Biomedical subjects

P Rogalla

Publications and source records attributed to P Rogalla.

At least 37 records · Page 2Linked to original sources

PubMed2004

[Cross-section diagnosis of tumors of the kidney and prostate gland: CT and MRI].

Computed tomography (CT) and magnetic resonance imaging (MRI) underwent significant technical advances in the past ten years, especially in the diagnostic evaluation of renal tumors. Either modality can perform unenhanced and contrast enhanced imaging with high resolution display of three-dimensional data sets of the entire abdomen including the arterial and the parenchymatous perfusion phase after injection of contrast medium. Multiplanar reconstructions of these three-dimensional data allow the display in any chosen orientation. The maximum intensity projection can create CT and MR angiograms. For the diagnosis of renal tumors, both modalities offer the possibility of a detailed visualization of both the parenchyma and the arterial and venous vessels, leading to an efficient preoperative work-up. For the MRI diagnosis of the prostate cancer, the achievable accuracy depends on the applied coil technique and on the available clinical information as well as on the experience of the examiner. For the preoperative MRI staging of prostate cancer, the accuracy has been stated to be between 51 % and 97 %.

Angiography↗

PubMed2004

[First line application of a modified dilatational tracheostomy in the intensive care].

BACKGROUND: Despite the growing clinical use of the percutaneous dilatational tracheostomy data concerning their first line application are still lacking. METHODS: Retrospective analysis of the intra- and postinterventional morbidity of a modified dilatational tracheostomy in a surgical intensive care unit of a German university hospital over a 2-year period. RESULTS: A total of 107 elective dilatational tracheostomies were performed in 105 patients. There were no intraoperative complications. 2 accidental decannulations occurred in the postoperative period. One conventional tracheostomy had to be performed secondary. Stoma side bleeding or clinical relevant infection had not been observed. After definite decannulation wound closure was spontaneous in all patients. CONCLUSIONS: The first line application of the dilatational tracheostomy has a low morbidity.

Adult↗

PubMed2004

Assessment of left ventricular volumes and function: intraindividual comparison of multi-slice spiral CT and electron beam CT in an animal model.

PURPOSE: To evaluate multi-slice spiral computed tomography (MSCT) for measurements of left ventricular volumes, ejection fraction (EF), and myocardial mass in comparison with electron beam CT (EBCT) as a reference method. MATERIAL AND METHODS: Six minipigs underwent both standardized contrast-enhanced MSCT (effective acquisition time per cardiac cycle 125.7+/-30.1 ms, reconstructed slice thickness 8 mm) and EBCT (acquisition time 50 ms, collimated slice thickness 8 mm). The contrast-to-noise ratio of the left ventricle was measured in each animal, and the contour sharpness of the myocardium was analyzed. Volumes (EDV, ESV, SV) ejection fraction (EF), and muscle mass were calculated by MSCT and by EBCT using the slice summation method. RESULTS: MSCT had a higher contrast-to-noise ratio and delineated the myocardial contours more sharply than EBCT. There was a close linear correlation between both modalities for all parameters (EDV: rP=0.88, ESV: rP=0.91, SV: rP=0.85, EF: rP=0.93; mass: rP=0.90; P<0.05 each). MSCT slightly overestimated ESV and slightly underestimated SV and EF compared with EBCT (P<0.05 each). CONCLUSIONS: Image quality in MSCT is superior to that of EBCT. Functional parameters correlate well between both modalities, but the accuracy of MSCT is limited by its lower temporal resolution.

Animals↗

PubMed2003

Human HMGA2 promoter is coregulated by a polymorphic dinucleotide (TC)-repeat.

HMGA proteins are thought to be causally involved in the progression of different diseases, including benign and malignant tumors, obesity, arteriosclerosis, and restenosis. As HMGA proteins are architectural transcription factors, their binding to DNA leads to changes in DNA-conformation modulating the environment for the assembly and function of transcriptional complexes, thus influencing the expression of a huge variety of genes. Despite the emerging role of HMGA proteins for important diseases, only limited information is available about mechanisms regulating the expression of the HMGA2 gene. In this report, 2240 bp of the 5' flanking region of the HMGA2 gene were functionally analyzed by luciferase assay experiments. Besides the identification of novel positive and negative regulatory elements, it was shown that transcription is initiated from two independent promoter regions within cell lines HeLa, MCF7, and L14TSV40. Furthermore, a functional polymorphic dinucleotide repeat (TCTCT(TC)(n)) 500 bp upstream of the ATG translational start codon was found to regulate strongly the human HMGA2 promoter with an activation pattern that correlates to its TC-repeat length.

