Werner Swobodnik - Academia.edu (original) (raw)

Uploads

Papers by Werner Swobodnik

Research paper thumbnail of »Sludge« in der Gallenblase - eine kritische Bestandsaufnahme

DMW - Deutsche Medizinische Wochenschrift, 2008

Research paper thumbnail of Nicht-invasive Diagnostik am Beinvenensystem in der Schwangerschaft

Ultraschall in der Medizin - European Journal of Ultrasound, 2008

In der Schwangerschaft sind invasive und radiologische diagnostische Methoden weitgehend zu verme... more In der Schwangerschaft sind invasive und radiologische diagnostische Methoden weitgehend zu vermeiden. Real-Time-Sonographie und Venenverschlusplethys-mographie ermoglichen jedoch auf gefahrlose Art und Weise, eine Aussage uber die Venenmorphologie und Venenfunktion zu machen. Mittels dieser Untersuchungsmethoden konnte aufgezeigt werden, das in der Schwangerschaft vergroserte Venenkaliber vorliegen im Vergleich zur Zeit nach der Entbindung. Es besteht ein signifikanter Unterschied. Aufgrund der venenver-schlusplethysmographischen Untersuchungen ist eine Einbuse der Venenfunktion post partum anzunehmen, da der Unterschied zu den Werten des 3. Trimenon nicht signifikant ist. In der Schwangerschaft ergab sich bei den Venenfunktionsmessungen haufig ein Hinweis auf ein Abstromhindernis, sonographisch zeigte sich gleichzeitig eine Venenerweiterung, ein Hinweis auf ein Abstromhindernis in Form des graviden Uterus. Zur Abklarung venoser Veranderungen in der Schwangerschaft scheint die Kombination der beiden genannten Untersuchungsverfahren also sinnvoll zu sein. During pregnancy one should largely avoid invasive and radiological diagnostic methods. However, realtime sonography and venous occlusion plethysmography yield nonhazardous Information on venous morphology and venous function. It became possible to demonstrate by means of these examination methods that the diameters of the veins are enlarged in pregnancy compared to the Situation post partum. The difference is significant. Venous occlusion plethysmography points to a deterioration of venous function post partum, since the difference to the values in the third trimenon is not significant. Venous function measurement often pointed to the existence of an obstacle to flow during pregnancy, whereas sonographically a dilatation of the veins was revealed the existence of an obstacle to flow represented by the pregnant uterus. Hence, it appears meaningful to combine both investigation methods to confirm the occurrence of venous changes during pregnancy.

Research paper thumbnail of Die Sonographie als Screening-Untersuchungsmethode des Venensystems in der Schwangerschaft - Vergleichende Untersuchungen am Arm- und Beinvenensystem

Ultraschall in der Medizin - European Journal of Ultrasound, 2008

Research paper thumbnail of Pain in extracorporeal shock wave lithotripsy

Urological Research, 2009

Pain tolerance has long been identiWed as a factor inXuencing successful treatment of renal calcu... more Pain tolerance has long been identiWed as a factor inXuencing successful treatment of renal calculi by shock wave lithotripsy (SWL). We aimed to clarify which factors directly inXuence pain tolerance to predict which patients are likely to undergo successful treatment. We analysed retrospectively 179 patients who received their Wrst SWL for a solitary kidney stone. All patients were on a non-opioid analgesia protocol and were treated on an outpatient basis. The target was to deliver 4,000 shock waves at an energy level of 4. In total, 53% of patients could tolerate the targeted shock wave number and energy and were retrospectively allocated into group A. Those who required a reduction in either energy levels or shock wave number were allocated in group B. Multivariate and univariate analysis showed that female patients, who are young with thin body habitus, have lower pain tolerance to SWL.

Research paper thumbnail of Real-time ultrasound evaluation of renal transplant failure during the early postoperative period

Ultrasound in Medicine & Biology, 1986

In a prospective clinical trial 385 ultrasound (US) examinations were performed on 50 renal allog... more In a prospective clinical trial 385 ultrasound (US) examinations were performed on 50 renal allograft patients. Baseline sonograms were obtained within 24 hrs of transplantation, and serial US examinations were performed in two to three days intervals during hospital recovery. 24 out of 28 cases of acute rejections (85.7%) were detected by US with an 8% false positive rate. Using statistical analysis, enlarged and sonolucent pyramids, areas of decreased parenchymal echogenicity and an increase in anterior-posterior diameter of the organ, proved to be the best US-rejection criteria. Fine needle aspiration cytology revealed a high rate of false positive rejection diagnosis (23.8%). The results demonstrate that US is a valuable diagnostic aid in the evaluation of postoperative renal transplant failure.

