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O Mundler

Publications and source records attributed to O Mundler.

45 records · Page 3Linked to original sources
PubMed1988

Value of radionuclide assessment with thallium 201 scintigraphy in carnitine deficiency cardiomyopathy.

The case of a 30 month-old boy who presented with isolated severe dilated cardiomyopathy is reported. The diagnosis of systemic carnitine deficiency was confirmed by low serum and tissue carnitine levels. During oral L-carnitine therapy, dramatic improvement of the cardiac function was assessed by radionuclide methods. Myocardial thallium 201 uptake was closely correlated with cardiac function studied by angioscintigraphy. These methods are simple, easily reproducible, non-invasive and involve little radiation. In a case of cardiomyopathy, we suggest an immediate trial of oral carnitine treatment; the efficacy of the therapy can be confirmed by isotopic tests with thallium 201 scintigraphy.

Cardiomyopathy, Dilated↗
PubMed1987

Left ventricular global and regional function during lumbar epidural anesthesia in patients with and without angina pectoris. Influence of volume loading.

The influence of lumbar epidural anesthesia without cardiac sympathectomy on global and regional left ventricular function was investigated prior to surgery in eight normal subjects (group 1) and in ten patients suffering from stable mild effort-related angina (group 2). In both groups, epidural blockade was performed with 10 ml 0.5% plain bupivacaine. To differentiate the effects due to epidural blockade from those related to volume expansion, three sets of measurements were obtained: control, epidural blockade without volume loading, and epidural blockade with volume loading (500 ml lactated Ringer's solution). Radionuclide angiography was used to determine cardiac output, left ventricular ejection fraction, end systolic and end diastolic volumes, and to analyse left ventricular wall motion. Peak systolic pressure-end systolic volume ratio was used as an index of myocardial contractility. Seventy-two hours postoperatively, a thallium 201 myocardial scintigraphy obtained after iv dipyridamole detected myocardial defects in all patients with a history of angina. These defects were fully redistributed in eight out of ten patients. Throughout the procedure, patients with a history of angina exhibited neither chest pain nor ECG evidence of myocardial ischemia. At control, left ventricular ejection fraction (LVEF) and systolic pressure-volume ratio (SPVR) were lower in group 2 than in group 1 (LVEF: 0.54 +/- 0.02 vs. 0.64 +/- 0.02, P less than 0.01), (SPVR: 2.3 +/- 0.2 vs. 3.3 +/- 0.4 mmHg/ml, P less than 0.05). In addition, 19 hypokinetic sectors were found in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Value of computed medical imaging in the surveillance of neo-adjuvant chemotherapy of osteogenic osteosarcoma in children and adolescents. 51 patients seen from 1984 to 1986].

The value of quantitative bone scintigraphy, digitised angiography, CT scanning and magnetic resonance imaging in the follow-up of neo-adjuvant chemotherapy for osteogenic osteosarcoma was assessed in 51 patients between 1984 and 1986. Bone scintigraphy was a very sensitive method of detecting bone metastases but of limited value in assessing the response to preoperative chemotherapy. CT scanning was very useful in small and medium sized tumours with predominantly non-calcific involvement of the soft tissue. At present, digitised angiography seems to be the best investigation for following up these patients as shown by the close histo-angiographical correlations. However, magnetic resonance imaging is a very promising method and may in future replace the more invasive aforementioned techniques in this indication.

Adolescent↗
PubMed1986

Response of left ventricular ejection fraction to recovery from general anesthesia: measurement by gated radionuclide angiography.

To test the hypothesis that, after anesthesia for noncardiac surgical procedures, the increased cardiac work during recovery induces wall motion and ejection fraction (EF) abnormalities in patients with mild angina pectoris, gated radionuclide angiography was performed in patients undergoing simple cholecystectomy under narcotic-relaxant general anesthesia. The ejection fraction was determined during anesthesia at the end of surgery, and then determined 3 min and 3 hr after extubation. A new angiography was performed 24 hr later, and a myocardial scintigraphy (Thallium 201) was performed during infusion of the coronary vasodilator, dipyridamole. In the first part of the investigation, eight patients without coronary artery disease (CAD) (group 1) and 20 patients with mild angina (group 2) were studied. In the second part of the study, seven patients (group 3) with mild angina pectoris received an intravenous infusion of 0.4 microgram X kg-1 X min-1 of nitroglycerin started before surgery and gradually decreased 4 hr after extubation. In group 1, EF remained unchanged at recovery. In contrast in group 2, EF responded abnormally to recovery: EF decreased from 55% during anesthesia to 45% 3 min after extubation (P less than 0.001). Patients in group 3, who received intravenous nitroglycerin, showed no change of EF at recovery. This study demonstrates that recovery from general anesthesia causes abnormalities in left ventricular function in patients suffering from CAD. These abnormalities are prevented by prophylactic intravenous nitroglycerin.

