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Biomedical subjects

R Bittner

Publications and source records attributed to R Bittner.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Imaging diagnosis of aggressive fibromatosis and the MRT-pathological correlation].

Aggressive fibromatoses (desmoid tumours) tend to grow in an infiltrative and destructive manner without metastases. Computed tomography of aggressive fibromatoses yields no uniform attenuation pattern. The tumours are typically isodense when no contrast medium is used and enhance clearly to hyperdense during infusion of contrast medium. In magnetic resonance tomography (MRT) a high signal (long T2) on T2-weighted pulse sequences as well as an accumulation of i.v. Gd-DTPA seems to be the characteristic appearance of aggressive fibromatoses, although different signal intensities can be seen. The MRT histopathologic correlation shows increasing signal intensities on T2-weighted sequences dependent on an increment in cellular content of the tumours. Only histopathological methods can provide a definite diagnosis.

Adolescent↗
PubMed1989

[Malignant chest wall infiltration in MR: comparison with CT and surgical findings].

CT and MRI were performed on 19 patients with pleura related thoracic tumors with respect to the detection of chest-wall invasion. All patients underwent surgery, which confirmed malignant infiltration in 16 cases, while this was excluded in three. CT showed chest-wall invasion in 12/19 patients. MRI demonstrated tumorous involvement in 16 patients. A reliable pattern of chest-wall invasion in MRI were high signal intensity lesions within the chest-wall in the T2-weighted images. However, increased signal intensity of pleural structures was found in inflammatory as well as in malignant lesions. MRI can prove the presence of chest-wall invasion when CT is equivocal.

Adult↗
PubMed1989

[Effect of tumor size and lymph node status on the prognosis of pancreatic cancer].

Between 1982 and 1987 186 patients with a carcinoma of the pancreas underwent surgery. In 69 patients (37%) a resective surgical procedure was performed. In these patients, lymph node staging was conducted intraoperatively. The operative mortality of the resection was 4.3%. The median survival of the resected patients with papillary carcinoma was 21 months and of the patients with ductal pancreatic carcinoma 7 months. A correlation between survival time and frequency as well as localization of the lymph node attack could be established. Only patients in the TNM stage I of a ductal carcinoma appeared to have profited significantly from the resection compared to the palliative procedure.

ACTH Syndrome, Ectopic↗
PubMed1989

[Perioperative glucose resorption and hormonal reaction following intraduodenal glucose administration].

Early postoperative enteral nutrition has repeatedly been described in the literature but has not found its place yet in everyday clinical life. We conducted perioperative intraduodenal glucose tolerance tests in 12 patients with a healthy metabolism who had to undergo moderately severe abdominal surgery. Our results suggest that the resorption is still markedly delayed 12 h postoperatively and that the hormonal regulation is also essentially disturbed. Therefore, we believe that enteral nutrition in the early postoperative period is beneficial only more than 24 h after surgery.

Adult↗
PubMed1989

[The value of irrigation].

Twenty percent of our patients who have had colostomy use irrigation to regulate the bowels. This decision is made by the patient himself after careful deliberation. By means of an irrigation set the large intestine is irrigated with approximately 1-1.5 l of water at body temperature. Subsequently there is a stool-free period of 24-28 h and a reduction of flatulence. The duration of irrigation is 45-60 min. Side effects are occasionally pressure sensation and mild convulsive symptoms, but there are no significant complications. Irrigation can begin after complete healing of the stoma, but is absolutely contraindicated in inflammatory intestinal diseases and relatively contraindicated in prolapse, hernia, stenosis, and intestinal damage by radiation.

Colostomy↗
PubMed1989

[A new multislice gradient echo sequence for magnetic resonance tomography of the liver].

