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T Roeren

Publications and source records attributed to T Roeren.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Computerized tomography diagnosis of a secondary extramedullary situated, non-secreting plasmacytoma of the right plica ventricularis].

We report the case of a 62-year-old male patient with an extramedullary non-secreting plasmacytoma of the right plica ventricularis. Although his skeletal lesions remained stable, the patient developed hoarseness. This was interpreted as mycotic laryngitis and computed tomography showed a tumor of the right plica ventricularis. Differential diagnosis included neoplasms of the larynx, thyroid gland or a lymphoma. After biopsy, however, histology revealed the rare diagnosis of a secondary extramedullary non-secreting plasmacytoma.

Biopsy, Needle↗
PubMed1995

[Portal hypertension and percutaneous transjugular portasystemic stent shunt].

This paper reports 1) the historic development of TIPSS, the transjugular intrahepatic portosystemic stent shunt from experimental evaluation to clinical realization. 2) The evolution of the instrumental technique during a period of 6 years of clinical applications is described in detail. 3) Results based on 204 consecutive procedures are demonstrated: e.g. the early technical success defined as successful completion of the procedure and 30-day survival was 95%; the clinical success defined as technically successful procedure and no rebleeding during the first 30 days was 83%, the 30-day mortality rate was 6.3%; the 30-day encephalopathy rate was 14.1%; the one-year re-bleeding rate was 11%; the one-year survival rate was 74%, the 3-year survival rate was 41%. 4) Problems of the TIPSS procedure are discussed including a 3-months re-stenosis rate of 46% and a cumulative one-year re-stenosis rate of 84% which requires correction by interventional procedures such as shunt dilatation or additional vascular stent placement. 5) Limitations and indications of TIPSS are elucidated based on hemodynamic and functional aspects of liver cirrhosis.

Esophageal and Gastric Varices↗
PubMed1995

Localized Langerhans cell histiocytosis of bone: treatment and follow- up in children.

We report a case of Langerhans cell histiocytosis (LCH) involving the right scapula in a 4-year-old child. Because of progressive shoulder pain and immobility methylprednisolone was injected directly into the lesion under computed tomography (CT) guidance. Follow-up studies with magnetic resonance imaging (MRI) and ultrasound (US) revealed continuous ossification of the osteolytic lesion with healing after 6 months. Plain films and CT confirmed the healing process. We consider intralesional corticoid instillation a safe method when performed under CT guidance. For initial evaluation and follow-up, MRI and US yielded reliable results in comparison to plain films and CT, thus helping to reduce the radiation dosage in children.

Administration, Topical↗
PubMed1994

Biliary tract strictures after orthotopic liver transplantation: diagnosis and management.

Biliary tract complications in 105 patients who had undergone orthotopic liver transplantation were reviewed in order to determine their incidence and localization. In addition, the possible endoscopic and percutaneous management of such complications was evaluated. Signs of cholestasis appeared in 32 of 105 (30.5%) transplant recipients after a mean of 6.5 months (range 1-19 months), and visualization of the biliary system was performed in all. Twenty biliary tract complications were observed in these 32 patients (62.5%). There were multiple strictures, both intrahepatic and extrahepatic, in 11 grafts. Five of the nine extrahepatic strictures were not confined to the site of the bile duct anastomosis, and involved the whole common bile duct of the donor liver, while the remaining four were confined. The multiple intrahepatic and extrahepatic strictures were related either to occlusion of the hepatic artery or to the fact that the graft had been in a cold ischemic state for a prolonged time. In contrast, multiple strictures and necrosis of the whole extrahepatic bile duct were attributed to local ischemia due to the harvesting procedure. Stenoses strictly confined to the site of anastomosis were thought to be due to surgical technique. Ten extrahepatic bile duct stenoses with considerably impaired bile flow were corrected endoscopically (four), percutaneously (three) and by surgery (three). In four patients with complications in the whole intrahepatic and extrahepatic system, retransplantation was necessary. Biliary tract complications in our patients occurred in up to 19% after liver transplantation on long-term follow-up. Complications of only the extrahepatic system can be treated successfully, whereas complications involving multiple stenoses of the intrahepatic bile duct system frequently require retransplantation.

