Biomedical subjects
N Rilinger
Publications and source records attributed to N Rilinger.
[Avascular bone necrosis].
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[Thrombectomy using a high-speed rotatable catheter--initial results].
Evaluation of the Amplatz rotational catheter for the recanalisation of acute thrombotic occlusions in various vascular regions. The Amplatz air-driven rotational catheter was used in 5 patients with acute vessel occlusion in various vascular regions: superficial and profundal femoral artery respectively and popliteal artery with tibiofibular trunk (case 1 and 2), a Collier-Shunt (case 3), the left main pulmonary artery (case 4) and the portal vein after TIPS procedure (case 5). A complete or partial recanalisation was achieved in all cases. Time accounted for recanalisation was between 40 and 90 seconds. No adjunctive intervention was necessary. No complications occurred. The Amplatz thrombectomy device allows a fast, safe and effective mechanical thrombectomy of peripheral arteries and haemodialysis shunts. Partial recanalisation of large caliber vessels is also possible.
[Percutaneous dynamic atherectomy with the aid of 12-F and 14-F transluminal atherectomy catheters (TEC): initial results].
OBJECTIVE: The presented study reports on the first experience with the large diameter 12 F and 14 F TEC system for percutaneous dynamic atherectomy of peripheral vascular obstructions. METHODS AND PATIENTS: The 12 F and 14 F TEC-extraction catheter was used to recanalize peripheral vascular obstructions in 4 patients. The extracted material was continuously aspirated during the procedure. Three patients with intermittent claudication suffered from chronic arterial occlusion (two cases) or from stenosis of an implanted stent (one case) in the region of the superficial femoral artery. In another patient with long-term dialysis history an insufficient collier shunt was treated by atherectomy. RESULTS: Complete vascular recanalisation was achieved in all cases. Supplementary intervention was not necessary. There were no complications. CONCLUSION: Atherectomy with the large diameter 12 F and 14 F TEC allows a safe and complete recanalisation of complex peripheral vascular occlusions. Further studies must show whether the enlarged vascular intrusion is justified by more favourable results.
[Superselective intra-arterial chemotherapy in therapy-refractory lymph node recurrences of breast carcinoma].
PURPOSE: To demonstrate a superselective intraarterial chemotherapy as a therapeutic alternative in the treatment of previously treated recurrent lymph node metastases in breast cancer. METHODS: 14 patients with recurrent lymph node metastases in cases of breast cancer were presented to be treated by intraarterial chemotherapy of 25 mg mitoxantrone/m2 over a period of 24 hours. In two patients with superclavicular lymph node involvement an intraarterial therapy could not be carried out because of a vascular connection to the anterior spinal artery. Involved lymph stations could be reached in superselective technique by side branches of the subclavian artery. Heparin coverage was given intravenously. Every patient had had surgery, radiation, systemic chemo- and hormonal therapy before and was now graded as inoperable. Therapy indication was given by local tumour-induced symptoms. RESULTS: In the 12 treated cases complete remission was seen in three, partial remission in 4, a steady state in two and a progressive disease in three. There were no complications or severe side effects. CONCLUSION: Intraarterial chemotherapy is an effective and well tolerated treatment in recurrent lymph node metastases in cases of breast cancer even if conventional therapies can no longer be used.
[Superselective embolization of tumor nodes in solitary kidney in inoperable patients].
PURPOSE: Evaluation of superselective embolisation of renal tumours in inoperable patients with solitary kidneys. METHODS AND PATIENTS: Eight inoperable patients with solitary kidneys bearing tumour nodules underwent 1-3 superselective embolisation procedures with ethibloc (5x) or polyvinyl alcohol (1x). Renal function was monitored with creatinine levels. Tumour size was controlled every three months by means of sonography. RESULTS: Technical success rate was 100%. In 3/3 patients haematuria could be stopped. Post-embolisation renal function was unchanged in 6 patients and deteriorated in two patients; creatinine level rose to a maximum of 2.2 mg%. We observed no other side effects. Seven of eight patients died during a median follow-up period of 9.3 months (4-18 months); in two cases they died due to their underlying malignant disease. One patient had local tumour progress. CONCLUSIONS: Superselective embolisation of renal tumours in patients with solitary kidneys may be a helpful, well-tolerated therapeutic option in inoperable, symptomatic patients.
[Epidurography: comparison with CT, spiral CT and MR epidurography].
