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Biomedical subjects

A Mundinger

Publications and source records attributed to A Mundinger.

At least 19 recordsLinked to original sources
PubMed1992

CT and MRI: prognostic tools in patients with AIDS and neurological deficits.

To determine the prognostic value of CT and MRI in AIDS we studied the survival of patients with neurological involvement, in relation to the initial imaging results. Twenty-six initial CT and 15 MRI examinations of 41 patients were reviewed for the presence of cerebral atrophy and/or focal lesions. The mean survival time of patients with initially normal imaging was longer (700 +/- 89 days) than that of patients with isolated cerebral atrophy (326 +/- 65) or isolated focal lesions (202 +/- 97). The shortest survival (78 +/- 44 days) was found in patients with both cerebral atrophy and focal lesions. The risk of death in patients with atrophy alone was 3.6 times higher, that in patients with focal lesions alone 6.4 times higher, and in patients with both changes 19.3 times higher than in patients with initially normal imaging. Cerebral imaging with CT and/or MRI thus allows identification of AIDS-related cerebral changes and may contribute to assessment of prognosis.

AIDS Dementia Complex↗
PubMed1992

[Imaging in isolated pulmonary immunocytoma].

A extranodal pulmonary immunocytoma that originated from the lung is reported. It was hidden behind the picture of a mid-lobe syndrome at repeated imaging controls over a 1.5-year period. In the further course a local progression occurred displayed by roentgenography and computer tomography including calcifications within the pulmonary tumor. A newly developing monoclonal gammopathy was detected by immunoelectrophoresis at the same time. Bronchopulmonary symptoms due to the tumor did not exist. After local resection of the lymphoma monoclonal gammopathy disappeared. However, a recurrence of monoclonal gammopathy developed after eight months.

Biopsy↗
PubMed1991

[Magnetic resonance tomography in the diagnosis of peripheral joints].

Magnetic resonance imaging (MRI) provides an excellent soft tissue contrast with high spatial resolution. Using spin echo and fast gradient echo sequences all relevant joint structures such as the hyaline cartilage, the meniscus, the ligaments, the tendons, the capsulae, and their adjacent muscles and their pathology are visualized. Diagnosis of osteonecrosis, meniscal and cruciate ligament lesions, as well as tumors, represents the major current indication for MRI. Due to its high cost MRI should be employed for the diagnosis of joint disease only to clarify equivocal findings of conventional radiographic, nuclear and tomographic methods. Prior clinical examination and laboratory tests are mandatory. As a component of a stepwise diagnostic approach, MRI often provides reliable differential diagnostic information.

Bone Diseases↗
PubMed1991

MRI of knee arthritis in rheumatoid arthritis and spondylarthropathies.

The knees of fifty-two patients suffering from rheumatoid arthritis (RA), 22 patients with seronegative spondylarthopathies (SA) as well as of 20 healthy volunteers were examined by magnetic resonance imaging (MRI). Osseous erosions (RA 52%-SA 18%; P less than 0.005), Baker cysts (RA 56%-SA 12%; P less than 0.005), pannus formation (RA 67%-SA 36%; P less than 0.05), and cartilage thinning with narrowing of the joint space (RA 46%-SA 18%; P less than 0.05) proved to be more frequent MRI findings in patients with RA. Additionally, in patients with RA erosions were more extensive. Follow-up MRI examinations of 19 patients revealed an improvement in MRI changes in SA within an average interval of 6 months. No substantial changes were noted in 7 of 13 RA patients. Quantitative and qualitative MRI findings of knee arthritis differ in patients with RA and SA and this was statistically significant. However, as there is considerable overlap of the MRI and radiographic changes in both groups the discriminating diagnostic value in the individual case was limited.

Adult↗
PubMed1990

Diagnostic imaging in metastatic lung disease.

Chest radiographs, full lung tomography and computed tomography of the chest provide increasing sensitivity for evaluation of pulmonary metastases. Pulmonary nodules of 5-10 mm diameter are detectable with increasing frequency by use of high kilovoltage chest radiographs. Full lung linear tomography provides an overall accuracy of 72-97% in diagnosis of pulmonary nodules. Chest CT delineates pulmonary nodules as small as 3 mm within 10 mm slice sections. However, as sensitivity increases, specificity diminishes in identifying metastatic nodules. Sensitivity in CT is also reduced by false negative findings due to unequal respiratory cycles. Comparative radiologic-pathologic evaluation of nodule detection proved CT to be the most sensitive screening method for pulmonary metastases. Timing of follow-up studies for pulmonary nodule detection in cancer patients can be determined by tumor growth kinetics; 3-6 month intervals proved to be useful.

