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Biomedical subjects

W Hruby

Publications and source records attributed to W Hruby.

At least 19 recordsLinked to original sources
PubMed2000

MR imaging for the preoperative planning of sphincter-saving surgery for tumors of the lower third of the rectum: use of intravenous and endorectal contrast materials.

PURPOSE: To evaluate the value of magnetic resonance (MR) imaging with a flexible surface coil in predicting the resectability of tumors in the lower rectum and the feasibility of sphincteral salvage. MATERIALS AND METHODS: In a prospective study, 61 patients with histologically proved primary adenocarcinoma of the lower or middle third of the rectum (<12 cm from the pectinate line) were examined at double-contrast-material-enhanced MR imaging with a circular polarized flexible surface coil. RESULTS: Assessment of anal sphincteral infiltration at MR imaging was excellent, with a specificity of 98% and a sensitivity of 100%. In the determination of tumor infiltration into adjacent organs (T4), the specificity was 100%, and the sensitivity was 90%, with surgical and histologic findings as the standards. While MR imaging showed negative nodes in 40 patients (stage N0 at MR imaging), histologic examination showed negative nodes in 27 patients and positive nodes in 34. At MR imaging, sensitivity was 68%, and specificity was 24%. CONCLUSION: While preoperative staging at MR imaging according to the TNM system still has limited value and accuracy, MR imaging provides the surgeon with valuable information regarding the presence of sphincteral invasion and the surrounding structures in patients with cancers in the lower third of the rectum.

Adenocarcinoma↗
PubMed1999

[Endovascular brachytherapy for the prevention of recurrence after PTA].

PURPOSE: Recurrent stenosis after PTA is caused by intimal hyperplasia and constrictive arterial remodeling. In experimental and first clinical studies, ionizing radiation has demonstrated its potential to control excessive intimal proliferation. We wanted to evaluate the safety, feasibility and efficacy of endoluminal irradiation after PTA and/or stent implantation. MATERIAL AND METHODS: From September 1996, 24 patients (24 lesions) who had a stenosis or occlusion measuring more than 5 cm in length in the superficial femoral artery or a restenosis after PTA underwent endoluminal irradiation. An isodose of 14 Gy was applied to the vessel wall using an Ir-192-HDR afterloading unit. The radiation was tolerated well; the additional time needed for the procedure was 30-45 min. RESULTS: In a mean follow-up time of 15 months we found a cumulative patency rate of 60%. No side effects were observed. CONCLUSION: Endovascular brachytherapy is a safe and brief procedure. In our selection of patients, a patency rate of approx. 40% after 1 year has to be expected. Thus, these first results are promising, although first published studies of endoluminal irradiation in peripheral vessels with stent implantation showed higher patency rates. No randomized data are currently available. We conclude that endovascular irradiation should be performed together with stent implantation in long lesions or recurrent stenosis after PTA, in order to control not only excessive intimal proliferation but also constrictive arterial remodeling.

Angioplasty, Balloon↗
PubMed1998

Special compression sutures: a new surgical technique to achieve a quick decrease in shunt volume caused by diffuse hemangiomatosis of the liver.

A new surgical technique for the management of shunting liver hemangiomas that otherwise would rapidly lead to intractable cardiac failure is presented. Rapid, significant reduction of shunt volume was achieved surgically by transhepatic compression sutures using PTFE pledgets and selective ligation of a large feeding vessel from the right hepatic artery.

Constriction↗
PubMed1997

[Ultrasound in diagnosis of traumatic intra-abdominal lesions. Value in primary diagnosis in the shock unit].

AIM: To evaluate sonography as a tool for initial diagnosis in emergency room patients with abdominal trauma. METHOD: 174 cases of abdominal trauma were selected from 1837 emergency care patients. The initial sonographic findings were compared to CT-evaluation, operative and autopsy results, and both clinical and sonographic follow-up. RESULTS: In 31 cases initial sonographic findings were positive, leading to 6 laparotomies. In another 6 cases, changes of follow-up sonographic testing led to laparotomy. In 143 patients, the initial sonographic evaluation was negative. In this group, follow-up evaluation revealed changes in 16 cases leading to 3 laparotomies. In 8 patients with stab injuries, the negative sonographic study was confirmed by operative findings. CONCLUSION: Sonography is a well-tested diagnostic method in evaluating patients with abdominal trauma. Follow-up examinations-even with negative initial results-are needed. While the time interval between evaluations depends on the individual risk factors, hourly reevaluation is generally appropriate.

Abdominal Injuries↗
PubMed1997

Renal pyelectasis in fetuses and neonates: diagnostic value of renal pelvis diameter in pre- and postnatal sonographic screening.