Research paper thumbnail of Electronic Data Base in Gastroenterological Endoscopy

Research paper thumbnail of Storage of Endoscopic Images

Research paper thumbnail of Die diagnostische Feinnadel-Gallenblasenpunktion: Indikation, Technik, Ergebnisse

Lithogener Index und Nukleationszeitbestimmung von Gallenblasengalle stellen pradiktive Parameter... more Lithogener Index und Nukleationszeitbestimmung von Gallenblasengalle stellen pradiktive Parameter fur den Erfolg einer medikamentosen Litholysetherapie von Gallenblasensteinen dar (Janowitz et al. 1989). Die Gewinnung reiner Blasengalle fur die bihare Analytik stellte bisher ein groses Problem dar und war nur intraoperativ durch Gallenblasenpunktion moghch. Damit war aber das therapeutische Vorgehen bei Steintragern schon vorentschieden. Als Kompromislosung wurden deshalb in der Vergangenheit verunreinigte Duodenalaspirate zur biliaren Analytik verwendet, wodurch vor allem Nukleationszeitbestimmungen (Burnstein et al. 1983) unzuverlassig wurden. Wir entwickelten deshalb eine Methode, bei der unter kontinuierlicher Ultraschallfuhrung die Gallenblase mit einer Feinnadel punktiert und nicht verunreinigte Gallenblasengalle beim wachen Patienten abgesaugt werden kann.

Research paper thumbnail of A neural network expert system to support decisions in diagnostic mapping

[1991] Computer-Based Medical Systems@m_Proceedings of the Fourth Annual IEEE Symposium

An expert system module has been integrated into clinical workstations used for report generation... more An expert system module has been integrated into clinical workstations used for report generation and the storage and retrieval of diagnostic images. The expert system works in the background and supports the physician's decisions. The system has been created for ultrasound examinations of the abdomen, it will be transferred to other domains. The knowledge-based system has been implemented for the same knowledge segment using two different methods: a rule-based approach with the AItool Joshua on a Symbolics machine for prototyping and knowledge debugging, and a neural network approach based on backpropagation. Our results showed that the neural network was robust and flexible for the mainly associative knowledge found in our application; it performed well in general and, specifically, on subsets of findings entered during the course of an examination. We therefore decided to combine both components.

Research paper thumbnail of Pathophysiologie der cholesteringallensteine

Research paper thumbnail of Abhängigkeit der Aussagekraft ultraschallgesteuerter diagnostischer Feinnadelpunktionen von Grösse, Lokalisation und Echocharakteristika des Punktionsziels

Research paper thumbnail of Gallstone disease : pathophysiology and therapeutic approaches

Pathobiochemistry and Pathophysiology of Gallstone Development: Importance for Clinical Decision ... more Pathobiochemistry and Pathophysiology of Gallstone Development: Importance for Clinical Decision Processses.- Increased Biliary Lithogenicity Through Cholesterol Supersaturation.- Nucleation and Aggregation of Cholesterol Crystals in the Early Phase of Gallstone Genesis.- Modulation of the Edge Tension of Lipid Membranes by Cholate and Cholesterol and the Micelle-Vesicle Transition in Model Bile Systems.- Pigment Gallstones and Secondary Calcification of Gallstones.- The Influence of the Gallbladder Epithelium on Gallstone Formation.- Biliary Proteins and Their Role as Nucleating Inhibitors/Promotors.- Neurohormonal Aspects of Gallbladder Contractility in Gallstone Disease: The Role of Cholecystokinin.- Environmental Factors and Gallstones.- Different Therapeutic Approaches to Gallstone Disease.- Is Therapeutic Intervention Necessary in Gallstone Disease? The Surgeon's Point of View.- Surgical Therapy for Acute Gallstone Complications.- Therapeutic Interventions in Patients with...

