[Pneumatosis intestinalis in abdominal infection].
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Aged↗
Biomedical subjects
E Schober
Publications and source records attributed to E Schober.
[The pharynx. The imaging of its normal anatomy].
BACKGROUND: The pharynx, being part of the digestive as well as the respiratory system, is embedded in the complex spatial anatomy of the neck and, due to its function and location, represents a very sophisticated region. DIAGNOSIS: Cross-sectional imaging with CT and MR imaging plays an indispensable complementary role to clinical work-up, as far as submucosal and deep cervical spaces are concerned. However, as dysphagia is a common symptom in clinical practice, interpretation of double contrast studies and videofluoroscopic investigations are also on frequent demand in the daily routine. CONCLUSION: Close interdisciplinary co-operation and the radiologist's familiarity with the anatomy of the region are required in order to use the diagnostic tools in an optimal fashion.
Cineradiography↗
Regional differences and temporal incidence trend of Type I diabetes mellitus in Austria from 1989 to 1999: a nationwide study.
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Adolescent↗
Significant association of strictures and internal fistula formation in Crohn's disease.
Intestinal inflammation in Crohn's disease (CD) may be complicated by the occurrence of strictures and fistulae. The pathogenesis of fistula formation is unknown. We therefore wanted to determine whether mechanical factors might contribute to the development of fistulae. Furthermore, we tried to define the path of internal fistulae through the muscular layer. For this purpose, surgical resection specimens from 42 consecutive patients with CD were prospectively studied. In gross examination the whole bowel was cut into circumferential cross sections 0.3 cm thick. Abnormal areas were histologically examined. Strictures were found in 38 patients (90.5%), and fistulae were observed in 27 (64.3%) patients. In 11 (40.7%) specimens fistulae were found within a stricture, in 15 (55.6%) at the proximal end, and in 1 (3.7%) no stricture was found. In 7 (25.9%) cases with fistulae, herniated mucosa was found within the muscularis propria or the subserosa. In 7 (25.9%) cases a blood vessel was identified near a fistula traversing the muscularis propria. From these findings we conclude that that mechanical factors may contribute to fistula formation. This is further supported by the fact that fistulae appear to traverse the muscular layer along piercing vessels.
Adult↗
Complications after laryngeal surgery: videofluoroscopic evaluation of 120 patients.
AIM: Videofluoroscopic assessment of the spectrum and incidence of swallowing complications after state-of-the-art laryngeal cancer surgery. MATERIALS AND METHODS: We retrospectively studied videofluoroscopic examinations of 120 patients (94 men, 26 women; mean age, 58 years) with suspected complications after laryngeal resection (partial laryngectomy, 65; total laryngectomy, 55). Swallowing function (i.e., oral bolus control, laryngeal elevation and closure, presence of pharyngeal residue, aspiration) and structural abnormalities such as strictures, fistulas and tumour recurrence were assessed by videofluoroscopy. RESULTS: Abnormalities were found in 110 patients, including strictures in nine, fistulas in six and mass lesions in 13 patients. Aspiration was found in 63 patients overall (partial laryngectomy, 61/65; total laryngectomy, 2/55), occurring before swallowing in five, during swallowing in 34, after swallowing in nine and at more than one phase in 15 patients. Pharyngeal paresis was detected in three and pharyngeal weakness in 19 patients. Pharyngo-oesophageal sphincter dysfunction was observed in 10 cases. CONCLUSION: Aspiration is a very common complication after partial laryngeal resection. It is mainly caused by incomplete laryngeal closure, sphincter dysfunction or pharyngeal pooling. Videofluoroscopy is the only radiological technique able to identify both disordered swallowing function and structural changes after laryngeal resection. Detection of these complications is crucial for appropriate further therapy.Kreuzer, S. H. (2000). Clinical Radiology55, 775-781.
Adult↗
Screening by anti-endomysium antibody for celiac disease in diabetic children and adolescents in Austria.
