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M Caselitz

Publications and source records attributed to M Caselitz.

At least 19 recordsLinked to original sources
PubMed2006

[Ultrasound education by simulator training high acceptance by ultrasound trainees of all qualification levels].

Ultrasound education improves by simulator training, however, the acceptance of ultrasound simulator training has not been investigated. Therefore we evaluated the participants response to simulator education during an ultrasound course of abdominal emergencies at an international ultrasound congress, at a regular ultrasound course and during courses at a regional hospital and an university hospital. Altogether, 62.3% of the participants judged the simulator image quality to be good. 84.3% considered the case selection to be good and 92.7% of the participants viewed the educational benefit to be good. 98.5% whished to have further ultrasound simulator courses to be developed and 95.3% of the participants opted for the integration of simulator training into the conventional ultrasound education.

Attitude of Health Personnel↗
PubMed2004

[Prognosis of hepatocellular carcinoma according to new staging classifications].

BACKGROUND AND OBJECTIVE: We investigated prognostic factors and survival of patients with hepatocellular carcinoma (HCC) in North-Germany. Established staging systems (Child-Pugh, Okuda and UICC classification) were compared with new prognostic scores from Italy (CLIP) and Spain (BCLC). PATIENTS AND METHODS: The clinical course of 62 consecutive patients (34-82 years, 48 males, 14 females) with HCC observed in the Medical School of Hannover from October 1996 to September 1998 were retrospectively analyzed. The patients were classified according to the staging systems of Child Pugh, Okuda, UICC, CLIP and BCLC. Follow-up ended on December 31 (st) 2001. RESULTS: Overall median survival was 11,3 (1 - 59,5) months. At univariate analysis (log-rank test) Okuda, UICC, CLIP and BCLC Score were each associated with a shorter survival. In contrast Child Pugh score provided no significant prognostication. By multiple regression analysis (Cox regression analysis), only the CLIP and UICC score and chronic hepatitis B infection were shown to be independent risk factors. CONCLUSION: Our investigations indicate, that the CLIP and UICC classifications identified those patients with the best prognosis and they, as well as chronic hepatitis C, were shown to be independent risk factors.

Adult↗
PubMed2004

[New concepts in ultrasound education in gastroenterology by simulator training].

Ultrasound is one of the most important imaging methods in medicine. However, ultrasound education is complicated by varying quantities and qualities of specific pathologies resulting from distinct patient collectives. Furthermore, under current clinical conditions ultrasound educators as well as trainees frequently lack the time necessary for a sufficient ultrasound education. Finally, current ultrasound education materials including "gold standard" images are not ideally suited for teaching scanning three-dimensional pathologies. In a direct cross over study we recently proved, that the ultrasound simulator we developed simulated the real patient examination reliably and reproducibly. By using this simulator as well in the classical beginner and advanced level courses as in focused courses of abdominal emergencies for instance, ultrasound trainees are able to practice scanning of well defined pathologies under realistic conditions, which has not been possible before. Furthermore, the ultrasound simulator is well suited for a structured ultrasound training in single hospitals as well as in continuous medical education. Finally, objective, standardized ultrasound quality control has become possible with the simulator.

Computer Simulation↗
PubMed2003

Increasing sensitivity of morphological diagnosis in hepatocellular carcinoma (HCC) by combination of cytological and fine-needle histological examination after ultrasound guided fine needle biopsy.

UNLABELLED: Increasing sensitivity of morphological diagnosis by combination of cytological and fine-needle histological examination after ultrasound guided fine needle biopsy in hepatocellular carcinoma (HCC). AIM: We investigated the factors which may affect the sensitivity of morphological diagnostics (cytology and fine-needle histology) in HCC after ultrasound guided biopsy. METHOD: In 62 patients, an ultrasound guided cytological (n = 62) and fine-needle histological (n = 45) biopsy was performed. In addition, the smears were investigated by cytophotometry (n = 62). RESULTS: Considering each method separately, the sensitivity of both cytological and histological diagnostics was about 80%. The sensitivity could be raised to 89% by combining the two methods. In seven patients, the HCC could not be primarily confirmed morphologically. In nine patients, the result of histological and cytological investigation was not congruent. With regard to the size of the biopsied lesion, tumor stage, cytophotometric finding and survival these 16 patients (group A) were compared with the 46 patients in whom the HCC could be primarily confirmed morphologically (group B). The statistical analysis did reveal a significantly lower percentage of tumors with diploid or tetraploid (euploid) cells in group B. Euploid tumors were significantly more highly differentiated. In patients with euploid tumors, the sensitivity of the cytological investigation was 67% and respectively 75% of the histological investigation. The sensitivity could be raised to 82% in this population by combining the two investigations. On the other hand in aneuploid tumors, the sensitivity could only be increased from 93% and 88% respectively to 97% by combining cytology and fine-needle histology. SUMMARY: Our investigations show that the sensitivity of morphological diagnostics can be raised especially in the highly differentiated HCC with a physiological DNA content by combination of cytological and fine-needle histological investigations.

