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Steffen Rickes

Publications and source records attributed to Steffen Rickes.

At least 19 recordsLinked to original sources
PubMed2006

Contrast-enhanced ultrasound in the diagnosis of pancreatic tumors.

Echo-enhanced ultrasound is a newly available imaging modality for the evaluation of pancreatic lesions. Neoplasms of the pancreas tend to have a characteristic vascularization pattern. Adenocarcinomas are often hypovascularized as compared to the surrounding tissue. On the other hand, neuroendocrine tumors are hypervascularized lesions. Masses associated with pancreatitis have a different vascularization pattern depending on the degree of inflammation and necrosis. Cystadenomas frequently show many vessels along fibrotic strands. Data from prospective studies have demonstrated that based on these imaging criteria, the sensitivity and the specificity of echo-enhanced sonography in diagnosing the degree of differentiation of pancreatic masses are equal to, or greater than, 85% and 90%, respectively. In conclusion, pancreatic tumors have a different vascularization pattern in echo-enhanced ultrasound. These characteristics can be used with high a diagnostic accuracy for differentiation.

Carcinoma, Pancreatic Ductal↗
PubMed2006

Small bowel obstruction in pregnancy.

BACKGROUND: Intestinal obstruction in pregnancy is rare. Symptoms are often unspecific and a high level of suspicion is essential for early diagnosis. Fetal and maternal mortality rates are higher during pregnancy due to delay in diagnosis. CASE: A 31-year-old primigravida with a history of abdominal surgery was admitted because of worsening abdominal pain, abdominal distension and elevated pancreatic enzymes. Ultrasound showed dilated small bowel loops. Explorative laparotomy revealed a small bowel obstruction with partial bowel necrosis caused by a single adhesion. A jejuno-jejunostomy was performed. Five days later, she developed peritonitis. A secondary laparotomy and caesarean section were done. CONCLUSION: In spite of timely diagnosis and prompt surgical intervention, our case was still complicated by peritonitis and early delivery. This underlines the necessity of immediate clinical suspicion. Small bowel obstruction should be considered in differential diagnosis of pregnant patients with a history of abdominal surgery.

Abdominal Pain↗
PubMed2006

Diagnostic quality of: polyps resected by snare polypectomy: does the type of electrosurgical current used matter?

BACKGROUND: Traditionally, snare polypectomy is performed using blended, coagulation, or pure cutting electrical current (EC). The aim of this study was to assess and compare the diagnostic quality of polyps obtained by snare polypectomy using two different electrosurgical currents. METHODS: Consecutive patients undergoing colonoscopy underwent polypectomy using either blended EC with a conventional electrosurgical generator (ESG) or using an ESG with a microprocessor that automatically controls cutting and coagulation (Endocut). An experienced blinded gastrointestinal (GI) pathologist evaluated the specimens for diameter, cautery damage (amount and degree), margin evaluability, architecture, and general histologic diagnostic quality. RESULTS: One hundred sixteen patients (69% men, mean age 63.8 +/- 15 yr) underwent 148 polypectomies (78 using blended current and 70 using Endocut). We found that the cautery degree was less with the Endocut than with the blended current (p < 0.02). Cautery amount was also higher in polyps resected using blended current (56%) than Endocut (51%) but this difference did not reach statistical significance (p= 0.1). Polyps resected using Endocut had better margin evaluability (75.7% to 60.3%, p= 0.046). The overall tissue architecture was similar in both groups. Polyps removed with blended current had less overall quality as compared to polyps removed by Endocut (p= 0.024). CONCLUSIONS: More extensive tissue damage occurred using blended EC with the conventional ESG than when using Endocut. The quality of the polypectomy specimens was overall better using Endocut. Finally, the ability to evaluate resected polyp margins and overall tissue histology was better with the microprocessor-controlled ESG than with the conventional ESG.

Aged↗
PubMed2006

Echo-enhanced ultrasound with pulse inversion imaging: A new imaging modality for the differentiation of cystic pancreatic tumours.

