IgM bullous disease associated with IgM gammopathy: a report of two cases and review.
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Female↗
Biomedical subjects
M Heller
Publications and source records attributed to M Heller.
Correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis.
A prospective study correlating high-resolution computed tomography (HRCT), lung function tests (PFT) and bronchoalveolar lavage (BAL) cytology in patients with interstitial lung disease (ILD) associated with rheumatoid arthritis (RA). Fifty-three RA patients with suspected ILD (19 men, 34 women) underwent 71 HRCT (14 of 53 with sequential HRCT, mean follow-up 24.3 months). The HRCT evaluation by two observers on consensus included a semi-quantitative characterisation of lesion pattern and profusion on representative anatomical levels. Fifty-two HRCT were followed by PFT and BAL. Agreement or discordance of HRCT-, PFT- and BAL findings were analysed with Pearson's correlation, kappa score and McNemar's test. Tobacco-fume exposure was estimated in pack years. Smoking/non-smoking groups were compared with Student's t test. In 49 of 53 patients, HRCT was suggestive of ILD associated with RA (66 of 71 HRCT). Reticular lesions were found in 40 of 53 patients, in 15 of 40 presenting as mixed pattern with ground-glass opacities (GGO). Pure reticular patterns predominated in patients with long duration of ILD (p>0.01). Pure GGO were not observed. Lesion profusion was highly variable and correlated moderately negative with diffusion capacity (mean 88.2% (SD +/- 20.9%); r=-0.54; p<0.001) and very weak with vital capacity and FEV1 (mean values 92.2% (SD +/- 18.3%); r=-0.27; p<0.05 and 89.8% (SD +/- 17.5%); r=-0.31; p<0.01). In patients with GGO, BAL differentials tended towards neutrophilia (kappa=0.39; p=0.04; McNemar test p>0.2), but not towards lymphocytosis (kappa=0.10; p=0.23; McNemar test p>0.2). Differences in smoking history were not significant (p>0.1). The HRCT appears most appropriate for the detection and follow-up of ILD associated with RA. The PFT and BAL correlate only partially with lesion profusion or grading on HRCT, but they contribute valuable information about dynamic lung function and differential diagnoses (pneumonia, medication side effects).
Aged↗
Percutaneous management of occlusive arterial disease associated with vasculitis: a single center experience.
The purpose of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty for occlusive arterial disease associated with vasculitis. Eleven patients (10 women, 1 man; ages 35-82 years) with the diagnosis of vasculitis of the large vessels underwent interventional treatment during intraarterial angiography. The causes included giant cell arteritis (n = 8) and Takayasu arteritis (n = 3). Thirty-three occlusive lesions (including brachiocephalic and renal arteries, and arteries of upper and lower extremities) were treated with balloon angioplasty and/or stent placement. Follow-up included clinical examination, angiography, and color duplex ultrasound. Technical success was 100% (25/25) for stenoses and 50% (4/8) for occlusive lesions, representing all lesions combined from different anatomic locations. Dissection (n = 3) and arterial rupture with retroperitoneal hematoma (n = 1) was found in three patients. During follow-up (mean 12 months), restenoses (n = 8) and re-restenoses (n = 1) occurred in 8 vascular areas. Three of these lesions were treated with repeated PTA (n = 4). The cumulative primary clinical success rate was 67.6%, cumulative secondary success rate 74.4%, and cumulative tertiary success rate 75.9%. Interventional therapy in systemic vasculitis provides promising results in technical success rates and followup. Angioplasty may result in arterial injury, but the rate of complications is low.
Adult↗
NMR in medicinal chemistry.
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Chemistry, Pharmaceutical↗
[Mechanical borderline indications in the treatment of unreamed tibial nailing].
The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goal was to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, and to identify borderline indications due to biomechanical factors. In finite element analyses of a human tibia, horizontal defects were modeled using unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures with unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.
Biomechanical Phenomena↗
Validation of air-displacement plethysmography for estimation of body fat mass in healthy elderly subjects.
