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M Libicher

Publications and source records attributed to M Libicher.

30 records · Page 2Linked to original sources
PubMed2000

[The intra-arterial calcium stimulation test in site diagnosis for surgical therapy of insulinoma].

BACKGROUND: Approximately 10% of all insulinomas--the most common neuroendocrine pancreatic tumor--occur in multiple sites of the pancreas (e.g., multiple endocrine neoplasia type I) and rarely as islet cell hyperplasia. Malignant insulinomas appear in 10% to 15% of cases. For these special groups and for patients with a reoperation preoperative localization of the tumour is advisable. With current imaging technology, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, and somatostatin receptor scintigraphy (SRS), localization of insulinomas is often inadequate. METHODS: In this study we report our results using intra-arterial calcium-stimulated venous blood sampling (ASVS) to localize and guide the management of insulinomas for patients with a reoperation because of recurrent insulinomas or persistent hyperinsulinism, for patients with malignant neoplasm and for patients with a previous abdominal operation. RESULTS: For all three cases the insulinomas were correctly localized by the ASVS in contrast to the preoperative imaging studies. CONCLUSIONS: Our experience and a review of the current literature demonstrate that ASVS is a highly accurate (sensitivity > 90%) and a safe method for preoperative localization of insulinomas. For patients with a reoperation ASVS is recommended and the extensive use of other costly preoperative methods should be avoided.

Adult↗
PubMed1999

Evaluation of angiogenesis and perfusion of bone marrow lesions: role of semiquantitative and quantitative dynamic MRI.

Magnetic resonance imaging (MRI) is a noninvasive technique that complements computed tomography (CT), conventional X-ray, and bone marrow biopsies by sampling a large volume of musculoskeletal bone and providing information that aids the diagnosis, staging, and follow-up of various lesions. Although less sensitive to the mineral components of bones, the MRI appearance of physiologic bone marrow is mainly a reflection of the relative amounts of red marrow, yellow marrow, and trabecular bone. Therefore, use of T1-and T2-weighted MR sequences with or without fat suppression currently remains the most common approach to musculoskeletal bone lesion imaging. An additional imaging strategy to characterize various bone lesions is the application of contrast-enhanced dynamic MRI. This article examines semiquantitative and quantitative dynamic imaging, evaluation, and postprocessing techniques in various benign and malignant musculoskeletal lesions. Practical guidelines for performing a dynamic contrast-enhanced MR examination are proposed.

Bone Marrow Neoplasms↗
PubMed1999

[Follow-up of TIPSS by color-coded duplex sonography using an ultrasonic signal enhancer. First results].

A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.

Constriction, Pathologic↗
PubMed1998

[After-care of TIPSS patients. Comparison between color Doppler ultrasound and portography].

PURPOSE: Comparison of color Doppler sonography and venous portography in patients with a transjugular intrahepatic portosystemic stent shunt (TIPSS). MATERIALS AND METHODS: In a prospective study 40 consecutive patients with TIPSS underwent venous portography and color Doppler sonography on the same day as follow-up. Shunt velocities were recorded within the TIPSS at the proximal (hepatic vein segment) and distal part (portal vein segment). RESULTS: In 28 patients with functioning TIPSS the mean shunt velocity ranged between 30 and 120 cm/s (median 60 cm/s) at the portal vein segment and between 60 and 155 cm/s (median 82 cm/s) at the hepatic vein segment. There was a significant increase of the mean shunt velocity in the hepatic vein segment (P < 0.001). In 12 patients with compromised TIPSS the mean shunt velocity was reduced to 26 +/- 7 cm/s at the portal venous end (P < 0.0001). CONCLUSION: Because of an accelerated shunt velocity in the hepatic vein segment a site-specific evaluation of both TIPSS endings is necessary with color Doppler sonography. In compromised TIPSS the shunt velocity is reduced at the portal venous end. Color Doppler sonography is a valid non-invasive means for follow-up of patients with TIPSS.

Adult↗
PubMed1998

[Use of the ultrasound contrast medium levovist in after-care of liver transplant patients. Improved vascular imaging in color Doppler ultrasound].

INTRODUCTION: A study was carried out to determine whether an improvement in the detection of vascular signals in patients after orthotopic liver transplantation can be achieved by the use of ultrasound contrast medium in colour Doppler sonography. MATERIAL AND METHODS: In the early postoperative follow-up of liver transplant recipients, 31 colour Doppler sonograms were obtained in 21 patients before and after intravenous injection of the ultrasound contrast agent Levovist (Schering, Berlin). A grading score with four categories was used to evaluate the sonograms with special regard to the visibility of colour and flow signals in the hepatic artery and also in the portal vein and the hepatic veins. The arterial and portal venous signals were evaluated in the hepatic portal and in the left and right lobe. RESULTS: With contrast enhancement significantly better arterial signals were seen in 20 of 31 sonograms for the hepatic portal, in 22 for the right lobe and in 26 for the left lobe. Better portal vein signals were obtained in 17 of 31 examinations for the right lobe and in 16 for the left lobe; only little improvement was obtained for the main stem of the portal vein. For the hepatic veins there was no significant improvement. CONCLUSIONS: Early vascular complications after liver transplantation usually occur in the hepatic arteries. With the use of contrast-enhanced colour Doppler sonography, better detection of arterial and peripheral portal signals can be achieved; peripheral portal vein branches can be helpful in finding small arteries.

