PubMed Health⌕ Search

Biomedical subjects

H H Holm

Publications and source records attributed to H H Holm.

At least 19 recordsLinked to original sources
PubMed1998

Interventional ultrasound in Europe.

"Interventional ultrasound," defined as any diagnostic and therapeutic procedure performed under ultrasound guidance was first introduced in Europe, where its early development took place in Vienna, in Copenhagen, in Italy and in Switzerland. However, many of the applications of interventional ultrasound have been based on important pioneer work using other less-suitable needle guiding methods from the pre-ultrasound era. The European contributions to "interventional ultrasound" have especially been in the development of new puncture equipment, in the dissemination of various biopsy techniques, and draining procedures and, more recently, in the development of many different tissue-ablation techniques. The above contributions, which are outlined in this historical review, have, together with significant contributions from the rest of the world-not least from the United States and Japan-created a most efficient diagnostic as well as therapeutic tool for the benefit of our patients.

Europe↗
PubMed1998

Perioperative Doppler ultrasonography: renal detection of renal graft perfusion.

Irreversible damage of renal transplants may be prevented if insufficient graft perfusion can be detected perioperatively. Colour and spectral Doppler ultrasonography were performed in 30 consecutive renal transplants. The perfusion of the graft and the Resistive Index (RI) were evaluated perioperatively (perioperatively and less than 15 min postoperatively) and 24 h after the operation in all patients. In four cases (13.3%) RI > 0.9 was detected and immediate surgical correction of the cause led to a normalization (RI < 0.8) in all four cases. A RI < 0.9 required no intervention in 26 cases (86.7%). All renal grafts in this series were functioning 1 month postoperatively. In a comparative group, 30 consecutive transplants carried out at our institution without perioperative Doppler ultrasonography evaluation, a loss of four renal grafts perioperatively was recorded retrospectively. We conclude that perioperative ultrasonography Doppler evaluation may provide an easy applicable and reliable method for early detection of insufficient renal graft perfusion, allowing surgical correction before irreversible damage of the graft occurs. RI > 0.9 is pathological. A continuation of the study is required to clarify the long-term value of perioperative Doppler ultrasonography graft monitoring.

Adult↗
PubMed1996

Interventional ultrasound.

Interventional ultrasound, i.e., US-guided interventions, are diagnostic or therapeutic minimally invasive procedures guided by real-time ultrasound imaging, preferably using attachable needle steering devices. Guided fine- and coarse-needle biopsies of US-detectable abnormalities provide a firm basis for diagnosis and therapy. Multiple US-guided drainage and catheterization procedures such as nephrostomy, pleuracentesis, cholecystostomy, abscess drainage and central venous catheterization, etc., are rapid and safe alternatives to conventional drainage methods and open surgery. Devices and methods for US-guided minimally invasive focal tissue ablation are rapidly developing. Focal treatment of malignant tumours in the liver and prostate, using a variety of US-guided methods, are investigated. Complications of interventional ultrasound are reportedly low with a 0.19% overall complication rate and a 0.04% mortality rate. It is concluded that ultrasound provides a safe and cost-effective dynamic imaging modality for guidance of the increasing range of diagnostic and therapeutic interventional procedures.

Biopsy, Needle↗
PubMed1995

[Ultrasonic angiography: principles and clinical use].

A new technique for detecting blood flow called Colour Doppler Energy (CDE), Power Doppler or Ultrasound Angio, is based on the integrated power spectrum of the standard Doppler signal used for Colour Flow Mapping (CFM). CDE is independent of the insonation angle, has no aliasing artefacts and improves the sensitivity with respect to detection of the presence or absence of flow compared to CFM. However, CDE provides no directional or quantitative information about the flow. CDE is superior to CFM in detection of low velocity flow, perfusion in small vessels, flow in torsioned vessels and flow in multiple vessels in the same image plane. The clinical applications are reviewed. Complicated stenosis, renal perfusion, penile Doppler and scanning of the vessels of the extremities are examples where CDE improves sensitivity in detecting flow compared to CFM.

Angiography↗
PubMed1994

Surgical treatment of primary hyperparathyroidism.

