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Biomedical subjects

W Wermke

Publications and source records attributed to W Wermke.

At least 37 records · Page 2Linked to original sources
PubMed2000

Improved accuracy in the diagnosis of intrahepatic bile duct ectasia in Caroli's disease by combination of ultrasound and endoscopic retrograde cholangiography.

Caroli's disease is characterized by dilatation of the intrahepatic bile ducts. Cholangitis, liver cirrhosis and development of a cholangiocarcinoma are possible complications. For optimal therapy, a correct diagnosis of the extent of the disease is mandatory. The present report demonstrates that the combination of endoscopic retrograde cholangiography and ultrasound may lead to a more reliable diagnosis of the extent of Caroli's disease. It is therefore essential to perform ultrasound in all these patients.

Bile Duct Diseases↗
PubMed2000

[Evaluation of doppler ultrasonography criteria for the differential diagnosis of pancreatic tumors].

AIM: In order to improve the differential diagnosis of pancreatic lesions, dopplersonographic criteria for the tumours were evaluated. METHODS: 35 patients diagnosed by conventional ultrasound as having a tumour of pancreas were further investigated by B-mode sonography, fundamental and echo-enhanced power-Doppler sonography focusing on specific properties of the tumours. The results were correlated to the histological findings. RESULTS: Ductal carcinomas and cystadenocarcinomas are often hypovascularized in comparison to the surrounding tissue. In contrast to this, neuroendocrine tumours and cystadenomas are mostly hypervascularized. Tumours associated with pancreatitis show different vascularization patterns depending on inflammation and the extent of necrosis. CONCLUSIONS: Pancreatic tumours display different vascularization patterns in the echo-enhanced power-Doppler sonography. These characteristics can be useful for the differential diagnosis of pancreatic tumours.

Carcinoma, Intraductal, Noninfiltrating↗
PubMed2000

Vascular complications in acute pancreatitis assessed by color duplex ultrasonography.

We determined the sensitivity of computed tomography and color duplex ultrasonography in the detection and characterization of vascular complications in acute pancreatitis. The relationship of these complications with the etiology and activity of the disease was assessed. In a prospective study, 189 patients with acute pancreatitis seen in the Department of Gastroenterology. Charité Hospital in Berlin over a period of 38 months underwent color duplex ultrasonography every second day for 3 weeks and thereafter at least once a week for 2 months. Dynamic computed tomography was performed within 72 hours after admission, and follow-up computed tomography scans were obtained. In 45 patients (23%), at least temporary thromboses of portal venous vessels were demonstrated by color duplex ultrasonography. The incidence of venous thromboses was 30% in severe acute pancreatitis with fluid collections without necroses and 57% in necrotizing pancreatitis. In 27 of those 45 patients, a formation of collaterals was documented. In 13 patients, arterial pseudoaneurysms were demonstrated. Vascular complications were significantly more frequent in alcohol-induced than in gallstone-induced pancreatitis. Only 62% of all sonographically diagnosed thromboses and only 32% of all collaterals were demonstrated by computed tomography. The prevalence of vascular complications in acute pancreatitis was much higher as suspected. The risk of gastrointestinal bleeding was lower than previously reported. Color duplex sonography is the method of choice for the detection of vascular complications in acute pancreatitis.

Acute Disease↗
PubMed1998

[18-year-old patient with hypercalcemia, hypophosphatemia, nephrocalcinosis and normal iPTH values. Primary hyperparathyroidism].

We report an 18-year old woman with surgically proven primary hyperparathyroidism (pHPT) and normal intact parathyroid hormone (iPTH) serum levels. The reason for this rare biochemical presentation are possible biologically active amino-terminal parathyroid hormone polypeptide fragments not detected by the widely used two-site immunoradiometric parathyroid hormone assay (PTH IRMA). Diagnosis and therapy of primary hyperparathyroidism therefore should not exclusively rest on the finding of hypercalcemia coupled with an elevated iPTH level.

Adenoma↗
PubMed1995

[Portal hypertension--current status of ultrasound diagnosis].

Splenomegaly, ascites, and anatomy of intra- and extrahepatic portal vessels can reliably be detected by ultrasound in case of portal hypertension. The increased diameter of the portal vein and its roots is a not sufficient sensitive and specific finding in portal hypertension. However a marked variation of diameter at the superior mesenteric vein during in- and expiration is nearly exclusive. With the help of colour flow imaging or duplex sonography additional finding of blood flow in the portal system can be detected noninvasively and continuously. Quantitative blood-flow measurement in routine examinations is unnecessary and reserved to special questions. Reverse flow or significantly decreased blood flow velocity or the detection of portocaval collaterals are reliable findings in portal hypertension. In addition thrombosis of portal vessels and its hemodynamic consequences can be seen. Because underlying diseases e.g. liver cirrhosis or tumours are diagnosed in the same procedure ultrasound techniques are used in first line when portal hypertension is suspected. The findings are complementary to endoscopy of upper g.i.tract and lead on the one hand to a well-aimed use of CT scanning or x-ray splenoportography, and--on the other hand--make them dispensable in a low of cases.

Blood Flow Velocity↗
PubMed1993

[Pathophysiology of gallstone formation].

There are two types of gallstones: cholesterol and pigment stones. The pathogenesis is divided into three phases: supersaturation, nucleation and stone growth. Hypersecretion of biliary cholesterol, crystallization promoting and inhibiting factors, gallbladder hypomotility, arachidonyl lecithin, prostaglandins, mucin and calcium play an important role in the formation of gallstones. For the formation of pigment stones a decreased secretion of biliary acids, an increased secretion of unconjugated bilirubin into the bile and an infection of the biliary tract are the most important causative factors.

Bile Acids and Salts↗
PubMed1992

[Ultrasonic diagnosis of bile duct calculi. A prospective study regarding the effects and the objective and subjective factors on accuracy in choledocholithiasis].

The reliability and diagnostic sensitivity of the sonographic identification of bile duct concrements is mainly determined by the examiner's competence and the size of the concrements, and secondly also by the diameter or patency of the bile ducts. Basing on the records of 175 patients on whom choledocholithiasis had been performed, a prospective study (reference: concrement removal after ERCP) showed that the sensitivity of the method is almost twice as high with an experienced examiner than with a less experienced physician (80% vs. 47%). In 231 other cases with extrahepatically conditioned cholestasis we found a 93% specificity of sonography in respect of excluding the presence of concrements. 93% of the concrements that were bigger than 10 mm were definitely diagnosed via sonography (71% sensitivity in case of concrements < 10 mm). If the proof of presence of concrements is differentiated according to bile duct width, it is seen that 85% of all concrements were visualised if the width of the ductus choledochus was > or = 8 mm and 71% in case of a width < 8 mm. The results of the study justify the use of sonography as a primary method in the diagnosis of concrements of the bile ducts; under certain conditions it is also possible to exclude the presence of stones. If findings do not agree with the clinical pattern of findings, or if the bile ducts cannot be visualised properly, diagnostic ERCP is indicated.

Ampulla of Vater↗
PubMed1991

[Post-traumatic hemobilia in childhood].

We observed three patients with a hemobilia after surgically or conservatively treated liver lacerations. The diagnosis was suspected on clinical grounds and verified by ultrasonography, computed tomography or angiography or a combination thereof. Depending on the findings therapy was planned reaching from conservative treatment to liver resection. Because this complication is rare it should be cared for in a specialized institution.

Child↗