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Biomedical subjects

W Schima

Publications and source records attributed to W Schima.

At least 55 records · Page 3Linked to original sources
PubMed2000

Videofluoroscopy of swallowing in symptomatic patients who have undergone long-term intubation.

OBJECTIVE: The aim of this study was to evaluate whether specific patterns of swallowing dysfunction occur in symptomatic patients after long-term intubation. SUBJECTS AND METHODS: Twenty-one patients (16 men, five women; mean age, 66 years) who presented with clinical signs of aspiration after long-term intubation (mean duration, 24.6 days) underwent videofluoroscopy. They were analyzed for functional abnormalities of the tongue, soft palate, epiglottis, hyoid and larynx, pharynx, and the upper esophageal sphincter. We assessed the presence or absence of aspiration, the type of aspiration (pre-, intra-, and postdeglutitive), and a spectrum of other swallowing abnormalities. RESULTS: There were 18 patients (86%) with radiologically proven aspiration. In another patient only laryngeal penetration occurred. There were 11 combinations of pre-, intra-, and postdeglutitive aspiration. Predeglutitive aspiration was predominant and present in 52% of our patients. We found functional abnormalities of the tongue in 48%, of the soft palate in 10%, of the epiglottis in 48%, of the pharynx in 71%, and of the upper esophageal sphincter in 24%. CONCLUSION: Patients who are symptomatic after undergoing long-term intubation do not develop a specific type or pattern of swallowing dysfunction or aspiration, but show a large variety of aspiration types and associated swallowing disorders. Nevertheless, videofluoroscopy has the ability to reveal complex deglutition disorders and to aid precise planning of individualized functional swallowing therapy.

Aged↗
PubMed2000

Transrectal sonography of anal sphincter infiltration in lower rectal carcinoma.

OBJECTIVE: The purpose of the study was to assess the accuracy of transrectal sonography in determining invasion by lower rectal cancer into the anal canal. SUBJECTS AND METHODS: Thirty-eight patients (14 women, 24 men; mean age, 65 years) with lower rectal cancer underwent transrectal sonography before surgery. Both depth of infiltration and tumor invasion into the anal canal were assessed, and results were compared with histopathology of the resected specimens. RESULTS: Infiltration into the anal canal was found histopathologically in 12 (32%) of 38 patients. Transrectal sonography revealed a true-positive diagnosis in 11 of these 12 patients. A false-positive diagnosis of anal canal infiltration was made in two patients for a sensitivity of 91%, a specificity of 85%, and an accuracy of 92%. In the 11 patients diagnosed correctly on transrectal sonography, the depth of tumor infiltration into the anal canal corresponded with histopathology. CONCLUSION: This study shows that transrectal sonography is an accurate method for assessment of anal canal infiltration in lower rectal cancer.

Adenocarcinoma↗
PubMed1999

MR imaging of the liver with Gd-BOPTA: quantitative analysis of T1-weighted images at two different doses.

This study evaluates the efficacy of gadobentate-dimeglumine (Gd-BOPTA) for enhancement of liver signal-to-noise ratio (SNR) and lesion-liver contrast-to-noise ratio (CNR) on T1-weighted spin-echo (SE) and gradient-recalled-echo (GRE) images at two different doses. Fifty patients with known or suspected liver lesions were examined at 1.5 T. T1-weighted SE (TR/TE 300/12 msec) and GRE images (TR/TE80/4.2 msec/flip angle 80 degrees) were obtained before and at 40-80 minutes and 90-120 minutes after administration of 0.05 or 0.1 mmol/kg Gd-BOPTA. Quantitative measurements of tissue signal intensity were performed at each dose. Liver showed significant enhancement after Gd-BOPTA on T1-weighted SE and GRE images (0.05 mmol: P < 0.05; 0.1 mmol: P < 0.001). The dose of 0.1 mmol/kg provided higher liver SNR than 0.05 mmol/kg. Mean liver SNR was higher on GRE than SE images (P < 0.0001). Lesion-liver CNR significantly increased on GRE images after 0.1 mmol (P < 0.05). There was a trend toward superiority of 0.1 mmol over 0.05 mmol/kg. GRE images were superior to SE images for pre- and post Gd-BOPTA lesion-liver CNR (P < 0.05). Our study suggests that Gd-BOPTA provides prolonged enhancement of liver SNR and CNR, that a dose of 0.1 mmol/Kg appears to be superior than 0.05 mmol/Kg, and that GRE techniques should be used in preference over SE techniques.

