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Biomedical subjects

H Lorch

Publications and source records attributed to H Lorch.

16 recordsLinked to original sources
PubMed2002

Psychoneuroendocrine disturbances in a patient with a rare granulomatous disease.

Erdheim-Chester disease (ECD) and Langerhans' cell histiocytosis (LCH) are rare granulomatosis-like diseases of unknown etiology which are characterized by lipoidgranulomatous infiltrates in various organs. Contrary to LCH, endocrine and cerebral lesions were infrequently observed in ECD. We report on a patient with the clinical diagnosis of ECD displaying endocrine and cerebral manifestations and skeletal, pulmonary and soft tissue involvement. Disturbance of the endocrine system was revealed by enlargement of the pituitary, partial deficiency of growth hormone (GH), hyperprolactinemia and testosterone deficiency. Cerebral involvement included sinus vein thrombosis, pathologic acoustic evoked potentials, persistence of gadolinium enhancement after magnetic resonance imaging and hypomania. These findings emphasize the importance to assess endocrine and cerebral function in patients with rare granulomatous diseases like ECD and multiorgan involvement.

Aorta, Abdominal↗
PubMed2001

[Recurrent hypoglycemia caused by malignant insulinoma: chemoembolization as a therapeutic option].

HISTORY AND CLINICAL FINDINGS: A 73-year-old previously healthy woman presented with recurrent weakness, vertigo and perioral paresthesia of 3 months' duration. Physical examination on admission was unremarkable and revealed a patient in good condition. INVESTIGATIONS: Recurrent episodes of fasting hypoglycemia let us to proceed with a fasting test. The test was stopped after 24 hours when the patient became presyncopal and was found to have a blood sugar value of 2.2 mmol/l (accompanied by inadequately increased values for proinsulin, insulin and C-peptide). Ultrasound and computertomography of the abdomen showed a huge inhomogeneous mass in the tail of pancreas and multiple lesions in the liver, respectively. Core needle biopsies revealed typical histopathological findings of a neuroendocrine carcinoma. TREATMENT AND COURSE: Eight cycles of chemotherapy were given using streptozotocin/doxorubicin for three cycles and streptozotocin/5-fluorouracil for the remaining therapy over a period of 16 months resulting in a reduction in size of liver metastases and improvement of symptoms. Following 6 months without any therapy new episodes of severe hypoglycemia and progression of the liver metastases occurred. Despite seven further cycles of chemotherapy and additional treatment with diazoxide/octreotide the patient remained hypoglycemic and continuous glucose infusions became necessary. Therefore, chemoembolization of the liver with streptozotocin/5-fluorouracil and lipiodol-emulsion was performed. This resulted in a significant improvement of symptoms and the patient could subsequently be discharged. The patient died 4 months later. CONCLUSION: Chemoembolization is an effective possibility in the palliative treatment of advanced malignant insulinoma.

Aged↗
PubMed2000

Current practice of temporary vena cava filter insertion: a multicenter registry.

PURPOSE: To evaluate the current practice of temporary vena cava filter placement and its complications. MATERIALS AND METHODS: A multicenter registry was conducted from May 1995 until May 1997 using a standardized questionnaire. One hundred eighty-eight patients were evaluated. Patient characteristics, filter indications, filter characteristics, and complications were registered. RESULTS: Deep vein thrombosis was proven in 95.2% of the patients. Main filter indication was thrombolysis therapy (53.1%). Average filter time was 5.4 days. An Antheor filter was inserted in 56.4%, a Guenther filter in 26.6%, and a Prolyser filter in 17.%. Transfemoral filter implantation was slightly preferred (54.8%). Four patients died of pulmonary embolism (PE) during filter protection. Major filter problems were filter thrombosis (16%) and filter dislocation (4.8%). When thrombus was found in or at the filter before explantation, additional thrombolysis was performed in 16.7%, additional filter implantation in 10%, and thrombus aspiration in 6.7%; 4.8% of filters were replaced with permanent filters. DISCUSSION: Temporary vena cava filters are placed to prevent PE in a defined patient population. Despite their presence, PEs still occur in a small percentage. Problems of filter thrombosis and dislocation have to be solved. CONCLUSION: The results of this multicenter registry support the need for innovative filter design, as well as a randomized, prospective study.

Adolescent↗
PubMed1999

[The in-vitro evaluation of different embolectomy catheters for the treatment of acute pulmonary embolism].

