[Congresses: virtual versus traditional].
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Congresses as Topic↗
Biomedical subjects
F Stöblen
Publications and source records attributed to F Stöblen.
Outcome and management of blunt liver injuries in multiple trauma patients.
BACKGROUND: In Germany, abdominal trauma in multiple- trauma patients can be observed in about 25-35% of all cases. Due to major bleeding complications, the initial treatment of blunt abdominal trauma in multiple-trauma patients has high priority. The aim of this study was to discuss management, treatment and outcome of blunt liver injury in multiple-trauma patients treated in our department. METHODS: The clinical records of 1192 multiple-trauma patients [injury severity score (ISS) 3-18] treated at the Surgical Department of the University Clinic of Essen from January 1975 to February 1998 were reviewed. Seventy-five patients with an ISS above 18 operated on due to a blunt liver injury could be included. The mean age was 29.82+/-1.80 years (60 males and 15 females). The degree of injury in this group was high (ISS 37.12+/-1.06). RESULTS: Twenty-three of the 75 (30.6%) patients died during their hospital stay. Deceased patients were older (27+/-2 years versus 37+/-4 years; P<0.01) and had a higher ISS (ISS=34.5+/-1 versus 43.2+/-2; P<0.01). In nine cases, death was strongly related to liver injury. Operational blood loss was higher in the group of multiply injured patients with liver injury and in those patients who did not survive (P<0.05). An increased mortality could be seen in this selected patient group when compared with our large collective of multiply injured patients. The age of the patients, the ISS and operative blood loss were the significant factors that influenced the operative mortality after blunt hepatic injuries in our study.
Adult↗
[3D-computed tomography for spatial arrangement of the cranial bones of the human fetus].
Aim of the study was to assess the value of in vitro three-dimensional computed tomography (3D-CT) as a new method for the depiction of the fetal skull. 3D-CT images of a fetal head of 24 weeks gestational age were generated with the implemented software on the basis of contiguous CT slices of 1 mm thickness. 3D-CT gave real three-dimensional information about morphology and spatial arrangement of the cranial bones. Using cutting and rotating procedures fast evaluation of all imaged ossified structures in arbitrary views without disturbing superpositions was possible, thus allowing easy identification and accurate description of the cranial bones and making isolated examinations of particular macroscopic sections of the specimens unnecessary. Advantages of 3D-CT over other evaluation techniques for the fetal cranium and its limitations are discussed. In conclusion, 3D-CT promises to be an effective tool for the investigation of fetal cranial development.
Fetus↗
[Optimization of beam filtering, kv-ma regulation curve and image intensifier entrance exposure rate to reduce radiation exposure in angiographic fluoroscopy].
AIM OF STUDY: Evaluation of radiation exposure and image quality during fluoroscopy using a new vascular X-ray system. MATERIAL AND METHODS: The measurements were made on an Integris V 3000 X-ray system with MRC tube and SpectraBeam technology (Philips Medical Systems, Hamburg). Entrance dose rates were measured with phantoms for the three fluoroscopy levels (1-3) which differed with regard to beam filtering and image intensiver entrance exposure rate. We evaluated 132 diagnostic and interventional angiographic studies. The angiographic investigators were asked to start with level 1 and to change to the next fluoroscopy level only in the case of insufficient image quality. RESULTS: Entrance dose rate is reduced by approx. 74% at fluoroscopy level 1 and by approx. 46% at level 2 relative to level 3 which is comparable to angiographic X-ray systems without MRC tube and SpectraBeam technology. Because level 1 ensured a sufficient image quality in 92% of the diagnostic and 60% of the interventional angiographic procedures a change to higher fluoroscopy levels was not necessary. CONCLUSION: Reduction of the intensifier exposure rate and the optimization of beam filtering enabled us to reduce the radiation exposure considerably. The procedure was well accepted by the angiographic investigators due to the diagnostically sufficient image quality of the fluoroscopy level 1.
Angiography, Digital Subtraction↗
Prophylactic cranial irradiation in locally advanced non-small-cell lung cancer after multimodality treatment: long-term follow-up and investigations of late neuropsychologic effects.
