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Biomedical subjects

R Fischbach

Publications and source records attributed to R Fischbach.

At least 73 records · Page 4Linked to original sources

Digital luminescence radiography and conventional radiography in abdominal contrast examinations.

In 326 patients abdominal contrast radiographs were compared to digital luminescence radiographs (DLR) and conventional screen-film system ones. The digital exposure dose was 50% of the conventional. In DLR, 2 different types of postprocessed images were obtained from each data set. A display with low spatial frequency enhancement filtered to look like a conventional radiograph was compared to a display with high spatial frequency enhancement. Conventional and DLR images were evaluated randomly and separately by 4 radiologists by means of a questionnaire. DLR proved to be diagnostically equivalent to the conventional technique with the exception of a slightly diminished visibility of the mucosal pattern. High spatial frequency enhancement did not provide additional diagnostic information and should be dispensed with in abdominal examinations.

Adult↗

Infradiaphragmatic bronchogenic cyst with high CT numbers in a boy with primitive neuroectodermal tumor.

Abdominal bronchogenic cysts are very rare with less than 20 published cases. We report the case of a retroperitoneal bronchogenic cyst in a 12-year-old boy, who initially presented with a primitive neuroectodermal tumor of the pelvis. Computed tomography (CT) showed a small, hyperdense nonenhancing mass adjacent to the right crus of the diaphragm. Follow-up CT after chemotherapy showed a decrease in CT attenuation of this mass, but a slight increase in size. At surgery the mass was loosely attached to the diaphragm and final pathology confirmed the diagnosis of a bronchogenic cyst.

Bronchogenic Cyst↗

CT analysis of temporomandibular joint state in children 5 years after functional treatment of condylar fractures.

This retrospective study assessed the temporomandibular joint (TMJ) state of children who had suffered unilateral condylar fractures at least 5 years before and had been treated by functional orthopedic methods alone. The sample group were examined radiologically by computed tomography (CT) spiral scans which were reformatted to two-dimensional (2-D) images in different anatomic planes and to 3-D reconstructions in various projections. Although the seven patients who formed the sample group showed good-to-excellent functional results, the quantitative and qualitative analysis of the scans revealed alterations of size, shape, bony remodeling, and position of the condyle on the fracture side, as well as adaptive changes of the temporal component of the joint. We recommend spiral CT for assessment of TMJ disorders and fractures of the condyle at the time of injury and for follow-up assessment.

Bone Remodeling↗

[X-ray studies of the peripheral joints: a comparison of digital luminescence radiography (DLR) and film-screen systems].

175 matched skeletal x-ray examinations were carried out by digital luminescent radiography (DLR) and conventional screen-film system combinations. In digital luminescent radiography (DLR) two differently postprocessed images were obtained from one x-ray exposure: A display with low spatial frequency enhancement was opposed to a second display with high edge enhancement. Conventional and digital images were evaluated randomly and separately by four radiologists using a questionnaire. DLR proved to be diagnostically equivalent to the conventional technique except for a diminished visibility of subtle erosions and fissures. As major advantages of DLR maybe pointed out that faulty exposures were avoided by the automatic adjustment of image brightness and that the soft tissue margins could be more easily delineated in displays with high edge enhancement than in conventional radiography. However, digital displays with high edge enhancement did not provide additional diagnostic information and led to artifacts at the edges of metal prostheses.

Adult↗

[An aneurysm of the portal vein].

Portal vein aneurysms are rare. We describe a patient with an aneurysmal dilatation (3 x 4.5 cm) of the right portal vein. Real-time ultrasonography revealed an anechoic lesion communicating with the portal vein, suggesting a portal vein aneurysm. Colour Doppler, contrast-enhanced computed tomography, and portal venography confirmed the diagnosis. No evidence of portal hypertension was found. Follow-up examinations did not reveal a significant change in the size of the aneurysm after 18 months.

Adult↗

[Genetic disposition of atherosclerosis? Case report of a monozygotic pair of twins].

