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Biomedical subjects

W Pircher

Publications and source records attributed to W Pircher.

At least 19 recordsLinked to original sources
PubMed1991

Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging.

To evaluate the sensitivity of sonography, CT, and MR imaging in the detection of hepatic masses in carcinoma patients, we conducted a prospective study of 75 consecutive patients with gastrointestinal tumors who were admitted for surgical resection of the primary tumor. Sonography was performed with convex transducers of 3.5 and 5.0 MHz. Three noninvasive CT techniques were used: unenhanced CT scans, the incremental bolus dynamic scanning technique, and delayed scanning 4-6 hr after bolus injection of 60 g of iodine. MR images (1.5 T) were acquired as presaturated T1- and T2-weighted spin-echo sequences and as breath-holding fast low-angle shot (FLASH) 60 degrees and FLASH 15 degrees sequences. As it is difficult to distinguish benign from malignant masses solely on the basis of morphologic criteria, the techniques for each imaging method were designed to detect and not to characterize hepatic lesions. Each examination was interpreted blindly, and the results were compared with surgical findings, intraoperative sonography, and biopsy of the liver as the gold standard. All focal hepatic masses verified at surgery, malignant or benign, were included in the analysis. Sixty-five (68%) of 95 focal hepatic masses were detected by CT, 60 lesions (63%) by MR, and 50 lesions (53%) by sonography. Although lesions 1-2 cm were shown almost equally well by CT and MR (74% and 77%, respectively), the detection rate of smaller lesions (less than 1.0 cm) decreased more drastically with MR (31%) than with CT (49%). Sonography had a sensitivity of only 20% with the smaller lesions. All imaging techniques had a sensitivity of 100% for focal hepatic masses larger than 2.0 cm. Our results show that CT has a higher overall sensitivity (68%) than MR and sonography for the detection of focal hepatic masses. When the results of the three procedures are combined, the overall sensitivity is 77%. This is unsatisfactorily low, as CT and MR have a size threshold of about 1.0 cm and are relatively unreliable for the detection of smaller lesions.

Adenocarcinoma↗
PubMed1989

[Duplex sonography in the diagnosis of renal artery stenoses following allogenic kidney transplantation].

Posttransplant renal artery stenosis (TRAS) as a cause of secondary hypertension is reported with an incidence of 1 to 10%. Early diagnosis of TRAS should be made by non-nephrotoxic and non-invasive means to lower the risk of hypertension. One to 66 months after kidney transplantation 335 patients underwent Duplex-scanning, 38 of cases for clinical tentative diagnosis of TRAS. Parameters for clinical diagnosis of TRAS were diastolic hypertension greater than 100 mm Hg with resistance to therapy (A), an abdominal bruit over the transplant (B), disturbance of renal function (serum-creatinine greater than 2 mg/dl) (C). Admission to study followed the parameter-combination A + B. A + C, B + C. Rejection crisis was excluded in 18/38 cases by fine needle biopsy, cyclosporine over-dosage was negative in 38/38 cases, 20/38 cases had normal renal function. Duplex-/Doppler-ultrasound criteria for TRAS were systolic peak velocity greater than 100 cm/s-1 and broadening of the diastolic frequency spectra with a smooth decline in diastole to an elevated diastolic level. In 32/38 cases (84.2%, n = 38) diagnosis of TRAS was made by duplex-scanning, angiography confirmed the result in 30/32 cases (93.75%, n = 32); sensitivity was 88.2% with a specificity of 66.6%. Duplex-scanning as a primary diagnostic means for TRAS seems a promising method compared to e.g. radionuclide imaging or angiography. Duplex-scanning is a non-nephrotoxic and non-invasive procedure repeatable at any time with only few preliminary conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Absorbable mesh in the treatment of rectal prolapse.

Transabdominal rectopexy is a widely used method with excellent results in the treatment of rectal prolapse; a variety of absorbable and non-absorbable materials has been described in the literature. In the Department of Surgery in the University of Munster we have been using absorbable mesh (Vicryl/Dexon) routinely to perform rectopexy. These materials are practically identical in their mode of degradation. Both are absorbed completely, releasing glycolic acid which is believed to be bacteriostatic. In this series of 62 cases absorbable mesh was used to fix the mobilised rectum to the sacrum. The operations were performed using one-dose antibiotic prophylaxis. There were no deaths. Two recurrences developed within two weeks of operation, one complete and one incomplete. Both cases, however, had been operated upon by inexperienced surgeons. Two further recurrences occurred after 36 and 45 months; thus the overall rate of recurrence was 6.4%. In no case was there abdominal or pelvic infection. We believe that absorbable mesh is a suitable material for performing rectopexy, reducing the rate of abdominal and particularly pelvic infection without increasing recurrence rate.

Adolescent↗
PubMed1988

[Treatment of pheochromocytoma: changes in diagnosis and therapy].

Evident progress has been made in the treatment of pheochromocytoma. The results of hormone analysis became very accurate, the method for tumor localisation are non invasive and safe: with 131-I-MIBG, ultrasonography and CT-scan an exact preoperative localisation is possible without serious risks. Patients are prepared for the operation with alpha- and beta-blocking agents. Modern methods of anaesthesia with continuous monitoring of blood pressure, pulmonary pressure and cardiac output and a standardized operative procedure are essential. From 1965 to 1987 71 patients with a total of 87 catecholamine producing tumors have been operated. In all cases a transabdominal access was chosen. Biadrenal tumors were removed in 8 patients, multiple (7) tumors in 2 patients. The comparison of the 2 time intervals 1965 to 1976 and 1977 to 1987 showed a significant decrease of serious intra- and postoperative complications. Surgical specimens of 36 patients with pheochromocytoma were used for immunohistologic evaluation. Marked positivity was found in 44% of cases for calcitonin. The reaction for vasoactive intestinal polypeptide (VIP) was positive in 28% of cases. Somatostatin was not detected in any case, neuron-specific enolase (NSE) in all cases. 6 patients with malignant pheochromocytoma were treated with high doses of 131-I-MIBG, 4 other patients received a combined chemotherapy.