BACKGROUND: Air-displacement plethysmography (ADP) is a non-invasive method for body composition analysis that divides the body into fat-free mass (FFM) and fat mass (FM) (= 2 compartment model, 2C). It places low demands on subject performance and is therefore most convenient in the elderly. OBJECTIVE: To validate ADP against dual energy X-ray absorptiometry (DEXA) and to compare it to a four-compartment model of body composition (4C; fat mass, total body water, bone mineral content and residual mass) in the elderly. METHODS: Body composition was assessed by ADP, DEXA and bioelectrical impedance analysis (BIA) in 26 healthy elderly subjects (15 women, 11 men) aged 60-82 years. RESULTS: Despite a high correlation of %FM assessed by ADP and DEXA we observed significant differences between the results of these methods for both sexes (2.5 +/-3.4%; bias +/- SD). Deviations of %FM(ADP) from %FM(DEXA) were dependent on bone mineral content (BMC(DEXA)) fraction of FFM. A low BMC(DEXA) was related to an overestimation of DEXA-derived %FM by ADP. There was a systematic bias between results from ADP and the 4C model. 76% of its variance was explained by the assumption of a fixed density of FFM. 96% of the variance in the density of FFM was explained by water content and only 4% by BMC(DEXA) of FFM. When compared to a 4C model, overestimation of %FM(ADP) increases with increasing water fraction of FFM. CONCLUSION: Although there is a tendency for overestimation of %FM(ADP),ADP is a valid method for body composition measurement in the elderly. The bias in %FM(ADP) is mainly related to water content of FFM and indicates that a correction factor for TBW may improve the accuracy of the ADP measurements in the elderly.
Absorptiometry, Photon↗
[In-vitro comparison of the effectiveness of different high-speed rotatory catheters].
OBJECTIVE: To determine the in vitro effectiveness of the Amplatz and Rotarex catheters for thrombus fragmentation and combined thrombus fragmentation and aspiration. MATERIALS AND METHODS: Clots (n = 100) from 5-day-old porcine blood (8.5 g) were fragmented with the 8F Rotarex trade mark catheter (RR; 40.000 rpm), which was directed with or without a coaxial guide wire (GW 0.020 inch [8 F RR(GW)], GW 0.014 inch [6 F RR(GW)]), and with the 7 F Amplatz catheter (ATD; 150.000 rpm), in an artery flow model (pulsed flow of 700 ml/min) simulating the superficial femoral artery. To increase the wall adherence of the thrombus, an additional equal number of silicon tubes (with an inner diameter of 7 mm) were fitted inside with a metallic mesh (wall-adherent thrombus [WAT]; 6 F RR(WAT), 8 F RR(WAT), 6 F R(WAT-GW), 8 F RR(WAT-GW), ATD(WAT) ). The effluent was passed through a three-step filter system (10 to 1000 micro m; pressure gradient 35 mmHg). RESULTS: Highest effectiveness was found for 8 F RR (no remaining thrombus detectable) compared to 6 F RR (0.08 g) and ATD (0.07 g), with a p < 0.001 for both methods. The aspirated volume was significantly lower when 6 F and 8 F RR were used with a coaxial guide wire (p < 0.001). The total emboli rate for 8 F RR was significantly lower compared to ATD (p < 0.001). Even when working without a guide wire, 8 F RR caused the lowest proportion of emboli (depending on the modification 0.12 % to 1.76 %; compared to all p < 0.05). Emboli rates reached 7.99 % for 6 F RR (compared to all p < 0.001) and were maximal 5.61 % for ATD. CONCLUSIONS: The tested mechanical thrombectomy catheters have a high potential for in vitro thrombectomy with moderate performance differences. In contrast to the guidewire-directed Rotarex fragmentation-aspiration device, the ATD trade mark fragmentation catheter and prototype Rotarex 6 F catheter have a considerable peripheral embolization rate of particles larger than 1000 micro m, probably requiring additional measures for in vivo thrombectomy.
Animals↗
[First clinical results in a study of contrast enhanced magnetic resonance angiography with the 1.0 molar gadobutrol in peripheral arterial occlusive disease--comparison to intraarterial DSA].
