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V Jacobi

Publications and source records attributed to V Jacobi.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Embolization of symptomatic myomas (UAE): technique, indication and results].

Presentation of indication, technique and results of transarterial uterine artery embolization (UAE) for the treatment of symptomatic myomas. Technical requirements are presented like DSA, catheters, superselective catheterisation and the different embolization materials as polyvinylalcohol (PVA) or microspheres, as well as the follow-up after UAE. The technical success rate of UAE is documented to range between 98 to 100 % and myomatous symptomatology disappears in 85 to 94 % of the cases. A reduction in the size of the myomata after UAE is observed between 48 to 70 %. A resolution of the hemorrhage disappears in 80 to 96 % of the cases immediately. Particulate embolization of the uterine artery is a new minimally invasive therapy in the management of symptomatic leiomyomas with a high efficiency and low rate of major complications. Further studies may prove the longterm results after UAE, the influence on fertility and possible late complications.

Angiography, Digital Subtraction↗
PubMed2003

[Stents in the iliac arteries: a minimally invasive method].

AIM: We demonstrate patients to reveal the conditions for good results with respect to acute and long term out-come of interventional therapy of iliac artery occlusion. MATERIAL AND METHODS: 225 Patients with aortoiliacal occlusion who underwent surgery or intervention were evaluated. All patients were discussed in an interdisciplinary angiologic conference. 63 patients primary had an operation, 161 patients primary were treated by intervention. The two cohorts were compared concerning their structure, the primary success and the primary and secondary patency over one year. RESULTS: Both cohorts showed significant differences, the surgical treated patient had a higher clinical stage as well as more complex iliacal occlusion. The interventional treated patients had higher comorbidity. Primary technical success and patency rates did not show any difference. The complication rate was equally low in both cohorts. In percutaneous treated patients after predilatation, embolization into the periphery occurred. With primary stent PTA, there was no embolization. CONCLUSION: The percutaneous recanalization also of long iliac occlusion is a save, successful alternative to surgery. Nevertheless, there are limits. For optimal therapy management an interdisciplinary consultation is necessary. To avoid embolization, after recanalization primary stent PTA should be performed.

Arterial Occlusive Diseases↗
PubMed2002

Rapid PCR-based diagnosis of disseminated histoplasmosis in an AIDS patient.

Disseminated histoplasmosis is an unusual opportunistic infection in patients with advanced HIV infection living outside endemic areas. Diagnosis usually is made on the basis of isolation of Histoplasma capsulatum from clinical specimens or histologic examination. Reported is the case of an HIV-infected Columbian individual in whom the diagnosis of histoplasmosis was established within 24 h of collection of an adequate bronchoalveolar lavage specimen. The diagnosis was made by detection of specific fungal DNA and confirmed by isolation of Histoplasma capsulatum from blood, bone marrow and respiratory specimens 10 days later. The patient recovered under antifungal treatment and remained asymptomatic up to the last follow-up visit 6 months later. The polymerase chain reaction assay might be a powerful and rapid diagnostic tool for the diagnosis of non-European invasive fungal infections and should be further evaluated.

AIDS-Related Opportunistic Infections↗
PubMed2002

Notched ureter sign.

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Diagnosis, Differential↗
PubMed2002

MR imaging characteristics of osteoradionecrosis of the pelvis after radiation therapy on gynecological tumors.

PURPOSE: To describe MR imaging characteristics of osteoradionecrosis (ORN) of the pelvis as a result of radiation therapy (RT) on gynecological tumors. MATERIAL AND METHODS: Radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on 9 women (mean age 67.5 years) with gynecological tumors to identify ORN. T1- and T2-weighted sequences and contrast-enhanced t1-weighted sequences with and without fat saturation were used. The patients began developing pain after the completion of RT indicating a possible ORN a which time MRI was performed. MR images were correlated with the results of clinical examinations. RESULTS: Depending on the time elapsed after RT, ORN presented with different signal intensities. The acquired images suggested that signal changes in T2-weighted images as well as the different enhancement behaviour of ORN could be dependent on the time elapsed after RT. Visualisation of the affected regions was best achieved with fat-saturated T1-weighted sequences. CT showed increased density in the affected regions corresponding to osteosclerosis. In all cases the sacroiliac joint was affected, some times bilaterally. CONCLUSION: MRI is helpful in detecting and characterizing ORN. Changes in signal intensity, based on histopathological tissue changes could make a chronological classification possible.