Dinucleotide Repeats↗

PubMed2003

[Modern imaging modalities in renal disease: CT and MRI].

Considerable technical advances have been made in computed tomography (CT) and magnetic resonance imaging (MRI) over the last 10 years. Both modalities allow for high-resolution imaging of the entire abdomen before as well as during the arterial and parenchymal perfusion phase after intravenous contrast medium administration. Multiplanar reconstructions of the three-dimensional source data sets yield views in any spatial orientation. Maximum intensity projections enable the generation of CT or MR angiographies as well as CT or MR urographies from delayed images. Thus, both modalities today allow for comprehensive diagnostic evaluation of renal disease by a single examination comprising detailed visualization of the parenchyma as well as of arterial and venous vessels and assessment of excretion. CT and MRI thus enable efficient preoperative diagnostic assessment in particular in patients with renal masses.

Humans↗

PubMed2003

[Imaging of the coronary arteries by means of multislice helical CT: optimization of image quality with multisegmental reconstruction and variable gantry rotation time].

PURPOSE: To evaluate the potential of multisegmental reconstruction and variable gantry rotation time for reducing motion-induced artifacts in coronary artery imaging by multislice helical CT. MATERIALS AND METHODS: The data sets of 20 patients (8 with HR < 60 bpm, 12 with HR > 60 bpm) were analyzed. The patients underwent multislice helical CT (Aquilion 8, Toshiba, Otawara, Japan) using the following parameters: 0.5 mm slice thickness, 250 mA, 120 kV, pitch of 0.25 and variable gantry rotation times of 400, 500, or 600 msec. Images were generated by halfscan and multisegmental reconstruction. In 9 coronary segments of each patient, the presence and severity of motion artifacts were assessed and graded on a scale between 5 (no artifacts) and 1 (heaviest artifacts). RESULTS: Diagnostically relevant motion artifacts were rare at low heart rates (< 60 bpm) for both types of image reconstruction (4 % of all segments). Higher heart rates (> 60 bpm) were associated with an increase in motion artifacts on halfscan reconstructions (33% of all segments, p < 0.05) but not on multisegmental reconstructions (4% of all segments). At low heart rates mean image quality did not differ between multisegmental and halfscan reconstruction (4.28 +/- 0.37 vs. 4.22 +/- 0.41; p > 0.05), whereas at higher heart rates image quality was better for multisegmental reconstruction than for halfscan reconstruction (4.23 +/- 0.47 vs. 3.11 +/- 0.63; p < 0.05). CONCLUSION: Multisegmental reconstruction with variable gantry rotation times suppresses motion artifacts and thus improves assessment of the coronary arteries in patients with higher heart rates.

Artifacts↗

PubMed2003

[Evaluation of passive cardiomyoplasty using left- and right-ventricular volume measurements by EBCT and MRI in patients with chronic congestive heart failure].

PURPOSE: To evaluate the efficacy of passive cardiomyoplasty with the determination of biventricular volumes, global systolic function as well as left-ventricular muscle mass. MATERIALS AND METHODS: In 19 patients with congestive heart failure of idiopathic or ischemic origin, a polyester mesh-graft was implanted around both ventricles for stabilization and functional support. Before and three months after surgery, 15 patients underwent EBCT and 4 patients with impaired renal function underwent MRI, for the evaluation of the volume and ejection fraction of both ventricles. RESULTS: EBCT demonstrated a decrease from 385 to 310 ml in LV-EDV, from 312 to 242 ml in LV-ESV, from 209 to 160 ml in RV-EDV and from 149 to 87 ml in RV-ESV, and an increase from 20 to 26% in LV-EF and from 37 to 50% in RV-EF as well as a reduction of LV-MM from 300 to 274 g (p < 0.05 each). Similar results were obtained by MRI. CONCLUSION: Following passive cardiomyoplasty, EBCT and MRI revealed an improvement of the global systolic function as well as a reduction of biventricular volumes and left-ventricular muscle mass.

Adult↗

PubMed2003

[Spatial and temporal resolution with 16-slice computed tomography for cardiac imaging].

