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Biomedical subjects

D Gottschild

Publications and source records attributed to D Gottschild.

At least 19 recordsLinked to original sources
PubMed2006

Treatment with granulocyte-colony stimulating factor in patients with acute myocardial infarction. Evidence for a stimulation of neovascularization and improvement of myocardial perfusion.

BACKGROUND: Stem cell therapy has been suggested to be beneficial in patients after acute myocardial infarction (AMI). Strategies of treatment are either a local application of mononuclear bone marrow cells (BMCs) into the infarct-related artery or a systemic therapy with the granulocyte-stimulating factor (G-CSF) to mobilize BMCs. Nevertheless, the mechanisms responsible for improvement of cardiac function and perfusion are speculative at present. This study has been performed to investigate the effect of G-CSF on systemic levels of vascular growth factors and chemokines responsible for neovascularization, that might help to understand the positive effects of a G-CSF therapy after AMI. METHODS AND RESULTS: Five patients in the treatment group and 5 patients in the control group were enrolled in this study. The patients in the treatment group received 10 microg/kg bodyweight/day of G-CSF subcutaneously for a mean treatment duration of 6.6 +/- 1.1 days. In both groups, levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and monocyte chemotactic protein-1 (MCP-1) were measured on day 2 to 3 and day 5 after AMI. The regional wall perfusion and the ejection fraction (EF) were evaluated before discharge and after 3 months with ECG-gated MIBI-SPECT and radionuclide ventriculography, respectively. Significant higher levels of VEGF (p < 0.01), bFGF (p < 0.05) and MCP-1 (p < 0.05) were found in the treatment group compared to the control group. Levels of VEGF and bFGF remained on a plateau during the G-CSF treatment and decreased significantly in the control group. The wall perfusion improved significantly within the treatment group and between the groups (p < 0.05), respectively. The EF improved significantly within the treatment group (p < 0.05), but the change of the EF between the groups was not significant. CONCLUSION: In patients with AMI, the treatment with G-CSF modulates the formation of vascular growth factors that might improve neovascularization and result in an improved myocardial perfusion and function.

Acute Disease↗
PubMed2004

Comparison of whole-body STIR-MRI and 99mTc-methylene-diphosphonate scintigraphy in children with suspected multifocal bone lesions.

The study was performed to compare whole-body short time inversion recovery (STIR) MR imaging and (99m)Tc-methylene diphosphonate planar scintigraphy in the examination of children with suspected multifocal skeletal malignant lesions. Sixteen patients with known or suspected malignant skeletal disease underwent both whole-body STIR MR imaging and bone scintigraphy. The lesions were described and numbered according to scintigraphic evaluation criteria. Thus, 16 regions were analyzed in each patient for the comparison between the two modalities. Histology was proven in the primary malignant regions. Follow-up MRIs were registered. Scintigraphy and MRI follow-up were evaluated as gold standard. A total of 139 different lesions was observed by both modalities. Baseline whole-body MRI revealed 119 bone lesions in 256 possible sites (46.5%); scintigraphy revealed only 58 lesions (22.6%). Congruence was observed in only four patients (25%). According to the location of the lesion, correlation was observed in 39/139 lesions (28%). In all, 57.5% of the lesions were detected only by MRI and 14.5% of the lesions were detected only by scintigraphy. Whole-body MRI was more sensitive (P<0.001). Of all lesions numbered which could be separated in the initial MRI, whole-body MRI detected 178 lesions in the patients. The results suggest that whole-body MRI using a STIR sequence is an effective radiation free method for examination of children with suspected multifocal bone lesions. MRI showed more lesions than conventional (99m)Tc-methylene diphosphonate scintigraphy. Therefore, whole-body MRI may be feasible as a screening modality for metastatic and skip lesions in osteosarcoma, PNET, Ewing sarcoma and Langerhans cell histiocytosis in children.

Adolescent↗
PubMed2004

[Mobilization of stem cells by granulocyte colony-stimulating factor for the regeneration of myocardial tissue after myocardial infarction].

