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Biomedical subjects

E Kirsch

Publications and source records attributed to E Kirsch.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1982

Molecular defects in inborn disorders of collagen metabolism.

Disturbances of collagen metabolism may result in the manifestation of clinical symptoms. The collagen disorders that best characterized are genetically inherited and are known to vary at the clinical and molecular levels. Defective posttranslational modifications of collagen chains due to mutant enzymes have been found in patients with the Ehlers-Danlos syndrome and cutis laxa. Altered selection of collagen types and defective primary structure of the molecules themselves are prominent features in osteogenesis imperfecta. In other pathological conditions, such as Marfan syndrome, no clear molecular defect has been identified as yet.

Collagen↗
PubMed1981

Some aspects of the modulation and regulation of collagen synthesis in vitro.

We reviewed here a number of publications containing data on the quantitative aspects of collagen synthesis in vitro. In one section we discussed the factors which modulate the amount of collagen synthesized in various culture systems and in another section we presented experimental evidence for regulatory mechanisms operating in collagen synthesis on the transcriptional and/or translational levels. We believe that growing knowledge of the mechanisms controlling collagen synthesis will help us to understand and deal with fibrotic processes better.

Animals↗
PubMed1981

Osteogenesis imperfecta: biochemical and clinical evaluation of 13 cases.

Skin fibroblasts were cultured from 13 patients with Osteogenesis imperfecta and collagen biosynthesis was investigated in vitro. In those patients characterised by only mild manifestations of the disease, the ratio of collagen types I and III was disturbed. By contrast, fibroblasts obtained from patients with Osteogenesis imperfecta of a more severe type synthesised collagen types I/III in a normal ratio.

Adolescent↗
PubMed1981

Disorder of collagen metabolism in a patient with osteogenesis imperfecta (lethal type): increased degree of hydroxylation of lysine in collagen types I and III.

Types I, II and III collagen were isolated from calvarium, skin and cartilage from a patient with recessive lethal osteogenesis imperfecta. the distribution of the various collagen types was normal in all three tissues. The alpha-chains were purified by molecular sieve and ion-exchange chromatography and were found to differ from the corresponding alpha-chains of age-matched controls only in that the alpha 1(I), alpha 2 and alpha 1(III) chains contained higher amounts of hydroxylysine with proportionally less lysine. alpha 1(II) was normal. The excess hydroxylysine residues were all glycosylated in the case of alpha 1(I) chains, but only partly so for the alpha 2 chains. Similar observations were made with collagen from fetuses at various stages of development. In these fetuses, however, the increase in the degree of hydroxylation of lysine in alpha 1(I), alpha 2 and alpha 1(III) varied with age, being highest in the youngest fetus. Seen in the context of embryonic development, the collagen of the patient would correspond to that of a fetus younger than 18 weeks, and one could speculate that the defect seen in this patient is the result of a disturbed process of maturation of connective tissue.

Autopsy↗