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Biomedical subjects

H J Brambs

Publications and source records attributed to H J Brambs.

At least 163 records · Page 9Linked to original sources
PubMed1994

[Diagnosis of fibrolamellar cancer].

A fibrolamellar carcinoma (FL-Ca) is a primary malignant tumor of the liver of unknown etiology, without cirrhosis and usually without an increase in tumor markers; it occurs mainly in young patients. As it can simulate malignant and benign tumors, particularly focal nodular hypoplasia (FNH), the diagnosis is difficult. Ultrasound and angiography show mostly uncharacteristic features, so ultrasound only has to ascertain that the tumor is there. Angiography can reveal vascular infiltrations and assess the resectability of the tumor, but diagnosis of FL-Ca is not always possible with angiography. CT has the highest specificity if calcifications are present, because calcifications in a tumor similar to FNH are pathognomonic for FL-Ca. By means of hepatobiliary functional scintigraphy FNH can be excluded. MRI seems to be important in differentiating the tumor from FNH, because the central scars of FL-Ca and FNH--if present--have a different signal intensity in T2-weighted images. The histological diagnosis of FL-Ca is also difficult. In patients with resectable tumors or prior to liver transplantation, an operative biopsy should be obtained to verify the diagnosis. In non-resectable tumors sonographic guided biopsy is justified.

Adult↗
PubMed1994

[Computed tomography of the paranasal sinus prior to endonasal surgery].

In a retrospective study 170 computed tomographies recorded in patients with chronic sinus disease were evaluated. The extent of sinus disease and the involvement of the different paranasal sinuses were well seen. Up to now 50 patients have undergone surgical treatment. The coincidence of the preoperative CT with the intraoperative findings was about 90%. Anatomic particularities of the paranasal sinus in an individual patient may predispose to recurrent sinusitis or mean there is an increased risk of intraoperative complications. The main risk factors are a far lateral location of the posterior ethmoid cells (28.8%), a much lower position of the cribriform plate in comparison to the ethmoid roof (11.8%), and extensive lateral aeration of the sphenoidal sinus (1.2%). All patients should undergo CT scanning in coronal and axial planes prior to endonasal sinus surgery. This gives a guide for detection of inflammatory lesions and anatomic variations or anomalies, thus making it possible to prevent intraoperative complications.

Humans↗
PubMed1994

Two different manifestations of botryoid sarcoma (embryonal rhabdomyosarcoma) of the biliary tree.

A 16-month-old girl and a 5-year-old boy with botryoid sarcoma of the biliary tree are presented. The girl's tumor infiltrated the liver, whereas the boy's tumor was confined to the extrahepatic biliary tree. Computed tomography not only enabled the evaluation of the tumor-surrounding structures, but also indicated the tumorous nature of the lesion following intravenous administration of a contrast agent. In cholangiograms, the exact extension of the intraluminal tumors could be differentiated by the typical bizarre filling defects.

Bile Duct Neoplasms↗
PubMed1993

Pancreatic and ampullary carcinoma. Ultrasound, computed tomography, magnetic resonance imaging and angiography.

Ultrasound remains the most readily available and least expensive of the imaging techniques used in assessment of the upper abdomen. Ultrasound is very useful in the detection of pancreatic tumors as well as in the evaluation of the extent of the disease. If ultrasound fails technically or is inconclusive, CT is recommended. Determination of CA 19-9 may help to decide whether ultrasound should be followed by CT or other examinations (51). Patients with any equivocal or inconclusive abnormality on ultrasound or CT should undergo ERCP. Even when ultrasound and CT of the pancreas appear normal there may be an indication for performing ERCP if the clinical suspicion of pancreatic cancer is still strong (52). Angiography is a reliable method of assessing major vascular tumor involvement, which to most surgeons would be a sign of unresectability. Although for some investigators CT is superior to angiography in assessing vascular involvement, angiography is performed preoperatively in many cases because it delineates the vascular anatomy, which can be abnormal in up to one third of patients. Percutaneous biopsy is an important technique for confirming the radiologic diagnosis of unresectable pancreatic carcinoma, particularly for differentiating pancreas carcinoma from other focal pancreatic lesions such as islet cell tumor, lymphoma, and chronic pancreatitis.

Adenocarcinoma↗
PubMed1993

[Modified implantation of a Wallstent in bile duct obstruction].

The self-expanding Wallstents are increasingly applied in malignant biliary obstructions. The deployment of the stent from the covering membrane is a relatively complicated mechanism susceptible to trouble. Sometimes the deployment of the stent from the catheter fails and the incompletely deployed stent has to be removed and rejected. In a total of 9 patients with malignant bile duct obstruction 11 deployed stents were inserted in a technical modification over a 10 F sheath. The proposed technique has the advantages of a reduction of costs and of an exact placement of the stent.

Aged↗
PubMed1993

[The role of embolization treatment of acute hemorrhage].

137 arteries of 95 patients were treated by transcatheter embolization for massive haemorrhage using Ethibloc, Gelfoam, wire coils and Tissucol (Fibrinogen + Thrombin). The bleeding was secondary to trauma in 23 patients, to neoplasms in 16 patients and to vascular malformations or chronic inflammatory processes in 41 cases. 15 patients were treated for iatrogenic bleeding following surgery. Bleeding was referred to haemoptysis (n = 27), pelvic (n = 24), renal (n = 16) or gastrointestinal haemorrhage (n = 13) as well as several other diseases (n = 15). Most patients were poor surgical candidates. The overall bleeding control rate was 89.5% with a incidence of recurrent bleeding in 14 out of 95 patients (14.7%) treated by re-embolization or surgery. 6 patients died (6.3%) due to intractable haemorrhage, 4 patients (4.2%) died of complications related to embolization procedure (4 x bowel infarction!) and 33 patients (34.7%) died of procedure-unrelated causes such as myocardial infarction, trauma, malignancy or other underlying diseases. 58 patients (61.1%) are still alive (follow-up 16.2 +/- 4.8 months). Significant complications (5.3%) included bowel necrosis (4x) and ischaemia of the spinal cord with incomplete paralysis in one patient. One patient suffered thrombosis of the common iliac artery due to angiography. On the basis of our results, peripheral embolization using Ethibloc can be recommended as palliative treatment for devascularisation of bleeding tumours. Satisfactory results are obtained in haemoptysis, renal and pelvic haemorrhage, but gastrointestinal bleeding should not be occluded by means of Ethibloc because of its considerable risk of bowel infarction.

