A patient with a benign course of neuromyelitis optica (Devic's syndrome) over 12 years: MRI follow up and histological findings.
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Adult↗
Biomedical subjects
A Saleh
Publications and source records attributed to A Saleh.
[Melorheostosis of the HWS in an intraspinal lipoma].
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Aged↗
Radiation exposure of patients in comprehensive computed tomography of the head in acute stroke.
BACKGROUND AND PURPOSE: To assess patient radiation exposure in comprehensive stroke imaging using multidetector row CT (MDCT) combining standard CT of the head, cerebral perfusion (CTP), and CT angiography (CTA) studies. METHODS: Examination protocols for CT and CTA of cerebral and cervical vessels, as well as CTP were simulated using a Somatom Sensation Cardiac 64. Effective doses were derived from measurements with the use of lithium-fluoride thermoluminescent dosimeters (LiF-TLD) at several organ sites using an Alderson-Rando phantom. RESULTS: LiF-TLD measurements resulted in effective doses of 1.7 mSv for CT, 1.9 mSv for CTA of intracranial vessels, and 2.8 mSv for CTA of cervical vessels, respectively. Depending on examination parameters, effective doses varied between 1.1 and 5.0 mSv for cerebral CTP. For CTP, local doses in the area of the primary beam ranged between 114 and 444 mGy. CONCLUSIONS: Comprehensive stroke imaging may result in up to 9.5 mSv with possible local doses of 490 mGy. Although critical doses for organ damage (eg, cataract formation or hair loss) are not reached, physicians need to be aware of possible radiation induced sequelae particularly in repetitive examinations.
Acute Disease↗
[Differential diagnosis of focal liver lesions using contrast-enhanced MRI with SHU 555 A in comparison with unenhanced MRI and multidetector spiral-CT].
PURPOSE: To evaluate the ability of contrast-enhanced MRI with SHU 555 A to provide additional information for characterization of focal liver tumors compared with non-enhanced MRI and multislice spiral CT. MATERIALS AND METHODS: In a prospective manner the images of 45 patients who underwent multislice spiral CT, unenhanced MRI alone and unenhanced and SHU 555 A-enhanced MRI including dynamic imaging at a field strength of 1.0 T were analyzed in a blinded reading. The readers had to determine on a scale from 1 to 5 whether a tumor was benign or malignant. Furthermore, the readers had to give a definitive diagnosis for each lesion. A true cut needle biopsy served as gold standard against which all imaging procedures were compared. RESULTS: The sensitivity for differentiation malignant vs. benign lesion was 77 % with spiral CT, 72 % with unenhanced MRI and 94 % with SHU 555 A-enhanced MRI, respectively (p < 0.05). The specificity for spiral CT was 73 %, for unenhanced MRI 83 % and for contrast-enhanced MRI 83 %, respectively (n. s.). Compared with the histopathologic results, the correct diagnosis was made with spiral CT in 25/45 (56 %), unenhanced MRI in 16/45 (36 %) and contrast-enhanced MRI in 32/45 (71 %) of the patients (p < 0.05). For the subgroup of patients with liver cirrhosis, the correct diagnosis was established with spiral CT in 16/23 (70 %), unenhanced MRI in 9/23 (39 %) and contrast-enhanced MRI in 19/23 (83 %) of the patients (p < 0.05). CONCLUSION: Contrast-enhanced MRI with SHU 555 A has the ability to improve the differential diagnosis of focal liver tumors compared with unenhanced MRI and multislice spiral CT.
Biopsy, Needle↗
CIDP and isolated osteosclerotic myeloma.
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Adult↗
Paraparesis due to pressure erosion of the thoracic spine by an aortic aneurysm: remission of symptoms following resection of the aneurysm and vertebral reconstruction.