Research paper thumbnail of Schweres Schwangerschaftserbrechen. Pathophysiologische Beobachtungen Und Neuer Therapeutischer Ansatz

Zeitschrift Fur Gastroenterologie, 1991

Research paper thumbnail of Strukturierte Befunderstellung für die Oberbauchsonographie

Research paper thumbnail of An integrated medical workstation with a multimodal user interface, knowledge-based user support, and multimedia documents

IEEE Symposium on Computer-Based Medical Systems, 1990

An integrated workstation developed for use in clinical medicine is described. The specific appli... more An integrated workstation developed for use in clinical medicine is described. The specific application domain is gastroenterology with endoscopic, ultrasonic, and laboratory units. The following modules for data collection and management during ultrasound examinations have been implemented and tested: a multimodal user interface with speech and symbol recognition to reduce complexity in human-machine interaction, knowledge-based components to support the user

Research paper thumbnail of Notfallkoloskopie : Durch schnelle Darmreinigung eine rasche Diagnostik ermöglicht

Zeitschrift Fur Gastroenterologie, 2010

Research paper thumbnail of Hartnäckige Obstipation : Mit Kombination vollständige Darmreinigung erzielt

Zeitschrift Fur Gastroenterologie, 2010

Research paper thumbnail of Ein Spracherkennungssystem in der elektronischen Befunddokumentation

Ultraschall-diagnostik ’89, 1990

Die rapide Entwicklung der Mikroelektronik mit starker Verbesserung der Preis/Leistungsrelation e... more Die rapide Entwicklung der Mikroelektronik mit starker Verbesserung der Preis/Leistungsrelation eroffnet nicht nur in der Technologie der Ultraschallgerate selbst neue Moglichkeiten, sondern auch in der Befunddokumentation und in der Gestaltung des medizinischen Arbeitsplatzes. Unsere Entwicklungen, die im Jahr 1984 begannen, setzten sich die folgenden Ziele: sofortige Verfugbarkeit elektronisch gespeicherter Befundtexte unter verschiedensten Fragestellungen. Zugriff auf Befunde von mehr als einem Arbeitsplatz aus. Strukturierung der Befunddaten. Speicherung auch von Bildern. Erleichterung der Eingabe durch Entwicklung einer multimodalen Oberflache mit Komponenten eines wissensbasierten Systems.

Research paper thumbnail of Pathologische Wandveränderungen der Gallenblase bei Steinträgern und Gesunden*

Ultraschall in der Medizin - European Journal of Ultrasound, 2008

: 2154 computerized ultrasound diagnoses of 1623 patients were evaluated retrospectively from Jan... more : 2154 computerized ultrasound diagnoses of 1623 patients were evaluated retrospectively from January 1st to October 31st 1987. The frequency of pathologic gallbladder wall changes in patients with stones and normal controls was examined applying 5 MHz annular array sector transducer. The occurrence of polyps, septae, sludge, kinking, carcinoma and adenomyomatosis was noted separately. The prevalence of polyps and septae in gallstone patients was increased fourfold if compared to the total number of examined patients. Sludge was found in 5.9% of gallstone patients compared to 2.2% in normal controls. Carcinoma and adenomyomatosis were present only in cases of cholelithiasis; the prevalence of these pathologic wall changes is obviously rare. The importance of polyps and septae in biliary lithogenicity is discussed.

Research paper thumbnail of Eine „intelligente“ Benutzeroberfläche für die Befunddokumentation in der Sonographie

Ultraschalldiagnostik ’90, 1991

Der Einsatz modernster Technologie erlaubt es, fur die Befunddokumentation in der Sonographie neu... more Der Einsatz modernster Technologie erlaubt es, fur die Befunddokumentation in der Sonographie neue Perspektiven zu eroffnen [1], insbesondere ist eine digitale Bildspeicherung auf relativ preisgunstigen Datentragern moglich. Basis eines schnell und einfach zu bedienenden Systems ist aber die Verwendung praxisgerechter Bildschirmformulare, aus denen sofort nach der Untersuchung ein Befund erstellt wird. Zur besseren Unterstutzung des Benutzers konnen Methoden der sogenannten „Kunsthchen Intelhgenz” zum Einsatz kommen.