INTRODUCTION: Pulmonary embolism (PE) is one of the most common cardiovascular diseases and frequently causes death. As a rule, PE is treated with thrombolytic therapy or surgical thrombectomy. MATERIALS AND METHODS: In an in vitro model of the right lung, we tested four different percutaneous transluminal thrombectomy devices: a pigtail-catheter with an angled 3-cm (40 degrees) distal tip, the clot-buster, the hydrolyser catheter, and a modified hydrolyser. In 16 consecutive and repetitive experiments fresh thrombi were inserted and we evaluated the effectiveness of the system with respect to time, fragment size, reduction of the Miller score, and handling. RESULTS: Mean intervention times of the catheter systems were 23 min (pigtail), 14.4 min (modified hydrolyser), 13.8 min (clot-buster), and 10.8 min (hydrolyser). The maximum size of the produced fragments range from 0.5 to 3.5 mm by the pigtail and from 0.5 to 1 mm by the other systems. The Miller score reduction was from 14.4 to 2.8 (pigtail), 13.8 to 1.8 (clot-busters), 14.6 to 1.2 (hydrolyser), and 16.4 to 1 (modified hydrolyser). DISCUSSION: All four catheter systems were effective in the treatment of pulmonary embolism. The pigtail catheter is the most simple system but more time consuming and less effective in the fragmentation of emboli and reduction of the Miller score compared to the other three catheter systems. These systems were comparable in our model but especially the handling of the hydrolyser was encouraging.

Acute Disease↗
PubMed1998

[Comparative magnetic resonance imaging of renal space-occupying lesions with a high and low field MRI system].

PURPOSE: A prospective study of the diagnostic accuracy and image quality of two MRI systems in the detection of renal tumors was investigated. MATERIALS AND METHODS: 34 patients with the clinical suspicion of a space-occupying renal lesion were examined by MRI with a low field (0.2 Tesla magnet) and a high field (1.5 Tesla magnet) for comparison. An "informed" and a "blind" observer evaluated all of the MR images. In addition, the signal-to-noise and contrast-to-noise ratios were evaluated as second quality parameters. RESULTS: In 29 cases the results could be compared with a confirmed release diagnosis. Diagnostic accuracy was comparable with both systems (Sensitivity for both observer on LF apparatus: 83%, HF apparatus: 81%) although the signal-to-noise and contrast-to-noise ratios were significantly poorer at low field. CONCLUSIONS: The low field system in comparable to the high field MRI for detection and differentiation of renal space-occupying lesions.

Diagnostic Errors↗
PubMed1997

[The angiography of kidney transplant arteries using carbon dioxide].

BACKGROUND AND OBJECTIVE: After renal transplantation hypertension occurs in 60-80% of patients, in 3-23% of them due to renal artery stenosis in the transplanted kidney. Angiographic assessment of the severity of the stenosis would best be done with a non-nephrotoxic contrast medium. We investigated the use of carbon dioxide, a bubble-forming contrast medium excreted via the lung, for its suitability in the angiography of the arterial system in the renal transplant. PATIENTS AND METHODS: In an uncontrolled series of observations on six patients with renal transplants and hypertension who were being treated with three or four antihypertensive drugs, the transplant's arteries were demonstrated with carbon dioxide, injected by Seldinger technique into the ipsilateral femoral artery, and the results recorded by subtraction angiography. RESULTS: The angiograms demonstrated postoperative kinked renal artery, a plaque in the external iliac artery, and a sharply angled origin of the external iliac artery in one case each, and three normal cases. CONCLUSIONS: Carbon dioxide is a suitable medium for demonstrating renal arteries in a transplanted kidney and is preferable to conventional contrast media for the angiographic diagnosis of possible renal artery stenosis.

Adult↗
PubMed1996

[Indications and results of surgically treated, with temporary vena cava filter managed patients].