BACKGROUND AND OBJECTIVE: Animal data suggest that mobilized bone marrow cells (BMC) may contribute to tissue regeneration after myocardial infarction (MI). However the safety, feasibility and efficacy of treatment with granulocyte colony-stimulating factor (G-CSF) to mobilize BMC after acute myocardial infarction in patients is unknown. We analysed cardiac function and perfusion in 5 patients who were treated with G-CSF in addition to standard therapeutical regimen. METHODS AND RESULTS: 48 h after successful recanalization and stent implantation in 5 patients with acute MI, the patients received 10 micro g/kg bodyweight/day G-CSF subcutaneously for a mean treatment duration of 7.6+/-0.5 days. Peak value of CD34 (+) cells, a multipotent subfraction of bone marrow cells, was reached after 5.0+/-0.7 days. After 3 months of follow-up global left ventricular ejection fraction (determined by radionuclid-ventriculography) increased significantly from 42.2+/-6.6 % to 51.6+/-8.3 % (P<0.05). The wall motion score and the wall perfusion score (determined by ECG gated SPECT) decreased from 13.5+/-3.6 to 9.9+/-3.5 (P<0.05) and from 9.6+/-2.9 to 7.0+/-4.5 (P<0.05), respectively, indicating a significant improvement of myocardial function and perfusion. No severe side effects of G-CSF treatment could be observed. Malignant arrhythmias were not observed either. CONCLUSION: In patients with acute MI, treatment with G-CSF to mobilize BMC appears to be well tolerable under clinical conditions. Improved cardiac function and perfusion may be attributed to BMC-associated promotion of myocardial regeneration and neovascularization.

Adult↗
PubMed2004

Impact of positron emission tomography on strategy in liver resection for primary and secondary liver tumors.

PURPOSE: Outcome of patients with metastatic disease mainly depends on accurate preoperative tumor staging. 18[F]fluorodeoxyglucose positron emission tomography (18F-PET) has been proven to be a valuable diagnostic tool in a number of different tumors but its direct influence on liver surgery has not been thoroughly investigated. MATERIALS AND METHODS: Between July 1999 and March 2000, 50 consecutive patients with 174 suspected liver lesions were admitted to the University Hospital Jena. All 50 patients underwent abdominal ultrasound, CT-scan, and 18-FDG positron emission tomography scanning. In 23 patients the diagnostic work-up was completed by MRI scan. RESULTS: Altogether there were a total of 174 histologically proven intrahepatic lesions, nine of which were benign. The sensitivity, specificity, and positive predictive value of PET for all hepatic lesions was 82%, 25%, and 96% compared with 63%, 50%, and 96% for abdominal ultrasound, 71%, 50%, and 97% for CT-scan, and 83%, 57%, and 97% for MRI-scan. In 23 of 50 patients 24 extrahepatic lesions were identified. In these patients the sensitivity and specificity of PET-compared to abdominal ultrasound, CT-scan, and MRI-scan for all extrahepatic lesions-was 63% and 60%, 29% and 25%, 47% and 50% and 40% and 50%, respectively. The findings on PET scan had a direct impact on operative management in nine patients (18%). CONCLUSIONS: Our series demonstrates good sensitivity and specificity for the detection of primary and secondary liver lesions which is superior to ultrasound and CT scan but not to MRI scan. The main value of PET scan consists in the detection of extrahepatic tumor (64%). Due to better detection of extrahepatic tumor, FDG-PET is a very useful addition to the currently used anatomically-based images in all cases of advanced tumor spread with high risk of extrahepatic tumor.

Adenoma, Liver Cell↗
PubMed2003

[Validity of iohexol clearance in patients with chronic renal failure and normal renal function in comparison to (99m)Tc-DTPA-clearance].

BACKGROUND AND OBJECTIVE: The most common method used for testing dynamic renal function is creatinine clearance, but it has some limitations, e. g. variable muscle mass and tubular secretion of creatinine. The use of radionuclides as an exact method is limited in terms of availability, cost and time needed for examination. We compared the plasma clearance of iohexol with the established (99m)Tc-diethylenetriaminepentaacetate acid (DTPA) clearance. The aim of the present study was to validate iohexol clearance as a simple and suitable method for measuring to determine GFR with a comparable sensitivity to radioisotopic methods. METHODS: 120 patients (49 females, 71 males), mean age of 56 (range 20 to 84) years with normal renal function and different stages of renal failure, mean creatinine clearance of 61.6 +/- 44,9 (range 1.8 - 181.1) ml/min/1.73 m2 received a bolus injection of 10 ml iohexol, a non-ionic low osmolar x-ray contrast medium. Using the one-compartment model, plasma samples were taken after 150, 240 and 480 minutes. The total plasma disappearance of iohexol was measured by x-ray fluorescence analysis and the clearance was calculated. The (99m)Tc-DTPA clearance was determined in accordance with a standard protocol. RESULTS: A high correlation was found between the clearance of iohexol and (99m)Tc-DTPA (r = 0.95). The average deviation between Iohexol and (99m)Tc-DTPA clearance was 7.4 ml/min/1.73 m2. Allergic and nephrotoxic side effects were not observed. CONCLUSION: Iohexol clearance is a valid method for measuring GFR in patients at any stages of renal failure. It is easy to perform and inexpensive.

