[Medical ENT diagnosis and therapy of sleep-associated respiratory disorders with obstruction of the upper airways].
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Airway Obstruction↗
Biomedical subjects
G Fürst
Publications and source records attributed to G Fürst.
[Monitoring ototoxic side effects in streptomycin therapy of tuberculosis patients with transitory evoked otoacoustic emissions TEOAE].
The transient stimulated otoacoustic emissions TEOAE's from 10 patients treated with Streptomycin for tuberculosis, were measured. The patients received a combination of four drugs consisting of isoniazid, rifampicin, pyrazinamid and streptomycin. All patients received a total of 30 grams of streptomycin during 30 days of treatment. Pure tone audiograms between 125 Hz and 8000 Hz were performed before, during and at the end of the treatment. The TEOAE's were measured in a soundproof cabin before during and after the streptomycin treatment. None of the patients experienced subjective dizziness, hearing loss or tinnitus. The pure tone audiograms showed no significant fluctuations. However, 14 of the 20 examined ears showed a significant decrease in the amplitudes of the TEOAE's. An observation of the TEOAE-amplitudes of each patient during the treatment allows an assessment of impending cochlear dysfunction before subjective hearing loss can be recognized.
Adult↗
Anatomy of the anal sphincters. Comparison of anal endosonography to magnetic resonance imaging.
PURPOSE: A recent application of endosonography in the evaluation of anal sphincter morphology has led to controversy about the possibility of precisely assessing the diameter of external and internal anal sphincter muscles. On the other hand, magnetic resonance imaging (MRI) has been proposed to allow a more detailed view of the anatomy of the pelvic floor. However, both techniques have not yet been compared directly. METHODS: Eight healthy volunteers (age range, 25-40 years; 5:3, male:female) participated. Anal ultrasound was performed using a 7.5-MHz rectal transducer which produced a transversal panorama display of 360 degrees, allowing an image perpendicular to the anal canal. Imaging of the diameter of the internal and external anal sphincter muscles was performed with the transducer placed in the midanal canal, and measurement was always performed by the same investigator in dorsal projection. MRI was performed using a 1.5 Tesla Magnetom (Siemens, Erlangen, Germany) to obtain sagittal and angled axial (perpendicular to the anal canal) planes for consecutive 3-mm slices which were evaluated by four independent raters. RESULTS: Muscle thickness of the sphincter muscles in dorsal projection was 1.96 +/- 0.61 mm for the internal sphincter and 6.35 +/- 1.07 mm for the external sphincter using ultrasound. It was 1.72 +/- 0.13 mm and 3.99 +/- 0.99 mm, respectively, using MRI. When both measures were compared, only the internal sphincter data correlated significantly (r = 0.818, P = 0.0023) between both measures. Sagittal resonance imaging of the anal canal did not allow for differentiation of both muscles at all. Differentiation among mucosa, submucosa, and internal anal sphincter is not possible with MRI but may well be performed with high-resolution ultrasound. CONCLUSION: Anal ultrasound carries the potential of becoming a routine clinical procedure for evaluation of the anal anatomy and morphology in defecation disorders, but current MRI assessment of the anal anatomy is elaborate, costly, and does not provide any further insights.
Adult↗
Morphologic effects of a sulfur(IV) aerosol on the nasal cavity of beagle dogs.
Morphologic changes were observed in nasal cavities of beagle dogs after long-term exposure to a respirable sulfur(IV) aerosol at a concentration equivalent to a sulfur dioxide (SO2) concentration of 0.6 mg/m3. The changes were characterized by a thickened epithelial layer resulting from epithelial proliferation, by a loss of secretory material, and by moderate mononuclear cell infiltration.
Administration, Inhalation↗
In vivo morphometry of planum temporale asymmetry in first-episode schizophrenia.
Magnetic resonance imaging is a promising tool for in vivo analysis of the neuropathology underlying schizophrenia. One of the most consistent features emerging from the majority of published studies is the lateralization of pathological findings, and this has led to hypotheses of impaired hemispheric specialization in schizophrenia. In previous work, we have validated morphometry of supratemporal language-related cortex using high-resolution magnetic resonance imaging and analyzed the relation of the so defined planum temporale to functional parameters of hemispheric specialization. In the present study, we examined planum temporale structural asymmetry in first-episode schizophrenics. Asymmetry coefficients obtained in these patients did not differ significantly from those in equally right-handed controls and were not correlated to standard psychopathological measures. These data are contrasted with other studies reporting lateralized brain pathology in schizophrenia with special emphasis on methodological considerations in neuroimaging procedures.
