Biomedical subjects

K Wernecke

Publications and source records attributed to K Wernecke.

At least 55 records · Page 3Linked to original sources

PubMed1987

[Intrahepatic collateral veins in obliteration of the inferior vena cava].

Occlusion of the inferior vena cava (IVC) can be either congenital or acquired. Tumors at the porta hepatis are the most common cause of acquired occlusion. Various pathways of venous collateralization are described. The development of a transhepatic venous shunt depends on the isolated inflow of the liver veins into the IVC at different levels, with flow reversal in the most inferior hepatic vein. The case of a 46-year-old female patient with an intrahepatic venous shunt is presented. Ultrasound, computed tomography, magnetic resonance imaging and angiography were performed. Their relative diagnostic values are discussed.

Collateral Circulation↗

PubMed1986

[Abscess therapy by ultrasound-guided fine needle puncture. 2].

29 intraabdominal abscesses were punctured with sonographic guidance. 26 cases were treated by an evacuating needle puncture which was curative in 23 cases (88%). The complications were temporary bacteraeminas in two cases, which were managed conservatively. Sonographically guided fine needle puncture is a simple and effective procedure for the treatment of abdominal abscesses and should be considered as an alternative to surgery and percutaneous drainage.

Abscess↗

PubMed1986

Mediastinal tumors: evaluation with suprasternal sonography.

Twelve patients with mediastinal masses evaluated by computed tomography (CT) and histologically verified were evaluated sonographically by means of the suprasternal approach. Eleven of 12 mediastinal tumors could be visualized sonographically, mainly as hypoechoic and perivascularly situated masses, and could be located topographically with a fair degree of certainty. Suprasternal sonography is particularly useful in the detection of small, perivascular lymphomas of the supraaortic branches. In patients with problematic CT findings, particularly children and patients with allergies to contrast media, suprasternal sonography can provide important additional information. Moreover, suprasternal sonography can be used to determine the consistency and to monitor the treatment of mediastinal tumors. Finally, the suprasternal approach is suitable for sonographically guided biopsies of mediastinal tumors.

Adolescent↗

PubMed1986

Pancreatic metastases: US evaluation.

The sonographic appearance of histologically verified pancreatic metastases is reported in seven patients with advanced spread of tumor. All metastases appeared as homogeneous, solid, space-occupying lesions with a more hypoechoic internal structure than the pancreatic parenchyma. In five cases, multiple metastases were demonstrated; in two cases, there was a solitary metastasis in the head and tail of the pancreas. Pancreatic metastases are diagnosed infrequently because of the paucity of clinical symptoms and the small size of the foci. In six patients, the diameters of the metastases were 0.5-2.0 cm, and only three patients had organ-related clinical symptoms. The putative diagnosis of organ metastases must be made when multiple hypoechoic foci can be demonstrated in the pancreas in a patient with a malignant tumor. Pancreatic carcinoma, acute pancreatitis, and focal infiltrates in Hodgkin and non-Hodgkin lymphomas must be considered when diagnosing multiple pancreatic lesions.

Adult↗

PubMed1986

[Radiological diagnosis of adrenal gland diseases].

Among all the radiological examination techniques, CT is today, besides scintigraphy, the method of choice as far as the detection of functional adrenal lesions is concerned. In primary aldosteronism, CT classification of the syndrome is based on the detection of an adenoma which can be reliably detected in adenoma sizes up to 8-10 mm. Thus, 70 to 80% of Conn's syndromes can be classified. In adrenal Cushing's syndrome, the distinction between adenoma and carcinoma of the adrenal gland is up to CT and can usually be easily made due to the characteristic morphology of each type of lesion. In case of a typical adrenal or juxtaadrenal tumor location, detection of a pheochromocytoma is likewise easy. In ectopic and multiple pheochromocytomas or such as occur as part of a MEN-syndrome, the situation is quite different. If lesions of the adrenal gland are found by accident in examinations otherwise indicated, the question arises whether the process is malignant or benign. In this respect, all the traditional imaging methods, including CT, involve a considerable factor of uncertainty, especially if a malignant tumor is anamnestically known and the question of metastases arises. According to recent information, MR-imaging seems to be advantageous concerning this difficult differential diagnosis.

Adrenal Gland Diseases↗

PubMed1986

[Percutaneous fine-needle biopsy of the adrenal glands].

The percutaneous approach to the adrenal glands is impeded by their high paraaortal subphrenic location. Regarding the information conveyed in literature and referring to our experience, a summary of the technique, indication and findings of percutaneous biopsy of the adrenal gland is presented. Percutaneous needle biopsy of the right adrenal gland is most easily performed by lateral transhepatic approach under sonographic guidance, while in biopsy of the left adrenal gland protection of the spleen, kidney, pancreas and stomach can only be achieved by dorsal approach under CT control. At present, the main indication for biopsy of the adrenal gland still is differentiation between metastases and non-functioning adenomas in tumor patients. Adequate technique provided, the sensitivity of punctures of the adrenal gland varies from 80 to 90%. Clinical suspicion of pheochromocytoma is an absolute contraindication for fine needle biopsy.

