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Biomedical subjects

W Jaschke

Publications and source records attributed to W Jaschke.

At least 73 records · Page 4Linked to original sources

GM-2 gangliosidosis (Sandhoff's disease): two year follow-up by MRI.

Two children with GM-2 gangliosidosis type 0 (Sandhoff's disease) followed up by MRI at 1.5 Tesla for 1.8 years are reported. One was presymptomatic at the first MRI examination. As her neurological status deteriorated, MRI showed low signal in bilaterally, on T2-weighted images the white matter with involvement of the optic radiations. In the second, MRI correlated well with the clinical progression of the disease, showing in the different stages involvement of thalamus and basal ganglia. There was no contrast enhancement and the grey matter remained normal.

Brain↗

[CT diagnosis of acute mesenteric vein thrombosis with intestinal infarction].

Imaging methods provide an important diagnostic basis to clarify mesenteric ischemia. Angiography is the definitive method of investigation in such cases. Other noninvasive methods such as ultrasonography, computed tomography, and magnetic resonance imaging must still prove their importance. We describe three cases of unspecific abdominal pain where the CT shows a mesenteric venous thrombosis with an infarcted bowel. The venous infarcted bowel is clearly demonstrated by CT when other signs for MTV such as ascites, bowel wall thickening, bowel dilatation, and pneumatosis intestinalis are present. CT seems to be a good procedure in order to identify unspecific abdominal pain as being caused by a vascular insufficiency.

Adult↗

[Patent foramen ovale and platypnea after pneumonectomy].

Six months after a pneumonectomy for myeloma, which had preoperatively been indistinguishable from bronchial carcinoma, a 50-year-old man presented with shortage of breath, cyanosis and episodes of syncope on standing or walking, symptoms which improved on lying down (platypnea). On one occasion these symptoms necessitated controlled artificial ventilation, but even at an inspiratory oxygen saturation of 100%, blood gases only partially improved (pCO2 27 mm Hg, pO2 67 mm Hg, O2 saturation 93%). Right heart catheterization in recumbency revealed a right to left shunt at atrial level of 37% of systemic flow. Contrast medium injection into the inferior vena cava near the heart demonstrated cardiac displacement and rotation. Part of the inferior vena cava flow passed into the left atrium via a patent foramen ovale: it is likely that this shunt increased in the upright position. After surgical closure of the patent foramen ovale and partial relocation of the heart (with a vicryl net) the patient has now remained free of symptoms for 5 years.

Dyspnea↗

[Clinical experiences with the Gianturco-Z stent in endotracheal and -bronchial stenoses].

We inserted Gianturco-Z stents in 17 patients with tracheobronchial stenoses on 18 occasions. Three patients had benign, all others malignant stenoses due to compression of the tracheobronchial tree by metastasising malignancies. In all cases the stents could be easily positioned and the patients experienced relief of their severe dyspnea. In one case there was fatigue breakage of the stent. The patient was therefore given a silicone tracheal stent.

Aged↗

[MR angiography of the vertebrobasilar circulatory area: the potential uses of the saturation technic to determine the direction of the flow].

MR angiography (MRA) combined with selective saturation techniques has proved to be a reliable method for the determination of flow direction and vascular supply at the level of the circle of Willis. We describe its application to the vertebrobasilar system (VBS) in ten volunteers and five patients with abnormal findings. In one patient with postsurgical stenosis of the brachiocephalic artery, reverse flow of the vertebral artery (VA) was demonstrated. Collateral blood flow from the anterior circulation over the posterior communicating arteries was shown in three patients with bilateral vertebral or proximal basilar artery occlusion. Due to increase of pressure during contrast injection into the contralateral VA, DSA showed reverse flow of a dissected VA in one patient. MR flow determination as well as TCD proved antegrade flow. All results correlated with both DSA and transcranial Doppler (TCD). The technique is little time consuming and is a promising add-on examination to conventional and MRA imaging of the VBS.

Adult↗

[MR tomographic studies of the cerebral circulation: the methodological principles and initial clinical experiences with T2*-weighted gradient-echo sequences and CM administration as a bolus].

Paramagnetic contrast agents produce local magnetic field inhomogeneity when they pass through the cerebrovascular system. This effect can be monitored with T2*-weighted gradient echo images, which show transient signal loss, while a bolus of GdDTPA is passing through the brain tissue. This signal loss is correlated to the local cerebral tissue perfusion and the local cerebral blood volume. In a prospective study 10 volunteers and 14 patients with cerebral infarcts and brain tumours were examined. After bolus application of GdDTPA a dynamic series of rapid T2*-weighted gradient echo images were recorded, and the local dynamics of contrast flow in brain tissue was examined. From the series of images, local changes in signal intensity were calculated pixel by pixel and presented as parameter images. By this method, infarcted areas and brain tumours can be distinguished from normal tissue by their contrast flow dynamics. The abnormal contrast dynamics depend on changes in local tissue perfusion and alterations in local blood volume. The separation of the influence of both parameters however is still an unsolved problem.

Adolescent↗

[MR tomography of the bone marrow in malignant systemic diseases. Diagnosis and therapeutic follow-up control].

This paper presents a short survey of the current status of bone marrow diagnosis in systemic neoplastic disease by means of MR imaging. The different patterns of bone marrow infiltration from lymphomas and leukaemias are presented and the differential diagnoses are discussed. Apart from the primary diagnosis the relevance of conventional MRI and chemical shift imaging for therapy follow up and after-care is discussed.

