Biomedical subjects
Publications and source records attributed to B Limberg.
Primary sclerosing cholangitis (PSC) and sarcoidosis are diseases of unknown etiology which are rarely associated. Here we report the case of a 31-year-old man with PSC and pulmonary sarcoidosis. In addition, we include a brief review on PSC and sarcoidosis, in particular with respect to etiopathogenesis and diagnosis.
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Successful completion of a transjugular intrahepatic portosystemic stentshunt (TIPSS) relies on knowledge of the individual hepatic vascular anatomy. The patients referred for TIPSS have an increased risk of contrast-medium-induced renal failure, and therefore the potential for a complete angiographic work-up during the procedure is limited. The same patient population also carries an increased risk of bleeding, which necessitates a rather accurate guiding technique for portal punctures. We have established transcutaneous sonographic guidance as a standard technique for transjugular portal puncture, reducing complication rates and intervention time. Competing imaging modalities for guidance are discussed.
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OBJECTIVES: The entire length of the colon, starting at the rectosigmoid junction and ending at the cecum, can be visualized by transabdominal sonography after retrograde water instillation into the colon. By this method, termed hydrocolonic sonography, it is possible to evaluate in detail the lumen, the colon wall, and the surrounding tissue. Five layers of different echogenicity can be differentiated within the colon wall. METHODS: In a prospective study of 440 patients, we compared the value of conventional abdominal sonography and hydrocolonic sonography with that of colonoscopy, in the diagnosis and differential diagnosis of ulcerative colitis and colonic Crohn's disease. RESULTS: In 93% of patients with Crohn's disease, the normal five-layer structure of the colonic wall was no longer in evidence, and the wall appeared hypoechogenic and clearly thickened. In contrast, in patients with ulcerative colitis, the five-layer structure could clearly be discerned, and although the colon wall remained hypoechogenic, it was only moderately thickened. Colonic Crohn's disease and ulcerative colitis were detectable by hydrocolonic sonography, with a sensitivity of 96% and 91%, respectively, whereas the sensitivity achieved by conventional abdominal sonography was only 71% and 62%, respectively. Furthermore, hydrocolonic sonography made possible the differentiation of Crohn's disease from ulcerative colitis in 93% of the cases. CONCLUSION: This new diagnostic procedure could thus advantageously be introduced for the diagnosis, differential diagnosis, and follow-up of patients with chronic inflammatory large bowel diseases.
Serial chest X-rays of 14 patients with parapneumonic ARDS (PARDS) were analysed retrospectively. Typical findings on chest X-ray films occurred after a latency period of 12-24 h following the clinical start of PARDS. We found some "early signs" of PARDS, such as central interstitial paravascular edema (14/14), bilateral hilar infiltrates (9/14) and the absence of pleural effusion (12/14).
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As part of a prospective study the value of hydrocolonic sonography in the diagnosis and differential diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) was assessed and compared with that of coloscopy as standard reference. Of 440 patients who were examined, 41 (23 men, 18 women; mean age 25 +/- 6 years) had CD and 36 (20 men, 16 women; mean age 32 +/- 8 years) had UC. CD and UC were correctly diagnosed by hydrocolonic sonography in 39 and 33 cases, respectively (sensitivity 95 and 91%, specificity 100 and 99%, respectively). Among healthy subjects five layers of variable echo density were demonstrated in the intestinal wall, while in all those with CD the wall was clearly thickened and in 36 of them the wall structure was also abnormal. In 16 patients the wall structure was homogeneous without evidence of layers and in 20, layers 1-3 were not demonstrable and layers 4 and 5 only rudimentary. In contrast, the 33 patients with UC diagnosed by hydrocolonic sonography had only slight thickening of the intestinal wall and all layers were present in 30 of them. CD and UC were correctly distinguished in 91%. Hydrocolonic sonography makes it possible to demonstrate in detail the structural changes in the intestinal wall in CD and UC so that the two conditions can be distinguished.
Because of therapeutic consequences preoperative sonography should be performed with a check list. Nevertheless false positive and false negative findings result in cases of gall-stones in the ductus cysticus, of acute cholecystitis and thickness of the gall-bladder wall. Therefore where sonographic findings differ from the intraoperative laparoscopic situs the operating surgeon should change to conventional cholecystectomy early enough to avoid complications.
Retrograde instillation of water into the colon makes it possible to visualize the colon sonographically from the rectosigmoid transition to the cecum in 97% of the patients examined. The sonographic views obtained using this technique, which is called hydrocolonic sonography, show the echo-free intestinal lumen, the five individual layers of the colon wall and the connective tissue surrounding the colon. Colonic polyps and carcinomas appear sonographically as echogenic structures projecting from the intestinal wall into the lumen. Colonic polyps larger than 7 mm diameter can be identified in 91% of cases, and the sensitivity of the technique in the detection of carcinomas of the colon is 97%. In addition, detailed evaluation of the structure of the bowel wall permits more precise staging of tumors of the colon. Aside from such localized changes, hydrocolonic sonography can also demonstrate typical changes in the wall structure in chronic inflammatory large-bowel diseases. In acute Crohn's disease the normal stratified appearance of the colonic wall is no longer in evidence and the wall appears visible thickened. In contrast, in patients with acute ulcerative colitis the normal sonographic stratified appearance of the colonic wall is maintained. Hydrocolonic sonography enables a detailed sonographic examination of the colonic lumen and the colon wall, thus providing additional information and allowing more precise diagnosis of many diseases of the colon.
