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Biomedical subjects

H Strunk

Publications and source records attributed to H Strunk.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Duplex ultrasonographic diagnosis of renal artery stenosis by intrarenal acceleration determination and recognition of the tardus-parvus phenomenon with special regard to multiple renal arteries].

PURPOSE: Use of the "tardus and parvus" abnormalities for the exclusion of significant renal artery stenosis, including multiple renal arteries. METHOD: The lobar and interlobar renal arteries of 50 hypertensive patients were examined by colour duplex sonography at three different levels. Analysis included determination of the early systolic acceleration time and evaluation of the early diastolic complexes. In all patients, intra-arterial catheter angiography was performed on the following day. RESULTS: 48 out of the 50 colour duplex examinations could be properly evaluated. Angiography showed that 21 patients (42%) had multiple renal arteries, in 13 there was a haemodynamically significant renal artery stenosis and amongst these 4 patients had bilateral renal artery stenoses. The sensitivity and specificity of the early systolic acceleration time at > or = 0.120 sec. was 77 and 46% respectively. Amongst the 17 haemodynamically significant stenoses shown by angiography, 10 demonstrated changes in the early systolic peaks of the Doppler spectrum, a sensitivity of 69% and specificity of 90%. CONCLUSION: Use of acceleration time and of the early systolic complexes cannot be recommended as sole methods during a screening procedure.

Adult↗
PubMed1995

[Stent implantation as a palliative therapeutic measure in tumor-induced stenoses of the large veins of the body].

PURPOSE: Self-expandable metallic stents were used to treat patients with malignant venous obstructions to determine their effectiveness in producing symptomatic palliation. METHODS: 20 patients with a total of 28 tumour-induced obstructions of the superior vena cava (n = 13), the inferior vena cava (n = 4), the subclavian (n = 4), the innominate (n = 5) and the iliac veins (n = 2) were treated with self-expandable metallic stents. 38 Gianturco stents and 21 Wallstents were applied. Patients were heparinised during the procedure and up to three days afterwards. RESULTS: In all patients correct positioning of the stents was achieved. In 16 patients stent placement resulted in relief of their symptoms. In 8 patients the symptoms completely disappeared without recurrence until death as a result of tumour progression. The follow-up ranged from 10 days to 14 months. In 8 still living patients no re-obstruction occurred (follow-up average three months). In one patient thrombotic stent occlusion occurred 6 days after the procedure; the v. cava superior was reopened again by local urokinase therapy. Three patients finally developed re-occlusion due to tumour progression. In one patient stent placement was complicated by migration of the Gianturco stent one day after stent implantation and reocclusion of the subclavian vein. CONCLUSION: The application of self-expandable metallic stents in patients with malignant venous obstruction is a useful palliative therapy.

Adult↗
PubMed1994

[Gadolinium-DTPA (Magnevist) as contrast medium for arterial DSA].

16 DSA investigations using intra-arterial Gd-DTPA were performed on 12 patients. The contrast medium was administered either as a 0.5 molar gadolinium solution (commercially available) or diluted with distilled water to a 0.2-0.4 molar gadolinium solution. The injection was made either by pressure injector or by hand. The aortic arch, abdominal aorta and pelvic and lower limb arteries were examined. 14 of the 16 procedures were diagnostically adequate, but compared with iodinated contrast materials, contrast was less marked. There were no cardiovascular, neurological or allergic side effects. Three patients suffered a feeling of heat and one patient had mild pain during the injection. Even large volumes rapidly injected (up to 20 ml/s of the commercially available solution) were well tolerated. DSA with intra-arterial Gd-DTPA seems to be a suitable alternative for vascular imaging if iodine-containing contrast materials are contraindicated.

Angiography, Digital Subtraction↗
PubMed1994

[Computerized tomography in diagnosis of lung metastases: improvement with the spiral technique].

