Biomedical subjects

T Diebold

Publications and source records attributed to T Diebold.

15 recordsLinked to original sources

PubMed2006

[Case report -- needle in the breast].

A case of a 23-year-old, foreign language speaking patient is reported, who presented herself in our out-patient clinic with stitching pain in the upper left quadrant of her left breast. Not until the third appointment and intensive questioning, leading to more detailed informations about the medical history, it was possible to diagnose a sewing needle in the breast by mammography. Neither clinical signs nor several ultrasound examinations lead to the diagnosis before.

Adult↗

PubMed2005

MR-guided biopsies of lesions in the retroperitoneal space: technique and results.

The purpose of this study was to evaluate the safety and precision of MRI-guided biopsies of retroperitoneal space-occupying tumors in an open low-field system. In 30 patients with indistinct retroperitoneal tumors [paraaortic lesion (n=20), kidney (n=2), suprarenal gland (n=3) and pancreas (n=5)] MR-guided biopsies were performed using a low-field system (0.2 T, Magnetom Concerto, Siemens, Germany). For the monitoring of the biopsies T1-weighted FLASH sequences (TR/TE=160/5 ms; 90 degrees ) were used in all patients and modified FLASH sequences (TR/TE=160/13 ms; 90 degrees ) in ten patients. After positioning of the needle in the tumors 114 biopsy specimens were acquired in coaxial technique with 16-gauge cutting needles (Somatex, Germany). The biopsies were successfully performed in all patients without vascular or organ injuries. The visualization of the aortic blood flow with MRI facilitated the biopsy procedures of paraaortic lesions. The size of the lesions ranged from 1.6 to 7.5 cm. The median distance of the biopsy access path was 10.4 cm. Adequate specimens were obtained in 28 cases (93.3%) resulting in a correct histological classification of 27 lesions (90%). In conclusion, MR-guided biopsies of retroperitoneal lesions using an open low-field system can be performed safely and accurately and is an alternative to CT-guided biopsies.

Adult↗

PubMed2003

[The role of stereotactic 11G vacuum biopsy for clarification of BI-RADS IV findings in mammography].

PURPOSE: To evaluate the potential of stereotactic vacuum breast biopsy in the histologic evaluation of suspicious mammographic findings ( BI-RADS IV). MATERIALS AND METHODS: In 221 patients with 227 probable mammographic lesions categorized as ( BI-RADS -IV), stereotactic biopsies were performed with an 11-gauge vacuum-assisted biopsy device (Mammotome). The evaluation included the histology of the specimens obtained with the Mammotome or with surgery, the time for the biopsy, the amount of bleeding, number of rotations and procured specimens, the extent of the resection and the complications. RESULTS: The biopsies were technically successful in 214 of the 227 probable mammographic lesions, with 176 lesions mostly resected and 34 lesions removed more than 50 %. No representative tissue was obtained from 4 lesions. All biopsies were performed without any clinically relevant complications and terminated after adequate material was obtained (O 28 specimens, 2.58 rotations). The mean time needed for performing the biopsy was 40.2 minutes. The histologic findings were DCIS (42 lesions), ADH (7 lesions), LCIS (3 lesions), ID-Ca (14 lesions, IL-Ca (3 lesions), and IDL-Ca (1 lesion). In 28 of 42 lesions with the initial DCIS histology, the surgical histology was also DCIS (n=28) or no residual tumor (n=10). In 4 lesions with an initial DCIS-histology, the surgical histology was invasive ductal cancer (9.5 %). The late follow-up examinations (up to 3 years) did not find any evidence of a false negative biopsy. CONCLUSION: Stereotactic vacuum breast biopsy ideally complements existing breast biopsy methods. The method is minimal invasive with a low rate of mostly minor complications.

Artifacts↗

PubMed2001

Postinterventional transcutaneous suture of femoral artery access sites in patients with peripheral arterial occlusive disease: a study of 930 patients.

