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Biomedical subjects

A Goldmann

Publications and source records attributed to A Goldmann.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Abdominal sonography in primary diagnosis of blunt abdominal trauma].

200 patients with blunt abdominal trauma were scanned by ultrasound primarily. 152 showed a normal sonographic examination. In 24 patients an organic injury was visualised. These 20 splenic injuries, 2 lesions of the kidney, 1 splenic and renal lesion and 1 hepatic and splenic rupture were confirmed by CT in 9 cases, by laparotomy in 9 cases, by sonographic follow-up in 2 cases. 23 patients showed an intraabdominal fluid collection, in 16 patients a decrease was seen by ultrasound. 7 patients were directly operated on because of a visible increase of intraabdominal fluid. The lesions consisted of 3 hepatic ruptures, 2 retroperitoneal bleedings. Ultrasound is a reliable tool in the diagnosis of blunt abdominal trauma on the day of admittance and in the evaluation of injuries in respect of operative or conservative management.

Abdominal Injuries↗
PubMed1992

[Magnetic resonance tomography of the liver with TurboFLASH and segmented acquisition. Fast imaging with flexible image contrast].

The value of a fast imaging sequence in diagnosing focal liver lesions was assessed in 43 patients. The sequence (TurboFLASH with segmented acquisition) allows the acquisition of T1- and T2-weighted images within a breath-hold interval. Lesion-liver contrast was compared with T2-weighted spin-echo, T1-weighted gradient-echo, and single shot TurboFLASH sequences. All lesions that were seen with the latter sequences were also visible on the segmented TurboFLASH images. Contrast on the segmented TurboFLASH images was similar to that of T2-weighted spin-echo sequences and superior to T1-weighted gradient-echo sequences. Signal of fat could be nulled at an inversion time of 10 ms, signal from liver tissue could be nulled at an inversion time of 300 ms. By minimising the liver signal, the lesions could be "highlighted". This was not possible with the other imaging sequences. The segmented TurboFLASH technique allows breath-hold imaging of the liver with arbitrary image contrast. The lesion-liver contrast is comparable to time-consuming T2-weighted spin-echo sequences.

Biopsy, Needle↗
PubMed1992

[Magnetic resonance tomographic imaging of pulsatile CSF movement in communicating hydrocephalus before and after shunt placement].

16 patients with hydrocephalus communicans and 5 healthy volunteers were examined to demonstrate the pattern of the pulsatile CSF flow. After implantation of a CSF shunt system the same patients were examined again to show the influence of the shunt on the CSF pulsations. We used a flow-sensitised, cardiac-gated 2D FLASH sequence and analysed the phase and magnitude images. It could be shown that most patients (n = 12) had a hyperdynamic pulsatile flow preoperatively. After shunt implantation the pulsatile CSF motion and the clinical symptoms were improved in 8 of these patients. MRI of pulsatile CSF flow movement seems to be a helpful noninvasive tool to estimate the prognosis of a shunt implantation in patients with hydrocephalus communicans.

Adult↗
PubMed1992

[Stent-supported percutaneous therapy of iliac vein stenosis following operative thrombectomy and placement of a shunt].

Among 15 patients with acute thrombotic disease of pelvic veins who had been submitted to operative thrombectomy and creation of arteriovenous fistula in the groin, 12 presented with stenotic lesions 3 months later. These stenoses were submitted to percutaneous angioplasty. If angioplasty failed, percutaneous placement of a vascular stent (wall stent) was performed immediately (n = 7). Stenting in cross-over-technique proved practicable in all cases. Secondary stenotic disease in the exclusively dilated area was observed in 3/5 cases and was also treated with a wall stent. In one patient with recurrent stenoses who refused stenting, extended thrombosis occurred after occlusion of the AV-fistula. At mid-term PTA was successful in only two cases. Intimal hyperplasia was observed in only one wall stent treated patient. Percutaneous treatment of iliacal stenoses in patients with postthrombotic syndrome may be performed safely under the protective effect of the fistula. With the presented technique, patency of pelvic veins could be restored in 11/12 patients with postoperative significant venous stenoses.

Adult↗
PubMed1992

Improved time-of-flight MR angiography of the brain with magnetization transfer contrast.

The authors hypothesized that magnetization transfer contrast (MTC) could be used to improve flow contrast in time-of-flight (TOF) magnetic resonance (MR) angiography. Two- and three-dimensional flow-compensated gradient-echo images were obtained with and without MTC. MTC images were obtained by applying low-power radio-frequency (RF) radiation with a frequency offset from the bulk "free" water resonance frequency before the excitation RF pulse. The signal intensity of stationary tissue decreased as the power applied for the MTC pulse was increased. A smaller decrease occurred in venous signal intensity as measured in the superior sagittal sinus, and less change was seen in the arterial signal intensity as measured in the middle cerebral artery. Cerebrospinal fluid showed no MTC effect. The use of MTC improved small-vessel depiction on maximum-intensity projection images. The authors conclude that use of MTC can substantially enhance the quality of TOF MR angiography of the brain.

Adult↗
PubMed1992

MR angiography of the liver.

Recently, several versatile techniques have been developed for performing magnetic resonance (MR) angiography in the body. Relative to MR angiography in the head and neck, these methods require more interactive involvement by a physician to derive their full benefit, but they show great promise in the clinical workup of several vascular problems relating to the liver. This article outlines practical clinical applications for MR angiography of the liver, based on the experience of the authors and others working in the field.