Computed tomography is the imaging modality of choice for detection or exclusion of pulmonary metastases. In most cases these are spheric, multiple, bilateral, and located in the peripheral areas of the middle and lower fields of the lungs. Differential diagnosis of solitary pulmonary nodules is difficult. Evaluating whether they are malignant or benign is insufficient despite the application of multiple CT criteria. Spiral computed tomography acquiring an imaging volume in a breathhold has led to significant improvement in the sensitivity of detecting pulmonary nodules. Imaging protocols are presented, and the influence of the different parameters is discussed. Although not all pulmonary metastases may be detected with spiral computed tomography, it is the most important examination when considering pulmonary metastasectomy. Computed tomography is the imaging modality of choice when monitoring pulmonary metastases during systemic therapeutic regimens by measuring all nodules or "indicator lesions."

Diagnosis, Differential↗
PubMed1994

[Computerized tomography of kidney tumors].

Among 220 renal tumors which we detected by computed tomography, there were 168 renal cell carcinomas, 24 tumor of the renal pelvis, 16 angiomyolipomas, 6 Wilms tumors, 3 oncocytomas, one liposarcoma, one mesenchymal tumor, and one rhabdomyosarcoma. Computed tomography had the highest accuracy of the diagnostic procedures with a sensitivity of 99.5% and a specificity of 98%. 83% of the renal cell carcinomas showed signs of malignancy in computed tomography; the staging of the renal tumors by computed tomography was correct in 67% of the cases. The diagnostic value of other diagnostic tools (sonography, urography, angiography, cavography) of renal tumors is discussed in terms of our own results.

Adolescent↗
PubMed1993

[Carbon dioxide--contrast medium for digital subtraction angiography].

UNLABELLED: Fundamental considerations: Despite appreciable improvements in conventional iodine-containing contrast media, vascular studies involving patients with renal insufficiency, hyperthyroidism or known allergic reaction to conventional contrast media continue to pose a problem. Own study: Testing the investigation of the possibility of visualizing vessels using carbon dioxide as a gaseous contrast medium. In 30 patients, angiography of the pelvis and legs (DSA) employing conventional iodine-containing media and/or CO2 were carried out simultaneously. RESULTS, handling and toleration were compared. In two further patients, percutaneous transluminal angioplasty and stent implantation, respectively, were successfully performed under CO2 control. RESULTS: All the findings obtained with "normal" DSA were also obtainable with CO2. The CO2 examination, however, was often plagued by incomplete contrasting of the blood vessels, with interruption of the contrast medium column, which made assessment more difficult. In two of the 30 patients undergoing angiography of the pelvis and legs, the investigation had to be abandoned on account of persistent intensive lower abdominal pain under CO2 injection.

Angiography, Digital Subtraction↗
PubMed1993

[Spiral CT with three-dimensional (3D) surface reconstruction in assessing solitary pulmonary foci].

Recently it has been thought possible to characterise a pulmonary lesion by its vascular involvement. The complex vascular relationships are difficult to demonstrate by the "normal" technique of transverse CT sections. Spiral CT with 3D-surface reconstruction makes it possible to evaluate the vessels accurately and simulates the appearances one would have by looking into the thorax with a demonstration of all vessels lying within the pulmonary space examined by CT. Venous involvement was shown in every one of 18 malignant lesions but was also found in 4 out of 11 benign lesions, arterial involvement occurred in 14 out of 18 malignant and in 2 benign lesions. CT evidence of vascular involvement is in favour of a malignant tumour but is no absolute proof.

Computer Graphics↗
PubMed1993

[Selective blood sampling from the sinus petrosus inferior: a comparison of CRF and TRH stimulation].

