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T Rösch

Publications and source records attributed to T Rösch.

At least 145 records · Page 8Linked to original sources
PubMed1993

[Endosonography of the gastrointestinal tract--an assessment of current status].

Endoscopic ultrasound (EUS) combines endoscopy and ultrasonography. A small ultrasonic transducer incorporated into the rigid tip of endoscopes is transported into certain regions of the upper and lower gastrointestinal (GI) tract under visual control. The method allows for a high-resolution imaging of the gastrointestinal wall and organs and structures in its immediate vicinity. This is especially valuable in the preoperative local staging of gastrointestinal malignancies (esophagus, stomach, pancreas, biliary tract, colon and rectum) according to the new TNM system. In patients without distant metastases EUS helps guiding treatment decisions. EUS is also used with clinical benefit in the diagnosis of submucosal tumors and in the preoperative localization of pancreatic endocrine tumors. Its role in the diagnosis and management of benign gastroenterological disorders has still to be established.

Diagnosis, Differential↗
PubMed1992

Localization of pancreatic endocrine tumors by endoscopic ultrasonography.

BACKGROUND: After a pancreatic endocrine tumor has been diagnosed on the basis of clinical signs and the results of laboratory tests, localization of the tumor by the usual imaging procedures fails in as many as 40 to 60 percent of patients. Endoscopic ultrasonography, a sensitive test for small carcinomas of the pancreas, might also be useful in patients with endocrine tumors of the pancreas that cannot be localized by conventional methods. METHODS: We studied 37 patients later shown to have 39 endocrine tumors of the pancreas who had negative results on transabdominal ultrasonography and CT. All the patients underwent endoscopic ultrasonography, and 22 also underwent selective angiography. All the tumors were confirmed by surgical excision and immunohistologic examination; they consisted of 31 insulinomas, 7 gastrinomas, and 1 glucagonoma, 0.5 to 2.5 cm (mean, 1.4 cm) in diameter. All but one of the patients were cured of their disease, as ascertained by at least six months of clinical and laboratory follow-up. RESULTS: Using endoscopic ultrasonography, we were able to localize 32 of the 39 tumors (sensitivity, 82 percent); no tumor was incorrectly localized. The size of the tumors was very similar (within 2 mm) to that predicted by endoscopic ultrasonography. Among the 22 patients who underwent both angiography and endoscopic ultrasonography, ultrasonography was significantly more sensitive than angiography for tumor localization (sensitivity, 82 percent vs. 27 percent). Among 19 control patients without pancreatic endocrine tumors, endoscopic ultrasonography was negative in 18 (specificity, 95 percent). CONCLUSIONS: Endoscopic ultrasonography is a highly sensitive and specific procedure for the localization of pancreatic endocrine tumors. It should be considered for the preoperative localization of such tumors once the clinical and laboratory diagnosis has been established.

Adenoma, Islet Cell↗
PubMed1992

[The endosonographic staging of pancreatic carcinoma].

Endoscopic ultrasound (EUS), conventional ultrasound (US), computed tomography (CT) and angiography were compared in their assessment of local resectability in 35 consecutive patients (19 men, 16 women; mean age 49.8 [42-821] years) with non-metastatic carcinoma of the pancreas. The findings were made prospectively and independently of each other. EUS proved to be superior to transabdominal US and to CT in the diagnosis of tumour infiltration of the portal and splenic veins. For the portal vein the sensitivity was 93% by EUS, 14% by US and 36% by CT. Corresponding figures for the splenic vein were 92%, 39% and 69%. EUS was markedly superior to angiography in the diagnosis of portal vein involvement (sensitivity of 93% and 36%, respectively), but the two methods had similar sensitivity regarding splenic vein infiltration (92 and 100%). Tumour involvement of the coeliac trunk was diagnosed with higher sensitivity angiographically (86%) than by EUS (57%), CT (71%) or US (29%). Regarding T and N staging, EUS was superior to both US and CT. These data indicate that EUS is the most accurate method for local tumour staging of potentially resectable pancreatic carcinoma. It can replace angiography in the diagnosis of portal vein infiltration.

Adult↗
PubMed1992

Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography, and angiography.

In a prospective study, endoscopic ultrasonography was compared with transabdominal ultrasonography, computed tomography, and angiography in 60 consecutive patients with pancreatic (n = 46) and ampullary (n = 14) cancer considered to be candidates for surgery. The diagnostic value of these imaging procedures in determining local resectability was assessed. The diagnosis of ampullopancreatic malignancy was made by operation (n = 40) or puncture/biopsy (n = 20). In the 40 patients who underwent surgery, endoscopic ultrasonography was significantly superior to abdominal ultrasonography and computed tomography in determining tumor size and extent and lymph node metastases of pancreatic and ampullary cancer. Furthermore, involvement of the portal venous system as judged by histopathology or surgical exploration was correctly assessed by endoscopic ultrasonography in 95%, whereas angiography (85%), computed tomography (75%) and abdominal ultrasonography (55%) were less sensitive. Of 11 cases of portal venous infiltration found at surgery, endoscopic ultrasonography correctly predicted 10, abdominal ultrasonography only 1, computed tomography 4, and angiography 5 (P less than 0.05 for all three comparisons). Twenty patients did not undergo surgery for different reasons: of those, 9 patients were excluded from operation because of portal venous involvement as shown by angiography. Endoscopic ultrasonography detected portal venous invasion in all these cases. In contrast to the venous system, arterial encasement was less reliably detected by endoscopic ultrasonography. In conclusion, endoscopic ultrasonography is the most effective single imaging procedure for local tumor staging in pancreatic and ampullary cancer. Thus, endoscopic ultrasonography will improve the assessment of tumor resectability and further decrease the need for explorative laparotomy.