Humans↗
PubMed1990

[Renal microaneurysms in necrotizing vasculitis--incidence in autopsy and clinical value].

Histological renal sections of 24 autopsied patients were evaluated for ectasias with greater than or equal to 2 mm diameter that corresponded to "microaneurysms" of radiologic nomenclature. Such renal "microaneurysms" of smaller and medium sized arteries were seen in 7/9 patients with periarteritis nodosa, 6/10 patients with secondary vasculitides and 1/5 patients with Wegener's Granulomatosis. Lumen ectasias in acute or subacute lesions of smaller and medium sized arteries were caused by fibrinoid necrosis of the arterial walls. Destruction of intimal elastic fibres and scar tissue within the arterial wall resulted in real aneurysmatic ectasias. Generalised, aggressive, necrotizing vasculitides show the highest frequency of microaneurysms. In that cases angiography can frequently establish the definite diagnosis by demonstration of microaneurysms.

Adult↗
PubMed1990

[Endoluminal angioplasty, in situ thrombolysis and arterial endoprosthesis. Immediate and long-term results (2 to 8 years): report of 5,216 operations].

Over a period of 8 years, 5,216 percutaneous transluminal angioplasties (PTA) and local thrombolysis were performed in the Department of Radiology of the University of Freiburg and the Hochrheinklinik of Bad Säckingen. From 1984 to 1989, 5,216 patients were reviewed clinically, and, in 360 cases, angiographically. The short-term results were compared with the long term results (i.e. 2 to 8 years after PTA or local lysis). The (stage IIb to stage IV) occlusive disease was treated by PTA. A successful PTA result was obtained in stage IIb in 73% of cases, in stage III in 68% of cases and, in stage IV in 36% of cases after 2-8 years including all regions of treated arteries. Complications occurred in 2.51% of cases. Over the last 2 years, dilatations, local thrombolysis and even intraluminal stent implantations can be controlled by ultrathin angioendoscopes.

Angioplasty, Balloon↗
PubMed1990

[The place of ERCP in pancreatic diagnosis. The change caused by sonography and computed tomography].

Based on 1099 endoscopic retrograde cholangiopancreatograms (ERCP), 659 examinations conducted in 1973-1980 prior to the introduction of computed tomography (CT) and 440 performed in 1988-1989, the impact of sonography and CT on ERCP is studied. The availability of CT did not cause any significant change in the frequency of and indications for ERCP. The rate of successful ERCP examinations increased from 73.6% to 92%. Complications occurred in 2.3%, and the mortality rate was 0.4% and was similar in both periods. ERCP was the third imaging procedure, being applied after sonography and CT, in most patients. The diagnostic value of ERCP in pancreatic disease is compared with that of sonography and CT in 116 patients with histologically or clinically proven diagnosis. The sensitivity is 79% for ERCP and 78% for CT. Indeterminate findings were recorded in 11% of the ERCP and 8% of the CT examinations; these rates can be decreased by complementary use of both imaging modalities.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

[Interstitial cancerous lung diseases. Lymphangiosis carcinomatosa and leukemic pulmonary infiltrates].

The radiological findings in pulmonary lymphangitic carcinomatosis and in leukemic pulmonary infiltrates mirror the tumor-dependent monomorphic interstitial pathology of lung parenchyma. It is a proven fact that pulmonary lymphangitic carcinomatosis is caused by hematogenous tumor embolization to the lungs; pathogenesis by contiguous lymphangitic spread is the exception. High-resolution CT performed as a supplement to the radiological work-up improves the sensitivity for pulmonary infiltrates in general and thus makes the differential diagnosis decided easier. Radiological criteria cannot discriminate the different forms of leukemia. Plain chest X-ray allows the diagnosis of pulmonary involvement in leukemia due to tumorous infiltrates and of tumor- or therapy-induced complications. It is essential that the radiological findings be interpreted with reference to the stage of tumor disease and the clinical parameters to make the radiological differential diagnosis of opportunistic infections more reliable.

Humans↗
PubMed1990

[A comparative study of methods of preparing the colon for a double-contrast study: Prepacol versus ricinus capsules with a cleansing enema].

