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It is important to separate splenic vein obstruction from other causes of variceal bleeding. The authors provide a diagnostic sequence for avoiding errors of management, citing a case to illustrate.
After explaining the principle of whole body computer tomography the field of indication is outlined with reference to some of our own experiences. Up to now, it has proved its value in the following indications: preoperative diagnosis, supplementing pulmonary radiodiagnosis, substitution of invasive diagnostic procedures in mediastinal diseases, clarification of diseases of the abdominal cavity, of space-occupying processes in the kidney, in the true pelvis, and detection of retroperitoneal processes. The financial expenditure for this novel method of investigation is described according to a formula. The cost of given or estimated numerical values show the importance of adequate usage. The added costs for a second personnel shift for an examination rate of more than 7 patients a day are trivial because of the high basic expenditure.
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A case is presented, of a patient aged 19, who, in the course of otic suppuration treated by tetracycline administration, developed a septicemic condition with a gigantic splenic abscess followed by generalized peritonitis. The initially unfavourable evolution had an improved course following splenectomy and peritoneal drainage, especially after the identification of the anaerobic germs that determined the infection (Bacteroides clostridii formis and Clostridium bifermentans) and the introduction of an adequate therapy.
The authors present a case with peritonitis following rupture of a splenic abscess in a female aged 18 years. Peritonitis developed in three stages. The diagnosis before surgery was of pelvic peritonitis. Bacteriologic examination revealed the presence of B. colli. Splenectomy was followed by complete recovery of the patient. The site of the primary infection could not be determined. The authors stress the usefulness of exploration of the splenic lodge in the so-called "primary" generalized peritonitis, in pelvic peritonitis or in all cases when the origin of the peritoneal infection is not known.
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Minimal risk, easy applicability and high efficiency of ultrasonography, makes this method a valuable screening procedure in upper abdominal diagnostics. Case history, physical examination and laboratory diagnostics should be followed by ultrasound procedures as the first directed examination. This review intends to evaluate the efficacy of ultrasonography in different gastroenterological, oncological, hematological and angiological diseases of the upper abdomen.
Bacterial endocarditis is an elusive disease that challenges clinicians' diagnostic capabilities. Because it can present with various combinations of extravalvular signs and symptoms, the underlying primary disease can go unnoticed.A review of the various extracardiac manifestations of bacterial endocarditis suggests three main patterns by which the valvular infection can be obscured. (1) A major clinical event may be so dramatic that subtle evidence of endocarditis is overlooked. The rupture of a mycotic aneurysm may simulate a subarachnoid hemorrhage from a congenital aneurysm. (2) The symptoms of bacterial endocarditis may be constitutional complaints easily attributable to a routine, trivial illness. Symptoms of low-grade fever, myalgias, back pain and anorexia may mimic a viral syndrome. (3) Endocarditis poses a difficult diagnostic dilemma when it generates constellations of findings that are classic for other disorders. Complaints of arthritis and arthralgias accompanied by hematuria and antinuclear antibody may suggest systemic lupus erythematosus; a renal biopsy study showing diffuse proliferative glomerulonephritis may support this diagnosis. The combination of fever, petechiae, altered mental status, thrombocytopenia, azotemia and anemia may promote the diagnosis of thrombotic thrombocytopenic purpura. When the protean guises of bacterial endocarditis create these clinical difficulties, errors in diagnosis occur and appropriate therapy is delayed. Keen awareness of the varied disease presentations will improve success in managing endocarditis by fostering rapid diagnosis and prompt therapy.
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The combined use of selective angiography, scintigraphy and ultra-sound is not reliable enough for the certain exclusion of visceral involvement in Hodgkin's disease. Since this is of importance in the planning of treatment, it confirms the recommendation made by Wagenknechts, Glatsteins and others that a diagnostic splenectomy be carried out in order to determine the presence of visceral involvement.
