Biomedical subjects

L Grenacher

Publications and source records attributed to L Grenacher.

24 records · Page 2Linked to original sources

PubMed2000

[Carcinoma of the stomach. Role of imaging for primary diagnosis and preoperative tumor staging].

The aim of imaging of gastric carcinoma has to be to diagnose the carcinoma as early as possible and to sort out the tumors that are resectable. At the same time imaging of gastric carcinoma should reduce the number of futile laparotomies in patients with advanced, non-resectable tumors to a minimum. Today, endoscopy is the method of choice to diagnose gastric carcinoma. Endosonography is advantageous if small carcinomas have to be judged for depth of tumor infiltration (early gastric carcinoma vs. advanced gastric carcinoma) because high resolution images of the gastric wall are obtained. Staging of large carcinomas that have grown beyond the gastric wall is best performed by hydro-CT because CT scans most accurately delineate infiltrations of surrounding organs/structures and help to plan surgery. Nowadays MRI is not suited for gastric imaging. MRI, however, has the highest potential to fundamentally improve staging of gastric carcinoma if high resolution imaging of the gastric wall is combined with screening for metastases in one examination.

Humans↗

PubMed1998

[Morphology and staging of primary mucosa-associated gastric lymphoma in hydro-CT imaging].

PURPOSE: Evaluation by hydro-CT in diagnosing and staging of primary non-Hodgkin lymphoma of the stomach (MALT). MATERIAL AND METHODS: 15 patients with MALT lymphoma underwent imaging by hydro-CT (helical CT scanning optimised for parenchymal and vessel contrast with distension of the gastric wall by water). The CT scans were evaluated for the site, morphology, extent and contrast enhancement of gastric lymphoma; in addition, the number and location of abdominal lymph nodes were examined. The results of CT imaging were compared with the findings at endoscopy + biopsy and endosonography and in case of gastrectomy also with the histopathological results. RESULTS: All lymphomas were correctly diagnosed and were mostly located in the distal parts of the stomach. MALT lymphoma typically grew submucosally, infiltration of the mucosa was rare. Most tumours showed marked contrast enhancement of the mucosa and poor enhancement of the submucosa. Hydro-CT and endosonography had similar accuracies in respect of staging of compartment I and II lymph nodes. Staging of distant nodal groups was more accurate by hydro-CT. CONCLUSION: Hydro-CT is non-invasive and may be used for diagnosis and staging of primary gastric lymphoma with a typical morphology of gastric lymphoma. Hydro-CT may be regarded as complementary to endosonography and is well suited for the initial diagnosis of gastric lymphoma as well as for the diagnosis of recurrent tumour.

Adult↗

PubMed1997

[Techniques for bladder neck suspension with osseous screw fixation].

We investigated the technical feasibility and clinical results of bone fixation techniques in combination with needle suspension for correction of female stress urinary incontinence. In our experience the screw-like bone anchor, which is drilled into the public tubercle, represents a minimally invasive but very stable and reliable technique. However, the needle suspension fixed to the bone anchor turned out to be critical. Even though the suspension was fixed in the paraurethral tissue with a deep Z-stitch between the bladder neck and the midurethra, the 1-year recurrence rate was 76%. Our data showed that the suspension sutures pull through the paraurethral tissue because there is no paravesical scar formation as in open procedures. Modifications of the suspension technique (four-point suspension, simultaneous laparoscopic or digital dissection of the paravesical space, combination with sling procedures) revealed significantly improved short-term results. Therefore we conclude that after improvement of the suspension technique the bone anchor will represent a valid option for minimally invasive fixation of a bladder neck suspension.

Bone Screws↗

PubMed1997

Laparoscopy-assisted penile revascularization: a new method.

