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Biomedical subjects

C F Dietrich

Publications and source records attributed to C F Dietrich.

At least 19 recordsLinked to original sources
PubMed2006

[The infammatory pseudotumour -- an unusual liver tumour].

We report on a 49-year-old male patient who was suspected to have a malignant liver tumour with enlarged perihepatic lymph nodes because of CT and ultrasound scanning. To verify the diagnosis and procure a histological specimen, the patient underwent laparotomy. Histologically, an inflammatory pseudotumour could be confirmed. This is a rare disease which can present with fever, abdominal pain, vomiting and weight loss indicating malignancy or abscess. The definite diagnosis is often only verified by surgery.

Biopsy, Fine-Needle↗
PubMed2006

[Differential diagnosis of severe hypoechoic oedema of the small bowel].

PURPOSE: To demonstrate the different causes of a marked and hypoechoic edema of the small bowel. MATERIALS AND METHODS: The study comprises patients over a period of 6 years with hypoechoic oedema of the intestinal tract, especially with cystic appearance of the valvulae conniventes. The causes of severe oedema were analysed retrospectively. Examinations were performed with ATL-, Siemens-, and GE-units using convex transducers (2 - 5 MHz) and high-frequency linear transducers (5 - 13 MHz). RESULTS: Hypoechoic oedema of the small bowel with thickening of the valvulae conniventes was observed in 37 patients. The most frequent diagnoses in our series were small-bowel obstruction (n = 8), gastroenteritis (n = 5), peritonitis (n = 5), mesenteric venous thrombosis (n = 4), hereditary angiooedema (n = 3), tumorous infiltration of the mesentery (n = 3), and small bowel ischaemia (n = 2). Other reasons included one case of mesenteritis, renal insufficiency, vasculitis, use of ACE inhibitors, chemotherapy, intravenous drip after surgery, and protein loss in coeliac disease, respectively. CONCLUSION: Severe oedema of the gastrointestinal tract is caused by many different diseases. Hypoechoic thickening of the valvulae conniventes is the typical sonographic sign. Additional clinical, anamnestic and pathohistological data are necessary in order to make a specific diagnosis.

Angioedema↗
PubMed2006

[Ultrasound in gastroenterology--liver and spleen].

Conventional B-mode and colour duplex imaging is the first choice imaging technique after history taking and physical examination and for the interpretation of laboratory parameters. In the hands of a gastroenterologist ultrasound has become an equally important diagnostic tool as endoscopy. The constantly evolving technique with its possibility of higher resolution by use of "harmonic imaging" and signal enhancement with contrast medium is the reason for a practically relevant review of the situation. Practical references will be given for diagnostics of the liver and portal system including the spleen. The significance of the sonographic diagnosis of "fatty liver" is critically discussed. The overall importance of ultrasound to distinguish different aetiologies of diffuse liver diseases is relatively low. Nevertheless, it is a very sensitive means to detect complications of liver cirrhosis. Portosystemic shunts and typical changes in blood vessel morphology can be diagnosed by colour duplex sonography and used as indirect signs of advanced damage to liver parenchyma. In addition, ultrasound has its value in the confirmation or exclusion of dilated bile ducts as well as in the detection and differentiation of circumscribed liver lesions. The characterisation of focal liver lesions by ultrasound is sufficient in typical cases. The use of ultrasound contrast media (signal enhancers) raises the rate of differentiation and can avoid the uncritical and sequential application of radiological imaging (computed tomography [CT] or magnetic resonance imaging [MRI]). If in doubt about the nature of a lesion, a histological diagnosis remains indispensable. The examination of the spleen and its feeding vessels is regularly done in cases of diffuse parenchymal liver disease when searching for its complications, e. g., portal hypertension. Focal spleen lesions can be observed especially in the context of lymphoma (infiltration) and other bone marrow diseases. Through the application of contrast media, changes of vascularisation (e. g., infarcts) can be visualised and traumatic lesions can be diagnosed more precisely.

Gastroenterology↗
PubMed2005

13C-methacetin breath test as liver function test in patients with chronic hepatitis C virus infection.

