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Biomedical subjects

S Thurnher

Publications and source records attributed to S Thurnher.

At least 37 records · Page 2Linked to original sources
PubMed1997

Endovascular AAA treatment: expensive prestige or economic alternative?

OBJECTIVES: To compare the costs of endovascular aneurysm treatment versus open surgery during the perioperative period. METHODS: Retrospective analysis of a consecutive series of 44 patients undergoing infrarenal abdominal aneurysm repair from February 1995 to March 1996 at a university teaching hospital. RESULTS: No endovascular procedure was converted to open repair. Operative time was shorter for endovascular treatment (207.6 min vs. 229.1 min, n.s.), as well as postoperative intensive care unit stay (ICU, 22.7 h vs. 55.0 h, p = 0.017) and the postoperative recovery period (5.6 days vs. 13.3 days, p < 0.001). Open surgery generated significantly more costs (25,374.07 ECU vs. 22,268.78 ECU, p < 0.001), despite evaluation and a more expensive endovascular procedure (10,699.48 ECU vs. 4032.01 ECU, p < 0.001). During the study, costs for open surgery exceeded the cost for endovascular treatment by 13.95%. CONCLUSIONS: Endovascular aneurysm treatment is cost effective and less expensive than open surgery. The main reason for cost saving is faster patient recovery after surgery, associated with a shorter LOS in the patients treated with endovascular procedure.

Aged↗
PubMed1997

Treatment of abdominal aortic aneurysms with transfemoral placement of stent-grafts: complications and secondary radiologic intervention.

PURPOSE: To determine the rate of complications of transluminally placed endovascular stent-grafts in patients with abdominal aortic aneurysms and to assess efficacy of secondary radiologic intervention. MATERIALS AND METHODS: In 28 patients, covered nitinol stents were implanted. Frequency and outcome of complications were evaluated after stent-graft placement (mean follow-up, 8.2 months). RESULTS: In 27 patients, 11 tube and 16 bifurcated grafts were implanted successfully. In one (4%) patient, distal migration of a bifurcated graft necessitated conversion to standard open repair. Technical success rates (successful deployment of the device and complete exclusion of the aneurysm at intraoperative angiography) for bifurcated and tube grafts were 24% (four of 17 patients) and 91% (10 of 11 patients). After surgery, leaks were seen in six bifurcated and five tube grafts. After secondary intervention, the final exclusion rate for bifurcated and tube grafts was 88% (15 of 17 patients) and 100% (11 of 11 patients), respectively; the overall success rate was 93% (26 of 28 patients) for exclusion of aortic abdominal aneurysms. Stent-graft thrombosis necessitated local thrombolysis in one patient. Overlapping of accessory renal arteries occurred in two patients. CONCLUSION: Complications after stent-graft placement in abdominal aortic aneurysms are frequent. Secondary radiologic intervention is successful in most cases.

Aged↗
PubMed1996

[Contrast media in peripheral angiography: does cost reduction mean loss of quality and safety? A reevaluation based on a randomized double-blind comparative study of ioxaglate versus iopromide].

PURPOSE: To evaluate whether meglumine-sodium-ioxaglate (Hexabrix) and iopromide (Ultravist) are identically appropriate for peripheral angiography. Outcome variables were pain, image quality and adverse events. METHODS: Sixty patients were included in a randomised double-blind study. In all patients an intraarterial digital subtraction angiography (i.a. DSA) of iliac and peripheral arteries was performed. RESULTS: Analysis of the study revealed no significant difference between both contrast media in terms of the main and additional outcome variables. In comparison to iopromide, ioxaglate caused milder pain sensations (VAS 4.70 vs. 7.76, p = 0.25). Mild adverse events were observed more frequently in ioxaglate angiography (11% vs. 0%, p = 0.1). CONCLUSION: Both contrast media seem to be appropriate for peripheral angiography using DSA technique. Ioxaglate causes a cost reduction of about 20-35%. However, an increase of mild adverse reactions up to 11% to 15% has to be accepted.

Adult↗
PubMed1996

Palliative treatment of obstructing esophageal cancer with nitinol stents: value, safety, and long-term results.

