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Biomedical subjects

R Felix

Publications and source records attributed to R Felix.

At least 433 records · Page 24Linked to original sources

[Spondylitis: borderline findings in magnetic resonance tomography].

MR studies of 41 patients with confirmed spondylitis were evaluated with regard to imaging findings resembling metastases or fracture. 30 patients had MR results considered typical for spondylitis (contiguous changes in two vertebrae and disc, soft tissue tumour). 11 patients had MR studies differing from this pattern. Absence of soft tissue involvement and discontinuous marrow changes may be misdiagnosed as bone marrow metastases.

Adult↗

[Brain SPECT with 123I-lisuride in patients with Parkinson's disease and controls].

The goal was to visualize cerebral dopamine-D2 receptors in 6 patients with Parkinson's disease and in 3 healthy controls using iodine-123-Lisuride-SPECT. In addition, we performed receptor-replacement studies using 123I-Lisuride and cold Lisuride as competitive ligands. The highest uptake of 123I-Lisuride was observed in the striatum, a region with known high dopamine receptor density. In two patients premedication with cold Lisuride displaced 123I-Lisuride from the dopamine receptor. 123I-Lisuride is valuable as a radiotracer in cerebral dopamine-D2 receptor scintigraphy. Whether or not it is possible to determine dynamic changes of dopamine receptor density or function by receptor replacement studies needs further evaluation in larger patient populations.

Adult↗

[Diagnostic significance and therapeutic consequences of computerized tomography (patient outcome research). II: General surgical diagnosis].

Computed tomography is one of the indispensable diagnostic methods in the treatment of many surgical patients. On the other hand, the high cost of equipment and effort and the expensive examination must be taken into account. For the purposes of a patient-outcome study all CT examinations of surgical patients performed in March to May 1993 were analysed under medical and economic aspects. 49% of the 210 examinations (153 patients) were primary examinations, 51% served as control examinations. In 61% the diagnosis was already known, but additional information with decisive influence on the further treatment was obtained. In 17% the supposed diagnosis could be verified and in 22% it was rejected. In 170 examinations (81%) the necessity of an operation was the question. 53% of all CT examinations revealed that indication for an operation was absent, and in 28% an operative intervention was performed. The CT examination of surgical patients cannot be substituted by lower-cost methods. The use of an efficient planning of the therapeutic procedures, shortcutting of many other diagnostic examinations, and the avoidance of unnecessary surgical interventions result in shortening the duration of treatment and are instrumental in reducing the total treatment cost.

Adult↗

[Estimating patient dosage in radiologic examinations. Effective doses of the most frequent roentgen examinations].

The effective dose (E) measures the stochastic risk of radiation exposure from the viewpoint of the induction of cancer and genetic diseases. In order to compare this risk in roentgen examinations, the effective dose was calculated for the most frequent roentgen examinations. The calculations were performed with a mathematical human phantom for a standard patient. Acquisition parameters were chosen according to national recommendations. The highest values were found for the small bowel enema and lumbar myelography, the lowest values for X-rays of the cervical spine, the paranasal sinuses and the upper thigh.

Body Burden↗

[Laser-induced thermotherapy of liver metastases with MRI control. Prospective results of an optimized therapy procedure].

In a prospective study MR-guided laser-induced thermotherapy (LITT) of liver metastases was optimized and the clinical parameters evaluated. Seventeen patients (4 women, 13 men) with a total of 29 lesions underwent LITT in 25 sessions through 1 March 1994. Twelve of them suffered from colorectal carcinomas, 5 from other primary tumors. Under local anesthesia a maximum of 5 lesions per patient were treated. For MR-guided LITT a neodymium yttrium aluminum garnet laser (Nd-YAG 1064 nm) with energy varying from 3 to 7.5 W was used. Energy and application time were defined through a computer program; they varied, dependent on the lesion size, location and consistency. To monitor the progress of LITT two special thermosensitive MR sequences (Thermo-Turbo-FLASH and FLASH-2D sequences) were individually optimized, whereby the increase in temperature correlates with an increase in signal loss. All procedures were well tolerated without significant early or late side effects. In only one patient was minimal air documentated in the pleural cavity with spontaneous resorption. Patients were dismissed without complaints after 24-h hospitalization. The control parameters of the contrast-enhanced dynamic MRI documented at optimal response a hypointense signal around the tip of the laser applicator, in accordance with laser-induced necrosis. In lesions 20 mm or smaller, nearly 100% tumor necrosis was achieved and in lesions larger than 20 mm, only 50%. Follow-up evaluation 6 months after treatment shows a significantly better response in lesions with a diameter of 20 mm or smaller, with a local tumor control rate of 66%. In lesions larger than 20 mm only a local tumor control rate of 35% could be achieved. Laser-induced thermotherapy (LITT) represents a new, minimally invasive technique for tumor destruction and a high response rate in small liver metastases.

