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Biomedical subjects

A Rieber

Publications and source records attributed to A Rieber.

At least 73 records · Page 4Linked to original sources
PubMed1996

Treatment of bile duct stones: value of laser lithotripsy delivered via percutaneous endoscopy.

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 occurred 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 per cutaneous 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.

Adult↗
PubMed1996

[Superselective intra-arterial chemotherapy in therapy-refractory lymph node recurrences of breast carcinoma].

PURPOSE: To demonstrate a superselective intraarterial chemotherapy as a therapeutic alternative in the treatment of previously treated recurrent lymph node metastases in breast cancer. METHODS: 14 patients with recurrent lymph node metastases in cases of breast cancer were presented to be treated by intraarterial chemotherapy of 25 mg mitoxantrone/m2 over a period of 24 hours. In two patients with superclavicular lymph node involvement an intraarterial therapy could not be carried out because of a vascular connection to the anterior spinal artery. Involved lymph stations could be reached in superselective technique by side branches of the subclavian artery. Heparin coverage was given intravenously. Every patient had had surgery, radiation, systemic chemo- and hormonal therapy before and was now graded as inoperable. Therapy indication was given by local tumour-induced symptoms. RESULTS: In the 12 treated cases complete remission was seen in three, partial remission in 4, a steady state in two and a progressive disease in three. There were no complications or severe side effects. CONCLUSION: Intraarterial chemotherapy is an effective and well tolerated treatment in recurrent lymph node metastases in cases of breast cancer even if conventional therapies can no longer be used.

Adult↗
PubMed1996

[Epidurography: comparison with CT, spiral CT and MR epidurography].

PURPOSE: The purpose of this study was to explain the origin of image patterns demonstrated by conventional epidurography, which is a controversially discussed topic in recent literature. MATERIAL AND METHODS: After introduction of thoracic epidural catheters and iopamidol injection, conventional epidurography and CT-epidurography were performed on 25 preoperative patients. After injection of Gadolinium-DTPA MR-epidurography was performed in two patients treated for chronic pain with already introduced epidural catheters. Three volunteers also underwent identical imaging after introduction of thoracic epidural catheters and in addition helical-CT epidurography using twin-beam technology. RESULTS: 40% of the patients demonstrated the railroad track phenomenon. We were able to prove that it is a sign of a rhythmically variable filling of segments of the lateral epidural space with contrast medium 76% of the patients demonstrated no ventral epidural space at the thoracic level. 56% of the patients showed a medial area of translucence combined with a band-shaped contrasting of the epidural space in the standard ap view. This was proven in all cases to be a plica mediana dorsalis by CT. In all volunteers who underwent helical-CT and MR epidurography we observed the railroad track phenomenon and the filling defect of the anterior thoracic epidural space. CONCLUSION: CT epidurography is well suited for obtaining new insights into the interpretation of findings obtained by conventional epidurography.

Analgesia, Epidural↗
PubMed1996

[The value of MR-mammography at 1.5 tesla in the differential diagnosis of non-puerperal mastitis and inflammatory breast carcinoma].

PURPOSE: The distinction between mastitis and inflammatory breast carcinoma is an important one. Current methods of evaluation including mammography, ultrasound and clinical examination do not enable this distinction. Dynamic magnetic resonance mammography (MRM) is a study with potential in this regard. MATERIAL AND METHODS: 12 patients, in whom clinical examination, mammography and ultrasound could not distinguish between both diseases, were reviewed retrospectively by means of MRM using a 1.5 T Siemens Magnetom SP and a circular mamma coil. We used dynamic 3-D gradient echo sequences with a duration of one minute. RESULTS: At present MRM cannot definitely distinguish between mastitis and inflammatory carcinoma, 80% of the inflammatory carcinomas were found to enhance more than 100% in the first minute, compared to 43% for mastitis. No other differences were seen. CONCLUSION: MRM proved useful in the follow-up of treated mastitis to demonstrate the success of antibiotic treatment of mastitis and to diagnose a histologically unconfirmed inflammatory carcinoma by means of a different follow-up.

Adenocarcinoma↗
PubMed1996

CT-guided intraarterial chemotherapy in locally advanced tumors.

In a retrospective study, 123 patients with tumors (the majority were recurrent pelvic or breast neoplasms) underwent 376 cycles of intraarterial chemotherapy. Contrast material-enhanced computed tomography was performed to check the position of the catheter during 221 cycles. On the basis of findings, the catheter was repositioned 46 (20.8%) times because of weak contrast enhancement in the tumor region (n=24[10.9%]), involvement of neighboring healthy tissue (n=15[6.8%]), or both (n=7[3.2%]).