AIM: To describe and discuss echo-enhanced sonography in the differential diagnosis of cystic pancreatic lesions. METHODS: The pulse inversion technique (with intravenous injection of 2.4 mL SonoVue) or the power-Doppler mode under the conditions of the 2nd harmonic imaging (with intravenous injection of 4 g Levovist) was used for echo-enhanced sonography. RESULTS: Cystadenomas frequently showed many vessels along fibrotic strands. On the other hand, cystadenocarcinomas were poorly and chaotically vascularized. "Young pseudocysts" were frequently found to have a highly vascularised wall. However, the wall of the "old pseudocysts" was poorly vascularized. Data from prospective studies demonstrated that based on these imaging criteria the sensitivities and specificities of echo-enhanced sonography in the differentiation of cystic pancreatic masses were >90%. CONCLUSION: Cystic pancreatic masses have a different vascularization pattern at echo-enhanced sonography. These characteristics are useful for their differential diagnosis, but histology is still the gold standard.

Cystadenocarcinoma↗
PubMed2006

Whipple's Disease.

Whipple's disease (WD) is a chronic debilitating disease caused by the bacillus Tropheryma whippleii. WD classically presents with the main clinical symptoms of polyarthralgias, chronic diarrhea, weight loss, and abdominal pain. Given its systemic involvement, it is common for WD to present with a multitude of other clinical scenarios--sometimes with predominant neurologic, cardiac, and dermatologic manifestations. WD can occur at any age, but it generally occurs during the fifth decade and predominantly in men. The diagnosis of WD is established by demonstrating the organism on biopsies from the involved system, by histology, electron microscopy, polymerase chain reaction, and more recently, by culture of bacteria. The histologic features include a coarse granular cytoplasm and foamy macrophages that stain strongly with the period-acid Schiff reagent. Current therapy includes an initial 2-week course of intravenous cephalosporins followed by 1-year oral trimethoprim-sulfamethoxazole.

Journal Article↗
PubMed2006

Impact of the operator's experience on value of high-resolution transabdominal ultrasound in the diagnosis of choledocholithiasis: a prospective comparison using endoscopic retrograde cholangiography as the gold standard.

OBJECTIVE: Transabdominal ultrasound (US) is the most frequently used imaging method for the diagnosis of choledocholithiasis. The aim of this prospective study was to evaluate the diagnostic accuracy of high-resolution US in the diagnosis of common bile duct stones depending on the operator's experience and in comparison with endoscopic retrograde cholangiography (ERC) as the gold standard. MATERIAL AND METHODS: From April 2003 through November 2004, 126 patients referred because of clinically and biochemically suspected common bile duct stones were included in the study. Two patients were excluded because they refused to undergo ERC. Consequently, the study comprised 124 patients (86 F, 38 M, mean age 63.2 years, range 21-91 years). High-resolution US was performed (2-5 MHz sector scanner; Siemens Elegra, Erlangen, Germany) by operators who were unaware of the results of other imaging procedures. The definitive diagnosis was established by means of ERC. RESULTS: Thirty-five out of 124 patients were investigated by experienced examiners. Twenty-seven of 35 patients (77%) were found to have stones at ERC. Bile duct stones were correctly found by US in 22 out of 27 patients (sensitivity 82%, 95% CI: 63-92). Of the 8 patients without stones at ERC, one false-positive diagnosis was made with US (specificity 88%, 95% CI: 53-98). Correct diagnoses were made in 29 out of 35 (accuracy 83%, 95% CI: 67-92) patients investigated by experienced examiners. Eighty-nine out of 124 patients were investigated by less-experienced examiners. Fifty-four of 89 patients (61%) were found to have stones at ERC. Choledocholithiasis was found correctly in only 25 out of 54 patients (sensitivity 46%, 95% CI: 34-59). Of the 35 patients without stones at ERC, three false-positive diagnoses were made with US (specificity 91%, 95% CI: 78-97). In conclusion, correct diagnoses were observed in 57 of 89 patients (accuracy 64%, 95% CI: 54-73) investigated by less-experienced examiners (p<0.05 in comparison with the results of experienced examiners). CONCLUSIONS: High-resolution US carried out by experienced examiners has a high diagnostic accuracy in the diagnosis of choledocholithiasis. Therefore, good training and continued experience are prerequisites for successful sonographic detection of bile duct stones using US. Under these conditions, further expensive and invasive methods such as ERC, magnetic resonance cholangiopancreatography and endoscopic ultrasonography may not be necessary in cases with a clear sonographic diagnosis.