PURPOSE: To assess the value of contrast enhanced (CE)-MR angiography (MRA) with 1.0 molar Gadobutrol (Schering, Germany) in comparison to intraarterial DSA in peripheral arterial occlusive disease (PAOD). MATERIALS AND METHODS: Within 48 hours, 30 symptomatic patients with PAOD were examined by CE-MRA (Gadobutrol dose 0.2-0.3 mmol/kg body weight) and DSA. For CE-MRA, a 1.5 T magnet (Vision, Siemens, Germany) was used (FA 35 degrees, TR/TE 4.6/1.8 ms, FOV 400 mm, matrix 230 x 512, total acquisition time 81 sec). Two radiologists evaluated a total of 600 vessel segments for stenotic lesions and image quality (1 = not visible to 5 = excellent). Treatment was independently planned on the basis of the MRA and DSA findings. RESULTS: The Kendall's tau-b coefficient was 0.92 for overall stenotic grading, and 0.92, 0.93 and 0.92, respectively, for the vascular flow in the iliac, femoropopliteal and crural arteries. Sensitivity, specificity, negative and positive predictive value, and accuracy were, respectively, 94, 97, 98 and 92, 96 % for > 50 % stenoses, 95, 99, 99, 95 and 99 % for iliac arteries, 96, 98, 98%, 94 and 97 % for femoropopliteal arteries, and 92, 94, 96, 89 and 94 % for crural arteries. Therapy planning by MRA and DSA coincided in 51 of 54 cases. No relevant adverse event occurred. CONCLUSION: CE-MRA with 1.0 molar Gadobutrol is highly efficient in diagnosing peripheral arterial occlusive disease and correlates excellently with DSA.
Aged↗
[MR-guided biopsies of undetermined liver lesions: technique and results].
PURPOSE: To evaluate safety and precision of liver tumor biopsies performed in an open low field system using different sequence techniques. MATERIALS AND METHODS: In 47 patients with liver tumors, MR-guided biopsies were performed in a low field system (0.2 Tesla, Magnetom Open, Siemens) using two different sequences. The procedure was monitored with T1-weighted FLASH sequences (TR/TE = 100/9; 70(3)) in all patients and with FISP-Rotated-Keyhole-sequence (TR/TE = 18/8; 90(3)) in additional 20 patients. After positioning of the needle tip in the tumors, 166 biopsy specimens were acquired with 16 G cutting needles (Somatex*). The diameter of the biopsied lesions ranged from 1 to 10 cm (mean diameter 3.2 cm). Visibility of the needles and precision of the biopsies were evaluated. RESULTS: All interventional biopsies were performed without vascular or organ injuries. Adequate specimens for histologic interpretation were obtained in 42 cases (89.3%). The biopsy results were non-specific in 2 patients (4.2%) and the lesions missed in 3 patients (6.3%). Mean in-room time was 35 minutes and the intervention time was 8.3 minutes. T1-weighted FLASH images proved optimal for confirming needle-tip placement during the biopsies or punctures. Organs, tumors and vessels were easily identified. The FISP sequence proved to be inferior in visualizing vessels and tumors. CONCLUSION: MR-guided liver biopsies are safely and precisely performed using T1-weighted FLASH-sequences with sufficient visualization of the lesions and might be complementary to US- or CT-guided biopsies.
Adult↗
[Transarterial chemoperfusion of inoperable pancreas carcinoma and local recurrence].
