Biomedical subjects
B Grün
Publications and source records attributed to B Grün.
Increased frequency of migraine in narcoleptic patients.
We explored the relationship between narcolepsy and different types of headaches. We interviewed 68 patients with idiopathic narcolepsy for the presence of headache symptoms based on the criteria of the International Headache Society (IHS). Eighty-one percent of the patients reported headaches that warranted an IHS headache diagnosis. Fifty-four percent of the patients (64% women, 35% men) had migraine with all IHS criteria fulfilled.
Electrophysiological brain stem investigations in idiopathic narcolepsy.
Narcolepsy is associated with various rapid eye movement (REM) sleep abnormalities. Distinct brain stem areas seem to play a prominent role in REM sleep regulation. Recent magnetic resonance imaging (MRI) studies have led to conflicting findings concerning the presence of structural brain stem lesions in patients with idiopathic narcoleptic syndrome. However, multimodal electrophysiological brain stem investigations may reveal functional brain stem abnormalities even in the absence of MRI abnormality. Therefore we investigated brain stem function in 12 idiopathic narcoleptic patients by systematically studying tegmental brain stem pathways. All of the patients met the diagnostic criteria of the International Classification of Sleep Disorders, with typical changes in polysomnography and the multiple sleep latency test. Electrophysiological investigations comprised masseter reflex, blink reflex, masseter inhibitory reflex, early auditory evoked potentials and electrooculography with vestibular testing. In no patient were electrophysiological brain stem abnormalities observed. Our findings do not support the existence of a relevant brain stem lesion in narcoleptic patients with normal neurological status.
[Percutaneous transluminal angioplasty of the deep femoral artery. Retrospective evaluation of early technical and clinical results in 196 cases of catheterization].
AIM: Stenosis of the deep femoral artery with simultaneous occlusion of the superficial femoral artery usually is considered to be a classical indication for vascular surgery. Angioplastic therapy of this vessel is rarely reported. Retrospective analysis of the technical and clinical results following catheter treatment of the deep femoral artery was performed to demonstrate the possibilities of this less invasive method. MATERIAL AND METHOD: 196 angioplasties in 174 patients were performed. 77 patients (39%) suffered from stage II disease according to Fontaine classification (grade I category 2/3 [Rutherford]), 36 (18%) from stage III (grade II category 4) and 75 (38%) from stage IV (grade III category 5). RESULTS: Catheter treatment was successfully performed in 77% (151/196) of the cases. Clinical improvement was seen following 61% (96/196) of the treatments. The complication rate was 3.4% (7/196: thrombosis of the CFA, ascending occlusion of the SFA, occlusion/spasm of the arteria circumflexa femoris lateralis, pulmonary embolism). CONCLUSION: Catheter treatment is a minimal invasive, cost-effective alternative to surgical reconstruction of the deep femoral artery.
[MRI and oncoscintigraphy with 99m-Tc-MIBI in the follow up of thyroid cancer].
Magnetic resonance imaging (MRI) and 99mTc-MIBI oncoscintigraphy are new procedures for the detection of recurrent differentiated thyroid cancer. We evaluated the utility of both techniques compared to ultrasonography, radioiodine scanning, and measurement of serum thyroglobulin in patients with (n = 21) or without suspicion (n = 34) of tumor relapse. Although MRI was most effective in detecting local recurrencies (sensitivity: 100%), additional diagnostic information was only obtained in patients with mediastinal lesions. On the other hand, oncoscintigraphy was less sensitive (67%) but highly specific in differentiating reactive lymph node enlargement from metastatic disease (specificity: 93.5%). Oncoscintigraphy may be used instead of radioiodine scanning in patients with doubtful lymph node findings and spare them withdrawal of TSH-suppressive hormone medication. Routine estimation of serum thyroglobulin proved to be highly efficient in screening for tumor relapse using a cut-off level of 3 ng/ml (accuracy: 100%).
[Color-coded duplex ultrasonography in the diagnosis of renal artery stenosis].
