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Abstract
Purpose: Fundamental gray-scale imaging (FGI) is known to be unuseful for thyroid imaging in the early postoperative setting. Thus, we evaluated the feasability of tissue harmonic imaging (THI) early after thyroid resection. Material and Methods: FGI and THI of the neck were perfomed in 48 consecutive patients 4 days after surgery. The examiner was blinded to patient diagnoses and types of surgery. FGI and THI examinations were stored on videotape and reviewed offline by two different readers who rated the quality of delineation of the organ borders and presence or absence of focal lesions. The results were compared to neck US performed 12 weeks after surgery. Results: Delineation of the thyroid remnants in THI/FGI was rated to be excellent in 22/2, good in 11/9, poor in 3/16 and not visible at all in 4/13 patients. The correlation between THI-volumetry and control-volumetry was very high (r=0.81; p<0.0001). THI but not FGI depicted presence or absence of solid thyroid nodules with 100% accuracy. Conclusion: THI is a feasible method for thyroid US in the early postoperative setting. It permits volumetry of the residual thyroid tissue and accurately depicts nodules within the thyroid remnant.
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Affiliation(s)
- A Saleh
- Institute of Diagnostic Radiology, University Hospital, Düsseldorf, Germany
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2
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Kaschner MG, Fürst G. [Chronic adhesive small intestine volvulus in adulthood, a rare clinical picture]. ROFO-FORTSCHR RONTG 2015; 36:123-5. [PMID: 25912330 DOI: 10.1055/s-0034-1384905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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3
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Abstract
Kasabach-Merritt-syndrome is rare coagulation disorder with consumption coagulopathy caused by vascular malformations. We report the case of a 44-year-old woman with repeated severe bleeding complications after small and medium sized operations with normal results in the tests of plasmatic coagulation. After discovery of a giant hemangioma of the liver the diagnosis was established. Activation of coagulation was stopped preoperatively by i.v.-heparinization and curative treatment by right-sided hemihepatectomy followed.
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Affiliation(s)
- T Vogel
- Klinik für Allgemein- und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf
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Knoefel WT, Gabor I, Rehders A, Alexander A, Krausch M, Schulte am Esch J, Fürst G, Topp SA. In situ liver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection. Br J Surg 2012; 100:388-94. [DOI: 10.1002/bjs.8955] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2012] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Portal vein embolization (PVE) has become a standard procedure to increase the future liver remnant (FLR) and enable curative resection of initially unresectable liver tumours. This study investigated the safety and feasibility of a new two-stage liver resection technique that uses in situ liver transection (ISLT) and portal vein ligation before completion hepatectomy.
Methods
A consecutive series of patients undergoing ISLT and extended right hepatectomy between 2009 and 2011 were compared with consecutive patients undergoing extended right hepatectomy after PVE. All patients had initially unresectable primary or secondary liver tumours, owing to an insufficient FLR (liver segments II/III).
Results
Fifteen patients who had PVE and seven who underwent ISLT before extended right hepatectomy were evaluated. ISLT induced rapid growth of the FLR within 3 days, particularly after insufficient PVE, from a mean(s.d.) of 293(58) ml to 477(85) ml, corresponding to a volume increase of 63(29) per cent. All patients who had ISLT underwent completion extended right hepatectomy within 8 days (range 4–8 days).
Conclusion
ISLT is an effective and reliable technique to induce rapid growth of the FLR, even in patients with insufficient volume increase after PVE.
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Affiliation(s)
- W T Knoefel
- Department of Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - I Gabor
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - A Rehders
- Department of Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - A Alexander
- Department of Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - M Krausch
- Department of Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - J Schulte am Esch
- Department of Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - G Fürst
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S A Topp
- Department of Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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5
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Jeanneret O, Antonini Philippe R, Trouilloud D, Ohl F, Chanal J, Fürst G, Jimmy G. Apport de mouvement et créativité chez des enfants âgés entre quatre et six ans. Sci Sports 2012. [DOI: 10.1016/j.scispo.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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6
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Heusch P, Kröpil P, Buchbender C, Heusner TA, Lanzman RS, Antoch G, Fürst G. Teilkörperdosis der Augenlinse des Untersuchers bei CT-gesteuerten Interventionen: erste Ergebnisse. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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7
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Lögters T, Fürst G, Hakimi M, Windolf J, Schädel-Höpfner M. Die intraläsionale Sklerosierung venöser Malformationen an der Hand mit Natriumtetradecylsulfat. HANDCHIR MIKROCHIR P 2011; 43:356-60. [DOI: 10.1055/s-0031-1280798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- T. Lögters
- Universitätsklinikum Düsseldorf, Klinik für Unfall- und Handchirurgie, Düsseldorf
| | - G. Fürst
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
| | - M. Hakimi
- Universitätsklinikum Düsseldorf, Klinik für Unfall- und Handchirurgie, Düsseldorf