The case of a 64-year old pair of monozygotic male twins with atherosclerotic disease of the iliaca arteries is described and the related literature dealing with the genetics of atherosclerosis is reviewed. Both patients had corresponding clinical history and physical findings and showed an almost identically localised and a high degree of stenosis of the right iliac artery of similar appearance. In both cases percutaneous transluminal angioplasty (PTA) was performed prior to placement of Plamaz stents. The well-known risk factors of atherosclerosis are hypertension, hypercholesterolaemia, cigarette smoking, diabetes mellitus, obesity, physical inactivity, and psychosocial influences. However, a number of atherosclerotic lesions cannot be accounted for solely on the basis of current knowledge of these risk factors. The reported case produces evidence of genetic factors as contributing components in the pathogenesis of established atherosclerotic disease.

Arteriosclerosis↗

[Acute adverse effects and complications of central venous digital subtraction angiography (DSA). Results of 2,600 studies].

Side-effects and complications from 2,600 intravenous digital-subtraction-angiographies (IV-DSA) are reported. All studies were performed in a standardized technique using a non-ionic contrast agent (Iopromid 370 mg J/ml). Side-effects or complications were noted in 2.5% of all IV-DSA. Most often nausea (0.92%), urticaria (0.5%), angina pectoris (0.5%) and symptomatic alterations of blood-pressure (0.27%) were recorded. 8.4% of all reactions occurred with a delay of at least one hour. All side-effects and complications resolved, partly under symptomatic therapy. In one (0.04%) out of 2,600 studies a severe allergoid reaction occurred, affording intensive-care therapy. With proper patient selection and a suitable technique, IV-DSA may be regarded--within the angiographic methods--as a procedure of relatively low risk.

Aged↗

[Stents in iliac vascular changes].

The results of 79 iliac stent placements in 64 patients are reported. The technical success rate was 96%. The systolic pressure gradient dropped from 44 mmHg before to 2.8 mmHg after stent placement. This differed significantly as compared to a group treated by conventional PTA (gradient 5.8 mmHg). The cumulative patency after 18-20 months was 90%. Angiographic controls up to 19 months after "stenting" demonstrated only one secondary stent occlusion. Iliac stents therefore are a very valuable supplement to classic PTA.

Angioplasty, Balloon↗

[Pulmonary lymphangiomyomatosis].

The case of a woman of 48 years of age suffering from pulmonary lymphangiomyomatosis is presented. Chest radiographs showed the reticular infiltrate of diffuse interstitial lung disease, whereas high resolution CT illustrated multiple, well-defined cystic lesions distributed diffusely through the lungs without fibrotic changes or nodular densities. The patient underwent open lung biopsy and pleurodesis because of recurrent pneumothorax. Treatment with medroxyprogesterone was initiated.

Female↗

Potentiation of the pressor effect of intravenously administered tyramine during moclobemide treatment.

Potentiation of the pressor effect of tyramine (TYR) by intravenous (i.v.) injection during moclobemide treatment was investigated in healthy volunteers and in depressed patients. The TYR sensitivity factor (TSF) is calculated as the ratio between the dose of TYR required to raise systolic blood pressure by 30 mmHg (TYR 30) without drug and that required with drug. After single-dose administration the TYR 30 for 100 mg moclobemide was 1.8 mg, and those for moclobemide 200 and 300 mg 1.6, compared with 3.2 for placebo, giving corresponding TSF values of 1.7, 2.0 and 2.0 respectively. Twenty-four hours after moclobemide intake, only the 300-mg dose yielded a mean TYR 30 value significantly different from placebo. The same doses of moclobemide given 3 times daily for 1 week resulted in a peak TSF of 2.0 with 100 mg, 2.9 with 200 mg and 3.3 with 300 mg (the latter dose being higher than normally recommended for 3 times daily administration). Nevertheless, 24 h after the last 300-mg dose the TSF was 1.2, similar to that of a single dose. In a study of 17 depressed female patients treated with moclobemide 100 mg 3 times daily, no relevant differences were found in TSF values from those of the volunteers. The authors conclude that, because of the short-lasting, reversible and selective MAO-A-inhibiting effect of moclobemide, there is no marked interaction with tyramine given by i.v. injection. No relevant difference was seen between depressed patients and healthy volunteers in the tyramine pressor effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗

Interaction studies with moclobemide.

