Biomedical subjects

H Hirche

Publications and source records attributed to H Hirche.

At least 37 records · Page 2Linked to original sources

PubMed1999

Intermittent prone positioning in the treatment of severe and moderate posttraumatic lung injury.

OBJECTIVE: Severe posttraumatic lung injury is characterized by impairment of gas exchange and pulmonary densities. The influence of intermittent prone positioning on pulmonary gas exchange and parenchymal densities was investigated prospectively in patients with pulmonary injury after multiple trauma with blunt chest trauma. SETTING: A six-bed trauma intensive care unit in a university hospital. DESIGN: Prospective, descriptive study. PATIENTS: Twenty-two consecutive patients with pulmonary injury after multiple trauma with blunt chest trauma and acute lung injury (n = 11) or severe acute respiratory distress syndrome (ARDS) (n = 11) according to the definitions of the consensus conference on ARDS. INTERVENTIONS: Pulmonary densities were calculated planimetrically from computed tomographic scans of the chest before the first and after the last cycle of prone positioning. Indications for prone positioning were a) mechanical ventilation with FIO2 >0.5 at positive end-expiratory pressure >10 cm H2O for >24 hrs; or b) pulmonary densities in two or more quadrants being constant or increasing within 48 hrs. Arterial blood gas analysis was performed every 2 hrs. Intrapulmonary right-to-left shunt (Qs/Qt) and alveolar-arterial PO2 difference were calculated 2 hrs after the beginning and end of every prone and supine cycle, respectively. Patients were ventilated in the prone position for 8 hrs each day. MEASUREMENTS AND MAIN RESULTS: Every single posture change from the supine to the prone position resulted in a significant average increase in the oxygenation index of 28+/-8 torr (3.7+/-1.1 kPa) (p<.0001). There was a significant improvement in oxygenation (4.3+/-0.8 torr [0.57+/-0.11 kPa]) with time between two consecutive measurements in the prone as well as the supine position (p<.0001). Alveolar-arterial PO2 difference and Qs/Qt showed a significant decrease of 25+/-7 torr (3.3+/-0.9 kPa) and 1.1+/-0.46%, respectively, for every cycle of prone positioning. Statistical analysis revealed no significant alteration of gas exchange within every prone and supine cycle. Total static lung compliance improved significantly over time (p<.001). However, ventilation of patients in the prone position demonstrated a mean decrease in compliance of 2.1+/-0.72 mL/cm H2O. The response to prone positioning was similar in patients with ARDS and acute lung injury and revealed no significant difference. In both groups, the course of the oxygenation index and Qs/Qt over time was almost parallel. Posture changes were continued for 9.0+/-1.1 days. The oxygenation index showed an overall increase of 129+/-20 torr (17.2+/-2.7 kPa) from baseline supine at the end of prone positioning (p<.0001). Pulmonary densities were reduced significantly from 31.1+/-2.5% to 3.8+/-0.81%, Qs/Qt was reduced from 24.9+/-1.5% to 11.7+/-0.32%, and FIO2 was reduced from 0.43+/-0.04 to 0.26+/-0.02 (p<.01). Gas exchange improved in all patients, and no patient died immediately as a result of respiratory failure. CONCLUSION: Repeated prone positioning recruits collapsed lung tissue and improves gas exchange in trauma patients with blunt chest trauma and severe ARDS as well as in trauma patients with acute lung injury.

Adolescent↗

PubMed1999

Atherosclerotic lesions are more frequent in femoral arteries than in carotid arteries independent of increasing number of risk factors.

The authors investigated the prevalence of atherosclerotic lesions in carotid and femoral arteries in people with varying risk factors. They searched for differences in the region of manifestation of atherosclerosis due to different risk factors. Over 5 years they investigated 4,200 people (2,600 men, 1,600 women aged 20 to 70 years) who reported feeling healthy. They did a B-mode sonography of the internal, external, and common carotid artery; and the common, the proximal superficial, and profundal femoral artery. They questioned the people regarding hypertension, hypercholesterolemia, diabetes mellitus, and smoking habits. Isolated carotid artery atherosclerosis was found in 2.8% of the men and 1.6% of the women; 10.9% of the men and 4.4% of the women had isolated femoral artery lesions. A combination of atherosclerotic lesions in both arteries was present in 8.3% of the men and 4.0% of the women. When only one risk factor was present atherosclerotic lesions of the femoral arteries were predominant. Diffuse atherosclerosis dominated with increasing number of risk factors. The rate of people with isolated carotid atherosclerosis was highest when no risk factor was present and decreased to a fixed rate of 12% to 17% independent of the number of risk factors. An increasing number of risk factors can be associated with a diffuse manifestation of atherosclerotic lesions. However, there are a certain number of people who demonstrate only carotid artery or femoral artery atherosclerosis independent of the number of risk factors.

