U C Leutloff

Universität Heidelberg, Heidelburg, Baden-Württemberg, Germany

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Publications (20)10.25 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Klinische Untersuchung: stark reduzierter AZ und EZ, Gewichtsabnahme von mehr als 10 kg während der letzten 3 Wochen (Größe 164 cm, Gewicht 48 kg). Abdomen wirkt eingefallen, epigastrisch sind hochgestellte Darmgeräusche mit stenosetypischer Peristaltik auskultierbar. Bei klinischem Verdacht auf eine adhäsionsbedingte Symptomatik im oberen Dünndarm wird der orale Kostaufbau gestoppt und eine weiterführende Diagnostik eingeleitet. In der Abdomenübersichtsaufnahme Luft in Projektion auf das Duodenum, im übrigen Abdomen nur wenig Luft nachweisbar. Zur weiteren Abklärung Magen-Darm-Passage nach oraler Gabe von wasserlöslichem jodhaltigem Kontrastmittel (Abb. 1). Zusätzlich wurde eine Abdomen-CT durchgeführt. Eine den Darm komprimierende Raumforderung läßt sich nicht nachweisen (Abb. 2).
    No preview · Article · Apr 2012 · Der Radiologe
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    ABSTRACT: The transjugular intrahepatic stent-shunt (TIPSS) is a well accepted minimal invasive therapy for complications of portal hypertension: recurrent variceal bleeding, refractory ascites and liver failure due to the Budd-Chiari syndrome. The high frequency of shunt stenoses and occlusions makes regular follow up examinations essential. Despite modern non invasive imaging methods direct portography still is the gold standard for shunt surveillance in TIPSS. Ultrasound is helpful to detect shunt dysfunction, but nevertheless its failure rate is considerable despite the use of contrast enhancers such as Levovist because of anatomic and physical limitations, particularly when TIPSS-tracts deep in the liver are present. Reintervention rates approach 90-100% after 24 months, with 100% in child's A patients with comparatively good liver function. However, a strict shunt surveillance program with early portography and reintervention when necessary guarantees high clinical success rates associated with very low rebleeding rates below 10%. Overall the secondary success rate is 80%. Secondary failures are mainly caused by lack of patient compliance during follow-up. In a subgroup of patients no shunt maturation is observed, requiring multiple shunt revisions. In cases of recurrent shunt occlusions an association with bile leaks is presumed. In selected cases patients with chronically recurrent shunt stenosis or occlusions may benefit from placement of TIPSS stent grafts.
    No preview · Article · Nov 2001 · Der Radiologe
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    ABSTRACT: The transjugular intrahepatic stent-shunt (TIPSS) is a well accepted minimal invasive therapy for complications of portal hypertension: recurrent variceal bleeding, refractory ascites and liver failure due to the Budd-Chiari syndrome. The high frequency of shunt stenoses and occlusions makes regular follow up examinanions essential. Despite modern non invasive imaging methods direct portography still is the gold standard for shunt surveillance in TIPSS. Ultrasound is helpful to detect shunt dysfunction, but nevertheless its failure rate is considerable despite the use of contrast enhancers such as Levovist because of anatomic and physical limitations, particularly when TIPSS-tracts deep in the liver are present. Reintervention rates approach 90–100% after 24 months, with 100% in child's A patients with comparatively good liver function. However, a strict shunt surveillance program with early portography and reintervention when necessary guarantees high clinical success rates associated with very low rebleeding rates below 10%. Overall the secondary success rate is 80%. Secondary failures are mainly caused by lack of patient compliance during follow-up. In a subgroup of patients no shunt maturation is observed, requiring multiple shunt revisions. In cases of recurrent shunt occlusions an association with bile leaks is presumed. In selected cases patients with chronically recurrent shunt stenosis or occlusions may benefit from placement of TIPSS stent grafts.
    No preview · Article · Sep 2001 · Der Radiologe
  • S Eisold · J Schmidt · D Antolovic · U Leutloff · M Libicher · E Klar
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    ABSTRACT: Approximately 10% of all insulinomas--the most common neuroendocrine pancreatic tumor--occur in multiple sites of the pancreas (e.g., multiple endocrine neoplasia type I) and rarely as islet cell hyperplasia. Malignant insulinomas appear in 10% to 15% of cases. For these special groups and for patients with a reoperation preoperative localization of the tumour is advisable. With current imaging technology, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, and somatostatin receptor scintigraphy (SRS), localization of insulinomas is often inadequate. In this study we report our results using intra-arterial calcium-stimulated venous blood sampling (ASVS) to localize and guide the management of insulinomas for patients with a reoperation because of recurrent insulinomas or persistent hyperinsulinism, for patients with malignant neoplasm and for patients with a previous abdominal operation. For all three cases the insulinomas were correctly localized by the ASVS in contrast to the preoperative imaging studies. Our experience and a review of the current literature demonstrate that ASVS is a highly accurate (sensitivity > 90%) and a safe method for preoperative localization of insulinomas. For patients with a reoperation ASVS is recommended and the extensive use of other costly preoperative methods should be avoided.
    No preview · Article · Oct 2000 · Der Chirurg
  • S. Eisold · J. Schmidt · D. Antolovic · U. Leutloff · M. Libicher · E. Klar
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    ABSTRACT: Einleitung: Etwa 10 % aller Insulinome – dem häufigsten endokrinen Pankreastumor – sind multiple Tumoren des Pankreas (z. B. multiple endokrine Neoplasie Typ I) oder präsentieren sich selten als Inselzellhyperplasie. In weiteren ca. 10–15 % der Fälle sind die Tumoren bei der Diagnosestellung maligne. Für diese speziellen Patientengruppen und Patienten mit einer Reoperation ist eine präoperative Lokalisationsdiagnostik aufgrund möglicher Schwierigkeiten bei der intraoperativen Lokalisation der Tumoren anzustreben. Die bildgebenden Verfahren, wie die Computertomographie (CT), Kernspintomographie (MRT), Ultraschall und Octreotidszintigraphie, sind in der Lokalisation oft unzureichend. Methoden: Diese Studie zeigt unsere Erfahrungen mit dem intraarteriellen Calciumstimulationstest (ASVS) zur regionalen Lokalisierung und dem operativen Management des Insulinoms bei Patienten mit einem Reeingriff aufgrund eines Rezidivs bzw. einer persistierenden Erkrankung oder eines malignen Insulinoms bzw. Patienten mit einer abdominellen Voroperation. Ergebnisse: Für alle 3 Patienten konnte der funktionelle ASVS die richtige präoperative Regionalisierung des Insulinoms diagnostizieren und war damit der präoperativen bildgebenden Diagnostik überlegen. Schlußfolgerung: In Übereinstimmung mit der aktuellen Literatur ist der ASVS eine sehr sensitive ( > 90 %) und wenig invasive Methode zur präoperativen Regionalisierung von Insulinomen. Für Patienten mit einem Reeingriff sollte dem ASVS der Vorzug gegenüber den verschiedenen, in der Summe kostenintensiven präoperativen Diagnostikverfahren gegeben werden. Background: Approximately 10 % of all insulinomas – the most common neuroendocrine pancreatic tumor – occur in multiple sites of the pancreas (e.g., multiple endocrine neoplasia type I) and rarely as islet cell hyperplasia. Malignant insulinomas appear in 10 % to 15 % of cases. For these special groups and for patients with a reoperation preoperative localization of the tumour is advisable. With current imaging technology, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, and somatostatin receptor scintigraphy (SRS), localization of insulinomas is often inadequate. Methods: In this study we report our results using intra-arterial calcium-stimulated venous blood sampling (ASVS) to localize and guide the management of insulinomas for patients with a reoperation because of recurrent insulinomas or persistent hyperinsulinism, for patients with malignant neoplasm and for patients with a previous abdominal operation. Results: For all three cases the insulinomas were correctly localized by the ASVS in contrast to the preoperative imaging studies. Conclusions: Our expierence and a review of the current literature demonstrate that ASVS is a highly accurate (sensitivity > 90 %) and a safe method for preoperative localization of insulinomas. For patients with a reoperation ASVS is recommended and the extensive use of other costly preoperative methods should be avoided.
    No preview · Article · Sep 2000 · Der Chirurg
  • U C Leutloff · S Eislod · J P Schenk · G Nöldge · J Schmidt · G W Kauffmann

