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Biomedical subjects

B Marincek

Publications and source records attributed to B Marincek.

At least 55 records · Page 3Linked to original sources
PubMed1999

[New perspectives in 3D MR colonography].

Filling the colon lumen with contrast allows for 3D-MR-colonography. The 3D data set can be postprocessed to multiplanar reconstruction, surface shaded displays as well as virtual colonoscopy. The latter facilitates the differentiation between haustra and polyps and enables detection of polyps down to 6 mm in size. Multiplanar reconstructions provide the assessment of the inner wall contour. The morphology of the colonic wall itself can be assessed on T1- or T2-weighted images. T1-weighted sequences performed before and after i.v. contrast administration and T2-weighted sequences depict pathologies based on their contrast uptake respectively on their tissue water content. This concept of colonic imaging practicable in less than 15 minutes is useful for the assessment of inflammatory disease, for polyp detection as well as for tumour staging.

Colonic Diseases↗
PubMed1999

A prospective study of risk-adapted therapy for large cell non-Hodgkin's lymphoma with VACOP-B followed by high-dose CBV and autologous progenitor cell transplantation for high-risk patients in remission.

Several centres reported a favourable outcome after high-dose chemotherapy with autologous progenitor cell transplantation in selected patients with high-risk large cell non-Hodgkin's lymphoma in first remission. Based on these observations, we wanted to prospectively determine the outcome of a risk-adapted therapy for patients with large cell lymphoma. Patients aged 60 years or less received 12 weeks of VACOP-B chemotherapy. For high-risk patients in remission this was immediately followed by high-dose chemotherapy with cyclophosphamide, carmustine and etoposide and autologous progenitor cell transplantation. High-risk criteria were defined before the establishment of the International Index and included large cell lymphoma stage III or IV or mediastinal large lymphoma with sclerosis stage II or higher, and the presence of bulky tumours and/or an elevated LDH. 89 patients fulfilled the clinical selection criteria and were entered onto this multicentre study. 82 patients were evaluable after confirmation of large cell histology by pathology review. Of these, 51 were considered to be in the low-risk group and 31 in the high-risk group. The 3-year event-free survival for all patients was 68%. The 3-year event-free survival was 76% for the low-risk and 55% for the high-risk group (P = 0.061). Only 22/31 high-risk patients were able to receive the high-dose chemotherapy in first remission as intended. In conclusion, although our study demonstrated that a risk-adapted therapy for large cell lymphoma could be safely administered, the potential impact on outcome of the strategy chosen here is likely to be small.

Adult↗
PubMed1998

[The thoracic roentgen image: emergency and routine indications in the clinic and general practice].

Even in the era of rapidly emerging cross-sectional imaging techniques (computed tomography, magnetic resonance imaging) the chest radiograph remains the most frequently performed diagnostic imaging procedure and has not lost any importance to other modalities. After technical considerations the value of chest radiography will be discussed based on the most widely applied indications in emergency and routine clinical settings and the link to subsequent imaging modalities will be outlined.

Ambulatory Care↗
PubMed1998

Prenatal diagnosis of fetal malformations by ultrafast magnetic resonance imaging.

Prenatal ultrasonography is the primary imaging modality in pregnancy as it allows direct real-time fetal examination. Antenatal magnetic resonance imaging (MRI) has so far been of limited clinical value owing to poor image quality. This was due to the long acquisition times that were needed to achieve a high enough spatial resolution for assessment of the small fetal anatomic structures resulting in severe motion artefacts. This problem has now been overcome by recent technical improvements. We present a case of fetal malformation (MURCS association), where an ultrafast T2-weighted RARE sequence (single shot fast spin echo sequence) provided images of excellent quality, which led to the correct antenatal diagnosis. MRI using this sequence can now be used for prenatal diagnosis and is thus likely to become an important adjunct to ultrasonography, especially in cases in which ultrasound findings are unclear of sonographic images are impaired by maternal obesity or oligohydramnios.