Adult↗
PubMed1999

[Radiologic staging of liver and pancreatic malignancies].

Modern therapeutic strategies can improve survival of patients with pancreatic or liver malignancies. A prerequisite is thorough radiologic assessment of these patients. A variety of radiologic techniques are available, such as ultrasound, contrast-enhanced CT, CTAP, contrast-enhanced MRI, and endoscopic ultrasound. In this review the advantages and weaknesses of the different techniques are presented in the staging of patients with HCC, cholangiocarcinoma, suspected liver metastases, and pancreatic carcinoma. In an era of economic restraints, funds are not flowing freely anymore for radiologic studies. We have to consider not doing so many different examinations for each patient. We have to decide in the future which diagnostic test we want to perform for detection and staging of a particular disease. For liver and pancreatic malignancies it is likely to be MRI that will take this role.

Bile Duct Neoplasms↗
PubMed1999

Spontaneous pneumomediastinum.

In this paper two cases of spontaneous pneumomediastinum, occurring in a patient with diabetic ketoacidosis and in a patient with bronchial asthma, are presented. We describe the radiological findings, the differential diagnosis and the important radiographic considerations in establishing the diagnosis. In addition, we discuss the anatomical pathways and review the pathophysiological mechanisms responsible for the development of respiratory spontaneous pneumomediastinum.

Adolescent↗
PubMed1999

World Wide Web and Internet: applications for radiologists.

Global exchange of information is one of the major sources of scientific progress in medicine. For management of the rapidly growing body of medical information, computers and their applications have become an indispensable scientific tool. Approximately 36 million computer users are part of a worldwide network called the Internet or "information highway" and have created a new infrastructure to promote rapid and efficient access to medical, and thus also to radiological, information. With the establishment of the World Wide Web (WWW) by a consortium of computer users who used a standardized, nonproprietary syntax termed HyperText Markup Language (HTML) for composing documents, it has become possible to provide interactive multimedia presentations to a wide audience. The extensive use of images in radiology makes education, worldwide consultation (review) and scientific presentation via the Internet a major beneficiary of this technical development. This is possible, since both information (text) as well as medical images can be transported via the Internet. Presently, the Internet offers an extensive database for radiologists. Since many radiologists and physicians have to be considered "Internet novices" and, hence, cannot yet avail themselves of the broad spectrum of the Internet, the aim of this article is to present a general introduction to the WWW/Internet and its applications for radiologists. All Internet sites mentioned in this article can be found at the following Internet address: http://www.univie.ac. at/radio/radio.html (Department of Radiology, University of Vienna)

Humans↗
PubMed1999

Pseudoaneurysm of the internal carotid artery after shrapnel injury in World War II: demonstration by CT angiography with 3D MIP reconstruction.

A case of pseudoaneurysm of the left internal carotid artery (ICA) after shrapnel injury is demonstrated by intra-arterial digital subtraction angiography (DSA) and computed tomography angiography (CTA) with subtraction technique. Although the pseudoaneurysm was well demonstrated by intra-arterial DSA, CTA was the only modality to demonstrate the three-dimensional shape of the perfused part of pseudoaneurysm and the aneurysmal neck, which affected the therapeutic strategy. The CTA technique is useful in the assessment of large pseudoaneurysms and for therapeutic planning.

Aged↗
PubMed1999

Pulmonary magnetic resonance angiography.

In the past few years magnetic resonance angiography (MRA) of the pulmonary vasculature has advanced from a research tool to a clinically relevant imaging modality. Early 2D phase-contrast and time-of-flight (TOF) sequences without the use of contrast agents were time-consuming and limited by considerable imaging and motion artifacts. Since the introduction of MR scanners with stronger gradients (> 20 mT/m) and contrast-enhanced techniques, imaging of the pulmonary vasculature with adequate spatial resolution within a single breathhold is now possible. In the detection of pulmonary embolism in the lobar or segmental arteries, contrast-enhanced MRA is now on the verge of being considered an established modality, possibly competing with conventional pulmonary angiography and contrast-enhanced helical CT. In the future, utilization of phased-array torso coils, the application of navigator pulse sequences, and 3D time-resolved ultrafast MRA will overcome the final limitations of current techniques. Blood-pool MR contrast agents may provide a "one-stop-shopping" approach to the investigation of lower extremity veins and pulmonary arteries in venous thromboembolism.

Contrast Media↗
PubMed1999

Bronchobiliary fistula after hemihepatectomy: cholangiopancreaticography, computed tomography and magnetic resonance cholangiography findings.

