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Biomedical subjects

W Hruby

Publications and source records attributed to W Hruby.

At least 55 records · Page 3Linked to original sources
PubMed1987

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↗
PubMed1987

[Long-term results using a nonionic contrast medium--a report of clinical experiences].

Between January 1982 and May 1986 more than 50,000 patients were examined radiologically with water-soluble (ionic and nonionic) contrast media at the Department of Radiology Rudolfsstiftung, Vienna. In 1983 only 2.2% of the contrast agents used were nonionic, in 1985 the share had increased to 53.3%. During this period the rate of drug-related side effects (DRSE) decreased from 6.9% (1983) to 3.3% (1985). From 1983 to 1985 DRSE were observed with 1952 patients after administration of ionic agents, whereas after application of nonionic media adverse reactions occurred in only 6 cases, so that DRSE rates of 6.98% respectively 0.07% resulted for ionic respectively nonionic contrast media. These results are discussed with regard to the physicochemical properties und physiological actions of ionic and nonionic contrast agents.

Angiography↗
PubMed1986

[Diagnosis and therapy of supravalvular aortic dissection (type A)--an interdisciplinary challenge].

Acute dissection of the ascending aorta is a life-threatening disease. Successful management requires close teamwork of internal medical specialist, radiologist and cardiovascular surgeon. The diagnostic and therapeutic approach is reviewed on the basis of 18 of our own cases - 15 men and 3 women aged from 42 to 88 years. Peculiarities of history, pain and ECG give valuable clues to the differentiation of aortic dissection from myocardial infarction and massive pulmonary embolism. As a non-invasive rapidly available diagnostic method echocardiography may yield decisive information about the aortic root and the presence of pericardial effusion. Definite confirmation of diagnosis is accomplished by aortography and/or computed tomography. Blood pressure and aortic flow must be decreased to the lowest level tolerated by the patient to prevent pericardial tamponade or rupture into the mediastinum. The urgency of surgical repair is underlined by a median survival time of 12 hours from onset of symptoms to death with conservative treatment. 7 of our patients were operated on. In 6 cases surgery was performed by means of extracorporeal circulation and the ascending aorta was replaced by a graft. 3 patients survived the operation (2 for over 2 years and three died in the postoperative period due to cerebral and pulmonary complications). In one case with inoperable dissection an axillo-femoral bypass was performed for relief of complete ischaemia of the left lower limb. Postoperatively, maintainance of the patient's blood pressure at the low normal level ist mandatory.

Adult↗
PubMed1985

Computed tomography in aortobifemoral Y grafts.

The fact that we have experience in assessing aortic aneurysms and the need for a noninvasive morphologic and hemodynamic method of examination for the follow-up of aortoiliac surgery motivated us to initiate a dynamic CT study of bifurcation prosthesis. Twenty-seven Y grafts (25 Dacron, 2 polytetrafluoroethylene) were studied by CT scan 1 month to 7 years postoperatively. There were normal CT findings in 16 patients, neointima formation in 6, graft occlusion (1 limb of the Y graft) in 3, and dilatation of the prosthesis in 2. Patent grafts showed enhancement of contrast medium. CT scans corresponded to clinical findings in all instances. Because of its noninvasiveness, assessment of perivascular changes, and semiquantitative measurements, dynamic CT may be applied in the follow-up of aortofemoral bifurcation grafts.

Aged↗
PubMed1985

Late sequelae of ultrasonic lithotripsy of renal calculi.

We examined 82 patients 12 to 43 (mean 22) months after renal calculi had been removed by ultrasonic lithotripsy. Recurrence was noted in 2 patients but this correlated to the previous stone-forming rate. Smaller fragments that had remained in 9 patients were passed in 2, removed percutaneously in 2 and unchanged in the remainder. There was no evidence of hypertension or urinary tract infection related to the procedure. There were 62 patients available for computerized tomography and 11 per cent of the kidneys showed minute calcifications not visible on plain films. Barely visible scarring was noted on the fibrous capsule posterior to the lower pole in 22 per cent of the cases and on the abdominal wall along the former nephrostomy tract in 46 per cent. However, a cortical scar was noted in only 1 kidney and no arteriovenous fistulas were found. On dimercapto-succinic acid scans it was impossible to localize the puncture site and serial 131iodine-hippurate renograms available in 18 patients showed a 7.6 plus or minus 2.8 per cent (mean plus or minus standard error of mean) increase in function. We conclude that percutaneous nephrolithotripsy with ultrasound is a safe and effective procedure with minimal late morbidity.

