to determine the cause of the bleeding. Another advantage is the certain detection of vessels supplying arterio-venous malformations and cavernous hemangiomas.

Adolescent↗
PubMed1990

[Ergotism: an occasional unrecognized cause of acute ischemia of the extremities].

Vasospasm related to ergot intoxication has been recognised since the Middle Ages when it occurred due to ingestion of rye contaminated with Claviceps purpurea. Today ergotism is a rare cause of peripheral ischaemia, most often associated with ergotamine tartrate therapy for migraine headaches. Recognition of the typical angiographic pattern is important, as the classic drug history may not be obtained, and the cause of the ischaemia can be overlooked. Early diagnosis is important as the outcome may be serious if left untreated. Arterial vasospasm, collateralisation, and secondary thrombus formation are the major angiographic findings. Ergotism responds to conservative therapy which includes drug withdrawal, intravenous nitroprusside, fluid therapy and heparinisation. We describe the angiographic findings of four cases and report on the results of therapy.

Adult↗
PubMed1990

[Percutaneous transluminal angioplasty of the subclavian artery: technic, results, risks].

The results of 27 percutaneous transluminal angioplasties (PTA) of the subclavian artery are reported in 25 patients. 13 patients complained of claudicatio brachii, 7 also demonstrated symptoms of vertebral-basilar insufficiency. In 5 cases this was the sole indication for PTA. 23 (85.2%) of 27 interventions were limited to the proximal section of the subclavian artery. In 22 (81%) the obstructions were localized on the left side. A technical success could be achieved in 24 (88.9%) of 27 interventions. The angiographic appearance of the homolateral vertebral arteries before and after PTA differed significantly. No PTA led to an occlusion of the previously patent vertebral artery. A retrograde flow was no longer seen after PTA. The haemodynamic significance was also demonstrated by the differences in brachial-occlusion pressures (mean 51 mmHg before, 7 mmHg after PTA). Complete or partial relief was achieved after technically successful PTA in 90% of patients with brachial symptoms and in 50% with vertebral-basilar insufficiency. Complications occurred in one (3.7%) of 27 procedures. Published data on PTA of the subclavian artery are discussed.

Adult↗
PubMed1990

[Percutaneous transluminal angioplasty of the infrarenal abdominal aorta].

The results of percutaneous transluminal angioplasty (PTA) (n = 13) of the lower abdominal aorta are reported in 12 patients. The mean patient age was relatively low (46 years). In 7 cases there were isolated aortic obstructions (6 stenoses, 1 occlusion). In the remaining 6 aortic stenoses, there were also major atherosclerotic lesions distally. The mean diameter of the aortic section in which PTA was performed, measured 8.2 mm. The total diameter of the PTA balloon(s) averaged 19.1 mm. The arterial gradient dropped significantly from 41.4 mm Hg (mean) to 2 mm Hg after PTA. The arm-ankle index increased significantly from 0.64 to 0.97. The follow-up included 9 patients; 1 showed restenosis 38 month after PTA. There were no clinically relevant complications. The data published on abdominal PTA in atherosclerotic lesions are summarized.

Adult↗
PubMed1990

[Undesirable side effects of contrast media during i.v. DSA--a comparison of 2 nonionic contrast media].

For the first time a controlled double-blind study was performed to compare side effects and complications of i.v. DSA with central venous application of iopamidol and iopromide. 200 consecutive patients 15-85 years of age were studied. The randomisation brought up two homogeneously structured groups of 100 patients each. Using a given protocol, 66% of the patients were classified as high-risk patients. Side-effects and complications were registered by an extensive, standardised protocol. In 71 (35.5%) of 200 patients contrast-media related side effects and complications were noted. 37 reactions in 24 patients (9 iopamidol, 15 iopromide group) were classified as clinically relevant. In four patients (4%) of each group a drug therapy was initiated. Contrast-media related reactions occurred with delay in 5.5% of initially symptom-free patients. In no case intensive care or hospital admission became necessary. There were no significant differences between the two non-ionic contrast media in the incidence of side effects and complications. Both substances were well tolerated in i.v. DSA. In the total population patients with diseases known as auto-immune diseases and prior drug reactions demonstrated clinically relevant reactions significantly more often.

Adolescent↗
PubMed1990

[The importance of i.v. DSA in the diagnosis of acute pulmonary embolism].

The high mortality rate of pulmonary embolism requires rapid and rational diagnosis especially with regard to the necessary decision about the best possible treatment. Analysis of data published in the literature, and of our own data, show that angiography of the a. pulmonalis according to the i.v. DSA technique is of central importance. This involves fewer hazards than conventional pulmonalis angiography while being comparatively satisfactory in respect of reliability of the results (more than 90%). It is, therefore, a safe basis for deciding on the appropriate treatment: lysis or surgery.

Acute Disease↗
PubMed1990

[Multiple aneurysms of unknown etiology in childhood--complications and diagnostic possibilities].

A 6.5-year old boy with already known multiple aneurysms of all major arteries presented with acute abdominal pain. As demonstrated by ultrasound a big aneurysm of the left renal artery thrombosed in the course of three days. As a result, the left kidney developed severe ischaemia. Although computed tomography and scintigraphy were applied, a plan for a definitive therapeutic procedure could be established only by arterial angiography. Both Ehlers-Danlos' syndrome and Kawasaki's syndrome were excluded. There were no facts suggesting an infective aetiology. Four other cases with multiple aneurysms of unknown aetiology in childhood have so far been described in literature.

Aneurysm↗
PubMed1990

[Radiologic diagnosis of hemorrhages of the gastrointestinal tract].

In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations.

Angiography, Digital Subtraction↗
PubMed1990

[Ergotism--a rare cause of acute ischemia of the extremities].

Clinical ergotism as seen today results almost exclusively from the excessive intake of ergotamine tartrate in the treatment of migraine headache. Vasospasm of peripheral arteries is the leading clinical picture. Beside formation of collaterals and secondary thrombosis, vasospasm is one of the specific findings in angiography. Early diagnosis and withdrawal of the medication makes complete restitution possible. In all other cases intraarterial or intravenous infusion of sodium nitroprusside or nitroglycerin has turned out to be the most effective therapy. Balloon dilatation or operative intervention are an alternative therapy in those cases, where amputation of the limb seems to be necessary.

Acute Disease↗
PubMed1990

[Effect of the geometry of atherosclerotic carotid artery lesions on their angiography image--an arteriography study].

Atherosclerotic lesions of the carotid arteries are frequently located eccentrically and are of asymmetric configuration. For their angiographic detection at least two orthogonal views are mandatory. The carotid bifurcations, the proximal internal carotid artery and the carotid siphon can be visualised free from vessel overlap only via often mandatory lateral views that must be obtained by selective arteriography (IA DSA). Smaller lesions and ulcerations of the carotid bifurcation area may be misinterpreted with nonselective IA DSA and IV DSA because of their geometry.

Adult↗
PubMed1990

[Chronic small bowel invagination due to leiomyoma].

A case of chronic intussusception of the distal ileum due to leiomyoma is reported. The vague abdominal symptoms lead to an extensive endoscopic and radiologic diagnostic work-up. Preoperative diagnosis was achieved by enteroclysis. The radiologic as well as intraoperative findings are described and the importance of enteroclysis in small bowel examinations is stressed.

Chronic Disease↗