OBJECTIVE: The purpose of our study was to evaluate the effectiveness of nitinol stents for palliation of dysphagia due obstructing esophageal cancer, safety of stent placement, and long-term results. SUBJECTS AND METHODS: Self-expanding uncoated nitinol stents were inserted either radiologically (14 patients) or endoscopically (12 patients) on an outpatient basis in 26 consecutive patients with dysphagia grade 3 or 4 caused by incurable malignant obstructions in the middle or distal third of the esophagus (n = 22) or at esophagojejunal anastomoses (n = 4). No esophagotracheal fistulas were seen in any patient. In 22 patients prior treatments had failed. Following insertion, the stent lumen was dilated to the maximum diameter. Finally, esophagography or esophagoscopy was done to confirm the position of the stent and patency of the esophageal lumen. Twenty-four hours after the procedure, esophageal function was investigated by a barium swallow. Patients were encouraged to ingest solid food thereafter. Improvement in dysphagia was evaluated 1 week after stent placement and during monthly interviews. Complications were defined as major (aspiration, bleeding, stent misplacement or dislocation, perforation) or minor (reflux esophagitis, chest pain, pharyngeal discomfort). Tumor ingrowth or overgrowth was considered a treatment failure. Twenty-three patients (88%) were followed until death: three patients (12%) were followed for a mean of 14 months. RESULTS: Exact positioning of the stent and dilation to its maximum diameter were technically feasible in all patients. No stents were placed in the stomach. Patency of the esophageal lumen was successfully restored in 25 patients. In one patient a broken strut of the stent after dilation caused a partial obstruction, which was detected endoscopically. Two patients had recurrent dysphagia due to tumor ingrowth or overgrowth, one after 1 month and the other after 3 months. In these patients an additional overlapping stent was successfully placed. No procedure-related mortalities or major complications occurred. The mean dysphagia grade of 3.5 was improved to a mean grade of 0.6 after stent placement. All patients could take liquids within the first 24 hr. Fifteen patients improved to dysphagia grade 0, seven patients to grade 1, and four patients to grade 2 within 1 week after the procedure. Twenty-three patients (88%) died during the follow-up period (mean survival, 5 months) as a result of their disease. Latest evaluation of the mean dysphagia grade was 0.7. Three patients (12%) are still alive (mean survival, 14 months) with a dysphagia grade 1 in one patient and grade 0 in two. CONCLUSION: Implantation of nitinol stents proved to be an effective and safe method of palliating severe dysphagia in patients with obstructing esophageal cancer. The improvement in dysphagia was impressive and long lasting. Placement of the stents was feasible without major procedure-related complications.

Aged↗
PubMed1995

Hepatic artery embolotherapy of hepatic metastases from carcinoid tumors: value of using a mixture of cyanoacrylate and ethiodized oil.

OBJECTIVE: Transcatheter embolization of the hepatic arterial supply is a well-known palliative treatment of tumor deposits in the liver. We performed a prospective study to evaluate the use of a mixture of N-butyl-2-cyanoacrylate and ethiodized oil with which a permanent vascular occlusion can be obtained, as an embolizing agent for transcatheter hepatic artery embolization for treatment of carcinoid hepatic metastases. SUBJECTS AND METHODS: Six patients had clinical symptoms from hormonal release by carcinoid hepatic metastases as well as elevated levels of 5-hydroxyindole acetic acid (5-HIAA) in the urine. Unilobar sequential transcatheter embolization of both the hepatic artery and the segmental hepatic arteries of both lobes of the liver was performed with a mixture of N-butyl-2-cyanoacrylate and ethiodized oil. CT and CT arterial portography (CTAP) were done to assess hepatic metastases and were used to monitor follow-up. Each patient had three CTAP studies; the third CTAP, performed 3 months after complete arterial devascularization, was compared with the first CTAP to evaluate tumor size. CT studies were performed routinely every 3 months thereafter and were compared with the initial CT scan to evaluate further tumor regression or progression. Tumor decrease and biochemical and symptomatic response rates were defined according to World Health Organization criteria. All complications and side effects of the treatment were documented. RESULTS: All patients showed complete symptomatic relief after embolization. The previously elevated levels of 5-HIAA in the urine returned to normal in three patients and in the other three patients were reduced by a mean of 89% of preembolization values. A decrease in tumor size by more than 50% was demonstrable in one patient; in five patients, hepatic lesions decreased in size by 25-50%. No new sites of metastatic liver disease were demonstrable in any patient during follow-up. No deaths or serious complications were directly attributable to the embolization procedure. All patients are alive after 12, 17, 18, 19, 19, and 19 months (mean, 17.3 months), respectively, with permanent relief of symptoms so far. CONCLUSION: Transcatheter embolization of both the hepatic artery and the segmental hepatic arteries with a mixture of N-butyl-2-cyanoacrylate and ethiodized oil provided excellent palliation in patients with carcinoid hepatic metastases. Complete and long-lasting relief of symptoms, a significant decrease or normalization of levels of 5-HIAA in the urine, and a reduction of metastatic tumor in the liver seem most likely to be the effect of sustained ischemia obtained with this permanent embolizing agent.

