Transjugular intrahepatic portosystemic shunt (TIPS) augments hyperinsulinemia in patients with cirrhosis.

Background/aims: Cirrhosis of the liver is characterized by glucose intolerance and hyperinsulinemia. Both increased insulin secretion and decreased insulin clearance appear to contribute to hyperinsulinemia in cirrhotic patients. A decrease in hepatic insulin extraction rate may be due either to hepatocellular dysfunction or to portosystemic shunting with decreased first-pass insulin clearance.

Color and pulsed Doppler ultrasound findings in normally functioning transjugular intrahepatic portosystemic shunts.

Objective: To evaluate blood flow changes inside normally functioning transjugular intrahepatic portosystemic shunts (TIPS), using color Doppler ultrasound (CDUS) and pulsed Doppler ultrasound (PDUS).

Methods: A total of 72 patients (mean age 54, range 36-78 years) underwent TIPS placement, portal angiography, CDUS and PDUS examinations. Measurements inside the stent were taken at the portal side, at the central part and at the venous end of the TIPS.

Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results.

Purpose: To evaluate the feasibility and safety of endovascular stent-graft placement in treating Stanford type B aortic dissection.

Materials And Methods: Seven patients underwent endovascular stent-graft placement for type B aortic dissection. Five patients had acute and two had chronic dissection.

Computer-assisted neurosurgery by using a noninvasive vacuum-affixed dental cast that acts as a reference base: another step toward a unified approach in the treatment of brain tumors.

Object: The purpose of the study was to evaluate the use of the Vogele-Bale-Hohner (VBH) mouthpiece, which is attached to the patient's upper jaw by negative pressure, for patient-image registration and for tracking the patient's head during image-guided neurosurgery.

Methods: A dynamic reference frame (DRF) is reproducibly mounted on the mouthpiece. Reference points, optimally distributed and attached to the mouthpiece, are used for registration in the patient's absence on the day before surgery.

Head and neck tumors: fractionated frameless stereotactic interstitial brachytherapy-initial experience.

The authors used a frameless stereotactic navigation system, the Vogele-Bale-Hohner head holder, and a targeting device to reproducibly position brachytherapy needles for fractionated interstitial brachytherapy in 12 patients with inoperable cancers of the head and neck. In all cases, deviations of the needle relative to the planned position were within 1-15 mm depending on the location of the tumor.

Virtual computed tomography colonoscopy: artifacts, image quality and radiation dose load in a cadaver study.

The purpose of our study was to evaluate the interdependency of spatial resolution, image reconstruction artifacts, and radiation doses in virtual CT colonoscopy by comparing various CT scanning protocols. A pig's colon with several artificial polypoid lesions was imaged after air insufflation with helical CT scanning using 1-, 3-, and 5-mm collimation, and pitch values varying from 1.0 to 3.

Internal mammary vessels as a model for power Doppler imaging of recipient vessels in microsurgery.

The aim of this interdisciplinary study was to evaluate power Doppler imaging as a method of collecting reliable preoperative data concerning the diameters and topography of exemplary internal mammary vessels as recipient vessels in reconstructive microsurgery. Thirteen female patients (range, 37 to 58 years; mean, 45.6 years) were examined preoperatively with power Doppler imaging from the first to the fifth intercostal space parasternally and bilaterally.

Comparative reject analysis in conventional film-screen and digital storage phosphor radiography.

The aim of this study was comparative analysis of rejected radiographs in conventional and digital radiology under the aspects number of rejected images and reasons for rejection. During 2 months waste films of conventional radiography were collected; in digital radiography each image-delete command at the postprocessing workstation was documented. Rejected images were analysed and assigned to four categories.

Sophisticated hospital information system/radiology information system/picture archiving and communications system (PACS) integration in a large-scale traumatology PACS.

Picture archiving and communications system (PACS) in the context of an outpatient trauma care center asks for a high level of interaction between information systems to guarantee rapid image acquisition and distribution to the surgeon. During installation of the Innsbruck PACS, special aspects of traumatology had to be realized, such as imaging of unconscious patients without identification, and transferred to the electronic environment. Even with up-to-date PACS hardware and software, special solutions had to be developed in-house to tailor the PACS/hospital information system (HIS)/radiology information system (RIS) interface to the needs of radiologic and clinical users.

[First experiences with the trauma radiologic PACS project at the University of Innsbruck Department of Radiology].

Radiography in an emergency setting is a demanding task, in technical as well as in logistical terms. Rapid acquisition of high quality radiographs under difficult conditions, for example severely injured patients with multi-organ trauma is important. All image data and radiological reports must be transmitted to the trauma surgeon as soon as possible.

