The trauma emergency room: a concept for handling and imaging the polytrauma patient.

Polytrauma is a life-threatening entity that requires immediate action by all specialties involved. Upon arrival in the hospital, the patient will be seen and managed primarily by three groups of medical personnel: (a) surgeons (trauma specialists), (b) intensive care specialists, and (c) radiologists. The usual medical approach within the first minutes to hours will consist of four important steps: (1) primary survey, (2) resuscitation and stabilization, (3) secondary survey, and (4) definitive care. Survey, with regard to polytrauma, means quick and comprehensive evaluation of the patient's situation, clinically as well as by imaging. To fulfill these requirements, an interdisciplinary trauma emergency room with appropriate equipment, infrastructure and environment is necessary. Immediately after the patient's arrival and within a short time span, a limited number of plain radiographs of the spine, chest, pelvis, and abdomen (and extremities and skull, if necessary) should be obtained without turning, moving, or repositioning the patient. Sonography will be applied simultaneously to visualize or exclude: free fluid collections within the pleural spaces and/or peritoneal cavity and in other compartments (retroperitoneum, pelvis, soft tissues). Organ lesions (such as lacerations of liver, spleen or kidneys) and posttraumatic pathology of large vessels (tears, occlusion, aneurysm) can be evaluated or detected by sonography. These basic imaging studies (plain films and sonography) together with the clinical findings may be conclusive, or at least serve as decision makers for further action which may include: (a) more detailed plain radiography examinations, (b) tailored computed tomography examinations, invasive/interventional procedures (angiography or image-guided punctures), or (c) immediate surgical intervention. This concept is a challenge for the medical groups involved. Unlimited interdisciplinary cooperation and mutual exchange of information are the fundamental principles for successful trauma care and management.

[Diagnosis of posttraumatic ruptures of the thoracic aorta in the full chest x-ray and in angiography]. / Die Diagnose posttraumatischer Rupturen der thorakalen Aorta im Thoraxübersichtsbild und in der Angiographie.

In the diagnosis of acute and chronic posttraumatic false aneurysms of the thoracic aorta the importance of imaging methods can't be overemphasized, especially, since clinical signs often are of no help. The findings in plain films and angiography in 17 patients with posttraumatic aortic rupture are described and discussed. The importance of angiography is stressed.

Workload of an imaging department in 1978 vs. 1982: changes, reasons, and resolutions.

The diagnostic radiology workload in a university-affiliated general hospital (primarily for inpatients) was recorded and analyzed as to number of examinations and room occupancy time of three different representative months in both 1978 and 1982. Examinations of conventional radiology decreased in number in all fields, markedly in the biliary system and GU tract and minimally in the chest and skeletal system, whereas ultrasound as well as CT rapidly increased in number and/or time. Special procedures (invasive/interventional) also increased in number and time with the exception of lymphography. Future planning of imaging rooms as well as training programs should be instituted based on these data.

[Percutaneous transthoracic needle aspiration biopsy of benign and malignant lung lesions]. / Perkutane transthorakale Nadelaspirationsbiopsie benigner und maligner Lungen-Läsionen.

Presentation of over 10 years' experience of percutaneous needle aspiration biopsy in about 200 patients, with special emphasis given to the technique and to the discussion of indications and contraindications, as well as of common problems.

[Percutaneous removal of an intravascular foreign body using a modified loop-snare technic]. / Perkutane Entfernung von intravaskulären Fremdkörpern durch modifizierte Fangschlingentechnik.

Successful percutaneous removal of embolized intravenous catheters in two patients is described. The long duration of intravascular presence of the foreign bodies necessitated an adaptation of the familiar loop-snare technique. Percutaneous, transluminal retrieval is the method of choice for the removal of intravascular foreign bodies and should be performed in preference to surgical management whenever possible.

CT-findings of carotid-cavernous fistula. A case report.

A case of traumatic CCF is used to emphasize the need for thin slice and bolus CT for early diagnosis.

[Test report on the system components for film processing by the middle-format technology]. / Erfahrungsbericht mit den Systemkomponenten für die Filmverarbeitung bei der Mittelformattechnik.

Industrially developed accessories for use with medium-format equipment, which have been tested in a-clinical settery, were evaluated separately. The automatic mounting system (Delcadro) with the plastic mount (Cadrix) was accepted by all of our colleagues, and was rated as an advantage, with hardly any reservations. A slight modification is needed in the design of the mounts. This equipment would be a desirable addition to our own equipment for routine work. The daylight system (camera magazine and feeder) is, in principle, certainly a step in the right direction. Handling of the magazine proved to be too complicated and it was prone to malfunctions. Simplification, especially of the loading mechanism, would be desirable. The film feeder is designed for use with conventional roll processing machines. In our opinion, a feeder will always be put to full use if the films processed in this machine are mainly or exclusively of middle format; the darkroom is not permanently staffed and/or adaptation to an existing daylight system (large formats) has already been effected and/or depending on availability, both large and medium size-formats can be processed fully automatically as quickly as possible. However, if films of various formats are processed by an assistant in a darkroom, it is possible to deal with the total quantity of films faster than with a feeder by inserting 3 or 4 medium-format films (or 2 or 3 large-format films) simultaneously. The Heliomat film viewer offers impressive reproductions of 100 mm film on a glare-free glass screen.(ABSTRACT TRUNCATED AT 250 WORDS)

[Erroneous diagnoses of space-occupying processes of the kidney]. / Fehldiagnosen bei Raumforderungen an der Niere.

Renal masses are occasionally misdiagnosed because: (1) there are two lesions present; the important lesion (the mass) is small and hidden by the second, less important lesion, which is more prominent on the film; (2) there is misleading or insufficient clinical information: (3) previous results and films are disregarded and/or unavailable. In individual cases, differentiation between malignant and benign masses may be impossible, despite the application of all of the imaging modalities available.

[Herpes zoster-exophthalmus without ophthalmoplegia (author's transl)]. / Zoster-Exophthalmus ohne Ophthalmoplegie.

A case of exophthalmic myositis was identified by a secondary herpes zoster exacerbation. The herpes zoster exophthalmus in this case remained - in contrast to all other cases so far published - free of signs of ophthalmoplegia and retrobulbar neuritis with visual acuity loss.

[Workload in a roentgenologic department 1978 and 1982. Changes--causes--consequences]. / Arbeitsbelastung einer Röntgenabteilung 1978 und 1982. Veränderungen--Ursachen--Konsequenzen.

This is an analysis of the workload in the imaging department (number of exams and room time) from 1978-1982. The different changes are listed and explained. During the 4 years there has been a significant increase in Ultrasound, CT, and special procedures (invasive/interventional), whereas in conventional radiology the workload decreased. The origin of requests for diagnostic work-up was found to be not only due to the total number of hospital beds. It depends mainly on the type of clinical specialty making use of the beds. The consequences of these findings are discussed briefly.