PubMed Health⌕ Search

Biomedical subjects

C Düber

Publications and source records attributed to C Düber.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Chloroma (granulocytic sarcoma, myeloblastoma). Clinical aspects and radiological diagnosis].

Six cases of granulocytic sarcoma are presented. A mediastinal chloroma and a tumor of the submandibular gland were observed with two patients as single sign of acute myeloic leukaemia. In one patient a chloroma appeared as first manifestation of acute myeloic leukaemia. Two patients exhibited the tumor as first symptom of a blastic crisis of chronic myelogenous leukaemia (femoral bone, lumbar spine). The sixth patient with a myelodyplastic syndrome showed a chloroma of the breast. Various radiological procedures were applied including plain radiography, MRT, CT and mammography. The results are compared with literature. Principles of therapy were supplemented.

Acute Disease↗
PubMed2000

[Solitary fibrous pleural tumors--rare tumors with unpredictable clinical behavior].

Solitary fibrous tumors of the pleura are rare tumors with unpredictable clinical behaviour. We report about two patients with an incidental finding of an intrathoracic tumor. Preoperative diagnosis was uncertain. In both patients, a solid tumor of the pleura was resected en bloc in combination with a wedge resection of the lung following anterolateral thoracotomy. The postoperative course was eventful. Six months after primary complete resection there were no signs of tumor recurrence.

Diagnosis, Differential↗
PubMed2000

Diabetes and peripheral arterial occlusive disease: prospective comparison of contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography.

OBJECTIVE: The purpose of this study was to compare contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography (DSA) for identifying and evaluating arteries of the distal calf and foot in diabetic patients with severe arterial occlusive disease who will undergo distal bypass surgery. SUBJECTS AND METHODS: Twenty-four feet of 24 consecutive patients with diabetes and limb-threatening lower extremity ischemia were prospectively imaged using an ultrafast three-dimensional fast low-angle shot sequence on a 1.5-T MR scanner. All patients also underwent DSA of the diseased extremity within 5 days. Images were interpreted in a randomized manner by two observers in conference. Each lower extremity was divided into seven potential arterial segments. Image analysis included the detection of patent, stenosed, or occluded vessel segments. A vascular surgeon formulated treatment plans on the basis of findings from DSA and then formulated treatment plans on the basis of findings from both DSA and MR angiography. RESULTS: MR angiography was significantly better than DSA in revealing peripheral runoff vessels (p < 0.001). In nine (38%) of the 24 patients, MR angiography showed patent pedal vessels suitable for distal bypass grafting that were not revealed by DSA. Because of the results of MR angiography, treatment plans changed in seven of the nine patients in whom patent vessels were subsequently used as target vessels for distal pedal bypass grafts. CONCLUSION: Contrast-enhanced three-dimensional MR angiography is superior to DSA in revealing patent vessel segments of the foot in diabetic patients with severe arterial occlusive disease. Contrast-enhanced three-dimensional MR angiography should be part of the diagnostic algorithm for patients in whom pedal bypass grafting is a therapeutic option.

Aged↗
PubMed1999

[Therapy of thromboembolic blockages in the crural arteries: Clinical experience with the Angiojet thrombectomy catheter].

UNLABELLED: To investigate the clinical impact of a new hydrodynamic thrombectomy catheter in thromboembolic occlusion of tibial arteries. METHOD: 10 patients with thromboembolic occlusion of all tibial arteries were treated with the Angiojet thrombectomy device in order to reestablish blood flow. Depending on angiographic and clinical results of thrombectomy, additional thrombolysis, PTA, recanalization, or surgical bypass grafting was performed. RESULTS: Antegrade blood flow in at least one tibial artery was reestablished in 6 cases with the thrombectomy device. However, additional treatment modalities were used in order to improve the outcome and to resolve adherent thrombi or to treat vessel stenoses and occlusions: thrombolysis (n = 9), PTA (n = 3), recanalization (n = 1), bypass grafting (n = 3), suction thromboembolectomy (n = 1), replacement of popliteal aneurysm (n = 1). The limb salvage rate was 7/10. The ratio of injected volume to aspiration volume was 1.04 +/- 0.07 indicating that the system works isovolumetrically. The device induced moderate hemolysis with plasma free hemoglobin rising by the factor 12.91 +/- 11.59, (P < 0.01). CONCLUSION: In cases with thromboembolic occlusions of tibial arteries the Angiojet thrombectomy catheter is a valuable addition to the interventional instrumentarium. It works isovolumetrically but induces moderate hemolysis and thereby may compromise renal function. However, in most cases additional treatment modalities are required.

