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Biomedical subjects

J Brossmann

Publications and source records attributed to J Brossmann.

At least 91 records · Page 5Linked to original sources
PubMed1996

Shoulder impingement syndrome: influence of shoulder position on rotator cuff impingement--an anatomic study.

OBJECTIVE: The purpose of the study was to investigate the relationship of the distal supraspinatus tendon to the coracoacromial arch on radiographs and MR imaging at various shoulder positions. MATERIALS AND METHODS: Radiopaque and gadolinium-impregnated markers were sutured to the distal aspect of the supraspinatus tendon and along the coracoacromial ligament in three cadavers. While varying positions of the shoulder, we obtained gross anatomic visualization, radiographs, and MR images. RESULTS: Impingement of the distal aspect of the supraspinatus tendon between the acromion and the greater tuberosity of the humerus was well visualized during forward flexion and abduction of more than 30 degrees. Shoulder impingement was best seen at 60 degrees forward flexion, 60 degrees abduction, and internal rotation. CONCLUSION: MR imaging of different shoulder positions may help reveal the pathogenesis of shoulder impingement syndrome.

Aged↗
PubMed1996

[The initial results of percutaneous therapy of popliteal aneurysms with stents].

PURPOSE: Are percutaneous stents a therapeutic alternative to bypass surgery in the treatment of popliteal aneurysms? MATERIAL AND METHODS: Three patients with femoropopliteal occlusion related to popliteal aneurysms were treated percutaneously. In two cases coated stents were used. In the third patient who underwent prior bypass surgery due to local fibrinolysis a reperfusion of the aneurysm occurred. He was treated with a Wallstent. RESULTS: Primary stent treatment was successful in all cases. There were no complications. One patient was lost to follow-up. One of the two coated stents occluded after one month due to a poor run-off of only one lower limb artery. The other coated stent is still patent after 6 months proven by angiography. CONCLUSION: Percutaneous therapy with coated stents could be an alternative to surgical bypass therapy for popliteal aneurysms. Obviously long-time patency is related to sufficient run-off.

Aged↗
PubMed1996

Spiral CT angiography and selective digital subtraction angiography of internal carotid artery stenosis.

PURPOSE: To determine whether spiral CT angiography allows accurate, quantitative evaluation of anatomic abnormalities, including detection of additional lesions, delineation of plaque morphology, and estimation of degree of internal carotid artery stenosis. METHODS: Spiral CT angiography with a maximum intensity projection technique was compared with selective digital subtraction angiography (DSA) in 92 carotid arteries. The category of stenosis was determined according to the North American Symptomatic Carotid Endarterectomy Trial: mild (0% to 29%), moderate (30% to 69%), severe (70% to 99%), and occlusion (100%). RESULTS: In 78 (85%) of the 92 cases, spiral CT angiography and selective DSA demonstrated the same degree of stenosis. All occlusions (n = 19) were diagnosed correctly with spiral CT angiography. Spiral CT angiography agreed with selective DSA in the classification of stenosis in 59% of the group with mild stenosis, in 82% of the group with moderate stenosis, and in 90% of the group with severe stenosis. In the groups with mild (n = 13), moderate (n = 9), and severe (n = 27) stenosis, correlation of spiral CT angiography with selective DSA was significant. Calcified plaques were readily diagnosed with the use of spiral CT angiography but delineation of ulcers was poor. Tandem lesions were not visible owing to the limited coverage. CONCLUSION: Spiral CT angiography is useful for the detection of proximal internal carotid stenoses that are greater than 30%. Depiction of mild stenoses appears to be limited. CT is superior for the detection of calcified plaques but it is not useful for the detection of ulcers.

Adult↗
PubMed1996

[CT-guided punctures: diagnostic value, therapeutic consequences and economic aspects].

PURPOSE: To evaluate the diagnostic and clinical relevance and therapeutic consequences of CT-guided biopsy with regard to economic aspects. METHODS: 213 CT-guided biopsies in 190 patients were evaluated. All information regarding patient referral, reason for request, body region, underlying diagnosis, and clinical consequences were registered over a period of 22.2 +/- 9.4 month. RESULTS: Patient referral to biopsy was mainly from the departments of surgery, internal medicine, and radiotherapy with the question of tumor and metastasis. Less than 5% of biopsies were performed in outpatients. Main regions were the lung (39%), the abdomen (35%), and the skeleton (11%). Biopsy and surgical histology corresponded in 73%. Largest diagnosis groups were benign unspecific tissues or other benign lesions in 24%. As a result of CTP no further procedures were necessary in 22.5%. Follow-up studies or conservative treatment were indicated in 11.3%. Surgical procedures were needed in only 15.5%. There was only one complication requiring therapy. CONCLUSION: CT-guided biopsy is a safe procedure, which helps to avoid unneccessary cost-intensive diagnostics and surgical treatment. If CTP is performed early and in outpatients residence time in the hospital is reduced and thus money is saved.