Adult↗
PubMed1997

Intravenous cholangiography is superfluous prior to laparoscopic cholecystectomy.

OBJECTIVE: Intravenous cholangiography (IVC) re-introduced into the preoperative diagnostic work-up of cholecystectomy after the change to the laparoscopic technique, was suggested to detect anatomical anomalies and bile duct stones. The value of IVC in this context was to be evaluated by this study. DESIGN: Prospectively controlled study. IVC findings were controlled by intraoperative imaging techniques such as laparoscopic sonography and intraoperative cholangiography. SETTING: Surgical unit of a university hospital. SUBJECTS: One hundred patients underwent laparoscopic cholecystectomy between January 1992 and January 1993. Eighty-five of these patients had both IVC and intraoperative cholangiography (IOC). There were nine technical failures for IVC and five for IOC. MAIN OUTCOME MEASURES: Anatomical variations and previously unsuspected common duct stones. RESULTS: Anatomical variations of the biliary tree and the hepatic vessels were detected by IVC in only three cases while IOC demonstrated 31 biliary and vascular anomalies in 28 patients. IVC demonstrated bile duct stones in one and IOC in two cases. CONCLUSIONS: We conclude that IVC is of little help in the diagnosis of anatomical variations of the biliary tree and should be omitted from the preoperative diagnostic work-up of laparoscopic cholecystectomy.

Adult↗
PubMed1996

[High-resolution computerized tomography of the lungs: bases, findings, indications].

High resolution computed tomography (HRCT) of the lungs uses thin-section CT (1- to 2-mm collimation scans) combined with a targeted reconstruction with a high-spatial frequency algorithm. HRCT is currently the most sensitive non-invasive imaging method for parenchymal and bronchoscopically inaccessible bronchial abnormalities of the lung. The following indications for HRCT of the pulmonary parenchyma are established: (1.) complementary examination in symptomatic patients with normal chest radiographs and/or normal pulmonary function testing; (2.) morphologic characterization of a nonspecific radiographic pattern; (3.) assessment of the activity and follow-up of a parenchymal disease; (4.) localization of a lung biopsy; (5.) localization of bronchiectasis.

Adult↗
PubMed1996

Azygos blood flow: phase contrast quantitation in volunteers and patients with portal hypertension pre- and postintrahepatic shunt placement.

Flow volume in the azygos venous system was quantitated with Cine-phase contrast (PC) velocity mapping in volunteers and compared with patients with known portal hypertension, who were referred for transjugular intrahepatic portosystemic shunt (TIPS) placement. Subsequently, the TIPS-induced hemodynamic effects on portal and azygos flow were analyzed. To assess intra- and intersubject variability, flow in the azygos veins was measured in each of 10 normal subjects at three different times. Subsequently, portal and azygos flow was quantitated in 20 patients with portal hypertension, before and after TIPS placement. All imaging was performed on a 1.5-tesla magnetic resonance imaging (MRI) system. Azygos flow was measured transaxially at the midthoracic level. Cine-PC flow measurements of the main portal vein followed morphological evaluation of the portal venous system with axial and coronal breath-held magnet resonance angiogram. Azygos flow in normal subjects was characterized by high inter- and low intrasubject variability. Azygos flow in patients with portal hypertension was significantly higher (P < .001). Following successful TIPS placement in 18 patients, Cine-PC revealed a mean decrease in azygos flow of 46.3% (P < .001) and a 134% (P < .001) increase of portal flow. Reflecting the complexity of portal hemodynamics, there was no correlation between the changes in the portal and azygos systems. In 2 patients with early occlusion of TIPS, documented invasively, portal and azygos flow values remained largely unchanged. Cine-PC enables the noninvasive, quantitative assessment of flow within the azygos venous system. Azygos flow was found to be markedly elevated in patients with portal hypertension. Combined portal and azygos PC flow measurements quantitate the therapeutic effect of TIPS placement.

Adult↗
PubMed1996

Sweet's syndrome involoving the musculoskeletal system during treatment of promyelocytic leukemia with all-trans retinoic acid.

