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Biomedical subjects

E Kirsch

Publications and source records attributed to E Kirsch.

At least 19 recordsLinked to original sources
PubMed1997

[Bilateral glomus tumors with a blood pressure regulation disorder due to baroreceptor dysfunction].

HISTORY AND CLINICAL FINDINGS: A 73-year-old woman was admitted because of vertigo of recent onset with a tendency to fall down and progressive hearing impairment with tinnitus over the last 2 years. Neurological examination also revealed right recurrent nerve paresis, facial hemispasm and lingual atrophy, pointing to a lesion involving cranial nerves VII, VIII, IX, X and XII. She was found to have spontaneous nystagmus to the left, due to peripheral vestibular function deficit, without otoscopic abnormalities. She was in atrial fibrillation with a blood pressure of 140/80 mm Hg. The suspected cause was a hormonally active glomus jugulare tumour with intermittent hypertension and involvement of several cranial nerves. INVESTIGATIONS: Repeatedly measured plasma and urinary catecholamine concentration was normal. Neuroradiology showed a contrast-rich lesion close to the jugular vein and the hypoglossal nerve, as well as a tumour in the left retromandibular fossa with displacement of the left internal carotid artery. The suspected cause of these findings was a neurologically asymptomatic left carotid body tumour with multiple cranial nerve deficits (VII, VIII, IX and XII) due to their compression at the base of the skull. No abnormal catecholamine activity could be demonstrated. TREATMENT AND COURSE: After complete excision of the right carotid body there were no further hypertensive crises. Later on the left carotid body tumour was embolised because it had continued to grow. CONCLUSION: The repeated hypertensive crises were probably caused by absent blood pressure regulation, the result of destruction of the afferent fibres. This destruction was due to compression of the hypoglossal nerve by the right jugular glomus, at the same time as the contralateral carotid body had been destroyed by tumour.

Aged↗
PubMed1997

Chronic complicated osteomyelitis of the appendicular skeleton: diagnosis with technetium-99m labelled monoclonal antigranulocyte antibody-immunoscintigraphy.

Chronic post-traumatic osteomyelitis (OM) represents a particular challenge for nuclear medicine and radiology since clinical and biochemical parameters are frequently unreliable. The aim of this study was to investigate the value of combined bone scan (BS) and immunoscintigraphy (IS) with technetium-99m labelled monoclonal antigranulocyte antibody (MAB) in patients with suspected chronic OM of the appendicular skeleton. Twenty-four patients (17 females and 7 males) with suspected chronic post-traumatic OM were evaluated with three-phase BS/99mTc-MAB-IS. The final diagnosis was established by means of bone culture and histology in 19 cases and clinical follow-up in five cases. The studies were reviewed by two independent and experienced observers; the interobserver agreement was calculated by kappa statistics. The sensitivity, specificity and accuracy of BS alone were 92%, 18% and 58%, respectively. Combined BS/99mTc-MAB-IS had a sensitivity, specificity and accuracy of 84%, 72% and 79%, respectively. Of 24 studies, 11 were true-positive, two false-negative, eight true-negative and three false-positive. Two patients presented with unexpected ectopic haematopoietic bone marrow in the appendicular skeleton that caused false-positive results. A high degree of interobserver agreement was found (kappa=0. 85). It is concluded that combined BS/99mTc-MAB-IS represents a very sensitive and reproducible method with an acceptable specificity for the investigation of chronic OM. Problems may occur in the differentiation of low-grade OM from aseptic inflammation. Another problem is ectopic marrow that may occur in the appendicular skeleton due to a chronic inflammatory stimulus. A former intramedullary intervention in the femur with displacement of haematopoietic marrow may also lead to an ectopic location.

Bone and Bones↗
PubMed1997

Foramen of Monro mass: MRI appearances permit diagnosis of cavernous haemangioma.

Cavernous haemangiomas are most commonly found in the subcortical white matter, the pons and the external capsule. We present a case of a cavernous haemangioma that appeared as an intraventricular mass at the foramen of Monro. Despite the unusual location the diagnosis was established by MRI because of the typical appearance. The differential diagnosis included primary and secondary neoplasms at the foramen of Monro.