Bone Marrow↗

[The treatment of bile duct stenoses using metal mesh endoprostheses (stents)].

Transhepatic biliary drainage is an established therapy for the palliative treatment of biliary stenosis. Long-term biliary drainage may be accomplished by the introduction of an endoprosthesis. Plastic endoprostheses are, however, prone to clogging and dislocation. A new type of endoprosthesis consisting of an expandable metallic mesh has, therefore, been developed. Results in 51 patients using two different types of metallic stents demonstrated that the technical success rate is higher with self-expanding stents than with balloon-expandable stents. Symptoms of obstructive jaundice were effectively palliated in the vast majority of patients (80%). Reobstruction during the first 4 weeks occurred in only 1 patient. Malfunction was related to the inappropriate length of the stent. At follow-up, 25% of patients with malignant biliary strictures developed recurrent jaundice, which was controlled by a single additional placement of a stent or a plastic endoprosthesis. In conclusion, although recurrent biliary stenosis is still a problem, the frequency of reinterventions can be considerably reduced by the use of metallic instead of plastic endoprostheses (20% vs. 45%).

Aged↗

[Percutaneous transluminal angioplasty (PTA) of the arteries of the arm in brachial and cerebral ischemia].

35 patients with brachial and/or cerebral ischemia underwent 37 PTA's. Indications for PTA were stenosis (n = 31) or occlusion (n = 1) of the subclavian artery, stenosis of the brachiocephalic trunk (n = 2), stenosis of the axillary artery (n = 2) and stenosis of the brachial artery (n = 1). 23 patients demonstrated a subclavian steal phenomenon. However, the minority of patients (n = 10) presented with neurologic symptoms, which could be provoked by brachial exercise in only 3 patients. 7 of the 10 patients with cerebral ischaemia demonstrated additional significant stenosis of the extracranial arteries. The technical success rate for PTA was 89.2%. Two patients showed relapse of the stenosis. The clinical success rate regarding brachial ischaemia was 94.4% (follow-up: 6-37 months). Neurologic symptoms disappeared after treatment in 72.7%. Minor complications without clinical sequelae occurred in 8.6%.

Adult↗

Cine-computed tomographic assessment of regional renal blood flow.

The new modality of cine-computed tomography was used to assess regional renal blood flow following hemorrhagic hypotension and administration of atrial natriuretic factor (ANF). As has also been established with other techniques, hypotension induced by hemorrhage caused cortical blood flow to fall from 5.3 (SD 0.8) to 2.1 (SD 1.1) ml.min-1g-1 (p less than 0.005; n = 7) proportionally more than inner medullary blood flow which fell from 0.45 (SD 0.24), to 0.26 (SD 0.08) ml.min-1g-1 (p less than 0.05) so that the ratio of the cortical to inner medullary blood flow decreased from 11.8 (SD 4.8) to 8.2 (SD 5.1) (p less than 0.01). In contrast, during natriuresis induced by ANF, cortical blood flow was unaltered (5.8, SD 1.1, vs 5.4, SD 0.9 ml.min-1g-1; NS; n = 5) while inner medullary blood flow declined from 0.66 (SD 0.13) to 0.51 (SD 0.11) (p less than 0.005) so the ratio of cortical to inner medullary blood flow increased from 8.8 (SD 1.3) to 10.9 (SD 1.7) (p less than 0.005). These results indicate that cine-CT appears to be an appropriate technique for demonstrating changes in distribution of intrarenal blood flow. Cine-CT may, therefore, be an attractive alternative for measuring regional renal blood flow.

Animals↗

PTA of the subclavian and innominate artery: short- and long-term results.

Twelve patients with brachial ischemia and/or subclavian steal syndrome underwent PTA of the subclavian, innominate and axillary artery. One technical failure occurred in a patient with a high grade stenosis of the subclavian artery. All other patients were successfully dilated. On long-term follow-up (mean: 12 months) only one patient had a recurrent stenosis which was successfully recanalized by PTA. This patient is asymptomatic since 12 months. The only severe complication was a transient amaurosis which occurred during catheterization. Balloon angioplasty was, therefore, not performed. In summary, PTA is an effective therapy for patients with brachial ischemia and/or subclavian steal syndrome. The long- and short-term results compare favorably with results obtained by surgery.

Angioplasty, Balloon↗

[Diagnosis and therapy of bleeding aneurysms of the peripancreatic arteries].

Aneurysms of the pancreatic arteries are a rare complication of pancreatitis. Most usually they are observed with pancreatic pseudocysts or pancreatic abscesses. In view of the danger of haemorrhage, the diagnosis and treatment of these aneurysms is of considerable clinical significance. Angiography plays a dominant role, since it can demonstrate the source of bleeding and, at the same time, provides effective treatment by means of vascular embolisation. This is illustrated by three examples.

Adult↗

[Documentation of digital image information--video or laser imager?].

The quality of hardcopies produced by a video- or laser imager was compared. Laser printing could be performed after analogue or digital data transmission, whereas the video imager allowed only analogue data transfer. Evaluation of CT-, MR-, DSA- and radiographic images showed no difference in diagnostic information between video and laser-produced hardcopies. For large formats (35 X 35 cm.), laser images produced by digital transmission were considerably superior to video signals and analogue transmission. There were advantages and disadvantages of both types of imaging, depending on the size of the matrix, the type of image produced, ease of use and capital cost.

Copying Processes↗