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K F Gratz

Publications and source records attributed to K F Gratz.

46 records · Page 3Linked to original sources
PubMed1984

[Scintigraphic diagnosis of bile leakage].

Specificity and sensitivity of cholescintigraphy for diagnosis of bile leakage were evaluated in a prospective study in 91 patients with partial liver resection and in 64 patients with liver transplantation. Sensitivity was found to be 0.93, specificity in the evaluable scintigrams 1.0. If all non-evaluable scintigrams are considered to be wrong, specificity was 0.83. Cholescintigraphy is a non-invasive method without irritation of the patient with a high specificity and sufficient sensitivity for demonstration or exclusion of a leak. These leaks may arise not only postoperatively but also after biopsies, trauma or spontaneously. In cases of clinical suspicion cholescintigraphy should be used as primary investigational tool.

Bile Ducts, Intrahepatic↗
PubMed1984

[Cholescintigraphy for determining focal nodular hyperplasia of the liver?].

The preoperative diagnosis of a focal nodular hyperplasia (FNH) is of special interest as in case of non-malignancy of this tumor no extirpation has to be carried out. 86 patients - 19 of them suffered from FNH - have been examined by 3 phasecholescintigraphy. There were no false positive findings (specifity 100 per cent). 2 out of 23 examined FNH were not recognized as such (sensitivity 87 per cent) because the tumor had been changed regressive largely. Cholescintigraphy is an excellent method to prove FNH not bothering the patient too much. Cholescintigraphy should be the first measure of differential diagnostic clarification whenever a benign tumor is suspected.

Adolescent↗
PubMed1984

Sonographic pattern of focal nodular hyperplasia of the liver.

Focal nodular hyperplasia of the liver (FNH) is a histologically defined benign hepatic tumour, possibly associated with the use of oral contraceptives. The present study deals with the question whether FNH can be distinguished from other lesions of the liver by ultrasonography alone or by a combination of real-time sonography and radiologic procedures. Therefore 18 cases of FNH, 16 females and 2 males, are presented. We retrospectively reviewed the diagnostic results of real-time sonography, hepatic scintigraphy, computed tomography with dynamic CT-densitometry, and angiography on these 18 patients. Ultrasonography enables the identification of the lesion in all of the 18 cases. FNH appears to show varying degrees of echogenicity (slight hypoechoic in 6 cases, isoechoic in 6 cases, and slight hyperechoic in 4 cases). In most of the patients the tumour had similar acoustic characteristics as the surrounding normal liver. By ultrasonography alone there is no possible differentiation of FNH from other hepatic tumours. Both the echo pattern of FNH and the results of the ultrasonically guided cytopuncture are unspecific.

Adolescent↗
PubMed1983

[Scintigraphic image of bile reflux following gastric and intestinal surgery].

Bile reflux may occur after a variety of reconstructive procedures in the gastro-intestinal tract and biliary system. The present paper deals with reflux into the duodenum, jejunum, stomach, oesophagus and into blind loops. The demonstration of reflux by 99mTc labelled IDA acid derivatives, and a possible quantitative approach, are discussed. The advantages of an isotope method are: 1. Direct demonstration of bile reflux without any intervention in the physiological process and with little trouble to the patient, 2. The ability to use the method for various reconstructive procedures and 3. The additional information obtained which may help in the differential diagnosis of blind loops, biliary obstructions, cholecystitis or liver metastases if there has been a gastrectomy for a malignant tumour. In combination with a second administration of a radio-isotope tracer, one may be able to demonstrate abnormalities in the motility of the stomach or gut, or pyloric stenosis or gastro-oesophageal reflux.

Bile Reflux↗
PubMed1983

[Sequelae of secondary jejunum interposition in gastrectomized patients].

Secondary interposition of the jejunum was performed in 45 patients who had 2/3 gastrectomy before. An additional a selective gastric vagotomy was done. All patients had a follow-up examination after 2 months to 6 years. Secondary disturbances like dumpingsyndrome were not observed. In 30 cases, which underwent sequential scintigraphic control examination no duodeno- gastral reflux could be observed. In 2 out of the 45 patients florid ulcers could be diagnosed by gastroscopy, in 3 of them silent ulcers.

Follow-Up Studies↗
PubMed1982

[Demonstration of postgastrectomy bile reflux by hepatobiliary sequential scintigraphy].