BACKGROUND: Unrecognized celiac disease (CD) may be found in a substantial proportion of patients with type I diabetes mellitus. METHODS: A cohort of 403 Austrian children and adolescents with type I diabetes mellitus (210 males and 193 females; age range, 1-22 years) was screened for celiac disease using the IgA anti-endomysium antibody test (EMA) and the immunoglobulin (Ig)G anti-gliadin (AGA-IgG) and IgA anti-gliadin (AGA-IgA) antibody test. RESULTS: Twelve patients' sera (2.98%) yielded positive EMA results and two patients' sera (0.49%) with IgA deficiency had high AGA-IgG values. All but one of these patients underwent intestinal biopsy. Six (1.49%) had clear histologic evidence of CD (flat mucosa), whereas three (0.74%) showed minor histologic changes (increase in intraepithelial lymphocytes) and four (0.99%), including the EMA-negative patients with IgA deficiency, had a normal mucosa. When the cases with silent and potential CD were combined, the overall prevalence in the current cohort was 2.98%. There was no difference in the hemoglobin (Hb)A1c level between antibody-positive and -negative patients, and subsequent gluten-free diet did not change this metabolic parameter. CONCLUSION: The prevalence of clinically unrecognized CD, found by EMA screening, is much higher in Austrian children with diabetes than in a comparable population without diabetes. The prevalence of CD in diabetic children in Austria is distinctly lower, however, than in several other countries.
Adolescent↗
Ocular haemodynamics and colour contrast sensitivity in patients with type 1 diabetes.
BACKGROUND: There is evidence that altered ocular blood flow is involved in the development and progression of diabetic retinopathy. However, the nature of these perfusion abnormalities is still a matter of controversy. Ocular haemodynamics were characterised with two recently introduced methods. METHODS: The cross sectional study was performed in 59 patients with type 1 diabetes with a diabetes duration between 12 and 17 years and an age less than 32 years and a group of 25 age matched healthy controls. Scanning laser Doppler flowmetry and laser interferometric measurement of fundus pulsation amplitude were used to assess retinal and pulsatile choroidal blood flow, respectively. In addition, colour contrast sensitivity along the tritan axis was determined. RESULTS: Fundus pulsation amplitude, but not retinal blood flow, increased with the progression of diabetic retinopathy. Retinal blood flow was influenced by plasma glucose levels (r = 0.32), whereas fundus pulsation amplitude was associated with HbA(1c) (r = 0.30). In addition, a negative correlation between the colour contrast sensitivity along the tritan axis and retinal blood flow was observed. CONCLUSIONS: The present study indicates that pulsatile choroidal blood flow increases with the progression of diabetic retinopathy. Increased retinal blood flow appears to be related to loss of colour sensitivity in patents with type 1 diabetes.
Adolescent↗
Cervical osteophytes impinging on the pharynx: importance of size and concurrent disorders for development of aspiration.
OBJECTIVE: This study evaluated the clinical significance of cervical osteophytes impinging on the pharynx in patients with dysphagia and the importance of concurrent disorders that may affect swallowing function. MATERIALS AND METHODS: On videofluoroscopy, anterior cervical osteophytes were found in 55 (32 men, 23 women; mean age, 69 years) of 3318 patients with dysphagia (1.7%). Coexisting diseases that affected swallowing function were found in 28 patients (stroke, n = 7; thyroidectomy, n = 7; tongue base or laryngeal cancer surgery, n = 5; other diseases, n = 9). Swallowing function was assessed with videofluoroscopy evaluating epiglottic tilting, laryngeal closure, impression of the hypopharynx, pharyngeal residue, and aspiration. RESULTS: With advancing age, the probability of aspiration (odds ratio, 1.07; p < 0.05) and of enlarging osteophytes (odds ratio, 1.26; p < 0.01) increased; the probability was higher for osteophytes at more than one vertebrae (odds ratio, 8.00; p < 0.01) and for concurrent diseases (odds ratio, 8.02; p < 0.01). Aspiration was found in 75% of patients with osteophytes larger than 10 mm and in 34% with osteophytes smaller than or equal to 10 mm. In 88% of patients with small osteophytes who aspirated, other diseases affected swallowing function. CONCLUSION: Aspiration is common in patients with dysphagia and cervical osteophytes larger than 10 mm. Aspiration is rare in patients with osteophytes smaller than or equal to 10 mm unless these patients suffer from other disorders that may affect swallowing.
