In a group of 25 patients examined by sonography, computer tomography and angiography with diagnoses confirmed during operation and by histology, the author compared the efficiency of the individual methods and a complex examination. Computer tomography proved to be the most efficient method which enabled, in addition to precise localization, appreciation of size and relation of the pathological focus to adjacent structures, to determine their nature in some. The complex examination in indicated cases significantly increased the diagnostic efficiency.
Ultrasonography is a direct method of representation, giving various advantages over other methods in the examination of parathyroid glands: it is rapid, non-radiation and economically undemanding. Dynamic examination by means of the linear electronic transducer of 3.5 MHz and the use of water path was used in 37 patients. In 7 patients with primary hyperparathyroidism was the examination rapid and the pictures of the adenomas were persuasive. In 30 patients with secondary hyperparathyroidism were found characteristic pictures, if the glands were enlarged to 8 mm or more. For the diagnosis of smaller glands a high resolution transducer will be necessary. Histological finding was available in 21 patients undergoing operation, and easily available method and it is therefore the procedure of the first choice.
The dilatation of oesophagus oral portion in the Kelly-Paterson (Plummer Vinson) syndrome was made in two female patients at the age of 58 and 81 years. For the extreme stenosis (2 and 3 mm) of the lumen the dilatation was first performed by the Grüntzig Catheter and after extension above 5 mm special oesophageal catheters with a balloon of 15 mm diameter (Cook) were used. The dilatation proved successful in both patients. The dilatation in the K.-P. syndrome must be performed with care beginning with catheters of small diameter and narrow end with a step-wise slow filling of the balloon. A good anesthesia of upper respiratory pathways and swallowing passages is required.
The authors review the modern concept of liver anatomy, related to the needs of surgeons in segmental resections. Important anatomical structures are described participating in division of the liver into four basic segments. The ultrasound anatomy of portal system, hepatic veins, hepatic fissures and liver hilus are dealt with in detail. Criteria for perfect examination of the liver by ultrasound are defined and representability of key anatomical structure under optimal conditions is analyzed in a group of 100 patients. The only non-constantly represented structure was fissura interlobaris (44%). Hepatic veins proved to be the most variable structures (17%). The results show that segmental anatomy of the liver may be very well represented by ultrasound. The authors discuss the importance of perfect knowledge of anatomy for quality examination.
A 52 years old woman was surgically treated at her 27 years of age for a defect of atrium septum of IInd type. The defect was covered by a patch taken from pericardium. The operation was followed twice by lung embolism. In 1986 there occurred deterioration of the condition. A recanalization of the defect was detected and the patient was recommended to operation. The operation was preceded by selective coronarography, which proved anomalous vascularization of myocardium in the left atrium. Echocardiography and computer tomography detected a pathological formation in this area. The suggested formation was not found during the operation. The explanation of anomalous vascularization of myocardium is believed to have been caused by a thrombus after the first operation; the thrombus may have caused proliferation of coronary vessels, then paradoxically resulted in lung embolism and the pathological vascularization persisted.
Thallium scintigraphy of myocardium is a diagnostic method of nuclear medicine which enables visualization of well perfused and vital tissue of myocardium by means of 201thallium absorbed by its cells. In the first part of the review the authors present various radiopharmaceuticals having been used in this area. Physical properties are described in greater detail as well as preparation and pharmacokinetics of 201thallium. The method of examination is described in its basic form, but also some special cases of detection and evaluation are presented, such as ECG-synchronised thallium scintigraphy of myocardium and one-photon transaxial tomography.
The paper verified literature data assuming that the heart damage caused by irradiation of thorax may be scintigraphically detected by means of 99mTc-pyrophosphate. Three dogs underwent a single irradiation of thorax with a gamma cobalt source by the Dose 40 Gy. The myocardium scan was performed 24 hours, 20 days, 50 days, 80 days and 93 days after the irradiation. The scintigraphic examination proved to be negative at all the intervals observed. A comparison of the scan with morphological findings and with radioactivity of tissue samples after the dogs were sacrificed 93 days after the irradiation proved that the negativity of the pyrophosphate scintigraphy was caused by a minimum damage of the myocardium and not by an inability of 99mTc-pyrophosphate to be incorporated into radiation lesions. The data in literature on myocardium damage by irradiation appear to be considerably exaggerated.
A series of nine vascular tumors of the lungs, five of them being benign hemangiomas, three hemangiosarcomas and one hemangiopericytoma is presented. In five patients the disease was detected on the basis of subjective complaints which indicated necessary hospitalization, in the other four patients the tumours were revealed by chance during preventive X-ray examination or X-ray examination for other causes. These patients were admitted to hospital for progression of lung changes. Five of the patients underwent surgery, lobectomy, was made in two cases, the other patients were treated by segmental, V-shape or atypical lung resection. Patients with benign hemangiomas manifested the best prognosis even in those where surgery was not possible. In cases of hemangiosarcoma or hemangiopericytoma the outlook is exceptionally serious even in primary forms. In the preoperation diagnostics of arteriovenous hemangiomas the tomographic examination and lung angiography represents an important help, in the other vascular tumours it is particularly CT and lung biopsy.
In the first part of the review the authors define general principles of evaluating thallium scintigraphy of myocardium. A standard evaluation protocol is proposed. A normal picture is described and the evaluation procedure of pathological findings is outlined. A particular attention is paid to the importance of mathematical processing of data by means of a computer for increasing sensitivity of the method and reproducibility of the results. In the conclusion the authors present table with examples of normal values of quantitative analysis of thallium scintigraphy of myocardium.
