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  • 11
    Electronic Resource
    Electronic Resource
    MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis (2000)
    Springer
    European radiology 10 (2000), S. 1377-1382 
    Details
    ISSN: 1432-1084
    Keywords: Key words: MR imaging – Gastrointestinal tract – Contrast agent – Inflammatory bowel disease – Crohn's disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of the study was to evaluate the additional findings of MRI following small bowel enteroclysis and to compare the efficacy of negative and positive intraluminal contrast agents. Fifty patients with inflammatory or tumorous small bowel disease were investigated by small bowel enteroclysis and consecutive MRI using breathhold protocol (T1-weighted fast low-angle shot, T2-weighted turbo spin echo). Patients were randomly assigned to either receiving a positive oral (Magnevist, Schering, Berlin, Germany) or a negative oral MR contrast media (Abdoscan, Nycomed, Oslo, Norway). The pattern of contrast distribution, the contrast effect, presence of artifacts, as well as bowel wall and extraluminal changes, were determined and compared between the contrast type using Fischer's exact test. Sensitivity, specificity, and diagnostic accuracy for MRI and enteroclysis were calculated. Twenty-seven patients had clinically proven Crohn's disease and two patients surgically proven small bowel tumours. Magnetic resonance imaging had important additional findings as abscesses and fistulae in 20 patients. Surgically compared sensitivities were 100 and 0 % for MRI and enteroclysis, for the detection of abscesses, and 83.3 and 17 % for the diagnosis of fistulae, respectively. Bowel wall thickening was more reliably detected with use of positive oral contrast media without intravenous enhancement (p 〈 0.001), whereas postcontrast negative oral contrast media allow for a superior detection (p 〈 0.001). T2-weighted sequences were necessary with use of negative oral contrast media, because loop abscesses may be masked. Magnetic resonance imaging should be performed in all patients with suspicion of extraintestinal complications, because the complications are more reliably detected by MRI. Negative oral contrast media show advantages with the use of intravenous contrast but can mask loop abscesses using only T1-weighted imaging.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300000354
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  • 12
    Electronic Resource
    Electronic Resource
    Quiz case of the month (1997)
    Springer
    European radiology 7 (1997), S. 589-590 
    Details
    ISSN: 1432-1084
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050212
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  • 13
    Electronic Resource
    Electronic Resource
    Treatment of bile duct stones: value of laser lithotripsy delivered via percutaneous endoscopy (1996)
    Springer
    European radiology 6 (1996), S. 734-740 
    Details
    ISSN: 1432-1084
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Extraction of stones from the bile ducts via standard endoscopic techniques, a percutaneous transhepatic approach, or a T-tube track can be unsuccessful. We report our preliminary experience with a combination of percutaneous cholangioscopy and dye laser lithotripsy. Flash lamp-excited dye laser (504 nm) lithotripsy delivered by percutaneous cholangioscopy (12 F) was evaluated in 13 patients with stones in the bile ducts. Conventional endoscopic treatment had not been attempted in 4 patients after hepaticojejunostomy and had failed in 3 patients after gastric bypass surgery or gastrectomy, and in 6 patients because of technical difficulties, i. e. due mainly to largeness of stones. In 12 patients a percutaneous transhepatic route was used. In 1 patient the T-tube track was used as access to the bile ducts. Laser lithotripsy resulted in successful fragmentation of stones in 12 patients (92%). The bile ducts cleared spontaneously in 2 patients only. Using additional techniques, i. e. sphincterotomy and stent insertion, the overall combined success rate for duct clearance after laser fragmentation was 100%. Four patients had a retrograde endoscopic sphincterotomy after failed attempts for stone removal at endoscopic retrograde cholangioscopy. Two patients had an antegrade fluoroscopically monitored sphincterotomy. Bleeding complications occured in 2 patients. This accounted for a high rate (15%) of severe complications. The intrahepatic bleeding in 1 patient was due to an intrahepatic vessel injury by the 13-F sheath. The periampullary bleeding in the other patient occurred after an antegrade papillotomy. Pulsed dye laser lithotripsy proved to be an effective technique in patients with difficult bile duct stones. The main problem of a percutaneous approach is the complete removal of the fragmented stones, which requires additional procedures in most cases. The percutaneous access is time-consuming and bears a relatively high risk of major bleeding complications. It should therefore be restricted to cases in which conventional endoscopic procedures are impossible or unsuccessful.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187681