Adult↗
Usefulness of an intravenous contrast medium in the characterization of high-grade internal carotid stenosis with color Doppler-assisted duplex imaging.
BACKGROUND AND PURPOSE: The remaining limitations of ultrasonographic imaging in accurately quantifying internal carotid stenosis or diagnosing internal carotid occlusion may be overcome by enhancing the echogenicity of flowing arterial blood with contrast agents. This study assessed the usefulness of the intravenous (transpulmonary) contrast medium SH U 508 A in improving the characterization and quantification of severe internal carotid stenosis. METHODS: We examined 32 patients (30 had vessels with a stenosis of greater than 70% luminal narrowing and 2 had vessel occlusions) using a 7.5-MHz linear-array transducer for color Doppler-assisted duplex imaging before and after injection of the contrast medium. RESULTS: The SH U 508 A-induced increase in carotid blood echogenicity began 11 +/- 2 (mean +/- SD) seconds after the start of the bolus injection, peaked at 21 +/- 2 dB, and showed a half-life of 75 seconds. Quantitative vascular measurements (cross-sectional luminal area reduction and plaque length, respectively) obtained before and after contrast application were highly correlated (r > .90). Visualization of the entire length of the intrastenotic residual flow lumen, however, was significantly improved by contrast enhancement (52% versus 83%, P = .01). CONCLUSIONS: This pilot study on patients with extracranial carotid artery disease suggested that ultrasonic contrast media may be most useful in improving the ultrasonography-based diagnosis of internal carotid occlusion.
Aged↗
[Measuring pharyngeal pressure in patients with nCPAP ventilation].
In 36 patients inspiratory and expiratory pressures in the pharynx were measured during nCPAP with pressures ranging from 5 to 20 mbar. The results were compared to the nasal resistance as measured by rhinomanometry and to minimal cross-sectional area of the nose as measured by acoustic rhinometry.
Airway Resistance↗
[Intracranial MR angiography].
Magnetic resonance angiography (MRA) is gaining wide acceptance as a screening modality for the intracranial vasculature. Previous reports have demonstrated that MRA is capable of accurately depicting the normal vascular anatomy and anatomic variants. To date various techniques have been applied in the evaluation of vaso-occlusive disease, aneurysms, arteriovenous malformations and venous sinus thrombosis. Recent technical developments have significantly improved spatial resolution and vascular contrast and will further enhance its routine clinical use. The purpose of this essay is to summarize the technical approaches, clinical role and limitations of MRA as they apply to the intracranial circulation.
Blood Flow Velocity↗
[Experiences with the "verification" of anti-HCV ELISA positive blood donors].
Because there is no real conformation assay available to confirm anti-HCV ELISA reactive screening results, we have used the combination of two supplementary tests to decide which blood donors must be notified and excluded from further donations. Overall we could 'confirm' about 35% of the screening-ELISA reactive results, which means a real prevalence of 0.17% of anti-HCV in our donor population.
Blood Donors↗
[Sigmoid sinus thrombosis, a therapeutic problem].
Thrombosis of the sigmoid sinus is a relatively uncommon illness. It may present in a septic or bland form, and the latter is more or less asymptomatic. Angiography, computerised tomography and magnetic resonance imaging are all at our disposal for diagnosis of both types of thrombosis, and proper diagnosis of the specific form of sinus thrombosis will determine the required therapy. Between 1985 and 1990 six patients with sigmoid sinus thrombosis were treated at the Departments of ENT, Johannes Gutenberg University, Mainz and Albert Ludwig University, Freiburg, Germany, on an in-patient basis. By means of these cases we present our experience with this uncommon condition.
AIDS-Related Opportunistic Infections↗
[The selective arterial and venous MR angiography of intracranial arteriovenous malformations].
