[Chance ultrasonographic finding of lymphangioleiomyomatosis].
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Adult↗
Biomedical subjects
H Strunk
Publications and source records attributed to H Strunk.
[Tissue harmonic imaging in comparison with conventional sonography: effect on image quality and observer variability in the measurement of the intima-media thickness in the common carotid artery].
OBJECTIVE: The purpose of this study was to determine if tissue harmonic imaging (THI) produced a higher image quality than conventional sonography and if THI reduced the observer availability in the intima media thickness (IMT) measurements of the common carotid artery (ACC). SUBJECTS AND METHODS: A prospective study was performed on 26 healthy volunteers and IMT was assessed by three experienced sonographers in 52 carotid arteries. A 7.5 MHz transducer was used to measure carotid IMT in both harmonic and fundamental modes. Three measurements of IMT were carried out on the far wall of the ACC along a 1 cm-long section proximal to the bifurcation. Image quality was graded from 1-3 (1 = excellent, 2 = good, 3 = poor). IMT measurements using harmonic and fundamental modes were compared and intra- and inter-observer variability were calculated. Statistical analyses were performed using a kappa analysis, ANOVA and the McNemar/Wilcoxon Test. RESULTS: In the 52 cases image quality was excellent in 51% using THI in comparison to 32% using conventional sonography. Image quality was graded significantly more frequent as excellent using harmonic sonography as compared to conventional sonography (p = 0.001). A significant difference in IMT was found between the measurements obtained by harmonic imaging in comparison to those obtained by conventional imaging (p < 0.0001). Using the harmonic mode inter-observer variability of the IMT measurements was significantly reduced from 8.1% to 5.2% (p < 0.001). CONCLUSIONS: THI produced a higher image quality with a better visualisation of carotid IMT and reduced significantly the intra- and inter-observer variability in the IMT measurements.
Adult↗
[Locoregional chemoperfusion with mitoxantrone for palliative therapy in bleeding bladder cancer compared with embolization].
PURPOSE: To assess the efficacy of intraarterial chemoperfusion (CP) with mitoxantrone in patients with bleeding bladder cancer; comparison with the results of intraarterial embolization therapy (ET). MATERIALS AND METHODS: Thirty patients with urinary bladder cancer and intractable bladder hemorrhage were treated with intraarterial (i.a.) CP (15 patients) using Mitoxantron 820 mg/m2/1-2 h) and i.a. ET (15 patients) using Histoacryl or Ethibloc. Bleeding control rate, recurrence of hemorrhage, survival rate and complications were evaluated. RESULTS: Complete control of the hemorrhage was achieved in 14/15 and 12/15 of the patients with CP and ET, respectively. Hemorrhage stopped in CP patients after an interval of (4 to 15) 10 days, and within 24 hours in ET patients. Recurrence of hemorrhage was observed in 3/14 of CP and 4/13 of ET patients. The survival rate was 4-5 months in both groups. Complications were observed in ET patients only (7/22). Posttherapeutic pain occurred significantly more often in ET patients (20/22) than in CP patients (6/31 versus 20/22). CONCLUSION: Intra-arterial chemoperfusion using Mitoxantron is an effective therapy in patients with intractable urinary bladder hemorrhage. Due to the delayed effect in CP, ET should be used in patients with life-threatening bleeding.
Adult↗
Intraarterial HCC therapy with I-131-Lipiodol.
We report on our 2-year experience with intraarterial liver therapy with I-131-Lipiodol in patients with hepatocellular carcinoma in Germany. 30 therapies with intraarterial delivery of I-131-labeled Lipiodol were performed in 14 patients with hepatocellular carcinoma (HCC) with or without portal vein thrombosis during hepatic angiography. The patients were monitored for 1) distribution of Lipiodol by CT, 2) distribution of applied activity by planar scintigraphy and SPECT, and 3) tumor response by CT, MRT and 18-FDG-PET. In 5 patients the tumor size was reduced after the first treatment (responder). Eight patients, primarily with big tumors (> 7 cm), had stable (4) or progressive disease (4), and 1 patient died because of renal failure. CT and SPECT showed pronounced I-131-lipiodol accumulation in the tumor tissue in all patients with variable distribution patterns. One patient had an acute pancreatitis like syndrome together with elevation of liver enzymes, probably due to arterial spasm. 9 patients had transient and mild symptoms in the upper abdomen, fever to 40 degrees C, and a leukocytosis. Two patients had a transient mild elevation of pancreatic enzymes. All patients had a transient rise in liver enzymes. In conclusion, therapeutic efficacy was dependent on the tumor mass. Side effects due to the radiopharmaceutical were tolerable, and other side effects may result from the angiography procedure related manipulations. These results are encouraging for tumors up to a moderate mass.
