Biomedical subjects

Lars Grenacher

Publications and source records attributed to Lars Grenacher.

11 recordsLinked to original sources

PubMed2006

Persistent left superior vena cava with absent right superior vena cava: morphological CT features and clinical implications.

Here we report a rare case of the persisting left superior vena cava with simultaneous absence of the right superior vena cava. This central venous variation has been identified during a routine chest CT scan as follow-up after colonic cancer in an asymptomatic patient with no previous history of heart diseases. Morphological features of this variation are illustrated on axial CT images and 3D image reconstructions. This anomaly occurs in 0.1% of the general population. In presence with the right superior vena cava it is the most common anatomical variation in the central venous system with a reported occurrence of 0.2-8%. Such condition can be associated with additional congenital cardiovascular malformations and heart diseases or rhythm abnormalities. Diagnosis can be difficult and is often achieved incidentally since hemodynamics in these patients can be normal and clinical symptoms are mostly absent. Important clinical implications include difficulties in central venous access or cardiac pacemaker placement as well as management consequences in cardiothoracic surgery. In conclusion clinicians should be aware of this anomaly and their clinical relevance to avoid possible complications.

Aged↗

PubMed2006

New coil concept for endoluminal MR imaging: initial results in staging of gastric carcinoma in correlation with histopathology.

Our aim was to conduct a prospective study to evaluate staging accuracy of a new coil concept for endoluminal magnetic resonance imaging (MRI) on ex vivo gastric carcinomas. Twenty-eight consecutive patients referred to surgery with a clinically proven primary gastric malignancy were included. Surgical specimens were examined with a foldable and self-expanding loop coil (8-cm diameter) at 1.5 Tesla immediately after total gastrectomy. T1- and T2-weighted and opposed-phase sequences (axial, frontal sections; 3- to 4-mm slice thickness) were acquired. Investigators blinded to any patient information analyzed signal intensity of normal gastric wall, gastric tumor, and lymph nodes. Findings were compared with histopathological staging. On surgical specimens, 2-5 gastric wall layers could be visualized. All gastric tumors (26 carcinomas, two lymphomas) were identified on endoluminal MR data (100%). Overall accuracy for T staging was 75% (18/24); sensitivity to detect serosal involvement was 80% and specificity 89%. N staging correlated in 58% (14/24) with histopathology (N+ versus N-). The endoluminal coil concept is feasible and applicable for an ex vivo setting. Endoluminal MR data provided sufficient detail for gastric wall layer differentiation, and therefore, identification of T stages in gastric carcinoma is possible. Further investigations in in vivo settings should explore the potential of our coil concept for endoluminal MR imaging.

Adenocarcinoma↗

PubMed2006

Interventional therapy of vascular complications following renal transplantation.

Renal transplantation is accepted as the preferred treatment for most cases of end-stage renal disease. Postoperative vascular complications include stenosis or thrombosis of the transplant renal artery or arteriovenous fistulas after biopsy. Impaired arterial perfusion of the transplant may be the leading cause for graft dysfunction or refractory hypertension. Therefore, non-invasive imaging modalities are required to detect and locate vascular complications with high accuracy. Doppler ultrasound is suited as a screening method for the detection of impaired graft perfusion. Magnetic resonance imaging (MRI) is used for an accurate diagnosis of vascular complications and to support decision for appropriate surgical or interventional treatment. Minimal invasive techniques like percutaneous transluminal angioplasty and stent placement have evolved as safe procedures with a high technical success rate reducing substantial morbidity. They can be considered as an alternative to surgical treatment of transplant renal artery stenosis (TRAS). Embolization of severe arteriovenous fistulas is the method of choice if the feeding artery can be occluded through a microcatheter. In selected cases, even catheter-guided fibrinolytic treatment of arterial thrombosis might be considered, if instantaneous surgery is considered a high-risk procedure. This article reviews the imaging features of common vascular complications after renal transplantation with focus on MRI. In addition, interventional radiological techniques are described for the treatment of TRAS, acute thrombotic occlusion, and arteriovenous fistulas.

Angioplasty, Balloon, Coronary↗

PubMed2005

The segments of the hepatic veins-is there a spatial correlation to the Couinaud liver segments?

