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E A Knopp

Publications and source records attributed to E A Knopp.

26 records · Page 2Linked to original sources
PubMedDate not supplied

MP-RAGE subtraction venography: a new technique.

Preliminary evaluation of a new magnetic resonance (MR) venography technique was performed with data sets from five patients undergoing MR imaging of the brain before and after intravenous administration of gadopentetate dimeglumine. Before contrast agent injection, the patients were imaged with MP-RAGE (magnetization-prepared rapid gradient-echo) and axial turbo T2-weighted sequences. After contrast agent injection, the MP-RAGE sequence was repeated. Images were post-processed with an algorithm that calculates, on a pixel-by-pixel basis, the absolute value of signal intensity of each postcontrast MP-RAGE partition minus that of each precontrast MP-RAGE partition. These subtracted partitions were then subjected to a standard maximum-intensity-projection algorithm to obtain the venogram. In all cases, the new method afforded a high-resolution venogram with clear depiction of venous sinus anatomy. Cortical venous anatomy was also clearly depicted.

Cerebral Veins↗
PubMedDate not supplied

Water excitation MPRAGE MRI of VII and VIII cranial nerves.

OBJECTIVE: Our goal was to compare magnetization prepared rapid gradient echo--water excitation (MRPRAGE-WE) with conventional spin echo (CSE) in the evaluation of the VII and VIII cranial nerves. METHODS: One hundred three consecutive patients with symptoms referable to the VII/VIII nerves were studied with CSE T1 and MPRAGE-WE following intravenous gadolinium contrast agent. Each right and left nerve pair was independently evaluated for the presence of an enhancing mass and for visualization of the nerves. RESULTS: On the CSE images, 26 definite and 2 possible lesions were identified, whereas 28 definite and 2 possible abnormalities were seen on the MPRAGE-WE. Four cases were better identified on the MPRAGE-WE and one better seen on the CSE. This difference was not statistically significant (p = 0.19). CSE demonstrated the nerves partially in 23 instances and completely in 6; MPRAGE-WE showed the nerves partially in 35 and completely in 73. This was highly significant (p<0.001). CONCLUSION: With equivalent or slightly improved lesion detection and better visualization of the nerves, MPRAGE-WE may replace CSE in studying the VII/VIII nerves.

Facial Nerve↗
PubMedDate not supplied

Dynamic contrast-enhanced T2*-weighted MR imaging of tumefactive demyelinating lesions.

PURPOSE: Dynamic contrast-enhanced T2*-weighted MR imaging has been helpful in characterizing intracranial mass lesions by providing information on vascularity. Tumefactive demyelinating lesions (TDLs) can mimic intracranial neoplasms on conventional MR images, can be difficult to diagnose, and often result in surgical biopsy for suspected tumor. The purpose of this study was to determine whether dynamic contrast-enhanced T2*-weighted MR imaging can be used to distinguish between TDLs and intracranial neoplasms that share common features on conventional MR images. METHODS: We retrospectively reviewed the conventional and dynamic contrast-enhanced T2*-weighted MR images and medical records of 10 patients with tumefactive demyelinating disease that was diagnosed by either biopsy or strong clinical suspicion supported by laboratory evaluation that included CSF analysis and evoked potential tests. Twelve TDLs in 10 patients and 11 brain tumors that appeared similar on conventional MR images were studied. Relative cerebral blood volume (rCBV) was calculated from dynamic MR data and was expressed as a ratio to contralateral normal white matter. rCBV values from 11 patients with intracranial neoplasms with very similar conventional MR imaging features were used for comparison. RESULTS: The rCBV values of TDLs ranged from 0.22 to 1.79 (n = 12), with a mean of 0.88 +/- 0.46 (SD). The rCBV values of intracranial neoplasms ranged from 1.55 to 19.20 (n = 11), with a mean of 6.47 +/- 6.52. The difference in rCBV values between the two groups was statistically significant (P =.009). The difference in rCBV values between TDLs and primary cerebral lymphomas (n = 4) was less pronounced but was statistically significant (P =.005). CONCLUSION: Dynamic contrast-enhanced T2*-weighted MR imaging is a useful diagnostic tool in differentiating TDLs from intracranial neoplasms and may therefore obviate unnecessary surgical biopsy.

Adolescent↗
PubMedDate not supplied

Preservation of myocardial ATP during cardioplegia: comparison of techniques.

