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W Schima

Publications and source records attributed to W Schima.

At least 73 records · Page 4Linked to original sources
PubMed1998

Pancreatic enhancement and pulse sequence analysis using low-dose mangafodipir trisodium.

OBJECTIVE: The purpose of this study was to evaluate pancreatic enhancement with low-dose mangafodipir trisodium (5 mumol/kg) using three different T1-weighted pulse sequences. SUBJECTS AND METHODS: Fifteen patients, six of whom had proven focal pancreatic tumors, underwent T1-weighted gradient-recalled echo imaging, spin-echo imaging, and fat-suppressed spin-echo imaging before and 30 min after injection of 5 mumol/kg of mangafodipir trisodium. Region-of-interest measurements were obtained in the pancreas before and after contrast enhancement. Signal-to-noise ratios were calculated in all 15 patients. Contrast-to-noise ratios were calculated in the six patients with pancreatic tumors. RESULTS: The signal-to-noise ratios of the pancreas increased after injection of mangafodipir trisodium on all three T1-weighted pulse sequences (p < .001). Enhanced fat-suppressed sequences (29 +/- 7.7) and gradient-recalled echo sequences (29 +/- 9.6) had the highest signal-to-noise ratios. Contrast-to-noise ratios between normal pancreatic tissue and pancreatic tumor also increased after contrast administration (p < .05) and were highest on the fat-suppressed (-9.6 +/- 4.0) pulse sequence. CONCLUSION: Mangafodipir trisodium produced marked pancreatic enhancement at a dose of 5 mumol/kg for all three T1-weighted pulse sequences. The enhanced T1-weighted spin-echo fat-suppressed sequence showed the highest signal-to-noise and contrast-to-noise ratios.

Adult↗
PubMed1998

Indium-111-DTPA-D-Phe-1-octreotide and technetium-99m-(V)-dimercaptosuccinic acid scanning in the preoperative staging of medullary thyroid carcinoma.

UNLABELLED: The early detection of all tumor sites in patients with medullary thyroid carcinoma (MTC) before primary surgery is important, because MTC tends to metastasize to regional lymph nodes of the neck and mediastinum early during the course of the disease. METHODS: In an approach to localize the primary tumor sites and to detect additional tumor involvement, we have performed in 22 patients with MTC either 99mTc(V)-dimercaptosuccinic acid (DMSA) and/or 111In-diethylenetriamine pentaacetic acid-D-Phe-1-octreotide scintigraphy. RESULTS: Indium-111-octreotide (150-200 MBq) identified the primary tumor in 10 of 14 patients (71%), whereas the primary tumor was visualized by 99mTc-DMSA (300-370 MBq) in 10 of 17 patients (58%). In 8 of 22 patients (36%), lymph node metastases were present at the time of diagnosis, as confirmed by histopathology and histochemistry after surgery (all <2 mm). Preoperatively, neither scan was able to detect lymph node involvement in these patients (0/8). CONCLUSION: Both 99mTc-DMSA and 111In-octreotide studies have similar sensitivity to localize primary MTC; however, these scans are not able to detect small lymph node involvement (micrometastases) before initial surgery. Unfortunately, both scans have no clinical implication for preoperative staging in patients with MTC.

Carcinoma, Medullary↗
PubMed1997

[Spontaneous remission of an amiodarone-induced pulmonary lesion].

Amiodarone is an effective class-III antiarrhythmic agent. However, during long term therapy 1-10% of patients develop severe adverse pulmonary reactions, which are potentially life threatening. We report the case of a patient who developed dyspnoea and extensive pulmonary infiltrates compatible with amiodarone-associated interstitial lung disease following 6 months of treatment with amdiodarone (300 mg daily) for atrial flutter. On discontinuation of amiodarone treatment the infiltrates impressively resolved almost completely within 8 weeks, without administration of corticosteroids.

Amiodarone↗
PubMed1997

[Diagnostic imaging after liver transplantation].