Cerebral Ventricle Neoplasms↗
PubMed1996

Magnetic resonance imaging of vertebrobasilar ectasia in trigeminal neuralgia.

Vertebrobasilar ectasia is a rare cause of typical trigeminal neualgia. In a recently published large series only thirty-one (2%) of 1404 consecutive patients with vascularly determined neuralgia were found to have vertebrobasilar compression. We present three patients with trigeminal neuralgia caused by vertebrobasilar ectasia, who were evaluated with high resolution magnetic resonance imaging (MRI). MRI studies provided accurate information on the anatomical location and course of the ectatic vessel in the cerebellopontine angle and the caused mass effect on the brainstem. With gadolinium-enhancement vascular compression of the trigeminal nerve was demonstrated clearly. Surgery confirmed compression of the fifth nerve by an ectatic and tortuous vertebrobasilar artery in two cases. Following microvascular decompression neither patient experienced further pain. The third patient was treated with a ventriculoperitoneal shunt, as he developed occlusive hydrocephalus caused by the vertebrobasilar dolicho-ectasia. MRI is useful in the evaluation of trigeminal neuralgia as it excludes other aetiologies such as tumour or arteriovenous malformation, but also demonstrates cranial nerve compression by ectatic vertebral arteries.

Basilar Artery↗
PubMed1996

Value of repeat-angiography in cases of unexplained subarachnoid hemorrhage (SAH).

PURPOSE: To investigate the rate of false negative initial cerebral angiography in spontaneous SAH and to ascertain why aneurysms remain undetected. Furthermore to validate CCT in predicting the presence and site of an angiographically missed aneurysm. METHODS: Forty-two patients with spontaneous SAH were investigated, in whom initial cerebral angiography did not reveal any bleeding cause. Repeat-angiography was performed in all patients 5 to 55 days (mean 15 days) after the bleeding event. All patients underwent CCT scans within 48h after the ictus. RESULTS: In 8 of 42 patients (19%) repeat-angiography revealed an aneurysm missed on initial angiography. The aneurysms were located on the AcomA (n = 2), the MCA (n = 2), the ACA (n = 1), the PICA (n = 2) and the junction of ICA and PcomA (n = 1). Presumable reasons for missing an aneurysm were spasms detected in four of eight cases on initial angiography and thrombosis of the aneurysm found in two cases at surgery. In two cases, multiple additional views just revealed the aneurysm appearing different in size and shape on repeat-angiography. CCT blood distribution pattern in four cases indicated presence and site of an aneurysm, while blood distribution was non-specific in the other four cases. CONCLUSION: Repeat-angiography plays an important role in defining the site of an initially occult aneurysm and should be performed in all cases of unexplained SAH. It is of particular importance if vasospasm has compromised the initial angiogram or if one part of the vascular tree is not optimally seen.

Adult↗
PubMed1996

Anatomic evaluation of the circle of Willis: MR angiography versus intraarterial digital subtraction angiography.

PURPOSE: To evaluate the reliability of source images and maximum intensity projection images of MR angiography in showing the arterial segments of the circle of Willis. METHODS: In 62 patients, 526 arterial segments of the circle of Willis were determined to be present, partially present, or absent by blinded observers evaluating MR angiographic source images and maximum intensity projection images. Vessel diameter was measured on source images. These results were then compared with the results from intraarterial digital subtraction angiography. RESULTS: MR angiographic maximum intensity projection images had a sensitivity of 87% and a specificity of 88% and MR angiographic source images had a sensitivity of 89% and a specificity of 63% in depicting the presence of a vessel segment. The positive predictive value of an arterial segment with a diameter of at least 1 mm was 99%. CONCLUSION: MR angiography is a sensitive technique for detecting the anatomy of the circle of Willis. Maximum intensity projection images are more specific than source images. An arterial segment with a diameter of at least 1 mm on the source image is almost always present and patent.

Adolescent↗
PubMed1995

[Xanthogranulomatous pyelonephritis with phlegmonous abdominal wall infiltration. Diagnosis and assessment of extent via computerized tomography].

