Christian Hannig

Superior mesenteric artery syndrome : diagnosis and treatment from the gastroenterologist's view

Background:Background: Superior mesenteric artery syndrome (SMAS) is caused by compression of the third part of the duodenum between the superior mesenteric artery and the aorta. It occurs most frequently in patients with rapid weight loss. Methods: We report two young patients, who each presented with a longstanding history of postprandial abdominal pain, nausea, and voluminous vomiting. The diagnosis of SMAS was established by digital fluoroscopy and contrast-enhanced spiral computed tomography (CT) scan. The findings obtained by endoscopic ultrasound (EUS) at the site of duodenal compression, using a miniprobe, were of substantial diagnostic value and in good agreement with the radiological observations. Results: Both patients, once diagnosed, were treated conservatively by providing enteral or parenteral high caloric nutrition. Weight gain was accompanied by the complete relief of symptoms. Conclusions: Pathogenesis, diagnostic procedures, and therapy are reviewed in order to draw attention to this rare entity.

Physiological and analytical studies on flavor perception dynamics as induced by the eating and swallowing process

The transfer of odorants from the oral to the nasal cavity was studied during food consumption by observation of the swallowing process using videofluoroscopic and real-time MRI (magnetic resonance imaging)-methodologies. Together with the application of the SOOM (spit-off odorant measurement)-technique, the exact timing of odorant transfer to the nose as well as the phenomenon of odorant adsorption to oral mucosa were investigated thus revealing a new understanding of flavor perception as it is caused during the eating process.

Dynamic near-real-time magnetic resonance imaging for analyzing the velopharyngeal closure in comparison with videofluoroscopy.

To demonstrate the feasibility of dynamic magnetic resonance imaging (MRI) with near‐real‐time temporal resolution (“real‐time MRI”) for analyzing the velopharyngeal closure in comparison with multiview videofluoroscopy.

MSCT for staging and response evaluation of esophageal cancer

ZusammenfassungPlattenepithelkarzinome und Adenokarzinome sind für die überwiegende Mehrheit der Ösophaguskarzinome verantwortlich. Die Prognose des Ösophaguskarzinoms ist weiterhin schlecht, da Frühsymptome fehlen und die Diagnose somit meist erst in fortgeschrittenen Stadien gestellt wird. Die bildgebende Diagnostik des Ösophaguskarzinoms hat im Wesentlichen 3 Aufgaben zu erfüllen: die exakte Bestimmung der lokalen Tumorausdehnung (T- und N-Stadium), den Ausschluss von Fernmetastasen (M-Stadium) sowie die frühe Beurteilung des Ansprechens auf eine neoadjuvante (Radio-)Chemotherapie (Responseevaluation). Die CT ist dem endoskopischen Ultraschall beim T- und N-Staging weiterhin unterlegen, spielt jedoch bei der Beurteilung einer Umgebungsinfiltration durch den Tumor (T4-Stadium) sowie beim Ausschluss von Fernmetastasen eine zentrale Rolle. Mithilfe der Multislice-CT (MSCT) erstellte Rekonstruktionen stellen oft die Beziehung des Tumors zu anatomischen Leitstrukturen, wie dem Tracheobronchialbaum oder dem Zwerchfell, anschaulicher dar als die axialen Quellbilder. Erste Versuche einer Therapiebeurteilung mittels CT-Volumetrie sind zwar vielversprechend, doch stellt die PET bzw. PET/CT mit dem Glukoseanalogon FDG derzeit die Methode der Wahl in der Responseevaluation dar.AbstractSquamous cell carcinomas and adenocarcinomas account for the majority of cases of esophageal cancer. Esophageal cancer often is diagnosed in advanced stages as clinical symptoms are lacking in early stages. The major aims of imaging in esophageal cancer are to determine local tumor extension (T and N staging), to rule out systemic disease (M staging), and to assess response to neoadjuvant therapy (response evaluation). CT is still inferior to endoscopic ultrasound in differentiating T stages and detecting regional lymph node metastases. However, it plays a central role in determining infiltration into adjacent organs (T4 stage) and in ruling out distant metastases. Multislice-CT (MSCT) offers the possibility of reconstructions, which often help to assess the relationship between tumor and anatomic landmarks like the tracheobronchial tree or the diaphragm. First results of CT volumetry for response evaluation are promising; however, PET and PET/CT with the glucose analogue FDG are the standard methods to evaluate response to neoadjuvant therapy.