| | - J. Windolf
- Universitätsklinikum Düsseldorf, Klinik für Unfall- und Handchirurgie, Düsseldorf
| | - M. Schädel-Höpfner
- University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Düsseldorf
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8
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Range P, Fürst G, Jost A, Schindler G, Hahn D. Bedeutung einer Late Enhancement Phase im Rahmen der ceMRA bei Patienten mit Beschwerden nach gefäßchirurgischem Eingriff. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Fürst G. Strahlenschäden durch interventionelle Eingriffe: Muss das heute noch sein? ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1278775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Kahn T, Fürst G. Zur Emeritierung von Professor Dr. med. Ulrich Mödder. ROFO-FORTSCHR RONTG 2010; 182:851. [DOI: 10.1055/s-0029-1245710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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12
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Lanzman RS, Fürst G, Blondin D, Scherer A, Mödder U, Winter J, Kröpil P. Where does it lead? Beurteilung von Herzschrittmachern im konventionellen Röntgenbild und CT des Thorax. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1253087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Kröpil P, Lanzman RS, Lux P, Winter J, Blondin D, Miese FR, Mödder U, Scherer A, Fürst G. Interdisziplinäre Bergung von Schrittmachersonden und Rekanalisation okkludierter Venen – der Radiologe im kardiochirurgischen Operationssaal. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0029-1248001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Dengler T, Kellner S, Fürst G. Erfahrungen mit einer einfachen Mikrotiterplatten-Technik für das GPT-«Screening» bei Blutspendern. Transfus Med Hemother 2009. [DOI: 10.1159/000222587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Schubert D, Müller M, Fürst G. [Endovascular therapy of a uretero-iliac prosthesis related fistula]. ROFO-FORTSCHR RONTG 2009; 181:695-7. [PMID: 19401976 DOI: 10.1055/s-0028-1109294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Walther C, Fürst G, Borgert S, Lanzman RS, Beck A, Mödder U, Blondin D. Implementierung einer semiautomatischen 3D-Volumetrie-Software (ECCET 3D) zur Lebervolumetrie. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Kreyling WG, Ferron GA, Fürst G, Heilmann P, Neuner M, Ruprecht L, Schumann G, Takenaka S, Heyder J. Early Response of the Canine Respiratory Tract Following Long-Term Exposure to a Sulfur(IV) Aerosol at low Concentration. III. Macrophage-Mediated Long-Term Particle Clearance. Inhal Toxicol 2008. [DOI: 10.3109/08958379209145668] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Fürst G, Fritz LB, Knoefel WT, Klein M, Ghodzisad A, Namdar T, Schulte am Esch J. Portalvenenembolisation und autologe CD133+ Knochenmarkstammzellen zur Stimulation der hepatischen Regeneration: Erste klinische Ergebnisse. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Abstract
Haemorrhage is a recognized complication of catheter-directed thrombolysis. We report one case of an afore unknown colo-rectal carcinoma, which was detected due to rectal bleeding following intraarterial thrombolysis. As reported with warfarin induced gastrointestinal bleeding complications, patients with unknown tumor developing rectal bleeding after thrombolysis procedure, should receive full diagnostic work-up of the gastrointestinal tract in order to exclude serious but potentially curable disease.
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Affiliation(s)
- E Schellhammer
- Institut für Diagnostische Radiologie, Universitätsklinik, Düsseldorf, Germany.
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20
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Lanzman R, Schellhammer F, Fürst G. [Early arterial enhancement of the liver: a pitfall in obstructions of the superior vena cava]. ROFO-FORTSCHR RONTG 2007; 179:534-5. [PMID: 17436189 DOI: 10.1055/s-2007-962965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Anapolski M, Papathemelis T, Dall P, Fürst G, Bender HG, Mohrmann S. Embolisation der Arteriae uterinae bds. in Kombination mit Methotrexat-Applikation bei einer Zervikalgravidität im 2. Trimenon bei bestehender vaginaler Blutung: Case report. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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22
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Schellhammer F, Wild M, Fürst G. Skapulothorakale Dissoziation mit letalem Ausgang. ROFO-FORTSCHR RONTG 2007; 179:82-3. [PMID: 17203447 DOI: 10.1055/s-2006-927190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Schellhammer F, Steinhaus D, Mödder U, Fürst G. Primäre Thrombin-Injektion zur Behandlung von Pseudoaneurysmen des Körperstammes. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Abstract
Persistent left-sided inferior vena cava (VCI) is a rare venous anomaly, its prevalence being estimated at 0.2-0.5%. Thrombotic occlusion of a VCI has been reported in only a few of these cases. We report the case of a 24-year old woman who suffered an acute thrombosis in a left-sided VCI and recurrent pulmonary embolism. After thrombectomy the course was uneventful. The diagnostic approach and the treatment strategy are discussed with reference to the literature.
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Affiliation(s)
- J Rudolph
- Klinik für Gefässchirurgie und Nierentransplantation, Universitätsklinikum Düsseldorf, Düsseldorf.
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25
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Abstract
Bile leak is a well-known complication of cholecystectomy. Endoscopic drainage and decompression of the biliary system including temporary insertion of a biliary stent is generally considered the treatment of choice. We report the successful obliteration of a bile leak using fibered platinum coils placed under fluoroscopic guidance after stent treatment had failed.
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Affiliation(s)
- F Schelhammer
- Institute of Diagnostic Radiology, University Hospital, Düsseldorf, Germany.
