Biomedical subjects

G Kacl

Publications and source records attributed to G Kacl.

7 recordsLinked to original sources

PubMed2000

Meningeal hemangiopericytoma in childhood.

Meningeal hemangiopericytoma (MHP) is extremely rare in childhood. Mean age at diagnosis is between 38 and 43 years. We present an 8-year-old boy with MHP of the middle cranial fossa. Imaging findings were indistinguishable from an aggressive bone tumor such as Ewing's sarcoma. Imaging findings are presented and discussed. Our case indicates that MHP should be considered in the differential diagnosis of skull-base tumors despite the fact that MHP is extremely rare in childhood.

Child↗

PubMed1999

Variable response to intracavernous prostaglandin E1 testing for erectile dysfunction.

OBJECTIVES: Anxiety and apprehension may negatively influence the erectile response to the first intracavernous injection with vasoactive agents. This may result in too many false-positive diagnoses of vascular insufficiency if the first injection ever made in a patient is used for color Doppler duplex sonography (CDS) evaluation. METHODS: One hundred sixty-eight consecutive patients (aged 18 to 75 years) with erectile dysfunction underwent a standardized evaluation, including the intracavernous injection test (ICIT) stimulated with 10 microg prostaglandin E1. Responses were recorded on a four-point scale: no response = 0, tumescence = 1, rigidity sufficient for intercourse = 2, full erection = 3. ICIT was repeated after 10 days and combined with CDS. The clinically assessed response to ICIT was correlated with end-diastolic flow velocity. RESULTS: Of 168 patients, 114 (68%) responded equally to the first and second ICIT, but 45 (27%) had an improved response, from tumescence to full erection in the second test (P <0.0001); in 9 (5%), the response deteriorated. The overall mean response was 1.6 (95% confidence interval 1.5 to 1.7) and 1.9 (95% confidence interval 1.7 to 2.0) (P <0.0001) for the first and second test, respectively. Of 168 patients, 89 (53%) responded with erections sufficient for intercourse when tested the first time and 104 (62%) did so after the second injection. CONCLUSIONS: Erectile response to diagnostic intracavernous injection of prostaglandin E1 significantly improved in the second compared with the first test. Therefore, cautious interpretation of CDS is advised when patients are injected for the first time because too many false-positive tests may result.

Adolescent↗

PubMed1998

Improved diagnostic accuracy in dynamic contrast enhanced MRI of the breast by combined quantitative and qualitative analysis.

To develop an optimized interpretation strategy of dynamic contrast enhanced breast MRI based on a combination of quantitative and qualitative criteria, the features of 120 histopathologically verified lesions were retrospectively analysed on contrast enhanced dynamically acquired (before and 1, 2, 4 and 7 min following injection of 0.2 mmol kg-1 gadolinium-DOTA) three-dimensional gradient echo images. Quantitative criteria, based on relative signal intensity measurements and qualitative morphological features, including lesion shape, margins and enhancement patterns were analysed in regard to differentiating malignant (n = 70) from benign (n = 50) lesions. Quantitative assessment of enhancement profiles was most accurate when analysis was based on early 1 min measurements. Using a 90% threshold, sensitivity and specificity in detecting breast cancer were 83% and 66%, respectively. When based on qualitative morphological analysis alone, sensitivity and specificity were 83% and 54%. Combined quantitative and qualitative assessment yielded a considerably higher sensitivity, specificity and accuracy of 93%, 74% and 85%, respectively. In conclusion, results from dynamic contrast enhanced breast MRI can be improved by basing the interpretation on both quantitative and qualitative criteria.

Adult↗

PubMed1997

Catamenial hemoptysis. Diagnosis with MRI.

Thoracic endometriosis is a rare disorder. We report a case of a 26-year-old woman with a 4-year history of catamenial hemoptysis due to thoracic endometriosis which was diagnosed by MRI and treated successfully by means of video-assisted thoracoscopic wedge-resection of the solitary pulmonary lesion. Medical therapy with hormones was not necessary. There is no evidence of recurrence 10 months after the operation. This case demonstrates that MRI of the chest may be considered for the diagnostic work-up of patients with catamenial hemoptysis. It also shows that wedge-resection of pulmonary endometriosis foci by means of video-assisted thoracoscopy-an approach that has not been described in the literature thus far-is an effective therapy in localized peripheral pulmonary parenchymal endometriosis.

