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Biomedical subjects

E Dinkel

Publications and source records attributed to E Dinkel.

At least 19 recordsLinked to original sources
PubMed1992

CT and MRI: prognostic tools in patients with AIDS and neurological deficits.

To determine the prognostic value of CT and MRI in AIDS we studied the survival of patients with neurological involvement, in relation to the initial imaging results. Twenty-six initial CT and 15 MRI examinations of 41 patients were reviewed for the presence of cerebral atrophy and/or focal lesions. The mean survival time of patients with initially normal imaging was longer (700 +/- 89 days) than that of patients with isolated cerebral atrophy (326 +/- 65) or isolated focal lesions (202 +/- 97). The shortest survival (78 +/- 44 days) was found in patients with both cerebral atrophy and focal lesions. The risk of death in patients with atrophy alone was 3.6 times higher, that in patients with focal lesions alone 6.4 times higher, and in patients with both changes 19.3 times higher than in patients with initially normal imaging. Cerebral imaging with CT and/or MRI thus allows identification of AIDS-related cerebral changes and may contribute to assessment of prognosis.

AIDS Dementia Complex↗
PubMed1991

[Magnetic resonance tomography in the diagnosis of peripheral joints].

Magnetic resonance imaging (MRI) provides an excellent soft tissue contrast with high spatial resolution. Using spin echo and fast gradient echo sequences all relevant joint structures such as the hyaline cartilage, the meniscus, the ligaments, the tendons, the capsulae, and their adjacent muscles and their pathology are visualized. Diagnosis of osteonecrosis, meniscal and cruciate ligament lesions, as well as tumors, represents the major current indication for MRI. Due to its high cost MRI should be employed for the diagnosis of joint disease only to clarify equivocal findings of conventional radiographic, nuclear and tomographic methods. Prior clinical examination and laboratory tests are mandatory. As a component of a stepwise diagnostic approach, MRI often provides reliable differential diagnostic information.

Bone Diseases↗
PubMed1991

MRI of knee arthritis in rheumatoid arthritis and spondylarthropathies.

The knees of fifty-two patients suffering from rheumatoid arthritis (RA), 22 patients with seronegative spondylarthopathies (SA) as well as of 20 healthy volunteers were examined by magnetic resonance imaging (MRI). Osseous erosions (RA 52%-SA 18%; P less than 0.005), Baker cysts (RA 56%-SA 12%; P less than 0.005), pannus formation (RA 67%-SA 36%; P less than 0.05), and cartilage thinning with narrowing of the joint space (RA 46%-SA 18%; P less than 0.05) proved to be more frequent MRI findings in patients with RA. Additionally, in patients with RA erosions were more extensive. Follow-up MRI examinations of 19 patients revealed an improvement in MRI changes in SA within an average interval of 6 months. No substantial changes were noted in 7 of 13 RA patients. Quantitative and qualitative MRI findings of knee arthritis differ in patients with RA and SA and this was statistically significant. However, as there is considerable overlap of the MRI and radiographic changes in both groups the discriminating diagnostic value in the individual case was limited.

Adult↗
PubMed1991

Pancreatic lesions in the von Hippel-Lindau syndrome.

Common manifestations of the von Hippel-Lindau syndrome, an autosomally dominant inherited cancer-prone disorder, include retinal angiomatosis, hemangioblastoma of the central nervous system, renal cysts, renal cancer, pheochromocytoma, and epididymal cystadenoma. Multiple cysts and microcystic (serous) cystadenomas of the pancreas have also been reported occasionally in patients afflicted with this syndrome. In the large Freiburg study of the von Hippel-Lindau syndrome composed of 66 affected individuals, pancreatic lesions were systematically studied. Fifty-five living individuals were examined by abdominal ultrasound imaging. Abnormal findings were confirmed by computed tomographic scan and/or magnetic resonance imaging. For an additional 11 decreased patients autopsy data were available. Cystic lesions of the pancreas were found in 10 patients (15%). One of these patients presented with multiple pancreatic cysts as the only manifestation of the syndrome. In one patient, a malignant islet-cell tumor was found at autopsy. Because multiple pancreatic cysts did not cause major clinical symptoms and because follow-up examinations over an average period of 5 years did not show significant progression of the lesions, it is concluded that these patients usually do not require surgical treatment. Abdominal ultrasound screening is recommended for patients at risk as a tool to identify potential von Hippel-Lindau syndrome gene carriers with pancreatic manifestations. In all patients with multiple pancreatic cysts, the von Hippel-Lindau syndrome should be included in the differential diagnosis.