Adult↗
PubMed2002

[Indicators for longterm survival after the transjugular portosystemic intrahepatic shunt procedure].

INTRODUCTION: Complications of portal hypertension can be treated effectively by the transjugular intrahepatic portosystemic shunt procedure (TIPS). Indicators for long time survival after TIPS implantation are presented. PATIENTS AND METHODS: From September 1992 until May 1995 forty-two consecutive patients (26 male, 16 female) with liver cirrhosis complicated by variceal bleeding (n = 27) or refractory ascites (n = 15) were treated by TIPS implantation and followed up clinically in a prospective, open study. The follow up period range was 5-3278 days. Univariate and multivariate regression analyses were applied to determine the correlation between patient characteristics and long term survival after TIPS implantation. The indicators were dichotomized at the median. The outcome variable was dichotomized. Positive outcome was defined as survival longer than three years without liver transplantation, all other outcomes were regarded as negative. Survival rates were determined for all patients and for subgroups according to results of the regression analyses. RESULTS: During follow-up liver transplantation was performed in 8 of the 42 patients. 29 patients died. Mean survival was 1440 (+/-1060) days. Survival after one, two, three and six years was 76% (n = 32), 69%(n = 29), 62% (n = 26) and 38% (n = 16), respectively. The multivariate regression analysis revealed a significant better survival related to a prothrombine time >70%, MEGX synthesis >30 microgram/l, and ICG clearance <13 min. Patients with high ICG clearance (OR = 1.9), high MEGX synthesis (OR = 5.0) or high prothrombine time scores (OR = 5.2) had a significantly longer survival. This survival advantage increased with follow up time. CONCLUSION: Longterm survival after TIPS implantation is influenced by the initial liver function. This survival advantage increases during follow up and is most pronounced after 6 years.

Adult↗
PubMed2001

[Hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber disease) and its manifestation in the liver].

M. Osler (Hereditary Hemorrhagic Telangiectasia, HHT) is an autosomal dominant inherited disease, with various vascular malformations. The genetic cause of this disease lies in different defects of transmembrane proteins (endoglin, activin receptor like-kinase 1) that can be defined as components of the receptor complex for transforming growth factor beta (TGF beta). Vascular malformations include the gastrointestinal tract and especially the liver. The location of mutations encoding hepatic involvement of M. Osler still remains unknown. These vascular malformations may lead to different shunts in the liver and can result to different complications like cardiac-insufficiency, portal hypertension and hepatic encephalopathy in adulthood. Color Doppler sonography is the method of choice for screening patients with M. Osler--suspected of having hepatic involvement. As in rare events conservative treatment of complications of hepatic involvement fail, embolization of the hepatic artery as minimal invasive therapy, surgical ligation of the A. hepatica and liver transplantation are possible treatment options. As there are only limited experiences with these therapeutic procedures patients with liver involvement should be treated at a center, where all therapy options are available.

Embolization, Therapeutic↗
PubMed2000

Comparison of portal venous flow in cirrhotic patients with and without paraumbilical vein patency using duplex-sonography.

