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Biomedical subjects

W Golder

Publications and source records attributed to W Golder.

At least 19 recordsLinked to original sources
PubMed2003

Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system.

OBJECTIVE: To evaluate a magnetic resonance imaging (MRI) scoring system for the assessment of spinal inflammation in patients with ankylosing spondylitis (AS) who participated in a randomized, placebo-controlled trial of infliximab, and to examine whether infliximab is also effective for the reduction of MRI-proven spinal inflammation. METHODS: Twenty patients with AS (9 women and 11 men, mean age 40.9 years) were examined at baseline and after 3 months. Nine patients had received infusions of infliximab (5 mg/kg body weight) at weeks 0, 2, and 6, and 11 patients had received placebo. Three MRI sequences and 2 scoring systems were used. Chronic lesions were evaluated by T1-weighted turbo spin-echo (TSE) sequences and were assigned a chronicity score. Active lesions were evaluated either by repetition of T1-weighted TSE sequences after infusion of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) or by short tau inversion recovery (STIR) sequences, and were assigned an activity score. The 40 images were evaluated twice by 2 readers who were blinded to the names of the patients and the dates of the examinations, and were analyzed in relation to the clinical results. RESULTS: Active spinal lesions were detected in 15 of 20 patients (75%); the frequency as determined by STIR was equal in the 2 groups. At baseline, the total MRI scores determined using Gd-DTPA, STIR, and T1 were 112.5, 156, and 253.5, respectively. The interrater variance and intrarater variance were, respectively, 6.4 and 7.7 for the active lesion score as determined by Gd-DTPA, 15.7 and 5.3 for the active lesion score as determined by STIR sequence, and 167.3 and 75.5 for the chronic lesion score as determined by T1 sequence. Based on the means of the scores assigned by the 2 readers, the active lesion score as determined by Gd-DTPA improved by 40% in the infliximab group compared with 6% in the placebo group, the active lesion score as determined by STIR improved by 60% in the infliximab group but deteriorated by 21% in the placebo group, and the chronic lesion score as determined by T1 improved by 7% in the infliximab group but worsened by 35% in the placebo group. Five patients in the infliximab group and 2 in the placebo group were clinical responders. The acute MRI changes correlated with clinical improvement as assessed by the Bath Ankylosing Spondylitis Disease Activity Index. CONCLUSION: This novel MRI scoring system performed well in assessing acute inflammation by using STIR and post-Gd-DTPA sequences. In correlation with clinical improvement in patients with active AS who were treated with infliximab, significant regression of spinal inflammation was shown by using the MRI activity scores.

Adult↗
PubMed2003

Long-term efficacy and safety of infliximab in the treatment of ankylosing spondylitis: an open, observational, extension study of a three-month, randomized, placebo-controlled trial.

OBJECTIVE: Treatment of ankylosing spondylitis (AS) with infliximab, an anti-tumor necrosis factor alpha monoclonal antibody, was shown to be efficacious in patients with active disease during a 3-month treatment period. The purpose of this study was to evaluate the efficacy and safety of infliximab treatment of AS for a 1-year period. METHODS: This study was an open, observational, extension study of a 3-month, randomized, placebo-controlled trial. All patients who had tolerated infliximab (infliximab/infliximab group) or placebo (placebo/infliximab 12-week crossover group) therapy for 3 months entered the open extension trial (n = 65). Infliximab was administered at a dosage of 5 mg/kg every 6 weeks after the induction phase (weeks 0, 2, and 6). The primary end point was a 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). RESULTS: At week 54, a total of 54 of the 69 patients (78%) continued to take infliximab. The intent-to-treat primary efficacy analysis at week 54 showed that 47% of patients in the infliximab/infliximab group (95% confidence interval 31-63) and 51% of the patients in the placebo/infliximab group (95% confidence interval 36-67) achieved 50% improvement in BASDAI scores. In the analysis of those who completed the study, the mean BASDAI scores improved between weeks 0 and 54 in both treatment groups: from 6.6 to 2.4 in the infliximab/infliximab group and from 6.3 to 2.6 in the placebo/infliximab group. The dosage of nonsteroidal antiinflammatory drugs was reduced in approximately 70% of the patients. There were significant improvements in measures of functioning, metrologic parameters, and quality of life. Between weeks 12 and 54, a total of 4 patients had serious adverse events that were possibly related to infliximab and resulted in their discontinuing the study. CONCLUSION: Infliximab therapy in AS patients resulted in a rapid and significant improvement in BASDAI scores (>50% improvement) and a durable response for 1 year. The safety profile of infliximab in AS was comparable to that observed in the postmarketing experience for the approved indications.