    No preview · Article · Feb 2000 · Der Radiologe
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    ABSTRACT: Summary Imaging Diagnostics of Colonic Diverticulosis and Its ComplicationsRadiodiagnostic imaging modalities in diverticulosis and diverticulitis for visualization of complications include supine radiograph of the abdomen, ultrasonography, barium studies of the colon, in case of diverticulitis and suspicion of penetration only water-soluble contrast medium studies, spiral-CT and magnetic resonance imaging (MRI). In cases of endoscopic failure to localize diverticular bleedings because of massive intraluminal blood clots, selective and superselective angiography is indicated for localization of the bleeding source and, if necessary, transcatheter embolization or vasopressin infusion to stop the bleeding. In endoscopical failure to pass the stenosis of inflammatory origin because of diverticulitis, only water-soluble contrast medium studies are indicated, mainly to visualize the post-stenotic areas of the colon orally to the stenosis. In cases of penetration or suspected perforation, fistulas in surrounding organ structures like adjacent bowel loops, urinary bladder or muscle tissue, ultrasound or spiral-CT are the favorite imaging modalities. Up to now, MRI does not play the role as ultrasound or spiral-CT do.
    No preview · Article · Jan 2000 · Chirurgische Gastroenterologie
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    ABSTRACT: A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.
    No preview · Article · Jan 2000 · Der Radiologe
  • [Show abstract] [Hide abstract]
    ABSTRACT: A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist® (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist® provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.
    No preview · Article · Nov 1999 · Der Radiologe
  • U C Leutloff · S Eisold · G Nöldge · T Fritz · G W Kauffmann