Adolescent↗
PubMed1994

[Palliative therapy of malignant bile duct stenoses].

The majority of patients (up to 80%) with malignant obstructive jaundice will not be eligible for curative treatment. Palliative treatment of choice is the percutaneous or endoscopic placement of endoprostheses with a low periprocedural morbidity and mortality. The development of expandable metallic stents led to improved patency rates compared to plastic endoprostheses. Reocclusion rates of approximately 20%, however, necessitate further improvements to optimize design and materials of these stents.

Bile Duct Neoplasms↗
PubMed1994

[Stent angioplasty of the intrarenal aorta and aortic bifurcation. Clinical and angiographical results of a prospective study].

PURPOSE: The study was carried out to evaluate clinical and technical success, early and late complications and patency rates after stent angioplasty of atherosclerotic stenoses and occlusions of the infrarenal abdominal aorta and aortic bifurcation. PATIENTS AND METHODS: This was a prospective study in 20 consecutive patients treated by implantation of balloon-expandable stents. All patients were followed-up after 6 and 12 months and at yearly intervals thereafter by physical examination, Doppler sonography and angiography. RESULTS: Nineteen of 20 patients had clinical and technical success. In two patients clinically relevant complications occurred. During a mean observation time of 19 months (range 3-51 months) restenosis occurred in one stent after 15 months and was successfully treated by balloon angioplasty. Two patients became symptomatic again due to new atherosclerotic disease. CONCLUSIONS: Percutaneous stent angioplasty of the infrarenal aorta and aortic bifurcation yields high immediate and mid-term success rates with primary patency of 90% and secondary patency of 95%. These results are slightly better than those with balloon angioplasty, but the limited number of patients in our and others' studies does not yet justify general recommendations.

Adult↗
PubMed1994

[Color Doppler controlled compression therapy of puncture aneurysms--a noninvasive therapy concept].

After transfemoral catheterization, pseudoaneurysms can occur in about 0.1-0.05% of cases, especially after the use of large instruments and a faulty puncture technique. Today, pseudoaneurysms can be easily and accurately diagnosed with the help of duplex and color Doppler ultrasound. Apart from its diagnostic application, color Doppler ultrasound also offers a noninvasive and cheap alternative therapy mode as compared to surgical repair. The purpose of our study was to evaluate the therapeutic efficiency of an ultrasound-guided compression technique for postpunctional pseudoaneurysms. Over a 12-month period, nine patients were sonographically diagnosed with postpunctional pseudoaneurysm of the femoral superficial artery. The compression therapy was only applied if no contraindications (e.g. rupture, retroperitoneal site of the lesion, infection, large haematoma with suspected ischaemia, and necrosis) were present. Two of the nine patients were primarily excluded from therapy because of a high risk of rupture or a large haematoma. Five patients of the remaining seven have been successfully treated. In one of the unsuccessfully treated patients, only a partial thrombosis of the aneurysm was obtained, followed by complete spontaneous thrombosis 4 days later. The second compression failed because of the 4-month time interval between angiography and compression therapy. A successful therapy clearly depended on the time interval between puncture and compression. We could not find any significant correlation between the aneurysm volume and the duration of compression. Color Doppler ultrasound-guided therapy is a noninvasive easily applicable, and cheap alternative to surgical repair of postpunctional pseudoaneurysms.

Adult↗
PubMed1994

[Historical and conceptional aspects of TIPSS].

The concept of a percutaneous approach to portosystemic shunting to treat variceal bleeding from portal hypertension dates back to the 60s. However, the clinical realization of this idea was based on the development of metallic endoprotheses (stents), which were essential for long-term patency of a parenchymal tract between the portal circulation and (systemic) hepatic veins that was created by a percutaneous transjugular approach (TIPSS: transjugular intrahepatic portosystemic stent shunt). The first clinical success of TIPSS was achieved in 1988 at the University of Freiburg, Germany. Since then, however, the concept and methodology of TIPSS have been constantly refined, so that this method has become a standard procedure for the interventional radiologist.