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  • 14
    Electronic Resource
    Electronic Resource
    Non-operative management of arterial liver hemorrhages (1999)
    Springer
    European radiology 9 (1999), S. 85-88 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Hepatic artery embolization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. A retrospective evaluation of embolotherapy in patients with arterial liver hemorrhages was carried out. Twenty-six patients, ranging in age from 10 days to 77 years with active arterial liver hemorrhages, underwent non-surgical embolotherapy. Bleeding was attributed to trauma (n = 21), tumor (n = 3), pancreatitis (n = 1), or unknown cause (n = 1). Twenty-nine embolizations were performed via a transfemoral (n = 26) or biliary (n = 2) approach. One bare Wallstent was placed into the common hepatic artery via to an axillary route to cover a false aneurysm due to pancreatitis. Treatment was controlled in 4 patients by cholangioscopy (n = 2) or by intravascular ultrasound (n = 2). Prior surgery had failed in 3 patients. Intervention controlled the hemorrhage in 24 of 26 (92 %) patients within 24 h. Embolotherapy failed in 1 patient with pancreatic carcinoma and occlusion of the portal vein. In 1 patient with an aneurysm of the hepatic artery treated by Wallstent insertion, total occlusion was not achieved in the following days, as demonstrated by CT and angiography. However, colour Doppler flow examination showed no flow in the aneurysm 6 months later. Complications were one liver abscess, treated successfully by percutaneous drainage for 10 days, and one gallbladder necrosis after superselective embolization of the cystic artery. Embolization is a effective tool with a low complication rate in the treatment of liver artery hemorrhage, even in patients in whom surgery has failed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050633
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  • 15
    Electronic Resource
    Electronic Resource
    Abdominal CT in familial Mediterranean fever: a case report (1998)
    Springer
    Abdominal imaging 23 (1998), S. 147-149 
    Details
    ISSN: 1432-0509
    Keywords: Key words: Abdomen—Perotonitis—Imaging—Computed tomography.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. In order to clarify abnormal findings at abdominal ultrasound (suspicion of late abscess subsequent to appendectomy) in a young male patient with known familial Mediterranean fever (FMF), a helical CT examination of the abdomen was performed. At CT, extensive serositis of the lower abdomen was detected. Findings at CT were verified 2 weeks later at laparoscopy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002619900308
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  • 16
    Electronic Resource
    Electronic Resource
    MRT of the abdomen in combination with enteroclysis in Crohn disease with oral and intravenous Gd-DTPA (1998)
    Springer
    Der Radiologe 38 (1998), S. 23-28 
    Details
    ISSN: 1432-2102
    Keywords: Key words Crohns' disease • MRI in Crohns' disease • Enteroclysis • MRI ; Schlüsselwörter M. Crohn • MRT bei M. Crohn • Enteroklyse • MRT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Trotz der Verbesserung der MR-tomographischen Diagnostik wird die MRT weiterhin nur selten in der Routinediagnostik bei entzündlichen Dünndarmerkrankungen eingesetzt. Ziel der Untersuchung war die Korrelation der Befunde von Enteroklyse und MRT bei Patienten mit bekanntem M. Crohn nach Optimierung der Darmkontrastierung. Ferner wurde untersucht, ob die MRT Zusatzinformationen zur Enteroklyse liefern kann. 60 Patienten im Alter von 17–72 Jahren wurden untersucht. Zunächst wurde eine Enteroklyse in konventioneller Technik durchgeführt, wobei der Methylzellulose in einer Mischung von 1:10 positives orales MR-Kontrastmittel (Magnevist enteral) zugesetzt wurde. Nach Abschluß der Enteroklyse erfolgte die MRT unter Verwendung T1- und T2-gewichteter Sequenzen (Flash 2D vor und nach i. v. Gd-DTPA bzw. TSE) in Atemanhaltetechnik in koronarer und axialer Schnittführung. Die in der Enteroklyse nachweisbaren Schleimhautveränderungen und Stenosenlänge entsprachen einer nachweisbaren Darmwandverdickung bzw. Stenose in der MRT. Mit der MRT konnten bei 28 Patienten Zusatzbefunde wie Fisteln, Abszesse oder Hydronephrosen diagnostiziert werden, oder die Stenose war wegen der überlagerungsfreien Darstellung in der MRT besser beurteilbar als mittels Enteroklyse. Mit der MRT kann ein wesentlicher Beitrag in der Diagnostik von entzündlichen Darmerkrankungen geleistet werden. Grundvoraussetzung scheint vor allem ein hohes Füllungsvolumen des Dünndarmes zu sein, um eine homogene Kontrastierung und gute Distension zu erreichen.
