Search PubMed⌕ Search

Biomedical subjects

P Legmann

Publications and source records attributed to P Legmann.

At least 37 records · Page 2Linked to original sources
PubMed1998

Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography.

OBJECTIVE: The purpose of this study was to compare dual-phase helical CT and endosonography for the diagnosis and staging of pancreatic tumors. SUBJECTS AND METHODS: Thirty patients with suspected pancreatic tumors underwent endosonography and dual-phase helical CT. A pathologic diagnosis was obtained in all cases with surgery (n = 23) or biopsy (n = 7), resulting in 27 neoplasms. Dual-phase helical CT and endosonographic findings were correlated with surgical and pathologic findings to determine diagnosis and resectability of pancreatic tumors. RESULTS: Overall diagnostic sensitivity was 92% for dual-phase helical CT and 100% for endosonography (p = .45). Overall accuracy for staging of pancreatic tumors was 93% for both dual-phase helical CT and endosonography. Overall accuracy for predicting resectability was 90% for both dual-phase helical CT and endosonography. Accuracy of predicting unresectability was 100% for dual-phase helical CT and 86% for endosonography (p > .80). Differences were not considered statistically significant. CONCLUSION: Dual-phase helical CT and endoscopic sonography do not differ significantly for diagnosis and assessment of resectability of pancreatic tumors.

Adenocarcinoma↗
PubMed1998

[Value of high-frequency (20 MHz)in the diagnosis of cutaneous tumors].

The purpose of the present study is to asses the value of high frequency ultrasonography (20 MHz), a new noninvasive imaging technique, in cutaneous tumors. Cutaneous tumors are clinically varied and their diagnosis is still based on histopathological analysis. 140 cutaneous tumors have been examined with US and imaging findings have been compared to the results of clinical and histological examinations. This study shows that high frequency ultrasonography, even though it cannot replace pathological analysis, may help the dermatologist in the positive diagnosis of some cutaneous tumors and in accessing the location and the in depth-extension of the lesions in the different layers of the skin.

Adolescent↗
PubMed1998

[Imaging of adrenal incidentalomas].

Imaging plays an important role in evaluating fortuitously discovered adrenal masses. These unanticipated masses (incidentalomas) are usually discovered at CT examinations. Although most incidentally discovered adrenal tumors are non-hyperfunctioning adenomas, they must be distinguished from primary or secondary malignant lesions. Recent studies have established that both unenhanced CT scans and chemical shift MR imaging can accurately differentiate benign adenomas from nonadenomatous masses by features that reflect the large amount of lipid found in most adenomas and absent in most nonadenomas. We review here the current imaging issues concerning adrenal incidentalomas including diagnostic approaches and management.

Adenoma↗
PubMed1997

Selective surgical indications for iatrogenic hemobilia.

BACKGROUND: This study was undertaken to assess the place for surgery in patients with iatrogenic hemobilia. METHODS: Nineteen patients were treated for hemobilia caused by percutaneous liver biopsy (n = 11), percutaneous transhepatic cholangiography (PTC, n = 5), or percutaneous biliary drainage (PBD, n = 3). Selective embolization was attempted in all patients who bled after percutaneous liver biopsy or PTC but one, whereas irrigation via the external catheter was tried first in patients bleeding after PBD. RESULTS: Selective embolization was successful in 13 cases (87%) of 15. Technical impossibility of selective embolization (n = 2) and absence of recognizable vascular lesion (n = 1) were the reasons for surgery in three actively bleeding patients. Indications for delayed surgery included hemocholecystitis (n = 3) and inadvertent embolization of the gallbladder (n = 1). Biliary decompression was only required after PTC and was achieved by endoscopic sphincterotomy (n = 3), percutaneous transtumoral intubation (n = 1), or surgery (n = 1) after failure of percutaneous biliary dilation. After PBD, repeat irrigation and tube replacement were used to stop the bleeding and to decompress the biliary tract without embolization or surgery. None of the 19 patients died, and none experienced recurrent bleeding. CONCLUSION: Surgical indications for iatrogenic hemobilia are limited and include failure or complication of arterial embolization, hemocholecystitis, and failed attempt at endoscopic or percutaneous biliary decompression in case of obstructive jaundice.