Aged↗
PubMed2002

[Bronchial artery embolization for therapy of pulmonary bleeding in patients with cystic fibrosis].

INTRODUCTION: Acute pulmonary emergencies in patient with cystic fibrosis (CF) can be found in cases of pneumothorax as well as hemoptysis. If the bleeding cannot be stopped by conservative methods, an embolization of the bronchial arteries should be done. MATERIALS AND METHOD: 11 patients were embolized using a combination of PVA particles and microcoils. RESULTS: From January 1996 to June 2001 17 bronchial arteries in 11 patients were embolized. 7 patients suffered from chronical hemoptysis, 4 patients had an acute hemoptysis. In 4 patients both sides were embolized, in 3 patients only one side. The remaining 4 patients needed a second intervention, embolizing the other side. The primary embolizated bronchial artery was still closed in all 4 patients. In 1 patient the selective catheterization of a bronchial artery was not successful, thus the embolization could not be carried out. 1 patient died 5 days after the intervention due to a fulminant pneumonia (Pseudomonas aeruginosa) without recurrent bleeding. In two patients atypical branches from intercostal arteries feeding the bronchial arteries were detected and successfully embolized. All patients profited from the therapy, as bleeding could be stopped or at least be reduced. 3 patients suffered from back pain during or after intervention. There were no severe complications like neurological deficiencies or necroses. CONCLUSION: The embolization of bronchial arteries using particles and microcoils is an effective intervention with a low complication rate in pulmonary bleeding of CF patients.

Bronchial Arteries↗
PubMed2002

[Mammographic positioning: how does it affect the gynecologist?].

High quality in breast imaging is of utmost importance for early diagnosis of breast cancer. Conventional x-rays are usually taken in 2 perpendicular views. This technique allows precise spacial localization of pathologic findings. Since 1983 mediolateral oblique (MLO) instead of mediolateral (ML)-projections have been recommended because they supposedly include more of the axillary tail of breast tissue. This makes sure that more carcinomas located in the axillary tail of breast tissue are detected. It is planned that MLO-positioning will be required as European quality standard for mammography. Our investigations show, however, that the MLO-projection has a number of distinct disadvantages that need to be discussed. Only 7 % of women at the most have an axillary tail demanding MLO positioning. Precise localization of a tumor is not possible anywhere in the breast if an MLO-projection is used. MLO positioning furthermore causes faese positives, so-called pseudolesions that demand further work-up. Radiotherapy is difficult because the tumorbed cannot be localized and thus precise saturation is not possible.

Breast↗
PubMed2001

Repositioning of malpositioned or flipped central venous catheters.

Primary misplaced or secondary flipped implanted catheters are located mostly in the right jugular vein. We demonstrate an effective method to replace fix implanted catheters such as Ports, Grochomg or Hickman catheters. Using a femoral venous approach, replacement into the superior vena cava can easily be done with a Sidewinder 1 catheter which is hooked over the misplaced central venous approach. In all our patients the method was successful. The repositioning technique described is simple, fast and has low costs. We can keep sterile conditions and do not need to solve the catheters' fixation.

Catheterization, Central Venous↗
PubMed2001

[Transjugular portosystemic stent shunt (TIPSS) as intervention in clinical complications of portal hypertension].

Most frequent complications in patients with liver cirrhosis are due to portal hypertension. Beside ascites circumvent vessels formate with vasodilatation. Due to counterregulation a secondary hyperaldosteronism develops with release of vasocontrictive agents. If conservative and endoscopic methods fail, indication for building a portosystemic shunt is given. The TIPSS procedure is less invasive than the surgical method of Warren-Shunt, so the radiological intervention has replaced surgery. Reducing the portal pressure by the shunt, the clinical complications change for the better. Still problems are defined as hepatic encephalopathy and right ventricular heart failure. Regular follow up investigations have to be performed to detect complications in the shunt. Using regular clinical and radiological check up TIPSS is of clinical benefit with good long term results.

