Biomedical subjects

F Winkelbauer

Publications and source records attributed to F Winkelbauer.

At least 19 recordsLinked to original sources

PubMed1998

Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies.

OBJECTIVES: To evaluate and compare outcomes and complications in patients having undergone gastrostomy by surgical (SG), percutaneous endoscopic (PEG), or percutaneous radiological (PRG) procedure. DESIGN: Retrospective analysis. SETTING: University-based tertiary care center. PATIENTS: Of 82 patients who met inclusion criteria, 14 patients (median age, 40 years) received a surgical tube placement (SG), in 24 patients (median age, 55 years) a PEG procedure was performed, and in 44 patients (median age, 57 years) the tube was placed under fluoroscopic guidance (PRG). Indications for gastrostomy were similar in all groups, representing mainly cancer of the oropharyngeal, head and neck region (51 [61%]) as well as the upper gastrointestinal tract (6 [8%]), neurological disorders (15 [18%]), and others (10 [13%]). MAIN OUTCOME MEASURES: Catheter function rates, major and minor procedure-related complications, and survival. RESULTS: Median follow-up was 17.2 months. Ten patients (71%) died in the SG group 7 to 855 days (median, 67 days) after the procedure, 7 patients (29%) died 5 to 263 days (median, 103 days) after PEG placement, and 30 patients (68%) died within 3 to 621 days (median, 112 days) after PRG, of their underlying disease or disease-related complications; 1 procedure-related death occurred 6 days after radiological tube placement. We observed a rate of minor complications of 43% (6 patients), 33% (8), and 36% (16) and a major complication rate of 14% (2 patients), 17% (4), and 11% (5) in the SG, PEG, and PRG groups, respectively. Tube function rates at 1 year were 67% (9 patients) and 68% (20) in the SG and PEG groups, respectively, and 10% lower (39) in the PRG group, although the difference was not statistically significant. CONCLUSIONS: There is no major difference between SG, PEG, and PRG concerning procedure-related complications. Tube function tends to be inferior after radiological tube placement.

Adolescent↗

PubMed1998

[Treatment of arterial aneurysms of the pelvic leg vessels using dacron covered nitinol stents].

PURPOSE: To evaluate the success rates of the implantation of stent grafts in the treatment of peripheral aneurysms. MATERIALS AND METHODS: In 13 patients with 15 aneurysms at the common iliac artery (n = 6), external iliac artery (n = 1), hypogastric artery (n = 2), femoral artery (n = 2) or popliteal artery (n = 4), implantation of dacron-covered nitinol stents was performed. The patients were followed up for three to 20 months (mean, 8.8 months) with intravenous digital subtraction angiography, CT or colour-coded Doppler sonography. RESULTS: In all cases, the aneurysm was successfully occluded after stent implantation. In one case with a popliteal aneurysm, kinking of the vessel caused thrombosis of the stent. The stent was successfully reopened. The aneurysm however, had to be surgically treated 9 months later. The primary and secondary patency rates at 6 months were 93% and 100%, respectively. CONCLUSION: The method described might be an alternative therapy to surgery. There are some limitations in respect of treatment of popliteal aneurysms.

Adult↗

PubMed1997

Radiographic detection of intrabronchial malpositions of nasogastric tubes and subsequent complications in intensive care unit patients.

OBJECTIVE: The aim of our study was to illustrate the radiographic spectrum of the intrabronchial malposition of nasogastric tubes and subsequent complications, and to discuss the role of radiography in the detection of such malpositions. DESIGN: Retrospective clinical investigation. SETTING: Tertiary care university teaching hospital. PATIENTS AND METHODS: We reviewed chest radiographs of 14 intensive care patients with nasogastric tubes malpositioned in the tracheobronchial tree. The site and anatomic location of the malposition were recorded. Complications due to tube malpositioning were monitored on follow-up radiographs and on computed tomographic examinations, which were available in 4 patients. RESULTS: Nine of 14 nasogastric tubes were inserted in the right and 5 in the left tracheobronchial tree. Tube tips were malpositioned in the lower lobe bronchi (50%), the intermediate bronchus (36%), and the main bronchi (14%). There was perforation of the bronchial system with subsequent pneumothorax in 4 patients. In 4 other patients, pneumonia developed at the former site of the malpositioned tube tip. Radiographic detection of nasogastric tube malpositioning was prompt in 9 patients and delayed in 5 patients. CONCLUSIONS: Whereas clinical signs of nasogastric tube malpositioning in intensive care patients may be absent or misleading, chest radiography can accurately detect nasogastric tube malpositions in the tracheobronchial tree, may prevent complications, and avoid the use of further costly or invasive diagnostic techniques.

Adult↗

PubMed1997

Endovascular AAA treatment: expensive prestige or economic alternative?

