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G H Mostbeck

Publications and source records attributed to G H Mostbeck.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Calcium in the lung or: it might not always be tuberculosis].

Pulmonary calcifications are a frequent finding in CT examinations of the chest. In many cases, characteristic CT morphology and distribution of pulmonary and mediastinal calcifications may lead to a straightforward specific diagnosis of the underlying disease. In that respect, calcifications are often the residual finding of previous infections. Less often, they may be due to neoplasms, metabolic disorders, occupational exposure or previous therapy. This review focuses on the etiology, pathogenesis and morphological CT features of pulmonary calcifications. A knowledge of the technical aspects of CT imaging is required to verify calcifications and avoid pitfalls.

Calcinosis↗
PubMed1996

[Ultrasound "screening examination" of the abdomen: of value or senseless?].

Screening examinations are diagnostic procedures without an individual indication with the purpose to detect a possible disease in an early, asymptomatic stage. Primary sonographic screening of the abdomen in individuals without any signs or symptoms of abdominal disease cannot be recommended. Secondary screening (sonographic examinations of the total abdomen in patients with unspecific symptoms) and to examine the remaining abdominal, pelvic and retroperitoneal organs which are not needed to answer the specific diagnostic question are procedures of doubtful benefit. However, ultrasound is recommended for specific screening programs, i.e. tumour detection or diagnosis of aneurysms, in those subpopulations with a high prevalence for the specific disease.

Abdomen↗
PubMed1996

[Evaluation system in assessing radiological examinations of clinical significance for the patient].

PURPOSE: The purpose of this study was to test a scoring system and its utility for the assessment of the clinical significance of radiological examinations. MATERIAL AND METHODS: The reports of all diagnostic studies obtained in patients with a clinical suspicion of pancreatitis, urinary tract obstruction, biliary or gallbladder diseases, ileus and gastrointestinal perforation were scored prospectively in 4 categories from 0 to 3. These categories were related to the ability to establish a definite diagnosis, to exclude suspected disease, to influence further diagnostic work-up and therapeutic decision-making. RESULTS: This scoring system showed significant differences of the efficacy of different imaging modalities in these 5 clinical settings. CONCLUSION: This scoring system was helpful to determine the clinical significance of radiological examinations.

Adult↗
PubMed1996

Three-dimensional spiral CT cholangiography in patients with suspected obstructive biliary disease: comparison with endoscopic retrograde cholangiography.

PURPOSE: To evaluate the diagnostic potential of spiral computed tomography (CT) performed after the administration of cholangiographic contrast material (spiral CT cholangiography) in patients with suspected obstructive biliary disease. MATERIALS AND METHODS: After infusion of meglumine iodoxamate, 29 patients underwent upper abdominal spiral CT with subsequent three-dimensional rendering of the biliary tract. In 27 patients, the presence, site, and extent of biliary obstruction were compared with that at endoscopic retrograde cholangiography (ERC). RESULTS: Spiral CT cholangiography correctly depicted biliary obstruction in 14 of 27 patients, with no false-positive or false-negative cases. In one patient, the precise length of a common bile duct stenosis could not be assessed with spiral CT cholangiography. ERC demonstrated intrahepatic ductal stenoses more clearly in two patients. In two patients with hilar cholangiocarcinomas, spiral CT cholangiography depicted undrained areas not seen with ERC. CONCLUSION: Spiral CT cholangiography allows accurate assessment of the biliary system in patients with suspected obstructive biliary disease.

Adult↗
PubMed1996

Deep venous thrombosis of the lower extremity: efficacy of spiral CT venography compared with conventional venography in diagnosis.

