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Biomedical subjects

G Brinkmann

Publications and source records attributed to G Brinkmann.

At least 19 recordsLinked to original sources
PubMed2004

[Complicating neonatal Escherichia coli meningitis].

Neonatal Escherichia coli meningitis is a serious disease with high mortality and poor outcome. Ventriculitis, brain abscess and subdural empyema are frequent, with no homogeneous recommendations available for these complications. The case of a newborn infant who developed sepsis and meningitis caused by E. coli is presented. During intravenous treatment with ampicillin, cefotaxime and gentamycin in recommended doses, the patient developed severe subdural abscesses detected on MRI. After consequent antibiotic therapy over 2 months with fosfomycin, amikacin and meropenem the patient improved clinically and the abscesses regressed and disappeared without neurosurgical intervention. At the age of 6.5 months the infant is healthy and well developed. The conservative treatment of subdural abscesses complicating neonatal Escherichia coli meningitis without neurosurgical intervention is possible. The treatment of the individual case should be discussed between pediatrician and neurosurgeon.

Amikacin↗
PubMed2001

Regional lean body mass and resting energy expenditure in non-obese adults.

OBJECTIVE: To study the effect of regional lean body mass (LBM) on resting energy expenditure (REE). Design Cross-sectional study in a homogenous group of 26 young healthy non-obese subjects. METHODS: Regional body composition was assessed by dual-energy X-ray absorptiometry (DEXA). REE was measured by indirect calorimetry. RESULTS: REE showed positive relationships with whole body LBM (LBMb; r=0.89) as well as with regional LBM (LBMtrunk = LBMt, r = 0.88, and LBMarms+legs = LBMe for LBMextremities, r = 0.89) with non-zero intercepts (between 1.86 and 2.83 MJ/d). REE per kg LBMb falls as LBMb increases (r = 0.77). By contrast, REE adjusted for regional distribution of LBM (i. e. the ratio of LBMt to LBMe) increases as LBMb increases (r = 0.91) showing a near-zero intercept (i. e. 0.048 MJ/d). Adjusting REE for LBMb as well as for the ratio of LBMt to LBMe can be used for comparison between subjects. CONCLUSIONS: Our data suggest that regional distribution of LBM is a determinant of REE. Assessment of LBMt and LBMe by DEXA provides a possibility to adjust for the non-linearity of REE on LBMb.

Absorptiometry, Photon↗
PubMed2001

Evaluation of hydroxyapatite implants in vertebral bodies and extremities by contrast-enhanced magnetic resonance imaging.

This pilot study evaluated hydroxyapatite (HA) implants (Endobon) into bone with magnetic resonance imaging (MRI). Nineteen patients (median age 57 years; range 18-67 years) have been evaluated. Eight received granulated HA into vertebral bodies after trauma, while 11 received HA blocks into extremity bones after trauma (n = 8) or fibrous dysplasia (n = 2). In a 1.5-T MR scanner, transversal T1-weighted, flash, 2-dimensional images were obtained. Signal intensities were measured in regions of interest (ROI) from the centre and periphery of HA, trabecular bone, fat and air before and after gadolinium (Gd) contrast enhancement, and the signal-to-noise ratio (SNR) was calculated. After Gd application the SNR in HA increased significantly, peripherally (11.7 without vs 18.2 with Gd, P = 0.003) more than in the centre (7.9 without vs 11.9 with Gd, P = 0.007). The SNR of the HA was higher in patients with block implants compared with granulated HA (P > 0.008). After Gd application, granulated HA enhances significantly less than HA blocks. During insertion of HA, the granulated form is compressed more and is therefore more compact than the HA block. This might hinder integration into the bone structure and the blood supply. SNR of the HA margin was higher than centrally, which might be due to granulomatous tissue after trauma and/or operation or beginning marginal integration.

Adolescent↗
PubMed2001

Has blood glucose level measured on admission to hospital in a patient with acute pancreatitis any prognostic value?

