[Intestinal tuberculosis: Easier overlooked than diagnosed]. / Darmtuberkulose: leichter zu übersehen als zu sichern.

Intestinal tuberculosis: Easier overlooked than diagnosed. The medical history of two Asian immigrants suffering from intestinal tuberculosis demonstrates the difficulties in finding the correct diagnosis. Intestinal tuberculosis resembles Crohn's disease with regard to clinical symptoms, macroscopic and microscopic intestinal findings. Sonographic, radiologic, endoscopic, and histological examinations facilitate distinguishing both entities. Diagnosis of intestinal tuberculosis is made by identification of the causative microorganism in tissue specimens. As this may be difficult and time-consuming, a therapeutic trial with anti-tuberculous agents may be warranted.

[Schwannomas of the stomach]. / Schwannome des Magens.

One benign and one malignant schwannoma of the stomach are presented. The gross appearance, degree of local invasion and the complications are demonstrated by double-contrast radiology technique and CT. Benign schwannomas can only be distinguished from the malignant ones on the basis of histological and immunohistochemical criteria.

[Roentgenographic pulmonary findings in long term ventilated multiple trauma patients (author's transl)]. / Röntgenologische Lungenveränderungen bei polytraumatisierten Patienten während Dauerbeatmung.

An analysis of roentgenographic pulmonary findings was done in 46 multiple trauma patients on controlled long term ventilation. 67% of the patients sustained thoracic trauma. The most common lung changes were interstitial and intraalveolar pulmonary edema and inflammatory pneumonia related to contusions, atelectasis and aspiration. The pulmonary lesions predominantly occurred in the middle and lower portions of each lung. The thoracic trauma group had four times as many lung changes than the non-thoracic trauma group. Daily roentgenographic controls are necessary in multiple trauma patients to explain a deterioration in pulmonary gas exchange leading to respiratory failure. To demonstrate discrete lesions in lung parenchyma, we recommend the high voltage technique for chest X-rays in intensive care units.

Thromboembolism after hip surgery.

Since 1973 a prospective trial of antithrombotic agents for the prophylaxis of deep venous thrombosis and pulmonary embolism was undertaken in 386 high risk patients. Five drugs were employed: 1. A combination of aspirin and dipyridamol (95 patients); 2. Dextran 60 (43 patients); 3. Dihydroergotamine (61 patients); 4. Low dose heparin (63 patients); 5. A combination of dihydroergotamine and low dose heparin (twice daily in 61 patients and three times daily in 63 patients). The patients were investigated by I125 fibrinogen uptake test, phlebography, lung scan and careful clinical evaluation before and after operation. In cases of established thrombosis simultaneous anticoagulation with heparin and coumadin was started. In the first group, 32 (34%) thromboses and three pulmonary emboli were detected of which one patient died. In the dextran group, 24 patients (54%) developed thrombosis and there were no fatal pulmonary emboli. In the low dose heparin group we detected 29 (46%) thromboses and three pulmonary emboli. Only the combination of low dose heparin and dihydroergotamine significantly reduced the incidence of thromboembolic complications-15 (25%) thromboses and no pulmonary emboli. The application of this combination three times a day showed no further improvement but more haemorrhagic complications appeared. Since 1975 no fatal pulmonary emboli have occurred in 720 patients undergoing total hip replacement.

[Haemodynamic, gas exchange and lung X-rays in multiple injuries with blunt chest trauma (author's transl)]. / Hämodynamik, Gasaustausch und radiologische Lungenbefunde bei Mehrfachverletzten mit stumpfem Thoraxtrauma.

