[Nuclear medical diagnosis of the abdominal organs].
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Abdomen↗
Biomedical subjects
J Lammer
Publications and source records attributed to J Lammer.
[Dose-effect relationship of glucagon on the stomach, pylorus and duodenum].
The effect of glucagon on the stomach, pylorus and duodenum was evaluated within the first 30 minutes p.i. Glucagon was administered intravenously in a dose of 0.1, 0.2, 0.4, 0.6 and 1 mg. The hypotonic effect was greater on the duodenum than on the stomach. The dose response of the pylorus was not uniform. It was possible to point out a direct relationship between the intensity and duration of the hypotonic effect and the administered dosage.
Adult↗
Carcinomatous metastases to the colon simulating Crohn's disease.
Multifocal lymphatic and hematogeneous metastatic infiltration of the colon by anaplastic carcinoma is described. The radiological and endoscopic examinations gave reason to believe that the patient was suffering from Crohn's disease. Only deep biopsy revealed the correct diagnosis. Clinical and pathological problems arising in the diagnosis are discussed.
Adult↗
[Computer tomographic diagnosis of pancreatitis and pancreatic cancer].
The article reports on 78 CT scans of surgically verified diseases of the pancreas, namely, 30 cases of chronic pancreatitis, 12 cases of haemorrhagic-necrotizing pancreatitis, and 36 cases of carcinoma of the pancreas. 12 of these cases were operable, whereas 234 were inoperable. The operable carcinomas were so small that proper diagnosis was effected in 50% only, whereas the inoperable carcinomas eluded CT identification in 17% of the cases only. The most important signs of an operable carcinoma of the pancreas are a well-defined enlargement and inhomogeneity of the parenchyma with reduced contrast, especially on bolus injection, as well as dilatation of the bile duct system. The most essential criteria for inoperability are absence of boundaries, especially towards the dorsal side, with infiltration of the retroperitoneal fatty tissue, and lack of delineation of the large vessels. According to the present state of the art, CT does not supply definite criteria for differentiating between an operable carcinoma of the pancreas and chronic fibrotic pancreatitis. Overstepping of the marginal contours is a reliably distinctive feature between carcinoma and pancreatitis, but it also points to the inoperable nature of the disease. Haemorrhagic-necrotizing pancreatitis is characterized by definite CT criteria, so that diagnosis is easy.
Adult↗
[Experience with endoscopic papillotomy (author's transl)].
The results of 64 endoscopic papillotomies (EPT) are reported. When precautions are taken the EPT is a highly effective procedure of low risk. The minimal stress for the patient, the high accuracy and the low number of complications guarantee this method a prominent place in the treatment of bile duct illnesses. Control examinations of 30 patients to 12 months after operation proved all patients symptom-free and neither biochemical nor clinical evidence of cholangitis or other complications.
Adult↗
[Proof of the jejunogastric bile reflux after BII partial gastrectomy using 99mTc diethyl-IDA (author's transl)].
A history was obtained and barium meal and gastroscopy performed on 42 patients after a Billroth II partial gastrectomy. In order to demonstrate and quantify jejuno-gastric bile reflux, hepato-biliary sequential scintigraphy was carried out using 99mTc diethyl-IDA. The method has advantages over conventional techniques in that it is easy for the patient and demonstrates reflux both when the stomach is empty and full. The result showed that all patients who had evidence of inflammatory changes or ulcers on barium meal or gastroscopy had evidence of reflux.
Adult↗
[Diagnostic value of osteoscintigraphy and osteoscintimetry for assessment of post-traumatic osteomyelitis and of its complications (author's transl)].
The importance of osteoscintigraphy and osteoscintimetry for diagnosis and case control in post-traumatic osteomyelitis and its complications is discussed by means of 182 bone scintigraphs. Scintigraphy as a functional examination enables clear statements on the probable future course of development of an infection of the bone, of a sequestrum, on the vitality of bone fragments, and on the probable course of infected psuedarthroses and spongiosa transplants.
Bone Plates↗
[Endoscopic retrograde cholangio-pancreaticography (ERCP) and computer tomography in the diagnosis of chronic pancreatitis, pseudocysts and carcinoma of the pancreas--a comparison (author's transl)].
In 107 patients, endoscopic retrograde cholangiopancreaticography (ERCP) and computer tomography (CT) were performed at a short time interval. The combined use of ERCP and CT yielded a correct diagnosis in chronic pancreatitis in 92% of the patients; pseudocysts were diagnosed correctly in 100% of the cases, whereas the rate of accuracy in carcinomas was 94%. In chronic pancreatitis, ERCP usually gave clear and comprehensive information. CT proved a valuable additional examination method wherever the findings did not supply a clear answer. Both examination method were ideally complementary in pseudocysts, so that ERCP and CT were found to be appropriate in each case. In carcinoma, ERCP proved superior to primary diagnosis, whereas CT served to confirm the findings and to assess the volume occupied by the tumor.
Adult↗
[Esophageal intramural pseudodiverticulosis (author's transl)].
