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PubMed1979

[Lumbar phelbography without catheterization. Technic, indications and results in the diagnosis of intervertebral disk herniation].

The authors present a new method of lumbar phlebology without catheterism by direct venous puncture of the femoral veins. An analysis of 300 contrast tests maked it possible to identify different types of pathological images characterized by disappearance and displacement of epidural veins corresponding as a rule to discal hernia when the uncharacteristic shadowy images do not allow one to make a precise conclusion or to determine whether an operation is needed. With equal reliability (96 percent), lumbar phlebography without catheterism is, by its simplicity and harmlessness and the absence of minor and major venous complications, preferable to phlebography by catheterism. Carried out in all subjects, whatever their age, without special precautions, it seems to us to now be the most desirable test to be used in the radiological investigation of lumbar discal hernias.

Epidural Space↗
PubMed1984

[Pitfalls in scrotal echotomography].

We reviewed 500 scrotal sonograms with a gray-scale equipment using a 7 Mega Hertz transducer. 7 cases are presented in which there are the two principal traps which must be avoided in the practice of scrotal ultrasound: To find as pathological, some scrotal or parascrotal structures which are anatomical. To confuse pathological images. These diagnostic problems are almost resolved by three conditions: A perfect knowledge of normal ultrasound anatomy, a good experience of the operator in this scope and a strict management of the ultrasonic investigation. There, the scrotal sonogram is highly reliable.

Adult↗
PubMed1980

[Significance of kidney and urinary tract abnormalities detected during bone scintiscans (author's transl)].

The kidneys and the bladder are regularly visible when bone scintiscans are performed during 99mTc-labelled phosphorus compounds, and abnormalities in the distribution of local activities within these organs are not uncommonly detected. The authors were able to compare such abnormalities with clinical, laboratory and X-ray data in 139 out of 1980 cases of bone scintiscan. In 84% of the cases the pathological image was associated with an established renal or urinary disease and was indeed often responsible for its unexpected discovery. Urinary tract abnormalities detected on bone scintigrams therefore deserve to be taken into consideration and should be confirmed by appropriate investigations.

Bone and Bones↗
PubMed1995

[Evaluation of the teaching of echo-endoscopy. Application to the assessment of invasiveness of cancer of the esophagus and the cardia].

OBJECTIVES: Learning endosonography (EES) is known to be difficult, and the theory must be understood before performing EES routinely. The aim of the study was to evaluate the diagnostic indexes of EES in the staging of cardio-oesophageal cancer after a period of theoretical apprenticeship of EES and a learning period in a centre experienced in EES since 1989. METHODS: Five observers, having never used EES, followed to EES examinations for a 3-6 month period. They then reviewed the standardized records of 29 patients with cardio-oesophageal cancer. They had to evaluate the degree of tumour infiltration within oesophageal wall and the site of metastatic lymph nodes. Results were compared with the diagnosis of 5 experienced senior endoscopists. Interobserver agreement was estimated with kappa statistics and considered excellent for k > or = 0.75, good to moderate if 0.75 > k > or = 0.40, and poor if k < 0.40. RESULTS: Inter-observer agreement was poor for the topographic diagnosis of lymph nodes (kappa index from -0.09 to 0.33), lower to that of the 5 senior observers (0.33 to 0.77). It was satisfactory for degree of tumour infiltration (T1: k = 0.66; T2: k = 0.58; T3: k = 0.56; T4: k = 0.46). The individual sensitivities were weak according to lymph nodes site, but good for presence of lymph nodes (86 to 100%), with a specificity of 40 to 73%. CONCLUSIONS: After theoretical training of EES, agreement and diagnostic performances are good enough to diagnose pathological images (except for T4 tumors), and poor for localizing images in the mediastinum. This emphasizes the difficulties in learning echo-anatomy and gives useful guidelines for training programs in EES.

Cardia↗
PubMed1993

[Acute pancreatitis in newly diagnosed type I diabetes mellitus with diabetic ketoacidosis and hypertriglyceridemia].

A 19 years old patient who presented grade D acute pancreatitis by abdominal CT with marked hypertriglyceridemia during a diabetic ketoacidosis (DKA) in the onset of a type I diabetes mellitus is described. The pancreatitis and DKA were resolved with the usual treatment, and the levels of triglycerides became normal within one week. Hyperamylasemia is frequent in DKA although of uncertain significance. Acute pancreatitis coinciding with DKA has been described, in this case radiologic findings demonstrated the diagnosis. No other bibliographic references have been found in which pathologic imaging in abdominal CT are described in a situation of DKA with hyperamylasemia. Moderate hypertriglyceridemia is common upon initiation of diabetes mellitus and likewise it usually presents during the course of acute pancreatitis. Pancreatitis could be secondary to hypertriglyceridemia and the latter to the insulin deficiency.

