Three-dimensional spiral CT angiography in the detection of cerebral aneurysm.

PURPOSE: The value of CT angiography in the detection and evaluation of aneurysms was compared to digital subtraction angiography (DSA). MATERIAL AND METHODS: Seventeen patients with acute subarachnoid hemorrhage (SAH) or with known or suspected aneurysm were investigated by means of spiral CT angiography, which included 3D reconstruction. These findings were compared with those at DSA. RESULTS: In 16 patients, 20 aneurysms were found; the remaining patient had an ectatic vessel that simulated an aneurysm. Seventeen of the angiographically proved aneurysms were detected at CT angiography (sensitivity 85%). One further aneurysm was identified retrospectively as the result of greater experience in the method. All the aneurysms that escaped detection at CT were 3 mm in size. All the vessels of the circle of Willis, except for the posterior communicating artery, were properly evaluated at CT angiography. Difficulties were encountered in assessing the posterior communicating artery and the extradural segment of the internal carotid artery owing to their close spatial relationship to the bony structures of the skull base and the cavernous sinus. CONCLUSION: CT angiography is a low-risk technique with a low level of invasiveness that is useful in following up known aneurysms. The 3D reconstruction yields further topographic information that helps in the planning of endovascular or surgical intervention. The facility for rotating the reconstructed vessels and displaying them from different angles is of particular value in cases difficult to assess at angiography.

Primary Candida albicans empyema associated with epidural hematomas in craniocervical junction.

The case of a 27-year-old patient with chronic candida empyema in the craniocervical junction is presented. Occlusive hydrocephalus at admittance, primary subdural candida empyema, and recurrent epidural bleedings are the outstanding features in the clinical course. Despite intact immunity this patient acquired primary candidosis of CNS. Pathological changes in dura, ventricular system, and CSF required multiple shunt revisions. Antimycotic therapy was performed with a combination of 3 antimycotics. The clinical improvement was prolonged by several complications.

[Massive foreign body reaction after intraocular penetration of hot, liquid plastic]. / Massive Fremdkörperreaktion nach intraokularer Einsprengung von heissem, flüssigem Kunststoff.

PATIENT: A 32-year-old male had an injury of his right eye by hot liquid plastic (Ultradur R). Intraoperatively, the eye was found broadly penetrated and filled up by more than 50% with ragged pieces of plastic. Computed tomography three days after wound closure revealed remaining foreign body material. As function was totally lost no further operation was considered. Seven weeks after the trauma, the eye was enucleated because of a painful phthisis. Histology showed numerous giant cells. CONCLUSIONS: Hot liquid plastic may perforate the eye and fill it up to a great extent. Due to intraocular cooling, pieces with sharp edges may develop, thus producing further (mechanical) tissue damage. Intraocular plastic is able to induce a massive foreign body reaction. It may be detected easily by computed tomography.

Five years of stereotactic radiosurgery at the University of Tübingen--a critical review of the method.

At the University of Tübingen a Linac based stereotactic system for radiosurgery has been used since 1991. The floorstand system (SRS 200, Phillips) developed at Gainsville is used in combination with a Cosman Roberts Weels system by Radionics. The floorstand enables the gantry to be rotated vertically and the table to be rotated in the horizontal plane. Additionally, patient's movements are reduced by the fixation of the stereotactic ring to the stereotactic floorstand. We report our experience with the first 50 patients treated between December 1991 and June 1995. The patients were treated with an interdisciplinary approach. This cooperation eases the transition from radiosurgery to other methods such as embolization, operation, and other radiooncologic treatment options.

Spontaneous gas-forming bacterial myonecrosis caused by group B streptococci and peptostreptococci.

We present the case of a patient who spontaneously developed a severe gas-forming infection involving the voluntary muscles of both thighs. The organisms responsible were group B beta-haemolytic streptococci together with peptostreptococci. Following surgical and medical treatment, the patient fully recovered. No predisposing factors, in particular no disease causing immunocompromise, could be identified.

[Pneumatosis coli--a rare complication of cytostatic therapy]. / Pneumatosis coli--eine seltene Komplikation der Zytostatikatherapie.

Recurring paroxysmal abdominal pain developed in a 19-year old woman suffering from acute lymphatic T-cell leukaemia, during induction chemotherapy with cyclophosphamide, cytarabine and mercaptopurine. Both the plain radiograph and CT of the abdomen showed pathognomonic intramural gas accumulations and free air below the right diaphragm, pointing to pneumatosis coli. There was marked pancytopenia (leucocytes 800/microliters,haemoglobin 7.6 g/dl, thrombocytes 10,000/microliters). Whereas the abdominal pain subsided rapidly under oxygen therapy and liquid nourishment, the radiological changes receded gradually. However, fever and diarrhoeas occurred subsequently. Fever persisted for 3 weeks despite treatment with antibiotics (three times 60 mg/d gentamicin, three times 2 g/d mefoxitin and three times 500 mg/d metronidazole, and later 30 mg/d amphotericin B) and subsided only after completion of the induction chemotherapy and an increase of leucocyte count.

[The clinical value of contrast CT in lymph node staging in the neck region]. / Klinische Wertigkeit der Kontrastmittel-CT beim Lymphknotenstaging in der Halsregion.

Pre-treatment CT examinations of 333 patients with squamous carcinomas in the head and neck region have been analysed. Two hundred and six patients had lymph-node metastases and lymph-node staging was ascertained. The criteria for metastatic involvement were lymph node size greater than 15 mm. and changes in structure (inhomogeneity, central hypodensity and ring enhancement). CT had a sensitivity of 93% and accuracy of 89%. This was better than palpation (sensitivity 64%, accuracy 72%). CT can be regarded as a reliable basis for treatment planning.

[T-staging of tongue and mouth floor tumors: comparison of ultrasonography and computerized tomography]. / T-Staging von Zungen- und Mundbodentumoren: Sonographie und Computertomographie im Vergleich.

A comparison was made between the pretherapeutic CT and ultrasound findings of 43 patients with tumors of the oral tongue and the floor of the mouth. Two tumors of the edge of the tongue (T1) each were not diagnosed by computed tomography and by sonography. In three cases a more precise determination of the tumor size was achieved by sonography. In 25 out of 38 cases the contrast between tumor and sound tissue was better in the sonographic image. The reduction and regressive modification of the tumor following to radiotherapy could be observed in eleven cases. Despite the benefits of sonographic investigation in this area due to the excellent contrast without any need of contrast media, the good availability and the absence of metal and movement artefacts, this method is not able to replace computed tomography. The most important disadvantages of sonography were found to be the incapability to show osseous erosions and the restricted or lacking possibility to assess the parapharyngeal and the retropharyngeal area.

[NMR tomography of the shoulder joint: clinical experiences with the saturation pulse technic]. / Kernspintomographie des Schultergelenkes: Klinische Erfahrungen mit der Sättigungspulstechnik.

High zoom factors for MRT of the shoulder joint can lead to disturbing artifacts. The use of special saturation coils can improve longitudinal magnetisation of the central image, making it possible to produce artifact-free images of the shoulder with high resolution. Two normals and 20 patients with the rotator cuff syndrome, as well as other inflammatory and neoplastic processes, have been examined. The findings have been correlated with those of arthrography, arthro-sonography, bone scintigraphy, CT and simple radiographic examination. The MRT findings were compared with the other imaging techniques and the results are discussed. MRT proved superior to other techniques, particularly in the elucidation of soft tissue abnormalities in the rotator cuff syndrome.