Skeletal changes after long-term therapy with synthetic retinoids.
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Acitretin↗
Biomedical subjects
R M Jungblut
Publications and source records attributed to R M Jungblut.
[Value of the esophagogram in preoperative assessment of esophageal carcinoma].
PURPOSE: In this study we utilized barium swallows exhaustively in each patient. After that we compare the results with the intraoperative findings. The goal is to select those criteria which contribute to the preoperative clinical staging of esophageal carcinoma. METHODS: In a retrospective study we examined the esophagograms of 65 tumor patients. We evaluated the location and length of the tumor, the deformation of the esophageal axis, stenosis, dilatation, and the radiological type of the tumor. All characteristics were correlated with the pathologically determined TNM-criteria, the stage of the tumor, and the palliative or curative type of resection. RESULTS: We found the following significant correlations: localisation/T-criterion, radiological type/T-and M-criteria, stenosis/type of resection, deformation of the axis, stenosis and radiological type/tumor stage. CONCLUSION: In the sense of a checklist the stenosis, the deformation of the esophageal axis and the radiological type of the tumor should be carefully evaluated and included in the report. With these data, the clinical stage of the tumor can be estimated.
Adenocarcinoma↗
[Dependence of axis deviation in the esophagram on computerized tomography determined wall thickness and its value in assessing depth of invasion of esophageal carcinoma].
PURPOSE: In this study we compared the abnormalities of the esophageal axis seen in the esophagogram with the thickness of the esophageal wall measured by computed tomography. We have investigated, how exactly both methods assess the local tumor invasion according to the TNM criteria and whether there is a relation between the esophageal axis and the wall thickness. METHODS: In a retrospective study we examined the esophagograms of 65 tumor patients. Computed tomography examinations were available in 40 cases. Using a graphical method the wall thickness was transferred to the esophagograms under consideration of the different scales of the images. RESULTS: There is no correlation between the different types of distortion of the esophageal axis and the wall thickness in computed tomography. However, it can be demonstrated that the distortion results from specific fixation effects with the surrounding tissue. CONCLUSIONS: Both radiological methods cannot determinate the tumor invasion correctly.
Adult↗
[Gastrointestinal metastasis of malignant melanoma].
In this paper we present a case study of a patient suffering from a gastrointestinal metastasis of a malignant melanoma. Normally in this location multiple and solid metastases were observed in the submucosa. Extraordinary in this case is the fact, that a polycystic tumor with more than 15 cm diameter has been found.
Adult↗
[Intraarterial digital subtraction angiography (i.a. DSA) of the lower limb using fine needle technique].
PURPOSE: Severe peripheral arterial occlusive disease (pAOD) requires adequate diagnostic imagery of poststenotic and postocclusive vascular regions. This study was designed to evaluate the validity of i.a. DSA using fine-needle technique (FNA) especially concerning the vascular area of the lower limb. MATERIAL AND METHODS: 206 FNA of the lower limb wer evaluated retrospectively. Besides evaluation of the image quality of the 1119 angiographic image series, main points of interest were the determination of accuracy of the FNA in comparison to the operative findings, the average radiocontrast agent consumption and the rate of complication. RESULTS: In all cases the image quality was rated either very good or good in the pelvic, femoral and popliteal vessels. 94% of the image series of the lower leg and foot could be rated as well as very good/good although 75% of all patients demonstrated an advanced stage of pAOD. Accuracy of FNA compared to operative findings came up to 82%. The average radiocontrast consumption amounted to 69 ml per examination. Overall, two major complications were seen. CONCLUSION: I.a. DSA of the lower limb using fine-needle-technique is an easily applied angiographic method of low radiocontrast agent consumption and a low complication rate. Essential information can be acquired preoperatively in planning far peripheral bypass anastomoses. Postoperative vascular complications can be safely assessed.
Angiography, Digital Subtraction↗
Complications following caval interruption.
Caval interruption is widely regarded as the treatment of choice for the prevention of recurrent pulmonary embolism (PE). The safety, ease of insertion and "convenience" of the devices are the main arguments for filter placement. Today many filters are placed for prophylactic reasons, sometimes without an established diagnosis of pulmonary embolism or underlying deep venous thrombosis. Early and late complications have been published but the rate is reported to be low, although only limited numbers of patients have been followed. In an 18-year period 11 patients with problems following caval interruption were treated, 10 with acute complications, one with chronic caval occlusion. Six were treated conservatively, five underwent venous thrombectomy and a.v.-fistula. The device was removed in four. During the same period only three permanent filters were placed in our hospital (two with complications). Caval interruption is useful in selected high-risk patients and is the least invasive but not necessarily the best treatment. Provided stringent criteria are applied, the early and late complications can be accepted in order to prevent sudden death in patients with threatening massive PE. Extended or more liberal indications for caval interruption are neither necessary nor justified.
