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  • 1
    ISSN: 1432-1084
    Keywords: Breast carcinoma ; Colour Doppler sonography ; Tumour vascularisation ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We examined 37 patients with proven breast cancer using colour-coded Doppler sonography. Feeding vessels as well as vascular structures in the centre and the periphery of the tumour could be detected in the majority of cases. In a minority, however, no or only a few vessels with very slow flow velocities could be demonstrated. These widely varying results correspond well to histological findings reported in the literature. Comparisons of different examinations suffer from the lack of sufficient standardisation and validation. We conclude that despite the detectability of tumour vessels in breast tumours the role of the method in the differentiation of benign and malignant lesions remains in doubt.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0932
    Keywords: Key words Adolescent idiopathic ; scoliosis ; Spinal instrumentation ; Spine length ; 3D correction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This is a prospective study comparing the short- and long-term three-dimensional (3D) changes in shape, length and balance of the spine after spinal instrumentation and fusion in a group of adolescents with idiopathic scoliosis. The objective of the study was to evaluate the stability over time of the postoperative changes of the spine after instrumentation with multi rod, hook and screw instrumentation systems. Thirty adolescents (average age: 14.5 ± 1.6 years) undergoing surgery by a posterior approach had computerized 3D reconstructions of the spine done at an average of 3 days preoperatively (stage I), and 2 months (stage II) and 2,5 years (stage III) after surgery, using a digital multi-planar radiographic technique. Stages I, II and III were compared using various geometrical parameters of spinal length, curve severity, and orientation. Significant improvement of curve magnitude between stages I and II was documented in the frontal plane for thoracic and lumbar curves, as well as in the orientation of the plane of maximum deformity, which was significantly shifted towards the sagittal plane in thoracic curves. However, there was a significant loss of this correction between stages II and III. Slight changes were noted in apical vertebral rotation, in thoracic kyphosis and in lumbar lordosis. Spinal length and height were significantly increased at stage II, but at long-term follow-up spinal length continued to increase while spinal height remained similar. These results indicate that although a significant 3D correction can be obtained after posterior instrumentation and fusion, a significant loss of correction and an increase in spinal length occur in the years following surgery, suggesting that a crankshaft phenomenon may be an important factor altering the long-term 3D correction after posterior instrumentation of the spine for idiopathic scoliosis.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European radiology 6 (1996), S. 198-198 
    ISSN: 1432-1084
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    European radiology 6 (1996), S. 262-274 
    ISSN: 1432-1084
    Keywords: Neoplasms ; Abdomen ; Pelvis ; Lymph node metastasis ; Malignant lymphoma ; Staging ; Stomach ; Pancreas ; Liver ; Kidney ; Bladder ; Prostate ; Testicles ; Ovary ; Uterus ; Colon ; Rectum ; Computed tomography ; Ultrasonography ; Positron emission tomography ; Magnetic resonance imaging ; Lymphangiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    European radiology 6 (1996), S. 673-674 
    ISSN: 1432-1084
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    European radiology 8 (1998), S. 517-527 
    ISSN: 1432-1084
    Keywords: Key words: Doppler ; US ; MRI ; Angiography ; Contrast agents ; Tumour vascularity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Non-invasive assessment of vascularity is a new diagnostic approach to characterise tumours. Vascular assessment is based on the pathophysiology of tumour angiogenesis and its diagnostic implications for tumour biology, prognosis and therapy response. Two current techniques investigating vascular features in addition to morphology are Doppler ultrasonography and contrast-enhanced MRI. Diagnostic differentiation has been shown to be possible with Doppler, and a high degree of observed vascularity could be linked to an aggressive course of the disease. Dynamic MRI using gadolinium chelates is already used clinically to detect and differentiate tumours. The histological correlation shows that capillary permeability is increased in malignant tumours and is the best criterion for differentiation from benign processes. Permeability and perfusion factors seem to be more diagnostic than overall vessel density. New clinical applications are currently being established for therapy monitoring. Further instrumental developments will bring harmonic imaging in Doppler, and faster imaging techniques, higher spatial resolution and novel pharmacokinetic concepts in MRI. Upcoming contrast agents for both Doppler and MRI will further improve estimation of intratumoural blood volume and vascular permeability.