INTRODUCTION: Orthotopic liver transplantation (OLT) has become an accepted treatment for end-stage liver disease. However, postoperative complications result in significant patient morbidity and mortality. Early detection and treatment of these complications is therefore of utmost importance. MATERIALS AND METHODS: We retrospectively reviewed the postoperative complications of the patients who underwent OLT at our institution. Duplex Doppler sonography and cholangiography were the primary imaging modalities in postoperative evaluation of the transplanted liver. Other important techniques were CT, MRI and angiography, which may contribute to a reliable diagnosis of vascular or biliary complications. RESULTS: Second to primary organ dysfunction, vascular complications are the most frequent cause of graft loss. Thrombosis of the hepatic artery is the most common and most serious vascular complication, with a reported incidence from 4 to 42%. Bile duct sludge, leaks and strictures are frequent complications after liver transplantation, which can contribute to graft dysfunction. Biliary tract complications usually occur within the first 3 months and require interventional radiological or surgical therapy. Since liver transplant recipients undergo immunosuppressive therapy, they are at increased risk of developing late post-transplant malignancies, which are best depicted by US, CT or MRI. However, radiological diagnosis of lympho-proliferative disorder has to be confirmed by liver biopsy. CONCLUSION: Cholangiography and Duplex sonography are routinely used in the postoperative evaluation of patients with OLT. CT, MRI, and angiography are problem-solving tools in equivocal cases.

Diagnostic Imaging↗
PubMed1997

Biliary Wallstent endoprosthesis in malignant hilar obstruction: long-term results with regard to the type of obstruction.

AIM: To evaluate the clinical efficacy of percutaneously placed biliary Wallstents in the management of malignant hilar obstruction with regard to the obstruction type. PATIENTS AND METHODS: Sixty-six Wallstents were inserted in 41 patients with inoperable hilar obstruction: 13 patients had a type I obstruction according to Bismuth-classification, 18 a type II, eight a type III, and two a type IV obstruction, respectively. Clinical follow-up data were obtained from all the patients and the referring physicians. RESULTS: Stent placement was technically successfully in all patients. The procedure-related death rate was 2% (one patient), but the overall 30-day mortality rate was 39%, mostly due to advanced malignant disease, cardiac failure or pneumonia. Stent occlusion was found in 11 patients (27%) after 87 days (mean; range, 8-190 days). After stent placement, the mean stent patency was 96 days and the mean survival was 131 days with no significant difference between patients with obstruction type I, II and III. Multivariate analysis revealed that patients with obstruction due to gallbladder carcinoma had a significantly shorter survival than patients with cholangio-carcinoma or hilar obstruction due to metastases. CONCLUSION: Overall, the insertion of Wallstent endoprostheses offers moderate results for palliation of hilar biliary obstruction regardless of the type of obstruction. In patients with cholangiocarcinoma, long-term results are good even for complicated strictures (type III). In patients with hilar obstruction due to gallbladder carcinoma the outcome is generally poor, regardless of the type of obstruction.

Adult↗
PubMed1997

Association of midoesophageal diverticula with oesophageal motor disorders. Videofluoroscopy and manometry.

PURPOSE: To evaluate the prevalence and clinical significance of associated oesophageal motor disorders in patients with midoesophageal diverticula. MATERIAL AND METHODS: We retrospectively reviewed videofluoroscopic and, if available, manometric studies of 30 patients with midoesophageal diverticula. The type of diverticulum and the presence and nature of oesophageal motor disorders were assessed. RESULTS: Videofluoroscopy showed that 24 patients had 26 pulsion-type diverticula and 6 patients had 7 traction-type diverticula. Oesophageal motor disorders were demonstrated in 21 of the 24 patients with pulsion-type diverticula and in 3 of the 6 with traction-type diverticula. Nineteen patients had nonspecific motor disorders, 5 had achalasia, and 5 had gastrooesophageal reflux or oesophagitis. CONCLUSION: Midoesophageal diverticula are most often of the pulsion-type and tend to be associated with an oesophageal motor disorder. Motor disorders are predominantly nonspecific, but achalasia may be encountered as well.

