Biomedical subjects

W Jaschke

Publications and source records attributed to W Jaschke.

At least 55 records · Page 3Linked to original sources

PubMed1998

Sonographic appearance of an appendix carcinoma.

Malignant appendix tumours are rare entities. Especially adenocarcinomas, which only appear in about 10% of appendix tumours, are very seldom. Preoperative diagnosis is very difficult due to a lack of typical clinical signs and a clinical appearance mimicking perforated appendicitis. Nevertheless, sonography is able to show indirect signs and therefore it can provide the surgeon with more information for a better operative treatment.

Adenocarcinoma↗

PubMed1998

[Doppler ultrasound determination of average blood flow velocity and flow volume in transjugular intrahepatic portosystemic shunt (TIPS)].

AIM: To determine if duplex sonographic measured Time Average Motion (TAM) is an effective parameter for screening examination in routine follow-up after TIPS implantation. PATIENTS AND METHODS: 35 patients underwent duplex sonographic examination by a 3.5 MHz transducer with a follow-up for 12.4 months. RESULTS: A reduction of TAM about 60% from baseline proved with a sensitivity of 90% and a specificity of 93.7% the presence of a hemodynamic relevant stenosis, which was confirmed with angiography. We failed to establish a threshold which pointed out with acceptable accuracy the presence of shunt dysfunction. CONCLUSION: TAM is a good parameter in colour-duplex sonography which permits an objective view of TIPS-function. Angiography should be performed only in patients with suspect duplex-results or clinical worsening. A secondary sign of shunt dysfunction is increasing ascites.

Adult↗

PubMed1998

[Ruptures of the medial gastrocnemius muscle: diagnosis with high resolution ultrasound].

AIM: Evaluation of high resolution ultrasound to diagnose rupture of the medial head of gastrocnemius muscle in patients with uncharacteristic calf pain. METHOD: 66 patients with clinically unclear calf pain were examined in a prospective study. RESULTS: Out of 66 patients, 51 showed sonographic criteria of a partial rupture of the medial gastrocnemius head. 47 ruptures were located in musculotendineus transition zone. CONCLUSION: High resolution sonography detect minimal lesions of the medial gastrocnemius muscle in patients with clinically uncharacteristic calf pain.

Adult↗

PubMed1998

[ACOnet (Austrian Academic Computer Network) as data carrier for teleradiologic consultations].

PURPOSE: To assess the feasibility of image transfer for teleradiologic consultations using the Austrian Academic Computer Network (ACOnet). The ACOnet corresponds between the main universities to a MAN (Metropolitan Area Network) with a transfer rate of 4 Mbps. Its use is free of charge for university institutions. MATERIALS AND METHODS: 1740 test image data sets and 620 image data sets for teleradiological consultations were exchanged without annotations between the Departments of Diagnostic Radiology of the universities of Innsbruck and Graz, using the ACOnet. RESULTS: Data transmission was reliable and fast with an average transfer capacity of 170.2 kBytes/s (94-341 kBytes/s). There were no major problems with image transfer during the test phase. CONCLUSION: Due to its high transfer capacity, the ACOnet is considered a reasonable alternative to the ISDN service.

Austria↗

PubMed1998

[First experiences with the trauma radiologic PACS project at the University of Innsbruck Department of Radiology].

Radiography in an emergency setting is a demanding task, in technical as well as in logistical terms. Rapid acquisition of high quality radiographs under difficult conditions, for example severely injured patients with multi-organ trauma is important. All image data and radiological reports must be transmitted to the trauma surgeon as soon as possible. To meet these needs with the promising means of modern X-ray technology, we decided to implement a completely digital X-ray division inside the new outpatient trauma department. In the setting of an outpatient emergency department digital radiography and PACS cannot be realised without problems. We present our first experience with the installation and 10 month filmless routine in the X-ray division for traumatology outpatients at the university of Innsbruck department of radiology.

Emergencies↗

PubMed1998

The Austrian Academic Computer Network and its usefulness for teleradiology.