Acute-Phase Proteins↗
PubMed2003

[Absorption of L-lysine diatrizoate from the gastrointestinal tract: the influence of surgery, inflammation and neoplasia].

PURPOSE: To ascertain whether the absorption of L-lysine diatrizoate, a sodium-free salt of the contrast-giving diatrizoic acid, from the gastrointestinal tract is increased by surgery, inflammation or neoplasia. MATERIAL AND METHODS: Using contrast medium containing L-lysine diatrizoate for intestinal opacification, this prospective study compared 32 radiographic examinations of the upper gastrointestinal tract with 52 radiographic examination of the lower gastrointestinal tract. In blood samples taken from the patients immediately after the radiographic examinations, the concentration of diatrizoic acid was determined by high pressure liquid chromatography. The results were correlated with sex, age, surgical history and any evidence of inflammatory or neoplastic diseases. RESULTS: The serum diatrizoic acid concentration in patients after oral administration was 3.62 (95% CI, 2.86 - 10.17) microg/ml. The titer was lower in patients who had undergone abdominal surgery than in patients without surgery. Serum diatrizoic acid concentration in patients after rectal administration was 0.30 (95% CI, 0.13 - 0.60) microg/ml. The titer was significantly higher (p < 0.05) in patients suffering from inflammatory conditions or neoplasms than in the other patients. CONCLUSION: The L-lysine salt of diatrizoic acid is absorbed in larger amounts from the upper than from the lower gastrointestinal tract. Absorption is not increased after abdominal surgery. However, inflammatory conditions and neoplasms of the large bowel increase the uptake of contrast medium from the intestine.

Abdomen↗
PubMed2003

[Recycling and reuse of disposable products in radiology].

Legitimacy and appropriateness of recycling and reuse of single-use disposable medical devices is a common issue in many areas of medicine. Advocates of reprocessing claim economic savings and environmental benefits. From the manufacturers' point of view, the single use is a characteristic property of their products. Moreover, they warn that using of recycled instruments makes the procedure more difficult and increases the rate of adverse events. As comparative tests demonstrate, reused products are sometimes inferior to the genuine ones with respect to mechanical properties, but these differences may have relatively little consequence for the performance of the products and the success rate of the interventions. With rigorous cleaning and sterilizing of the instruments, patients do not run an increased risk of infection. Sterile single-use products are subject to the German Medical Products Act (1994) and the German Medical Devices Ordinance (1998). New legal provisions (in force since January 1st 2002) have restricted professional recycling of used devices further. Companies reprocessing medical products for the original users are free from certification liability. CE can no longer be issued for devices newly placed on the market. Lawyers controversially discuss whether patients must be informed about the use of recycled products. In view of the otherwise strict regulations concerning the information given to patients, it seems imperative to obtain a written informed consent when reprocessed devices are used. This might interfere with the confidential relationship of patients and physicians. The combination of increased risk, strict legal regulations, ethical concern and adverse publicity demand to refrain from reprocessing and reusing disposable equipment in diagnostic and interventional radiology.

Disposable Equipment↗
PubMed2002

Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial.

UNLABELLED: BACKGROUND Treatment options for patients with ankylosing spondylitis are few. We aimed to assess the effectiveness of infliximab, an antibody to tumour necrosis factor (TNF)-alpha, in treatment of such patients. METHODS: In this 12-week placebo-controlled multicentre study, we randomly assigned 35 patients with active ankylosing spondylitis to intravenous infliximab (5 mg/kg) and 35 to placebo at weeks 0, 2, and 6. One patient in the infliximab group was withdrawn from the study. Our primary outcome was regression of disease activity of at least 50%. To assess response, we used validated clinical criteria from the ankylosing spondylitis assessment working group, including disease activity (BASDAI), functional indices (BASFI), metrology (BASMI), and quality of life (short form 36). Analyses were done by intention to treat. FINDINGS: 18 (53%) of 34 patients on infliximab had a regression of disease activity at week 12 of at least 50% compared with three (9%) of 35 on placebo (difference 44% [95% CI 23-61], p<0.0001). Function and quality of life also improved significantly on infliximab but not on placebo (p<0.0001 and p<0.0001, respectively). Treatment with infliximab was generally well tolerated, but three patients had to stop treatment because of systemic tuberculosis, allergic granulomatosis of the lung, or mild leucopenia. INTERPRETATION: Our results show that treatment with infliximab is effective in patients with active ankylosing spondylitis. Since there are some potentially serious adverse effects, we recommend that this treatment mainly be used in co-operation with rheumatological centres.