To diagnose possible renal artery stenosis in 120 patients (36 women, 84 men; mean age 57.3 [21-84] years) colour duplex sonography (CDS) of the renal arterial tree was performed before 53 intraarterial angiographies and 67 central venous digital subtraction angiographies. The criterion of stenosis was a maximal flow velocity of > 180 cm/s in the colour duplex sonogram and a diameter reduction of > 50% in the angiogram. CDS demonstrated the renal artery bed in 209 of 247 renal arteries (85%). 84 of the 209 had regional maximal velocities of > 180 cm/s. The sensitivity and specificity of CDS when comparing it with both angiographic methods (in 185 cases that could be evaluated, in 74 of them with abnormal results) were 91 and 88.2%, respectively. Comparing CDS results with those by intraarterial angiography alone (88 cases, with 51 abnormal findings), sensitivity and specificity were 92.1 and 91.8%, respectively. These results demonstrate that CDS can reliably demonstrate flow obstructions in the renal arterial tree and can thus be recommended for the diagnosis of renovascular hypertension.
[Determination of the length of the occlusion in extremity arteries--color duplex ultrasound versus angiography].
In the management of patients with peripheral arterial occlusive disease the length and location of an arterial occlusion has an impact on the choice of the method of arterial reconstruction, i.e. percutaneous transluminal angioplasty or vascular surgery. The aim of this study was to determine the accuracy of colour-coded Doppler sonography (CDS) compared to conventional contrast arteriography in detecting the length and localisation of an occlusion in peripheral arteries. 100 legs of 94 patients (27 women, 44 to 82 years of age [mean 60.9 years] and 67 men, 21 to 78 years of age [mean 61.3 years]) with clinically suspected artery occlusion were examined prospectively with CDS before angiography and angioplasty. The exact localisation was correctly diagnosed by CDS in 95% with a high correlation (r = 0.95) of occlusion length between both methods. The sensitivity in detecting occlusions was 98% (positive predictive value 98%). It is concluded that colour-coded Doppler sonography can diagnose the length and location of an occlusion in peripheral arteries accurately and therefore can be used as a noninvasive method to select patients for further therapy management.
[An incidental finding of a progressive diaphyseal dysplasia (Camurati-Engelmann syndrome)].
In a 35 year-old female diaphyseal hyperostosis of femur and tibia indicative of a Camurati-Engelmann syndrome (progressive diaphyseal dysplasia) were discovered during routine phlebography. This rare disorder belongs to the group of osteochondrodysplasias and affects primarily the diaphyses of long bones. Sporadic as well as familial cases have been observed. Although the cause and pathogenetic mechanism of the disease are unknown, an autosomal dominant inheritance is being discussed. Diagnosis was based on radiological findings, which are presented along with the scintigraphic appearance of the disease.
[Progress in arterial reconstruction of the upper and lower leg--percutaneous transluminal procedures].
Conventional PTA represents the state of the art method for treating arterial occlusive disease of the leg arteries. Rotational angioplasty is an improvement over conventional PTA in treating long proximal occlusions of the SFA. It can also be used as a second treatment in cases that were primarily unsuccessful with PTA, with an initial success of 59%. Stent implantation is mainly indicated in limb-threatening ischemia. It also permits successful management of an aneurysm as a late and rare complication correlated to PTA. Atherectomy produces better initial success in eccentric stenotic lesions than PTA. It also permits the successful management of obstructive intimal flaps after angioplasty. The new techniques only improve on PTA, if they are used in the differential therapeutic strategy mentioned above.
[Osteonecrosis of the ossa sesamoidea hallucis--its pathology, diagnosis and differential diagnosis].
Basing on case reports, the embryology and anatomy of the great toe sesamoid bones are described. Pathogenesis of the osteonecrosis of these bones is explained, and the role of radiology in diagnosis and as an important aid in differential diagnosis is pointed out.
[Asymptomatic calcified aneurysm of the inferior pancreaticoduodenal artery--differential diagnostic considerations].
A calcified aneurysm of the inferior pancreaticoduodenal artery with simultaneous occlusion of the celiac axis but without any local symptoms is presented. In the description of the diagnostic procedure, the considerations relating to differential diagnosis against solitary circumferentially calcified masses in the right upper quadrant of the abdomen are discussed. As a result of increasingly sophisticated examination techniques, especially digital subtraction angiography, computed tomography and ultrasonography, these aneurysms, which were formerly thought to be rare, are now discovered surprisingly often. Knowledge of this vascular malformation and its differential diagnoses helps to avoid risky methods of examination.
[A complication and angioplasty: successful catheter lysis of an occlusion of the external iliac artery].
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