[Myocardial heart metastasis in rapidly progressing renal cell carcinoma].
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Adult↗
Biomedical subjects
A H Mahnken
Publications and source records attributed to A H Mahnken.
[Compression of the suprascapular nerve by a ganglion--MRI diagnosis].
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Adult↗
[Changes in the region and the proximal aneurysm neck after endovascular repair of infrarenal aortic aneurysms].
PURPOSE: To analyze short and mid-term changes of the proximal aneurysm neck and to evaluate renal function after endovascular repair of infrarenal abdominal aortic aneurysms. MATERIALS AND METHODS: 24 of 29 patients, who were treated endoluminally with the bifurcated Vanguard Stent graft between 1997 and 1999 underwent spiral CT follow-up after 1, 3, 6 and every 12 months. Mean follow-up period was 10.5 months (3-32 months). Follow-up included spiral CT scanning. The aortic diameter as well as cross-sectional area were measured. Stent graft position and renal perfusion were checked by spiral CT. Serum creatinine levels were determined preoperatively and during follow-up. RESULTS: Supra- and infrarenal aortic sizes remained stable. No correlation to the distance between the stent-graft and the renal arteries was observed. Caudal migration of the stent-graft with an average of 6.5 (3-15) mm occurred in 13 patients. Cranial migration was observed in 3 patients. Uncovered stent wires partially overlapped at least one renal artery in 18 patients. No renal infarction occurred. No significant increase of the serum creatinine level was found. CONCLUSION: The risk of proximal endoleakage due to post-interventional dilatation of the aorta abdominalis seems to be low. Insufficient stent graft fixation requires a wide distance between the proximal end of the stent graft and the aneurysm. In the mid-term uncovered stent wires overlapping the renal arteries had no relevant influence on renal function.
Aged↗
[Papillary renal cell carcinoma: comparison of CT and gross morphology].
OBJECTIVE: To analyze the CT appearance of papillary renal cell tumor (pRCT) under consideration of gross pathology. MATERIAL AND METHODS: Preoperative CT-scans of 10 patients suffering from pRCT were re-evaluated by two experienced radiologists. CT appearance was correlated to gross morphology. RESULTS: On CT, 9/10 tumors were depicted as rounded, well circumscribed and sharply delineated masses. These tumors presented a hypodense central area correlating to necrosis in gross pathology. The central area of necrosis was surrounded by vital tumor tissue, presenting as a serpiginous, contrast-enhancing margin on CT. One tumor was polycyclic due to multiple tumor nodules, but sharply demarcated towards the surrounding renal tissue. CONCLUSIONS: pRCT presents a quite unique CT appearance similar to its gross pathology.
Adult↗
[MRI of osteomyelitis: sensitivity and specificity of STIR sequences in comparison with contrast-enhaned T1 spin echo sequences].
PURPOSE: To evaluate the need for additional MR sequences including administration of Gd-DTPA after inconspicuous Short-Tau Inversion-Recovery (STIR) sequence to exclude the diagnosis of osteomyelitis. MATERIAL AND METHODS: 112 MR examinations of 79 patients acquired for the detection of possible osteomyelitis were analyzed retrospectively. All examinations were performed at 0.5 T including STIR, T1-weighted spin echo sequences (T1 SE) before and after application of Gd-DTPA. Additionally, 93 T2-weighted spin echo sequences were available. The examinations were analyzed by two experienced radiologists. First, the STIR sequences were studied, followed by the T1 SE images before and after administration of contrast material. Finally, the T2-weighted images were evaluated. Diagnoses were confirmed by operation (22), biopsy (10), and follow-up (80). RESULTS: In 53 cases osteomyelitis was diagnosed, while the remaining 59 cases suffered from another disease. The sensitivity of the STIR sequence was 100% while the specificity for osteomyelitis was 49.2%. The specificity increased to 79.7% by including T1 SE images into the analysis and reached 83.1% after considering the contrast enhanced images. T2-weighted images yielded no additional information. CONCLUSION: The combination of STIR and T1SE images shows a high sensitivity and specificity for osteomyelitis, thus obviating the need for any additional examinations.
Adolescent↗
Unilateral absence of the left pulmonary artery associated with coronary-to-bronchial artery anastomosis.
Unilateral absence of the pulmonary artery and bronchial-to-coronary artery anastomosis are rarely described congenital vascular anomalies. The authors report a case of a 49-year-old female presenting with both anomalies. The presenting symptoms and pertinent diagnostic imaging are described, including conventional radiographs, angiography, computed tomography, and magnetic resonance imaging, and the therapeutic options available are discussed.
Angiography↗
[Not Available].
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Bibliographies as Topic↗
[Computer-assisted retrograde drilling of osteochondritic lesions of the talus with the help of fluoroscopic navigation].