Staging und Therapiebeurteilung des Ösophaguskarzinoms mittels MSCT

ZusammenfassungPlattenepithelkarzinome und Adenokarzinome sind für die überwiegende Mehrheit der Ösophaguskarzinome verantwortlich. Die Prognose des Ösophaguskarzinoms ist weiterhin schlecht, da Frühsymptome fehlen und die Diagnose somit meist erst in fortgeschrittenen Stadien gestellt wird. Die bildgebende Diagnostik des Ösophaguskarzinoms hat im Wesentlichen 3 Aufgaben zu erfüllen: die exakte Bestimmung der lokalen Tumorausdehnung (T- und N-Stadium), den Ausschluss von Fernmetastasen (M-Stadium) sowie die frühe Beurteilung des Ansprechens auf eine neoadjuvante (Radio-)Chemotherapie (Responseevaluation). Die CT ist dem endoskopischen Ultraschall beim T- und N-Staging weiterhin unterlegen, spielt jedoch bei der Beurteilung einer Umgebungsinfiltration durch den Tumor (T4-Stadium) sowie beim Ausschluss von Fernmetastasen eine zentrale Rolle. Mithilfe der Multislice-CT (MSCT) erstellte Rekonstruktionen stellen oft die Beziehung des Tumors zu anatomischen Leitstrukturen, wie dem Tracheobronchialbaum oder dem Zwerchfell, anschaulicher dar als die axialen Quellbilder. Erste Versuche einer Therapiebeurteilung mittels CT-Volumetrie sind zwar vielversprechend, doch stellt die PET bzw. PET/CT mit dem Glukoseanalogon FDG derzeit die Methode der Wahl in der Responseevaluation dar.AbstractSquamous cell carcinomas and adenocarcinomas account for the majority of cases of esophageal cancer. Esophageal cancer often is diagnosed in advanced stages as clinical symptoms are lacking in early stages. The major aims of imaging in esophageal cancer are to determine local tumor extension (T and N staging), to rule out systemic disease (M staging), and to assess response to neoadjuvant therapy (response evaluation). CT is still inferior to endoscopic ultrasound in differentiating T stages and detecting regional lymph node metastases. However, it plays a central role in determining infiltration into adjacent organs (T4 stage) and in ruling out distant metastases. Multislice-CT (MSCT) offers the possibility of reconstructions, which often help to assess the relationship between tumor and anatomic landmarks like the tracheobronchial tree or the diaphragm. First results of CT volumetry for response evaluation are promising; however, PET and PET/CT with the glucose analogue FDG are the standard methods to evaluate response to neoadjuvant therapy.

The Postoperative Pharynx and Larynx

Dysphagia is often seen in patients following surgery to the pharynx and larynx. It may be due to altered anatomy, altered physiology, or altered function. Dysfunction may be due to sensory disturbances or altered biomechanics due to resection of muscles or repositioning of muscles. Radiotherapy with or without chemotherapy often contributes substantially to dysfunction. Mucosal abnormalities are best evaluated during endoscopy while extraluminal abnormalities including tumor recurrence are evaluated with MR or CT.

The Post-Operative Pharynx and Larynx

Dysphagia is often seen in patients following surgery to the pharynx and larynx. It may be due to altered anatomy, altered physiology or altered function. Dysfunction may be due to sensory disturbances or altered biomechanics due to resection of muscles or repositioning of muscles. Radiotherapy with or without chemotherapy often contributes substantially to dysfunction. Mucosal abnormalities are best evaluated during endoscopy while extraluminal abnormalities including tumour recurrence are evaluated with MR or CT.

Staging und Therapiebeurteilung des Ösophaguskarzinoms mittels MSCT@@@MSCT for staging and response evaluation of esophageal cancer

ZusammenfassungPlattenepithelkarzinome und Adenokarzinome sind für die überwiegende Mehrheit der Ösophaguskarzinome verantwortlich. Die Prognose des Ösophaguskarzinoms ist weiterhin schlecht, da Frühsymptome fehlen und die Diagnose somit meist erst in fortgeschrittenen Stadien gestellt wird. Die bildgebende Diagnostik des Ösophaguskarzinoms hat im Wesentlichen 3 Aufgaben zu erfüllen: die exakte Bestimmung der lokalen Tumorausdehnung (T- und N-Stadium), den Ausschluss von Fernmetastasen (M-Stadium) sowie die frühe Beurteilung des Ansprechens auf eine neoadjuvante (Radio-)Chemotherapie (Responseevaluation). Die CT ist dem endoskopischen Ultraschall beim T- und N-Staging weiterhin unterlegen, spielt jedoch bei der Beurteilung einer Umgebungsinfiltration durch den Tumor (T4-Stadium) sowie beim Ausschluss von Fernmetastasen eine zentrale Rolle. Mithilfe der Multislice-CT (MSCT) erstellte Rekonstruktionen stellen oft die Beziehung des Tumors zu anatomischen Leitstrukturen, wie dem Tracheobronchialbaum oder dem Zwerchfell, anschaulicher dar als die axialen Quellbilder. Erste Versuche einer Therapiebeurteilung mittels CT-Volumetrie sind zwar vielversprechend, doch stellt die PET bzw. PET/CT mit dem Glukoseanalogon FDG derzeit die Methode der Wahl in der Responseevaluation dar.AbstractSquamous cell carcinomas and adenocarcinomas account for the majority of cases of esophageal cancer. Esophageal cancer often is diagnosed in advanced stages as clinical symptoms are lacking in early stages. The major aims of imaging in esophageal cancer are to determine local tumor extension (T and N staging), to rule out systemic disease (M staging), and to assess response to neoadjuvant therapy (response evaluation). CT is still inferior to endoscopic ultrasound in differentiating T stages and detecting regional lymph node metastases. However, it plays a central role in determining infiltration into adjacent organs (T4 stage) and in ruling out distant metastases. Multislice-CT (MSCT) offers the possibility of reconstructions, which often help to assess the relationship between tumor and anatomic landmarks like the tracheobronchial tree or the diaphragm. First results of CT volumetry for response evaluation are promising; however, PET and PET/CT with the glucose analogue FDG are the standard methods to evaluate response to neoadjuvant therapy.