Adult↗
PubMed2006

Sonographic diagnosis and endoscopic therapy of a biliopancreatic fistula complicating a pancreatic pseudocyst.

This is the first report of a case of biliopancreatic fistula complicating a pancreatic pseudocyst diagnosed correctly by transabdominal ultrasound. The diagnosis was confirmed by magnetic resonance and endoscopic retrograde cholangiopancreatography. The fistula was treated successfully with biliary stenting. The clinical and imaging features of this exceptional complication are presented along with a brief review of the topic.

Aged↗
PubMed2006

SonoCT improves on conventional ultrasound in the visualization of the pancreatic and bile duct: A pilot study.

BACKGROUND AND AIMS: In sonographic diagnostic investigation, evaluation of the ductus Wirsungianus and the ductus hepatocholedochus plays an important role. The present prospective study sought to establish whether SonoCT can improve on conventional B-mode sonography in the visualization of the pancreatic and bile duct. SUBJECTS AND METHODS: In the pilot study, ductus Wirsungianus and ductus hepatocholedochus of 14 healthy volunteers were assessed by an experienced and an inexperienced examiner, respectively, using both traditional B-mode sonography and SonoCT. Assessment was based on a predetermined set of criteria. RESULTS: Both examiners were able to determine duct structures significantly more effectively using SonoCT. Compared with traditional B-mode sonography, the use of SonoCT also led to significant improvements in terms of delineation and clarity of representation in both ductus Wirsungianus and ductus hepatocholedochus. CONCLUSION: SonoCT yields better results than conventional B-mode sonography in terms of delineation, visualization of borders and artefact-free representation of both ductus Wirsungianus and ductus hepatocholedochus. Appropriate training and experience of the examiner, however, remain key prerequisites for success in evaluating pathological changes of the ducts. Future studies will be needed to determine whether certain diseases can be diagnosed more readily using SonoCT rather than conventional sonographic technique.

Adult↗
PubMed2006

"Just ascites"?

Explore the source record for details and available documents.

Ascites↗
PubMed2005

Echo-enhanced ultrasound--a new imaging modality for the differentiation of pancreatic lesions.

INTRODUCTION: Echo-enhanced ultrasound is a newly available mode of imaging for differential diagnosis of pancreatic tumours. Ductal carcinomas are often hypovascularised compared with the surrounding tissue. Neuroendocrine tumours, on the other hand, are hypervascularised lesions. Tumours associated with pancreatitis have a different vascularisation pattern depending on inflammation and necrosis. Cystadenomas frequently have many vessels along the fibrotic strands. RESULTS: Data from prospective studies have demonstrated, on the basis of these imaging criteria, that the sensitivity and specificity of echo-enhanced sonography for differentiation of pancreatic masses are >or=85 and >or=90%, respectively. CONCLUSIONS: Pancreatic tumours have a different vascularisation pattern in echo-enhanced ultrasound. These characteristics can be used with high diagnostic accuracy for differential diagnosis.

Carcinoma, Pancreatic Ductal↗
PubMed2005

Comparison of 13C- urea blood test to 13C-breath test and rapid urease test for the diagnosis of Helicobacter pylori infection.