BACKGROUND: There are only a few descriptions in the literature of thoraco-abdominal aortic aneurysms responsible for erosion of the vertebral column and compression of the spinal cord. This case is therefore presented to provide an opportunity to discuss the pathomechanic aspects and to demonstrate the feasibility of total surgical repair by an interdisciplinary approach. METHODS: A thoraco-abdominal aortic aneurysm caused extensive erosion of vertebral bodies T5-8, leading to invasion of the spinal canal and compression of the cord. The clinical signs were paraparesis and chronic thoracolumbar pain. In a combined operation the aneurysm was replaced by a Dacron prosthesis. Corpectomy of T5-8 was carried out and a titanium mesh cage filled with autogenous bone tissue was inserted. The vertebral column was stabilized using dorsal and lateral instrumentation. FINDINGS: Clinical and imaging follow-up after three years showed remission of the patient's severe paraparesis and chronic pain and long-term technical success of the vertebral and aortic reconstruction. INTERPRETATION: Complete thoraco-abdominal aortic replacement and spinal column repair can be successfully accomplished with good clinical and neurological long-term results.
Aortic Aneurysm, Abdominal↗
Prediction of relapse after antithyroid drug therapy of Graves' disease: value of color Doppler sonography.
Opinions differ regarding the indications for antithyroid drugs, radioiodine and surgery in patients with Graves' disease because the likelihood of long-term remission after medical treatment cannot be predicted. The aim of this study was to assess the value of quantifying thyroid blood flow in an attempt to predict outcome following withdrawal of antithyroid drug therapy. Spectral Doppler recordings were obtained from the thyroid arteries in 24 patients with Graves' disease at the time of diagnosis. Thyroid blood flow levels measured at the time of diagnosis of Graves' disease were correlated with outcome following withdrawal of medical treatment (mean duration of treatment: 14 months). Clinical follow-up for at least 18 months (range: 18 - 39 months) after antithyroid drug withdrawal was possible in 13 patients (12 women). Mean peak systolic velocity and volume flow rate values as well as thyroid volume measured at the time of diagnosis were significantly higher (139 cm/s, SD 46; 195 ml/min, SD 170; 52 ml, SD 18) in patients who relapsed after drug treatment compared with patients in remission (71 cm/s, SD 27; 67 ml/min, SD 61; 25 ml, SD 13). The correlation between thyroid blood flow measurements and thyroid volume was high (r = 0.79 - 0.96). Recurrence of disease could be predicted with a sensitivity of 71 % and a specificity of 100 % based on thyroid blood flow measurements. This preliminary data suggest that quantification of thyroid blood flow by means of Doppler sonography might be a useful tool to predict the outcome of Graves' disease following withdrawal of medical treatment and could be helpful in finding the adequate kind of therapy.
Adult↗
Exclusion of brain lesions: is MR contrast medium required after a negative fluid-attenuated inversion recovery sequence?
We hypothesized that in patients with negative fluid-attenuated inversion recovery (FLAIR) images T(2) weighted fast spin-echo (FSE) images and T(1) weighted spin-echo (SE) images before and after intravenous administration of gadolinium-based contrast medium display no pathology either. Thus, we assessed the negative predictive value of FLAIR images to rule out MR-detectable brain lesions. 1026 consecutive cranial MR examinations were reviewed. Routine MRI of the brain included T(1) weighted coronal imaging before and after administration of gadopentetate dimeglumine, axial T(2) weighted FSE and fast-FLAIR imaging. The FLAIR images were rated by two radiologists into categories of 0 (without pathologic changes) and 1 (with pathologic changes). Two other radiologists analysed the complete examination. In 284 MR examinations of the brain no abnormalities were found (28%). FLAIR-ratings were false-negative in four cases and false-positive in 30 cases. Sensitivity and specificity of the FLAIR sequence for MR-detectable brain lesions were 99.5% and 89.4%. The unselective application of gadolinium avoided one false-negative MR-reading and improved the sensitivity of the MR-examination from 99.5% to 99.6%. Positive and negative predictive values were 96.1% and 98.4%, respectively. The interobserver reliability was kappa=0.93 for the FLAIR-readers and 0.89 for the readers who rated the complete examination. In conclusion, negative FLAIR images provide a high negative predictive value for MR-detectable brain lesions. Thus, in patients with negative FLAIR images the unselective application of gadolinium seems to be unnecessary.
