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Biomedical subjects

G Wilms

Publications and source records attributed to G Wilms.

At least 91 records · Page 5Linked to original sources
PubMed1995

The history of angiography.

From the beginning of the era of X-rays, cardiac radiology has become a target of this new technique. Early pioneers, Ciegem, Rieder, Rosenthal, Williams rapidly accumulated extensive experience with fluoroscopy and radiography and publications on cardiac diseases as soon as 1899 and 1901 and 1902. The next step in cardiac diagnosis was achieved by Forsmann in 1929, with the first attempt at cardiac catheterization and angiocardiography. Many clinicians, Moniz, Reboul, Rousthoi contributed to the development of the technique between 1930 and 1940. A further turning point came in 1941 when Cournand demonstrated that cardiac catheterization was a safe method in man. In the technical field major progress came from Scandinavia were rapid filming was born. The management of ischaemic disease, changed dramatically with the demonstration of coronary anatomy, largely due to Sones, Judkins and Amplatz. A further progress was initiated in 1977 by Gruentzig who invented balloon angioplasty.

Angiocardiography↗
PubMed1994

Localized brain proton NMR spectroscopy in young adult phenylketonuria patients.

Localized proton magnetic resonance spectroscopy with short echo time (TE = 20 ms) was used to investigate biochemical changes in the cerebral white matter of 20 young adult patients (median 19 years) with phenylketonuria (PKU). Results were compared with those of a group of 12 age-matched healthy volunteers (median 25 years). Concentrations of N-acetyl-aspartate (NAA) and choline (Cho) relative to creatine (Cr) were unchanged. However, concentrations of inositol (Ins) relative to creatine were found to be significantly lower (P < 0.001) in the PKU patients (0.30 +/- 0.09 versus 0.57 +/- 0.17). Individual inositol concentrations did not correlate with age, diet, serum phenylalanine (Phe) levels or extent of pathological regions in the T2-weighted images. The lack of correlation with individual data suggests that the decreased inositol concentration could be related to a metabolic deficiency during fetal development. No signal from the phenyl ring protons of phenylalanine was detected in the PKU patients (phenylalanine serum concentration < or = 1.27 mM), which suggests that concentration of phenylalanine may be lower in brain than in serum.

Adolescent↗
PubMed1994

Gadodiamide injection at 0.1 and 0.3 mmol/kg body weight: a phase III double-blind, parallel, randomised clinical investigation of known or suspected central nervous system lesions at 1.5 T.

We studied 78 patients with clinically suspected central nervous system abnormalities (66 intracranial, 12 spinal) by MRI before and after administration of the nonionic contrast medium gadodiamide injection. A parallel, double-blind, randomised design was followed. Two dosages were used: 38 patients underwent studies with 0.1 mmol/kg body weight (b.w.) and 40 with 0.3 mmol/kg b.w. MRI showed abnormalities in 36 of the 38 patients receiving the lower dose and 39 of the 40 patients receiving the higher dose. In 3 patients from each group more lesions were seen following injection than before. The contrast medium improved the delineation of abnormal structures and assessment of tumour size and increased their signal intensity indices in both groups, but especially at the higher dose. Administration of gadodiamide injection provided more diagnostic information in about 75% of the patients, independently of the dose. There were no reports of discomfort, but 7 patients reported adverse events considered unrelated to the gadodiamide injection. The two doses were found to be equally safe and efficient for diagnosis.

Central Nervous System Diseases↗
PubMed1994

MR imaging of spondylitis with gadopentetate dimeglumine enhancement.

MR images of 17 patients with spondylitis were reviewed. T1 weighted spin-echo scans were obtained in 17 patients and proton density and T2 weighted scans were obtained in 15 patients. Unenhanced and gadopentetate dimeglumine enhanced scans were obtained in all patients. Five patients had pyogenic spondylitis, two patients tuberculous spondylitis, two patients fungal spondylitis and eight patients postoperative spondylitis. The four criteria described by Thrush and Enzmann were generally applicable in our study: 1) narrowing of the intervertebral disc; 2) cortical bone erosion; 3) abnormal signal in the adjacent vertebral bodies and 4) abnormal paraspinous or epidural soft tissue. In addition to plain sagittal T1 and T2 weighted images we suggest the routine administration of gadopentetate dimeglumine to assess the extent of the soft tissue mass and to differentiate postoperative spondylitis from a normal postoperative course, by showing disc enhancement. Disc enhancement occurs infrequently in the normal postoperative course. If it is associated with adjacent vertebral bone marrow changes it should be considered as postoperative spondylitis. A differential diagnosis between pyogenic, tuberculous, fungal and postoperative spondylitis was not possible although the pattern of enhancement in tuberculous spondylitis was different from the other cases of spondylitis.