At present, the available methods to diagnose active H. pylori infection are endoscopy with biopsy for histology, culture, rapid urease tests, 13C or 14C urea breath test, urine antibody and the stool antigen test. The aims of this study were to simplify the 13C urea test by measuring 13C in blood rather than breath, and to evaluate the usefulness of the 13C urea blood test for the diagnosis of H. pylori infection. Patients who underwent upper endoscopy for standard clinical indications (e.g. dyspepsia, abdominal pain) were enrolled. A total of 161 patients (93F, 68M, mean age 47 +/- 14.2) were evaluated; 50 (31%) of them were H. pylori positive, and 111(69%) were H. pylori negative. H. pylori infection was diagnosed with a rapid urease test (CLO-test) and 13C urea breath test (UBT). Performance characteristics for the 13C urea blood test for diagnosis and evaluation of H. pylori eradication were calculated using UBT and CLO as gold standards. The fifty H. pylori-positive patients were treated with triple antibiotic therapy for two weeks. Four weeks after finishing antibiotic therapy patients were retested with a commercial UBT and urea blood test. The 13C blood test had sensitivities of 92 and 98% and specificities of 96 and 100% as compared with urea breath test and CLO, respectively. We conclude that the 13C urea blood test is highly sensitive and specific for the initial diagnosis and control of eradication of H. pylori infection.

Adolescent↗
PubMed2005

[Crohn's disease associated with Takayasu's arteritis].

A 26-year-old woman with Crohn's disease presented with increase of her abdominal pain, abdominal fremitus and decrease in peripheral pulses. The CT scan and the angiography revealed occlusive stenosis of several arteries: left subclavian, celiac, renal, superior mesenteric and abdominal aorta. This findings were consistent with Takayasu's arteritis. The patient underwent surgical revascularization to bypass the occlusive lesions in celiac and superior mesenteric arteries, and the stenosis in abdominal aorta. Subsequent controls showed that she remains free of cardiovascular symptoms three years after surgery but presents progression of her inflammatory bowel disease.

Adult↗
PubMed2004

Differentiation of cystic pancreatic neoplasms and pseudocysts by conventional and echo-enhanced ultrasound.

BACKGROUND AND AIMS: Echo-enhanced sonography is a non-invasive and increasingly used procedure for the differentiation of pancreatic tumors. However, the diagnostic accuracy of this procedure compared to conventional ultrasound for the differential diagnosis of cystic pancreatic neoplasms from pseudocysts has never been investigated in a prospective study. METHODS: Thirty-one patients with a cystic pancreatic lesion at the conventional ultrasound (mean age 57 years, range 36-82 years) were included in the study. Sonography was performed by an experienced examiner who was unaware of the patients' clinical diagnosis. The exact diagnosis was based on histological evidence from biopsy examination (surgical or transabdominal fine needle biopsy for all cystic neoplasms and five pseudocysts), or a follow-up of at least 18 months (four pseudocysts). RESULTS: Of the 31 patients, 19 had cystadenomas, three had cystadenocarcinomas, and nine had pseudocysts. Only 27% of the cystadenomas and 67% of the pseudocysts could be correctly classified by conventional ultrasound. Conversely, 95% of the cystadenomas (P = 0.0001) and all pseudocysts were diagnosed correctly by echo-enhanced sonography. The sensitivity of echo-enhanced sonography with respect to diagnosing cystadenoma was 95% and its specificity was 92%. The corresponding values for pseudocysts were both 100%. CONCLUSION: Echo-enhanced sonography has a high sensitivity and specificity in the differential diagnosis of cystic pancreatic tumors. With this procedure the differentiation of cystadenomas and pseudocysts can be improved. However, histology is the standard of reference.

Adult↗
PubMed2004

Echo-enhanced sonography--an increasingly used procedure for the differentiation of pancreatic tumors.

Echo-enhanced sonography is increasingly being used for differential diagnosis of pancreatic tumors. Ductal carcinomas are often hypovascularized compared with the surrounding tissue. On the other hand, neuroendocrine tumors are hypervascularized lesions. Tumors associated with pancreatitis have a different vascularization pattern depending on inflammation and necrosis. Cystadenomas frequently show many vessels along the fibrotic strands. Pancreatic tumors have a different vascularization pattern in echo-enhanced sonography. These characteristics can be used for differential diagnosis. However, histology is the standard of reference.

Adenocarcinoma↗