The use of the CT scanner for cardiac imaging is mainly influenced by the spatial and temporal resolution that can be achieved with the applied technologies and procedures. The data acquisition with 16 x 0.5 mm scan slice thickness and a special multisegment image reconstruction procedure are a new combination for accurate imaging of the cardiac morphology. A 0.5 mm slice thickness and an overlapping pitch < 0.35 generate an isotropic image voxel of 0.35 x 0.35 x 0.35 mm. The object size of a coronary artery with a diameter of 2.5 mm amounts to a relative spatial blurring factor K (d) of approximately 15 %. The segment reconstruction with 4 segments from 4 consecutive cardiac cycles requires the optimum acquisition time of 50 ms for one frame. The relative exposure factor K (t) with reference to the R-R interval is an appropriate measure to validate the influence of coronary artery movement on the image quality at different heart rates. This relative exposure varies between 10 % and 20 % for a heart rate of 40 to 140 beats per minutes (bpm) and its mean is approximated by a linear trend function with K (t) = 14 %. A constant value in this linear trend function means a constant "blurring" of the imaged coronary arteries, independent of the actual heart rate. Thus, computed tomographic examinations can be carried out for heart rates between 40 and 140 bpm without using beta-blocking medication. Case studies of the 3D reconstruction and curved reformatting of coronary arteries with stents and calcifications show the achievable image quality at different heart rates.

Algorithms↗

PubMed2003

Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis.

BACKGROUND AND STUDY AIMS: It is still difficult to visualize changes in the small intestine. Wireless capsule enteroscopy is a new method that promises to provide new insights into the small intestine. In a prospective study, the diagnostic yield of wireless enteroscopy was therefore compared with computed tomography (CT) enteroclysis. PATIENTS AND METHODS: Twenty-two patients with suspected small-bowel pathology underwent CT enteroclysis and wireless capsule enteroscopy examinations, conducted by two independent blinded investigators. The results of the two investigations (diagnoses and the number, extent, and location of lesions detected) were compared by a third investigator. RESULTS: The patients included in the study had obscure gastrointestinal bleeding (n = 8), Crohn's disease (n = 8), unexplained diarrhea (n = 5), or suspected carcinoid tumor (n = 1). Pathological lesions were detected using capsule enteroscopy in 13 patients (59 %) and using CT enteroclysis in eight (36 %; P = 0.12). In seven patients (one case each of colonic Crohn's disease, diverticulitis, Meckel's diverticulum, carcinoid tumor, mesothelioma, colonic polyps, and irritable bowel syndrome), no pathological changes were found in the small intestine using either method. The diagnosis was established by wireless capsule enteroscopy in four patients with obscure bleeding, whereas CT enteroclysis was positive in only one patient ( P = 0.1). Crohn's disease was found in two patients with unexplained diarrhea. Small-bowel lesions were identified in six patients with known Crohn's disease using capsule enteroscopy or CT enteroclysis. The only side effect of wireless capsule enteroscopy observed was abdominal pain in one patient with Crohn's disease. There were no serious side effects with CT enteroclysis. CONCLUSIONS: Wireless capsule enteroscopy detects more small-bowel lesions than CT enteroclysis in patients with obscure gastrointestinal bleeding and Crohn's disease.

Adolescent↗

PubMed2003

High mobility group protein HMGA1 expression in breast cancer reveals a positive correlation with tumour grade.

Members of the HMGA protein (high mobility group protein A) family act as master switches of the chromatin structure by bending DNA and thus modulating the formation of transcription factor complexes of a number of target genes. Accordingly, HMGA proteins have been shown to be associated with the development and/or progression of a variety of benign and malignant tumours. Nevertheless, the HMGA1 expression studies published so far have not included primary breast cancer samples. In this study we have investigated the HMGA1 expression patterns in a series of 170 breast cancer samples by immunohistochemistry. We have found a strong variation in HMGA1 expression between the tumours. Based on an immunoreactive score (IRS) 14.1% of the tumour samples were scored to IRS 8-12 (strong positivity for HMGA1), 24.7% were scored to IRS 4-6 (moderate positivity), 25.3% were scored to IRS 1-3 (weak positivity), and 35.9% showed no positivity at all. Immunoreaction could be detected in all histological types of breast cancers analysed with the exception of invasive papillary and cribriform carcinoma. Statistical analysis revealed a strong correlation between tumour grade and HMGA1 expression (rs=0.3516, p<0.0001). Thus, the HMGA1 expression level can be considered a potential prognostic marker for breast cancer.

Breast Neoplasms↗

PubMed2002

[Using multislice spiral CT in neuroradiologic imaging].