BACKGROUND: The 13C-methacetin breath test enables the quantitative evaluation of the cytochrome P450-dependent liver function. AIM: To find out whether this breath test is sensitive in noncirrhotic patients also with chronic hepatitis C in early stages of fibrosis. METHODS: Sixty-one healthy controls and 81 patients with chronic hepatitis C underwent a 13C-methacetin breath test. In all patients, a liver biopsy was performed. The liver histology was classified according to the histology activity index-Knodell score. RESULTS: Delta over baseline values of the patients at 15 min significantly differed from controls (19.2 +/- 9.2 per thousand vs. 24.1 +/- 5.7 per thousand; P < 0.003). The cumulative recovery after 30 min in patients was 11.4 +/- 4.8% and in healthy controls 13.8 +/- 2.8% (P < 0.002). However, patients with early fibrosis (histology activity index IVB) did not differ in delta over baseline values of the patients at 15 min (23.2 +/- 7.9 per thousand vs. 22.6 +/- 7.2 per thousand; P = 0.61) or cumulative recovery (13.6 +/- 3.7% vs. 13.2 +/- 3.8%; P = 0.45) from patients with more advanced fibrosis (histology activity index IVC). Patients with clinically nonsymptomatic cirrhosis (histology activity index IVD; Child A) metabolized 13C-methacetin to a significantly lesser extent (delta over baseline values of the patients at 15 min: 8.3 +/- 4.9 per thousand; P < 0.005 and cumulative recovery after 30 min: 5.6 +/- 3.2%; P < 0.003). The 13C-methacetin breath test identified cirrhotic patients with 95.0% sensitivity and 96.7% specificity. CONCLUSION: The non-invasive 13C-methacetin breath test reliably distinguishes between early cirrhotic (Child A) and noncirrhotic patients, but fails to detect early stages of fibrosis in patients with chronic hepatitis C.

Acetamides↗
PubMed2005

Sonographic characterisation of hepatocellular carcinoma at time of diagnosis.

BACKGROUND: Hepatocellular carcinoma (HCC) is a malignant liver tumour with a high prevalence world-wide. For screening procedures conventional transabdominal B-mode ultrasound and AFP determination are commonly used. We investigated 100 consecutive patients with histologically proven hepatocellular carcinoma in order to evaluate sonographic characteristics in unselected patients and to compare native and contrast-enhanced ultrasonographic techniques. PATIENTS AND METHODS: We investigated 100 consecutive patients with hepatocellular carcinoma at time of diagnosis with respect to echogenicity, patterns of vascularity, and portal/hepatic vein thrombosis. In addition to B-mode and native power Doppler sonography, contrast-enhanced power Doppler sonography with SHU 508A was used in 65 patients. RESULTS: The ultrasound appearance with conventional B-mode of hepatocellular carcinoma was hypoechoic in 48 % of the cases, isoechoic in 9 %, hyperechoic in 19 %, and in 25 % a mixture between hyper- and hypoechoic appearance was found compared to the surrounding liver tissue. Contrast-enhanced power Doppler sonography with SHU 508A changed the pattern of tumour vascularity in 27 % of patients into hypervascular, mainly in small lesions. DISCUSSION: At the time of diagnosis, the most commonly observed finding in hepatocellular carcinoma is that they appear hypervascular, independent of their size. The use of ultrasound contrast media should be considered to achieve characterisation of liver nodules in cirrhotic livers because they can improve the evaluation of tumour vascularity. Hypovascular HCC are found in about 10 % even after the administration of a contrast agent.

Adenoma↗
PubMed2005

["White bowel". A sonographic sign of intestinal lymph edema?].

AIM: We recently introduced the term "white bowel" to describe the hyperechoic appearance of the bowel wall found in a patient with HIV-associated enteropathy. The aim of this study was to describe changes of the bowel wall and to demonstrate possible causes of this phenomenon. PATIENTS AND METHODS: 10 patients identified as showing this phenomenon were enrolled in this study. The ultrasound examinations of the patients were re-evaluated with special regard to the echogenicity of the different layers of the bowel wall, to mesenteric lymph nodes, and to thrombosis of the mesenteric vein. RESULTS: Diagnosis in these 10 patients included: HIV-associated enteropathy aggravated by Mycobacterium avium-intracellulare infection (n = 3); endemic coeliac disease and complications arising from T-cell lymphoma (n = 2); carcinoma of the small and large intestine (n = 3); Whipple's disease (n = 2). Sonography typically showed echogenic thickening of the wall of the small intestine -- mainly of the mucosal layer. Enlarged mesenteric lymph nodes (with both hypoechoic and occasionally hyperechoic appearance) were present in the majority of cases. In 3 cases, mesenteric vein thrombosis was also demonstrable. CONCLUSION: The "white bowel" was found in patients with different diseases. Most of the patients showed enlargement of the mesenteric lymph nodes. Lymph oedema of the bowel wall probably constitutes the main reason for this phenomenon.

