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Biomedical subjects

C Wunsch

Publications and source records attributed to C Wunsch.

At least 19 recordsLinked to original sources
PubMed2003

[Thoracic findings in pediatric patients with cystic fibrosis].

Cystic fibrosis is the most common autosomal recessive metabolic disease in Europe with an incidence of 1:2500. The severity of the lung disease is the most important factor of morbidity and mortality in CF-patients. Because of the better diagnostic and therapeutic modalities life expectancy has increased significantly. The underlying pathology is a defect of chromosome 7, which encodes the regulation of the fluid balance across the cell membrane which effects chloride as well as sodium. The exocrine glands produce a viscous mucus which obstructs the airways and promotes infections. The result is the destruction of lung parenchyma. In daily routine, chest x-ray is still the most important radiological tool, although computed tomography depicts changes in morphology earlier and more exactly. Recent research studies show that MRI has-because of its additional functional options-interesting aspects for the future.

Adolescent↗
PubMed2000

Improved estimates of global ocean circulation, heat transport and mixing from hydrographic data.

Through its ability to transport large amounts of heat, fresh water and nutrients, the ocean is an essential regulator of climate. The pathways and mechanisms of this transport and its stability are critical issues in understanding the present state of climate and the possibilities of future changes. Recently, global high-quality hydrographic data have been gathered in the World Ocean Circulation Experiment (WOCE), to obtain an accurate picture of the present circulation. Here we combine the new data from high-resolution trans-oceanic sections and current meters with climatological wind fields, biogeochemical balances and improved a priori error estimates in an inverse model, to improve estimates of the global circulation and heat fluxes. Our solution resolves globally vertical mixing across surfaces of equal density, with coefficients in the range (3-12) x 10(-4) m2 s(-1). Net deep-water production rates amount to (15 +/- 12) x 10(6) m3 s(-1) in the North Atlantic Ocean and (21 +/- 6) x 10(6) m3 s(-1) in the Southern Ocean. Our estimates provide a new reference state for future climate studies with rigorous estimates of the uncertainties.

Journal Article↗
PubMed1999

[Foreign body aspiration].

Aspiration of foreign bodies is a common cause of respiratory distress in children between the age of 6 months and 3 years. The diagnosis of radiopaque foreign bodies is easy when the whole respiratory tract is depicted. Nonopaque foreign bodies need a more differentiated diagnostic approach. The first step should be plain films in inspiration and expiration. The performance of additional chest radiographs, fluoroscopy and if need be CT or nuclear scans depends on the result of the plain films. The chest radiograph may reveal a variety of findings, the commonest of which is unilateral air trapping. Rarely, atelectasis, recurrent pneumonia at the same localisation and inspiratory obstruction are found. Combinations of the above-mentioned findings are possible. Moreover, the absence of positive radiological findings does not exclude the diagnosis of foreign body aspiration.

Bronchography↗
PubMed1999

[Foreign body ingestion].

Foreign body ingestion is not infrequent in infants and children. The diagnosis of radiopaque foreign body ingestion does not pose a major problem. It is crucial to take an X-ray from the pharynx to the level of the pylorus. If a foreign body that might get stuck at the ileocoecal valve is ingested, it is necessary to perform a radiograph of the whole abdomen. Foreign bodies that do not pass the cardia must be extracted endoscopically. In the case of foreign bodies with a smooth contour that have passed the pylorus, parents are advised to check the child's stool or collect it and bring it for X-raying. If after a week there is no definite evidence that the foreign body has been excreted a follow-up radiograph is carried out. If the foreign body is still in the stomach or duodenum, endoscopy is necessary. The detection of nonopaque foreign bodies can be facilitated by giving oral contrast medium, making the depiction of the foreign body as a filling defect possible. As a complication, perforation can occur, the diagnosis of which may entail the use of sonography, conventional radiography and, to a lesser extent, CT.

Child↗
PubMed1999

Abdominal aortic aneurysm. Detection of multilevel vascular pathology by time-resolved multiphase 3D gadolinium MR angiography: initial report.