OBJECTIVE: Pre- and postnatal pyelectasis detected by sonographic screening is of questionable pathologic importance. Therefore, we defined the natural course and diagnostic value of renal pelvis diameter (RPD) during fetal life and the neonatal period as such dilatation was revealed on routine sonography. MATERIALS AND METHODS: Routine sonography in pregnant women was obtained between gestational weeks 22 and 30. Sonograms were obtained for 1021 fetuses, of which 15 could not be followed up as neonates. The remaining 1006 fetuses also underwent neonatal sonography. All neonates with an RPD larger than 5 mm were followed up sonographically. Neonates with an RPD larger than 9 mm or persistent widening (> 5-9 mm) were examined by voiding cystourethrogram, radionuclide renogram, or both. RESULTS: Thirty fetuses (3%) had an RPD larger than 5 mm. Nine of these fetuses also had an RPD larger than 5 mm as neonates. Of these nine neonates, one had bilateral grade II vesicoureteric reflux (VUR) and two had urinary tract obstructions (one posterior urethral valve and one ureteropelvic junction obstruction). Forty-nine neonates whose results on fetal sonograms had been normal showed an RPD larger than 5 mm on neonatal sonograms. Grade III VUR was found in one boy, and ureteropelvic junction obstruction was found in two boys. The kidneys of 54 neonates who showed an RPD larger than 5 mm without urinary tract obstruction were followed up until an RPD of 0-5 mm was evident. RPD normalized within 1 year of birth, whether VUR was present or not. Symptomatic urinary tract infection was diagnosed in 17 infants who had no renal pelvis dilatation seen on pre-or postnatal screening during the observation period. Seven of the 17 neonates had VUR. Conversely, none of the infants with pre- postnatal dilatation presented with symptomatic urinary tract infection. However, in one neonate an asymptomatic urinary tract infection without VUR was diagnosed by routine urinalysis. CONCLUSION: In our study, we linked renal pelvis dilatation on pre- and postnatal sonograms to obstructive uropathies rather than to vesicoureteric reflux. Prenatal sonography proved less sensitive than postnatal sonography in revealing obstructive uropathies. An RPD smaller than 10 mm on neonatal sonography was of no pathologic significance because renal collecting systems normalized spontaneously in all infants within 1 year of birth. These neonates and infants had no significant risk for urinary tract infection and did not need further evaluation.

Dilatation, Pathologic↗
PubMed1997

[Digital radiology].

Digital radiology is the integration of established and new digital imaging modalities into a system which enables the filmless communication of radiological information. It is becoming an indispensable tool in daily medical practice, and yields improved, faster medical communication, reduces the patient's dose and saves 307 307 archivation costs. Some knowledge of the inherent features of digital images and some open-mindedness for a change in viewing and workflow habits is necessary to make full profit of these possibilities. This paper describes digital radiography and the aspects of radiological networking based on 5 years experience with one of the very first filmless radiology departments worldwide.

Computer Communication Networks↗
PubMed1995

Conventional film-screen versus computed storage phosphor radiography. Simulated miliary lung disease in an anthropomorphic phantom.

RATIONALE AND OBJECTIVES: In this experimental study, the authors examined whether laser printed hardcopies from digital storage phosphor radiographs yield diagnostic performance equal to conventional film-screen radiographs in the detection of simulated miliary disease, using a standardized object. METHODS: A commercially available anthropomorphic chest phantom was used for radiographic evaluation. Miliary disease was simulated by superimposing one to four sheets of millet seeds on the lungs, resembling a miliary disease pattern with varying degrees of detectability. An observer study (receiver-operating characteristic) with eight radiologists was conducted to compare the reader performance using hardcopies of computed storage phosphor radiography versus the conventional film-screen system, optimized for chest x-rays. The digitally generated images were presented as a double-image hardcopy, with a conventionally adopted version and an edge enhanced image version. RESULTS: When analyzed separately, one out of the eight observers performed slightly better using the conventional films. When treated as a group, analysis of the areas under the receiver-operating characteristic curves demonstrated no significant difference in reader performance for each of the systems under investigation (t = 0.286). The Wilcoxon test could not prove a statistical difference. CONCLUSION: Storage phosphor technology is a method that yields equal diagnostic performance as conventional film in evaluating miliary disease of the chest.

Adult↗
PubMed1994

[Findings of digital intensive or bed lung radiographs at the monitor vs. hard copy: a clinical ROC study].

45 bedside chest examinations acquired with storage phosphorus radiography, were displayed on a viewing box as single-format hard copies and at a high-performance digital reporting console. 6 observers performed an ROC study. For the pathologies under question, significantly better results were shown in monitor reporting due to pneumonic infiltration whereas no significant differences were found for pulmonary or mediastinal masses, or for pneumothoraces.

