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W Wiesner

Publications and source records attributed to W Wiesner.

At least 37 records · Page 2Linked to original sources
PubMed2001

Three-dimensional dynamic MR hysterosalpingography: a preliminary report.

The aim of this study was to evaluate the feasibility of three-dimensional dynamic MR hysterosalpingography (3D MR HSG) for visualization of the cavum uteri and demonstration of bilateral fallopian tube patency as an alternative to conventional hysterosalpingography. Five infertile female patients underwent 3D dynamic MR HSG prior to conventional hysterosalpingography. The MR protocol consisted of axial T1-weighted spin-echo (SE), axial/coronal T2-weighted fast SE (FSE), and 3D MR angiography sequences before, during, and after injection of a diluted gadolinium solution into the cavum uteri via a balloon catheter. Positioning of the catheter was feasible in all patients. In one patient the catheter slipped out during MRI and in one patient the catheter was placed far in the cavum uteri. In three patients catheter position was optimal at the level of the cervical canal. Evaluation of pelvic anatomy, myometrium, and ovaries was possible in all patients on the basis of T1-weighted SE and T2-weighted FSE. Three-dimensional visualization of the dilated cavum uteri was possible in four patients. In these four patients 3D MR HSG also proved bilateral fallopian tube patency which was confirmed in each patient by conventional hysterosalpingography. Three-dimensional MR HSG is feasible and further research should be done to determine if this technique can evolve into an alternative technique to conventional hysterosalpingography with the advantages of no radiation and additional visualization of the uterus wall and ovaries.

Adult↗
PubMed2001

Nonocclusive ischemic colitis in a 12-year-old girl: value of unenhanced spiral computed tomography.

A 12-year-old girl was hit by a car and arrived in the emergency room in hemorrhagic shock. Contrast-enhanced computed tomography of the abdomen showed traumatic rupture of the liver and large amounts of intraperitoneal hemorrhage. Unenhanced computed tomography showed a hyperdense thickening of the wall of the descending colon. This finding was consistent with a nonocclusive ischemic colitis, which was confirmed some days later by endoscopy, at a time when the patient had already developed Gram-negative bacteremia. We discuss the pathogenesis of nonocclusive ischemic colitis, computed tomography findings, and the value of unenhanced computed tomography.

Anti-Bacterial Agents↗
PubMed2001

Hepatic imaging with multidetector CT.

Combining the advantages of a multirow detector array with a fast gantry rotation time, multidetector computed tomographic (CT) scanners can acquire sections at a faster rate than was previously possible. As a result, multidetector CT permits scanning during multiple specific phases of intravenous contrast enhancement and the acquisition of very thin sections over a large area, allowing the creation of multiplanar reconstructions with high z-axis resolution. The authors present an imaging strategy for the diagnosis and staging of hepatic pathologic conditions that emphasizes the role of multidetector CT. Users must master several scanning parameters to obtain the best image quality. For hepatic CT, it is practical to use relatively narrow collimation, increasing the pitch as needed to cover the entire liver. The choice of reconstruction interval is dependent on the problem for which the study is being performed. Water is recommended as an oral contrast agent for non-axial reconstructions, since high-attenuation oral contrast agents might degrade them. Appropriate scanning delays for hepatic CT are dependent on the contrast-agent injection strategy used. A triple-pass technique, highlighting the arterial, parenchymal, and portal venous phases of enhancement, is recommended.

Contrast Media↗
PubMed2001

Anterior versus posterior slippage: two different types of eccentric pouch dilatation in patients with adjustable laparoscopic gastric banding.

PURPOSE: To describe two different types of band dislocation that may occur in morbidly obese patients following adjustable laparoscopic gastric banding (ALGB) with the LAP-BAND. MATERIALS AND METHODS: 170 morbidly obese patients were treated with an LAP-BAND at our institution. In the first 20 patients the band was positioned transbursally, which means that the lesser sac is penetrated during laparoscopic band implantation. In the following 150 patients the operation technique was changed to suprabursal band positioning where the lesser sac is not penetrated. Plain radiographs and single contrast studies of all patients who developed band instability in the follow-up were analyzed retrospectively and compared to the clinical and intraoperative findings and to the operation technique used. RESULTS: Over a time period of 3.5 years 'posterior slippage' occurred in all 20 patients with transbursal band placement, but it never occurred after suprabursal band placement. Never- theless 4 patients with suprabursal band placement presented with an eccentric pouch dilatation, secondary to 'anterior slippage' after the seromuscular stitches had burst on the anterior and superior surface of the band. All these patients presented with food intolerance and all of them had to be reoperated. The radiographic findings were pathognomonic for each type of band dislocation. CONCLUSION: Band dislocation is a known major complication that may occur following ALGB and it may present in two different forms. While 'posterior slippage' can be avoided if the band is placed suprabursally, 'anterior slippage' may still occur. It is important to be familiar with both types of band dislocation since they require early detection and surgical band replacement or band refixation.