PURPOSE: Relapse pattern and late toxicities in long-term survivors were analyzed after the introduction of prophylactic cranial irradiation (PCI) into a phase II trial on trimodality treatment of locally advanced (LAD) non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Seventy-five patients with stage IIIA(N2)/IIIB NSCLC were treated with induction chemotherapy, preoperative radiochemotherapy, and surgery. PCI was routinely offered during the second period of study accrual. Patients were given a total radiation dose of 30 Gy (2 Gy per daily fraction) over a 3-week period starting 1 day after the last chemotherapy cycle. RESULTS: Introduction of PCI reduced the rate of brain metastases as first site of relapse from 30% to 8% at 4 years (P =.005) and that of overall brain relapse from 54% to 13% (P <.0001). The effect of PCI was also observed in the good-prognosis subgroup of 47 patients who had a partial response or complete response to induction chemotherapy, with a reduction of brain relapse as first failure from 23% to 0% at 4 years (P =.01). Neuropsychologic testing revealed impairments in attention and visual memory in long-term survivors who received PCI as well as in those who did not receive PCI. T2-weighted magnetic resonance imaging revealed white matter abnormalities of higher grades in patients who received PCI than in those who did not. CONCLUSION: PCI at a moderate dose reduced brain metastases in LAD-NSCLC to a clinically significant extent, comparable to that in limited-disease small-cell lung cancer. Late toxicity to normal brain was acceptable. This study supports the use of PCI within intense protocols for LAD-NSCLC, particularly in patients with favorable prognostic factors.
Adult↗
Impact of CT in patients with sepsis of unknown origin.
PURPOSE: To evaluate the diagnostic relevance of CT in patients with sepsis of unknown origin. MATERIAL AND METHODS: Sixty-three consecutive intensive care patients with suspicion of an abscess and negative or inconclusive previous radiological examinations were included. CT was performed using the helical technique. A total of 45 abdominal and 38 chest examinations were evaluated. RESULTS: 5/38 examinations of the chest revealed the source of sepsis (pleural empyema 2, lung abscess 1, mediastinitis 1, retrosternal abscess 1). 7/45 abdominal CT examinations showed the source of sepsis (intraabdominal abscess 2, hepatic abscess 3, intestinal perforation 1, gangrenous colitis 1). CONCLUSION: CT is useful for the evaluation of patients with fever or sepsis without a known source. Due to the detection of a septic focus by CT, 19% of the patients in our study could be immediately referred to causal therapy as percutaneous drainage or surgery.
Abdominal Abscess↗
SPIO-MR imaging versus double-phase spiral CT in detecting malignant lesions of the liver.
PURPOSE: To assess the diagnostic performance of superparamagnetic iron oxide MR (SPIO-MR) imaging compared with double-phase spiral CT in detecting liver metastases and hepatocellular carcinoma. MATERIAL AND METHODS: Thirty-eight patients with a total of 144 malignant lesions of the liver were examined by CT and SPIO-MR. After definition of a gold standard by a panel of experts, the patient images were randomized and presented to a blinded jury of 5 independent observers whose task was to identify as many lesions as possible. The results were tested for statistical significance using multifactorial analysis of variance (alpha=5%). RESULTS: SPIO-MR produced the highest detection rate and was significantly superior (p<0.05) to unenhanced MR imaging and double spiral-phase contrast-enhanced CT (DPS-CECT). Maximum performance in DPS-CECT was obtained during the portal venous contrast phase but was significantly inferior to SPIO-MR imaging. The scores for unenhanced CT and unenhanced MR were significantly lower than for the corresponding enhanced procedures. SPIO-MR imaging produced a higher incidence of false-positive findings (n=39). CONCLUSION: SPIO-MR produced a significantly better detection rate for malignant focal liver lesions compared with double-phase spiral DPS-CECT but was associated with a higher rate of false-positive findings.
Adult↗
Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease.