Adolescent↗
PubMed1985

Adrenal cortical carcinoma: preoperative demonstration of right atrial extension by sonography and computerized tomography.

We report a case of adrenal cortical carcinoma with tumor thrombus extending to the right atrium. Tumor extension was demonstrated preoperatively with sonography and computerized tomography. We recommend that both modalities be used when evaluating masses in the suprarenal space. The preoperative diagnosis of tumor extension via the adrenal vein into the inferior vena cava was confirmed at operation.

Adrenal Cortex Neoplasms↗
PubMed1985

[Pre- and postoperative diagnosis of an aortic aneurysm by dynamic computed tomography with omission of angiography].

A study which was prospective with regard to the method, showed 41 cases of aortic aneurysms in a collective of 3597 body-CT-examinations (1.14%). By means of CT and its possibility of reconstruction all morphological details of an aneurysm become visible. The course of the vessels to the bowel and to the kidneys are shown with the same excellence as in angiography. However, additional information which angiography cannot supply, is also given, like non-perfused lumen, changed wall structure and perivascular changes. Measurement of flow can be performed in the vessel and in the organ, the arterial supply of which is involved in aneurysmatic disease. The method is non-invasive. This is important for control after operation. Morphological changes of the vessel prosthesis are detected, as well as bleeding and infection. Functional parameters are determined semiquantitatively.

Adult↗
PubMed1985

[Venous diagnosis using duplex sonography].

Duplex sonography is an excellent alternative in sonographically accessible regions of the venous system if i.v. administration of contrast media for opacification is not possible for technical reasons or because of medical contraindications.

Adult↗
PubMed1984

[Dynamic computer tomography following vascular operations in aortic aneurysms or aortoiliac occlusive disease].

Thirty-five aorto-iliac reconstructions (27 aorto-bifemoral Y-grafts, two aortic tube grafts, one aortic endarterectomy, 5 ileo-femoral bypass operations) were studied by CT-scans one week to seven years postoperatively. A General Electric CT/T 8800 with Dynapak software was used. Coronary, sagittal and oblique reconstructions as well as time-density diagrams were performed. There were normal CT-findings in 22 patients (63%), excessive Neointima formation in seven, graft occlusion (one limb of Y-graft) in three, prosthetic dilatation in two and suspicious graft infection in one patient. Patent bypasses showed enhancement of contrast medium. CT-scans corresponded with clinical findings in all instances. Because of its non-invasiveness, assessment of perivascular alterations and semiquantitative measurements dynamic CT is applicable in the follow-up of aorto-iliac arterial reconstructions.

Aged↗
PubMed1984

[Cerebral blood flow measurement by dynamic computed tomography before and after reconstructive vascular surgery].

Sequential changes of cerebral regional blood flow and parenchymal perfusion were examined with dynamic CT in 12 patients with arteriosclerotic occlusive disease before and after vascular reconstructive surgery. ROI density values were recorded bilaterally in corresponding regions of the brain tissue and vessels. Interpretation is based on transient time of the bolus (timing of peak), delay of the peak and amplitude of the change of density-time curve. Differences of hemodynamics before and after surgery are demonstrated, a practical technique for measuring the relative perfusion.

Adult↗
PubMed1984

Late sequelae of percutaneous nephrostomy. Work in progress.

Renal scans of 36 patients were obtained with and without the use of contrast material, and a dynamic CT study was performed at least three years after percutaneous nephrostomy (PNS) to evaluate the late effects of that procedure on kidney morphology and function. Only one kidney showed a cortical scar (1 X 1 X 1 cm in size) at the puncture site, and there were no signs of a loss of renal function or of alterations of the collecting system. Eight kidneys demonstrated slight capsular fibrosis at the puncture site, three were displaced posteriorly, and ten had some slight perirenal scarring around the lower pole. Overall, the morphological alterations were minimal and considerably less than those associated with open surgery. Coupled with the minimal complication rate associated with the initial PNS procedure, these findings indicate that PNS may be considered safe.

Adult↗
PubMed1984

[Comparison of the side effects of urographic contrast media (iothalamate, diatrizoate, iodamide, iopamidol) within the scope of a CT study].

