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H J Brambs

Publications and source records attributed to H J Brambs.

At least 19 recordsLinked to original sources
PubMed1992

[Bile duct endoprostheses in tumor disease: when is the expense justified?].

Percutaneous transhepatic catheters should be reserved for the minority of palliatively treated tumor patients because of the chronic complications and the discomfort to the patients. Plastic biliary endoprostheses relief malignant obstructive jaundice in most patients sufficiently. Late complications such as occlusion and displacement occur relatively often. The major advantages of expandable metal stents are the relative ease and the low rate of complications during the insertion procedure. The wide lumen and the small surface ensure good flow of bile and reduce the risk of occlusion and cholangitis. However, further development is necessary and the very expensive devices should be restricted to those patients with long life expectancy.

Bile Duct Neoplasms↗
PubMed1992

[Acute diverticulitis--radiological and endoscopic studies].

In patients with suspected acute diverticulitis, plain abdominal radiographs may demonstrate free gas in the abdomen. Ultrasound can indicate the nature of disease but is not sufficient to assess the extent of the inflammation. If perforation is suspected, a water-soluble contrast agent should be used to demonstrate diverticulitis and peridiverticular abscess. Computed tomography is ideally suited for the evaluation of the disease. it permits the radiologist to tell the clinician the exact extent of the extramucosal inflammation and the involvement of adjacent organs and structures.

Acute Disease↗
PubMed1992

[The potentials and limits of blood-flow quantification in the peripheral arteries with MRT using a phase-mapping procedure].

MRT is able to demonstrate arteries while MR angiography can quantify blood flow by a noninvasive method. In the present paper blood flow measurements were carried out in four selected cases on the basis of phase mapping. In 3 patients with lesions in the pelvis or thigh, angiography was performed in order to localise the stenosis or occlusion and this was followed by quantitative blood flow measurements. The results showed that angiography may not always provide all necessary information concerning a haemodynamically significant stenosis. The method may also be used for quantifying blood flow in the renal arteries and that it has significant advantages over the colour Doppler method.

Aorta, Abdominal↗
PubMed1992

[Percutaneous transhepatic cholangioscopic color laser lithotripsy in bile duct calculi].

Tunable dye laser lithotripsy is an effective and low risk treatment in patients with bile duct stones in which transpapillary maneuvers failed. The percutaneous approach allows to introduce small caliber endoscopes (10.5 F) to fragment the calculi under vision. This technique was evaluated in 8 patients who had undergone a biliodigestive anastomosis or in whom the biliary calculi could not removed by standard retrograde treatment. Laser lithotripsy resulted in sufficient fragmentation in 7 patients. Bile duct clearance proved to be a particular problem with the percutaneous access. When a retrograde sphincterotomy is not possible an antegrade papillotomy must be attempted under fluoroscopic guidance. In bile duct strictures the implantation of expandable stents facilitates the passage of fragments and may prevent recurrent stricture and development of new stones.

Aged↗
PubMed1992

[Differential diagnosis of angiodysplasias using angiography and CT with special reference to the MR tomographic aspects].

The basic prerequisite for a rational therapy of angiodysplasia is differentiated diagnostics, especially the differentiation between arteriovenous malformations, haemangiomas, and venous malformations. Angiography reveals the arterialisation, arteriovenous fistulas, CT infiltrations of bone and soft-tissue. MRT demonstrates completely the extent of haemangiomas because of its bright signal intensity in the T2-weighted images. Hence, differentiation of malignant vessel tumours and malformations with rapid blood flow is possible, because the signal intensity is much lower in MRT. The three supplementary methods allow a correct diagnosis of angiodysplasia.

Angiodysplasia↗
PubMed1991

[Endoscopic retrograde pancreatography (ERP) in acute alcoholic and biliary pancreatitis].

An analysis of the ERP findings in 31 patients with acute pancreatitis enable us to define the terminology of the pancreatogram in these diseases. Irregularities of the ducts indicate previous damage to the organ. A frequent phenomenon is thinning of lateral branches, which can be explained by compression due to oedema. Early parenchymal staining indicates abnormal permeability of the duct epithelium. Cavities are an expression of acute pseudo-cysts. A sign characteristic of alcoholic pancreatitis is the presence of contrast defects due to protein plugs and due to increased viscosity of pancreatic secretions. These observations confirm the theory that protein precipitates due to abnormal secretions play an important role in acute pancreatitis.

Acute Disease↗
PubMed1991

[Intra-arterial angio-CT as a perfusion control before intra-arterial chemotherapy in bronchial, breast and liver tumors].