Adult↗
PubMed1996

[Spiral CT angiography versus DSA in detection of carotid stenoses].

PURPOSE: To determine the value of spiral CT angiography for evaluation of internal carotid artery stenosis. METHODS: Spiral CT angiography was compared with selective intraarterial DSA in 40 patients with 72 internal carotid artery stenoses. Quantification of stenoses was performed according to the NASCET-study and categorized in mild (0-29%), moderate (30-69%), severe (70-99%) and occlusion (100%). RESULTS: The total agreement of spiral CT angiography with DSA in all stenoses was 78% (r = 0.933; p < 0.0001). In the mild stenoses group there was an agreement of 56% (r = 0.598; p = 138), in the moderate stenosis group there was an agreement of 59% (0.623; p = 0.0128) and in the group with severe stenosis the agreement was 97% (0.944; p < 0.0001). All occlusions were correctly interpreted by spiral CT angiography (r = 1; p = 0.0082). CONCLUSION: The agreement of spiral CT angiography with DSA is good. Especially SCTA allows a good correlation in the severe stenosis group and in the occlusion group. DSA remains the standard of reference, because of its ability to demonstrate tandem lesions and collateral flow.

Adult↗
PubMed1995

Cine MR imaging before and after realignment surgery for patellar maltracking -- comparison with axial radiographs.

OBJECTIVE: Comparison of motion-triggered cine magnetic resonance (MR) imaging and conventional radiographs for the assessment of operative results of patellar realignment. SUBJECTS AND METHODS: Fifteen patients with recurrent patellar dislocation or patellar subluxation were evaluated with conventional axial radiographs before and after realignment surgery by measuring the congruence angle (CA), lateral patellofemoral angle (LPFA), and lateral displacement (d). In eight patients the patellofemoral joint was additionally evaluated pre- and postoperatively with motion-triggered cine MR imaging by determining the bisect offset (BSO), lateral patellar displacement (LPD), and patellar tilt angle (PTA). RESULTS AND CONCLUSIONS: Significant differences between the pre- and postoperative measurements were found for all MR imaging parameters (BSO, LPD, PTA: p<0.01) but not for the conventional X-ray parameters (CA: p = 0.70, LPFA: p = 0.56; d: p = 0.04). Motion-triggered cine MR imaging was superior to conventional tangential radiographs for assessing the effectiveness of patellar realignment surgery.

Adolescent↗
PubMed1995

[The initial results of spiral CT angiography in demonstrating stenoses of the a. carotis].

PURPOSE: To determine the value of spiral CT angiography in Maximum Intensity Projection (MIP)-technique for evaluation of carotid artery stenosis. METHODS: A comparison of the MIP technique with intraarterial DSA was done in 24 patients with 40 stenoses. Quantification of stenosis was determined according to the NASCET study: mild (0-29%), moderate (30-69%), severe (70-99%) and occlusion (100%). RESULTS: Totally the correlation of spiral CT angiography with DSA was 80% (r = 0.93; p = 0.0001). In the moderate stenosis group (r = 1; p = 0.1573), severe stenosis group (r = 0.89; p = 0.002) and the occlusion group (r = 1; p = 0.0009) there was a good correlation with DSA. In the mild stenosis group (r = 0.55; p = 0.0704) correlation of spiral CT angiography with DSA was poor. Spiral CT angiography allows an excellent delineation of calcifications. Tandem lesions and collateral flow cannot be shown with spiral CT angiography. CONCLUSION: Intraarterial DSA remains the gold standard for evaluation of carotid artery stenosis, because DSA is the modality which shows the whole length of the carotid artery and yields information on tandem lesions and collateral flow.

Adult↗
PubMed1995

[Venous stent application with a simultaneous cubitofemoral approach].

In 4 patients with superior inflow obstruction caused by stenosis or occlusion of the central veins it was not possible to pass the guide wire from transfemoral. An additional transbrachial access was applied to avoid the stenosis or occlusions. Patency of the veins from transbrachial was achieved in all cases. After pulling the extensively long guide wire through the still horizontal venous lock, successful Wallstent application was performed from transfemoral in all 4 patients. No peri-interventional or post-interventional complications were seen during 2 days follow-up.