BACKGROUND: Ultrasonic examination has become increasingly important in the diagnosis of diseases of the gastrointestinal tract. In neoplastic diseases of the large intestine, however, the diagnostic value of conventional transabdominal sonography is limited. The purpose of this investigation was to determine whether the evaluation and staging of colonic tumors would be improved by the retrograde instillation of water into the colon in a procedure called hydrocolonic sonography. METHODS: Three hundred patients were examined in a prospective study in which both conventional transabdominal sonography and transabdominal hydrocolonic sonography were performed before the diagnosis was verified by colonoscopy. The indication for the examinations was abdominal pain, diarrhea, weight loss, or the presence of occult blood in a stool specimen. RESULTS: With the instillation of water into the colon, it was possible to display the colon sonographically from the rectosigmoid transition to the cecum in 97 percent of the patients examined. In addition to permitting the evaluation of the colonic lumen, the procedure allowed the five layers of the colonic wall and the connective tissue surrounding the colon to be examined in detail. Only 9 of 29 carcinomas were diagnosed by conventional abdominal sonography (31 percent), whereas hydrocolonic sonography permitted the diagnosis of 28 (97 percent). No polyps could be detected by conventional abdominal sonography, whereas hydrocolonic sonography permitted the diagnosis of 38 of 42 polyps greater than or equal to 7 mm (91 percent) and 3 of 12 polyps less than 7 mm (25 percent). In addition, detailed evaluation of the structure of the bowel wall with hydrocolonic sonography permitted a more precise staging of colonic tumors. CONCLUSIONS: Hydrocolonic sonography, a new diagnostic procedure, can facilitate the diagnosis and staging of colonic tumors.
The effect of a standardized test meal on portal haemodynamics was measured by duplex ultrasonography in healthy subjects (12 men and 13 women; mean age 43 +/- 9 years) and patients with liver cirrhosis (14 men and 11 women; mean age 55 +/- 10 years). Maximal flow velocity, vessel diameter and flow volume were measured in the portal vein and superior mesenteric artery before the test meal and 15, 30 and 45 min thereafter. After a 12-hour fasting period maximal flow velocity in the portal vein was significantly lower in the cirrhosis patients than the normal subjects (P less than 0.05), but the individual values clearly overlapped. 30 min after the test meal flow velocity in the portal vein rose by 22%, flow volume by 29% in the cirrhosis patients, but by 76% and 131%, respectively, in the normal controls (P less than 0.01). Vessel diameter remained constant in the patients, but increased significantly in the controls (P less than 0.05). There was no overlapping of values between the two groups. The increase in flow velocity in the superior mesenteric artery was nearly the same in both groups. It is concluded that, after a test meal the haemodynamic differences between normal subjects and cirrhosis patients becomes quite marked and thus can provide a more exact diagnosis of portal hypertension by duplex ultrasonography.
Sonography is adding a new dimension to diagnosis of Crohn's disease: the analysis of the transmural and peri-intestinal manifestations of the chronic inflammation. Distortions in the structure of intestinal wall are recognizable, the impact on transport of intestinal content can be judged, penetration of inflammation into the bowel surrounding as fistula, abscess, mesenteriitis und peritonitis is safely seen. Differential diagnosis on a strictly sonographic basis is difficult. The paper represents the results of an expert meeting held at the University of Frankfurt/M.
To investigate whether the retrograde instillation of fluid into the colon would improve the diagnostic value of ultrasonography in assessing neoplastic diseases of the large intestine 220 patients were examined by colonic sonography before colonoscopy. Polyps larger than 7 mm diameter could be identified in 91% of cases, whereas polyps smaller than 7 mm could not always be visualised. The sensitivity of the technique in the detection of colonic carcinomas was 94% and the specificity was 100%. The results suggest that colonic sonography is an effective diagnostic procedure that may find application as a screening procedure for neoplastic diseases of the colon.
Retrograde instillation of liquid into the colon allows a specific, percutaneous sonographic examination of the colon to be performed. As part of a prospective study of the diagnosis of colonic tumors in 260 patients, this form of colon sonography was examined together with colonoscopy. Sonographically, colonic polyps and carcinomas of the colon manifested as echogenic, parietal masses. Using colonic sonography, it was possible to identify 96% of the carcinomas that had been diagnosed colonoscopically. The sonographic diagnosis of polyps was insufficient if they were smaller than 6 mm: if they were larger than 7 mm, however, diagnostic sensitivity was 91%. The results of this study show that colon sonography is a new, sensitive method in the diagnosis of colonic tumors.
The entire length of the colon, starting at the recto-sigmoid junction and ending at the cecum, can be visualized sonographically following retrograde water instillation into the colon. Using this method it is possible to evaluate in detail the lumen, the intestinal wall and the surrounding connective tissue. Severe active colonic Crohn's disease and ulcerative colitis can be detected by diagnostic sonography of the colon with a sensitivity of 91% and 89% respectively. Crohn's disease can be differentiated from ulcerative colitis in 86% of the cases by means of colonic sonography. Transabdominal sonography of the fluid-filled colon is a new diagnostic procedure especially in children with Crohn's disease and ulcerative colitis.