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Biomedical subjects

G Wilms

Publications and source records attributed to G Wilms.

At least 73 records · Page 4Linked to original sources
PubMed1996

Selective transcatheter embolization of a uterine arteriovenous malformation with preservation of the reproductive capacity.

Uterine arteriovenous malformations are very rare. Transcatheter embolization has become the treatment of choice. It is safe and effective. Moreover the reproductive capacity can be preserved. We report a successful pregnancy after hyperselective transcatheter embolization of an arteriovenous malformation in a 27-year-old woman and present an overview of the literature.

Adult↗
PubMed1996

Aggressive pituitary macroadenoma: CT and MR appearances.

Two cases of aggressive pituitary macroadenoma (prolactinoma) with diffuse invasion of the skull base are described. Clinical signs usually appear late. CT shows the bone destruction, whereas MRI accurately delineates the extension of the tumor and involvement of the surrounding neurovascular structures. Histopathology and immunohistochemical staining are necessary for a definitive diagnosis differentiating prolactimonas from a wide range of skull base tumours and for deciding on additional therapy and prognosis. Aggressive pituitary macroadenoma is a large and diffuse tumor which is difficult to treat; therapy usually consists of extensive surgery, radiotherapy and pharmacotherapy with dopaminergic agents.

Adult↗
PubMed1995

Thrombolytic therapy of peripheral arterial occlusion with recombinant staphylokinase.

BACKGROUND: Recombinant staphylokinase (STAR) induces fibrin-specific coronary artery recanalization in patients with evolving myocardial infarction. The present pilot study evaluates its thrombolytic efficacy, safety, fibrin specificity, and immunogenicity in patients with peripheral arterial occlusive disease. METHODS AND RESULTS: Thirty patients (37 to 86 years of age) with angiographically documented thromboembolic peripheral arterial occlusion of recent origin (21 +/- 5.5 days, mean +/- SEM) were treated with heparin and intra-arterial STAR given as a 1-mg bolus followed by a 0.5-mg/h infusion in 20 patients or as a 2-mg bolus followed by a 1-mg/h infusion in 10 subsequent patients. With 7.0 +/- 0.7 mg STAR infused over 8.7 +/- 1.0 hours, recanalization was complete in 25 patients, partial in 2, and absent in 3. Two major hemorrhagic complications occurred: one fatal hemorrhagic stroke and one hypovolemic shock caused by bleeding at the angiographic puncture site. Administration of STAR did not induce fibrinogen breakdown or a significant prolongation of template bleeding time. STAR-neutralizing activity and anti-STAR IgG were low at baseline, increased markedly from the second week on, and remained elevated for several months. CONCLUSIONS: Intra-arterial administration of STAR restores vessel patency in patients with peripheral arterial occlusion in the absence of fibrinogen degradation.

Female↗
PubMed1995

Characterisation of intracranial aneurysms with MR angiography.

The purpose of this study was to compare the accuracy of 3D time-of-flight (TOF) acquisitions in the characterisation of intracranial aneurysms. Fourteen patients with aneurysms proven on intra-arterial angiography were first studied with a 3D TOF acquisition. When the aneurysms were incompletely demonstrated, additional MR angiography (MRA) acquisitions were performed, including black-blood MRA, 2D TOF, phase-contrast and contrast-enhanced TOF.3D TOF MRA was sufficient for detection of the aneurysm in 13 of 14 cases and characterisation of the aneurysm was possible in 6. All the initial shortcomings of the TOF technique could be analysed and explained by means of additional MRA techniques. This study suggests that the combination of different MRA techniques offers new possibilities for noninvasive investigation of intracranial aneurysms.

Adult↗
PubMed1995

Magnetic resonance angiography of supratentorial tumours: comparison with selective digital subtraction angiography.

We compared magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (IADSA) in the study of brain tumours and assessed the utility of gadolinium-enhanced MRA. We studied 17 patients with supratentorial brain tumors. The entire brain was imaged with multiple overlapping thin volume acquisitions. After IV injection of gadolinium-DTPA, a single thick-slab MRA acquisition was performed. Standard three-dimensional (3D-TOF) acquisitions (in six patients) and 3D-TOF with magnetization transfer prepulse and tilted optimisation nonsaturing radiofrequency excitation pulses (in 11 patients) were used. Displacement of the anterior cerebral artery, main stem and insular branches of the middle cerebral artery was seen well on unenhanced and contrast-enhanced MRA. Displacement of the lenticulostriate and anterior choroidal arteries was seen only once, after Gadolinium. Tumour encasement of the middle cerebral artery was demonstrated in one patient. Tumour vessels were seen in 2 of 8 cases before and 3 of 8 after gadolinium; Tumour hypervascularity was seen only after gadolinium, in 3 of 8 cases. Study of the veins was possible only on gadolinium-enhanced MRA. Displacement of the venous angle was seen in 4 of 7 patients in the frontal, and in all of 8 patients on the lateral projections. Early venous drainage was not seen. Patency of the dural venous sinuses was demonstrated in all patients, but in one neoplastic occlusion of a cortical vein was recognized.

Adult↗
PubMed1995

Uncommon posterior cranial fossa anomalies: MRI with clinical correlation.

The clinical and MRI findings in two cases of rhombencephalosynapsis (RS) and two of tectocerebellar dysraphia (TCD) with an associated occipital encephalocele were studied to elucidate the clinical picture and embryogenesis of these rare anomalies. To our knowledge, only one case of TCD [1] and four of RS [2, 3] examined by MRI during life have been reported. The clinical picture in the cases of RS was rather constant and there were similarities with TCD. Consideration of the embryogenesis of the neural tube suggests a temporal proximity of the abnormalities, with TCD arising at a slightly earlier time.