Aged↗
PubMed1995

[CT angiography in the follow-up after carotid endarterectomy].

PURPOSE: To prove the usefulness and clinical value of early CT angiography with maximum intensity projection after carotid endarterectomy: for demonstrating postoperative results. METHODS: In 16 patients with angiographically confirmed 20 high grade stenoses of internal carotid artery CT angiography was performed before and after carotid surgery within 7 days. The evaluation of successful surgery was related to complete plaque removal and patency of internal carotid artery after endarterectomy based on preoperative CT angiography. Classification of stenosis was performed according to the NASCET study. RESULTS: In 2/20 cases severe stenoses remained after surgery, which were demonstrated using CT angiography and confirmed by digital subtraction arteriography. 3/20 cases showed mild stenosis and 15/20 were normal. CONCLUSION: CT angiography is best suited to evaluate results after carotid surgery. The method enables delineation of complete removal of calcified plaque and patency of carotid artery.

Aged↗
PubMed1995

[A modified technic for local rt-PA catheter-mediated lysis].

PURPOSE: To develop an economic and efficient concept for more time-saving local rt-PA thrombolysis therapy. METHOD: 40 patients with peripheral vascular occlusive disease stage IIb-III according to the Fontaine classification and with angiographically proven occluded segments of pelvic and lower limb arteries were treated by a modified concept of local rt-PA catheter thrombolysis. Via a thin guide wire the catheter for thrombolysis is slowly advanced through the thrombus without fluoroscopic control, outside the room in which angiography is performed. In 24 cases a short-term lysis and in 16 cases a long-term lysis was carried out. RESULTS: The initial success rate was 75%, the patency rate in six months' follow-up was 66.7%. The ankle-brachial index decreased from 0.4 +/- 0.3 to 0.8 +/- 0.2 on the average. There were no relevant clinical complications. The average occupancy time of the angiography room or table was 60 +/- 52 min, the average time of fluoroscopy was 17 +/- 13 min. CONCLUSION: In modified local rt-PA thrombolysis, short-term lysis and long-term lysis were mostly performed outside the angiography room, so that the exposure to radiation and there fore the radiation dose were reduced for both the patient and the attending staff. The angiography room is thus available for other patients and can therefore be used more efficiently.

Adult↗
PubMed1995

In vivo P-31-MR-spectroscopy of focal hepatic lesions. Effectiveness of tumor detection in clinical practice and experimental studies of surface coil characteristics and localization technique.

RATIONALE AND OBJECTIVES: The influence of partial tumor sampling in a volume of interest (VOI) on the ratios of phosphorus metabolites was examined by localized phosphorus magnetic resonance spectroscopy (P-31-MRS). Experiments were performed to investigate the characteristics of the surface coil used and precession of spatial localization. METHODS: A total of 24 patients with liver metastases and 20 volunteers were studied by P-31-MRS. Patients were divided in two groups: VOI < 50% (n = 8) and VOI > 50% (n = 16) occupied by tumor. For evaluation of the surface coil and localization method (image selected in vivo spectroscopy), phantom studies were performed. RESULTS: Superficial focal liver tumors were detectable with a surface coil at a distance within the coil radius. The image selected in vivo spectroscopy permitted the study of phosphorus metabolism in a defined VOI, phosphomonoester/beta-adenosine triphosphate and phosphodiester/beta-adenosine triphosphate were elevated significantly in spectra of both patient groups. CONCLUSIONS: Detection of small tumor volumes within a VOI filled by less than 50% of the tumor is possible, with results statistically different from that in normal volunteers.

Adult↗
PubMed1995

Application of the maximum entropy method for evaluating phosphorus-31-magnetic resonance spectra in patients with liver metastases.

RATIONALE AND OBJECTIVES: The clinical feasibility and application of the maximum entropy method for data analysis from in vivo phosphorus-31-magnetic resonance (P-31-MR) spectra of the liver were determined. METHODS: Image-guided localized P-31-MR spectroscopy was performed in 24 patients with liver metastases and in 20 healthy volunteers. The spectra were obtained with a whole body scanner operating at 1.5 T using a surface coil. Phosphomonoester/beta-adenosine triphosphate (ATP), phosphodiester/beta-ATP, and inorganic phosphate/beta-ATP were calculated from the maximum entropy method-spectra and from spectra evaluated with standard data processing (Fourier transformation spectra). RESULTS: Phosphomonoester/beta-ATP and phosphodiester/beta-ATP were increased significantly with both methods in patients' spectra. Maximum entropy method spectra showed a distinct pattern with low noise. It was easier to determine peak borders and to attach resonances to the different metabolites using this method. CONCLUSIONS: Maximum entropy method is an alternative method for evaluation and quantification of P-31-MR spectra data and is preferred to standard data processing with Fourier transformation in cases of reduced signal-to-noise ratio of spectra.