Adult↗

[Multiple slab MR angiography of the A. carotis interna: a preoperative comparative study].

PURPOSE: With the introduction of MR angiography (MRA) into clinical routine, arteriosclerotic lesions of the supraaortic vessels may be well demonstrated. MATERIAL AND METHODS: The comparison between Multislab MRA (gradient echo, TOF) and X-ray angiography (XRA) as reference in 70 patients suspicious of stenotic lesions in the internal carotid artery proved the high reliability of these methods. RESULTS: In determining the degree of stenosis, according to the NASCET study (North American Symptomatic Endarterectomy Trial), a correlation between MRA and XRA of 92.3% could be calculated. The principal problem of MRA is the overestimation of high-grade stenoses; we observed 5 false-positive results in severe stenosis. Sensitivity and specificity were 95.6 and 92.6%, respectively, for detection of severe (> 60%) stenosis. CONCLUSION: Despite its limitations, MRA is a clinically important noninvasive technique for preoperative evaluation of patients undergoing carotid endarterectomy.

Adult↗

[Diagnostic value and therapeutic consequences of computerized tomography (patient outcome research)--1: Diagnosis in traumatology].

During three months of 1993, 201 primary traumatologic patients (125 m, 76 f, x = 42.6 years) underwent 230 computed tomography examinations (= one CT of one body region) in the radiologic department of the Rudolf Virchow University Hospital. 87.0% of the CT's were performed completely without contrast media, 2.6% exclusively supported by intravenously given contrast media, 9.1% in both ways, and 1.3% after intra-articular contrast media administration. 97.4% served for primary diagnostic purposes and 2.6% for the control of therapeutic results. In 47.8% of the CT's, the principle diagnosis in the scanned body region was known before CT, i.e. by conventional X-ray examinations, but further detailed information was necessary to clarify the indication for operation and to choose the operative mode. In 52.2%, the diagnosis without CT was impossible by other, non-invasive and not more expensive methods. The CT diagnoses were correctly positive in 58.7% (suspected diagnosis verified, additional detail information...) and correctly negative in 41.3% (suspected diagnosis excluded). 60.9% of CT's demonstrated a missing indication for operation in the examined body region; in 39.1% the operation followed. The most frequently performed diagnostic methods before CT were conventional X-ray and sonography, whereas after CT further examinations were seldom needed. We conclude that traumatologic CT's contribute decisively to the reduction of costs by avoiding more expensive examination methods, avoiding redundant operations, and abridging stay duration in the hospital because of more efficient therapy planning.

Abscess↗

[Digital image intensification radiography in endoscopic retrograde cholangiopancreatography].

The standard in ERCP is the use of the conventional radiography system. Digital radiography system are very seldom used in ERCP, and then mostly by digital luminescence radiography. In this study we report our experience with digital image amplification radiography (DIAR) in ERCP. We examined 53 patients of clinical routine aged from 21 to 90 years. During the ERCP we used the X-ray statues and the real-time exposures. At the end of an examination the image post-processing followed. Both conventional and digital image amplification radiography needed the same examination conditions. The special X-ray protection (special lead-shields) used at digital ERCP did not hinder the examination. The DIAR provided at least the same amount of information as conventional radiography. An advantage of DIAR is the possibility of image post-processing such as contrast change, zooming, etc., and the digital archiving and communication. The examination time was reduced by about 30% as compared conventional ERCP, resulting in a reduction of the X-ray exposure time for the patients. The disadvantages of DIAR can surely be compensated by a high ERCP-rate.

Adult↗

[Tuberculosis and radiologic diagnosis 100 years after W. C. Roentgen].