Acute Disease↗
PubMed1993

[The value of the AMBER system in demonstrating intrathoracic space-occupying lesions. A comparative ROC study of the AMBER and conventional technics for postero-anterior views of the thorax. Advanced Multiple Beam Equalization Radiography].

Since October 1991 the AMBER technique has been used for the diagnosis of chest diseases in about 4,000 patients. The ability of this technique, compared with conventional methods, for demonstrating intrathoracic masses on p.a. views has been assessed. Amongst the patients there were 43 with coin lesions, 18 with hilar and 33 with mediastinal masses. ROC analysis showed the AMBER technique to be superior in demonstrating coin lesions (AMBER 0.92, conventional 0.85) and mediastinal masses (AMBER 0.89, conventional 0.73). There was a small, statistically not significant, disadvantage in the AMBER technique for demonstrating hilar masses (AMBER 0.80, conventional 0.84).

Chi-Square Distribution↗
PubMed1993

[Radiation sensitivity of the normal bile duct during high dose rate afterloading irradiation with Iridium 192. Experimental studies in pigs].

This animal study was designed to assess the tolerance of the normal bile duct to a single intraluminal high-dose-rate afterloading irradiation. This information is essential for treatment recommendations in irradiation therapy of malignant bile duct stenoses. In 16 pigs bile duct catheters were inserted surgically. Over these devices single intraductal doses of 7.5 Gy and 15 Gy were applied using an iridium-192 source. After a period of two to three months the bile ducts and the surrounding structures were investigated by means of cholangiography, angiography, and macropathological and histological investigations. A single intraductal dose of 7.5 Gy leads to a slightly scarred shrinkage of the bile duct with sclerosis and obliteration of the capillary vessels. Vasculitis and necrosis of the bile duct wall are still evident three months after irradiation. A single dose of 15 Gy leads to severe lesions with widespread necroses of the bile duct wall which tend to bleed, and result in a high degree of shrinkage of the bile duct. The radiation damage is most prevalent near the papilla and in the narrow segments near the liver. Single intraluminal high-dose-rate afterloading doses of 7.5 and 15 Gy cause significant lesions and complications at the bile ducts. As the intact bile duct is the Achilles heel of intraductal therapy, considerably lower single doses are recommended for a fractioned treatment.

Animals↗
PubMed1993

[Biliary cystadenoma].

Biliary cystadenomas are rare biliary ductal neoplasms of congenital origin. There is an excellent correlation between CT and sonographic findings for number, size and location of the lesions. However, sonography can demonstrate better morphologic features such as thickened wall, mural nodules and septations. CT shows more clearly the accurate size and location of the neoplasm to surrounding structures. Angiography is not diagnostic; however, it can help to distinguish between benign and malignant lesions. MRI provides useful information for surgical planning, demonstrating well the relationship of the tumor to vascular structures and other organ systems. Complete excision is the treatment of choice to prevent recurrence or malignant transformation of biliary cystadenomas.

Adolescent↗
PubMed1993

[Percutaneous intraductal ultrasound of the bile ducts].

Miniaturization of ultrasound probes (6 F, 20 MHz) enables to perform intraluminal sonography of the bile duct in patients in whom a percutaneous transhepatic access has been achieved for diagnostic or therapeutic reasons. Initial experiences in 13 patients with malignant bile duct obstruction and in 8 patients with benign bile duct disease are described. Intraluminal ultrasound displays the normal anatomy and pathologic processes of the bile ducts and reveals information on therapeutic procedures within the bile ducts. Malignant tumors and benign strictures can be differentiated in most cases. In malignant disease, this diagnostic method improves the difficult staging of bile duct tumors and gives information on tumor extension, infiltration of adjacent tissues and vessels, and lymph node enlargement. The limited penetration depth of 1.5-2.0 cm creates problems in the staging of tumors particularly at the hepatic hilum. The procedure is simple and devoid of risks, but requires some refinements and improvements to attain a wider use in different clinical problems.

Adult↗
PubMed1993

[Intraductal ultrasound of the bile ducts].

Intraluminal ultrasound with 12.5 and 20 MHz transducer allows precise analysis of the extrahepatic bile ducts and the adjacent structures. Inflammatory and malignant thickening of the bile duct wall can be assessed without difficulty. It is not possible, however, to differentiate between benign and malignant bile duct thickening, and for this purpose biopsy is required in addition. In tumor staging intraluminal ultrasound is superior to conventional ultrasound, because tumor infiltration into the adjacent tissues can be assessed and lymph nodes along the hepaticoduodenal ligament can be detected. Owing to the ultrasound frequencies available, local staging is limited to a circumference of 1.5/2 cm. Intraluminal ultrasound provides additional information that is useful in the diagnosis and therapy of bile duct stones and in different types of palliative tumor therapy. The procedure is simple and not too time consuming, and it involves no risks to the patient.

Bile Duct Diseases↗
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↗