Adult↗
PubMed1992

Endosonographic diagnosis of submucosal upper gastrointestinal tract tumors.

Endoscopic ultrasound (EUS) was performed in 37 patients with upper gastrointestinal tract submucosal tumors (SMT). Fourteen of these were located in the esophagus, 20 in the stomach, and 3 in the duodenum. In 26 patients histologic confirmation was achieved by operation (n = 15) or biopsy/puncture (n = 11). EUS was able to visualize all tumors and, with one exception, determined their originating wall layer correctly. It became evident that myogenic tumors arise from the echo-poor layers (second layer and fourth--that is, muscularis propria) and that other lesions, such as cysts or fibromas, originate from the third, echo-rich layer (submucosa). Tumor size was correctly (+/- less than 5 mm) predicted in 87% of cases. Computed tomography, performed in 22 patients, was successful in visualizing the SMT in only two-thirds of cases. No single endosonographic criterion could be obtained which enabled accurate differentiation between benign and malignant SMT. However, from a clinical point of view, it seems reasonably safe to regard smaller (less than 3 cm), smoothly demarcated SMT as benign and follow them up by repeated EUS, especially in patients at risk for surgery. Larger masses (greater than 5 cm) and those with irregular borders should be suspected of being malignant. In the future, application of new, small ultrasound probes that can be used during conventional endoscopy (two SMT were visualized successfully) may greatly simplify the procedure.

Diagnosis, Differential↗
PubMed1992

[Clinical relevance of endosonography in diagnosis of pancreatobiliary diseases].

Endoscopic ultrasonography allows a high-resolution imaging of the pancreas and the extrahepatic biliary tract due to the high ultrasonic frequencies employed. This is of clinical benefit in the delineation of small pancreatic carcinomas complementary to ERCP and in the preoperative localization of endocrine tumors of potential pancreatic origin. Endosonography is the most accurate method presently available for the local staging of pancreatobiliary malignancy and thus helps avoiding diagnostic laparotomy for staging purposes. The role of endoscopic ultrasonography in the diagnosis of benign diseases such as chronic pancreatitis and choledocholithiasis has not yet fully been established. Endosonography, however, has no role in the differential diagnosis of benign and malignant disorders of the pancreas and biliary tract.

Ampulla of Vater↗
PubMed1992

[Endosonography in gastroenterology--an intermediate evaluation].

Endoscopic ultrasonography has widened the diagnostic spectrum of gastrointestinal disorders in two respects: For the first time it became possible to visualize the gastrointestinal wall with its layer structure. EUS was shown to be highly accurate in the local staging of gastrointestinal tumors (T and N stage). The clinical relevance of endosonography derives from stage-dependent treatment protocols selecting patients for different forms of tumor therapy. The second advantage of endosonography is a high-resolution imaging of the pancreas enabling the detection of small lesions (e.g. endocrine tumors). Endoscopic ultrasonography is furthermore the most reliable method for local staging of pancreatic and ampullary carcinoma. The role of endosonography in benign gastroenterological disorders is less well established. With the increasing use of laparoscopic surgery endosonography may become even more important in the future.

Diagnosis, Differential↗
PubMed1991

[Endoscopic ultrasound in gastroenterologic tumors].

By means of endoscopic ultrasound (EUS) the visualization of the gastrointestinal wall Layers as well as a high-resolution imaging of the pancreas with neighbouring large vessels has become possible. EUS is especially sensitive in the local tumor staging in esophageal, gastric, pancreatic and ampullary carcinoma (accuracy rates 80-90%). Lymph node metastases are correctly identified in 70-80%. This also applies to the rectal cancer employing rigid instruments. Experience with colonic endosonography is still too limited to permit any definitive conclusions. For the primary diagnosis of submucosal tumors of the upper GI tract, and for the detection of small pancreatic lesions (e.g. endocrine tumors), endosonography is of high diagnostic accuracy.

Endoscopes, Gastrointestinal↗
PubMed1991

Gastric fundus impression caused by splenic vessels: detection by endoscopic ultrasound.

When a submucosal impression of the stomach fundus is seen during upper GI endoscopy, a true submucosal tumor can reliably be differentiated from an extragastric impression by endoscopic ultrasound (EUS). We report on 15 patients in whom EUS identified splenic vessels near the splenic hilum causing an impression of the posterior wall of the gastric fundus. Neither by EUS nor conventional ultrasound, computed tomography or clinical follow-up, was a tumor in the stomach or upper abdomen that could have been the cause of the gastric wall impression, identified. Two of the 15 patients had portal hypertension with multiple intra-/paramural venous collateral vessels. Twenty patients examined for other reasons and 10 patients with portal hypertension but without fundic impressions, served as controls: In these cases the splenic vessels were shown by EUS to follow a course more distant to the gastric wall. Thus, normal vascular structures should be included in the differential diagnosis of gastric fundus impression detected by endoscopy.

Diagnosis, Differential↗
PubMed1991

An unusual case of active tuberculosis of the oesophagus in an adult.

A case is reported of a 56-year-old woman of Libyan origin presenting with dysphagia, retrosternal pain and weight loss. Oesophago-gastroduodenoscopy revealed an ulcerated tumor in the upper oesophagus strongly suggesting a malignancy. A positive Mendel-Mantoux test along with histological evidence of epitheloid cell granulomas and clinical findings consistent with pulmonary and lymph node tuberculosis led to the presumptive diagnosis of oesophageal tuberculosis. The diagnosis was later confirmed by positive bacteriological cultures of oesophageal biopsies and gastric washings. It is very unusual for dysphagia to be the presenting symptom of active adult tuberculosis. Oesophageal tuberculosis is extremely rare and must be distinguished predominantly from oesophageal carcinoma.

Deglutition Disorders↗