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Biomedical subjects

G Küffer

Publications and source records attributed to G Küffer.

At least 19 recordsLinked to original sources
PubMed1997

[A proposal for the MR staging of early rheumatoid arthritis in the metacarpophalangeal and proximal interphalangeal joints].

PURPOSE: MRI can demonstrate pathology of joint disease in the early course of rheumatoid arthritis prior to destructions seen on conventional radiographs. In a prospective study, we tried to develop a systematical classification of joint pathology demonstrated by MRI, which would be essential for scoring the course of the disease. PATIENTS AND METHOD: Metacarpophalangeal and interphalangeal joints of 48 patients suffering from early rheumatoid arthritis (mean disease duration: 6.4 months) were evaluated by MRI using a high-resolution transmitter-receiver coil. Examinations included 2 mm sliced T2-, T1- and gadolinium enhanced T1-SE sequences in coronal and axial orientation. In consideration of pathological findings on MRI and histopathogenetical pathways of destruction in rheumatoid arthritis a MR-score (0-5) was established. RESULTS: This allowed to score each joint examined: score 0 (normal) in 47.8%/49.5%, score 1 in 35.5%/50.5%, score 2 in 4.2%/0%, score 3 in 10.8%/0%, score 4 in 1.5%/0% of the metacarpophalangeal/interphalangeal joints, respectively. CONCLUSIONS: Using the MR-score a relative individual destruction number can be calculated, which may be used to follow up patients in the early course of rheumatoid arthritis (e.g. drug therapy studies). The presented MR scoring system has to be evaluated further in longitudinal studies and must be correlated to radiographical and clinical findings.

Adult↗
PubMed1997

[Dural carotid-cavernous sinus fistulas: clinical aspects, diagnosis and therapeutic intervention].

BACKGROUND: Carotid cavernous fistulas are cerebral artenovenous shunts which may present with ocular or orbital signs. Direct fistulas are distinguished from dural shunts with respect to the anatomical situation. PATIENTS: We report on two patients with spontaneous dural carotid cavernous fistulas with multiple feeding vessels. Both patients required endovascular embolization. RESULTS: Therapy was successful in both patients. We present an overview of the clinical picture, the diagnostic procedure, the differential diagnosis and the therapeutic possibilities in this clinical entity. CONCLUSION: Both patients prove the importance of an immediate differential diagnostical classification so that a specific neuroradiological diagnostic can be ensured. Today's advanced endovascular technology offers therapeutic options with less risk for the patient than in recent years.

Arteriovenous Fistula↗
PubMed1997

MR imaging of soft-tissue changes after percutaneous transluminal angioplasty and stent placement.

PURPOSE: To evaluate the different tissue reactions at magnetic resonance (MR) imaging after balloon dilation and placement of covered and uncovered stents. MATERIALS AND METHODS: Contrast material-enhanced MR imaging was performed in 14 patients with polyester-covered nitinol stents, 10 patients with conventional metallic stents, and 12 patients who underwent peripheral percutaneous transluminal angioplasty. Lesions were located in the subclavian, iliac, femoral, and popliteal arteries. RESULTS: MR imaging demonstrated perivascular soft-tissue inflammation in 11 of 14 (79%) patients with polyester-covered stents. Eight (57%) of these patients showed clinical symptoms. No reaction was found among the group with uncovered stents and those who underwent peripheral percutaneous transluminal angioplasty. CONCLUSION: The polyester-covered nitinol stent can induce systemic and severe local reactions. These reactions seem to be specific to this type of stent. No definite cause has been established, although the phenomenon appears to be self-limiting.

Aged↗
PubMed1997

[Instrumental diagnosis for therapeutic decision: intra-arterial DSA versus 3D CT-angiography in abdominal aortic aneurysms].

Compared to intraarterial DSA, 3D spiral CT-angiography could be an reliable alternative method for preoperative evaluation and planning of abdominal aortic aneurysms. 3D data reconstruction with new rendering techniques (especially "volume rendering") provides unique information about mural thrombus, calcified plaques, vessel kinking and renal/visceral arteries. However, the more invasive intraarterial DSA should be performed in patients with complex occlusive disease of the iliac arteries, renal or visceral artery stenoses, or pathological findings in peripheral duplex sonography or if intraluminal exclusion with endostent placement is planned.

Angiography, Digital Subtraction↗
PubMed1997

[Combined interventions in transfemoral stent implantation in infra-renal abdominal aortic aneurysm].

The transluminally placed endovascular graft (TPEG) is a novel method for the treatment of abdominal aortic aneurysms (AAA). Aortobiiliacal application requires three anchor sites and can often not be performed in cases of aneurysm, occlusion, or elongation of the iliac arteries. Here the aorto-uniiliacal stent implantation combined with crossover bypass provides an alternative procedure, and thus broadens the therapeutic endovascular spectrum.

Aortic Aneurysm, Abdominal↗
PubMed1995

[Extraskeletal Ewing sarcoma: differential diagnosis of a soft tissue tumor].

We report on a 30-year-old man from Vietnam who complained about diffuse pain in the left epigastrium. Using the ultrasound a pleural effusion in the left recessus costodiaphragmaticus was found. The chest X-ray showed a paravertebral soft-tissue tumor at the left side, with CT and NMR a sarcoma was suspected. The patient was treated by local resection of the tumor, histologically an extraosseous Ewing's sarcoma was identified. Due to the following chemotherapy and local radiation therapy no local recurrence and metastases have developed for 32 months.

Adult↗
PubMed1995

[Differential radiologic diagnosis of HIV-associated lung diseases].