Carcinoid Tumor↗
PubMed1994

Determination of optimal time window for liver scanning with CT during arterial portography.

PURPOSE: To determine the optimal time window for scanning the liver with computed tomography (CT) during arterial portography (CTAP). MATERIALS AND METHODS: After vasodilation and contrast medium injection into the superior mesenteric artery (80 mL at 5 mL/sec), 25 repeated scans were obtained at a single level within 83 seconds in 13 patients. Attenuation was measured on every scan, and time-attenuation curves were created. Enhancement characteristics of the portal vein, liver parenchyma, aorta, and tumors were evaluated. RESULTS: Parenchymal enhancement of more than 60 HU was achieved between 18 seconds +/- 4 (standard deviation) and 67 seconds +/- 15, and high parenchyma-to-tumor contrast of more than 50 HU occurred between 18 seconds +/- 3 and 62 seconds +/- 14. CONCLUSION: To scan the liver within such a narrow time window, a spiral CT technique is necessary. When the above injection parameters are used in CTAP, the spiral CT sequence should be started 20 seconds after the beginning of the injection.

Adult↗
PubMed1993

[Value of ultrasound in follow-up of biliary metal stents--initial results].

Self-expandable metallic biliary endoprostheses (= "stents") are an accepted therapeutic alternative in the palliative treatment of malignant biliary obstruction. The physiological direction of bile flow is re-established for a varying period of time. Sonography is an acutely available modality for the evaluation of symptomatic patients who are carriers of such endoprostheses. The cause of recurrent obstructive jaundice can be diagnosed quickly and a new intervention can be planned carefully.

Adenoma, Bile Duct↗
PubMed1991

[Cervical carcinoma staging with magnetic resonance tomography: the use of gadolinium-DOTA with 31 patients].

Thirty-one patients with histologically proven carcinoma of the cervix were studied by contrast-enhanced MRI. T2-weighted sequences in a spin-echo mode and T1-weighted sequences were carried out before and after the application of Gd-DOTA. This resulted in improved staging. Contrast-enhanced MRI provided valuable additional information concerning tumour extension into the parametrium. In the presence of motion artifacts and ill-defined infiltration into the parametrium on the T2 sequences, the use of contrast-enhanced T1 images provided a valuable addition to the investigation of carcinoma of the cervix.

Adult↗
PubMed1990

MR imaging of the uterus: low-signal-intensity abnormalities of the endometrium and endometrial cavity.

T2-weighted magnetic resonance (MR) images showing focal areas of low signal intensity involving the endometrium or endometrial cavity were analyzed retrospectively in 28 women. The causes of the hypointense foci were disclosed histologically in 25 patients and by follow-up MR examinations in the other 3. The low signal intensity foci were due to submucosal leiomyoma (11 patients), blood clot (7 patients), endometrial carcinoma (4 patients), early intrauterine pregnancy (3 patients), retained products of conception (2 patients), and endometrial hamartoma (1 patient). The correct diagnosis was made on the basis of MR findings alone in 9 of the 11 submucosal leiomyomas. MR findings were nonspecific in the remainder of the cases. The results indicate that, on MR images, hypointense foci within the endometrium or endometrial cavity can arise from a variety of causes. Often, a specific diagnosis is not possible, and correlation with clinical history is essential.

Abortion, Therapeutic↗
PubMed1990

[Gd-DOTA in musculoskeletal diseases].

T1-weighted images after the injection of Gd-DOTA, a new paramagnetic contrast medium, were compared with non-enhanced T2-weighted images in 42 consecutive cases of musculoskeletal pathology. In addition we evaluated the incidence of side effects. Enhanced T1-weighted images were superior in depicting the various parts of a lesion and the borders between the lesion and normal tissue or perifocal reaction. On the other hand the non-enhanced T2-weighted images better depicted the border between the perifocal reaction and normal tissue. In aggressive lesions, especially in malignant tumours, the two sequences are complementary. Enhanced T1-weighted images did not contribute significantly to assessing benign lesions. The incidence of side effects was acceptable and no severe reactions occurred.

Adolescent↗
PubMed1989

Rapid, contrast-enhanced, diuretic magnetic resonance imaging of unilateral partial ureteral obstruction. An experimental study in micropigs.