BACKGROUND: To evaluate the side effects and tumor response of a locoregional transarterial chemoperfusion with Mitomycin C and Gemcitabine in advanced pancreatic cancer. MATERIALS AND METHODS: Between October 2001 and August 2002, 16 patients were treated in 80 transarterial chemoperfusion sessions with a mean of 5 sessions per patient and a pause of 4 weeks between the sessions. The chemotherapy consisted of a combination of Mitomycin C (8.5 mg/m 2) and Gemcitabine (500 mg/m 2), administered within 1 hour. The tumor response was evaluated by MRT and CT and the quality of life by a patient questionnaire. RESULTS: All patients tolerated the procedure well. The therapeutic outcomes were as follows: in 50 % (n=8) of patients, minor response with a decrease in size of the primary tumor and metastases up to 20 %; in 25 % (n = 4) of patients, stable disease; and in 25 % (n = 4) of patients, progressing metastases with stable primary tumor. Eleven patients (68.75 %) reported a good quality of life without impaired performance of their daily activities. Side effects were moderate and reversible between the treatment cycles. After one year 25 % of the patients were still alive. CONCLUSION: Transarterial chemoperfusion is a minimally invasive treatment for pancreatic carcinomas and local recurrences with little side-effects and can be delivered on an outpatient basis. It might be indicated as potential neoadjuvant treatment before surgery or as palliative treatment to provide clinical benefits and to improve the quality of life.
Activities of Daily Living↗
[Ectopic thyroid tissue in the right mandibular angle: differential diagnosis of uncertain soft tissue swelling of the neck].
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Aged↗
[Radiology of the primary systemic vasculitides].
Determination of disease extension and disease activity are in the foreground of diagnostic imaging in vasculitides. There are several radiologic modalities available each having specific indications. Magnetic resonance imaging (MRI) readily depicts granulomas and mucosal inflammations in the paranasal sinuses, nasal cavity and orbits. Computed tomography detects osseous lesions of the skull. Due to its superb sensitivity MRI is an established screening modality for CNS vasculitides, although there are limitations with regard to specificity. In spite of its limited accuracy in most institutions angiography is still required for radiological confirmation of CNS vasculitis. Perfusion and diffusion MR-imaging may combine the advantages of "conventional" MRI and angiography. By now the method is not fully validated for vasculitides, however. Vascular disease in Takayasu's arteritis and in giant cell arteritis involving predominantly large and medium sized vessels is readily diagnosed by non invasive magnetic resonance angiography. Percutaneous transluminal angioplasty has proven to be an effective and save therapeutic modality for the cure of vascular stenoses and occlusions. Plain film radiography in two planes is the established modality for pulmonary imaging. In pulmonary vasculitides a more thorough analysis of lung disease is provided by high resolution computed tomography. Diagnostic imaging does substantially assist in the interdisciplinary management of patients suffering from vasculitides.
Adolescent↗
[Radiology in managed care environment: opportunities for cost savings in an HMO].
PURPOSE: A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. MATERIALS AND METHODS: We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were docu-mented in Microsoft Excel(R) and analyzed by non-parametric tests using SPSS(R) 8.0 (Statistical Package for the Social Sciences) for Windows(R). RESULTS: The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. CONCLUSION: We identified initiatives with estimated potential savings of approximately $ 5.5 million. Some of these initiatives are similar to the reforms to reduce cost and improve quality that are already implemented or proposed within the German healthcare system.
Budgets↗
A new concept for covered stent protected carotid angioplasty: an ex vivo study.
OBJECTIVE: To determine the efficacy of a covered stent prototype designed for protected carotid angioplasty to reduce cerebral embolization. MATERIAL AND METHOD: The covered stent tested is made of nitinol, coated with a polyurethane membrane (MembraX trade mark; porous size 80 micro m). In a bench-top model (flow-rate 650 ml/min, pulsatile flow [dicrote] 123 Pulses/min, pressure 100/60 mm Hg [mean pressure 80 mmHg]) with inserted human carotid (n = 6) stent implantation was performed (8/32 mm). Passed particles (mg) were determined in the effluent of a 100 micro m filter prior to intervention, after stent deployment and after final dilation (5 mm). RESULTS: When stenting carotid arteries obtained from human cadavers, the highest rate of particle embolization was measured while crossing the lesion with the delivery device (6,8 mg; for all p < 0,05), embolization after additional balloon angioplasty and particle rates measured in the effluent filter prior covered stent placement were significantly lower (3,8 mg; p < 0,05). Branches of the external carotid artery remained patent in all cases. CONCLUSIONS: The introduced concept of covered stent protected carotid angioplasty with the MembraX trade mark prototype has proven promising results for low cerebral embolization rates ex vivo. Further evaluations using an animal model and a miniaturization of the delivery device are warranted prior to human use.