Multislice computed tomography (MS-CT) was introduced into clinical radiology in 1999 and has shown a significant effect on various indications for computed tomography (CT) imaging in neuroradiology. Technical highlights of this new scanner type are the simultaneous data acquisition by up to four detector rows at present, an accelerated rotation time, and a reduction of the slice thickness to as low as 0.5 mm. These features account for an extended scan area, such as head and neck imaging in polytraumatized patients, detailed contrast-enhanced studies of the cervicocerebral vascular system from the carotid bifurcation to the vertex, as well as cerebral perfusion studies of a larger brain volume with an improved time resolution compared to established CT procedures. In addition, the diagnostic yield of the CT is increased with respect to several applications by reducing common image artefacts at the level of the cervicothoracic junction as well as those caused by metallic implants. Apart from improving the image quality of the primary cross-sectional slices, MS-CT significantly enhances two- and three-dimensional image reconstructions. Radiation protection is an important issue with MS-CT, especially when skull base imaging is considered.

Artifacts↗

PubMed2002

[Multislice CT of the abdomen--current indications and future trends].

Multislice CT systems allow the simultaneous acquisition of multiple slices per gantry rotation. In combination with faster gantry rotation times of 0.5 seconds, the abdominal structures can be displayed in higher spatial and temporal resolution. In MS-CT of the liver it is possible to scan the entire organ with an optimal slice thickness of 2 - 3 mm within a defined perfusion phase in less than 10 seconds. This results in an improved detection and characterization of focal liver lesions. A high-quality, 3-dimensional reconstruction of the hepatic arterial and portalvenous system is obtained with the same data set. The diagnostic use of the simultaneously acquired perfusion data will lead to a better characterization of focal liver lesions in the future. The diagnostics of the pancreas also profits from MS-CT, especially for the detection of small tumors and the evaluation of resectability of a pancreatic carcinoma. All abdominal structures can be displayed in a coronal view without loss of image quality because of the almost isotropic voxels obtained. This proves to be beneficial for the preoperative diagnostics of renal cell carcinomas, especially if the tumor extension into adjacent organs (e. g., liver or spleen) in the longitudinal direction has to be evaluated. The multiplanar display and the sophisticated 3-dimensional reconstruction tools have a substantial value for the abdominal CT angiography. It proves to have a major diagnostic impact on acute abdominal aortic and visceral arterial diseases because even large distances in the z-direction can be covered with high spatial resolution.

Abdominal Neoplasms↗

PubMed2002

[Comparing the visualization of microcalcifications with direct magnification in digital full-field mammography vs. film-screen mammography].

PURPOSE: To evaluate the conspicuity of microcalcifications in magnified mammographic views of preparations obtained with full field digital mammography (FFDM), film-screen mammography (FSM), and the DIMA technique. MATERIAL AND METHODS: Twelve preparations were examined by FFDM and FSM using 1.8 x magnification and DIMA using 7 x magnification. Parameter settings were identical for all three techniques. The number of visible microcalcifications was then determined for each modality by three radiologists. As far as possible, all preparations were X-rayed at 22 kV and 10 mAS. RESULTS: Altogether 9705 calcifications were counted (DIMA: 1609/1542/1534; FFDM: 1020/753/881; FSM: 901/643/822). The total number of microcalcifications identified with the DIMA technique was 4685 as compared to 2654 with FFDM and 2366 with FSM. The calcifications counted with FFDM and FSM thus corresponded to 56.6 % and 50.5 %, respectively, of those identified with DIMA. The differences between the groups were statistically significant (F-Test, p < 0.05). CONCLUSION: Significantly more calcifications are identified when magnified mammographic views of preparations containing microcalcifications are obtained with the DIMA technique compared to FFDM or FSM. FFDM depicts markedly more calcifications than FSM. This means one should increase spatial resolution. Digital mammography offers the potential for improved visualization of microcalcifications with advanced applications.

Breast Neoplasms↗

PubMed2002

Esophageal necrosis and perforation of the left main bronchus following photodynamic therapy of esophageal carcinoma.

Photodynamic therapy is an effective palliative treatment of esophageal cancer. Minor complications associated with this therapy include pleural effusions, fever or esophageal strictures. In addition to this major complications such as respiratory-esophageal fistula and bronchus perforation have been described. We report here our experience with a patient who developed a complete esophageal necrosis and perforation of the left main bronchus following photodynamic therapy. The surgical and intensive care management of the patient is described and the literature discussed.

Bronchial Diseases↗

PubMed2002

[Incidence and distribution pattern of pulmonary saddle emboli: Diagnosis by electron beam tomography (EBT)].