Sigmoid perforation due to diverticulitis is a life-threatening complication in the postoperative course of allogenic kidney transplantation. The incidence of diverticulosis is especially high among patients with autosomal dominant polycystic kidney disease (ADPKD). Thus, those who undergo allogenic kidney transplantation represent a high-risk group. The aim of this study was to evaluate the prevalence of diverticulosis in ADPKD patients awaiting renal transplantation and the incidence of bowel perforation following allogenic kidney transplantation due to ADPKD. Within the group of 1128 patients who underwent transplantation between January 1974 and January 1990, there were 46 patients (4.07%) whose indication for transplantation was ADPKD. There was one patient who developed a sigmoid perforation under postoperative immunosuppression. Surgical treatment was a discontinuity resection of the sigmoid (Hartmann's procedure). The postoperative course was favorable, the bowel continuity has already been restored, and the graft is still functioning well. Fifteen of the 28 (53.5%) ADPKD patients awaiting transplantation had colon diverticulosis (12 male and 3 female patients). No case of bowel perforation has thus far been observed in 15 of these patients who have undergone transplantation. A sigmoid resection was necessary in one patient due to diverticulitis without perforation. We did not find a higher prevalence of diverticulosis in patients with ADPKD, nor did we see a higher incidence of sigmoid perforation during post-transplant immunosuppression in this study.
Adult↗
[MRI with supermagnetic iron particles versus double-spiral CT in identification of malignant liver lesions].
PURPOSE: The purpose of this study was to evaluate the efficacy of MRI with superparamagnetic iron oxide (SPIO) and double-spiral CT in the detection of liver metastases and hepatocellular carcinoma. METHODS: 38 patients with a total of 144 malignant hepatic lesions underwent CT and MRI. A panel of experts defined the gold standard. Five experienced judges performed independently blinded evaluation of the number of detectable lesions. Multifactorial variance analysis was used to determine the statistical significance. RESULTS: SPIO-MRI shows the highest rate of detection and is significantly superior to native MRI and native CT. The highest rate of detection by CT is shown in the portal-venous phase of contrast; nevertheless, the rate is significantly inferior to SPIO-MRI. In general, the native phases of CT and MRI are significantly inferior to the contrast phases of both. SPIO-MRI shows a higher rate of false positive findings. CONCLUSION: The time-consuming and cost-intensive SPIO-MRI significantly increases the rate of detectability for malignant liver lesions compared with double-spiral CT but it also increases the rate of false positive findings.
Adult↗
[Effect of collimation and pitch on radiation exposure and image quality in spiral CT of the thorax].
PURPOSE: The aim of the study was to optimize the scan parameters for spiral-CT of the thorax. METHODS: Using a Somatom AR-SP (Siemens AG, Erlangen) CT-unit, four different scanning protocols (collimation/table feed) were compared: A (5/10), B (10/10), C (10/15), D (10/20). High contrast resolution in the xy-plane and in the z-direction were investigated with special phantoms. Noise levels were measured using a water phantom, the radiation exposure of lung parenchyma was investigated using an Alderson-Rande-Phantom. An anthropoid chest phantom was scanned to compare the image quality of the four protocols. RESULTS: Protocol A showed the best resolution in the z-direction; the resolution in the xy-plane was equal for all protocols. Image noise in the center of the water phantom was 58 HU for protocol A and 40 HU for the other three. The following equivalent organ dose were measured for lung parenchyma: A 14 mSv, B 29 mSv, C 20 mSv, D 14 mSv. CONCLUSION: Scanning protocols with small collimation and a pitch of 2 are characterised by low radiation exposure and excellent resolution in the z-direction. These parameters seem to be most suitable for lung scanning.
Diagnostic Imaging↗
[Post-traumatic priapism in a 10-year-old boy].
The case of a 10-year-old boy with post-traumatic priapism after perineal trauma is presented. Interdisciplinary treatment using angiography and selective catheter embolization for juvenile high-flow priapism is demonstrated. The literature and the diagnostic possibilities resulting from color duplex sonography are discussed.
Arteriovenous Fistula↗
[CT angiography of the pulmonary artery in patients with bronchial carcinoma].
The aim of the study was to evaluate 3D computed tomography (3D-CT) for the visualization of tumor extent with respect to the infiltration of the pulmonary arteries in patients with locally advanced small and nonsmall-cell lung cancer. A total 61 examinations in 40 patients with bronchial carcinoma were performed with contrast-enhanced (150 ml injected with 4 ml/s after bolus tracking) 2 mm spiral CT (pitch 1.5, increment 1 mm) (Somatom Plus4, Siemens AG, Germany). Using the implemented software cine mode, surface shaded display (SSD), and maximum intensity projection (MIP), reconstructions of the pulmonary arteries and the tumors were generated. In comparison to conventional spiral thoracic CT, the optimized cross-sectional images of the mediastium represented a benefit with the technique described, and this can help to diagnose vessel infiltration and may therefore be of value for pre- and post-therapeutic staging in modern stage-adapted multimodality treatment programs.