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26
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27
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Schellhammer F, Krömeke O, Poll L, Fürst G, Mödder U. [Nonocclusive ischemia of the right colon]. Radiologe 2006; 47:721-4. [PMID: 16541274 DOI: 10.1007/s00117-005-1331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nonocclusive disease (NOD) is known to be a common cause of ischemic colitis, which is frequently underestimated. MATERIAL AND METHODS A computer-assisted search of radiological reports at our institute over a period of 18 months, describing ischemic colitis of the ascending colon with an unimpaired perfusion of the superior mesenteric artery, was performed. RESULTS A retrospective analysis of the clinical and radiological data of 14 patients was performed. In ten cases colonic ischemia was confirmed clinically or intraoperatively. Most of our patients needed intravenous catecholamines due to severe hypotension. However, no significant radiographic predictors could be identified. CONCLUSION Awareness of NOD seems to be crucial. Especially in cases of acute abdominal pain associated with severe hypotension, renal insufficiency, or pancreatitis, one should include NOD as a differential diagnosis at an early stage.
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Affiliation(s)
- F Schellhammer
- Institut für diagnostische Radiologie, Heinrich-Heine-Universität, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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28
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Fürst G, Schulte am Esch J, Hosch SB, Klein M, Ghodsizad A, Wecker B, Poll LW. Portalvenenembolisation und Applikation von CD133+ Knochenmarkstammzellen in die Leber: Ein neues Konzept zur Unterstützung der Leberregeneration? ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Schellhammer FS, Krömeke O, Poll L, Fürst G, Mödder U. Nichtokklusive Ischämie des rechtsseitigen Kolons. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-868243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Saleh A, Cohnen M, Fürst G, Mödder U, Feldkamp J. Prediction of Relapse after Antithyroid Drug Therapy of Graves' Disease: Value of Color Doppler Sonography. Exp Clin Endocrinol Diabetes 2004; 112:510-3. [PMID: 15505758 DOI: 10.1055/s-2004-821308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Opinions differ regarding the indications for antithyroid drugs, radioiodine and surgery in patients with Graves' disease because the likelihood of long-term remission after medical treatment cannot be predicted. The aim of this study was to assess the value of quantifying thyroid blood flow in an attempt to predict outcome following withdrawal of antithyroid drug therapy. Spectral Doppler recordings were obtained from the thyroid arteries in 24 patients with Graves' disease at the time of diagnosis. Thyroid blood flow levels measured at the time of diagnosis of Graves' disease were correlated with outcome following withdrawal of medical treatment (mean duration of treatment: 14 months). Clinical follow-up for at least 18 months (range: 18 - 39 months) after antithyroid drug withdrawal was possible in 13 patients (12 women). Mean peak systolic velocity and volume flow rate values as well as thyroid volume measured at the time of diagnosis were significantly higher (139 cm/s, SD 46; 195 ml/min, SD 170; 52 ml, SD 18) in patients who relapsed after drug treatment compared with patients in remission (71 cm/s, SD 27; 67 ml/min, SD 61; 25 ml, SD 13). The correlation between thyroid blood flow measurements and thyroid volume was high (r = 0.79 - 0.96). Recurrence of disease could be predicted with a sensitivity of 71 % and a specificity of 100 % based on thyroid blood flow measurements. This preliminary data suggest that quantification of thyroid blood flow by means of Doppler sonography might be a useful tool to predict the outcome of Graves' disease following withdrawal of medical treatment and could be helpful in finding the adequate kind of therapy.
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Affiliation(s)
- A Saleh
- Institute of Diagnostic Radiology, University Hospital Düsseldorf, Düsseldorf, Germany.
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31
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Saleh A, Wenserski F, Cohnen M, Fürst G, Godehardt E, Mödder U. Exclusion of brain lesions: is MR contrast medium required after a negative fluid-attenuated inversion recovery sequence? Br J Radiol 2004; 77:183-8. [PMID: 15020358 DOI: 10.1259/bjr/62546157] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We hypothesized that in patients with negative fluid-attenuated inversion recovery (FLAIR) images T(2) weighted fast spin-echo (FSE) images and T(1) weighted spin-echo (SE) images before and after intravenous administration of gadolinium-based contrast medium display no pathology either. Thus, we assessed the negative predictive value of FLAIR images to rule out MR-detectable brain lesions. 1026 consecutive cranial MR examinations were reviewed. Routine MRI of the brain included T(1) weighted coronal imaging before and after administration of gadopentetate dimeglumine, axial T(2) weighted FSE and fast-FLAIR imaging. The FLAIR images were rated by two radiologists into categories of 0 (without pathologic changes) and 1 (with pathologic changes). Two other radiologists analysed the complete examination. In 284 MR examinations of the brain no abnormalities were found (28%). FLAIR-ratings were false-negative in four cases and false-positive in 30 cases. Sensitivity and specificity of the FLAIR sequence for MR-detectable brain lesions were 99.5% and 89.4%. The unselective application of gadolinium avoided one false-negative MR-reading and improved the sensitivity of the MR-examination from 99.5% to 99.6%. Positive and negative predictive values were 96.1% and 98.4%, respectively. The interobserver reliability was kappa=0.93 for the FLAIR-readers and 0.89 for the readers who rated the complete examination. In conclusion, negative FLAIR images provide a high negative predictive value for MR-detectable brain lesions. Thus, in patients with negative FLAIR images the unselective application of gadolinium seems to be unnecessary.