PURPOSE: To investigate and describe the volume, position and shape of venous segments within the human liver and define their spatial correlation to the Couinaud segments (CS) and to the portal vein segments (PVS). MATERIAL AND METHODS: This study was based on 64 routinely acquired CT scans of patients undergoing hepatic surgery. The final analysis included 19 patients. All 19 CT data sets were transformed into 3D liver models. Three venous segments were postulated reflecting the left, middle, and right hepatic vein. Each venous segment was furthermore divided in two venous subsegments. Volume, position and shape of these venous segments/subsegments were calculated and, finally, compared with the volume, position and shape of the Couinaud segments and the portal vein segments. RESULTS: The right hepatic vein covers with 539.8 +/- 119.5 ml (47.1%) the largest part of total liver volume followed by the middle hepatic vein 372.7 +/- 151.1 ml (32.5%) and the left hepatic vein 248 +/- 75.9 ml (20.4%). The Couinaud liver segments and portal vein segments 2, 3, 5, 7, and 8 have consistent positional assignments within the three venous segments. Only the CS 4a, 4b, and 6 showed significantly different positions compared to the PVS 4a, 4b, and 6 (P < 0.03). The venous subsegments have a broad volumetric distribution reaching from 79 to 337 ml. There is no positional correlation of venous subsegments compared to Couinaud segments or portal vein segments at all (kappa < 0.75). In contrast, the venous segments/subsegments which can be assigned to either liver halve and either liver lobe have an identical volume, shape and position compared to the corresponding Couinaud liver segments (kappa > 0.75). CONCLUSION: The venous segments distinguish liver areas divided by the left and middle hepatic vein in exactly the same pattern as Couinaud segments and portal vein segments do. However, the comparison of shape and position of venous subsegments showed no correlation with both liver segmental approaches.

Adult↗

PubMed2004

Experimental functional analysis of self-expanding stents using a new developed ex vivo model.

OBJECTIVE: To modify an ex vivo test procedure for balloon expandable stents as a means to evaluate the mechanical properties of self-expanding stents. METHODS: Ten stents each of 7 different stent models measuring 10 mm in diameter (LUMINEXX Vascular Stent/Memotherm-FLEXX Vascular Stent [identical to Bard], Jostent SelfX, Jostent SelfX high radial force [Jomed], sinus-Repo stent, sinus-SuperFlex stent [Optimed], S.M.A.R.T. stent [Cordis], and Easy Wallstent [Boston Scientific]) were implanted in common iliac arteries taken from cadavers (n = 35). They were randomized to either the right or left bifurcation. The vessels were then maintained at 37 degrees C for 24 hours in a special solution that inhibited autolysis, making it possible for the stents to expand. Afterward, they were filled with silicone caoutchouc. After another 24 hours, the vessel walls and stents were removed from the hardened casts. By means of fine analytic measurements, we demonstrated that the volume of a hardened cast formed in the stent cylinder is an indirect but precise measure of the radial force of a stent. Furthermore, using correlation analysis, we examined the relationship between radial force and vessel diameter as well as that between radial force and the degree of arteriosclerosis. RESULTS: The differences between the actually measured volumes, ie, radial strength, (1 cm stent length) of the various stent models (LUMINEXX/Memotherm-FLEXX: 0.6198 mL +/- 0.1537 mL; Jostent SelfX: 0.6756 mL+/- 0.1298 mL; Jostent SelfX high radial force: 0.6321 mL+/- 0.1817 mL; sinus-Repo stent: 0.5508 mL+/- 0.1485 mL; sinus-SuperFlex stent: 0.6174 mL+/- 0.0953 mL; S.M.A.R.T. stent: 0.5627 mL+/- 0.1270 mL; and Easy Wallstent: 0.5613 mL+/- 0.1019 mL) were not statistically significant (P > 0.05), but the differences to the theoretically possible volumes that we had previously calculated were highly significant (P < 0.05). Correlation and regression analyses demonstrated a significantly stronger relationship between stent volume and vessel diameter than between stent volume and degree of arteriosclerosis. CONCLUSION: The modification of our ex vivo model of balloon-expandable stents now makes it possible for researchers to obtain comparable and realistic values for both the radial force and the expansion of self-expanding stents under realistic conditions. Our methods should therefore be employed as an additional procedure to optimize the preclinical evaluation of new stent during certification.

Adult↗

PubMed2003

Resistance to hoop stress in balloon expandable stents: evaluation in an ex vivo model.

