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Biomedical subjects

M Oudkerk

Publications and source records attributed to M Oudkerk.

At least 127 records · Page 7Linked to original sources
PubMed1993

Stenting in malignant vena caval obstruction.

BACKGROUND: For patients with recurrent vascular obstruction of the vena cava due to tumor regrowth after chemotherapy or radiation therapy and occasionally surgery, no current therapy is available. With the development of intravascular stenting, a new option becomes available in the treatment of a vena caval syndrome. METHODS: Twenty-two patients were treated for malignant obstruction of the vena cava by single, double, and triple Z-type metal stents. All patients had been pretreated extensively and their disease was not amenable to other therapeutic techniques at the time of stenting. RESULTS: Correct positioning of the stents was achieved in all patients. In 68% of patients (n = 15), the symptoms completely disappeared without recurrence until death as a result of tumor progression. In 18% of patients (n = 4), a remarkable improvement was observed, but there was no complete disappearance of symptoms. In 14% of patients (n = 3), reocclusion of the vena cava occurred. The median survival time was 3.0 months (range, 1 week to 9 months). CONCLUSIONS: The application of Z-type metal stents in patients with recurrent malignant obstruction of the vena cava appears to be a useful palliative procedure.

Constriction, Pathologic↗
PubMed1993

Digital subtraction sialography of the parotid glands in primary Sjögren's syndrome.

Digital subtraction sialography of the parotid glands was performed in 34 patients with primary Sjögren's syndrome (SS) and 78 patients suspected of having primary SS in whom the diagnosis could be excluded (NON-SS). The following sialographic features were found more frequently in the patients with primary SS than in the NON-SS patients: a sparse overall branching pattern of the ducts, progressive widening and irregularity of the duct walls, disappearance of a homogeneous parenchyma blush and the occurrence of peripheral acinar dilations. The most discriminating findings between the 2 patient groups were the presence of acinar dilations and the disappearance of the homogeneous parenchyma blush. The sensitivity and specificity of the presence of acinar dilatations were 79 and 95%, respectively. Both the sensitivity and specificity of the presence of an irregular or absent parenchyma blush were 91%. The concurrent finding of acinar dilatations and an irregular or absent parenchyma blush had a sensitivity of 77% and a specificity of 95%. We conclude that digital subtraction sialography is a useful adjunctive diagnostic procedure for primary SS.

Adult↗
PubMed1992

Liver metastases from colorectal carcinoma: detection with continuous CT angiography.

A diagnostic approach to assess liver metastases from colorectal carcinoma was prospectively evaluated in 30 patients with and without metastases on the basis of findings at conventional computed tomography (CT). With the technique, termed continuous CT angiography (CCTA), CT data were continuously sampled for 24 seconds at the same section level after initiation of a 3-second injection of 10-20 mL of contrast medium in the common hepatic artery. The procedure was repeated for each contiguous section level of the liver. Findings at preoperative ultrasound (US), conventional CT, and CCTA were compared with those at intraoperative US and surgical exploration as the standard of reference. Forty-four liver metastases were identified in 16 patients, and 14 patients had no metastases. CCTA had a sensitivity of 98% (43 lesions identified) and higher accuracy (81% [54 of 67 diagnoses]) than US and conventional CT. The data indicate that CCTA can supplement information obtained with conventional imaging techniques in patients who must undergo hepatic surgery because of metastases from colorectal carcinoma.

Adult↗
PubMed1992

Primary Sjögren's syndrome: clinical spectrum and mode of presentation based on an analysis of 50 patients selected from a department of rheumatology.

In this study we report on the clinical characteristics at the time of referral and during follow-up of 50 patients with primary Sjögren's syndrome (SS) in a rheumatological practice. The mean age of the patients at the time of diagnosis was 51.5 years. Four of them were men and 46 women. During a mean follow-up period of 9.1 yr (1-21 yr) from symptom onset the most common signs and symptoms were arthralgia (94%), complaints of dryness of the eyes (90%), mouth (82%) and skin (56%), weariness (64%), exanthema (48%), Raynaud's phenomenon (42%) and arthritis (42%). An elevated erythrocyte sedimentation rate (72%), elevated serum gammaglobulin (49%) and leucocytopenia (42%) were the most frequently encountered abnormalities of routine laboratory tests. After the initial hospital evaluation the diagnosis primary SS was made in only 10 (20%) of the patients. The diagnostic delay was on average 3.1 yr. Knowledge of the considerable heterogeneity of the disease may prevent extensive evaluations and provide better clinical care for patients with primary SS.

Diagnostic Errors↗
PubMed1986

Ultrasonography of acute cholecystitis: clinical and histological correlation.