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Affiliation(s)
- A Saleh
- Institute of Diagnostic Radiology, Clinic of Thoracic and Cardiovascular Surgery, University Hospital Düsseldorf, Germany
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32
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Affiliation(s)
- M Klammer
- Department of Dermatology, University of Duesseldorf
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33
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Ernst S, Cupisti K, Kemper J, Dotzenrath C, Goretzki PE, Fürst G. Angiographic ablation of an ectopic mediastinal hyperplastic parathyroid gland using a left internal mammary artery coronary bypass. AJR Am J Roentgenol 2003; 181:95-7. [PMID: 12818837 DOI: 10.2214/ajr.181.1.1810095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S Ernst
- Department of Diagnostic Radiology, University of Duesseldorf, Moorenstr. 5, D-40225 Duesseldorf, Germany.
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34
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Ernst S, Luther B, Zimmermann N, Böhner H, Wilke R, Feindt P, Fürst G. [Current diagnosis and therapy of non-occlusive mesenteric ischemia]. ROFO-FORTSCHR RONTG 2003; 175:515-23. [PMID: 12677507 DOI: 10.1055/s-2003-38441] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Non-occlusive mesenteric ischemia (NOMI) is a life threatening disease. Therapy and prognosis depend upon the length of time elapsed between primary clinical manifestation and the time of definitive diagnosis and treatment. MATERIALS AND METHODS NOMI was diagnosed by intraarterial selective angiography in four patients. After a bolus administration of 20 g Alprostadil (Prostavasin) into the superior mesenteric artery, intraarterial perfusion was continued with 60 microg Alprostadil/day via the catheter for three days. RESULTS The mesenteric ischemia resolved in all patients. One patient recovered completely. Three patients recovered from mesenteric ischemia, but died subsequently due to complications of their primary diseases. CONCLUSION When NOMI without perforation or necrosis of the bowel wall is suspected clinically, immediate intraarterial angiography is the diagnostic method of choice. If NOMI is confirmed, the appropriate treatment is the intraarterial application of potent vasodilators for several days. The diagnostic work-up in suspected NOMI and the impact of different radiological examinations are explained. The literature is reviewed.
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Affiliation(s)
- S Ernst
- Institut für Diagnostische Radiologie, Heinrich-Heine-Universität, Dusseldorf.
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35
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Abstract
MR-urography presents a new diagnostic approach to the urinary system, resulting in images comparable to those known from i.v.-urography. T2-weighted MR-urograms demonstrate static fluid without ionizing radiation or nephrotoxic contrast media. The excretory renal function can be examined by the use of gadolinium-enhanced T1-urography. The degree and cause of ureteric obstruction can be diagnosed with high sensitivity and specificity. On the other hand, urolithiasis is frequently misdiagnosed by MR-urography and, in this case, spiral CT should be used. Pediatric or pregnant patients can be examined as well as donors before and patients after renal transplantation. Furthermore, in case of a tumor MR-imaging, including MR-angiography, is a potential diagnostic "all-in-one" approach.
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Affiliation(s)
- M Cohnen
- Institut für Diagnostische Radiologie, Universitätsklinikum Düsseldorf.
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36
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Fürst G. [Radiological acute diagnosis in suspected perforation of the large intestine]. Kongressbd Dtsch Ges Chir Kongr 2002; 118:307-10. [PMID: 11824267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The last decade has seen changes in imaging procedures in patients with suspected colon perforation. Many traditional emergency imaging techniques have been replaced with helical CT, that can be performed with great accuracy, less patient discomfort and, probably, decreased cost. Because CT is more sensitive than conventional radiography in identifying subtle pneumoperitoneum, helical CT is ideally suited for rapid evaluation of the abdomen for patients with acute pain from suspected perforation. CT is often indicated when free air is seen at conventional radiography but perforation site is not clear. It is also indicated when air is strongly suspected despite normal abdominal radiographic findings.
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Affiliation(s)
- G Fürst
- Institut für Diagnostische Radiologie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf
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Saleh A, Cohnen M, Fürst G, Godehardt E, Mödder U, Feldkamp J. Differential diagnosis of hyperthyroidism: Doppler sonographic quantification of thyroid blood flow distinguishes between Graves' disease and diffuse toxic goiter. Exp Clin Endocrinol Diabetes 2002; 110:32-6. [PMID: 11835123 DOI: 10.1055/s-2002-19992] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The aim of our study was to evaluate the usefulness of color duplex sonography to distinguish Graves' disease from diffuse toxic goiter. 24 patients with Graves' disease and 13 patients with diffuse toxic goiter underwent B-mode- and color duplex sonography of the thyroid gland. All patients had hyperthyroidism and elevated (99m)Tc-uptake. Spectral Doppler recordings were obtained at all thyroid arteries. Representative color flow maps of the thyroid gland were analyzed, calculating the percentage area of the thyroid gland, occupied by color pixels (color pixel density). The B-mode ultrasound pattern was subjectively assessed on a 4-point rating scale. In patients with Graves' disease the mean peak systolic velocity (PSV) (SD) was 110 (+/- 49) cm/s, the mean volume flow rate (VFR) was 123 ( +/- 67) ml/min and the mean color pixel density (CPD) was 33 (+/- 12) %. For patients with diffuse toxic goiter mean PSV (SD) was 43 ( +/- 9) cm/s (p < 0.001), mean VFR was 23 (+/- 10) ml/min (p < 0.001) and mean CPD was 9 (+/- 6) % (p = 0.007). CPD and spectral duplex recordings were positively correlated (CPD/PSV: rs = 0.77, CPD/VFR: rs = 0.75; p < 0.0001). No significant differences were observed concerning RI values. Sensitivity was 87% and specificity 92% for CPD and VFR and 87% and 100% for PSV. We conclude, that color duplex sonography can reliably distinguish diffuse toxic goiter from Graves' disease and therefore contributes significantly to the differential diagnosis of hyperthyroidism in diffuse thyroid disease.