One hundred and two patients with primary hyperparathyroidism underwent a total of 108 bilateral neck explorations with attempted identification and biopsy of all four glands. Hypercalcaemia was surgically eliminated in 97 of 102 patients (95%). Of the remaining hypercalcaemic patients one was cured by percutaneous ethanol injection and one was reoperated and cured in another hospital. Three patients with persistent hypercalcaemia refused reoperation. Transitory hypocalcaemia with a median duration of 15 days was found in 36 patients, and permanent hypocalcaemia in two patients (1.9%). Permanent paralysis of the recurrent nerve occurred in three patients (2.9%). Twenty-one patients developed other postoperative complications from which they all recovered without sequelae. No postoperative deaths occurred. Our results show that surgical treatment of primary hyperparathyroidism--including bilateral neck exploration and attempted biopsies of all parathyroid glands--is safe with a high cure rate.

Adult↗
PubMed1994

Transabdominal and endoluminal ultrasonic scanning of the lower ureter.

I.v. urography is often insufficient for visualization of the intramural and juxtavesical portion of the ureter. In 30 consecutive patients (July 1st 1993-January 31st 1994) where i.v. urography was inconclusive, but had evoked suspicion of pathology in--or adjacent to--the lower ureter, abdominal ultrasound (including color Doppler) and endoluminal (transrectal or -vaginal) ultrasound were performed. A final diagnosis was obtained in 26: Ureteric stone (14), prostatic cancer (4), bladder cancer (2), stricture of ureteric orifice (1), TURB sequelae (1), ureterocele (1), bladder stone (1), detrusor hypertrophy (1), normal ureter (1). Abdominal ultrasound scanning gave more, same, and less information than i.v. urography in 8, 8, and 10 cases, respectively. In 14 of 22 cases abdominal color Doppler revealed a unilateral abnormal "ureteral jet"--in 13 of the cases on the side with suspected obstruction. Endoluminal ultrasound scanning gave more, same, and less information than i.v. urography in 20, 4, and 2 cases, respectively. The 20 cases where endoscanning gave more information included detection of 14 distal ureteric stones. In 3 cases it identified other types of distal obstruction, in two cases it determined the length of cancer obstruction and in one it detected the presence of ureteral dilatation. It is concluded, that endoluminal ultrasound of the ureter is indicated when i.v. urography evokes suspicion of pathology in the intramural or juxtavesical part of the ureter.

Abdomen↗
PubMed1993

Abdominal ultrasound combined with histological and cytological fine needle biopsy of suspected ovarian tumors.

To investigate, in a population of women suspected of an ovarian mass, whether pelvic ultrasound (US) and US combined with US-guided fine needle biopsy (FNB) increased the detection rate and whether tumor specific diagnoses could be obtained, a cohort of 307 patients suspected of an ovarian mass underwent US examination as part of routine gynecologic work-up. In cases of solid or solid/cystic lesions a US guided FNB for histology as well as cytology was proposed. All 35 primary ovarian cancers, 6 of 7 secondary ovarian cancers, and 3 of 4 non-ovarian cancers were demonstrated on US. Among 17 cases with normal palpation and an ovarian mass on US, operation disclosed 3 ovarian cancers. FNB identified 24 of 27 primary ovarian cancers and 7 of 7 cancers of extra-ovarian origin. The use of US, in this study, increased the detection of masses in the pelvis and FNB provided a reliable verification.

Abdomen↗
PubMed1993

Ultrasonically guided chemical parathyroidectomy in patients with primary hyperparathyroidism: a follow-up study.