Adolescent↗
Autologous bone marrow-derived stem cell therapy in combination with TMLR. A novel therapeutic option for endstage coronary heart disease: report on 2 cases.
We report 2 cases in which patients with coronary heart disease not amenable for conventional revascularization underwent transmyocardial laser revascularization (TMLR) and implantation of AC133+ bone-marrow stem cells. The reason for using TMLR in combination with stem cell application is to take advantage of the synergistic angiogenic effect. The local inflammatory reaction induced by TMLR should serve as an informational platform for stem cells and may trigger their angiogenic differentiation. Functional analysis of myocardial performance after treatment in these 2 cases revealed dramatic improvement of the wall motion at the site of the TMLR and stem cell application. Because TMLR does not enhance myocardial contractility and there was no angiographic evidence of major collaterals to the ischemic region in either patient, we assume that the synergistic effect of stem cells and TMLR-induced angiogenesis occurred; however, our assumption is of a speculative nature. We think that TMLR in combination with stem cell transplantation might become a novel revascularization therapy for ischemic myocardium.
Aged↗
[Predictive parameters of infectiologic complications in patients after TIPSS].
AIM: To define predictive parameters of a complicated clinical course after the TIPSS procedure. METHODS: Blood cultures were drawn prospectively in 41 patients from a central line and from the portal venous blood before stent placement as well as from the central line 20 min after intervention. C-reactive protein (CRP) (mg/dl) and white blood cell count (WBC,/microl) on the day of TIPSS-procedure (d0), the first (d1) and seven (d7) days after TIPSS were compared in patients with a complicated clinical course (spontaneous bacterial peritonitis,pneumonia,sepsis; group I) to patients without clinical complications (group II) RESULTS: Group I showed a significant increase in CRP (d0: 1.8+/-1.0; d1: 3.2+/-1.5; d7: 4.3+/-3.2), and white blood cell count (d0: 7700+/-2600; d1: 10800+/-2800; d7: 7500+/-1800) on the first day after TIPSS-procedure in comparison to group II (CRP: d0: 1.6+/-0.6; d1: 1.8+/-1.0; d7: 1.9+/-0.6. WBC: d0: 6900+/-1500; d1: 8000+/-1600; d7: 7600+/-1400). Microbiological analysis showed in 12% skin or oral flora in the last sample. CONCLUSIONS: The course of CRP and WBC-count during the first week after TIPSS procedure may indicate patients with a potential risk of a complicated clinical course.
Adult↗
Environmental benefits and economic costs of manure incorporation on dairy waste application fields.
Model simulations performed representing dairies in a 93000 ha watershed in north central Texas suggest that manure incorporation results in reduced phosphorus (P) losses at relatively small to moderate cost to producers. Simulated manure incorporation with a tandem disk on fields double-cropped with sorghum/winter wheat resulted in up to 33, 45, and 37% reductions in per hectare sediment-bound, soluble, and total P losses in edge-of-field runoff, relative to simulated surface manure applications. The effects of incorporation were evaluated at three different manure application rates. On aggregate across all three manure application rates, significant declines in P losses were obtained with incorporation except for sediment-bound P losses under the N-based manure application rate scenario. We found that the practice of incorporating manure shortly after it has been broadcast on the soil surface could help reduce P losses in such situations where P-based rates alone prove inadequate. The cost the producer incurs when manure is incorporated is on average about 1% of net returns when manure is applied at the N rate and 2-3% when it is applied at alternative P-based rates. In practice the costs could be lower because producers may substitute the manure incorporation operation for a tandem disk operation performed prior to manure application. As more and more dairy producers switch to the use of sorghum and corn silage in dairy rations and consequent on-farm production of these forages, the practice of manure incorporation may help to reduce phosphorus losses resulting from dairy manure applications to fields with these forage crops.
Animals↗
Components, therapeutic value and uses of myrrh.