Aged↗
PubMed1999

Dynamic phosphorus-31 magnetic resonance spectroscopy of the quadriceps muscle: effects of age and sex on spectroscopic results.

RATIONALE AND OBJECTIVES: Phosphorus-31 (31p) magnetic resonance spectroscopy (MRS) is used to assess the influence of sex and age on quadriceps muscle metabolism before and after exercise. METHODS: Fifty-four healthy volunteers and 56 patients with an arterial occlusive disease were examined by dynamic 31p MRS. In the magnet, the quadriceps muscle was stressed by an isometric and an isotonic form of exercise until exhaustion. RESULTS: Older subjects showed a significantly larger ratio of inorganic phosphate (P(i)) to phosphocreatine (PCr) than younger subjects (r = 0.52, P = 8 x 10(-9)). With subjects' increasing age, the ratio of adenosine triphosphate (beta-ATP) to total phosphate decreased (r = -0.36, P = 5 x 10(-5)). The ratio of phosphomonoester to beta-ATP and phosphodiester (PDE) to beta-ATP showed a strong age dependence (r = 0.71 and 0.69, P = 3 x 10(-17) and 4 x 10(-15), respectively). The pH was the only one of the evaluated spectroscopic parameters that showed a sex dependence. Female subjects had a significantly lower pH (7.03+/-0.02) than male subjects (7.05+/-0.03) (P = 6 x 10(-4)). With increasing age, the maxima of P(i) to PCr were less extreme during both of the exercises (r = -0.51, P = 3 x 10(-16)). Likewise, the exercise-induced acidosis was less severe with increasing age (r = -0.51, P = 7 x 10(-16)). After the exercises ended, the times of half recovery of P(i) to PCr and the pH neither correlated with the subjects' age nor with sex or the cross-sectional area of the quadriceps muscle. CONCLUSIONS: The sex and age of volunteers or patients may affect spectroscopic results in a significant way. This influence has to be considered in the interpretation of spectroscopic studies. According to the recovery rates of P(i) to PCr and the pH, an age-related deterioration of muscular metabolism seems to be avoidable by appropriate physical activity.

Adenosine Triphosphate↗
PubMed1998

[Efficacy of ultrasound controlled direct reposition of fragments of the posterior vertebral body facet].

To calculate canal compromise and decrease of midsagittal diameter caused by retropulsion of fragments into the spinal canal we analyzed the pre- and postoperative computed tomographies of 32 patients with unstable thoracolumbar burst fractures treated by USS (universal spine system). Our intention was to examine the efficiency of ultrasound guided repositioning of the dispaced fragments which was performed in all 32 cases. We found a clear postoperative enlargement of canal area (ASP preoperatively 55%, postop. 80%) and midsagittal diameter (MSD preop. 58%, postop. 78%). 10 of 13 patients presented a postoperative improvement of neurological deficit, no neurological deterioration occurred. Fractures with neurological deficit showed more canal compromise (52%) and less midsagittal diameter (MSD compromise 51%) than those without (40% or 39%). There was no correlation between the percentage of spinal canal stenosis and the severity of neurological deficit. Below L 1 the spinal canal is greater than between Th 11 and L 1, so a more important spinal stenosis is tolerated. In case of unstable burst fractures with neurological deficit the ultrasound guided spinal fracture reposition is an effective procedure concerning the necessary improvement of spinal stenosis: an additional ventral approach for the revision of the spinal canal is unneeded. In fractures without neurologic deficit the repositioning of the displaced fragments promises an avoidance of long-term damages such as myelopathia and claudicatio spinalis.

Adolescent↗
PubMed1998

[Effect of oxygen inhalation on hemodynamics in chronic thromboembolic pulmonary hypertension].

PURPOSE: This study evaluates the haemodynamic effects of oxygen inhalation on pulmonary artery pressure and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. METHOD: In 47 patients with chronic thromboembolic pulmonary hypertension haemodynamic parameters were measured before and after oxygen inhalation. RESULTS: In moderately severe and severe pulmonary hypertension oxygen inhalation significantly reduced mean pulmonary artery pressure by about 11.1% and 4.6%, respectively. However, pulmonary vascular resistance was not significantly affected. Oxygen saturation improved and heart rate was reduced. Cardiac index decreased in severe pulmonary hypertension. Systemic vascular resistance increased. CONCLUSION: We conclude that oxygen inhalation reduces pulmonary artery pressure and improves oxygen supply in patients with moderately severe and severe chronic thromboembolic pulmonary hypertension.

Blood Pressure↗
PubMed1998

[Chronic thromboembolic pulmonary hypertension: hemodynamic effects of selective pulmonary artery DSA with nonionic contrast media].