BACKGROUND: Early detection of pancreatic necrosis allows better management of the disease. Contrast-enhanced computed tomography (CT) as the gold standard for detecting pancreatic necrosis is expensive. AIM OF THE STUDY: This study was to evaluate for the first time whether blood glucose estimation on hospital admission--a simple, cheap, readily available laboratory parameter--may detect pancreatic necrosis and have prognostic value in acute pancreatitis. METHODS: Single blood glucose estimation upon hospital admission was evaluated prospectively for detecting pancreatic necrosis and as a prognostic indicator. The study included 241 nondiabetic patients with a first attack of acute pancreatitis. All underwent CT within 72 h of admission. RESULTS: High blood glucose (> 125 mg/dl) correlated significantly with complex high clinical and biochemical prognostic scores (Ranson, Imrie), a high Balthazar score, pancreatic pseudocysts, and a long hospital stay, but not with organ failure, indication for artificial ventilation, dialysis, surgery, length of intensive care, and mortality. Pancreatic necrosis detection sensitivity of high blood glucose was 83%, specificity 49%, positive predictive value 28%, and negative predictive value 92%. CONCLUSION: A patient with normal blood glucose on admission is unlikely to have pancreatic necrosis. Contrast-enhanced CT would not be needed unless the patient fails to improve.

Acute Disease↗
PubMed2000

Lists of face-regular polyhedra

We introduce a new notion that connects the combinatorial concept of regularity with the geometrical notion of face transitivity. This new notion implies finiteness results in the case of bounded maximal face size. We give lists of structures for some classes and investigate polyhedra with constant vertex degrees and faces of only two sizes.

Journal Article↗
PubMed2000

Paraneoplastic cerebellar degeneration in pediatric Hodgkin disease.

Paraneoplastic cerebellar degeneration (PCD) is a rare neurological complication in adults with extracerebral neoplasms. It is characterized by a diffuse cerebellar dysfunction, usually leading to severe neurological sequelae. In childhood, this complication is extremely rare. We report on PCD as primary manifestation of Hodgkin disease (HD) in a thirteen-year old boy. On magnetic resonance imaging, irreversible atrophy of the cerebellum developed within three months. Antibodies against Purkinje cells were detectable at diagnosis and normalised after successful treatment of the lymphoma. Cerebellar symptoms, however, only partially resolved. The necessity of a search for a malignant tumour is emphasised in the presence of an otherwise unexplained, subacutely developing, diffuse cerebellar dysfunction.

Adolescent↗
PubMed2000

[Quantification of fluid flow in magnetic resonance tomography: an experimental study of a flow model and liquid flow measurements in the cerebral aqueduct in volunteers].

PURPOSE: To study the feasibility o MRI for quantification of fluid flow in a tube model and the cerebral aqueduct (CA) in volunteers. VOLUNTEERS AND METHODS: All studies were performed on a 1.5 T MR scanner using a head coil and a FLASH 2D phase contrast sequence with a velocity encoding at 20 cm/s. Flow (real value, ml/sec) of a saline fluid was measured in a flexible tube model with different inside diameters: 0.75-3 mm. Three flow velocities were given (normal value). To test the reproducibility, three studies were done using a flow of 0.12 or 0.14 ml/sec and a tube diameter of 0.75 and 2.0 mm. The ratio of normal to real flow value was calculated (ideal ratio = 1). MRI of CA and flow quantification was done in 24 volunteers (28 +/- 4 years). RESULTS: Using tubes with a diameter of 0.75 and 1.5 mm the real flow was sometimes higher than the velocity encoding of the phase contrast sequences. Because of this measurements of the fluid flow and the flow velocities were impossible. There was agreement for fluid flow quantification in the tube of 3.0 mm and high agreement in the tube of 2.0 mm in diameter with reproducible results. The mean diameter of the CA in normal subjects was 2.0 +/- 0.3 mm, the mean cerebral flow was 0.04 +/- 0.02 ml/sec and the peak velocity 3.06 +/- 1.59 cm/sec. CONCLUSIONS: Reliable flow quantification with MRI is feasible if the diameter of the lumen is greater than 1.5 mm, and if the flow velocity is lower than the velocity encoding. In cases of smaller diameters and higher flow velocities the velocity encoding has to be changed. Because of this the quantification seems to be inaccurate in cases of aqueductal stenosis with the method we used.

Adult↗
PubMed2000

Metabolically active components of fat free mass and resting energy expenditure in nonobese adults.

