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Biomedical subjects

G W Kauffmann

Publications and source records attributed to G W Kauffmann.

157 records · Page 9Linked to original sources
PubMed1977

[Health care activities for outpatients with non-tuberculous lung diseases by the departments for pulmonary diseases and tuberculosis (author's transl)].

Development of capacities and activities of the outpatient departments for pulmonary diseases and tuberculosis (PALT) is represented by the annual reports. At present, patients with non-tuberculous lung diseases are prevailing. Most of them are sent by physicians working in basic public-health-service. Special diagnostic and therapy should be done in close co-operation with the family physicians, the industrial physicians and the hospital physicians; above all this specialized medical care has to contain activities, which are concentrated in these departments, because it is suitable for the patients.

Ambulatory Care↗
PubMedDate not supplied

Prolonged survival following palliative renal tumor embolization by capillary occlusion.

Nine patients with renal cell carcinoma and severe hematuria were palliatively treated with a new type of angioocclusion: the concept of capillary embolization. The so-called occlusion gel Ethibloc was used as embolizing agent. Each patient was followed up until death or for at least 4 years. All patients had a stage T3 or T4 tumor, 3 patients had metastases to multiple organs, 3 had lung metastases, and 3 were free of metastatic disease. In all cases, very high volumes (14-40 ml) of the embolizing agent were necessary to achieve total occlusion of the entire arterial compartment. Patients without metastatic disease had a mean survival time of 6 years and 4 months, all of them without signs of malignant disease. Patients with metastases had a mean survival time of 3 years. Compared with the natural history of renal cell carcinoma treated otherwise, this represents a substantial prolongation of survival time. Contrary to other angioocclusive treatment modalities, the concept of capillary occlusion with Ethibloc seems to achieve total tumor destruction.

Capillaries↗
PubMedDate not supplied

TNM staging of gastrointestinal tumors by hydrosonography: results of a histopathologically controlled study in 60 patients.

BACKGROUND: The study is a prospective evaluation of preoperative TNM staging of gastrointestinal tumors by hydrosonography (HUS). METHODS: Sixty patients with suspected gastric or colorectal cancer underwent HUS for TNM staging. All patients were operated on and the tumors completely removed when possible. HUS findings were correlated with histopathologic staging. RESULTS: HUS correctly localized tumors in 75% of patients. T stage accuracy was low for gastric cancers (41%). N staging of gastric cancers was accurate in 68% of all cases and was highly specific (100%). Staging was more accurate for colorectal tumors (70%), especially with respect to infiltration of other structures (sensitivity 100%, specificity 95%). N staging, however, was not reliable, mostly owing to impaired examination conditions. CONCLUSION: HUS easily misses tumors of the gastric cardia and distal part of the rectum. T staging of colorectal tumors with HUS is highly accurate, reaching 92% if the tumor is localized. T1 cancers of the stomach tend to be overstaged, and serosal infiltration by gastric cancers is often misjudged. With the exception of cardial gastric and distal rectal cancers, HUS comes close to endosonography for staging gastrointestinal tumors. HUS does not require intraluminal access.

Colorectal Neoplasms↗
PubMedDate not supplied

Experimental evaluation of early and long-term effects of microparticle embolization in two different mini-pig models. Part I: kidney.