Adult↗
PubMed1998

[Morphology and staging of primary mucosa-associated gastric lymphoma in hydro-CT imaging].

PURPOSE: Evaluation by hydro-CT in diagnosing and staging of primary non-Hodgkin lymphoma of the stomach (MALT). MATERIAL AND METHODS: 15 patients with MALT lymphoma underwent imaging by hydro-CT (helical CT scanning optimised for parenchymal and vessel contrast with distension of the gastric wall by water). The CT scans were evaluated for the site, morphology, extent and contrast enhancement of gastric lymphoma; in addition, the number and location of abdominal lymph nodes were examined. The results of CT imaging were compared with the findings at endoscopy + biopsy and endosonography and in case of gastrectomy also with the histopathological results. RESULTS: All lymphomas were correctly diagnosed and were mostly located in the distal parts of the stomach. MALT lymphoma typically grew submucosally, infiltration of the mucosa was rare. Most tumours showed marked contrast enhancement of the mucosa and poor enhancement of the submucosa. Hydro-CT and endosonography had similar accuracies in respect of staging of compartment I and II lymph nodes. Staging of distant nodal groups was more accurate by hydro-CT. CONCLUSION: Hydro-CT is non-invasive and may be used for diagnosis and staging of primary gastric lymphoma with a typical morphology of gastric lymphoma. Hydro-CT may be regarded as complementary to endosonography and is well suited for the initial diagnosis of gastric lymphoma as well as for the diagnosis of recurrent tumour.

Adult↗
PubMed1996

[Cicatricial small intestinal stenosis following chemotherapy for a gastrointestinal lymphoma].

HISTORY AND CLINICAL FINDINGS: 4 weeks after completing a course of chemotherapy for non-Hodgkin lymphoma of the jejunum a 45-year-old woman developed pain in the left upper abdomen and postprandial vomiting so that she could no longer take food by mouth. INVESTIGATIONS: On admission she looked cachectic and had obviously lost weight. Plain abdominal X-ray gave no evidence of perforation or ileus. Gastroduodenoscopy showed no local recurrence. But contrast jejunal radiography (after Sellink) demonstrated two severe band-like stenoses of the jejunum with prestenotic dilatation. As she had not had any previous operation or radiotherapy, cicatricial stenosis was considered as the most likely cause. As the symptoms continued and stenosing local recurrence could not be excluded, surgical resection was indicated. TREATMENT AND COURSE: Two cicatricial intramural stenoses of the proximal jejunum were found and histologically confirmed without evidence of lymphoma recurrence. After the operation the patient was again able to take food by mouth without problem. Follow-up examination 8 months later showed no recurrence and she was free of gastrointestinal symptoms. CONCLUSION: After chemotherapy for gastrointestinal lymphoma obstruction of the small intestine may occur due to chemotherapy-induced scarring.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

[Ultrasound of extracerebral spaces in infants: standardized examination technique].

High resolution ultrasound (5/7.5 MHz, linear array) allows imaging of the extracerebral space in infants. A standardised state-of-the-art imaging technique is described that can be performed during routine cranial sonography. Diagnosing dilated subarachnoid space is possible by comparison to normal values. Pathological findings of the subarachnoid and subdural space can be differentiated. Evaluation of the following conditions is possible: external hydrocephalus, cortical atrophy, pyogenic meningitis, subdural hematoma and hygroma. High resolution ultrasound can add helpful information in situations in which magnetic resonance imaging or computed tomography were previously needed. Since it is a noninvasive method, ultrasound is ideal for follow-up studies and hence the method of choice.

Dilatation, Pathologic↗
PubMed1995

Localized Langerhans cell histiocytosis of bone: treatment and follow- up in children.

We report a case of Langerhans cell histiocytosis (LCH) involving the right scapula in a 4-year-old child. Because of progressive shoulder pain and immobility methylprednisolone was injected directly into the lesion under computed tomography (CT) guidance. Follow-up studies with magnetic resonance imaging (MRI) and ultrasound (US) revealed continuous ossification of the osteolytic lesion with healing after 6 months. Plain films and CT confirmed the healing process. We consider intralesional corticoid instillation a safe method when performed under CT guidance. For initial evaluation and follow-up, MRI and US yielded reliable results in comparison to plain films and CT, thus helping to reduce the radiation dosage in children.

Administration, Topical↗
PubMed1992

US measurement of the subarachnoid space in infants: normal values.

The subarachnoid space was examined with real-time ultrasonography (US) in 89 healthy infants. US of the brain in all infants revealed no abnormalities. Three variables were measured in the coronal plane at the level of the foramen of Monro: the sinocortical width (SCW) ranged from 0.4 to 3.3 mm, the craniocortical width (CCW) from 0.3 to 6.3 mm, and the interhemispheric width (IHW) from 0.5 to 8.2 mm. All variables can be used routinely, as the SCW could be demonstrated in all infants, and the CCW and IHW were demonstrated in 96% (85 of 89). Correlation of sonographic measurements with the independent variables age, head circumference, body weight, and body length was poor. To differentiate normal from pathologically dilated subarachnoid spaces, the following upper limits are proposed on the basis of the 95th percentile: 3 mm for SCW, 4 mm for CCW, and 6 mm for IHW.

Female↗
PubMedDate not supplied

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↗