Aged↗
Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study.
BACKGROUND: Recent small studies on hepatorenal syndrome (HRS) indicate some clinical benefit after transjugular intrahepatic portosystemic stent-shunt (TIPS) but sufficient long term data are lacking. AIM: We studied prospectively feasibility, safety, and long term survival after TIPS in 41 non-transplantable cirrhotics with HRS (phase II study). PATIENTS AND METHODS: HRS was diagnosed using current criteria (severe (type I) HRS, n=21; moderate (type II) HRS, n=20). Thirty one patients (14 type I, 17 type II) received TIPS (8-10 mm) while advanced liver failure excluded shunting in 10. During follow up (median 24 months) we analysed renal function and survival (Kaplan-Meier). RESULTS: TIPS markedly reduced the portal pressure gradient (21 (5) to 13 (4) mm Hg (mean (SD)); p<0.001) with one procedure related death (3.2%). Renal function deteriorated without TIPS but improved (p<0.001) within two weeks after TIPS (creatinine clearance 18 (15) to 48 (42) ml/min; sodium excretion 9 (16) to 77 (78) mmol/24 hours) and stabilised thereafter. Following TIPS, three, six, 12, and 18 month survival rates were 81%, 71%, 48%, and 35%, respectively. As only 10% of non-shunted patients survived three months, total survival rates were 63%, 56%, 39%, and 29%, respectively. Multivariate Cox regression analysis revealed bilirubin (p<0.001) and HRS type (p<0.05) as independent survival predictors after TIPS. CONCLUSIONS: TIPS provides long term renal function and probably survival benefits in the majority of non-transplantable cirrhotics with HRS. These data warrant controlled trials evaluating TIPS in the management of HRS.
Feasibility Studies↗
Detection of thrombosis in the portal venous system: comparison of contrast-enhanced MR angiography with intraarterial digital subtraction angiography.
PURPOSE: To determine whether intraarterial digital subtraction angiography (DSA) can be replaced by contrast material-enhanced magnetic resonance (MR) angiography in the assessment of patency or thrombosis of the portal venous system in patients with portal hypertension. MATERIALS AND METHODS: Thirty-six patients with portal hypertension underwent contrast-enhanced MR angiography and intraarterial DSA for assessment of the portal venous system. The images were evaluated for vessel patency or thrombosis of the portal, splenic, or superior mesenteric vein. RESULTS: Of the 101 vessels evaluated, 42 were thrombosed. Overall sensitivity, specificity, and accuracy for the detection of thrombosis were 100%, 98%, and 99%, respectively, for MR angiography and 91%, 100%, and 96%, respectively, for DSA; differences between the imaging methods were not statistically significant. Only in four patients with six vessels (6%) were there discordant findings between MR angiography and DSA. CONCLUSION: Noninvasive contrast-enhanced MR angiography has the potential to replace intraarterial DSA as the standard method to assess the whole portal venous system.
Adolescent↗
Bowel wall thickening on transabdominal sonography.
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Abdomen↗
[Variants of the hepatic artery: detection with color--coded sonography pre and post levovist injection].
PURPOSE: Detection of hepatic artery variants is of great clinical importance, for instance, pre liver transplantation, pre intraarterial chemotherapy or for measurement of the Doppler perfusion index. We therefore investigated how accurate variants of the hepatic artery can be detected using color-coded sonography pre and post Levovist injection. MATERIALS AND METHODS: 52 patients (21-78 years) were examined using color-coded sonography pre and post Levovist injection. After the sonographic examination, intraarterial digital subtraction angiography was performed and the results were compared. RESULTS: Using angiography 14 variants of the hepatic artery were detected in 13 patients. The most common variant in 10 patients were hepatic arteries originating from the superior mesenteric artery. This could be detected with unenhanced color-coded sonography in 8 and with enhanced sonography in 9 patients. In one patient in addition, a hepatogastric trunk was noted by angiography, this was not recognized by sonography. In 2 patients with a hepatogastric trunk, this variant was sonographically seen after Levovist injection in both but with unenhanced sonography in only 1 patient. CONCLUSION: Most variants of the arterial hepatic blood supply can be diagnosed using conventional color-coded sonography. In some cases enhanced sonography provides additional information, but even with these techniques all variations cannot be detected.