In a controlled prospective study of 50 multiple trauma patients special cardio-respiratory monitoring was performed from the moment of admission to the hospital up to seven days. We compared haemodynamic and respiratory data and roentgenograms from 34 patients with blunt thoracic trauma with those of 16 patients without thoracic trauma. The mortality of the thoracic trauma group was higher (56%) than in the control group (19%). Long term intubation was necessary in the first group for an average of 17 days and in the second group for 6.2 days. In the thoracic trauma group there was a higher total pulmonary resistance and a lower cardiac index. Despite mechanical ventilation the pulmonary gas exchange was impaired in the thoracic trauma cases, especially due to an increased shunt fraction. In 16 of the thoracic-trauma patients roentgenograms detected at least temporary pulmonary oedema simultaneously with the increase of shunt fraction and the impairment of pulmonary gas exchange of those patients.

Intestinal disaccharidase activities and activity ratios in a group of 60 adult German subjects.

Lactase, maltase and sucrase activities were determined in samples of jejunal mucosa obtained by suction biopsy from 60 healthy adult German males. Primary adult hypolactasia ("lactase deficiency") was found in 8 subjects (13%). Maltase:lactase and sucrase:lactase activity ratios were significantly higher in post-weaning hypolactasia than in adult lactase persistence. Sources of variation in disaccharidase activities measured in biopsy tissue homogenates are discussed.

[Hemodynamics and pulmonary gas exchange in radiographically observed posttraumatic lung edema (author's transl)]. / Hämodynamik und pulmonaler Gasaustausch bei radiologisch beobachteten posttraumatischen Lungenödemen.

A prospective study of 46 multiple trauma patients was undertaken using standard intensive care techniques with special circulatory and respiratory monitoring. In 19 cases roentgenograms detected at least temporary pulmonary edema; only 3 of these patients sustained no discernible lung contusions. The hemodynamic data did not explain the pulmonary edema. Despite ventilatory support of all patients, pulmonary gas exchange was abnormal prior to radiological findings of pulmonary edema. The most significant explanation of the investigated data is early capillary leakage in the lung inducing an enlarged transit space at the interstitial site.

[Combined arteriovenous dysplasia and disturbed osseous growth (author's transl)]. / Kombinierte arteriovenöse Dysplasie und gestörtes Knochen-wachstum.

Basing on own observations by the authors in 10 patients with angiodysplasia and circumscribed gigantism of an extremity, typical phlebographic and arteriographic findings are described. Classification of the angiodysplasia of the Klippel-Trenaunay and F. P. Weber type is in accordance with suggestions advanced in recent literature. The x-ray methods required for the purpose of establishing the diagnosis, are described.

[Misinterpretation of chest roentgenogram in intensive care patients (author's transl)]. / Fehlermöglichkeiten bei der Interpretation der Röntgenthoraxaufnahme in der Intensivmedizin.

Misinterpretation of chest roentgenograms in intensive care patients can be largely obviated by a skilled technique and a thorough knowledge on the part of the radiologist of the structural changes in the lungs and their differential diagnostic significance. Correct interpretation is facilitated by relating the observed changes to the pathophysiological clinical findings.

Angiographic results in interstitial, vascular and glomerular kidney diseases.

In earlier stages of parenchymal kidney diseases different changes are to be seen in angiography. No single sign appeared to be pathognomonic for glomerular nephritis, vascular disease or interstitial nephropathy. But the disproportionate frequency of some angiographic features assumed discriminatory value. Morphometry of the renal arteriograms discriminated statistically significant interstitial, vascular and glomerular diseases. The correct angiographical diagnosis was made in 76%.

[Long-term results after transluminal recanalization of arterial obliterations (author's transl)]. / Langzeitergebnisse nach transluminaler Rekanalisation arterieller Obliterationen.

The study provides information on 22 patients in whom a total of 24 transluminal recanalization procedures were carried out because of obliterations of the A. femoralis superficialis. In addition to 6 primary failures, there were 7 occlusions within 12 hours to 6 months after treatment. Eleven patients were examined 18 to 36 months after surgery. Of these only one patient had a new occlusion. The results are compared with those of other study groups. Morphologic vascular changes are considered to be the cause of the relatively high number of primary failures. The significance of prophylaxis with anticoagulants is pointed out.