[Ruptures of the medial gastrocnemius muscle: diagnosis with high resolution ultrasound].

Aim: Evaluation of high resolution ultrasound to diagnose rupture of the medial head of gastrocnemius muscle in patients with uncharacteristic calf pain.

Method: 66 patients with clinically unclear calf pain were examined in a prospective study.

Results: Out of 66 patients, 51 showed sonographic criteria of a partial rupture of the medial gastrocnemius head.

[Doppler ultrasound determination of average blood flow velocity and flow volume in transjugular intrahepatic portosystemic shunt (TIPS)].

Aim: To determine if duplex sonographic measured Time Average Motion (TAM) is an effective parameter for screening examination in routine follow-up after TIPS implantation.

Patients And Methods: 35 patients underwent duplex sonographic examination by a 3.5 MHz transducer with a follow-up for 12.

Sonographic appearance of an appendix carcinoma.

Malignant appendix tumours are rare entities. Especially adenocarcinomas, which only appear in about 10% of appendix tumours, are very seldom. Preoperative diagnosis is very difficult due to a lack of typical clinical signs and a clinical appearance mimicking perforated appendicitis.

The Austrian Academic Computer Network and its usefulness for teleradiology.

To study the value of the Austrian Academic Computer Network (ACOnet) for teleradiology, 1740 test image data-sets and 620 image data-sets were exchanged between the departments of diagnostic radiology of the Universities of Innsbruck and Graz using the ACOnet service. Data transmission was reliable and fast with an average transfer capacity of 170 kByte/s (range 94-341). During the test phase, no major problems with image transfer occurred.

[ACOnet (Austrian Academic Computer Network) as data carrier for teleradiologic consultations].

Purpose: To assess the feasibility of image transfer for teleradiologic consultations using the Austrian Academic Computer Network (ACOnet). The ACOnet corresponds between the main universities to a MAN (Metropolitan Area Network) with a transfer rate of 4 Mbps. Its use is free of charge for university institutions.

Fibromuscular dysplasia of the internal carotid artery in a child with alpha-1-antitrypsin deficiency.

Fibromuscular dysplasia (FMD) is a non-inflammatory segmental arteriopathy of unknown origin. Most often the renal arteries are affected, however, also mesenteric, lumbar, vertebral, or carotid arteries may be involved. FMD has frequently been reported as a cause of stroke in adults, but very rarely in children.

Gastric antral vascular ectasia with portal hypertension: treatment with TIPSS.

Gastric antral vascular ectasia, or "watermelon stomach," is a distinct clinical entity within the spectrum of upper gastrointestinal mucosal vascular abnormalities. The pathobiology of the disease is unclear. We here describe a case that emphasizes the importance of the "watermelon stomach" as differential diagnosis of occult gastrointestinal blood loss and report on its successful treatment through installation of a transjugular intrahepatic portosystemic stent shunt (TIPSS).

Virtual computed tomography gastroscopy: a new technique.

Background And Study Aims: The aim of the present study was to establish a suitable method for virtual computed tomography (CT) gastroscopy.

Patients And Methods: Three-millimeter helical CT scans of a pig stomach were obtained after air insufflation and instillation of diluted diatrizoic acid (Gastrografin), and with double contrast. In addition, three patients with gastric tumors were studied after ingestion of an effervescent agent (Duplotrast, 6 g) and intravenous injection of hyoscine butylbromide (Buscopan, 1 ml).

Therapy for biliary stenoses and occlusions with use of three different metallic stents: single-center experience.

Purpose: The authors report their experience with three different metallic stents for the treatment of biliary obstructions during a 6.5-year period (between February 1989 and June 1995).

Materials And Methods: In an uncontrolled, nonrandomized, and prospective study, 168 patients with obstructive jaundice underwent transhepatic placement of metallic stents.

[Virtual endoscopy with post-processing helical CT data sets].

Purpose: The purpose of this work was to test a newly developed, post-processing software for virtual CT endoscopic methods. Virtual endoscopic images were generated from helical CT data sets in the region of the shoulder joint (n = 2), the tracheobronchial system (n = 3), the nasal sinuses (n = 2), the colon (n = 2), and the common carotid artery n = 1). Software developed specifically for virtual endoscopy ("Navigator") was used which, after a previous threshold value selection, makes the reconstruction of internal body surfaces possible by an automatic segmentation process.

Adrenal-sparing laparoscopic surgery for aldosterone-producing adenoma.

We herein present the first case in the literature of enucleation of an aldosterone-producing adenoma by laparoscopy. The indication for adrenal-sparing surgery was bilateral adrenal adenoma. The operation turned out to be easier than laparoscopic adrenalectomy.