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S Tuengerthal

Publications and source records attributed to S Tuengerthal.

At least 19 recordsLinked to original sources
PubMed2005

[The radiology of opportunistic pneumonias. I: Epidemiological, laboratory and clinical background].

In the guidelines of the German Society of Pneumology on diagnosis and therapy of opportunistic pneumonias, chest x-ray is listed as the basic diagnostic method in congenital and acquired immunodepression. In case of discrepancy between radiographic and the clinical findings or in cases of bilateral infiltrates, infection refractory to therapy or a difficult course in patients requiring artificial ventilation, a CT, or if necessary, ultrasound or MRI should be carried out. Cross-sectional imaging allows more precise assessment of the radiological pattern, estimation of the degree of severity (number of infiltrated segments) and detection of complications (pleural effusion, empyema, thorax wall infiltration). Clinical and laboratory parameters, bacteriological and serological examinations as well as information on the underlying immunocompromising factors must be taken into account in the differential diagnosis. The radiographic finding is an important diagnostic parameter which is used in the determination of the degree of severity of the pneumonia. The pattern of findings is one of rationales for the use of antibiotic therapy. In the first part of this contribution the epidemiological, laboratory and clinical background of the diagnosis of opportunistic pneumonias is discussed.

Diagnosis, Differential↗
PubMed2004

Perfusion CT in patients with advanced bronchial carcinomas: a novel chance for characterization and treatment monitoring?

Advanced bronchial carcinomas by means of perfusion and peak enhancement using dynamic contrast-enhanced multislice CT are characterized. Twenty-four patients with advanced bronchial carcinoma were examined. During breathhold, after injection of a contrast-medium (CM), 25 scans were performed (1 scan/s) at a fixed table position. Density-time curves were evaluated from regions of interest of the whole tumor and high- and low-enhancing tumor areas. Perfusion and peak enhancement were calculated using the maximum-slope method of Miles and compared with size, localization (central or peripheral) and histology. Perfusion of large tumors (> 50 cm3) averaged over both the whole tumor (P = 0.001) and the highest enhancing area (P = 0.003) was significantly lower than that of smaller ones. Independent of size, central carcinomas had a significantly (P = 0.04) lower perfusion (mean 27.9 ml/min/100 g) than peripheral ones (mean 66.5 ml/min/100 g). In contrast, peak enhancement of central and peripheral carcinomas was not significantly different. Between non-small-cell lung cancers and small-cell lung cancers, no significant differences were observed in both parameters. In seven tumors, density increase after CM administration started earlier than in the aorta, indicating considerable blood supply from pulmonary vessels. Tumor perfusion was dependent on tumor size and localization, but not on histology. Furthermore, perfusion CT disclosed blood supply from both pulmonary and/or bronchial vessels in some tumors.

Adult↗
PubMed2004

[Standardized CT/HRCT-classification of the German Federal Republic for work and environmental related thoracic diseases].

High resolution computed tomography (HRCT) plays an indispensable role in the diagnosis of pneumoconiosis and other lung damage arising from inhalation. Till now, however, there has been no agreed standardized convention for the use of the technique, or for documenting results uniformly. A task-group on Diagnostic Radiology in Occupational and Environmental Diseases of the German Radiological Society has produced a coding sheet based on experience gained in production of consultants' clinical reports, experts' examinations of patients seeking compensation for occupational lung disease, and physicians' professional development courses. The coding sheet has been used in a national multicenter study. It has been further developed and tested by an international working group comprising experts from Belgium (P.A. Gevenois), Germany (K.G. Hering, T. Kraus, S. Tuengerthal), Finland (L. Kivisaari, T. Vehmas), France (M. Letourneux), Great Britain (M.D. Crane), Japan (H. Arikawa, Y. Kusaka, N. Suganuma), and the USA (J. Parker). The intention is to standardize documentation of computertomographic findings in occupationally and environmentally related lung and pleural changes, and to facilitate international comparisons of results. Such comparisons were found to be achievable reproducibly with the help of CT/HRCT reference films. The classification scheme is purely descriptive (rather than diagnostic), so that all aspects of occupationally and environmentally related parenchymal and pleural abnormalities may be recorded. Although some of the descriptive terms used are associated with pneumoconiosis (e.g., rounded opacities in silicosis, or, in asbestosis, interlobular septal and intralobular non-septal lines, as well as honeycombing) many overlapping patterns that need to be considered for differential diagnosis are also included in the scheme.

Disability Evaluation↗
PubMed2003

[Further development of the International Pneumoconiosis Classification--from ILO 1980 to ILO 2000 and to ILO 2000/German Federal Republic version].