Resting energy expenditure (REE) and components of fat-free mass (FFM) were assessed in 26 healthy nonobese adults (13 males, 13 females). Detailed body composition analyses were performed by the combined use of dual-energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI), bioelectrical impedance analysis (BIA), and anthropometrics. We found close correlations between REE and FFM(BIA) (r = 0.92), muscle mass(DEXA) (r = 0.89), and sum of internal organs(MRI) (r = 0.90). In a multiple stepwise regression analysis, FFM(BIA) alone explained 85% of the variance in REE (standard error of the estimate 423 kJ/day). Including the sum of internal organs(MRI) into the model increased the r(2) to 0.89 with a standard error of 381 kJ/day. With respect to individual organs, only skeletal muscle(DEXA) and liver mass(MRI) significantly contributed to REE. Prediction of REE based on 1) individual organ masses and 2) a constant metabolic rate per kilogram organ mass was very close to the measured REE, with a mean prediction error of 96 kJ/day. The very close agreement between measured and predicted REE argues against significant variations in specific REEs of individual organs. In conclusion, the mass of internal organs contributes significantly to the variance in REE.

Absorptiometry, Photon↗
PubMed1999

Kinematic MR imaging in surgical management of cervical disc disease, spondylosis and spondylotic myelopathy.

PURPOSE: To estimate the clinical value and influence of kinematic MR imaging in patients with degenerative diseases of the cervical spine. MATERIAL AND METHODS: Eighty-one patients were examined with a 1.5 T whole body magnet using a positioning device. Cervical disc disease was classified according to clinical and radiographic findings into 4 stages: stage I=cervical disc disease (n=13); stage II=spondylosis (n=42); stage III=spondylosis with restricted motion (n=11); and stage IV=cervical spondylotic myelopathy (n=15). Findings on kinematic MR images were compared to those on flexion and extension radiographs, myelography, CT-myelography and static MR imaging. Furthermore, the influence of kinematic MR imaging on surgical management and intra-operative patient positioning was determined. RESULTS: Additional information obtained by kinematic MR imaging changed the therapeutic management in 7 of 11 (64%) patients with stage III disease, and in 13 of 15 (87%) patients with stage IV disease. Instead of an anterior approach, a posterior surgical approach was chosen in 3 of 11 patients (27%) with stage III disease and in 6 of 15 patients (40%) with stage IV disease. Hyperextension of the neck was avoided intra-operatively in 4 patients (27%) with cervical spondylotic myelopathy, and in 1 patient with stage II (2%) and in 1 patient with stage III (9%) disease. Kinematic MR imaging provided additional information in all patients with stages III and IV disease except in 1 patient with stage III disease, when compared to flexion and extension radiographs, myelography, CT-myelography and static MR examination. CONCLUSION: Kinematic MR imaging adds additional information when compared to conventional imaging methods in patients with advanced stages of degenerative disease of the cervical spine.

Cervical Vertebrae↗
PubMed1998

Biomechanical aspects of the subarachnoid space and cervical cord in healthy individuals examined with kinematic magnetic resonance imaging.

STUDY DESIGN: In vivo flexion-extension magnetic resonance imaging studies of the cervical spine were performed inside a positioning device. OBJECTIVE: To determine the functional changes of the cervical cord and the subarachnoid space that occur during flexion and extension of the cervical spine in healthy individuals. SUMMARY OF BACKGROUND DATA: As an addition to static magnetic resonance imaging examinations, kinematic magnetic resonance imaging studies of the cervical spine were performed to obtain detailed information about functional aspects of the cervical cord and the subarachnoid space. The results were compared with published data of functional flexion-extension myelograms of the cervical spine. METHODS: The cervical spines of 40 healthy individuals were examined in a whole-body magnetic resonance scanner from 50 degrees of flexion to 30 degrees of extension, using a positioning device. At nine different angle positions, sagittal T1-weighted spin-echo sequences were obtained. The images were analyzed with respect to the segmental motion, the diameter of the subarachnoid space, and the diameter of the cervical cord. RESULTS: The segmental motion between flexion and extension was 11 degrees at C2-C3, 12 degrees at C3-C4, 15 degrees at C4-C5, 19 degrees at C5-C6, and 20 degrees at C6-C7. At flexion, a narrowing of the ventral subarachnoid space of up to 43% and a widening of the dorsal subarachnoid space of up to 89% (compared with the neutral position, 0 degrees) were observed. At extension, an increase in the diameter of the ventral subarachnoid space of up to 9% was observed, whereas the dorsal subarachnoid space was reduced to 17%. At flexion, there was a reduction in the sagittal diameter of the cervical cord of up to 14%, and, at extension, there was an increase of up to 15%, compared with the neutral position (0 degrees; these values varied depending on the cervical segment. Statistically significant differences (P < 0.05) were found between flexion and extension in the diameter of the ventral and dorsal subarachnoid space and in the diameter of the cervical cord. CONCLUSIONS: Compared with the results of previous studies using functional cervical myelograms, kinematic magnetic resonance imaging provides additional noninvasive data concerning the physiologic changes of the cervical subarachnoid space and the cervical cord during flexion and extension in healthy individuals.