OBJECTIVES: To compare the costs of endovascular aneurysm treatment versus open surgery during the perioperative period. METHODS: Retrospective analysis of a consecutive series of 44 patients undergoing infrarenal abdominal aneurysm repair from February 1995 to March 1996 at a university teaching hospital. RESULTS: No endovascular procedure was converted to open repair. Operative time was shorter for endovascular treatment (207.6 min vs. 229.1 min, n.s.), as well as postoperative intensive care unit stay (ICU, 22.7 h vs. 55.0 h, p = 0.017) and the postoperative recovery period (5.6 days vs. 13.3 days, p < 0.001). Open surgery generated significantly more costs (25,374.07 ECU vs. 22,268.78 ECU, p < 0.001), despite evaluation and a more expensive endovascular procedure (10,699.48 ECU vs. 4032.01 ECU, p < 0.001). During the study, costs for open surgery exceeded the cost for endovascular treatment by 13.95%. CONCLUSIONS: Endovascular aneurysm treatment is cost effective and less expensive than open surgery. The main reason for cost saving is faster patient recovery after surgery, associated with a shorter LOS in the patients treated with endovascular procedure.

Aged↗

PubMed1996

Two cases of fractured esophageal nitinol stents.

We report here on two cases of fractured nitinol stents in the esophagus. In case 1, the correctly inserted stent broke spontaneously shortly after insertion. In a second case, a nitinol stent broke after laser application due to tumor ingrowth with massive bleeding. In both cases, a second stent was implanted in order to reestablish food passage. The fracture of the stent in case 1 seemed to be caused by defective material, whilst in case 2 the stent broke because of thermal overstrain during laser application. The use of electrocoagulation or laser in the stent area should therefore be avoided; argon plasma coagulation may offer an effective alternative in treating tumor ingrowth. As there was a risk from piercing broken filaments with the second stent, covering a fracture using stents with tight walls or plastic tubes seems to be a more effective approach than the inserting an uncovered stent type.

Aged↗

PubMed1996

[Contrast media in peripheral angiography: does cost reduction mean loss of quality and safety? A reevaluation based on a randomized double-blind comparative study of ioxaglate versus iopromide].

PURPOSE: To evaluate whether meglumine-sodium-ioxaglate (Hexabrix) and iopromide (Ultravist) are identically appropriate for peripheral angiography. Outcome variables were pain, image quality and adverse events. METHODS: Sixty patients were included in a randomised double-blind study. In all patients an intraarterial digital subtraction angiography (i.a. DSA) of iliac and peripheral arteries was performed. RESULTS: Analysis of the study revealed no significant difference between both contrast media in terms of the main and additional outcome variables. In comparison to iopromide, ioxaglate caused milder pain sensations (VAS 4.70 vs. 7.76, p = 0.25). Mild adverse events were observed more frequently in ioxaglate angiography (11% vs. 0%, p = 0.1). CONCLUSION: Both contrast media seem to be appropriate for peripheral angiography using DSA technique. Ioxaglate causes a cost reduction of about 20-35%. However, an increase of mild adverse reactions up to 11% to 15% has to be accepted.

Adult↗

PubMed1996

Modifications of the paraspinous muscle flap: anatomy and clinical application.

Soft-tissue defects of the back, particularly involving the paravertebral tissues, are generally covered with myocutaneous, muscle, or fasciocutaneous flaps. The case of a 64-year-old man with a paravertebral malignant fibrous histiocytoma is reported. To ensure adequately radical margins, the ipsilateral trapezius and latissimus dorsi muscles as well as the costal periosteum and the spinous processes were resected between T9 and T12. The resulting defect was covered with a pedicled latissimus dorsi flap and an island flap of the paravertebral muscles. Prompted by this case, we studied the blood supply of the paravertebral muscles in 10 cadavers. The vasculature was visualized after flushing with colored latex and microsurgical dissection. Another 4 specimens were subjected to angiography and tomography. In the majority of cases (8 of 10), three perforators emerging from the intercostal arteries were identified. These were found to communicate in a longitudinal and vertical direction. Before piercing the fascia, they ramified in three layers matching the layers of the paravertebral muscles. Since the intercostal arteries were shown to communicate through anastomoses of adequate caliber, the paravertebral muscles appear to be useful candidates for proximally or distally pedicled transposition or island flaps.

Aged↗

PubMed1994

[Ultrasound diagnosis of persistent varicocele after sclerotherapy].