RATIONALE AND OBJECTIVES: To develop a new model for a more realistic evaluation of radial strength and elastic recoil of balloon expandable stents using a new ex vivo model in human cadaver bifurcations of the aorta. MATERIALS AND METHODS: Four different stents (each group n = 10) were implanted in cadaver common iliac arteries. Randomization was performed either to right or left iliac artery. The specimens were cast filled with silicone caoutchouc and after 24 hours the vascular walls including the stents were removed from the hardened casts. The weight of the cast cylinders of the stents was measured in air and in purified water: the difference of the two values resulted in the buoyancy force and because of that the volume of the bodies as a relative degree for the radial strength could be calculated. The findings were correlated with the workbench tests of the manufacturers. RESULTS: Manufacturer's workbench tests were incomparable because of wide spread specifications. There was a significant difference between the theoretical maximal volume (0.866 mL) and the real cast volumes ( P< 0.025) that corresponds directly to the elastic recoil of the stents. The following mean real cast volumes were measured (corrected for 1 cm): Sinus-Stent 0.677 mL, Palmaz-Stent 0.708 mL, Jostent 0.715 mL, Saxx-Stent 0.732 mL, thus reflecting the various degree of radial strength; therefore, the ranking in radial strength resistance was Saxx, Jostent, Palmaz, and Sinus. CONCLUSION: High radial strength and low elastic recoil are important requirements of any stent design. Ex vivo tests unlike in vitro physical testing facilitate a realistic evaluation of the inherent stent characteristics. The model used in this study proved to be uniformly valid for physical stent design testing.

Adult↗

PubMed2002

Retained surgical sponge with migration into the duodenum and persistent duodenal fistula.

Migration of a retained surgical sponge into the bowel is a rare cause of bowel obstruction. Thus far, there have not been any reports that the site of initial migration of the sponge was identified by imaging studies or surgical exploration because the onset of symptoms is usually delayed. Unique about the case presented herein is that a barium meal follow-through study revealed a duodenal fistula that had developed after uneventful cholecystectomy due to a retained surgical sponge that had migrated into the duodenum and obstructed the distal jejunum. Imaging findings are presented and discussed.

Duodenal Diseases↗

PubMedDate not supplied

In vitro comparison of self-expanding versus balloon-expandable stents in a human ex vivo model.

The objective was to compare the radial strength and expansile precision of self-expanding stents and balloon-expandable stents in a human cadaver bifurcation model. Seven different self-expanding (LUMINEXX, JOSTENT SelfX, JOSTENT SelfX hrf, Sinus-Repo, Sinus SuperFlex, Easy Wallstent, SMART) and four different balloon-expandable stent models (Palmaz, Sinus Stent, SAXX Medium, JOSTENT peripheral), each type 10 stents (total n = 110 stents) were implanted into the common iliac arteries of human cadaver corpses. The maximum stent diameter was 10 mm for all models. After stent implantation, the specimens were filled with silicone caoutchouc. After 24 h, the vascular walls including the stents were removed from the hardened casts. Diameters were taken and the weight of the cast cylinders was measured in air and in purified water to calculate the volume of the bodies (according to Archimedes Law) as a relative but precise degree for the radial strength of the implanted stents. The cylindrical casts of the self-expanding stents showed lower mean diameters (8.2 +/- 1.0 mm) and mean volumes (0.60 +/- 0.14 ml/cm) than in the balloon-expandable stent group (10.1 +/- 0.3 mm and 0.71 +/- 0.04 ml/cm, respectively; p < 0.01). The nominal maximum diameter of 10 mm was not achieved in any of the self-expanding stents, but this was achieved in more than 70% (29/40) of the balloon-expandable stent specimens (p < 0.05). The variation between achieved volumes was significantly larger in self-expanding (range: 0.23-0.78 ml/cm) than in balloon-expandable stents (range: 0.66-0.81 ml/cm; p < 0.05). Self-expanding stents presented considerably lower radial expansion force and lower degree of precision than balloon-expandable stents.

Cadaver↗

PubMedDate not supplied

Radiofrequency thermal ablation: increase in lesion diameter with continuous acetic acid infusion.