Adolescent↗
PubMed1990

Diagnostic imaging in metastatic lung disease.

Chest radiographs, full lung tomography and computed tomography of the chest provide increasing sensitivity for evaluation of pulmonary metastases. Pulmonary nodules of 5-10 mm diameter are detectable with increasing frequency by use of high kilovoltage chest radiographs. Full lung linear tomography provides an overall accuracy of 72-97% in diagnosis of pulmonary nodules. Chest CT delineates pulmonary nodules as small as 3 mm within 10 mm slice sections. However, as sensitivity increases, specificity diminishes in identifying metastatic nodules. Sensitivity in CT is also reduced by false negative findings due to unequal respiratory cycles. Comparative radiologic-pathologic evaluation of nodule detection proved CT to be the most sensitive screening method for pulmonary metastases. Timing of follow-up studies for pulmonary nodule detection in cancer patients can be determined by tumor growth kinetics; 3-6 month intervals proved to be useful.

Humans↗
PubMed1990

[Renal microaneurysms in necrotizing vasculitis--incidence in autopsy and clinical value].

Histological renal sections of 24 autopsied patients were evaluated for ectasias with greater than or equal to 2 mm diameter that corresponded to "microaneurysms" of radiologic nomenclature. Such renal "microaneurysms" of smaller and medium sized arteries were seen in 7/9 patients with periarteritis nodosa, 6/10 patients with secondary vasculitides and 1/5 patients with Wegener's Granulomatosis. Lumen ectasias in acute or subacute lesions of smaller and medium sized arteries were caused by fibrinoid necrosis of the arterial walls. Destruction of intimal elastic fibres and scar tissue within the arterial wall resulted in real aneurysmatic ectasias. Generalised, aggressive, necrotizing vasculitides show the highest frequency of microaneurysms. In that cases angiography can frequently establish the definite diagnosis by demonstration of microaneurysms.

Adult↗
PubMed1990

[Computed tomographic-guided fine-needle biopsy of the pancreas for histology determination].

Computed tomography-guided fine-needle biopsies of the pancreas were performed in 54 patients. In 46/54 biopsies, the material obtained permitted a histological diagnosis despite the small external needle diameter of only 0.95 mm. The only complication was due to laceration of an artery of the transverse mesocolon. The prevalence of malignant tumors was 67%. Adenocarcinoma was diagnosed in more than 80% of all biopsies; rare findings were malignant carcinoid or centroblastic lymphoma. Benign tumors included mucinous adenocystoma and serous microcystic adenoma. Within the group of patients where pathologic-anatomic evaluation was possible, the sensitivity of fine-needle biopsy for malignant tumors was 87% and the specificity 100%. A positive needle biopsy diagnosis for a malignant tumor reduces the number of exploratory laparotomies needed and is helpful in the planning of surgery.

Adenocarcinoma, Mucinous↗
PubMed1990

[The place of ERCP in pancreatic diagnosis. The change caused by sonography and computed tomography].

Based on 1099 endoscopic retrograde cholangiopancreatograms (ERCP), 659 examinations conducted in 1973-1980 prior to the introduction of computed tomography (CT) and 440 performed in 1988-1989, the impact of sonography and CT on ERCP is studied. The availability of CT did not cause any significant change in the frequency of and indications for ERCP. The rate of successful ERCP examinations increased from 73.6% to 92%. Complications occurred in 2.3%, and the mortality rate was 0.4% and was similar in both periods. ERCP was the third imaging procedure, being applied after sonography and CT, in most patients. The diagnostic value of ERCP in pancreatic disease is compared with that of sonography and CT in 116 patients with histologically or clinically proven diagnosis. The sensitivity is 79% for ERCP and 78% for CT. Indeterminate findings were recorded in 11% of the ERCP and 8% of the CT examinations; these rates can be decreased by complementary use of both imaging modalities.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

[The value of bronchoalveolar lavage in the diagnosis of interstitial lung diseases].