The discovery of the x-rays by W. C. Roentgen 100 years ago significantly improved the diagnosis and follow-up of tuberculosis, therapy control became possible, and the basis for prevention was set by early detection. Within few years, the "Roentgen" rays had been made a triumphant progress around the world, and Roentgenology was established as an independent medical discipline. Even after a century of developments like tomography, ultrasound, conventional/-high resolution and spiral computed tomography, digital radiography, digital subtraction angiography, and magnetic resonance imaging, innovations in the field of medical imaging appear to be unlimited, an evolution, which had been initiated by Roentgen. Today, therapists and radiologists are again challenged by the renaissance of tuberculosis, partially in new "clothes" by increasing numbers of HIV-patients. These specific changes clinically and radiological often appear atypical, and require subtile radiological diagnostics with the use of new imaging modalities. CT and MRI allow for follow-up of chemotherapy in mediastinal lymph node disease, significantly improve pleural diagnosis, and both are methods of choice in vertebral and cerebral tuberculous disease. Digital radiography and digital net-work allow for x-rays at the lowest dose, improved comparison in the follow-up, as well as for "online"-evaluation of images on the department's screen. Today, optimal diagnosis of tuberculosis includes the bacteriologic and clinical diagnosis and radiological imaging. To face the challenge of recurrent tuberculosis in in the second century after after Roentgen successfully, an intensive interdisciplinary cooperation of therapists and radiologists is necessary.

Diagnostic Imaging↗

[Diagnostic results of abdominal computerized tomography in HIV-infected patients].

The exact frequency of pathologic findings in abdominal computed tomograms of HIV-infected patients is not yet known. To analyse such findings, CT scans of 339 HIV-infected patients were reviewed. While over four fifths of patients displayed abnormal findings; hepatosplenomegaly, lymphadenopathy, pathologically enlarged lymph nodes, and bowel wall thickening were the most common signs of disease. Only for enlarged lymph nodes could a dependency on clinical stage of the infection be demonstrated. As a conclusion, abdominal computed tomography reveals pathologic findings in the vast majority of HIV-infected patients, almost independent of clinical stage. Specifically, CT provides well documented lymph node staging. There are practically no age-or sex-dependent disease patterns in abdominal CT scans.

AIDS-Related Opportunistic Infections↗

[Space-occupying lesions of the lacrimal gland in CT and MRI exemplified by 4 cases].

In an extended case report, we discuss four cases with masses in the lacrimal fossa representing the most important entities in this region (lymphoma, pleomorphadenoma, inflammatory pseudotumor, and malignant epithelial tumor). The different indications for CT and MRI are explained. For the differential diagnosis of lacrimal gland lesions, the following imaging parameters are important: the shape of the lacrimal gland, the inner structure, the degree of contrast enhancement, and the surrounding bony structures. In the evaluation of the expansion of lacrimal gland lesions, CT in thin slices with multiplanar reconstructions is equal to MRI. However, the contrast-enhancement of lacrimal glands is better evaluated with MRI than with CT. The bony structures are better visualized on CT than on MRI.

Adenoma, Pleomorphic↗

[Differential diagnosis of focal liver lesions with MRI using the superparamagnetic contrast medium endorem].

PURPOSE: In a phase III/III-B trial the specific contrast enhancement of benign liver tumors, especially FNH and adenoma, versus malignant liver tumors such as HCC and metastases (colorectal and endocrine tumors) was evaluated using the superparamagnetic iron oxide ENDOREM. MATERIAL AND METHODS: 57 patients were prospectively investigated using T2-(TR/TE=2000/90) and T1-(550/15) weighted spinecho (SE), FLASH-2D-gradientecho (GE), and fat suppressed (FATSAT) sequences before and after administration of ENDOREM (concentration: 0.2 mmol Fe/ml, dose: 15 micromol/kg (b.w.) in transverse slice orientation on a 1.5 Tesla MAGNETOM (Siemens, 63 SP). In 8 patients an in vivo-in vitro correlation 30 minutes after resection was performed. In 12 patients benign primary liver tumors (FNH (n = 10), adenoma (n = 1), and hemangioma (n = 1) were histopathologically proved. Malignant liver tumors (HCC (n = 11, cholangiocarcinoma (n = 1), metastases from colorectal carcinoma (n = 13), and endocrine tumors (n = 4)) were found in 29 patients. 11 patients with liver cirrhosis due to Wilson's disease and 5 with cirrhosis due to other reasons were investigated. RESULTS: Contrast-enhanced studies allowed detection of more lesions in 19 of 41 patients with liver tumors. Benign liver tumors showed significant loss of signal intensity of 43.0% +/- 17.9 for FNH, 32.4% for adenoma and 10.2% for hemangioma in proton density-weighted SE images. Malignant tumors showed only minimal signal loss: HCC: 5.3% +/- 17, cholangiocarcinoma: -1.6%, colorectal: -2.0% +/- 11.1, endocrine metastases: 4.2% +/-4.1. Normal liver parenchyma and spleen tissue demonstrated significant signal loss of 59.2% +/- 14.9 and 42.3 +/- 012.5. In ten patients and 13 lesions of FNH, a capsule was seen in 7.7% plain and 23.1% enhanced. Scar tissue was found in 30.8% plain, 84.6% enhanced. In the patient with adenoma, capsule with contrast enhancement was seen, but no scar was detected, whereas in patients with HCC a capsule was seen in three cases enhanced. Statistical analysis (Friedman-test, Wilcoxon-test) showed a statistically significant difference in signal loss between benign and malignant liver lesions (p < 0.05). CONCLUSION: The use of superparamagnetic iron oxide ENDOREM) allows differentiation of benign and malignant liver tumors on the basis of contrast enhancement, existence and specific enhancement of capsule or scar. In vitro correlation show some limitations of in vivo MRI.

