This study was performed to evaluate the frequency of postdeglutitive aspiration in lateral hypopharyngeal pouches and to correlate postdeglutitive aspiration to pouch size and dynamics.
Two ...radiologists retrospectively analyzed 325 videofluorography examinations of patients swallowing. The 325 patients were 22-81 years old, 173 men and 152 women. Patients who had undergone surgery of the hypopharynx were excluded from the study. All pouches found on videofluorography were classified into grade I, II, or III. Because iodinated contrast agent had been used initially, patients who had no or minimal aspiration underwent a second imaging examination using high-density barium.
Of the 325 patients, 118 had lateral hypopharyngeal pouches: 77 bilateral and 41 unilateral. Postdeglutitive aspiration was diagnosed in 14 (56%) of the 25 grade III pouches and in two (3%) ot the 58 grade II pouches. Aspiration was not seen in any of the 112 grade I pouches.
The prevalence of postdeglutitive aspiration is high in patients who have grade III pouches. To date, no appropriate conservative treatment has been described; however, in severe cases surgery is warranted.
Summary
Background and Objective
: Response rates of cutaneous‐subcutaneous or lymph node metastases of melanoma to systemic chemotherapy are rather low. We report our clinical experience with ...superficial and deep regional hyperthermia in combination with radiotherapy and/or chemotherapy with carboplatin.
Patients/Methods
: We treated 15 patients with metastatic melanoma (6 men, 9 women; age 39 – 84 years, mean age 60 years) by using superficial or deep regional hyperthermia produced by electromagnetic energy. Superficial hyperthermia was delivered to skin or lymph node metastases in combination with radiochemotherapy in 12 patients, while deep regional hyperthermia was administered with an annular array applicator to lymph node metastases either in combination with radiochemotherapy (1 patient) or with carboplatin alone (2 patients). The clinical response was assessed by clinical evaluation and/or computer tomography and/or ultrasonography at monthly intervals.
Results
. Both superficial and deep regional hyperthermia was well tolerated. We observed 5 complete local remissions (34 %), 6 partial local remissions (40 %) and 2 patients with stable disease (13 %). The best results were obtained in cutaneous or retroperitoneal metastases.
Conclusions
. Local response can be achieved in inoperable metastatic melanoma using superficial or deep regional hyperthermia in combination with radiochemotherapy or chemotherapy.
Zusammenfassung
Hintergrund
: Die Ansprechraten von Haut‐ oder Lymphknotenmetastasen des Melanoms auf die systemische Chemotherapie sind gering. Wir berichten über unsere klinische Erfahrung mit Oberflächenhyperthermie und tiefer regionärer Hyperthermie in Kombination mit Strahlentherapie und/oder Chemotherapie mit Carboplatin.
Patienten/Methodik
: Wir behandelten 15 Patienten mit metastasiertem Melanom (6 Männer und 9 Frauen im Alter von 39 bis 84 Jahren, mittleres Alter 60 Jahre) mit Oberflächenhyperthermie oder tiefer regionärer Hyperthermie hervorgerufen durch elektromagnetische Energie. Die Oberflächenhyperthermie mit einem lokalen Applikator wurde bei Haut‐ und Lymphknotenmetastasen in Kombination mit Strahlen‐ und Chemotherapie bei 12 Patienten angewandt, die tiefe regionäre Hyperthermie mit einem ringförmigen Applikator wurde bei Lymphknotenmetastasen bei einem Patienten in Kombination mit Strahlen‐ und Chemotherapie und bei 2 Patienten in Kombination mit Carboplatin allein eingesetzt. Das Ansprechen wurde klinisch und/oder computertomographisch und/oder sonographisch evaluiert.
Ergebnisse
: Die Hyperthermiebehandlungen wurden gut toleriert. Wir konnten lokal 5 komplette Remissionen (34 %), 6 partielle Remissionen (40 %) und bei 2 Patienten eine stabile Erkrankung (13 %) beobachten. Die besten Ergebnisse konnten bei retroperitonealen Lymphknotenmetastasen und Hautmetastasen erzielt werden.
Schlussfolgerungen
: Unsere Ergebnisse zeigen, dass bei inoperablen Melanommetastasen ein lokales Ansprechen mit Oberflächenhyperthermie und tiefer regionärer Hyperthermie in Kombination mit Strahlentherapie und/oder Chemotherapie erzielt werden kann.
The purpose of this prospective study was to analyze whether ultrasound (US) features are helpful for the differentiation and characterization of small solid (< or = 3 cm) renal masses.
70 small ...solid (< or = 3 cm) renal masses were evaluated sonographically with respect to size, location, echogenicity, homogeneity, shadowing, hypoechoic rim, and cystic regions. In addition, all masses were evaluated with spiral-computed tomography (CT). A diagnosis of angiomyolipoma (AML) was made when a lesion contained components with attenuation of fat (> -10 HU). The amount of fat and soft tissue of an AML detected on CT was correlated with the presence of shadowing seen on sonography.
10 (29%) of the 35 renal cell carcinomas (RCC) were hyperechoic to renal parenchyma, but no RCC was as echogenic as the renal sinus fat. Acoustic shadowing was only observed in AML. 11 (34%) AML with shadowing tended to have a larger amount of soft tissue. A hypoechoic rim and cystic regions were only found in RCC. 14 of 35 (40%) RCC showed a hypoechoic rim. Cystic regions were found in 12 of the 35 RCC (34%).