In a controlled study, we analyzed the efficiency of cleansing out the colon and the best contrast medium of two different regimens (total n = 237) for preparing the colon for double-contrast examination. The recommendations regarding diet and liquid intake, contrast medium and examination technique were identical in both groups. The combination laxative Prepacol without cleansing enema resulted in a more thoroughly cleaned colon that ricinol with cleansing enema (very good/good cleanliness: Prepacol, 92.4%; ricinol, 83.2%, p less than 0.05). However, the quality of contrast medium (good: Prepacol 71.2% as opposed to ricinol 74.8%) was (independent of the preparation method) below standard regarding cleansing of the colon. Better patient compliance was accomplished by Prepacol because the medication was easier to take, and omitting the cleansing enema was a reduction in burden for both patients and medical staff. Written instructions for diet is essential and was of help to the patients.

Adult↗
PubMed1989

The clinical value of percutaneous transluminal angioscopy. Angioscopical findings in primary vascular diagnosis and in interventional radiology.

Since the introduction of ultrathin angioendoscopes into clinical application conventional or digital angiography have been controlled by using the same approach like in angiography. In dogs and angiography patients this new angioscopic method for arteries without surgical intervention has been developed. The approach is transfemoral. Endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), thrombolysis, thrombus extraction and a new kind of stents and their application. An ultrathin endoscope with an outer diameter of 1.6 mm and working channel of 0.35 mm is used. Guide wires, contrast media and drugs for local thrombolysis can be applied through this channel. The endoscope is placed into the region of interest under fluoroscopic control and view is obtained by using 0.9% NaCl for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. It was possible to demonstrate the proceedings of dilatation, recanalization, local lysis, stent-application and thrombus-extraction.

Constriction, Pathologic↗
PubMed1989

[Renal artery aneurysm in Wegener's granulomatosis].

Microaneurysms of renal and visceral arteries are characteristic signs of periarteritis nodosa. Normally they are not found in Wegener's disease, where glomerulonephritis is commonly observed. We report on a patient with vasculitis of the upper and lower respiratory tract, focal glomerulonephritis, prostatic and pulmonary granulomas and anti-cytoplasm antibodies corresponding to Wegener's disease. The most striking findings in angiography were multiple small aneurysms of the peripheral branches of the renal artery. At necroscopy these angiographic findings were histologically proven as necrosis of the arterial wall with destruction of the elastic lamina, causing local vascular ectasia. These renal vascular changes are a characteristic sign of periarteritis nodosa. The combination of clinical, laboratory, radiologic and histologic findings in our patient can be explained as an overlap-syndrome of Wegener's disease and periarteritis nodosa. We assume that the combination of pathologic findings in our patient correspond to a rare atypical renal manifestation of Wegener's disease.

Aneurysm↗
PubMed1989

[Primary manifestation of Wegener's granulomatosis of the prostate].

In approximately 2-7% of patients with Wegener's granulomatosis involvement of the prostate has been demonstrated histologically. This usually comes about quite late in the course of disease, after generalization of the granulomatous vasculitis from respiratory tract to kidneys and other organs. The patient we present had a highly atypical first manifestation of Wegener's granulomatosis in the prostate, generalized vasculitis not developing until later. When a biopsy shows unclear granulomatous changes in the prostate, a test for anticytoplasmatic antibodies should be performed in addition to the conventional serologic and cultural examinations. Anticytoplasmatic antibodies are highly specific for the diagnosis of active Wegener's granulomatosis. Early diagnosis and immediate initiation of immunosuppressive therapy with cyclophosphamide and corticosteroids can prevent or limit organ damage and improve the prognosis in Wegener's granulomatosis.

Autoantibodies↗
PubMed1989

[Thoracic calcification in the elderly--frequency and clinical value].

Chest X-ray films of 200 patients, aged between 90 and 102 years, were analysed for frequency of distribution and varying degrees of thoracic calcification. Calcification was found within the aortic wall in 89%, costal cartilage 79%, lung parenchyma 65%, lung hilum and/or mediastinum 64%, and tracheobronchial cartilages 55%. The degree of calcification was dependent on the tissue and sex involved (significant p less than 0.001). Calcification is of clinical value more often in younger patients than in the elderly. The classification, pathogenesis and differential diagnosis of thoracic calcifications are discussed.

Aged↗