Sonograms of 45 consecutive patients with histologically proven acute cholecystitis were retrospectively reviewed. The following sonographic criteria were evaluated for the presence of: thickening of the gallbladder wall; enlargement of the transverse diameter; gallbladder pressure pain (Murphy's sign); local hypoechoic areas in the bladder wall, and finally the indistinct internal appearance. All 4 patients (8.9%) with acalculous cholecystitis were detected by ultrasound. Its sensitivity as a test to detect acute cholecystitis is 88.9%, its specificity and accuracy 97.8 and 96.1%, respectively.

Acute Disease↗
PubMed1986

Reconsideration of conventional tomography versus computerized tomography in the evaluation of lung metastases.

Several published reports compare linear chest tomography to computerized chest tomography regarding the detection of lung metastases in adults. As linear tomography does not result in a sectional image, a study comparing multidirectional tomography to computed tomography in the chest was carried out. Equal sensitivity and specificity of these two modalities is shown by reviewing 28 cases who had known extrathoracic malignancies prospectively. The currently prevailing impression that computerized tomography is superior in the detection of lung metastases is thus not justified.

Adolescent↗
PubMed1983

CT recognition of acute aortic dissection.

Twenty-six patients with suspected acute aortic dissection were investigated using computed tomography (CT) as the primary mode of investigation. The diagnosis was controlled by aortography or surgery or both. There were no false-positive or false-negative studies using CT. Aortography was performed on 19 of the 21 patients with aortic dissection and was positive in each instance. However, in two illustrated cases, CT indicated proximal or type A aortic dissection, whereas the corresponding aortograms indicated distal or type B aortic dissection. In two of the 21 acute aortic dissections, only CT was performed, and in both instances surgical confirmation was obtained. The results suggest that CT is at least as accurate as aortography in the diagnosis of acute aortic dissection.

Acute Disease↗
PubMedDate not supplied

MR lesion detection in a breast cancer population.

Implementation of MR imaging of the breast as an extension of the existing imaging modalities in the diagnosis of breast cancer was evaluated in a university cancer center, MR imaging of the breast was performed in 54 patients, in whom the MR results were compared with the triple test (the combination of clinical examination, mammographic evaluation, and cytology) and the final histological diagnosis. MR imaging of the breast depicted 30 of the 33 malignancies (sensitivity, 91%). In two of the malignancies, the carcinoma was clinically and mammographically occult. For the three patients with a false-negative MRI diagnosis, the conventional mammography showed suspicions clustered microcalcifications as a sign of in situ carcinoma. For seven patients, MR imaging of the breast incorrectly suggested the presence of a malignant lesion (specificity, 67%). To improve MR specificity, we perform MR-guided ultrasonographic fine-needle aspiration biopsy (FNAB). Although MR imaging of the breast is a highly sensitive examination, conventional x-ray mammography remains the most efficient imaging modality in the diagnosis of breast cancer. In our patient population, MR imaging of the breast had additional value for women with mammographically dense breast tissue and especially for patients with clinical evidence of breast carcinoma that could not be detected with conventional diagnostic methods.

Adenocarcinoma↗
PubMedDate not supplied

Gradient echo MRI for measurement of the pulmonary autograft diameter after transplantation to the aortic root: validation and comparison with ultrasound.

The purpose of this study was to s the value of MRI for measurement of pulmonary autograft diameters after transplantation to the aortic root in adults. Thirty-eight adults underwent this operation. MRI and transesophageal echocardiography (TEE) were performed in 30 and 27 patients, respectively, after a mean follow-up period of 2.8 years. For internal validation of MRI, measurements at the diastolic short and long axes of the sinus level were used. Pulmonary autograft diameters were measured and compared with MRI and TEE at five different levels: the subannular region (1), annulus (2), sinus (3), sinotubular junction (4), and the distal part of the autograft (5). The correlation coefficient (r2) between long- and short-axis measurements for corresponding sinuses was .97. Diameters obtained with MRI were 1 to 3 mm larger than those obtained with TEE (P < .05), except for the annulus at systole (P > .3). Cine gradient echo MRI is an appropriate technique to evaluate pulmonary autograft diameters during follow-up. Concordance with TEE was good, apart from a systematic difference of approximately 2 mm.

Adult↗
PubMedDate not supplied

Self-expanding metal stents for palliative treatment of superior vena caval syndrome.