OBJECTIVE: To evaluate multiphasic 3D gadolinium-enhanced magnetic resonance angiography (3D-Gd-MRA) for detection of vascular pathology at multiple levels of the aorta and iliac arteries. METHODS: In 18 patients with abdominal aortic aneurysm (n = 13), dissection (n = 3), or both (n = 2), multiphase 3D-Gd-MRA was performed acquiring five consecutive (6.8 seconds) 3D data sets in a single breath-hold. In each of the five time-resolved phases, vessel visibility of the abdominal aortic branches and iliac arteries was assessed. The extent of vessel involvement by the aneurysm or dissection seen on multiphase 3D-Gd-MRA was compared with standard imaging and surgical findings. Digital subtraction angiography was available for comparison in 4 cases, CT angiography in 10 cases. RESULTS: Due to the delayed filling of the aortic aneurysm, the proximal aortic branches and the aneurysm neck demonstrated an inversely related enhancement compared with the distal abdominal and iliac vessels (P < 0.001). Review of all five phases of multiphase 3D-Gd-MRA allowed optimal visualization of each vessel segment without any artifacts due to parenchymal or venous overlay. In dissections, review of three phases was required (P < 0.001) for diagnostic evaluation of the true and false lumens. Substantially more vessel involvement was detected on multiphase 3D-Gd-MRA; this was surgically confirmed in 10 of 11 cases and affected therapy management in 11 of 18 cases. CONCLUSIONS: Multiphase 3D-Gd-MRA is a convenient, robust, and safe technique for presurgical anatomic mapping of complex aortic aneurysms and dissections.

Aortic Dissection↗
PubMed1998

[Radiologic diagnosis of bone metastases].

Metastases are the most common malignant tumors of the skeleton. Several imaging modalities can be engaged for the diagnosis of skeletal metastases. They may be combined, depending on the individual clinical setting. Plain films are used for evaluation of symptomatic regions of the skeleton. Sensitivity is low, but benign skeletal disorders causing clinical symptoms can usually be identified in plain films. Bone scintigraphy is employed for a survey of the entire skeleton with high sensitivity for the presence of metastases, but only poor specificity. Computed tomography (CT) and magnetic resonance imaging (MRI) are advanced diagnostic methods, essential particularly in the diagnosis of metastatic spinal disease. Using CT, additional percutaneous bone biopsies can be performed easily and safely. Of all imaging modalities, MRI has the highest sensitivity for skeletal metastases. Other advantages are the possibility of multidirectional slice positioning and excellent soft tissue contrast.

Bone Neoplasms↗
PubMed1998

[Hydro-CT in detection and staging of pancreatic carcinoma].

PURPOSE: To document our experience with spiral hydro-CT of the pancreas based on a combination of pharmacologic intestinal paralysis and water distension of the stomach and duodenum with specific reference to tumor detection rate, differentiation of malignant versus benign tumors and assessment of tumor resectability in a prospective study on 211 consecutive patients. MATERIAL AND METHODS: Between May 1994 und September 1997, 211 patients with suspect of pancreatic neoplasm from clinical, laboratory or other imaging data were examined. Our Hydro-CT techniques were based on intravenous injection of 40 mg N-butylscopolaminiumbromid (Buscopan) for intestinal paralysis, gastric and duodenal wall distension by oral administration of an average of 1.5 l warm tap water, 30 degrees RAO patient's positioning, individualized contrast injection technique using portal vein enhancement as reference and thin slice spiral CT (3 mm slice thickness, 6 mm table feed and 3 mm secondary reconstruction). Examined parameters were: (1) tumor detection rate, (2) differentiation of malignant versus benign disease, (3) differential diagnosis and (4) accuracy of assessment of resectability by identification of infiltration into adjacent organs and vessel structures relevant for resectability such as splenic, superior mesenteric, portal vein and celiac trunk, superior mesenteric, splenic and hepatic arteries. As gold standard for positive tumor detection and description surgery (of potentially resectable tumors) and microscopic diagnosis (of clearly unresectable tumors) were used and for negative tumor detection an event-free survival of six months, respectively. RESULTS: 96% of the examinations were well tolerated. In only 4% was on-site administration of a gastric tube required because of vomiting. In 2% of the patients a slight allergic reaction to the contrast medium was seen. The prevalence of a pancreatic neoplasm was 37.8%. In tumor detection Hydro-CT reached an overall accuracy of 94.8% with a sensitivity of 93.7% and a specificity of 95.2%. 52 patients underwent surgical exploration 34 of whom with tumorfree resection margins (RO resection) corresponding to a resection of 42.5%. In those assessment of resectability reached an overall accuracy of 94.6% with a sensitivity of 91.2% and specificity of 95.6%. CONCLUSION: The new technique of Hydro-CT based on the slice and spiral methodology including pharmacologic intestinal paralysis and water distension results in a high tumor detection rate and reliable assessment of resectability.

Aged↗
PubMed1998

[Diagnostic imaging for therapy control of primary bone tumors].

