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Biomedical subjects

M Georgi

Publications and source records attributed to M Georgi.

244 records · Page 14Linked to original sources
PubMedDate not supplied

Transjugular intrahepatic portosystemic shunting (TIPS) with balloon-expandable and self-expanding stents: technical and clinical aspects after 3 1/2 years' experience.

PURPOSE: To evaluate prospectively our experience with transjugular intrahepatic portosystemic shunt (TIPS) using four different metallic stents. METHODS: Between November 1991 and April 1995, 57 patients (41 men and 16 women; age 35-72 years, mean 54 years) underwent the TIPS procedure. Techniques for portal vein localization before and during TIPS were fluoroscopy, computed tomography (CT) studies, wedged hepatic venography, arterial portography, and ultrasound. After predilation we deployed balloon-expandable (n = 48) and self-expanding (n = 45) metallic stents. Fifteen patients underwent variceal embolization. Initial follow-up angiograms (mean 6.9 months, range 3-24 months) were obtained in 39 of these patients. RESULTS: Fifty-three patients (93%) had successful TIPS placement. The mean decrease in portal pressure was 42.7%. Besides fluoroscopy, the most helpful techniques for portal vein localization were venography and CT. Residual stenosis (n = 1) and late shortening (n = 4) of Wallstents resulted in shunt dysfunction. The technical problems encountered with the Palmaz stent resulted from its lack of flexibility. We combined balloon-expandable and self-expanding stents in 12 patients. The 30-day and late follow-up (mean 11.9 months) percutaneous reintervention rates were 11.3% and 64.2%, respectively. There were no clinically significant complications related to the TIPS insertions. CONCLUSION: An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-expanding stent.

Adult↗
PubMedDate not supplied

Influence of ethanol on the salsolinol excretion in healthy subjects.

This report describes the change of salsolinol (SAL) levels in the urine of healthy subjects after ethanol ingestion. A new rapid method for SAL extraction from urine sample and a GC-MS assay were used to study the urinary SAL excretion in a group of adult males (n = 14) and females (n = 13) with and without ingestion of ethanol. The results of this study show that the urinary SAL output of all subjects is significantly influenced by the intake of ethanol. A decrease in the SAL level was found in the urine of most of the volunteers (n = 17), whereas only eight subjects showed an increase in the SAL level after administration of ethanol.

Adult↗
PubMedDate not supplied

Prominent occipitotemporal vein: an association with temporal lobe epilepsy?

Eight patients with a prominent occipitotemporal vein on MR imaging, and ipsilateral temporal lobe epilepsy are reported. The ages of the patients ranged from 2 months to 12 yr. There were five males and three females. Abnormal electroencephalographic (EEG) findings were evident in all the patients, and they had focal seizures. MR images revealed prominent (4 mm or more in width) occipitotemporal veins in the ipsilateral sides, and otherwise unremarkable findings. Three similar patients have previously been reported in the literature. We speculate that a prominent occipitotemporal vein may represent a consequence or a cause of a certain type of temporal lope epilepsy. Further clinicoradiologic studies are required to clarify the question raised by these observations.

Child↗
PubMedDate not supplied

Therapy for biliary stenoses and occlusions with use of three different metallic stents: single-center experience.

PURPOSE: The authors report their experience with three different metallic stents for the treatment of biliary obstructions during a 6.5-year period (between February 1989 and June 1995). MATERIALS AND METHODS: In an uncontrolled, nonrandomized, and prospective study, 168 patients with obstructive jaundice underwent transhepatic placement of metallic stents. Patients were excluded if they were deemed too ill for intervention or had incorrectable coagulopathy. Those patients undergoing external and/or intraluminal radiation therapy, and patients in whom an internal-external catheter was kept in place after insertion of a stent were not included. Inoperable malignant disease was diagnosed in 157 patients (93.5%). Eleven patients presented with a benign biliary stricture that could not be managed by means of angioplasty. One hundred fifty-five Wallstents were placed in 122 patients, 65 tantalum Strecker stents were placed in 30 patients, and 18 Memotherm stents were placed in 16 patients. The patients were followed until September 1996 or until death. RESULTS: Regarding malignant obstruction, the 30-day mortality rate was 10.7% without any procedure-related death, and overall survival rates after 100 and 200 days were 63% and 22%, respectively. Regarding benign stricture, eight of 11 patients were alive after a median follow-up of 50.6 months without any 30-day mortality. Major complications occurred in 16 patients (10.2%) who had malignancy, and in two patients (18.2%) with benign biliary disease. The cumulative patency rate in malignant obstructions was significantly higher for the Wallstent than for the Memotherm stent (P < .05) and nonsignificantly higher for the Wallstent than for the tantalum Strecker stent (P > .05). Reintervention due to recurrent obstructive jaundice was necessary in 28 patients (17.8%) with malignancy, and in six patients (54.5%) with benign stricture. CONCLUSIONS: The Wallstent is the most effective in achieving long-term palliation in patients with malignant obstructive jaundice. The treatment of benign biliary strictures with metallic stents is associated with a low long-term patency rate.

Adult↗
PubMedDate not supplied

Proton chemical shift imaging of bone marrow for monitoring therapy in leukemia.