Adult↗
PubMed2003

[The value of fluorodeoxyglucose positron emission tomography (FDG-PET) in differentiation of pancreatic lesions].

Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is a functional imaging modality that is based on the metabolic activity which is higher in most malignant tumors than benign tissues. This short review describes the basics of FDG-PET and gives a discussion of its role in differentiation of focal pancreatic lesions. The diagnostic accuracy in patients with active inflammation or cancer of the pancreas can be improved by dynamic acquisition of focal pancreatic lesions.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2002

[Assessment of radiation exposure caused by transmission scans in SPECT: an anthropomorphic dosimetry study].

Transmission measurements are performed in SPECT to correct for attenuation of the gamma quanta in the body. In this study, we measured the additional radiation dose caused by transmission scans using a field of collimated 153Gd rod sources. Two measurement series were performed with a anthropomorphic phantom and thermoluminescence dosimeters. For a typical SPECT study, we found a mean dose rate of 2.2 +/- 0.8 micro Sievert per hour (range: 1.2-3.9 micro Sievert per hour). For a measurement time of 20 min, this corresponds to a mean equivalent patient radiation dose of 0.73 micro Sievert. Thus, the radiation exposure caused by transmission scans can be neglected compared to the radiopharmaceutical dose and may not be considered as a limiting factor for the clinical application of attenuation correction in SPECT.

Gadolinium↗
PubMed2002

[Assessment of radiation exposure caused by transmission scans in SPECT: an anthropomorphic dosimetry study].

Transmission measurements are performed in SPECT to correct for attenuation of the gamma quanta in the body. In this study, we measured the additional radiation dose caused by transmission scans using a field of collimated 153Gd rod sources. Two measurement series were performed with an anthropomorphic phantom and thermoluminescence dosimeters. For a typical SPECT study, we found a mean dose rate of 2.2 +/- 0.8 micro Sievert per hour (range: 1.2-3.9 micro Sievert per hour). For a measurement time of 20 min, this corresponds to a mean equivalent patient radiation dose of 0.73 micro Sievert. Thus, the radiation exposure caused by transmission scans can be neglected compared to the radiopharmaceutical dose and may not be considered as a limiting factor for the clinical application of attenuation correction in SPECT.

Gadolinium↗
PubMed2001

Recovery of the cardiac adrenergic nervous system after long-term beta-blocker therapy in idiopathic dilated cardiomyopathy: assessment by increase in myocardial 123I-metaiodobenzylguanidine uptake.

UNLABELLED: In chronic heart failure, elevated plasma norepinephrine (NE) levels and a disparity between the neuronal release and the effective reuptake of NE lead to an increased concentration of NE in the presynaptic cleft, causing a downregulation of the myocardial beta-adrenoceptors. The clinical and prognostic effectiveness of beta-blocker therapy has been shown in patients with chronic heart failure in several large trials. The purpose of this study was to investigate the effect of long-term beta-blocker therapy on the cardiac adrenergic nervous system as assessed by the myocardial uptake of 123I-metaiodobenzylguanidine (MIBG), an analog of NE, in idiopathic dilated cardiomyopathy (IDC). METHODS: In 10 patients with IDC and stable chronic heart failure the myocardial MIBG uptake was measured at baseline and at 1 y (median, 11.5 mo) after treatment with beta-blockers (metoprolol, n = 5; bisoprolol, n = 1; and carvedilol, n = 4) in addition to standard medication. In parallel with the changes in MIBG uptake, the New York Heart Association functional class, the left ventricular ejection fraction (LVEF), and the left ventricular end-diastolic diameter (LVEDD) were documented before and after 1 y of therapy with beta-blockers. RESULTS: During the 1-y follow-up, a significant increase in myocardial 123I-MIBG uptake (P = 0.005) in parallel with an improved LVEF (P = 0.005) and a reduced LVEDD (P = 0.019) was found. A trend toward an improvement of the New York Heart Association functional class under the beta-blocker therapy (P = 0.139) was also found. CONCLUSION: Assessment of the myocardial 123I-MIBG uptake is a useful noninvasive tool for evaluating changes in cardiac sympathetic nerve activity under medical therapy. Long-term treatment with beta-blockers in IDC causes a recovery of the cardiac adrenergic nervous system concomitantly with a clinical and hemodynamic improvement.