Adrenal Gland Diseases↗

PubMed1985

Sonography of infantile polycystic kidney disease.

Seven children aged 1 day to 12 years with infantile polycystic kidney disease (IPCD) were evaluated by a new high-resolution real-time ultrasound scanner. Instead of the monotonous increased echogenicity of renal parenchyma seen with earlier ultrasound equipment, the echo texture of IPCD became more differentiated, showing disseminated tiny cysts associated with high-amplitude echoes. Even in the newborn, cysts as small as 2 mm in diameter could be detected. Analysis of the new sonographic features of IPCD reveals specific "pepper and salt" and "striped" patterns. In association with such well-known sonographic findings as bilateral enlarged kidneys and poor definition of renal sinus, medulla, and cortex, this pattern allows one to make the final diagnosis of IPCD.

Child↗

PubMed1985

[Therapeutic results of ultrasonically-guided kidney cyst punctures].

The behaviour of renal cysts following puncture was studied in 62 patients on whom a simple diagnostic puncture had been performed and on fourteen patients who, in addition, had some of their own blood injected into the cyst. Twenty-one patients (34%) of the first group and eight patients (57%) of the second group showed definite reduction in the size of the renal cyst after an average period of observation of fifteen months. In 7%, the cyst disappeared completely following puncture. Parapelvic cysts showed much less tendency to disappear than did cortical cysts. The results of injecting autologous blood are comparable with those of injecting lipid soluble contrast media as a sclerosing agent. Before surgical removal of a symptomatic renal cyst is contemplated, puncture and evacuation of the cyst with autologous blood injection is recommended.

Adult↗

PubMed1985

[Sonographic and computed tomographic diagnosis of liver metastases. A review].

This article reviews the diagnosis of liver metastases by sonography and computed tomography. The ultrasonographic and computer tomographic features of hepatic metastases are described emphasizing the various signs of malignancy and the differential diagnosis of focal liver disease. The advantages and disadvantages of each imaging technique as well as a diagnostic approach in the evaluation of hepatic tumors are discussed.

Adult↗

PubMed1985

Treatment of pyogenic splenic abscess by ultrasonically guided fine needle puncture.

One case of pyogenic splenic abscess, diagnosed and treated by several ultrasonically guided fine needle punctures, is presented. This noninvasive procedure provided a definitive therapy preserving the spleen. Evacuating fine needle puncture seems to be an alternative therapy of splenic abscess, especially in patients with reduced operability.

Abscess↗

PubMed1984

[Ultrasound-guided thin-needle biopsy in focal liver diseases. I. Malignant hepatic tumors].

Eighty-six patients with focal liver disease underwent sonography-guided percutaneous fine needle biopsy for definitive diagnosis. Twenty-five out of twenty-six neoplastic liver tumors were correctly recognized as malignant. A sensitivity of 96% and a specificity of 98% (25 true positives, 60 true negatives, 1 false negative) was obtained. The high accuracy rate of this diagnostic procedure is explained by the precision of sonographic guidance and the copious excision of tissue material. In 57% of the malignant tumors, small tissue cylinders were obtained besides cytological material, which allowed a definitive tumor diagnosis in 11 out of 15 cases by histologic examination. In addition, the histologic evaluation of tissue fragments enables the differentation between primary and secondary hepatic malignomas. Because of the higher specificity of histological diagnosis, fine needle puncture of solid liver tumors should always provide tiny tissue cylinders for histologic examination.

Adolescent↗

PubMed1984

[Ultrasound-guided thin-needle biopsy in focal liver diseases. II. Benign focal liver diseases].

Sixty patients with benign focal liver disease underwent sonography-guided percutaneous fine needle biopsy for definitive diagnosis. The benignancy of all lesions was determined accurately by cytohistologic evaluation. All 44 liquid space-occupying lesions (30 hepatic cysts, 9 abscesses, 3 hematomas, 2 serous residual cavities after surgery) could be classified by cytological, biochemical and bacterial examination. The diagnosis of hepatic hemangiomas by fine needle puncture is problematic, because the cytological identification of benign endothelial cells is difficult. The histological examination of tissue cylinders of 4 small echogenic lesions revealed focal fatty change of the liver. Tissue fragments of focal nodular hyperplasias and liver cell adenomas showed histologically typical liver cells arranged in trabecular structure. The additional identification of bile ducts supplies proof of focal nodular hyperplasia and excludes liver cell adenoma. Percutaneous puncture of liver abscesses and cysts afforded effective therapeutic decompression. Eight out of 9 liver abscesses were cured by evacuating fine needle puncture. More than 50% of the liver cysts showed long-term growth shrinkage subsequent to puncture. The histological confirmation of benign and malignant liver tumors by sonographyguided fine needle biopsy is considered a decisive step forward in the diagnostic possibilities of update imaging methods.

