Biomedical subjects
H Helmberger
Publications and source records attributed to H Helmberger.
Adenocarcinoma of the gastro-esophageal junction: CT for monitoring during neoadjuvant chemotherapy.
OBJECTIVE: A clinical study was performed to assess the diagnostic value of spiral CT for evaluation of response during neoadjuvant chemotherapy (CTx) in patients with adenocarcinoma of the gastro-esophageal-junction (GEJ). Results were compared to those of endoscopy. METHODS AND MATERIAL: Twenty-five patients with histologically proven adenocarcinoma of the GEJ scheduled to undergo neoadjuvant CTx were studied. Before CT examination, 1200 ml of a vanilla flavoured paraffin emulsion were applied orally to the fasting patients and 40 mg BuscopanR or 2 mg glucagon were injected i.v. for hypotonia. Iodine (100 ml) was injected automatically (3 ml/s) and the CT scan was started 10 s after complete administration of CM. For response evaluation to CTx, four standardized parameters were measured by two experienced, blinded radiologists. The results were categorized according to the WHO classification of 1981 and compared to those of endoscopy. RESULTS: In 24 of 25 patients endoscopic and computed tomographic response evaluation showed a close correlation (r = 0.96). CONCLUSION: Spiral CT with negative oral contrast agent is a suitable technique for monitoring of GEJ masses. In combination with standardized metric parameters it offers a quantitative response evaluation in patients with GEJ masses during neoadjuvant CTx.
Interventional radiology in the treatment of blunt liver trauma: case report with review of literature.
Hepatic trauma remains one of the most serious problems in abdominal injury. Whenever possible a non-resectional approach is clearly preferred. Refinements of interventional radiology as an adjunct to surgery in blunt liver trauma may play an increasingly vital role in reducing mortality. The literature is reviewed with reference to the diagnostic procedure and the treatment strategy in blunt liver trauma.
[Possibilities of spiral-CT for diagnosis of focal liver lesions].
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[MRI of the knee joint: first results of a comparison of 0,2-T specialized system and 1,5-T high field strength magnet].
PURPOSE: Diagnostic accuracy and image quality of a specialised system for MR examinations of peripheral joints were evaluated. MATERIALS AND METHODS: 20 patients with acute or chronic injuries of the knee were examined using a low-field MR system (0.2 T). For comparison, all patients were also studied with a 1.5 T high field strength magnet and all diagnoses were correlated with arthroscopic findings. RESULTS: We found compatible diagnostic accuracies (cruciate ligaments 90%, menisci 75-90%) and good image quality ratings for the low field system ("good" and "excellent" image quality in 83% of cases). CONCLUSION: The low-field MR-system offers low-cost MR examinations of peripheral joints with good image quality and reliable diagnostic information.
[Primary non-Hodgkin's lymphoma of the mandible: a rare differential diagnosis].
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[Volumetry of abdominal tumors. Problems--feasibility].
If multimodal tumor therapy in the abdomen is to be effective, exact staging is required for which one needs precise planimetric and volumetric data. The most important indication for clinically reliable volumetric determination of tumor size in the abdominal region is monitoring liver metastases during chemotherapy. Determination of volume can be effectively realized using 3D reconstruction. Therefore, the primary data set must be complete and contiguous. The mass should be depicted strongly enhanced and free of artifacts. At present, this prerequisite can only be complied with using thin-slice spiral CT. Phantom studies have proven that a semiautomatic reconstruction algorithm is recommendable. The basic difficulties involved in volumetric determination of tumor size are the problems in differentiating active malignant mass and changes in the surrounding tissue, as well as the lack of histomorphological correlation. Possible indications for volumetry of gastrointestinal masses in the assessment of neoadjuvant therapeutic concepts are under scientific evaluation.
[Role of i.v. cholangiography and ultrasonography in preoperative diagnosis before laparoscopic cholecystectomy].
In a prospective clinical study the relevance of i.v. cholangiography and ultrasonography for preoperative diagnosis before laparoscopic cholecystectomy was assessed. Imaging of the common bile duct was realized successfully via i.v. cholangiography in 96.3% of all patients. Compared with ERCP, i.v. cholangiography diagnosis proved correct in 91.6% of all cases with pathological depiction of the common bile duct. Ultrasonography offered a sensitivity of 97.8% for assessing the common bile duct diameter. However, the distinction between intraductal concrements and artifacts caused by air superposition may be difficult. I.v. cholangiography is the most sensitive and easy to realize diagnostic technique to identify concrements in the common bile duct. The results of this study indicate that a combined strategy of i.v. cholangiography and ultrasonography may replace ERCP for preoperative diagnosis before laparoscopic cholecystectomy, if there is a sufficient depiction of the common bile duct and without concrements in it.