OBJECTIVE: We evaluated the long-term results in two different groups of patients with primary hyperparathyroidism treated with ultrasonically guided percutaneous ethanol (96%) injection into parathyroid tumours. DESIGN: A prospective long-term follow-up (more than 6 months). Ethanol (96%) was injected under ultrasonic guidance into biopsy verified solitary parathyroid tumours. Basic treatment included a maximum of three treatments with an interval of about 1 month (group 1) or 1 week (group 2). Dose of ethanol was half the volume of the parathyroid tumour. PATIENTS: Two different groups of patients with only one ultrasonically detected and biopsy verified parathyroid tumour were treated. Group 1 (n = 18) were treated regardless of the severity of the hyperparathyroid disease. Group 2 (n = 14) were selected for treatment either due to severe hypercalcaemic symptoms (n = 3), a high surgical risk (n = 5), or refusal of surgery (n = 6). MEASUREMENTS: The volume of the parathyroid tumours was measured as half the product of maximum length, width, and depth. Blood tests included measurements of ionized calcium, total calcium and PTH. RESULTS: In group 1, 12 of 18 patients (66%) could be followed more than 6 months. Follow-up ranged from 12 to 58 months (median 45 months). A significant decrease (P < 0.001) in serum concentrations of ionized calcium and total calcium was observed. Eight patients (44%) later underwent surgical parathyroidectomy. Injection therapy was regarded as successful in 10 of 18 patients (56%). In group 2, 11 of 14 patients (79%) were followed more than 6 months. Follow-up ranged from 18 to 50 months (median 39 months). A significant decrease (P < 0.001) in serum concentrations of ionized calcium, total calcium and intact PTH (1-84) was observed. Treatment was successful in 11 of 14 patients (79%). Two patients required parathyroid surgery. Re-examination with ultrasound showed a significant reduction in the volume of the treated parathyroid tumours. Fibrosis surrounding the parathyroid tumours was detected in eight of 10 patients who subsequently had operations. One patient from each group had a complication of a unilateral permanent vocal cord paralysis following injection therapy. CONCLUSION: Partial or complete long-term remission of primary hyperparathyroidism can be achieved using ultrasound-guided chemical parathyroidectomy. However, the intervals between treatments should be short and the treatment should be reserved only for patients not fit for surgery.

Adult↗
PubMed1993

Acute change in parathyroid function in primary hyperparathyroidism following ultrasonically guided ethanol injection into solitary parathyroid adenomas.

Ultrasonically guided percutaneous injection of 96% ethanol into solitary parathyroid tumours in patients with primary hyperparathyroidism may be used as an alternative to surgery in selected patients. Contrary to surgical parathyroidectomy, the acute changes in parathyroid function following ultrasound-guided chemical parathyroidectomy have never been described. Seven consecutive and highly selected patients with primary hyperparathyroidism were treated with ultrasonically guided injection of ethanol (96%) into solitary and biopsy-verified parathyroid tumours. Basic treatment included a maximum of three injections separated by intervals of 24 h. In six of the seven patients normal serum values of ionized calcium were achieved within 36-120 h (median 36 h) and normal serum values of intact parathyroid hormone within 6-78 h (median 24 h). Three patients received two injections and three patients three injections. One patient remained hypercalcaemic in spite of three injections. Subsequent surgery showed the patient to have two parathyroid adenomas, of which only one had been detected ultrasonically. The present study has demonstrate a fast normalization of parathyroid function following two to three ethanol injections into solitary parathyroid tumors in selected patients with primary hyperparathyroidism.

Adenoma↗
PubMed1993

Gastric and duodenal wall thickening on abdominal ultrasonography. Positive predictive value.

In a retrospective study, 79 patients with gastric (n = 59) or duodenal (n = 20) wall thickening on conventional abdominal ultrasonograms were included. To reduce bias, patients with a microscopic diagnosis of upper GI neoplasia present at the time of scanning were excluded. The final diagnosis was based upon endoscopy, operation, upper GI series, or autopsy. Among the 59 cases of gastric wall thickening, 33 (56%) proved to be gastric cancer, one (2%) was benign neoplasia, and 17 (29%) showed nonneoplastic pathology (ulcer, gastritis, fibrosis). In eight cases (13%) no gastric pathology was present in the final diagnosis, thus producing false-positive sonographic diagnoses. Among the 20 cases of duodenal wall thickening, five (25%) proved to be duodenal cancer and seven (35%) showed nonneoplastic duodenal pathology. We concluded that gastric or duodenal wall thickening shown on abdominal sonography is a significant finding indicating upper GI pathology (malignant or nonmalignant) in a high percentage of the gastric (86%) and duodenal (60%) cases.