Esophageal Intramural Pseudodiverticulosis (EIP) is a very rare disease, which may affect patients of all age. EIP is characterized by dilatation of the esophageal submucosal glandular elements. The characteristic radiographic appearance supported by endoscopy makes the diagnosis. Stenosis and motility disturbance caused by secondary chronic esophagitis due to EIP were found in most patients. The etiology of EIP is unknown.
Diverticulum, Esophageal↗
Malignant insulinoma: permanent hepatic artery embolization of liver metastases--preliminary results.
PURPOSE: To evaluate permanent hepatic artery embolization of liver metastases of malignant insulinoma as a therapeutic procedure. METHODS: Three female patients had persistent severe hypoglycemia after distal pancreatectomy because of a malignant insulinoma. Computed tomography (CT) and CT-portography (CTAP) were used for tumor assessment and follow-up and demonstrated multiple hypervascular metastases 0.5-3 cm in diameter in both lobes of the liver. Unilobar sequential transcatheter embolization of the hepatic artery was performed with an interval of 1-2 months between the procedures. Permanent occlusion was achieved by using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil as an embolizing agent. RESULTS: In all patients, embolization of the hepatic artery was technically feasible and complete occlusion could be obtained. In two patients, collaterals originating from the right inferior phrenic artery were embolized superselectively 3 months after bilobar embolization. CTAP at that time revealed marked decrease in tumor size of more than 50%. All patients responded to the treatment as confirmed by normalization of measurable hormone levels, glucose levels, and disappearance of symptoms. Two patients are still alive after 24 and 31 months from the time of the first embolization. Current investigations revealed normal laboratory data and no further tumor progression in the liver. The third patient died 15 months after the first embolization; she also had developed ileus due to local recurrence of the primary tumor and lymph node metastases. CONCLUSION: Hepatic arterial embolization appears to be an effective means of palliation for liver metastases of malignant insulinoma. Long-term improvement seems most likely to be the result of extensive ischemia from permanent occlusion.
Embolization, Therapeutic↗
Covered self-expanding transhepatic biliary stents: clinical pilot study.
PURPOSE: We report our preliminary results with a new type of self-expanding covered stent for treatment of malignant biliary obstruction. METHODS: Wallstents, fully covered with high elasticity polyurethane, with an unconstrained diameter of 10 mm and a total length of 69 mm, were placed transhepatically under fluoroscopic guidance in five patients. The length of the biliary obstruction varied between 30-50 mm. At 1 and 3 months (82-98 days) clinical assessment, serum bilirubin measurement, and ultrasound examination of the biliary tree were performed. RESULTS: Initial uncomplicated deployment of the stents and internal drainage was possible in all patients. Distal stent migration resulted in early biliary reobstruction in one patient. At 3-month follow-up, partial reobstruction, most probably due to sludge formation, was found in another patient. CONCLUSION: Our initial results indicate that the covered, self-expanding Wallstent endoprosthesis can be reliably and safely deployed transhepatically for malignant biliary obstruction.
Aged↗
Spiral computed tomographic angiography of the renal arteries: a prospective comparison with intravenous and intraarterial digital subtraction angiography.
PURPOSE: To assess the accuracy of computed tomographic angiography (CTA) in the evaluation of the renal arteries in comparison with intravenous (IVDSA) and intraarterial digital subtraction angiography (IADSA). METHODS: In 18 patients, 35 CTAs and DSAs (27 IADSA, 8 IVDSA) of the renal arteries were performed. CTA was done with 2-3 mm collimation,2-4 mm/sec table speed, after intravenous injection of 80 ml of contrast medium at 4 ml/sec with a scanning delay time of 14-21 sec. No previous circulation time curve was performed. CTA data were reconstructed with maximum intensity projection (MIP) and shaded surface display (SSD). The presence of stenosis was assessed on a three-point rating scale (grade 1-3). The quality of the examinations; visualization of the ostium, the main artery, and its branches; vessel sharpness, linearity, and intraluminal contrast filling were evaluated. We compared CTA with DSA. RESULTS: CTA had 96% sensitivity, 77% specificity, and 89% accuracy in the detection of stenoses > 50%. Due to technical errors two stenoses were erroneously diagnosed as positive but there were no false negative diagnoses. The quality of CTA was good in 56% and moderate in 34% of cases. Visualization of the ostium and main artery was graded as 1.74 (out of 2) points and of the renal branches as 1.02 (out of 2) points and of the renal branches as 1.02 (out of 2) points. The quality of CTA images was worse than that of IADSA in 52%, equal in 41%, and better in 7% of cases. CTA was equal to IVDSA in 25% and better in 75% of the cases. CONCLUSION: CTA is an accurate noninvasive method for the evaluation of renal arteries. Examination quality is essential for the diagnosis. CTA is limited in its ability to visualize the branches of the renal artery and accessory arteries. CTA seems to be superior to IVDSA.
Adult↗
Successful exclusion of a large femoropopliteal aneurysm with a covered nitinol stent.