A multislice gradient echo sequence was developed for screening the liver and examined in studies on probands. This sequence is characterized by pronounced T1-weighting and low susceptibility to artifacts as well as a good contrast-to-noise ratio. Examination of the probands yielded suitable parameters for the repetition time, the delay echo, the excitation pulse angle and the number of data acquisitions. The optimized sequence yields, at a repetition time of 306 msec and an echo delay of 12 msec, 18 adjacent slices. With these measurement parameters an excitation pulse angle of 90 degrees was found to be adequate. Four data acquisitions (5.4 minutes measurement time) resulted in an effective reduction of motion artifacts. Compared with the T1-weighted spin echo sequences, the entire liver can be measured in half the time when using the multislice gradient echo sequence.

Humans↗
PubMed1989

[Cephalic pancreatectomy with conservation of the duodenum in chronic pancreatitis with inflammatory lesions of the head of pancreas. Results of 15 years' experience].

In 122 patients with severe chronic pancreatitis and inflammatory enlargement of the head of the pancreas a duodenum-preserving resection of the pancreatic head was performed. Postoperative hospitalization was 16 days in median, the frequency of re-operation was 4.9%. In the early postoperative phase one patient died and hospital mortality amounted to 0.8%. Following a medium follow-up period of 4.2 years (min. 6 months, max. 15 years) 7 patients died (late mortality 4.9%). 77% of the patients were completely free of abdominal pain, 84% went back to their previous occupation. During the follow-up period in 81% of the patients the glucose metabolism was unchanged, in 13% it deteriorated, and in 5% it improved permanently; 80% of the patients had a marked increase in weight averaging 8.7 kg. Compared to the Whipple procedure the duodenum-preserving resection of the head of the pancreas spares the patient with chronic pancreatitis a gastric resection, the duodenectomy, and the resection of the extrahepatic bile ducts. The limited operative intervention at the head of the pancreas in terms of a subtotal resection and the preservation of the duodenum explains the low early and late postoperative morbidity and mortality.

Adult↗
PubMed1989

[MRT of intrathoracic space-occupying lesions--conventional and new rapid study technics].

100 patients with histologically and cytologically confirmed intrathoracic space-occupying growths were examined by CT and MR over and above conventional x-ray film diagnosis. MR tomography was performed in all the 100 patients via ECG-triggered T1 and T2 weighted spin echo sequences. The last 35 patients were additionally examined via gradient echo sequences with which it is possible to examined 24 consecutive layers in any layer plane within 7 minutes without ECG triggering. Comparative evaluation of CT and MR tomography yielded an equally high degree of sensitivity when identifying intrathoracic growths. Compared to CT, determination of tumour status via MR tomography proved easier in individual cases. Other advantages of MR tomography were seen in the staging of bronchial carcinomas. Compared with conventional spin echo sequences the rapid gradient echo sequences reduced examination periods by more than 50%. In the cardiac region and the mediastinal structures that pulsate with it the diagnostic value of the gradient echo images is at present slightly impaired by fuzziness caused by movement. The image quality of the spin echo images is comparatively good in the regions of the superior and posterior mediastinum, the lungs and the thoracic wall.

Carcinoma, Bronchogenic↗
PubMed1989

[Data on surgical indications in necrotizing pancreatitis--results of a validation study].

134 patients with necrotizing pancreatitis were operated. Preoperative organ insufficiency (pulmonary or renal), the presence of shock or sepsis and the intraoperative morbidity factors: parenchymal necroses greater than 30%, extrapancreatic necroses, ascites and in particular bacterial contamination were directly correlated with prognosis and mortality. The occurrence of these morbidity factors consequently signifies an urgent indication for operation.

Acute Disease↗
PubMed1988

Necrosectomy and postoperative local lavage in necrotizing pancreatitis.