Adult↗
PubMed2005

[Endoscopic ultrasound in chronic pancreatitis].

Endoscopic ultrasound has continuously gained importance and has proven to be of clinical value in patients with chronic pancreatitis. In addition, the much lower complication rate when compared to ERCP has to be recognised. Some authors have indicated that endoscopic ultrasound in the evaluation of chronic pancreatitis is the imaging method of choice, depending on both ductal and parenchymal criteria, but there are still some limitations. The two major limitations of EUS preventing it being the "gold standard" in patients with chronic pancreatitis are the lack of standard criteria to be used, and adequate education. Endoscopic ultrasound is difficult to learn and therefore teaching has to be standardised. A general acceptance of the staging of chronic pancreatitis using a catalogue based on criteria compatible to the Cambridge classification is required. Difficulties in evaluating parenchymal criteria with the exception of "indicative" calcifications, depend on the differentiation of the normal ageing process from sequelae of acute pancreatic, ethyl-toxic fibrosis and early stages of chronic pancreatitis. In addition, the differentiation of hypoechoic and cystic lesions as inflammatory changes or neoplastic tumours is still difficult; complementary imaging methods also have low sensitivity in this area. In conclusion, there is no doubt that endoscopic ultrasound has proven to be of value using an interdisciplinary approach in the evaluation and therapy of pseudocysts, peripancreatic necrosis, and pancreatic and bile duct obstruction.

Aged↗
PubMed2005

Contrast-enhanced endoscopic ultrasound with low mechanical index: a new technique.

AIM: Recent advances in technology have supported the development of new endoscopic ultrasound systems making it possible to use low MI contrast-enhanced imaging techniques (wide band harmonic imaging done with endoscopic ultrasound is currently at a preliminary stage). We now report on the first use of contrast-enhanced, low mechanical index, real-time endoscopic ultrasound (CELMI-EUS) in six patients using prototype technology. MATERIALS AND METHODS: CELMI-EUS was performed using an electronic echo-endoscope HITACHI/Pentax EG-3830UT and adapted dynamic contrast harmonic wide-band pulsed inversion software with low mechanical index (MI = 0.09 - 0.25) before and up to 180 seconds after injection of SonoVue (4.8 mL) in six patients. RESULTS: Adequate visualisation of the arterial and portal venous phases was achieved in all patients. The pancreas and liver were studied thereafter. In contrast to the satisfactory visualisation of these vessels, enhancement of the left liver lobe was sufficient only in 4 patients. In the remaining 2 patients with liver cirrhosis, the enhancement was less pronounced in contrast to the strong enhancement of the hepatic artery and portal vein. CONCLUSION: Recent advances in technology have supported the development of new echo-endoscopic systems making it possible to use real-time, low mechanical index, contrast-enhanced imaging techniques with endoscopic ultrasound. We have preliminarily shown that arterial, portal venous and parenchymal contrast enhancement is possible.

Adult↗
PubMed2005

Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound.

Non-invasive differentiation of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) is difficult. The aim of this study was to assess the accuracy of contrast-enhanced phase inversion ultrasound to differentiate between histologically proven FNH and HCA, analysing the arterial and (early) portal venous phase. 32 patients with histological proven FNH (n=24) or HCA (n=8) have been included in this prospective study. Examination technique: Siemens Elegra, phase inversion harmonic imaging (PIHI) with low mechanical index (MI)<0.2-0.3 using SonoVue (BR 1). The contrast enhancing tumour characteristics were evaluated during the hepatic arterial (starting 8-22 s) and early portal venous phase (starting 12-30 s). The image analysis was performed by three examiners. In 23 of 24 patients with FNH the contrast pattern revealed pronounced arterial and (early) portal venous enhancement. Homogeneous enhancement was detected during the hepatic arterial phase in all eight patients with HCA. In contrast to patients with FNH, no enhancement was seen during the portal venous phase. In conclusion, contrast-enhanced phase inversion ultrasound demonstrated pronounced arterial and portal venous enhancement in patients with focal nodular hyperplasia. In contrast, after homogeneous enhancement during hepatic arterial phase, no enhancement during hepatic portal venous phase was detected in patients with hepatocellular adenoma. Therefore, this technique might improve the functional characterization of benign hypervascular focal liver lesions.