Adult↗

PubMed1999

Different prevalence of asymptomatic atherosclerotic lesions in males and females.

The detection of atherosclerotic lesions in asymptomatic healthy subjects is possible using ultrasound. Populations can be investigated in order to detect differences in early and asymptomatic atherosclerosis due to gender and risk factors. This study investigated 2605 male (21-69 years) and 1601 female (20-70 years) employees and civil servants of the city of Düsseldorf, Germany. The ultrasound investigations were performed with an ATL device, type Ultramark 4 plus, and a 7.5-MHz linear transducer on the carotid and proximal femoral arteries. An atherosclerotic lesion was defined as visibly different from the intima by its echogenicity and by being larger than 1 mm. A thickening of the intima media complex was not considered to be atherosclerosis. The prevalence of atherosclerotic lesions in male subjects was higher than those in female subjects regardless of age. In male subjects it was 5.3% (30-39 years), 19.8% (40-49 years), 36.7% (50-59 years) and 47.7% (60-70 years). The female subjects had a prevalence of 2.1%, 8.4%, 17.5% and 37.7% in the corresponding age groups. Risk factors such as smoking, hypertension and hypercholesterolemia were higher in men than in women. The increase of atherosclerotic lesions from one decade to another was highest in women between 50 and 59 years and 60 and 70 years. This large increase could not be explained by a similar increase in risk factors. It was therefore concluded that male subjects had a higher prevalence of atherosclerosis at earlier ages than females, but female subjects showed a postmenopausal rise in prevalence.

Adult↗

PubMed1999

SPIO-MR imaging versus double-phase spiral CT in detecting malignant lesions of the liver.

PURPOSE: To assess the diagnostic performance of superparamagnetic iron oxide MR (SPIO-MR) imaging compared with double-phase spiral CT in detecting liver metastases and hepatocellular carcinoma. MATERIAL AND METHODS: Thirty-eight patients with a total of 144 malignant lesions of the liver were examined by CT and SPIO-MR. After definition of a gold standard by a panel of experts, the patient images were randomized and presented to a blinded jury of 5 independent observers whose task was to identify as many lesions as possible. The results were tested for statistical significance using multifactorial analysis of variance (alpha=5%). RESULTS: SPIO-MR produced the highest detection rate and was significantly superior (p<0.05) to unenhanced MR imaging and double spiral-phase contrast-enhanced CT (DPS-CECT). Maximum performance in DPS-CECT was obtained during the portal venous contrast phase but was significantly inferior to SPIO-MR imaging. The scores for unenhanced CT and unenhanced MR were significantly lower than for the corresponding enhanced procedures. SPIO-MR imaging produced a higher incidence of false-positive findings (n=39). CONCLUSION: SPIO-MR produced a significantly better detection rate for malignant focal liver lesions compared with double-phase spiral DPS-CECT but was associated with a higher rate of false-positive findings.

Adult↗

PubMed1998

Impact of resting and ischemic blood flow on infarct probability in ischemic preconditioning--a new approach to infarct size-blood flow data by logistic regression.