3-Iodobenzylguanidine↗
PubMed1999

Cardiac sympathetic activity as measured by myocardial 123-I-metaiodobenzylguanidine uptake and heart rate variability in idiopathic dilated cardiomyopathy.

In patients with idiopathic dilated cardiomyopathy (IDC) the increased sympathetic activity owing to chronic congestive heart failure leads to an imbalance of cardiac autonomic tone, as reflected by decreased heart rate variability (HRV). Iodine-123-metaiodobenzylguanidine (123-I-MIBG), which has the same affinity for sympathetic nerve endings as norepinephrine, can be used to assess the integrity and function of the cardiac sympathetic nervous system. The aim of the present study was to measure cardiac sympathetic activity by assessing 123-I-MIBG uptake compared with HRV in patients with IDC. In 12 patients with IDC and mild to moderate heart failure, myocardial MIBG uptake was calculated from the myocardial (M) to left ventricular cavity (C) voxel values density ratio and the 123-I activity in a blood sample as a reference (= M/C ratio) using a double radionuclide study with 123-I-MIBG and technetium-99m-MIBI. To investigate the relation between myocardial MIBG uptake and HRV in time domain, the linear regression between the M/C ratio, a new scintigraphic parameter, and the mean RR interval or the HRV triangular index, respectively, was determined. A significant correlation between the M/C ratio and mean RR interval (r = 0.52; p = 0.016) or M/C ratio and HRV triangular index (r = 0.76; p = 0.003), respectively, was found. Thus, the significant correlation between the M/C ratio and HRV indicate that they are both suitable noninvasive methods for evaluating cardiac sympathetic activity in patients with IDC and, furthermore, favor the view that there is evidence of a relation between HRV and the disorder of the cardiac presynaptic sympathetic nerve endings as demonstrated by a reduced M/C ratio.

3-Iodobenzylguanidine↗
PubMed1997

Radioimmunodetection of neuroblastoma cells with I-131-radiolabelled antibodies.

The murine anti-neuroblastoma monoclonal antibodies 15/7 and 19/1/4 should be tested for specific radiolocalization of neuroblastoma by immunoscintigraphic imaging of this tumour growing in mice. Radioiodination of both antibodies was done by chloramine-T method resulted in an immunoreactivity of 75%. The calculated specific activity varied from 51.1 to 126.2 kBq/microgram IgG. In each case, about 500 kBq of labeled antibodies were intraperitoneally injected into human neuroblastoma (SK-N-MC, SK-PN-DW and IMR 5) xenografted severe complete immunodeficient (SCID) mice. Whole-body scintigraphy was performed daily by a scintiscanner to localize the tumour site. After last scanning principal organs were removed and their I-131-uptake was determined by measuring the impulse rate. The best scintigrams were done with I-131-19/1/4 at the second day after antibody injection. Radioconjugates were accumulated at highest in the tumour at the third day after application of 15/7 and 19/1/4 with a tumour uptake of 0.4 and 2.2 per cent of injected dose per gram (%ID/g), respectively. The 15/7-moAbs was accumulated approximately 9-fold higher in the SK-N-MC and SK-PN-DW grafts than in principal organs, whereas the tumour/non-tumour-ratio of the 19/1/4 moAb was 3:1. The results indicate the efficacy of these two neuroblastoma antibodies in radiolabelling and their usefulness for tumour imaging of neuroblastoma engrafted SCID-mice.

Animals↗
PubMed1991

Induced hypertension as an approach to treating acute cerebrovascular ischaemia: possibilities and limitations.

As, after an stroke, the autoregulation of the cerebral vessels in the ischaemic region is disturbed to a high degree, it is, on principle, possible to improve the blood flow particularly in the zone surrounding the infarct (penumbra) by raising the systemic blood pressure. During a basic treatment with low-molecular dextrans (infukoll M40), 37 patients with an acute ischaemic cerebral stroke multiply underwent elevations in blood pressure up to systolic values of about 210 to 220 mmHg. A comparison with a control group (n = 44) who were treated with low-molecular dextrans revealed no differences in lethality on the 21st day after the stroke. However, a very good acute effect in terms of a short-term improvement was remarkable a result that is noteworthy also in future.

