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H J Brambs

Publications and source records attributed to H J Brambs.

At least 19 recordsLinked to original sources
PubMed1997

[Radiation exposure in digital micturition cystourethrography in children. How much exposure by fluoroscopy?].

OBJECTIVE: Determination of the proportion of the dose-area product caused by fluoroscopy at voiding cystourethrography in children, using digital image intensifier technology. PATIENTS AND METHODS: Using computer-assisted dosimetry, we determined the dose-area product and the respective proportions of the dose-area product caused by fluoroscopy and radiography as well as the number of radiographs taken at a given examination of 40 children (8 children less than 2 years old, 15 children between 2 and 6 years old and 17 children between 6 and 15 years old). RESULTS: The computer software program correctly differentiated between fluoroscopy and radiography in 80% of cases. Incorrect results were primarily observed in newborns and young children. The total radiation dose ranged in relation to patient age from 22 to 651 cGy x cm2. Fluoroscopy was responsible for an average 78% of the applied radiation dose. CONCLUSION: Computer-assisted dosimetry is useful in determining the proportion of the dose-area product caused by fluoroscopy in older children undergoing voiding cystourethrography. When image intensifier technology is used, this accounts for more than 75% of the total radiation dose. The method is not suitable for use in small children.

Adolescent↗
PubMed1997

Bone and soft tissue manifestations of alveolar echinococcosis.

OBJECTIVE: The present study demonstrates the osseous and soft tissue manifestations of alveolar echinococcosis (AE). PATIENTS: We report on eight patients with AE with bone or soft tissue involvement confirmed at biopsy or needle cytology. RESULTS: All eight patients showed hepatic involvement. Four exhibited infiltration of the spine as a result of direct spread of the hepatic primary lesion; distant metastases were observed in only three of these patients. Calcifications, which are typical for hepatic manifestations of the disease, were observed in soft tissue in only two of eight cases (25%); we observed no instances of endovesicular daughter cysts. CONCLUSIONS: AE manifests itself in the vertebral column as a form of spondylitis and in soft tissue presents similar to an abscess. Since in most of these cases spread of the disease per continuitatem from the liver is present, the diagnosis is easily made from the characteristic hepatic findings.

Adult↗
PubMed1997

[Interventional treatment of hemobilia].

PURPOSE: Aim of the study was to assess the use of embolisation in cases of iatrogenic haemobilia. METHOD: In 18 patients with severe haemobilia after percutaneous biliary system drainage or stent implantation, an embolisation with minicoils (17 x) or gelfoam particles, was performed. To achieve a sufficient vascular obstruction, Histoacryl (4 x) or Ethibloc (1 x) were additionally used in five cases. A transarterial approach was used in 17 cases. In one patient, an approach through the biliary system was possible. RESULTS: In all cases, the bleeding source was identified (5 false aneurysms, three biliary leaks, 9 irregularities at the junction of the artery and drainage catheter, 1 multiple collaterals at the proximal end of the stent). In 17 out of 18 cases, haemorrhage ceased definitely. In one case of a patient with pancreas carcinoma and obstruction of the portal vein as well as a simultaneous high grade stenosis of the hepatic artery propria, it was only possible to embolise small collaterals to avoid liver necrosis. This resulted in an incomplete bleeding of control. An infected haematoma was the only complication. It was treated by drainage over 10 days. During an observation period ranging approximately 7.6 months, 10 of the patients died due to their basic illness. CONCLUSION: Embolisation is an effective procedure in the treatment of haemobilia, with a low complication rate.

Aged↗
PubMed1997

Mechanical thrombectomy of embolic occlusion in both the profunda femoris and superficial femoral arteries in critical limb ischaemia.

We report our preliminary experience using the Amplatz device for percutaneous thromboembolectomy in acute occlusion in both the profunda femoris artery (PFA) and superficial femoral artery (SFA) in four patients (mean age 78.5 years). All patients suffered from acute lower limb ischaemia, Fontaine Grade 3, due to cardiac embolization. Estimated occlusion times range from 3 h to 3 days. All four patients were treated successfully. Device activation time for both the PFA and the SFA was 85 s +/- 15 s. Total procedure time was 25 min +/- 10 min. There was no need for adjunctive procedures or intensive care monitoring. We conclude that the Amplatz device is a very effective and safe procedure for the quick restoration of vascular patency in cases of simultaneous embolically occluded PFA and SFA.

Acute Disease↗
PubMed1997

MRI of breast cancer: influence of chemotherapy on sensitivity.

MR mammography (MRM) seems to be a sensitive method for detection of breast cancer. The effect of cytotoxic agents on the dynamics of contrast medium uptake in primary breast carcinoma or recurrent disease is not known. This study addresses this question and evaluates MRM as a method of monitoring therapeutic success. A total of 13 patients (age range 34-62 years) with histologically confirmed breast cancer were investigated. The patients received neoadjuvant intravenous (iv) chemotherapy. MRM and interpretation of the dynamic measurements were performed in a standardized manner after positioning the patient in a double breast coil. A gradient echo sequence (Flash 3D, TE 5 ms, TR 12 ms, flip angle 25 degrees) was acquired before and 1, 2, 3 and 8 min after intravenous injection of Gd-DTPA 0.15 mmol kg-1 body weight. A T2 weighted SE sequence (TE 103 ms, TR 6900 ms, 4 mm, field of view 350 mm) was also obtained. MRM was performed prior to histological evaluation and after chemotherapy. All cases of malignancy were correctly diagnosed with MRM. Based on MR findings, eight patients were classified as "responders" and the remaining as "non-responders". In the "responders" a flattening of the Gd-DTPA uptake curve after the first cycle of chemotherapy of complete absence of Gd-DTPA uptake after the fourth cycle was observed. The change in Gd-DTPA uptake behaviour led to an underestimation of the extent of tumour in two patients and false negative findings in four patients. MRM provides information regarding response to therapy following the first cycle. MRM does not provide information regarding invasive tumour tissue in "responders".