The purpose of this study was to evaluate a percutaneous vascular suture (PVS) device in patients with peripheral arterial occlusive disease (PAOD) for achievement of immediate hemostasis at the vascular access site and early ambulation of fully anticoagulated patients after peripheral interventional procedures. From June 1995 to March 2000, a vascular suture using a PVS device (6-10 Fr) was applied in 930 patients with PAOD. All patients had received an endoluminal intervention in the pelvic and/or the contralateral femoropopliteal region via a retrograde access through the common femoral artery (CFA). The incidence of complications within 12 hr after intervention, prior to discharge, and at 30-day follow-up was assessed employing clinical examination, treadmill test, and color Doppler ultrasound and the safety of the PVS device was determined. The efficacy of the system was measured by the percentage of achieved immediate hemostasis and early ambulation. PVS was technically successful in 92.2% independently from the degree of calcification at the access site. In 7.8%, an appropriate suture delivery could not be performed and these patients were successfully treated by conventional compression technique. Device malfunction or insufficient suture closure occurred in 1.7% and 2.1%, respectively. In 7.0%, groin-related complications occurred. Ambulation within 2-4 hr after successful suture was possible in 96.1%. All patients were free of any local symptoms at 30-day follow-up. The PVS device provides a safe and effective solution to achieve immediate hemostasis, thus permitting early ambulation in fully anticoagulated patients with PAOD after peripheral interventional procedures.

Arterial Occlusive Diseases↗

PubMed2001

Reconstructed anterior cruciate ligaments using patellar tendon ligament grafts: diagnostic value of contrast-enhanced MRI in a 2-year follow-up regimen.

We analyzed prospectively the diagnostic efficacy of contrast-enhanced MRI following anterior cruciate neoligament (ACL) reconstruction. One hundred fifty-six MR examinations were performed 2, 12, 52, 76, and 104 weeks post-operatively on 68 patients with ACL transplants. Sagittal, parasagittal, and coronal images using unenhanced T1- and T2-weighted spinecho sequences, and post-contrast images utilizing T1-weighted spinecho and fat-saturated sequences, were acquired. Results were correlated with those of the pivot shift, Lachman, and a mechanical test. The MR examination criteria included morphological analysis, signal intensity, transplant contrast enhancement, secondary signs (e.g., elongation of normal ligaments), and comparison with clinically standardized test results. Two weeks post-operatively all neoligaments showed homogeneous low signal intensity on T1- and T2-weighted spinecho sequences indistinguishable from that of normal cruciate or patellar ligaments [contrast-to-noise ratio (C/N) on T1: 1.6], with a 9% percentile enhancement. At 12-52 weeks, signal intensity increased (C/N: 6.7), with a mean 50% percentile enhancement. The 1-year follow-up allowed no definite assessment of the neoligament's course. At 76 and 104 weeks, significant decrements in signal intensity (C/N: 3.0) and ligamentous percentile enhancement (25%) occurred. All patients tested displayed stable transplants 2 years post-operatively. Contrast-enhanced MRI allows accurate evaluation of morphology and function up to 3 months postoperatively and 1-2 years following ACL reconstructive surgery.

Adolescent↗

PubMed2001

[Visualization techniques in multislice CT-coronary angiography of the heart. Correlations of axial, multiplanar, three-dimensional and virtual endoscopic imaging with the invasive diagnosis].

OBJECTIVE: To evaluate the performance of 4 different visualization techniques for multislice CT datasets from the coronary arteries in comparison to coronary angiography. MATERIAL AND METHODS: 42 patients were examined prospectively using both multislice CT and angiocardiography. All CT scans were performed at collimation 4 x 1 mm, pitch 1.5 and a rotation time of 500 msec. Using retrospective ecg-gating, image reconstruction parameters were 1.25 mm slice thickness, 0.5 mm increment and kernel B30. Each patient's CT dataset subsequently was explored using axial, multiplanar, three-dimensional, and virtual endoscopic visualization modes. RESULTS: Axial scans showed the highest sensitivity in the evaluation of stenoses (66.7%), followed by virtual endoscopy (55.9%), multiplanar (48.6%), and three-dimensional reformations (33.3%). With regard to the detection of atherosclerotic plaques, axial scans (71.2%), three-dimensional reformations (70.1%), and virtual endoscopy (69.1%) displayed comparable sensitivities, whereas multiplanar reformations showed distinctly lower results (55.6%). On combining the techniques a sensitivity of 74.2% for the detection of atherosclerotic plaques, of 72.0% for the identification of high-grade stenoses, respectively, was obtained. The specificity of all four visualization modes amounted to 91.9% and above. Best results have been obtained within the RIVA (sensitivity 85.2%). CONCLUSION: For the detection of atheromatous changes CT angiocardiography does not achieve a sensitivity as high as angiocardiography and is restricted to the three major branches. At heart rates below 60 bpm axial scans showed the best correlation in the quantification and classification of atherosclerotic plaques.