Increased splenic uptake of radiocolloids is a helpful sign in the scintigraphic diagnosis of various hepatocellular diseases, but little attempt has been made to quantify this physiologic phenomenon. We have devised a simple computer method that compares average splenic activity to average right-lobe liver activity. The method is reproducible (r = 0.97) and exhibits little interobserver variation (r = 0.99). One hundred clinically normal subjects were found to have a nearly symmetrical distribution of S/L ratios around a mean of 0.77, with a s.d. of 0.20. Fifteen subjects normal by biopsy were found to have a similar mean spleen-to-liver (S/L) ratio of 0.74. Based upon a normal range of 0.37 to 1.17 (0.77 +/- 2 s.d.), elevated S/L ratios were found in fatty metamorphosis (85%), cirrhosis (67%), and chronic hepatitis (43%). Abnormal S/L ratios in the range from 1.17 to approximately 1.4 were not visually obvious. Overall sensitivity of the S/L ratio in these three diseases is 69%. When combined with the other scintigraphic indications of hepatocellular disease (nonhomogenous colloid uptake, hepatomegaly, splenomegaly, and bone-marrow colloidal uptake), the liver scan was found to have a sensitivity of 93%.
Human splenic sinuses were observed for the induction of alkaline phosphatase (AP) activity in mucopolysaccharidoses of type I and II, in GM1 gangliosidosis, and in Niemann-Pick's disease, type A. A substantially lower degree of activity was found in Sanfillipo's disease, type A, and in hemosiderin pigmentation of the sinuses. In a number of hematological affections and in control spleens AP activity could not be proved by histochemical means. From the formal pathogenetic view, enzyme activity induction is probably related to lysosomal deposition of the material stored.
104 examinations were carried out on 81 patients with a new commercial emission computer tomographic scanner. The technique provides additional information in half the brain scans, but only in one third of liver scans. No indications for this examination could be discovered in a relatively small clinical material for the examination of the kidneys or the skeleton. Other organs were not included in this assessment. The authors confirm reports in the literature which show that this method is not particularly valuable for finding pathology. It finds its application in conforming or excluding suspected abnormalities and for better localisation and delineation of lesions, thereby aiding differential diagnosis. However, further technical improvements and increased clinical experiency may increase the applicability of the technique.
AG 60.99, an emulsion of poppy-seed oil, is proposed as a promising organ-specific agent for computed tomography (CT) of the liver and spleen. This agent not only opacifies the hepatic parenchyma enough to enhance visualization of the bile ducts but also demonstrates the vascular anatomy with smaller doses than those required for conventional studies.
The work was undertaken owing to great difficulties in diagnosis and treatment of histiocytosis X (HX) in children, which occurs comparatively rarely and its clinical symptoms are of great variety. The analysed material included 45 cases of children with HX treated in one clinical department. A big number of analysed cases makes safe conclusions possible. The aim of this work was evaluation of therapeutic methods used in HX, on the basis of the results obtained from the HX treatment and with consideration of such prognostic factors as: the age of the child when the first pathological symptoms occurred , the extent of the pathological process and the localization of the lesions. The results of the research carried out on 23 children in whom the pathologic process concerned the skeletal system only were evaluated separately. Remaining 22 cases in which the lesions were noticeable not only in the skeletal system, but also in other organs and systems were divided in two groups: group 1 (11 children) included all the cases treated till 1969 by different methods with the use of different cytostatics; group 2 (11 children) included the cases observed by the author introducing a new method of treatment based on intensive therapy followed by the usage of Vinblastine or both Vinblastine and Prednisone. In the evaluation of the extent of the pathologic process and localization of lesions the following symptoms were taken into consideration: skeletal and skin lesions, enlargement of lymphatic nodes and liver, lesions of gums--i.e. movable teeth, lesions in ears, lungs, hematopoietic system, and fever. The presence of these symptoms is proved by the clinical, radiological and laboratory examinations. The age of the patient with the first symptoms of the disease was established through inquiry, the appearance at least one of the HX symptoms such as: protrusion of the soft tissue, skin lesions and discharge from the ears was considered as the beginning of the disease. In the group of children with lesions limited only to skeletal system, the age of the appearance of the first symptoms was between 1-12 years. The greatest morbidity was between the 4-th and the 8-th year of life (Fig. 1). The main methods of treatment were surgery and/or radiotherapy. Chemotherapy was used sporadically as supplementary treatment. In all cases response was good. (Tab. 1.). The generalized form of the disease is observed as a rule among the youngest children. In our own material of 20 cases out of all 22, the first symptoms of the disease appeared before 3-rd year of life was over. (Fig. 4.).(ABSTRACT TRUNCATED AT 400 WORDS)
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