Adult↗
[Diagnosis and therapy of bronchial artery aneurysm].
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Adult↗
I-131-Lipiodol therapy in liver neoplasms.
Twelve patients with liver neoplasms [10 HCC, 1 CCC, 1 multiple breast cancer metastases (BCM)] were treated by transarterial I-131-Lipiodol. Computed tomography (CT) and single photon emission CT (SPECT) showed pronounced I-131-Lipiodol accumulation in the tumor tissue in all cases. In three patients with HCC a reduction of tumor size was achieved after the first treatment. The remaining patients had big tumor masses; 5 of these (4 HCC, 1 CCC) had stable disease after the first treatment, and 2 HCC were progressive. One patient died immediately after therapy due to other reasons. The BCM proved significant reduction in number and size. Eighteen-FDG-PET (positron emission tomography with fluor-18-deoxy-glucose) and CT controls showed in part different results with pretherapeutic PET proving high interindividual variability in tumor activity. Side effects were tolerable. In summary, the therapy procedure with transarterial I-131-Lipiodol is safe and effective in tumors with moderate tumor mass.
Aged↗
[Transjugular liver biopsy with a modified Tru-Cut system: a retrospective study of its successes and complications].
PURPOSE: Evaluation of success and complications in transjugular liver biopsy with a semiautomatic device. METHODS: A retrospective analysis of 27 transjugular liver biopsies with a modified Tru-Cut system was performed on 25 patients between 3/95 and 12/97. RESULTS: In 26 of 27 biopsies (96.4%) histopathologically useful liver parenchyma could be obtained. In only one case unspecific connective tissue was found. There were no clinically evident complications, only one parenchymal hematoma was observed by ultrasound (1/27 = 3.6%). CONCLUSION: The tested device was highly successful in obtaining liver biopsies on patients suffering from coagulopathies with a low complication rate and a simple use.
Adult↗
[Detection of an abdominal space-occupying lesion with CT after surgery of duodenal ulcer. Mycotic infected aneurysm of the gastroduodenal artery as a complication after surgery of duodenal ulcer].
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Aneurysm, Infected↗
[Chance ultrasonographic findings in a former chemical industry employee].
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Carcinogens↗
[Native and signal-enhanced power Doppler sonography for characterization of liver lesions].
PURPOSE: To evaluate the characterisation of liver lesions using power Doppler sonography before and after intravenous injection of the ultrasound contrast agent Levovist. MATERIALS AND METHODS: 39 patients with 41 liver lesions (10 haemangiomas, 2 focal nodular hyperplasias (FNH), 2 focal fatty infiltrations, 1 echinococcal lesion, 11 hepatocellular carcinomas, 14 metastases and one cholangiocarcinoma) were evaluated prospectively. Power Doppler images before and after intravenous injection of the ultrasound contrast agent Levovist were analysed by two radiologists and one gastroeterologist, who subjectively classified the distribution (peripheral, central, diffuse) and amount (none, minimal, moderate and strong) of flow pattern in each sonographic examination. Histological verification was obtained in all liver lesions, except in haemangiomas, where MR imaging and in one FNH where scintigraphy was regarded as sufficient proof. RESULTS: On the whole, power Doppler sonography after contrast injection was superior to unenhanced power Doppler-sonography in 20 liver lesions and equal in 7. After contrast injection, previously visible flow was enhanced in 14 patients, in 6 lesions flow was detected, which was not seen before in the power mode. Moderate or strong flow signals were detected before contrast injection in 8/26, post contrast injection in 18/26 malignant tumours. Contrawise, 13/15 benign lesions did show any or only minimal flow signals before and 10/15 after contrast injection. CONCLUSION: Intratumoural flow signals favour a malignant tumour. The absence of flow signals is a frequent finding in benign lesions but does not rule out malignancy.
Carcinoma, Hepatocellular↗
[TIPSS: technical and clinical results after 4 years].