In 10 patients with hypophyseal Cushing microadenomas, selective bilateral sampling from the inferior petrosal sinuses was performed and the effect of stimulation by iv TRH and CRF was compared. On the side of the microadenoma. ACTH concentration rose from 650 +/- 242 pg/ml to 2712 +/- 843 pg/ml following injection of CRF and 2025 +/- 242 pg/ml after TRH. Contralateral values were 165 +/- 79 pg/ml, 490 +/- 200 pg/ml and 165 +/- 72 pg/ml respectively. Prolactin concentration on the side of the adenoma was 98 +/- 49 ng/ml before stimulation, 236 +/- 62 ng/ml after CRF and 747 +/- 168 ng/ml after TRH. Contralateral concentration was 22 +/- 10 ng/ml, 64 +/- 19 ng/ml respectively. Sampling localised all adenomas correctly, whereas contrast-enhanced MRT diagnosed only four adenomas.

Adenoma↗
PubMed1993

[Retrograde venous occlusion--therapy of impotence of venous origin].

Retrograde occlusion of penile drainage veins can produce improvement in patients with impotence due to venous leaks. We performed 50 transfemoral and three transjugular procedures; 46 (86%) were technically successful. Clinical improvement was found in 24 out of the 46 procedures (52%). In 20 patients spontaneous intercourse became possible, in four this occurred after intracavernous injection of vaso-active substances. In eleven patients there was deterioration after one to twenty months; in seven this was treated by repeated venous occlusion. In 13 patients improvement has been maintained over a period of one to thirty months (average 10.5 months). There were no complications.

Angiography↗
PubMed1993

[The safety belt: effects on injury patterns of automobile passengers].

Since 1984 the law concerning safety belts has been implemented; this paper deals with the findings in 386 victims of motor accidents who were x-rayed between 1981 and 1989. Minor injuries have been ignored. The number of passengers wearing belts increased by 30% after 1984. The number of passenger injuries did not decrease. Injuries directly caused by the belts included a small number of fractures of clavicles, the sternum and ribs and one pelvic fracture, one serious abdominal injury with tearing of the mesenteric artery and one ruptured spleen. An indirect result of wearing seat belts was a marked increase in cervical whiplash injuries and some increase in thoracic vertebral fractures. None of the belt induced injuries proved fatal. Amongst those using seat belts there was a significantly lower fatality rate and injuries causing prolonged disability. In particular, using seat belts, serious injuries to the skull and brain were reduced by 80%. Similarly injuries to the abdomen, the odontoid, pelvis and hip joint were greatly reduced. The advantages of wearing a seat belt greatly outweigh the disadvantages.

Accidents, Traffic↗
PubMed1993

Percutaneous ultrasonic angioplasty: initial results of an in-vitro study on normal and atherosclerotic human vessel segments.

The aim of the present study was to assess the efficacy and safety of a new ultrasound catheter system in vitro before employing it in humans. Ultrasound energy was applied to 141 normal and atherosclerotic human vessel segments, obtained at autopsy. Macroscopical and histological examination of the treated vessel segments revealed that ultrasound energy is atraumatic to the normal vessel wall. In atherosclerotic vessel segments, there was macroscopically significant reduction in the size of plaques. In 7/10 completely occluded femoral arterial segments, recanalization could be achieved. The resulting lumen approximated the diameter of the wire probe. Therefore, ultrasound energy is an appealing form of energy for recanalization of completely obstructed atherosclerotic vessels and for disintegration of atherosclerotic plaques. Clinically, ultrasonic angioplasty may become an adjunctive modality to balloon angioplasty.

Angioplasty, Balloon↗
PubMed1993

[Injuries of the thoracic skeleton].

Injuries of the thoracic skeleton are an important indicator of other, relevant traumatic changes after a polytrauma. Most fractures occur in the ribs, followed by fractures of the clavicle, the scapula and the sternum. Because of their high kinetic energy, car accidents are the main reason for thoracic fractures. The basic radiologic tool is the a.p. projection of the thorax in supine position; in addition, other conventional x-ray examinations or computed tomography are performed. Most thoracic fractures are treated conservatively, only in few cases (instability of the thorax, risk of pseudoarthrosis, incongruence of joint surfaces) surgical procedures are used.

Clavicle↗
PubMed1992

[Ultrasound-proven adrenal gland tumor. References for diagnostic management].

