Development of a cost-effective system for digital off-line analysis of transrectal ultrasound.

BACKGROUND: Transrectal ultrasound (TRUS) is the most sensitive and accurate technique for preoperative staging and follow-up of rectal cancer. One of the most relevant problems of this technique is that the assessment of TRUS is possible only during real-time examination. Furthermore, interpretation of the ultrasound findings is difficult and requires long experience. We show the development of a new, cost-effective software solution for off-line examination and documentation of transrectal ultrasound. METHODS: The ultrasound device is connected to a frame-grabber card in a standard PC. Video capturing is done using a freeware software solution and various video codecs. The whole examination course is recorded. The examiner only has to concentrate on producing an artifact-free realization of the examination. RESULTS: The software solution offers a flexible review of each individual "frame" of the investigation on the personal computer, very similar to CT and MRI scans. Infiltration depth and lymph node status can be assessed at any time, independently of the investigation and the investigator. The picture quality is excellent even if a lossy codec is used. It is not necessary to do definitive assessment of the TRUS during the examination. CONCLUSIONS: This new technique gives a cost-effective possibility for high-quality off-line staging, re-examination, re-evaluation, and documentation of rectal cancer. TRUS becomes an examiner-independent objective examination technique for staging and follow-up of rectal cancer.

Group A streptococcal toxic shock syndrome with severe necrotizing fasciitis following hysterectomy--a case report.

In the last 10 years an increasing number of cases of group A streptococcal toxic shock syndrome have appeared in various clinical settings. The manifestation of this syndrome includes rapidly progressive multiorgan failure and soft-tissue necrosis. This report presents a case of streptococcal toxic shock syndrome caused by Streptococcus pyogenes with severe necrotizing fasciitis of the abdominal wall following hysterectomy. Aggressive surgical intervention with debridement of all necrotic tissue necessitated resection of the complete abdominal wall (skin, subcutaneous tissue, muscle and peritoneum). The abdominal wall defect was covered with free myocutaneous flaps and split-skin grafts. Optimal treatment, including adequate antibiotic therapy and radical surgical intervention, is an indispensable prerequisite of successful outcome.

Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT.

Aortic abnormalities are commonly encountered and may represent a diagnostic challenge in patients with acute or chronic clinical symptoms. Contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) is a new promising method in the diagnosis and follow-up of pathological aortic lesions. CEUS with SonoVue allows a more rapid and noninvasive diagnosis, especially in critical patients because of its bedside availability. This review compares CEUS findings with those documented on computed tomography angiography (CTA), allowing the reader to appreciate the usefulness of CEUS in this clinical situation.

Treatment of secondary stent-graft collapse after endovascular stent-grafting for iliac artery pseudoaneurysms.

We report the case of a patient who developed an asymptomatic pseudoaneurysm in the left external iliac artery after transplant nephrectomy. The pseudoaneurysm most probably arose as a suture aneurysm from the external iliac artery after removal of the graft renal artery. Obviously we can not exclude the possibility it was a true aneurysm, although this seems much less likely. The pseudoaneurysm was detected during a routine CT scan and was treated interventionally with a stent-graft. One month later the asymptomatic patient underwent a vascular ultrasound examination including color Doppler, power Doppler, and B-flow as a routine control. An endoleak with collapse of the stent-graft was diagnosed. There was no evidence of stent infection. At a reintervention, the pseudoaneurysm was successfully treated using two uncovered Palmaz stents at the proximal and distal edge of the stent graft. Peri- and post-interventional ultrasound and CT angiography confirmed the exclusion of the aneurysm without an endoleak.

Perforation of the colon: a rare complication of hepatocellular carcinoma.

Direct infiltration of the colon by hepatocellular carcinoma (HCC) is a rare condition. Only a few reports can be found in the literature. Here we present a case of direct infiltration of the ascending colon by an exophytic growing HCC of the right posterior liver lobe, in which treatment with transarterial chemoembolization (TACE) had been performed. Tumor invasion became evident by abdominal pain and lower gastrointestinal bleeding. Diagnosis was established by contrast-enhanced multidetector computed tomography (CE-MDCT), demonstrating the direct tumor invasion with concomitant perforation of the infiltrated colon segment. Based on these findings, rapid and effective surgical treatment could be achieved.

[3-phase spiral CT--a new noninvasive procedure for the differentiation of multifocal liver lesions]. / Drei-Phasen-Spiral-CT--ein neues nichtinvasives Verfahren zur Differenzierung multifokaler Leberläsionen.