Body Mass Index↗
PubMed2001

Pseudotumor of the pancreatic head associated with idiopathic retroperitoneal fibrosis.

A 68-year-old male presented with abdominal pain and obstructive jaundice. CT revealed a large mass in the pancreatic head that was initially interpreted as pancreatic carcinoma. Needle biopsy revealed only fibrous tissue with signs of chronic inflammation. Together with typical findings of an idiopathic retroperitoneal fibrosis, the final diagnosis of multifocal idiopathic fibrosclerosis with focal pseudotumorous pancreatic head fibrosis could be made.

Aged↗
PubMed2001

Pseudo-achalasia following laparoscopically placed adjustable gastric banding.

BACKGROUND: The complication of pseudo-achalasia may occur after laparoscopic adjustable gastric banding (LAGB) in patients with normal band position and normal stomal width. We hypothesized that this complication occurs especially in patients with preexisting insufficiency of the lower esophageal sphincter (LES), who show poor compliance secondary to lacking the sensation of satiety and who therefore also have insufficient weight loss at follow-up. METHODS: Early and late postoperative barium meal studies of 120 LAGB patients were retrospectively analyzed to identify patients who developed esophageal widening and dysmotility despite normal band position and normal stomal width. Results were compared with preoperative endoscopies, clinical findings, each patient's compliance with dietary instructions and postoperative weight loss. RESULTS: 9/120 patients developed pouch dilatation, esophageal widening and esophageal dysmotility as a late complication, despite normal band position and normal stomal width. All these patients had shown preexisting insufficiency of their LES endoscopically. They all showed bad compliance with dietary instruction, and they all abused their distal esophagus as an additional pouch. 7 of these patients presented with insufficient weight loss at follow-up, whereas of 3 other patients with pre-existing LES insufficiency who had shown good compliance, only 1 showed insufficient weight loss. Insufficient weight loss after 1 year was significantly more common in patients with pre-existing LES insufficiency (8/12 patients, 67%) than in patients with a competent LES (26/108 patients, 24%). CONCLUSION: Patients with pre-existing LES insufficiency appear to be at risk for pouch dilatation and esophageal decompensation despite normal band position and normal stomal width. These patients are prone to show lack of satiety and poor compliance with dietary instruction, use of their lower esophagus as additional space for food, and tend to have insufficient weight loss. Preoperative manometry should be used to identify such patients, where the indication for gastric banding should be discussed very critically.

Adult↗
PubMed2001

Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome.

OBJECTIVE: The purpose of this study was to analyze the correlation between pneumatosis or portomesenteric venous gas, or both, the severity of mural involvement, and the clinical outcome in patients with small- or large-bowel ischemia. MATERIALS AND METHODS: CT scans of 23 consecutive patients presenting with pneumatosis or portomesenteric venous gas caused by bowel ischemia were reviewed. The presence and extent of both CT findings were compared with the clinical outcome in all patients and with the severity and extent of ischemic bowel wall damage as determined by surgery (15 patients), autopsy (three patients), or follow-up (five patients). RESULTS: Seven patients showed isolated pneumatosis, and 16 patients showed portomesenteric venous gas with or without pneumatosis (11 and five patients, respectively). Pneumatosis and portomesenteric venous gas were associated with transmural bowel infarction in 14 (78%) of 18 patients and 13 (81%) of 16 patients, respectively. Nine patients (56%) with portomesenteric venous gas died. Of seven patients with infarction limited to one bowel segment (jejunum, ileum, or colon), only one patient (14%) died, whereas of the 10 patients with infarction of two or three bowel segments, eight patients (80%) died. CONCLUSION: CT findings of pneumatosis intestinalis and portomesenteric venous gas due to bowel ischemia do not generally allow prediction of transmural bowel infarction, because they may be observed in patients with only partial ischemic bowel wall damage. The clinical outcome of patients with bowel ischemia with these CT findings seems to depend mainly on the severity and extent of their underlying disease.