Adult↗
PubMed1997

Focal liver lesions: characterization with conventional spin-echo versus fast spin-echo T2-weighted MR imaging.

PURPOSE: To compare prospectively the diagnostic accuracy of T2-weighted conventional spin-echo (SE) and fast SE magnetic resonance (MR) imaging for differentiation of benign (hemangiomas or cysts) from malignant (metastases or hepatocellular carcinoma) liver lesions. MATERIALS AND METHODS: Fifty-three patients with 55 confirmed liver lesions (20 hemangiomas, eight cysts, 22 metastases, four hepatocellular carcinomas, one malignant fibrous histiocytoma) underwent T2-weighted conventional SE (repetition time msec/echo time [TE] msec = 3,100/ 80,160) and fast SE (5,000-5,000/99-104 [effective TE]) MR imaging at 1.5 T. The images were evaluated quantitatively (lesion-liver signal intensity ratio and lesion T2 index [SIlesion TE80/SIlesion TE160, where SI = signal intensity] and qualitatively (blinded reading) by using receiver operating characteristic analysis. RESULTS: Quantitatively, the T2 index (Az = .988) was more accurate than the signal intensity ratio at conventional SE (Az = .920) and fast SE (Az = .910) imaging (P < .05). Qualitatively, there was no statistically significant difference between the blinded reading of conventional SE (Az = .988) and fast SE (Az = .986) images in lesion characterization (benign vs malignant). There was a trend, however, toward superiority of conventional SE imaging for evaluation of "hypervascular" metastases (n = 9). CONCLUSION: With the specific parameters used, conventional SE and fast SE images provide equal accuracy for characterization of focal liver lesions. In patients with hypervascular metastases, double-echo conventional SE images may be preferable.

Adult↗
PubMed1997

Differentiation of liver hemangiomas from metastases and hepatocellular carcinoma at MR imaging enhanced with blood-pool contrast agent Code-7227.

PURPOSE: To evaluate differentiation of liver lesions at magnetic resonance (MR) imaging enhanced with Code-7227. MATERIALS AND METHODS: Thirty-five patients with 38 proved liver lesions (15 hemangiomas, 17 metastases, six hepatocellular carcinomas [HCCs]) underwent T1-weighted gradient-echo and T2-weighted fast-spin-echo MR imaging at 1.5 T before and after intravenous administration of Code-7227 (1.1 mg iron per kilogram of body weight). RESULTS: In hemangiomas, the mean contrast-to-noise ratio on precontrast and postcontrast images, respectively, increased from -4.51 +/- 4.7 (standard deviation) to 5.19 +/- 6.3 on T1-weighted images and decreased from 14.73 +/- 7.4 to 0.64 +/- 5.1 on T2-weighted images. In comparison, metastases remained hypointense to liver on T1-weighted images (from -5.77 +/- 5.9 to -7.8 +/- 6.8) and hyperintense on T2-weighted images (from 8.73 +/- 5.4 to 12.61 +/- 6.1). Although HCC enhanced more than metastases, they also remained hypointense to liver on T1-weighted images (from -4.87 +/- 6.1 to -1.79 +/- 5.7) and hyperintense on T2-weighted images (from 10.12 +/- 7.9 to 8.7 +/- 6.4). The degree of enhancement on T1-weighted images and of signal intensity drop on T2-weighted images were significantly lower in malignant liver masses than in hemangiomas (P < .001). CONCLUSION: Distinctly different enhancement patterns with Code-7227 helped accurate differentiation of liver lesions.

Adult↗
PubMed1997

Prognostic factors for swallowing rehabilitation following head and neck cancer surgery.