Aged↗
PubMed1985

Left ventricular dysfunction after non-cardiac surgical procedures in patients with ischemic heart disease.

In order to demonstrate the presence of postischemic ventricular dysfunction after non-cardiac surgical procedures, myocardial perfusion scintigraphy with thallium 201 and radionuclide ventriculography were performed before and 24 h after intervention in 20 patients suffering from angina pectoris. A long-term ECG recording was used in all patients to detect peroperative myocardial ischemia. In 14 of the 20 patients studied, both ventriculography and thallium scintigraphy were unchanged at the postoperative study. Comparison of pre- and postoperative radionuclide data revealed an increased deficit in one patient, both increased deficit and decreased ejection fraction in four others and a decreased ejection fraction in one other. In these five last patients, continuous ECG recording demonstrated the occurrence of peroperative ST segment depression. These results underline the part played by prolonged peroperative episodes of myocardial ischemia in the occurrence of postoperative left ventricular dysfunction.

Adult↗
PubMedDate not supplied

High negative predictive value of slow lymphatic drainage on metastatic node spread detection in malignant limb and trunk cutaneous melanoma.

AIM: Harvesting of the "sentinel lymph node" (SLN) as identified by lymphoscintigraphy (LSG) is becoming increasingly important in the staging of patients with malignant melanoma. The purpose of the current study was to determine whether the appearance time of the LSG had a prognostic value in predicting metastasis dissemination in thick cutaneous malignant melanoma. METHODS: Between July 1999 and July 2003, 88 consecutive patients with histologically proven melanoma with a Breslow's thickness > 1 mm, without clinical or radiological evidence of lymph node involvement or metastasis, prospectively underwent lymphoscintigraphy with 32 Mbq Tc 99m sulfur colloid prior to sentinel lymphadenectomy with sentinel lymph node (SLN) histological examination. RESULTS: LSG was performed in 88 patients with limb and trunk melanoma and identified a total of 149 sentinel nodes. Pathological examination revealed lymph node involvement in 21 patients (24%). All positive SLNs were imaged with a scintigraphic appearance time of less than 30 min. With a scintigraphic appearance time greater than 30 min, the negative predictive value (NPV) of spread in the SLN was 100% (27/27)(CI 87-100%). CONCLUSION: The strong NPV of LSG in identifying "slow" sentinel lymph nodes in patients with no clinical evidence of lymph node involvement suggests that patients could be spared sentinel lymph node biopsy when LSG detects "slow" sentinel lymph nodes. Another prospective study will be required to confirm that the scintigraphic appearance time of sentinel lymph nodes is an important predictive parameter of metastatic disease in sentinel lymph nodes and consequently might reduce the number of sentinel lymph node biopsies.

Adult↗
PubMedDate not supplied

[Ileal duplication in adults. Value of 99m pertechnetate scintigraphy].

Duplications of the small bowel are an uncommon group of congenital malformations whose symptoms rarely occur in adults. We report the case of a 21 year-old man who suffered during four years from symptoms related to the ulceration of ectopic gastric mucosa in an ileal duplication (spontaneously resolving peritonitis, pelvic abscess, recurrent gastrointestinal bleeding and chronic abdominal pain). Radiological and endoscopic explorations and a first laparotomy failed to provide the diagnosis. 99m pertechnetate (99mTcO4) scintigraphy demonstrated ectopic gastric mucosa and guided the radiological detection of an ileal ulceration. Injection of 99mTcO4 during a second laparotomy located the ectopic gastric mucosa at the level of a tumefaction found on the mesenteric side of the terminal ileum. Duplication was only recognized at pathological examination of the ileal resection. This case emphasizes the need to evoke a duplication in clinical circumstances like those described in this patient as well as the usefulness of 99mTcO4 in the diagnosis of such a malformation.

Adult↗
PubMedDate not supplied

[Two cases of FSH secreting adenomas (author's transl)].

The authors report two cases of FSH secreting adenomas in men and attempt to draw out some features of these very uncommon pituitary tumors. Absence of gynecomastia is emphasized. Diagnosis proceeds from systematic radio-immunoassay of pituitary hormones. Evidence of FSH secretion results from paradoxical gonadotropin stimulation by TRH and secretory granules seen by electronic microscope. Immunofluorescence studies are still to perform. Dynamic testicular secretion and, in one case, histologic examination were performed.

Adenoma↗