    No preview · Article · Aug 1998 · Der Radiologe
  • U.C. Leutloff · S. Eisold · G. Nöldge · T. Fritz · G.W. Kauffmann
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    ABSTRACT: Klinisch zeigte sich eine deutliche Weichteilschwellung am linken Ellenbogen. Die periphere Durchblutung und Motorik waren unauffällig, die Sensibilität war lediglich an D IV und D V leicht eingeschränkt Zur weiteren diagnostischen Abklärung wurde eine konventionelle Röntgenaufnahme des linken Ellenbogens in zwei Ebenen angefertigt (Abb. 1a und b). In der AP-Aufnahme sieht man bei noch offenen Epiphysenfugen des Epicondylus ulnaris und radialis humeri eine erhöhte Transparenz des distalen Humerus radialseitig. Die Außenkontur des distalen Humerus erscheint intakt, jedoch erkennt man eine zweite Kontur proximal des hemero-radialen Gelenks. In der Seitenaufnahme sieht man eine halbmondförmige Struktur ventral in der Ellenbeuge sowie eine Verlagerung der Fettlamelle ventral und dorsal als Hinweis auf einen Gelenkerguß. Ihre Diagnose ?
    No preview · Article · Jul 1998 · Der Radiologe
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    ABSTRACT: A study was carried out to determine whether an improvement in the detection of vascular signals in patients after orthotopic liver transplantation can be achieved by the use of ultrasound contrast medium in colour Doppler sonography. In the early postoperative follow-up of liver transplant recipients, 31 colour Doppler sonograms were obtained in 21 patients before and after intravenous injection of the ultrasound contrast agent Levovist (Schering, Berlin). A grading score with four categories was used to evaluate the sonograms with special regard to the visibility of colour and flow signals in the hepatic artery and also in the portal vein and the hepatic veins. The arterial and portal venous signals were evaluated in the hepatic portal and in the left and right lobe. With contrast enhancement significantly better arterial signals were seen in 20 of 31 sonograms for the hepatic portal, in 22 for the right lobe and in 26 for the left lobe. Better portal vein signals were obtained in 17 of 31 examinations for the right lobe and in 16 for the left lobe; only little improvement was obtained for the main stem of the portal vein. For the hepatic veins there was no significant improvement. Early vascular complications after liver transplantation usually occur in the hepatic arteries. With the use of contrast-enhanced colour Doppler sonography, better detection of arterial and peripheral portal signals can be achieved; peripheral portal vein branches can be helpful in finding small arteries.
    No preview · Article · Jun 1998 · Der Radiologe
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    ABSTRACT: Introduction: A study was carried out to determine whether an improvement in the detection of vascular signals in patients after orthotopic liver transplantation can be achieved by the use of ultrasound contrast medium in colour Doppler sonography. Material and methods: In the early postoperative follow-up of liver transplant recipients, 31 colour Doppler sonograms were obtained in 21 patients before and after intravenous injection of the ultrasound contrast agent Levovist® (Schering, Berlin). A grading score with four categories was used to evaluate the sonograms with special regard to the visibility of colour and flow signals in the hepatic artery and also in the portal vein and the hepatic veins. The arterial and portal venous signals were evaluated in the hepatic portal and in the left and right lobe. Results: With contrast enhancement significantly better arterial signals were seen in 20 of 31 sonograms for the hepatic portal, in 22 for the right lobe and in 26 for the left lobe. Better portal vein signals were obtained in 17 of 31 examinations for the right lobe and in 16 for the left lobe; only little improvement was obtained for the main stem of the portal vein. For the hepatic veins there was no significant improvement. Conclusion: Early vascular complications after liver transplantation usually occur in the hepatic arteries. With the use of contrast-enhanced colour Doppler sonography, better detection of arterial and peripheral portal signals can be achieved; peripheral portal vein branches can be helpful in find-ing small arteries.
    No preview · Article · May 1998 · Der Radiologe
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    ABSTRACT: Comparison of color Doppler sonography and venous portography in patients with a transjugular intrahepatic portosystemic stent shunt (TIPSS). In a prospective study 40 consecutive patients with TIPSS underwent venous portography and color Doppler sonography on the same day as follow-up. Shunt velocities were recorded within the TIPSS at the proximal (hepatic vein segment) and distal part (portal vein segment). In 28 patients with functioning TIPSS the mean shunt velocity ranged between 30 and 120 cm/s (median 60 cm/s) at the portal vein segment and between 60 and 155 cm/s (median 82 cm/s) at the hepatic vein segment. There was a significant increase of the mean shunt velocity in the hepatic vein segment (P < 0.001). In 12 patients with compromised TIPSS the mean shunt velocity was reduced to 26 +/- 7 cm/s at the portal venous end (P < 0.0001). Because of an accelerated shunt velocity in the hepatic vein segment a site-specific evaluation of both TIPSS endings is necessary with color Doppler sonography. In compromised TIPSS the shunt velocity is reduced at the portal venous end. Color Doppler sonography is a valid non-invasive means for follow-up of patients with TIPSS.
