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  • 1
    ISSN: 1279-8517
    Keywords: Peritoneum ; Infections ; Renal fasciae ; Retroperitoneal compartments
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Il est habituellement admis que l'extension rétro-rénale des processus nécrotiques du pancréas comporte une atteinte de l'espace para-rénal postérieur. Or l'analyse de coupes tomodensitométriques montre que, chez la plupart des patients, cet espace n'est pas intéressé, ce qui implique un mécanisme différent. Nous avons étudié les bases anatomiques de ces extensions rétro-rénales au cours d'une étude statique et fonctionnelle, portant sur 12 sujets, et comportant des coupes tomodensitométriques, des dissections et des coupes histologiques. Nous avons observé que le fascia rénal postérieur était plus épais que son homologue antérieur et qu'il pouvait être facilement séparé en deux couches par la dissection ou l'injection de latex. Par ailleurs nous avons montré que la couche profonde du fascia postérieur était en continuité avec le fascia antérieur et que la couche superficielle était en continuité avec le fascia latéro-conal. Le point de séparation des deux couches du fascia postérieur, et l'extension médiale de ce dernier, variait considérablement sur les scanners réalisés sur 100 malades. Ces résultats permettent de penser que les coulées de nécrose pancréatique s'étendent derrière le rein, en séparant les deux couches du fascia rénal postérieur.
    Notes: Summary Retrorenal extension of pancreatic inflammatory processes are considered to involve invasion of the posterior pararenal space. Analysis of computed tomographic (CT) images demonstrates preservation of posterior pararenal fat in most patients, implicating some other mechanism. We have examined the anatomical basis for these retrorenal extensions in static and functional studies of 12 cadavers using CT imaging, dissection and histological techniques. We observed that the posterior renal fascia was thicker than the anterior, that it could be easily separated into two layers by manual dissection and injections of liquid latex, that the inner (anterior) layer of the posterior fascia was continuous with the anterior fascia and the outer layer continuous with the lateroconal fascia. The point at which the two layers of the posterior fascia separated laterally and the medial extent of the posterior fascia varied considerably in CT scans of 100 patients. These data are interpreted to mean that pancreatic effusions extend posterior to the kidney by separating the two layers of the posterior renal fascia.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0897-3806
    Keywords: fasciae ; kidney ; abdomen ; perirenal spaces ; pararenal spaces ; Life and Medical Sciences ; Miscellaneous Medical
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine
    Notes: Our objective was to describe the boundaries and sites of communication of the posterior peritoneal compartments in order to explain extensions of pathological processes in retroperitoneal areas. To this end we examined these distinct bilateral compartments [anterior (AP) and posterior (PP) pararenal and perirenal (P) spaces] in four bodies by CT scans, dissections, crosssections, latex injections, and light microscopy. Perirenal areas bilaterally were closed spaces which extended from the inferior surface of the diaphragm to the superior pelvic aperture (pelvic inlet) tapering superiorly and inferiorly in the shape of two cones with a common base at the midrenal area where they communicated across the median plane. The AP is a potential space on the right but contains the pancreas on the left. Each has shorter superior and inferior extensions than the corresponding PP space. Tough, often multilaminar, fasciae surrounded these spaces and limited the spread of injected latex except where vascular pathways permitted inter-compartmental spread. Computer-assisted 3-D reconstructions showed that these spaces extended potentially from the diaphragm into the pelvis. These compartments and their fasciae help explain the predictable yet restricted clinical extensions of pancreatitis, renal infections, and aortic aneurysms in the posterior abdomen.
    Additional Material: 26 Ill.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Spiralcomputertomographie ; CT-Angiographie (CTA) ; CT-Subtraktionsangiographie ; Key words Spiral computed tomography ; CT-angiography (CTA) ; CT-subtraction-angiography (CTSA)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: To develop and implement a method to obtain digital subtraction (DS) spiral computed tomography angiograms (SCTA) in order to avoid superimposition of bony structures and vascular calcifications on SCTA maximum intensity projections (MIPs) and shaded surface display (SSD). Method: Two SCTA data sets, one before and one during the injection of a contrast agent bolus, were obtained with identical scan parameters. Since ordinary subtraction of the two data sets fails to reliably separate bones and calcifications from the vascular lumen because of motion, a so-called elastic subtraction procedure was designed to correct 3D misregistration between the two data sets. It automatically accommodates for local position changes between baseline and contrast images, including regionally inconsistent non-linear displacements and arbitrary rotations. This method was tested in seven patients and evaluated against ordinary DS in terms of image quality and artifacts. Results: In all patients “elastic” CTSA proved superior to ordinary DS. It provides automated and reliable separation of vessels from bones and calcifications. This improves the delineation of vessels in the neck and the skull base and of intracranial vessels. DS-SCTA facilitates MIPs and SSD without artifacts introduced by thresholding. Conclusion: Elastic DS-SCTA is a robust method for automated unmasking of vessels from bones and warrants clinical trials and comparison with MR- and conventional angiography.
    Notes: Zusammenfassung Es wurde eine Methode zur überlagerungsfreien Darstellung von Gefäßen mittels der CT-Angiographie (CTA) entwickelt und erprobt. Dazu wurde ein automatisierter, sog. „elastischer“ digitaler Subtraktionsalgorithmus entwickelt, der es ermöglicht, einen Spiral-CT-Datensatz ohne Kontrastmittel von einem solchen mit Kontrastmittel artefaktfrei zu subtrahieren. Der „elastische“ Subtraktionsalgorithmus korrigiert stochastische, transmissionsbedingte und durch Bewegung verursachte Inkongruenzen zwischen den beiden zu subtrahierenden Datensätzen und ist somit der einfachen digitalen Subtraktion überlegen. Bisher wurde die CT-Subtraktionsangiographie (CTSA) an 7 Patienten im Bereich der Hals- und intrakraniellen Gefäße erprobt. Der „elastische“ Subtraktionsalgorithmus war bei der Beurteilung von Bildqualität und -artefakten in allen Fällen und statistisch signifikant besser als die einfache digitale Subtraktion. Die „elastische“ CTSA ermöglicht eine automatisierte Trennung von ossären Strukturen und Gefäßen und erleichtert somit die überlagerungsfreie, räumliche und selektive Darstellung der Hals- und intrakraniellen Gefäße.
    Type of Medium: Electronic Resource
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