PURPOSE: To compare the efficacy of spiral computed tomographic (CT) venography with conventional venography in the diagnosis of suspected deep venous thrombosis (DVT). MATERIALS AND METHODS: In a prospective study, 52 consecutive patients with clinically suspected unilateral or bilateral DVT were studied with CT venography and conventional venography. In cases in which conventional venographic findings were inconclusive, color-coded duplex sonography and follow-up examinations were performed to make a final diagnosis. CT venography of both extremities covered a 100-cm section from the ankle to the inferior vena cava (IVC). Contrast material diluted with saline was injected in a dorsal vein of each foot. CT and conventional venography (including color-coded duplex sonography and follow-up findings) were correlated for three venous regions for each patient. RESULTS: Correlation was excellent between CT and conventional venographic findings in the detection of DVT. The sensitivity of CT venography was 100% (confidence interval: 0.92, 1.00), specificity was 96% (confidence interval: 0.84, 0.98), positive predictive value was 91%, and negative predictive value was 100%. CT venography more clearly demonstrated thrombus extension of DVT into the pelvic veins and IVC than conventional venography alone. CONCLUSION: CT venography is a valuable tool in the diagnosis of DVT. Compared with conventional venography, CT requires use of 80% less contrast material.

Contrast Media↗
PubMed1996

Distinction between obstructive and nonobstructive hydronephrosis: value of diuresis duplex Doppler sonography.

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of diuresis duplex Doppler sonography in distinguishing between obstructive and nonobstructive hydronephrosis by calculating the resistive indexes before and after administration of furosemide. SUBJECTS AND METHODS: We prospectively studied 48 kidneys in 26 patients with suspected chronic renal obstruction. All patients underwent diuretic renography and duplex Doppler sonography before and after administration of furosemide. According to the findings at diuretic renography, kidneys were classified as nonobstructed (n = 12), indeterminate (n =9), obstructed (n = 8), or normal (n = 19). The mean resistive index of each kidney and the difference between the mean resistive indexes of both kidneys were calculated before and after administration of 0.5 mg furosemide per kilogram of body weight. A receiver operating characteristic curve was generated to determine the discriminatory resistive index value for diagnosing obstruction. RESULTS: Resistive indexes were not significantly different between kidneys with nonobstructive dilatation and normal kidneys before and after diuresis. Significant differences in resistive indexes before and after diuresis were seen between kidneys with obstructive dilatation and kidneys with nonobstructive dilatation, and between normal kidneys. Kidneys with obstructive dilatation showed a significant increase in resistive index after administration of furosemide. In the indeterminate kidneys, furosemide had a heterogeneous effect on the resistive indexes, indicating obstructive resistive indexes in five kidneys and nonobstructive resistive indexes in four kidneys. Receiver operating characteristic analysis revealed a diuresis resistive index of 0.75, which resulted in an accuracy rate of 95% in diagnosing renal obstruction. CONCLUSION: Diuresis duplex Doppler sonography is accurate in the differentiation of obstructed from nonobstructed kidneys and may facilitate the distinction between obstructive and nonobstructive hydronephrosis, notably in kidneys classified as indeterminate according to diuretic renography.

Diuresis↗
PubMed1996

Preoperative imaging of lower extremity varicose veins: color coded duplex sonography or venography.

We prospectively examined 137 limbs in 112 consecutive patients with clinical evidence of severe varicosis by color coded duplex sonography and ascending venography (including varicography in 48 limbs) to evaluate the diagnostic capabilities of color coded duplex sonography in the assessment of venous anatomy, variant varicosis, postthrombotic changes, and incompetence of the superficial and perforating venous system. Additionally, descending venography was performed in the first 52 limbs and compared to color coded duplex sonography in the diagnosis of deep and superficial venous reflux. Variant venous anatomy (21 cases) was missed in two limbs and misinterpreted in one limb by ascending venography compared to surgery. Color coded duplex sonography was inconclusive in two cases. Variant varicosis (59 cases) was missed in seven surgically proved cases by venography and in one case by color coded duplex sonography. Color coded duplex sonography was inconclusive in five cases. Ascending venography was slightly superior to color coded duplex sonography in the detection of postphlebitic changes. Good agreement was found between color coded duplex sonography and descending venography in the grading of superficial (k = 0.75) and deep venous reflux (k = 0.79). Excellent agreement was found between ascending venography in the grading of long (k = 0.96) and short (k = 0.94) saphenous vein reflux. More incompetent perforating veins were detected by ascending venography, (and varicography) than by color coded duplex sonography, but the latter technique allows direct preoperative marking of the skin, which is beneficial for the surgeon. We conclude that color coded duplex sonography is a valuable imaging tool before venous stripping and is capable of replacing invasive ascending and descending venography. Only patients with inconclusive color coded duplex sonographic results (e.g., complex variant venous anatomy) should proceed to venography.

