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Biomedical subjects

K Dirks

Publications and source records attributed to K Dirks.

7 recordsLinked to original sources
PubMed2002

Fatal Hemorrhage following perforation of the aorta by a barb of the Gianturco-Rösch esophageal stent.

Self-expanding metal stents are an established option in the palliative treatment of malignant stenoses of the esophagus. Herein, we report on a 60-year-old man with a recurrent stenosis that developed 2 months after radiochemotherapy for a squamous cell carcinoma in the middle part of the esophagus. To relieve progressive dysphagia, a Gianturco-Rösch stent (Cook-Z stent, 10 cm, PE-covered, manufactured by William Cook Europe) was implanted. Six weeks later, precipitous massive hemoptysis leading to the collapse and death of the patient occurred. Autopsy showed that a barb in the middle of the stent had perforated the aortic arch, resulting in massive bleeding into the gastrointestinal tract, and aspiration. Although hemorrhage and esophageal perforation are known late complications of all types of metal stents, our case is the first description of a perforation involving a fixation barb. These barbs are a particular feature of the European version of the Cook-Z stent, and are intended to prevent stent migration. In future, any hemorrhage observed after stent implantation should prompt a search for perforation by a barb (autopsy!). If necessary, the European version of the Gianturco Z stent should be modified.

Aorta, Thoracic↗
PubMed2001

[Sonography in hereditary angioedema: typical findings demonstrated by the example of 3 cases].

Hereditary angioedema (HAE) is a hereditary disorder (deficiency of C1 esterase inhibitor) with spontaneous cutaneous and subcutaneous edemas, which involve the gastrointestinal tract in 50 - 75 %. Recurrent abdominal pain attacks in younger patients with an ultrasonographic evidence of aszites (up to 1 - 2 litres are frequent), should always let think of a HAE. Additionally in one female patient we found pleural effusion repeatedly during the episodes. HAE typically shows segments of GI-tract with a marked wall thickening. In our patients stomach (2 x), small bowel (2 x) and colon (1 x) were involved. Obstruction of the lumen by the edema may cause vomiting or ileus. By means of high-resolution sonography we could show for the first time that only mucosal and submucosal layer were affected, the L. muscularis propria was preserved. Characteristic was a hypoechoic thickening of the interior layers of the wall: In one patient we found anechoic lacunae within the mucosal layer, probably corresponding to a bullous edema. An accurate ultrasonic examination enables a reliable judgement of the severity level of HAE. It can contribute in this way to the decision whether the application of C1-INH-concentrate is necessary or not.

Adult↗
PubMed2000

[Multiple circular liver foci in chronic hepatic porphyria: two sonographic case reports].

UNLABELLED: Appearance of liver foci in patients with chronic hepatic porphyria has been described in literature several times since 1988. We present two impressive examples of multiple coin-like lesions in the liver of patients with till than unknown porphyria. A 61-year-old women was hospitalized with suspected liver metastases: sonography showed multiple ring-like liver foci up to 2 cm. In a 52-year-old man sonography incidentally detected multiple liver foci, in this case homogeneous hyper-echogenic. In both patients a liver tumor was excluded by biopsy, the histologic examination of the specimens only showed uncharacteristic alterations. DISCUSSION: Sonographic findings in hepatic porphyria most times are only uncharacteristic alterated. But 10% of the patients show multiple hyper-echogenic hepatic foci: these lesions typically have a well marked rim, some times they even appear like a ring. In color doppler examination hepatic vessels are not affected by the lesions. The lesions themselves do not show an increased vascularisation. This allows to discriminate from other liver tumors, especially from liver metastases. Histologic findings are not pathognomonic, laboratory research is subsequently required. Strictly avoiding alcoholic drinks the presented discoveries are in principle reversible.

Diagnosis, Differential↗
PubMed1999

[An unusual cause of gastrointestinal hemorrhage: pseudoaneurysm of the gastroduodenal artery in chronic pancreatitis].

