[Long-term follow up of therapy-conditioned cerebral changes in acute lymphatic leukemia].
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Antineoplastic Combined Chemotherapy Protocols↗
Biomedical subjects
H Lanfermann
Publications and source records attributed to H Lanfermann.
Metabolic changes in acute and subacute cerebral infarctions: findings at proton MR spectroscopic imaging.
PURPOSE: To analyze the advantages of proton magnetic resonance (MR) spectroscopic imaging in the evaluation of acute and subacute cerebral infarcts. MATERIALS AND METHODS: Metabolite maps of choline-containing compounds, total creatine consisting of creatine and phosphocreatine, N-acetyl aspartate (NAA), and lactate were obtained in 23 patients with acute and subacute cerebral infarctions 1-35 days after onset of symptoms. Maps were obtained with a 1.5-T MR system with 32 x 32 phase-encoding steps. RESULTS: Distinct abnormal metabolite distributions could be detected in all lesions larger than 1 cm in diameter. In the center of infarcts with a diameter larger than the section thickness of 2 cm, NAA values decreased to 20% +/- 8 compared with contralateral brain as early as 1 day after onset of symptoms (P < .0001). Choline was reduced to 67% +/- 30 (not significant) and creatine to 51% +/- 22 (P = .0025). Large amounts of lactate were detected in all acute infarcts. Choline, creatine, and lactate values declined during the first 5 weeks after stroke. CONCLUSION: MR spectroscopic imaging allows visualization of metabolic changes in stroke with a reasonable spatial resolution.
Acute Disease↗
[Spectroscopic imaging of the brain. Examination technique and clinical applications].
PURPOSE: MR spectroscopy allows the acquisition of a two-dimensional array of spatially resolved proton spectra of the human brain, known as MR spectroscopic imaging. Here the examination protocol and clinical applications in focal brain lesions are presented. METHOD: An array of data is acquired from a tissue slice positioned in the brain. These data can be presented as a set of spectra, in which each spectrum is allocated to a specific position in the sample, or as a set of images or "metabolite maps". RESULTS: The NAA signal typical for neuronal tissue is decreased in the centre of brain tumours as well as in brain infarcts. The intensity of the choline signal is increased in solid tumour tissue, whereas it is reduced in infarcts. CONCLUSION: Spectroscopic imaging reveals metabolite alterations in and around focal lesions. The spatial resolution of spectroscopic imaging enables matching with other macro-morphological or functional imaging methods like positron emission tomography.
Adult↗
Pilocytic astrocytomas of the posterior fossa. A follow-up study in 33 patients.
The extent of resection in pilocytic astrocytoma of the posterior fossa often remains undefined and the indications for further treatment in incompletely resected tumours are a matter of debate. It has been also realized that the problem of hydrocephalus in patients with pilocytic astrocytoma of the posterior fossa has not yet been solved and the diagnostic impact of postoperative CT findings remains questionable. We retrospectively reviewed the data from 33 patients harbouring a pilocytic astrocytoma of the posterior fossa to evaluate the impact of surgical technique in terms of radicality and of postoperative imaging results upon prognosis and adjunctive treatment. In addition, the issue of hydrocephalus was considered and related to different treatment modalities. Thirty patients underwent surgical treatment whereas 3 had open biopsy of the tumour. Macroscopically gross total resection of the tumour was performed in 20 patients, whereas resection was partial in 10. Follow-up was obtained in 29 patients for a period which ranged between 2 and 184 months (85 months +/- 56 months). Outcome was good in 24 patients who had only slight neurological deficit and poor in 3 patients, who were severely disabled. Two patients died during the follow-up period. Recurrent tumour growth occurred in 2 cases with incompletely resected tumours. From the series presented, it was concluded that long-term follow-up with CT seems mandatory in cases with contrast-enhancing residual tumour. Recurrent tumour growth should be assumed in postsurgical patients with an enlarging area of enhancement shown in follow-up CT studies. Permanent ventriculoperitoneal shunting is required in certain patients with pre- or postoperative hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Intraoperative recording of parietal SEP can miss hemodynamic infarction during carotid endarterectomy: a case study.
Serial recording of median nerve somatosensory evoked potentials (SEPs) provides reliable intraoperative information on critical lowering of brain perfusion which compares favorably with other monitoring methods. However, single-channel parietal SEP recording may not detect hemodynamic cerebral infarctions affecting the pre-rolandic area. Following left carotid endarterectomy for high-grade symptomatic stenosis in a 66-year-old male, predominantly motor hemiparesis and aphasia were detected which were largely reversible. Pre- and intraoperative SEPs were normal. Postoperative SEPs showed significant interhemispheric amplitude differences. Postoperative CT examinations demonstrated hemodynamic watershed-type infarctions. This rare complication of carotid endarterectomy was not detected by intraoperative single-channel parietal SEP monitoring.
