Search PubMed⌕ Search

Biomedical subjects

M C Freund

Publications and source records attributed to M C Freund.

At least 19 recordsLinked to original sources
PubMed2004

Aberrant left hepatic artery in laparoscopic antireflux procedures.

BACKGROUND: The aberrant left hepatic artery (ALHA) is an anatomic variation that may present an obstacle in laparoscopic antireflux procedures. Based on our experience, we addressed the following questions: How frequent is ALHA? When or why is it divided? What is the outcome in patients after division of the ALHA? METHODS: From a prospective collected database of 720 patients undergoing laparoscopic antireflux surgery, we collected the following information: presence of an ALHA, clinical data, diagnostic workup, operative reports, laboratory data, and follow-up data. RESULTS: In 57 patients (7.9%) (37 men and 20 women; mean age, 51 +/- 15.7 years), an ALHA was reported. Hiatal dissection was impaired in 17 patients (29.8%), requiring division of the ALHA. In three patients (5.3%), the artery was injured during dissection; in one case (1.8%), it was divided because of ongoing bleeding. Ten of the divided ALHA (55.5%) were either of intermediate size or large. Mean operating time was 2.2 +/- 0.8 h; mean blood loss was 63 +/- 49 ml. Postoperative morbidity was 5.3% and mortality was 0%. None of the patients with divided hepatic arteries had postoperative symptoms related to impaired liver function. Postoperatively, two patients (11.7%) had transient elevated liver enzymes. At a mean follow-up of 28.5 +/- 12.8 months, no specific complaints could be identified. CONCLUSIONS: ALHA is not an uncommon finding in laparoscopic antireflux surgery and may be found in > or =8% of patients. Division may be required due to impaired view of the operating field or bleeding. Patients do not experience clinical complaints after division, but liver enzymes may be temporarily elevated.

Adult↗
PubMed2004

Quantitative assessment of periarticular osteopenia in patients with early rheumatoid arthritis: a preliminary report.

BACKGROUND: Involvement of the metacarpophalangeal (MP) joints is one of the major problems in patients with rheumatoid arthritis (RA). Although several data about the cumulative influence of steroid intake on bone are available, the course of demineralisation in RA has not been described by quantitative methods until now. PATIENTS AND METHODS: Computed tomography (CT) sections of 96 MP joints in 12 RA patients and of 32 MP joints in four age-matched healthy controls were investigated. Patients were classified according to Steinbrocker. Densitometric evaluation of subchondral bone density was performed by CT osteoabsorptiometry (CT-OAM). Quantitative CT-OAM was used to evaluate mineralisation of the articular surfaces in MP joints. RESULTS: In the distal articular surface of MP joints, the number of density maxima was reduced from 3 to 2.1+/-0.3, 1.9+/-0.5 and 1.3+/-0.3 in RA patients with early, mild to moderate, and severe disease, respectively. Means of calcium concentrations were 633.4+/-35. 3 mg Ca2+/mL, 518.9+/-56.2 mg Ca2+/mL, 497.7+/-23.8 mg Ca2+/mL and 455.1+/-28.6 mg Ca2+/mL for controls and RA patients with early, mild to moderate, and severe RA, respectively. Mineralisation of the distal articular surface was significantly reduced in all groups of RA patients [probability (p) = 0.005]. Regarding the number of density maxima, no differences were detected in the proximal articular surface of normal and RA fingers. However, mineralisation of the proximal articular surface was significantly reduced in all groups of RA patients (p = 0.004). Means of calcium concentrations of the proximal articular surface were 494.1+/-48.5 mg Ca2+/mL, 413.0+/-16.2 mg Ca2+/mL, 406.0+/-51.4 mg Ca2+/mL, 390,4+/-41.1 mg Ca2+/mL for controls and RA patients with early, mild to moderate, and severe RA, respectively. CONCLUSION: Patients with early and untreated RA show loss of mineralisation and altered morphology of the MP joints of the hand, even before corticosteroid therapy. CT-OAM provides evidence for an early alteration of functional anatomy in MP joints.