Bronchoalveoläre lavage (BAL) allows microscopic, cytologic and immunocytologic diagnosis of alveolar and interstitial lung disease. The indications for BAL depend on chest X-rays, signs and symptoms and lung function tests, e.g., spirometry or whole-body plethysmography, CO-diffusion capacity and blood gases during exercise. Supporting laboratory parameters are angiotensin converting enzyme, antinuclear antibodies and serum precipitins. Pulmonary parenchymal pathology documented on chest X-rays or by high-resolution computed tomography of the chest allows selective investigation of the involved areas. Different typical patterns with predominantly neutrophils or lymphocytes and their subsets or the presence of malignant cells or Pneumocystis carinii in the BAL fluid allowed the diagnosis in 115 patients. If possible, histological confirmation should be achieved by transbronchial biopsy. When indications are carefully applied and are based on the history as well as the clinical signs and symptoms, BAL is an efficient diagnostic tool in interstitial lung disease, which can be performed in out-patients even if transbronchial biopsy is done.

Alveolitis, Extrinsic Allergic↗
PubMed1990

[Interstitial cancerous lung diseases. Lymphangiosis carcinomatosa and leukemic pulmonary infiltrates].

The radiological findings in pulmonary lymphangitic carcinomatosis and in leukemic pulmonary infiltrates mirror the tumor-dependent monomorphic interstitial pathology of lung parenchyma. It is a proven fact that pulmonary lymphangitic carcinomatosis is caused by hematogenous tumor embolization to the lungs; pathogenesis by contiguous lymphangitic spread is the exception. High-resolution CT performed as a supplement to the radiological work-up improves the sensitivity for pulmonary infiltrates in general and thus makes the differential diagnosis decided easier. Radiological criteria cannot discriminate the different forms of leukemia. Plain chest X-ray allows the diagnosis of pulmonary involvement in leukemia due to tumorous infiltrates and of tumor- or therapy-induced complications. It is essential that the radiological findings be interpreted with reference to the stage of tumor disease and the clinical parameters to make the radiological differential diagnosis of opportunistic infections more reliable.

Humans↗
PubMed1989

[Pulmonary changes in AIDS].

We reviewed retrospectively the clinical records of 28 patients with AIDS staged group IV according to CDC-criteria. Among these, 19 had pulmonary disease: most of them (n = 17) had pneumocystis carinii pneumonia (Pcp). 12/17 patients with proven Pcp displayed typical x-ray findings with diffuse perihilar interstitial infiltration sparing lung periphery. 3/17 had atypical features and 2 normal chest x-ray findings. These data are important to identify patients with pulmonary complications of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Aggressive abdominal fibromatosis: the place of diagnostic imaging].

Aggressive fibromatoses are locally invasive, non-metastasising, fibroblastic soft-tissue tumours. On the basis of examinations made in 6 patients with histologically confirmed diagnosis, the reliability of different imaging modalities in preoperative diagnosis and in follow-up is discussed. The inhomogeneous tumour composition was evident in all imaging procedures. Computed tomography offered the highest sensitivity for tumour detection and proved accurate in demonstrating the characteristic radial tumour spreading of mesenteric aggressive fibromatosis; the attenuation values ranged from 18 to 58 HU. in pre-contrast CT scans. In magnetic resonance imaging the tumours mostly produced a low signal in T1- and T2-weighted sequences; the calculated T2-relaxation times ranged from 97 to 186 ms.

Abdominal Muscles↗
PubMed1989

[Form, size and function of the sports heart--differentiation from pathological findings].