To study the value of the Austrian Academic Computer Network (ACOnet) for teleradiology, 1740 test image data-sets and 620 image data-sets were exchanged between the departments of diagnostic radiology of the Universities of Innsbruck and Graz using the ACOnet service. Data transmission was reliable and fast with an average transfer capacity of 170 kByte/s (range 94-341). During the test phase, no major problems with image transfer occurred. Assuming that problems like security of patient data-sets, data compression and data verification can be solved, the ACOnet service would be a useful additional tool for telemedicine applications throughout Austria and eastern Europe.

Austria↗

PubMed1997

Virtual computed tomography gastroscopy: a new technique.

BACKGROUND AND STUDY AIMS: The aim of the present study was to establish a suitable method for virtual computed tomography (CT) gastroscopy. PATIENTS AND METHODS: Three-millimeter helical CT scans of a pig stomach were obtained after air insufflation and instillation of diluted diatrizoic acid (Gastrografin), and with double contrast. In addition, three patients with gastric tumors were studied after ingestion of an effervescent agent (Duplotrast, 6 g) and intravenous injection of hyoscine butylbromide (Buscopan, 1 ml). Virtual endoscopy images were computed on a Sun Sparc 20 workstation (128 megabytes of random access memory, four gigabytes of hard disk space), using dedicated software (Navigator, General Electric Medical System Company). The endoscopy sequences were compared with real endoscopic examinations and with anatomical specimens. RESULTS: In the cadaver studies, the best results were obtained with plain air insufflation, whereas virtual CT gastroscopy with diluted contrast and with double contrast showed artifacts simulating polyps, erosions, and flat ulcers. Patient studies showed good correlation with the fiberoptic endoscopy findings, although large amounts of retained gastric fluid substantially reduced the quality of the surface reconstruction. CONCLUSION: These preliminary results show that virtual CT gastroscopy is able to provide insights into the upper gastrointestinal tract similar to those of fiberoptic endoscopy. However, due to the limited spatial resolution of the CT protocol used, as well as inherent image artifacts associated with the Navigator program's reconstruction algorithm, the form of virtual CT gastroscopy studied was not capable of competing with the imaging quality provided by fiberoptic gastroscopy.

Animals↗

PubMed1997

Adrenal-sparing laparoscopic surgery for aldosterone-producing adenoma.

We herein present the first case in the literature of enucleation of an aldosterone-producing adenoma by laparoscopy. The indication for adrenal-sparing surgery was bilateral adrenal adenoma. The operation turned out to be easier than laparoscopic adrenalectomy. The postoperative course was uneventful, and the patient was cured; split adrenal function tests showed normal function of both adrenal glands.

Adenoma↗

PubMed1997

Fibromuscular dysplasia of the internal carotid artery in a child with alpha-1-antitrypsin deficiency.

Fibromuscular dysplasia (FMD) is a non-inflammatory segmental arteriopathy of unknown origin. Most often the renal arteries are affected, however, also mesenteric, lumbar, vertebral, or carotid arteries may be involved. FMD has frequently been reported as a cause of stroke in adults, but very rarely in children. We report the case of an 11-year-old boy who presented with an ischaemic infarction in the anterior part of the territory of the left middle cerebral artery. Angiography demonstrated a 'string of beads' lesion suggestive of FMD causing occlusion at the origin of the middle artery. Laboratory analyses revealed the protease inhibitor (Pi) phenotype SZ (PiSZ) of alpha-1-antitrypsin deficiency as well as decreased antioxidants and signs of enhanced lipid peroxidation. Such an imbalance may be associated with diminished resistance to oxidation, possibly causing direct cellular and tissue injury. Whether alpha-1-antitrypsin deficiency and an impaired status of antioxidants, as seen in our patient, might play a role in the pathogenesis of FMD is presently unclear.

Antioxidants↗

PubMed1997

A cost analysis of an emergency computerized tomography teleradiology system.