A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihepatectomy, trauma, hydatid disease, choledocholithiasis and other causes of biliary obstruction. We report the case of a 56-year-old man with colon cancer, who developed a BBF 2 months after right hemihepatectomy for liver metastases. The findings at endoscopic retrograde cholangiopancreaticography (ERCP), computed tomography (CT) and magnetic resonance cholangiography (MRC) included a stricture of the common bile duct and biliary leakage from the liver resection plane with biliary infiltration of the right lower lobe of the lung. The patient was treated successfully by endoscopic insertion of a biliary plastic stent which bridged the stricture and lead to closure of the fistula.

Biliary Fistula↗
PubMed1999

Resection of a Langerhans cell histiocytosis granuloma of the hypothalamus: case report.

The natural course and optimal treatment for isolated hypothalamic Langerhans cell histiocytosis (LCH) are unknown. We describe an adult female in whom total resection of a hypothalamic LCH granuloma was performed 12 years after transphenoidal resection of a pituitary adenoma. A retrospective review of the histological specimen of the first operation revealed CD1a positive cells characteristic of LCH along with a plurihormonal adenoma 12 years earlier. No other manifestations of LCH were found and MRI of the brain at the last follow-up 4 years after surgery did not show any recurrent or additional lesion. The diagnosis of isolated hypothalamic LCH is only possible by biopsy and our case demonstrates the feasability of a gross total resection in certain cases.

Female↗
PubMed1999

[Idiopathic sclero-choroid calcification].

BACKGROUND: Idiopathic sclerochoroidal calcification (ISC) is an unusual, benign disorder occurring at the level of the posterior choroidea and sclera. Clinical differential diagnosis includes choroidal osteoma, choroidal metastasis, choroidal melanoma, choroidal amelanotic naevus and choroiditis. PATIENT: A 61-year old man was referred with the diagnosis of multifocal choroidal tumor in both eyes. Fundoscopy showed bilateral yellow lesions located near the superotemporal arcade. RESULTS: Fluorescein angiography shows the late staining of the choroidal lesions. Ultrasonographically highly reflective lesions (sclerochoroidal placoid lesions at the sclero-choroidal interface in the CT) confirms the clinical diagnosis. The serum calcium and phosphate metabolism is normal. CONCLUSION: The Idiopathic Sclerochoroidal Calcification (ISC) is a rare echographical differential diagnosis to the choroidal osteoma. ISC is a heterotopic calcification of the posterior pole in both eyes, usually located near the superotemporal arcade.

Calcinosis↗
PubMed1998

Globus sensation: pharyngoesophageal function, psychometric and psychiatric findings, and follow-up in 88 patients.

BACKGROUND: The globus sensation has been widely regarded as psychogenic, but organic disorders were found to be etiologically significant. OBJECTIVE: To investigate the structural, functional, psychological, and psychiatric factors possibly eliciting the globus sensation and influencing its course. METHODS: Eighty-eight patients, 67 women and 21 men (aged 22-71 years), referred to 2 tertiary care centers underwent history taking, otolaryngological examination, pharyngoesophageal videofluoroscopy and manometry, psychosocial evaluation, psychometric tests, psychiatric interview, and when indicated, esophagogastroduodenoscopy, esophageal bolus transport, gastroesophageal reflux, and gastric emptying studies. According to revealed disorders, therapy was initiated, and the outcome was studied. RESULTS: Only 15 patients had normal pharyngoesophageal function; of these 15, 6 had chronic tonsillitis or pharyngitis, 3 had thyroid adenomata, 4 had cervical spondylosis, and 1 each had dry oropharyngeal mucosa and chronic bronchitis. Of the other 73 patients, 2 had pharyngeal dysfunction, 24 had achalasia, 1 had diffuse esophageal spasms, 3 had "nutcracker esophagus," 30 had nonspecific esophageal motor disorders, and 13 had gastroesophageal reflux. Psychometry revealed no more anxiety and depression than in general medical outpatients. Of 58 patients interviewed, 37 met criteria for psychiatric disorders. Psychometric scores and psychiatric characteristics were unrelated to the sensation's course. Therapy was recommended, but only 26 patients were treated accordingly; 22 received nonspecific treatment. Follow-up 3 to 59 months later revealed that the sensation had vanished in 13 patients who had received specific treatment, 5 who had received nonspecific treatment, and 6 who had received no treatment; it was alleviated in 10 who had received specific treatment, 13 who had received nonspecific treatment, and 9 who had received no treatment; and it was unchanged in 3 who had received specific treatment, 5 who had received nonspecific treatment, and 23 patients who had received no treatment. CONCLUSIONS: Pharyngoesophageal disorders may be sensed only vaguely, inducing the globus sensation. Psychological and psychiatric characteristics could be relevant to the discomfort experienced but are unlikely to be etiologically significant.

