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Biomedical subjects

A Gabelmann

Publications and source records attributed to A Gabelmann.

29 records · Page 2Linked to original sources
PubMed1996

[Morphology of the carpal tunnel. Movement studies in patients with constriction symptoms and healthy probands using MR tomography].

The morphological correlation of the phenomenon of increased pressure in the carpal tunnel during wrist flexion and extension--as has been proved though measurements using wick-catheters--was studied in healthy subjects (n = 15) and symptomatic patients with carpal tunnel syndrome (n = 15). Our own measurements using magnetic resonance imaging (MRI) showed that there is a significant reproducible decrease in carpal tunnel diameter when the wrist is held in position of either flexion or extension. During flexion the diameter is decreased at the pisiformes and hamate level as well as it is lowered during extension at the pisiformes level. This might explain the rise in carpal tunnel pressure and thus the consecutive negative influence on the median nerve. Proximal swelling, distal flattening and increased signal intensity of the median nerve as well as the palmar bulging of the flexor retinaculum at the level of the hook of the hamate and at the level of the pisiformes were significantly higher in patients with carpal tunnel syndrome than in normal volunteers (from p < 0.05 to p < 0.001). In post-operative follow-up examinations of 13 patients with no clinic symptoms the distal flattening of the median nerve normalized in 94% within 3 months. The increased signal of the median nerve on T2-weighted images decreased postoperatively in 2/3 of the patients, whereas the motor latency of the median nerve recovered only in 39% of our patients who had 100% partial or complete clinical benefit. These findings imply that postoperative imaging may be helpful for evaluating the success or failure of surgical treatment.

Adult↗
PubMed1995

Noncavernomatous portal vein thrombosis in hepatic cirrhosis: treatment with transjugular intrahepatic portosystemic shunt and local thrombolysis.

PURPOSE: To evaluate the use of the transjugular intrahepatic portosystemic shunt (TIPS) and local, low-dose thrombolysis in the treatment of complete, noncavernomatous portal vein occlusion. MATERIALS AND METHODS: TIPS implantation and portal vein recanalization was attempted in seven patients with noncavernomatous portal vein obstruction and recurrent variceal bleeding. TIPS placement was followed by thrombolytic therapy to restore portal venous blood flow. Hemodynamic effects and clinical characteristics after the procedure and during follow-up were assessed. RESULTS: The implantation of TIPS and the recanalization of the portal vein trunk were successful in all patients. The treatment reduced the portal venous pressure gradient and restored portal blood flow. No bleeding complications were observed. CONCLUSION: TIPS placement and recanalization of the main portal vein is a safe and effective treatment option for patients with liver cirrhosis and noncavernomatous portal vein occlusion.

Combined Modality Therapy↗
PubMed1994

The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding.

BACKGROUND: Transjugular placement of an intrahepatic stent is a new technique to establish a portosystemic shunt for treatment of portal hypertension. A puncture needle is advanced in a catheter through the inferior vena cava into a hepatic vein; then an intrahepatic branch of the portal vein is punctured and an expandable stent of metallic mesh is implanted to establish the shunt. METHODS: We attempted the stent-shunt procedure in 100 of 112 consecutive patients with variceal bleeding due to cirrhosis, who were then followed for a mean (+/- SD) of 12 +/- 6 months. Of the 100 patients, 22 had Child-Pugh class C cirrhosis, 10 were treated on an emergency basis, and 68 had alcoholic cirrhosis. The shunt was established with use of Palmaz stents expanded to 8 to 12 mm in diameter. RESULTS: Technical success was achieved in 93 percent of the patients. The mean (+/- SD) time for the procedure was 1.2 +/- 0.3 hours. The shunt reduced the portal venous pressure gradient by 57 percent. Major complications were hemorrhage (intraabdominal bleeding in six patients, biliary bleeding in four, and bleeding in the liver capsule in three) and migration of the stent into the pulmonary artery (in two patients). At follow-up, stenosis of the shunt was evident in 21 patients and occlusion in 10 patients; 10 of these 31 patients had variceal rebleeding. Stenoses and occlusions of the shunt were all treated successfully by redilation, thrombolysis, or implantation of an additional stent. Hepatic encephalopathy (stages I to III) developed in 25 percent of the patients. The proportion of patients with shunts who remained free of variceal rebleeding was 92 percent at six months and 82 percent at one year. The 30-day mortality was 3 percent. The cumulative one-year survival was 85 percent. CONCLUSIONS: These results suggest that the transjugular placement of an intrahepatic portosystemic stent is an effective and safe treatment for variceal hemorrhage in patients with portal hypertension due to cirrhosis.

Esophageal and Gastric Varices↗
PubMed1994

Current status of the Strecker stent.

Knitted flexible tantalum stents proved to be a valuable adjunct to percutaneous transluminal angiplasty (PTA) in the case of insufficient PTA results, and their use was established in the distal aorta, the iliac, the femoro-popliteal, the renal, and the coronary arteries. Recently, long arterial occlusions were defined as new indications for primary stenting; stent indications were further extended to the subclavian, the carotid, and the splanchnic arteries. Due to higher incidence of acute and late complications after stent treatment of small diameter arteries, patients have to be selected thoroughly. Newly designed drug-releasing stents tested in animal experiments promised to be suitable to diminish the incidence of late restenosis due to intinal hyperplasia, thus providing better long-term patency.

Angioplasty, Balloon↗
PubMed1993

Percutaneous recanalization of iliac artery occlusions: results of a prospective study.