The value of rapid, contrast-enhanced, diuretic magnetic resonance (MR) imaging (using ferrioxamine B and furosemide) in demonstrating partial unilateral ureteral obstruction and the potential of such MR imaging in differentiating obstructive from nonobstructive hydronephrosis was assessed in six micropigs. MR imaging (0.35 Tesla, partial-flip technique with repetition time [TR] of 125 milliseconds, echo-delay time [TE] of 20 milliseconds, and flip angle of 70 degrees) was performed before, and at 5, 12, and 19 days after partial ureteral obstruction. Additionally, MR images were acquired 5, 12, and 19 days after release of obstruction. The diuretic was injected 10 minutes after the contrast medium. MR findings were correlated with results from nuclear scintigraphy (99mTc-DMSA uptake). MR images provided good morphologic detail from which renal size, parenchymal thickness, and degree of hydronephrosis could be determined. Contrast medium allowed assessment of cortical uptake and urinary excretion. The course of cortical signal enhancement best characterized the difference between obstructive and nonobstructive hydronephrosis. Normal kidneys and kidneys with nonobstructive hydronephrosis showed progressive decrease in cortical signal enhancement (-11.7% within 40 minutes) after furosemide injection. The kidneys with obstructive hydronephrosis demonstrated a plateau of signal enhancement without decrease (-0.7% within 40 minutes). These results demonstrate the utility of rapid contrast-enhancing, diuretic MR imaging in differentiating obstructive from nonobstructive hydronephrosis.

Animals↗
PubMed1989

Noncontrast and contrast enhanced MR imaging in the evaluation of partial ureteral obstruction: an experimental study in the micropig.

Twelve Yucatan micropigs (3 controls; 3 sham-operated; 6 with unilateral obstruction) were studied to assess the value of noncontrast and contrast-enhanced (Gadolinium-DTPA) magnetic resonance (MR) imaging in the evaluation of partial ureteral obstruction. MR findings were correlated with findings of quantitative (Tc-99m-DMSA) scintigraphy, and histology. On noncontrast T1-weighted images, the normal porcine kidney demonstrated good corticomedullary contrast (CMC = 16.8% +/- 5.0). Five minutes after administration of Gd-DTPA, there was enhancement of the renal cortex (+24.4% and medulla (+46.2%), and CMC was no longer discernible. Enhancement of the urine within the collecting system (+119.1%) was also observed. The obstructed kidneys demonstrated marked thinning of the renal parenchyma and decreased signal intensity on noncontrast T1- and T2-weighted images (P less than 0.01). Urine in the dilated collecting system did not differ significantly from urine in controls except in the three animals with urinary tract infection (P less than 0.05). Five minutes following injection of Gd-DTPA, there was enhancement of the renal parenchyma in all kidneys. Excretion was seen in three pigs and no excretion in two. Thus, useful information can be obtained in partial ureteral obstruction from both pre-contrast and Gd-DTPA-enhanced MR images of the kidney.

Animals↗
PubMed1988

Imaging the testis: comparison between MR imaging and US.

The potential role of magnetic resonance (MR) imaging in the diagnosis and local staging of testicular tumors was evaluated in 23 patients who subsequently underwent surgery or biopsy. Findings at MR imaging were compared with those at ultrasonography (US) and were correlated with the surgical-histologic findings. At surgery, three patients were found to have extratesticular and 20 patients intratesticular abnormalities. This distinction had been correctly made with both imaging modalities, but US did not demonstrate the intratesticular abnormality in four patients with diffuse infiltrating tumors. Neither modality allowed differentiation of benign from malignant disorders. When local tumor staging was analyzed in 11 patients, the accuracy of both modalities was disappointing (true-positive findings with MR imaging in seven patients and with US in five). At present, US remains the primary imaging modality for testicular disease. MR imaging should be employed when findings at physical examination and US are discrepant and considered when diffuse infiltrative disease is suspected.

Humans↗
PubMed1988

Müllerian duct cyst: diagnosis with MR imaging.

The value of magnetic resonance (MR) imaging in diagnosing clinically suspected müllerian duct cysts was assessed in six patients. MR imaging correctly demonstrated the abnormality to be intraprostatic, consistent with the diagnosis of müllerian duct cysts in four patients, and allowed the diagnosis to be excluded in the other two. The demonstration of prostatic zonal anatomy, the ability to obtain direct images in all three orthogonal planes, and a large field of view make MR imaging valuable in the study of suspected müllerian duct cysts.

Adolescent↗