[34-year-old patient with headache attacks and hypokalemic hypertension].
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Adrenal Gland Neoplasms↗
Biomedical subjects
H Müller-Miny
Publications and source records attributed to H Müller-Miny.
Endoscopic manometry of esophageal varices: evaluation of a balloon technique compared with direct portal pressure measurement.
BACKGROUND/AIMS: Recently, a non-invasive endoscopic balloon technique for esophageal manometry was published. In the present study, we assess its methodological aspects together with the relationship to portal pressure. METHODS: In 20 patients with liver cirrhosis who had received an intrahepatic portosystemic stent-shunt (TIPS), we evaluated portal and variceal pressure before and after balloon occlusion of TIPS (random order). Portal pressure was measured continuously via a portal venous catheter, and variceal pressure was determined at the same time independently by two endoscopists using two balloon techniques (inflation until varix collapses; deflation until varix reappears). RESULTS: Overall, mean (+/-SD) portal pressure (28.5+/-7 mmHg) was significantly higher (p<0.001) than mean variceal pressure (24.4+/-6 mmHg). Balloon manometry-determined variceal pressure values were 10+/-15% higher with the inflation technique (26.2+/-7 mmHg) than with the balloon deflation technique (22.6+/-6 mmHg, p<0.001). Portal pressure and variceal pressure correlated significantly (p<0.001; balloon inflation: r=0.61, balloon deflation: r=0.66, mean values of inflation and deflation: r=0.68). Short-term TIPS occlusion led to mean increases of 52% and 35% in portal pressure and variceal pressure, respectively. The manometry results of both endoscopists correlated well with either balloon technique (r> or =0.93; p<0.001) and we saw no adverse effects. CONCLUSIONS: Variceal balloon manometry provides non-invasive variceal pressure data which correlate to portal pressure assessed prior to and after short-term TIPS occlusion. However, probably due to variance in collateral anatomy, variceal pressure does not exactly predict portal pressure and its acute changes in the individual patient. The averaged variceal pressure of the inflation and deflation balloon technique provides the best relation to portal pressure combined with a good interobserver reliability and warrants further clinical evaluation.
Adult↗
[TIPSS: technical and clinical results after 4 years].
PURPOSE: Retrospective analysis of the technical and clinical results after transjugular portosystemic stent shunt (TIPSS) procedure. METHOD: Between 1992 and 1996 we tried to establish a TIPSS in 90 patients. The indications were: recurrent variceal haemorrhage (n = 74), refractory ascites (n = 12), hepatorenal syndrome (HRS) (n = 4). Due to advanced liver cirrhosis 16 patients suffered of severe renal dysfunction (HRS). 57 patients had ascites. RESULTS: TIPSS implantation was technically successful in 96.7% (1992-1994: 5.1%, 1995-1996: 100%) of the patients. Complications occurred in 14.9% (1992-1994: 25.6%, 1995-1996: 6.3%). TIPSS-associated mortality was 2.3% (1992-1994: 5.1%, 1995-1996: 0%). 76.1% of the patients required reinterventions. 85.3% of reinterventions were necessary in the first year after TIPSS placement. The survival rate without reintervention was 28%, 21% and 9% for Child A, B, and C patients, respectively. Recurrent variceal haemorrhage occurred in 12.7%. De novo hepatic encephalopathy developed in 13.8%. Ascites improved in 79.2% and renal function in 75% of the patients. CONCLUSION: TIPSS is an effective method to treat recurrent variceal haemorrhage, refractory ascites and HRS. Complication and mortality rate depend on the investigator's experience and on the technique used.
Adult↗
Diagnostic value of MR imaging in comparison to CT in the detection and differential diagnosis of renal masses: ROC analysis.