Necrosectomy with postoperative continuous local lavage was performed in a prospective study involving 95 patients with necrotizing pancreatitis. In the same period 567 patients with oedematous-interstitial pancreatitis were treated non-operatively with a hospital mortality rate of 0.7 per cent. In patients with necrotizing pancreatitis the median Ranson criteria score was 4.5 points; operation was required at a median of 7 days after the onset of symptoms because of non-response to conservative treatment. In all, 59 per cent of the patients (56 out of 95) developed extended intrapancreatic parenchymal necrosis, 70 per cent had ascites, and 66 per cent had intra- and extrapancreatic necrosis; 42 per cent of the patients had bacterial infection of the necrotic tissue. For lavage a median of 8 l/24 h of fluid were instilled postoperatively for 25 days (median). The lavage fluid showed high levels of immunoreactive trypsin, phospholipase A2, and endotoxin in the early postoperative period. Hospital mortality rate was 8.4 per cent. Necrosectomy and continuous postoperative lavage can achieve high survival rates in patients with necrotizing pancreatitis. Postoperative local lavage allows the continuous non-operative evacuation of biologically active compounds and devitalized tissue, and avoids damage to remaining vital exocrine and endocrine pancreatic tissue.

Acute Disease↗
PubMed1988

'Entero-insular axis' and surgical trauma.

To study the optimal means of postoperative energy supply, three glucose loads (5 g, 15 g, 40 g) were given via the enteral or the parenteral route before and immediately after abdominal surgery. Pre- and post-operatively, glucose and insulin concentrations were strongly dose-related after both kinds of administration. But the postoperative insulin concentrations were higher than the preoperative ones. Likewise, in both test situations the 'insulinogenic index' was significantly higher postoperatively than preoperatively. After the enteral glucose load, however, the index was 3 to 10 times higher than after the parenteral one. According to these results, even in the early postoperative period the enteral route of glucose administration is not only feasible but seems also to be superior to the parenteral one.

Adult↗
PubMed1988

[Necrosectomy and bursa lavage in necrotizing pancreatitis. Results of a prospective clinical study].

In a prospectively performed clinical trial a surgical management protocol including necrosectomy and postoperative local lavage of the necrosis cavity and the omental bursa was applied in 95 patients with necrotizing pancreatitis. In 80% of them severe organ failures occurred preoperatively, in spite of intensive care treatment. The median value of early prognostic signs of these patients was 4.5. Intraoperatively 59% showed extended pancreatic necroses and 66% an extension of the necroses into extrapancreatic tissue structures; in 42% bacteria were detected in the necrotic material. After necrosectomy the postoperative local lavage was performed for an average period of 25 days with 8 1 of lavage fluid per 24 hours in median. The average intensive care period came to 7.0 days, the average postoperative hospital time was 60 days. The hospital mortality amounted to 8.4%. The advantage of this management protocol including necrosectomy and postoperative local lavage lies in the continuous emptying of vasoactive and toxic substances, germs and necrotic material.

Acute Disease↗
PubMed1988

[Magnetic resonance tomography (MRT) in bronchial cancer].

Comparative studies were made of 47 patients suffering from histologically and cytologically confirmed bronchial carcinoma, using CT and MRT respectively. CT examinations were performed before and after intravenous administration of contrast medium, whereas the MR examinations were conducted via EEG-triggered T1 and T2 marked SE sequences in the axial and coronary planes. Both methods were assessed in respect of tumour visualisation and documentation of tumour spread. Staging of tumour and lymph nodes yielded largely concurring results for CT and MRT. Exceptions were seen in 7 of 10 patients with malignant involvement of the pericardium and in 3 of 27 patients with lymph node metastases located mediastinally and subcarinally where only MRT showed a positive involvement of the pericardium or lymph nodes (with possible consequences for the staging of the tumour or lymph nodes). Decisive advantages of MRT compared with CT were seen in the identification of infiltration of the aortic-wall, in the differentiation of the poststenotic syndrome, in the visualisation of the thoracic wall infiltration and functional information on blood flow rate in upper venolus obstruction caused by a carcinoma.

Carcinoma, Bronchogenic↗