Diagnostic Imaging↗
PubMed2001

Older patients with high-risk fungal infections can be successfully allografted using non-myeloablative conditioning in combination with intensified supportive care regimens.

Leukaemic patients with advanced disease and severe fungal infections as well as older patients with substantial co-morbidity are usually excluded from conventional allotransplantation because of increased morbidity and mortality. We approached allogeneic transplantation in four patients with a median age of 62 years (one chronic myeloid leukaemia in blast crisis, one high-risk acute myeloid leukaemia (AML) in first complete remission (CR1), one AML in 2nd relapse, one AML in CR2 with pre-existing fungal lung infections (two aspergillus, two mucor) and additional co-morbidity (diabetes n = 2, aortic aneurysm n = 1, arterial sclerosis n = 2) by combining non-myeloablative conditioning with an intensified supportive care regimen, including amphotericin B and 4-12 (median 9) prophylactic granulocyte transfusions from granulocyte colony-stimulating factor (G-CSF)-stimulated volunteer donors. G-CSF was also given to patients until neutrophil recovery. All four patients recovered to a neutrophil count of 0.5 x 109/l after a median of 11.5 d (range 11-13 d). Prophylactic granulocyte transfusions also reduced the need for platelet transfusions and minimized mucositis. All patients were discharged at a median of 25 d (range 18-59 d) and are alive and well after a median follow-up of > 390 d (range 336-417 d) without evidence of leukaemia. Regression of the fungal lesions was documented in three patients, with a slight progression detected by computerized tomography scan of the chest in one patient. We conclude that pulmonary fungal infections are not a contraindication for allogeneic stem cell transplantation, if non-myeloablative conditioning regimens are used in combination with granulocyte transfusions, intravenous amphotericin B and G-CSF.

Acute Disease↗
PubMed2001

[Optimization of the indications for breast biopsy by preoperative conference].

In connection with a series of second reviews of mammographies as part of a preoperative conference, criteria are presented that allow a correct diagnosis, thus avoiding unnecessary breast surgery. In addition, it is shown that preoperatively all diagnostic findings must be reviewed as a whole, in order to make the appropriate decision for the patient. A total of 145 patients was admitted for breast surgery between 1994 and 1997. Group 1: The mammographies of 133 patients were re-evaluated and additional exams were performed. In only 17% (23 cases) could the first diagnosis be confirmed and the patients went to surgery. In 110 cases a single mammographic view sufficed to show that there was no suspicious finding in the breast. Instead there was a pseudolesion, not visible after an image had been taken with appropriate technique. Group 2: For 12 additional patients, a synopsis of different findings was presented and analysed at a preoperative conference. Even although imaging may have been performed correctly, a conference can still contribute to the optimization of indocations. Unnecessary breast surgery can can thus be avoided.

Biopsy↗
PubMed2000

[Cystic fibrosis--initial diagnosis in a 39-year-old patient].

BACKGROUND: Cystic fibrosis is the most common hereditary disorder among Caucasians. Most of the patients are diagnosed as children. However, some cases are going undiagnosed into adulthood and are then often misdiagnosed because the non-pediatricians do not know cystic fibrosis very well and do not consider this diagnosis in adult patients. CASE REPORT: We present the medical history of a woman, who was diagnosed with cystic fibrosis at the age of 39 years, although she had suffered from bronchiectasis, pancreatic insufficiency and liver cirrhosis since many years. Her medical history was long with some diagnosis, but because of her age nobody considered the final diagnosis. CONCLUSION: In adult patients with bronchiectasis, liver cirrhosis and pancreatic insufficiency in combination or with only one of these symptoms, cystic fibrosis should be included into the differential diagnosis.

Adult↗
PubMed2000

Cluster of pulmonary infections caused by Cunninghamella bertholletiae in immunocompromised patients.