Adjuvant chemotherapy has significantly improved the prognosis of patients with bone sarcomas. Preoperative diagnostic imaging of tumor response to such therapy has become a mainstay for the assessment of prognosis, planning of surgery and further treatment. During therapy, responding tumors show characteristic changes on conventional radiography, angiography, sonography, radionuclide studies, CT and MR. The usefulness and the limitations of each imaging modality in assessing response to therapy are reviewed. The diagnostic importance of specific changes such as tumor volume reduction, calcification and tumor vascularization is discussed.

Adolescent↗
PubMed1998

[CT-angiography as a non-invasive method for the evaluation of the patency of TIPSS (transjugular intrahepatic portasystemic shunt)].

PURPOSE: To evaluate the feasibility of determining patency of the transjugular intrahepatic portosystemic shunt (TIPSS) by non-invasive CT angiography (CTA). MATERIALS AND METHODS: (1) Non-enhanced scanning of the shunt. (2) Bolus tracking by injecting 20 ml of non-ionic contrast material through a cubital vein access to determine the time to maximal shunt enhancement. (3) Contrast-enhanced spiral CT study applying a delay according to the time to peak of the shunt, 3 mm collimation, 5 mm table feed and 3 mm reconstruction interval. (4) 3D and multiplanar reconstructions. (5) Evaluation of the questions: intrahepatic shunt patent or not; evidence of intimal hyperplasia; evidence of stenosis and potential location. (6) Transjugular portography via the stent. (7) Comparison of angiographic findings and CT morphology. RESULTS: Eight patients had inconspicuous CTA. Four of them had a normal shunt at angiography, four had slight intimal hyperplasia. No intervention was necessary in these patients. CTA of three patients showed intimal hyperplasia (lumen reduction between 10% and 50%). The diagnosis was angiographically confirmed in all cases. Due to a high portosystemic gradient intervention was required in all. In five patients CTA and angiography showed a stenosis (reduction of shunt lumen > 50%). All required a revision including stent placement or PTA of the shunt tract. Four shunts were occluded; all occlusions were shown both in CTA and angiography. CONCLUSIONS: None of the shunts with normal findings at CTA required revision. All shunts conspicuous on CTA resulted in revision. In this study, CTA turned out to be an accurate, non-invasive method to evaluate the patency of TIPSS.

Angiography↗
PubMed1997

[Malignant lymphoma. Diagnosis and after-care in adults with special reference to cross-sectional imaging].

Radiological staging continues to remain the basis of a critical therapy of malignant lymphoma. As staging system, the Ann Arbor classification with some added modification is used. Up to now, CT is the imaging study of choice for staging and follow-up of cases of lymphoma. In future however, due to the advantages of the MRI, parts of the staging will be performed by MRI only. Imaging studies provide accurate measurement of extent of nodal disease. The detection of extra-nodal disease depends on the growth pattern and on the location. Focal lesions of sufficient size can be readily detected, diffuse infiltration is often missed. Computed tomography precisely reflects pathologic changes of lung involvement, but the findings are not specific. One weakness of the imaging studies is the low detection rate of splenic and hepatic involvement. Staging of gastrointestinal lymphoma has been improved by "hydro-CT" or "Hydro-MRI".

Adult↗
PubMed1997

[Lymphoma in childhood].

Manifestation of childhood Hodgkin's disease and Non-Hodgkin's lymphoma differ, especially in the latter, from those in adults. Extranodal involvement is seen even more frequently in childhood Non-Hodgkin's lymphomas than in adults. This article reviews the radiological findings in malignant lymphomas in children, explains the differences in the manifestation of Hodgkin's lymphomas, of different subtypes and of the malignant lymphomas in adults. The problems in diagnosis of organ manifestation and special problems of diagnostic imaging procedures in children are discussed.

Adolescent↗
PubMed1997

[Malignant lymphoma in childhood. Ultrasound diagnosis].

The sonographic diagnosis of malignant lymphoma in childhood is described. Malignant lymphomas are sonographically relatively uniform: initial enlargement of the lymph nodes and organs involved and disturbance of normal echo texture by mainly hypoechoic lesions can be found. Generally, four sonographic patterns of infiltration are described: diffuse, small nodular, large nodular and bulky type. Secondary, tumor-related or inflammatory complications (e.g. dislocation or compression of vessels, thoracic inlet syndrome, venous thrombosis, ileus, urinary retention, abscess and effusion) can be sonographically evaluated. Response to therapy correlates with normalization of size and echo texture and recovery from tumor-related complications. Differential diagnosis with ultrasound is based on the topographic distribution and echo pattern of infiltration and, with certain restrictions, on the echogenicity of lesions and perfusion feasible with Doppler sonography. The primary diagnosis has to be established histologically.

Child↗
PubMed1996

[Spiral CT portography in preoperative diagnosis of liver metastases].