Adult↗
PubMed2002

Temporary unilateral microembolization of the lung-a new approach to regional chemotherapy for pulmonary metastases.

BACKGROUND: Except in patients with resectable disease, treatment of pulmonary metastases is still disappointing. Regional chemotherapy may be a suitable method for delivering more effective doses to regionally confined tumors while minimizing systemic toxicity. We propose an unilateral chemoembolization of the lung applicable by endovascular method. MATERIALS AND METHODS: An unilateral microembolization of the lung with degradable starch microspheres (DSM) alone (group 1) and combined with carboplatin (group 2) was performed on Sprague-Dawley rats (n = 12). Microcirculatory parameters were studied by in vivo videomicroscopy and radiological pattern on pulmonary angiogram. RESULTS: After injection of DSM, mean embolization time in subpleural capillaries was 7.1 +/- 2.3 min, followed by a mean flow retardation of 14.3 +/- 4.6 min; 21.4 +/- 4.7 min after embolization, original flow of erythrocytes was observed demonstrating reperfusion and reversibility of microembolization. After reperfusion relative fluorescence measured in subpleural alveoli was 0.13 +/- 0.049 in group 1, 0.105 +/- 0.016 in group 2, and 0.11 +/- 0.036 in control group (NS). Alveolar septal diameter was 17.3 +/- 1.13 microm in group 1, 16.8 +/- 1.25 microm in group 2, and 16.6 +/- 1.08 microm in control group (NS), demonstrating neither altered permeability nor pulmonary edema. Pulmonary angiogram confirmed patency of the central pulmonary artery. CONCLUSION: For the first time unilateral microembolization of the lung could be established in an experimental model. By injection of DSM, reversible embolization on arteriolar and capillary level could be demonstrated without occlusion of the main branches of the pulmonary arteries. Alveolar-capillary membrane disorder as symptom of early toxicity could not be detected even with additional application of carboplatin.

Animals↗
PubMed2002

Functional magnetic resonance imaging - basics and applications in oncology.

Functional MR imaging (F-MRI) permits to visualize active processes evolving in the human brain. The shifts in blood oxygenation following local neuronal activation are used for generating an MR signal. Specific procedural problems have to be solved when using F-MRI in patients with brain neoplasms. The relationship between perirolandic tumors and the adjacent motor areas has been studied most intensively. When the resection of tumors in the motor area is considered, functional imaging can help the surgeon to avoid or at least to minimize postoperative functional deficits. Overall, F-MRI study results are useful in at least one crucial preoperative decision step for about 90% of brain tumor patients. Experience with functional imaging in radiotherapy of brain neoplasms is still limited. Presently, F-MRI cannot yet replace intraoperative brain mapping.

Brain↗
PubMed2001

[Non-neoplastic hypertrophic osteoarthropathy due to infected aortic prosthesis. Diagnostic imaging aspects].

Secondary hypertrophic osteoarthropathy of the legs is a rare complication of arterial graft surgery. The syndrome is composed of arthralgias, clubbing of the toes and periostosis of the long bones and is usually associated with an infected aortic prosthesis. Often a CT-guided biopsy is performed in order to identify the graft as the primary focus. In addition to the lamellar periostosis demonstrable by conventional radiographs, a vast edema of the bone marrow and surrounding soft tissue is disclosed by MRI. Imaging promotes the early surgical reintervention.

Aorta, Abdominal↗
PubMed2001

[Body build and radiation exposure in static roentgen studies (I): A contribution for determining a national reference dose value. Promoted by the Federal Office for Radiation Protection (St.Sch 4163)].