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  • 7
    ISSN: 1432-1084
    Keywords: Key words: Breast neoplasms ; Diagnosis ; Breast neoplasms ; US ; Doppler studies ; Computers ; Diagnostic aid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of our study was to reassess the diagnostic performance of image-based, computer-assisted colour Doppler quantification under routine conditions. We used a computer-assisted protocol that quantitatively characterises a colour Doppler image by the relative amount of colour pixels (colour pixel density, CPD) and the colour hues (numerically expressed by the mean colour value, MCV) in 44 patients with breast carcinoma and 49 patients with benign breast lesions. Studies were carried out over two periods by two examiners, subsequently in charge of breast ultrasound. During the first period, the sensitivity of the MCV was 92 %, the specificity 75 %; the sensitivity of the CPD was 80 %, the specificity 81 %. During the second period, the sensitivity of the MCV was 58 %, the specificity 77 %; the sensitivity of the CPD was 68 %, the specificity 71 %. Despite measures to create uniform examination conditions, the diagnostic performance of this method may decline under routine conditions.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Der Radiologe 36 (1996), S. 285-291 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Sonographie ; Kosten-Nutzen-Analysen ; Key words Utrasonography ; Cost-benefit analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Despite the low costs of a single examination, the overall expenses for ultrasonography are exceptionally high (1.4 billion DM in 1993), not counting the costs of further examinations because of unclear findings. The advantages of sonography are that it is harmless and yields diagnostically important results. Its clinical benefit is beyond doubt in the case of acute clinical symptoms, but unclear for staging and follow-up of malignant tumors. It has been shown to be efficient in screening for renal and prostatic cancer. Here, the costs for sonographic screening appear to be potentially outweighed by the reduction in treatment expenses. However, the cost of sonographic examinations can somtimes be avoided: sonography should not be used if there is no clear indication or if the examiner is not really qualified or the equipment is insufficient. There is a conflict of interest when the referring physician performs to sonography himself, leading to unnecessary examinations. To limit costs it would be potentially helpful if sonographic examinations are only performed when the indications are valid. The education of the examining physicians must be improved, better equipment must be used, scanners can be shared, and patients can be referred to colleagues who are more experienced in sonography. The currently reformed reimbursement scheme is of little value because it does not permit a qualified, thorough, cost-efficient examination.
    Notes: Zusammenfassung Trotz geringer Kosten der einzelnen Untersuchung ist das Gesamtaufkommen für die Sonographie mit 1,4 Mrd. DM 1993 außerordentlich hoch, zuzüglich der Kosten für die Abklärung unklarer Befunde. Die Vorteile der Sonographie hinsichtlich der Unschädlichkeit und der Leistungsfähigkeit sind groß. Der klinische Nutzen ist bei aktuellen diagnostischen Fragestellungen hoch, bei Untersuchungen zum Staging und zur Nachsorge von Tumoren strittig und beim Screening nur für das Nieren- und Prostatakarzinom erwiesen. Bei diesen Tumoren würden die Kosten eines sonographisches Screenings durch eingesparte Therapiekosten voraussichtlich aufgewogen werden. Verantwortlich für überflüssige Kosten durch die Sonographie sind v. a. ihr ungezielter, nicht indizierter Einsatz, die Praxis der Selbstüberweisung, mangelnde Qualifikation der Untersucher sowie unzureichende apparative Ausstattung. Eine Begrenzung der Kosten wäre durch sorgfältige Indikationsstellung, bessere Qualifikation der Untersucher, bessere Geräte (ggf. in gemeinsamer Nutzung) und die Konsultation von in der Sonographie erfahrenen Kollegen möglich. Die seit 1996 gültige EBM-Reform ist insofern nur eingeschränkt hilfreich, als sie eine qualifizierte und dennoch kostendeckende Untersuchung nicht zuläßt.
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Der Radiologe 38 (1998), S. 135-137 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Iatrogener Fremdkörper • Gossypibom • Chirurgische Komplikation • Abdomen CT ; Key words Foreign bodies • Gossypiboma • Surgery ; complications • Computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Retained surgical towels (gossypiboma) present a diagnsotic problem if they remain asymptomatic for many years. We report on one 51 year old patient with repeated septic temperatures in the early post-operative phase after hemicolectomy. The contrast enhanced CT of the abdomen revealed a well-defined round soft-tissue mass with a dense, enhanced wall containing an internal high-density wavy and striped area. At laparotomy a secondary infected surgical sponge with abscess formation was found.
    Notes: Zusammenfassung Chirurgische Fremdkörper aus Baumwolle (Gossypibome) bleiben oftmals über Jahre asymptomatisch; die Diagnose kann problematisch sein. Wir stellen den Fall eines 51jährigen Patienten vor bei dem es nach einer Kolonteilresektion postoperativ wiederholt zu einer Sepsis kam. Computertomographisch war eine ca. 3 cm messende weichteildichte Raumforderung mit geschlängeltem hyperdensen Einschluß und diskreter KM-Anreicherung des Randes zu erkennen. Dabei handelte es sich um ein superinfiziertes Bauchtuch mit Abszeßbildung.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Der Radiologe 38 (1998), S. 327-329 
    ISSN: 1432-2102
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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