We carried out a cost analysis of a teleradiology system for emergency computerized tomography (CT) examinations. Teleradiology was implemented by connecting two spiral CT scanners in the University Hospital in Innsbruck and the Regional Hospital in Zwettl. It enabled the remote hospital in Zwettl to get fast and competent reports of emergency CT examinations when there was no specialist radiologist available. In 13 months' use for routine night and weekend service, the system proved fast and reliable. During the study period 121 emergency examinations of 116 patients were transmitted from Zwettl to Innsbruck. The fixed costs of teleradiology were for the ISDN connection and amounted to DM230 plus DM696/year rental. The average cost of one emergency CT examination by teleradiology was DM372 (range 308-453). One possible alternative, transporting the films by taxi for reporting elsewhere, was cheaper (estimated cost DM156), but would have been much slower. Another alternative, transporting the patient to the nearest central hospital for scanning, was much more expensive: DM524 by road or DM4667 by helicopter ambulance.

Austria↗

PubMed1997

[Virtual endoscopy with post-processing helical CT data sets].

PURPOSE: The purpose of this work was to test a newly developed, post-processing software for virtual CT endoscopic methods. Virtual endoscopic images were generated from helical CT data sets in the region of the shoulder joint (n = 2), the tracheobronchial system (n = 3), the nasal sinuses (n = 2), the colon (n = 2), and the common carotid artery n = 1). Software developed specifically for virtual endoscopy ("Navigator") was used which, after a previous threshold value selection, makes the reconstruction of internal body surfaces possible by an automatic segmentation process. We have evaluated the usage of the software, the reconstruction time for individual images and sequences of images as well as the quality of the reconstruction. All pathological findings of the virtual endoscopy were confirmed by surgery. RESULTS: The post-processing program is easy to use and provides virtual endoscopic images within 50 seconds. Depending of the extent of the data set, virtual tracheobronchoscopy as a cine loop sequence required about 15 minutes. Through use of the threshold value-dependent surface reconstruction the demands on the computer configuration are limited; however, this also created quality problems in image calculation as a consequence of the accompanying loss of data. CONCLUSIONS: The Navigator software enables the calculation of virtual endoscopic models with only moderate demands on the hardware.

Artifacts↗

PubMed1997

Gastric antral vascular ectasia with portal hypertension: treatment with TIPSS.

Gastric antral vascular ectasia, or "watermelon stomach," is a distinct clinical entity within the spectrum of upper gastrointestinal mucosal vascular abnormalities. The pathobiology of the disease is unclear. We here describe a case that emphasizes the importance of the "watermelon stomach" as differential diagnosis of occult gastrointestinal blood loss and report on its successful treatment through installation of a transjugular intrahepatic portosystemic stent shunt (TIPSS).

Aged↗

PubMed1996

[Transjugular intrahepatic portasystemic shunt. A new therapeutic method in portal hypertension].

Over the last three years, 53 patients underwent transjugular portosystemic shunting (TIPS). 49 patients were treated successfully (92.5%). Procedure-related morbidity (intention to treat) was seen in 11 patients (20.8%): encephalopathy (n = 5), sepsis (n = 3), right heart failure (n = 2) and progressive liver failure (n = 1). 30-day mortality rate was 13.2% (7/53); five of these patients were in stage Child-Pugh C, one patient in stage B, and one patient had a known coronary heart disease. 30-day rebleeding rate was 6.1% (3/49), but all these patients could be retreated successfully by radiological methods (PTA, embolisation, thrombolysis). Angiographic follow-up (mean six months) of 35 patients detected 30 (85.7%) haemodynamic relevant obstructions (stenosis of stent: n = 4, stenosis of hepatic vein: n = 15, stenosis of stent and hepatic vein: n = 5, occlusion of TIPS-shunt: n = 6). Secondary patency rate following percutaneous reintervention was 91.3%. All rebleedings in the follow-up (n = 7) were treated successfully by TIPS-revision. Five out of 12 patients (41.7%) with refractory ascites were treated successfully by TIPS (complete resolution of ascites after three months: n = 4, significant reduction of ascites: n = 1). We conclude that transjugular portosystemic shunt is an effective way of treating portal hypertension, but there is a need to develop methods to prevent the high incidence of shunt stenosis.

Adult↗

PubMed1996

[The smart-scan procedure of spiral computed tomography. A new method for dose reduction].