Cerebellum↗
PubMed1995

Childhood neuroborreliosis: clinicoradiological correlation.

We report the cranial CT and MRI findings in three children with Lyme disease (neuroborreliosis). The neuroimaging findings in children have been rarely reported. We found cranial MRI far superior to cranial CT. Ring-enhancing lesions have been described in acute disseminating encephalomyelitis and multiple sclerosis but not in neuroborreliosis. Although other infectious and inflammatory diseases cannot be excluded, Lyme disease should be included in the differential diagnosis and put forward as being the most likely diagnosis in the appropriate clinical setting. Gadopentetate dimeglumine is helpful in assessing the response to antibiotic treatment.

Brain↗
PubMed1995

Time-of-flight MR angiography of the brain: comparison of acquisition techniques in healthy volunteers.

OBJECTIVE: The saturation phenomenon that limits vessel visibility in unenhanced time-of-flight MR angiograms can be overcome by the injection of MR contrast agents that shorten the T1 of the blood. Unlike the situation with unenhanced MR angiographic acquisitions, in which the MR parameters must be carefully adjusted to reduce saturation effects, optimization procedures for contrast-enhanced MR angiography focus on the acquired shortening of the T1 of the blood and the time evolution of the T1 over the entire measurement. To improve the quality of contrast-enhanced time-of-flight MR angiographic acquisitions in the brain, we compared different acquisition techniques that exploit shortening of the T1 of the blood. SUBJECTS AND METHODS: High-resolution MR angiographic examinations were done with a 1-T MR system for 12 healthy volunteers. Doses of 0.1 and 0.2 mmol of gadopentetate dimeglumine per kilogram of body weight were injected on two separate days to allow for identical timing of the comparative studies after contrast material injection. The effects of dose of contrast material, MR parameters (TR and flip angle), method of injecting the contrast material (monophasic, biphasic, or continuous slow injection), and K-space acquisition schemes (regular schemes versus collecting the central K-space lines near the beginning or the end of the acquisition) were studied. RESULTS: Higher doses provided better MR angiograms. The flip angle and the TR had to be adjusted on the basis of the Ernst equation and therefore depended on an estimation of the averaged T1 value over the entire measurement. Comparison of the different K-space acquisition schemes confirmed that the evolution of the T1 of the blood over the entire measurement time is important, especially for longer measurements. There was no noticeable difference between the MR angiograms acquired with monophasic or biphasic injections. These injection schemes provided more detailed MR angiograms than did continuous slow injection over the entire measurement. CONCLUSION: Our results show that the quality of contrast-enhanced MR angiograms can be remarkably increased when acquisition techniques that exploit the short T1 of the blood are used.

Adult↗
PubMed1995

The use of magnetic resonance angiography in stereotactic neurosurgery.

The authors discuss the advantages and disadvantages of the use of magnetic resonance (MR) angiography images in stereotactic neurosurgery. Current computer programs designed to assist the neurosurgeon in the planning of stereotactic neurosurgical interventions use intraarterial digital subtraction angiography images to visualize the blood vessels. Magnetic resonance angiography is a recent technique with a number of advantages over the digital subtraction method: it is less invasive and less prone to complications; it provides truly three-dimensional data sets that can be viewed from any direction; and it can visualize both stationary and flowing tissues with the same imaging device and localizer frame. Although digital subtraction images are still superior in contrast and vascular detail, state-of-the-art high-resolution MR angiography sequences provide sufficient vascular detail for planning surgery. Contrast-enhanced MR angiography images were acquired using adapted gradient-echo sequences to compensate for flow-induced distortions; postacquisition distortion correction was not necessary. Five methods to integrate and inspect a possible trajectory in the MR angiography data are discussed. Initial clinical experience with eight patients led to the conclusion that MR angiography is a valuable imaging modality that can be integrated reliably into a stereotactic neurosurgery planning procedure.

Adult↗
PubMed1995

External iliac artery fibrodysplasia.

We report a patient in the "atherosclerotic age" with symptomatic fibromuscular hyperplasia of both external iliac arteries. Our patient had a history of bilateral intermittent claudication secondary to a concentric narrowing of a long segment of both external iliac arteries. A typical associated involvement of both internal carotid arteries was present.

Carotid Artery, Internal↗
PubMed1995

[Spiral CT of the renal blood vessels].

Spiral CT angiography has been successfully applied to the detection and grading of renal artery stenoses. In this manuscript the technique, the diagnostic accuracy and the advantages and limitations of this new method are discussed.

Angiography↗
PubMed1995

[Spiral CT of cerebral aneurysms].

Spiral CT was performed in 9 patients with 13 cerebral aneurysms known from angiography. All lesions were detected by spiral CT, the smallest lesion measuring 3 mm in diameter. The neck of the aneurysm and the anatomical relations could be determined very accurately in all cases. Advantages of spiral CT over magnetic resonance angiography include: the short examination time, the independence of flow rate and cardiac output, and the excellent visualisation of calcification, thrombus and the bony landmarks. Disadvantages are the necessity of iodinated contrast media, the long postprocessing and reconstruction time and the possibility of overlap from bone and venous blood.

Cerebral Angiography↗
PubMed1995

Embolization of bleeding gastroduodenal pseudoaneurysm in pancreatitis.

A case of successful wire coil embolization of a bleeding gastroduodenal pseudoaneurysm secondary to necrotizing pancreatitis with pseudocyst formation is reported. The embolization technique using multiple coils is discussed and compared with other techniques previously described.

Aneurysm↗