Blood Vessels↗
PubMed1992

[Potentialities and limitations of MR angiography in the imaging of intracranial aneurysms].

The potential value of MR angiography in imaging of intracranial aneurysms was analyzed in seven patients. Six cases were confirmed by angiography or computed tomography. In one patient MR angiography was not useful in distinguishing bleeding from an aneurysm. Five aneurysms were imaged by 3D angiography, one was diagnosed by 2D angiography. The extent of thrombosis was evaluated by selective presaturation. MR angiography was a useful non-invasive method in imaging of intracranial aneurysms. However, for complete work-up angiography is mandatory.

Humans↗
PubMed1992

[Prevention of periarticular ossification following endoprosthetic hip replacement using postoperative irradiation].

The development of heterotopic ossification (HO) after total hip replacement or other surgical hip procedures can considerably impair the functional result and quality of life in up to 73% of all patients. Predisposing high risk factors for heterotopic ossification are severe pre-intra- and/or postoperative hip trauma, previous development of ipsi- and/or contralateral heterotopic ossification, hypertrophic osteoarthritis, active rheumatoid spondylarthritis as well as male sex. Over the past two decades a variety of surgical, pharmaceutical and radiotherapeutic prophylactic measurements have been proposed and tested in clinical trials. Since June 1988, we have treated 77 patients or 80 hips respectively with prophylactic irradiation. Individual risk factors included severe coxarthrosis grade IV, ipsi- or contralateral heterotopic ossification and severe hip trauma. As of July 1991 60 patients with a minimum follow-up of six months could be analyzed using clinical and radiological scoring systems. The patients had been prospectively randomized in two different treatment arms: 32 patients were treated with low dose (LD), five times 2 Gy daily fractions to a total dose of 10 Gy, whereas 28 patients were treated with high dose (HD), ten times 2 Gy (eight patients) or five times 3.5 Gy (20 patients). Operative procedures and individual risk factors were equally distributed in both groups. 23 patients (38% received indometacin three times 25 mg for six weeks, 19 patients (32%) diphosphonate EHDP 20 mg/kg body weight and 18 patients (30%) had no additional medication. 56/60 (93%) patients developed no significant heterotopic ossification and/or remained without impairment of their postoperative radiological and clinical hip status according to the applied Brooker and Harris Scores. Only 4/60 (7%) patients demonstrated treatment failures developing postoperative worsening one grade of Brooker score in two patients and two and three grades of Brooker score in the two others. Only 1/49 patients experienced a treatment failure, when radiotherapy had been initiated before and at postoperative day 4 compared to 3/11 patients initiated after postoperative day 4 (p less than 0.001). 3/32 patients (9.4%) in the LD group and 1/28 (3.6%) in the HD group were scored as treatment failures (nonsignificant). Radiotherapy treatment duration and additional medication had no impact on the outcome. In conclusion postoperative radiotherapy has shown high efficacy in prevention of heterotopic ossification as long as the treatment is initiated within the first four days after surgery. With respect to acute toxicity postoperative radiotherapy seems to be without any competition compared to surgical and pharmaceutical approaches including corticoid, diphosphonate and nonsteroid antiphlogistic drugs.

Adult↗
PubMed1992

Magnetic resonance angiography in the body.

Magnetic resonance angiography (MRA) is gaining wide acceptance as a clinical tool for evaluation of the carotid arteries and intracranial circulation. MR angiographic methods are far less widely employed in the body. However, several very powerful techniques have been developed which provide a wealth of clinical information and which may soon replace alternative imaging techniques for a variety of applications. As compared with MRA of the head and neck, these techniques require more interactive involvement by a physician and more familiarity with the imaging machine to derive their full benefit. Based on the experience of the authors and others working in the field, this article outlines strategies for MRA of the abdomen, pelvis and thorax, and reviews the clinical situations in which these techniques have proved useful.

Abdomen↗
PubMed1992

[Computed tomographic aspects of intestinal intussusception].

This article describes typical CT findings of intestinal intussusception of different genesis and localisation. It is shown that a characteristic image resembling a target is obtained both in case of an invaginated Meckel's diverticulum, an idiopathic ileocolic intussusception in an infant, and in colorectal invagination in condition after resection of a polyp of the sigmoid. Compared with the conventional imaging methods such as sonography, colon contrast enema or contrast imaging of the small intestine, CT enables not only unequivocal diagnosis of intestinal invagination but frequently also the identification or exclusion of underlying causes that trigger the phenomenon.

Colonic Diseases↗
PubMed1992

Image artifacts in fast magnetic resonance imaging.

Image artifacts are unwanted, spurious signal intensities that interfere with clinical diagnosis. This article gives an overview of image artifacts in magnetic resonance imaging. We discuss the causes of these artifacts, provide clinical examples, and offer solutions to avoid them.

Artifacts↗
PubMed1991

[Sonographic detection of splenic injuries after blunt abdominal trauma].

During one year 150 patients with blunt abdominal trauma were scanned by ultrasound on the day of admittance. In 18 patients a splenic lesion was diagnosed by ultrasound. These lesions consisted of 12 splenic ruptures and of 6 splenic haematomas. The diagnosis was confirmed in 9 cases by laparotomy, in 7 cases by computed tomography and in 2 cases by sonographic follow-up. In all patients ultrasound was used in the follow-up assessment. Emergency sonography was not only a reliable diagnostic tool, but was also appropriate as an easy follow-up imaging.

Abdominal Injuries↗