Adult↗
PubMed1996

Power Doppler versus color Doppler imaging in renal allograft evaluation.

The purpose of this study was to evaluate the impact of PDS compared to conventional CDI in the followup of 72 renal allograft patients. Renal allograft vascularization, assessed by PDS and CDI, was scored from 0 to 4, where 0 was the cortical "blush" and 4 was residual central perfusion. These scores were correlated with the resistive index, serum creatinine levels, hematocrit, and, in 35 cases, biopsy results. PDS scores of renal perfusion were one grade lower than CDI scores in 59 of 72 patients and two grades lower in two of 72 patients. A statistically significant correlation was found between PDS scores and the RI (r2 = 0.6, P < 0.05). However, no significant correlation was found between PDS scores and creatinine levels or hematocrit values. PDS scores are not related to histologic findings in renal allograft dysfunction. Overall, five biopsy-related arteriovenous fistulas were detected, two of which were missed on the initial PDS examination. In conclusion, PDS provides more complete visualization of the renal allograft vessel tree than CDI. However, biopsy-related arteriovenous fistulas are better seen by CDI.

Biopsy↗
PubMed1996

Randomized comparison of sitting and prone positions for stereotactic fine-needle aspiration breast biopsy.

In a prospective randomized study, 103 women had stereotactic biopsies performed either in the prone (n = 51) or sitting (n = 52) position. Questionnaires were administered before and after biopsy, to measure anxiety, pain and subjective experience in all patients. Vasovagal reactions were scored from 0 to 2 according to severity. There was no significant difference between biopsies performed in the sitting or the prone position with regard to overall tolerance. Significantly more patients biopsied in the prone position (15 of 51, 29 per cent) than in the sitting position (seven of 52, 13 per cent) would prefer premedication before a repeat biopsy (P = 0.04). Of the total patient group, three women fainted, one in the prone position and two others in the sitting position. Breast biopsies performed in the prone or sitting position are equally well tolerated. Somatic reactions such as fainting are not a major problem during breast biopsy; however, attention should be focused on patient care, including information given before the procedure.

Anxiety↗
PubMed1995

Diabetes insipidus in Langerhans cell histiocytosis: results from the DAL-HX 83 study.

Diabetes insipidus (DI) in Langerhans cell histiocytosis (LCH) is a common complication of unclear etiology. The incidence varies among different publications from 15% to 50%. In the prospective DAL-HX 83 study, 19 out of 199 patients (9.5%) registered with newly diagnosed LCH were diagnosed to have DI. All patients were stratified according to uniform criteria. One hundred and six patients with disseminated disease were treated with standardized polychemotherapy promptly after diagnosis. At the time of diagnosis of LCH, DI was already established in 8 out of 199 patients (4%). After diagnosis, DI occurred in only one out of the remaining 91 patients with localized disease (1%) and in 10 out of 100 remaining patients with disseminated disease (10%). In 8 patients, the onset of DI was associated with other signs of active LCH. The cumulative risk to develop DI after a median observation time of 5 years 3 months was 11%. Retrospective analysis of clinical features revealed multisystem involvement, skull and orbital lesions, and in particular intracranial extension from osseous lesions to constitute risk factors for DI. Magnetic resonance imaging studies (MRI) were available in 12 patients and showed abnormalities of the pituitary region in 10 children. In none of the patients with established DI was it reversed or ameliorated by any treatment. However, the rapid institution of systemic chemotherapy for disseminated disease seems to prevent the occurrence of DI and may be responsible for the low frequency of DI in the DAL-HX83 study.