Acute Disease↗
PubMed1996

[Traveling on the data highway--online information for urologists].

Global exchange of information is one of the major sources of scientific progress in medicine. Electronic media have recently supplemented the standard methods of scientific communication such as congresses, books and journals. Currently, 30 million computers are part of the world-wide, exponentially growing network, the ""information superhighway''. Numerous resources offered by the network are becoming increasingly useful in clinical medicine. In Germany, three major networks are currently available: T-Online/Datex-J, Compuserve and Internet. The majority of information relevant to urologists can be found in the Internet. This information includes medical journals that can either partly or completely be read online, online library catalogs, scientific images (pathology and radiology), and databases on urologic oncology and basic research in urology. Even outside academic institutions access to the "information superhighway" is easily available. Currently, the "information superhighway" constitutes a new source of database-type information; in the near future, medical education, clinical consultation and worldwide cooperation in clinical studies will be new fields of scientific communication employing worldwide computer networks.

Forecasting↗
PubMed1998

Amiodarone induced epididymitis in children.

PURPOSE: Amiodarone is an antiarrythmic agent, which is often successfully used when all other antiarrythmics have failed. Sterile epididymitis is a recognized complication of treatment in adults, occurring in up to 11% of patients. To date there have been no reported cases of amiodarone induced epididymitis in children. We present a previously unrecognized cause of epididymitis in boys. MATERIALS AND METHODS: The medical records, including radiographic imaging, pathology and operative reports, of 2 postpubertal boys who had sterile epididymitis after prolonged therapy with amiodarone were reviewed. RESULTS: In both cases the onset of scrotal pain and subsequent evaluation led to diagnosis of epidydimitis. Amiodarone was determined to be the cause, and cessation of the drug resulted in symptom resolution in 1 case. CONCLUSIONS: While it remains uncertain, the pathophysiology of amiodarone induced epididymitis is likely related to its high concentration in testicular tissue. Recognition that amiodarone is a rare but significant cause of epididymitis in children is important to prevent unnecessary surgery in high risk patients. Amiodarone induced epididymitis in children tends to be a self-limited process and of secondary importance to the serious cardiac disease. Whereas discontinuing amiodarone risks sudden cardiac death, a reduction in dosage or temporary cessation of the drug may result in rapid resolution of the epididymitis.

Adolescent↗
PubMedDate not supplied

The way forward in asthma: integrative physiology.

In the process of searching for the pathogenesis and effective treatment of asthma, it has increasingly been realized that the key processes occur at the cellular and molecular levels. Recognition of this principle and the appropriate tools have led to explosive developments in the description of the fundamental abnormalities in the disease and discovery of potential targets for therapeutic intervention. However, remarkably, the link between these cellular processes and the phenotypic expression of asthma has been more difficult to understand. How does inflammation cause variable airways obstruction and the perceived dyspnea? Very recent research, including the combined use of pathology, imaging techniques, and in vivo and in vitro physiological experiments, has renewed interest in the integrative airway pathophysiology in asthma. This research has provided new knowledge on the mechanisms determining the essential abnormalities in the patients with this disease, namely excessive airway narrowing and impaired bronchodilation following a deep breath. It is postulated that inclusion of such physiological abnormalities in new and long term therapeutic strategies will lead to a better clinical as well as histological outcome of asthma.

Airway Obstruction↗
PubMed1998

[Aspects of evolving urogenital tuberculosis. 60 cases].

Based on the results of a retrospective study of 60 patients treated between January 1984 and December 1994, the authors review the current clinical features of urogenital tuberculosis. The sex-ratio shows a male predominance of 65%. The mean age is 48 years. Cystitis and low back pain are the main symptoms of the disease. IVU, performed in all patients, showed pathological images in 98.3% of cases. Urine culture was positive in 23 out of the 50 cases in which it was performed. Serious forms were relatively frequent, with bilateral lesions in 12 cases, associated with renal failure in 4 of them, or unilateral renal destruction in 43 cases. All patients were treated with triple- or quadruple-agent tuberculostatic therapy. 54 patients required one or several surgical procedures: 43 nephrectomies, 7 ureterovesical reimplantations, 11 augmentation enterocystoplasties, 1 Bricker ureteroileostomy, 3 ureterostomies, 1 ureteric resection and 4 epididymectomies. Two patients admitted in a context of deterioration of the general state died during the days following admission. 56 patients were reviewed with a minimum follow-up of 6 months. Two were cured by medical treatment alone. Among the 54 operated patients, clinical improvement was obtained in 43 patients (91%) and radiological improvement was obtained in 33 of the 36 cases in which IVU was performed (91%). In conclusion, despite the various anti-tuberculosis campaigns, urogenital tuberculosis remains a serious disease, essentially because of the delayed diagnosis.