Aged↗
PubMed1995

Theoretical considerations and in vitro results for the development of percutaneous transcatheter balloon embolectomy.

RATIONALE AND OBJECTIVES: To prove the feasibility of performing percutaneous transcatheter embolectomy using a funnel-shaped catheter tip and balloon embolectomy catheters. METHODS: A theoretical model is described to assess the influence of the diameter of an introductory device and coaxially introduced embolectomy catheter. A funnel-shaped catheter tip was attached to 7F, 8F, and 9F introductory sheaths. In vitro embolectomy of 5 g and 12 g thrombi was performed with 3F and 4F embolectomy catheters. RESULTS: The number of extractions required was significantly related to the ratio of the diameters of the sheaths and embolectomy catheter shafts. The combination of a 7F sheath with a 4F embolectomy catheter required the greatest number of extractions (8.4 +/- 1.7). The least number of extractions was needed for the combination of a 9F sheath with 4F and 3F embolectomy catheters (1.6 +/- 0.7 and 1.8 +/- 0.4, respectively). CONCLUSIONS: Our results indicate that percutaneous embolectomy with balloon embolectomy catheters is feasible. However, further research is necessary before the final catheter design is chosen.

Catheterization↗
PubMed1995

Plantar compartments of the foot: MR appearance in cadavers and diabetic patients.

PURPOSE: To demonstrate the plantar compartments of the foot on magnetic resonance (MR) images. MATERIALS AND METHODS: The plantar compartments of four cadaveric feet underwent MR imaging and were sectioned. Fifteen MR studies in 11 patients with compartmental fluid were evaluated. The epicenter of infection was determined from review of the history, radiographs, and MR images. RESULTS: In the cadaveric feet, distribution of contrast material conformed to the compartmental anatomic features. MR findings in the specimen correlated exactly with gross findings. All seven feet with infection centered at the second through fourth metatarsal heads demonstrated only central compartment fluid. In seven of eight feet with a more medial or lateral epicenter of infection, fluid was seen in the lateral or medial compartment and in the central compartment. In one foot with a lateral epicenter of infection, fluid was confined to the lateral compartment. CONCLUSION: MR imaging accurately depicts the compartmental anatomic features of the foot.

Cadaver↗
PubMed1995

[Functional MRI of the femoropatellar joint].

Conventional X-ray examinations of the patellofemoral joint in 30 degrees, 60 degrees and 90 degrees of knee flexion demonstrate the position of the patella. On the other hand, they have been shown to be insufficient for the diagnosis of patellofemoral maltracking in the critical range between 30 degrees of flexion and full extension. Motion-triggered and ultrafast MRI offer new possibilities for functional diagnosis of the patello-femoral joint under active knee motion. Functional MRI of the patellofemoral joint is suggested as an alternative to arthroscopy, particularly in patients with anterior knee pain or suspected patellar maltracking.

Arthroscopy↗
PubMed1995

[Spiral CT of the thorax with double table feed in relation to slice thickness].

PURPOSE: The aim of the study was to reduce investigation time, radiation dose, and contrast material when performing spiral-CT of the thorax. METHODS: 50 patients with different clinical diagnoses underwent spiral-CT of the thorax with double table feed and 45 ml contrast material (lopentol) were injected. Density measurements were performed as follows: main pulmonary artery without contrast injection, carotid artery, subclavian artery, ascending and descending aorta, aortic arch, main pulmonary artery and thoracic aorta after contrast injection. RESULTS: In comparison to the density of the main pulmonary artery without contrast injection there was an increase of density of 134 HU. 45 ml of the contrast agent were sufficient in all cases for delineation of the mediastinal vessels. Investigation time was 16-18 s and all patients were able to hold their breath during this time, so no artifacts were seen. Radiation dose was cut in half. CONCLUSION: Spiral-CT with double table feed enables investigations of the thorax in less than 20s. 45 ml of a contrast agent are sufficient for performing this examination. There are no essential diagnostic deficits with this technique.

Absorptiometry, Photon↗