Adolescent↗
PubMed1995

[The experiences of a hospital radiology department with outside referrals for the preoperative marking of suspicious breast lesions].

PURPOSE: To outline the experience of a referral radiology department with preoperative localisation procedures on the basic of mammograms obtained by other facilities. MATERIAL AND METHODS: 342 consecutive female patients aged 56.5 +/- 11.9 years underwent preoperative breast localisation procedures prior to surgery. Of these patients 241 had their mammograms obtained in various private practices and 101 in the radiology department. Retrospectively all mammograms were classified by lesions morphology, lesion size and presence or absence of calcifications. RESULTS: The overall benign-to-malignant ratio (B/M-ratio) was 1.7:1. In the referred patient group the B/M-ratio was 1.9:1, compared to a B/M-ratio of 1.3:1 obtained by the radiology department. Referred patients presented significantly (p < 0.001) more often with calcifications that patients from the radiology department. CONCLUSION: Possible factors for the higher B/M-ratio in referred patients are prompt referral to surgical biopsy, misinterpretation of mammograms, failure in the written report, lack of a second opinion and lack of feedback and communication between surgeon, pathologist and radiologist.

Aged↗
PubMed1995

[Malignant neoplasms after kidney transplantation: value of an annual radiological screening program].

PURPOSE: To evaluate the prevalence of malignant neoplasms after renal transplantation by means of a radiological screening programme and to determine the role of some clinical and demographic parameters concerning pathogenesis of these malignancies. MATERIAL AND METHODS: Between November 1992 and June 1994 in a prospective study 504 consecutive renal allograft recipients (331 m, 173 f) aged 51 +/- 13 years underwent routine abdominal ultrasound examinations including the renal transplant and p.a. and lateral chest x-rays once a year. RESULTS: This screening programme revealed 11 malignant neoplasms in 11 patients (2.2%). We detected 6 renal cell carcinomas (RCC) in the patient's native kidneys, two RCCs in two renal allografts, two non-Hodgkin-lymphomas in the liver and the renal allograft, respectively, and one ovarial carcinoma. Patients with renal cell carcinomas in the native kidneys were significantly older than allograft recipients without tumors. The presence of acquired cystic kidney disease (ACKD) seems to be an additional risk for the development of RCC. There were no significant differences in the time on dialysis, the time with functional renal allograft, and the immunosuppressive therapy. CONCLUSION: Yearly abdominal ultrasound screening including the renal allograft is a valuable tool for the early detection of neoplasms in asymptomatic renal allograft recipients. However, routine yearly chest x-rays should not be performed in renal allograft recipients without preexisting tumours.

Adult↗
PubMed1995

Prevalence of acquired cystic kidney disease and tumors in native kidneys of renal transplant recipients: a prospective US study.

PURPOSE: To determine the prevalence of acquired cystic kidney disease (ACKD) and renal neoplasms in the native kidneys of renal transplant recipients. MATERIALS AND METHODS: The ultrasound (US) scans in 385 renal allograft recipients were prospectively studied. In addition, 65 patients with ACKD underwent two additional US examinations on different days to assess intra- and interobserver variability with regard to the number of cysts and their diameter. RESULTS: ACKD was present in 96 of 385 patients. Patients with ACKD were significantly older than patients without ACKD, had undergone hemodialysis for a longer period, and were predominantly men. There was no significant difference in the time with functioning graft. Renal cell carcinoma (RCC) was diagnosed in six patients at histologic examination. Of these six patients, five had evidence of ACKD. CONCLUSION: The frequency of ACKD increases with the duration of hemodialysis. The risk for the development of ACKD is increased in men and older patients. The malignant potential of ACKD persists after renal transplantation.

