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Biomedical subjects

E Gmelin

Publications and source records attributed to E Gmelin.

At least 19 recordsLinked to original sources
PubMed2001

DIMA enlargement mammography in microcalcifications: a prospective study with ROC analysis.

The purpose of this study was to investigate whether the four-fold magnification mammography (direct magnification, DIMA) technique would perform better than conventional 1.5-fold magnification mammography in the differentiation of breast microcalcifications into benign and malignant. Fifty patients with non-palpable microcalcifications detected by mammography were examined immediately prior to surgical biopsy using both a conventional (1.5-fold) and the DIMA (fourfold) magnification mammography techniques. The microcalcifications were classified by five experienced radiologists using morphological criteria. A receiver operating characteristics curve (ROC) analysis of the sensitivity and specificity of both techniques in assessing malignancy was then carried out. The DIMA mammography technique was slightly but non-significantly superior to the conventional method in detecting malignancy (p > 0.05). Coarse granular and pleomorphic calcifications were detected more frequently with the DIMA technique. Coarse calcifications were significantly more frequently associated with histologically benign findings, whereas fine granular calcifications were significantly more likely to be malignant lesions. Assessment of malignancy associated with microcalcifications using morphological criteria is not significantly improved by mammography techniques with higher magnification.

Biopsy↗
PubMed2000

[Radiographic image magnification as quality control of microcalcification imaging within the scope of histopathological control of breast biopsy tissue].

PURPOSE: Evaluation of specimen radiography as a quality control for the detection of microcalcifications by the pathologist during histopathological examination of breast biopsies. MATERIALS AND METHODS: 29 breast biopsy specimen with microcalcifications were radiographed using the magnification (x4) mammography System DIMA Plus MI I before and after the histopathological examination. Tissue with detected microcalcifications after the histopathological examination was reexamined histologically. RESULTS: In 55% (16/29) of all specimen we could identify missed microcalcifications. In 5 specimens the microcalcifications were missed completely. The radiologically detected areas of residual microcalcifications were reexamined histologically and in one case invasive parts of a carcinoma were detected, which primarily had been diagnosed as an in-situ carcinoma. In 6 cases the radiographs of the intraoperative specimen radiography were sent to the pathologist together with the biopsy. In these cases the rate of complete detection of the microcalcifications increased from 39% to 66%. CONCLUSION: Specimen radiography should be performed not only intraoperatively but also as part of the histopathological examination.

Biopsy, Needle↗
PubMed1999

[Digital subtraction angiography with carbon dioxide--basic principles, technique and clinical application].

Carbon dioxide digital subtraction angiography Carbon dioxide (CO2) digital subtraction angiography offers the possibility for diagnostic and interventional angiographic procedures in high risk patients for ionidated contrast material. As a gaseous contrast agent its physicochemical properties have special requirements concerning the radiologists knowledge, the X-ray equipment, the injector and the catheters. This article reviews the current literature concerning the history, physics and physiology, indications and contraindications, clinical use, adverse effects and possible complications of carbon dioxide digital subtraction angiography.

Angiography, Digital Subtraction↗
PubMed1999

[Detection of microcalcifications in breast specimens by 4-fold DIMA direct magnification radiography compared to 1.5-fold conventional magnification radiography].

AIMS OF STUDY: The purpose of this study was to investigate the efficacy of 4-fold magnification breast specimen radiography (direct magnification, DIMA) compared to conventional 1.5-fold magnification radiography in evaluating the presence or absence of carcinoma at the surgical margins by detection of microcalcification. METHODS: Fifty breast specimens with non-palpable microcalcifications were examined during surgical biopsy using both DIMA (4-fold) and conventional (1.5-fold) magnification specimen radiography. The number of detected microcalcifications of the whole specimen, of an area of 5 mm distance to the margins and of the area of the suspicious cluster of microcalcifications was counted and the results compared with the histological examination as a gold standard. RESULTS: In 50 specimen 2821 (1305 within 3 mm distance to the margins) microcalcifications were detected with the DIMA mammography technique compared to 1608 (446) microcalcifications with the conventional technique. This increased detection rate by DIMA-magnification radiography was accompanied by a decreased specificity in comparison to the conventional magnification radiography (33.3% DIMA versus 83.3% conventional) regarding the evaluation of presence or absence of carcinoma at the surgical margins. Differentiating the microcalcifications into calcifications belonging to the suspicious cluster and those that are located outside the cluster led to an increase in specificity (83.3% DIMA versus 100% conventional). CONCLUSIONS: The efficacy of breast specimen radiography in evaluating the presence or absence of carcinoma at the surgical margins by detection of microcalcification is not improved by 4-fold magnification radiography (direct magnification, DIMA) compared to conventional 1.5-fold magnification radiography due to an increase in false-positive results. Analysis of the attachment of the microcalcifications to the cluster can improve the specificity.

Biopsy↗
PubMed1999

[The demonstration of microcalcification in breast core biopsies: DIMA specimen radiography (7x) compared to the histopathological findings].