The linear regression analysis of infarct size (IS) v ischemic myocardial blood flow (MBF) does not account for the heterogeneity of MBF and infarcted tissue; moreover, it cannot assess a blood flow threshold for infarction (MBFT) accurately, as with ischemic preconditioning (IP) the close relationship between ischemic MBF and IS otherwise observed is lost. Finally, the impact of resting blood flow on myocardial infarction cannot be considered in such analysis. Therefore, in a retrospective data analysis of 32 enflurane-anaesthetized swine undergoing 90 min severe ischemia and 120 min reperfusion without (CON, n = 12) or with IP induced by either 3 (IP3, n = 8) or 10 min ischemia (IP10, n = 12) and 15 min reperfusion, a MBFT was assessed by logistic regression (LR) in individual tissue pieces. MBFT was arbitrarily defined as that ischemic MBF (microspheres) at which infarct probability was 0.2, derived from the ratio of infarcted (n = 141, TTC) to all tissue samples (n = 684). The duration of the preconditioning ischemia and MBF both at rest and during the sustained ischemia were significant predictors of infarct probability. Ischemic MBFT at an infarct probability of 0.2, was 0.089 +/- 0.023 ml/min/g in CON. MBFT was decreased to 0.051 +/- 0.03 ml/min/g with IP3 (P < 0.05 v CON) and further to 0.004 +/- 0.037 ml/min/g with IP10 (P < 0.05 v CON, IP3). Corresponding to the leftward shift of MBFT, the relationships between infarct probability and MBF were shifted in parallel by IP with no change in their slopes.

Animals↗

PubMed1998

Is there a methimazole dose effect on remission rate in Graves' disease? Results from a long-term prospective study. The European Multicentre Trial Group of the Treatment of Hyperthyroidism with Antithyroid Drugs.

OBJECTIVE: The optimal antithyroid drug regimen for Graves' disease remains a matter of controversy. The European Multicentre Trial Group has investigated the effects of methimazole drug dose on the long-term outcome of Graves' disease. DESIGN: Extended follow-up of patients from a prospective multicentre trial, designed to study methimazole dose effects on the outcome of Graves' disease. We have reported previously that the relapse rates did not differ after a medication-free observation period of 12 months; the relapse rates were 37% and 38%, respectively. In this paper, we describe the outcome in these patients after a mean observation period of 4.3 +/- 1.3 years and have looked for potential predictors of this outcome. PATIENTS: Three hundred and thirteen patients with Graves' disease were randomized to treatment with a constant dose of 10 or 40 mg of methimazole for 1 year, with levothyroxine supplementation as required. MEASUREMENTS: At the time of inclusion into the trial: thyroid size, T4, T3, TSH-binding inhibiting immunoglobulins, urinary iodide excretion, thyroid uptake, Crook's therapeutic index of hyperthyroidism (a measure of clinical disease severity). At the time of follow-up examination: TSH, T4, T3, thyroid size, thyroid ultrasound, THS-binding inhibiting immunoglobulins. RESULTS: The overall relapse rate was 58%. There was no difference in relapse rates between patients treated with either 10 or 40 mg of methimazole (58.3 vs. 57.8%). Five patients had become spontaneously hypothyroid, without obvious relationship to antithyroid drug dose. Patients who relapsed and patients who remained in remission did not differ with respect to: age, goitre size, ophthalmopathy, median iodine excretion, serum T4 or serum T3, Crook's therapeutic index and thyroid uptake at the time of study entry. Thus, none of these variables was potentially suitable for predicting outcome. This finding was confirmed by Cox's proportional hazard regression. Thyroid volume, measured by ultrasound, did not differ between patients in remission and patients with relapse. There was no difference in the course of endocrine eye signs, in the requirement for steroid and radiotherapy for eye signs, or in thyroid echostructure between patients in the 10 and in the 40 mg group, nor was serum TSH different in patients who had remained in remission (0.8 +/- 0.6 mU/l in the 10 mg group, 1.0 +/- 0.8 mU/l in the 40 mg group). CONCLUSIONS: The dose of methimazole in Graves' disease therapy can safely be kept to the minimal required dose. This will provide the same chance of remission as higher doses, and provide the best balance of risk and benefit.

Adult↗

PubMed1998

[MRI with supermagnetic iron particles versus double-spiral CT in identification of malignant liver lesions].