Angiography↗
Tuberculosis in liver transplant recipients: recurrence after transplantation?
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Actuarial Analysis↗
Outcome of severe pneumonias after orthotopic liver transplantation.
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Acyclovir↗
Laparoscopic fenestration of a lymphocele following combined pancreas-kidney transplantation.
The development of a lymphocele is an uncommon but well-known complication following a kidney transplantation. In case of recurrence after puncture and aspiration, a laparoscopic procedure seems to be the treatment of choice. For the preoperative workup ultrasound is essential; CT scan is to be favored if available. A large fenestration is easy to perform laparoscopically and thus the lymphocele is drained into the abdominal cavity. Because of the immunosuppressive treatment, adhesions hindering a laparoscopic approach are unusual. The conclusion is that surgeons trained in laparoscopic techniques have an important role in these infrequent abdominal problems.
Adult↗
Assessment of renal function in type I diabetic patients after kidney, pancreas, or combined kidney-pancreas transplantation.
The long-term kidney function (KF) in the three categories of diabetic type 1 pancreas (P) transplant recipients (simultaneous P and kidney [SPK]; P after K [PAK]; PTx alone [PTA] was studied sequentially over a 2-year period in 62 patients who received a bladder-drained allograft that functioned for at least 1 year. Fifty-three (85%) patients were analyzed at 1 month, 42 (68%) at 1 year, and 16 (26%) at 2 years posttransplant. Comparison of KF was made within each recipient category and between categories. In addition, the KF in the SPK and PAK patients was compared to a matched group of diabetic type 1 recipients of KTx alone (functioning at least 1 year). In the SPK group, KF was stable over time: the mean +/- SD serum creatinine (mg/dl) was 1.5 +/- 0.5 at 1 month, 1.8 +/- 1.0 at 1 year, and 1.7 +/- 0.5 at 2 years. In the PAK category, the pre-PTx serum creatinine value was 1.4 +/- 0.5, and then remained stable after the PTx (1.3 +/- 0.2 at 1 month, 1.3 +/- 0.4 at 1 year, and 1.2 +/- 0.4 at 2 years). In the recipients of a PTA, the values at 1 month (1.1 +/- 0.4), 1 year (1.4 +/- 0.5), and 2 years (1.3 +/- 0.5) were significantly higher (P less than or equal to 0.03) than the pre-PTx value (0.9 +/- 0.2); and results at 1 month and 2 years were lower than those at 1 year, a significant difference compared to the 1-month value (P = 0.01). Comparisons between the categories of PTx recipients demonstrated that the pre-PTx value in the PTA group (0.9 +/- 0.2) was significantly lower (P = 0.01) than in the PAK group (1.4 +/- 0.5). At 1 month the serum creatinine value in the PTA category (1.1 +/- 0.4) was significantly lower (P = 0.02) than in the SPK category (1.5 +/- 0.5), but thereafter (1 and 2 years) the difference was not significant (P greater than 0.1). KF in recipients of KTx alone was similar at each post-Tx time point when compared to the SPK and PAK categories. We concluded that a PTx can be performed in diabetics without a detrimental effect on a simultaneously or a previously transplanted kidney and that a statistically significant, albeit minimal to moderate, initial but not progressive deterioration in native KF occurs in recipients of a PTx alone.
Creatinine↗
LaparoLith. A new instrument for stone fragmentation in laparoscopic cholecystectomy.
Laparoscopic cholecystectomy can be performed with incisions of a maximum diameter of 10 mm. The removal of a stone-filled gallbladder at the end of an operation via the 10-mm port needs often-extensive tissue-consuming manipulations for stone removal or minilaparotomy. Stone fragmentation can be achieved by mechanical crushing and by ultrasound-, electrohydraulic-, and tunable dye laser lithotripsy. The clinical employment of the LaparoLith (Baxter Healthcare Corporation), an instrument which allows mechanical fragmentation of stones inside the gallbladder, is presented here. We have used the LaparoLith in nine patients and have been successful in stone fragmentation in seven of these. The LaparoLith seems to be helpful in laparoscopic cholecystectomy, preventing extension of the subnavel incision.
Cholecystectomy, Laparoscopic↗