[Interventional radiology in acute mesenteric ischemia].
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Aged↗
Biomedical subjects
G Schindler
Publications and source records attributed to G Schindler.
Helical CT cholangiography for the detection and localization of bile duct leakage.
OBJECTIVE: We describe the use of helical CT cholangiography or helical CT after administration of biliary i.v. contrast material to verify and localize bile duct leakage. CONCLUSION: Helical CT cholangiography revealed bile leaks in seven patients after penetrating trauma or liver or gallbladder surgery and excluded bile leaks in two patients with blunt liver trauma. Endoscopic retrograde cholangiography was performed in only one of seven patients with bile leakage and was avoided in an additional two patients in whom CT cholangiography excluded leakage. The method is a feasible, noninvasive tool for the detection and localization of bile leaks and may help avoid endoscopic retrograde cholangiography.
Adult↗
Different missense mutations in histidine-108 of lysosomal acid lipase cause cholesteryl ester storage disease in unrelated compound heterozygous and hemizygous individuals.
Cholesteryl ester storage disease (CESD) and Wolman disease (WD) are both autosomal recessive disorders associated with reduced activity of lysosomal acid lipase (LAL), that leads to the tissue accumulation of cholesteryl esters in endosomes and lysosomes. WD is caused by genetic defects of LAL that leave no residual enzymatic activity, while in CESD patients a residual LAL activity can be identified. We have analyzed the LAL cDNA in three CESD patients from two nonrelated families and identified the mutations responsible for the disease. The associated genetic defects characterized revealed compound heterozygosity for a splice defect leading to skipping of exon 8, due to a G-->A transition at position -1 of the exon 8 splice donor site, and a point mutation leading to a Hisl08Pro change (CAT-->CCT) in two patients (siblings) with mild CESD phenotype. A further CESD patient was hemizygous for a His108-->Arg missense mutation (CAT-->CGT) in combination with a partial deletion of the LAL gene and was affected more severely. Expression of the LAL enzymes with the His108-->Pro and His108-->Arg mutation in insect cells revealed residual enzymatic activities of 4.6% versus 2.7%, respectively, compared with controls. Therefore, His108 seems to play a crucial role in folding or catalytic activity of the lysosomal acid lipase. This is the first description of two different, naturally occurring mutations involving the same amino acid residue in the lysosomal acid lipase in unrelated CESD patients. Moreover, our results demonstrate that the variable manifestation of CESD can be explained by mutation-dependent, variable inactivation of the LAL enzyme.
Amino Acid Substitution↗
Optimizing liver contrast in helical liver CT: value of a real-time bolus-triggering technique.
Optimal liver enhancement during portal venous-phase helical CT is crucial in the detection of parenchymal liver lesions. In the prospective study reported here we investigated the effects of a real-time bolus-tracking system on mean and maximal liver enhancement. In 79 patients referred to us for abdominal CT we injected 120 ml of non-ionic contrast (300 mg I/ml) at a rate of 3 ml/s. After a nonintravenous contrast upper abdominal scan a portal venous phase was performed. In 39 patients (mean weight 72.6 +/- 18.7 kg, range 48-139 kg) real-time bolus tracking was performed using the CARE Bolus software (Siemens, Erlangen, Germany). The software performs repetitive low-dose test scans in a preselected region of interest and measures the Hounsfield attenuation and liver enhancement in real-time. After a critical threshold (we selected 31 HU) is surpassed, the software starts diagnostic spiral scanning. Our control consisted of 40 patients weighing 51-100 kg (mean 73.2 +/- 11.1 kg) who were scanned with a fixed, preselected start delay of 80 s. Mean hepatic enhancement was 54.0 +/- 9.9 HU (range 33.3-74 HU) in 37 automatically triggered patients, mean peak hepatic enhancement 64.6 +/- 12.6 HU (range 42.0-91.8 HU). In 2 patients of the study group scanning had to be started manually. In the control group with fixed delay mean enhancement was 48.3 +/- 9.2 HU (range 33.8-71.6 HU) and peak enhancement 55.5 +/- 9.7 HU (range 39.7-81.0 HU). Differences were significant (p < 0.05, Student's t-test). Real-time bolus tracking significantly increased mean hepatic enhancement and may improve portal venous hepatic CT scanning.