PURPOSE: In this article a new method - the Smart-Scan-Technique - for dose reduction during spiral computed tomography is described. This technique allows a dynamical adaptation of the tube current according to the measured local density structure form and absorption values of the object of interest. Its clinical applicability for dose reduction is investigated. In addition, changes in image quality are evaluated. METHODS: Specially designed, water filled plexiglas-phantoms, an Alderson-Rando phantom, and 20 patients were used to simulate possible measures of patients within the thoracic and abdominal region. For those two regions the dose reduction, the modulation transfer function, and the pixel noise were measured. RESULTS: Depending on patient geometry dose reduction up to 20% could be achieved with the Smart-Scan-Technique. This technique also enabled a decrease of the modulation transfer function and an increase of the pixel noise by 8%. CONCLUSION: Relevant dose reductions can be achieved by applying the Smart-Scan-Technique in spiral computed tomography.

Absorption↗

PubMed1996

[The value of colloid scintigraphy and erythrocyte scintigraphy in detecting acute or intermittent gastrointestinal hemorrhages].

PURPOSE: In a retrospective analysis the diagnostic value of two scintigraphic methods was compared with each other. METHOD: 104 patients with acute or intermittent gastrointestinal haemorrhage were examined with 121 scintigraphic studies. We compared scintigraphic results with surgical findings, endoscopic results or final clinical diagnosis. We used two scintigraphic methods, colloid scintigraphy and in vivo/vitro red blood cell scintigraphy. RESULTS: Our scintigraphic findings reached a sensitivity of 72% and a specificity of 100%. We calculated a sensitivity of 68% for colloid scintigraphy and a sensitivity of 79% for red blood cell scintigraphy. The correct localisation of bleeding was successful in 52 (98%) cases. CONCLUSIONS: Our results demonstrate that red blood cell scintigraphy is the method of choice in detecting intermittent gastrointestinal hemorrhage. We believe that with new preparation kits for in vivo labelling red blood cell scintigraphy will become seriously competitive for the colloid scintigraphic method.

Acute Disease↗

PubMed1996

[Establishment of an emergency CT service by means of teleradiology].

UNLABELLED: The teleradiological connection between the University Hospital in Innsbruck, Tyrol, and the Regional Hospital in Zwettl, Lower Austria, is presented as an example of a routine online connection of two helical CT systems. PURPOSE: To establish a practicable and cost-efficient emergency CT service in a remote hospital during night time and on weekends. MATERIAL AND METHODS: Online connection of a GE HiSpeed Advantage-Spiral-CT and a GE Prospeed-Spiral-CT via two Sun SPARC 10 work stations and ISDN. RESULTS: The transmission of 121 CT data sets from 116 patients revealed a sufficiently fast average transmission time of 15 (6-53) minutes and average transmission costs of DM 9.00 per examination. The system was technically reliable, cost-efficient and practicable in clinical routine application. CONCLUSIONS: Teleradiology enables remote hospitals to provide an emergency CT service even if there is no radiological specialist available outside office hours. Thus time-consuming and cost-intensive patient transfers and delay of therapy can be reduced.

Austria↗

PubMed1996

[Dose reduction in computerized tomography with a new scan procedure].

A new investigation technique in computed tomography--the Smart Scan process--and the associated reduction in tube current are discussed. In addition, the reduced dosage values resulting from the reduced current values are compared with those of a standard measurement and image characteristics such as picture unit noise are evaluated. By means of three special water phantoms with dimensions corresponding to those of actual patient geometries and a pool of 183 patients, the Smart Scan process was tested by the control algorithm implemented on a spiral computer tomograph. The dosage values with and without the Smart Scan being activated were determined. Dosage reductions of up to 18% can be realized with this new examination technique. In particular, patients with transverse oval head profiles will benefit from this modality.

Adolescent↗

PubMed1996

Unusual thoracic collaterals of gastro-oesophageal varices in a patient with end-stage liver disease.

Thoracic varices are rare anomalies in patients with liver cirrhosis and portal hypertension. Gastro-oesophageal varices usually drain into the azygos or hemiazygos vein. The case is reported here of an unusual collateral pathway of gastro-oesophageal varices with drainage to the vena anonyma system presenting as lung masses on chest X-ray, which completely resolved after successful liver transplantation.

Collateral Circulation↗