Adenoma, Liver Cell↗

Magnetic resonance perfusion imaging with gadolinium-DTPA. A quantitative approach for the kinetic analysis of first-pass residue curves.

RATIONALE AND OBJECTIVES: To present a mathematic approach for the analysis of first-pass gadolinium (Gd)-DTPA kinetics and to validate the numerical tools using simulated and measured kinetics. METHODS: In a capillary plasma filter, pulsatile flow was varied between 7.4 and 12.6 mL/second. After contrast bolus injection, the arterial input curve and the residue curve were recorded simultaneously. Signal intensity versus time curves were converted to concentration versus time curves. By deconvolution of these curves and tracer kinetic analysis, the mean transit time of the contrast medium through the organ model was calculated. RESULTS: A satisfactory correlation (r = 0.98) between the inverse of mean transit time and flow measured volumetrically was demonstrated. CONCLUSIONS: The kinetic analysis of first-pass curves in an organ model indicates that this approach might be useful for in vivo assessment of organ blood flow.

Blood Flow Velocity↗

c-Fos: a key regulator of osteoclast-macrophage lineage determination and bone remodeling.

Mice lacking the proto-oncogene c-fos develop the bone disease osteopetrosis. Fos mutant mice were found to have a block in the differentiation of bone-resorbing osteoclasts that was intrinsic to hematopoietic cells. Bone marrow transplantation rescued the osteopetrosis, and ectopic c-fos expression overcame this differentiation block. The lack of Fos also caused a lineage shift between osteoclasts and macrophages that resulted in increased numbers of bone marrow macrophages. These results identify Fos as a key regulator of osteoclast-macrophage lineage determination in vivo and provide insights into the molecular mechanisms underlying metabolic bone diseases.

Animals↗

[Therapeutic results of radioiodine therapy of hyperthyroid thyroid gland diseases].

PATIENTS AND METHODS: The result of radioiodine treatment administered to 126 patients with hyperthyroidism between 1986 and 1991 were analysed retrospectively. The indications for radioiodine treatment were single hyperfunctioning nodules (n = 47), multinodular goitre (n = 33), diffuse goitre (n = 19) and Graves' disease (n = 27); the respective doses of 131I, calculated with the Doering and Kramer formula, were 300 Gy (30,000 rad), 150 to 200 Gy (15,000 to 20,000 rad), 100 to 120 Gy (100,000 to 120,000 rad) and 100 Gy (100,000 rad). The uptake of radioiodine was measured on a daily basis and in the case of 46 patients (36.5%) additional treatment given on the third day of treatment. RESULTS: For the patients undergoing regular follow-up, data were collected in 1992, at least six months post-therapy. Evaluation revealed a total applied dose of 131I of 20 +/- 12.4 mCi (median +/- SD) per patient. non-response to treatment making hospitalisation and renewed therapy necessary was observed in 1.6% of the group. In only two further patients did scintigraphy reveal compensated toxic adenoma. In 36% of patients with single hyperfunctioning nodules, 21% of those with multinodular goitre, 53% of those with diffuse goitre and 56% of those with Graves' disease hyperthyroidism was observed. In the great majority of cases, hypothyroidism occurred in the first year following treatment.

