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  • 1
    Electronic Resource
    Electronic Resource
    Value of Somatostatin Receptor Scintigraphy for Preoperative Localization of Carcinoids (1996)
    Springer
    World journal of surgery 20 (1996), S. 162-167 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Most carcinoid primary tumors are small and do not cause symptoms until complications (e.g. intestinal obstruction) or symptoms and signs of the carcinoid syndrome occur. Therefore in most cases an assessment of the primary tumor and its metastases must be performed. To determine the value of somatostatin receptor scintigraphy (SRS) for localizing carcinoid tumors, we compared the results of SRS with those obtained with computed tomography (CT) and ultrasonography (US) in 22 patients who had not undergone surgery for removal of the primary tumor. We could not find an advantage of SRS over CT and US for detecting the primary lesions. Tumors 〉 2 cm in diameter were regularly detected using all methods. SRS was not superior to CT or US for the detection of liver metastases. SRS showed the liver metastases in 16 of 18 patients, whereas CT and US detected liver metastases in all patients. For localization of extrahepatic abdominal and extraabdominal metastases (lymph nodes, bone), whole-body SRS showed an advantage over CT and US. We conclude that SRS is not superior to CT or US for localization of primary carcinoid tumors or liver metastases, although it did prove successful for visualizing extrahepatic and extraabdominal tumor spread. Additionally, SRS is useful for identifying receptor-positive metastases that may be treated by somatostatin analogs. Thus SRS should be performed in patients with a known carcinoid tumor, except those with an appendiceal carcinoid measuring 〈 1 cm in diameter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900025
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  • 2
    Electronic Resource
    Electronic Resource
    Surgical Management for Carcinoid Tumors of Small Bowel, Appendix, Colon, and Rectum (1996)
    Springer
    World journal of surgery 20 (1996), S. 183-188 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Carcinoid tumors occur most frequently in the gastrointestinal tract. Despite their ability to produce hormones, most of the midgut and hindgut carcinoids covered in this study are clinically silent, and the diagnosis is often not made before emergency surgery or evaluation for liver metastases. Because the rate of lymph node involvement and the prognosis of carcinoid tumors depend on their site and size, surgery refers to these two factors too. Lymph node metastases are most commonly found with small bowel carcinoids (20–45%), providing the rationale for an extended resection including the adjacent lymph node drainage area. Carcinoid tumors of the appendix 〈 1 cm in diameter rarely metastasize, simply requiring appendectomy for treatment. Lesions 〉 2 cm should be treated by right hemicolectomy because of their approximately 30% risk of lymph node metastases. Resection should always be done for carcinoid tumors of the colon resection as for adenocarcinomas. Rectal carcinoids 〈 2 cm rarely metastasize, directing the conclusion that for these smaller lesions local excision is sufficient; for lesions 〉2 cm a standard cancer resection should be performed provided distant metastases are absent. In general, the younger the patient or the larger the primary tumor, the more aggressive the treatment should be.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900028
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  • 3
    Electronic Resource
    Electronic Resource
    Localization, Malignant Potential, and Surgical Management of Gastrinomas (1998)
    Springer
    World journal of surgery 22 (1998), S. 651-658 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Between 1987 and 1996 a total of 25 patients with proved Zollinger-Ellison syndrome (ZES) have been treated in our department. If preoperative imaging studies did not show diffuse metastatic disease, patients were scheduled for operation with a standardized surgical approach including thorough exploration and intraoperative ultrasonography (IOUS) of the pancreas and a longitudinal duodenotomy, with separate palpation of the anterior and posterior walls. Postoperatively, patients were followed up by physical examination, fasting gastrin levels, and the secretin stimulation test. Altogether 10 patients had duodenal wall gastrinoma, 14 patients pancreatic gastrinoma, and the tumor was not found in 1 patient. Only 15 tumors (60%) (2 duodenal wall and 13 pancreatic gastrinomas) could be visualized preoperatively. Intraoperatively, 24 of 25 primary gastrinomas were localized. The mean size of duodenal wall gastrinomas (9.6 mm) was significantly smaller than that of pancreatic gastrinomas (28.7 mm) ( p 〈 0.05). At the time of surgical exploration, five duodenal and seven pancreatic gastrinomas had metastasized. The incidence of lymph node metastases was similar for both tumor sites, whereas patients with pancreatic gastrinomas more frequently had liver metastases. The presence of liver metastases was the most important determinant for survival. Four patients (40%) with duodenal and seven with pancreatic (50%) gastrinomas (mean follow-up 5.2 years) were biochemically cured by operation. Of the remaining patients, eight are still alive with recurrent disease. Our results suggest that preoperative localization of gastrinomas often fails despite all modern imaging methods. Therefore a standardized surgical exploration of the pancreas including IOUS and a duodenal exploration should be performed to achieve optimal results. Preoperative diagnostic imaging tests should include computed tomography, ultrasonography, and somatostatin receptor scintigraphy to exclude diffuse metastases. In contrast to liver metastases, lymph node metastases do not have a significant influence on survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900448
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  • 4
    Electronic Resource
    Electronic Resource
    Reactive thymic hyperplasia following treatment of ACTH-producing tumors (1997)
    Springer
    Der Radiologe 37 (1997), S. 913-917 
    Details
    ISSN: 1432-2102
    Keywords: Key words Thymic hyperplasia • Hypercortisolism • Computed tomography ; Schlüsselwörter Thymushyperplasie • Hyperkortisolismus • Computertomographie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Durch operative oder medikamentöse Therapie von ACTH-produzierenden Tumoren wird der exzessiv erhöhte Kortisolspiegel abrupt korrigiert. Die damit verbundenen pathopysiologischen Veränderungen entsprechen der Erholungsphase des Organismus nach extremer Streßbelastung durch Trauma, Operation oder Chemotherapie von Tumoren. In beiden Fällen kommt es zu einer – möglicherweise sogar überschießenden – Regeneration des Immunsystems. In der bildgebenden Diagnostik ist dies als „Rebound“thymushyperplasie zu beobachten. Diese ca. 6 Monate posttherapeutisch auftretende anteriore mediastinale Raumforderung kann besonders in Fällen von noch unbekanntem Primärtumor zu Fehldiagnosen Anlaß geben. Anhand der beiden folgenden Kasuistiken wird versucht, den pathophysiologischen und zeitlichen Zusammenhang zwischen dem Kortisolabfall und der reaktiven Thymusvergrößerung dem Diagnostiker und dem Therapeuten ins Bewußtsein zu rufen.