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Affiliation(s)
- A Saleh
- Institute of Diagnostic Radiology, University Hospital Düsseldorf, Germany.
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Saleh A, Fürst G, Feldkamp J, Godehardt E, Grust A, Mödder U. Estimation of antithyroid drug dose in Graves' disease: value of quantification of thyroid blood flow with color duplex sonography. Ultrasound Med Biol 2001; 27:1137-1141. [PMID: 11527601 DOI: 10.1016/s0301-5629(01)00410-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The purpose of this study was to evaluate if there is an association between the antithyroid drug dose that is needed to establish euthyroidism and thyroid blood flow measurements. A total of 23 Graves' disease patients with euthyroidism taking antithyroid drug therapy were enlisted to undergo spectral duplex sonography of the thyroid arteries and color-flow mapping of the thyroid gland. Color pixel density (CPD) was calculated with computer assistance from the color-flow maps. There was a strong correlation between the CPD and methimazole dose (rp = 0.79). Methimazole maintenance dosage could be predicted from CPD values with a coefficient of determination of 0.62. In conclusion, CPD measurements could be a useful tool for the clinical endocrinologist to estimate the antithyroid drug dose that is needed to maintain euthyroidism.
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Affiliation(s)
- A Saleh
- Institute of Diagnostic Radiology, Heinrich Heine University, Düsseldorf, Germany.
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39
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Saleh A, Ernst S, Grust A, Fürst G, Dall P, Mödder U. Real-time Compound imaging: Verbesserte Erkennbarkeit von Punktionsnadeln und Markierungsdrähten gegenüber Single-line- Ultraschall? ROFO-FORTSCHR RONTG 2001; 173:368-72. [PMID: 11367848 DOI: 10.1055/s-2001-12467] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM To compare the visibility of biopsy needles and localization wires using real-time compound imaging (SonoCT) and single-line ultrasound (SLU). METHODS 14-18 G biopsy needles and 5 different localization wires with and without puncture needle were placed into cadaverous muscle in 4 different angulations (0, 12, 18 and 25 degrees). Sonography was performed with an ATL HDI 5000 sonography device with a 5-12 MHz linear array using single-line ultrasound and compound imaging with 3 and 9 frames (Comp3 and Comp9) from different viewing angles. Images of the needles were obtained in the longitudinal plane without changing depth, focus position, and gain settings between the measurements. The mean grey values of the needle (gv_n) and of the background (gv_b) were obtained from histograms. Contrast was calculated using the equation (gv_n-gv_b)/gv_b + gv_n). Mean contrast in single-line and compound images was compared for each angulation using a Student t-test. RESULTS The mean contrast at 0 degree was 0.686 in single-line ultrasound. This was significantly higher than in Comp3 (0.62) and Comp9 (0.633) (p < 0.05) images. At 12 degrees no significant differences could be observed. At 18 degrees image contrast was significantly higher in compound images with 0.493 (Comp3) and 0.498 (Comp9), compared to SLU (0.433) (p < 0.05). At 25 degrees the difference between compound images (Comp3: 0.394; Comp9: 0.402) and SLU (0.306) was greatest (p < 0.0001). CONCLUSION At 0 degree and 12 degrees visibility is very good for all tested materials. For steeper angulations contrast was partly critical in SLU and significantly enhanced with compound imaging. Thus, SonoCT may be useful to increase precision of ultrasound-guided percutaneous interventions.
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Affiliation(s)
- A Saleh
- Institut für Diagnostische Radiologie, Heinrich-Heine-Universität Düsseldorf.
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Saleh A, Cupisti K, Fürst G, Feldkamp J, Grust A, Mödder U. Erlaubt das Tissue Harmonic Imaging eine frühe postoperative Schilddrüsenvolumetrie? ROFO-FORTSCHR RONTG 2001; 173:325-8. [PMID: 11367841 DOI: 10.1055/s-2001-12459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM Therapy for endemic goitre after surgical resection depends on the residual thyroid volume. Post-operative changes have been known to impair the fundamental sonographic evaluation of residual thyroid tissue. It was our aim to determine whether THI is a feasible method for thyroid volumetry after surgery. METHODS 48 patients underwent thyroidectomy, hemithyroidectomy, near total resection, or partial resection of the thyroid gland. In all patients THI of the neck was performed 4 (mean; range: 2-7 days) days after surgery using an Elegra sonographic device (Siemens, Erlangen, Germany) with a transmitted frequency of 3.4 MHz and received frequency of 6.8 MHz. The examiner was blinded to the patient's diagnosis and the type of surgery. The residual tissue volume measured by means of THI and intra-operative volumetry were both compared to sonographic volumetry 12 weeks after surgery, the latter serving as the gold standard. Accuracy of THI and intraoperative volumetry were tested for significant differences using a paired t-test. RESULTS Volumetry by the surgeon was available in 26 patients (54%). The men error of THI volumetry was 2.4 ml (SD: 3.3 ml; maximum: 17 ml). The mean error of intraoperative volumetry was 1.4 ml (SD: 1.9 ml; maximum: 6 ml). The mean difference between THI and intraoperative volumetry was 1 ml (SD: 2.7 ml; maximum: 7 ml; p = 0.085). CONCLUSIONS THI permits early volumetry of the residual tissue after thyroid surgery comparable with the intraoperative volumetry. Thus, THI may be helpful in guiding the substitution of thyroid hormones.