Adult↗
PubMed1994

Evaluation of left atrial contribution to left ventricular filling in aortic stenosis by velocity-encoded cine MRI.

Velocity-encoded cine MRI (VEC-MRI) can measure volume flow at specified site in the heart. This study used VEC-MRI to measure flow across the mitral valve to compare the contribution of atrial systole to left atrial filling in normal subjects and patients with left ventricular hypertrophy. The study population consisted of 12 normal subjects (mean age 34.5 years) and nine patients with various degrees of left ventricular hypertrophy resulting from aortic stenosis (mean age 70 years). VEC-MRI was performed in double-oblique planes through the heart to measure both the mitral inflow velocity pattern (E/A ratio) and the volumetric flow across the mitral valve. The left atrial contribution to left ventricular filling (AC%) was calculated. The results were compared with Doppler echocardiographic parameters. The VEC-MRI-derived mitral E/A ratios showed a significant linear correlation with E/A ratios calculated from Doppler echocardiography (r = 0.94), and the VEC-MRI-derived E/A ratios (2.1 +/- 0.5 vs 1.0 +/- 0.4) and AC% values (24.9 +/- 7.2 vs 45.7 +/- 16.4) were significantly different between normal subjects and patients with aortic stenosis (p < 0.01 in both groups). The same differences were seen in the Doppler echocardiographic parameters. The VEC-MRI-derived E/A ratio and AC% showed significant hyperbolic and linear correlations with left ventricular mass indexes (r = 0.95 and 0.86). In addition, the VEC-MRI-determined E/A ratio and the volumetric AC% displayed a highly significant hyperbolic correlation (r = 0.95). Thus VEC-MRI can be used to evaluate left ventricular diastolic filling characteristics in normal subjects and patients with abnormalities of diastolic filling.

Adult↗
PubMed1994

[Breast ductal carcinoma in situ. The clinical image in the mammogram].

Thirty-one consecutive cases of ductal carcinoma in situ (DCIS) were retrospectively analysed to determine the spectrum of mammographic appearances. 68 per cent of the lesions appeared as microcalcifications, 52% as structural or irregular, poorly defined soft-tissue abnormalities, respectively. A mass lesion was noted in 23% of cases. 4 patients presenting with DCIS had negative mammograms and were diagnosed by means of additional examination techniques such as galactography, sonography, and cytologic evaluation in case of bloody nipple discharge. The authors conclude that there is a wide spectrum of mammographic imaging of DCIS.

Adult↗
PubMed1994

[Ultrasound-guided fine-needle biopsy with an automatic full-incision system: the initial experiences and comparison with a conventional biopsy gun].

The purpose of this study was to evaluate the efficacy of a new automatic biopsy device (Autovac, Angiomed, Karlsruhe, Germany) in ultrasound (US) guided biopsies of focal abdominal lesions. 50 consecutive patients with focal abdominal lesions underwent US guided biopsies. In the first 24 patients, needle passes were performed with the Autovac system (outer diameter 0.95 mm) as well as with the Biopty gun (outer diameter 0.9 mm) (Bard Covington, USA). The size and the quality of the histologic and the cytologic material obtained by both systems were evaluated by histopathologists blinded to the system used. Autovac yielded significantly more material (defined as the area of the obtained tissue cores) and a significantly higher quality score than did the Biopty system. 96% of the histologic specimen and 100% of the cytologic smears obtained with Autovac were diagnostic, compared to 70 and 81% with Biopty, respectively. With the exception of a short-time elevation of the blood pressure in one patient, no complications occurred. The results indicate an advantage of the automatic full-cut type system Autovac over the tru-cut type Biopty gun in US-guided biopsies of focal abdominal lesions.

Abdomen↗