In 1993 in Germany an estimated number of 50,000-70,000 individuals were infected with the human immunodeficiency virus (HIV), WHO estimations ranged up to 14 million HIV-positive individuals including 1 million children. AIDS-related diseases frequently occur in the lung. 65% of all AIDS-defining illnesses begin with life-threatening pulmonary infections. Most frequently HIV-positive patients present with Pneumocystis carinii pneumonia, followed by atypical mycobacteriosis, bacterial infections, Kaposi's sarcoma and non-Hodgkin lymphoma. The purpose of this article is to identify pulmonary HIV-associated diseases by focusing on radiological patterns and correlating them with clinical findings.

AIDS-Related Opportunistic Infections↗
PubMed1993

["Vibration white finger" syndrome in 8 grinders of a large metal manufacturing industry].

PATIENTS: Eight patients with vibration white finger syndrome (VWF) were seen in our angiological outpatient department. They were all turbine grinders working in the same large factory. One patient presented with a pronounced Raynaud's phenomenon only, while all the others additionally complained of numbness, weakness and pain affecting both hands. FINDINGS: We requested an intra-arterial DSA of the right hand of all patients, which in some patients revealed, in addition to severe vasospasm, also blood vessel breaks. The patient who apparently was exposed to vibration the longest also had aneurysms affecting the capillaries of all fingers.

Adult↗
PubMed1993

Efficacy and tolerance of recombinant tissue-type plasminogen activator in patients with thrombotic or embolic occlusions of leg-arteries.

The efficacy and safety of recombinant tissue-type plasminogen activator (rt-PA) was evaluated in 46 patients with thromboembolic arterial occlusions in leg arteries. rt-PA was given over 1-4 h with a maximum dose of 18 mg. The effect of rt-PA treatment was determined as patency of the occluded arteries in 44 different patients 14 days after treatment. In 41 patients at least one artery was recanalized (93%) by rt-PA, and in almost half of these patients (48%) no residual stenosis were detected after the lytic treatment. A slight residual stenosis was detected in 29% of the patients and a severe residual stenosis in 21%. An additional treatment with percutaneous transluminal angioplasty was performed in 23 of the 44 patients and successful in 21 (91%). In 8 patients an addition catheter-embolectomy was performed. No difference in patency rate was detected between patients with thrombotic and those with embolic occlusions. The age of the occlusion influenced the patency rate; occlusions under the age of 5 weeks showed a patency rate of 96% compared to 82% in older occlusions. The length of the occlusion did not have any influence on the outcome of the rt-PA treatment. From the results of this open study we conclude that a dose of up to 18 mg of rt-PA is both safe and effective in the treatment of thromboembolic occlusions in leg arteries.

Adult↗
PubMed1991

[Simpson's atherectomy in embolizing leg artery stenoses].

We report on the treatment and follow-up of six patients with an unilateral "blue toe" syndrome. This is caused by atheromatous micro-embolisation to the digital arteries and requires urgent attention due to the painful cutaneous necroses and impending digital gangrene. In all patients, Simpson's atherectomy of proximally situated femoropopliteal stenoses caused the pre-gangrenous digital changes to heal completely. In a mean observation period of ten months no relapse occurred. The embolising material was presumably parietal fibrino-platelet thrombi which could be observed with angioscopy and were regularly detectable histologically in the excised tissue.

Aged↗
PubMed1990

Sclerosing epitheloid angiosarcoma of bone and lung--intravascular sclerosing bronchioloalveolar tumor.

A 39-year-old woman was admitted to hospital with severe pain in the left shoulder due to an endothelial bone tumor. The tumor showed the same histologic signs as an intravascular sclerosing bronchioloalveolar tumor of the lung (IVBAT) which had been enucleated 2 years previously. This combination is uncommon. It is discussed whether the IVBAT is a malignant tumor with metastases or a benign tumor with coincidental tumors in other organs of the same endothelial vascular origin. We consider this to be an epitheloid angiosarcoma of the lung with, in our case, bone metastases; this is in agreement with some most recent reports on the disease.

Adult↗
PubMed1990

Value of 67gallium scintigraphy in primary diagnosis and follow-up of opportunistic pneumonia in patients with AIDS.

Opportunistic pneumonias are a life-threatening complication in patients with AIDS. Early diagnosis and therapy is necessary to improve the prognosis. This study was designed to assess the value of 67gallium scintigraphy in the primary detection and follow-up of these special pneumonias. 67Gallium scintigraphy was performed in 40 patients: 10 normal controls and 30 HIV-positive patients with AIDS or AIDS-related complex (ARC). 67Gallium scan results were compared with current chest x-rays and the results of pathogen detection. The evaluation of positive scans was based on a quantification of the pulmonary uptake, expressed as a pulmonary/soft tissue uptake ratio. Only 8 of 30 patients had a normal scan, while 22 of 30 showed diffuse (13/22) or focal (9/22) increases of pulmonary uptake. In seven of eight patients with normal scans the chest radiograph was negative as well. The one patient with negative scan but positive chest radiograph had pulmonary Kaposi's sarcoma. In 11 of 22 patients, the 67gallium scan and chest x-ray were positive simultaneously. In the other 11 of 22 patients with positive scans, chest radiographs were initially negative but showed pathology in five cases within 1-2 weeks. The reason for positive scans in most cases was an opportunistic lung infection; other forms of pneumonia were observed only in two cases. The defined uptake ratio was demonstrated to be a highly sensitive parameter for monitoring pneumonia and the effects of therapy in follow-up studies. In conclusion, quantitative 67gallium scintigraphy proved to be a reliable and highly sensitive method for primary detection and follow-up of opportunistic pneumonias in patients with AIDS.

AIDS-Related Complex↗