PURPOSE: The purpose of this study was to evaluate the efficacy of MRI with superparamagnetic iron oxide (SPIO) and double-spiral CT in the detection of liver metastases and hepatocellular carcinoma. METHODS: 38 patients with a total of 144 malignant hepatic lesions underwent CT and MRI. A panel of experts defined the gold standard. Five experienced judges performed independently blinded evaluation of the number of detectable lesions. Multifactorial variance analysis was used to determine the statistical significance. RESULTS: SPIO-MRI shows the highest rate of detection and is significantly superior to native MRI and native CT. The highest rate of detection by CT is shown in the portal-venous phase of contrast; nevertheless, the rate is significantly inferior to SPIO-MRI. In general, the native phases of CT and MRI are significantly inferior to the contrast phases of both. SPIO-MRI shows a higher rate of false positive findings. CONCLUSION: The time-consuming and cost-intensive SPIO-MRI significantly increases the rate of detectability for malignant liver lesions compared with double-spiral CT but it also increases the rate of false positive findings.

Adult↗

PubMed1998

[Measurement of the humidity of inspired air in ventilated patients with various humidifer systems].

INTRODUCTION: Humidification of inspired gas in artificially ventilated patients positively influences mucociliary function and secretolysis. We performed this study to examine the properties of heat and moisture exchangers in comparison with hot water humidifiers and dry artificial ventilation. METHODS: We measured inspired humidity with a special sensor in 41 patients after coronary artery bypass grafting with cardiopulmonary bypass. Three Heat and Moisture Exchangers (HME) and a hot water humidifier were used to humidity the inspired gas of artificially ventilated patients. Humidity measurements were compared. RESULTS: Hot water humidifiers produced the highest humidification (average of 38.4 mg/l, 37-43 mg/l); lowest humidification was produced by dry artificial ventilation (average of 8.7 mg/l, 6-11 mg/l). Heat and moisture exchangers (HME) produced humidity between 24 and 36 mg/l. Highest humidification was produced by HME hygrobac s (average of 32.2 mg/l, 31-36 mg/l) and hygrovent s (average of 31.4 mg/l, 29-35 mg/l); lowest humidification was produced by HME hygroster (average of 28.6 mg/l, 24-31 mg/l). Multifactorial analysis shows a significant impact of the humidification method on the humidity of inspired gas. The multiple comparison procedure (Tukey) shows significant differences (alpha = 0.05) between all humidification techniques on inspired gas except the heat and moisture exchangers hygrobac s and hygrovent s. CONCLUSIONS: Hygrobac s and hygrovent s may be an alternative to hot water humidifiers. Further clinical studies of HMEs and hot water humidifiers will be necessary to evaluate the influence of inspired gas humidity on the outcome of artificially ventilated patients.

Air↗

PubMed1998

Monoclonal antibody therapy for resected Dukes' C colorectal cancer: seven-year outcome of a multicenter randomized trial.

PURPOSE: As previously shown, antibody treatment increased survival of patients with resected colorectal cancer of stage Dukes' C. Since the 5-year analysis was criticized because of the wide range (2.7 to 7.5 years) of follow-up time, we performed a 7-year analysis with only four of 189 patients monitored for less than 5 years. PATIENTS AND METHODS: A total of 189 patients with resected Dukes' C colorectal cancer were randomly allocated to infusions of a total of 900 mg 17-1A antibody, 500 mg postoperatively followed by 4 monthly doses of 100 mg (n=99), or to observation only (n=90). Primary end points were overall survival and disease-free interval. Patients were stratified by a dynamic randomization according to center, sex, location of tumor, number of affected lymph nodes, and preoperative carcinoembryonic antigen concentration. RESULTS: Randomization produced balanced distribution of risk factors. After 7 years of follow-up evaluation, treatment had reduced overall mortality by 32% (Cox's proportional hazard, P < .01; log-rank, P=.01) and decreased the recurrence rate by 23% (Cox's proportional hazard, P < .04; log-rank, P=.07). The intention-to-treat analysis gave a significant effect for overall survival (Cox's proportional hazard, P < .01; log-rank, P=.02) and disease-free survival (Cox's proportional hazard, P=.02; log-rank, P=.11 ). While distant metastases were significantly reduced (Cox's proportional hazard, P=.004; log-rank, P=.004), local relapses were not (Cox's proportional hazard, P=.65; log-rank, P=.52). This differential effect of 17-1A antibody on disseminated isolated tumor cells versus occult local satellites may explain the increased significance seen in the overall survival. CONCLUSION: The now-matured study shows that 17-1A antibody administered after surgery prevents the development of distant metastasis in approximately one third of patients. The therapeutic effect is maintained after 7 years of follow-up evaluation.

