[Data networking in a newly established radiology institute as exemplified by the Donau Hospital in Vienna].
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Austria↗
Biomedical subjects
W Hruby
Publications and source records attributed to W Hruby.
[Differential diagnosis of a low echo thyroid gland].
Hypothyrosis as a result of inflammatory disease of the thyroid gland, often is a diagnostic problem because of the insidous onset and its lack of specific symptoms. In the rather large amount of literature about sonography of the thyroid no papers with a systematic approach to this entity are found. In a prospective study we evaluated 36 proven cases and found a characteristic sonographic pattern of the thyroid with regard to its size, contour and structure.
Adolescent↗
Renal vein anatomy and its implications for retroperitoneal surgery.
Because of its complicated embryological development, the anatomy of the renal veins shows extensive variability. A full understanding of the potential anatomical variations is imperative for retroperitoneal operations. Based on 4,520 retroperitoneal computerized tomography scans, anatomical studies of autopsy material of 354 unselected cases and intraoperative observations made during 215 major retroperitoneal procedures, an attempt was made to define the most common renal vein variants and retrace their development during embryogenesis. Awareness of rare anomalies in urological and general surgery is crucial to prevent severe damage to the venous drainage of the left kidney, and because troublesome bleeding may occur during vascular and retroperitoneal oncological procedures in patients with unknown venous anomalies. We found the incidence of these variants to be 0.8 versus 1.7 versus 3.7%, respectively.
Humans↗
[Differential diagnosis of the low-echo thyroid gland].
Hypothyrosis as a result of inflammatory disease of the thyroid gland, often is a diagnostic problem because of the insidious onset and its lack of specific symptoms. In the rather large amount of literature about sonography of the thyroid no papers with a systematic approach to this entity are found. In a prospective study we evaluated 36 proven cases and found a characteristic sonographic pattern of the thyroid with regard to its size, contour and structure.
Adolescent↗
[Sonography of the lungs and pleura].
Diagnoses were made by ultrasound in 73 out of 80 cases with unclear thorax x-ray. One case was misinterpreted, no diagnoses were possible in 6 cases. Pleural effusion or opacities reaching the pleura are necessary to perform ultrasound examination. Sonographic findings in pleural or pulmonary changes are discussed and correlated with pathological anatomical findings. Additional information can be obtained by sonography in pleural lesions and in pulmonary lesions masked by pleural effusion. Atelectases can be differentiated from pneumonia, and tumours can be identified in peritumorous pneumonia or atelectases.
Adult↗
[Vena cava filter for the prevention of pulmonary embolism: experiences with percutaneous implantation and long-term follow-up].
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Adult↗
[Clinical relevance of extracorporeal shockwave lithotripsy (ESWL) in choledocholithiasis].
Primary endoscopic removal of bile duct stones is an established method of treatment. However, the extraction of stones is impossible in about 10% of cases despite successful endoscopic papillotomy and manual lithotripsy. Over a period of two years extracorporeal shock-wave lithotripsy (ESWL) was performed in 32 patients. Piezolith 2200, a second generation lithotripter was used, which requires neither analgesia nor anaesthesia for the patient. Localisation of the stones was carried out by means of a 3.5 MH 2 sector scanner. ESWL treatment was successful in 24 of 32 patients (75%). In 6 patients the bile duct stones were too large or too numerous and in 2 patients sonographic localisation was impossible. Out of a total of 131 patients with stones in the biliary tract only 9 (6.8%) needed surgery. Piezoelectric lithotripsy is a safe and effective adjunct procedure for the treatment of bile duct stones which were not extractable by endoscopy.
Aged↗
[Laryngeal and hypopharyngeal carcinoma--the limits and advantages of sonography].
29 patients with carcinoma of the larynx and the hypopharynx were evaluated not only for staging cervical lymph nodes but also for classification of the primary tumour. With appropriate technique it is possible to assess tumour infiltration (T4) of surrounding tissue of the larynx at all levels. Tumour classification T1 to T3 is possible in patients with tumour of the epiglottis (regio supraglottis, UICC). The endolaryngeal tumour T1 to T3 (regio glottis and subglottis, UICC) still remains the domain of the microlaryngoscopy. The limits of the method are apparent in hypopharynx carcinomas where in only 50% of the patients the tumour could be assessed.
Aged↗
Percutaneous endoscopic cholecystolithotripsy. Work in progress.
In spite of long-term adjunctive oral dissolution therapy, residual gallstones have been reported in up to 50% of gallstone patients 3 months after extracorporeal shock-wave lithotripsy. Six women and five men, aged 31-75 years, underwent percutaneous endoscopic cholecystolithotripsy between April 1988 and October 1988. The gallbladder was punctured by means of an anterior transperitoneal approach. The tract was dilated, and gallstones were removed with a modified 21-F cholecystoscope under direct visual inspection. Calculi too large for extraction were disintegrated with ultrasound or electrohydraulic lithotripsy. Eight patients were stone-free and two had small residual stones 3 months later; nine were stone-free 6 months after the procedure. Although more invasive than shock-wave lithotripsy, percutaneous endoscopic cholecystolithotripsy has the advantage of immediate removal of more calculi, causes less pain, necessitates less postoperative immobilization, and allows patients to leave the hospital sooner.
Adult↗
Stonebearing gallbladders: CT anatomy as the key to safe percutaneous lithotripsy. Work in progress.