AIM: In a prospective study we examined the effect of paraumbilical vein patency on the portal venous blood flow in patients with liver cirrhosis by Duplex-sonography. In this context we investigated the influence of the aetiology and the severity of cirrhosis on the development of venous paraumbilical shunts. METHOD: In 70 patients (Child A: 16; Child B: 27; Child C: 27) with cirrhosis of different aetiologies the portal venous flow velocity, the blood flow volume, and the diameter of the portal vein were examined by Duplex sonography after an overnight fast. RESULTS: 16 patients had a patent paraumbilical vein. The mean portal venous flow velocity (19.2 +/- 7.8 cm/s) and the flow volume (1.29 +/- 0.50 l/min) were significantly higher in patients with paraumbilical vein patency than in patients without paraumbilical shunts (14.4 +/- 4.6 cm/s; p = 0.029 and 0.88 +/- 0.34 l/min; p = 0.007 respectively). The prevalence of shunts of the paraumbilical vein in cirrhotics was significantly lower in category Child A (6.3%) than in Child B (25.9%; p = 0.011) and Child C (33.3%; p = 0.006). CONCLUSION: The occurrence of relatively high portal blood flow velocities in cirrhotics must remind the examiner of the potential existence of spontaneous portosystemic shunts. Those shunts must be carefully looked for with colour-Doppler ultrasound. In order to assess the true parenchymal blood flow we suggest to perform additional measurements of the right portal trunk and the left portal vein distal to the shunt. With an increase in the severity of liver cirrhosis the incidence of paraumbilical vein patency rises.

Adult↗
PubMed1999

[Atypical gallstone ileus: radiologic and sonographic findings].

We report on a case of an atypically located gallstone ileus as a rare complication of cholecystolithiasis. A 61-year old lady with a history of diabetes type II and nephrolitiasis presented with abdominal pain lasting for 8 days and with vomiting and diarrhoea. Physical examination revealed a palpable tumour and pain in the left lower abdomen. An extensive elevation of blood sugar, CRP and leukocytosis was found. Initially X-ray of the abdomen and sonography showed signs of a subileus. Additionally a 5 x 2 cm mass with dorsal shadowing was detected by ultrasound. Gallbladder and the biliary system were normal. The sonographic suspicion of a gallstone ileus was confirmed by a subsequent CT scan. Under operation the gallstone was found in the distal Jejunum. A gallstone ileus must be included in the differential diagnosis of a tumour in the left lower abdomen. A tumour with dorsal shadowing and signs of a subileus may be the only sonographic findings of a gallstone ileus.

Cholelithiasis↗
PubMed1999

[Treatment of multilocular hepatocellular carcinoma (HCC) of 4.5 cm and 3.5 cm diameter using percutaneous ethanol injection in a patient with advanced liver cirrhosis].

UNLABELLED: Treatment of hepatocellular carcinoma (HCC) with percutaneous ethanol injection (PEI) is established for tumors up to 3 cm. We report on treatment of a multilocular HCC with a maximum size of 4.5 cm. CASE REPORT: In a 76-year-old woman with a liver cirrhosis (Child C) due to chronic hepatitis C HCC with two nodules (diameter 3.5 cm and 4.5 cm) was diagnosed. Because of the patient's reduced general state of health and the advanced cirrhosis surgical treatment and chemoembolization were declined. The two nodules were treated in ten settings during 15 weeks under ultrasound guidance with 85 ml of 96% ethanol. There were no severe side effects. The patient's general condition improved and serum alpha-fetoprotein concentration decreased from 21,126 to 800 micrograms/l. Seven months after the diagnosis of the HCC she was admitted to another hospital due to a cerebral hemorrhage. A few days later she died because of a pneumonia. In spite of detailed micro- and macroscopically investigation no tumor was found during the autopsy. This case report shows that HCC up to a diameter of 4.5 cm can be effectively treated by PEI. This treatment modality is cheap and well-tolerated even in patients suffering from advanced cirrhosis.

Aged↗
PubMed1998

A multicenter, prospective, open label, randomized, controlled phase IIIb study of SH U 508 a (Levovist) for Doppler signal enhancement in the portal vascular system.