This study evaluates the usefulness of MR angiography (MRA) in analysing cerebral arterial blood supply and venous drainage in patients with intracranial arteriovenous malformations (AVM). Selective MRA of the carotid, middle cerebral or vertebrobasilar territories was performed by means of presaturation of up to three of the brain-supplying arteries at the level of the middle or lower neck (angled presaturation slabs). Results obtained with selective, non-selective arterial, as well as venous MRA in 13 consecutive patients were compared with the findings at intraarterial angiography, the latter serving as the "gold standard". Sensitivity in identifying major feeding arteries was 100%. Determination of the absolute and relative AVM sizes at selective MRA corresponded with IAA. The mean difference was 17.6 and 3.9% respectively. Both display of superficial and deep venous drainage was provided by 2-dimensional venous MRA. The authors conclude that selective MRA of cerebral arteries as used here is a powerful non-invasive method to demonstrate blood supply by single feeding vessels in intracranial malformations. 2D venous MRA permits an accurate evaluation of the venous drainage pattern.
Adult↗
[Quantification of extracranial carotid stenosis. Magnetic resonance angiography and Doppler sonography versus intra-arterial angiography].
UNLABELLED: To assess various non-invasive techniques for quantifying internal carotid artery CA stenosis, per cent luminal diameter reduction on intraarterial angiograms (IAA) was measured in 63 patients with ICA stenosis or occlusion. These data were compared with independent measurements based on MR-angiography, continuous-wave (cw) Doppler ultrasonography, systolic peak flow velocity and colour Doppler assisted duplex imaging. Correlations with IAA were equally strong for MR angiography, cw Doppler and colour Doppler analysis (0.95; 0.92; 0.92). Positive predictive values for > or = 70% ICA stenosis were lower and negative predictive values were higher for cw Doppler (0.85; 0.92) and colour duplex analysis (0.81; 0.94) than for MR angiography (0.86; 0.88). Statistical analysis showed non-linear correlations between percentage of lumen diameter narrowing and the length of the zone of signal intensity loss (0.72) and maximum systolic peak flow velocity (0.77). CONCLUSION: Several non-invasive methods do compare with IAA in identifying and quantifying high-grade ICA stenosis and may suffice for decisions on treatment.
Adult↗
[The hemodynamics and anatomy of the circle of Willis. The technic and clinical value of selective MR angiography].
This study evaluates the usefulness of MR angiography in analysing the individual collateral flow dynamics and anatomy of the circle of Willis in 56 patients with high-grade extracranial carotid stenosis or occlusion. Selective MRA of the carotid or vertebrobasilar area was performed by means of presaturation up to the brain-supplying arteries at the level of the middle neck (angled presaturation slabs). Results obtained with selective and non-selective MRA in 56 consecutive patients were compared with the findings at transcranial Doppler ultrasonography and arterial angiography. Ischaemic cerebral infarctions were classified by computerized tomography and correlated with the results of collateral flow analysis: Sensitivity of selective MRA in detecting intracranial collateral flow via anterior or posterior communicating artery was 96 and 97%, respectively; sensitivity in depicting extracranial transorbital flow was lower (71%). Non-selective MRA was 100% sensitive in detecting a non-filling of the horizontal (A1) segment of the anterior cerebral artery and in identifying an origin of the posterior cerebral artery from the intracranial carotid artery. Slow flow infarctions occurred more frequently in patients with transorbital and posterior-to-anterior collateral flow than in patients with collateral flow via anterior communicating artery.
Angiography↗
Between-method correlation in quantifying internal carotid stenosis.