Cervical Vertebrae↗
Complications of continuous ambulatory peritoneal dialysis: findings on MR peritoneography.
OBJECTIVE: The purpose of this study was to assess the diagnostic value of MR peritoneography in complications of continuous ambulatory peritoneal dialysis. SUBJECTS AND METHODS: Twenty consecutive patients treated with continuous ambulatory peritoneal dialysis who were clinically suspected of dialysis-related complications were prospectively studied with MR peritoneography. For MR peritoneography, 20 ml of gadodiamide was added to 2000-ml dialysate solution (1.36% glucose) that was instilled into the peritoneal cavity. MR peritoneography was performed with the peritoneal cavity filled (n = 12) and after complete drainage of the contrast material-dialysate mixture (n = 20) on a 1.5-T MR unit with a phased array coil. Imaging included axial T1-weighted fast low-angle shot (TR/TE, 174/4.2) with and without fat saturation and axial and coronal T2-weighted fat-saturated turbo spin-echo (3000/138) sequences. All studies were performed without IV contrast material. Images were reviewed for evidence of peritoneal leaks, hernias, loculated fluid collections, and adhesions. RESULTS: Abnormal findings were detected in 13 (65%) of 20 patients and included retroperitoneal leaks (n = 6), diaphragmatic leaks (n = 2), catheter exit-site leaks (n = 2), inguinal hernias (n = 2), and peritoneal adhesions (n = 1). CONCLUSION: MR peritoneography is useful for the evaluation of complications related to continuous ambulatory peritoneal dialysis, and it offers excellent tissue contrast and multiplanar imaging for assessment of complications.
Adolescent↗
Videofluoroscopy of swallowing in symptomatic patients who have undergone long-term intubation.
OBJECTIVE: The aim of this study was to evaluate whether specific patterns of swallowing dysfunction occur in symptomatic patients after long-term intubation. SUBJECTS AND METHODS: Twenty-one patients (16 men, five women; mean age, 66 years) who presented with clinical signs of aspiration after long-term intubation (mean duration, 24.6 days) underwent videofluoroscopy. They were analyzed for functional abnormalities of the tongue, soft palate, epiglottis, hyoid and larynx, pharynx, and the upper esophageal sphincter. We assessed the presence or absence of aspiration, the type of aspiration (pre-, intra-, and postdeglutitive), and a spectrum of other swallowing abnormalities. RESULTS: There were 18 patients (86%) with radiologically proven aspiration. In another patient only laryngeal penetration occurred. There were 11 combinations of pre-, intra-, and postdeglutitive aspiration. Predeglutitive aspiration was predominant and present in 52% of our patients. We found functional abnormalities of the tongue in 48%, of the soft palate in 10%, of the epiglottis in 48%, of the pharynx in 71%, and of the upper esophageal sphincter in 24%. CONCLUSION: Patients who are symptomatic after undergoing long-term intubation do not develop a specific type or pattern of swallowing dysfunction or aspiration, but show a large variety of aspiration types and associated swallowing disorders. Nevertheless, videofluoroscopy has the ability to reveal complex deglutition disorders and to aid precise planning of individualized functional swallowing therapy.
Aged↗
Seasonality of birth in children with diabetes in Europe: multicentre cohort study. European Diabetes Study Group.
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Adolescent↗
Risk factors for type I diabetes mellitus in children in Austria.
