Esophageal carcinoma: CT--staging of tumor infiltration.
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Biomedical subjects
Publications and source records attributed to F Karnel.
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Doppler colour flow imaging provides colour-coded visualisation of blood flow additional to the B-mode image. In this study, the carotid arteries of 92 patients were examined comparing duplex sonography with Doppler colour flow imaging. Efficiency of these methods was evaluated by angiography in 16 patients. Examination time was shorter by using Doppler colour flow imaging; evaluation of haemodynamics and anatomical changes was simplified.
The accuracy of genital urography in the diagnosis of intersex and for the demonstration of the internal genitalia has been studied in 16 patients. It was found that the radiological appearances agreed in all cases with the surgical findings. Individual malformations of the genitals have been considered with reference to the classification of Shopfner and Prader and the advantages and disadvantages of various examination techniques are discussed.
In our retrospective study, we evaluated the role of CT in cases of liver transplantation. 118 examinations (37 pre- and 81 post-operative) were carried out in 46 transplant recipients. Pre-operatively CT was used to exclude retroperitoneal secondary lesions, although ultrasound was superior in the region of the porta hepatis. Patency of the portal vein can be established by means of duplex sonography and CT. Portography is indicated only in exceptional circumstances. Post-operative complications (abscesses, hematomas, infarcts) can be demonstrated by CT. CT-guided fine needle biopsies and percutaneous drainage can be carried out post-operatively, even under difficult conditions. Liver cell necrosis, if extensive, represents a serious risk to transplant survival. CT may clarify this, while other problems and differential diagnosis may be solved by angiography.
Percutaneous catheter drainage of a mediastinal pseudocyst was performed in two patients. Access was gained through computed tomography (CT)-guided puncture of the abdominal portion of the pseudocyst in one patient, and a transhepatic-subxiphoid approach was used in the other. Guide wires and catheters were advanced into the mediastinal pseudocysts under CT control. Drainage was technically successful in both patients, with no procedure-related complications. Percutaneous drainage is an alternative to the surgical treatment of symptomatic and nonresolving mediastinal pseudocysts, provided that a safe access route can be found.
Percutaneous transluminal laser angioplasty (PTLA) with a metal contact probe and a sapphire contact probe was performed under experimental conditions and in 88 patients with femoropopliteal artery occlusions. The experiment revealed that more ablation was caused by the sapphire probe than by the metal probe. Because of heat accumulation in subsurface tissue layers the metal probe caused a three to four times larger zone of thermal necrosis surrounding the tissue defect. Clinically both contact probes revealed similar results. The initial rate of recanalization of femoropopliteal artery occlusions with a mean length of 8 cm was 78% (metal probe) to 82% (sapphire probe), and the perforation rate was 14% (metal probe) to 8% (sapphire probe). Doppler ultrasound examinations after 6 months revealed a patency rate of 84%. PTLA has proved to be a successful and safe procedure for recanalization of arterial obstructions that are not appropriate for fibrinolysis.
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Five histologically confirmed tumors of the carotid body and seven lymph node metastases in the area of the carotid bifurcation were investigated with real-time sonography. In addition, 10 patients underwent measurements of intratumorous flow by way of a pulsed Doppler system. The typically hypervascular tumors of the carotid body revealed flow signals with standardized adjustment of Doppler sonography. The hypovascularized lymph node metastases did not demonstrate flow on Doppler sonography. In all patients, either preoperative angiography or enhanced computerized tomography was done and these studies confirmed the degree of vascularization of the mass as determined by Doppler sonography. Duplex sonography permitted noninvasive demonstration of hypervascular tumors in the area of the carotid bifurcation, a finding highly suggestive of nonchromaphil paraganglioma of the carotid body.
Our experience with sonography of the neck (about 1,500 examinations) indicates that most of the structures that are of therapeutic importance can be demonstrated by ultrasound. The cervical nerves, however, cannot be differentiated sonographically from perivascular fat because there is insufficient impedance difference presented by the myelin sheaths. The typical sonographic anatomy of the anterior and lateral cervical muscles, of the major vessels, the thyroid and parathyroid and salivary glands has been analysed. The structures that can be shown by sonography have been related to dissections of the neck.
308 patients with salivary gland diseases were investigated using real-time sonography. In 142 patients we suspected neoplasms of the salivary glands on the sonograms. In the remaining 166 patients we investigated the following entities: sialolithiasis (74 patients), acute sialadenitis (54 patients), abscess formation (16 patients), chronic sialadenitis or autoimmune disease (53 patients) and cysts of salivary gland (5 patients). The changes in the sonographic morphology of the different diseases will be described. The role of ultrasound in the diagnosis of the different diseases will be discussed and the indications for sonographic investigations are summarised.
The authors describe the appearance of focal sparing in otherwise diffuse fatty infiltration of the liver found in 35 patients. These are pseudotumours which are less echogenic than the surrounding abnormal parenchyma. They are sharply marginated, of triangular shape and show no mass effect--neither by displacement of vessels nor by deformity of the contour of the liver. These characteristic morphologic features allowed a differentiation from neoplasms or abscesses in 80% of our cases. Hence, biopsies are rarely indicated in these patients.
The technique of conventional dacryocystography has recently been improved and extended by utilizing new technological developments. Digital dacryocystography, performed with computer-controlled X-ray equipment with a C-arc, and coupled to an image intensifier-TV system, enables the passage of the contrast medium to be observed, the image to be enlarged to any desired size, and also offers the advantages of digital subtraction angiography. A great deal of diagnostic information is thus obtained, making precise localization of stenoses of the lacrimal pathways possible. The method is especially useful for localizing stenoses of the lacrimal pathways, presaccal, intrasaccal and postsaccal stenoses which are difficult to demonstrate by conventional methods; and combined stenoses of the efferent lacrimal pathways. Exact localization is an essential prerequisite for choosing an appropriate surgical procedure.
The value of high resolution real time sonography for the detection of cervical lymph-node metastases in head and neck cancers was assessed in 118 histological proven cases. The accuracy of sonography (89%) proved to be superior to palpation (80%). In 9 patients a thrombosis of the internal jugular vein was detected. The ability of sonography to detect tumorous infiltration of the arterial vessel wall is discussed in 12 patients. Regarding possible artefacts, sonography is the only imaging modality which can solve this problem. Sonography should be performed preoperatively in all patients with malignant head and neck tumors for cervical lymph-node staging.
Comparative investigations were done by duplex sonography, thermography and phlebography in 142 patients with 158 varicoceles. Verification of clinical varicoceles (130/158) was performed by duplex sonography in all cases and by thermography in 93%. Measurement errors were due to dorsally located varicoceles near the radix of the penis (3/130) and by small, two-sided varicoceles (6/130). Small subclinical varicoceles (28/158) were detected by real-time sonography in 89%, by Doppler sonography in 64%, and by thermography in 53%. In three patients with normal real-time sonography, subclinical varicoceles were found by Doppler sonography alone. The combination of both sonographic methods is highly sensitive for the detection of subclinical varicoceles and should be done in all cases without therapeutic results.
The original concept of percutaneous, radiological abscess drainage was confined to well circumscribed, solitary abscesses, that could be reached by a short access avoiding transgression of uninvolved organs or compartments. With increasing experience criteria for percutaneous abscess drainage have been expanded to radiological treatment of pancreatic, periappendiceal, diverticular, interloop and mediastinal abscesses and fluid collections. The authors present their experience with percutaneous treatment of such "complicated" abscesses in 140 patients.
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