PURPOSE: Comparing the sensitivity in detecting microcalcifications in stereotactically guided core biopsy specimen of the breast of direct magnification (DIMA) specimen radiography (x7) with the histological examination. MATERIALS AND METHODS: In 52 patients 509 stereotactically obtained core biopsy (14-gauge) specimens of the breast were radiographed by direct magnification (DIMA) specimen radiography (x7) and examined histologically. RESULTS: In 188 specimen microcalcifications were detected by magnification radiography compared to 98 by histological examination. Only 3% of the specimen microcalcifications were seen exclusively in the histological examination. In core biopsies with malignancy the relative proportion of biopsies with radiologically detected microcalcifications was increased (59% versus 32%). CONCLUSION: Concerning the detection of microcalcifications in core biopsy specimen of the breast, the direct magnification (DIMA) radiography (x7) was superior compared to the histological examination. Due to the high relative proportion of biopsies with radiologically detected microcalcification and malignancy, we recommend a comprehensive histological examination of these specimen. Confirmation of microcalcifications in core biopsies should be achieved by magnification radiography to prove that the suspicious area in the breast was truly sampled. Specimen radiography simultaneously with the biopsy procedure can reduce the number of punctures in the process of documenting the presence of calcifications early in the biopsy procedure.

Biopsy↗
PubMed1995

[Transfemoral fenestration and stent implantation in aorto-iliac dissection].

Subacute left lower limb ischemia developed in a patient with aortic dissection. Angiography revealed a dissection of the aorta abdominalis and a severe stenosis of the left common iliac artery. The patient underwent successful percutaneous fenestration and intravascular stent placement. The patient is currently (4 month post-intervention) ambulating without any signs of the leg ischemia. Percutaneous balloon fenestration and, if necessary, stent placement should be considered as a treatment option and a alternative to surgery in selected cases.

Aortic Dissection↗
PubMed1995

Intermittent regional therapy with rt-PA is not superior to systemic thrombolysis in deep vein thrombosis (DVT)--a German multicenter trial.

In a prospective and randomized multicenter trial the efficacy of intermittent regional and systemic thrombolytic therapy for DVT was evaluated. 137 patients with phlebographically confirmed acute DVT above the calf region were treated with 20 mg of rt-PA for 4 h each day. Thrombolysis was applied either locally via a dorsal pedal vein of the firmly bandaged affected leg or systemically using a cubital vein. Treatment lasted for 4-7 days, and during this time unfractionated heparin was applied continuously with the dosage adjusted according to aPTT (1.5-2.0 times the normal value). A second phlebography was performed within 24 h after the end of treatment. Results were evaluated by an independent radiologist who was unaware of the treatment given. Significant thrombolytic results (e.g. lysis of more than 50% of the original thrombus and complete recanalization of all affected veins) were reached in only 1/3 of all patients. Rates of recanalization did not differ in both groups and bleeding complications occurred in 26.5%. We conclude that intermittent local or systemic application of 20 mg rt-PA seems to be ineffective in the treatment of DVT.

Adolescent↗
PubMed1993

Insufficient hemodialysis access fistulas: 18 months' experience in laser-supported dilation.

Patients with end-stage renal failure disease frequently develop venous stenoses or occlusions in their hemodialysis access fistulas caused by intimal fibrosis. A complete dilation with high pressure balloons up to 20 atm may be unsuccessful in those cases. We investigated two new pulsed dye laser devices for the ablation of obstructions, which were not adequately treatable with a previous balloon angioplasty. From November 1990 to April 1992 a total of 154 percutaneous transluminal angioplasties (PTAs) of hemodialysis access fistulas were performed. In 23 of them an additive laser angioplasty was necessary. Twenty patients with Cimino fistulas presented 28 stenoses and two occlusions, and three Goretex loops presented all occlusions. Two pulsed dye laser devices emitting at 504 nm and 595 nm wavelength were tested. Technical success was achieved in 22/23 cases, but clinical success was obtained in 20/23 patients because two early reocclusions caused by thrombosis appeared. Five restenoses occurred 2, 3, 10, and in two cases 14 months after angioplasty with a mean follow-up period of 13.5 (5-18) months. Pulsed dye laser ablation in hemodialysis access fistula lesions due to intimal fibrosis is a valuable enrichment of radiological recanalization techniques and an alternative to surgery if stand alone balloon PTA fails.

Angioplasty, Laser↗
PubMed1993

[Thrombotic and thromboembolic occlusions of leg arteries and bypasses. Short-term versus long-term lysis].

Since thrombolytic therapy is less invasive than operative thrombectomy, it is often used as initial treatment for thrombotic or thrombo-embolic occlusions of lower limb arteries or by-passes. We compared four patient groups with acute and subacute occlusions: 1. 19 patients with occluded by-passes treated by rapid lysis using 15.5 (2.5-35) mg rt-PA. 2. 12 patients with by-pass occlusions treated with initial rt-PA in a dose of 6.5 (2.5-12.5) mg followed by prolonged lysis with 5.6 (2.5-10) x 10(6) units of urokinase. 3. 16 patients with arterial occlusions treated by rapid lysis with 15 (2.5-25) mg rt-PA. 4. 14 patients with arterial occlusions given 10.5 (2.5-60) mg rt-PA followed by overnight treatment with 5.9 (2.5-15) x 10(6) units of urokinase. For by-pass recanalisation, prolonged lysis overnight had a success rate of 83% (10/12) which was better than short term lysis with a success rate of 74% (14/19). Similar results were obtained in arterial occlusions with a success rate of 86% (12/14) compared with 69% (11/16). Long term lysis did, however, have significantly more complications. In about one-third of cases further procedures had to be used in addition to lytic therapy.

Aged↗