Catheterization↗
PubMed1994

[Transjugular intrahepatic portasystemic stent shunt (TIPSS). Technique of implantation].

Implantation of a transjugular intrahepatic portosystemic stent shunt (TIPSS) is guided by ultrasound and fluoroscopy. Today this stent is clinically established as a concept of "minimal invasive therapy" to treat recurrent variceal bleeding in patients with portal hypertension. We describe its technical steps in detail, giving the materials used. "Intraoperative" and "postoperative" monitoring and the typical features of an ideal shunt are described.

Catheterization↗
PubMed1994

[Long-term results after TIPSS with the Palmaz stent].

Since our first clinically successful TIPSS procedure in 1988 numerous steps to improve the safety and methodology have helped to increase the technical and clinical success while the rate of complications could be significantly reduced. In our series of more than 200 patients the technical success rate is more than 95% and the early clinical success rate (< 30 days after TIPSS) 89%, respectively. Early shunt occlusion was found in 1.5% of our patients. 3 months after TIPSS, however, transjugular portography reveals significant shunt stenosis in 46% needing either shunt re-dilatation or additional stent placement. This relatively high rate of re-intervention is being significantly reduced during the further follow-up with a frequency of 17% at a 6 month interval and 6% at a 12 month interval, respectively. The need for re-intervention is strongly associated with liver function and the patients' coagulation status: Child's A patients needed re-intervention substantially more often than those in stage B or C at each given follow-up interval. The decreasing need for re-intervention over time appears to be associated with the formation of an endothelial cell layer on the surface of the shunt tract.

Catheterization↗
PubMed1994

Acetylsalicylic acid in the prevention of early stenosis and occlusion of transjugular intrahepatic portal-systemic stent shunts: a controlled study.

Stenosis or occlusion of the transjugular intrahepatic portal-systemic stent shunt may be initiated by aggregation and activation of thrombocytes on the surface of the metallic stent material. To find effective prevention of this event, we conducted a controlled trial administering acetylsalicylic acid for 3 mo. Forty-four patients (8 women and 36 men) with portal hypertension were included in this study. The patients were randomized into a group receiving 100 mg acetylsalicylic acid/day (n = 21) or into a control group (n = 23). Treatment was started immediately after transjugular intrahepatic portal-systemic stent shunt. Three months after transjugular intrahepatic portal-systemic stent shunt, 15 patients in the acetylsalicylic acid group and 19 patients in the control group underwent clinical reevaluation, gastroscopy and recatheterization with determination of the portal-systemic pressure gradient. No variceal bleeding occurred in any patients. In four patients in the acetylsalicylic acid group, erosive gastritis was observed in gastroscopy in contrast to only one patient in the control group. Complete patency of the stent was noted in 10 of 15 patients in the acetylsalicylic acid group and in 14 of 19 patients in the control group. Transjugular intrahepatic portal-systemic stent shunt restenosis associated with a significant increase of the portal-systemic gradient occurred in five patients in the acetylsalicylic acid group, which required redilation in all and additional stent placement for expansion of the stented tract in two patients. In the control group, redilation was necessary in five patients with additional stent extension in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Parapneumonic ARDS. The radiomorphologic transition of a pneumonia into an ARDS].

Serial chest X-rays of 14 patients with parapneumonic ARDS (PARDS) were analysed retrospectively. Typical findings on chest X-ray films occurred after a latency period of 12-24 h following the clinical start of PARDS. We found some "early signs" of PARDS, such as central interstitial paravascular edema (14/14), bilateral hilar infiltrates (9/14) and the absence of pleural effusion (12/14).

Adult↗
PubMed1993

[The role of embolization treatment of acute hemorrhage].