Adult↗
[The computed tomographic diagnosis of inflammatory abdominal aortic aneurysms].
Amongst 1599 patients undergoing surgery for abdominal aortic aneurysm, there were 89 patients (5.6%) who showed typical features of inflammatory aneurysms of the abdominal aorta (IAAA). 37 of the 89 patients had been examined preoperatively by CT. In 73% of the cases (27/37) a correct diagnosis had been made. Localisation, width and extent of the IAAA was correctly diagnosed in all patients. Involvement of the renal arteries by the inflammatory process, the extent of thrombus and of mural calcification were accurately shown. The inflammatory tissues were typically ventral and lateral to the aorta. Frequently, there were adhesions to neighbouring structures. Aortic rupture, aortic dissection and retroperitoneal lymphoma may produce similar CT appearances; nevertheless, CT remains at present the method of choice for the diagnosis of IAAA because of its high sensitivity.
Adult↗
[Hypodense oral intestinal contrasting for the diagnostic optimization of abdominal computed tomograms in children].
37 children were examined for diagnostic improvement of the oral intestinal contrasting images in abdominal computed tomography with a hypodense solution of mannitol (n = 23) in comparison with a suspension of BaSO4 (n = 14). Because of the hypodense intestinal contrasting images the artifacts of the images induced by the bordering surface could be reduced, the condition of fullness of the intestine and the judgement of the intestinal wall improved. The parenchymatous organs and points of abdominal lymph nodes could be defined and judged more easily through the hypodense contrasting images. On the whole the picture quality of the computed tomography of the young child could be increased with the hypodense solution of mannitol.
Administration, Oral↗
In situ replacement of infected vascular prostheses with rifampin-soaked vascular grafts: early results.
Based on the excellent results of experimental studies with antibiotic-bonded vascular prostheses for prevention of graft infection, gelatin-sealed grafts soaked with rifampin were implanted in situ in five patients with vascular infection. All patients were at risk for limb loss or death and could not be treated by standard techniques such as graft excision and extra-anatomic bypass. In one patient an infected aortic stump aneurysm with involvement of both renal and visceral arteries was found. He was treated by implantation of a bifurcation rifampin-soaked graft between the subdiaphragmal aorta and both renal arteries and reimplantation of celiac and superior mesenteric artery into the graft. In four patients with in-flow or runoff problems on angiography, an antibiotic-soaked graft was used for replacement of a partially or totally infected graft. Cultures were positive for Staphylococcus aureus in three and coagulase-negative staphylococci in two patients. Wound healing was uncomplicated; there was no need for amputation. After a follow-up of at least 6 months, all grafts were patent without any evidence of reinfection on computed tomographic scan. We conclude that infected vascular prostheses can be replaced in situ by rifampin-soaked grafts in patients at high risk for death or major amputation.
Aged↗
[Perirenal metastasis of a malignant melanoma in a young child].
A perirenal metastasis of a malignant melanoma in a young child can accompany a big tumor volume with extensive calcifications and tumor necroses. The characteristics of the tissue on computed tomography or ultrasound did not allow the certain differentiation of this situation from tumors of the adrenal or tumors of the kidney.
Adrenal Gland Neoplasms↗
[An aneurysm of the ischiadic artery].
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Aged↗
[Castleman tumor, lichen ruber and pemphigus vulgaris: paraneoplastic association of immunological diseases?].
In a 45-year-old patient with an unusual clinical course of wide-spread cutaneous and oral lichen planus as well as pemphigus vulgaris of the oral cavity, both refractory to standard therapy, a Castleman tumour was suspected. Computer tomography disclosed a solid retroperitoneal tumour in the pelvis. After its surgical removal both dermatoses regressed substantially within a matter of weeks. In 1954 and again in 1956, Castleman described a thymoma-like lymph node hyperplasia, for which various synonyms are used. Castleman tumours are classified into the common hyalin-vascular type (80-90%), the rarer plasma cell type (10-20%) and the intermediate type. It is usually a benign lymphoma of variable location, but mostly intrathoracic. There is a remarkable association of Castleman tumours with skin diseases (lichen planus, pemphigus vulgaris, Kaposi sarcoma), neurological diseases (POEMS syndrome, myasthenia gravis, arteritis temporalis, Guillain-Barré syndrome), and internal diseases (nephrotic syndrome, amyloidosis, plasmacytoma, rheumatoid arthritis, thrombotic thrombocytopenic purpura). The coincidence of Castleman tumours with various immune phenomena and immunological diseases is higher than could be expected by chance, presenting a challenging pathophysiological model of antibodies and variable immunodeficiencies.
Castleman Disease↗
[Necrotizing panniculitis in pancreatitis].