AIM: Due to the narrow access to the talar dome and the proximity of osteochondritic lesions to the joint surface, the therapeutic retrograde drilling often requires multiple attempts and repeated intraoperative X-ray-control. The advantages of a fluoroscopy-based computer-assisted navigation system regarding efficient planning and easy performance of the ideal drill path are evaluated in respect to accuracy and radiation exposure, as well as to time requirements. METHOD: A 5 mm spherical target was subcortically implanted in the medial aspect of the talar dome of 16 human cadaver specimens. Free-hand drilling was performed using the FluoroNav TM system in one group and conventional repetitive C-arm control in the other. The computed evaluation of the operative results was realized in a CT-generated 3D-model with the help of the DISOS planning and calculation program. The distance of the tip of the drill to the center of the lesion was measured, as well as X-ray exposure and total operating time. RESULTS: The CAS procedure missed the lesion only once. The mean deviation of the computer-guided drill path was measured to be 2 mm, whereas the conventional method led to a mean distance of 5 mm from the target. Conventional drilling failed to reach the target in 5 cases, violating the articular cartilage twice. Navigation reduced the traditionally required multiple attempts of the intervention to just one drill canal and reduced radiation time to 25 %. Despite the increased technical preparation required, the navigated procedure only exceeded the conventional operating time by 2 minutes. CONCLUSION: Thanks to the significantly increased accuracy, fluoroscopic navigation offers a high degree of safety and efficacy for this minimally invasive procedure. The operation can easily be performed successfully causing only minimal collateral damage to the bone, preserving the joint surface. The inherent risks of the retrograde drilling of osteochondritic lesions are lower with navigation, while the radiation exposure of the patient and the staff is significantly reduced.
Cadaver↗
[Posteromedial bowing of the lower leg and neuroblastoma with possible neurofibromatosis type I: a case report and literature review].
BACKGROUND: The posteromedial bowing of the tibia is a rare condition that is not yet known to be related to neurofibromatosis. The case of a three month-old boy with the tentative diagnosis of neurofibromatosis is described. He developed paraplegia due to an abdominal neuroblastoma at the age of 9 months. This led us to a review of the literature. METHOD: 122 cases of posteromedial bowing of the tibia in 20 publications of the years 1949 - 2000 were analysed under special respect to gender, side of affection, shortening of the lower leg, treatment and possible cause. RESULTS: The posteromedial bowing of the lower leg seems to affect more boys as well as the left side. As far as described in all but one case it was the first delivery. Regularly, a limb shortening and pes calcaneovalgus is to be found. 99 children were treated conservatively, 21 got an operation of the affected side. In 19 performed osteotomies no pseudarthrosis occurred. One case of a fracture due to an adequate trauma without healing problems is described.
Abdominal Neoplasms↗
[Minimally-invasive computer-assisted fluoroscopic navigation for kyphoplasty].
AIM: The transpedicular placement of a hollow needle into vertebral bodies for kyphoplasty requires utmost accuracy and thereby permanent multiplanar X-ray control. Facing the increasing number of vertebral compression fractures, the aim of this work was the implementation of computer-assistance to optimise the issue. Prior to clinical implementation, experimental trials were undertaken to analyse the quality-improving options of the technique. METHOD: The virtual image of the planning and the puncture were correlated with the postoperative X-ray image of the needle. The real canal in the bone was then correlated with the preoperative planning in a CT-based 3D model and differences were calculated. As a measure of accuracy the deviation of the needle from the ideal intruding vector and the distance between its top and the centre of a predefined target were scrutinised and related to the indications of the navigation system. Operating time, radiation exposure and general applicability were additionally assessed. All data were compared with those of a conventional control group. RESULTS: Planning and navigation could be executed with high accuracy. With an exactly transpedicular approach, neural structures were safely circumnavigated without once missing the target. In the control group the distance fault was up to 9 mm. The navigated drilling differed from the ideal trajectory by 1 degrees to max. 4 degrees. Conventional C-arm control led to a divergence of 4 degrees to 8 degrees . Radiation exposure could be reduced through computer assistance by 76 % to a fourth of the conventionally resulting amount and the pure operating time thereby decreased by 40 %. The inconvenient course of repeated positioning of the C-arm was overcome. CONCLUSION: In challenging cases of deteriorated anatomy and difficult radiomorphologic orientation, especially of the lower thoracic spine, the CAOS-procedure succeeds in finding the optimal pedicular approach to the vertebral body, helps to avoid collateral damage and minimises the overall risk of the procedure. High accuracy and reduced radiation exposure justify the clinical use of fluoroscopic navigation for transpedicular instrumentation.
Decompression, Surgical↗