Adenocarcinoma↗

PubMed1997

3-hydroxybutyrate blocks the transient K+ outward current in myocardial mouse cells in a stereoselective fashion.

1. Mouse ventricular myocytes develop a large transient K+ outward current (I(TO)) which accelerates repolarization and is a crucial determinant for the regulation of the action potential duration at various heart rates. The effect of 3-hydroxybutyrate on I(TO) was investigated under voltage- and current-clamp conditions. 2. The drug blocked I(TO) in a stereoselective manner with the L-enantiomer being the effective and the D-enantiomer, the ineffective form. The blocking action of the L-enantiomer was established immediately and it could be completely washed out within several tens of seconds. 3. The dose-response characteristic for the peak I(TO) showed a strict 1:1 binding of the drug to the receptor with a concentration of half-maximum effect of 2.1 mmol l(-1). 4. The action of L-hydroxybutyrate was voltage independent, did not need channel opening and preferentially affected the slow component of both inactivation and recovery from inactivation. 5. At the high concentration of 20 mmol l(-1) the optically inactive form, the racemate, did not affect I(TO), indicating that the ineffective D-enantiomer interacts with the channels at much lower concentrations. 6. At a concentration of 10 mmol l(-1), L-hydroxybutyrate prolonged the action potential by 218 +/- 26 and 127 +/- 10% (means +/- S.E.M.) at 50 and 90% repolarization, respectively. 7. It is concluded that the non-physiological L-hydroxybutyrate is a novel type of blocker of I(TO), It interacts either with the channel itself, or with a receptor protein closely related to the channel and preferentially affects slow inactivation.

3-Hydroxybutyric Acid↗

PubMed1997

Preservation of pig liver allografts after warm ischemia: normothermic perfusion versus cold storage.

Warm ischemia is known to induce substantial damage to the liver parenchyma. With respect to clinical liver transplantation, the tolerance of the liver to warm ischemia and the preservation of these organs have not been studied in detail. In isolated reperfused pig livers we proceeded according to the following concept: Livers were subjected to 1 or 3 h of warm ischemia. Subsequently, these organs were preserved by either normothermic perfusion or cold storage (histidine-tryptophan-alpha-ketoglutarate, HTK) for 3 h each. After storage, liver function was assessed in a reperfusion circuit for another 3 h. Parameters under evaluation were bile flow, perfusion flow, oxygen consumption, enzyme release into the perfusate (creatine kinase, glutamic oxaloacetic transaminase (GOT), lactic dehydrogenase, and glutamic pyruvic transaminase), and histomorphology. Damage to the liver was lowest after warm ischemia of 1 h. The results after cold storage were superior to those after normothermic perfusion (GOT: 3.2 +/- 0.3 and 2.6 +/- 0.2 U/g liver; cumulative bile production: 14.7 +/- 2.1 and 9.4 +/- 1 ml, respectively; P < 0.05). In contrast, we found substantial damage at the end of reperfusion in livers undergoing 3 h of warm ischemia under both preservation techniques with severe hepatocellular pyknoses and essentially altered nonparenchymal cells. The results suggest that pig livers undergoing 1 h of warm ischemia and cold storage for 3 h with HTK solution may lead to functioning after transplantation.

Alanine Transaminase↗

PubMed1997

Detection of radiographic findings in lung fibrosis using storage phosphor plates.

The aim of this work was to examine the influence of the filter kernel size on the detectability of differing radiological findings in interstitial lung disease. In 97 patients with confirmed pulmonary fibrosis chest radiographs were obtained with a filmscreen system of speed class 200 and with correspondingly exposed storage phosphorous plates. The size of the filter kernel used for the image postprocessing varied between sigma 5 and sigma 70. The detectability of interstitial lung changes was evaluated independently by eight readers on the basis of a defined rating system. The results were analysed using multifactorial analysis of variance with Scheffé test at a significance level of p = 0.05. Small kernel sizes (S 5, S 10) combined with high edge enhancement were only of benefit in the imaging of septal lines, but reduced the detectability of nodular and reticular structures. Good detail detectability of both micronodules and septal lines was obtained with a medium kernel size of sigma 40. Storage phosphor radiography utilizing the appropriate choice of postprocessing parameters provides equivalent image quality for evaluating interstitial lung changes compared with a modern filmscreen technique.