PURPOSE: To determine the incidence of acute pulmonary emboli extending across the bifurcation of the main pulmonary artery, lobar arteries or segmental arteries (interpulmonary, interlobar or intersegmental saddle emboli, respectively). METHODS: 128 patients with clinically suspected acute pulmonary embolism underwent electron beam tomography (EBT). 140 scans were acquired in the continuous volume scanning mode (3 mm slice thickness). 100 ml of contrast material were intravenously administered. Studies were reviewed for the presence of acute pulmonary embolism and the number and location of interpulmonary, interlobar or intersegmental saddle emboli. Saddle emboli were defined as emboli extending across the bifurcation of a vessel into both branches by at least 5 mm each. RESULTS: 30 of 128 (23.4 %) patients (15 men; mean age 59 +/- 17 years) had acute pulmonary embolism. One or more saddle emboli were present in 20 of 30 patients (66.7 %), a total of 77 saddle emboli were detected ranging from 1 to 10 per patient. Distribution of the saddle emboli in the 20 patients was as follows: 5 interpulmonary, 28 interlobar and 44 intersegmental. CONCLUSIONS: Pulmonary saddle emboli are present in the majority of patients with acute pulmonary embolism. They are often multiple and may be found at different levels of the pulmonary arterial vasculature.

Acute Disease↗

PubMed2001

Significant correlation between the breakpoints of rare clonal aberrations in benign solid tumors and the assignment of HMGIY retropseudogenes.

Recently, we described a mechanism by which a retropseudogene, during evolution, becomes an exon of a pre-existing active gene. Similar mechanisms may account for the activation of processed genes by chromosomal rearrangements in neoplasms. Because genes of the high-mobility group protein family HMGI(Y) are known to be involved in the development of a variety of benign solid tumors, it was the aim of the present study to analyze breakpoints of clonal chromosome abnormalities in that group of benign tumors for a possible correlation with retropseudogenes of the HMGIY gene. Whereas the HMGIYL1 retrospeudogene has recently been mapped to Xp22.1, we assigned a further retropseudogene by FISH to 4q13, and database research allowed us to assign a third retropseudogene to 12q24.1. Sequence analyses of these retropseudogenes revealed high-identity indices to the HMGIY gene and no frame-shift divergences. Breakpoint information was obtained from cytogenetic aberrations in uterine leiomyomas, lipomas, pleomorphic adenomas, and pulmonary chondroid hamartomas because, in all of these tumor entities, cytogenetic subgroups involving genes of the HMGI(Y) family exist. Chromosomal bands harboring HMGIY retropseudogenes were affected with a significantly higher frequency than expected under the assumption of purely randomly occurring breakages. These results support our hypothesis that HMGIY-related retropseudogenes can be affected by chromosomal rearrangements in benign human tumors.

Base Sequence↗

PubMed2001

Coronary magnetic resonance angiography: experimental evaluation of the new rapid clearance blood pool contrast medium P792.

The signal-enhancing characteristics of a new monodisperse monogadolinated macromolecular MR contrast medium (P792) were evaluated for magnetic resonance angiography (MRA) of the coronary arteries. A total of 15 cardiac examinations were performed in pigs at 1.5 T using a 3D gradient-echo sequence. Images were acquired during breath-hold before and up to 35 min after IV injection of Gd-DTPA (0.3 mmol Gd/kg), Gd-BOPTA (0.2 mmol Gd/kg), and P792 (13 micromol Gd/kg). An increase in the signal-to-noise ratio (SNR) of 97% +/- 17%, 108% +/- 37%, and 109% +/- 31% in coronary arteries and of 82% +/- 19%, 82% +/- 24%, and 28% +/- 18% in myocardium, respectively, was measured during the first postcontrast acquisition. The blood-to-myocardium signal-difference-to-noise ratio (SDNR) was significantly higher for P792 than for the other Gd compounds (P <.05) for up to 15 min after injection. Qualitative assessment showed that visualization of the coronary arteries and their branches was significantly better for P792 compared to the low-molecular Gd compounds (P <.05). The blood pool contrast medium P792 is well suited for MRA of the coronary arteries.

Animals↗

PubMed2001

[Virtual bronchoscopy].

Flexible bronchoscopy represents a clinically well-established invasive diagnostic tool. Virtual bronchoscopies, calculated from thin-slice CT sections, allow astonishing immitations of reality although principal differences exist between both technologies: the fact that colour representation is artificial and concommitant interventions are impossible limits the clinical use of virtual bronchoscopy. However, its value increases when calculations can be attained within minutes due to technological advancements, and when virtually any chest CT is suitable for further postprocessing. Indications, findings and the clinical role of virtual bronchoscopy are discussed.

Bronchoscopy↗