The aim of this work was to compare MR imaging and CT in the detection of renal masses and in the differential diagnosis between benign and malignant lesions. In 33 patients with 54 renal lesions CT and MR images were evaluated by four readers with regard to tumor detection and characterization using a receiver-operating-characteristics (ROC) analysis. The MRI protocol consisted of a T1-weighted spin-echo (SE) sequence (TR/TE: 300/10 ms) before and after contrast administration and a heavily T2-weighted turbo-SE (TSE) sequence (TR/TE: 5500/150 ms). Az values for the area under the ROC curves for lesion detection were 0.92 +/- 0.04 for CT and 0.91 +/- 0.05 for MRI, respectively, which was not statistically different. The MRI technique was slightly, but not significantly, better than CT in the overall characterization (accuracy in differentiation between benign and malignant) of renal lesions with an Az value of 0.90 +/- 0.05 compared with 0.88 +/- 0.06 for CT. The MRI technique proved to be statistically superior to CT (p < 0.01) in the correct characterization of benign renal lesions. MRI equals CT in the overall detection and differential diagnosis of renal masses. MRI is very helpful for further differential diagnosis of lesions which are equivocal on CT especially in the differentiation between complicated cysts and cystic or hypovascular renal cell carcinoma.
Adult↗
[Standardized ultrasound study of the knee joint].
Explantation of the Standard sonographic views with corresponding MRI scans: The sonographic examination of the knee joint can supply additional information in many pathological conditions. In the standardised examination, ventral, lateral and dorsal sectional planes are obtained. In addition, special examinations for the anterior and posterior cruciate ligaments and the menisci can be performed. The important anatomic structures as visualised via ultrasound are compared with the corresponding MRI images. Ultrasound offers a safe, inexpensive way for additional imaging of the injured knee.
Equipment Design↗
[The typical radiological findings and course of invasive pulmonary aspergillosis in the immunosuppressed patient].
PURPOSE: This retrospective study was designed to show whether invasive pulmonary aspergillosis, which is often difficult to diagnose by bronchoscopy or serology, can be diagnosed at an early stage by typical radiological findings on conventional radiographs or by CT, specially high resolution CT (HR-CT). PATIENTS AND METHODS: In 19 Patients with 20 disease episodes, 20 thorax radiographs and eight spiral CT examinations were performed and in four cases HR-CT was also available. The earliest pathological findings and the course of the disease were analysed and the results of the various examinations were compared. RESULTS: 90% of chest examinations, including CT and HR-CT, showed the following lesions as part of the earliest changes: round or wedge-shaped opacities or the so-called "halo" sign. CT or HR-CT always demonstrated more lesions than plain chest radiographs; 75% of lesions appeared typical and thereby contributed to the diagnosis. CONCLUSION: The typical radiological findings of round or wedge-shaped opacities and the so-called "halo" sign are additional criteria for the diagnosis of invasive pulmonary aspergillosis. The superiority of CT or HR-CT in the demonstration of pathological changes suggests that these should be used early in the investigation of patients who are specially at risk.
Adult↗
[Comparison between direct radiographic enlargement and mammography technique in detection of osseous changes of the hand skeleton in hyperparathyroidism].
PURPOSE: To compare direct magnification radiography and mammographic film-screen systems in osseous changes of the hand in hyperparathyroidism. MATERIALS AND METHODS: The hands of 60 patients who were suspected to have primary (5), secondary or tertiary (both 55) hyperparathyroidism were evaluated with direct magnification radiography and a mammographic film-screen system (S12.5). Posterior-anterior views of each hand were obtained with both techniques. The magnification radiographs were made with a focal spot size of 40 or 60 microns, digital luminescence radiography (S600/1200), and a x 6 or 8 magnification. The 240 films were evaluated for subperiosteal, intracortical and endosteal resorptive changes by five radiologists using a grading according to five levels of confidence. RESULTS: A significant improvement (p < 0.05) in the diagnosis of periosteal and intracortical bone resorption was shown, but no significant changes in endosteal resorption with direct magnification radiography. As compared to mammographic film-screen systems, magnification radiography improved the diagnostic accuracy (24%). The time needed for the evaluation of periosteal and intracortical bone resorption was shortened with direct magnification radiography (-4%/ -15%), and the time for giving the diagnosis decreased (-10%).
Adult↗
[MRI of the pancreas: value of standard versus fat-suppressed pulse sequence at 0.5 T].