Research paper thumbnail of »Sludge« in der Gallenblase - eine kritische Bestandsaufnahme

DMW - Deutsche Medizinische Wochenschrift, 2008

Research paper thumbnail of Nicht-invasive Diagnostik am Beinvenensystem in der Schwangerschaft

Ultraschall in der Medizin - European Journal of Ultrasound, 2008

In der Schwangerschaft sind invasive und radiologische diagnostische Methoden weitgehend zu verme... more In der Schwangerschaft sind invasive und radiologische diagnostische Methoden weitgehend zu vermeiden. Real-Time-Sonographie und Venenverschlusplethys-mographie ermoglichen jedoch auf gefahrlose Art und Weise, eine Aussage uber die Venenmorphologie und Venenfunktion zu machen. Mittels dieser Untersuchungsmethoden konnte aufgezeigt werden, das in der Schwangerschaft vergroserte Venenkaliber vorliegen im Vergleich zur Zeit nach der Entbindung. Es besteht ein signifikanter Unterschied. Aufgrund der venenver-schlusplethysmographischen Untersuchungen ist eine Einbuse der Venenfunktion post partum anzunehmen, da der Unterschied zu den Werten des 3. Trimenon nicht signifikant ist. In der Schwangerschaft ergab sich bei den Venenfunktionsmessungen haufig ein Hinweis auf ein Abstromhindernis, sonographisch zeigte sich gleichzeitig eine Venenerweiterung, ein Hinweis auf ein Abstromhindernis in Form des graviden Uterus. Zur Abklarung venoser Veranderungen in der Schwangerschaft scheint die Kombination der beiden genannten Untersuchungsverfahren also sinnvoll zu sein. During pregnancy one should largely avoid invasive and radiological diagnostic methods. However, realtime sonography and venous occlusion plethysmography yield nonhazardous Information on venous morphology and venous function. It became possible to demonstrate by means of these examination methods that the diameters of the veins are enlarged in pregnancy compared to the Situation post partum. The difference is significant. Venous occlusion plethysmography points to a deterioration of venous function post partum, since the difference to the values in the third trimenon is not significant. Venous function measurement often pointed to the existence of an obstacle to flow during pregnancy, whereas sonographically a dilatation of the veins was revealed the existence of an obstacle to flow represented by the pregnant uterus. Hence, it appears meaningful to combine both investigation methods to confirm the occurrence of venous changes during pregnancy.

Research paper thumbnail of Die Sonographie als Screening-Untersuchungsmethode des Venensystems in der Schwangerschaft - Vergleichende Untersuchungen am Arm- und Beinvenensystem

Ultraschall in der Medizin - European Journal of Ultrasound, 2008

Research paper thumbnail of Pain in extracorporeal shock wave lithotripsy

Urological Research, 2009

Pain tolerance has long been identiWed as a factor inXuencing successful treatment of renal calcu... more Pain tolerance has long been identiWed as a factor inXuencing successful treatment of renal calculi by shock wave lithotripsy (SWL). We aimed to clarify which factors directly inXuence pain tolerance to predict which patients are likely to undergo successful treatment. We analysed retrospectively 179 patients who received their Wrst SWL for a solitary kidney stone. All patients were on a non-opioid analgesia protocol and were treated on an outpatient basis. The target was to deliver 4,000 shock waves at an energy level of 4. In total, 53% of patients could tolerate the targeted shock wave number and energy and were retrospectively allocated into group A. Those who required a reduction in either energy levels or shock wave number were allocated in group B. Multivariate and univariate analysis showed that female patients, who are young with thin body habitus, have lower pain tolerance to SWL.

Research paper thumbnail of Real-time ultrasound evaluation of renal transplant failure during the early postoperative period

Ultrasound in Medicine & Biology, 1986

In a prospective clinical trial 385 ultrasound (US) examinations were performed on 50 renal allog... more In a prospective clinical trial 385 ultrasound (US) examinations were performed on 50 renal allograft patients. Baseline sonograms were obtained within 24 hrs of transplantation, and serial US examinations were performed in two to three days intervals during hospital recovery. 24 out of 28 cases of acute rejections (85.7%) were detected by US with an 8% false positive rate. Using statistical analysis, enlarged and sonolucent pyramids, areas of decreased parenchymal echogenicity and an increase in anterior-posterior diameter of the organ, proved to be the best US-rejection criteria. Fine needle aspiration cytology revealed a high rate of false positive rejection diagnosis (23.8%). The results demonstrate that US is a valuable diagnostic aid in the evaluation of postoperative renal transplant failure.

