[A metastasizing mediastinal cystic mesothelioma].
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Humans↗
Biomedical subjects
W Kersjes
Publications and source records attributed to W Kersjes.
[Computed tomography in malignant primary bone tumors].
The importance of computed tomography is examined in malignant primary bone tumours using a strongly defined examination group of 13 Patients (six Ewing's-sarcomas, five osteosarcomas, one chondrosarcoma and one spindle-shaped cell sarcoma). Computed tomography is judged superior compared to plain radiographs in recognition of bone marrow infiltration and presentation of parosteal tumour parts as well as in analysis of tissue components of tumours, CT is especially suitable for therapy planning and evaluating response to therapy. CT does not provide sufficient diagnostic information to determine dignity and exact diagnosis of bone tumours.
Adolescent↗
Multiple nodular foci in the liver associated with chronic hepatic porphyria after previous treatment of breast cancer.
More than 7 years after the diagnosis and treatment of breast cancer (T1N1aM0), multiple nodular foci were observed in the liver of a 40-year-old woman at ultrasonographic examination. The lesions were confirmed by CT scan, but CT-guided liver biopsy revealed only non-specific alterations. At subsequent peritoneoscopic examination, bluish-brown foci were indeed visible on the liver surface, but guided liver biopsies again failed to corroborate the suspected metastases. Instead, histology showed mild portal fibrosis, moderate steatosis and siderosis of hepatocytes, as before. Only the intense red fluorescence of part of the biopsy material under Wood's light suggested the diagnosis of chronic hepatic porphyria or porphyria cutanea tarda, here presumably as a consequence of prolonged alcohol consumption. Subsequent porphyrin studies in urine, faeces and plasma yielded the typical constellation of latent porphyria cutanea tarda (chronic hepatic porphyria type C). The activity of erythrocyte uroporphyrinogen decarboxylase was normal, which argued against a genetic predisposition. After 1 year of strict alcohol abstinence and low-dose chloroquine treatment the "nodular foci" in the liver were no longer visible on ultrasonogram and CT scan; only proton-weighted NMR imaging (SE 1500/30) still showed ill-defined areas of higher signal intensity. The renal excretion of porphyrins had decreased considerably. The levels are now consistent with the diagnosis of subclinical chronic hepatic porphyria type A. Modern non-invasive imaging techniques are tremendously useful, but they have their pitfalls. Focal liver lesions may present serious diagnostic problems, especially when they are found in a patient with a history of carcinoma at an extrahepatic primary site. A rare example is described.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[The value of x-ray signs in the follow-up of Crohn's disease].
The value of various radiological signs in the follow-up of Crohn's disease has been studied in 175 radiological examinations of the gastro-intestinal tract in 39 patients. Changes in the significant radiological signs in Crohn's disease, such as spicula, cobblestone pattern, stenoses and fistulas, provide information on the development of the disease and on the effect of treatment. The signs have a prognostic significance only insofar as their persistence excludes any improvement. Radiological follow-up is particularly useful for spotting complications and for the early recognition of recurrences.
Adolescent↗
[Multiple circular liver foci in latent porphyria cutanea tarda].
A 41-year-old patient with latent porphyria cutanea tarda is described; 8 years after mastectomy for carcinoma, sonography and CT showed multiple hepatic foci, which were at first interpreted as liver metastases. A liver biopsy was carried out during laparoscopy and u/v fluorescence and subsequent laboratory tests confirmed the diagnosis of porphyria cutanea tarda. Treatment with resochin produced almost complete resolution of the liver abnormalities within 9 months. Magnetic resonance tomography using proton-weighted SE sequences showed a few foci of high signal intensity.
Adult↗
[Digital subtraction angiography of acquired arteriovenous fistulas of the extremities].
The signs of arterio-venous fistulae in the extremities have been evaluated by DSA in 20 patients. Angiographic signs for the presence of A-V fistulae are the following findings: dilatation of the supplying artery, elongation of the supplying artery, solitary A-V aneurysm, angiomatous A-V aneurysm, reduced blood flow distal to the A-V fistula, early venous filling, development of a venous collateral circulation and demonstration of retrograde venous flow. Angiography remains the method of choice for demonstrating A-V fistulae.
Angiography↗
[Arterial DSA using a trans-brachial 4-French catheter].