PURPOSE: This study evaluates the effects of pulmonary bolus injection of nonionic contrast medium on pulmonary artery pressure and resistance in patients with chronic thromboembolic pulmonary hypertension. METHODS: In 39 patients (age 52 +/- 15) haemodynamic measurements were performed during bolus injection of nonionic contrast medium in a control group (I), in moderately severe (II) and severe pulmonary hypertension (III). RESULTS: Initial inspiratory arrest caused significant pressure increase in all groups prior to bolus injection (delta PAsyst: 7.1 +/- 6.7 [I], 6.8 +/- 3.9 [II] und 7.2 +/- 7.9 mmHg p < 0.05). However, contrast bolus injection (25.1 +/- 2.3 ml iopamidol, 13.0 ml/s) caused only minor additional pressure increase (delta PAsyst: 2.2 +/- 1.4 [I], 2.7 +/- 1.9 [II] und 4.9 +/- 5.4 mmHg [III] p < 0.05). After angiography pulmonary artery pressure and vascular resistance was increased only moderately, predominantly in group III. Systemic vascular resistance was slightly decreased. CONCLUSION: In patients with moderately severe and severe chronic thromboembolic pulmonary hypertension bolus injection of nonionic contrast medium causes no major haemodynamic effects.

Adult↗
PubMed1998

Dynamic phosphorus-31 magnetic resonance spectroscopy in arterial occlusive disease: effects of vascular therapy on spectroscopic results.

RATIONALE AND OBJECTIVES: The aim of the authors' prospective study was to explore therapy-induced changes of muscular metabolism in arterial occlusive disease (AOD). MATERIALS: Before and after vascular therapy, respectively, 31 patients with AOD were examined by dynamic phosphorus-31 (31P) magnetic resonance spectroscopy (MRS) at 1.5 T; in the magnet, the quadriceps muscle was stressed by an isometric and an isotonic form of exercise until exhaustion, respectively. Twenty-three patients were treated by standardized percutaneous transluminal angioplasty; eight patients underwent a vascular operation. RESULTS: Vascular therapy induced a marked improvement of clinical and angiographic results. At the same work load, exercise-induced metabolic changes of the quadriceps muscle were significantly less pronounced after the vascular therapy: maxima of the ratio inorganic phosphate (Pi)/phosphocreatine (PCr) (isometric exercise: 0.34 [after therapy] versus 0.44 [before therapy]; isotonic exercise: 0.36 [after therapy] versus 0.51 [before therapy]) as well as minima of pH (isometric exercise: 7.00 [after therapy] versus 6.93 [before therapy]; isotonic exercise: 7.00 [after therapy] versus 6.93 [before therapy]). In relation to maximal values of Pi/PCr, the extent of acidosis was smaller after vascular therapy, resulting in a flatter slope of the regression line between these parameters (b = -0.24 +/- 0.10 versus b = -0.31 +/- 0.09). After both of the exercises, time of half recovery of Pi/PCr was significantly shorter after vascular therapy (isometric exercise: 43 seconds [after therapy] versus 83 seconds [before therapy]; isotonic exercise: 42 seconds [after therapy] versus 57 seconds [before therapy]). CONCLUSIONS: After effective vascular therapy, minor exercise-induced metabolic changes (increased "work/energy cost-index"), a decreased contribution of anaerobic glycolysis to total adenosine triphosphate production as well as a markedly increased recovery rate of Pi/PCr are unequivocal spectroscopic proofs of an improved oxidative metabolism of muscle cells because of increased tissue perfusion.

Adenosine Triphosphate↗
PubMed1998

[Clinical relevance of thoracic CT in intensive care and emergency medicine].

PURPOSE: Evaluation of the impact, indications, and therapeutic efficiency of chest CT in intensive-care and emergency patients. MATERIALS AND METHODS: Retrospective assessment of 741 consecutive chest CT, or which 74% were acquired in the spiral technique, in intensive-care and emergency patients. Chest CT scans and respective clinical data were compared. RESULTS: 16% of all examinations were indicated to resolve questions arising from the chest radiogram, 10% to confirm or exclude pulmonary embolisms and 10% to confirm or exclude aortic dissection. In 10% a focus of infection was sought. 57% of all CT examinations had an impact on therapy, in 7% further diagnostic tests were prompted. Among a total of 588 clinical decisions based upon chest CT, the most frequent therapeutic conclusions consisted in: minimally invasive CT guided interventions in 17%. A new drug was administered in 13%, surgical intervention was performed in 13%, bed-side interventions such as insertion of a drainage tube in 13%, and a given pharmacological therapy was continued in 11%. CONCLUSION: Chest CT has a strong impact on patient management in emergency and critical-care medicine. CT guided interventions are frequently used in critically-ill patients. The introduction of the spiral technique has led to important new CT indications in the field of non-invasive vascular diagnosis, namely the assessment of pulmonary embolism and aortic dissection.