In 1465 patients the side effects of urographic contrast media for enhancement in CT were compared. The results show that the reaction frequency with iotalamate is 5.1%, with diatrizoate 7.0% and with iodamide 8.9%, but only 0.5% with iopamidol. The number of incidents to be expected with iopamidol is one decimal place lower. Obviously this has to do with its low osmolality. On the other hand we interpret the comparatively slightly higher incidence rate when using iodamide as a result of its higher lipophilic nature.

Adolescent↗
PubMed1984

[Testicular tumor staging: the ranking of CT and ultrasonic diagnosis].

In a retrospective study 79 patients suffering from a tumour of the testis were analysed between March 1977 and March 1983. Of these, 31 patients were examined via CT. The radiologist's task was the staging of these cases. The results show the superiority of CT diagnosis, which led to only one false-negative report. For the evaluation of stage II ultrasonography is useful, too, even though small lymphomas might be overlooked. If CT is not available, sonography, which is less costly, might be a good substitute. With regard to cooperative therapy, staging together with the histology of the primary tumour and determination of tumour markers are of essential importance.

Adolescent↗
PubMed1984

[Staging of adenocarcinoma of the kidney--CT largely replaces catheter angiography].

In renal adenocarcinoma (hypernephroma) CT as a rule provides the same information as angiography. Our experience is based on a collection of 61 tumour cases, divided in stages according to the TNM system. In retrospect, 39 of our own cases were investigated by CT as well as by angiography; the accuracy of both methods was tested on 33 operative findings. Prospectively 22 cases were examined by CT only and results controlled via 20 operative findings. CT is superior in the T and N stages. Usually demonstration of vein invasion is as good in CT as in catheter angiography. Metastases in the adrenals and the liver are vasible in CT. Seen from the point of view of a "non-touch procedure" (particularly to be demanded with a tumour metastasising as early as this!) the non-invasive method of CT proves especially suitable. We use CT primarily in all cases of suspicion. In singular cases CT is supplemented by further angiographic investigations, e.g. cavography. Exceptions to the topical proceedings mentioned above are a suspected tumour in a solitary kidney, and bilateral tumours. Such cases should be investigated by catheter angiography following i.v. urography and/or sonography.

Adenocarcinoma↗
PubMed1983

[Comparative study on the effect of the dopamine receptor blockers metoclopramide and domperidone on stomach emptying and the visualization of the small intestine in monocontrast].

The effects of a new dopamine receptor blocking agent, domperidone are compared pharmacoradiographically with the well-know action of metoclopramide. The investigated parameters were pyloric muscle function, passage time through the small intestine and, in correction with this, an evaluation of barium filling of the small intestine. Our investigations show that domperidone at dosages of 0.1 mg/kg and 0.2 mg/kg body weight does not accelerate intestinal junction as markedly as 0.3 mg/kg metoclopramide. Nevertheless, domperidone is as well suited as metoclopramide for pharmacoradiography of gastric emptying and for radiological examination of the small intestine. Hence, it can be concluded that the stimulation of the pyloric muscle as the leading pace maker of propulsion is achieved satisfactorily. Contrary to the findings with metoclopramide, domperidone shows no central nervous side effects. It appears that domperidone, at therapeutic dosages, does not pass the blood-brain barrier. Hence, this pharmaceutical preparation should prove of particular value in paediatrics.

Adult↗
PubMed1983

[Increasing importance of biliary cysts (choleceles)].

Biliary cysts are connected with the biliary tract and primarily contain bile. Mostly this connection persists, which differentiates these cysts from all the others in this region. Therefore biliary cysts lead to a number of clinically serious complications such as calculi and abscess formation, cholangitis, cholestatic cirrhosis (possibly leading to portal hypertension or hepatoma), continuous enlargement of the cyst resulting in perforation into the abdominal cavity (and biliary peritonitis). The biliary cysts occur as a congenital-hereditary disease or develop because of an occlusion of hepatic artery branches. The congenital disease ist extremely rare. The secondary choleceles are caused by thrombo-embolic disorders (infarcts, periarteritis nodosa) or iatrogenically (ligations of vessels after traumatic liver rupture, embolization). Over the past years the secondary choleceles have gained in importance. Each case of cholecele should be diagnosed as early as possible. Though sonography and CT display cystic lesions excellently, differential diagnosis, however, remains difficult. The diagnosis is requested from the radiologist because therapeutic consequences are considerable.

Adult↗