Adolescent↗
PubMed1995

Biomedical image processing in pathology: a review.

Pathologists make a diagnostic decision by viewing a specimen and measuring various diagnostically important attributes of an isolated object such as size, shape, darkness, colour and texture. This is a complex process. In recent years, computer-aided image processing and analysis systems have played a significant role in quantitative pathology. This paper summarises basic image processing and analysis techniques and reviews related work in pathology and cytology based on computational image processing since 1987. Firstly, we present a general introduction to image enhancement, segmentation, morphometry and visualisation for those medical colleagues who may not have the necessary background in this area. (The mathematical treatment is kept to minimum and appropriate references are cited to satisfy the more mathematically oriented readers. Selected examples are provided to demonstrate the effects of various basic image processing algorithms on a MRI scan. It should be emphasised that the reviewed techniques are generally used as preprocessing steps in analysing microscopic images and powerful algorithms are more sophisticated and problem-specific.) Secondly, we review image cytometric and histometric methods, standards, calibration and applications. Finally, we touch upon three dimensional confocal image processing and analysis, applications of artificial neural networks, and optical disk database management for recording and retrieving a large number of digitised high resolution images. The development of integrated optical microscope and computer, systems is also briefly described.

Artificial Intelligence↗
PubMed2004

Comparison of ultrahigh- and standard-resolution optical coherence tomography for imaging macular hole pathology and repair.

PURPOSE: To compare ultrahigh-resolution optical coherence tomography (UHR-OCT) technology to a standard-resolution OCT instrument for the imaging of macular hole pathology and repair; to identify situations where UHR-OCT provides additional information on disease morphology, pathogenesis, and management; and to use UHR-OCT as a baseline for improving the interpretation of the standard-resolution images. DESIGN: Observational and interventional case series. PARTICIPANTS: Twenty-nine eyes of 24 patients clinically diagnosed with macular hole in at least one eye. METHODS: A UHR-OCT system has been developed and employed in a tertiary-care ophthalmology clinic. Using a femtosecond laser as the low-coherence light source, this new UHR-OCT system can achieve an unprecedented 3-mum axial resolution for retinal OCT imaging. Comparative imaging was performed with UHR-OCT and standard 10-mum resolution OCT in 29 eyes of 24 patients with various stages of macular holes. Imaging was also performed on a subset of the population before and after macular hole surgery. MAIN OUTCOME MEASURES: Ultrahigh- and standard-resolution cross-sectional OCT images of macular hole pathologies. RESULTS: Both UHR-OCT and standard-resolution OCT exhibited comparable performance in differentiating various stages of macular holes. The UHR-OCT provided improved imaging of finer intraretinal structures, such as the external limiting membrane and photoreceptor inner segment (IS) and outer segment (OS), and identification of the anatomy of successful surgical repair. The improved resolution of UHR-OCT enabled imaging of previously unidentified changes in photoreceptor morphology associated with macular hole pathology and postoperative repair. Visualization of the junction between the photoreceptor IS and OS was found to be an important indicator of photoreceptor integrity for both standard-resolution and UHR-OCT images. CONCLUSIONS: Ultrahigh-resolution optical coherence tomography improves the visualization of the macular hole architectural morphology. The increased resolution of UHR-OCT enables the visualization of photoreceptor morphology associated with macular holes. This promises to lead to a better understanding of the pathogenesis of macular holes, the causes of visual loss secondary to macular holes, the timing of surgical repair, and the evaluation of postsurgical outcome. Ultrahigh-resolution optical coherence tomography imaging of macular holes that correspond to known alterations in retinal morphology can be used to interpret retinal morphology in UHR-OCT images. Comparisons of UHR-OCT images with standard-resolution OCT images can establish a baseline for the better interpretation of clinical standard-resolution OCT images. The ability to visualize photoreceptors and their integrity or impairment is an indicator of macular hole progression and surgical outcome.