The ILO (1980) Classification has been revised during recent years. The new version is now available as the International Classification of Radiographs of Pneumoconioses (Revised edition 2000). The Guidelines booklet is currently available only in English. Those involved felt it was important to maintain continuity with the ILO (1980) edition, in particular to retain the standard radiographs, despite their restricted quality, so as to ensure comparability with earlier national and international data sets. The standard films illustrating pleural abnormalities, and 'u'-shadows, have been modified and reconstituted. The most important changes relate to assessment of film quality, pleural abnormalities, and additional symbols. In Germany, film quality is characterised as "+", "+-", "+--" and "u" according to whether the ability to assess pneumoconiosis is judged to be unimpeachable ("+") to unusable ("u"). If a film is not classified as "+", then written comments regarding defects are required. For "diffuse" pleural thickening, the ILO (2000) edition now requires the presence also of obliteration of the costophrenic angle. This was not required in the earlier (1980) edition and, as previously, is also not stipulated in the German version. A minimum width of 3 mm (previously 0-5 mm), coded "a", is required both for plaques as well as for the margin to the lateral chest wall. Congruence is thus achieved for criteria, which, in German practice, lead to an indication of suspect occupational disease. Plaques on the diaphragm are not considered for measurement of extent; they are only coded as present or absent. If calcification is identified, then this must also be classified and measured as a localised plaque. Extent of calcification on its own, previously coded "0" to "3", is no longer specified. The following new symbols, illustrated by new diagrams, have been introduced: aa = atherosclerotic aorta; at = apical thickening; cg = calcified granuloma (or other non-pneumocononiotic nodules); me = mesothelioma (already previously differentiated from "ca" on the German record sheet); pa = plate atelectasis; pb= parenchymal bands; ra = rounded atelectasis; od = other disease. (Examples of the latter are illustrated diagrammatically by lobar pneumonia, aspergilloma, goiter and hiatal hernia.) Earlier national differences (ILO 1980/German Federal Republic) on particular issues have also been agreed among German "double-readers" ["Zweitbeurteiler"]. However, conformity between the original (ILO 2000) text and the national (German) modified text has been retained in large measure. The detailed descriptions of the standard films differ in certain respects from the German (1980) definitions. Some revision of individual descriptions of the films are proposed. Except for a few differences, agreement was reached here too. The definitive date for the change in Germany is expected to be in early 2004. The standard films are already available now through ILO offices in Geneva or Bonn (addresses in appendix.)

Germany↗
PubMed2001

Near-fatal hemoptysis and emergency surgical repair after aortic patch-plasty.

A 38-year-old man presented with massive hemoptysis followed by hemorrhage shock. The patient's history revealed a Dacron patch repair for aortic coarctation and recoarctation carried out twice, once 23 and once 10 years ago. Diagnosis of a ruptured descending aortic aneurysm with an aortobronchial fistula into the left lower lobe was established using CT scan. Emergency surgery consisted of left pneumonectomy and descending aortic graft replacement during deep hypothermic circulatory arrest. The patient was discharged 12 days later.

Adult↗
PubMed1999

[MRT, CT and sonography in the preoperative assessment of the primary tumor spread in malignant pleural mesothelioma].

PURPOSE: Evaluation of the diagnostic value of the imaging modalities computed tomography (CT), magnetic resonance imaging (MRI), and thoracic sonography in the preoperative staging of malignant pleural mesothelioma. MATERIALS AND METHODS: The diagnostic accuracy of CT (n = 41), MRI (n = 24), and thoracic sonography (n = 37) were evaluated in 51 patients with histologically proven diffuse malignant pleural mesothelioma. Values of sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for the assessment of the diaphragm, lung, thoracic wall, pericardial wall, myocardium, and (retro)peritoneal space. RESULTS: The accuracy rates for CT were 85%, 98%, 83%, 73%, 71%, and 83%. MRI had an accuracy of 71%, 92%, 71%, 83%, 71%, and 96%, the thoracic ultrasound examinations of 76%, 63%, 51%, 60%, 71%, and 89%. CONCLUSIONS: According to these results CT remains the method of choice in the preoperative assessment of T-stage of malignant pleural mesothelioma. MRI is of nearly the same value, but is not a must. Sonography may be supplementary method for operation planning.

Female↗
PubMed1997

[The intracavitary administration of contrast medium in the aftercare of complicated thoracic empyema with long-term drainage: x-ray fluoroscopy compared to computed tomography].