PURPOSE: To contribute data on radiation exposure in static x-ray procedures and to compare them with anthropometric parameters. METHOD: 121 chest x-rays and 100 lumbar spine examinations were carried out and the dose-area product (DAP) measured for each of the projections. Additionally, body height, body weight and the sagittal and transversal diameters of the examined regions were recorded. Dose measurements were statistically evaluated and the following data determined: Frequency distribution, median, 25%- and 75%-percentiles as well as correlations with sex, body weight and diameters. RESULTS: Median DAP was 13 (men: 16; women: 11) resp. 50 (62; 37) cGycm2 with pa resp lateral chest x-ray. Values were closely correlated with body weight (r = 0.704/0.659) and diameter of the chest (r = 0.657/0.579). Median DAP was 175 (239; 126) resp 531 (670; 361) cGycm2 with ap resp lateral lumbar spine examinations. Values were closely correlated with body weight (r = 0.678/0.666) and diameter of the abdomen (r = 0.664/0.658). CONCLUSIONS: DAP of chest x-rays and lumbar spine examinations is strongly influenced by the constitution of the patients. Men are nearly twice as largely exposed to radiation as women.

Adult↗
PubMed2001

[Body structure and radiation exposure in dynamic X-ray studies. A contribution to determining national reference values].

PURPOSE: To contribute data on radiation exposure in dynamic X-ray procedures and to compare them with anthropometric parameters. METHODS: 50 venographies of the lower extremity, 51 abdominal arteriographies, and 121 double contrast examinations of the small bowel were carried out and the dose-area product (DAP) measured for each of the procedures. Additionally, fluoroscopy time, number of shots, body height, body weight, and the sagittal diameter of the examined region were recorded. Dose measurements were statistically evaluated and the following data determined: Frequency distribution, mean, median, 25%- and 75 percentiles as well as correlations with sex, body weight, and diameters. RESULTS: Median DAP was 587 (men: 540; women: 636) cGycm2 with venography of the lower extremities. DAP/min was better correlated with body weight (r = 0.663) than with diameters of the thigh (r = 0.611). Mean DAP was 14,869 (18,070; 10,980) cGycm2 with abdominal arteriography. DAP/min was badly correlated both with body weight (r = 0.285) and diameters of the abdomen (r = 0.249). Mean DAP was 4527 (5096; 4114) cGycm2 with enteroclysis. DAP/min was well correlated with both body weight (r = 0.621) and diameters of the abdomen (r = 0.628). CONCLUSION: DAP of venography of the lower extremity and enteroclysis is greatly influenced by the constitution of the patient. The differences between men and women are, however, not as striking as with static X-ray procedures. By contrast, in abdominal arteriography body weight and diameter play a limited role for radiation exposure.

Age Factors↗
PubMed2001

CT-guided aspiration biopsy of infected aortic graft in a patient with hypertrophic osteoarthropathy. Saline injection to improve diagnostic yield--a case report.

Unilateral hypertrophic osteoarthropathy can be a diagnostic clue to chronic infection of an aortic graft and aorto-enteric fistula. In a 62-year-old woman, non-invasive diagnostic procedures failed to prove the infection. CT-guided fine needle biopsy revealed the pathogens prompting re-intervention. The biopsy result was markedly improved by injecting physiologic saline into the perigraft tissue.

Aorta, Abdominal↗
PubMed2001

Positron emission tomography and lymphoma therapy.

FDG-PET is both able to provide information of lymphomatous organ involvement not available by conventional imaging techniques (US, CT, MRI) and to give reliable data otherwise obtainable only by using invasive procedures. As a whole body-screening technique, PET reduces diagnostic requirements and potential complications. Nevertheless the conventional imaging techniques are essential for the exact localisation and correct interpretation of PET findings. A number of factors that may produce false-positive results have to be taken into consideration, including post-treatment inflammatory changes and the sensitivity of the method in the setting of minimal residual disease. Despite its potential of a screening method being performed prior to other imaging procedures, PET is not yet established as a routine element for the primary staging of Hodgkin's disease and non-Hodgkin's lymphoma. Its value for re-staging is less doubtful due to the frequency of stage migration and possible changes in therapy related to the use of PET. Detailed cost-effectiveness studies are needed to assess the economic implications of an expanded use of PET in lymphoma therapy.

Fluorodeoxyglucose F18↗
PubMed2000

Craniosynostosis in cherubism.

Cherubism is a rare autosomal dominant fibro-osseous disorder that affects almost exclusively maxilla and mandible. Extracranial skeletal involvement is rare. We report on three affected males in three generations. The youngest affected relative was examined at age 4 months. He also had craniosynostosis. His affected father and grandfather had cherubism and clubbing of the fingers. Cherubism was mapped to region 4p16. Because of the associated cranio-synostosis, we excluded the FGFR3 gene as a candidate gene for cherubism.

Adult↗