Percutaneous cholecystolithotripsy can be performed with a transhepatic or transperitoneal approach. Because the anatomy of the gallbladder varies from person to person, the authors began a study to evaluate the position of the gallbladder with computed tomographic scans of 100 patients known to have stones in their gallbladders. Four variations in the relationship of the gallbladder to the liver and anterior abdominal wall were noted: completely intrahepatic gallbladders (39%) (type I), gallbladders bulging anterior to the anterior rim at least in part (35%) (type II), gallbladders completely anterior to the liver (17%) (type III), and gallbladders in a lateral position (9%) (type IV). In 51%, the colon was in direct contact with the gallbladder, and in 13% it was positioned between the abdominal wall and gallbladder. A safe percutaneous puncture was not possible in 34% of the patients (nine type IV gallbladders, 23 type I organs, and two type III gallbladders with anterior interposition of the colon).
Adult↗
Interventional uroradiology.
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Angioplasty, Balloon↗
[Bone metastases diagnosed by ultrasound].
Osteoclastic bone metastases - mostly associated with soft tissue infiltration - but also osteoblastic metastases present a typically sonographic appearance. These patterns are discussed in two cases. Nearly 50% of skeletal metastases are located in sonographically easily accessible regions. The use of this low-cost and simple method complementary to other diagnostic procedures is discussed.
Aged↗
[Noninvasive diagnosis of post-puncture vascular complications of the femoral artery: i.v. DSA and duplex sonography].
In 1200 cases of angiographic or invasive procedures with puncture of the femoral artery, vascular complications occurred in 10 patients (0.8%). In a prospective study, duplex sonography and intravenous digital subtraction angiography were used as diagnostic methods in these cases. All 10 cases with vascular complications were diagnosed correctly by means of i.v. DSA, and the underlying pathology was documented exactly. Duplex sonography yielded the correct diagnosis in 8 cases, and 1 case was incorrectly diagnosed as an aneurysm; angiography suggested an arteriovenous fistula, which was surgically verified. In one case duplex sonography was negative. The noninvasive procedure of duplex sonography plays an important role in the diagnosis of post-puncture vascular complications. Because of its high accuracy, this simple method should be the first diagnostic step. Intravenous DSA should be used in cases where the results obtained with duplex sonography are equivocal.
Aged↗
[Comparison of ultrasonic and CT diagnosis of solid liver tumors].
A prospective study compares the results of ultrasound and CT diagnostics in 323 patients with liver tumours. The accuracy of both methods is high: the sensitivity of ultrasound comes up to 90.4%, of CT to 96.1%. The important role of the comparatively economic ultrasound in specific tumour diagnosis is eg shown by the fact that if lesions of high and low echogenicity were found in one patient, or if there were found calcifications, the tumour was always a malignoma. This specificity was missing in the cost intensive CT which is also more time consuming and needs i.v. contrast.
Adenoma, Bile Duct↗
[Behavior of contrast media in liver tumors in computerized tomography--correlation between pharmacokinetics and histological structure].
The characteristics of contrast medium in liver tumours were studied via CT in a prospective study in 247 patients. In 30 cases, dynamic CT was performed additionally. Analysis of the time density diagrams shows the pharmacokinetics of the lesion corresponding to the histological structure classified into 4 types according to Claussen and Lochner. We were able to prove that at a fast scan (15 slices in 3 minutes) the specific pharmacokinetics of a tumour can be determined. Classification in this way is possible in the majority of cases. Pharmacokinetics of tumours are related to histology, but a specific histological diagnosis cannot be made as yet.
Adenoma, Bile Duct↗
[Is lymphadenectomy in stage I of non-seminomatous testicular cancer still justified?].
Testicular cancer is the tumour of the male genital tract which is most easily and successfully treated today. This very circumstance dictates that for ethical reasons we are more bound than ever to prevent unnecessary diagnostic and therapeutic procedures in these young patients. They should receive only the maximum necessary and not the maximum possible therapy. The difference between these two critical concepts determines the extent of treatment morbidity. Retroperitoneal lymphadenectomy (RLA) is only a diagnostic procedure in approximately 85% of cases. This is the reason for critically reviewing the necessity of this investigation in early non-seminomatous cancer of the testes. The prognostic impact of vascular invasion by the primary tumour is demonstrated in a retrospective study of 86 pathohistological specimens of germ cell tumours. We suggest the inclusion of vascular invasion basically as criterion for any prospective "wait and see" protocol in early non-seminomatous germ cell tumours.
Combined Modality Therapy↗
Belt device for simplified CT-guided puncture and biopsy: a technical note.
A new radiolucent device for increased accuracy of CT-guided fine-needle punctures permits precise determination of the optimum angle, depth, and position of the fine needle, which can be preset from the data supplied on the CT monitor. Puncture and repeat scans for controlling the tip of the needle can be performed with the patient in a stationary position. The device is designed as a belt that holds a needle holder sheath and a goniometric scale, both of which can be moved to varying positions around the patient.
Biopsy, Needle↗
Percutaneous nephrostomy--techniques.
Percutaneous nephrolithotripsy has become a widely accepted procedure, that permits the removal of up to 90% of all renal calculi with minimal morbidity and success rates of over 95%. Together with extracorporeal shock wave lithotripsy and the introduction of the ureterorenoscope it has revolutionised the surgical therapy of this clinical entity, and has reduced the need for open surgical interventions to approximately 5% of the numbers required before these methods became available. The success of percutaneous endoscopic surgery depends mainly on the correct position of the percutaneous nephrostomy, which must provide access to all renal calculi via a straight tract, yet should avoid significant trauma to the kidney or perirenal structures. This situation differs from the requirements for simple drainage of obstructed kidneys, as the collecting system of stone bearing kidneys is usually not dilated and the tract has to be adapted to the specific anatomical situation. Special techniques and material have been developed to meet these demands. The purpose of this article is to present our approach, based on percutaneous nephrolithotripsy in 2100 reno-ureteral units. Special reference is given to difficult anatomic situations, which frequently result in failure in inexperienced hands.
Dilatation↗