PURPOSE: To define the value of conventional radiography compared with CT in the follow-up of complicated, long-term tube drained pleural empyema after intracavitary application of contrast medium. METHODS: 28 patients with complicated pleural empyema (stage III) and long-term tube drainage were submitted to fluoroscopy of the pleural cavity and a CT of the thorax after contrast medium had been instilled into the pleural space. Both examinations were judged by the following criteria: number and morphology of pleural cavities, quality of drainage and accompanying thoracic disease. RESULTS: 49 pleural cavities were diagnosed. Judgement of drainage corresponded in 79% of cases and differed in 21% with proof of further not drained cavities only on CT. 4 bronchopleural fistulas were diagnosed by fluoroscopy, of which only 2 were evident on CT. Accompanying thoracic disease was reliably detected by CT only. CONCLUSIONS: Diagnosis of bronchopleural fistulas and judgement of the pleural drainage is best possible using fluoroscopy after application of contrast medium into the pleural space. CT is most accurate to detect further cavities that have not been drained, to look for concomitant thoracic disease, and to judge the morphology of the pleural cavity. Conventional radiography of the pleural space is effective and recommended to be used as a first line investigation for the follow-up of stage III empyemas. Patients in poor general condition (fever, elevated blood markers indicating inflammation) should be examined by both fluoroscopy and CT.

Adolescent↗
PubMed1994

[Mediastinal actinomycosis with formation of an esophagotracheal fistula. A case report].

Before antibiotics were available, actinomycosis was the most commonly diagnosed "fungal disease" of the lung because of its morphological similarity to true fungi. At that time actinomycosis presented a fairly typical clinical picture of empyema thoracis and sinus tracts in the chest wall. Nowadays it has become a rare infectious disease that is usually caused by the bacterium Actinomyces israelii and is amenable to treatment by most antibiotics available today. The following report describes the case of a 59-year-old man with an uncommon mediastinal actinomycosis that caused an oesophagotracheal fistula. This complication may develop due to the necrotizing inflammatory process that is typical for actinomycosis. With regard to the literature, the clinical manifestations of the disease and diagnostic and therapeutic considerations are discussed.

Actinomycosis↗
PubMed1993

[Intravascular ultrasound in preoperative diagnosis of central bronchial tumors--initial clinical experiences].

In the course of preoperative diagnosis, intravasal sonography for tumour imaging was conducted in three patients suffering from central bronchial carcinoma. The catheters of 6.0 or 4.8 French diameter were advanced in each case after pulmonary angiography via the left or right pulmonary artery up to the tumour area. Endosonographic tumour imaging was compared with the findings of the other preoperative diagnostic measures and in two cases with intraoperative and postoperative findings. The vascular walls of the central pulmonary arterial segments showed sonographically no typical three-layer structure. In all cases, however, tumour infiltration was showed up by disappearance of the vascular wall reflexes in the relevant pulmonary artery branches. Visualisation of the mediastinal pulmonary artery segments or of the main stem of the pulmonary artery is difficult with the wire-guided catheters used, since these cannot be stabilised in the centre of the vessel. Development of suitable catheters with low-frequency transducers and greater depth of penetration is imperative especially for the diagnostically important visualisation of the surrounding mediastinal structures.

Adenocarcinoma↗
PubMed1991

Classification of lung cancer: first experiences with the new TNM classification (4th edition).

In January 1987, the 4th edition of the TNM classification for malignant lung tumours by the International Union Cancer (UICC) came into effect. Thus, for the first time, a uniform worldwide staging system for lung cancer became available. In order to validate the new TNM definitions for lung cancer the data of 3,000 patients were analysed prospectively. Several items were examined: 1) the agreement between clinically (TNM) and pathologically (pTNM) confirmed classification; 2) the value of the various diagnostic techniques estimating the pathologically confirmed classification; 3) the influence of the TNM definitions on separating distinct prognostic groups. With regard to the primary tumour (T), clinical and pathological classifications were identical in 64%; for lymph node involvement (N) the agreement was 48%; for distant metastases it was 90% and for the stages it was 55%. As for the primary tumour (T) the accuracy of radiography (59%) was nearly identical to computed tomography (58%). Both techniques were less precise in determining the extent of lymph node involvement (computed tomography 50%, radiography 43%, correct assessments). The statistically significant differences in prognosis for the various T-, N- and M-categories as well as for the stages could be confirmed. By the new 1987 TNM definitions (4th edition) for lung cancer international conformity became feasible as well as practical, and the improvement in its prognostic relevance provided, therefore, a more reliable basis for establishing guidelines for individual oncological concepts of therapy.

Carcinoma, Bronchogenic↗
PubMed1990

[Conventional section study of thoracic organs. Improved diagnosis with compensation filters of anatomically molded acrylic glass containing lead].