Adult↗
PubMed2003

[High-resolution computed tomography (HRCT) of the pediatric lung].

High-resolution computed tomography (HRCT) of the lung is a very valuable method in the evaluation of children with acute and chronic lung disease due to the high spatial resolution and precise display of anatomy and pathology without superposition. The following publication will describe an optimized HRCT technique in order to reduce dose, explain various HRCT pattern and explain typical pediatric lung diseases.

Adolescent↗
PubMed2002

[Diagnostic imaging in acute neurological status in childhood].

The diagnostic imaging of children with acute, non-traumatic, neurologic symptoms enables a fast and non-invasive localization and diagnosis. A spectrum of typical disorders will be described dependent on the location of neurologic symptoms (central, spinal, or peripheral nervous system). Different non-invasive imaging modalities e.g. US with colour-coded doppler, CT, MRI are utilized dependent on age of the patient and neurologic symptoms. The purpose of this article is to describe the spectrum of diagnostic imaging for each of these common disorders.

Acute Disease↗
PubMed1999

[Long-term follow-up MRI in children with craniocerebral trauma].

PURPOSE: A prospective study was initiated for the correlation of the findings in the initial cranial CT with the long-term follow-up MRI in children with severe head injury. Another aim was the evaluation of frequency and location of lesions, found only in MRI. METHODS: 70 children with severe head injury and initially performed pathological CCT were followed up (mean time 3 years) by MRI. RESULTS: 71% of the children had a pathological MRI. In 43% of the children with subdural bleeding could be found parenchymal lesions in the underlying cortex. All 15 children with epidural bleeding had unsuspicious findings at the former hematoma. All of the contusions were found as parenchymal residual lesions. 44% of the children had evidence of parenchymal lesions in the follow-up MRI initially and retrospectively not revealable. 16 lesions in the corpus callosum were only revealed by MRI. CONCLUSION: This study shows the higher sensitivity of magnetic resonance imaging in non-hemorrhagic parenchymal lesions and in "diffuse axonal injury". A MRI-examination is recommended in children with severe head injury, especially in patients with normal CCT and posttraumatic neurological deficits.

Adolescent↗
PubMed1999

Arteriovenous fistula of the thyroid gland associated with spontaneous bleeding from a flow-induced aneurysm of the inferior thyroid artery.

A case of acute, spontaneous cervical hemorrhage caused by a ruptured aneurysm of the inferior thyroid artery is described. This lesion was accompanied by an arteriovenous fistula within the thyroid gland that caused a flow-induced aneurysm. Diagnosis and treatment were successfully performed by selective angiography with endovascular occlusion and embolization. Both diagnostic and therapeutic management are discussed, and the related literature is reviewed. To our knowledge, this is the first reported case of an aneurysm of a thyroid artery in conjunction with an intraparenchymatous arteriovenous fistula of the thyroid gland.

Aged↗
PubMed1999

[Management of injuries of the thoracic and lumbar vertebrae in children].

Traumatic injuries of the thoracic and lumbar spine are rare in children and differ in pathomorphology, healing process and prognosis from those in adults. Before growth arrest the vertebral epiphysis has an important role in pathomorphology and prognosis; therefore, treatment should recognize the age-dependent potential for growth and remodelling. This study demonstrates the different anatomic and pathomorphologic characteristics of traumatic spinal injuries in 40 children. Additionally, prognosis and the various forms of treatment are discussed in the context of the recent literature. In total we observed 85% compression-type injuries and 15% distraction- and rotation-type injuries. Vertebral body fractures were treated conservatively and segmental disruptions by fusion. Long-term follow-up was performed on average 8 years after the accident in 26 patients clinically and in 21 patients radiologically. Most patients had no physical complaints or clinical symptoms. Additionally, the radiographs did not demonstrate any post-traumatic defects. In summary, spinal injuries up to the age of 12 without initial neurologic symptoms have a favorable prognosis.

Age Factors↗
PubMed1998

Bone bruise of the knee: histology and cryosections in 5 cases.