137 arteries of 95 patients were treated by transcatheter embolization for massive haemorrhage using Ethibloc, Gelfoam, wire coils and Tissucol (Fibrinogen + Thrombin). The bleeding was secondary to trauma in 23 patients, to neoplasms in 16 patients and to vascular malformations or chronic inflammatory processes in 41 cases. 15 patients were treated for iatrogenic bleeding following surgery. Bleeding was referred to haemoptysis (n = 27), pelvic (n = 24), renal (n = 16) or gastrointestinal haemorrhage (n = 13) as well as several other diseases (n = 15). Most patients were poor surgical candidates. The overall bleeding control rate was 89.5% with a incidence of recurrent bleeding in 14 out of 95 patients (14.7%) treated by re-embolization or surgery. 6 patients died (6.3%) due to intractable haemorrhage, 4 patients (4.2%) died of complications related to embolization procedure (4 x bowel infarction!) and 33 patients (34.7%) died of procedure-unrelated causes such as myocardial infarction, trauma, malignancy or other underlying diseases. 58 patients (61.1%) are still alive (follow-up 16.2 +/- 4.8 months). Significant complications (5.3%) included bowel necrosis (4x) and ischaemia of the spinal cord with incomplete paralysis in one patient. One patient suffered thrombosis of the common iliac artery due to angiography. On the basis of our results, peripheral embolization using Ethibloc can be recommended as palliative treatment for devascularisation of bleeding tumours. Satisfactory results are obtained in haemoptysis, renal and pelvic haemorrhage, but gastrointestinal bleeding should not be occluded by means of Ethibloc because of its considerable risk of bowel infarction.

Acute Disease↗
PubMed1993

[Isolated Ledderhose fibromatosis plantaris].

Plantar fibromatosis or Ledderhose syndrome has rarely been discussed in the medical literature. This clinical entity includes nodular Dupuytren-like indurations of the plantar aponeurosis. We present a case of a young man with isolated disease of his right foot and describe the clinical and pathomorphological features of this disease as well as its characteristic findings at magnetic resonance tomography. The therapy of choice is a subtotal resection of the plantar aponeurosis to prevent irreversible contractions of the toes. The prognosis following fascietomy is good.

Adult↗
PubMed1992

Diagnosis and treatment of retroperitoneal hematoma in multiple trauma patients.

From 1984 to 1991 20 multiple trauma patients with pelvic fractures and retroperitoneal bleeding from pelvic vessels underwent angiographic localization and embolization of massively bleeding arterial vessels. Nine patients survived (multiple trauma index grade III, Hanover polytrauma index), three patients with very severe injuries died immediately (multiple trauma index grade IV). After successful control of bleeding by embolization, three other patients died from severe brain injuries and five patients from septic multiorgan failure. The interval to definite localization and treatment of the bleeding source was three times shorter in the group of survivors, and the amount of transfusions needed was less by a factor of three. This underlines the importance of early angiography in multiple trauma patients with pelvic fractures and persisting hemorrhage. Embolization has proven to be effective in the treatment of such injuries.

Adolescent↗
PubMed1992

Renal artery aneurysm: surgical indications and results.

The clinical course of 23 patients with 28 renal artery aneurysms (RAAs) is reported. The RAAs were recorded over a period of 10 years. Thirty-five per cent of the RAAs (eight of 23 patients) were detected during the investigation of hypertension, whereas 26% (six of 23 patients) were discovered incidentally while imaging atherosclerotic arterial disease in the aorto-iliac region by angiography. Twenty-two aneurysms were treated surgically and primary nephrectomy was necessary in one case. The surgical technique used was excision of the aneurysm with bypass grafting in 13 cases (seven Dacron, five vein, one arterial bypass), a running suture following aneurysm excision in four cases and an end-to-end anastomosis in two cases. The results (for a period of 1-10 years) were excellent in all but three cases: two early graft occlusions (vein interposition) and one late occlusion (Dacron bypass) in the course of a re-operation which had become necessary because of a ruptured aneurysm of the gastro-epiploic artery after 3 months. Three of 23 patients were treated by embolisation of four intraparenchymal aneurysms. The follow-up of a non-treated saccular aneurysm showed a total thrombosis of the aneurysm within 4 years and fixed renal hypertension developed later in this patient. We suggest surgical repair of an RAA regardless of its size and the clinical symptoms, in order to prevent microembolism into the renal parenchyma and to avoid the development of fixed renal hypertension. Intrarenal aneurysms can be treated by embolisation to stop severe haematuria thus preserving the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