Aged↗
PubMed2005

MR imaging of the finger tendons: normal anatomy and commonly encountered pathology.

MR imaging has emerged as a powerful tool in the evaluation of soft tissue structures such as the tendons of the hand and finger due to its excellent soft tissue contrast and multiplanar imaging capabilities. In the finger and hand, perhaps more than in any other location in the body, a detailed and intimate understanding of anatomy is crucial for lesion localization, directing clinical management and predicting long-term prognosis. These issues are of paramount importance to both the clinician and imager, both faced with the challenge of the complex anatomy and pathology associated with these delicate structures. The anatomy of the finger including intrinsic and extrinsic muscles, retinacular structures, and tendons will be discussed. The MR imaging features of common lesions of the tendons of the hand and finger will be reviewed.

Diagnosis, Differential↗
PubMed2003

Obturator externus bursa: anatomic origin and MR imaging features of pathologic involvement.

PURPOSE: To investigate the anatomy of the obturator externus bursa of the hip and describe the magnetic resonance (MR) imaging features of pathologic involvement. MATERIALS AND METHODS: The authors dissected eight cadaver hemipelvises to assess for the presence of periarticular bursae of the hip and bursal communication with the fascial plane of the obturator externus muscle. In addition, 10 consecutive patients with obturator externus bursa enlargement were prospectively identified with MR imaging. A bursa was considered present when a fluid collection was seen extending along the obturator externus muscle, continuous with the posterior inferior hip joint. The direction, extent, contour, and thickness of the bursa and hip capsule were recorded. Surgical findings were available for eight of the 10 patients, with histopathologic correlation between the bursal lining and hip capsule. RESULTS: At cadaveric dissection, one specimen showed a bursa communicating with and extending from the posteroinferior aspect of the hip joint deep to the obturator externus tendon. In all 10 patients, MR images showed a hip joint effusion with a continuous bursa extending medially and displacing the obturator externus inferiorly. At surgery, a bursa was seen displacing the obturator externus muscle inferiorly and originating from the posteroinferior aspect of the hip joint in all eight patients. Results of pathologic analysis confirmed disease identical to the primary hip abnormality in all eight patients. CONCLUSION: The obturator externus bursa is a potential posteroinferior communication of the hip joint capsule, can be a site of disease spread from the hip joint, and can be accurately identified with MR imaging.

Adult↗
PubMed1995

Operative confirmation of three-dimensional computed tomographic and magnetic resonance imaging of cerebrovascular pathology.

The conventional neuroradiological evaluation of aneurysms and arteriovenous malformations employs computed tomography (CT), magnetic resonance imaging (MRI), and detailed cerebral angiography. These techniques may be inadequate to define fully the cerebrovascular anatomy in patients with giant aneurysms or with arteriovenous malformations (AVMs) located near so-called eloquent brain structures. Therefore, we examined the usefulness of three-dimensional (3-D) MRI and CT images of the brain and cerebral vessels for predicting operative anatomical findings in selected cases of complex cerebrovascular pathology. In six of nine (67%) patients with giant aneurysms undergoing direct surgical treatment, the 3-D images were confirmed to be accurate, and they furnished information that is not available by conventional imaging. In three of these nine (33%) patients, failure of the 3-D images to predict operative findings accurately could be directly related to inappropriate imaging technique or to anatomical findings below the limit of resolution for CT or MRI. In 13 of 19 (68%) patients with an AVM, the 3-D images were considered helpful for treatment selection or planning, primarily because they enhanced the understanding of the relationship of the AVM nidus to brain structures of known functional significance. The results of our initial experience with 3-D imaging of cerebrovascular pathology are described in this report.

Adolescent↗
PubMed2001

Cervical spine: postmortem assessment of accident injuries--comparison of radiographic, MR imaging, anatomic, and pathologic findings.