Aged↗

PubMed2000

[Inflammatory diseases of the pharynx. The imaging findings and diagnostic strategy].

PURPOSE: To demonstrate imaging findings in inflammatory diseases of the pharynx and possible complications. MATERIAL AND METHODS: Radiologic imaging of the pharynx is based on the use of conventional X-ray films, computed tomography and magnetic resonance imaging, plain and contrast enhanced. RESULTS: The advantages of cross sectional imaging techniques like CT and MRT lie in the possibility to diagnose submucosal disease and localized as well as general complications. Most frequently abscesses and phlegmonous diseases have to be diagnosed. CT proves advantageous due to its fast imaging protocol and the widely availability. MRI is superior due to its superior soft tissue contrast and the multiplanar imaging. CONCLUSION: Spiral-CT and MRI mean valuable diagnostic tools for the evaluation of inflammatory diseases of the pharynx and possible complications.

Adult↗

PubMed1999

Phase I trial of gemcitabine (Gemzar), 24 h infusion 5-fluorouracil and folinic acid in patients with inoperable pancreatic cancer.

Gemcitabine (Gemzar) has a significant impact upon survival and quality of life for patients with pancreatic cancer, compared with 5-fluorouracil (5-FU). This phase I study was initiated to define the recommended dose of 5-FU delivered as a 24 h infusion in combination with gemcitabine (1000 mg/m2) and folinic acid (200 mg/m2) in patients with inoperable pancreatic cancer, treated on an outpatient basis. Drugs were administered weekly for 4 weeks out of 6 weeks. Sixteen chemonaive patients (median age 59 years, range 51-66) were enrolled, 15 had stage IV and one stage III disease. The median Karnofsky performance score (KPS) was 70 (range 60-80). Six patients received 5-FU 750 mg/m2, eight received 5-FU 1000 mg/m2 and two received 5-FU 1250 mg/m2. The maximum tolerated dose of 5-FU was 1000 mg/m2. Hepatotoxicity was dose limiting. One patient who received 5-FU 1250 mg/m2 died as a result of hepatorenal failure. There was one partial response, nine patients had stable disease for more than 3 months and 13 patients had improved KPS. The median time to progressive disease was 31 weeks (range 5-50 weeks). A phase 11 trial is underway to further assess the activity of this combination at the recommended dose of 750 mg/m2 5-FU.

Adult↗

PubMed1998

[Diagnosis of the abdominal vascular system by means of electron-beam computed tomography (EBT)].

PURPOSE: To evaluate the potential of electron-beam computed tomography (EBT) in the pre- and postinterventional assessment of vascular abdominal pathologies. MATERIAL AND METHODS: Forty patients with implanted transjugular portosystemic shunt (TIPS), 12 patients with peripheral arterial occlusive disease and 8 patients with infrarenal abdominal aortic aneurysm after endovascular implantation of bifurcation stents were prospectively examined with contrast-enhanced EBT during one year. The evaluation included analysis of time-density curves (TDC) and 3D reconstructions. Results were compared with Doppler sonography and/or DSA. RESULTS: In 30 of 40 TIPS patients, identical results were found with EBT, Doppler sonography and/or DSA. Reduced perfusions of the TIPS, which were subsequently confirmed by DSA, could not be shown with EBT in 3 patients. Nine of 12 patients with peripheral arterial occlusive disease and angiographically proven stenosis (> 75%) showed a reduced and delayed peak density of the time-density curves. The quantification of arterial stenosis, however, did not follow the angiographic values. In all patients with the implanted bifurcation stents, EBT could correctly exclude a leakage of the stent. CONCLUSION: EBT has certain advantages over conventional spiral CT in the evaluation of abdominal vascular pathologies due to the additional assessment of perfusion parameters. Clinical indications for the use of EBT are seen especially in the postinterventional follow-up of patients with implanted stents.