Adult↗

PubMed1983

[Treatment of intra-abdominal abscesses by ultrasonically guided fine-needle puncture].

23 abdominal abscesses were diagnosed by ultrasound and confirmed by sonographically guided puncture. 18 cases were treated by an evacuating needle puncture and 5 cases by sonographically guided percutaneous drainage. In 12 out of 15 patients, fine needle puncture was curative without surgery required (80%). 2 out of 4 patients treated by percutaneous drainage had to be operated. Initially, 4 patients were operated, though after fine needle puncture or drainage a complete remission of symptoms and leukocytosis was observed. There were 2 complications: one hemorrhage leading to death following fine needle puncture of a pancreatic abscess and one temporary septicaemia. Sonographically guided fine needle puncture is simple and effective procedure in treatment of abdominal abscesses and should be considered as an alterative to surgery.

Abscess↗

PubMed1983

[Ultrasonically guided antegrade pyelography in kidney transplantations].

The indications for, and technique of ultrasound-guided antegrade pyelography of renal transplants are illustrated by eight patients. Because of the detailed anatomical information which the antegrade method provides, it is superior to other diagnostic methods for the investigation of ureteric obstruction or fistulae. The severity of renal pelvis dilatation as shown by sonography must not be taken as a criterian for the grade of obstruction, since transplants may show dilated collecting systems, even in the absence of obstruction. In our view, real time sonography with a suitable probe provides the best means of achieving successful puncture of the renal pelvis. The combination of ultrasound-guided puncture and radiological contrast examination of the ureter is the best diagnostic method available and lead, in all eight cases, to immediate and definitive treatment.

Adolescent↗

PubMed1983

Transgluteal sonography. A new approach to the posterior pelvic compartment.

Ten patients with presacral tumors proved by histologic and computed-tomographic investigations underwent ultrasound scanning. The sound beam was directed through the ischial foramen along longitudinal, transverse, and oblique planes. Nine of 10 tumors localized in the sacral fossa were identified sonographically. In six of 10 instances, tumor demarcation was possible. Sonographic evaluation was impaired because of distance between the transducer and the target due to a patient's large volume and by the cranial location of the tumor. The transgluteal approach is suggested for sonographically guided percutaneous biopsy.

Adult↗

PubMed1983

[Accuracy quota in fine needle puncture].

Percutaneous fine-needle biopsies guided by X-ray were performed in 100 patients utilizing the Nordenström canula. All cases have now been clinically controlled for at least 14 and up to 30 months. The follow up allowed further conclusions due to the dignity of histologically negative biopsies. Positive results on malignant lesions were obtained in 74% of cases. Our experience revealed that negative aspiration biopsies should be considered false negative until they could be confirmed by further investigations.

Abdominal Neoplasms↗

PubMed1983

[Value of ultrasonic diagnosis in diseases of the gallbladder and bile ducts. A survey].

This paper presents a survey of possibilities and limitations of ultrasound in diseases of the gallbladder and the biliary tract. The diagnostic value of ultrasound is demonstrated and compared to other radiologic procedures as i.v. cholecystocholangiography, transhepatic cholangiography and endoscopic retrograde cholangiography. The diagnosis of gallbladder lesions and extrahepatic biliary tract obstruction can be sufficiently assessed by ultrasound, in most cases there is no need of other invasive procedures.

Bile Duct Neoplasms↗

PubMed1982

[Perirenal masses following kidney transplantation. Ultrasonically guided punctures and aspirate analyses].

24 perirenal masses in renal allograft recipients were aspirated by means of ultrasonographically guided percutaneous fine needle puncture, analysed biochemically, bacteriologically and identified as 15 lymphoceles, 5 hematomas, 2 abscesses and 2 urinomas. The discrimination criteria, based on macroscopic findings and biochemical analysis, are previously described in detail. According to ultrasonographic and clinical characteristics the lymphoceles are divided into two groups: 1. Large lymphoceles without any sign of rejection, which seem to be caused by injury of lymphatic vessels in the pelvic region of the graft recipient. 2. Small lymphoceles with signs of rejection, which evidently result from increased secretion of lymph by the allograft. In 54 punctures a therapeutic effect was achieved in small abscesses and lymphoceles only, which were drained percutaneously. A repeated fine needle evacuation of lymphoceles did not result in an obliteration of the lymphocele in any case. Ultrasonographically guided fine needle puncture of perirenal masses is of great importance, since the perirenal fluid can be identified exactly and an immediate and definitive therapy is made possible.

Abscess↗