Due to the increasing number of ultrasonographic examinations, tumors of the adrenal glands are being detected more and more often. In the present paper, suggestions for the further diagnostic evaluation are made: in the case of sonographically detected solid tumors of the adrenals, computed tomography is the next procedure of choice. If CT scan also fails to enable an unequivocal diagnosis, the next step must be laboratory investigations. Hormone-producing tumors, irrespective of size, as well as non-hormone-producing tumors larger than 6 cm in diameter or symptomatic neoplasms are all treated by surgery. In the case of an oncological patient with an asymptomatic non-hormone-producing tumor, differential diagnosis via needle aspiration should be attempted in all tumors measuring less than 6 cm in diameter. In the event of an incidental finding, fine needle aspiration is performed only in lesions measuring between 4 and 6 cm; for tumors of less than 4 cm, we consider a wait-and-see approach, with follow-up examinations at 3-month intervals to be justified.

Adrenal Gland Neoplasms↗
PubMed1992

[Percutaneous sonographic angioplasty. Initial experimental results].

Aim of the present study was to examine in vitro the effects of a new ultrasound catheter system on atherosclerotic and normal vessels before employing the system in humans. 141 attempts were made on 32 vascular preparations obtained at autopsy. The vessels were opened longitudinally within 24 hours of death, dilated with gelatine and were then "treated" in a waterbath using varying degrees of pressure, angle of incidence, sound intensity and duration of sound. Macroscopic and histological examinations of the preparation showed no morphological change in normal vessels except evidence of pressure by the catheter. In particular, there were no perforations of the vessel wall. In atherosclerotic segments there was significant reduction in the size of plaques following treatment.

Angioplasty, Balloon↗
PubMed1992

[The incidence of focal liver lesions in patients with colorectal carcinoma].

The preoperative sonographic findings in 166 patients with confirmed colorectal carcinomas were analysed to determine the frequency of focal liver lesions. In 15 patients liver metastases were found at the first examination and in a further 16 patients they were detected subsequently. Homogeneous high-intensity echoes were found in only one patient. Cysts occurred in 13 and haemangiomas in 11 patients. The latter showed solitary lesions which exceeded 25 mm in only one patient and otherwise measured between 6 mm and 15 mm. Focal abnormalities of fat distribution were found in 12 patients. Even in a tumor patient, the first differential diagnosis of a solitary, homogeneous liver lesion of less than 2 cm is a hemangioma and further investigation is mandatory.

Colorectal Neoplasms↗
PubMed1992

[Long-term observation after percutaneous transluminal angioplasty in the pelvic and leg areas].

In this study 163 patients had long term follow ups after PTA; the value of a test which had previously hardly been used, the "Cox proportional hazards model", for prognostic purposes is stressed. In this test account is taken of the severity of the stenosis before PTA, the extent of re-stenosis following PTA and the distance of the occlusion from the aorta and these are related to the likelihood of success. The use of the Cox proportional hazards model with an accurate description of the clinical material and the use of the Kaplan-Meier method is recommended in order to obtain comparable figures for the results obtained in various centres. In this study patency after six months was 77%, after a year 67%, after three years 46% and after five years 37%.

Angioplasty, Balloon↗
PubMed1992

[Distribution of the incidence of sonographically detected focal liver changes in patients with colorectal cancer].

Aim of the following study was to investigate how often liver metastases are detected in oncologic patients as compared to other focal liver lesions. Preoperative sonographic examinations of 209 patients with proven colonic or rectal cancer were studied. In 19 liver metastases were detected, which in only one patient were homogeneous echogenic. Liver cysts were found in 17, hemangiomas in 15 patients, all of whom where solitary lesions and between 6 and 25 mm in diameter. Focal fatty infiltration was diagnosed in 14 patients. In conclusion, a sonographically detected liver lesion, which is homogeneous echogenic and less than 20 mm in size, is most likely to be a hemangioma and should be further investigated, if therapeutically relevant.

Colorectal Neoplasms↗