Search PubMed⌕ Search

Biomedical subjects

W Pircher

Publications and source records attributed to W Pircher.

9 recordsLinked to original sources
PubMed1991

Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging.

To evaluate the sensitivity of sonography, CT, and MR imaging in the detection of hepatic masses in carcinoma patients, we conducted a prospective study of 75 consecutive patients with gastrointestinal tumors who were admitted for surgical resection of the primary tumor. Sonography was performed with convex transducers of 3.5 and 5.0 MHz. Three noninvasive CT techniques were used: unenhanced CT scans, the incremental bolus dynamic scanning technique, and delayed scanning 4-6 hr after bolus injection of 60 g of iodine. MR images (1.5 T) were acquired as presaturated T1- and T2-weighted spin-echo sequences and as breath-holding fast low-angle shot (FLASH) 60 degrees and FLASH 15 degrees sequences. As it is difficult to distinguish benign from malignant masses solely on the basis of morphologic criteria, the techniques for each imaging method were designed to detect and not to characterize hepatic lesions. Each examination was interpreted blindly, and the results were compared with surgical findings, intraoperative sonography, and biopsy of the liver as the gold standard. All focal hepatic masses verified at surgery, malignant or benign, were included in the analysis. Sixty-five (68%) of 95 focal hepatic masses were detected by CT, 60 lesions (63%) by MR, and 50 lesions (53%) by sonography. Although lesions 1-2 cm were shown almost equally well by CT and MR (74% and 77%, respectively), the detection rate of smaller lesions (less than 1.0 cm) decreased more drastically with MR (31%) than with CT (49%). Sonography had a sensitivity of only 20% with the smaller lesions. All imaging techniques had a sensitivity of 100% for focal hepatic masses larger than 2.0 cm. Our results show that CT has a higher overall sensitivity (68%) than MR and sonography for the detection of focal hepatic masses. When the results of the three procedures are combined, the overall sensitivity is 77%. This is unsatisfactorily low, as CT and MR have a size threshold of about 1.0 cm and are relatively unreliable for the detection of smaller lesions.

Adenocarcinoma↗
PubMed1989

[Duplex sonography in the diagnosis of renal artery stenoses following allogenic kidney transplantation].

Posttransplant renal artery stenosis (TRAS) as a cause of secondary hypertension is reported with an incidence of 1 to 10%. Early diagnosis of TRAS should be made by non-nephrotoxic and non-invasive means to lower the risk of hypertension. One to 66 months after kidney transplantation 335 patients underwent Duplex-scanning, 38 of cases for clinical tentative diagnosis of TRAS. Parameters for clinical diagnosis of TRAS were diastolic hypertension greater than 100 mm Hg with resistance to therapy (A), an abdominal bruit over the transplant (B), disturbance of renal function (serum-creatinine greater than 2 mg/dl) (C). Admission to study followed the parameter-combination A + B. A + C, B + C. Rejection crisis was excluded in 18/38 cases by fine needle biopsy, cyclosporine over-dosage was negative in 38/38 cases, 20/38 cases had normal renal function. Duplex-/Doppler-ultrasound criteria for TRAS were systolic peak velocity greater than 100 cm/s-1 and broadening of the diastolic frequency spectra with a smooth decline in diastole to an elevated diastolic level. In 32/38 cases (84.2%, n = 38) diagnosis of TRAS was made by duplex-scanning, angiography confirmed the result in 30/32 cases (93.75%, n = 32); sensitivity was 88.2% with a specificity of 66.6%. Duplex-scanning as a primary diagnostic means for TRAS seems a promising method compared to e.g. radionuclide imaging or angiography. Duplex-scanning is a non-nephrotoxic and non-invasive procedure repeatable at any time with only few preliminary conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Absorbable mesh in the treatment of rectal prolapse.

Transabdominal rectopexy is a widely used method with excellent results in the treatment of rectal prolapse; a variety of absorbable and non-absorbable materials has been described in the literature. In the Department of Surgery in the University of Munster we have been using absorbable mesh (Vicryl/Dexon) routinely to perform rectopexy. These materials are practically identical in their mode of degradation. Both are absorbed completely, releasing glycolic acid which is believed to be bacteriostatic. In this series of 62 cases absorbable mesh was used to fix the mobilised rectum to the sacrum. The operations were performed using one-dose antibiotic prophylaxis. There were no deaths. Two recurrences developed within two weeks of operation, one complete and one incomplete. Both cases, however, had been operated upon by inexperienced surgeons. Two further recurrences occurred after 36 and 45 months; thus the overall rate of recurrence was 6.4%. In no case was there abdominal or pelvic infection. We believe that absorbable mesh is a suitable material for performing rectopexy, reducing the rate of abdominal and particularly pelvic infection without increasing recurrence rate.

Adolescent↗
PubMed1988

[Treatment of pheochromocytoma: changes in diagnosis and therapy].