The diagnostic value of conventional chest tomography was improved dramatically by filters, manufactured of transparent acrylic glass containing 120 or 240 mu lead aquivalent (DuPont, Neu Isenburg). A perfect compensation of the chest anatomy and pathology in ap-pulmonary tomography can be done easily because the anatomically shaped filters are mobile-mounted in front of the x-ray tube. The position of each filter is visible on the patient's skin. This enables the radiographer to routinely obtain tomograms with diagnostic density values ranging from S = 0.4-2.0. For 6 characteristic areas this was measured in 98%. Such films allow subtle analyses of the tracheal and bronchial wall, the segmental bronchi and pulmonary vessels or pathologic lesion. Compared to cross-sectional imaging CT and MRT, the frontal tomogram shows several aspects of the hilar compartment more clearly because the main central pulmonary structures are located primarily craniocaudally. The conventional tomogram therefore supplies additional views with high spatial resolution. The clinical importance of diagnostic information obtained with ap-tomography using the ATCF are shown in 4 cases. In our hospital, the thoracic surgeon therefore demands conventional tomography with the ATCF to complete staging of benign or malignant chest disease preoperatively.

Acrylates↗
PubMed1988

[Evaluation of intrapulmonary round foci using thin-layer computed tomography].

100 patients with 122 round pulmonary lesions were examined preoperatively by CT, using either 8 mm or 2 mm sections. The most important findings were: radial extensions were seen on the fine sections in 95% of primary bronchial carcinomas (48 cases), in 60% of lung metastases (31 cases) and in 70% of chronic inflammatory lesions (24 cases), but they were not seen in benign tumours or hamartomas. Similar findings were observed for perifocal consolidation. Calcification was found in 80% of the tuberculomas (15 cases) and in 37% of the hamartomas (8 cases), but it also occurred in 15% of the primary bronchial carcinomas and in almost 13% of the lung metastases. Thin section CT provided more information than did 8 mm sections in 44% patients, concerning the outline of the lesion, and in 60% it was better at showing calcification. It was not possible to define a pattern of calcification which would distinguish benign from malignant lesions.

Adult↗
PubMed1987

[Conventional roentgen study in the diagnosis of primary and secondary chest wall tumors].

In patients with chestwall tumors conventional radiography is most often the next diagnostic step for differentiation and staging. Plain chest films, taken according to ILO-80 regulations, fluoroscopy and x-rays of the bony structures of the thorax are basic examinations. Diagnostic features are intra- and extrathoracic soft tissue masses and/or disturbances of normal fat pads. CT and/or MR are superior for analyzing soft tissue masses and cannot be missed. But bone lesions are better to analyze on conventional x-rays. Skeletal scintigraphy helps to increase the effectivity and is requested before tomography. Invasive diagnostic procedures (phlebography, arteriography, myelography, bronchography) should be performed only after CT- or MR-examinations. They can add important diagnostic details. Selective arteriography enables the radiologist to embolize vessels of large tumors preoperatively, reducing surgical risks, or may be helpful in patients with non-resectable tumors.

Bone Neoplasms↗
PubMed1987

Diffuse pulmonary ossification associated with metastatic melanoma of the lung.

A case with advanced diffuse pulmonary ossification is described. The patient underwent surgical treatment of a malignant nodular melanoma of the right shoulder followed by postoperative cytostatic therapy for 6 months. He developed renal insufficiency and pulmonary infiltrates 3 years after the operation. Two metastases into the lung were operated 4 years after extirpation of the melanoma. Histopathological findings revealed two major metastases of a malignant amelanotic melanoma and multiple tumour thromboses in lymphatic and venous vessels. Severe interstitial lung damage including diffuse pulmonary ossification and focal interstitial fibrosis was noted. Morphometric measurements of ossified nodules revealed increased ossification in fibrotic lung areas. Immunohistology for differentiating immunoglobulins and lymphocytic subpopulations was insuspicious. The findings suggest that diffuse intraalveolar ossification is probably not related to pulmonary congestion.

Biopsy↗
PubMed1986

Chronic progredient diffuse alveolar damage probably related to exposure to herbicides.

Clinical history and wedge biopsy specimen findings of a Vietnam veteran suffering from progressive severe tissue damage of lung are presented. The patient served as a soldier in defoliated areas for 2 years and developed severe chest pain and dyspnoea with chronic postnasal dripping, maxillary sinusitis and allergic asthmoid bronchitis with pronounced obstructions and eosinophilia. Recurrent onsets of symptoms over a period of 10 years led to wedge biopsies of the left upper lobe, right lower lobe and mediastinal lymph node. Histology is consistent with chronic, slightly progressive diffuse alveolar damage including moderate interstitial fibrosis. Total destruction of mediastinal lymph node with deposits of amorphous material and foreign body giant cells were noted. Histology findings and clinical course favor hypersensitivity reaction of lung and congestion of exogeneous material probably related to exposure to herbicides.

2,4,5-Trichlorophenoxyacetic Acid↗