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Affiliation(s)
- A Saleh
- Institut für Diagnostische Radiologie, Heinrich-Heine-Universität Düsseldorf.
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Luckey P, Kemper J, Niehues T, Schroten H, Fürst G. Diagnostic role of inspiration and expiration CT in a child with relapsing polychondritis. AJR Am J Roentgenol 2001; 176:61-2. [PMID: 11133539 DOI: 10.2214/ajr.176.1.1760061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- P Luckey
- Institut für Diagnostiche Radiologie, Medizinische Einrichtungen der Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
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Winter J, Gramsch-Zabel H, Fürst G, Koch JA, Zimmermann N, Gams E. Long-term follow-up of left ventricular pacing via a posterior cardiac vein after mechanical tricuspid valve replacement. Pacing Clin Electrophysiol 2001; 24:125-6. [PMID: 11227959 DOI: 10.1046/j.1460-9592.2001.00125.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Permanent cardiac pacing was recommended in a 66-year-old woman with mechanical prosthetic mitral and tricuspid valves. To avoid a thoracotomy, a conventional endocardial lead was inserted with a steerable stylet (Locator) into the posterior cardiac vein via the right cephalic vein. Four weeks later, lead dislodgement required reoperation. The lead position remained stable up to 29 months.
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Affiliation(s)
- J Winter
- Department of Thoracic and Cardiovascular Surgery, Heinrich Heine-University, Moorenstrasse 5, 40225 Duesseldorf, Germany
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Abstract
AIM OF THE STUDY About 30% of the patients with acute aortic dissection suffer from organ or limb ischemia. We analyzed the influence of ischemic localization and method of operative treatment (aortic fenestration or extraanatomic bypass revascularization) on morbidity and mortality. PATIENTS AND METHODS From 1 May 1987 to 31 December 1998 21 patients with 24 vascular complications such as renal or intestinal ischemia, lower extremity ischemia and paraplegia following acute aortic dissection were treated at our institution. Recruitment was retrospective in 16 and prospective in 5 patients. In 5 patients (24%) the complication was associated with Stanford A, in 16 (76%) with Stanford B dissection. Ten patients (48%) complained of malperfusion of only one region, whereas 11 patients (52%) suffered from ischemia of two or three different regions. Aortic fenestration and resection of the dissected membrane was performed in nine cases (37%). Fifteen patients (63%) were treated with extraanatomic bypass techniques. RESULTS One third of the patients died, four of them due to aortic penetration or perforation and two due to visceral ischemia. During follow-up of 32 (1-110) months two patients developed aortic complications. One died of aortic perforation, while the other developed a thoracoabdominal aneurysm and had to be treated by a tube graft replacement. CONCLUSIONS Outcome depended more on the spontaneous course of aortic dissection and on prompt diagnosis and therapy of the complications than on the different operative techniques.
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Affiliation(s)
- B T Müller
- Klinik für Gefässchirurgie und Nierentransplantation, Heinrich-Heine-Universität Düsseldorf
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Abstract
Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed.
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Affiliation(s)
- R Peters
- Department of Radiology, Heinrich-Heine-University, Moorenstrasse 5, D-40225 Düsseldorf, Germany
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45
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Fürst G, Saleh A, Wenserski F, Malms J, Cohnen M, Aulich A, Neumann-Haefelin T, Schroeter M, Steinmetz H, Sitzer M. Reliability and validity of noninvasive imaging of internal carotid artery pseudo-occlusion. Stroke 1999; 30:1444-9. [PMID: 10390321 DOI: 10.1161/01.str.30.7.1444] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Our study evaluated noninvasive tests for the diagnosis of atheromatous internal carotid artery (ICA) pseudo-occlusion. METHODS Twenty patients (17 men, 3 women; mean age +/-SD, 64.3+/-11.6 years) with angiographically proven atheromatous ICA pseudo-occlusion (20 vessels) were prospectively examined with MR angiography (MRA; 2D and 3D time-of-flight techniques), color Doppler-assisted duplex imaging (CDDI) and power-flow imaging (PFI) with and without an intravenous ultrasonic contrast agent. As a control group, 13 patients (13 men; mean+/-SD age, 63.0+/-9.0 years) with angiographically proven ICA occlusion (13 vessels) were studied with the same techniques. For the determination of interobserver agreement (kappa statistics), the findings of each diagnostic technique were read by 2 blinded and independent observers who were not involved in patient recruitment and initial data acquisition. Specificity and sensitivity were calculated for all noninvasive techniques (observer consensus) in comparison to the standard of reference (intra-arterial angiography). RESULTS Interobserver reliabilities were kappa=0.86 for intra-arterial angiography, kappa=0.90 for unenhanced CDDI, kappa=0. 93 for enhanced CDDI, kappa=0.93 for unenhanced PFI, kappa=1.0 for enhanced PFI, kappa=0.93 for 2D MRA, and kappa=0.77 for 3D MRA, respectively (P<0.0001). Specificities and sensitivities were 0.92 and 0.70 for unenhanced CDDI, 0.92 and 0.83 for enhanced CDDI, 0.92 and 0.95 for unenhanced PFI, 1.0 and 0.94 for enhanced PFI, 1.0 and 0.65 for 2D MRA, and 0.89 and 0.47 for 3D MRA, respectively. CONCLUSIONS Advanced ultrasonographic techniques, especially PFI (with only 1 false-positive diagnosis of occlusion in the present series), can provide reliable and valid data to differentiate between ICA pseudo-occlusion and complete occlusion. In contrast, time-of-flight MRA at its present state is not capable of predicting minimal residual flow within a nearly occluded ICA.