    Notes: Summary In spite of the improved MR-diagnosis of the abdomen, MRI is not used as a routine method for the diagnosis of inflammatory small bowel disease. The aim of this study was – after optimazation of the bowel opacification – the correlation of the findings obtained with enteroclysis and MRI in patients with known Crohns' disease. 60 patients beween 17 and 72 years of age were investigated. First, an enteroclysis was performed in typical manner. The applicated methylcellulosis was blended with positive oral MR contrast media (Magnevist oral, Schering). After enteroclysis, MRI of the abdomen was performed using T1- and T2-weighted breathhold sequences (Flash 2D pre- and postcontrast and TSE) in axial and coronal planes. The lenght of the affected bowel and the stenosis seen with enteroclysis correlated well with the visible thickening of the small bowel wall and the stenosis seen in MRI. Using MRI, additional findings could be obtained in 28 patients, such as fistulas, abscesses or a hydronephrosis, or a better assessment of the stenosis was possible with MRI, because of the avoidance of overshadowing of the affected bowel loop with MRI. A brilliant MR-tomographic imaging of the small bowel is possible under the condition, that the small bowel contrast is optimal. The main prerequisite is a large filling volume of the small bowel to reach a homogeneous contrast and a good distension of the small bowel lumen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050319
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  • 17
    Electronic Resource
    Electronic Resource
    Developmental anomalies and congenital disorders of the pancreas (1996)
    Springer
    Der Radiologe 36 (1996), S. 381-388 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Pankreas anulare ; Pankreas divisum ; Pankreasheterotopie ; Genetische Erkrankungen des Pankreas ; Moderne Bildgebung ; Key words Anular pancreas ; Pancreas divisum ; Heterotopic pancreas ; genetic disorders ot the pancreas ; Modern imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Developmental anomalies of the pancreas result from fusion failure between the dorsal and ventral pancreatic ducts (pancreas divisum) or from rotational failure of the ventral bud (pancreas anulare). These variations and anomalies of the ductal anatomy can be asymptomatic throughout life or can cause varying symptoms in different age periods. Pancreas divisum and pancreas anulare can be confirmed exclusively by means of pancreatography. Congenital disorders of the pancreas derive from genetic defects involving different organ systems, which usually dominanate the clinical symptoms. Developmental anomalies and congenital disorders of the pancreas lead to varying morphological alterations of the organ which can be assessed by means of modern imaging.
    Notes: Zusammenfassung Entwicklungsanomalien des Pankreas sind auf die embryonale Entstehung des Organs zurückzuführen und sind durch eine Malfusion (Pankreas divisum) oder eine Malrotation (Pankreas anulare) der beiden Anlagen verursacht. Diese Anomalien können lebenslang symptomlos bleiben oder in unterschiedlichen Altersstufen zu Beschwerden führen. Pankreas divisum und Pankreas anulare können letztlich nur durch eine Gangdarstellung des Pankreasganges gesichert werden. Bei den kongenitalen Erkrankungen liegen genetische Defekte vor, bei denen meist andere Organsysteme mitbetroffen sind und bei denen die extrapankreatischen Schäden meist im Vordergrund der Krankheitsbilder stehen. Sowohl die Entwicklungsanomalien des Pankreas als auch die kongenitalen Erkrankungen führen zu unterschiedlichsten morphologischen Veränderungen des Organs, die mit modernen bildgebenden Verfahren zu erfassen sind.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050086
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  • 18
    Electronic Resource
    Electronic Resource
    Neugeborenes mit zerebraler Symptomatik (1996)
    Springer
    Der Radiologe 36 (1996), S. 591-592 
    Details
    ISSN: 1432-2102
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050115
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  • 19
    Electronic Resource
    Electronic Resource
    Interventionelle Behandlungsmöglichkeiten von Blutungen bei fortgeschrittenen Karzinomen der Cervix uteri (1999)
    Springer
    Der Radiologe 39 (1999), S. 795-798 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Fortgeschrittenes Zervixkarzinom ; Blutung ; Embolisationsbehandlung ; Key words Cervix uteri ; Advanced carcinoma ; Hemorrhage ; Embolization treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: Retrospective evaluation of percutaneous interventional treatment of locally advanced cervical carcinoma. Materials and methods: Since 1991, 13 patients with advanced tumor disease have been referred to our department for diagnosis and therapy of an acute blood loss. In all patients (age 40–88 years, mean 61 years) hemorrhage was detected by decrease in red blood cell count. In all cases patients suffered from locally advanced or recurrent disease after surgery and/or additional radio- or chemotherapy. Embolization was performed by transfemoral access using minicoils in most cases, liquid agents less often and a covered vascular stent in one patient. Results: The site of the hemorrhage or the blood pooling of the tumor could be seen in all cases angiographically. Twenty-seven treatment cycles (2.1 per patient) were performed at intervals of 3 days to 6 months. The maximum time of follow-up and additional treatments if necessary was 1 year. In 9 of 13 patients (69%) the bleeding could be stopped immediately with a single treatment or initial treatment via both iliac arteries. One patient (7,7%) died during therapy because of an uncontrollable bleeding and consecutive decrease in red blood cells count. The remaining three patients (23%) showed slight persistent or recurrent bleeding, which could be managed interventionally until the following episode. There were two complications (15%) during therapy, representing a coil misplacement and a coil wash-out, which both could be managed interventionally. Conclusion: Hemorrhage following locally advanced or recurrent cervical carcinoma can be stopped interventionally in about 70% of cases. Even in partial success it is possible to manage the acute life-threatening situation. Follow-up examinations of up to 1 year justify this therapeutic concept.