Occurrence, constituents and medicinal use of myrrh, obtained from the stem of different Commiphora species are reviewed. The constituents of the volatile oil, the resin and the gum are outlined in detail. Myrrh has considerable antimicrobial activity and is medicinally used in a variety of diseases.
Animals↗
[Imaging of supradiaphragmatic manifestations of extranodal non-Hodgkin's lymphoma].
Malignant lymphomas are differentiated into Hodgkin's and non-Hodgkin's-lymphoma (NHL). The following article discusses the imaging of extranodal NHL in supradiaphragmatic localizations. Lymphoma can affect nearly all tissues, and represent a rare entity as primary extranodal NHL. A secondary involvement of non-nodal tissue as consequence of a generalized lymphoproliferative disease is more common,and may be seen as well in HIV-positive patients defining AIDS. As extranodal lymphoma mimic the radiologic appearance of other malignant tumors, direct diagnosis without histologic analysis is often impossible. The article describes typical manifestations of lymphoma of the lungs, the head and neck area including the large glands, and rare localizations as the heart or the breast.
Head and Neck Neoplasms↗
[Modern diagnostic imaging: MR urography].
MR-urography presents a new diagnostic approach to the urinary system, resulting in images comparable to those known from i.v.-urography. T2-weighted MR-urograms demonstrate static fluid without ionizing radiation or nephrotoxic contrast media. The excretory renal function can be examined by the use of gadolinium-enhanced T1-urography. The degree and cause of ureteric obstruction can be diagnosed with high sensitivity and specificity. On the other hand, urolithiasis is frequently misdiagnosed by MR-urography and, in this case, spiral CT should be used. Pediatric or pregnant patients can be examined as well as donors before and patients after renal transplantation. Furthermore, in case of a tumor MR-imaging, including MR-angiography, is a potential diagnostic "all-in-one" approach.
Adult↗
Differential diagnosis of hyperthyroidism: Doppler sonographic quantification of thyroid blood flow distinguishes between Graves' disease and diffuse toxic goiter.
The aim of our study was to evaluate the usefulness of color duplex sonography to distinguish Graves' disease from diffuse toxic goiter. 24 patients with Graves' disease and 13 patients with diffuse toxic goiter underwent B-mode- and color duplex sonography of the thyroid gland. All patients had hyperthyroidism and elevated (99m)Tc-uptake. Spectral Doppler recordings were obtained at all thyroid arteries. Representative color flow maps of the thyroid gland were analyzed, calculating the percentage area of the thyroid gland, occupied by color pixels (color pixel density). The B-mode ultrasound pattern was subjectively assessed on a 4-point rating scale. In patients with Graves' disease the mean peak systolic velocity (PSV) (SD) was 110 (+/- 49) cm/s, the mean volume flow rate (VFR) was 123 ( +/- 67) ml/min and the mean color pixel density (CPD) was 33 (+/- 12) %. For patients with diffuse toxic goiter mean PSV (SD) was 43 ( +/- 9) cm/s (p < 0.001), mean VFR was 23 (+/- 10) ml/min (p < 0.001) and mean CPD was 9 (+/- 6) % (p = 0.007). CPD and spectral duplex recordings were positively correlated (CPD/PSV: rs = 0.77, CPD/VFR: rs = 0.75; p < 0.0001). No significant differences were observed concerning RI values. Sensitivity was 87% and specificity 92% for CPD and VFR and 87% and 100% for PSV. We conclude, that color duplex sonography can reliably distinguish diffuse toxic goiter from Graves' disease and therefore contributes significantly to the differential diagnosis of hyperthyroidism in diffuse thyroid disease.
Adult↗
Early postoperative tissue harmonic sonography of the thyroid gland.
