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A Müller

Publications and source records attributed to A Müller.

764 records · Page 43Linked to original sources
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Echo-enhanced transcranial color-coded duplex sonography in the diagnosis of cerebrovascular events: a validation study.

BACKGROUND AND PURPOSE: Transcranial color-coded duplex sonography (TCCD) is a diagnostic technique for evaluation of intracranial arteries in patients with acute stroke. Echo-enhancing contrast agents (EEAs) are necessary to visualize intracranial vessels in up to 30% of patients because of limited acoustic bone windows. In this study, we assessed the diagnostic efficacy of echo-enhanced TCCD (eTCCD) in correlation with the gold standard, digital subtraction angiography (DSA). METHODS: We prospectively evaluated all patients with eTCCD who subsequently underwent DSA for evaluation of cerebrovascular symptoms over a 24-month period. We administered Levovist as an EEA. Two blinded reviewers analyzed all eTCCD findings and correlated them with DSA. RESULTS: We included 132 consecutive patients (40 women, 92 men; mean age, 58 +/- 14 years) with 164 datasets: 24/164 had normal findings, 98/164 had abnormalities of extracranial carotid arteries, 32/164 had abnormalities of intracranial arteries, and 21/164 had abnormalities in vertebrobasilar circulation as determined by DSA. For eTCCD, we found a sensitivity of 82% (95% confidence interval [CI]: 75%-90%), a specificity of 98% (95% CI: 90%-100%), a positive predictive value of 99% (95% CI: 94%-100%), and a negative predictive value of 75% (95% CI: 64%-85%); 7/164 (4%) examinations were inconclusive because of insufficient bone windows. The interobserver agreement was almost perfect (kappa value, 0.92; 95% CI: 0.87-0.97). CONCLUSION: eTCCD provides high diagnostic validity for the status of the major intracranial arteries. In particular, a normal vessel status reliably assessed by an experienced sonographer could supersede further imaging procedures. In patients with acute ischemic stroke not eligible for established angiographic techniques, eTCCD may be useful as an alternative imaging technique.

Adolescent↗
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[Correction of fatal genetic diseases using bone marrow transplantation. 2].

Genetic diseases can be treated by transplantation of normal allogeneic bone marrow. Four patients with congenital disorders of their hematopoietic and/or lymphoid stem cells have been transplanted. One patient had a congenital aplastic anemia (Blackfan-Diamond), one had Gaucher's disease, one had congenital agranulocytosis Kostmann and one had chronic granulomatous disease. All patients received busulfan, cyclophosphamide and total nodal irradiation as preparatory regimen. Total nodal irradiation and cyclophosphamide were used as immunosuppressive agents. In all cases hematopoietic ablation and donor lymphoid and hematopoietic engraftment were achieved. The basic disorders of all transplanted children could be corrected completely. All children are alive and well.

Agranulocytosis↗
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[Correction of fatal genetic diseases using bone marrow transplantation. 1].

Bone marrow transplantation (BMT) was mainly used for the treatment of immunological, hematological and oncological diseases. Genetic diseases can also be treated by transplantation of normal histocompatible allogeneic bone marrow. This type of marrow transplantation is used for the treatment of inborn errors whose clinical expression is restricted to lymphoid or hematopoietic cells. The therapeutic role of bone marrow transplantation in the treatment of generalized genetic diseases is under investigation. Genetic disorders that can be cured include congenital immune deficiencies, infantile malignant osteopetrosis, thalassemia, infantile agranulocytosis, chronic granulomatous disease, lysosomal storage diseases and others. The use of autologous bone marrow after the insertion of a normal gene (gene therapy) in vitro circumvents the need for a histocompatible donor.

Bone Marrow Transplantation↗
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[Effectiveness of the examination of the different categories of contacts of pulmonary tuberculosis patients as a part of epidemiological investigations].

In view of evaluating the global efficiency of the epidemiologic investigation in relation to its area an analysis was carried out of 127 investigations involving 1 252 tb contacts. The contacts were classified in three groups: intrafamilial and intradomiciliary, intrafamilial but outside the home, and extrafamilial and outside the home; the results of the examinations were compared between them on the one hand and with the proportion of allergic children (51.6%) and the instantaneous prevalence of bacilli eliminating cases (0.31%) on the other hand. These were obtained in an area with a high endemic ratio of tuberculosis, following integral biological and radiophotographic case-finding. Children who were tb contacts, belonging to the first group also included the highest proportion of allergies (48.3%) while in the other two groups the number of allergic children was similar to that of allergic children in the locality with a high endemic ratio of tuberculosis. The radiophotographic examination of adults who were contacts of tuberculous patients showed that the lowest proportion of tuberculous patients with active tuberculosis (0.4%), which was found in the third group, was still above the instantaneous prevalence of bacilliferic patients from the area with high ratio of endemic tuberculosis. In conclusion, the present technical structure of epidemiological investigations corresponds to the actual level of the endemy and no group of contacts can be excluded from the investigation.

Adolescent↗