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Biomedical subjects

P Stoeter

Publications and source records attributed to P Stoeter.

At least 55 records · Page 3Linked to original sources
PubMed1996

Clinical and neuroradiological findings in classic infantile and late-onset globoid-cell leukodystrophy (Krabbe disease).

In the present study the clinical course and imaging of early and late-onset forms of Krabbe disease are analyzed. We report on 11 patients with a biochemical diagnosis of galactosyl ceramide beta-galactoside deficiency. Two presented as the classic infantile form and died within the second year of life. In 9 children the first clinical signs, such as gait difficulties and visual failure, started after age 2 years. All these patients developed slow regression of motor and mental capacities, and most of them died within their first decade. In patients of both groups computed tomography (CT) and magnetic resonance imaging (MRI) were performed. In the late-onset form, hypodensities of the central white matter and pyramidal tracts were the leading radiological signs, whereas in the early-onset form, hyperdensities and cerebellar white matter lesions were also detected. From our results it becomes clear that variability of Krabbe disease refers not only to clinical manifestation but also to CT and MRI findings. Better knowledge of phenotypic and radiological diversity will help to understand the pathogenesis of the disease.

Age of Onset↗
PubMed1990

[The basis for ultrasonic phenomena during the injection of x-ray contrast media].

During the injection of contrast media for cerebral angiography, high-intensity ultrasound reflections can be recorded by Doppler sonography and B-mode scanning. This phenomenon was examined during carotid angiography and by in vitro experiments in tube models. Our results show that these high-intensity reflections are caused by: (1) transient interfaces of impedance between small compartments of contrast medium and blood and (2) small gas bubbles, which are always present in freshly aspirated contrast medium. Therefore, intraarterially injected contrast medium acts as an ultrasound contrast medium as well.

Adult↗
PubMed1989

[Synchronous pulse changes in contrast density during carotid angiography].

The relationship between maximal contrast density in DSA and blood flow in doppler sonography was examined in tube model studies and in carotid angiography. During pulsatile flow, pulse-synchronous changes of contrast density can be registered. The maxima of opacification coincide with the doppler-sonographic phase of re-increasing blood flow after a preceding depression. This is caused by the accumulation of contrast medium at the tip of the catheter during diastole and the subsequent dilution of contrast medium by the increasing blood flow during systole. In model studies as well as in angiography, the time interval between the doppler-sonographic maximum of flow and the maximum of contrast density is very constant and is prolonged with increasing distance from the tip of the catheter. This latency between 2 maxima which are registered at the same region of interest, is caused by the higher speed of propagation of the flow wave compared to the actual movement of the blood corpuscles and contrast medium. The understanding of the relationship between cardiac action, blood flow, and contrast density may improve the functional interpretation of angiograms.

Adult↗
PubMed1987

CT-findings in haemorrhages from aneurysms of the anterior communicating artery: correlation with angiography and clinical course.

CT findings, angiography and clinical course were analyzed in a series of 31 patients with a recent subarachnoid haemorrhage (SAH) from an aneurysm of the anterior communicating artery (ACoAA). It is shown that 3 types of bleedings can be distinguished according to the CT findings. In the first group (52%), suffering a mild or moderate bleeding into the basal cisterns and/or the cisterna lamina terminalis, the aneurysm mostly points downwards and is orientated straight in the midline, the Hunt and Hess Grade at admission is I or II and the prognosis following early surgery is good. In the second group (29%), the aneurysm mostly is orientated towards one side, additional bleeding occurs into the gyrus rectus and the mediobasal frontal lobe, they are in HH Grade II and III and the prognosis following surgery also is relatively good. In group three (19%) however, the aneurysm points upwards, they present with severe bleeding into the cisterna lamina terminalis, the cavum septum pellucidum and rupture into the putamen, hypothalamus and the ventricle. In this group, the HH grade at admission is IV or V and the prognosis is extremely unfavourable. It is concluded, that this classification may be used for decision on early surgery.

Adult↗
PubMed1987

[Subclavian steal: transcranial Doppler sonography of the basilar artery].

In 32 patients with high-grade obstruction of the proximal subclavian artery or of the brachiocephalic trunk and complete or incomplete forms of subclavian steal in the ipsilateral vertebral artery, blood flow in the basilar artery was investigated by transcranial Doppler sonography. With complete steal effect in respect of the vertebral artery, we found, contrary to other investigators, in most cases alterations of the flow in the basilar artery even at rest. These alterations are a systolic deceleration of flow velocity or an alternating flow directed towards the arm in systole and towards the brain in diastole. In about 40% of cases blood flow in the basilar artery could not be assessed, either because the depth of investigation reached was too low, or because--especially in cases with systolic deceleration in one vertebral artery--it was impossible to define the origin of the basilar artery.