Adult↗
PubMed1994

Integration of ultrasound in a fully digital radiology department.

OBJECTIVES: The authors' experiences concerning the use of video-framegrabbers for the integration of ultrasound devices into a fully digital imaging environment are presented. METHODS: Video acquisition workstations (VAW) (Siemens, Gammasonics Inc., Hoffman Estates, IL) are used in our department to link ultrasound devices to the picture archiving and communication system (PACS). A study was carried out concerning the impact of this integration on throughput by comparing the average times for image acquisition and storage in this digital system with the times found in a conventional archive, which is still used for some ultrasound units. The annual costs for the two kinds of archives were compared. RESULTS AND CONCLUSION: Video acquisition is a feasible way of integrating ultrasound in a digital environment. No impact on throughput has been found for the radiologist carrying out the examination, but for the assisting technologist, the times for image retrieval and archiving could be reduced from 3 minutes and 8 seconds to 24 seconds per patient. The instant availability of previous studies could be increased from 93.5% to almost 100%. Archive costs could be reduced by 28%, with further reductions to be expected using different archive configurations.

Austria↗
PubMed1994

[Clinical experiences with PACS: digital radiology].

We present our experience during the first 21 months of using hospital-wide network technology and digital archiving in connection with digital radiology in the Radiology Department at the SMZO/Danube hospital in Vienna. This means digital generation, archiving and distribution of radiographs as well as monitor reporting embedded in HIS and RIS. The clinical use of PACS demands full integration of all subsystems and modalities in a digital way, as was first realized at the Danube Hospital. With this approach, a reduction in radiation dose, improved communication and thus a reduction in the length of hospital stay and health care cost are attained.

Austria↗
PubMed1992

The Vienna SMZO-PACS-project: the totally digital hospital.

This paper gives an overview of the SMZO-PACS-Project in the form of a rough specification of the system architecture and the functional parameters related to it. The PACS architecture, determined by the large amount of data volume produced in the SMZO Hospital is outlined. In both radiology and trauma departments high technical requirements concerning data throughout and fault tolerance are demanded. Therefore these PACS modules are designed to minimize the workload of the network so that the performance is not degraded in the case of fault of a single component. A PACS module includes image acquisition devices of a certain modality with related reporting workstations and a distributed electronic archive. The functionality of the modules is described, special interest is posed on the integration of the different information management systems PACS, RIS and HIS, to achieve a complete record of data input and throughput in the hospital.

Austria↗
PubMed1992

Integration of radiology and hospital information systems (RIS, HIS) with PACS: requirements of the radiologist.

PACS development has now reached a stage where it can clearly be stated that the technology for storage, networking and display in a fully digital environment is available. This is reflected by an already large and rapidly increasing number of PACS installations in USA, Western Europe and Japan. Such installations consist of a great variety of information systems, more or less interconnected, like PACS, HIS, RIS and other departmental systems, differing in both hardware and software. Various data - even if they only concern one person - are stored in different systems distributed in the hospital. The integration of all digital systems into a functional unit is determined by the radiologist's need of quick access to all relevant information regardless where it is stored. The interconnection and functional integration of all digital systems in the hospital determine the clinical benefits of PACS. This paper (1) describes the radiologist's requirements concerning this integration, and (2) presents some realistic solutions such as the Siemens ISI (Information System Interface), and a mobile viewing station for the wards (visitBox).

Austria↗
PubMed1992

[Strut fractures in the long-term follow-up of Günther cava filters--the results after 64 filter implantations].

Follow-up of patients with inferior vena cava filters was performed every 3 months with clinical controls, plain radiographs and duplex sonography. Whereas the clinical results were excellent (no recurrence of pulmonary embolism), radiological controls showed broken anchoring legs in 14 cases and a broken filter basket in one patient. In two cases, the broken anchoring prongs had perforated the inferior vena cava wall. All patients with broken filters were clinically asymptomatic. CT showed no morphological changes in these cases. As experience proves, strict follow-up of caval filters for early detection of complications is mandatory even with well-established filter types.

Coumarins↗
PubMed1992

[The value of barium double-contrast study in the aftercare of gastrectomy patients (Roux-Y)].

We evaluated 32 patients who had undergone jejuno-oesophagostomy for gastric carcinoma. Double contrast radiography was performed 3 to 36 months after gastrectomy, 3 to 14 days prior to routine endoscopy. Endoscopy is superior to double contrast radiography in detecting tumour recurrence, particularly in small tumours, due to the possibility of biopsy. Double contrast radiography is excellent in demonstrating the afferent loop. We found a high number of jejuno-oesophageal reflux and very different small intestine transit times without correlation to clinical signs and symptoms.

Adult↗