Antineoplastic Agents↗
PubMed1996

[Therapeutic interventions in benign bile duct strictures].

Surgical treatment of benign bile duct strictures continues to be associated with significant lethality. Thus, radiological interventions become increasingly important. A total of 32 patients were treated. Their bile duct strictures had different origins. We performed percutaneous transhepatic cholangiographies in 32 patients, cholangioscopies in 7, and biopsies in 2 patients. Therapeutic interventions included percutaneous transhepatic drainages in 30 patients, laser lithotripsies in 5, and dilatations in 8 patients. As a total, 36 stents (mostly Palmaz stents) were implanted in 27 patients. Acuflex stents were implanted in 2 of these patients and were extracted after successful clearance of the bile ducts following stone fragmentation. No severe complications were observed. Five out of 8 dilatations were unsuccessful, so that stents were implanted. Five patients died. Three stent occlusions and 1 spontaneous stent migration occurred after an average of 29 months; the latter could be treated by means of radiological procedures. The remaining patients are living symptom-free, on average, since 18.6 months.

Adolescent↗
PubMed1996

Papillary cystic and solid tumor of the pancreas.

The papillary cystic and solid tumor of the pancrease (PCSTP) is a primary pancreatic neoplasm of unknown etiology occurring most commonly in young women and regularly containing hemorrhagic areas. Clinical symptoms are non-specific. Although these tumors reach an average diameter of 10 cm, they are often discovered by accident. Because patients with surgically resected PCSTP have very good prognoses, it is important to distinguish these tumors from other growths in the pancreas, for example mucinous cystadenoma. Whereas, due to the variable proportion of fluid components, these tumors offer non-characteristic structure at ultrasonography, computed tomography (CT) possesses high specificity for PCSTP, particularly when calcifications are present. Angiography distinguishes these tumors from hypervascular neoplasms, such as the endocrinologically inactive islet cell tumor. Magnetic resonance tomography (MRT) is especially suited for imaging the hemorrhagic areas in solid tumor formations, as well as hemorrhagic debris in the fluid portions and layer phenomena are frequently observed.

Adult↗
PubMed1995

[Dynamic 3D MR mammography using a rapid gradient-echo sequence].

Up to now, MR mammography is performed by two different methods: 2-D techniques with high temporal resolution and 3-D techniques with high spatial resolution. This article investigates whether a dynamic examination of the breast using a novel 3-D-gradient-echo sequence is feasible with sufficient spatial and temporal resolution. MR imaging was performed on a 1.0 Tesla imager using a gradient field strength of 15 mT/m. Phantom measurements were done to evaluate the correlation between signal intensity and contrast medium concentration for different sequences. Subsequently, 40 patients with 22 histologically verified lesions were examined using the double breast coil and a novel FLASH3D sequence (TR/TE/fa 9/3/50 degrees). Reading of the films in standardized documentation, multiplanar reconstruction (MPR), calculation and maximum intensity projection (MIP) of subtraction images as well as signal-to-time curve calculations in selected ROIs were performed for data evaluation. In the phantom measurements the FLASH3D-9/3/50 degrees sequence yielded the best correlation between signal intensity and Gd-DTPA concentration. The sequence provided good visualization even of small lesions. The 3-D postprocessing procedures facilitated the detection and localization of the lesions. Therefore, the new FLASH3D-9/3/50 degrees sequence enables a dynamic 3-D examination of the breast with a sufficient spatial and temporal resolution.

Adolescent↗
PubMed1995

[The measurement of the femoral torsion angle in children by NMR tomography compared to CT and ultrasound].

PURPOSE: Anteversion of the femoral neck was measured by MRI in 19 children (37 hips) preoperatively before femoral rotation osteotomies. MATERIAL AND METHODS: The results of this new technique were compared with values for anteversion obtained by CT and ultrasound. The measurements were performed independently by two observers to determine the correlation between the three different methods and to assess their reliability. RESULTS: It was possible to show a high correlation coefficient (Pearson) between MRI and CT (r = 0.77) as well as MRI and sonography (r = 0.81). The mean angles obtained by CT (34 degrees, range +5 to +82 degrees) and ultrasound (25.6 degrees, range +10 to +40 degrees) appeared larger than the MRI values (mean angle 23.2 degrees, range 0 to +65 degrees), which can be explained by the different measurement techniques. Mean inter- and intra-variability was low for MRI (r = 0.97 and r = 0.97) and CT (r = 0.99 and r = 0.96) but slightly higher for sonography (r = 0.88 and r = 0.88). MRI is a new reliable and precise method to evaluate femoral anteversion that does not require ionising radiation. CONCLUSION: MRI is recommended for preoperative planning of paediatric femoral rotation osteotomy patients.

Adolescent↗