Search

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Endotracheal drug administration plays an important role in rabbit models of pulmonary injury and lung disease. However, anatomical features of the oral fissure and pharynx of rabbits make orotracheal intubation a difficult task with a high failure rate. We developed a new technique for airway access in rabbits under fluoroscopic control using a balloon catheter. The procedure consists of four major steps: (1) a shortened 5-french vertebralis catheter is placed into the mesopharynx just above the epiglottic valve, (2) through the catheter lumen a guidewire is carefully moved across the epiglottis and inserted into the trachea, (3) the vertebralis catheter is replaced by a balloon catheter that subsequently is introduced into the tracheal tree over the guidewire, and (4) with the balloon catheter in the right position the guidewire is removed and the balloon is inflated so that finally the drug can be delivered. This procedure was performed in 55 New Zealand White rabbits under general anesthesia with ketamine/xylazine. In all 55 cases the procedure was performed successfully without any major complications and within a reasonably short time period. Removal of the catheter and awakening of the animals were uneventful. The described technique is a simple and safe method for airway access in rabbits and can be useful in chronic experiments for endotracheal drug administration. [ABSTRACT FROM AUTHOR]

Purpose: The diagnosis of the rare primary malignant tumors of the pulmonary arteries is often delayed as symptoms are nonspecific.Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) of three patients with occlusion of the right pulmonary artery, two with sarcoma and one with chronic thromboembolic disease were analyzed for discriminating diagnostic criteria.Results: Criteria suggesting pulmonary artery sarcoma are inhomogeneous high or low attenuation (hemorrhage, necrosis), soft-tissue density in pulmonary arteries, vascular distension, enhancement after administration of gadopentetate dimeglumine. Criteria for chronic thromboembolic disease are homogeneous soft-tissue lesions, abrupt vascular narrowings and cut-offs, as well as regional parenchymal hyperdensities.Conclusion: CT and MRI provide complementary findings suggesting advanced pulmonary artery sarcoma instead of chronic thromboembolism. [ABSTRACT FROM AUTHOR]

Percutaneous penile venoablation with sclerosing agents and coils was performed in 58 patients. Of 104 ablations attempted, 44 of 51 (86%) transpenile, and 46 of 53 (86.7%) retrograde interventions were technically successful. In 40 patients (69%) erectile function improved (intercourse was possible in 21 without additional measures). Initially improved erectile function deteriorated in 24 patients during follow-up (in an average of 6 months); in 15 of these, intercourse was still possible with injection of vasoactive drugs. In 7 patients, repeat venoablation improved erectile function again. Hot contrast medium was slightly superior to sodium morrhuate as a sclerosing agent. In successfully treated patients, the average decrease in venous leakage was 30 ml/min vs 13 ml/min in treatment failures, with considerable overlap between both groups. Only minor complications were observed. We conclude that percutaneous penile venoablation is technically feasible, and safe. Whether the procedure will have a definite role in the treatment of venogenic impotence, however, still has to be determined. [ABSTRACT FROM AUTHOR]

The sensitivity of MR imaging for detection of pulmonary metastases was evaluated in 23 patients. The MR imaging was performed with T2-weighted turbo-spin-echo (TSE) sequences at 1.5 T. The MR images were compared with spiral volumetric CT which served as the radiological standard. All MR images were interpreted by two radiologists without knowledge of CT findings. The MR imaging technique initially enabled correct identification of altogether 286 of 340 metastases (84 %) resulting in sensitivities of 36 % (size of nodules < 5 mm), 83 % (size of nodules 5-10 mm), 92 % (size of nodules 10-15 mm), and 100 % (size of nodules > 15 mm). Retrospectively with knowledge of CT findings an additional 39 metastases were visible; 15 remained undetected even retrospectively. The results of this paper suggest that MRI still does not have a role for screening for pulmonary metastases. It proves, however, that the incidental diagnosis of a pulmonary lesion on T2-weighted TSE images is highly reliable in representing a pulmonary nodule also visible on CT. However, thus far the malignant nature especially of small nodules detected by MRI (as by CT) remains uncertain even in patients with known malignant neoplasm. [ABSTRACT FROM AUTHOR]