Adenoma, Liver Cell↗
PubMed2004

Improved characterisation of histologically proven liver tumours by contrast enhanced ultrasonography during the portal venous and specific late phase of SHU 508A.

PURPOSE: Ultrasound is reported to be relatively unreliable in the characterisation of liver tumours. The purpose of this study was to assess the ability of contrast enhanced phase inversion ultrasound (PIUS), a new highly sensitive contrast specific technique, performed during the liver specific phase of Levovist, to differentiate between benign and malignant lesions of the liver. PATIENTS AND METHODS: A total of 174 patients with histologically proven liver tumours were prospectively examined with conventional B mode ultrasound and two minutes after intravenous bolus injection of SHU 508A (Levovist). The examination technique comprised: Siemens Sonoline Elegra, phase inversion harmonic imaging (ECI); high mechanical index (1.2-1.7) using a delayed two minute post contrast scanning technique. RESULTS: In all patients with malignant disease, hypoechoic contrast enhancement was seen during the portal venous phase, and convincing but variably less demarcated in 13 patients with hepatocellular carcinoma compared with all patients with liver metastases. The liver tumours proved to be histologically benign in 95 patients and malignant in 79 patients. Homogenous contrast enhancement with a mainly isoechogenic appearance in the portal venous and liver specific late phase was seen in almost all patients with benign liver lesions with the exception of one patient with an inflammatory pseudotumour of the liver and five patients with abscesses. These six exceptions all demonstrated a hypoechoic appearance in the portal venous and liver specific late phase. DISCUSSION: The ability of unenhanced ultrasonography to characterise liver disease is known to be limited. PIUS performed during the portal venous and liver specific late phase of Levovist may differentiate between benign and malignant liver tumours in most cases, with the exception of, for example, abscesses, scars, necrosis, cysts, and calcifications, which need to be excluded clinically and by conventional B mode ultrasonography.

Adolescent↗
PubMed2003

Nodular regenerative hyperplasia of the liver: a rare differential diagnosis of cholestasis with response to ursodeoxycholic acid.

Nodular regenerative hyperplasia of the liver (NRHL) is an uncommon non-malignant finding typically associated with haematological or auto-immune disease. The main clinical symptom is portal hypertension in the absence of underlying liver cirrhosis. The pathogenesis of NRHL remains unknown. We report a case of NRHL with cholestasis and progression to liver insufficiency without any underlying disease and no association with systemic disease or drug intake. Cholestasis and liver function tests improved significantly during treatment with ursodeoxycholic acid (750 mg per day). Based on this case, it may be concluded that treatment with ursodeoxycholic acid might be beneficial in patients with NRHL and progression to liver insufficiency.

Biopsy↗
PubMed2003

Reduced risk for pancreatitis after endoscopic microtransducer manometry of the sphincter of Oddi: a randomized comparison with the perfusion manometry technique.

BACKGROUND AND STUDY AIMS: Endoscopic microtransducer manometry of the sphincter of Oddi has been shown to be a reliable alternative to perfusion manometry for evaluating sphincter of Oddi motor function. It avoids volume loading of the biliopancreatic system, and may therefore be associated with a lower risk of inducing postmanometry pancreatitis.[nl] PATIENTS AND METHODS: During a 2-year period, microtransducer manometry of the sphincter of Oddi was carried out in 215 patients (median age 42 years; 155 women; biliary study in 152 cases, additional pancreatic evaluation in 63 cases). Sphincter of Oddi manometry was conducted as the sole procedure in all patients. The frequency of pancreatitis was assessed prospectively and graded according to established guidelines. A total of 130 consecutive patients (median age 37 years, 92 women; 30 with biliary type II, 58 with type III, 34 with pancreatic type I, and eight with type II) were then randomly assigned to undergo microtransducer or perfusion manometry of the sphincter of Oddi in a standardized fashion. RESULTS: During the initial 2-year period, nine cases of pancreatitis (a pancreatitis frequency of 4.2 %) were observed after microtransducer manometry, and most were of mild degree (six mild, two moderate, and one severe). No deaths occurred, and no surgical procedures were required. In the randomized part of the study, the demographic and clinical characteristics of the patients in both groups, as well as the technical aspects of the procedures performed, were well matched. The frequency of pancreatitis after microtransducer manometry was 3.1 %, compared with 13.8 % after perfusion manometry ( P < 0.05). Pancreatitis occurred in two patients after microtransducer manometry, and was mild in both cases. After perfusion manometry, mild pancreatitis occurred in six patients and moderate pancreatitis in three. CONCLUSION: Endoscopic microtransducer manometry of the sphincter of Oddi is associated with a lower risk for postmanometry pancreatitis than standard perfusion manometry.

