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Biomedical subjects

W Gross-Fengels

Publications and source records attributed to W Gross-Fengels.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Status of the captopril test in the diagnosis of hypertension].

The place of captopril (C) testing in the screening for renovascular hypertension is still controversial. Baseline and C-stimulated plasma renin concentrations (PRC) were measured in 113 hypertensives, who where referred for the exclusion of secondary hypertension. In addition intravenous digital subtraction angiography (DSA) and a renal scintigraphy were performed. When renal artery disease was revealed by DSA or renin was stimulated the renal arteries were visualized by direct arteriography (and treated by angioplasty if possible). 86 patients underwent each diagnostic test: 21% had renovascular hypertension. Unilateral renal artery stenosis (n = 10) was detected by the captopril test (cutoff values: baseline greater than 40 microU/ml, after C greater than 180 microU/ml, sensitivity 100%). Bilateral renal artery stenosis (n = 8) was missed when the disease was equally severe on either side (sensitivity 50%). The specificity of C testing was 82%, overall sensitivity (uni- and bilateral disease 78%, prevalence 21%, predictive value of the positive test 0.56, predictive value of the negative test 0.93). With i.v.-DSA the renal arteries were technically evaluable in 91% (82/92) of cases. The sensitivity for the detection of all renal artery stenoses was 79% (uni-lateral 100%, bilateral 40%, specificity 97%). The sensitivity of renal scintigraphy for the detection of unilateral renal artery stenoses was 50%, for the detection of bilateral renal artery stenoses 43%, specificity 81%. The present study demonstrates the usefulness of captopril for the detection of unilateral renal artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Interdisciplinary treatment of pancreatic cancer].

Resection of the pancreas due to carcinoma represents with an operative mortality of 3.5% and three-year-survival of 15% an operative strategy, which should be carried out as a therapy of choice only on selected patients with an early cancer stage (ex. T1). But no other treatment offers the chance of long-time survival and curation. There seems to be no influence of operative therapy on patient prognosis in advanced cancer stages. In these cases, palliative treatment (ex. biliodigestive anastomosis or transcutaneous biliary drainage) are methods of choice. A main palliative aspect should be a painless patient. This can be achieved by oral or i.v. medication and/or chemical neurolysis of plexus coeliacus.

Adult↗
PubMed1989

[Distribution pattern of atheromatous lesions of the carotid circulation--significance for the angiographic strategy of cerebrovascular insufficiency].

Atherosclerosis of the cervico-cerebral arteries is a generalized disease which frequently involves the whole carotid system. The bifurcations (48.7%), the proximal 2 cms. of the internal carotid arteries (61.6%) and the carotid siphons (60.3%) are most frequently affected. Angiography may demonstrate ulcerated lesions in up to 25% of cases. "Tandem stenoses" in both the extracranial segments of the carotid arteries (4.6%) and isolated hemodynamically significant stenoses in the carotid siphons (.7%) are uncommon. Nevertheless their presence may play an essential role in therapeutical decision making. Because of the multiplicity of lesions, the claim for preoperative selective arteriography is justified. IA DSA may replace film angiography, if image quality and medical information are identical. IV DSA and Doppler-procedures as a rule cannot replace selective arteriography in preoperative work-up.

Adult↗
PubMed1989

[Diagnosis of intracerebral aneurysms].

Even today intracerebral aneurysms are a diagnostic challenge. CT is still the method of choice in the acute phase of subarachnoid haemorrhage. In later stages potential results of aneurysmal bleeding like oedema and infarction are better detected by MRI. Selective arteriography remains an obligatory element of radiologic diagnosis preoperatively and in cases of possible interventional proceedings. A synthesis of all methods ensures high diagnostic accuracy.

Aortic Dissection↗
PubMed1989

[Differentiation between dissection and a true aneurysm of the descending thoracic aorta using magnetic resonance tomography].

The case reviewed here demonstrates that magnetic resonance imaging in contrast to CT and i.v. DSA can differentiate between aortic dissection with partially thrombosed false lumen and a true aneurysm using the spin-echo and the gradient-echo technique. The gradient-echo technique was able to depict the moving intimal flap as well as the higher blood flow velocity in the true lumen.

Aged↗
PubMed1988

Digital subtraction angiography: the intravenous approach.

With further improvement of digital subtraction angiography (DSA) equipment, and the development of sophisticated soft-ware programs, the intravenous approach again has become an promising diagnostic alternative in certain clinical settings, if the patient's cardiac output is not severely diminished. In many cases an additional arterial study is not necessary. The diagnostic results, advantages and limitations of the intravenous approach in imaging the brachiocephalic, renal and peripheral vessels are discussed.

Angiography↗
PubMed1988

[Abdominal real-time sonography in patients with vascular prostheses].

