Biomedical subjects
Publications and source records attributed to W Rödl.
Modern medical imaging technics as ultrasound and computerized tomographies with X-rays, nuclear magnetic resonance or ultrasound permit the representation of soft tissues including muscles. For muscular dystrophies, these diagnostic methods may allow a more detailed staging and evaluation of single muscle groups. The value for Duchenne carrier detection has meanwhile been proven.
From 1972 and 1982 we observed 6 cases of diffuse pleural mesothelioma and 3 cases of peritoneal mesothelioma in the Department of Internal Medicine of the University of Erlangen-Nürnberg. In 5 of 6 cases one sided noncharacteristic relapsing pleural effusion was the only sign of the pleural tumor process. Only in one case a pleural tumor constallation was diagnosed. Tomography of the lung showed a normal free central bronchial system and peripheral bronchial infiltration or displacement. In all cases CT scans were able to localize the tumor furthermore to demonstrate the exact extension and the infiltration of the mediastinum or of the diaphragm into the abdomen. Beside conventional x-rays such as double contrast examination of the colon and mesenterial angiography CT scans played the major role in diagnosing this rare peritoneal mesothelioma. Massive ascites, mesenterial infiltration, thickening of the mesenterial radix, and tumor embedding of bowel and vessels is of diagnostic significance. To ensure the diagnosis one has to do a thoraco- or laparoscopy.
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Modern sonography has led to an increased appraisal of the therapeutic consequences in cases of polypoid lesions of the gallbladder wall. In 30 patients it was attempted to differentiate between cholesterol polyps and polypoid lesions suspect for malignancy. Histologic results and data in the literature induce us to recommend cholecystectomy in solitary lesions of more than 5 mm, combined occurrence with gallstones and in patients beyond the 60th year of life.
Four patients with spontaneous bleeding from the pancreas are described. Transpapillary bleeding is diagnosed endoscopically. Angiography can demonstrate the eroded vessel directly. Ultrasound, CT and ERCP demonstrate the underlying abnormality in the pancreas. Bleeding into a cyst produces characteristic echoes, or an increase in density. NMR is able to demonstrate pancreatitis and pancreatic pseudo-cysts. Early diagnosis is extremely important, since without appropriate surgery, pancreatic bleeding is frequently fatal.
The partial muscular dystrophic process in carrier women for X-linked muscular dystrophy, which results in an increased fatty and connective tissue infiltration of thigh and calf muscles, can be shown by ultrasound and X-ray CT. These technics are of special value in older women, where CK levels have normalized. Age dependencies and the consequences for genetic counseling will be discussed.
Up until recently in clinical practice suspected hemochromatosis with a pathological iron-screening test (plasma iron, percentage transferrin saturation, serum ferritin, desferrioxamine-induced urinary iron excretion) made a liver biopsy necessary. Today, as a first step, the density of the liver parenchyma can be measured by means of computed tomography. Normal findings obviate the need for laparoscopy. Since the late forties weekly or twice weekly phlebotomy has been the sole form of treatment for manifest idiopathic hemochromatosis. In the mid-sixties the hopes placed in chelating substances (desferrioxamine) were not fulfilled, because the plasma half-life (only 7-10 minutes) of this drug was too short. Even with several daily injections only a small amount of iron was removed from the body tissue (10-25 mg daily urinary iron excretion). The introduction of portable infusion pumps in the late seventies offered us a new possibility of administering desferrioxamine by subcutaneous injection (Propper et al., 1976). Until that time such treatment was successfully used only in the field of pediatrics to treat secondary transfusion hemochromatosis in thalassemia. In one case of idiopathic hemochromatosis with severe organic involvement (right heart failure, repeated esophageal hemorrhage and bronzed diabetes) we had to achieve rapid iron elimination, and for this purpose we used continuous long-term desferrioxamine administration by means of a portable infusion pump (Autosyringe) in addition to phlebotomy. Since, particularly in the critical initial phase of treatment when heart failure was always threatening, great care had to be exercised in the use of phlebotomy, iron removal was achieved largely by desferrioxamine administration (daily up to 240 mg iron elimination in urine and stools).(ABSTRACT TRUNCATED AT 250 WORDS)
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Cystic dilatations of the biliary tract are rare anomalies. In the individual case, diagnosis may pose great problems. The relevance of the various methods was assessed in eight patients investigated with different diagnostic methods. In all patients the predominant symptom was uncharacteristic upper abdominal complaints. Two patients showed intermittent jaundice. Among non-invasive methods sonography is preeminent and permits precise demonstration of intra- and extrahepatic biliary duct dilatations. It can be complemented by CAT-scanning. Whereas intravenous cholegraphy does not permit sufficient ascertainment of the diagnosis, ERCP and PTC allow precise demonstration of the anomaly. Functional hepatobiliary scanning is indicated where endoscopic methods are not available. Among the eight patients sonography was decisively relevant in five cases and ERCP in all cases. The remaining functional assessments furnished important additional informations.