PURPOSE: Using a pig model: (1) to evaluate the vascular distribution pattern, including the homogeneity and completeness of the intra-arterial microsphere distribution, of 40-120-microm trisacryl-gelatin microspheres (Embospheres) in acute whole-kidney embolization; (2) to evaluate the durability and biocompatibility of 40-120-microm trisacryl-gelatin microspheres (Embospheres) in chronic partial kidney embolization. METHODS: Twenty-two animals were divided into four groups: group 1 (n = 4) underwent total arterial renal occlusion with immediate euthanasia. Groups 2-4 had chronic superselective and partial renal embolization with increasing follow-up times: group 2 (n = 2), 1 week; group 3 (n = 7), 4 weeks; and group 4 (n = 9), 14 weeks. Key endpoints in group 1 were homogeneity and completeness of acute embolizations. In groups 2-4 the key endpoints were durability of embolization and particle-related inflammation in chronic partial embolizations as assessed by quantitative angiography or histomorphometry. A numerical angiographic occlusion score (0.0 to 4.0, where 3.0 is optimal) was developed to assess and quantify the angiographic durability of superselective embolizations (groups 2-4). RESULTS: In group 1, a relatively homogeneous distribution of the particles from segmental arteries to the precapillary level was shown by histomorphometry. Some particles reached the glomerular vas afferens (10 microm diameter). In groups 2-4, a mild recanalization appeared during follow-up. The immediate average postembolization occlusion score of 3.18 +/- 0.73 was reduced to 1.44 +/- 0.73 (statistically significant). Microscopy revealed subtotal necrosis but no foreign body granuloma formation. The intra-arterial appearance of giant cells closely attaching to the surface of the embolic spheres inside the vessel lumen was noted. Vessel walls showed major ischemic reactions. CONCLUSION: Microspheres 40-120 microm in diameter might achieve total occlusion of the arterial kidney vasculature when injected centrally as a result of their fairly homogeneous distribution. Segmental renal infarction occurs after chronic partial embolization despite recanalizations during follow-up. Only mild specific intra-arterial foreign body reactions were found.

Acrylic Resins↗
PubMedDate not supplied

Angiomorphometry in malignant tumors and inflammatory disease.

Angiographic differentiation of malignant and inflammatory lesions is occasionally impossible, since certain criteria for malignancy also apply to benign lesions. The authors analyzed samples of microangiographic specimens of kidneys with inflammation, tumor, and normal control organs to define mathematically the frequency of such angiographic parameters as caliber fluctuation, vascular avulsion, change of direction and diameter, and change in predominant vascular structure. The described method is transferred to clinical angiograms, and results of both groups are compared. In this preliminary analysis, caliber fluctuation appears to be the single most important criterion for differentiation of malignant and benign angiographic alterations.

Adenocarcinoma↗
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Experimental study of the effectiveness of capillary embolization using contrast-enhanced Ethibloc.

In experimental and clinical use, Ethibloc in combination with 40% glucose preinjection has proven to be of major advantage in tumor embolization. However, its low radiographic contrast is a limiting factor in monitoring its vascular distribution and venous propagation. Various contrast media were tested in order to enhance this contrast in laboratory and animal experiments. Normal rat kidneys (N = 96) and renal tumors, induced by Dimethylnitrosamine (N = 66) were tested as in previous studies. Ethibloc-N was produced by substituting Lipiodol for poppy seed oil which is an ingredient of the original Ethibloc. This proved to be the only embolization medium that combined the excellent properties of the original Ethibloc with increased contrast. All other embolization media tested resulted in new complications such as under-or overembolization and pulmonary embolism.

Animals↗
PubMedDate not supplied

MRI for staging of gastric carcinoma: first results of an experimental prospective study.

PURPOSE: Our goal was to define the accuracy of MRI in the staging of gastric carcinomas. METHOD: Twenty consecutive surgical specimens were imaged immediately after gastrectomy for gastric carcinoma. Imaging was performed with a 1.0 T imaging system. T1-weighted, T2-weighted, and opposed phase images were acquired and analyzed for tumor infiltration of the gastric wall and the presence of perigastric lymph nodes. T and N stages were classified according to the International Union Against Cancer classification. Finally histopathologic staging of the specimens was compared with staging by MRI. RESULTS: In gastric specimens, three to five layers of the gastric walls were visible. There were typical signal intensity patterns on T1-weighted, T2-weighted, and opposed phase images. Tumor diagnosis and lymph node detection were best achieved by opposed phase imaging. Nineteen of 20 (95%) carcinomas were localized by MRI; T staging accuracy was 65%. The sensitivity to detect metastatic lymph nodes was 87%, specificity 60%. N staging accuracy (nodes positive versus negative) was 80%. CONCLUSION: High resolution MRI of gastric tumors is possible ex vivo. MRI enabled differentiation of up to five layers of the gastric wall, and therefore staging of gastric carcinomas is technically possible. However, to evaluate the exact role of MRI as a staging tool of gastric carcinomas, a correlation between MR morphology and the histologic structure of the gastric wall has to be achieved first.