UNLABELLED: The aim of this study was to investigate environmental risk factors in the development of type 1 diabetes mellitus in a population-based case-control study. Parents of all patients with manifestation of type 1 diabetes between 1989 and 1994 in Vienna were asked to complete a questionnaire (n = 114). Control children (n = 495), matched for age and sex, were randomly recruited from all schools in Vienna. Fathers of diabetic children were significantly older at the time their children were born than fathers of control children (P = 0.015). Children with diabetes were more likely to be second- or third-born children (P<0.05) and fewer went to kindergarten than the control group children (P = 0.007). No significant difference in duration of gestation, percentage of delivery by caesarean section, birth weight or length was found. Neonatal jaundice was more often observed in the patient group (P = 0.038). Breast feeding was reported by 82.7% of mothers of diabetic children and by 81% of mothers of control children, and the duration of breast feeding was longer in patients than in controls (n.s.). CONCLUSION: In our study, the development of type 1 diabetes mellitus was associated with higher paternal age and neonatal jaundice. No correlation could be found with dietary intake of cow's milk products in early infancy, vaccination and other environmental factors.
Adolescent↗
Stenosis of the common bile duct due to Ormond's disease: case report and review of the literature.
In a 46-year-old man endoscopic retrograde cholangiopancreatography and computed tomography scan showed a stenosis of the common bile duct by a hypodense mass highly suggestive of a Klatskin tumor. Histologic examination of the resected tumor revealed only non-specific inflammatory, fibrotic tissue without any evidence of malignancy. Three months later, the patient presented with hydronephrosis of the left kidney. Computed tomography scan showed a retroperitoneal mass with encasement of the left ureter. A percutaneous nephrostomy was performed and immunosuppressive therapy with prednisolone and azathioprine was initiated. Under this medication, almost complete regression of the pelvic mass and reopening of the ureter were observed within 3 weeks. Eight months later, azathioprine was withdrawn and prednisolone was tapered continuously to a dose less than 10 mg/day. After a follow-up of 2 years, the patient is still well. Although the histologic findings were non-specific, further evaluation of this case suggests that Ormond's disease was responsible for the tumor that had to be resected.
Cholangiopancreatography, Endoscopic Retrograde↗
Relation of plasma leptin to lipoproteins in overweight children undergoing weight reduction.
BACKGROUND: In obese children, plasma leptin is elevated and correlates with the body mass index (BMI). In obese adults, plasma leptin decreases during weight reduction. Since the leptin system changes dynamically in puberty, we asked whether weight reduction in obese adolescents has similar consequences for plasma leptin as in overweight adults. In plasma, a portion of leptin is bound to several as yet uncharacterised proteins. We therefore studied the possible association of leptin with plasma lipoproteins. SUBJECTS AND METHODS: We measured plasma leptin, lipoprotein cholesterol and apolipoproteins (apo) A-I and B in 34 obese children (age 12.5+/-1.9 y, relative BMI 165.0+/-28.1%) before and after three weeks of weight reduction in a dietary camp. Lipoprotein binding of endogenous and exogenously radiolabelled leptin was studied by preparative ultracentrifugation. RESULTS: Plasma leptin was higher in obese children than in normal weight controls and fell from 16.5+/-9.8 ng/ml to 10.0+/-8.6 ng/ml after weight reduction (P < 0.001). In multivariate regression, relative BMI and apoA-I were significant predictors of baseline leptin and accounted for 38% (P = 0.003) and 15% (P = 0.006) of the variance of baseline leptin concentrations in obese children. Only the difference in plasma high-density lipoprotein (HDL)-cholesterol independently predicted the change of plasma leptin that was associated with weight reduction, explaining 29% of the variance of leptin changes (P = 0.0032). A substantial portion of both endogenous and exogenously labelled leptin was recovered with HDL isolated by ultracentrifugation. CONCLUSIONS: We conclude that plasma leptin decreases in overweight children undergoing short term weight reduction. In obese children, plasma apoA-I and HDL-cholesterol are independent predictors of leptin concentrations during weight loss, respectively. In addition, HDLs transport a variable portion of leptin in the circulation.
Adult↗
The prevalence of IDDM in the first degree relatives of children newly diagnosed with IDDM in Austria--a population-based study. Austrian Diabetes Incidence Study Group.