Aged↗
[Neurinomas and neurofibromas of the trigeminal nerve].
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Adult↗
[CT and MRT in progressive multifocal leukoencephalopathy (PML)].
Radiological findings and course of progressive multifocal leukoencephalopathy in 14 patients (1 woman, 13 men; 13 HIV seropositive, 1 chronic lymphatic leukaemia) were analysed retrospectively and correlated with clinical symptoms. A total of 21 CT and 16 MRI studies were evaluated. CT scans and MR images of 9 patients, which had been obtained in less than two weeks, could be compared to each other. MRI was superior to CT: 6 lesions with a diameter of 1 cm and below were not detected on CT scans, in 5 patients the extent of lesions was underestimated. Cortical involvement, mass effect or signs of atrophy were missing. Only 1 of 67 lesions showed a tiny enhancement after Gd injection. Due to the pattern and spread of lesions, which showed a close correlation to the neurologic symptoms, three different types of PML are suggested: 1. initial precentral demyelinisation with contralateral hemiparesis (n = 8); 2. lesions in temporo-occipital locations with visual disturbances (n = 2); 3. predominantly bilateral lesions of cerebellar white matter with ataxia (n = 4).
Adult↗
The dynamics of magnetic resonance findings in patients with a spinal haematoma.
In 6 patients with an incomplete transverse section, magnetic resonance (MR) imaging revealed a spinal haematoma. The MR signal intensity changed with the interval between the haemorrhage and the MR investigation. Signal intensities of T1- and T2-weighted images exhibited specific changes with time after the haemorrhage, allowing for a retrospective assessment of the time of onset of the haemorrhage.
Adult↗
[Rupture and successful operation of mycotic aneurysm of the superior cerebellar artery].
We report on a case with mycotic aneurysm of the superior cerebellar artery which developed four months after treatment of infective endocarditis. Although the course of illness was complicated by rupture and recurrent bleeding, the patient was successfully treated by surgery.
Aneurysm, Infected↗
[Intracranial aneurysms. A comparison between magnetic resonance tomography and arteriography].
42 MRI of 36 patients with cerebral aneurysms were analysed retrospectively and compared with selective angiography. 92% of aneurysms proven by angiography were also detected by MRI. The smallest and surgically confirmed aneurysms had a diameter of 2-3 mm on MRI. 3 aneurysms were only demonstrated by selective angiography (8%). This concerned 5 mm sized aneurysms located at the anterior communicating artery (2) and middle cerebral artery (1). On the other hand 2 thrombosed aneurysms were only delineated by MRI (6%). Because partial thrombosis could not be demonstrated by angiography extensions of aneurysms were underestimated in 44% (n = 16) angiographically. A 2.5 cm sized lobulated aneurysm of the internal carotid artery was initially evaluated by MRI as being thrombosed subtotally, due to flow-phenomena. Angiography though showed a wide perfused lumen without visible thrombosis. A progressive thrombosis of a mycotic aneurysm of the internal carotid artery was shown by MRI during septic thrombosis of the cavernous sinus. In this case the number of angiographic controls could be reduced by use of MRI. Nevertheless, MRI was not able to substitute selective angiography, especially to exclude under 6 mm sized cerebral aneurysms. MRI could not demonstrate clearly the vessels in the neighbourhood of saccular aneurysms preoperatively.
Adult↗
[Magnetic resonance tomographic diagnosis of vascular processes in the vertebrobasilar system--analysis of 35 of our own cases and a literature review].
35 patients with abnormalities of the vertebrobasilar system were studied via magnetic resonance imaging (11 saccular aneurysms, 10 vascular malformations, 9 basilar arteries with dolichoectasia, 5 thromboses of the vertebral or basilar artery). The two smallest aneurysms of the basilar top had a diameter of 2-3 mm. Most vascular malformations could be differentiated by typical MRT symptoms. All 5 cavernous angiomas were negative in angiography (cryptic). The shape and size of the basilar artery and its relationship to the third ventricle were best demonstrated on coronal slices. Flow-related intraluminal loss of signal allows a differentiation between vascular perfusion and thrombosis already on plain images (partial) thrombosis and artery dissection can be differentiated from flow effects based on identical findings in at least two planes or additional gradient echo images.
Adult↗
[Acute adverse effects and complications of central venous digital subtraction angiography (DSA). Results of 2,600 studies].
Side-effects and complications from 2,600 intravenous digital-subtraction-angiographies (IV-DSA) are reported. All studies were performed in a standardized technique using a non-ionic contrast agent (Iopromid 370 mg J/ml). Side-effects or complications were noted in 2.5% of all IV-DSA. Most often nausea (0.92%), urticaria (0.5%), angina pectoris (0.5%) and symptomatic alterations of blood-pressure (0.27%) were recorded. 8.4% of all reactions occurred with a delay of at least one hour. All side-effects and complications resolved, partly under symptomatic therapy. In one (0.04%) out of 2,600 studies a severe allergoid reaction occurred, affording intensive-care therapy. With proper patient selection and a suitable technique, IV-DSA may be regarded--within the angiographic methods--as a procedure of relatively low risk.