BACKGROUND AND PURPOSE: The degree of internal carotid stenosis has emerged as the most important predictor of ischemic stroke in extracranial carotid artery disease. The purpose of this study was to assess the validity of the noninvasive techniques for quantifying internal carotid stenosis with respect to the accepted standard of intra-arterial angiography. METHODS: We measured the maximum percentage reduction in luminal diameter on the intra-arterial digital subtraction angiograms of 56 symptomatic patients with extracranial internal carotid stenosis (n = 77) or occlusion (n = 20). These data were compared with independent measurements based on continuous-wave Doppler ultrasonography, pulsed-wave Doppler spectrum analysis, color Doppler-assisted duplex imaging, and magnetic resonance angiography. RESULTS: Correlations with intra-arterial angiography were equally strong (r > .90) for magnetic resonance angiography, continuous-wave Doppler, and color duplex analysis. Positive and negative predictive values for (therapeutically relevant) 70% to 99% stenosis were higher for continuous-wave Doppler (.82, .97) and color duplex (.84, .98) than for magnetic resonance angiography (.79, .81). Also, accuracy in quantifying high-grade stenosis was better for both of these ultrasonographic techniques, mainly due to the frequent occurrence of a "flow gap" on the magnetic resonance angiograms. Continuous-wave Doppler and magnetic resonance angiography, but not color duplex, failed to detect slow residual arterial flow in one and two cases of symptomatic "pseudo-occlusion" of the internal carotid, respectively. CONCLUSIONS: (1) Several noninvasive methods compare well with intra-arterial angiography in identifying and quantifying high-grade internal carotid stenosis; (2) the use of these noninvasive methods may suffice for treatment decisions; and (3) because residual between-method disagreement is partly explained by principles of physics, the validity of continuous-wave Doppler and color duplex in quantifying 60% to 99% stenosis is likely to be underestimated by correlation with intra-arterial angiography.
Blood Flow Velocity↗
[The local lysis therapy of spontaneous renal artery dissection with arterial thrombosis].
A 33-year-old previously completely healthy man developed severe, at first colicky then persisting, pain in the left flank. The blood pressure was 190/110 mm Hg and he had pain over the left kidney on percussion. There was a mild leucocytosis (10,300/microliters), serum creatinine of 1.5 mg/dl and a rise in lactate dehydrogenase level to 395 U/l, while the urine was unremarkable. The pyelogram demonstrated on the left the upper calyceal system only and this very weakly. Colour Doppler ultrasound showed a massively reduced blood flow in the left renal vein while the artery was not visible. Digital subtraction angiography demonstrated eccentric narrowing of the left renal artery by an intravascular thrombus, providing the diagnosis of spontaneous renal artery dissection with thrombosis. Complete recanalization occurred after local thrombolysis with 500,000 IU urokinase over 7 hours, and subsequent administration of four times 40 mg tissue plasminogen activator over 4 hours. But the scintigram still demonstrated impaired renal function with decrease in clearance to 10% of total. The patient was still symptom-free on re-examination 16 months later, serum creatinine concentration was stable at 1.3 mg/dl and the blood pressure was normal.
Adult↗
[Reconstruction of defects of the anterior wall of the frontal sinus using autologous bone transplantation obtained by calvarian split graft].
We present the technique to gain free calvarian split bone grafts for reconstruction of the anterior wall of the frontal sinus. The indication for surgery, the surgical technique and the results in 12 patients are discussed.
Adolescent↗
[Renal stent implantation. The current indications, 2-year results and the possibilities for percutaneous stent recovery].
Use of the Strecker flexible balloon-expandable tantalum stent for treatment of renal artery stenosis after failed angioplasty or transaortic thrombendarterectomy was evaluated in 18 patients (17 hypertensive, 1 normotensive). Right (n = 10) and left (n = 6) renal arteries were involved; in 2 patients renal artery stenosis had developed after kidney transplantation. Indications for stent placement were inadequate immediate postangioplasty response (n = 16), and obstructing intimal flaps following transaortic endarterectomy (n = 2). Stent placement was technically successful (less than 20% residual stenosis) and patency was preserved in 14 patients. Mid-term results (mean, 12-13 months) of 11 patients showed restenoses (greater than 50%) in 2 patients, and improvement of hypertension in 8 patients. The Strecker stent may be helpful in treating residual stenosis after failed revascularization procedures of the renal arteries, although long-term efficacy of stent placement will not be known until trials with more subjects and longer follow-up periods are completed.
Adult↗
[The imaging diagnosis of acute renal transplant obstruction with special reference to antegrade pyelography].
30 patients with an acute build-up of renal transplant were examined comparatively via antegrade pyelography (AP), computed tomography (CT) and sonography (SONO). In the proof of obstructions and compressions of the ureter of renal transplant, antegrade pyelography was superior to sonography and computed tomography. Perirenal collections of fluids were recognised correctly via sonography by 73% (11/15) and computed tomography by 87% (13/15). The computer tomogram is superior in the differentiation of perirenal collection of fluids. In establishing proof of the cause of an acute build-up of renal transplant it was evident that computed tomography with a sensitivity of 64% and a specificity of 94% was slightly superior.
Acute Disease↗