Dependent on the nature, intensity and scope of muscular exercise, regular athletic training can result in changes in the size and form of the heart, which can be recorded by radiologic and echocardiographic techniques. Brief anaerobic exercise and purely static forms of training (sprint, strength sports) do not produce substantial increases in the size of the heart, but a rotund heart shape with rounding of the cardiac tip and in some cases a discrete increase in the wall thickness of the ventricular myocardium is frequently observed. Dependent on the scope of the training and the intensity, aerobic, endurance-oriented training (endurance sports) can induce considerable enlargement of all cardiac chambers with a change in the cardiac configuration, which is most nearly comparable to combination mitral vitium. Comparison of physiological hypertrophy of the athletic heart with pathological forms of cardiac hypertrophy (such as cardiomyopathies) is in many cases not unequivocally possible with plain X-ray films, but it is usually successful with echocardiographic examination methods.

Adult↗
PubMed1989

[Pulmonary hypertension. Clinical picture and therapy].

Pulmonary hypertension occurs frequently in patients with chronic lung disease and contributes to morbidity and mortality. The most common symptoms are dyspnea, fatigue, chest pain, and syncope; sudden death can occur. Signs of pulmonary hypertension include prominent a-waves in the jugular venous pulse, a prominent P2 and murmur of tricuspid regurgitation. Introduced in 1964, cardiac catheterization is still required for the clinical assessment. Many patients reveal a vasoconstrictive component in their lung vessels that is potentially reversible therapeutically. Accurate noninvasive diagnostic methods and an understanding of the mechanisms causing pulmonary hypertension are necessary, as is appropriate therapy based upon the results.

Humans↗
PubMed1989

[Thoracic calcification in the elderly--frequency and clinical value].

Chest X-ray films of 200 patients, aged between 90 and 102 years, were analysed for frequency of distribution and varying degrees of thoracic calcification. Calcification was found within the aortic wall in 89%, costal cartilage 79%, lung parenchyma 65%, lung hilum and/or mediastinum 64%, and tracheobronchial cartilages 55%. The degree of calcification was dependent on the tissue and sex involved (significant p less than 0.001). Calcification is of clinical value more often in younger patients than in the elderly. The classification, pathogenesis and differential diagnosis of thoracic calcifications are discussed.

Aged↗
PubMed1989

[Pulmonary artery hypertension in chronic obstructive lung disease. The place of morphometric studies in thoracic radiography].

Standard biplane chest X-rays were tested for the validity of morphometric criteria in the diagnosis of pulmonary artery hypertension. Twenty-seven patients suffering from chronic obstructive lung disease were examined and compared with a control group without cardiopulmonary disease. The diameter of the right and left pulmonary artery, pulmonary conus and the hilar-to-thoracic ratio were significantly increased in patients with chronic obstructive lung disease (p less than 0,0001). Measurement of the right pulmonary artery was 19.7 +/- 3.9 mm compared to 13.6 +/- 1.2 mm of the control group; mean hilar thoracic index was 0.35 compared to 0.31. Thus if the width of the descending branch of the right pulmonary artery was above 16 mm, pulmonary arterial hypertension was suggested, with a specificity of almost 100%, although the sensitivity of the diagnosis was only 59%. The mean pulmonary arterial pressure obtained by right heart catheterization correlated poorly with the morphometric criteria obtained.

Adult↗
PubMed1988

Renal growth in patients nephrectomized for Wilms tumour as compared to renal agenesis.

Compensatory growth in 27 undiseased congenital solitary kidneys and in 31 solitary kidneys in patients with Wilms tumour was monitored in long-term follow-up studies by ultrasound volume biometry. In congenital solitary kidneys hypertrophy was not detectable at the time of birth. Parenchymal mass increase achieved 188% of the volume of a healthy kidney within at least 4 years of life and afterwards paralleled the physiological growth documented in healthy kidney pairs. Disease-free kidneys in Wilms tumour patients all developed a similar 180% volume augmentation within 2-4 years after nephrectomy, irrespective of the chosen mode of radiation and single or triple chemotherapy. The age of the patient at onset of surgical and concomitant conservative therapy determined slight differences in kinetics but not in degree of compensatory growth.

Adolescent↗