Intra-arterial angio-CT is used increasingly in the diagnosis of liver metastases since the sensitivity of this method is greater than that of IV-contrast CTs. We carried out this procedure in eight patients with inoperable carcinomas of the bronchus, eight patients with carcinoma of the breast, one patient with an hepatocellular carcinoma and one patient with carcinoma metastases, before starting intra-arterial chemotherapy or tumour embolisation. The procedure permitted optimal placing of the catheter to ensure complete perfusion of the tumour. Perfusion of normal tissue can be reduced to a minimum. Failure of contrast filling on the angio-CT indicates the presence of a second vessel supplying the tumour.

Angiography, Digital Subtraction↗
PubMed1991

[Intra-arterial chemotherapy in locally advanced breast carcinomas].

Transcatheter arterial chemotherapy with mitoxantrone was carried out in 9 patients suffering from advanced breast cancer. The anticancer agent was selectively injected in the internal mammary artery. In 2 cases the catheter was super-selectively advanced into a peripheral branch of the internal mammary artery supplying the breast carcinoma. No complication of the transcatheter treatment could be observed. CT examinations for controlling the catheter position showed perfusion of breast cancers between 40 and 90 per cent. Histological examinations of the 7 resected specimens revealed extensive necrosis in all cases. All 7 patients who underwent surgery have been without local recurrence for 3 to 12 months after treatment.

Adult↗
PubMed1991

[Coincidence of Gaucher disease with primary hepatocellular carcinoma].

Case report on a 48-year-old man with Gaucher's disease and a HBsAg-positive cirrhosis simultaneously. Postmortem examination revealed a hepatocellular carcinoma suggested by antecedent ultrasound examination. The coexistence of Gaucher's disease and hepatocellular carcinoma has not been described before. A possible relationship between Gaucher's disease and hepatocellular carcinoma is supposed due to Gaucher's disease and association to the hepatitis B infection.

Carcinoma, Hepatocellular↗
PubMed1991

[Combined intra-arterial chemotherapy and radiotherapy in inoperable non-small cell bronchial carcinoma].

The five years survival rates of patients with non-operable non-small cell lung carcinoma are between 6% and 9%. Multiple attempts have been made to improve the response rate and the survival of these patients with different chemo- and radiotherapy schemes. The systemic chemotherapy with cisplatin-vindesine is until now one of the most active treatments with a response rate of 40%, but it is limited because of its side effects and toxicity. Eleven patients are treated one to four times with an intraarterial infusion of 3 mg/m2 vindesine and 20 mg/m2 cisplatin into the tumor-feeding bronchial artery combined with a simultaneous radiotherapy (60 Gy). Until now no major side effects occurred and the systemic toxicity was insignificant. An objective tumor response was encountered in 7/11 patients. The intraarterial chemotherapy combined with radiotherapy is strictly local and therefore effective especially in patients with limited or locally advanced disease.

Adenocarcinoma↗
PubMed1991

[Renal artery aneurysms].

Between 1980 and 1990, 21 patients with 26 renal artery aneurysms (0.4-16.5 cm in diameter) were diagnosed and treated at the Surgical Center, University of Heidelberg. Surgical reconstructive methods were applied to treat extrarenal and interventional embolization to treat intrarenal aneurysms. The most effective diagnostic method is selective intraarterial angiography. The etiology, age distribution, localization and clinical aspects are discussed. Four bleeding intrarenal aneurysms were embolized with full preservation of renal function (one solitary kidney). After surgical reconstruction of the aneurysmatic vessel, 80% of the hypertensive patients turned normotensive. Follow-up of a nontreated sacciform aneurysm showed total thrombosis within 4 years. In the same period, fixed renal hypertension developed in the patient because of recurrent microembolism in the renal parenchyma. Therefore, we suggest immediate treatment of a renal aneurysm to prevent the development of renal hypertension.

Adult↗
PubMed1990

[Therapy of bile duct occlusion. Transhepatic/endoscopic "Rendezvous procedure" and percutaneous transhepatic stent placement].

Conversion of a percutaneous transhepatic drainage (PTD) into internal drainage by transhepatic/endoscopic implantation of an endoprosthesis or percutaneous transhepatic implantation of a stent is a relatively simple technique associated with few complications. The advantage of both methods is that they can be performed if endoscopic placement of an endoprosthesis fails, as is often the case in patients with a prior Billroth II procedure or hepaticojejunostomy. Indications, methodology and experience with 29 patients treated with these procedures are described.

Biliary Tract Neoplasms↗
PubMed1990

[The sonographic image of gallbladder adenomyomatosis].

Compared with oral or intravenous cholecystography, a diagnosis of adenomyomatosis of the gall bladder is only rarely made by ultrasound. In nine patients this diagnosis was made by sonography and confirmed at operation or by cholecystography. In four patients it was an incidental finding during ERCP. The main feature is localised or generalised thickening of the wall of the gall bladder with a smooth outer contour. In seven cases there were small cysts in the wall and in two echogenic areas in the wall. An important criterion for distinguishing between inflammatory and neoplastic mural thickening is the contractility of the gall bladder.

Cholangiopancreatography, Endoscopic Retrograde↗