252 consecutive patients with left-sided idiopathic varicocele were admitted into this prospective study. 30 patients did not receive a transcatheter sclerotherapy on account of their venous morphology on the selective phlebogram. Ultrasound examinations including Doppler sonography were performed before and 1, 3, and 6 to 12 (average 10) months after transcatheter sclerotherapy of the varicocele. For evaluation of therapeutic success the maximal diameter of the pampiniform plexus, the maximal diameter of the largest vein of the plexus, and, by means of Doppler ultrasound, reflux were measured. A continual decrease of these parameters was observed approximately one year after sclerotherapy. 9% of patients (20 patients) had a persisting varicocele. A premature decision for repeat sclerotherapy or operative correction of possibly persisting varicoceles can be avoided by employing a sonographical follow-up of more than 10 months.

Adolescent↗

PubMed1994

[Rate of thrombosis after cava filter implantation. Long-term results].

Thrombosis of the access site and occlusion of the inferior vena cava after placement of an inferior vena caval filter are known complications of caval interruption. 30 patients were evaluated with colour-coded Doppler sonography 4 to 66 months (average 2.5 years) after percutaneous placement of either a Günther filter, a Bird's Nest filter or a Simon-Nitinol filter. One right internal jugular vein had post-thrombotic alterations. One inferior vena cava was found to be occluded 15 months after Simon-Nitinol filter placement. The long-term occlusion rates of access site and inferior vena cava after percutaneous filter introduction are low. These two factors need not be considered if implantation of a caval filter is contemplated.

Adult↗

PubMed1993

[Value of ultrasound in follow-up of biliary metal stents--initial results].

Self-expandable metallic biliary endoprostheses (= "stents") are an accepted therapeutic alternative in the palliative treatment of malignant biliary obstruction. The physiological direction of bile flow is re-established for a varying period of time. Sonography is an acutely available modality for the evaluation of symptomatic patients who are carriers of such endoprostheses. The cause of recurrent obstructive jaundice can be diagnosed quickly and a new intervention can be planned carefully.

Adenoma, Bile Duct↗

PubMed1993

[Ultrasound diagnosis of cervical lymph node tuberculosis].

Lymph node tuberculosis is the most frequent tuberculous manifestation in the otorhinolaryngological area. In 13 patients with histologically verified tuberculous lymphadenitis cervical sonographic examinations revealed characteristic findings. The sonographic features typical for this disease were multiple, enlarged, conglomerating roundish and oval lymph nodes. These lymph nodes were hypoechoic, exhibited dorsal sound amplification and had sharp margins. With caseation, however, there were blurred borders. In cold abscesses an inhomogeneous texture with inhomogeneous shadows was found. Differential diagnosis included non-specific abscess-forming lymphadenitis, lymph node metastases and malignant lymphoma. A tentative diagnosis of cervical lymph node tuberculosis may be made due to the polymorphous sonographic pattern if history and clinical findings are taken into account. A proper histological and microbiological work-up is still essential for confirmation of the sonographic diagnosis.

Adult↗

PubMed1993

[Doppler ultrasound of the saphenous vein as a bypass. Detection of arteriovenous fistulae].

In 13 patients who underwent a femorodistal revascularisation with an in situ saphena vein graft and who had been operated on by angioscopic technique, intraoperative angiography and postoperative colour-coded Doppler sonography and i.v./i.a. digital subtraction angiography (DSA) were performed to detect arteriovenous fistulas (AV fistulas). In intraoperative completion angiography no AV fistulas were seen. Colour-coded Doppler sonography and DSA studies performed three to five days postoperatively revealed AV fistulas in 8 patients. The fistulas could be exactly located by sonography, and, if confirmed haemodynamically significantly by i.v./i.a. DSA, they were marked on the skin and ligated. In the detection of AV fistulas in in situ saphenous vein grafts operated by angioscopic technique colour-coded doppler sonography and i.v./i.a. DSA showed equivalent results. In the detection of connections of AV fistulas to the deep draining veins the i.v./i.a. DSA was superior.

Aged↗

PubMed1993

[The sonographic diagnosis of recurrences after parathyroid autotransplantation. The preliminary results of a prospective study].

Reactive renal hyperparathyroidism is a complication of chronic renal failure. The treatment of choice is resection of all four parathyroid glands and autotransplantation of a piece of parathyroid into the muscles of the fore-arm. In a prospective study, the transplant site was examined postoperatively in 35 patients by sonography on at least one occasion. In 3 patients (8.6%) enlargement of the autotransplant was observed and in 2 patients this was associated with clinical and biochemical changes; these were also confirmed histologically. The sonographic appearances of satisfactory and abnormal transplants are described. The value of the method remains to be determined.

Adult↗

PubMed1993

Diagnosis of hyperparathyroidism with US after autotransplantation: results of a prospective study.