PURPOSE: Assessment of the accuracy of SH U 508 A (Levovist) enhanced Doppler sonography in the evaluation of blood flow abnormalities in the portal vascular system. METHOD: In an open label, controlled, prospective multicenter study, patients referred for Doppler sonography of the portal vascular system were randomized to receive SH U 508 A if indicated or to an observation group (ratio of 4:1). Patients who had diagnostically insufficient Doppler signals received SH U 508 A (2.5 g [200, 300 or 400 mg/ml]), followed by confirmatory dynamic CT. Corresponding patients in the observation group received alternative imaging procedure(s). RESULTS: Of 588 patients 265 patients received SH U 508 A. In 253 (95.5%) of these patients a diagnosis was possible following administration of SH U 508 A (Levovist). Diagnostic confidence improved from 35.3% to 89.7%. If compared with dynamic CT, SH U 508 A enhanced Doppler had a sensitivity of 80.5% and a specificity of 89.7%. Whereas diagnosis was not possible with SH U 508 A enhanced Doppler in only 12 patients, a diagnosis was not possible in 29 patients with dynamic CT. SH U 508 A enhanced Doppler in particular improved visualization of the portal vein (15.6%), TIPS (15.8%), superior mesenteric vein (16.1%), collateral circulation (20.7%) and inferior mesenteric vein (25%). SH U 508 A was very well tolerated; only eight patients experienced minor adverse events possibly related to SH U 508 A administration. CONCLUSION: SH U 508 A enhanced Doppler improved the diagnostic confidence and visualization of the portal vascular system compared to base line scans with insufficient Doppler signal and proved reliable compared to dynamic CT.

Adult↗
PubMed1998

Sonography under Daylight Conditions.

PURPOSE: Gray scale image assessment in clinical ultrasound requires working in dim light or a dark room. Daylight conditions offer the advantage of shorter visual reaction time and enhanced visual perception. Look-up table manipulations could improve image brightness. MATERIALS AND METHODS: We investigated the possibility of brightness and contrast enhancement of coloured adaptive linear look-up tables (CALUT's) and their artifact resistance. Therefore under real-time conditions red/brown, green and blue CALUT's were calculated using the gray scale distribution (mean and standard deviation) of the actual image. The changes in contrast of several structural features (echo-poor and echogenic lesions, artifacts) were assessed by clinical investigators (n = 7). RESULTS: The CALUT's produced, independent of the original, images with constant brightness and contrast. Even under daylight conditions no artifacts appeared. Under scotopic conditions the red/brown CALUT's showed the best results compared to the unchanged image and the gray, green, and blue CALUT's. Hyper and hypoechoic differences with small contrast to the surrounding tissue are enhanced and can be detected more easily. CONCLUSION: Daylight sonography allows examination even in non-darkened rooms without loss of information. Eye adaptation to changing light conditions is no longer necessary; the offered image information is more suitable for the eye.

Algorithms↗
PubMed1998

[3D and color Doppler ultrasound evaluation of cystic space-occupying lesion near the head of the pancreas].

AIM: Differential diagnosis of cystic lesions in the abdomen may be very difficult. We present the clinical manifestation and the diagnostic steps of a rare case of an aneurysm of the gastroduodenal artery mimicking a cystic lesion. We also discuss the imaging methods we used to verify the diagnosis such as colour Doppler sonography and 3D-sonography. METHOD AND PATIENT: A 42-year old woman with chronic pancreatitis was admitted to our hospital after an extended diagnostic program (sonography, computed tomography and laparoscopy) with the diagnosis of a pancreatic pseudocyst with vascular erosion. Using conventional sonography we found a cystic lesion of 5 x 5 cm diameter with parietal deposits between pancreas and coeliac trunk. After colour Doppler sonography we found an arterial jet in the cystic tumor; initially the source of the jet seemed to be the hepatic artery. We referred the patient to our department of radiology with the diagnosis of hepatic artery aneurysm. The aneurysm was confirmed by the angiography and was embolised with coils in the same session. However, the source of the aneurysm was not the hepatic, but the gastroduodenal artery. By postangiographical 3D-sonography we could clearly reconstruct the relation of the aneurysm to the gastroduodenal artery. CONCLUSION: Colour Doppler sonography should be the first imaging tool for clarifying cystic lesions in the abdomen. 3D-sonography is a reliable and useful method to identify visceral vessels of the abdomen. Nowadays the "gold standard" angiography should preferably be used as a therapeutic procedure.

Adult↗
PubMed1998

Percutaneous sonographic gastrostomy: method, indications, and problems.