Critical Care↗
PubMed1997

[Early results of pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension].

Pulmonary thromboendarterectomy (PTE) is a potentially curative procedure in chronic thromboembolic pulmonary hypertension. From June, 1989, to December, 1994, we performed PTE in 109 consecutive patients. Multiple changes in surgical approach and postoperative management have been implemented since January, 1995. We report the early results of 32 thromboendarterectomies performed from January, 1995, to January, 1997. Thirty-two patients (16 females, 16 males; mean age 55 years) were operated using cardiopulmonary bypass, deep hypothermia and circulatory arrest. Preoperative NYHA functional class was III in 21 and IV in 11 patients. Pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (mPAP) were elevated to 967 +/- 238 dynes.s.cm-5 and 51 +/- 11 mm Hg respectively. The perioperative mortality rate was 9.3% (3 of 32). Twenty-nine survivors were weaned from mechanical ventilation and extubated after a mean of 35 hours (12 to 190 hours). PVR was reduced to 301 +/- 151 dynes.s.cm-5 (p < 0.001) and mPAP was reduced to 28 +/- 10 mm Hg (p < 0.001). Pulmonary thromboendarterectomy is an effective surgical procedure for chronic thromboembolic pulmonary hypertension. By means of modifications in surgical approach and postoperative management, early results can be improved and perioperative mortality can be decreased to less than 10%.

Chronic Disease↗
PubMed1997

[Whole body spiral CT in primary diagnosis of patients with multiple trauma in emergency situations].

PURPOSE: The aim of this study was to evaluate the role of a fast whole body helical CT scanner for primary diagnosis in trauma patients. METHODS: 27 severely injured patients (9 women, 18 men; mean age 43 years) were first examined with a helical CT scanner allowing for digital radiograms up to a length of 1024 mm and continuous helical scans of up to 70 seconds (slice thickness 3 to 10 mm, pitch factor up to 2). The primary CT diagnosis was verified either by x-ray after the CT examination or during the subsequent days, by abdominal ultrasound, by additional CT scans in the following days, and by clinical follow-up. RESULTS: CT showed all clinically relevant injuries of the head, spine, chest, abdomen and pelvis. The diagnosis and classification of vertebral fractures was performed immediately. 4% of the fractures of the extremities and the ribs were not seen primarily. 6% of the injuries were outside the CT scan field. CONCLUSION: Helical CT is a reliable and fast method to obtain vital information and to improve management planning in severely injured patients. It reduces the number of conventional x-ray examinations. In certain cases, additional x-rays of extremity fractures may be required.

Abdominal Injuries↗
PubMed1997

[Dynamic 31-phosphorus magnetic resonance spectroscopy of the m. quadriceps: therapy-induced changes in arterial occlusive disease].

PURPOSE: The present investigation aimed at examining changes in muscle metabolism caused by treatment of arterial occlusive disease, using dynamic 31-phosphorus methods. METHOD: 32 patients with arterial occlusive disease were examined in a 1.5 T apparatus with a 6 cm surface coil before and after treatment. The metabolic changes in the quadriceps muscles were visualised during a 36 s phosphorus spectrum during rest, exercise (isometric and isotonic) and during a period of recovery. RESULTS: Vascular therapy resulted in a significant increase in the duration of both types of exercise during dynamic phosphorus spectroscopy (isometric exercise: 282 s against 199 s: p = 0.002, isotonic exercise: 575 s against 222 s; p = 5 x 10(-6). After treatment, exercise-induced changes in pH (7.00 against 6.94; p = 0.004 and 7.00 against 6.93; p = 0.02) and the ratio Pi/PCr (0.34 against 0.44; p = 0.002 and 0.36 against 0.50; p = 0.009) were significantly smaller than before therapy, using a similar amount of exercise. Recovery time of Pi/PCr (45 s against 82 s; P = 10(-5) and 42 s against 57 s; p = 0.01) and pH value (154 s against 181 s; p = 0.14 and 173 s against 214 s; p = 0.22) showed significant reduction after treatment. CONCLUSIONS: Dynamic 31-phosphorus magnetic resonance spectroscopy indicates increased mitochondrial oxidative capacity in the quadriceps muscles as evidence for increased oxygen supply to muscle tissue following vascular therapy.