In three patients with different forms of leukemia, follow-up examinations before, during, and after chemotherapy and bone marrow transplantation were performed by proton chemical shift imaging (1H-CSI). The relative fat and water fractions were computed in representative regions of the marrow in the femur, pelvis, and lumbar spine. On serial examinations the fat fractions increased over time, in agreement with the responses to therapy proven by bone marrow biopsies from the iliac crest. These preliminary results suggest a role for magnetic resonance and CSI in the monitoring of therapy in leukemia and systemic neoplastic diseases.

Acute Disease↗
PubMedDate not supplied

Assessment of cerebral blood volume with dynamic susceptibility contrast enhanced gradient-echo imaging.

OBJECTIVE: Dynamic susceptibility contrast (DSC) enhanced MRI was used to study relative cerebral blood volume (rCBV). MATERIALS AND METHODS: We examined 15 healthy subjects and 47 patients with vascular stenosis or occlusion, with brain infarctions, and with cerebral neoplasms. During bolus injection of Gd-diethylenetriamine pentaacetic acid, a series of rapid T2*-weighted fast low angle shot two-dimensional images were recorded from the same slice. From these images, changes in signal intensity during bolus passage were computed pixel-by-pixel and converted into contrast agent concentration curves. Applying the principles of indicator dilution theory, images of rCBV were calculated. RESULTS AND CONCLUSION: Regions of infarctions show almost zero rCBV. In patients with high-grade vascular stenosis or occlusion a bolus delay in comparison to the unaffected side and an increased mean transit time can be observed. Some of the affected areas show an increased rCBV, which is a well-known physiological mechanism that takes place to compensate for the reduced cerebral blood pressure. In brain tumors, rCBV imaging reveals focal or homogeneous areas of increased blood volume. This can even be observed in low-grade astrocytomas with unaffected blood-brain barrier. In CBV imaging, the effects of radiotherapy on tumor tissue can be monitored as a significant decrease of rCBV in tumor tissue after therapy.

Adult↗
PubMedDate not supplied

[Does the "fatty pelvis" exist? Quantitative computer tomography studies].

50 Patients weighing between 45 and 114 kg underwent standardized computed tomography of the pelvis. Fat compartments from inside and outside of the small pelvis were assessed quantitatively by means of tracing the fat tissue borders and planimetry. Fat compartments within the small pelvis showed a rather weak correlation with body weight and the so called Rohrer-Index as a weight/height-Index, correlations with the latter being slightly better. From the fat compartments within the single levels the functional reduction of birth channel diameters caused by fat tissue was calculated for. The weight/height-index dependent increase of space demand within the birth channel was rather pronounced at the pelvic brim becoming slighter when reaching mid-pelvis or even pelvic outlet. Hence, the common assumption can no longer be maintained, that adiposity necessarily causes soft tissue dystokia due to larger fat compartments within the small pelvis.

Adipose Tissue↗
PubMedDate not supplied

[Changes in pelvic anatomy in 8 decades--computerized tomography study of obstetrically relevant pelvic measurements].

An increasing proportion of obstetric operative procedures due to cephalopelvic disproportion gave raise to the question, whether there has been a change in pelvic anatomy during the past decades. In a retrospective evaluation of 467 computerized pelvic tomograms of patients aged between 18 and 88 years relevant parameters of pelvic proportion were determined. As these parameters are not subject to age-conditioned changes, the values may be viewed as representative for the time of patients' birth or fertility period respectively. Changes in pelvic anatomy turned out to be complex: The transverse elliptic shape of pelvic inlet changed into sagittal elliptic form, the pelvic midplane is contracted progressively, sacral concavity is reduced. Obviously, this obstetrically adverse development is influenced by the fact, that unfavourable pelvic conformation can be transmitted more intensively by the generous indication for cesarean section. This development is contrasted by the circumstance of fetal acceleration. Therefore, an increase in cephalopelvic disproportion has to be expected. For the sake of a safe obstetrical management in these situations the generous use of ante partum pelvimetric diagnosis seems to be advisable.

Adolescent↗
PubMedDate not supplied

[New aspects of radiologic pelvimetry. Digital image intensification radiography: preliminary results of validation possibilities and results in various types of pelvic disproportion].

Within 1 year with 1325 births 54 cases necessitated operative obstetric intervention due to a disproportion between fetal head and maternal pelvis. In 40 cases radiologic pelvimetry was performed, using the conventional technique. 75% of cases turned out to be due to a midplane or outlet contraction. As, on the one hand, this type of pelvic disproportion seems to be of increasing importance, on the other hand generously adoperated radiologic diagnosis is not well accepted by the patients due to X-ray burden, Digital Image Intensifier Radiography (DIR) has been introduced for pelvimetry. X-ray burden amounts to only 5% of that of the conventional technique. Enhanced postprocessing and interactive measurement possibilities are further advantages of DIR. Using the appropriate softwear, interactive measurement results are characterized by the lack of mistakes due to X-ray divergence, if only the distance between measurement level and desk surface is known. By analyzing 30 computer tomograms measurement levels of the most important pelvic distances could be calculated in relation to the position of the anterior iliac spine. These relations show a very low interindividual variation. Thus, possible errors in measurement amount to a maximum of only 3.5%. The evaluation of our cases reveals the necessity to reassess the normal ranges for pelvic parameters, for the use of those deriving from conventional pelvimetry failed to describe correctly the anatomy of birth channel. For this sake, additional measurements, esp. of sacral and pelvic outlet anatomy have to be performed. Based upon these measurements, a computer aided modelling of the birth channel and a simulation of the birth could be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Simulation↗