Adult↗

Macrophage colony-stimulating factor restores bone resorption in op/op bone in vitro in conjunction with parathyroid hormone or 1,25-dihydroxyvitamin D3.

The in vivo administration of macrophage colony-stimulating factor (M-CSF) restores osteoclastogenesis and bone resorption in the op/op murine osteopetrosis. In vitro, exogenous M-CSF has been shown to be necessary for the generation of osteoclast-like cells in cocultures of hematopoietic and mesenchymal cells obtained from this mutant. In this study we investigated the capacity of M-CSF and other cytokines and hormones, alone or in combination, to induce bone resorption in explants of op/op metatarsals and metacarpals prelabeled with 45Ca. The effect on bone resorption was verified by counting the number of osteoclasts generated in the mineralized matrix. No osteoclast formation and no bone resorption were observed in the absence of M-CSF. M-CSF alone had only a slight effect at the high concentration of 10(4) units/ml. Addition of PTH or 1,25-(OH)2D3 together with M-CSF induced both osteoclastogenesis and bone resorption. The release of 45Ca was linear with time up to 15 days. PTH or 1,25-(OH)2D3 could not be substituted by TNF-alpha or IL-1, whereas IL-6 had a weak effect. M-CSF could not be replaced by GM-CSF. This study further emphasizes the role of M-CSF, PTH, and 1,25-(OH)2D3 in osteoclastogenesis.

Animals↗

Evaluation of urinary pyridinium crosslink excretion as a marker of bone resorption in the rat.

The aim of this study was to evaluate the value of the urinary excretion of the pyridinium crosslinks, pyridinoline (Pyr) and deoxypyridinoline (D-Pyr), as markers of bone resorption in the rat. The excretion of the crosslinks was compared with that of urinary [3H]tetracycline ([3H]TC) excretion from chronically [3H]TC-prelabeled animals, a technique established to monitor bone resorption in the rat. Bone resorption was modulated by Ca restriction, infusion of PTH, thyroparathyroidectomy, and administration of different bisphosphonates. Furthermore, the urinary crosslinks were assessed in three different osteopetrotic mutations in the rat. We found a delayed response of Pyr and D-Pyr excretion to acute changes in bone resorption compared with [3H]TC excretion. This delay was 1 day after Ca restriction and longer after other treatments, such as PTH administration or bisphosphonate treatment, with which it was more than 3 weeks. In contrast, chronic states with stimulation or inhibition of bone resorption showed similar changes in excretion of the urinary crosslinks and [3H]TC, except after PTH administration. The excretion of the crosslinks was greatly reduced in osteopetrotic rats (op/op, tl/tl, and ia/ia) and increased to normal levels in tl/tl rats after stimulation of bone resorption by M-CSF administration. These results suggest that, in rats, urinary excretion of the pyridinium crosslinks reflects bone resorption in chronic but not always in acute conditions. The cause of this discrepancy is still unclear.

Amino Acids↗

Role of colony-stimulating factor-1 in bone metabolism.

Colony-stimulating factor-1 (CSF-1) is a cytokine required for proliferation, differentiation, activity, and survival of cells of the mononuclear phagocytic system. The growth factor is synthesized as a soluble, matrix, or membrane associated molecule. The specific functions of these forms are not clear. However, some data suggest a dependence of the development of various populations of tissue macrophages on the locally expressed and presented cytokine. Deficiency in CSF-1, as is the case in the murine mutant strain op/op, results in low numbers of macrophages and monocytes and, most striking, leads to osteopetrosis due to a virtual absence of osteoclasts. Using the op/op mutation as a model, CSF-1 was established as one of the growth factors for osteoclasts. The expression of CSF-1 receptors, encoded by the proto-oncogene c-fms, by osteoclast precursors and osteoclasts, suggested an effect of this cytokine not only during osteoclast formation but also on the mature cells. In fact, CSF-1 was shown to inhibit the resorbing activity, to stimulate migration, and to support survival of isolated osteoclasts in vitro. By these actions on cells of the osteoclast lineage, CSF-1 induces recruitment of new osteoclasts, leading to a net increase of bone resorption, and might govern the spatial distribution of resorption sites within the bone. During these processes, locally expressed and presented forms of the growth factor may play a crucial role, as will be discussed in this article.

Animals↗