Abdomen↗

PubMed1998

[Endovascular reconstruction of the infrarenal abdominal aortic aneurysm--experiences with 3 endovascular stent prosthesis systems].

Seventeen patients were treated with endovascular stent grafts for AAA (seven Stentor, two Vanguard, three Talent and three EVT grafts). Intraoperative conversion to open procedure was necessary in three cases. One patient had open operation 24 h postoperatively for graft thrombosis. All patients had uneventful recovery. During follow-up (1-35 months) nine patients did not require reintervention. One patient had open repair for persistent endoleak: within 2 months postoperatively one midgraft endoleak, one graft limb thrombosis and one groin infection were treated. We did not observe any late complications.

Aged↗

PubMed1997

[Dynamic and static MRI using superparamagnetic MRI contrast medium Resovist for visualizing primary and secondary liver tumors].

PURPOSE: To analyse characteristics of benign and malignant liver tumours in dynamic and static MR imaging with the superparamagnetic MR contrast medium Resovist. MATERIAL AND METHODS: All 30 patients were examined on a 1.5 Tesla MR unit (Magnetom 63 SP, Siemens AG, Erlangen, Germany) using proton density (PD) weighted (w), T2-weighted-spin-echo, a T1-weighted SE, and a T1-weighted FLASH-2 D gradient echo (GRE) sequence before, during and after the application of Resovist. Dynamic imaging was performed using a T2-weighted GRE-sequence (TurboFLASH; TR/TE = 11/30; flip angle = 10 degrees; Tl = 600 ms). Histopathology revealed benign liver lesions in 8 patients and malignant lesions in 22 patients. RESULTS: Dynamic T2-weighted sequence revealed an early loss of signal intensity in normal liver parenchyma (percentage signal intensity loss (PSIL) = 40.0 +/- 12.2% by 4 mumol Fe/kg, 47.2 +/- 18.8% by 8 mumol Fe/kg and 62.7 +/- 13.0% by 16 mumol Fe/kg), in the spleen, as well as in FNH (PSIL = 49.5 +/- 7.3% by 8 mumol Fe/kg), and regenerating nodules in the first minute after application of Resovist. In two of 4 cases with HCC a short drop in signal intensity was immediately observed after the application, whereas signal intensity remained unchanged in all other malignant liver tumours. Enhanced PDw and T2-weighted SE-sequences revealed an improved detection and delineation of malignant liver lesions versus plain MR imaging. 17 liver lesions of a size lower 10 mm were additionally detected in postcontrast T2-weighted SE-sequences in 4 patients. CONCLUSION: Dynamic and static versus plain MR imaging of primary and secondary liver lesions is markedly improved by the superparamagnetic contrast material Resovist, especially in case of intravenous bolus application of this liver-specific contrast medium.

Adult↗

PubMed1997

Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis.

RATIONALE AND OBJECTIVES: This study assessed the diagnostic potential of magnetic resonance imaging for the evaluation of the tibiofibular syndesmosis. METHODS: A total of 38 patients with an acute ankle trauma and clinical suspicion of a syndesmotic tear were prospectively studied with conventional plain film radiography and magnetic resonance imaging. Magnetic resonance imaging studies included plain T1-weighted (T1-w) and T2-weighted (T2-w) sequences and contrast-enhanced T1-w sequences 0 to 3 days after trauma. All images were read by two independent radiologists before surgical intervention. Sensitivity and specificity were determined for the two observers and the concordance of the two observers were calculated using the interobserver analysis (Kappa-Test). Intraoperative inspection (n = 21) revealed rupture of the anterior tibiofibular ligament (ATIF) in 15 patients, intact ATIF in 6 patients, and intact posterior tibiofibular ligament (PTIF) in 21 cases. Clinical and follow-up examinations revealed an intact syndesmotic complex in another 17 patients. RESULTS: Primary diagnostic criteria for diagnosing a ligamentous tear included tibiofibular diastasis in conventional plain films; nonvisualization of the ATIF; an abnormal course, a wavy, irregular contour of the ligament; increased signal intensity of the ligament in T2-w sequences, in plain T1-w sequence, and marked enhancement in T1-w after contrast. Important secondary signs were defined as joint fluid in the tibiofibular space and prolapse of interspace fat. Highest diagnostic accuracy was achieved if three or more diagnostic criteria could be visualized. Both readers performed best with the enhanced T1-weighted and the T2-weighted images in transverse orientation. The interobserver analysis resulted in high concordance: Kappa = 0.9 (confidence interval: 0.76 to 1.00) for all patients, and in Kappa = 0.76 (confidence interval: 0.45 to 1.0) for surgically treated patients. CONCLUSIONS: Magnetic resonance imaging of the syndesmotic complex is a highly sensitive and specific tool for the pretherapeutic-evaluation of syndesmotic injury.