Adult↗

PubMed1996

[The value of color-coded duplex ultrasound as standard assessment in erectile dysfunction].

Erectile dysfunction has taken on increasing importance in urologic practice. Still open is the question of which tests are mandatory for adequate clinical assessment of erectile dysfunction. One accepted standard modality is the intracavernous pharmacotest with vasoactive agents. In contrast, color duplex sonography is not considered mandatory although it reveals detailed information about penile vessels and functional implications. The question remains whether the information gained by color duplex sonography is relevant for therapy, making it an indispensable standard procedure. Patients with erectile dysfunction were evaluated, without preselection, by extensive history, clinical evaluation, laboratory tests, tumescence and rigidity measurements, intracavernous administration of vasoactive drugs and color duplex sonography. Seventy-nine patients were available for final analysis. Color duplex sonography revealed 39 normal tests, 16 arterial impairments. 19 venous leakages and 5 arteriovenous fistulae. Intracavernous vasoactive agents (pharmacotest) revealed 44 reactions sufficient for intercourse and 35 insufficient responses. In 89% of patients, the diagnoses on color duplex sonography and intracavernous pharmaco-testing were similar. The accuracy of the two methods in diagnosing erectile dysfunction was not statistically different (McNemar's test). In contrast to intracavernous pharmaco-testing, color duplex sonography permitted further etiologic subdivision into arterial disease, venous leakage, arteriovenous fistula and normal result. This was made possible by measuring significantly (P < 0.01) different arterial peak flow velocities, end-diastolic velocities and calculated resistance index. These data did not imply direct clinical consequences. Color duplex sonography and intracavernous pharmacotesting reveal comparable results concerning the diagnosis of an erectile dysfunction. In contrast to pharmacotesting, color duplex sonography reveals details of the nature of the erectile dysfunction. Because this information has no profound implications for the choice of therapeutic procedure, color duplex sonography can not be recommended as a standard procedure in the evaluation of erectile dysfunction.

Adolescent↗

PubMed1992

[The imaging diagnosis of sclerosing peritonitis (SP) following continuous ambulatory peritoneal dialysis (CAPD)].

Sclerosing peritonitis is a serious complication of CAPD characterised by thickened peritoneal membranes which lead to decreased ultrafiltration and intestinal obstruction. The roentgenographic signs of SP were analysed in 11 patients who underwent plain x-ray of the abdomen, follow-through examinations of the small bowel, ultrasonography and computed tomography. Results were correlated with the histological degree of SP. Besides the non-specific findings of intestinal obstruction, patients with histologically marked SP had loculated fluid collections, thickening of the bowel wall and/or peritoneum, peritoneal calcifications and thickened peritoneal membranes. Due to the fact that postoperative complications often occur in patients with SP, detection of the radiological signs should lead to cautious surgical interventions and changeover to haemodialysis.

Acute Disease↗

PubMedDate not supplied

Imaging diagnosis of sclerosing peritonitis and relation of radiologic signs to the extent of the disease.

BACKGROUND: Sclerosing peritonitis (SP) is a serious complication of chronic ambulatory peritoneal dialysis (CAPD) that is characterized by thickened peritoneal membranes, leading to impaired ultrafiltration and intestinal obstruction. The aim of this study was to analyze the radiographic signs of SP in symptomatic patients and to compare them with the histological severity of the disease. METHODS: In 14 patients with symptoms of intestinal obstruction related to SP, plain films of the abdomen, upper GI follow-through examinations, ultrasonography, and computed tomography were evaluated retrospectively. Imaging findings such as bowel motility, bowel wall and peritoneal thickness, and the presence of intraperitoneal fluid collections were correlated to the histological degree of the fibrosis. RESULTS: Signs of intestinal obstruction and disturbed motility were present in all cases. In addition, patients with histologically severe SP had loculated fluid collections, thickening of the bowel wall and/or peritoneum, peritoneal calcifications, and thickened peritoneal membranes, and suffered more often from postoperative complications. CONCLUSION: The detection of characteristic radiographic signs in CAPD patients presenting with symptoms of intestinal obstruction may suggest the presence of severe SP and should lead to cautious surgical interventions.

Adult↗