    Notes: Summary Surgical or conservative treatment of ACTH-producing tumors results in acute drop of the previously excessively high cortisol levels. The following associated pathophysiological changes also occur in the organism's recovery from stress, such as trauma, operation or chemotherapy of tumors. Both cases result in a regeneration of the immune system, which might even be exalted. The corresponding radiographic feature is the ”rebound” enlargement of the thymus occuring about six months after remission of hypercortisolism. Histological examination reveals benign thymus hyperplasia. Especially in cases of still unkown primary tumor the appereance of this anterior mediastinal mass can lead to misdiagnosis. We present the cases of two patients with diffuse thymic hyperplasia following surgical and medical correction of hypercortisolism. One patient suffered from classic Cushing's disease responding to transsphenoidal resection of an ACTH-secreting pituitary microadenoma. Six months later CT of the chest incidentally demonstrated an anterior mediastinal mass known as thymic hyperplasia. The second patient presented with an ectopic, still unkown source of ACTH-production. Six months after medical correction of hypercortisolism CT of the thorax showed an enlargement of the anterior mediastinum. Thymectomy was performed in order to exclude thymus carcinoid. Histological examination revealed benign thymus hyperplasia with negative immunostaining. Conclusion: Radiologists and clinicians should be familiar with the pathophysiological changes resulting from precipitously dropping cortisol levels in order to prevent diagnostic errors and unnecessary operations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050302
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  • 5
    Electronic Resource
    Electronic Resource
    The anatomical basis of anal endosonography (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 986-990 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Anal endosonography — Longitudinal muscle — External anal sphincter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: Anal endosonography is an imaging modality new to the diagnostic workup of incontinence. Interpretations even of normal endosonomorphologic findings now vary considerably. The conjoined longitudinal muscle (LM), a widely ignored structure, has until recently not been fully recognized by anal endosonography. The aim of this study, therefore, was to accurately determine the normal anatomy of the anal canal and correlate it with the findings obtained by anal endosonography. Methods: Eight postmortem specimens of the anal canal were examined by endosonography. The findings were correlated with macroscopical dissection and gross sectional histology of the same specimens. Results: The external echogenic ring is composed of two anatomical structures: the LM and the external anal sphincter (EAS). However, during anal endosonography the LM cannot always be differentiated from the EAS. Histologically, the relation of the diameters of the LM and the EAS ranged from 0.45:1 to 1.25:1. The narrow hyperechogenic ring between the inner hypoechoic layer and the external hyperechoic ring is an artificial finding that cannot be related to a distinct anatomical structure and most likely represents a sonographic interface. Conclusions: This study exactly outlines the relation of diameters of the conjoined longitudinal muscle and external anal sphincter for the first time. Until now, the LM has been underestimated in its dimensions. The role of such a thick muscular structure should be included in the conception of anal continence in the future. Especially in view of the fact that anal endosonography is increasingly used in the diagnostic workup of incontinence and fistula in ano, it is essential to understand the anatomical basis of endosonography. This study accurately delineates the sonomorphology of the anal muscles. When viewed in light findings reported here, endosonographic findings in diseases of the anal canal are now based on a correct idea of the correlation between endosonomorphology and anal anatomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900508
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  • 6
    Electronic Resource
    Electronic Resource
    ``Surgical'' ultrasound in suspected acute appendicitis (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 362 -365 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Ultrasound — Acute appendicitis — Prospective trial — Medical decision making
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Ultrasonography (US) by acknowledged experts enhances the diagnostic performance and reduces the rate of negative laparotomies in patients with suspected acute appendicitis (AA). Methods: The diagnostic accuracy and clinical impact of routine US performed by surgical residents was prospectively studied in 504 unselected patients admitted for AA. Clinical and US findings were correlated with laparotomy findings and pathological outcome in 135 patients (113 cases with proven AA, prevalence 22.4%) and clinical as well as follow-up data were compared in the remainder. Results: The overall accuracy, sensitivity, and specificity of the clinical diagnosis of AA were 84.9%, 51.3%, and 94.6% and those of US were 93.6%, 83.1%, and 96.6%. Joint evaluation of the results from clinical evaluation and US further improved diagnostic performance (accuracy 93.4%, sensitivity 84.1%, specificity 96.2) and significantly reduced the rate of diagnostic errors to 3.4% (p 〈 0.001) and unnecessary laparotomies to 9.6% (p 〈 0.01) in patients with suspected AA. Conclusions: Ultrasonographic evaluation of the patient with suspected AA is considered to be of value in surgical practice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900364
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