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Affiliation(s)
- G Fürst
- Institute of Diagnostic Radiology, Department of Neurology, Heinrich-Heine-University Düsseldorf, Germany
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Skutta B, Fürst G, Eilers J, Ferbert A, Kuhn FP. Intracranial stenoocclusive disease: double-detector helical CT angiography versus digital subtraction angiography. AJNR Am J Neuroradiol 1999; 20:791-9. [PMID: 10369348 PMCID: PMC7056155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND PURPOSE To our knowledge, no large-scale studies comparing the accuracy of CT angiography (CTA) to intraarterial digital subtraction angiography (DSA) of intracranial stenosis have been reported. We attempted to determine the diagnostic value of intracranial CT angiography (CTA) of normal vasculature and variants as well as of stenoocclusive disease. METHODS One-hundred and twelve patients underwent CTA and intraarterial angiography, and 2205 vascular segments were examined to ascertain presence, visibility, and degree of arterial stenoses (n = 105) as well as anatomic variants. Source, maximum intensity projection (MIP), and MIP-generated multiplanar reformatted (MPR) images were evaluated. RESULTS All 55 anatomic variants were identified correctly. Visibility of small-vessel segments was increased from 75% to 83% by using source images. MPR was helpful in differentiating distal vertebral hypoplasia from stenosis and in overcoming artifacts. All 43 occlusive segments were graded correctly (sensitivity = 100%, predictive value = 93.4%) as follows: severely stenotic ([n = 23], sensitivity = 78%, predictive value = 81.8%); moderately stenotic ([n = 36], sensitivity = 61%, predictive value = 84.6%); and mildly stenotic ([n = 3], sensitivity = 66%, predictive value = 28%). Normal segments (n = 2100) had a sensitivity of 99.5%, and CTA evinced a specificity of 99% for detecting stenoocclusive disease. Approximately one-third of wrong assessments were related to the petrous segment of the carotid artery. CONCLUSION CTA with double-detector technology and advanced postprocessing algorithms, including MPR, is about as reliable as MRA in depicting the vasculature of the anterior and posterior circulation and in grading intracranial stenoocclusive lesions, with the exception of the petrous segment of the carotid artery. CTA might be superior to MRA in the evaluation of poststenotic low-flow segments.
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Affiliation(s)
- B Skutta
- Institute of Diagnostic and Interventional Radiology, Klinikum Kassel Kassel, Germany
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Grust A, Röhrborn A, Braunstein S, Peters R, Fürst G. [Heterotopic pancreatic tissues--a rare differential diagnostic problem in stomach tumors]. Rontgenpraxis 1999; 51:439-42. [PMID: 10063373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Grust
- Institut für Diagnostische Radiologie, Heinrich-Heine-Universität Düsseldorf
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Fürst G, Müller-Mattheis V, Cohnen M, Trautner C, Haastert B, Saleh A, Malms J, Ackermann R, Mödder U. Venous incompetence in erectile dysfunction: evaluation with color-coded duplex sonography and cavernosometry/-graphy. Eur Radiol 1999; 9:35-41. [PMID: 9933376 DOI: 10.1007/s003300050623] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to assess the accuracy of multi-parameter measurements with color-coded duplex sonography (CCDS) for the diagnosis of venous leakage in patients with erectile dysfunction. Sixty patients with repeated unsatisfactory reactions after intracavernous injection of vasoactive substances underwent CCDS. Following intracavernous injection of prostaglandin E1, peak systolic velocity (PSV), enddiastolic velocity (EDV), time averaged velocity (TAV), resistance index (RI), and pulsatility index (PI) were measured in the cavernous arteries over 30 min (one measurement per minute). The results were compared with independent measurements based on dynamic pharmaco-cavernosometry/cavernosography (DPCC). Dynamic pharmaco-cavernosometry/cavernosography revealed venous leakage in 33 patients. Of 48 patients with normal PSV ( > 25 cm/s), 25 had veno-occlusive dysfunction and the remainder presented normal venous function. No statistically significant differences between these groups were found in EDV, RI, and PI measurements. In contrast, differences in TAV were significant between patients with (mean 9.4 +/- 4.6 cm/s) and without venous leakage (mean 5.5 +/- 2.2 cm/s; p = 0.001). Analysis of relative frequencies revealed a broad overlap of EDV, TAV, RI, and PI measurements between both groups. Sensitivities and specificities determined from receiver-operating-characteristic curves were > 80 % and > 50% for a TAV threshold of 5 cm/s, and an RI threshold of 1.0. Measurements of EDV, TAV, RI, and PI in patients with repeated unsatisfactory reactions on intracavernous prostaglandin injection are poor predictors of venous leakage and should not replace DPCC in the investigation of vasculogenic impotence.