[High-degree bilateral carotid stenoses].
The indication for carotid endarterectomy in patients with unilateral stenotic lesions as well as the operative risk in patients with bilateral disease is still controversial among experts. We performed a retrospective analysis in our patients with bilateral carotid endarterectomy. 578 patients underwent carotid endarterectomy at our institution from 1986-1992: 54 patients (9.3%) had bilateral carotid disease. 30% of these patients were asymptomatic and 16% had symptoms from both sides. Surgical results concerning the optimal restoration of blood supply (75%) and the occurrence of recurrent stenosis (8%) were comparable for patients with unilateral and bilateral carotid endarterectomy. On the contrary, in patients with bilateral carotid disease, both the operative morbidity (2.8%) and mortality (1.8%) were increased as compared to the total study population (1.9% and 0.45% resp.). Carotid endarterectomy is very effective in preventing stroke especially in patients with multiple vessel disease as compared to the natural history of these lesions.
Radiologic diagnosis and staging of gallbladder and bile duct tumors.
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[Spiral CT in aortic aneurysms. 2D and 3D reconstructions and CT angiography].
Spiral CT was performed in 8 normals and 40 patients with alterations of the large thoracic and abdominal vessels. It proved to be the ideal basis for 2D and 3D reconstructions. In 2D reconstruction the topographic aspects of aortic aneurysms were displayed better compared to the axial scans. In 3D reconstruction the segmentation of small vessels, and vessels running parallel to the scan plane showed problems. Stenoses were displayed unsatisfactory. In patients with aortic aneurysms 3D reconstruction showed well the location and dimension of the aneurysm as well as its position to branching arteries and the intraarterial thrombus. In case of dissecting aneurysms the true and the false lumen could clearly be distinguished. Colour-coded 3D reconstruction proved to be valuable to illustrate topographic information that could be detected only with difficulty on examining the original axial scan.
[CT arterioportography in the spiral technic for the demonstration of liver metastases].
CT arterioportography using indirect portal venous application of contrast media is the most sensitive preoperative diagnostic technique for detection of liver metastases. Spiral CT allows continuous examination of the liver (no gap) during a single breathhold. Due to short measurement times an optimized vessel and tissue contrast can be achieved during the portal venous phase. Compared with intraoperative ultrasonography CTAP using spiral CT offers similar sensitivity (96%) in the detection of liver metastases and thus emerges as an important technique for diagnosis and follow-up of liver metastases.
[The value of computed tomography in the diagnosis of the local and lymph node recurrences of head and neck tumors].
544 CT studies of 231 patients were evaluated retrospectively to assess the role of CT in posttherapeutic monitoring of patients with head and neck tumours. CT (80%) was inferior to clinical evaluation (87%) in diagnosing recurrent malignancy due to a lack of specificity (76 vs. 92%). With CT small recurrencies were missed. Occasionally evaluation of the oral cavity was impaired by metal artifacts (dental fillings). However with larger recurrent tumours, CT offered important additional information regarding extent, infiltration of deeper compartments and bony destruction in 51% of the cases. CT (95%) was superior to clinical evaluation (80%) in diagnosing recurrent lymph node metastases. A baseline CT study at about 6-8 weeks after the end of therapy is of great importance for follow-up studies.
Severe bilateral carotid stenosis.
An analysis of the relevant data from the Veterans Affairs Cooperative Study Group in asymptomatic patients, showed that 26 of the 32 ipsilateral strokes occurred during the first two years of clinical follow-up. Furthermore, as observed in the medical group, half the neurologic outcome events were strokes and were not preceded by transient ischemic attacks. In the North American Symptomatic Carotid Endarterectomy Trial over a 2-year period, 45 percent of those with occlusion had a stroke compared to 15 percent in the surgical group. These data dispel the traditionally held view that patients with severe contralateral disease should not be subjected to surgery. However, the referral of patients to centers capable of low rates of surgical complications is essential in a plan that includes carotid endarterectomy with optimal medical management.
[Computed tomography of diffuse liver diseases. 2. Hepatitis--vascular origins--storage diseases].
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[3D reconstruction of CT data sets. A methodologic comparison].
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[Computed tomography of diffuse liver diseases. 1: Study methods-- steatosis hepatis--liver cirrhosis].
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[Efficiency of CT-guided percutaneous drainage of an abdominal abscess].
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