After gastrectomy and jejunal interposition by the Longmire technique, symptoms due to alkaline reflux oesophagitis may occur, which are caused by duodeno-jejunal and jejuno-oesophageal bile reflux. Twenty-seven patients who had gastrectomies performed for malignant tumours one to three years previously were examined by hepatobiliary sequential scintigraphy in order to see whether this is able to demonstrate bile reflux. In addition to endoscopies, biopsies and radiological examinations, 45 sequential scintigrams were carried out. Agreement of results during routine use was investigated for five observers. There were considerable variations in results amongst different observers. Nevertheless, in four out of the five observers, there was a significant correlation with the clinical findings (p less than 0.05). Only by using functional scintigraphy with digital data recording is it possible to demonstrate or exclude bile reflux with any degree of certainty. Eight out of twelve patients with marked symptoms, and four out of 28 without symptoms showed reflux into the interposed segment (correlation 0.7, p greater than 0.05). Patients with symptoms showed a high incidence of oesophagitis by the above-mentioned methods (correlation (0.52, p greater than 0.05). Correlation between the results of barium meals and clinical findings was considerably less (0.25) and was not significant. Sequential scintigraphy is therefore better for clarifying reflux symptoms than radiological examination or endoscopy and biopsy.

Esophagitis, Peptic↗
PubMed1982

[Focal nodular hyperplasia of the liver--is a radiologic diagnosis possible? (author's transl)].

Focal nodular hyperplasia of the liver (FNH) is a histologically defined benign tumor, which can be distinguished from other space-occupying diseases of the liver. The present paper deals with the question whether FNH can be distinguished from other lesions of the liver by a combination of radiologic procedures. Therefore 10 patients with FNH of the liver underwent sonography, hepatic scintigraphy, computed tomography with dynamic CT--densitometry, and angiography. The computed tomography with dynamic CT--densitometry using intravenous bolus injection of contrast medium seems to be the most accurate method for detection of FNH of the liver.

Adolescent↗
PubMedDate not supplied

Sporadic unilateral adrenomedullary hyperplasia with hypertension cured by adrenalectomy.

Adrenomedullary hyperplasia (AMH) with increased urinary excretion of epinephrine is regarded as the earliest adrenal manifestation in familial pheochromocytoma; however, pathogenetic mechanisms and morphogenesis involved in the development of sporadic adrenomedullary diseases are unknown as yet. We present 4 patients with clinical, biochemical, imaging, and morphological findings of sporadic unilateral adrenomedullary hyperplasia cured by unilateral adrenalectomy. All patients were hypertensive with intermittent hypertensive crises, and with increased catecholamine concentrations in urine and serum. Correct unilateral localization was achieved by 123-I-BG-scan (planar and SPECT) (n = 2) or cavovenous blood sampling with selective catheterization of both suprarenal veins (n = 2). Histomorphometric analyses revealed diffuse adrenomedullary hyperplasia in all 4 specimens with significant increase of relative volume to 17.6% (controls, 8.7%), and of estimated medullary weight to 0.95 g (controls, 0.45 g); corticomedullary ratio (C:M) was decreased to 5.4 (controls, 11.2). DNA histograms showed euploidy in all cases. In 3 patients, DNA analysis revealed evidence of cell proliferation, but without increase to grade of malignancy indices (0.101-0.523). Adrenalectomy was performed preferentially by a translumbar approach; the operative and postoperative course was uneventful in all 4 patients. Blood pressure without antihypertensive drugs returned to normal in 3 patients, in 1 patient to the upper normal limit.

Adrenal Gland Diseases↗
PubMedDate not supplied

Benign liver tumors: differential diagnosis and indications for surgery.

The differential diagnosis for hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma may be difficult. Reliable diagnosis is mandatory for the decision of whether to apply surgery or observation. Experience with long-term observation in nonoperated patients with hemangioma and FNH is limited. A group of 437 patients from a single institution were analyzed with regard to a diagnostic algorithm, the indications for surgery, and observation. There were 238 hemangiomas, 150 cases of FNH, 44 adenomas, and 5 mixed tumors. Of the 437 patients, 173 underwent surgery; 103 with hemangioma and 54 with FNH were observed at our own institution, whereas 117 patients underwent follow-up elsewhere or were lost. Among the operated patients with confirmed histology, a good diagnostic yield was found for a combination of ultrasonography (US), contrast (bolus)-enhanced computed tomography (CT), and labeled red blood cell (RBC) scanning: sensitivity 85.7%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 81.8%, and accuracy 91.3%. For FNH and combination of US and CT plus cholescintigraphy showed a sensitivity 82.1%, specificity 97.1%, PPV 95.8%, NPV 84.6%, and accuracy 90.3%. Surgical mortality was 0.6%. Observation of patients with hemangioma and FNH for a median of 32 months revealed no increase in tumor size in 80% and a decrease in fewer than 7%. There was no tumor rupture and no evidence of malignant transformation. We concluded that liver hemangioma and FNH can be differentiated from adenoma with high sensitivity, specificity, and accuracy by labeled RBC scanning and cholescintigraphy in combination with US and contrast-enhanced CT. In the case of symptoms or an equivocal diagnosis with respect to adenoma or hepatocellular carcinoma, surgery can be performed with very low risk. Because in asymptomatic patients with observed hemangioma or FNH no increase of tumor size can be expected for many years, the indications for surgery must be carefully evaluated.

Adenoma, Liver Cell↗