Carcinoma↗
PubMedDate not supplied

MRI of pouch-related fistulas in ulcerative colitis after restorative proctocolectomy.

PURPOSE: Our purpose was to determine the value of MRI in diagnosing pouch-related fistulas in patients with ulcerative colitis and to compare pulse sequences with and without contrast enhancement in their performance of visualization. METHOD: Forty-four patients with pelvic symptoms after restorative proctocolectomy underwent MRI. All 26 patients with pouch-related fistulas were treated surgically; 18 patients with pouchitis were treated conservatively. MRI was performed at 1.0 T with T1-weighted FLASH sequences before and after administration of Gd-DTPA, T2-weighted and proton density-weighted turbo SE sequences, and a T2-weighted fat saturation sequence. Images were analyzed for the presence of fistula; pulse sequences were additionally compared for best visualization on a four point scale of diagnostic confidence. RESULTS: MRI detected 23 of 26 cases of fistulas; there were no false-positive diagnoses. Surgery revealed fistulas in three cases in which no pathology was found on MRI. Two patients had a short sinus tract at the pouch-anal anastomosis, and a third patient had a pouch-vaginal fistula. The Gd-enhanced FLASH sequence obtained the highest score, and second best was the T2-weighted fat saturation technique. CONCLUSION: MRI is a valuable technique for diagnosing pouch-related fistulas, However, there are limitations in detection of short sinus tracts and pouch-vaginal fistulas. Highest diagnostic confidence is obtained with a Gd-enhanced FLASH sequence, which might be helpful after pelvic surgery or if the fact saturation technique is equivocal.

Adult↗
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Helical hydro-CT for diagnosis and staging of gastric carcinoma.

PURPOSE: The purpose of this work was to define the accuracy of helical hydro-CT (HHCT) in the diagnosis and staging of gastric carcinoma. METHOD: One hundred twelve patients with gastric carcinoma were preoperatively imaged by HHCT. Gastric distension was achieved by ingestion of up to 1,500 ml of water. Bolus tracking was performed, and peristalsis was minimized by intravenously administered spasmolytics. Contrast material was then injected, and helical scanning was performed at the time of peak enhancement of the liver. CT images were analyzed for tumor infiltration of the gastric wall, and TNM staging criteria were applied according to the International Union Against Cancer (UICC) classification. The results were correlated with histopathologic findings. RESULTS: One hundred two of 115 (89%) gastric carcinomas were correctly diagnosed by HHCT. Small malignant ulcers (< or =2 cm) that corresponded to early gastric carcinoma were not visible on CT scans. T and N staging accuracies were 51% each; abdominal M staging was correct in 79% of all cases. The positive and negative predictive values of HHCT to foresee curative resection of gastric carcinoma were 75 and 84%, respectively. CONCLUSION: Mural thickening as well as marked contrast enhancement of the gastric wall are firmly related to gastric carcinoma. The accuracy of HHCT is acceptable for M staging but inadequate for local staging of gastric carcinoma. Nonetheless, HHCT is a useful guide for choosing between tumor resection and nonoperative treatment of patients. We therefore recommend HHCT as the method of choice for preoperative imaging of gastric carcinoma.

Adult↗
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Percutaneous lithotripsy of renal calculi.

Percutaneous nephrostomy and stone removal was performed 240 times in 84 patients during a five-year period. Surgery was necessary in only two cases; hemorrhage requiring blood transfusion occurred in four. Perforation of the renal pelvis in five patients healed without sequelae. Final control of the nephrostomy was achieved in almost all cases. Indications and technical points regarding percutaneous lithotripsy are discussed.

Adolescent↗