Adult↗
PubMed1997

Protein-losing enteropathy secondary to hepatic venous outflow obstruction after liver transplantation.

A 42-year-old man with a history of repeated abdominal surgery and lymph node tuberculosis underwent orthotopic liver transplantation for primary sclerosing cholangitis. Two years after transplantation, this patient developed a severe protein-losing enteropathy with no evidence of cardiac disease or lymphoproliferative disorder. Imaging work-up revealed hemodynamically significant stenosis of the supra-hepatic caval anastomosis, which was treated by percutaneous balloon angioplasty. All clinical and biochemical disorders resolved within 1 month after percutaneous dilatation, but relapsed simultaneously with recurrent anastomotic stenosis 15 months later. Repeat caval angioplasty resulted in rapid recovery, which strongly suggests that hepatic venous outflow obstruction was responsible for the protein-losing enteropathy in this patient.

Adult↗
PubMed1997

Technetium-99m sestamibi scintigraphy, magnetic resonance imaging and venous blood sampling in persistent and recurrent hyperparathyroidism.

Surgical treatment for primary hyperparathyroidism (HPT) is effective in 90% of cases. Recurrent or persistent HPT occurs in 10% of cases. Parathyroid imaging is indicated to confirm and locate an abnormal gland before reoperation. The aim of this study was to evaluate whether the combination of 99Tcm sestamibi scintigraphy, MRI and venous blood sampling (VBS) improved the overall sensitivity for abnormal parathyroid gland detection. 18 patients with recurrent or persistent HPT underwent sestamibi scintigraphy (n = 18), MRI (T1 weighted and STIR sequences) (n = 18) and venous blood sampling (n = 12) at different sites (internal jugular veins, innominate veins, and superior vena cava). All patients underwent surgical exploration. MRI yielded positive results in 15 cases (sensitivity 88%), sestamibi scintigraphy in 14 cases (83%) and VBS in 10 cases out of 12 (83%). Combined results of MRI, sestamibi and VBS yielded positive results in 16 cases (94%). The combination of MRI, sestamibi scintigraphy and VBS improved accuracy in detecting abnormal parathyroid glands before reoperation.

Adenoma↗
PubMed1997

[Primary bilateral adrenal lymphoma as viewed by MRI. Apropos of a case].

Clinically silent adrenal involvement in lymphoma is a relatively common occurrence, involvement of bilateral adrenal glands by lymphoma as the sole manifestation of lymphoma is very rare, with only 30 cases reported in the literature. We report a patient with this unusual conditions, with CT scan and MRI aspects.

Adrenal Gland Neoplasms↗
PubMed1997

[Role of selective venous catheterization with assay of parathormone 1-84 in the treatment of persistent hyperparathyroidism].

From March 1993 to October 1994, 12 patients operated for persistent hyperparathyroidism had preoperative catheterization of large cervical and mediastinal veins (CLCMV) with determination of serum concentration of intact parathyroid hormone. Other localization procedures included: ultrasonography (US, n = 9), computed tomography (CT, n = 8), magnetic resonance imaging (MRI, n = 5), and sestamibi radionuclide imaging (MIBI, n = 9). A (1-84 PTH) gradient of 1-84 PTH was demonstrated in all patients, localizing a lesion in the neck (n = 9) or in the mediastinum (n = 3). An adenoma was found in nine patients either in the neck (n = 6) or in the mediastinum (n = 3), and 2 patients had glandular hyperplasia. Two patients remained hypercalcemic despite the removal of parathyroid tissue during CLCMV-guided reexploration. An other patient underwent unsuccessful neck reexploration. The sensitivity of other procedures was lower: US: 22%, CT: 50%, MRI: 60%, and MIBI: 66.5%. After a median follow-up of 13 months, 9 patients were cured of their hyperparathyroidism (75%) and 3 had persistent hypercalcemia. Our results suggest that CLCMV with 1-84 PTH measurement is the most accurate localization procedure in persistent hyperparathyroidism.

Adult↗
PubMed1996

Cyclic sciatica. A manifestation of compression of the sciatic nerve by endometriosis. A case report.