The output beams of fast electrons and high energy fotons of a linear accelerator Mevatron KD 80/67 provide broad spectrum of therapeutic application. The properties of static fields of bremsstrahlung, modification of dose distribution by means of wedge filters, properties and advantages of asymmetric diaphragms and possibilities of shaping the irradiation fields are described. Dose distribution in rotation therapy with bremsstrahlung is presented. In electron beams the author presents cohorts of selected isodoses of static fields for all energies and define important therapeutic values. A possibility of shaping basic fields and the use of rotation therapy with electron beam is suggested.
Nonspecific spondylodiscitis at the child age represents a distinctive disease of intervertebral disc and adjacent subchondral parts of vertebral bodies. Their early diagnostics may be difficult due to latency of radiographic manifestation of the finding and possible mistaking for other pathological conditions, especially tuberculosis spondylitis. The paper demonstrates several cases of the disease which we encountered recently. The authors discuss clinical and X-ray symptoms of the disease with a particular attention to modern methods of visualization, especially computer tomography. Etiopathogenesis of the disease is analyzed and some new knowledge of the disease is presented, differential diagnosis is discussed. In the conclusion attention is paid to early diagnosis of the disease and introduction of proper therapy.
The authors present a retrospective evaluation of radiograms of 57 fractures from skeleton overload dealing with lower extremities. Three kinds of symptoms detected in the first radiological examination are presented. In addition to periostosis and sclerosis there is also a clearing as an expression of interrupted bone in a form of infraction, fissure or fracture. The symptoms may occur in combination.
The author presents case histories of his patients and draws attention to the most frequently occurring developmental anomalies of truncus coeliacus. In addition to variations in the division and course of vessels of Tripus Halleri, there are also frequent hypoplasies of vessels and orificial compressions, caused by anomalous course of ligamentum arcuatum. The author also draws attention to the evaluation of the importance of vascular anomalies from the point of view of hemocirculation changes detected by angiography, used also in clinical practice until recently. In the last years the digital subtraction angiography and ultrasonography modified by the method of duplex scanning--exercise Doppler, substitute the classical abdominal angiography and materialize regional hypoperfusion of organs in clinically uncertain abdominal symptomatology.
The authors refer to a 58-year female patient with truncus coeliacus agenesis. From the branches of tripus Halleri of a. gastrica sin., a hepatica comm. divides directly from aorta and a. lienalis from a. intercostalis post XII. 1. sin. In addition to anomalous division the unpaired arteries of abdominal aorta are also hypoplastic. The contribution draws attention to the fact that in the past vascular anomalies were considered clinically unimportant and their importance became manifest at the time of organ transplantation. The knowledge of vascular anomalies is required for taking the graft as well as during the transplantation itself.
The authors refer to the observation of 43 years old woman with Ewing's sarcoma of the pelvic region, who displayed, a year after local extirpation of the tumour, clinically and radiographically, a metastasis in the adrenal-renal region. The patient died due to generalization of the tumour during the next year after an attempt to remove the metastasis, where a radical intervention proved impossible. Metastases of malignant tumours of locomotor apparatus into this region proved to be rare and such is the observation of the extensive affection in the Ewing's sarcoma.
The use of ionic contrast media for translumbar aortoarteriography frequently results in unwanted movements of lower extremities caused by transient convulsive muscular pains. The use of suitable pretreatment and examination procedure may help to avoid general anesthesia and the ensuing risk. The communication presents the procedure and drugs which enable making aortoarteriography without general anesthesia faster and without muscular pains in the extremities.
In patients with chronic kidney failure in the long-term dialysis programme multiple minute cysts frequently develop in the shrunken kidneys. In addition to the cysts, in 20% of patients there are also multiple kidney tumours causing severe complications. In most cases the clinical picture of the disease is insignificant, hematuria being the most frequent manifestation. The authors present their cohort of 21 patients with irreversible kidney failure, who have been examined by computer tomography in the 1986-1987 years. The mean period of dialysis programme was 5.7 years, chronic glomerulonephritis and interstitial nephritis being the basic disease. The patient were, according to the results of computer tomography, divided into four groups: 1. the presence of cysts or tumours was not demonstrated, 2. multiple cysts were found in bilateral localization, 3. less than 3 cysts were found, 4. there was a kidney tumour. A factor causing the development of the cysts has not yet been identified. It is presumed that the disease is caused by a biologically active substance which is not efficiently dialyzed. On the basis of the present work the authors recommend the aimed examination of the kidneys in patients at the stage of chronic kidney insufficiency and particularly in patients subjected to dialysis for long period of time. The recommended examination is by computer tomography and the attention should be centered to possible occurrence of acquired cystic disease of kidney tumours.
The experiment in four dogs verified a suitability of the Czechoslovak preparation Vilan 500, a copolymer of polyvinyl acetate - polyvinyl alcohol in 93% ethanol, for the embolism of venous vascular bed in the percutaneous, transfemoral catheterization way. In all four cases there was a complete occlusion of embolized spermatic or pararenal veins, verified by a control angiography after one hour and after three months. The prepared venous samples were also examined by histology and changes indicating intraluminar thrombotization and subsequent fibrous reconstruction were observed. In view of the results reached it may be concluded that the catheterization technique and the use of Vilan 500 is suitable as an alternative of non-surgical solution of varicocele.
An early diagnosis of the tumour relapse after performed nephrectomy for a malignant kidney tumour is necessary in order to influence further fate of the patient. The most suitable method for determining a correct diagnosis is computer tomography. The authors present a cohort of 79 patients with a pathological finding in 21 of them. In the other patients the finding after the operation proved to be normal, i.e. the bed was free after the performed nephrectomy, retroperitoneal vessels were free and the line of m. psoas on the surgically treated side proved to be intact. Computer tomography can prove not only the relapse, but also metastatic affection of other organs, particularly in the liver and adrenals.