Renal cell carcinomas display a broad range of echogenicities indicating that small RCC (< or = 3 cm) and AML are not definitely distinguishable by their type of echogenicity. The presence of shadowing, a hypoechoic rim, and cystic regions enable differentiation of small (< or = 3 cm) AML from RCC with a high specificity. Accordingly, sonography has the potential to characterize small (< or = 3 cm) hyperechoic renal masses, with high specificity. However, the low sensitivity of these US features may require a CT for accurate diagnosis.
Ranging behind hemangiomas, focal nodular hyperplasias (FNH) are the second most common benign solid liver lesions. Women between the age of 20 and 50 years are predominantly affected. In rare cases ...FNH may occur in children. Etiologically, an arteriovenous vascular malformation of the liver is discussed, which causes pseudotumorous growth of the surrounding liver parenchyma. Morphological features such as the presence of a radial vascular architecture and feeding arteries within a central scar are characteristic for the presence of FNH. Imaging techniques which enable the depiction of the arterial blood supply with a characteristic centrifugal filling pattern, the contrast enhancement in the early arterial phase, the absence of calcifications and of a tumour capsule and the typical enhancement of the central scar, are of particular importance. Knowledge of these features is important in order to differentiate FNH from other hypervascular focal liver lesions with tendency of scar formation, such as hepatic adenomas, giant hemangiomas, hepatocellular and fibrolamellar carcinomas, and metastases. Diagnosis and differential diagnosis of FNH will be enabled by a combined modality approach consisting of (Doppler) sonography and triphasic CT. To confirm the diagnosis of FNH, dynamic MRI is advisable. Because of the invasiveness of angiography as well as the limited sensitivity and spatial resolution of the various scintigraphic methods, these modalities no longer play a role in the diagnostic work-up of FNH. Lesions lacking typical features diagnostic for FNH remain subjects for biopsy and histological examination.
Due to long scan times it was impossible to make dynamic swallowing imaging using computer tomography (CT) of the third or fourth generation. This study evaluates whether electron beam tomography ...with scan times of 100 ms enables a more detailed dynamic imaging of swallowing disorders. Examination using electron beam tomography was done in three planes: (1) Passavant's cushion (n = 6), (2) thyrohyoid membrane (n = 9), and (3) upper esophageal sphincter (n = 5). The technique is discussed here in detail and documented with figures of the plane before swallowing as well as the intradeglutitive reachend plane. This study shows that electron beam tomography enables dynamic imaging of pharyngeal deglutition in transverse planes and can give useful additional information to the videofluorographic or kinematographic swallowing examination, which remain the gold standard in the functional evaluation of swallowing disorders.
To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings.
Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 ...patients with obstructed biliary Wallstents. The reason for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered stents had been inserted in 12 patients; in 3 cases a polyurethanecovered prototype Wallstent had been used. Stent occlusions occurred after 1-55 months. PTCS was performed with a 2.3-mm endoscope through an 11 Fr sheath. Biopsies were taken via the working channel of the endoscope.
In all patients with noncovered stents the inner surface of the stent was highly irregular with seaweed-like protrusions (biopsy-proven granulation tissue). Stent incorporation varied from absent (n = 1) to subtotal (n = 8), but was always incomplete, no matter how long the stent had been in place. Tumor ingrowth was histologically proven in 2 patients. One patient had a large occluding concrement at the proximal end of the stent. In patients with covered stents, the inner surface appeared more regular; however, viable granulation tissue was found inside two stents and tumor ingrowth in one of them.
PTCS showed that incorporation of the stent is virtually always incomplete. The factors contributing most to stent occlusion are the buildup of granulation tissue, bile sludge, and tumor overgrowth. Stone formation and tumor ingrowth can also be important, although less common causes of occlusion. A polyurethane stent covering could not prevent tumor ingrowth in one patient and the buildup of viable granulation tissue inside the stent in two further patients; mean stent patency in the three patients with such a stent was 3 months.
Because of the anatomic localisation of the retroperitoneal space, the detection and elucidation of pathology in the retroperitoneum calls for clinical acumen and the utilisation of imaging ...techniques. During the past two decades, efforts spearheaded by the work of M. A. Meyers led to an enhanced understanding of retroperitoneal anatomy and pathology. Conventional radiographic techniques are often incapable of detecting and/or characterising retroperitoneal abnormalities. Sonography may be limited by patient-dependent-factors. CT is unaffected by bowel gas and provides discrete cross-sectional images of the organs, fascial planes and retroperitoneal compartments, making it an ideal tool for assessment of retroperitoneal disease. In clinically stable patients MRT may be a useful modality for providing helpful and additional information in characterising retroperitoneal abnormalities. In this review article the diagnostic possibilities of benign not organ-related diseases of the retroperitoneum are described. This is intended to give the reader an insight into the etiology and distribution patterns of retroperitoneal fluid and gas collections as well as into diagnosis and differential diagnosis of benign retroperitoneal diseases. The diagnostic impact of the different imaging modalities is discussed.