PURPOSE: To assess the ability of postmortem radiography and magnetic resonance (MR) imaging to depict occult cervical spine injuries as compared with anatomic and pathologic findings. MATERIALS AND METHODS: The cervical spines of 10 adult accident victims underwent radiography and MR imaging, with T1-weighted, fast spin-echo T2-weighted, and four gradient-echo pulse sequences. The frozen specimens were cut into 3-mm-thick slices (sagittal plane) and photographed, and microfocus radiographs were obtained. Imaging findings were compared with the anatomic and pathologic findings. RESULTS: Eight of the 10 specimens had 28 posttraumatic lesions: three fractures (two missed at the initial MR imaging reading), 10 facet joint capsule lesions with bleeding, five soft-tissue and ligament lesions, eight disk lesions, and two spinal cord lesions. Radiography depicted one lesion (4%). Two partial ruptures of the anterior annulus fibrosus were depicted at only MR imaging. Initially, 11 of 28 lesions were detected on MR images; retrospectively, 17 of 28 lesions were correlated with anatomic findings. CONCLUSION: Soft-tissue and intervertebral disk and ligament injuries account for 89% (25 of 28) of posttraumatic cervical spine lesions detected on postmortem images. Occult lesions, including apophyseal joint injuries, were found in clinically noninjured cervical spines. MR imaging was limited in the depiction of discrete lesions when T1-weighted non-fat-saturated, fast spin-echo T2-weighted, and gradient-echo pulse sequences were used.

Adult↗
PubMed1995

Hepatocellular adenoma: MR imaging features with pathologic correlation.

OBJECTIVE: The purpose of this study was to describe the MR imaging characteristics of hepatic adenomas and to correlate these features with pathologic findings. MATERIALS AND METHODS: Sixteen patients from four institutions who had 31 hepatocellular adenomas underwent MR imaging with T1- and T2-weighted pulse sequences at 1.5 T. Dynamic gadolinium-chelate-enhanced gradient-recalled-echo (GRE) MR imaging was done in eight patients with 15 lesions. Twenty-three lesions in 15 patients were confirmed by surgical excision. MR images were retrospectively reviewed by three experienced radiologists for signal intensity of lesions relative to liver, heterogeneity, contrast enhancement, and presence of signs of histopathologic correlates. These imaging findings were then compared with histopathologic findings. RESULTS: Nearly all (29 of 31 lesions) hepatocellular adenomas showed heterogeneous signal intensity on MR images. Most (19/31) were predominantly hyperintense on proton density- or T2-weighted images; the predominant signal intensity on T1-weighted images varied. Thirteen of 15 lesions showed early arterial enhancement relative to liver on dynamic GRE MR images. MR imaging was most successful in showing intratumoral hemorrhage (10 of 12 histopathologically proven lesions), large intratumoral vessels (five of five), fatty change (three of six), and peliosis (three of three cases). In two lesions, capsules (one of five) and central scars (one of three) were detected. CONCLUSION: Hepatocellular adenomas have a highly variable appearance on MR images because of their varied histologic appearances. Although no definitive MR imaging signal or structural characteristics can be identified, tumor heterogeneity, particularly when related to hemorrhage, and early arterial enhancement can suggest a diagnosis of hepatocellular adenoma in the proper patient population.

Adenoma, Liver Cell↗
PubMed1994

Three-dimensional volumetric ultrasound imaging of arterial pathology from two-dimensional intravascular ultrasound: an in vitro study.

The objectives of this study were to evaluate: (1) the feasibility of generating three-dimensional (3-D) ultrasound (US) volumetric images of arterial segments from intravascular (IV) US images by retaining full range of gray levels; (2) the feasibility of volumetric quantitation of various arterial wall pathology from the 3-D volume US images of arterial segments. IVUS provides morphologic details of arterial wall diseases. This is seen as variation in gray levels. However, when a 3-D US image is generated currently, the full range of gray levels is not utilized. This limits optimal assessment of arterial wall pathology. Sequential cross-sectional IVUS images from 11 arterial segments consisting of various pathology were obtained in vitro by calibrated withdrawal of an IVUS catheter. These images were digitized by an 8 bit digitizer to retain full 256 gray levels of brightness. 3-D volume generation was carried out using "ANALYZE" software. After the IVUS imaging, arterial segments were sectioned transversely in a 0.3-0.4 mm cross section and stained with hematoxylin, eosin and elastin. Geometrical measurements and gross morphological changes of the arterial segments were noted and correlated with the corresponding section of the image from the three-dimensional volume. Arterial wall pathology, its extent and its effect on lumen geometry were easily appreciated in multiple tomographic sections of a 3-D volume image. Similarly, arterial wall pathology was easily quantitated from 3-D volume. The above assessments were only feasible by retaining full range of gray levels in the 3-D volume image. This study indicates that (1) it is feasible to generate a 3-D US volume image by retaining full range of gray levels from IVUS images, (2) retaining full range of gray levels allows optimal assessment of arterial wall pathology and its extent in 3-D volume, and (3) IVUS allows quantitation of arterial wall pathology, and thereby one can assess the effect of intervention.

Arteries↗