Heavily injured patients, patients who underwent operations on pelvis, hips, abdomen or malignoma surgery, as well as gynaecology patients suffering from malignoma or previous deep femoral vein thrombosis in connection with pregnancy or obesity are at risk to suffer from pulmonary embolism with potentially lethal course. In a retrospective study we evaluated the advantage of the prophylactic use of temporary vena cava filters and their side effects. The indications were 18 cases of surgery, with known iliacal vein or cava thrombosis, 3 cases of pregnancy thromboses, and 1 high-dose heparinisation after acute pulmonary embolism without lysis. Additionally a postoperative lysis therapy was performed due to a life-threatening pulmonary embolism in 1 patient. 1 Cook filter (transfemoral), 3 Angiocor filters (transbrachial), and 19 Antheor filters (3 transjugular, 5 transfemoral, 11 transbrachial) were implanted. In these patients no clinically visible pulmonary embolism occurred under therapy, 3 thrombi were detected in the filter. Complications were caused either by the underlying therapy alone (1 lethal outcome of abdominal aortic aneurysm surgery), by the combination of therapy and cava filter implantation (1 case of arm haematoma, 1 ascending thrombosis) or by filter implantation alone (2 cases of v. subclavia thrombosis, 1 dislocation, 1 basket rupture). Since temporary cava filters have no secondary complications per se, their use seems justified as long as there is strict indication including presence of iliacal vein or cava thrombosis and risk of thrombi mobilisation.

Abdominal Neoplasms↗
PubMed1994

[Involvement of the pericardium in Churg-Strauss syndrome].

In two patients (24 and 26 years old) with chronic bronchial asthma, allergic rhinitis, peripheral blood eosinophilia of 48% and 51%, respectively, mononeuritis multiplex and abnormal erythrocyte sedimentation rate, Churg-Strauss syndrome was diagnosed. Acute pericarditis with abnormal ECGs and compensatory sinus tachycardia was documented in both cases as a sign of systemic vasculitis. Echocardiography revealed hemodynamically relevant pericardial effusions of 1.3 cm and 2.7-3.2 cm leading in one case to slightly diastolic compression of the right ventricle. The pericardial lesions showed good response to diuretic therapy with furosemide and administration of immunosuppressive agents like cyclophosphamide and azathioprine in combination with corticosteroids. The two presented cases underline that pericardial effusions of hemodynamic significance can be prominent clinical features of Churg-Strauss syndrome.

Adrenal Cortex Hormones↗
PubMedDate not supplied

MR-guided placement of a temporary vena cava filter: technique and feasibility.

The purpose of this paper was to investigate the feasibility of MR-guided insertion of a temporary vena cava filter on an open low-field imager. In vivo procedures were performed on four anesthetized pigs using a common nonferromagnetic temporary vena cava filter and a special prototype guidewire developed for vascular interventions guided by low-field MRI. Breath-hold spoiled gradient-echo sequences (fast low-angle shot [FLASH]) with flow compensation were used for position monitoring of the passively visualized intravascular devices. Using the described technique and equipment, all steps of the procedure were feasible in the MR unit. Practicability of the procedure seems to be sufficient for clinical purposes but was inferior compared to the conventional technique of filter placement.

Animals↗
PubMedDate not supplied

Central venous access ports placed by interventional radiologists: experience with 125 consecutive patients.

PURPOSE: To assess safety and function of central venous port systems implanted percutaneously in the interventional radiology suite. METHODS: One hundred and twenty-five consecutive ports in 123 patients were evaluated retrospectively. One hundred and twenty ports were implanted via the subclavian vein. RESULTS: Technical success was 100%. Fourteen patients (11.2%) experienced immediate procedural complications, all minor (pneumothorax 1.6%). During follow-up (4-343 days, mean service period 97.8 days), nine complications occurred, six of which were major. These were three port infections which led to hospitalization and port removal, one chamber penetration through the skin, and two port occlusions. Port removal as a result of complications was performed in six patients. Altogether, 20 complications occurred within a total of 11,056 days of service, which means 1.8 events per 1000 days of service. CONCLUSION: Percutaneous implantation of central venous port systems is safe and easy to perform. Complication rates of this study compare favorably with those of other radiological and surgical series.

Administration, Cutaneous↗
PubMedDate not supplied

Temporary vena cava filters and ultrahigh streptokinase thrombolysis therapy: a clinical study.

PURPOSE: To assess the efficacy of temporary vena cava filters in patients undergoing ultrahigh-dose streptokinase thrombolysis for iliocaval thrombosis and to determine therapy success and filter and therapy complications. METHODS: Forty-five patients were studied regarding extension and characteristics of thrombosis, duration, success, and complications of thrombolysis therapy, filter type, access route, pulmonary embolisms, and filter complications. RESULTS: Complete recanalization was achieved in 57% of cases. Filters were inserted predominantly via a transbrachial route. One fatal pulmonary embolism (2%) occurred 1 day after starting thrombolysis. No other pulmonary embolism was noted. Other complications were induced by thrombolysis alone (n = 12), thrombolysis and filter (n = 9), and filter alone (n = 11). CONCLUSION: Fatal pulmonary embolisms as a complication of ultrahigh-dose treatment of pelvic or caval thrombosis can not safely be prevented by the temporary vena cava filters currently available. Filter design needs to be improved.