PURPOSE: Retrospective analysis of the technical and clinical results after transjugular portosystemic stent shunt (TIPSS) procedure. METHOD: Between 1992 and 1996 we tried to establish a TIPSS in 90 patients. The indications were: recurrent variceal haemorrhage (n = 74), refractory ascites (n = 12), hepatorenal syndrome (HRS) (n = 4). Due to advanced liver cirrhosis 16 patients suffered of severe renal dysfunction (HRS). 57 patients had ascites. RESULTS: TIPSS implantation was technically successful in 96.7% (1992-1994: 5.1%, 1995-1996: 100%) of the patients. Complications occurred in 14.9% (1992-1994: 25.6%, 1995-1996: 6.3%). TIPSS-associated mortality was 2.3% (1992-1994: 5.1%, 1995-1996: 0%). 76.1% of the patients required reinterventions. 85.3% of reinterventions were necessary in the first year after TIPSS placement. The survival rate without reintervention was 28%, 21% and 9% for Child A, B, and C patients, respectively. Recurrent variceal haemorrhage occurred in 12.7%. De novo hepatic encephalopathy developed in 13.8%. Ascites improved in 79.2% and renal function in 75% of the patients. CONCLUSION: TIPSS is an effective method to treat recurrent variceal haemorrhage, refractory ascites and HRS. Complication and mortality rate depend on the investigator's experience and on the technique used.
Adult↗
[Visualization of renal arteries and value of color-coded duplex sonography in renal artery stenoses using an ultrasound signal enhancing agent].
PURPOSE: To assess whether the use of an echo-enhancing agent reliably allows the diagnosis of renal artery stenosis with colour-coded Doppler sonography. MATERIALS AND METHODS: We examined the main, segmental, and, if present, the accessory renal arteries of 31 patients before and after intravenous injection of Levovist using colour-coded Doppler sonography and compared the results with digital subtraction angiography. A rise in peak systolic velocity in the main renal artery and a reduction of the acceleration index in segmental arteries were used as parameters to detect renal artery stenosis. RESULTS: After i.v. administration of Levovist the main stem of the renal arteries could be well delineated in 36 of 62 cases (58%) during colour-coded Doppler sonography against 31 cases without Levovist. Taking only the visible cases in account the sensitivity of native as well as of enhanced colour-coded Doppler sonography of the renal main stem was 100%, the specificity was 96% and 94%, respectively. Only one of 11 accessory renal arteries was identified after echo enhancement. The segmental arteries were seen only after echo enhancement in 12 cases so that 60 of the total of 62 renal arteries (95%) could be evaluated. The sensitivity and specificity of the native examination were 67% and 70%. After echo enhancement sensitivity was 75% and specificity was 81%. CONCLUSION: Using an echo-enhancing agent the sensitivity and specificity for detection of relevant renal artery stenosis could only be slightly improved compared to the native examination.
Aged↗
[Splenic echinococcosis--a rare differential diagnosis in a cystic lesion of the spleen].
Cystic tumours of the spleen are generally rare and a parasitic origin is relatively improbable. Our case report, however, shows that in case of a splenic cyst, differential diagnosis must always consider the possibility of echinococcosis. We report on a patient suffering from a cystic lesion of the spleen where radiology yielded the final pointer to diagnosing an echinococcosis of the spleen.
Adult↗
[Diagnosis and therapy of Budd-Chiari syndrome].
PURPOSE: Budd-Chiari syndrome is a fairly uncommon disease in Europe. This often leads to its late diagnosis. The syndrome is characterised by portal hypertension and splanchnic congestion due to obstruction of hepatic venous outflow. This paper describes the treatment of three patients with Budd-Chiari syndrome by interventional therapeutic techniques and discusses alternative treatment modalities. PATIENTS AND METHODS: The first patient presented with veno-occlusive disease and was treated by the placement of a transjugular intrahepatic portosystemic stent-shunt. The second patient showed an occlusion of the major hepatic veins. After percutaneous recanalisation, a stent was placed in the right hepatic vein which remained patient. The third patient had a membranous obstruction of the right hepatic vein which was treated by percutaneous balloon dilatation. RESULTS: In all patients the clinical symptoms resolved completely after treatment and no complications were encountered. CONCLUSIONS: The authors conclude that interventional therapeutic techniques offer a wide variety of possibilities for the treatment of patients with Budd-Chiari syndrome and are safe, effective and relatively inexpensive. However, further studies are required to assess the long-term results and survival rates of these patients.
Adult↗