PURPOSE: The purpose of this study was to explain the origin of image patterns demonstrated by conventional epidurography, which is a controversially discussed topic in recent literature. MATERIAL AND METHODS: After introduction of thoracic epidural catheters and iopamidol injection, conventional epidurography and CT-epidurography were performed on 25 preoperative patients. After injection of Gadolinium-DTPA MR-epidurography was performed in two patients treated for chronic pain with already introduced epidural catheters. Three volunteers also underwent identical imaging after introduction of thoracic epidural catheters and in addition helical-CT epidurography using twin-beam technology. RESULTS: 40% of the patients demonstrated the railroad track phenomenon. We were able to prove that it is a sign of a rhythmically variable filling of segments of the lateral epidural space with contrast medium 76% of the patients demonstrated no ventral epidural space at the thoracic level. 56% of the patients showed a medial area of translucence combined with a band-shaped contrasting of the epidural space in the standard ap view. This was proven in all cases to be a plica mediana dorsalis by CT. In all volunteers who underwent helical-CT and MR epidurography we observed the railroad track phenomenon and the filling defect of the anterior thoracic epidural space. CONCLUSION: CT epidurography is well suited for obtaining new insights into the interpretation of findings obtained by conventional epidurography.
[The value of MR-mammography at 1.5 tesla in the differential diagnosis of non-puerperal mastitis and inflammatory breast carcinoma].
PURPOSE: The distinction between mastitis and inflammatory breast carcinoma is an important one. Current methods of evaluation including mammography, ultrasound and clinical examination do not enable this distinction. Dynamic magnetic resonance mammography (MRM) is a study with potential in this regard. MATERIAL AND METHODS: 12 patients, in whom clinical examination, mammography and ultrasound could not distinguish between both diseases, were reviewed retrospectively by means of MRM using a 1.5 T Siemens Magnetom SP and a circular mamma coil. We used dynamic 3-D gradient echo sequences with a duration of one minute. RESULTS: At present MRM cannot definitely distinguish between mastitis and inflammatory carcinoma, 80% of the inflammatory carcinomas were found to enhance more than 100% in the first minute, compared to 43% for mastitis. No other differences were seen. CONCLUSION: MRM proved useful in the follow-up of treated mastitis to demonstrate the success of antibiotic treatment of mastitis and to diagnose a histologically unconfirmed inflammatory carcinoma by means of a different follow-up.
[CT osteodensitometry in the area immediate to hip endoprostheses].
UNLABELLED: The value of metal artifact reduction in quantitative bone density determination in the vicinity of metallic implants was studied. METHOD: Ten cadaver femora with hip endoprostheses implanted intra vitam were examined in CT with varying slice thicknesses, tube voltage, scan time and magnification factor. The artifact-laden images were then processed using a metal artifact reduction programme (MAR). The metallic implant was removed, allowing the bone slices to be examined again with the same imaging parameters, but without the bothersome metal artifacts. This allowed comparison of bone density values obtained before and after application of MAR with data obtained after implant removal. RESULTS: A comparison of the bone density measurements between the sample group without implants and the group with indwelling implants prior to MAR showed an unexpected correlation coefficient r = 0.975-0.977. The correlation coefficients after MAR rose to r = 0.987-0.992 in 125 kV and r = 0.989-0.991 in 85 kV modes. The reproducibility of the density measurements for the groups without implants and with implants following MAR showed variation coefficients (VC) of 1.16% and 0.75% respectively. The reproducibility of the manual definition of the region of interest (ROI) in bone showed a VC = 2.19%. CONCLUSIONS: Bone density in the vicinity of metallic implants can be reliably and reproducibly determined using MAR.
[Presentation of a new self-expanding vascular spiral stent].
The technical details as well as first clinical results of a newly developed Nitinol stent are presented. The spiral-shaped Nitinol stent was implanted in two patients with complicated peripheral arterial obstruction after bypass surgery. Stent implantation was very exact and technically simple using a special implantation catheter. While one patient is free of symptoms three months after stent implantation, an early obstruction was observed in the other patient one day after the interventional procedure. The specific spiral design allows a simple percutaneous extraction of the stent. A cross-over use of the stent seems principally possible, but limited due to the length of the implantation catheter of 70 cm. Prospective clinical studies are, however, warranted.
[Virtual cystoscopy based on spiral CT data].
Simulation of three-dimensional cystoscopy based on helical CT scan data in real-time in patients with tumours of the urinary bladder. In three patients with histologically confirmed carcinoma of the urinary bladder, a helical CT scan with double detector technology was carried out preoperatively. A native scan was first performed, followed by an examination in the early contrast medium enhanced phase. After adequate contrasting of the urinary bladder (30 minutes latency), further images were acquired. These data were transferred to a separate graphic computer workstation and reconstructed. The results were then compared with the cystoscopic and pathohistological findings. All tumours of the urinary bladder identified at fiberoptic cystoscopy were also visualised by virtual cystoscopy. The best reconstruction results were obtained from data acquired after the 30-minute latency period. Virtual cystoscopy represents an interesting option in helical CT scanning, which is able to visualise polypoid tumours of the urinary bladder. Its clinical relevance, however, must be demonstrated in studies with a larger number of patients examined.
Endovascular stenting in patients with Iliac compression syndrome. Experience in three cases.