Adult↗
PubMed2003

[Sonographie von pleura und lunge].

The value of ultrasound examination of the pleura and lungs remains highly underestimated to this day. While the ventilated lungs and the osseous skeleton of the thorax represent potent obstacles for ultrasound, a multitude of pathological processes of the chest wall, pleura, and lungs results in altered tissue composition, providing markedly increased access and visibility for sonographic examination. These conditions support the sonographic diagnosis of pleural and pulmonary disorders. However, the main value of pleura and lung ultrasonography is not the primary diagnosis of chest lesions but the follow up, differential diagnosis, detection of complications, such as abscesses and post embolic lung infarction, and guidance of diagnostic and therapeutic interventions in patients with pathological pleural and pulmonary findings. Punctures and drainages of fluids, e. g., haematothorax, empyema, chylothorax as well as biopsies of solid lesions can safely be performed under ultrasound-guidance. It is of special importance that pleura and lung ultrasonography, as a non-invasive method, can be repeated without discomfort or radiation exposure for the patient and is therefore valuable in the follow-up of pathological findings. Adequate interpretation of sonographic pleura and lung findings has to consider the patient's history, physical examination, chest X-ray and other results obtained by complementary imaging technologies (e. g. thoracic computed tomography).

Humans↗
PubMed2003

[Improved detection and characterisation of liver tumors with echo-enhanced ultrasound].

Contrast-enhanced ultrasound techniques represent the most challenging efforts in recent ultrasound developments. Contrast-enhanced imaging of the liver will be reviewed with respect to the literature and our own experience. Echo-enhancing agents, also known as ultrasound contrast media, have improved the accuracy of liver ultrasound within recent years. The characterisation of focal liver lesions which is possible by flow characteristics and the improved detection of liver tumors give special importance to the contrast agents. The agents consist of air or gas bubbles coated with different shell media. These micro-bubbles act as strong reflectors to the ultrasound beam enhancing the backscatter signal up to 30 dB. There are differences between blood pool agents and agents with a liver-specific late phase. The agents remain in the vessels during the vascular phase and lead to enhancement of different structures (arterial, capillary, portal venous, and sinusoidal perfusion). This is the first real-time imaging technique of liver lesions that allows a unique analysis of tumor perfusion. Liver tumors known to be hyperperfused in the arterial phase (e. g., focal nodular hyperplasia, hepatocellular carcinoma, and hyperperfused metastases) can be detected and characterised. Hypoperfused tumours (e. g., liver metastases of the gastrointestinal tract) can be recognised in the portal venous phase as less perfused "black spots". Due to of the recently available improved ultrasound technology and affordable ultrasound systems, a reduction in the use of computed tomography (CT) and magnetic resonance imaging (MRI) may be possible, allowing these important technologies to be available for other indications (e. g., brain, thorax).

Adenoma, Liver Cell↗
PubMed2002

[Doppler imaging of hepatic vessels - review].

Hepatic blood flow has been investigated using color Doppler ultrasonography in patients with liver disease, especially in patients with portal hypertension (e. g. liver cirrhosis, portal vein thrombosis, Budd-Chiari-syndrome). Duplex examination protocols, however, differ considerably because no standard technique has been established so far. Whereas there is an agreement about the angle of the ultrasound application (< 60 degrees ), neither the exact location nor the relevant examination parameters have been standardized. Based on a search of the relevant literature, published examination techniques and results were analyzed. These findings are to serve as a basis for a prospective multicenter study for the determination of standard values.

Blood Flow Velocity↗