OBJECTIVES: This study evaluated the application of ultrasound (US) guidance in the percutaneous placement of gastric feeding tubes in patients in whom endoscopic placement of a nutrition tube is not possible. METHODS: Thirty-eight patients with upper gastrointestinal obstruction were entered in a prospective study with US-guided nutrition tube application. Feasibility of placement, side effects, and nutritional states were monitored for a mean follow-up of 4 months. RESULTS: Ultrasound allowed rapid puncture after filling of the stomach with water through a nasal tube in 34/38 cases. In four cases a total upper gastrointestinal obstruction required an initial stomach insufflation through a direct puncture. Puncture-related major complications were not observed. Minor complications during the observation time were one late dislocation, five cases with broken material after about 6 months (four could be changed by using the Seldinger technique), and two minor local infections. The nutrition through feeding tubes stabilized body weight and body composition parameters. CONCLUSION: The percutaneous sonographic gastrostomy (PSG) is a safe and minimally invasive procedure for enteral nutrition in all cases with upper gastrointestinal obstruction when endoscopic placement of a feeding tube is not possible. Percutaneous sonographic gastrostomy may help to stabilize the nutritional parameters and general condition in patients with malignant diseases.

Adult↗
PubMed1998

Clinical outcome of transfemoral embolisation in patients with arteriovenous malformations of the liver in hereditary haemorrhagic telangiectasia (Weber-Rendu-Osler disease).

BACKGROUND: Arteriovenous malformations of the liver in Osler's disease may present as high output cardiac failure. A few case reports suggested that treatment with arterial embolisation may have beneficial effects in such patients. AIMS: To investigate the efficacy and safety of this treatment modality in a prospective pilot study. PATIENTS AND METHODS: Four women and one man (aged 39-59 years) with the dominant hepatic manifestation of Osler's disease presented with symptoms of cardiac failure and elevated cardiac output. Arteriovenous malformations were treated in three to five sessions with arterial embolisation using coils. The outcome was analysed by measurement of cardiac output and scoring of clinical symptoms. RESULTS: Embolisation was technically feasible in all patients and adequate occlusion of vascular malformations was achieved in four patients. After completion of therapy symptoms improved in four patients, while one patient suffered from abdominal pain due to cholangitis. One patient died seven months after the embolisation treatment from variceal bleeding. Mean cardiac output significantly decreased from 14.2 (range 12-17.3) l/min to 8 (range 5.9-10.6) l/min (p = 0.043). After a median follow up of 23 months (range 7-50 months), three of five patients had a long lasting improvement of clinical symptoms and cardiac function. CONCLUSIONS: This first treatment series of patients with dominant hepatic involvement in Osler's disease indicates that arterial embolisation may prevent cardiac failure by significantly lowering cardiac output.

Adult↗
PubMed1998

Hereditary hemorrhagic telangiectasia: effective protocol for embolization of hepatic vascular malformations--experience in five patients.

PURPOSE: To develop a hepatic artery embolization protocol and investigate its efficacy in a prospective study treating patients with hereditary hemorrhagic telangiectasia and predominant hepatic involvement. MATERIALS AND METHODS: One man and four women with hereditary hemorrhagic telangiectasia presented with symptoms of high-output heart failure, abdominal angina, or severe portal hypertension. The hepatic arteries were embolized in stages in three to five sessions at 1- to 15-week intervals. After peripheral embolization with polyvinyl alcohol particles, proximal arteries were embolized with coils. Computed tomography and assessment of cardiac output were performed before and after therapy and at the end of follow-up (median, 25 months; range, 12-55 months). RESULTS: After embolization, analgesics and antiemetics were necessary for a median of 5 and 2 days, respectively. Other than ischemic cholangitis (one patient), no complications were observed. The mean cardiac output decreased significantly (P < .05) from 14.2 L/min to 8.0 L/min. Symptoms of high-output heart failure, abdominal angina, and portal hypertension resolved in all patients. Seven months after embolization, one patient died of postoperative sepsis after an unsuccessful surgical attempt to create a portacaval shunt. Delayed recurrence of symptoms was not noted in the other patients. CONCLUSION: In symptomatic patients with hereditary hemorrhagic telangiectasia and predominant hepatic involvement, embolization of the hepatic arteries in stages is well tolerated by the patients and results in good clinical improvement at midterm follow-up.

Adult↗