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  • 1
    ISSN: 1433-0423
    Keywords: Key words Dacryocystorhinostomy • Polyurethane stent • Stenosis of the nasolacrimal duct ; Schlüsselwörter Dakryozystorhinostomie • Polyurethan-Stent • Tränenwegsstenose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Hintergrund: Die Dakryozystorhinostomie stellt noch immer das Standardverfahren bei absoluter Tränenwegsstenose dar. In letzter Zeit wurden Methoden entwickelt, die es ermöglichen, unter Beibehaltung der natürlichen Abflußwege eine Durchgängigkeit zu erzielen. Die auf der Seldingertechnik beruhende Methode der retrograden Implantation eines durchgängigen Polyurethan-Röhrchens in den Ductus nasolacrimalis ist eine vielversprechende Alternative. Patienten und Methoden: Es wurden 30 Patienten mit einer radiologisch gesicherten Tränenwegsstenose therapiert, darunter 15 Patienten mit absoluter und 2 mit relativer postsakkaler Tränenwegsstenose. Das Alter betrug 22–87 Jahre (Mittelwert 58,9 ± 16 Jahre). Der Polyurethan-Stent wurde unter Durchleuchtungskontrolle implantiert. Seine Durchgängigkeit wurde direkt postoperativ, nach 4 Wochen und nach 8 Monaten mittels Dakryozystographie kontrolliert. Ergebnisse: Insgesamt wurden 25 kurze (35 mm) und 5 lange (45 mm) Stents implantiert. Letztere reichten bis in den Canaliculus superior. Bei 24 von 30 Patienten konnte auch nach 4 Wochen und bei 9 von 10 Patienten nach 8 Monaten Durchgängigkeit des Stents klinisch nachgewiesen werden. Bei einer Patientin mußte der Stent unter Durchleuchtungskontrolle wieder rekanalisiert werden. Bei einem weiteren Patienten kam es zu einer Verlagerung eines kurzen Stents in den oberen Kanalikulus, so daß er nach 2 Monaten gezogen werden mußte. Postoperative Dakryozystitiden traten bei keinem der Patienten auf. Schlußfolgerung: Erfolgs- und Komplikationsraten lassen den Polyurethan-Stent als eine echte Alternative zur Toti-Operation erscheinen, wenngleich die Nachkontrollzeiten noch zu kurz für eine abschließende Beurteilung sind. Die Vorteile liegen im geringeren Zeitaufwand, der fehlenden Hautinzision und der problemloseren Anästhesie, die Nachteile in der bisherigen Notwendigkeit einer Durchleuchtungseinheit.
    Notes: Summary Dacryocystorhinostomy is still the standard procedure complete stenosis of the nasolacrimal duct. New methods try to preserve the natural lacrimal pathway. Song implanted in 1995 a nasolacrimal polyurethane stent through the nasolacrimal duct. The results and complications of this new method are described in this prospective study. Methods: Thirty consecutive patients with complete obstruction of the nasolacrimal duct or lacrimal sac were included in the study. The stenosis was localized by dacryocystography. The ages ranged from 22 to 87 years (mean, 58.9 ± 16 years). Dacryocystography was performed immediately, 4 weeks and 8 months after the procedure to verify the position and patency of the stent. Results: Twenty-five short (35 mm) and 5 long (45 mm) stents were implanted. Twenty-four of 30 patients after 4 weeks and 9 of 10 patients after 8 months had reduced or no complaints. In 1 patient the stent was obstructed. Forceful irrigation with saline solution permitted recanalization. In 1 patient the stent had moved into the upper canaliculus. Because of irritation of the canaliculus it had to be pulled out after 2 months. Conclusion: The follow-up is still too short to recommend stent implantation as a real alternative to dacryocystorhinostomy. The main advantages are that the procedure is faster, no incision is necessary, and the local anesthesia is easier. The disadvantage is the need for X-ray examination.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-2277
    Keywords: Key words Doppler sonography ; Acute rejection ; Chronic rejection ; Tacrolimus ; Kidney transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of the present study was to differentiate acute rejection, chronic rejection, and tacrolimus nephrotoxicity with color and power Doppler imaging of renal transplants. One hundred examinations were obtained from 45 patients. Pulsatility and resistive indices were calculated from color Doppler images. The grade of renal vascularization was quantified using computer-assisted pixel analysis in a rectangular region-of-interest. The percentage of vessel-covered renal parenchyma (POV) was calculated using a histogram that discriminated renal vessels from renal parenchyma via power Doppler images. Furthermore, the distance from the most peripherally located vessels to the renal capsule (PVD) was measured. A reduced POV K 55 % proved to be the best discriminator when chronic rejection was suspected (sensitivity 79 %, specificity 87 %). Tacrolimus nephrotoxicity showed not only a moderate elevation of the Doppler signal but also an increased PVD L 3.9 mm and a normal POV. We conclude that the evaluation of renal vessels by power Doppler images improves diagnostic accuracy for patients with renal allografts.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-2161
    Keywords: Key words Femoral torsion ; Torsional difference ; Ultrasound ; Femoral fractures ; Anterior condylar line