    No preview · Article · May 1998 · Der Radiologe
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    ABSTRACT: Purpose: Comparison of color Doppler sonography and venous portography in patients with a transjugular intrahepatic portosystemic stent shunt (TIPSS). Materials and methods: In a prospective study 40 consecutive patients with TIPSS underwent venous portography and color Doppler sonography on the same day as follow-up. Shunt velocities were recorded within the TIPSS at the proximal (hepatic vein segment) and distal part (portal vein segment). Results: In 28 patients with functioning TIPSS the mean shunt velocity ranged between 30 and 120 cm/s (median 60 cm/s) at the portal vein segment and between 60 and 155 cm/s (median 82 cm/s) at the hepatic vein segment. There was a significant increase of the mean shunt velocity in the hepatic vein segment (P<0.001). In 12 patients with compromised TIPSS the mean shunt velocity was reduced to 26±7 cm/s at the portal venous end (P<0.0001). Conclusion: Because of an accelerated shunt velocity in the hepatic vein segment a site-specific evaluation of both TIPSS endings is necessary with color Doppler sonography. In compromised TIPSS the shunt velocity is reduced at the portal venous end. Color Doppler sonography is a valid non-invasive means for follow-up of patients with TIPSS.
    No preview · Article · May 1998 · Der Radiologe
  • S Eisold · T Fritz · K Buhl · U Leutloff · P J Meeder
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    ABSTRACT: Because this disease is so rare the optimum treatment of pigmented villonodular synovitis (PVNS), in particular the diffuse form differs in the literature. The most important surgical procedures are arthroscopic and open synovectomy. The prevention of disease progression, as well as joint destruction and dysfunction, depends upon the early diagnosis of PVNS. During 1994 and 1995, we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months. Two patients were treated with complete synovectomy, one patient underwent partial synovial resection, and in the final case an arthrodesis was performed. Our results indicate that an MRI is essential for diagnosis and treatment planning. For the localized form of PVNS, it appears that a partial synovectomy is appropriate. However, in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium, a total synovectomy is indicated because of the high recurrence rate. In our study, all four patients had disease involving secondary bony lesions and, in one case, joint destruction. Based on our findings, it is clear that early surgical therapy is the only recommended curative intervention. The decision regarding the surgical approach, arthroscopic versus open, depends on the form of PVNS, the extent of the disease and secondary changes of the joint.
    No preview · Article · Apr 1998 · Der Chirurg
  • S. Eisold · T. Fritz · K. Buhl · U. Leutloff · P. J. Meeder
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    ABSTRACT: Because this disease is so rare the optimum treatment of pigmented villonodular synovitis (PVNS), in particular the diffuse form differs in the literature. The most important surgical procedures are arthroscopic and open synovectomy. The prevention of disease progression, as well as joint destruction and dysfunction, depends upon the early diagnosis of PVNS. During 1994 and 1995, we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months. Two patients were treated with complete synovectomy, one patient underwent partial synovial resection, and in the final case an arthrodesis was performed. Our results indicate that an MRI is essential for diagnosis and treatment planning. For the localized form of PVNS, it appears that a partial synovectomy is appropriate. However, in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium, a total synovectomy is indicated because of the high recurrence rate. In our study, all four patients had disease involving secondary bony lesions and, in one case, joint destruction. Based on our findings, it is clear that early surgical therapy is the only recommended curative intervention. The decision regarding the surgical approach, arthroscopic versus open, depends on the form of PVNS, the extent of the disease and secondary changes of the joint.
    No preview · Article · Feb 1998 · Der Chirurg

  • No preview · Article · Jan 1997 · RöFo - Fortschritte auf dem Gebiet der R

  • No preview · Article · Dec 1996 · RöFo - Fortschritte auf dem Gebiet der R
  • U C Leutloff · T Roeren · K Feldmann · M Sillem · T Rabe · G Kauffmann

    No preview · Article · Jun 1996 · Rontgenpraxis