Acquired coarctation due to calcified thrombus in atherosclerosis of the descending thoracic aorta. Two cases and a review.

An extremely rare manifestation of atherosclerosis is described. Two women, aged 57 and 55, presented with upper extremity hypertension and diminished femoral pulses. Plain radiography and total angiographic visualization of the aorta demonstrated focal highly obstructing intraluminal masses containing heavy flocculent calcification in the upper descending thoracic (case 1) and the thoracoabdominal aorta (case 2) producing a significant pressure gradient. The acquired coarctation due to calcified thrombus was relieved by resection and graft replacement in one and placement of a thoracoabdominal bypass graft in the second patient.

Computerized tomography after internal fixation of the spine.

32 patients with internal fixation of the spine were postoperatively examined by computerized tomography. Details of metallic osteosynthetic material were demonstrated in all our cases. Bony structures were well defined in 27 patients, whereas soft tissue imaging was degraded by scattering artifacts in 14 of 20 examinations. Application of intrathecal contrast medium, however, was helpful for the evaluation of intraspinal soft tissues. Involvement of extraspinal soft tissues could be interpreted on the basis extent of vertebral osseous destruction.

[Percutaneous transluminal angioplasty of the brachiocephalic vein in sarcoidosis with superior inflow obstruction]. / Uber eine perkutane transluminale Angioplastie (PTA) der Vena brachiocephalica bei Sarkoidose mit oberer Einflussstauung.

A case of sarcoidosis is reported, which began 25 years ago. As a late complication the patient developed compression syndrome of the superior caval vein, which was caused by swelling of the lymph nodes. After surgical treatment, which was carried out by removing the regional lymph nodes and implantation of a dacron prosthesis, stenosis occurred within the proximal part of the prosthesis, which was treated by the PTA technique according to the Dotter method.

Noninvasive, quantitative determination of muscle blood flow in man by a combination of venous-occlusion plethysmography and computed tomography.

Because of the lack of non-invasive methods for measuring muscle blood flow, quantitative investigations of blood flow in the skeletal muscle of hypertensive subjects are rare. We therefore developed a new method for the determination of muscle blood flow noninvasively and quantitatively by a combination of computed tomography and venous occlusion plethysmography (strain-gauge method). At two sites on one forearm (p = site of the largest diameter, d = 1 cm proximal to the epicondyle lat.) the volumes of tissues [Vt = total volume, VM = muscle volume, VSk = bone volume, VR = residual volume = Vt - (VM + VSk)] were determined by computed tomograms and total forearm blood flow (Fp and Fd, respectively in ml/100 ml tissue x min) measured by strain-gauge plethysmography. After correcting for the bone volume at the different sites, Fp and Fd were transformed into the absolute influx rates of blood volume (Qp and Qd). From Qp and Qd and the different tissue volumes, the muscle blood flow (FM in ml/100 ml muscle x min) could be calculated: (formula; see text) Results thus derived were compared with data from the literature Cooper et al. (17). At rest there was neither a significant difference in Fp (own results: 3.62 +/- 1.67, Cooper: 3.25 +/- 1.42 ml/100 ml tissue x min, means +/- S.D.) nor in FM (4.08 +/- 2.07 and 3.66 +/- 1.57 ml/100 ml muscle x min, respectively), however, Fp and FM were significantly different (p less than 0.05). In the mean, FM was 13% greater than Fp, range: -40 to +38% (Cooper 15%, range: -17 to +43%). The individual difference could not be predicted by any of the parameters. Testing the procedure by means of a pharmacological agent (clonidine) with known effects on muscle blood flow (no change) and skin blood flow (decrease) revealed the correct reproduction of this hemodynamic pattern with our method. The usual identification of total with muscle blood flow would have led to false conclusions.

[Significance of computerized tomography in the diagnosis and therapy of fractures of the posterior pelvic ring and hip joint]. / Die Bedeutung der Computertomographie für Diagnostik und Therapie der Frakturen des hinteren Beckenringes und des Hüftgelenkes.

Conventional röntgenologic examinations of fifty patients with posttraumatic pelvic bone injuries were compared with computertomographic examinations. The major advantage of computertomography of the pelvis is in our view the more precise evaluation of injuries of the dorsal pelvic ring. Almost fifty percent of the fractures of the sacrum and two thirds of the injuries of the iliosacral joint in our series could not be diagnosed on conventional examinations. Computertomography of fractures of the sacrum and fractures of the acetabulum give us important informations about the extension of the fracture, its dislocation, its degree of instability and accompanying soft tissue injuries. So planning of operative treatment becomes much easier.

[CT diagnosis of a mycotic aneurysm of the femoral artery following typhoid infection]. / CT-Diagnostik eines mykotischen Aneurysmas der Arteria femoralis nach Typhus-Infektion.

A mycotic aneurysm of the femoral artery, which developed in the course of typhoid fever, was localized and diagnosed exclusively by computed tomography. Angiography was not used as it is invasive and was thus considered too risky for the patient, who was also suffering from chronic lymphatic leukemia.

[Superior vena cava syndrome--clinical aspects, etiology and case reports]. / Das Vena Cava superior-Syndrom--Klinik, Atiologie und casuistische Beiträge.

The so-called superior-Cava Syndrome is caused by obstructions by centrally localized tumors by thrombosis or by inflammations of the mediastinum. In cases of tumorous infiltration a graft can be inserted. The different phenomena of thrombosis caused by nutritial catheters and pace makers are of clinical importance. Acute thrombosis of the brachio-cervical veins and the Vena Cava can be treated successfully by means of thrombolysis. Besides CT bilateral brachial phlebography communicates optimal information concerning localization of vascular obstruction and collateral circuits.