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. A torsional difference of more than 15° is found in up to 30% of patients following closed intramedullary nailing of femoral fractures. The diagnosis is usually established postoperatively by computed tomography. A torsional deformity of more than 15° should be corrected by early derotation. In order to enable an intraoperative control and possible correction to avoid a second operation for the patient, a new ultrasound-based method suitable for the intraoperative setting has been developed, using the anterior condylar line as a distal reference line. Design and patients. In a prospective study the torsional difference after closed intramedullary nailing of femoral fractures was measured postoperatively by ultrasound in 32 patients and compared with standard CT readings. Results. Torsional differences measured by ultrasound and CT showed a high correlation (r=0.8) and a median difference of less than ±3°. Conclusions. By the introduction of the anterior condylar line as a distal reference line femoral torsion can accurately be assessed by ultrasound in a position required for intraoperative control and possible correction.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1615-3146
    Keywords: Kerspintomographie ; Kollateralbandruptur ; Knorpelläsion ; Hochauflösende Oberflächenspule ; Magnetic resonance imaging ; Collateral ligament rupture ; Cartilage lesion ; High-resolution coil
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Aim of this study was the evaluation of a prototype of a new high-resolution MRI coil for the detection of finger trauma. The practicability of this new coil for the assessment of traumatic lesions of the finger joints and the diagnostic value of this new method in clinical practice was assessed. Twenty patients between 13 and 50 years of age (mean 28 years) were examined with a 1.5-T whole-body-imager Magnetom SP 63 scanner (Siemens, Erlangen, Germany). A prototype of a high-resolution MRI coil with a diameter of 2.5 cm was used. T1- and T2-weighted images with an in plane resolution of 0.I95 x 0.098 mm were acquired. Bone structures, joint cartilage and capsule, ligaments, tendons and soft tissue alterations were assessed. All 19 patients with pathological changes at the finger joints had a joint effusion. With MR imaging, fractures were detected in almost all patients, compared with the X-ray examinations. Cartilage contusion showed high signal intensity. The collateral ligaments could best be assessed in the transversal, and ligament ruptures in the coronal plane. Hemorrhage in the tendon showed an increased signal intensity in T1- and T2-weighted, edema only in T2-weighted images. Especially traumatic lesions of cartilage and of ligaments can be sufficiently assessed by the high-resolution MRI due to its high anatomic resolution compared to common methods like X-ray. High-resolution MRI is practicable in clinical routine.
    Notes: Zusammenfassung Ziel der vorliegenden prospektiven Untersuchung war es, die Wertigkeit der hochauflösenden Kernspintomographie mittels einer speziellen Oberflächenspule in der Beurteilung von traumatischen Veränderungen der Fingergelenke zu evaluieren. Ferner sollte die Praktikabilität der Methode in der klinischen Routine überprüft werden. Es wurden 20 Patienten im Alter zwischen 13 und 50 Jahren (im Mittel 28 Jahre) an einem 1,5-T-Ganzkörpertomographen (Magnetom SP 63, Firma Siemens, Erlangen) untersucht. Als Spule wurde ein Prototyp einer hochauflösenden Oberflächenspule mit einem Durchmesser von 2,5 cm benutzt. T1- und T2-gewichtete Sequenzen mit einer maximalen Auflbsung in der Bildebene von 0,195 x 0,098 mm wurden zur Beurteilung von Knochen, Gelenkknorpel und -kapsel, der Sehnen und des Weichteilgewebes akquiriert. Kernspintomographisch fand sich bei 19 Patienten ein pathologischer Befund. Bei all diesen Patienten konnte ein Gelenkerguß nachgewiesen werden. Knöcherne Absprengungen, die anhand konventioneller Röntgenaufnahmen diagnostiziert wurden, zeigten sich kernspintomographisch als dislozierte signalreiche Strukturen. Gelenkknorpelkontusionen stellten sich hyperintens dar. Zur Beurteilung der Kollateralbānder eignete sich vor allem die koronare Schichtebene, da in dieser die Kollateralbdnder per continuitatem darstellbar sind. Sehneneinblutungen wiesen eine Signalerhöhung in T1- und T2-Wichtung auf. Ödeme der Weichteile und Bandstrukturen imponierten in T2-gewichteten Aufnahmen als signalreiche Strukturveränderungen. Aufgrund der hohen anatomischen Detailerkennbarkeit eignet sich die hochauflbsende Kernspintomographie als ergänzendes diagnostisches Verfahren zur nichtinvasiven Diagnostik von traumatischen Knorpel- und Bandläsionen. Unter Berücksichtigung des Zeitaufwandes handelt es sich dabei um eine im klinischen Alltag praktikable Methode.
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  • 6
    Publication Date: 2021-03-16
    Language: English
    Type: other , doc-type:Other
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  • 7
    Publication Date: 2021-03-16
    Language: English
    Type: conferenceobject , doc-type:conferenceObject
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  • 8
    Publication Date: 2021-03-16
    Language: English
    Type: other , doc-type:Other
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  • 9
    Publication Date: 2021-03-16
    Language: English
    Type: article , doc-type:article
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  • 10
    Publication Date: 2022-07-19
    Language: English
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