Adolescent↗
Enhanced upregulation of the Fc gamma receptor IIIa (CD16a) during in vitro differentiation of ApoE4/4 monocytes.
We recently reported a positive correlation of the pool size of lipopolysaccharide receptor (CD14)dim and Fc gamma receptor IIIa (CD16a)+ monocytes in peripheral blood to the apolipoprotein E4 (apoE4) phenotype and a negative correlation to high density lipoprotein (HDL) cholesterol levels (Arterioscler Thromb Vasc Biol. 1996;16:1437-1447). In this study, the in vitro differentiation of mononuclear phagocytes derived from healthy blood donors homozygous for the E3/3 or the E4/4 phenotype was analyzed during 7 days of culture in serum-free medium supplemented with macrophage colony-stimulating factor (M-CSF). The CD16a expression, which indicates Fc receptor-dependent phagocytic activity, increased to a significantly higher level in apoE4/4 monocytes than in apoE3/3 cells. The costimulatory molecule CD40, which indicates antigen-presenting capacity, was upregulated more strongly in apoE3/3 monocytes compared with E4/4 cells, but the difference did not reach a significant level. The expression of differentiation-associated surface proteins (CD14, CD33, CD45) and adhesion molecules (CD11a, CD11b, CD11c, CD49d) was not significantly different between apoE3/3 and apoE4/4 monocytes. However, a significantly decreased intracellular apoE concentration and a reduced amount of secreted apoE were found in apoE4/4 monocytes during in vitro differentiation. No differences were found in the surface expression of the low density lipoprotein receptor-related protein (CD91) and the uptake of fluorescence labeled low density lipoprotein between apoE3/3 and apoE4/4 monocytes. These data indicate that the apoE4/4 phenotype significantly influences the M-CSF-dependent differentiation of monocytes toward a more CD16a-positive phagocytic phenotype.
Adult↗
Acute renal failure following high intravenous doses of naftidrofuryloxalate.
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Acute Kidney Injury↗
[Initial experience with the NOVACOR left heart assist system in transition for heart transplantation at the Grosshadern Clinic].
We recently used an electrically powered left ventricular assist device (NOVACOR Corp., Oakland, Calif.) to support the circulation of a 17-year-old man with profound circulatory impairment. He had been regularly listed for cardiac transplantation previously because of dilated cardiomyopathy, and decompensated acutely with severe biventricular failure before a suitable donor heart became available. Isolated left ventricular support with the NOVACOR system provided adequate haemodynamics and recovery of right ventricular, hepatic and renal function. After 2 days of support, orthotopic heart transplantation could be performed successfully. Five days after transplantation he developed a massive cerebral haemorrhage during a hypertensive crisis of which he recovered completely after neurosurgery without any residuals. He ist currently doing extremely well some 14 months after transplantation.
Adolescent↗
[Thrombosis prevention in outpatients with lower limb injuries].