Adolescent↗
PubMedDate not supplied

In vitro studies of temporary vena cava filters.

PURPOSE: To evaluate the clot trapping capacity of different temporary vena cava filters in a vena cava model. METHODS: A vena cava flow model was built using PVC tubing, a hemodialysis membrane and a pulsatile pump. Blood was imitated by a Dextran 40 solution. Five different temporary vena cava filters and two prototypes were tested using human thrombi. The mechanism of clot capture was observed. RESULTS: Decreasing rank order according to decreasing percentage of clots captured for the 21-mm diameter vena cava model was Cook (C) > Angiocor (A) > Cordis (CD) > Antheor (TF-6) > DIL for thrombi with a diameter of 3 mm and A > C > CD > TF-6 > DIL for 5-mm thrombi. In a cava with diameter of 28 mm, decreasing rank order was C > CD = A > TF-6 > DIL and C > CD = A > DIL > TF-6 for 3- and 5-mm thrombi, respectively. Two new prototypes, the TF-8 and TF-10 filters, achieved better results than the TF-6 filter and were in most conditions comparable to the A and CD filters. In most cases, thrombi were trapped between filter and cava wall. CONCLUSION: The vena cava flow model demonstrates significant differences in rates of clot capture (range 22%-98%) depending on cava diameter, thrombus size, and filter type.

Equipment Design↗
PubMedDate not supplied

Clinical experience with temporary vena caval filters.

PURPOSE: To look at the benefits and complications of different vena caval filters inserted prophylactically. Three temporarily implantable caval filter systems were used in 67 patients. MATERIALS AND METHODS: Twelve Cook filters (six transjugular, six transfemoral), 11 Angiocor filters (one transjugular, 10 transbrachial), and 44 Antheor filters (three transjugular, four transfemoral, 37 transbrachial) were successfully implanted. In known iliac vein or caval thrombosis, the prophylactic filters were placed during thrombolytic therapy in 46 cases, surgery in 17 cases, thrombosis in pregnancy in three cases, and high-dose heparinization without lysis in one case. RESULTS: One patient had a fatal pulmonary embolism during treatment; seven thrombi were detected in the filter. Other complications were caused either by the underlying therapy alone (one fatal outcome of abdominal aorta aneurysmal surgery, two cases of cerebral hemorrhage, two cases of retroperitoneal hematomas, two cases of streptokinase fever reactions, one compartment syndrome, two cases of macrohematuria), by the combination of therapy and caval filter implantation (three cases of groin hematomas, three cases of arm hematomas), or by filter implantation alone (two cases of subclavian vein thrombosis, one catheter infection, one dislocation, one air embolism, one basket rupture). The bleeding complications were related to the aggressive thrombolytic therapy and would have occurred without filter implantation. CONCLUSION: Because temporary caval filters have no long-term complications per se, their use seems sensible as long as there are stringent indications, including the presence of iliac vein or caval thrombosis and risk of thrombus mobilization. The Antheor filter system was the most convenient system for implantation.

Adolescent↗
PubMedDate not supplied

[Successful partial lysis of a 4-level-thrombosis by rt-PA - case report].

Thromboembolism of the vena cava, the venae iliaca communis, externa, femoralis, poplitea, and the fibular vein group of the left lower limb was diagnosed in a 13 year old girl. Several thrombogenic risk factors (APC-resistence, homocystinuria, contraception, smoking) were identified. Due to painful symptoms and for prevention of postthrombotic syndrome continuous systemic thrombolysis with rt-PA (0,5 mg/kg/d), in addition to heparine, was performed for 6 days. Diagnostic imaging at the end of therapy demonstrated complete and partial recanalization of the vena cava inferior, venae iliaca communis and externa. The distal veins of the leg remained occluded. After catheterization of the internal jugular vein and placement of a cava filter only mild pulmonary embolism occurred during systemic thrombolysis. No further complications were observed. All in all, therapy was tolerated well. Systemic thrombolysis with rt-PA in children and adolescents, although not established for regular treatment, is an effective therapeutic option in severe venous thrombosis.

Activated Protein C Resistance↗