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Gastrointestinal tuberculosis has become a rare disease. Lesions are predominantly located in the ileocecal region, but all parts of intestinum can be involved. Occurrence in the esophagus is very rare. Protean manifestations often prevent an accurate diagnosis on time, especially if pulmonary symptoms are absent or misjudged. The further clinical course is determined by late complications of tuberculosis. We present 3 cases of gastrointestinal tuberculosis (two of esophagus, one of ileocecal region) in order to remind of this rare disease, which is associated with so many pitfalls.
Malignant diseases of the lymphoreticular system can become manifest within the gastrointestinal tract, either isolated, involving solitary organs, in generalized form, or as diffuse polyposis. The ratio of primary to secondary lymphomas is quoted as being 1:2 to 1:3. The clinical picture is characterized by their spread. Abdominal pain, loss of weight, anorexia, nausea and vomiting, including even gastrointestinal hemorrhage, are the most frequently observed symptoms. The involvement of the gastrointestinal tract in Hodgkin's and non-Hodgkin lymphomas of, on average, some 10%, is confirmed in our own material over the past 7 years. From a total of 580 malignant lymphomas, 47 cases were confirmed, endoscopically and bioptically, to have gastrointestinal involvement, primary lymphomas accounting for 1/3, secondary for 2/3. Gastric lymphomas accounted for 59.6%, small-bowel lymphomas for 25.5%, a large-bowel involvement was seen in 14.9%. The centrocytic-centroblastic and lymphoblastic lymphomas predominate.
The effects of exposure to continuous light, continuous darkness, and administration of melatonin on prostatic androgen receptors in relation to pubertal development in rats were examined. Darkness produced dissimilar results between the pubertal and adult groups. Whereas the prostate weight in the pubertal group remained unaltered, it increased in the adult group. In the pubertal group exposed to darkness, plasma melatonin increased significantly, and androgen receptors declined, whereas in the adult group these receptors rose significantly with a simultaneous increment of melatonin concentration in plasma. Exposure to continuous light did not produce any effective alterations in the parameters examined. The afternoon melatonin administration showed trends similar to those seen in animals exposed to darkness. The results indicate that exposure to darkness or administration of melatonin both have age-dependent effects on prostatic androgen receptors. Exposure to darkness may interfere with the process of sexual maturation in the pubertal animal as a result of increased melatonin production.
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A 71-yr-old female patient was admitted for investigation of a massive leukocytosis and loss of weight. Physical examination revealed a reduction in the respiratory excursion of the left lung, a left pleural friction rub located ventrobasally and tension of the upper abdominal wall. Additional diagnostic procedure excluded extrasplenic disease. Ultrasound-guided puncture demonstrated the presence of pus in the splenic bed, and splenic abscess was diagnosed. Subsequent surgery confirmed this diagnosis. Histological findings revealed extensive splenic infarction. Since bacteriological investigation revealed the identical pathogens in the pus obtained with the puncture needle, in the intraoperative swab and in the midstream urine, the splenic abscess was most likely caused by hematogenous spread of a urinary tract infection into the splenic infarction. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day, free of symptoms. The clinical picture, radiological diagnosis, origin, therapy and course of splenic abscess are discussed with reference to the literature.
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