The antithrombotic effect of a low molecular weight heparin was examined in a prospective randomized trial of 204 outpatients (121 men, 83 women, mean age 34.7 [16-76] years) who required immobilization with a plaster cast because of injury to the lower limb. Subjects in group I (n = 99) received a daily subcutaneous injection (36 mg) of heparin fragment calcium throughout their period in plaster (mean of 15.6 [7-66] days), while group II subjects (n = 105, mean period in plaster 15.7 [7-41] days) acted as untreated controls. Thrombosis was diagnosed by compression sonography, and positive findings were confirmed by phlebography. Thrombosis occurred in 24 patients altogether, 6 in group I (6.1%) and 18 in group II (17.1%) (P less than 0.05). While patients with thromboses had a mean of 1.96 risk factors overall, those in group I had a mean of 2.6 risk factors. Patients without thrombosis had a mean of 1.24 risk factors. The rate of thrombosis was higher in patients with fractures (4 out of 27 in group I; 10 out of 35 in group II) than in those with ligament and soft-tissue injuries (2 out of 72 in group I; 8 out of 70 in group II). The severity of trauma is apparently an important thrombogenic factor.--General thrombo-prophylaxis seems advisable for surgical outpatients requiring immobilisation treatment with a plaster cast.
Adolescent↗
[Advanced carpal collapse (SLAC-wrist) in scaphoid pseudarthrosis. Therapy concept: medio-carpal partial arthrodesis].
Longstanding unstable scaphoid nonunions inevitably lead to carpal collapse and symptomatic secondary arthrotic changes, ruling out reconstructive procedures to the scaphoid itself. Partial mediocarpal fusion, however, can preserve some wrist motion and markedly reduce or even eliminate wrist pain. By correcting the malalignment of the lunate and capitate, carpal height is restored. By excision of the scaphoid, its destroyed articular surfaces are removed. In 26 of 31 patients undergoing mediocarpal fusion, complete or at least significant reduction of wrist pain was observed. Average grip strength increased by 23%, whereas wrist mobility decreased by 33 to 40% with a relatively short follow-up of 14 months. Total wrist fusion remains the last line of defense.
Adult↗
[The current status of the diagnosis and therapy of nonocclusive intestinal ischemia (NII)].
Nonocclusive gut ischaemia is a disease of advanced age. Its causes are reduced cardiac output or shock, facilitated by digitalis, adrenaline, ergotamine and diuretics. The persisting microcirculation and development of gut necrosis leads to an increase in certain serum enzymes, such as lactate, LDH and CK-NB. The early application of mesenteric angiography using a DSA technique reveals four grades of underperfusion. Early and correct diagnosis of the disease should lead to intra-arterial treatment with prostaglandin. In ten out of 42 cases, conservative therapy led to reperfusion of the gut.
Aged↗
[Prevention of thrombosis with low molecular weight heparin in ambulatory patients with injury of the lower extremity: an ultrasound study].
The aim of the study was to evaluate the risk of thrombo-embolism in outpatients with traumatic injuries of the lower limb, which are immobilised by plaster cast. 204 patients were randomly divided into 2 groups. Group I (99 pat.) got a daily injection of a low molecular weight heparin. In group II (105 pat.) no prophylaxis was done. The diagnosis of deep venous thrombosis (DVT) was carried out by compression sonography. A total of 24 patients developed DTV: In group 16 patients (6.1%), in group II 18 (17.1%) (p less than 0.05). In patients with fractures in group I (22 pat.) 4 DVT (14.8%) occurred and in group II (35 pat.) 10 (28.6%), respectively. The median age of all the patients was 34.7 years and relatively low. A general prophylaxis in all outpatients having traumatic injuries of the lown limb with immobilisation by cast is recommended.
Adult↗
[Non-occlusive ischemic enteropathy--diagnosis, differential diagnosis and therapy].
Reduced cardiac output is the pathogenetic principle of non-occlusive disease. Prerequisites for early diagnosis include anamnesis, clinical and laboratory findings, sonography, mesentericography, contrast enema, and coloscopy. Conservative treatment with vasoactive drugs is promising in early stages. As the abdominal symptoms develop latently, laparotomy is indicated in most cases in order to identify necrosis or perforation and to allow surgery according to the intraoperative findings. Despite indisputable progress made during the past years, the death rate in our patients (n = 42) is still 43%. Only early diagnosis and consequential therapy can achieve better results.
Diagnosis, Differential↗
[Computed tomography of soft tissue tumors of the hand and the forearm].