Arterial DSA by the trans-brachial route, using a 4-French-catheter has been performed in 33 patients. In these patients, trans-femoral DSA is contra-indicated because of previous surgery or markedly reduced femoral pulsation. Intravenous DSA was not expected to provide diagnostically adequate information in these patients, in view of the well known method limitations of this method. In 20 patients, the abdominal aorta, pelvis and lower limb arteries were examined, in 14 only the leg arteries, in ten patients the arteries in the neck and in three patients the thoracic and abdominal aorta. Trans-brachial DSA provided good demonstration of the vessels in all cases.
Angiography↗
[MR tomography of hepatic hemangioma].
MR tomography of the liver using 1.5 T has been carried out in 63 patients with focal lesions in order to demonstrate haemangiomas and to differentiate these from primary and secondary malignant liver tumours. This differentiation was possible in all patients, using conventional spin echo and inversion recovery sequences in combination with sonography. Accuracy was much less good when using gradient echo sequences. With sufficiently large tumours, measurement of relaxation time made possible diagnosis of all the 22 haemangiomas.
Adult↗
[Radiological diagnosis and therapy of postoperative abdominal lymphoceles].
Eighty-one patients with postoperative abdominal lymphoceles were examined by CT and ultrasound. Both methods provide accurate information regarding localisation and extent of the lymphocele. In 51 patients conservative treatment under sonographic or CT observation was carried out. In seven patients, irradiation lead to complete regression. In 21 patients, interventional radiological therapy was carried out with simultaneous irradiation in seven cases. In five patients surgery was necessary. Asymptomatic lymphoceles should be treated conservatively and only after the appearance of clinical symptoms should interventional radiological or surgical measures be carried out.
Abdomen↗
[Acute renal failure in a prominent aneurysm of the iliac artery].
This is a report on a patient of 64 years of age who was admitted to hospital as an inpatient thirteen years after obliteration of the iliac artery with an extension plasty. He complained of irregular stools and occasional abdominal pain. Imaging methods were employed on account of a drop in the haemoglobin count, progressive renal insufficiency and a palpable tumor in the lower abdomen. These methods supplied evidence of a false aneurysm originating from the iliac endarterectomy, combined with compression of the ureter and small intestine. Based on the present case report, the general complex of problems in diagnosing aneurysms of the iliac artery is discussed.
Acute Kidney Injury↗
Comparison of quantitative ground substance analysis in biopsy and resected tumour in osteosarcomas.
Osteosarcomas may show variable differentiation. They are divided into osteoblastic, chondroblastic and fibroblastic subgroups depending on their dominant histological differentiation. The pattern of histological differentiation of osteosarcoma is supposed to have an influence on the response to chemotherapy and in this study the relationship between the differentiation of the tumours and response to chemotherapy was examined in 22 osteosarcomas. For this purpose the nuclear size of tumour cells was determined on imprints and the area of the different ground substances on tumour sections after undecalcified preparation. Tumours with little nuclear polymorphism and those with an area of chondroblastic ground substance of more than 20% in the biopsy showed a poor response to chemotherapy. We conclude from our results that lack of nuclear polymorphism and in particular a large area of chondroblastic ground substances in the biopsy, can be regarded as an unfavourable prognostic factor in the response to primary chemotherapy. A comparison of the area of chondroblastic ground substance in biopsy and resection material proves that the biopsy delivers a representative view of the total area of chondroblastic ground substance for the groups of responder and non-responder. Patients with a large amount of chondroblastic ground substance in the biopsy probably require more aggressive chemotherapy.
Adolescent↗
[Esophageal involvement in Crohn's disease].
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Adult↗
[CT findings in ruptured abdominal aortic aneurysms].
In nine patients with ruptured aneurysms of the abdominal aorta and in one patient with a ruptured aneurysm of a common iliac artery who also had an abdominal aortic aneurysm, CT was performed. Three of the nine patients were also examined by sonography. CT proved to be the method of choice in the diagnosis of ruptured abdominal aortic aneurysms. The most important CT signs are: demonstration of an aortic aneurysm; haematoma usually unilateral and retroperitoneal; ventral or ventro-lateral displacement of a kidney; enlargement of the psoas, which may be indistinguishable from the haematoma, possibly with direct penetration of the psoas fascia; indistinct margin of the aortic wall at the rupture site.
Aged↗
Histomorphometric analysis of osteoclastic bone resorption in metastatic bone disease from various primary malignomas.