The authors report their experience in the percutaneous treatment of the iliac compression syndrome in three women (20-53 years old) with acute iliofemoral deep venous thrombosis; in one case, there was an additional thrombus in the inferior caval vein. They were treated by percutaneous implantation of Palmaz stents in the left common iliac vein 1 day after surgical thrombectomy and construction of an arterial venous fistula. All patients showed marked improvement, as determined from venograms obtained immediately after stent implantation. The arteriovenous fistulae were closed 3 months later. At 6 months follow-up, the median clinical and color-coded duplex ultrasound indicates that all stents are patent and all patients are free of symptoms.
CT-guided intraarterial chemotherapy in locally advanced tumors.
In a retrospective study, 123 patients with tumors (the majority were recurrent pelvic or breast neoplasms) underwent 376 cycles of intraarterial chemotherapy. Contrast material-enhanced computed tomography was performed to check the position of the catheter during 221 cycles. On the basis of findings, the catheter was repositioned 46 (20.8%) times because of weak contrast enhancement in the tumor region (n=24[10.9%]), involvement of neighboring healthy tissue (n=15[6.8%]), or both (n=7[3.2%]).
[Adjuvant regional chemotherapy in resected advanced pancreas carcinoma].
Systemic chemotherapy in patients who underwent resection of pancreatic carcinoma has not been significantly improved median survival times. We investigated whether regional chemotherapy administered via celiac trunc infusion increases survival rates in patients with locally advanced pancreatic carcinoma after resection of the primary. From 12/1992 to 2/1995 we treated 18 patients with regional chemotherapy consisting of mitoxantrone (d1), 5-FU + folinic acid (d2-4) and CDDP (d5) on five consecutive days. This cycle was repeated up to 6 times. Besides non-symptomatic GI-ulcerations (3/18) no severe side effects were observed. The median survival is actually 17.8 months (regression analysis). Compared to a historical control of our department survival times are significantly prolonged (17.8 vs. 9.3 months, p < 0,0003). In conclusion we state that adjuvant regional chemotherapy in patients with advanced pancreatic cancer is well tolerated and prolongs survival significantly.
[Radiologic diagnosis of infectious spondylitis].
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[Experiences with an alternative distension medium in oral contrast imaging of the small intestine].
PURPOSE: The image quality of oral small bowel imaging is often poor on account of the small bowel enema. A new contrast medium should increase the image quality due to better compliance of patient because of the better taste of substance. The loading of patient with radiation or time should not increase. METHODS AND PATIENTS: We investigated prospectively 40 patients, randomized in two groups of 20 patients each. Two different substances were used as contrast medium: barium-methylcellulose and Barium-Mucofalk, respectively. The quality of the double contrast, profile of the mucosa, duration of radiation, duration of examination, dose-area product, and taste of the substance were judged for significance. RESULTS: The taste of the new contrast medium was judged to be better: twice as often as "good" and five times less often as "bad", the difference was not significant due to the small number of patients. There is no significant difference in the other criterias. CONCLUSION: Mucofalk is an alternative contrast medium for oral small bowel radiology in cases of difficult placement of the tube for enema. The quality of double contrast and visualization of the profile of mucosa are the same while the taste is better.
[Management of iatrogenic hemorrhage after mechanical vascular recanalization].
Nine patients with hemorrhage due to revascularization procedures underwent successful embolization (5), surgery (2), covered stent implantation (1), or long-lasting ballon dilatation (1). Bleeding was the result of Fogarty thrombectomy (3), ring stripper revascularization (1), balloon dilatation (3), or perforation of the artery with the guide wire (1). In all cases, bleeding was stopped successfully without sequelae for the patients. In spite of the preceeding hemorrhage, local fibrinolysis with 1,000,000 units of urokinase was performed on the same day in 3 patients without any complications being observed.
[Regional chemotherapy in advanced pancreatic carcinoma].
BACKGROUND: Even after resection median survival times in advanced pancreatic carcinoma are seldom more than one year. The aim of our study was to evaluate the effectivity of regional chemotherapy in patients suffering from unresectable pancreatic cancer. PATIENTS AND METHODS: From 2/92 until 11/94 32 patients with unresectable pancreatic cancer (17 patients stage III, 15 patients stage IV) were treated by celiac trunc infusion. One cycle consisted of mitoxantrone (d 1), 5-FU, folinic acid (d 2 to 4) and cisplatinum (d 5). RESULTS: Besides a few severe complications, therapy was well tolerated in 101 cycles. In unresected patients with stage III tumors the median survival is 12 months compared to 4.8 months in patients with biliodigestive bypasses (p < 0.006) and 4 months in regionally infused patients stage IV compared to 2.7 months in untreated patients (n.s.). CONCLUSION: Regional chemotherapy in advanced pancreatic carcinoma is well tolerated and increases median survival in patients with stage III tumors.