Computed tomography was carried out in 32 patients with clinically equivocal soft-tissue lesions of the hand (24 times) and forearm (8 times). The CT scans were performed with the patients in standard positions; thin slices and zoom technique were used. All soft-tissue tumors were correctly diagnosed with regard to localization, size and infiltration of the surrounding tissue. The histological diagnosis was correct in tendon-sheath proliferations, deposits caused by metabolic disorders, epithelial and ganglion cysts, hemangiomas, lipomas and in one schwannoma. A malignancy was suspected and was proven to be correct in two cases. False-positive diagnoses of a malignant soft-tissue tumor were made in one case of an aggressive fibromatosis, in a rapidly progressive, ossifying myositis, and three times in the presence of postoperative scar tissue following the resection of a sarcoma. Finally, a case of proliferative myositis regarded as semimalignant was underrated by CT. The hand surgeon considered CT diagnostics to be very helpful in planning operations in an anatomically complex organ such as the hand.
Adolescent↗
[Computerized tomography of the hand: examination technic, normal anatomy, indications].
The results of 480 computed tomograms carried out in the hand are presented. The digital slice imaging technique shows following advantages: a) Imaging of the complex carpus without superimposition giving a better understanding of carpal biomechanics. b) Anatomically exact imaging of the soft tissues determined by density analysis. In the following states relevant information can be obtained by CT of the hand: 1. Posttraumatic states of the carpus such as scaphoid non-union, lunato-malacia in stages I and II, complex fracture dislocations, and carpal instabilities; 2. cystic transformation of the bone; 3. non-idiopathic CTS; 4. clinically unequivocal soft-tissue masses. In our institution conventional tomography has been largely replaced by carpal CT within a progressive diagnostic programme. Today CT is the best method for imaging soft-tissue masses of the hand.
Carpal Bones↗
[A dissecting aortic aneurysm with unilateral compression of the pulmonary artery].
A case of aortic aneurysm associated with unilateral compression of one pulmonary artery is presented. The combination of a mediastinal tumor and unilateral high transparency of the lung in the presence of an aneurysm should suggest this possibility.
Aortic Dissection↗
[Non-occlusive ischemia enteropathy. Diagnosis, therapy and prognosis].
Reduced cardiac output is the pathogenetic cause of non-occlusive ischemic enteropathia. The abdominal symptoms develop latently and surgery prevalently ensues during the stage of intestinal wall necrosis or perambulating peritonitis. There is a lethality of 50-100% and 50% at this clinic. Prerequisites of early diagnosis are: anamnesis and clinical finding, - laboratory constellation, - sonography, - mesentericography. In early stages, conservative treatment by vasodilators is promising. The laparotomy, however, is indicated in most cases in order to identify necrosis or perforation and to allow surgery according to its stages.
Diagnostic Imaging↗
[Value of imaging procedures in the diagnosis and staging of bladder tumors].
A retrospective study of 161 patients with carcinomas of the bladder was carried out to assess the value of CT (247 examinations), transurethral sonography (32 examinations), and the early results of MRT. For TA-T3a staging, according to the TNM classification of the IUCC, transurethral sonography was particularly valuable. CT is useful for demonstrating transmural tumour growth (T3b) and organ invasion (T4), involvement of regional lymph nodes and distant metastases. Tumours in the roof of the bladder and at its base are well shown by MR tomography, using multiplanar sections.
Adult↗
[Computed tomography in the diagnosis of injuries of the posterior pelvic girdle].
Sixty-two patients who had suffered trauma to the posterior part of the pelvis were examined by CT and conventional methods; the latter showed abnormalities in only 70%. This part of the body is involved particularly frequently in the case of high velocity injuries. An obvious fracture of the ventral part of the pelvis, with or without ligamentous injury, is an indication for performing CT in order to clarify the situation and to evaluate the stability of the pelvis.
Fractures, Bone↗