PURPOSE: Fundamental gray-scale imaging (FGI) is known to be unuseful for thyroid imaging in the early postoperative setting. Thus, we evaluated the feasability of tissue harmonic imaging (THI) early after thyroid resection. MATERIAL AND METHODS: FGI and THI of the neck were performed in 48 consecutive patients 4 days after surgery. The examiner was blinded to patient diagnoses and types of surgery. FGI and THI examinations were stored on videotape and reviewed offline by two different readers who rated the quality of delineation of the organ borders and presence or absence of focal lesions. The results were compared to neck US performed 12 weeks after surgery. RESULTS: Delineation of the thyroid remnants in THI/FGI was rated to be excellent in 22/2, good in 11/9, poor in 3/16 and not visible at all in 4/13 patients. The correlation between THI-volumetry and control-volumetry was very high (r=0.81; p<0.0001). THI but not FGI depicted presence or absence of solid thyroid nodules with 100% accuracy. CONCLUSION: THI is a feasible method for thyroid US in the early postoperative setting. It permits volumetry of the residual thyroid tissue and accurately depicts nodules within the thyroid remnant.
Female↗
Contrast-enhanced MR urography in the evaluation of renal transplants with urological complications.
AIM: The diagnostic work-up of renal transplants with impaired function due to urological problems can be difficult. This study was performed to assess sensitivity and specificity of non-invasive contrast-enhanced MR urography (MRU). METHODS AND MATERIALS: Thirty-five patients with renal transplants (25 - 71 years, mean: 53.4 years) with sonographically diagnosed hydronephrosis or perirenal fluid collections were assessed by MR urography. MR examinations were carried out at a 1.5 T clinical scanner (Vision, Siemens, Erlangen, Germany) with a 512 matrix contrast-enhanced fat-suppressed T1-weighted FLASH 3D sequence in breath-hold technique. MIP reconstructions were used to produce MR urography. MRU diagnoses were compared to operative results. RESULTS: In all patients, images with sufficient contrast in the renal collecting system were obtained. Hydronephrosis was confirmed in 20 patients, 8 patients showed a different pathology while 7 had normal findings. Compared to operative results, sensitivity of MRU was 100% with a specificity of 78%, respectively. One ureteral stone was misdiagnosed as a stricture, and 2 suspected ureteral stenoses could not be found upon operation. CONCLUSIONS: Contrast-enhanced MR urography is a highly sensitive and specific non-invasive method to evaluate patients suspected of having typical post-transplant urological complications. It may replace invasive procedures such as antegrade pyelography in the pre-operative work-up.
Adult↗
Usefulness of K-1 (CD-30) marker in Hodgkin's disease.
OBJECTIVE: To identify Hodgkin's and Reed Sternberg like cells by a single Immunomarker (Ki-1; CD-30) and to highlight diagnostic specificity of these cells in Hodgkin's disease, as these cells are frequently encountered in other lymphoproliferative disorders on H&E sections. METHODOLOGY: Seventy-nine histologically diagnosed cases of lymph node biopsies (59 cases of Hodgkin's disease, 15 cases of Non Hodgkin's lymphoma and 5 cases of non neoplastic lymphoid tissue) were subjected to Ki-1 (CD-30) immunostaining as all cases revealed Hodgkin's and/or Reed Sternberg like cells on H&E stained sections. RESULTS: Out of 59 cases of Hodgkin's disease, 49 (83%) showed Ki-1 (CD-30) immunoreactivity for Reed Sternberg and Hodgkin's cells. None of the 15 cases of non-Hodgkin's lymphoma (2 small lymphocyte type, 11 diffuse large cells type, 2 lymphoblastic type) showed positive Ki-1 (CD-30) immunostaining. Only one case of the remaining 5 cases of non-neoplastic lymphoid lesion (2 toxoplasmic lymphadenitis, one histiocytic necrotizing lymphadenitis, one reactive hyperplasia and one chronic non specific lymphadenitis) showed positive Ki-1 immunostaining. CONCLUSION: Ki-1 (CD-30) is a reliable marker for Hodgkin's Reed Sternberg like cells in histologically proven cases of Hodgkin's disease but not for similar cells encountered in other lymhoproliferative lesions.
Biomarkers, Tumor↗