Induction therapy of promyelocytic leukemia with all-trans retinoic acid is a standard therapy despite significant side-effects. The most important, the "retinoic acid syndrome", consists of a hyperinflammatory reaction with capillary leakage (edema, pleural, and pericardial effusion), infiltration of myeloid cells into internal organs and systemic signs of inflammation. We describe here two cases of another hyperinflammatory reaction during all-trans retinoic acid therapy, the Sweet's syndrome, consisting of infiltrates of the skin and internal organs by neutrophilic granulocytes. Fever, painful erythematous cutaneous plaques, prominent musculoskeletal involvement (myositis, fasciitis), a sterile pulmonary infiltration and intercurrent proteinuria characterized the clinical course of all-trans retinoic acid-associated Sweet's syndrome. Treatment with glucocorticoids led to resolution of the syndrome within 48 h. Three other cases of all-trans retinoic acid-associated Sweet's syndrome without involvement of internal organs, prominent on our cases, were published previously. Recognition of ATRA-associated Sweet's syndrome is of practical importance.

Adult↗
PubMed1996

Diagnostic improvement in MRI of gynecological neoplasms.

The use of pelvic MRI is still limited because of motion artifacts due to respiration, blood flow and peristalsis and because of lack of contrast between bowel loops and adjacent organs. As in CT it has been suggested that the administration of an oral contrast agent might improve MR image quality. Both positive (T1) and negative (T2) agents have already been used in clinical trials. Lumirem (AMI-121) is a negative oral contrast agent consisting of a solution of superparamagnetic iron oxide particles with silicone coating. In a phase III clinical trial we have determined the safety and efficacy of Lumirem in the assessment of gynecological neoplasms. Twenty (20) patients underwent MRI at 1.5 Tesla. T1w SE and T2w fast SE images were obtained before and after the ingestion of 600-900 ml Lumirem.

Female↗
PubMed1996

Rapidly progressive portal hypertension 23 years after post-traumatic arterioportal fistula of the liver.

Intrahepatic arterioportal fistulas may occur after blunt abdominal trauma and lead to severe portal hypertension, which can be prevented by early diagnosis and treatment. The diagnostic workup of an asymptomatic young male with elevated transaminases revealed an arterioportal fistula secondary to a traumatic liver rupture during childhood, 23 yr earlier. Three years after initial diagnosis, the patient presented with gastrointestinal hemorrhage. Progression of portal hypertension had resulted in esophageal varices and ascites. After ligation of the right hepatic artery, the esophageal varices and ascites disappeared. Twelve months after surgery, the patient is asymptomatic without any signs of liver decompensation or recurrence of gastrointestinal hemorrhage. Our case demonstrates that rapid progression of portal hypertension with severe complication can occur in patients with arterioportal fistula after a long-lasting asymptomatic course of 23 yr. Simultaneous chronic hepatitis C may have a contributory role.

Accidents, Traffic↗
PubMed1995

[Amyloid struma].

A 71-year-old woman with a seven-year history of seronegative polyarthritis had to be intubated and ventilated because of acute respiratory failure. The chest radiograph and computed tomography revealed bilateral pleural effusions and massive enlargement of the thyroid which compressed the trachea. Concentration of the thyroid-stimulating hormone was slightly reduced, while that of peripheral thyroid hormone was normal. Histological examination of a goitre specimen after strumectomy showed macrofollicular goitre with massive amyloid deposits. Amyloid was subsequently also demonstrated in the gastrointestinal tract. The patient died 5 months later from respiratory failure. A second patient, 47 years old at hospitalization, had been suffering from arthritic psoriasis since she was a child and had been undergoing haemodialysis for renal failure caused by amyloid. She had undergone angiography because the haemodialysis shunt had become occluded. She had been admitted because of an increase in goitre size during the last 6 months and a malignancy was suspected. Computed tomography showed the thyroid enlargement with retrosternal extension and a nodule in the thyroid isthmus. After injection of contrast medium for the angiography she developed, on the basis of probably already existing hyperthyroidism with an increased level of thyroid-stimulating immunoglobulin, clinically and biochemically manifest hyperthyroidism, which was treated with thiamazole (15 mg daily) and propranolol (40 mg twice daily). Cytological examination of a fine-needle biopsy of thyroid tissue revealed amyloid deposits. The patient died 4 years later, shortly after bilateral hip replacement for femoral neck fractures. At autopsy a large amyloid goitre and amyloid deposits in the kidneys, gastrointestinal tract and coronary arteries were found.