Analysis of more than 100 penile revascularizations using the Mannheim modification showed a success rate as high as 82% in properly selected patients. However, the dissection of the epigastric artery requires a relatively large incision, with the risk of postoperative bleeding, pain, and hernia formation. Therefore, we designed a laparoscopic approach for dissection of the epigastric vessels. From January 1995 to October 1996, we performed laparoscopy-assisted penile revascularization in 15 pharmacotesting nonresponders with erectile dysfunction. The first step is dissection of the penile vessels to minimize the occlusion time of the epigastric arteries. Thereafter, the extraperitoneal cavity is exposed using a balloon-trocar system inserted via a 15-mm suprapubic incision. A pneumoextraperitoneum is established, and two further cannulas are inserted (10 mm subumbilical, 5 mm in the lower abdomen contralateral to the desired epigastric artery). The dissection of the epigastric vessels starts caudally at the origin from the external iliac vessels and continues to the periumbilical area. All branches are dissected between clips, keeping the artery and vein together. For extraction of the artery, we insert another 5-mm port through the incision at the penile base. After desufflation of the extraperitoneal space and closure of the trocar wounds, microsurgical penile revascularization is performed using the previously described modification of the Hauri procedure. The mean operating time for laparoscopic dissection of epigastric artery was 120 minutes. No intraoperative complication occurred. One patient suffered from an inguinal hematoma. After a median follow-up of 12 month, 53% of patients showed spontaneous erections, and another 27% achieved a full erection with the aid of additional pharmacotherapy. Laparoscopic dissection of the epigastric arteries proved to be feasible, resulting in a considerable reduction of overall morbidity of penile revascularization without reducing the efficacy of the procedure.

Adult↗

PubMed1996

[Cicatricial small intestinal stenosis following chemotherapy for a gastrointestinal lymphoma].

HISTORY AND CLINICAL FINDINGS: 4 weeks after completing a course of chemotherapy for non-Hodgkin lymphoma of the jejunum a 45-year-old woman developed pain in the left upper abdomen and postprandial vomiting so that she could no longer take food by mouth. INVESTIGATIONS: On admission she looked cachectic and had obviously lost weight. Plain abdominal X-ray gave no evidence of perforation or ileus. Gastroduodenoscopy showed no local recurrence. But contrast jejunal radiography (after Sellink) demonstrated two severe band-like stenoses of the jejunum with prestenotic dilatation. As she had not had any previous operation or radiotherapy, cicatricial stenosis was considered as the most likely cause. As the symptoms continued and stenosing local recurrence could not be excluded, surgical resection was indicated. TREATMENT AND COURSE: Two cicatricial intramural stenoses of the proximal jejunum were found and histologically confirmed without evidence of lymphoma recurrence. After the operation the patient was again able to take food by mouth without problem. Follow-up examination 8 months later showed no recurrence and she was free of gastrointestinal symptoms. CONCLUSION: After chemotherapy for gastrointestinal lymphoma obstruction of the small intestine may occur due to chemotherapy-induced scarring.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1996

[CT-guided puncture].

Sonographic and CT-guided punctures allow the evaluation of suspected lesions in the head, thorax, abdomen, retroperitoneum and skeletal system. The size of the lesion to be evaluated determines the size and the diameter of the puncture needle. The quantity of the material obtained will be defined by the diameter of the needle, i.e. fine-needle biopsy is more adequate for cytological than for histological evaluation. Strict adherence to the indications and contraindications for puncture and painstaking performance of the procedure go a long why towards minimizing the complications. The advantage of CT-guided puncture, in contrast to an ultrasound-guided procedure, is visualization during the puncture procedure free from overshadowing. This permits punctures of lesions located deep in the thorax or the abdomen which are overshadowed by the lungs, by air in the small or large bowel or by bone structures. Moreover, this technique yields much more information about the tissues and organs surrounding the suspected lesion. This information is much more investigator-related with ultrasound-guided puncture. Therefore, the CT-guided puncture has become mandatory in the evaluation of suspected lesions. Moreover, using the same technique, percutaneous drainage of fluids in the interpleural space, abscesses in organs, hematomas, lymphoceles and urinomas; ablation of metastases; and sympathicolysis can be carried out. CT-guided puncture thus changes from a minimally invasive diagnostic procedure to a minimally invasive therapy.

Biopsy, Needle↗