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Affiliation(s)
- G Fürst
- Institute of Diagnostic Radiology, Heinrich Heine University, P. O. Box 101007, D-40001 Düsseldorf, Germany
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Müller-Mattheis V, Reinhardt M, Gerharz CD, Fürst G, Vosberg H, Müller-Gärtner HW, Ackermann R. [Positron emission tomography with [18 F]-2-fluoro-2-deoxy-D-glucose (18FDG-PET) in diagnosis of retroperitoneal lymph node metastases of testicular tumors]. Urologe A 1998; 37:609-20. [PMID: 9887489 DOI: 10.1007/s001200050223] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In 1991, this prospectively designed study was started to assess the potentials of positron emission tomography with 18FDG in the diagnostic workup for the detection of lymph node metastases in testicular cancer, since there were no data available concerning this subject at this time. In 54 patients (27 patients with pure seminoma, 27 patients with non-seminomatous tumors) 18FDG-PET results were compared with the findings obtained with abdominal computed tomography, serum level of tumor markers (AFP, beta-HCG), and the histopathological findings after primary or post-chemotherapy retroperitoneal lymph node dissection. In 21 patients with pure seminoma (clinical stage I according to the Lugano classification) 18FDG-PET results were identical with those of the abdominal computed tomography, so PET does not add relevant informations in this group of patients. In 7 patients presenting with non-seminomatous testicular cancer (stage I), PET was not able to detect the existing micrometastases in 4 patients. In 1/7 case PET examination showed a suspicious focal lesion, this lymph node had 2 micrometastases within inflammatory changes. In 1/7 patient 18FDG-PET definitely revealed metastatic lesions, while the CT scans where judged to be unobtrusive and tumor marker levels were within the normal range. In the 4 patients with pure seminomas stage II B and II C (N = 6), that have undergone retroperitoneal lymph node dissection following chemotherapy, 18FDG-PET correctly predicted absence of tumor in 3 out of these 4, and in 1/4 patient the benign nature of a persistent large tumor after two cycles of polychemotherapy was correctly identified which eventually turned out to be a ganglioneuroma. This lesion falsely was classified as malignant tumor with abdominal computed tomography, and in 2/4 patients post-chemotherapy residual retroperitoneal lesions in the CT scans could not be assessed exactly whether or not malignant tumor was present. In 20 patients presenting with non-seminomatous testicular cancer (stage II and III) 18FDG-PET was able to demonstrate therapeutic effects of chemotherapy by showing decreasing tracer activity in those regions, that had hypermetabolic foci prior to chemotherapy. It became evident in testicular cancer that there is a single entity which is not characterized by increased glucose metabolism, the mature teratoma. In lesions detected by abdominal computed tomography which do not present increased 18FDG uptake, mature teratoma as well as scar/necrosis or rare other tumors with normal glucose metabolism can be supposed, but additional characteristics based on different 18FDG uptake were not observed. In 1/20 case post-chemotherapy PET scan detected a hypermetabolic lesion, which was suspicious for metastatic spread, but in the histopathological examination this lesion was identified as inflammatory tissue reaction. Based on the data reported here in 18FDG-PET cannot be considered a standard diagnostic tool in the staging examinations in testicular cancer. It is of clinical relevance in patients who present residual tumor after chemotherapy. In this situation 18FDG-PET is helpful in deciding whether or not a residual mass post-chemotherapy contains active tumor. 18FDG-PET can not replace retroperitoneal lymph node dissection for staging purposes.
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Saleh A, Santen R, Malms J, Feldkamp J, Fürst G, Scherbaum WA, Mödder U. [B-mode ultrasound and modern Doppler ultrasound methods in diseases of the thyroid gland and parathyroid glands]. Radiologe 1998; 38:344-54. [PMID: 9646340 DOI: 10.1007/s001170050364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Color-coded duplex sonography is the main innovation in diagnostic ultrasound in recent years. It allows quantification of tissue vascularity and appreciation of vascular morphology. Due to the unique thyroid hypervascularity in Graves' disease this diagnosis can be made with color Doppler sonography alone. The decrease of vascularity during the course of disease is a relevant parameter throughout the follow-up. Hypervascularity is also observed within areas of inflammatory infiltration in thyroiditis, but the level is lower than in Graves' disease. Sonographic differentiation of benign from malignant thyroid nodules is not possible yet. Color-coded duplex sonography is not useful in the initial detection of parathyroid masses, but may be helpful in distinguishing parathyroid lesions from other cervical masses.
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Affiliation(s)
- A Saleh
- Institut für Diagnostische Radiologie, Heinrich-Heine-Universität Düsseldorf
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