More than 7 years after the diagnosis and treatment of breast cancer (T1N1aM0), multiple nodular foci were observed in the liver of a 40-year-old woman at ultrasonographic examination. The lesions were confirmed by CT scan, but CT-guided liver biopsy revealed only non-specific alterations. At subsequent peritoneoscopic examination, bluish-brown foci were indeed visible on the liver surface, but guided liver biopsies again failed to corroborate the suspected metastases. Instead, histology showed mild portal fibrosis, moderate steatosis and siderosis of hepatocytes, as before. Only the intense red fluorescence of part of the biopsy material under Wood's light suggested the diagnosis of chronic hepatic porphyria or porphyria cutanea tarda, here presumably as a consequence of prolonged alcohol consumption. Subsequent porphyrin studies in urine, faeces and plasma yielded the typical constellation of latent porphyria cutanea tarda (chronic hepatic porphyria type C). The activity of erythrocyte uroporphyrinogen decarboxylase was normal, which argued against a genetic predisposition. After 1 year of strict alcohol abstinence and low-dose chloroquine treatment the 'nodular foci' in the liver were no longer visible on ultrasonogram and CT scan; only proton-weighted NMR imaging (SE 1500/30) still showed ill-defined areas of higher signal intensity. The renal excretion of porphyrins had decreased considerably. The levels are now consistent with the diagnosis of subclinical chronic hepatic porphyria type A. Modern non-invasive imaging techniques are tremendously useful, but they have their pitfalls. Focal liver lesions may present serious diagnostic problems, especially when they are found in a patient with a history of carcinoma at an extrahepatic primary site. A rare example is described. [ABSTRACT FROM AUTHOR]

During the past few years, a new tumor type has emerged in the pediatric and adolescent group of cancer patients, which has been designated malignant peripheral neuroectodermal tumor (MPNT). This tumor has some clinical and pathological signs in common with either soft-tissue sarcomas or classic Ewing's sarcoma, but is defined as a distinct entity because of its immunohistological characteristics. The tumor expresses neuronal markers, but the pattern varies: chromogranin, neuron-specific enolase, synaptophysin, protein S-100 and others. MPNT can occur in the urogenital region. The differential diagnosis on clinical grounds must include Ewing's and soft tissue sarcomas, and also Wilms' tumor and its variants. MPNT are often wide spread in the urogenital region when first diagnosed. Response to radiotherapy and combination chemotherapy is limited. Radical surgery is not always possible. The prognosis therefore remains rather poor at this time. A selection of MPNT patients is presented to demonstrate the various problems associated with this diagnosis. MRI and CT of all patients showed large tumors with direct infiltration of the surrounding structures. MRI is the best imaging modality for diagnosis and therapy monitoring in these tumors, because of its high soft-tissue contrast. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effectiveness of venous occlusions achieved by embolization with platinum microwire coils. Follow-up venographies in 19 patients, 1-20 months (average 8 months) after coil embolizations, were evaluated. Twenty-eight of 126 (22.2%) coil embolizations were found to be patent. Coils which had not formed or partially formed upon embolization had a patency/recanalization rate of 37.5% (12/32). Among coils which had formed nearly completely or completely only 16 of 95 (17%) showed venous patency. As coil embolization had been augmented by sclerotherapy in all patients, the effectiveness of long-term venous occlusion by platinum wire coils alone is probably lower than our figures indicate. We conclude that attention to complete or near-complete coil formation upon embolization appears to be critical to maximize long-term occlusive effects of platinum microcoils. Their effectiveness in general, however, is lower than anticipated. [ABSTRACT FROM AUTHOR]

A case of parosteal osteosarcoma in the very rare location of the talus is presented. The radiological, pathological, and clinical characteristics of parosteal osteosarcoma are described and the differential diagnosis discussed. [ABSTRACT FROM AUTHOR]