Adrenal Gland Neoplasms↗
PubMed1987

[Bilhemia--a review of diagnosis and therapy].

Bilhemia is a rare complication after liver injuries with high mortality. Clinical signs are rapid increase of direct and total bilirubin up to extreme values and increase of bile acids in serum. The reason is an intrahepatic connection between biliary and venous system. The bilio-venous fistula can be shown by ERCP and retrograde cholangiography via T-drainage. Localisation can be ensured by ultrasonography und computertomography. Treatment consists in resection of bilio-venous fistula, tamponade of intrahepatic cavities by use of a net of polyglactin-910 (Vicryl) or polyglycolic acid (Dexon) or sucking T-drainage.

Abdominal Injuries↗
PubMed1984

[Restoration of work capacity after major vascular surgical interventions. Expectations and reality].

130 patients who had been working pre-operatively were examined and interviewed at least one year after an aorto-femoral bypass operation; 40.8% had continued smoking. Although 83.8% of patients were satisfied with the result of the operation, 73.9% could not be fully rehabilitated despite a successful operation. The majority of patients in whom work capacity had not been restored was in the group which was economically best protected (civil servants and employees). Apparently it is not the operation but the standard of socio-economic protection which is decisive in restoring work capacity.

Aorta↗
PubMed1984

[An ischemic-septic disease picture following acute occlusion of the superior mesenteric artery].

The pattern of symptoms which evidences acute mesenterial infarction has been investigated on more than 40 pigs by applying diverse non-surgical therapeutic approaches during transarterial balloon occlusion of the A. mesenterica superior. All animals died within 38 hours, much earlier after central occlusion than after blockage of the peripheral branches of the artery. A convincing delay could only be observed in the group treated by antibiotics. In two groups of clinical patients, 20 before and 28 after the experimental study, we found a significantly better prognosis in the latter group. About 46% of them got an antibiotic treatment immediately after being admitted to hospital. However, recently the time elapsing from the vascular accident to laparotomy has been shorter than in the last two decades. This contributes to better chance of survival in mesenterial ischaemia. Thus, antibiotic protection and early surgical intervention can be considered to be crucial for survival after mesenterial infarction.

Adult↗
PubMed1980

[Benign tumors of the esophagus (author's transl)].

Benign esophageal tumors are rare. Intraluminal and intramural tumors may be distinguished according to localization,--intramural leiomyomas occur most often. Retrosternal pain and dysphagia are the most frequent symptoms, rather often there are however no symptoms at all. X-ray examination and esophagoscopy should be applied for making a diagnosis, intramural tumors however may escape endoscopic diagnosis. Biopsies are indicated only, if mucosal alterations can be observed macroscopically. For final diagnosis the tumor has to be removed completely by surgery. In most cases this can be achieved by transthoracal enucleation, in special cases it may be necessary to remove part of the esophagus. Nine cases are reported.

Aged↗
PubMed1979

[Clinical experience with acute mesenteric vascular occlusion (author's transl)].

Between 1964 and 1978 twenty patients suffering from acute mesenteric vascular occlusion were treated in the surgical department (University of Münster). The average duration of the anamnesis until their hospitalization was 3.1 days and the actual operation was performed 11.35 hours later on the average. In only 15% of the cases had a correct preoperative diagnosis been given. As regards the frequency of causation, 60% of the mesenteric vascular occlusions were caused by a mesenteric arterioembolism, 20% by a mesenteric venous embolism, 10% by a mesenteric arterial thrombosis and 10% by a non-obstructive occlusion. In a post cardiac infarction condition was the predisposing factor in 50% of all cases, valvular defect in 33.5% and tachyarrhythmia in 16.6%. The causes found for the mesenteric venous tbrombosis were insufficiency of the right heart, absolute bradyarrhythmia, recurrent venous thrombosis of the leg, and myeloproliferative syndromes.

Adolescent↗
PubMed1978

[Results of Implantation of Aorto-Femoral Bifurcation Prostheses (author's transl)].

From June 1974 to December 1975, 139 aorto-femoral Y-grafts were implanted at the surgical clinic of the University of Münster. The operation mortality was 4.3 percent. Among the postoperative complications were sexual disfunction and paraesthesia. For the ileo-femoral occlusions the postoperative success rate was 90 percent, combined ileo-femoro-crural changes showed good results in 60 percent of the cases. The results show that isolated reconstruction in the pelvic area is successful in most cases, even in combined ileo-femoro-crural obstruction. Only in exceptional cases a second operation (reconstruction of femoral artery) is necessary after a period of about one year.

Adult↗
PubMed1977

[Diagnosis of peripheral arterial vascular disorders using Doppler-ultrasonography].

Most important in vascular surgery is the exact preoperative diagnosis. The Doppler-ultrasonography is an exact and simple method to estimate localization and different changes in the peripheral arteries; the results allow a dependable preselection for necessary preoperative angiography. Advantages and results of Doppler-ultrasonography are described. Two cases are demonstrated.

Adult↗