Acute Disease↗
PubMed1990

[Functional scintigraphic studies of perfusion and ventilation during high frequency jet ventilation (HFJV)].

In a controlled study, functional-scintigraphic investigations into perfusion and ventilation were performed on 10 dogs with non-damaged and extremely severely damaged lungs. The pulmonary damage was produced by injecting oleic acid (OA) into the right atrium of the heart under controlled ventilation (IPPV). The scintigraphic examinations were carried out using 133Xenon. The study compared HFJV (HFJV100, HFJV300) with IPPV in the non-damaged lung as well as HFJV300 with IPPV and CPPV (PEEP 1 kPa) after damage by OA. With the aid of the present radionuclide investigations, new insights can be gained into the largely unclear regional conditions of the gas exchange under HFJV in both the healthy and the damaged lung. Results from controlled studies on the distribution of ventilation and perfusion under HFJV have not been reported to date. The functional-scintigraphic examination with 133Xe on dogs shows, based on specific conditions of the gas exchange and special anatomic conditions of the lungs, a ventilation distribution that differs fundamentally from all other forms of ventilation, including HFOV, preference being given to apical pulmonary segments. This refers to the normal and the damaged lungs alike. However, ventilation-specific changes in pulmonary perfusion do not occur. The resulting deviating regional VA/Q relationship are obviously not of crucial influence upon the gas exchange. Rather, it is influenced and determined by damage-induced intraregional functional-structural alterations in the lung.

Animals↗
PubMed1990

[High-frequency jet ventilation and the function of the right heart--an animal experimental study].

In a controlled study, 10 dogs with normal and severely damaged lungs were subjected to nuclide angiocardiographic investigations into the function of the right ventricle. The pulmonary injury was produced by infusion of oleic acid (OA) into the right atrium during controlled ventilation (IPPV). The angiocardiographic examinations were performed using 133Xenon in the first pass technique. The study compared HFJV (HFJV 100, HFJV 300) with IPPV in the non-damaged lung as well as HFJV 300 with IPPV and CPPV (PEEP 1.0 kPa) after injury by OA. Whereas for the non-damaged lung no different right ventricular (RV) function between IPPV and HFJV was observed, the RV functional parameters after OA injury under HFJV showed, as opposed to CPPV, more favourable values on the whole. This became clear in particular in the significantly higher ejection fraction (RVEF) during HFJV. The RV function which is influenced during CPPV in terms of a favourable oxygenation is the consequence of an increased mean pressure in the airways with subsequent rise in the RV afterload and decrease in the RV preload. In contrast, the more favourable RV haemodynamics during HFJV are associated with a comparatively lower mean airway pressure and a significantly worse oxygenation. As the RV function also during HFJV has to be seen in direct dependence on the mean airway or intrapulmonary pressure necessary for sufficient oxygenation, the employment of this form of ventilation in the presence of an acute respiratory insufficiency has no impact on the RV haemodynamics different from the other compared forms of ventilation.

Animals↗
PubMed1989

[The value of lung perfusion scintigraphy in radiation pneumonitis in comparison with the diffusing capacity DLCO].

The value of lung perfusion scintigraphy (Tc99m) and lung diffusing capacity are compared with references to early detection of radiogenic pneumonitis. Perfusion scintigraphy completed by diffusing capacity is excellent suitable for early detection. Risk cases are recognized up to 40 days earlier than by X-ray. Severity of radiogenic pneumonitis can be diminished remarkable by prevention therapy.

Breast Neoplasms↗
PubMed1988

[Thyroid diseases in advanced age].

Nearly all diseases of the thyroid, such as nodular goitre, thyroid carcinoma, non-immunogenic hyperthyroidism and idiopathic hypothyroidism, exhibit an increase in frequency with age. Their recognition is rendered more difficult by the often oligosymptomatic, ambiguous clinical picture, but it is the timely treatment that is of particular prognostic importance to an organism weakened due to polymorbidity. In all hard nodular alterations, a malignoma must be ruled out by sonography, scintigraphy and cytopuncture. In all iodine-deficient regions such as the GDR, a frequent occurrence of thyroid autonomy with manifestation of hyperthyroidism following iodine contamination has to be taken into account. Hypothyroidism is often misinterpreted as age-related changes. By employing adequately modern in vitro methods and imaging procedures it will be possible to further improve diagnosis and prognosis of the thyreopathy in the old age ranges.

Aged↗