A 34-year-old woman who 14 years previously had undergone a left nephrotomy for nephrolithiasis complained of pain in the left renal fossa which was reddened and painful on percussion. She had a fever of 38.2 degrees C. C-reactive protein was raised to 80 mg/l, the white cell count to 14,620/microliters (83% neutrophils). Protein and white cells were found in the urine together with a significant number of E. coli on urine culture. Plain film of the abdomen showed a staghorn calculus and ultrasonography demonstrated renal enlargement with a possible paranephritic abscess. The computed tomography diagnosis was xanthogranulomatous pyelonephritis, on the basis of renal enlargement, staghorn calculus, hypodense areas with typical density values (10-15 Hounsfield units), contrast enrichment and extrarenal extension of partly phlegmonous partly fused-together inflammatory changes. The abscessing parts were drained under computed tomography control. Starting 7 days pre-operatively the patient had been receiving ciprofloxacin (0.4 g daily) intravenously. A nephrectomy had to be performed subsequently. Antibiotic treatment was discontinued 2 weeks later and she was discharged symptom-free. The diagnosis of diffuse xanthogranulomatous Pyelonephritis was confirmed by histological examination of the surgical specimen.

Abdominal Abscess↗
PubMed1995

[Perimesencephalic subarachnoid hemorrhage: clinical and computer tomography aspects].

AIM: The blood distribution on CCT and the prognosis of patients with nonaneurysmal subarachnoidal haemorrhage were retrospectively studied and compared to a patient group with aneurysmal haemorrhage. METHODS: The blood distribution on CCT (72 h after bleeding episode) of 26 patients with nonaneurysmal subarachnoidal haemorrhage confirmed by two normal cerebral angiograms was compared to the blood distribution of 76 patients with aneurysmal haemorrhage. The clinical condition of these patients was further analysed, 4-60 months after the bleeding episode. RESULTS: In 62% of patients with nonaneurysmal haemorrhage the blood distribution was perimesencephalic. The aneurysmal blood distribution pattern was more extended and only one patient showed a perimesencephalic pattern. 80% of the patients without aneurysms in angiography had no limitations in daily functional capacity. CONCLUSION: The perimesencephalic pattern is frequently found in patients with nonaneurysmal subarachnoidal haemorrhage, the prognosis of these patients is excellent. Rarely is the perimesencephalic haemorrhage caused by a ruptured aneurysm. It needs thorough angiographic evaluation.

Adult↗
PubMed1994

[The findings and value of computed tomography in pleural empyema].

Chest radiographs and CT images of 25 patients with pleural empyemas were compared retrospectively with those of 20 patients with pleural exudates and transudates in order to determine criteria for differential diagnosis and to define the place of CT in the diagnosis of pleural empyemas. The sign which was most suggestive of an empyema on a chest radiograph was an encapsulated effusion in an atypical position (18/25); this was found in only 4 out of 20 exudates and in none of the transudates. On CT, changes in the pleura, the subcostal tissues and the configuration and position of the fluid were suggestive of an empyema. In nearly all patients with a pleural empyema there was thickening and increased contrast uptake of the parietal pleura (22/25) and thickening and increased density oft the subcostal tissues (23/25). Usually, empyemas were encapsulated and biconvex (20/25). None of the patients with pleural transudates showed any of these changes. In the presence of some pleural exudates, pleural (14/20) or thoracic (11/20) changes were noted. In part, these changes were due to previous treatment (sclerotherapy) or tumour infiltration (7/20). An attempt to correlate the CT findings with changes in the pleura and subcostal tissues with the clinical empyema stages I-III, according to Light, showed that CT was unable to distinguish between early and late empyemas. Consequently, diagnostic aspiration remains necessary for correct treatment.

Adult↗
PubMed1987

Compositional analysis of collagen from patients with diverse forms of osteogenesis imperfecta.