Research paper thumbnail of Electronic Data Base in Gastroenterological Endoscopy

Research paper thumbnail of Storage of Endoscopic Images

Research paper thumbnail of Die diagnostische Feinnadel-Gallenblasenpunktion: Indikation, Technik, Ergebnisse

Lithogener Index und Nukleationszeitbestimmung von Gallenblasengalle stellen pradiktive Parameter... more Lithogener Index und Nukleationszeitbestimmung von Gallenblasengalle stellen pradiktive Parameter fur den Erfolg einer medikamentosen Litholysetherapie von Gallenblasensteinen dar (Janowitz et al. 1989). Die Gewinnung reiner Blasengalle fur die bihare Analytik stellte bisher ein groses Problem dar und war nur intraoperativ durch Gallenblasenpunktion moghch. Damit war aber das therapeutische Vorgehen bei Steintragern schon vorentschieden. Als Kompromislosung wurden deshalb in der Vergangenheit verunreinigte Duodenalaspirate zur biliaren Analytik verwendet, wodurch vor allem Nukleationszeitbestimmungen (Burnstein et al. 1983) unzuverlassig wurden. Wir entwickelten deshalb eine Methode, bei der unter kontinuierlicher Ultraschallfuhrung die Gallenblase mit einer Feinnadel punktiert und nicht verunreinigte Gallenblasengalle beim wachen Patienten abgesaugt werden kann.

Research paper thumbnail of A neural network expert system to support decisions in diagnostic mapping

[1991] Computer-Based Medical Systems@m_Proceedings of the Fourth Annual IEEE Symposium

An expert system module has been integrated into clinical workstations used for report generation... more An expert system module has been integrated into clinical workstations used for report generation and the storage and retrieval of diagnostic images. The expert system works in the background and supports the physician's decisions. The system has been created for ultrasound examinations of the abdomen, it will be transferred to other domains. The knowledge-based system has been implemented for the same knowledge segment using two different methods: a rule-based approach with the AItool Joshua on a Symbolics machine for prototyping and knowledge debugging, and a neural network approach based on backpropagation. Our results showed that the neural network was robust and flexible for the mainly associative knowledge found in our application; it performed well in general and, specifically, on subsets of findings entered during the course of an examination. We therefore decided to combine both components.

Research paper thumbnail of Pathophysiologie der cholesteringallensteine

Research paper thumbnail of Abhängigkeit der Aussagekraft ultraschallgesteuerter diagnostischer Feinnadelpunktionen von Grösse, Lokalisation und Echocharakteristika des Punktionsziels

Research paper thumbnail of Gallstone disease : pathophysiology and therapeutic approaches

Pathobiochemistry and Pathophysiology of Gallstone Development: Importance for Clinical Decision ... more Pathobiochemistry and Pathophysiology of Gallstone Development: Importance for Clinical Decision Processses.- Increased Biliary Lithogenicity Through Cholesterol Supersaturation.- Nucleation and Aggregation of Cholesterol Crystals in the Early Phase of Gallstone Genesis.- Modulation of the Edge Tension of Lipid Membranes by Cholate and Cholesterol and the Micelle-Vesicle Transition in Model Bile Systems.- Pigment Gallstones and Secondary Calcification of Gallstones.- The Influence of the Gallbladder Epithelium on Gallstone Formation.- Biliary Proteins and Their Role as Nucleating Inhibitors/Promotors.- Neurohormonal Aspects of Gallbladder Contractility in Gallstone Disease: The Role of Cholecystokinin.- Environmental Factors and Gallstones.- Different Therapeutic Approaches to Gallstone Disease.- Is Therapeutic Intervention Necessary in Gallstone Disease? The Surgeon's Point of View.- Surgical Therapy for Acute Gallstone Complications.- Therapeutic Interventions in Patients with...