Aged↗
PubMed1995

[Endosonography in diagnosis of insulinoma].

AIM: In a prospective study endoscopic ultrasonic localisation of clinically suspected insulinomas was compared with the findings of abdominal ultrasound, computed tomography and magnetic resonance imaging. METHOD: From Dec. 1990 to Jan. 1995 11 patients (8f, 3m, median age 42 [27-79] years) were enrolled in the study. The preoperative endosonographic findings were compared to surgery (n = 7) or clinical follow-up (n = 4). RESULTS: Endoscopic ultrasound identified a solitary tumour (mean size 12.4 mm) in 7 of 11 patients, which was proven at surgery in 5 patients and by transhepatic portal venous sampling after negative partial pancreas resection in 1 patient. One patient is still awaiting surgery. Clinical follow-up (n = 2) and negative intraoperative and histological findings of partial pancreas resection (n = 1) confirmed a true negative examination in 3 patients. One patient with negative endoscopic ultrasound is still under medication for recurrent hypoglyctemia. Abdominal ultrasound (n = 11), computed tomography (n = 11) and magnetic resonance imaging (n = 5) were negative in all investigated patients. CONCLUSION: Endoscopic ultrasound is highly accurate for localisation of insulinomas and should be performed early in the preoperative management of these patients.

Adult↗
PubMed1995

Malignant peritoneal mesothelioma after Thorotrast exposure.

A case of a malignant peritoneal mesothelioma in a 63-year-old male patient with a history of exposure to Thorotrast in 1945 is presented. There was no history of exposure to asbestos. The clinical manifestation was a serosal effusion, which required weekly ascites puncture until therapy with intraperitoneal bleomycin was initiated. The latter treatment led to a significant reduction of ascites without any influence on tumor progression. Unfortunately, intraperitoneal bleomycin was accompanied by pulmonary toxicity, but at a higher total dose than known for intravenous administration. Three years after diagnosis the patient is still alive, without relapse of ascites production after bleomycin had to be stopped. Considering the risk of pulmonary fibrosis with high-dose intraperitoneal bleomycin and the lack of efficacy on tumor reduction, bleomycin seems to offer no advantage with respect to cisplatin.

Adenocarcinoma↗
PubMed1995

Staging of metastatic melanoma by whole-body positron emission tomography using 2-fluorine-18-fluoro-2-deoxy-D-glucose.

Metastatic melanoma was staged in 15 patients using whole-body positron emission tomography (PET) and the radiopharmaceutical 2-fluorine-18-fluoro-2-deoxy-D-glucose (FDG). PET correctly demonstrated 30 metastases in lung, brain, pancreas, nasal cavity, skin and subcutaneous tissue, and lymph nodes. It detected 97% of all metastases exceeding its spatial resolution (> 5 mm). Two cutaneous metastases (approximately 3 mm) did not show increased FDG uptake; the overall detection sensitivity was 91%. Two false-positive lesions in one patient were due to severe wound infection. PET correctly excluded malignancy in four cases where suspicious lesions were found with conventional cross-sectional imaging modalities but later ruled out by fine-needle biopsy. PET therefore proved to be an excellent method for staging of metastatic melanoma. Due to its high sensitivity for malignant lesions and the possibility of covering the whole body in one examination, it can replace staging techniques employing multiple imaging modalities: chest X-ray, ultrasonography and computed tomography. Furthermore, it provides information on the malignant potential of the detected lesion.

Adult↗