Female↗

PubMed1997

[Value of lung filter, asymmetric film-screen technique and digital storage screen radiography in diagnosis of coin lesion].

AIM: To evaluate the image quality of an asymmetric film-screen combination (a-FSC), a conventional screen-film combination (FSC) at speed class 200, a lung filter, and digital luminescence radiograms in detecting pulmonary nodules. METHODS: Detail perception studies were carried out with an anthropomorphic phantom. The image systems were exposed under standardised conditions with 125 kVp. The systems' perception efficiency was evaluated on the basis of 12.240 single observations with ROC analysis. RESULTS: In the overall evaluation the a-FSC and the filter achieved equally high assessments of 0.878 +/- 0.018 and 0.860 +/- 0.21 respectively (p > 0.05). The 200 speed FSC and the storage phosphor screen radiograms did not differ significantly. In the mediastinum all the tested systems were clearly superior to the 200 speed FSC (p < 0.05). In the lung fields on the other hand the 200 speed system was given a higher assessment of 0.866 +/- 0.026. The a-FSC had slight advantages over the lung filter and the digital imagining modes (p > 0.05). CONCLUSIONS: The a-FSC and digital luminescence radiograms provide significantly more diagnostic information in the mediastinum, together with high detail detectability in the lung fields and without requiring additional dosage.

Humans↗

PubMed1996

Prognostic implications of monosomy 3 in uveal melanoma.

BACKGROUND: A high proportion of patients with uveal melanoma die of metastatic disease. In a subgroup of uveal melanomas there is the loss of one chromosome 3. To assess the prognostic implications of this genetic anomaly, we studied 54 patients for a median of 3.4 years. METHODS: 180 patients underwent primary enucleation for malignant uveal melanoma at the Ophthalmology Department of the Universitätsklinikum Essen between 1987 and 1993. Tumour material was available for chromosome analysis and DNA preparation from 69 of these patients (for logistic reasons unlikely, we believe, to introduce bias). 15 patients were excluded from our study: nine because the methods for assessment of monosomy 3 were unsuccessful; five because of insufficient information about their relapse status; one because histopathological data were incomplete. Of the 54 remaining patients, the tumours of 16 were assessed for copy number of chromosome 3 by karyotype analysis, of 30 by comparative genomic hybridisation, and of eight by both techniques. Clinical status was assessed by contact with family doctor or a clinical check up. Statistical analysis was by the log-rank test and Cox proportional-hazard regression. FINDINGS: The tumours of 30 patients had monosomy 3. 17 (57%) of these patients relapsed with metastatic disease, and the 3-year relapse-free survival rate was 50%. By contrast, of the 24 patients whose tumours had retained both chromosomes 3, none developed metastatic disease. In univariate analysis monosomy 3 was the most significant (p < 0.0001) predictor of poor prognosis in uveal melanoma, followed by tumour location (p < 0.0007) and tumour diameter (p < 0.0021). Histopathological subtype, age, sex, extrascleral growth, and tumour thickness had no additional predictive value. INTERPRETATION: In uveal melanoma, monosomy 3 is a significant predictor of both relapse-free and overall survival.

Aged↗

PubMed1996

Unsharp masking of low-dosed digital luminescence radiographs: results of a receiver operating characteristics analysis.

The extent to which the diagnostic performance of low-dosed storage phosphors can be improved by suitable image postprocessing was investigated. Storage phosphor radiographs and conventional 200- and 400-speed screen-film combinations of an anthropomorphic chest phantom with simulated nodules and linear structures were compared. The detection of test bodies was determined in a ROC analysis based on 16200 individual observations. The two analog screen-film systems did not differ significantly. As far as the storage phosphor radiographs are concerned, a higher diagnostic performance was achieved with a large filter kernel (S 40) whereas small filter kernels and edge-enhanced imaging modes reduced the detection of detail. The image quality of low-dosed storage phosphors is thus similar to high-amplification screen-film combinations if large filter kernels are used in postprocessing of the image.