Pseudoaneurysm of the peripancreatic arteries is a typical cause of gastrointestinal bleeding (GIB) in patients with chronic pancreatitis. 1-10% of chronic pancreatitis are associated with an a pseudoaneurysm, especially of the splenic or gastroduodenal artery. Endoscopy often is not successful in finding the cause of bleeding. Sonography, especially color Doppler ultrasound, is the best diagnostic tool, indicating the need for celiac angiography. We report on a 59-year-old woman with recurrent severe GIB since 1995. In 1998 another bleeding occurred and sonography showed a pseudoaneurysm of the gastroduodenal artery. Typical criteria are an echo-free, pulsatile lesion with an ring-like border. Color Doppler proves a turbulent perfusion inside and shows the feeding vessel. A transcatheter embolization with stainless steel coils was successful, six months later the pseudoaneurysm was mainly obliterated.

Aneurysm↗
PubMed1998

[Ligamentum arcuatum syndrome: color doppler ultrasound diagnosis in abdominal pain of unknown origin in young patients].

PURPOSE: To assess the diagnostic potential and accuracy of CDS in the diagnosis and management of visceral artery stenosis in young patients with abdominal pain. METHOD: 126 patients < 45 y with abdominal pain were examined by CDS. Other diseases were excluded before. Systolic (Vmax.sys.) and end diastolic (Vmax.diast.) peak velocities in exspiration and inspiration were measured in the celiac (CA) and superior mesenteric artery (SMA). Vmax.syst. > 1.8 m/s in exspiration and inspiration was regarded as a respiratory fixed stenosis. This was followed by intraarterial digital subtraction angiography (i.a. DSA) including visualization of the pancreaticoduodenal artery (PDA), and, if fixed stenosis was confirmed, by operation. CDS was again performed in the follow-up. RESULTS: CA stenosis were found in 19 patients (mean age 28.9 y). 4 were respiratory fixed, 2 combined with SMA stenoses or occlusion, all proved by i.a. DSA. The others had no evidence of fixed CA stenoses. The 4 operated patients were postoperatively immediately well. One with intermediate pain again had a stenosis in the SMA-bypass which was successfully treated by PTA. The others were treated with dietary procedures and regularly controlled by CDS. CONCLUSION: Ligamentary CA stenosis in young patients is rare, but may lead to considerable abdominal pain and weight loss. Hemodynamicly significant stenoses are proved by CDS with respiratory fixed Vmax.syst. > 1.8 m/s and Vmax.diast. > or = 1 m/s; i.a. DSA often shows a retrograde perfusion of the PDA. Such patients should be treated surgically. CDS should be performed in the follow-up.

Abdominal Pain↗
PubMed1987

[Nutritional behavior of non-insulin-dependent type II diabetes patients using the KALI 2.1.2 computer program].

Forty patients with non-insulin-dependent diabetes mellitus (NIDDM) were investigated regarding their individual diet history, including dietary pattern and dietary habits. The energy intake in men was 2,180 +/- 460 kcal/day. The carbohydrate content was 192 +/- 57 g/day (38 +/- 7%), protein 93 +/- 20 g/day (19 +/- 3%) and fat 96 +/- 26 g/day (43 +/- 7%). Nutritional intake of saturated fatty acids was 37 +/- 11 g/day, whereas the intake of polyenic acid was 14 +/- 5 g/day. Thus the p/s-quotient was 0.4 +/- 0.1. The cholesterol intake amounted to 396 +/- 165 mg/day. The dietary fibre content was 33 +/- 21 g/day. The caloric intake of women was 1,800 kcal/day. The daily amount of carbohydrate was 154 +/- 46 g/day (37 +/- 6%), of protein 82 +/- 21 g/day (20 +/- 4%), of fat 82 +/- 32 g/day (43 +/- 6%). Saturated fatty acids were 33 +/- 14 g/day, polyenic acid 11 +/- 5 g/day, the p/s-quotient 0.4 +/- 0.2. The cholesterol intake was calculated to be 341 +/- 118 mg/day. The supply of electrolytes, trace elements and vitamins was often marginal. We found that usually practiced diabetes diet is too fatty, rich in cholesterol and poor in carbohydrate and fibre. As a result of the high amount of fat, which comprises 43% of the total calories and the low p/s-quotient of 0.4, the diet must be considered atherogenic.

Blood Pressure↗