Arm↗
PubMed1986

Transcranial Doppler monitoring of blood flow in the middle cerebral artery during angiography and drug perfusion.

With the new technique of transcranial Doppler sonography it is possible to record transient changes of blood flow within the major basal cerebral arteries. The injection of saline and contrast medium into the internal carotid artery is followed immediately by a marked turbulence of flow within the middle cerebral artery depending on the amount and pressure of the injected material. In addition, the flow in the middle cerebral artery is increased by the injection of saline, but reduced by the injection of contrast medium for 3 to 4 seconds and finally increased for 8 to 10 seconds. No changes are seen on the contralateral side. The recordings of blood flow within the middle cerebral artery during 1.3-bis(2-chlorethyl)nitrosurea (BCNU) perfusion of glioblastoma recurrences via a flow-directed balloon catheter showed no obvious alterations during injections into the upper part of the carotid siphon, but a marked reduction of diastolic flow during injections into the middle cerebral artery. The reduction of flow may explain some of the complications of angiography.

Adult↗
PubMed1984

Doppler-sonographic examination of the arterial flow in the carotid and supratrochlear arteries during carotid angiography.

In 55 patients, the blood flow in the carotid and supratrochlear arteries was examined by Doppler sonography during cerebral angiography. In general, a threefold response was observed: an initial phase of turbulence during the injection was followed by a phase of depressed and then of increased arterial flow. The second phase of reduced perfusion which probably is caused by the increased viscosity of the mixture of contrast medium and blood, is more pronounced in the internal carotid artery, whereas the third phase of accelerated flow is more marked in the external carotid artery. In patients with an occlusion of the internal carotid artery, the cerebral blood supply often depends on the collateral pathway via the ophthalmic artery. In these cases, the reduction of the blood flow is specially marked and long-lasting, as we could show. This may contribute to a higher angiographic risk of those cases with an important ophthalmic collateral flow.

Adolescent↗
PubMed1983

[Diagnosis and therapy of lateral intervertebral disk displacements. I. Normal roentgen anatomy of the lumbar nerve roots in computer tomography].

As a basis for the CT diagnosis of lateral disc herniations, the normal anatomy of the nerve roots from L4 to S1 within the lateral recess, is described and compared with the myelographic and CT findings. In myelograms, the roots can be demonstrated from where they leave the dural sac, for about the height of one vertebral body as far as the spinal ganglion in the upper part of the intervertebral foramen, where the subarachnoid space terminates. By non-enhanced CT, the roots can be distinguished from the surrounding fat only in the widening lower part of the lateral recess. The ganglion and the spinal nerve can be shown in the intervertebral foramen and further distally where they can no longer be seen on the myelogram,. Thus, of both these complementary techniques, CT s more suitable for the diagnosis of lateral disc herniations.

Humans↗
PubMed1983

[Diagnosis and treatment of lateral disc herniations. II. Classification, pathomechanical aspects of development, radiological demonstration, and operative approach].

Lateral disc herniations can be classified into three types according to their location. Type I is a prolapse within the lateral recess. In myelograms, it compresses the lateral part of the dural sac and the adjacent nerve root which is running to the intervertebral foramen below. Type II is situated at the entrance of the intervertebral foramen and compresses the adjacent nerve root only. The extreme lateral prolapse of type III compresses the ganglion within the intervertebral foramen, but often does not produce myelographic findings. All three types, especially the extreme lateral prolapse without myelographic changes, can also be demonstrated directly by the non-enhanced CT examination. The best operative approach, which depends on the location of each prolapse, is described.

Humans↗
PubMed1983

[The reliability of computer tomography in the diagnosis of recurrent symptoms after lumbar disc operations].

In 67 patients with recurrent complaints after operations of herniated lumbar disks, the CT findings were compared with the results of the subsequent second operation. Postoperative complications as haemorrhages or inflammations appear as localised or diffuse densities within the spinal canal in the operated segment and can be diagnosed without difficulty. The differentiation between a true recurrent herniation and scar formation is difficult, mainly within the first 4 weeks after operation. Even with the administration of iv. contrast medium, the diagnostic accuracy is not higher than 70%. In addition to the enhancement effect, which is not always reliable, the shape, position and density of a suspected structure can be used as diagnostic criteria.