Acrylic Resins↗

PubMed1996

Standardized ultrasound examination for evaluation of instability of the acromioclavicular joint.

Anteroposterior X-ray views of both acromioclavicular (AC) joints with 10-kg weights held in each hand are the generally accepted procedure for diagnosis of Tossy I-III grades of AC joint separation. An analogous diagnosis can be made by standardized ultrasound examination. Ten individuals with Tossy-I, 11 with Tossy-II and 8 with Tossy-III instability were examined both radiographically and by B-mode ultrasound. The degree of AC joint separation was uniformly determined on the basis of a calculated index (AC Index = AC joint width of uninjured side/AC joint width of injured side). The mean AC Index for Tossy-I instability determined by ultrasound was 1.0; mean indices of 0.49 and 0.5 were determined for Tossy-II injury by ultrasound and X-ray, respectively, and of 0.21 and 0.2, respectively, for Tossy-III instability. Statistical analysis showed significant differences between the mean AC indices of all three groups (P < 0.0001). We conclude that the reliability of ultrasound examination of AC joint instability is equal to that of radiographic measurement. Standard X-rays of the shoulder remain mandatory only to exclude fracture. The indication for operative stabilization of the AC joint can be established on the basis of the grade of AC joint instability measured by the side-effect-free and cost-effective method of ultrasound examination (AC Index < 0.3 equivalent to Tossy-III instability).

Acromioclavicular Joint↗

PubMed1996

[The time span between symptom onset and starting treatment in head and neck tumors].

The interval between the onset of symptoms in patients with head and neck cancers and the introduction of treatment was evaluated. During a 1-year period, patients were interviewed to determine the duration of any delays from the onset of complaints until the first visit to a doctor. Also asked was how long it took to be referred to an ENT specialist and actual referral to our department. We then determined the interval from diagnosis to the introduction of therapy. It was found that the delay of patients who went directly to an otorhino-laryngologist was shorter (median, 8 weeks) than that of patients who first went to their family doctors (median, 13 weeks) (P < 0.02). The latter then took an additional 4 weeks before sending patients to an otorhinolaryngologist. Referral from the ENT specialist to our department took another 2 weeks, as well as our staging and pre-therapeutic management. Our findings show that the patient himself is the critical factor in delaying diagnosis and therapy. Tumor patients with greater professional qualification went to their doctors earlier (P < 0.0001) or more often went directly to an ENT specialist (P < 0.002). Consultations of physicians without experience in otorhinolaryngology caused yet further delays.

Adult↗

PubMed1996

Frequency-filtered image post-processing of digital luminescence radiographs in pulmonary nodule imaging.

AIM: The aim of the study was to optimize unsharp masking image post-processing of digital luminescence radiographs (DLR) for the representation of pulmonary nodules, and to compare DLR to screen-film radiography at two dose levels. PATIENTS AND METHODS: A total of 284 CT-validated pulmonary nodules were evaluated. One hundred and forty-nine nodules were exposed with a 200-speed screen-film combination (SFC) and 135 nodules with a 400-speed SFC, with correspondingly exposed storage phosphor images. The kernal size in digital post-processing using 'unsharp masking' was varied between S 10 (2.83 mm) and S 70 (19.80 mm). A total of 11928 individual assessments were obtained from six independent observers and evaluated in multifactorial variance analyses. RESULTS: The large filter kernels of S 40 and S 70 were on a par with the 200-speed SFC (P > 0.05). As the exposure dose was reduced, the quality of the digital image vis-à-vis the 400-speed SFC improved significantly (P < 0.05). Smaller filter kernels (S 10; S 20) producing edge-enhancement processing were significantly inferior to the analog image technique in both dose ranges (P < 0.05). CONCLUSIONS: At speed class 200, low-frequency emphasizing digital image post-processing with large filter kernels are significantly superior to high-frequency emphasizing filtrations for the recognition of pulmonary nodules. In the lower dose range DLR with large filter kernel unsharp masking processing showed significantly improved image quality compared to 400 speed SFC for the detection of pulmonary nodules.

Adolescent↗