Collagen was extracted by pepsin treatment from various tissues and skin fibroblasts of 23 patients belonging to different types of osteogenesis imperfecta (OI), and characterized by molecular sieve and ion exchange chromatography, gel electrophoresis, and amino acid analysis. We found an elevated collagen III/I ratio in the skin of one patient with OI type I but almost normal values in skin fibroblasts of two other patients of this OI type. Five patients with OI type II had a normal collagen III/I ratio in their skin and skin fibroblasts, but the degree of hydroxylation of lysine residues in collagen I and III from their skin, bone, calvarium, and noncalcified calvarial tissue was increased. Patients belonging to OI types II, III, and IV had also considerable amounts of collagen III in their long bones, while bone tissue from controls contained only type I collagen. The content of type V in calcified tissues was virtually the same in controls and patients.

Adolescent↗
PubMed1986

Modulation of collagen type synthesis in organ and cell cultures of fibroblasts.

Fibroblast cultures are widely used to study abnormalities of collagen metabolism in both inborn and acquired diseases. However, there is reason to question the extent to which the experimental information obtained from in vitro culture systems in fact reflects the in vivo situation. In the present study we analyzed the proportions of collagens I and III synthesized by human and mouse skin fibroblasts maintained under various culture conditions. The amount of type III collagen extracted from skin specimens was lower than that which was newly synthesized in organ culture. Cells obtained by enzymatic disintegration of skin specimens synthesized more type III collagen than fibroblasts grown from explants. However, subcultivation of the enzymatically liberated cells resulted in a continuous decline of type III collagen production which eventually reached levels similar to those observed in explant cultures.

Animals↗
PubMed1984

Collagen type distribution and macromolecular organization of connective tissue in different layers of human skin.

Human skin is composed of several layers which are characterized by a specific macromolecular organization of connective tissue. Three approaches were used to quantify the collagen types present in each of the different layers: biochemical analysis of authentic tissue, metabolic labeling of organ cultures, and metabolic labeling of fibroblast monolayers. We obtained reproducible evidence for a somewhat higher ratio of type III/type I collagen synthesis in the papillary dermis and the subcutaneous fat compared to the reticular layer. Constant amounts of alpha 1 (I) trimers and type V collagen were found in all layers. The degree of hydroxylation of lysine in either type I or type III collagen was the same in any layer of the skin.

Adipose Tissue↗
PubMed1983

Analysis of cyanogen bromide peptides of type I collagen from a patient with lethal osteogenesis imperfecta.

The CNBr peptides of type I collagen from bone of a patient with lethal osteogenesis imperfecta and age-matched controls were isolated by molecular-sieve chromatography and their amino acid compositions were determined. No differences were found between the compositions of the peptides from the patient and those from the controls, except for an increase in the degree of hydroxylation of lysine in all peptides from the patient. Type I collagen CNBr peptides from chick-embryo skin [Barnes, Constable Morton & Kodicek (1971) Biochem. J. 125, 925--928] and guinea-pig scar tissue [Shuttleworth, Forrest & Jackson (1975) Biochim. Biophys. Acta 379, 207--216] also have an increased degree of hydroxylation of lysine with an otherwise normal amino acid composition, and it was believed that this could be an embryonic form of collagen. As a similar collagen was present in the bones of the patient studied, it seems possible that the same 'embryonic' collagen is synthesized during development, in repair process and also in genetic disorders of collagen metabolism.

Amino Acids↗
PubMed1982

Immunofluorescent localization of type IV collagen and laminin in human skin and its application in junctional zone pathology.

Purified antibodies against type IV collagen and laminin were used ot localize basement membranes by indirect immunofluorescence in various anatomical regions of normal and diseased human skin. The two proteins showed extensive codistribution. A continuous linear staining was found along the epidermal-dermal junction and around hair follicles, sebaceous gland acini and small capillaries. The same proteins also surrounded individual cells such as those found in vessels, hair erector muscles and subcutaneous tissue. Blister formation in bullous pemphigoi left type IV collagen and laminin on the floor of the blister, while the bullous pemphigoid antigen as detected by human autoantibodies was found on both sides of the blister. In solid basal cell carcinoma a strong staining was found around all tumour islands as well as focally within the cell clusters. This suggests that the tumour cells produce these basement membrane proteins but have lost, at least in part, control of polar deposition.

Adolescent↗