The present study deals with qualitative und quantitative analysis of osteoclastic bone resorption in metastatic bone disease. 267 cases were examined histomorphologically and divided into three developmental stages. In the first 'phase of early appearance' no bone resorption takes place. The stimulation of osteoclastic resorption in the surroundings of tumour tissue is typical in the second 'phase of interaction'. Pressure atrophy, aseptic necrosis and osteolysis by the tumour cells themselves are other mechanisms of bone destruction in the last 'phase of carcinomatosis'. Because osteoclasts are exclusively responsible for the loss of bone tissue in the 'phase of interaction', this stage is suited for precise quantitative analysis of osteoclastic resorption. 24 pure osteolytic secondary bone tumours of various primary lesions were examined histomorphometrically. The numerical values were compared with each other and with standard values of healthy individuals. In contrast with normal bone tissue the fractional resorption surfaces und osteoclast indices increase in metastases. Activated osteoclasts are larger and have more nuclei. The numbers of osteoclast index and nuclei per osteoclast are significantly higher in renal than in breast carcinoma. Osteoclasts can be activated in distances of more than 500 micron from tumour tissue. The mean stimulation distance in metastasis from squamous cell carcinoma is markedly higher than in secondary bone tumours of breast carcinoma. Several osteoclast activating substances and divers mechanisms of stimulation might be responsible for different numerical values of morphometric parameters in metastases from various primary malignancies.
Bone Neoplasms↗
Effectiveness of platinum wire microcoils for venous occlusion: a study on patients treated for venogenic impotence.
The purpose of this study was to determine the effectiveness of venous occlusions achieved by embolization with platinum microwire coils. Follow-up venographies in 19 patients, 1-20 months (average 8 months) after coil embolizations, were evaluated. Twenty-eight of 126 (22.2%) coil embolizations were found to be patent. Coils which had not formed or partially formed upon embolization had a patency/recanalization rate of 37.5% (12/32). Among coils which had formed nearly completely or completely only 16 of 95 (17%) showed venous patency. As coil embolization had been augmented by sclerotherapy in all patients, the effectiveness of long-term venous occlusion by platinum wire coils alone is probably lower than our figures indicate. We conclude that attention to complete or near-complete coil formation upon embolization appears to be critical to maximize long-term occlusive effects of platinum microcoils. Their effectiveness in general, however, is lower than anticipated.
Angiography↗
Pulmonary artery sarcoma mimicking chronic thromboembolic disease: computed tomography and magnetic resonance imaging findings.
PURPOSE: The diagnosis of the rare primary malignant tumors of the pulmonary arteries is often delayed as symptoms are nonspecific. METHODS: Computed tomography (CT) and magnetic resonance imaging (MRI) of three patients with occlusion of the right pulmonary artery, two with sarcoma and one with chronic thromboembolic disease were analyzed for discriminating diagnostic criteria. RESULTS: Criteria suggesting pulmonary artery sarcoma are inhomogeneous high or low attenuation (hemorrhage, necrosis), soft-tissue density in pulmonary arteries, vascular distension, enhancement after administration of gadopentetate dimeglumine. Criteria for chronic thromboembolic disease are homogeneous soft-tissue lesions, abrupt vascular narrowings and cut-offs, as well as regional parenchymal hyperdensities. CONCLUSION: CT and MRI provide complementary findings suggesting advanced pulmonary artery sarcoma instead of chronic thromboembolism.
Adult↗
Percutaneous penile venoablation for treatment of impotence.
Percutaneous penile venoablation with sclerosing agents and coils was performed in 58 patients. Of 104 ablations attempted, 44 of 51 (86%) transpenile, and 46 of 53 (86.7%) retrograde interventions were technically successful. In 40 patients (69%) erectile function improved (intercourse was possible in 21 without additional measures). Initially improved erectile function deteriorated in 24 patients during follow-up (in an average of 6 months); in 15 of these, intercourse was still possible with injection of vasoactive drugs. In 7 patients, repeat venoablation improved erectile function again. Hot contrast medium was slightly superior to sodium morrhuate as a sclerosing agent. In successfully treated patients, the average decrease in venous leakage was 30 ml/min vs 13 ml/min in treatment failures, with considerable overlap between both groups. Only minor complications were observed. We conclude that percutaneous penile venoablation is technically feasible, and safe. Whether the procedure will have a definite role in the treatment of venogenic impotence, however, still has to be determined.
Embolization, Therapeutic↗