PURPOSE: To evaluate the long-term results of recanalization of occluded iliac arteries with local low-dose thrombolysis, angioplasty, and, if necessary, stent implantation. MATERIALS AND METHODS: Forty-seven patients with acute or chronic occlusions of the common or external iliac artery, or both, underwent local low-dose thrombolysis (n = 47), percutaneous transluminal angioplasty (PTA) (with balloon dilation [n = 43] and rotational angioplasty [n = 30] in the patients in whom a retrograde recanalization was performed), and, if needed, intravascular stent placement (n = 18). Follow-up lasted 3-53 (mean, 21) months. RESULTS: The primary recanalization rate was 98% (46 of 47). The mean ankle-brachial index increased from 0.33 to 0.81 within 14 days after treatment and was 0.76 at the most recent follow-up. Two early (< 14 days) and two late reocclusions (after 24 and 30 months) occurred; one restenosis detected with duplex sonography and angiography was observed after 19 months. CONCLUSION: This therapy represents a true alternative to vascular surgery and a first-line treatment for acute or chronically occluded iliac arteries.

Adult↗
PubMed1993

Effect of local low-dose thrombolysis on clinical outcome in acute embolic renal artery occlusion.

PURPOSE: To determine the utility of local thrombolysis in treatment of acute embolic renal artery occlusion. MATERIALS AND METHODS: Fourteen patients with acute embolic renal artery occlusion treated with local low-dose thrombolysis were studied. Diagnosis was made with renal scintigraphy and selective renal arteriography. RESULTS: Thrombolysis was successful in 13 of 14 patients. During 1-72 months of follow-up (mean, 27.1 months), renal function did not improve on the side of complete renal artery occlusion, whereas stabilization of renal function at the pretherapy level was seen in patients with incomplete obstruction of the renal artery or complete obstruction at the level of segmental branches. In none of the patients did renal function return to normal. CONCLUSION: In acute embolic renal artery occlusion, thrombolytic therapy does not restore renal function and is therefore not indicated once the ischemic tolerance of the kidney (approximately 90 minutes) has been exceeded.

Acute Kidney Injury↗
PubMed1991

[Thrombolytic therapy of pulmonary artery embolism in early pregnancy with recombinant tissue-type plasminogen activator].

We report on successful thrombolytic treatment of massive pulmonary embolism in a patient in early pregnancy with recombinant tissue-type plasminogen activator (rt-PA). Therapy was started with 20 mg rt-PA intravenously over 20 minutes, followed by two further infusions of 20 mg rt-PA within the next 8 hours. Clinical symptoms and haemodynamic parameters improved 24 hours after initiation of therapy. No bleeding complications were observed and the foetus was not affected. Further thromboembolic episodes could be prevented by anticoagulation with low molecular weight heparin up to full term normal delivery.

Adult↗
PubMedDate not supplied

MRI of the abdomen with positive oral contrast agents for the diagnosis of inflammatory small bowel disease.

Magnetic resonance imaging (MRI) is being used more often in the evaluation of inflammatory bowel diseases. A prerequisite for adequate image quality is the oral application of contrast medium, which can be administered with different modalities. Positive and negative oral contrast media can be used; in terms of diagnostic efficacy, there appears to be no relevant differences between them. Sequences usually are acquired using breath-hold or respiration-triggered protocols. The underlying principle is visualization of circumscribed thickening of the intestinal wall, which shows a pathologic pattern of contrast medium uptake. The available data suggest that MRI is equally as effective as enteroclysis in the primary diagnosis of Crohn's disease and actually more sensitive in the detection of extraintestinal manifestations such as fistulae or abscesses. Supporters of the method predict that MRI will replace enteroclysis in the long term.

Abdomen↗
PubMedDate not supplied

Comparison of contrast-enhanced power Doppler ultrasound (Levovist) and computed tomography in alveolar echinococcosis.

BACKGROUND: To date, no study has compared unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound with three-phase helical computed tomography (CT) for the analysis of the vascularization of hepatic lesions in patients who have alveolar echinococcosis. METHODS: Fifteen patients (11 female and four male; average age, 45.8 years) with confirmed Echinococcus multilocularis infection underwent unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound (2- to 5-MHz transducer head) and three-phase helical CT. The largest identified lesion in each patient was studied. RESULTS: CT visualized vascularization peripheral or central to the largest echinococcal lesions in 11 of 15 patients. Vascularization in the area of the echinococcal lesions was not visualized by unenhanced or contrast-enhanced power Doppler ultrasound in any of the 15 patients studied. CONCLUSION: Three-phase helical CT visualizes the vascularization associated with Echinococcus multilocularis lesions in the liver. Neither unenhanced nor contrast-enhanced ultrasound in power mode is suitable for this application.

Adult↗
PubMedDate not supplied

Effect on intimal hyperplasia of dexamethasone released from coated metal stents compared with non-coated stents in canine femoral arteries.

PURPOSE: Polymer-coated, dexamethasone (DXM)-releasing stents were tested in order to assess the efficacy of DXM released locally for the prevention of stent restenosis due to intimal hyperplasia. METHODS: Strecker stents coated with a biodegradable membrane containing DXM were implanted percutaneously into the femoral artery in 14 dogs. The contralateral artery received a conventional non-coated stent serving as control. The drugs are eluted by degradation of the carrier membrane. Follow-up intraarterial digital subtraction angiography (DSA) was obtained at 3, 6, 9, 12, and 24 weeks with subsequent autopsy. Specimens for gross and microscopic pathology were obtained and histomorphometry was performed. RESULTS: Four of 14 DXM-coated stents showed thrombotic occlusion within the first 3 weeks; ten DXM-coated stents remained patent. At follow-up DSA, DXM-coated stents showed a significantly wider lumen than the non-coated stents. At morphometry there was less intimal hyperplasia over DXM-coated stents than over non-coated stents (p < 0.05). CONCLUSION: DXM-coated stents reduce neointimal hyperplasia in dogs when compared with non-coated stents.

Angiography↗