We evaluated the histopathologic and cryosectional appearance of bone bruise injuries of the knee detected on MRI. Histologic evaluation of bone biopsies from 3 patients revealed microfractures of cancellous bone, edema and bleeding in the fatty marrow. Between intact lamellar bone trabecules, fragments of hyaline cartilage mixed with highly fragmented bone trabecules were found. Postmortem specimens were obtained from 2 more patients, killed in motor vehicle accidents. MRI revealed bone bruise injuries of the lateral femoral condyle and of the lateral tibial plateau in 1 knee and anterior cruciate ligament disruption, a medial meniscus tear and bone bruise injury of the tibial plateau and of the lateral femoral condyle in the other specimen. The specimens were embedded in physiologic saline solution and frozen to -30 degrees C. By rotationcryotomy, 1 mm slices were removed from the surface of the specimens and documented on photographs. Subchondral lesions and bleeding were found, corresponding to the MR images.

Adult↗
PubMed1996

[The smart-scan procedure of spiral computed tomography. A new method for dose reduction].

PURPOSE: In this article a new method - the Smart-Scan-Technique - for dose reduction during spiral computed tomography is described. This technique allows a dynamical adaptation of the tube current according to the measured local density structure form and absorption values of the object of interest. Its clinical applicability for dose reduction is investigated. In addition, changes in image quality are evaluated. METHODS: Specially designed, water filled plexiglas-phantoms, an Alderson-Rando phantom, and 20 patients were used to simulate possible measures of patients within the thoracic and abdominal region. For those two regions the dose reduction, the modulation transfer function, and the pixel noise were measured. RESULTS: Depending on patient geometry dose reduction up to 20% could be achieved with the Smart-Scan-Technique. This technique also enabled a decrease of the modulation transfer function and an increase of the pixel noise by 8%. CONCLUSION: Relevant dose reductions can be achieved by applying the Smart-Scan-Technique in spiral computed tomography.

Absorption↗
PubMed1996

[Dose reduction in computerized tomography with a new scan procedure].

A new investigation technique in computed tomography--the Smart Scan process--and the associated reduction in tube current are discussed. In addition, the reduced dosage values resulting from the reduced current values are compared with those of a standard measurement and image characteristics such as picture unit noise are evaluated. By means of three special water phantoms with dimensions corresponding to those of actual patient geometries and a pool of 183 patients, the Smart Scan process was tested by the control algorithm implemented on a spiral computer tomograph. The dosage values with and without the Smart Scan being activated were determined. Dosage reductions of up to 18% can be realized with this new examination technique. In particular, patients with transverse oval head profiles will benefit from this modality.

Adolescent↗
PubMed1992

[Thoracic radiographs with the AMBER system. A comparison of the diagnostic image quality of film-screen and storage-phosphor radiographs on the grid-partition stand and the AMBER system].

Since April 1990, chest radiographs in the Mannheim clinic have been performed with a slit technique (Kodak AMBER System). In this study, image quality from conventional film/screen combination and from storage phosphor radiography was compared with that from the AMBER system. Phantoms were used to measure spatial resolution and to determine the detectability of nodules. Image quality affecting various structures within the thorax was evaluated on 200 p.a. and 48 lateral radiographs by three radiologists from Mannheim and four from Berlin. In the retrocardiac, retrodiaphragmatic, mediastinal and peripheral portions the best image quality was obtained by film/screen with the AMBER system. Compared with conventional film/screen images, there was no improvement from the AMBER system within the lung parenchyma. The use of storage phosphor plates with the AMBER system did not lead to any further improvement in image quality.

Evaluation Studies as Topic↗
PubMed1992

[MR tomography of the bone marrow in malignant systemic diseases. Diagnosis and therapeutic follow-up control].

This paper presents a short survey of the current status of bone marrow diagnosis in systemic neoplastic disease by means of MR imaging. The different patterns of bone marrow infiltration from lymphomas and leukaemias are presented and the differential diagnoses are discussed. Apart from the primary diagnosis the relevance of conventional MRI and chemical shift imaging for therapy follow up and after-care is discussed.

Bone Marrow↗