Hydrocolonic sonography.
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Colonic Diseases↗
Biomedical subjects
M Düx
Publications and source records attributed to M Düx.
[Tenoplasty of the long head of the biceps in massive rotator cuff tear].
AIM: It was the aim of this study to investigate the success of biceps tenoplasty in massive interval rotator cuff tears. METHOD: Fifteen patients, who had a massive rotator cuff tear in the area of the interval and a pathology of the long head of the biceps tendon, were examined clinically and by MRI. A primary reconstruction of the rotator cuff tear was possible in none of the patients. All patients had a secondary reconstruction with a biceps tenoplasty. The Constant Score was determined postoperatively and the satisfaction of the patients was explored. RESULTS: The mean age at the time of the operation was 55 years. The examination was 23 months postoperatively. A simultaneous rupture of the supraspinatus- and subscapularis tendon was seen in 12 patients, an additional rupture of the infraspinatus tendon in 3 patients intraoperatively. The long head of the biceps was dislocated in 10 patients and subluxated in 5 patients. The postoperative determined Constant Score was 82.7 points. The personal satisfaction was investigated by asking for the German schoolmarks, which extend from 1 (excellent) to 6 (not satisfactory). The preoperative schoolmark was 5.2 and the postoperative schoolmark 1.4. In the MRI examination one rerupture could be seen, an atrophy of the supraspinatus tendon was evaluated in four patients. Knowing the postoperative result, all patients would have repeated the operation. CONCLUSION: The biceps tenoplasty is a suitable operative method to achieve a better function and relief of pain in massive interval rotator cuff tears with simultaneous pathology of the long head of the biceps tendon. A high degree of personal satisfaction for the patient can be achieved.
Adult↗
MRI for staging of gastric carcinoma: first results of an experimental prospective study.
PURPOSE: Our goal was to define the accuracy of MRI in the staging of gastric carcinomas. METHOD: Twenty consecutive surgical specimens were imaged immediately after gastrectomy for gastric carcinoma. Imaging was performed with a 1.0 T imaging system. T1-weighted, T2-weighted, and opposed phase images were acquired and analyzed for tumor infiltration of the gastric wall and the presence of perigastric lymph nodes. T and N stages were classified according to the International Union Against Cancer classification. Finally histopathologic staging of the specimens was compared with staging by MRI. RESULTS: In gastric specimens, three to five layers of the gastric walls were visible. There were typical signal intensity patterns on T1-weighted, T2-weighted, and opposed phase images. Tumor diagnosis and lymph node detection were best achieved by opposed phase imaging. Nineteen of 20 (95%) carcinomas were localized by MRI; T staging accuracy was 65%. The sensitivity to detect metastatic lymph nodes was 87%, specificity 60%. N staging accuracy (nodes positive versus negative) was 80%. CONCLUSION: High resolution MRI of gastric tumors is possible ex vivo. MRI enabled differentiation of up to five layers of the gastric wall, and therefore staging of gastric carcinomas is technically possible. However, to evaluate the exact role of MRI as a staging tool of gastric carcinomas, a correlation between MR morphology and the histologic structure of the gastric wall has to be achieved first.
Carcinoma↗
MRI of pouch-related fistulas in ulcerative colitis after restorative proctocolectomy.
PURPOSE: Our purpose was to determine the value of MRI in diagnosing pouch-related fistulas in patients with ulcerative colitis and to compare pulse sequences with and without contrast enhancement in their performance of visualization. METHOD: Forty-four patients with pelvic symptoms after restorative proctocolectomy underwent MRI. All 26 patients with pouch-related fistulas were treated surgically; 18 patients with pouchitis were treated conservatively. MRI was performed at 1.0 T with T1-weighted FLASH sequences before and after administration of Gd-DTPA, T2-weighted and proton density-weighted turbo SE sequences, and a T2-weighted fat saturation sequence. Images were analyzed for the presence of fistula; pulse sequences were additionally compared for best visualization on a four point scale of diagnostic confidence. RESULTS: MRI detected 23 of 26 cases of fistulas; there were no false-positive diagnoses. Surgery revealed fistulas in three cases in which no pathology was found on MRI. Two patients had a short sinus tract at the pouch-anal anastomosis, and a third patient had a pouch-vaginal fistula. The Gd-enhanced FLASH sequence obtained the highest score, and second best was the T2-weighted fat saturation technique. CONCLUSION: MRI is a valuable technique for diagnosing pouch-related fistulas, However, there are limitations in detection of short sinus tracts and pouch-vaginal fistulas. Highest diagnostic confidence is obtained with a Gd-enhanced FLASH sequence, which might be helpful after pelvic surgery or if the fact saturation technique is equivocal.
Adult↗
Helical hydro-CT for diagnosis and staging of gastric carcinoma.
PURPOSE: The purpose of this work was to define the accuracy of helical hydro-CT (HHCT) in the diagnosis and staging of gastric carcinoma. METHOD: One hundred twelve patients with gastric carcinoma were preoperatively imaged by HHCT. Gastric distension was achieved by ingestion of up to 1,500 ml of water. Bolus tracking was performed, and peristalsis was minimized by intravenously administered spasmolytics. Contrast material was then injected, and helical scanning was performed at the time of peak enhancement of the liver. CT images were analyzed for tumor infiltration of the gastric wall, and TNM staging criteria were applied according to the International Union Against Cancer (UICC) classification. The results were correlated with histopathologic findings. RESULTS: One hundred two of 115 (89%) gastric carcinomas were correctly diagnosed by HHCT. Small malignant ulcers (< or =2 cm) that corresponded to early gastric carcinoma were not visible on CT scans. T and N staging accuracies were 51% each; abdominal M staging was correct in 79% of all cases. The positive and negative predictive values of HHCT to foresee curative resection of gastric carcinoma were 75 and 84%, respectively. CONCLUSION: Mural thickening as well as marked contrast enhancement of the gastric wall are firmly related to gastric carcinoma. The accuracy of HHCT is acceptable for M staging but inadequate for local staging of gastric carcinoma. Nonetheless, HHCT is a useful guide for choosing between tumor resection and nonoperative treatment of patients. We therefore recommend HHCT as the method of choice for preoperative imaging of gastric carcinoma.
Adult↗