Complete destruction of both femoral heads following idiopathic necrosis of the femoral heads in a diabetic patient with hyperuricemia and hyperlipoproteinemia

A practically complete destruction of both femoral heads including the femoral necks and acetabula was encountered in a 69-year-old patient with diabetes, which varied in intensity. This destruction, documented by radiographs which had been taken 8 years prior, had started as the typical picture of "idiopathic femoral head necrosis". In addition to diabetes, hyperuricemia and hyperlipoproteinemia were present at the time when the femoral head necrosis was first evidenced. One episode of gout was recorded. In recent years, following therapy, the hyperurecemia and hyperlipoproteinemia had normalized. The question is raised, as to whether or not the present radiological findings represent a complication of aseptic femoral head necrosis, combined with a diabetic arthropathy of the hip joints. Details of the angiographic findings and a spondylopathy, which have all the characteristics of a neuropathic spondylopathy, would favor this hypothesis. When associated with a diabetic condition, generalized osteoporosis and hypertrophic spondylosis of such a particular nature require special mention.

[Radiographic features of a giant true cyst of the pancreas (author's transl)]

Case report of a 48 year old female patient with a large abdominal mass, found to be a true cyst of the pancreas following surgical removal. Plain film findings were a large soft tissue mass in the abdomen to the left of the midline, displacement of small bowel and colon descendens with splenic flexure to the right, and upward displacement of stomach and left kidney. A renal scan showed decreased uptake in the area of the lower pole of the left kidney. Angiography demonstrated the mass to be of cystic nature with the cyst wall getting its blood supply from two left renal arteries. Celiac and mesenteric arteries were displaced to the right. The origin of the cyst was in the tail of the panpcreas; and its wall had true epithelial lining. Special emphasis is made on the value of checking for amylase in the work-up of cystic abdominal masses.

[Arteriographic findings in a Schipper's fracture at the shaft of the femur (author's transl)]

This report on a Schipper's fracture at the shaft of the femur in a twelve-year old boy is preceded by a systematic tabulation of the various non-traumatic types of fracture and a general synopsis of stress fractures. At the time of a first exacerbation of pain which had been persisting for several weeks, the x-ray film showed periostal callus formation and a discrete, transverse zone of increased density. Four weeks later, this zone had widened, the central region showing a fine, tape-like translucence. The arteriogram showed a local increase in the number of vessels in the vicinity of the stress fracture.

[Control of the success of radiotherapy in case of mastocarcinomas by means of mammography (author's transl)]

The authors present the experience about modifications of the mammographic data caused by X-ray irradiations which are described in three publications of other authors. Then they mention a first case observed by themselves in 1953 and give a detailed description and documentation of a new observation. In these cases and contrary to the reports of the other authors, a total regression of the tumor shadow in the radiogram was found. The first patient had demonstratable pulmonary metastases already when she was irradiated and the new patient died of cachexia. Before she died, metastases of the vertebral column were demonstrated by radiography which, according to the general and clinical findings, had certainly already existed at the beginning of radiotherapy. It had not been possible to find out what was the nature of pasty swellings lying near the tumor which had not been visible on the radiogram.

[Retropneumoperitoneum and pneumomediastinum following proctoscopy (author's transl)]

A 66-year-old patient developed a retropneumoperitoneum and pneumomediastinum after a proctoscopy. Following the examination, which was done as an out patient, he had some pain but was able to reach home without difficulty. Radiography of the abdomen on the next day showed definite gas collection round the right kidney and below the middle of the diaphragm. The mediastinum showed some translucencies consistent with cranial spread of air from the retropneumoperitoneum; it was particularly marked round the aorta. The film also showed supraclavicular emphysema. After being placed supine the patient's symptoms rapidly disappeared. There were no complications and no treatment was necessary. The case is discussed in relation to the relevant literature.

[Formation of a large blister with subsequent necrosis of the skin following paravenous contrast medium injection at the dorsum of the foot in a patient with oedema and deep phlebothrombosis (author's transl)]

In a female patient with an oedema of the leg as a result of deep phlebothrombosis, a great blister developed at the dorsum of the foot proximal to the site of injection following phlebography effected by paravasal contrast medium injection. The blister was transparent and contained clear, serous liquid. Skin necrosis developed at this site which took months to heal. The reason is sought in a stasis of contrast medium caused by the oedema. It is suggested that in future cases of this kind, cortisone treatment should be attempted.

[Roentgen findings in the full-size abdominal radiograph in occlusion syndromes at the visceral aortic branches (author's transl)]

The acute visceral ischaemia syndrome (which, in typical cases, is caused by embolism or thrombosis of the arteria mesenterica cranialis or, in some cases, by a functional reduction of flow in that vascular area), is usually assigned to the roentgenologist under the heading "acute abdomen" for effecting an abdominal fullsize radiograph. Although this does not allow safe diagnosis and differential diagnosis, it does provide valuable pointers in quite a number of cases. One of the most specific symptoms is the so-called flexure cut-off symptom consisting of a pronounced accumulation of gas (wind) from the caecum to the left flexure. a typical case and one each similar case in a chronic visceral triple occlusion and a polycythaemia, are demonstrated. The mandatory diagnostic consequence of this symptom is immediate aorto-arteriography unless a functional cause is evident and can be successfully treated by conservative measures.

[Occlusion of the three unpaired aortic branches with the development of an extensive Riolan's anastomosis (author's transl)]

A 60-year-old patient with occlusion of the inferior and superior mesenteric arteries and the coeliac axis developed a collateral circulation from the iliac arteries through the rectal vessels, the ascending ramus of the inferior mesenteric artery and the medical colic branch of the superior mesenteric artery. These collaterals were able to ensure survival of all three vascular territories. Along the medial wall of the descending colon and the sigmoid a second, less well developed collateral circulation could be demonstrated by iliac arteriography. The branches of the superior mesenteric artery and of the coeliac axis were only partly demonstrated, or failed to fill, during a free aortic injection and a counter current arteriogram. Clinically the occlusion of the unpaired aortic branches manifested itself as periumbilical pain after food. The involvement of the visceral aortic branches to this extent in the presence of generalised vascular disease is related to an attack of dysentry 38 years previously.

[The importance of the intervertebral disk in the differential diagnosis of traumatic, inflammatory and congenital spondylopathies (author's transl)]

A review of the pathology of the intervertebral disk from the differential diagnostic angle could be neither systematic nor at all comprehensive, and had to be necessarily selective. The total relevant knowledge, without being restricted to differential diagnosis, is contained in far more than 5,000 individual publications. I hope that the few facts presented here will convey an idea of the dimensions, and that the selection will be found interesting.

[Evaluation of exposure level in the handling of explosives]

For the clarification of a supposed case of poisening by handling of explosives containing nitric acid ester in a man who was an expert in performing explosions the proof of the exposition was necessary. By the determination of free nitrite in the blood as well as by measuring of blood pressure and pulse in persons exposed in the same way the intake of nitrated constituents of the explosive could be made clear. The advantage of the determination of free nitrite in the blood in contrast to the determination of the met-Hb is discussed. It is referred to an additional potential endangering by gun fumes and the measures for the protection of labour which are to be derived from this.

[A contribution to the radiological findings interpreted by Haubrich as atelectatic rale of the inferior lobe (author's transl)]

Three cases were reported with craniocaudal shadow stripes (in part double but also irregular or arched) on chest films taken in a dorsal position. The cases were elderly patients with signs of cardiac and circulatory insufficiency. It was questioned whether the cause was an atelectatic rale of the inferior lobe as Haubrich assumes. The author's own hypothese were supported overagainst Haubrich's explanation.