100 sonograms were performed in 71 patients up to 13 years (average 21.8 months) after various surgical interventions of the abdominal aorta. Patients were examined e.g. for complications in the early postoperative stage or abnormal local findings and during clinical follow-ups. Ultrasound showed e.g. 13 aneurysms of grafts and anastomoses, 19 haematomas, 4 lymphoceles, 3 graft occlusions and 2 graft infections. Beyond the implantation site in 45 sonograms additional pathological findings were demonstrated, which were unknown in 13 patients (e.g. renal carcinoma, liver metastases, hydronephrosis). In patients with aortic grafts real-time sonography of the abdomen can be regarded as a relatively easily performed, valuable method.

Adult↗
PubMed1988

[Treatment of arterial occlusions of the lower extremities using 2-stage local application of urokinase].

We report the results of a 2-phase urokinase protocol for treatment of 28 arterial occlusions of the lower extremities. 26 patients, aged 43-86, with up to 6 weeks old occlusions were treated. In Phase I (average duration 2.7 h) the urokinase solution was injected in intervals directly into the occlusion-material via a F-5 catheter (120,000 U/h). In the following phase II (average duration 26.1 h) 100,000 U/h were given as a continuous arterial infusion and a full heparin regimen was started. In 86% of the treatments there was an improvement as shown by angiography. 75% of the patients could be released from the hospital without a further surgical revascularisation. Alterations of the systemic coagulation-system and bleeding-complications at the puncture site must be expected.

Aged↗
PubMed1988

[DSA in the postoperative diagnosis of patients with kidney transplants].

Image quality and diagnostic significance of intravenous and intraarterial DSA following renal transplantation were assessed in 40 angiographic studies. In 27 of 40 DSA (67.5%) there were pathologic findings such as a renal artery stenosis, aneurysms or rejection within this selected group of patients. There were significant differences in image quality between intravenous and intraarterial DSA. The value of intravenous DSA is limited, particularly in patients with complex anastomosis, implanted polar arteries and kinking stenosis.

Adult↗
PubMed1988

[Early and late results of percutaneous transluminal angioplasty of renal artery stenoses].

The initial and long-term results of percutaneous transluminal angioplasty of renal artery stenoses are reported. In 4 out of 73 (5.5%) patients the angioplasty catheter could not be placed in the stenotic area. In 67 patients partial or complete dilatation of the segments treated was possible. Complications requiring therapy occurred in 12.3%. Most (80.3%) of the patients were discharged from hospital with completely corrected or improved hypertension. Cure or improvement was noted more often in patients with fibromuscular dysplasia, short history of hypertension, pathologic renin quotient, normal total hippuric acid clearance, or age under 40 years. On follow-up examination a mean of over 14 months after angioplasty 51.7% of the patients had normal blood pressure or less pronounced hypertension, while in 60.9% the total hippuric acid clearance had increased.

Adult↗
PubMed1988

[The type, scope and clinical relevance of early radiologic diagnosis of aneurysms of the popliteal artery].

The popliteal aneurysm as the cause of an acute arterial obliteration pattern is sometimes misinterpreted or overlooked. However, if a femoropopliteal aneurysm is confirmed, the therapeutic approach is substantially different. The article reports on the results of the radiological diagnosis of 17 popliteal aneurysms and the diagnostic relevance of the applied imaging processes is discussed. Real-time sonography and angiography complement each other in their findings and prove to be an indispensable part of preoperative diagnosis.

Aged↗
PubMed1987

[DSA for the imaging of tumor-caused vascular changes and complications during local chemotherapy of the liver via the portal system].

In 18 patients with primary or secondary liver tumours, 38 digital subtraction angiographies (DSA) of totally implanted catheter systems for liver perfusion were performed during a period of 8 months. The systems had been used for an average of 6.9 months. In 22 out of 38 examinations secondary reactions of liver arteries were observed, in 7 the therapeutic regimen was changed after DSA. Patients with an extensive tumour involvement of the liver showed mural thromboses or obstructions of liver arteries relatively more often (4 of 7) than patients with smaller size tumours (2 of 11). In 7 cases the therapeutic regimen was changed after DSA. DSA of implanted liver catheters is a valuable, well tolerated, easily and rapidly performed method.

Adult↗
PubMed1987

[Imaging of iatrogenic aneurysms and AV fistulas of the lower extremity with IV-DSA and sonography].

Using IV-DSA and ultrasound (real-time), we demonstrated 13 false aneurysms, 2 isolated AV fistulas, 7 aneurysms of profunda patches and 8 aneurysms of bypass grafts. Aneurysms and AV fistulas developed in all 30 patients after different diagnostic and therapeutic procedures. Ultrasound showed partial thromboses of the aneurysms, perivascular changes and compression of the femoral vein, that could not be demonstrated by IV-DSA. On the other hand IV-DSA allowed the recognition of important findings not shown sonographically, such as AV fistulas and stenoses of the proximal and distal arteries. These findings were relevant for further surgical approach. It is therefore concluded that in patients with suspected aneurysm of the femoral or popliteal artery, IV-DSA and ultrasound should be used in conjunction rather than as alternative methods.

Adult↗