PURPOSE: To compare five pulse sequences in 60 patients with pancreatic disease by means of MRI at 0.5 T. METHODS: T1 weighted Spin-Echo sequences (T1W SE) before and after i.v. contrast medium administration, fat-suppressed T1W SE sequences after i.v. contrast medium administration, T2 weighted Turbo-Spin-Echo sequences (T2W TSE), and fat-suppressed T2W TSE were evaluated within an ROC study. RESULTS: The standard sequences (T1W SE before and after i.v. contrast medium administration, T2W TSE) were superior to the fat-suppressed T1W and T2W (T)SE sequences in delineating the anatomy and for correct diagnosis. The T1W sequence with and without i.v. contrast media detected all anatomic structures best. In most instances the correct diagnosis and coexistent findings in the diseased pancreas were obtained with the T2W sequence. CONCLUSION: Fat-suppressed sequences are less useful in the diagnosis of pancreatic disease by MRI at medium field strength compared to the standard sequences.
Diagnosis, Differential↗
[Isolated splenomegaly].
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Diagnosis, Differential↗
Splenic abscesses and abdominal tuberculosis in patients with AIDS.
Tuberculous splenic abscesses do virtually not occur in immunocompetent patients. Tuberculous abscesses have been reported only from areas, where the prevalence of both HIV infection and tuberculosis is very high such as Central Africa. In our institution two of seven patients with AIDS and disseminated tuberculosis who were treated during the year 1994 developed tuberculous splenic abscesses. Both patients were resident in Central Europe and had fever and weight loss prior to admission. Multiple hypoechoic lesions up to 1.5 cm in diameter developed in the spleen of both patients on day 11 and 16 after admission, respectively. Initially no symptoms related to the splenic involvement and no leucocytosis were seen in both patients. One patient developed leucocytosis and left sided flank pain caused by a subtotal splenic abscess because the diagnosis and therapy of tuberculosis was delayed. Both patients responded promptly to triple drug antituberculous therapy without surgical intervention. We conclude that also in European patients multiple hypoechoic/hypodense lesions in the spleen of HIV positive patients are highly suggestive of disseminated tuberculosis. Follow-up by ultrasound may help to establish the correct diagnosis and may further prevent unnecessary complications in these patients.
AIDS-Related Opportunistic Infections↗
[Nodular pulmonary opacities caused by a severe suppurative bronchitis and bronchiectases].
HISTORY AND CLINICAL FINDINGS: A 67-year-old man with chronic obstructive pulmonary disease (COPD) for many years and a heavy smoker was hospitalized because of increasing dyspnoea and moderately productive cough. His general condition was clearly impaired. He was markedly cyanotic, he had a barrel-shaped chest, and there were wheezing rhonchi throughout the lung. Body temperature was 37.8 degrees C. He had mild ankle oedema. The preliminary diagnosis was exacerbation of the COPD with global respiratory failure. TESTS: There was severe hypoxaemia (pO2 48 mm Hg) with hypercapnia (pCO2 46 mm Hg). Vital capacity was reduced to 1.81, one-second forced expiratory volume 0.91. Chest radiograph revealed multiple nodular opacities, such as seen in bronchial carcinoma with metastases. But computed tomography showed fluid-filled bronchi. Bronchoscopy demonstrated large amounts of dirty-white, sticky secretions as high up as the trachea, confirming the preliminary diagnosis. Klebsiella oxytoca and haemophilus influenzae were cultured from the secretions. TREATMENT AND COURSE: Immediate administration of amoxycillin and clavulanic acid (2.2 g daily) quickly led to clinical improvement. Chest x-ray was normalized after 10 days. But long-term oxygen treatment was instituted because of persisting resting hypoxaemia (pO2 46 mm Hg), after which he was discharged free of dyspnoea. CONCLUSION: To clarify nodular pulmonary opacities in a chest radiograph computed tomography should be performed before bronchoscopy.
Aged↗
[Percutaneous drainage of refractory necrotizing tumors: experience in 9 patients].
PURPOSE: The ranking of percutaneous drainage treatment in necrolytic advanced tumours was assessed. METHOD: 9 patients with refractory symptomatic necrolytic tumours were treated for alleviation by percutaneous drainage. Additionally, an attempt to sclerose the necrotic cavity was performed in 6 patients (6 x mitoxantrone 30 mg/24 hrs, of which 1 x additionally 98% alcohol). RESULTS: In 5 of the 9 patients symptomatic relief was obtained, but complete sclerosing of the necrotic cavity succeeded in only two patients. In two patients with necrotic tumours of the pelvis there was a bacterial superinfection of the tumour necrosis. CONCLUSION: Percutaneous alleviation is only occasionally successful in patients with necrolytic tumours. Therapy becomes effective probably only in case of successful sclerosing of the tumorous cavity.