Cunninghamella bertholletiae is a rare cause of pulmonary mucormycosis. We describe a cluster of invasive pulmonary infections caused by C. bertholletiae in 4 immunocompromised patients that occurred during a 2-year period at 1 center. Three of the patients were receiving antifungal prophylaxis with itraconazole. Presenting symptoms were fever unresponsive to antibacterial chemotherapy, hemoptysis, and infiltrates on chest radiograms. Three patients were treated with liposomal amphotericin B. Only 1 patient survived.

Aged↗
PubMed2000

[Computed tomography and magnetic resonance tomography in tuberculous spondylitis. A review of the literature and the authors' own observations].

PURPOSE: The findings of tuberculous spondylitis in MRT have been described extensively. Nevertheless the diagnostic value of both methods in the diagnosis of this severe manifestation of the tuberculous disease was not yet defined definitely. MATERIALS: We performed a review of the recent literature and a retrospective analysis of the findings in ten patients with proven tuberculous spondylitis. Here we evaluated 10 CT and 6 MRT. RESULTS: Major findings in computed tomography (n = 10) were osseous sequestration (8/10), subperiosteal bone apposition (6/10), abscess of the surrounding tissue. (8/10) and calcification of the masses (3/10). In all cases which were examined by MRT (n = 6) marrow edema was seen. Affection of the soft tissue was described by means of MRT in 5/6 patients. All patients showed rim enhancement. CONCLUSIONS: MRT shows signs of infection (bone marrow edema) which is an early but rather unspecific finding. The commonness of osseous lesions in advanced tuberculous spondylitis suggests a benefit of computed tomography in the later stages. Both methods are complementary in the differential diagnosis of tuberculous and non-specific spondylitis.

Adult↗
PubMed2000

[Computed tomographic appearance of pulmonary mucormycosis].

AIM: Analysis of the morphological characteristics of pulmonary mucormycosis using computed tomography (CT). MATERIAL AND METHODS: Prospective analysis of CT studies in 9 patients out of 19 patients with proven pulmonary mucormycosis. RESULTS: Pulmonary mucormycosis was most frequently found in the upper lobe bilaterally (51% of all nodules). In 22% of the manifestations, the morphological criterion of a "bird's nest" could be verified in CT, in 37% central necrotic areas were detected. In 37% an open bronchus was diagnosed, in 6% we observed bronchiectases. 43% of all nodules presented with a halo sign. In three patients we found pleural effusions, enlarged mediastinal lymph nodes were diagnosed in one patient. CONCLUSION: Computed tomography allows an improved diagnosis and therapeutic follow-up in patients suffering from pulmonary mucormycosis.

Adult↗
PubMed2000

[Percutaneous transvenous recovery of foreign bodies using a self-made wire loop].

AIM: Several techniques exist to retrieve catheter and guide wire fragments. In this report we summarize our cost-saving method. MATERIALS AND METHODS: A 7-8F guiding catheter and a self-made loop consisting of a 260 cm/0.035 in. Terumowire was used. RESULTS: 45 of 48 fragments were retrieved completely using this method. For the three remaining fragments (all pacemaker electrodes), retrieval was attempted with a "Goose-Neck" loop, two of them failed. The procedure was well tolerated, there were no severe complications. CONCLUSION: Usually venous foreign bodies can be retrieved completely by this cost-saving method, the use of expensive industrial loops or baskets can be avoided.

Angiography↗
PubMed2000

[Galactography: important preoperative method for breast surgery].

Galctography still is a very important method in the diagnosis of breast disease. We studied the influence of indication on the diagnostic and therapeutic efficacy of galactography. Between 1990 and 1998 210 galactographies performed in a standardized fashion were evaluated in relation to the histopathologic findings. Most of the pathology was caused by papilloma followed by ectatic ducts and carcinoma. There was also a large number of normal ducts. In patients that were operated on, there was a very high percentage of agreement between radiological and histopathological diagnosis. If indication and performance are precise, galactography yields very good results and thus contributes substantially to the surgical approach. In particular it guides the surgeon safely to the pathologic finding and thus guarantees its excision within a small volume of tissue.

Breast↗