    Notes: Zusammenfassung Ziel der vorliegenden Arbeit war die retrospektive Auswertung und Darstellung der Bedeutung interventioneller Methoden in der Behandlung von Patienten mit lokal fortgeschittenem Zervixkarzinom. Seit 1991 wurden uns 13 Patientinnen mit fortgeschrittener Tumorerkrankung und akuten Blutungen zur radiologischen Evaluierung und ggf. Intervention vorgestellt. Bei allen Patienten in einem Alter zwischen 40 und 88 Jahren (Durchschnitt: 61 J.) waren Blutungen mit deutlichem Hb-Abfall bis hin zur vitalen Bedrohung aufgetreten. In allen Fällen handelte es sich um Karzinome der Zervix uteri im fortgeschrittenem Stadium oder um Rezidive nach initialer Operation mit begleitender Radio- bzw. Chemotherapie. Bei allen Patienten konnten die Blutungsareale oder das Pooling des Kontrastmittel im Tumor angiographisch lokalisiert werden. Insgesamt erfolgten 27 Embolisationstherapien (2,1 pro Patient) in Abständen von 3 Tagen bis zu 6 Monaten und maximal über einen zeitlichen Verlauf von über 1 Jahr. In 9 von 13 Fällen konnte durch eine solitäre Behandlung bzw. eine zweizeitige Therapie über beide Iliakalarterien die Blutung akut zum Stillstand gebracht werden (69%). Eine Patientin verstarb noch während der Embolisation infolge des Blutverlustes (7,7%). Die anderen 3 Patientinnen zeigten abgeschwächt persistierende oder frühzeitig rezidivierende Blutungen (23%). Als Embolisate wurden vorwiegend Spiralen, selten flüssige Embolisate und einmal ein ummantelter Stent verwendet. Periinterventionelle Komplikationen traten in zwei Fällen auf. Hier gelang es sowohl eine fehlplazierte Spirale, als auch eine Embolisatverschleppung interventionell zu bergen. In etwa 70% können Tumorblutungen bei Zervixkarzinomen interventionell beherrscht werden. Auch wenn nur ein Teilerfolg zu verzeichnen ist, kann zumindest die lebensbedrohliche Akutsituation meist abgewendet werden. Daß z.T. Verläufe über 1 Jahr ohne Möglichkeit einer weiteren kurativen Behandlung der Tumoren vorliegen, rechtfertigt unserer Meinung nach diesen Therapiansatz.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050578
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  • 20
    Electronic Resource
    Electronic Resource
    Diagnosis and treatment of common bile duct stones (CBDS) (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 856-864 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Common bile duct stones — Gallbladder — Bile duct calculi — Laparoscopic cholecystectomy — Endoscopic retrograde cholangiopancreaticography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Common bile duct stones (CBDS) are a frequent problem (10–15%) in patients with symptomatic cholecystolithiasis. Over the last decade, new diagnostic and surgical techniques have expanded the options for their management. This report of the Consensus Development Conference is intended to summarize the current state of the art, including principal guidelines and an extensive review of the literature. Methods: An international panel of 12 experts met under the auspices of the European Association of Endoscopic Surgery (EAES) to investigate the diagnostic and therapeutic alternatives for gallstone disease. Prior to the conference, all the experts were asked to submit their arguments in the form of published results. All papers received were weighted according to their scientific quality and relevance. The preconsensus document compiled out of this correspondence was altered following a discussion of the external evidence made available by the panel members and presented at the public conference session. The personal experiences of the participants and other aspects of individualized therapy were also considered. Results: Our panel of experts agreed that the presence of common bile duct stones should be investigated in all patients with symptomatic cholecystolithiasis. Based on preoperative noninvasive diagnostics, either endoscopic retrograde cholangiopancreaticography (ERCP) or intraoperative cholangiography should be employed for detecting CBDS. Eight of the 12 panelists recommended treating any diagnosed CBDS. For patients with no other extenuating circumstances, several treatment options exist. Stones can be extracted during ERCP, or either before or (in exceptional cases) after laparoscopic or open surgery. Bile duct clearance should always be combined with cholecystectomy. Evidence for further special aspects of CBDS treatment is equivocal and drawn from nonrandomized trials only. Conclusions: The management of common bile duct stones is currently undergoing some major changes. Many diagnostic and therapeutic strategies need further study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900729
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