Adult↗
PubMed1998

Critical evaluation of the specificity of MRI and TVUS for differentiation of malignant from benign adnexal lesions.

The aim of our work was to study the specificity of MRI in comparison with transvaginal US for differentiation of malignant from benign adnexal lesions. A total of 67 patients with clinically suspicious adnexal lesions were evaluated by MRI. Transaxial and coronal images were acquired using T1-weighted sequences before and following IV contrast and T2-weighted sequences. In all patients transvaginal ultrasound examinations (TVUS) were performed. For both imaging modalities each lesion was classified separately as either benign or malignant according to previously published criteria. Pathologic findings were available in 65 cases. Both MRI and TVUS correctly classified the 12 malignant lesions (sensitivity 100 %). Specificity (MRI: 78.2 %, TVUS: 65.5 %) and accuracy (MRI: 82 %, TVUS: 71.6 %) were higher with MRI than with TVUS, but differences were statistically not significant (p = 0.18 and p = 0.20, chi-square test). There was agreement/disagreement between findings of MRI and US in 52/15 lesions. The macroscopic criteria for malignancy are unspecific and result in a limitation of the specificity of both MRI and TVUS. The MRI technique is a valuable adjunct to TVUS by enabling further clarification of adnexal tumors with equivocal complex or solid vaginal sonographic findings.

Adnexal Diseases↗
PubMed1998

Skeletal involvement and follow-up in linear nevus sebaceous syndrome.

Linear nevus sebaceous syndrome is a rare neurocutaneous syndrome in which associated radiographic findings of the peripheral skeletal system are uncommon. We report a follow-up study of a patient with mainly unilateral changes of the skeletal system involving the thorax and the right arm and leg.

Abnormalities, Multiple↗
PubMed1998

[Ultra-rapid T2-weighted MR imaging during suspended respiration for the examination of focal lesions of the liver: a comparison of TSE, HASTE and HASTE-STIR sequences using a CP body array coil].

PURPOSE: A comparison of ultra rapid T2-weighted HASTE and HASTE-STIR sequences during suspended respiration for the detection of focal lesions of the liver. MATERIAL AND METHODS: Twenty-one patients (59 +/- 12 years) with a total of 33 focal lesions (7 < or = 1 cm, 19 < or = 3 cm; 17 cystic liquid and 16 solid lesions) were examined with a 1.5 T MR apparatus. Sequences: T2 weighted HASTE (TEeff = 64 ms, 90 ms), HASTE-STIR (TEeff = 64 ms, 81 ms) TSE (TE = 132 ms) and T1-weighted FLASH 2D. RESULTS: The T2-weighted TSE and both HASTE sequences showed all the lesions. Two out of the 33 lesions were not demonstrated by the other sequences. Best image quality without movement artefacts and the best resolution of the lesions in the T2-weighted sequences, with the most favourable contrast/noise ratio (36.6 +/- 33.1) and signal/noise ratio (20.8 +/- 10.5) resulted from the HASTE 90, followed by the HASTE 64 sequence (27.5 +/- 24.2; 24.6 +/- 9.1). Both these techniques were superior to the TSE sequence (23.9 +/- 29.4; 13.9 +/- 7.4), which resulted in movement artifacts. With the HASTE-STIR sequences it was possible to show 31 and 32 of the 33 lesions respectively, with very good resolution but poor signal/noise ratio. CONCLUSION: HASTE sequences have the potential of improving the diagnosis of focal liver lesions.