Dynamic CT is an established method for the differentiation of focal liver lesions by monitoring the contrast enhancement. It is especially restricted in the assessment of small and multiple lesions due to respiratory organ movements. Spiral-CT allows the examination of large volumes in the breathhold technique. Spiral-CT with controlled i.v. contrast media administration can be used for the assessment of the entire liver in distinct phases of perfusion. We describe the use of this new technique in a patient with multifocal nodular hyperplasia (FNH), for whom assessment with dynamic CT was not suitable. The lesions were first located with a conventional contrast-enhanced CT-scan. The impossibility to assess all the lesions with dynamic CT led to the decision to perform a three-phase spiral-CT with three sequential scans (native, arterial, and portal perfusion phase). The entire liver was scanned after power injector-controlled i.v. administration of contrast media with the following parameters: 1) arterial phase: 70 ml contrast media, 2 ml/s, start delay 18 s; 2) portal phase: 80 ml contrast media, 2 ml/s, start delay 60 s; slice 8 mm, table feed 8 mm, increment 4 mm; 24 s of breathhold data acquisition.

Partial purification and characterization of succinyl-CoA synthetase from Saccharomyces cerevisiae.

Succinyl-CoA synthetase from Saccharomyces cerevisiae was partially purified (20-fold) with a yield of 44%. The Michaelis-Menten constants were determined: Km (succinate) = 17 mM; Km (ATP) = 0.13 mM; Km (CoA) = 0.03 mM. The succinyl-CoA synthetase has a molecular weight of about 80000 dalton (as determined by polyacrylamide gradient gel electrophoresis). The pH optimum is at 6.0. During fermentation the activity of succinyl-CoA synthetase is lower than in aerobically grown yeast cells. The presence of succinyl-CoA synthetase in fermenting yeasts may be regarded as an indication for the oxidative formation of succinate. In fermenting yeast cells succinyl-CoA synthetase is repressed by glucose if ammonium sulphate serves as nitrogen source. This catabolite repression is not observed with disaccharides or when amino acids are used as nitrogen source.

Detection and mapping of intraabdominal adhesions by using functional cine MR imaging: preliminary results.

PURPOSE: To identify and map intraabdominal adhesions by using functional cine magnetic resonance (MR) Imaging. MATERIALS AND METHODS: Twenty-seven patients suspected of having intraabdominal adhesions were examined. Section-by-section dynamic depiction of induced visceral slide throughout the whole abdomen was achieved by using a transverse or sagittal true fast imaging with steady-state precession sequence. Location and type of diagnosed adhesions were documented by using the nine segments of the abdominal map. These criteria and intraoperative results were compared in 13 patients. RESULTS: MR images depicted a total of 42 intraabdominal adhesions; 21 (50%) were in the lower abdomen. The most common types of adhesions were located between the ventral abdominal wall and small-bowel loops (n = 10 [24%]) and between adjacent small-bowel loops (n = 9 [21%]). Comparison with the intraoperative results showed a sensitivity of 87.5% and a specificity of 92.5%. MR imaging was most accurate in depicting adhesions to the abdominal wall (15 [94%] of 16) and subperitoneal space (eight [100%] of eight). The presence of adhesions between bowel loops was overestimated. CONCLUSION: Detection of visceral slide at functional cine MR imaging is easy to perform and represents a well-tolerated and accurate procedure for use in the identification of intraabdominal adhesions in patients with chronic pain and equivocal clinical findings.

[Pattern of distribution of apolipoproteins A and B in the lipoprotein fractions of serum in pregnant patients and post partum]. / Verteilungsmuster von Apolipoprotein A und B in den Lipoproteinfraktionen des Serums bei Schwangeren und post partum.

Investigating the for gestationally caused changes and their restitution p. partum we determined in 104 women without metabolic disorders the apolipoproteins A and B respectively in serum, in the main lipoprotein fractions VLDL, IDL, LDL, HDL and in the "rest protein" remaining after separation of the lipoproteins from the serum. In gestation there is an increase in the serum level of apo A of about 30% (p less than 0.001) reaching its maximum in the middle period of pregnancy. The post partal restitution of these changes takes more than 5 weeks happening faster at primarily delactated women. Gestational changes concerning apo A are only caused by a 30% higher concentration of apo A in HDL (p less than 0.001). The serum level of apo B seems to increase continuously meanwhile gestation reaching its maximum from about 60% (p less than 0.001) at the term. The restitution of the gestational changes concerning apo B also requires more than 5 weeks showing no dependence from lactation. The changes of serum apo B are quantitatively most influenced by the 45% higher concentration of apo B in LDL (p less than 0.001), despite the marked changes of apo B in relation to the nonpregnant comparative group found in VLDL and IDL respectively with either 270% (each p less than 0.001). Hyperbetalipoproteinemia in pregnancy was proved in 32%, but in no case the ratio apo B/apo A showed pathological values, because of also raised levels of apo A in these women. By this astonishing phenomenon the gestational hyperlipoproteinemia is characterized as an autonomic metabolic situation, which represents no earlier described type according to the Fredrickson classification.(ABSTRACT TRUNCATED AT 250 WORDS)