Adult↗
PubMed1997

MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults.

OBJECTIVE: Our objective was to determine the accuracy, precision, and reliability of MR imaging as a technique for measurement of the femoral antetorsional angle. SUBJECTS AND METHODS: We used MR imaging to measure anteversion of the femoral neck in 44 patients: 19 children (range, 3-17 years old; mean, 11 years old) and 25 adults (range, 18-83 years old; mean, 29 years old). RESULTS: We found a high correlation between MR imaging and CT measurements (r = 77). On CT, the mean angle for children was 34 degrees and for adults it was 22.2 degrees. On MR imaging, the mean angle for children was 23.22 degrees and for adults it was 15.71 degrees. The mean anteversion angles obtained by CT exceeded those obtained by MR imaging. Mean interobserver and intraobserver agreements were high for MR imaging (r = .97 and r = .97, respectively) and for CT (r = .99 and r = .96, respectively). CONCLUSION: Compared with CT as the gold standard, MR imaging measurement of femoral anteversion allows precise anatomic measurements and produces reliable, reproducible results. MR imaging is recommended for preoperative planning in pediatric patients with femoral rotation osteotomies.

Adult↗
PubMed1997

Musculoskeletal involvement in cystic echinococcosis: report of eight cases and review of the literature.

OBJECTIVE: Our purpose was to describe the morphologic appearance of musculoskeletal lesions in patients with cystic echinococcosis shown by CT and MR imaging. CONCLUSION: Patients with musculoskeletal lesions of cystic echinococcosis typically have cystic structures in adjacent soft tissues. These cysts morphologically resemble abscesses, with peripheral uptake of contrast medium and variable signal intensities on T1-weighted MR images. The absence of calcifications or endovesicular daughter cysts does not exclude the diagnosis of cystic echinococcosis.

Adult↗
PubMed1996

[Space-occupying lesions in the liver--rational step-wise diagnosis].

For high diagnostic quality, it is crucial that the examiner has an exact knowledge of the liver tumor pathology in order to search for characteristic criteria. On the other hand knowledge of the overall spectrum of all diagnostic possibilities would also be necessary, for isolated cases, i.e. to be able to select in an individual clinical situation the critical investigation or the efficient sequence of investigations, in order to produce a swift and reliable diagnosis. With it, however, comes the aggravation of perpetual technical improvements in the tomographic imaging technique, and a wide variety of contrast mediums are constantly being developed and introduced, causing continuous problems in taking the right decision.

Carcinoma, Hepatocellular↗
PubMed1996

Treatment of bile duct stones: value of laser lithotripsy delivered via percutaneous endoscopy.

Extraction of stones from the bile ducts via standard endoscopic techniques, a percutaneous transhepatic approach, or a T-tube track can be unsuccessful. We report our preliminary experience with a combination of percutaneous cholangioscopy and dye laser lithotripsy. Flash lamp-excited dye laser (504 nm) lithotripsy delivered by percutaneous cholangioscopy (12 F) was evaluated in 13 patients with stones in the bile ducts. Conventional endoscopic treatment had not been attempted in 4 patients after hepaticojejunostomy and had failed in 3 patients after gastric bypass surgery or gastrectomy, and in 6 patients because of technical difficulties, i.e. due mainly to largeness of stones. In 12 patients a percutaneous transhepatic route was used. In 1 patient the T-tube track was used as access to the bile ducts. Laser lithotripsy resulted in successful fragmentation of stones in 12 patients (92%). The bile ducts cleared spontaneously in 2 patients only. Using additional techniques, i.e. sphincterotomy and stent insertion, the overall combined success rate for duct clearance after laser fragmentation was 100%. Four patients had a retrograde endoscopic sphincterotomy after failed attempts for stone removal at endoscopic retrograde cholangioscopy. Two patients had an antegrade fluoroscopically monitored sphincterotomy. Bleeding complications occurred in 2 patients. This accounted for a high rate (15%) of severe complications. The intrahepatic bleeding in 1 patient was due to an intrahepatic vessel injury by the 13-F sheath. The periampullary bleeding in the other patient occurred after an antegrade papillotomy. Pulsed dye laser lithotripsy proved to be an effective technique in patients with difficult bile duct stones. The main problem of a per cutaneous approach is the complete removal of the fragmented stones, which requires additional procedures in most cases. The percutaneous access is time-consuming and bears a relatively high risk of major bleeding complications. It should therefore be restricted to cases in which conventional endoscopic procedures are impossible or unsuccessful.

Adult↗
PubMed1996

[Solid pseudopapillary tumors of the pancreas].

We report on three female patients with solid pseudopapillary tumors of the pancreas. The histogenetic origin of this entity is still unclear. The tumor, usually occurring in young women, forms large masses (up to 10 cm in diameter) before becoming symptomatic. Metastases have very rarely been reported. In contrast to other pancreatic tumors, the main pancreatic duct was displaced, but of normal caliber without stenosis, in all our patients. Despite the large size of the tumors, they were curatively resected in all three cases. Two of the tumors infiltrated the parenchyma or adipose tissue of the pancreas but did not spread into the lymph nodes or other organs. All of the patients are alive and without signs of tumor recurrence up to 8 years after surgical resection.

Adult↗