Adult↗
PubMed1994

Iatrogenic spinal epidermoid tumour associated with tuberous sclerosis. A diagnostic pitfall.

We present a case of spinal epidermoid tumour that was probably caused by lumbar punctures. The tumour was detected on MRI in a child with tuberous sclerosis complaining of atypical low back pain. Preoperatively the tumour was considered to be a cystic astrocytoma of ependymoma of the conus terminalis. The association of tuberous sclerosis with a spinal tumour is rare but has been recorded in the literature. The diagnosis was an epidermoid tumour (E.T.). The MRI appearances were unusual for a spinal ET: the signal intensity changes were different from those reported in the literature and the presence of calcification and cavitation has not yet been reported. This case represents a diagnostic pitfall, since both entities were unrelated.

Child↗
PubMed1994

Current trends in the treatment of cerebral aneurysms.

This paper describes the techniques and indications of the endovascular treatment of cerebral aneurysms. Although the treatment of choice for cerebral aneurysms is surgical, some lesions are inoperable, especially because of their localisation, their broad implantation with absence of a surgical neck or because of the critical clinical condition of the patient. For these cases, endovascular alternatives are available. For giant aneurysms of the vertebrobasilar system or large aneurysms of the carotid syphon, the endovascular treatment consists in the occlusion of the carrier vessel with endovascular balloons, after previous test occlusion. For small aneurysms, with difficult surgical access, like the basilar tip, the treatment is performed with electrocoils (GDC coils). These soft platinum coils are detached from the delivery wire by an electric current. It is the final purpose to entirely pack the aneurysm with coils. Finally, endovascular therapy can be of use in the treatment of vasospasms due to subarachnoid hemorrhage. In case of failure of medical therapy, balloon angioplasty or intra-arterial infusion of papaverine can elevate the vasospasm and prevent ischemic complications.

Angioplasty, Balloon↗
PubMed1994

Simultaneous occurrence of developmental venous anomalies and cavernous angiomas.

PURPOSE: To study the clinical and radiologic findings in 15 patients presenting with both developmental venous anomalies and cavernous angiomas and to determine which lesions caused the acute clinical symptoms. METHODS: Lesions were infratentorial in 7 patients and supratentorial in 7 other patients. In one patient the developmental venous anomaly was infratentorial and the cavernous angioma supratentorial. In all 15 patients clinical examination and CT were performed. In 10 patients MR was performed at the time of the initial CT scan. In 5 patients only late MR is available. RESULTS: Acute clinical signs were present in 9 patients (epilepsy, hemiplegia, meningeal signs, cranial nerve deficit). On CT the cavernous angioma was missed in 9 patients, in 6 patients because of acute hemorrhage. On MR the cavernous angioma was missed in 1 of 2 cases with acute hemorrhage but seen in all other patients. On repeat MR all cavernous angiomas were correctly identified. On CT, 11 developmental venous anomalies were seen. On MR all developmental venous anomalies were seen. CONCLUSIONS: The frequent association of developmental venous anomalies and cavernous angiomas is confirmed. MR is superior to CT in the detection of both cavernous angiomas and developmental venous anomalies. Furthermore our data support the hypothesis that cavernous angiomas and not the developmental venous anomalies cause the acute clinical symptoms because of hemorrhage.

Adult↗
PubMed1994

Local thrombolysis for occluded arterial grafts: is the yield worth the effort?

This study reports the results and complications of local thrombolytic therapy of 50 recently occluded grafts. These occurred in 41 patients with acute severe but still reversible ischemia. The majority were infra-inguinal synthetic grafts. Thrombolysis was induced with urokinase (n = 1), streptokinase (n = 11) or alteplase (n = 38) via an intra-arterial catheter. Complete angiographical lysis was obtained in 36 grafts (72%) and partial lysis in 6 (12%). The highest lysis rate was obtained with alteplase (32/36; 89%). Complementary endovascular and/or surgical intervention was needed in 17 patients to correct an underlying stenosis and/or to save the limb. Fifteen complications occurred (30%) of which distal embolization (n = 4) and bleeding (n = 8 of which 3 fatal) were the most frequent. Six of the bleeding episodes occurred in patients on chronic aspirin intake. The late results were poor. At six months, the primary patency of successfully lysed grafts dropped to 19% and the limb salvage rate to 64%. Thrombolytic therapy is far from the ideal management of thrombosed grafts: maintenance of restored patency is the challenge.

