Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease.

New lesions were shown by Tc99m bone scans to have developed in sixty patients with known metastatic cancer or high-risk primary cancer and normal neurologic examinations; they were further evaluated with plain radiographs, spinal computed tomography (CT), and CT myelography (CT-M) according to an algorithm. Three groups were identified based on plain radiographs: group 1 (normal radiograph), group 2 (compression fracture as indicated by radiograph), group 3 (evidence of metastasis as indicated by radiograph). In group 1 (n = 18), spinal CT revealed that 33% of the patients had benign disease and 67%, metastases; epidural compression was seen in 25% of the patients with metastasis as indicated by CT-M. In group 2 (n = 26), CT-M disclosed that 38% had a benign compression fracture and 62% had metastases and that 63% of the patients with metastases had an epidural compression. In group 3 (n = 16), spinal CT revealed that 15 patients had metastases (one patient had benign disease). Epidural cord compression was seen in 47% of the patients with metastatic disease. In all groups, the presence of cortical bone discontinuity around the neural canal (seen in 31 patients) was highly associated with epidural compression (seen in 20 patients). Our approach allowed the early and accurate diagnosis of spinal metastasis and epidural tumor as well as the diagnosis of benign disease and was useful in planning optimal local therapy.

Sepsis from sinusitis in nasotracheally intubated patients. A diagnostic dilemma.

The cause of sepsis in the intensive care unit patient can be a perplexing diagnostic problem. We have recently encountered seven patients who had sepsis associated with sinusitis of the paranasal sinuses. They represented 26 percent of all patients who had nasotracheal intubation for 5 days or more. Sinusitis as a complication of nasotracheal intubation has been previously reported, but its frequency has not been appreciated. Three case reports are presented to emphasize the importance of making this diagnosis. Standard x-ray studies will not adequately demonstrate all the paranasal sinuses. We have utilized computerized tomography to study these patients and found it to clearly demonstrate all the paranasal sinuses. We suggest a plan to help prevent sinusitis from nasotracheal intubation. Should this complication occur, however, the nasotracheal tube should be removed and the sinuses surgically drained or treated aggressively with topical agents.

[HBs-antigenemia in patients with pulmonary tuberculosis (author's transl)]. / HBs-AntigenAämie bei Tuberkulosekranken.

1637 patients of a department for lung tuberculosis were tested for HBs-antigen. 32 patients (1.95%) were found to be HBs-antigen-positive. This incidence is higher than in patients of an internal clinic and much higher than in the middle-european population at the same time. In no positive case acute hepatitis could be diagnosed. The hospitalization time was prolonged in the positive cases.

The radiographic manifestations of von Hippel-Lindau disease.

The radiographic findings and method of investigation are presented in the retrospective and prospective study of 221 descendents of an individual affected with von Hippel-Lindau disease. Among 42 affected individuals, most of the reported manifestations were found, such as cerebellar hemangioblastoma, retinal angioma, and renal cell carcinoma. A new manifestation, pancreatic carcinoma, was also seen. Although pheochromocytoma is common in some reported families, no cases were found in this group. An organized multidisciplinary approach is necessary to effectively identify and treat individuals affected with this disease.

Sand aspiration in drowning and near drowning.

Aspiration of sand and other foreign material is often discovered at autopsy in victims of drowning, but is not commonly seen radiographically. Two such cases are described, one of drowning and one of near drowning. In each case, the sand was radiopaque because of its calcium carbonate content and created a "sand bronchogram", i.e., sand in the tracheobronchial tree. With early recognition, successful bronchoscopic removal of the aspirated sand is possible.

[Rehabilitation after myocardial infarct. Assessment of result and possibilities for the prognosis of success]. / Rehabilitation nach Myokardinfarkt. Erfolgsbeurteilung und Möglichkeiten zur Prognose des Erfolges

Data of 253 patients with acute myocardial infarction (data collected from primary hospital, from the rehabilitation center-- R.C.-- and from a questionnaire dealing with the individual problems of the rehabilitation period; response rate 77%) were correlated in order to derive criteria for the estimation of the success of rehabilitation. It could be shown that the increase in physical performance and the clinical judgement in the R.C. are well paralleled by the further course of the rehabilitation period (return to work etc.). On the other hand it seemed difficult to predict rehabilitative results from the hospital data alone. It was only shown that the severity of the disease had a major influence upon rate of and interval, before return to work.

Septic candidasis with intrahepatic cholestasis and immunoglobuline deficiency after renal transplantation.

Two renal allograft recipients with acquired immunoglobulin deficiency had a disseminated infection with candida albicans. Septic fever, intrahepatic cholestasis and pulmonary mycotic disease were the prominent clinical symptoms. Recurrence of septic fever during the clinical course was associated with increase of intrahepatic cholestasis. On the other hand there was an amelioration of cholestasis when effective antimycotic therapy was instituted. In our patients there was no evidence that intrahepatic cholestasis was drug-related. It was assumed that toxic metabolits of candida albicans were responsible for intrahepatic cholestasis.