Adult↗
PubMed1992

Bladder tumor control by abdominal ultrasound and urine cytology.

In 1983 our department introduced ultrasound with urine cytology instead of cystoscopy in the control of low risk bladder tumors. A total of 65 patients with exophytic, noninvasive bladder tumors (stage Ta, grades 1 to 3) underwent 340 ultrasound and urine cytology examinations. Positive diagnoses were confirmed by cystoscopy, and negative diagnoses were confirmed by either no clinical symptoms and negative ultrasound investigation at least 12 months later, negative cystoscopy or negative postmortem examination. Ultrasound revealed 13 tumors 2 to 25 mm. large and 11 were confirmed at cystoscopy. Ultrasound overlooked tumors in 2 patients. None of these tumors was larger than 2 mm. Urine cytology correctly indicated tumors in only 2 cases, falsely indicated tumors in 3 and missed tumors in 11. Results support the fact that ultrasound can continue to be used as an alternative to cystoscopy in selected bladder tumor control patients. Urine cytology had little predictive value in this study.

False Negative Reactions↗
PubMed1991

[The intraurethral plug. A new alternative in the treatment of women with stress incontinence].

The intraurethral plug has been developed for treatment of women with stress-incontinence. The plug is made of thermoplastic-elastomeric material and consists of a meatus plate, a soft stalk and one or two beads along the stalk. The individual plug is constructed on the basis of the result of the urethral pressure profile. The plug is removed manually prior to micturition and after micturition a new plug is introduced by the patient. A plug with two beads was employed in period 1 (seven days) and a plug with one bead for period 2 (seven days). Twenty-two patients completed period 1. Eight of these patients did not complete period 2, mainly on account of unchanged incontinence during period 1 or repeated loss of the plug with one bead. In periods 1 and 2, 73% and 79% of the patients, respectively, were both subjectively and objectively continent or considerably improved. This preliminary investigation demonstrates that the intraurethral plug may be an alternative form of treatment of women with stress incontinence.

Adult↗
PubMed1991

Long-term results of ultrasonically guided implantation of 125-I seeds combined with external irradiation in localized prostatic cancer.

Transperineal 125-iodine seed implantation guided by transrectal ultrasonography and subsequent external beam irradiation was employed in the treatment of 32 patients with localized prostatic carcinoma (16 poorly differentiated). Follow-up is currently 35-98 months with a median of 65 months. Distant metastases have developed in 18 patients, of whom 11 have died from prostatic cancer. Median change in prostatic volume was a reduction of 35%. Re-biopsy or transurethral resection of the prostate was performed in 25 patients after 1-4 years, revealing still malignant histology in 10 (40%), of whom 8 have developed distant metastases or died from prostatic cancer. Fourteen patients suffered from late complications of which surgical intervention was indicated in five cases. Nine patients are presently free of progression and prostate specific antigen is less than 0.5 ng/ml in 8 of these. The future role of ultrasonically guided implantation in the management of prostatic cancer is discussed.

Adenocarcinoma↗
PubMed1991

Ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia: an in vitro study.

Ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia is a new technique that involves placement of a laser fiber in solid tissue under ultrasound guidance followed by irradiation from within the area to be treated. We have previously described a diffuser tip modification of the bare laser fiber, that proved to produce spherical coagulations of predictable size. In the present paper we describe the development of an ultrasonically guided technique which permits simultaneous laser irradiation and interstitial temperature measurements under real time ultrasound monitoring. The laser lesion appeared on the ultrasound image as a hyperechoic area growing in size with time as energy was applied. Macroscopically the laser lesion emerged as a sphere with a central cavity delineated by a rim of charred tissue and beyond this a larger zone of whitish coagulation. The correlation coefficient (Pearson's r) between ultrasonically and macroscopically measured diameter of the laser lesion was calculated to r = 0.89. It is concluded that ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia may have a potential as a tool in the future treatment of ultrasonically visible neoplasias like liver metastases and prostate cancer.

Animals↗