Arterial Occlusive Diseases↗
PubMed1997

CT angiography versus intraarterial digital subtraction angiography for assessment of aortoiliac occlusive disease.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of CT angiography (CTA) with a single helical acquisition for assessment of stenoses and occlusions of the iliac arteries. SUBJECTS AND METHODS: In our prospective study, intraarterial digital subtraction angiography and IV CTA were performed from the suprarenal aorta to below the femoral bifurcation in 30 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were also obtained. The accuracy of CTA with and without analysis of axial images was determined. RESULTS: Sensitivity and specificity of CTA were 100% for iliac artery occlusions with a confidence interval 85-100% and 97-100%, respectively. When axial scans were interpreted, 14 of 15 high-grade (> 75%) stenoses were recognized. Sensitivity and specificity of CTA were 93% (range, 68-100%) and 99% (range, 97-100%), respectively. When maximum intensity projections alone were analyzed, sensitivity for the diagnosis of 15 high-grade stenoses was only 53% (range, 27-79%) because calcified plaques obscured six stenoses. CONCLUSIONS: CTA accurately reveals iliac artery occlusions. Observers of CT angiograms may overlook short stenoses in rare instances. Calcified plaques limit the use of maximum-intensity-projection images.

Angiography↗
PubMed1996

Hemodynamic effects of nonionic contrast bolus injection and oxygen inhalation during pulmonary angiography in patients with chronic major-vessel thromboembolic pulmonary hypertension.

BACKGROUND: Pulmonary angiography is the gold standard for the diagnosis of chronic thromboembolic pulmonary hypertension; however, major complications have been reported. This study evaluates the hemodynamic effects of direct pulmonary nonionic contrast bolus injection and oxygen inhalation in patients with chronic thromboembolic pulmonary hypertension. METHODS AND RESULTS: In 33 patients, hemodynamic parameters were measured after oxygen inhalation and during bolus injection of nonionic contrast medium in a control group (group 1. n = 11), in a group of patients with moderately severe pulmonary hypertension (group 2, n = 9), and in a group with severe pulmonary hypertension (group 3, n = 13). Oxygen inhalation significantly improved oxygen supply. Pulmonary artery pressure and heart rate were reduced, but pulmonary vascular resistance and total pulmonary resistance were not significantly affected. One hundred ninety-eight angiograms were performed selectively on both pulmonary arteries in the posterior-anterior, oblique, and lateral views. Before contrast bolus injection, RAP and PAP significantly increased because of initial inspiration. Contrast bolus injection caused only a minor pressure increase (delta PA systolic, 2.3 +/- 1.4, 2.5 +/- 1.8, and 5.0 +/- 5.2 mm Hg, groups 1, 2, and 3, respectively) without significance between the groups. After the angiography, pulmonary artery pressure was moderately increased, predominantly in group 3, but pulmonary vascular resistance was not significantly changed. Systemic vascular resistance was decreased. Cardiac index increased in groups 1 and 2 but was unchanged in group 3. Systemic pressure therefore decreased in group 3. CONCLUSIONS: We concluded that bolus injection of nonionic contrast medium causes no major hemodynamic effects even in patients with severe chronic thromboembolic pulmonary hypertension. Oxygen contributes to safety during the procedure.

Administration, Inhalation↗
PubMed1996

[Retroperitoneal, mediastinal and subcutaneous emphysema with pneumothorax after colonoscopy].

HISTORY: Severe ulcerative colitis had been diagnosed in a 25-year-old man six years ago. That same year he underwent laparoscopy for mechanical ileus. Since then he has been on a maintenance dose of sulphasalazine without any further symptoms. Because of a known pseudopolyposis coli, repeat coloscopy was performed. EXAMINATIONS AND FINDINGS: The endoscope was smoothly introduced and the examination was without pain. No premedication had been given. A biopsy was obtained during withdrawal of the endoscope. Suddenly the patient noticed marked scrotal swelling. The examination was terminated abruptly. No lesions of the wall of the distal colon were seen when the endoscope was pulled out immediately. Quickly, cutaneous emphysema developed over the right side of the abdomen and thorax up to the neck. The patient could no more properly hear his own voice. Radiology demonstrated bilateral pneumoretroperitoneum, mediastinal emphysema and pneumothorax. TREATMENT AND COURSE: The patient was put on parenteral nutrition for 4 days and prophylactically received amoxycillin, calvulanic acid and metronidazole. The air was gradually absorbed and the patient discharged symptom-free after 7 days. CONCLUSION: In contrast to intraperitoneal perforation, which usually causes acute symptoms of peritonitis and requires urgent surgical treatment, the course of the much rarer retroperitoneal perforation is more benign with few symptoms and can be managed conservatively.

Adult↗