Drug interactions with moclobemide given to healthy subjects and depressed patients are reviewed. The drugs investigated for safety were antihypertensives, digoxin, oral contraceptives, anticoagulants and benzodiazepines. Cimetidine was studied for the pharmacokinetic effect, and possible interactions with alcohol (stimulation and/or sedation) were included. Finally, since inhibition of monoamine oxidase (MAO) can increase noradrenergic transmission, possible interaction with neuronal reuptake inhibitors such as tricyclic antidepressants (TCAs) was investigated. Whereas replacement of the older, irreversible MAO inhibitors by a TCA was held to be dangerous and to require a therapy-free interval, the studies reviewed here provide evidence that amitriptyline can replace or be added to moclobemide without any sign of impaired tolerance, need for dose reduction or a therapy-free interval. Combined administration of moclobemide and desipramine was also tolerated well. Moclobemide did not interact with the direct-interacting sympathomimetics norepinephrine and isoproterenol and only to a negligible extent with phenylephrine. The combination of moclobemide with antihypertensive agents did not cause postural hypotension or an increase in other side effects. No clinically relevant interaction was observed between moclobemide and phenprocoumon, glibenclamide, oral contraceptives, digoxin or benzodiazepines. Cimetidine increased the concentration of moclobemide in plasma after a single oral dose by about 100%. If moclobemide is to be used in a patient pretreated with cimetidine, treatment should therefore start with the lowest therapeutic dose and then be adjusted to clinical needs. Since moclobemide is devoid of anticholinergic effects, no interaction with alcohol was anticipated. High therapeutic doses (600 mg/day) induced an effect similar to that of low doses of a TCA, but with 100-300 mg no interaction with alcohol was seen, even in elderly people.

Antidepressive Agents↗

[Ergotism: an occasional unrecognized cause of acute ischemia of the extremities].

Vasospasm related to ergot intoxication has been recognised since the Middle Ages when it occurred due to ingestion of rye contaminated with Claviceps purpurea. Today ergotism is a rare cause of peripheral ischaemia, most often associated with ergotamine tartrate therapy for migraine headaches. Recognition of the typical angiographic pattern is important, as the classic drug history may not be obtained, and the cause of the ischaemia can be overlooked. Early diagnosis is important as the outcome may be serious if left untreated. Arterial vasospasm, collateralisation, and secondary thrombus formation are the major angiographic findings. Ergotism responds to conservative therapy which includes drug withdrawal, intravenous nitroprusside, fluid therapy and heparinisation. We describe the angiographic findings of four cases and report on the results of therapy.

Adult↗

[Chronic small bowel invagination due to leiomyoma].

A case of chronic intussusception of the distal ileum due to leiomyoma is reported. The vague abdominal symptoms lead to an extensive endoscopic and radiologic diagnostic work-up. Preoperative diagnosis was achieved by enteroclysis. The radiologic as well as intraoperative findings are described and the importance of enteroclysis in small bowel examinations is stressed.

Chronic Disease↗

Efficacy and tolerability of moclobemide compared with imipramine in depressive disorder (DSM-III): an Austrian double-blind, multicentre study.

The antidepressant efficacy, tolerability, and safety of moclobemide, a reversible, monoamine oxidase-A inhibitor, were compared with those of imipramine in parallel groups of patients with a major depressive episode, in a 4-week, multicentre (17 centres), randomised study. A total of 381 patients were randomly allocated to either treatment; they were not required to avoid tyramine-rich foods. Drop-out rates were comparable in both groups at about 17%. Judged primarily on the HRSD, no significant differences in efficacy were observed between the groups, but the number of patients presenting with adverse events, as well as the total number of adverse events, was greater with imipramine. Cardiovascular tolerability was satisfactory and physical examination, body weight, and laboratory values were essentially unaffected in both groups.

Adjustment Disorders↗

Evaluation of daunomycin toxicity on lens epithelium in vitro.

Posterior capsule opacification is the major complication of extracapsular cataract extraction (ECCE). Lens epithelial cells derived from the periphery of the lens are thought to migrate posteriorly and contribute significantly to the postoperative proliferations at the posterior pole. We have evaluated the effects of the antiproliferative drug daunomycin on cultured porcine lens epithelial cell viability and proliferation. We observed that the mitotic activity of the cells is suppressed by a single short time treatment with daunomycin at a concentration as low as 2.5 mg/l. Long term effects on the reproductive capacity of the lens epithelial cells may not be as pronounced as the inhibition of other cells examined before e.g. retinal pigment epithelium and fibroblasts. Our results indicate that daunomycin may be useful for the pharmacologic prevention of postoperative proliferations in patients treated by ECCE.

Animals↗