Insulin dependent diabetes mellitus shows a strong familial predisposition and an unexplained geographical variation in incidence. It is not known whether the risk of IDDM in first degree relatives depends on the risk in the background population. The aim of the study was to assess the prevalence of IDDM in parents and siblings of newly diagnosed children with IDDM in Austria, a known area of low risk for IDDM. The family history data of all diabetic children (< 15 years) diagnosed between 1988-1994 in Austria were analysed. The cumulative incidence of IDDM in siblings of newly diagnosed diabetic children was 0.0026772 cases/year, this means 29.7 times increased risk compared to the background population. Of the diabetic children 5.8% had at least one parent with IDDM and the prevalence of IDDM in fathers (3.9%) was higher (p = 0.015) compared to mothers (1.9%). The risk of IDDM tended to be higher for offsprings of diabetic fathers (OR 3.8, p < 0.003) in families with 2 or more children than in single child families, where the prevalence was 4.2% both in fathers and mothers. In conclusion the prevalence of IDDM in parents of diabetic children in Austria was lower than reported in populations with high IDDM incidence. This may reflect a lesser degree of genetic predisposition of the Austrian population. The prevalence of IDDM in siblings was similar to that in high risk populations. We saw an interaction of gender of the diabetic parent and diabetic offspring and the family size.
Adolescent↗
Dietary intake of Austrian diabetic children 10 to 14 years of age.
BACKGROUND: The dietary intake of 63 children with insulin-dependent diabetes mellitus (IDDM; age 10 to 14 years) was weighed by dietitians for 2 days during a summer camp for youth with diabetes. Data were analyzed for the content of macronutrients with the help of a computer database program. METHODS: The dietary intake of children with diabetes was compared with that of healthy Austrian school children and with the current nutritional recommendations for children with IDDM. RESULTS: The mean intake of carbohydrate did not meet the recommended level, whereas sucrose, fiber, and protein intake approximated the recommendations. The total consumption of fat and cholesterol, however, exceeded the recommended values. The nutritional intake of Austrian children with IDDM was similar to that of healthy children of the same age and thus reflected regional dietary habits. CONCLUSION: Dietary educational measures on a national basis are needed to change harmful local eating patterns.
Adolescent↗
Transabdominal bowel sonography for the detection of intestinal complications in Crohn's disease.
BACKGROUND: The course of Crohn's disease is characterised by the occurrence of intestinal complications such as strictures, intra-abdominal fistulas, or abscesses. Standard diagnostic procedures may fail to show these complications, in particular fistulas. AIMS: To test the value of transabdominal bowel sonography (T) for the detection of intestinal complications in Crohn's disease. METHODS: T was prospectively performed in 213 patients with Crohn's disease in a university based inflammatory bowel disease referral centre. Thirty three underwent resective bowel surgery and were included in this study. The accuracy of T to detect strictures, intra-abdominal fistulas, or abscesses was compared with surgical and pathological findings. RESULTS: T was able to identify strictures in 22/22 patients and to exclude it in 10/11 patients (100% sensitivity, 91% specificity). Fistulas were correctly identified in 20/23 patients and excluded in 9/10 patients (87% sensitivity, 90% specificity). Intra-abdominal abscesses were correctly detected in 9/9 patients and excluded in 22/24 patients (100% sensitivity, 92% specificity). CONCLUSIONS: In experienced hands T is an accurate method for the detection of intestinal complications in Crohn's disease. T is thus recommended as a primary investigative method for evaluation of severe Crohn's disease.
Abdominal Abscess↗
[Radiologic evaluation of Crohn disease].
PURPOSE: This paper discusses the role of different imaging modalities in the diagnostic work-up of Crohn's disease (CD). METHODS: We present a concept, which emphasizes different diagnostic aspects with regard to primary diagnosis, follow-up and assessment of complications of CD. The most effective imaging approach to various diagnostic problems of CD is discussed in detail. DISCUSSION: With regard to the primary diagnosis barium studies should contribute to differentiate between CD and ulcerative colitis. Beyond that, these studies should evaluate location and extent of disease. During the follow-up bowel sonography provides staging of disease and enables the detection of complications at an early stage. CT is a valuable tool in the preoperative assessment of complications, such as fistulae and abscesses.
Barium Sulfate↗