STUDY DESIGN: A case of cyclic sciatica secondary to ovarian cyst endometriosis is presented. OBJECTIVES: To report the clinical description and magnetic resonance imaging aspects of cyclic sciatica. SUMMARY OF BACKGROUND DATA: Endometriosis of the sciatic nerve is rare, but must be included in the differential diagnosis of sciatic mononeuropathies. METHODS: The authors report a new case of a woman whose cyclic sciatica was caused by an ovarian cystic endometriosis lesion. RESULTS: Magnetic resonance imaging was described as hyper- and hypointense on T1-weighted sequences, and hyperintense on T2-weighted sequences at the sciatic notch. CONCLUSION: Magnetic resonance imaging may permit a specific diagnosis of this unusual cause of sciatica by showing a hemorrhagic mass in the region of the sciatic nerve. Early recognition is necessary to prevent permanent damage to the sciatic nerve.

Adult↗
PubMed1996

Iodixanol in leg phlebography: a randomized, double-blind parallel group phase III trial comparing iodixanol to ioxaglate.

PURPOSE: To evaluate the safety and efficacy of iodixanol (Visipaque) in phlebography in order to obtain experience from the use of this contrast medium in this i.v. indication. PATIENTS AND METHODS: Phlebography was performed in 150 patients, as a comparative prospective, double-blind, randomized parallel group study comparing iodixanol 270 mgI/ml with ioxaglate 320 mgI/ml. The tolerability was assessed from occurrence of discomfort, adverse events up to 30 min following injection and late adverse events. Efficacy was assessed by recording the diagnostic information on each venous segment. Statistical analysis was performed using the Cochran-Mantel-Haenszel test in order to correct for a possible centre effect. RESULTS: Frequency of patients reporting discomfort (P=0.002) or adverse events (P<0.001) was statistically significantly lower after the injection of iodixanol than after ioxaglate. There was no statistical difference regarding late adverse events and diagnostic information. CONCLUSION: Iodixanol 270 mgI/ml yielded the same diagnostic information as ioxaglate 320 mgI/ml and was associated with fewer patients reporting adverse events and discomfort.

Adult↗
PubMed1996

Contrast material injection for hepatic helical computed tomography. Comparative study of five protocols.

RATIONALE AND OBJECTIVES: The authors develop and compare contrast material injection protocols suitable for hepatic helical computed tomography. METHODS: One hundred twenty-one patients who underwent contrast-enhanced computed tomography (CT) of the liver with spiral CT imaging were evaluated for enhancement of the liver parenchyma and for post-enhancement attenuation of the aorta and portal vein with iohexol. Patients were assigned randomly to five protocols with different flow rates, volume of contrast material, and scan delays. RESULTS: Mean parenchymal contrast enhancement was statistically significantly higher with protocol 5 (biphasic injection of 100 mL of iohexol 300 (g/100 mL) at a flow rate of 1.5 mL/second followed by 25 mL at 2 mL/second; total iodine load = 37.5 g, with a scan delay of 70 seconds). The highest aortic enhancement and the second highest portal vein enhancement were obtained with this protocol. CONCLUSION: The authors suggest an easily tolerated injection protocol able to ensure high parenchymal liver enhancement and satisfactory aortic and portal vein enhancement. This protocol includes a long scan delay (70 seconds), biphasic low flow injection rate, and a relatively low iodine load.

Adult↗
PubMed1995

Spontaneous unilateral adrenal hemorrhage: computerized tomography and magnetic resonance imaging findings in 8 cases.

PURPOSE: We report and discuss the imaging features of 8 cases of spontaneous unilateral adrenal hematomas, a rare lesion. MATERIALS AND METHODS: Computerized tomography (CT) was done in 8 cases, magnetic resonance imaging (MRI) in 5, and CT and MRI in 5. Imaging findings were reviewed and correlated with histological findings in all 8 cases. RESULTS: MRI was the most accurate imaging modality and showed variable appearances. On pathological evaluation the hematomas were old and organized. No contrast enhancement was noted on CT or MRI. CONCLUSIONS: One must not consider the diagnosis of spontaneous adrenal hematoma only as superimposed on a phechromocytoma or malignant lesion in the case of an incidentally discovered large adrenal mass with normal biological findings. MRI signs of adrenal hemorrhage and the failure of enhancement of such a mass should strongly suggest adrenal hematoma.