Evident progress has been made in the treatment of pheochromocytoma. The results of hormone analysis became very accurate, the method for tumor localisation are non invasive and safe: with 131-I-MIBG, ultrasonography and CT-scan an exact preoperative localisation is possible without serious risks. Patients are prepared for the operation with alpha- and beta-blocking agents. Modern methods of anaesthesia with continuous monitoring of blood pressure, pulmonary pressure and cardiac output and a standardized operative procedure are essential. From 1965 to 1987 71 patients with a total of 87 catecholamine producing tumors have been operated. In all cases a transabdominal access was chosen. Biadrenal tumors were removed in 8 patients, multiple (7) tumors in 2 patients. The comparison of the 2 time intervals 1965 to 1976 and 1977 to 1987 showed a significant decrease of serious intra- and postoperative complications. Surgical specimens of 36 patients with pheochromocytoma were used for immunohistologic evaluation. Marked positivity was found in 44% of cases for calcitonin. The reaction for vasoactive intestinal polypeptide (VIP) was positive in 28% of cases. Somatostatin was not detected in any case, neuron-specific enolase (NSE) in all cases. 6 patients with malignant pheochromocytoma were treated with high doses of 131-I-MIBG, 4 other patients received a combined chemotherapy.

Adrenal Gland Neoplasms↗
PubMed1979

[Clinical experience with acute mesenteric vascular occlusion (author's transl)].

Between 1964 and 1978 twenty patients suffering from acute mesenteric vascular occlusion were treated in the surgical department (University of Münster). The average duration of the anamnesis until their hospitalization was 3.1 days and the actual operation was performed 11.35 hours later on the average. In only 15% of the cases had a correct preoperative diagnosis been given. As regards the frequency of causation, 60% of the mesenteric vascular occlusions were caused by a mesenteric arterioembolism, 20% by a mesenteric venous embolism, 10% by a mesenteric arterial thrombosis and 10% by a non-obstructive occlusion. In a post cardiac infarction condition was the predisposing factor in 50% of all cases, valvular defect in 33.5% and tachyarrhythmia in 16.6%. The causes found for the mesenteric venous tbrombosis were insufficiency of the right heart, absolute bradyarrhythmia, recurrent venous thrombosis of the leg, and myeloproliferative syndromes.

Adolescent↗
PubMed1978

[Results of Implantation of Aorto-Femoral Bifurcation Prostheses (author's transl)].

From June 1974 to December 1975, 139 aorto-femoral Y-grafts were implanted at the surgical clinic of the University of Münster. The operation mortality was 4.3 percent. Among the postoperative complications were sexual disfunction and paraesthesia. For the ileo-femoral occlusions the postoperative success rate was 90 percent, combined ileo-femoro-crural changes showed good results in 60 percent of the cases. The results show that isolated reconstruction in the pelvic area is successful in most cases, even in combined ileo-femoro-crural obstruction. Only in exceptional cases a second operation (reconstruction of femoral artery) is necessary after a period of about one year.

Adult↗
PubMed1977

[Diagnosis of peripheral arterial vascular disorders using Doppler-ultrasonography].

Most important in vascular surgery is the exact preoperative diagnosis. The Doppler-ultrasonography is an exact and simple method to estimate localization and different changes in the peripheral arteries; the results allow a dependable preselection for necessary preoperative angiography. Advantages and results of Doppler-ultrasonography are described. Two cases are demonstrated.

Adult↗
PubMedDate not supplied

Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery.

The effects of intraoperative changes in plasma colloid osmotic pressure (COP) on the formation of intestinal edema were studied in patients during modified Whipple's operation (hemipancreato-duodenectomy). Eighteen patients (ASA physical status I or II) were randomly assigned to one of three groups. They received either lactated Ringer's (RL group, n = 6), 10% hydroxyethyl starch (HES group, n = 6), or 20% human albumin (HA group, n = 6) as a volume replacement solution, which was given to maintain central venous pressure (CVP) at the preoperative level. Jejunal specimens were obtained after the first transsection of the jejunum and prior to the jejuno-jejunostomy. Their water fraction (g H2O/g tissue dry weight) was measured gravimetrically. COP was determined prior to induction of anesthesia and upon removal of the second jejunal sample. In the RL group, 3,850 +/- 584 ml (data are means +/- SEM) of volume replacement solution were infused from induction of anesthesia to removal of the second jejunal sample. In the HES group, 1,358 +/- 45 ml were infused, and in the HA group, 463 +/- 49 ml were infused. During this time, COP decreased from 20.3 +/- 0.5 mmHg to 14.1 +/- 0.6 mmHg in the RL group, remained at 22.0 +/- 0.9 mmHg in the HES group, and increased from 20.7 +/- 0.9 mmHg to 28.1 +/- 0.9 mmHg in the HA group.(ABSTRACT TRUNCATED AT 250 WORDS)

Albumins↗