Adult↗
PubMed1998

[Postoperative complications after larynx resection: assessment with video-cinematography].

In past decades, the surgical techniques for treating laryngeal carcinoma have been vastly improved. For circumscribed tumors, voice-conserving resections are possible and for extensive neoplasms, radical laryngectomy, sometimes combined with chemoradiation, has been developed. Postoperative complications regarding swallowing function are not uncommon. Radiologic examinations, especially pharyngography and videofluoroscopy, are most often used to evaluate patients with complications after laryngeal surgery. An optimized videofluoroscopic technique for evaluation of complications is described. The radiologic appearance of early and late complications, such as fistulas, hematomas, aspiration, strictures, dysfunction of the pharyngoesophageal sphincter, tumor recurrence, and metachronous tumors is demonstrated.

Deglutition Disorders↗
PubMed1998

Radiographic detection of achalasia: diagnostic accuracy of videofluoroscopy.

AIMS: To retrospectively evaluate the accuracy of videofluoroscopy in the diagnosis of achalasia. MATERIALS AND METHODS: Videofluoroscopic studies of the oesophagus of 53 patients (25 males, 28 females; mean age, 49 years) with manometrically revealed diagnosis of achalasia were retrospectively evaluated. The videofluoroscopic examinations had been carried out with one swallow of low-density barium suspension in the erect and up to three swallows in the prone oblique position. Videofluoroscopically, a diagnosis of achalasia was made in 31 of the patients (58%) with manometrically proven achalasia, of whom only nine had oesophageal dilatation. Non-specific oesophageal motor abnormalities were diagnosed radiographically in 18 patients (34%) and a normal motility in four patients (8%). CONCLUSION: Videofluoroscopy is a valuable and sensitive technique for the detection of disordered oesophageal motility in achalasia.

Barium Sulfate↗
PubMed1998

Considerations on stimulated anal neosphincter formation: an anatomic investigation in search of alternatives to the gracilis muscle.

Electrically stimulated anal neosphincter formation with transposed gracilis is performed clinically in an increasing number of patients. The use of a stimulated gluteus maximus in this application has been reported also. The question arises whether or not an optimal design for such a procedure has already been ascertained. An anatomic study was performed on 30 human cadavers to evaluate the semitendinosus muscle and its suitability for construction of a stimulated anal neosphincter. Semitendinosus fulfilled requirements for transposition around the anal canal in all cases. The muscle length was found adequate for transposition; nerve and vascular supply provided a suitable arc of rotation. The pattern of innervation might allow selective stimulation of that particular part of the muscle, which is intended to restore sphincter function. For clinical application, a vascular delay procedure is strongly recommended.

Anal Canal↗
PubMed1998

Visualization of intestinal splenosis by somatostatin receptor scintigraphy.

A case of intestinal splenosis in a splenectomized patient is presented. (111)In-DTPA-D-Phe-1-octreotide ((111)In-OCT) scintigraphy, computed tomography, as well as magnetic resonance imaging suggested a tumor in the small intestine. The histopathological finding after operation revealed an intestinal splenosis. This case illustrates that intestinal splenosis may mimic a tumor by (111)In-OCT scan. In a splenectomized patient, a splenosis should therefore be considered.

Adult↗
PubMed1998

Radio-opaque markers for stereotactic imaging of uveal melanoma.

In in vitro and in vivo studies, episclerally sutured radio-opaque markers were evaluated as localizers for better determination of the clinical tumour volume prior to stereotactic radio-therapy of uveal melanoma. Four different types of markers were studied in vitro: tantalum marker, 2.5 mm in diameter; ring-shaped markers custom-designed in polymethyl methacrylate (PMMA), 2.6 mm and 3.0 mm in diameter; and barium-impregnated silicone rubber spheres, 2 mm in diameter. In vivo PMMA markers 3.0 mm in diameter and barium-impregnated silicone rubber spheres 2 mm in diameter were used. The best results were obtained with the barium-impregnated silicone rubber spheres both in vitro and in vivo. For the CT-delineation of selected uveal melanomas with either a flat discoid shape or flat tumour extensions or when adjacent serous retinal detachment is present, small episclerally sutured barium-impregnated silicone rubber spheres are useful as localizers for determining the clinical tumour volume.

Humans↗