Adrenal Gland Diseases↗
PubMed1995

Hepatic artery thrombosis after liver transplantation: diagnosis with spiral CT.

OBJECTIVE: The purpose of this study was to prospectively evaluate spiral CT with maximum-intensity projection in the diagnosis of hepatic artery thrombosis in patients with liver transplants. SUBJECTS AND METHODS: Thirty liver transplant recipients (19 men, 11 women; mean age, 49 years) underwent Doppler sonography and spiral CT with maximum-intensity projection to evaluate both hepatic parenchyma and hepatic vessels. In five cases, these examinations were followed by angiography for suspected hepatic artery thrombosis. RESULTS: Among the 30 patients, results of both Doppler sonography and spiral CT were abnormal in five patients. In all five patients, Doppler sonography revealed an absence of intrahepatic arterial signal (sensitivity, 100%). Spiral CT showed the hepatic artery to be patent from its origin to the anastomosis and then occluded distally in four patients and showed occlusion of the entire hepatic artery in one patient (sensitivity, 100%). Aortography and/or selective arteriography of the celiac axis confirmed the diagnosis of hepatic artery thrombosis in all five cases. The other 25 patients had a normal clinical outcome, 24 with normal findings on Doppler sonograms (specificity, 96%), and 23 with normal findings on spiral CT. Two patients had false-positive CT studies because of technical failures (specificity, 92%). CONCLUSION: Spiral CT with maximum-intensity projection is highly accurate in identifying hepatic artery thrombosis after liver transplantation.

Adult↗
PubMed1994

[Spontaneous unilateral adrenal hematomas. 10 cases].

Spontaneous unilateral adrenal haematoma is a very rare condition. We report 10 such cases in which the pathological examination confirmed the diagnosis and for which computed tomography (CT) (n = 10) and magnetic resonance imaging (MRI) (n = 5) were performed. The diagnosis of this condition was difficult because there was no specific clinical setting nor any specific functional disorder. CT most often revealed a large mass (> 4 cm) of one of the adrenal glands, most often displaying soft-tissue attenuation and thus not specific. However, MRI suggested the diagnosis, showing foci of hypersignal on T1-weighted images and heterogeneous masses on T2-weighted images, predominantly displaying hypersignal and not enhancing, after Gd-DTPA dynamic perfusion study. Pathologic examination of the surgical specimen confirmed either idiopathic haematoma (n = 5) or haematoma possibly associated with a small benign tumour (n = 5). The diagnosis of adrenal haematoma must be considered when an unilateral isolated large adrenal mass is discovered in an asymptomatic patient. MRI with Gd-DTPA dynamic perfusion study has to be performed and one may suggest waiting and repeat imaging (so as to follow decrease in size or signal changes) in order to avoid surgery.

Adrenal Gland Diseases↗
PubMed1994

MR imaging and CT of surgical materials currently used in ophthalmology: in vitro and in vivo studies.

PURPOSE: To assess methods of imaging postoperative changes in the eyeball by performing in vitro and in vivo studies of the main solid and fluid materials used in the treatment of cataract and retinal detachment. MATERIALS AND METHODS: The samples were analyzed in vitro with computed tomography (CT) and magnetic resonance (MR) imaging performed at 0.5 T. In vivo studies were performed in seven patients who underwent lens implantation (n = 1), scleral buckling with hydrogel or silicone (n = 6), and retinopexy with gas or silicone oil (n = 6). The attenuation and signal intensity of the materials were compared with values for anatomic structures. RESULTS: Lens implants were difficult to visualize. Each scleral buckling and retinopexy material was easily differentiated from the others and from anatomic structures at both CT and MR imaging. CONCLUSION: Postoperative CT or MR imaging may be useful after retinal detachment surgery, particularly when ultrasound is not reliable after intravitreous gas-fluid interchange.

Eye↗