Adult↗
PubMed1983

[Successful treatment of brain metastases in breast cancer with blood-brain barrier-impervious cytostatics and hormones].

11 patients (age 36-60 years) with breast cancer and CT-scan documented brain metastases (BM) were treated with hormonochemotherapy: 5-fluorouracil 500 mg/m2 i.v. day 1 + 8, adriamycin 50 mg/m2 i.v. day 1, cyclophosphamide 500 mg/m2 i.v. day 1-q4 weeks (FAC) and tamoxifen (TXF) 20 mg/day per os. Ovarectomy was carried out in 3 praemenopausal patients. In 3 cases single BM were surgically resected (2 subtotal, 1 total). One patient was shunted due to a hydrocephalus occlusus. Complete response (CR), i.e. normalization of CT-scan and disappearance of CNS related symptoms, was achieved in 9 out of 11 patients. One patient with partial remission (PR) and another with progressive disease died 6 and 5 months after diagnosis of BM. The median duration of remissions of all patients was 12 (5-43) months. The median survival time from diagnosis of BM was 15 (5-44) months and from mastectomy 46 (26-142) months. The cumulative probability of surviving was 63% one year after diagnosis of BM. One relapsing patient achieved a second CR, another a PR by whole brain irradiation. 4 patients survived more than 18 months from the diagnosis of BM. It appears that chemo-hormonotherapy provides a rational approach to palliation in breast cancer patients with BM in prolonging the survival.

Adult↗
PubMed1983

[Prenatal development of cerebral veins and sinuses with variants and dysplasias].

A review is given on the development of the cerebral veins and sinuses in man illustrated by schematic drawings and phlebograms of comparable embryos and fetuses of higher vertebrates. The system of venous sinuses arises early in development from three dural plexuses and the primary head sinus according to a constant pattern. The internal cerebral veins and particularly the temporo-basal veins arise at a later stage from longitudinal anastomoses of ventral segmental veins of the pial venous plexus of the brainstem. Accordingly they exhibit a high degree of variability in the adult.

Brain↗
PubMed1982

[CT differential diagnosis and findings in intracerebral haemorrhage (author's transl)].

The CT findings of 73 patients with spontaneous and traumatic intracerebral haematomas are described. The course and pattern of resorption of the bleeding is evaluated. It is shown that the resorption of all haematomas is terminated by the end of week 7 independent of their maximum diameter. Only smaller haemorrhage of less than 2 cm can be resorbed in a shorter time. Moreover, the underlying pathophysiologic mechanisms of faster resorption of bleeding located in the basal ganglia and the neighbouring white matter are discussed. The CT findings revealed no clear-cut characteristics for differential diagnosis of the etiology of haematomas, but proved very helpful in defining the prognosis.

Adolescent↗
PubMed1982

[The value of CT in the diagnosis of traumatic fronto-basal CSF fistulae (author's transl)].

In 20 patients with fronto-basal CSF fistulae, radiograms, tomograms and CTs in the axial and coronal projection were taken before operation. The evaluation showed that small fractures of the cribriform lamina could be demonstrated most clearly by CT with narrow coronal sections. Although the resolution properties of CT is still inferior to that of tomography for small osseous fissures, good CT results could be achieved by the better demonstration of accompanying mucosal swelling and/or small effusions. Fractures of the walls of the frontal sinuses, on the other hand, where shown better by tomography and those of the frontal calotte by normal radiograms.

Adolescent↗
PubMed1982

[Diagnostic importance of CT examination of the lumbosacral region of patients with lumbo-sciatica (author's transl].

In 160 patients with lumbo-sciatic complaints, CT examinations of the lumbo-sacral region were carried out. In 106 of these cases, which were controlled by myelography and/or operation, the CT diagnosis was correct in 74%. In 19%, the CT findings were uncertain, and in 7% they were wrong. A reliable CT diagnosis could be made mainly in the case of a medial or medio-lateral disc herniation of a size above 0.5 cm in diameter if the patient was not operated previously, and in extremely lateral prolapses into the intervertebral foramen without myelographic changes. Small medial protrusions, specially within a narrow spinal canal, or postoperative controls often gave rise to uncertain findings. However, osseous changes as compressions of the lateral recess or the narrow spine syndrome were demonstrated usually better by CT than on routine radiograms. Nevertheless, the indication for the performance of a lumbo-sacral CT should be kept narrow and should be limited to cases with clear-cut radicular signs.

Adult↗