A 46-year old man developed subcutaneous fat necrosis of the right upper thigh in association with pancreatitis. The panniculitis established by biopsy resolved 4 years later. Subcutaneous nodular fat necrosis is a rare dermatological manifestation of pancreatitis or pancreas carcinoma which may be clinically indistinguishable from erythema nodosum. Biopsy of the skin lesion reveals a characteristic histological picture with necrotic fat cells surrounded by lymphocytes, histiocytes and plasmacells.
Adipose Tissue↗
[Achalasia as a mask of cardial carcinoma].
Increasing dysphagia and weight loss between 3 and 30 kg developed in eight patients aged 27-70 years (mean age 53 years) within a period of 1.5 to 12 months. In five patients X-ray film showed the typical pattern of achalasia with dilatation of the tubular oesophagus and a smooth taper of the terminal part. Although in all patients the cardia became patent only after the endoscope had been advanced by pushing it forward to overcome stenosis or after bougienage, and although the malignoma had always been included in differential diagnostic considerations, a malignoma was identified only three times in 30 histological examinations. Oesophageal manometry demonstrated findings characteristic of achalasia in five patients, in three patients the examination could be performed only incompletely. In six patients computed tomography revealed pathological hypertrophy of the cardiac wall. Intraoperatively all cardiac tumours were in an advanced stage.
Adult↗
The value of preoperative chest X-rays in gynecological patients.
We assessed the value of preoperative chest x-rays in gynecological patients. Abnormalities were noted in the chest x-rays of 10% of 1175 patients with genital or breast disorders. When the chest x-ray was abnormal, 48% of patients had no clinical features of intrathoracic disease. Abnormal chest x-ray results did not seem to have a major influence on the decision to operate or on the type of anesthesia used. In our series, probably only one patient would have received inappropriate treatment in the absence of a chest x-ray. We conclude that preoperative chest x-rays are of value in ruling out metastases in patients with a suspected neoplasm, but have little value in other circumstances.
Adult↗
Prognostic significance of tumor volume in localized Ewing's sarcoma of bone in children and adolescents.
A total of 60 consecutive patients with localized Ewing's sarcoma of bone who were entered into the Cooperative Ewing's Sarcoma Study of the German Society of Pediatric Oncology from January 1981 until April 1985 were evaluable for tumor volume at diagnosis. The tumor volume was calculated from plain X-rays and CT scans as ellipsoidal or cylindrical depending on the tumor configuration and presence or absence of a soft tissue component. The 3-year disease-free survival rate according to Kaplan-Meier life table analysis was 78% for tumors with a volume less than 100 ml compared to 17% for tumors greater than or equal to 100 ml volume. These results were independent of the site of the tumor, though larger tumors were primarily located in central and proximal extremity sites. Maximal tumor extension was less precise than tumor volume in predicting prognosis. The ratio of tumor volume to body surface area, body length, or body weight did not increase the ability to separate prognostic groups compared to tumor volume. The better prognosis for patients following radical surgery seems to be in part due to a biased distribution of tumor volumes within local therapy groups, since more patients with smaller tumors had surgery for local control.
Adolescent↗
Correlation of abdominal CT imaging with autopsy findings in patients with malignant tumors.
The value of abdominal computed tomography (CT) in diagnosing localized involvement of liver, pancreas, adrenals, and lymph nodes was evaluated in 117 patients with suspected or known malignant tumors by correlation with autopsy findings. Sensitivity, specificity, and accuracy of CT for localized liver disease was calculated to be 80% (84%), 96% (97%), and 90% (92%); for pancreatic tumors: 81% (86%), 98% (100%), and 95% (97%); for adrenal tumors: 65% (92%), 100% (100%), and 92% (98%); and for lymph node enlargement 75 (88%), 97% (98%), and 87% (94%), respectively. Results of routine evaluation could be improved, especially in the adrenal region, when scans were reevaluated by highly experienced examiners (results given in parenthesis). Computed tomography is a highly valuable diagnostic tool in the primary diagnosis and in the follow-up of tumor patients. The high costs are offset by a reduction in invasive procedures and a shortened hospital stay.
Abdominal Neoplasms↗
Retrospective radiographic study of skeletal changes after long-term etretinate therapy.
Radiographic skeletal examinations were performed in eight adult patients who had received the aromatic retinoid etretinate for various disorders of keratinization over periods ranging from 1 to 7 years. Age- and sex-matched controls were also examined. In all patients, alterations of ossification were found to a varying degree, including calcification of the anterior spinal ligament, vertebral hyperostoses at the anterosuperior and anteroinferior margins of the vertebral bodies, unilateral bridging of vertebral bodies, hyperostoses of the calcanei at the insertion of the plantar ligament and bone accretion at the anterolateral lips of the acetabula. All the bone changes were asymptomatic. Serum calcium, inorganic phosphate, alkaline phosphatase, calcitonin and parathormone were within normal physiological ranges. In general, the bone changes observed after long-term etretinate treatment closely resembled the effects of isotretinoin on the skeleton.
Adult↗