PURPOSE: To evaluate the influence of continuous infusion of acetic acid 50% during radiofrequency ablation (RFA) on the size of the thermal lesion produced. METHODS: Radiofrequency (RF) was applied to excised bovine liver by using an expandable needle electrode with 10 retractable tines (LeVeen Needle Electrode, RadioTherapeutics, Sunnyvale, CA) connected to a commercially available RF generator (RF 2000, RadioTherapeutics, Sunnyvale, CA). Experiments were performed using three different treatment modalities: RF only (n = 15), RF with continuous saline 0.9% infusion (n = 15), and RF with continuous acetic acid 50% infusion (n = 15). RF duration, power output, tissue impedance, and time to a rapid rise in impedance were recorded. The ablated lesions were evaluated both macroscopically and histologically. RESULTS: The ablated lesions appeared as spherical or ellipsoid, well-demarcated pale areas with a surrounding brown rim with both RF only and RF plus saline 0.9% infusion. In contrast, thermolesions generated with RF in combination with acetic acid 50% infusion were irregular in shape and the central portion was jelly-like. Mean diameter of the coagulation necrosis was 22.3 +/- 2.1 mm (RF only), 29.2 +/- 4.8 mm (RF + saline 0.9%) and 30.7 +/- 5.7 mm (RF + acetic acid 50%), with a significant increase in the RF plus saline 0.9% and RF plus acetic acid 50% groups compared with RF alone. Time to a rapid rise in impedance was significantly prolonged in the RF plus saline 0.9% and RF plus acetic acid 50% groups compared with RF alone. CONCLUSIONS: A combination of RF plus acetic acid 50% infusion is able to generate larger thermolesions than RF only or RF combined with saline 0.9% infusion.

Acetic Acid↗

PubMedDate not supplied

Limits of Couinaud's liver segment classification: a quantitative computer-based three-dimensional analysis.

PURPOSE: Traditionally, liver surgery relies on Couinaud's liver segment classification. As the position and shape of these segments are variable and their borders are hidden within the homogeneous liver mass, the accuracy of segment identification methods needs computer-aided reevaluation. METHOD: The segmental liver anatomy of 23 patients receiving diagnostic helical CT scans because of suspected intrahepatic lesion was analyzed with the aid of a computer-based operation-planning system. We compared the standard Couinaud classification, which depends particularly on the main stems of portal and hepatic veins, with a method that calculates the segment borders by analyzing the complete portal venous tree. Volume, shape, and position of the liver segments found by each method were compared. RESULTS: With reference to the portal vein-based method, segmental volumes were overestimated by the classic Couinaud method by up to 24% and underestimated to 13%. Volumes of Couinaud segments 4a, 7, and 8 were generally larger compared with those obtained by the portal vein-based method, whereas segments 3 and 6 were smaller. Gross variations were found in segments 5, 7, and 8. When shape and position were considered, poor correlation was found for five segments (median kappa = 0.35-0.45). Only segments 2, 7, and 8 had kappa values clearly above 0.45 in the majority of cases. The plane that divides the two hemilivers along the middle hepatic vein and the border between the left sector (segments 2 and 3) and the medial sector (4a and 4b) were found in both methods with very good conformity (kappa > 0.75). CONCLUSION: Couinaud's method of dividing the liver into eight autonomous liver segments has to be accepted as a good approximation. Nevertheless, the volume, position, and shape of these segments and their segmental borders show significant variability.

Adult↗

PubMedDate not supplied

Magnetic resonance imaging for local staging of gastric carcinoma: results of an in vitro study.

OBJECTIVE: Preoperative staging of gastric carcinoma is limited by the fact that available imaging modalities do not enable accurate evaluation of the depth of infiltration of the gastric wall. The aim of this study was to evaluate the efficiency of conventional magnetic resonance imaging (MRI) in local staging of gastric carcinoma. METHODS: Sixty-five specimens of patients with proven gastric carcinoma were examined immediately after gastrectomy. Examination was performed with a 1-T MRI and included T1-weighted, T2-weighted, and opposed phase images. Images were analyzed for the number of visible wall layers and their signal intensity characteristics, for tumor localization and depth of infiltration. T-stage was classified according to the TNM system. Finally, the staging by MRI was compared with the histopathological staging of the specimens. RESULTS: The mucosal, submucosal, and proper muscle layers could be differentiated by the typical signal intensities. Depiction of the subserosa or serosa was not possible. In 65 specimens, 67 carcinomas were found by the pathologist. Sixty-four of 67 (96%) histologically proven carcinomas were correctly localized by MRI; T-staging accuracy was 50% only, mainly because of overstaging pT2 tumors as T3. CONCLUSIONS: MRI enables differentiation of gastric wall layers and, therefore, technically allows the evaluation of the local tumor stage of gastric carcinomas. However, infiltration of the subserosal and serosal layer cannot be proved accurately. Overstaging pT2 tumors is one of the most predominant problems. Yet further technical developments in high-resolution imaging of the gastric wall may improve T-staging in the near future and overcome today's staging limitations.

Adenocarcinoma↗