A 70-year-old woman presented with a large femoro-popliteal aneurysm. A covered nitinol stent was implanted successfully and complete exclusion of the aneurysm was achieved. At follow-up 5 months later the stent was still patent and the patient was free of symptoms. However, moderate stenosis was seen at the proximal end of the stent.
Aged↗
Gastric wall dissection as a complication of percutaneous gastrostomy.
A percutaneous gastrostomy (PG) was complicated by gastric wall dissection and partial tube malposition. It occurred after tangential puncture along the greater curvature of the stomach which was performed in order to avoid an enlarged left lobe of the liver. To prevent this complication we recommend not using hydrophilic guidewires during PG.
Aged↗
Percutaneous angioscopy: improved technique.
Ten angioscopies with a pressure infusion set resulted in similar visualization times and irrigation volumes as 42 angioscopies with a specially constructed roller pump. Diagnostic image quality, however, was obtained almost exclusively with the roller pump. Three examinations were nondiagnostic. Total viewing time per patient was approximately 1 min with the roller pump and 2 min with the pressure infusion system. In the 30 patients examined, angioscopy changed the initially chosen form of therapy in 5 patients.
Aged↗
Laser angioplasty of peripheral arteries: an epilogue?
This review gives a short overview of the results of 15 years of experimental and clinical work on laser angioplasty. Experimentally, photothermal and photomechanical ablation of plaque could be demonstrated. However, laser angioplasty did not cause reduction of platelet adhesion and intimal hyperplasia. Clinically, the technique of laser angioplasty was continuously improved until the initial recanalization rates and long-term patency rates in femoropopliteal artery occlusions were the same as the success rates of percutaneous transluminal angioplasty (PTA). This was proven by various randomized studies. Currently, laser angioplasty cannot be proposed as a routine procedure because it is an expensive technology. However, laser recanalization and debulking of total occlusions should be further developed, especially in combination with endoluminal graft placement.
Angioplasty, Balloon↗
The role of multi-slice spiral CT angiography in patient management after endovascular therapy.
OBJECTIVES: To bring out the role of multi-slice spiral CT angiography (MS-CTA) in patient management after endovascular therapy of subclavian artery stenosis. METHODS: Twenty-one consecutive patients with clinically suspected restenosis after endovascular treatment of subclavian artery stenosis or occlusion were included in the study. Eleven patients had been treated with percutaneous transluminal angioplasty (PTA) alone and 10 with PTA and stenting. The mean follow-up period after PTA or stenting was 57 (+/-27 SD) months. CTA was performed using a bolus-triggered high-resolution protocol with biphasic intravenous contrast medium injection. Axial images and curved planar reformations (CPRs) were rated by three readers with regard to patency of supra-aortic vessels. Imaging findings were correlated with a standardized clinical assessment. RESULTS: All examinations were of diagnostic quality. Of 21 referred patients, 7 had significant reobstruction of the treated subclavian artery. Six of the 7 patients with significant restenosis on CTA were treated conservatively (antiplatelet agents), despite 2 of them being symptomatic on the standardized clinical assessment, which showed a sensitivity and specificity of 86% in predicting stenosis. One patient was treated with PTA and stent deployment because of strong subjective suffering. CONCLUSION: MS-CTA is useful for exclusion or quantification of clinically suspected restenosis in carefully selected patients after endovascular therapy where ultrasound is inconclusive and/or contrast-enhanced magnetic resonance angiography is contraindicated.
Angioplasty, Balloon↗
PTA versus carbofilm-coated stents in infrapopliteal arteries: pilot study.
PURPOSE: To determine the primary success and short-term patency of stent application as a primary treatment modality for high-grade lesions of the infrapopliteal arteries compared with treatment with percutaneous transluminal angioplasty (PTA) in critical limb ischemia in a randomized prospective study. METHODS: Endovascular therapy was performed on 95 lesions in 51 patients (mean age 72.0 years, range 47-80 years) who presented clinically with Fontaine stages III and IV. One patient underwent treatment in both limbs. After angiographic lesion identification, patients were randomized for treatment by PTA (53 lesions in 27 patients) or stent application (42 lesions in 24 patients). Follow-up by clinical investigation and conventional angiography or spiral CT angiography was performed in 37 patients (57 lesions) 6 to 12 months after the procedure, or when clinically indicated. Evaluation was performed by two observers, double-blinded, with thresholds for lesion restenosis of 50% and 70%. Statistical evaluation was performed on a lesion basis by Kaplan-Meier estimated probability rates, and log-rank and Wilcoxon tests. The primary endpoint was the angiographic patency rate of treated lesions. RESULTS: The inter-reader agreement was high (kappa = 0.82). For the stent group the cumulative primary patency at 6 months was 83.7% at the 70% restenosis threshold, and 79.7% at the 50% restenosis threshold. For PTA, the primary patency at 6 months was 61.1% at the 70% restenosis threshold and 45.6% at the 50% restenosis threshold. Both results were statistically significant (p < 0.05). CONCLUSION: Infrapopliteal stent application is an effective treatment modality for high-grade lesions in chronic critical limb ischemia. Compared with PTA, higher patency rates can be expected after 6 months.
Aged↗