Adult↗
PubMed2000

Spiral CT in an acute spontaneous aorto-caval fistula.

A patient with a known infrarenal atherosclerotic aneurysm measuring 8 cm presented with sudden dyspnoe, lower back pain and enormous venous congestion of the lower extremities. Spiral CT rendered precise diagnosis and localisation of a large and acute spontaneous aorto-caval fistula and made early surgical intervention possible. Abdominal aorto-caval fistulas are rare complications and can occur after surgery, trauma or spontaneously in an atherosclerotic or inflammatory aneurysm. Spiral CT enables a rapid and precise diagnosis facilitating the planning of the therapeutic approach to this complication.

Acute Disease↗
PubMed2000

Omental infarction associated with right-sided heart failure.

A 31-year-old man with a known congenital heart disease presented with cardial decompensation and an acute abdomen with tenderness in the right inferior abdominal quadrant. Because infectious parameters were slightly elevated, acute appendicitis was suspected. A CT scan showed an isolated focal infiltration of the omentum, superficial to the ascending colon, small amounts of ascites, and dilated hepatic and mesenteric veins. Laparoscopic resection and histopathologic examination confirmed hemorrhagic omental infarction due to thromboses of several small omental veins. This is a report on the pathogenesis, differential diagnoses, and CT findings of omental infarction.

Acute Disease↗
PubMed2000

Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience.

PURPOSE: To assess the performance of three-dimensional (3D) magnetic resonance (MR) venography of the pelvis and lower extremities in patients without acute deep venous thrombosis by using a lower extremity vascular coil and pedal injection of paramagnetic contrast material. MATERIALS AND METHODS: Conventional and MR venography were performed in 35 legs in 25 patients referred for evaluation of varicosities (n = 8) and postthrombotic changes (n = 7) and assessment of the great saphenous veins prior to bypass surgery (n = 10). Injection of 120 mL of diluted (1:15) gadopentetate dimeglumine into a pedal vein was performed manually at a rate of 1 mL/sec, and 3D gradient-recalled echo data sets of the upper and lower veins were collected. Conventional and MR venographic images were analyzed separately in a blinded fashion. RESULTS: MR image quality was comparable to that of conventional venograms. Varicose changes of the great and small saphenous veins (sensitivity, 94% [44 of 47]; specificity, 96% [89 of 93]) were assessed as reliably as their status before bypass surgery (sensitivity, 98% [53 of 54]; specificity, 92% [47 of 51]). Postthrombotic changes were diagnosed with a sensitivity of 100% [13 of 13] and a specificity of 98% [88 of 90]. CONCLUSION: Direct 3D MR venography comprehensively displays the lower extremity venous system and permits assessment of postthrombotic and varicose changes and the bypass suitability of the saphenous vein.

Adult↗
PubMed2000

Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications.

PURPOSE: To determine the role of radiographic assessment in patients who underwent an adjustable laparoscopic gastric banding (ALGB) for the treatment of morbid obesity, and to evaluate the frequency and type of postoperative complications. MATERIALS AND METHODS: From September 1995 to March 1998, 98 consecutive patients (18 men, 80 women; mean age, 39 years; age range, 22-62 years) with morbid obesity (mean body weight, 132 kg; mean body mass index, 47.1 kg/m(2)) underwent ALGB. In all patients, fluoroscopy was performed postoperatively to confirm band position and to exclude perforation and at 6-8 weeks later to measure and adjust the stoma between the pouch and stomach for optimal weight loss. All patients underwent another examination 12 months postoperatively, whereas patients with unsatisfactory weight loss or patients suspected of having complications were examined earlier and on several occasions. RESULTS: Port puncture was feasible in all cases, and stomal adjustments could easily be repeated. Absolute (ie, total) weight loss after 1 year ranged from 8.8% to 39.2% (mean, 18.3%). Twenty patients showed unsatisfactory weight loss. No early complications occurred. Late complications occurred in 34 patients and included pouch dilatation (concentric or eccentric with posterior slippage), eccentric band herniation, band penetration, disconnection, axial pouch herniation, and port-site infection. CONCLUSION: ALGB is an effective method in the treatment of morbid obesity. Radiographic assessments are crucial in the management of weight loss and detection of postoperative complications.

Adult↗