Within a period of 12 months we preoperatively performed spiral CT portography (CT-AP) including individual determination of contrast injection kinetics, in 18 consecutive patients. The findings were compared with the microscopic findings in 15 resected specimens. A total of 51 perfusion defects were identified with CT-AP, 40 of which were finally diagnosed as metastases. A total of 36 hepatic lesions were identified at microscopy. 28 of which were metastases, all seen at CT-AP. 12 perfusion defects were misdiagnosed false positive as being of metastatic origin. Thus the sensitivity of CT-AP was 100%, the specificity 65% and the overall accuracy 78%. Therefore, CT-AP using the spiral CT technique is currently the most accurate method for preoperative staging of metastatic disease of the liver. Improvements of the scanning and contrast injection techniques will further improve the clinical value of this examination.

Adenoma, Liver Cell↗
PubMed1996

Recovery of interphase nuclei from extreme structural alterations in centrifuged fern protonemal cells.

Nuclear ability to recover morphologically and physiologically from tremendous elongation induced by centrifugation was investigated in single-celled protonemata of the fern Adiantum capillus-veneris. Basipetal centrifugation at a strength of ca. 2000 g for more than 1 h caused an extremely long (more than 500 microns), thread-like chromatin-containing extension of the nuclear envelope in the centrifugal direction. The nucleolus was either located inside a terminal widening of the extension, or it was detached from the thread and located outside the nucleus. Such enucleolation occurred in about half of the nuclei during 3 h of basipetal centrifugation. After centrifugation, the nuclei recovered morphologically by completely reducing the chromatin thread. One day after the end of centrifugation, all nuclei again contained a nucleolus, indicating that nucleolar regeneration had taken place in the interphase nucleus. Almost all basipetally centrifuged cells were still able to divide under white light conditions. A strong delay in the division time course may be attributed to recovery processes of the nuclear internal order. The remarkable ability of the Adiantum interphase nuclei to recover morphologically and physiologically is assumed to be due to processes which also drive the maintenance of the functional nuclear structure during interphase.

Cell Fractionation↗
PubMed1984

Sorbitol dehydrogenase deficiency in several pig tissues: potential implications for studies of experimental diabetes.

Screening for red blood cell sorbitol dehydrogenase deficiency in 12 different mammalian species was performed. A wide inter-species variability in red cell sorbitol dehydrogenase with a virtually complete deficiency in pigs was observed. Aldose reductase and sorbitol dehydrogenase activities in 12 different pig tissues also were measured. Aldose reductase activity was present in all the tissues studied, whereas organ specificity for sorbitol dehydrogenase was observed. Sorbitol dehydrogenase activity was not detectable in lenses, among other tissues, making the pig a potential model for studies in experimental diabetes, particularly for the investigation of sorbitol dehydrogenase deficiency as a risk factor in the development of cataracts.

Aldehyde Reductase↗
PubMed1982

Red blood cell sorbitol dehydrogenase deficiency in a family with cataracts.

Sorbitol dehydrogenase (SORD) was quantitatively assayed in a family in which four out of five brothers and their father had bilateral cataracts. Three sibs (two of them with cataracts) and both their father and paternal grandfather had SORD activity of about 25% of the reference values; of the other two affected sibs one had about 50% and the other had 75%; the mother and two paternal uncles had about 75%. These results do not define a clear cataract-SORD deficiency etiopathogenic relationship, nevertheless, they strongly suggest activity polymorphism in human red cell SORD, which would be highly relevant not only to the study of cataracts but of other major complications in diabetes.

Cataract↗
PubMed1981

A simple screening procedure for glucose phosphate isomerase, phosphofructokinase, aldolase and glyceraldehyde-3-phosphate dehydrogenase deficiencies.

A simple screening procedure for the detection of glucose-phosphate isomerase (GPI), phosphofructokinase (PFK), aldolase (AL) and glyceraldehyde-3-phosphate dehydrogenase (GAPD) deficiencies in blood, is described. These enzymes catalyze the second, third, fourth, and sixth reactions in the Embden-Meyerhof pathway. The procedure is based on the conversion of glucose-6-phosphate to 1,3-diphosphoglycerate (1,3-DPG) which is catalyzed by the sequential action of the GPI, PFK, AL and GAPD. The presence of the enzyme activities is visually estimated by the reduction of NAD+ (non-fluorescent) to NADH (fluorescent) which occurs when 1,3-DPG is formed. Absence of fluorescence indicates the deficiency of anyone of the four enzymes, which are specified by using separately the PFK, AL and GAPD respective substrates.

Anemia, Hemolytic, Congenital↗