Aged↗
[Conventional and cine-MRT in patients with aneurysms of the abdominal aorta].
We studied 40 patients with aneurysms of the abdominal aorta by MRI. These results were compared with those obtained by real-time sonography (n = 40), angiography (n = 32) and CT (n = 16). In 30 patients the imaging results were compared--as far as possible--with the operative findings. MRI proved more reliable, especially if compared with sonography, in evaluating renal or iliac artery involvement. Mural thrombi were detected more often (93%) by MRI than by CT (85%) or sonography (83%). Cine-MRI showed strong turbulences in 33%. Turbulences did not correlate with the size of the aneurysm.
Adult↗
[Intracranial giant aneurysm due to the effects of radiation].
Two cases of intracranial giant aneurysms of the carotid artery are presented, probably caused by radiation damage. Both patients had been treated for hypophyseal adenoma by transfrontal implantation of yttrium seeds (35 and 45 mCi). Preoperative carotid angiographies had shown no vascular abnormalities; the aneurysms were revealed 8 and 11 years after these examinations. No identical cases could be found in the literature. Further etiological hypotheses are discussed.
Adenoma↗
[Percutaneous transluminal angioplasty of the subclavian artery: technic, results, risks].
The results of 27 percutaneous transluminal angioplasties (PTA) of the subclavian artery are reported in 25 patients. 13 patients complained of claudicatio brachii, 7 also demonstrated symptoms of vertebral-basilar insufficiency. In 5 cases this was the sole indication for PTA. 23 (85.2%) of 27 interventions were limited to the proximal section of the subclavian artery. In 22 (81%) the obstructions were localized on the left side. A technical success could be achieved in 24 (88.9%) of 27 interventions. The angiographic appearance of the homolateral vertebral arteries before and after PTA differed significantly. No PTA led to an occlusion of the previously patent vertebral artery. A retrograde flow was no longer seen after PTA. The haemodynamic significance was also demonstrated by the differences in brachial-occlusion pressures (mean 51 mmHg before, 7 mmHg after PTA). Complete or partial relief was achieved after technically successful PTA in 90% of patients with brachial symptoms and in 50% with vertebral-basilar insufficiency. Complications occurred in one (3.7%) of 27 procedures. Published data on PTA of the subclavian artery are discussed.
Adult↗
[Undesirable side effects of contrast media during i.v. DSA--a comparison of 2 nonionic contrast media].
For the first time a controlled double-blind study was performed to compare side effects and complications of i.v. DSA with central venous application of iopamidol and iopromide. 200 consecutive patients 15-85 years of age were studied. The randomisation brought up two homogeneously structured groups of 100 patients each. Using a given protocol, 66% of the patients were classified as high-risk patients. Side-effects and complications were registered by an extensive, standardised protocol. In 71 (35.5%) of 200 patients contrast-media related side effects and complications were noted. 37 reactions in 24 patients (9 iopamidol, 15 iopromide group) were classified as clinically relevant. In four patients (4%) of each group a drug therapy was initiated. Contrast-media related reactions occurred with delay in 5.5% of initially symptom-free patients. In no case intensive care or hospital admission became necessary. There were no significant differences between the two non-ionic contrast media in the incidence of side effects and complications. Both substances were well tolerated in i.v. DSA. In the total population patients with diseases known as auto-immune diseases and prior drug reactions demonstrated clinically relevant reactions significantly more often.
Adolescent↗
[Multiple aneurysms of unknown etiology in childhood--complications and diagnostic possibilities].
A 6.5-year old boy with already known multiple aneurysms of all major arteries presented with acute abdominal pain. As demonstrated by ultrasound a big aneurysm of the left renal artery thrombosed in the course of three days. As a result, the left kidney developed severe ischaemia. Although computed tomography and scintigraphy were applied, a plan for a definitive therapeutic procedure could be established only by arterial angiography. Both Ehlers-Danlos' syndrome and Kawasaki's syndrome were excluded. There were no facts suggesting an infective aetiology. Four other cases with multiple aneurysms of unknown aetiology in childhood have so far been described in literature.
Aneurysm↗
[Automatic correction of the signal intensity of surface coils. Clinical application and relevance].
Homomorphic filtering permits correction of the decrease in signal intensity in magnetic resonance imaging with surface coils seen in tissues lying farther away from the coil. The study presented compares the originals with the images following automatic correction of signal intensity and demonstrates the superiority of the examinations with corrected signal intensity. In conclusion, it is recommended that automatic correction of signal intensity be used in magnetic resonance imaging with surface coils.
Humans↗