PURPOSE: Two stent types (a new Wallstent and a Z-stent) were investigated in 30 patients with recurrent malignant superior vena caval syndrome (SVCS). METHODS: Eligibility requirements were that the patient had recurrent symptoms after appropriate radiation therapy, chemotherapy, or both; >/= 75% of the vessel was occluded; and there was collateral flow. Because of the limited availability of stents, it was not possible to perform a prospectively randomized study. RESULTS: In the Z-stent group (17 patients), occlusion of the stent due to acute thrombosis occurred within 12 hr in 4 patients (24%), but in the other 13 patients (76%) symptoms disappeared completely. After 2 weeks the cavogram in these patients showed no signs of thrombosis, and 12 (61%) of the patients remained symptom-free. There was partial occlusion in 5 patients (29%), without relevant clinical symptoms. Of the 13 patients who received Wallstents, only 1 had an acute immediate thrombosis (8%). Symptoms disappeared completely in the other 12 patients and no signs of thrombosis were seen. However, after 2 weeks complete stent occlusion with SVCS was found in 3 patients (23%) and partial occlusion with minor clinical symptoms in 6 (46%). Only 3 patients (23%) had complete relief of the SVCS. The difference between the rates of occlusion of the two stents after 2 weeks was highly significant (p = 0.008). CONCLUSIONS: The overall clinical success rate for long-term patency was 100% for the Z-stents and 69% for the new Wallstent. These results suggest that when used for this purpose, the new Wallstent is more thrombogenic at 2 weeks than the Z-stent.

Combined Modality Therapy↗
PubMedDate not supplied

Cavernous transformation of the portal vein secondary to tumor thrombosis of hepatocellular carcinoma: spiral CT visualization of the collateral vessels.

BACKGROUND: We investigated the constituting collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC) by using contrast-enhanced spiral computed tomographic (CT) examination. METHODS: Fifty-four histopathologically proven HCC patients with tumor thrombosis-induced CTPV were retrospectively included and assigned to cirrhosis negative (n = 31) and positive (n = 23) groups. Another 15 cirrhotic patients with portal hypertension but no HCC and CTPV were used for comparison. Standardized dual-phase contrast-enhanced spiral CT was performed for all patients. CT appearances of the collateral vessels of CTPV were observed, and their visualization rates were analyzed. RESULTS: Biliary (cystic and paracholedochal veins) and gastric (left and right gastric veins) branches of the portal vein were the most frequently visualized collateral vessels of CTPV. There was a marked difference in CT visualization rates for biliary branches between patients with and without CTPV (83-94% vs. 0). No difference existed in visualization rates for gastric branches across the three groups (77-87% for left gastric, 58-61% for right gastric vein). CONCLUSIONS: Biliary and gastric branches of the portal vein are the major collateral vessels of CTPV. The intergroup differences in CT visualization rates may provide clues to the roles that they might play in the hemodynamic adaptation process of CTPV.

Adult↗
PubMedDate not supplied

Digital subtraction angiography in abnormal perfusion scintigraphy of the lungs.

A normal lung perfusion isotope scan can exclude pulmonary emboli. However, the demonstration of lung emboli presents problems, as an abnormal lung perfusion scan can have various causes. Some of these can be excluded if the perfusion scan is assessed in combination with a chest X-ray and a ventilation scan. In this study, 21 patients with an abnormal perfusion scan were also examined using digital subtraction angiography (DSA) of the lungs. With the help of DSA it was possible to differentiate between the various causes of a lung perfusion defect on the isotope scan by having a sufficiently reliable pulmonary angiogram. From experience it appears that the quality of the pulmonary angiogram confined to the first three divisions obtained with DSA, is comparable with that from a conventional pulmonary angiogram. A perfusion isotope scan is the initial screening modality for suspected lung emboli, if this shows an abnormality, DSA seems to be indicated as the next step.

Angiography, Digital Subtraction↗
PubMedDate not supplied

Intravenous coronary angiography using electron beam computed tomography.

Intravenous coronary angiography with electron beam computed tomography (EBCT) allows for the noninvasive visualisation of coronary arteries. With dedicated computer hardware and software, three-dimensional renderings of the coronary arteries, veins, and other cardiac structures can be constructed from the individual transaxial tomograms. Interest in this technique is growing, and recently a number of clinical studies have been published comparing EBCT coronary angiography with conventional cine-coronary angiography. In this article, image acquisition, postprocessing techniques, and the results of recently published clinical studies are discussed. EBCT coronary angiography is a promising imaging technique of coronary arteries. Currently, it is a reasonably robust technique for the visualization and assessment of the left main and left anterior descending coronary artery. However, at the moment a relatively high proportion of the right and circumflex coronary angiograms are noninterpretable. Improvements in image acquisition and postprocessing techniques are expected to improve visualization and diagnostic accuracy of the technique.

Beta Particles↗