Adult↗
[Efficacy of high-frequency cinematography in diagnosis of dysphagia].
Dysphagia is a common symptom in clinical practice. Due to the broad spectrum of underlying diseases many disciplines are involved in the therapy and diagnosis of dysphagia, where radiology plays a central role. The radiologist is confronted with different diagnostic problems and has to choose the most appropriate type of investigation. In many cases no organic disorder can be demonstrated by clinical examination, endoscopy or conventional radiological techniques. In this setting cineradiography is an outstanding tool for finding functional or structural changes in the swallowing chain. This study underlines the efficiency of cineradiography in the diagnosis of dysphagia.
Adult↗
[CT follow-up after transjugular intrahepatic portosystemic stent shunt (TIPSS)].
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Adult↗
[Determination of the growth rate of tumor-like space-occupying lesions of the bones. A study of 1154 lesions of the long tubular bones].
In 1088 primary and secondary bone tumors and tumorlike lesions and in 66 inflammatory lesions, the growth rate was graded according to the Lodwick classification. Grade IA and grade IB were correlated with benign lesions in 99.8% and 91.3% of cases, respectively. In contrast, grade III and grade II were associated with malignant tumors in 100% and 89.6%, respectively. With increasing age, the proportion of malignant tumors among those graded as IB or II increased significantly. Tumors classed as grade IC were benign in 57.5% and malignant in 42.5% of cases. The growth rates of the individual tumor entities were analyzed.
Adolescent↗
[Aneurysmal bone cyst or giant cell tumor. The value of x-ray diagnosis for differential diagnosis].
Depending on analysis of radiographic morphology, location and patient's age of 72 aneurysmal bone cysts (ABC) and 47 giant cell tumours (GCT), the following criteria suggest an ABC with a high positive predictive value: location in the diaphysis (100%), in the shaft (92%), in the metaphysis or metadiaphysis (86%), patient younger than 17 years (97%) and growth rate grade Lodwick-IA (88%). GCT were selected via the following criteria: epimetaphyseal location (82%) and growth rate grade Lodwick-II (100%). In 14% of the cases, differential diagnosis between both entities is radiologically impossible.
Adolescent↗
[X-ray morphology of eosinophilic granuloma other than skull and spine].
The radiological findings in 39 patients with a manifestation of eosinophilic granuloma (e.g.) other than skull and spine were evaluated. The localisation was found in the femur (26%), clavicula (20%) and ribs (20%). The lesions were located in 81% in the diaphysis and in 9.5% either in the epi-metaphysis or epi-metadiaphysis. Associated periosteal reactions were observed in 38% of the patients, and were solid in 25%, lamellar in 10%, and in 3% complex. The majority of the tumours were classified as Lodwick IB lesions (41%). Lodwick IC lesions were seen in 13%, Lodwick II lesions in 25.5% and Lodwick III lesions in 20.5% of the patients. In patients below the age of 20 years the eosinophilic granuloma is characterised by a Lodwick IB lesion without or with a solid periosteal reaction, which allows differentiation from Ewing's sarcoma or osteomyelitis. Contrariwise, in patients above 20 years of age the e.g. appears with a higher Lodwick grade. Hence, differentiation, X-ray morphology, between e.g., metastasis, lymphoma, and multiple myeloma does not seem possible.
Adolescent↗
[Localization dependent patterns of findings in chondroblastoma].
In a retrospective study the radiographs of 48 chondroblastomas from the files of the Bone Tumour Registry of Westphalia were evaluated. The purpose of the study was to investigate whether chondroblastomas display localisation-dependent radiographic patterns. All radiographs were analysed using the Lodwick criteria. All chondroblastomas (mean age: 18 y., m:f = 1.25:1) showed a geographic pattern of bone destruction. 32 lesions affected long bones, 10 short bones, and 6 flat bones. Chondroblastomas localised in flat bones (Lodwick IA: 0%, IB: 33%, IC: 67%) demonstrated more aggressive patterns of bone destruction compared to lesions affecting long bones (Lodwick IA: 56%, IB: 31%, IC: 13%) or short bones (Lodwick IA: 40%, IB: 50%, IC: 10%). There was no difference between the three bone types in other radiographic patterns (periostitis, calcification, trabeculation).
Adolescent↗