Acute Disease↗

PubMed1997

Hepatocellular carcinoma: evaluation with dynamic and static gadobenate dimeglumine-enhanced MR imaging and histopathologic correlation.

PURPOSE: To analyze the potential of gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging for the characterization and diagnosis of hepatocellular carcinoma (HCC) by using static and dynamic sequences. MATERIALS AND METHODS: Twenty-eight patients with histopathologically proved HCC were evaluated with T1- and T2-weighted spin-echo and static and dynamic gradient-echo sequences before, during, and after intravenous administration of 0.1 mmol/kg gadobenate dimeglumine (0.5 mol/L). RESULTS: During the perfusion phase of the dynamic sequence, all 16 nodular well-differentiated HCC lesions showed a rapid increase in signal intensity 10-30 seconds after injection followed by a progressive decrease in signal intensity. The nine poorly differentiated HCC lesions showed no rapid increase in signal intensity. All eight large (> 3 cm), nodular, well-differentiated HCC lesions showed a hypointense rim before injection and both hypo- and hyperintense rims (double-ring sign) immediately after injection, compared with normal liver parenchyma. About 55 seconds after injection, substantial single-rim enhancement was detected in 21 of the 28 HCC lesions. CONCLUSION: Dynamic gadobenate dimeglumine-enhanced MR imaging allows improved characterization of HCC lesions, which show rapid increase in signal intensity during the early, arterial phase in well-differentiated HCC lesions and a double-ring sign in large well-differentiated nodular HCC lesions.

Carcinoma, Hepatocellular↗

PubMed1995

Liver failure due to disseminated HSV-1 infection in a newborn twin.

Most cases of neonatal herpes simplex virus (HSV) infection result from contact with maternal genital tract secretions and are caused by infections with HSV type 2. We report on a fatal HSV-1 infection in a newborn twin presenting with liver failure. The infection was acquired by single contact with an aunt. The route of transmission was proven by PCR followed by restriction endonuclease fingerprinting and DNA sequencing. This report demonstrates that liver failure may be an early and single symptom in life-threatening neonatal HSV-1 infection.

DNA, Viral↗

PubMedDate not supplied

MRI in pre- and postoperative assessment of tracheal stenosis due to pulmonary artery sling.

OBJECTIVE: To evaluate the potential of MRI in the assessment of tracheal stenosis due to tracheal or vascular malformations, 45 children with severe respiratory distress were examined prospectively during a period of 1 year. Five of these children had tracheal stenosis due to a sling left pulmonary artery (SLPA). MATERIALS AND METHODS: Magnetic resonance examinations of the anesthetized children were performed with a 1.5 T Siemens MR imager using electrocardiographically gated T1-weighted SE sequences in transverse and sagittal slice orientations. Slice thickness was 3 mm and each sequence was repeated after shifting the slice position by 1 mm. Monitoring during the examinations included ECG, oscillatory blood pressure, respiratory rate, and oxygen concentration. Magnetic resonance findings were compared with esophagography, selective pulmonary angiography, bronchoscopy, Doppler sonography, and surgery. All examinations were repeated after surgical therapy to assess the improvement in tracheal stenoses and the patency of the ligated and reimplanted left pulmonary arteries. RESULTS: Magnetic resonance imaging clearly revealed the course of the SLPA and its topographic relationship to the trachea as well as the coexistence of cardiovascular and tracheobronchial or esophageal malformations. The degree and length of tracheal stenoses, which were measured in the pre- and postoperative axial slices and graphically displayed, as well as the angles of the right and left main stem bronchi, could be accurately determined. CONCLUSION: Magnetic resonance imaging in combination with bronchoscopy yielded the necessary and sufficient information for diagnosis and aided the surgeon in planning operative strategy and in postoperative follow-up.

Angiography↗