Adult↗
Bolus-chasing contrast-enhanced 3D MRA of the lower extremity. Comparison with intraarterial DSA.
PURPOSE: To evaluate step-table 3D contrast-enhanced (CE) MRA with bolus chasing for the detection and grading of stenoses in patients with peripheral vascular disease (PVD) of the lower extremities. MATERIAL AND METHODS: Fifty patients were studied by step-table bolus-chasing 3D-CE-MRA and i.a. DSA within 24 h. After determination of the individual circulation time, CE-MRA was performed during power injection of 40 ml of Gd-DTPA. To cover the whole range between the renal arteries and the feet with three slab locations, the scanner table was manually advanced twice for 350 mm. Total imaging time was 1 min 23 s. The degree of stenosis and image quality of the images were evaluated by 2 observers. In addition, a treatment plan was established based on the 3D-CE-MRA and DSA investigations. RESULTS: In 44 of 50 patients (88%), the visualization of the arterial tree from the renal arteries to the foot was possible. Forty-six of 50 patients (92%) had good or very good image quality. In the calf, 3D-CE-MRA was superior to DSA in 6 patients. For the detection of stenosis >50%, sensitivity was 99.5%, specificity 98.8%, positive predictive value 95.6% and the negative predictive value 99.8%. Cohen's kappa for 3D-CE-MRA vs. DSA was 0.926; for interobserver agreement it was 0.96. CONCLUSION: Bolus-chasing 3D-CE-MRA with manual table movement is a simple, robust and easy to perform technique which provides high quality angiograms of the lower extremity arterial system and is comparable to, i.a., DSA for the diagnosis of PVD.
Adult↗
Value of micro-CT as an investigative tool for osteochondritis dissecans.
PURPOSE: To evaluate micro computed tomography (micro-CT) for the assessment of osteochondritis dissecans in comparison with histology. MATERIAL AND METHODS: Osteochondritis dissecans lesions of 3 patients were evaluated using micro-CT (0.125 mA, 40 keV, 60 microm slice thickness, 60 microm isotropic resolution, entire sample) and light microscopy (toluidine blue, 3-5 microm slice thickness). The methods were compared regarding preparation time, detectability of tissue types and morphologic features of bone and cartilage. RESULTS: Non-destructive micro-CT imaging of the entire sample was faster than histologic preparation of a single slice for light microscopy. Morphologic features of bone and cartilage could be imaged in a comparable way to histology. It was not possible to image cells or different tissue types of bone and cartilage with micro-CT. CONCLUSION: Micro-CT is a fast, non-destructive tool that may be a supplement or, if detailed histologic information is not necessary, an alternative to light microscopy for the investigation of osteochondritis dissecans.
Adult↗
Methanol contamination of Romanian home-distilled alcohol.
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Alcoholic Beverages↗
Selective water excitation for faster MR imaging of articular cartilage defects: initial clinical results.
Our objective was to compare a water-excitation (WE) 3D fast low-angle shot (FLASH) MR sequence for faster imaging of articular cartilage defects of the knee to a conventional fat-saturated (FS) 3D FLASH MR sequence. This prospective study included 16 knees of 16 patients with suspected cartilage lesions. The MR imaging in transverse and sagittal planes included (a) FS 3D FLASH (TR/TE: 45 ms/11 ms, scan time 8 min, flip angle 50 degrees), and (b) WE 3D FLASH (TR/TE: 28 ms/11 ms, scan time 4 min 58 s, flip angle 40 degrees). For each sequence signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were quantified. The detected cartilage lesions were evaluated using a semi-quantitative four-scale scoring system (grades 0-III). The data were compared between the sequences using the paired Student's t-test. No statistically significant differences between the sequences were found for SNR, CNR, and cartilage defect grading (p=0.14-0.8). The WE 3D FLASH MR imaging seems to be promising for fast imaging of articular cartilage lesions of the knee.
Cartilage Diseases↗