Thirty-two head and neck surgical patients with prolonged moderate to severe aspiration were assessed with videoendoscopic and videofluoroscopic swallowing studies to reveal all components of dysphagia and aspiration. All patients received functional swallowing therapy, and 75% of the patients regained full oral intake diet. The duration of non-oral feeding varied widely. The outcome of swallowing rehabilitation (success or failure, duration of non-oral feeding) was statistically correlated with preoperative tumour stage, patients' age, therapy onset, severity of aspiration and the results of the videofluoroscopic measurements of oral and pharyngeal transit time, pharyngeal delay time, duration of laryngeal closure and cricopharyngeal opening, hyoid and laryngeal elevation, presence or absence of a stenosis at the pharyngoesophageal segment. The following factors proved to be statistically significant for the prognostic estimate of swallowing rehabilitation: preoperative tumour stage, therapy onset, and severity of aspiration. For postoperative swallow recovery, an early therapy onset after thorough diagnostics with videoendoscopic and videofluoroscopic swallowing studies is recommended. Videofluoroscopic measurements will yield some prognostic estimate of oropharyngeal dysphagia and aspiration. Videoendoscopy, by it's availability and immediacy, proved to be useful for monitoring the course of rehabilitation.

Adult↗
PubMed1996

Globus sensation: value of static radiography combined with videofluoroscopy of the pharynx and oesophagus.

Pharyngo-oesophageal abnormalities are found in a high proportion of patients with globus sensation. This study compares the diagnostic value of static single- and double-contrast radiography of the pharynx and oesophagus with videofluoroscopy and with videofluoroscopy combined with static radiography in these patients. Pharyngeal and oesophageal morphology and motor function were studied in 130 consecutive patients with globus sensation (46 males, 84 females; mean age, 47 years) by means of static single and double-contrast radiography and by videofluoroscopy. Videofluoroscopy revealed significantly more functional and structural abnormalities compared to static radiography. Pharyngeal and/or oesophageal disorders were found in 89 vs. 47 patients (chi2 [1] = 19.82, P = 0.0001), pharyngeal abnormalities in 54 vs. 27 patients (chi2 [1] = 13.5, P < 0.0002), and oesophageal abnormalities in 72 vs. 27 patients (chi2 [1] = 28.13, P < 0.0001). Videofluoroscopy combined with static radiography revealed significantly more abnormalities than videofluoroscopy alone (chi2 [1] = 4.23, P < 0.05), and assessed mucosal details more reliably than videofluoroscopy alone. The most frequent abnormalities found were nonspecific oesophageal motor disorders, pharyngo-oesophageal sphincter dysfunction, pharyngeal stasis, achalasia, and laryngeal penetration or aspiration of barium. In most patients with globus sensation, pharyngeal and/or oesophageal abnormalities can be detected radiographically. Videofluoroscopy revealed significantly more functional but not morphological abnormalities than did static radiography. Videofluoroscopic studies combined with static radiography had a higher diagnostic value than videofluoroscopic studies alone.

Adolescent↗
PubMed1995

[Globus sensation].

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Conversion Disorder↗
PubMed1995

[The civil law liability in radiology. An analysis of the administration of justice].

This study comprises 76 published judgments by German and Austrian civil courts between 1966 and 1993 concerning liability in the field of radiology. There has been a marked increase in the number of legal proceedings in the 1980's and even more so in the second half of this decade. This is due to an increased tendency to sue doctors without any legal cause in the hope of possible compensation. In 40.8% of the cases the doctor was held liable and required to compensate the patient for personal injury and suffering pain. Most of the cases were related to complications during the examination procedure. The reason most frequently cited by the courts for sentencing doctors was the fact that they did not previously inform the patient adequately about the examination and its possible consequences.

Austria↗
PubMed1995

[Functional disorders of the esophagus. Radiologic diagnosis].

Radiological evaluation of esophageal motility and the lower esophageal sphincter has gained increased attention in recent years. Videofluoroscopic investigation of esophageal motor function is superior to static film radiography, as repeated analysis of the videotaped recordings is possible. With emphasis on radiological techniques, normal esophageal physiology and motility and a variety of esophageal motor disorders are discussed in this review paper. Radiological evaluation of gastroesophageal reflux and reflux esophagitis is described. Clinical and radiological findings in esophageal motility disorders and gastroesophageal reflux disease and the radiological efficacy compared to that of manometry and pH-metry are discussed.

Barium Sulfate↗