Adenoma↗
PubMed1998

Dynamic changes of the spinal canal in patients with cervical spondylosis at flexion and extension using magnetic resonance imaging.

RATIONALE AND OBJECTIVES: The authors determine the dynamic changes of the spinal canal during flexion and extension in patients with cervical spondylosis. METHODS: Forty-six patients were studied inside a whole-body magnetic resonance (MR) scanner with between 50 degrees of flexion and 30 degrees of extension, using a positioning device. At neutral position (0 degree) and maximum flexion and extension sagittal T2-weighted turbo spin echo sequences were acquired. RESULTS: A significant (P < or = 0.05) increase of spinal stenosis was found at extension (48%, 22 of 46 patients) when compared with flexion (24%, 11 of 46). Cervical cord compression was diagnosed at flexion in 5 patients (11%) and at extension in 9 patients (20%). Concerning the number of patients with cervical cord compression at flexion and extension, significant differences (P < or = 0.05) were found in patients with degenerative changes at four segments compared with patients with one segment involvement. CONCLUSIONS: Magnetic resonance imaging identified a significant percentage of increased spinal stenosis at flexion and, especially, at extension, which was not observed at neutral position (0 degree). Flexion and extension MR imaging demonstrates additional information using a noninvasive technique concerning the dynamic factors in the pathogenesis of cervical spondylotic myelopathy.

Adult↗
PubMed1998

Classification system based on kinematic MR imaging in cervical spondylitic myelopathy.

BACKGROUND AND PURPOSE: Functional myelographic studies are often used to evaluate the dynamic changes of the cervical spinal canal during flexion and extension. The purposes of this study were to use kinematic MR imaging to assess the dynamic changes of the cervical spine in patients at different stages of degenerative disease and to describe a classification system based on static and dynamic factors in the pathogenesis of cervical spondylitic myelopathy. METHODS: Eighty-one patients with different stages (I-IV) of degenerative disease of the cervical spine were examined with MR imaging. In the neutral position (0 degrees) and at maximum flexion and extension, spinal stenosis was classified for each segment according to the following grading system: 0 = normal, 1 = partial obliteration of the anterior or posterior subarachnoid space, 2 = complete obliteration of the anterior or posterior subarachnoid space, and 3 = cervical cord compression or displacement. RESULTS: At flexion and extension, the prevalence of spinal stenosis and cervical cord impingement increased as the stage of degenerative disease progressed. With regard to a pincer effect (anterior and posterior cord impingement) and cord encroachment at multiple segments, statistically significant differences were observed at stages III and IV as compared with stages I and II. Significant increase in cord impingement was seen in 22 (27%) of 81 patients at extension, as compared with four (5%) of 81 patients at flexion. CONCLUSION: Regardless of the stage of degenerative disease and grade of spinal stenosis at the neutral position (0 degrees), cervical spinal motion may contribute to the development of cervical spondylitic myelopathy.

Adult↗
PubMed1997

[Magnetic resonance imaging vs. three-dimensional scintigraphy in the diagnosis and monitoring of mandibular osteomyelitis].

Bone scintigraphy is routinely used in the diagnosis of lower jaw osteomyelitis; however, the radiation dosage of 3.5 mSv is quite high. Magnetic resonance imaging (MRI) gives information about soft tissue and bone marrow alterations. This study compares the sensitivity of the two imaging modalities in the diagnosis of lower jaw osteomyelitis. Thirteen patients with clinical signs of the disease were examined and followed up using both methods, three-phase bone scintigraphy and MRI. Compared to three-phase bone scintigraphy, MRI has the same diagnostic sensitivity. However in one case of active osteomyelitis bone scintigraphy showed a false-negative result. MRI once indicated a higher activity rate but never failed to provide the diagnosis. In addition, it gives exact information about the location, size and involvement of the soft tissue. A STIR sequence should be performed in addition to the native and contrast-enhanced T1-weighted spin echo sequence. The metal artifacts of the antibiotic chain on the MRI can be eliminated by replacing the wire by nonresorbent suture material. In the diagnosis of lower jaw osteomyelitis, three-phase bone scintigraphy can be replaced by the MRI.

Humans↗