Preservation of myocardial ATP enhances the heart's ability to resume normal function following aortic crossclamping (AXC). Preservation of this high energy substrate during 4 cardioplegia delivery techniques was evaluated and compared with changes occurring during 4 hours of continuous coronary perfusion. Dogs (31) were placed on cardiopulmonary bypass and transmural left ventricular biopsies obtained for control ATP measurements. Animals were then divided into five groups: Group I (n = 6): 4 hrs. of continuous coronary perfusion (CCP); Group II (n = 6): 3 hrs. continuous AXC, multidose blood cardioplegia (MBC); Group III (n = 6): 3 hrs. continuous AXC, multidose crystalloid cardioplegia (MCC); Group IV (n = 6): 2 hrs. intermittent AXC, single dose BC (SBC); Group V (n = 7): 2 hrs. continuous AXC, continuous perfusion BC (CBC). In each group, where applicable, myocardial biopsies were taken at 30 minute intervals during AXC, before and after cardioplegia injection, and 30 minutes following final unclamping and rewarming. Hearts in Group II (MBC) and V (CBC) showed greatest preservation of ATP stores (increases 1.1 +/- 1.2%, increases 1.8 +/- 0.9% respectively; p greater than .05) ATP levels rose as high as 23 +/- 2% (p less than .005) above control immediately following cardioplegia injection in Group II (MBC). Group IV showed poorest preservation of ATP (decreases 26 +/- 5%, p less than .01) with levels falling as much as 37 +/- 10% (p less than .01) during the period of AXC. Hearts in Group I (CCP) demonstrated a 15.6 +/- 7.5% decrease in ATP from control (p less than .05). Group III (MCC) also showed a steady decline in ATP declining 18 +/- 3% (p less than .005) from control. These data indicate that multidose blood and continuous-blood cardioplegia techniques will maintain normal myocardial ATP stores throughout the period of AXC. These groups actually show a slight rise in ATP as compared to 4 hrs. of continuous coronary perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMedDate not supplied

A simplified method for delivery of cold blood cardioplegia and aortic root venting during coronary artery bypass.

We present a simplified method for delivery of cold blood cardioplegia and left ventricular decompression during coronary artery bypass surgery when aortic occlusion is utilized. The system provides immediate delivery of the cardioplegic solution followed by continuous sump suction on the aortic root to decompress the left ventricle and to aspirate non-coronary collateral flow. This system has been utilized in over 200 consecutive cases of coronary revascularization without complication and is a safe, effective and inexpensive method of both delivery of the cardioplegic agent and maintenance of a dry quiet operative field.

Aorta↗
PubMedDate not supplied

Release of particulate matter from extracorporeal tubing: ineffectiveness of standard arterial line filters during bypass.

Microemboli resulting from extracorporeal circulation have been considered to be a cause of organ dysfunction after cardiopulmonary bypass. A scanning electron microscopic study was carried out to quantitate the number of nonbiological particles which escape capture by the arterial line filter in a standard extracorporeal circulation circuit. Five different lots of polyvinylchloride (PVC) tubing from the same manufacturer were used in closed circuit extracorporeal pump set-ups consisting of a typical length of PVC tubing, a cardiotomy reservoir, and an arterial line filter (Pall 40 microns (mu)). A liter of Plasmalyte was circulated through this set-up for 15 minutes at 2 liters/minute with the pump head set at almost total occlusion. The circulated Plasmalyte from each pump line was then collected and passed through a 0.22 mu Millipore filter. Numerous particles ranging from 5-40 mu in diameter were observed on the surface of the filters. A mean of 51.2 particles/mm2 of filter was found after the first recirculation period. By extrapolation the mean total number of particles contained in the Plasmalyte was calculated to be 70,943. A second similar 15 minute rinse on the same pump set-ups revealed the release of a mean of 51.0 particles/mm2, or a mean total number of 70,665 particles. Analysis of variance showed no significant difference in the number of particles produced by the first compared with the second recirculation period but there were significant differences (P less than .05) between the numbers of particles produced by the different lots of tubing. This study demonstrates that commonly employed tubing packs and standard roller pump designs for extracorporeal circulation are associated with continuous release of particulate matter (5-40 mu) which is not removed by the arterial line filters most often employed. These particles seem to be released at a constant rate which makes an initial pre-bypass filtration run ineffective. Such particles can only be removed by continuous use of lower porosity filters in the pump circuit. The clinical significance of these large numbers of small particles is unknown, but they may contribute to the multi-organ failure often seen in prolonged (greater than 2 hour) periods of cardiopulmonary bypass.

Equipment Failure↗