The best treatment for reactive hyperparathyroidism, a complication of chronic renal failure, consists of resection of all four parathyroid glands and subsequent autotransplantation of parathyroid fragments into the brachioradialis muscle of the forearm. These procedures normalize the elevated parathyroid metabolism in at least two-thirds of the patients. In this prospective study, the parathyroid transplant was examined at least once with ultrasound (US) during postoperative follow-up for a maximum of 84 months in 22 women and 13 men who were undergoing long-term hemodialysis for reactive hyperparathyroidism. In 32 of these 35 patients, the graft-bearing forearm had a normal appearance on US scans. Three patients had one or two hypoechoic lesions 5-11 mm in diameter. Graft-dependent recurrent hyperparathyroidism was verified in two of these patients by means of clinical, biochemical, and histologic examination. It is concluded that US is effective in the recognition and localization of graft-dependent recurrent hyperparathyroidism.

Adult↗

PubMed1993

[Pseudo-faulty location of a Swan-Ganz catheter in a persistent left superior vena cava].

The insertion of a Swan-Ganz catheter may cause various complications including intravascular malpositioning due to congenital anomalies of the large veins. A persistent left superior vena cava is the most frequent anomaly of the large vessels. It is usually diagnosed either as an incidental finding at autopsy or during X-ray imaging for confirming proper position of central venous and pulmonary catheters. The incidence of this condition based on autopsy series is approximately 0.3%. CASE REPORT. A 52-year-old patient was admitted to the surgical ICU with the diagnosis of acute pancreatitis. Because of haemodynamic instability, a pulmonary artery flotation catheter was inserted via the left subclavian vein without difficult. The chest radiograph showed the catheter along the left border of the heart going into the right pulmonary artery. An angiographic examination with bolus contrast injection confirmed a persistent left superior vena cava. CONCLUSION. This type of malposition calls for further detailed diagnosis of the vascular status, as the knowledge of accompanying congenital cardiovascular defects is essential for further invasive diagnostic and surgical procedures. The intensivist should be aware of its occurrence in order to not mistake catheters as being present in the arterial circulation or malpositioned outside the venous circulation.

Catheterization, Swan-Ganz↗

PubMed1992

[The urethrocystogram and perineal sonography compared].

Perineal sonography and urethrocystography were performed on 45 patients in the same sitting to evaluate the sonographical method with regard to its applicability as a routine examination method. Corresponding results were obtained 14 times (= 30%). In 31 patients (= 70%) urethrocystographic and ultrasonic measurements diverged. The urethrocystogram must therefore remain an integral part in the work-up of urinary incontinence.

Adult↗

PubMed1992

The spine deformity index in osteoporosis is not related to bone mineral and ultrasound measurements.

In 34 female patients suffering from osteoporotic vertebral compression fractures, the spine deformity index (SDIM) was determined, according to the method of Minne et al (1988), to reflect the radiological severity of established osteoporosis. Peripheral (single-photon absorptiometry (SPA) of the non-dominant distal forearm) and axial (quantitative computed tomography (QCT) of the lumbar spine) bone mineral measurements, as well as the broadband ultrasound attenuation of the os calcis, were performed in the osteoporotic patients and in a control group of 20 age-matched women. No correlation could be found between bone mineral measurements and radiological severity of osteoporosis, expressed as SDIM. All three densitometry methods showed clearly reduced values in patients with vertebral crush fractures. Correlations established in the control group between peripheral and axial bone mass (SPA versus QCT) could no longer be found in the osteoporotic group, thus indicating changes in bone mineral density of the spine after the occurrence of osteoporotic fractures. Our data show that SDIM is an additional parameter of osteoporotic change in the spine, independent from bone mass measurements. In the management of osteoporotic patients, quantitative radiological methods (i.e. SDIM) in addition to densitometry might be of value for grading and monitoring the progress of disease.

Absorptiometry, Photon↗

PubMed1992

[Quality control of laser imagers].

Multiformat imagers based on laser systems are used for documentation in an increasing number of investigations. The specific problems of quality control are explained and the persistence of film processing in these imager systems of different configuration with (Machine 1: 3M-Laser-Imager-Plus M952 with connected 3M Film-Processor, 3M-Film IRB, X-Rax Chemical Mixer 3M-XPM, 3M-Developer and Fixer) or without (Machine 2: 3M-Laser-Imager-Plus M952 with separate DuPont-Cronex Film-processor, Kodak IR-Film, Kodak Automixer, Kodak-Developer and Fixer) connected film processing unit are investigated. In our checking based on DIN 6868 and ONORM S 5240 we found persistence of film processing in the equipment with directly adapted film processing unit according to DIN and ONORM. The checking of film persistence as demanded by DIN 6868 in these equipment could therefore be performed in longer periods. Systems with conventional darkroom processing comparatively show plain increased fluctuation, and hence the demanded daily control is essential to guarantee appropriate reaction and constant quality of documentation.

Diagnostic Imaging↗