Research paper thumbnail of Schweres Schwangerschaftserbrechen. Pathophysiologische Beobachtungen Und Neuer Therapeutischer Ansatz

Zeitschrift Fur Gastroenterologie, 1991

Research paper thumbnail of Strukturierte Befunderstellung für die Oberbauchsonographie

Research paper thumbnail of An integrated medical workstation with a multimodal user interface, knowledge-based user support, and multimedia documents

IEEE Symposium on Computer-Based Medical Systems, 1990

An integrated workstation developed for use in clinical medicine is described. The specific appli... more An integrated workstation developed for use in clinical medicine is described. The specific application domain is gastroenterology with endoscopic, ultrasonic, and laboratory units. The following modules for data collection and management during ultrasound examinations have been implemented and tested: a multimodal user interface with speech and symbol recognition to reduce complexity in human-machine interaction, knowledge-based components to support the user

Research paper thumbnail of Notfallkoloskopie : Durch schnelle Darmreinigung eine rasche Diagnostik ermöglicht

Zeitschrift Fur Gastroenterologie, 2010

Research paper thumbnail of Hartnäckige Obstipation : Mit Kombination vollständige Darmreinigung erzielt

Zeitschrift Fur Gastroenterologie, 2010

Research paper thumbnail of Ein Spracherkennungssystem in der elektronischen Befunddokumentation

Ultraschall-diagnostik ’89, 1990

Die rapide Entwicklung der Mikroelektronik mit starker Verbesserung der Preis/Leistungsrelation e... more Die rapide Entwicklung der Mikroelektronik mit starker Verbesserung der Preis/Leistungsrelation eroffnet nicht nur in der Technologie der Ultraschallgerate selbst neue Moglichkeiten, sondern auch in der Befunddokumentation und in der Gestaltung des medizinischen Arbeitsplatzes. Unsere Entwicklungen, die im Jahr 1984 begannen, setzten sich die folgenden Ziele: sofortige Verfugbarkeit elektronisch gespeicherter Befundtexte unter verschiedensten Fragestellungen. Zugriff auf Befunde von mehr als einem Arbeitsplatz aus. Strukturierung der Befunddaten. Speicherung auch von Bildern. Erleichterung der Eingabe durch Entwicklung einer multimodalen Oberflache mit Komponenten eines wissensbasierten Systems.

Research paper thumbnail of Pathologische Wandveränderungen der Gallenblase bei Steinträgern und Gesunden*

Ultraschall in der Medizin - European Journal of Ultrasound, 2008

: 2154 computerized ultrasound diagnoses of 1623 patients were evaluated retrospectively from Jan... more : 2154 computerized ultrasound diagnoses of 1623 patients were evaluated retrospectively from January 1st to October 31st 1987. The frequency of pathologic gallbladder wall changes in patients with stones and normal controls was examined applying 5 MHz annular array sector transducer. The occurrence of polyps, septae, sludge, kinking, carcinoma and adenomyomatosis was noted separately. The prevalence of polyps and septae in gallstone patients was increased fourfold if compared to the total number of examined patients. Sludge was found in 5.9% of gallstone patients compared to 2.2% in normal controls. Carcinoma and adenomyomatosis were present only in cases of cholelithiasis; the prevalence of these pathologic wall changes is obviously rare. The importance of polyps and septae in biliary lithogenicity is discussed.

Research paper thumbnail of Eine „intelligente“ Benutzeroberfläche für die Befunddokumentation in der Sonographie

Ultraschalldiagnostik ’90, 1991

Der Einsatz modernster Technologie erlaubt es, fur die Befunddokumentation in der Sonographie neu... more Der Einsatz modernster Technologie erlaubt es, fur die Befunddokumentation in der Sonographie neue Perspektiven zu eroffnen [1], insbesondere ist eine digitale Bildspeicherung auf relativ preisgunstigen Datentragern moglich. Basis eines schnell und einfach zu bedienenden Systems ist aber die Verwendung praxisgerechter Bildschirmformulare, aus denen sofort nach der Untersuchung ein Befund erstellt wird. Zur besseren Unterstutzung des Benutzers konnen Methoden der sogenannten „Kunsthchen Intelhgenz” zum Einsatz kommen.