Acute Disease↗
PubMed1993

Posterior fossa dermoid cyst associated with dermal fistula: report of 2 cases and review of the literature.

Two cases of dermoid cysts of the posterior fossa in association with a dermal fistula and with different clinical presentations are reported. The patient in case 1 is a 14-month-old girl with a history of recurrent bacterial meningitis. Case 2, a 7-year-old girl, presented with a skin "granuloma" at the inion. Both cases, and a review of the literature, demonstrate the need for a thorough exploration of the cranial and spinal midline skin areas in every newborn and argue for widespread use of nuclear magnetic resonance imaging whenever a suspected midline lesion is found.

Brain Neoplasms↗
PubMed1993

Optimization of distal artery opacification in peripheral arteriography: comparison between nitroglycerin, tolazoline and buflomedyl.

A prospective double blind randomized comparative study was performed in patients with insufficient distal artery opacification during peripheral arteriography, in order to compare the vasodilating capabilities of intraarterially injected nitroglycerin, tolazoline and buflomedyl versus placebo. All three vasodilating agents showed statistically significant improvement of distal artery opacification as compared to the placebo (p < 0.0001). Overall results were better for buflomedyl (p = 0.231) then for tolazoline (p = 0.142) and nitroglycerin, but these differences were statistically not significant. It is concluded that buflomedyl is an excellent vasodilating agent in peripheral arteriography.

Adrenergic alpha-Antagonists↗
PubMed1993

Oculo-auriculo-vertebral spectrum malformation and contralateral absence of internal carotid artery.

We report a 50 year old mildly retarded male with right sided hemifacial microsomia, vertebral defects and absence of the left internal carotid artery. It is very unlikely that the congenital vascular abnormality on the left side in this patient is responsible for the right sided congenital facial abnormalities. Therefore we discuss the possibility that abnormal migration of or interaction with cells of the cranial neural crest has resulted in absence of the internal carotid artery on the left side and oculo-auriculo-vertebral spectrum malformation on the right side.

Angiography, Digital Subtraction↗
PubMed1993

Embolization of arteriovenous malformations of the brain: preliminary experience.

Transcatheter embolization was performed in 8 young patients (mean age 24.5 years) with intracerebral arteriovenous malformations. In total 12 arteries were embolized in 10 sessions. Clinical complaints of the patients included epilepsy in 4, sudden coma in 3 and severe sudden neurological deficit in 1. Intracerebral hemorrhage was documented in 4 patients and subarachnoid hemorrhage in 1. In all patients, prior to embolization a superselective Wada-test was performed under wake-up anesthesia. Embolization was performed with a mixture of acrylic glue and lipiodol. In one patient a detachable balloon was added. In 6 patients embolization of all the feeding arteries was possible, with total obliteration of the arteriovenous malformations in 4 and subtotal embolization (> 90%) in 2. In 2 patients reduction of the size of the arteriovenous malformation by one third was followed by total surgical removal of the lesion. In 1 patient reflux of the embolization material in the anterior choroidal artery caused severe neurological deficit with good clinical recuperation.

Adolescent↗
PubMed1993

Cerebral metastatic malignant melanoma: CT and MR findings with pathological correlation.

Cerebral metastases of malignant melanoma usually have a characteristic appearance on CT and MRI. They present as multiple small lesions at the junction of grey and white matter. On CT the lesions are slightly hyperdense with moderate contrast enhancement. On MRI, typical T1 and T2 shortening is seen. In our case these findings were due to abundant presence of melanin without associated hemorrhage.

Aged↗
PubMed1993

Systemic to pulmonary artery shunting.

Two cases showing systemic to pulmonary artery shunting, during the venous phase of bronchial arteriography are presented. In the first patient with chronic bronchiectasis, the shunting is believed to be due to newly formed vessels in the granulomatous tissue. At pulmonary angiography, the increased pressure in the pulmonary arteries simulated an angiographic defect due to dilution of the contrast by retrograde opacification from a left to right shunt. In a second patient with proven pulmonary embolism a true defect was present at pulmonary angiography. Systemic to pulmonary artery shunting is believed to develop secondary to hypoxia.

Bronchial Arteries↗