Significance of inhalation and perfusion scintigraphy for the diagnosis of pulmonary embolism (author's transl)

Inhalation and perfusion scintigrams, general radiological examination of the thorax and an EKG were done on 43 patients with clinically suspected pulmonary embolism. In 11 cases, the clinical diagnosis could be confirmed on the basis of the scintigraphic examination. In the remaining 32 patients, an embolich event could be excluded by pulmonary scintigram, radiological examination and later the clinical course. A synopsis of clinical observations, X-ray and scintigraphy, therefore, permitted a basically reliable diagnosis of pulmonary embolism; selective pulmonary angiography should be used only in exceptional cases.     

The technique of anesthesia for the prevention and treatment of gaseous embolism in the neurosurgical sitting position (author's transl)

The sitting position in neurosurgery gives always three problems for the anaesthesist: --maintain the cerebral perfusion pressure, --not to aggravate intracranial hypertension, --detect gaseous embolism. The clinical signs of air embolism often look like the awakening of the patient. That is why it is necessary to use specific methods to detect them: Doppler, Swan-Ganz catheter, and/or continuous CO2 recording of expired air by capnograph. Among the various methods to prevent air embolism we have used controlled respiration with a positive and expiratory pressure (P.E.E.P.). In our series (45 operations) gas embolism occurred in 13% of the patients operated upon without positive and expiratory pressure, and 0% with P.E.E.P.     

The diagnosis of IgD-Myelomatosis (author's transl)

Two patients with IgD-lambda myelomatosis are presented and the differential diagnosis is discussed. Typical features of this disease are the high incidence of Bence-Jones proteinuria, osteolytic lesions, amyloidosis and the predominance of male patients. Furthermore, an augmentation of serum IgD level to 165 mg% was observed in a 22-year-old female patient with presumed Coxsackie myocarditis. The theories in regard to IgD function are discussed.     

Experience with radio isotope myelography from neurosurgical aspects (author's transl)

Experience with Radio Isotope Myelography is reported here. 169Yb-DTPA as a tracer was intrathecally injected at lumbar region in twenty three patients with various spinal cord lesions. The first scanning is perfomed after comfirming by gamma-camera that the tracer reaches to the lesion, the second and the third scannings are done according to the ascending rate of the tracer. (I) Normal scintimyelogram (A) In normal case, the shape of the Radio Isotope Myelogram well corresponds the shape of anatomical subarachnoid space. (B) In normal adult cases, the tracer comes up to the cisterna magna in 20-25 minutes after the lumbar injection. Therefore, the scintimyelographic diagnosis should be made not only by the shape but also by the ascending rapidity of the tracer. (II) Abnormal scintimyelogram Abnormal scintimyelograms could be summarized as following three categories. (A) "Delay": It means delay of the ascending of the tracer. Besides, "Transient delay" found in a case of Arnord-Chiari's malformation was proposed. (B) "Partial block": It meas a defect at the level of the lesion. This "Partial block" were observed in cases of spinal cord angioma, cervical spondylosis and spinal cord tumor etc. (C) "Complete block": It means the stagnation of the tracer below the lesion. To sum up, Rario Isotope Myelography, especially in partial block, can more easily and more sensitively represent the maximum extent of the spinal cord lesion than other myelographic study or angiographic one. On the other hand, we can not qualitatively diagnose about the lesions by its indistinct border.     

The EEG in intensive care units for diagnosis, monitoring and prognosis (author's transl)

The clinical electroencephalography of the sixth and seventh decade of this century saw its task in the coordination of EEG-findings and nosological entities. The method seemed to be limited to the discovery of positive correlations of EEG-patterns and diagnoses. The psychopharmacological induced psychodynamics of psychoses, the EEG-dynamics of epileptic patients--enforced by anticonvulsant drugs--and the modern intensive medicine teach us nowaday to leave static EEG-reflection and instead turn to a more pathophysiological way of thinking. Clinical EEG deals only with an actual sample of a continuum, a functional diagram of age, brain metabolism, vigilance and a possibly convulsive capacity. The comparison of samples enables us to have a better insight into the gradient of steppness of EEG-pattern changes. It is to be correlated with clinical and biochemical parameters. Further comparison of samples allows criterions concerning the extent of cerebral lesion, its course, termination, with or without neurological deficiency. In a series of cases of acute neurological, neuropsychiatric and internal diseases the above mentioned necessity of a more pathophysiological EEG-interpretation is being demonstrated.     

Sterilization during puerperium (author's transl)

Sterilization of the woman during puerperium is performed immediately following delivery via a periumbilical incision during a caesaren section isthmica intraperitonealis via laparoscopy or 3--5 days following delivery by pelviscopy. The surgical procedure currently in use for ligating or severing the fallopian tubes is accompanied by extensive loss of blood. This procedure should, therefore, be replaced by the coagulation method which is safer and does not contribute to the formation of adhesions. If the abdomen has been dissected, either high frequency current or the Endo-coagulation procedure may be used to produce the destructive heat necessary to coagulate the fallopian tubes. If the abdomen has not been opened and the coagulation of the fallopian tubes must be performed via pelviscopy, the Endo-coagulation method should be used instead of the high frequency current procedure which cannot be absolutely controlled by the surgeon. The Endo-coagulation procedure works at or about the temperature of boiling water. The failure rate for this procedure is about 2--3 %0.     

Possibilities for cultural diagnosis of vaginal flora (author's transl)

Reported in this paper are some possible approaches to culturing of vaginal flora. Plastic slides and various selective culturing media are described. The results so far achieved are likely to suggest that the above approach is applicable in practice.     

Differential diagnosis of acquired clubfoot (author's transl)

The article introduces a patient of 14 years of age in whom clubfeet as well as paraspasticity had developed from his sixth year of life. Instead of the previously suspected heredodegenerative disease, a lipoma was found in the distal spinal canal which had prevented ascension of the spinal cord and had thus produced the described phenomenon.     

Ultrasonic diagnosis of fetal ascites (author's transl)

Fetal ascites is relatively rare, but confronts the obstetrician with difficult decisions. By X-ray methods such as plain X-ray or fetography fetal ascites may only be suspected. Performing ultrasonic examinations however it is not only possible to detect the fluid collection in the peritoneal cavity but as well to recognize the inducing causes. This is documented by sonograms of three cases observed within the last year. The different decisions for the obstetrician in respect to fetal ascites with or without malformations are discussed.     

Circulatory changes in neurosurgical patients with intracerebral angiomas in neuroleptanaesthesia (author's transl)

In 10 neurosurgical patients with intracerebral angiomas circulatory and respiratory functions were studied. After induction of anesthesia the cardiac output declined from an average value of 7.63 +/- 2.13 1.min-1 to 3.99 +/- 0.43 1.min-1 (-48%) in consequence to the decline of the heart rate by 24% and the stroke volume by 32%. In the same time increased the calculated peripheral resistance in reverse proportion to the decline of the cardiac output by 47%. The oxygen transport decreased after induction of anaesthesia by 48% while the oxygen uptake decreased by 28.6%. The oxygen utilization coefficient increased by 48% (0.33) and documented a satisfactory relation between oxygen-uptake and oxygen utilization in neuroleptanaesthesia.