PubMed Health⌕ Search

Biomedical subjects

J Müller-Brand

Publications and source records attributed to J Müller-Brand.

At least 19 recordsLinked to original sources
PubMed2005

Stunning and left ventricular function--how long is the ventricle knocked out? Left ventricular function correlated with ischemic burden and recovery time after stress.

PURPOSE: Little is known about the relation between severity of ischemia and duration of myocardial stunning. The aim of this study was therefore to characterize the impact of ischemia on myocardial stunning and on its duration. METHODS: 310 patients (pts) who underwent myocardial perfusion SPECT (MPS) were evaluated. MPS acquired with a rest Thallium/stress Technetium-99m sestamibi protocol were scored with respect to % myocardium ischemic. Left ventricular post-stress ejection fraction (psEF) was evaluated by the widely used QGS algorithm. Resting LVEF (rEF) was assessed by invasive ventriculography. Patient groups were then compared with respect to different extents of ischemia and different time intervals between stress and imaging (< or = 60 min and > 60 min after stress). RESULTS: 21% of pts had a normal MPS, 8% had evidence of scar, 37% had evidence of ischemia, and 34% had evidence of scar plus ischemia. Pts with normal MPS had a significantly higher psEF than pts with ischemia, 61+/-8% and 56+/-8%, respectively (p=0.006), whereas rEF was not different. Overall, pts with < or = 10% myocardium ischemic had significantly higher psEF than pts with > 10% myocardium ischemic, 53+/-11% and 49+/-9%, respectively (p=0.006), whereas rEF was not different. In pts with evidence of ischemia who underwent imaging < or = 60 min after stress testing, pts with < or = 10% myocardium ischemic had higher psEF than pts with > 10% myocardium ischemic, 60+/-7% and 53+/-8%, respectively (p=0.037). In contrast, pts with evidence of ischemia who underwent imaging > 60 min after stress testing had similar psEF irrespective of extent of ischemia (53%+/-8 in pts with < or = 10% ischemia and 54%+/-8 in pts with > 10% myocardium ischemic, p=0.12). CONCLUSIONS: Ischemia had a significant impact on psEF in patients who underwent imaging less than 1 h after stress. More than one hour after stress testing stunning seems to be less relevant in the interpretation of psEF.

Adult↗
PubMed2005

Radioiodine uptake and thyroid hormone levels on or off simultaneous carbimazole medication: a prospective paired comparison.

AIM: To allow radioiodine (RAI) treatment in patients with need for anti-thyroid drug medication and low RAI uptakes we investigated the feasibility of discontinuing carbimazole for 3 days to enhance the RAI uptake without concurrent exacerbation of hyperthyroidism. METHODS: We prospectively investigated RAI dynamics and thyroid hormone concentration in 12 patients with low RAI uptake (<30%) under simultaneous carbimazole medication and 3 days after discontinuation. At both time points fT(4), T(3) and TSH were monitored. RESULTS: Discontinuation of carbimazole for 3 days led to a significant increase of RAI uptake in all patients. We found an enhancement up to 4.9-fold compared to the measurement on carbimazole. The mean RAI uptake increased from 15.2 +/- 4.4% to 50.1 +/- 15.5% (p<0.001). The intrapersonal radioiodine half-life increased from 4.2 +/- 1.6 days to 5.4 +/- 0.7 days (p = 0.13). Mean thyroid hormone concentration was not affected by the three day withdrawal of anti-thyroid drugs and no patient suffered from an aggravation of biochemical hyperthyroidism. CONCLUSION: A withdrawal of carbimazole for 3 days is long enough to provide sufficiently high RAI uptakes for RAI treatment in patients with low RAI uptakes and short enough to avoid the risk of exacerbation of hyperthyroidism.

Adult↗
PubMed2004

Radioiodine therapy in hyperthyroidism: inverse correlation of pretherapeutic iodine uptake level and post-therapeutic outcome.

BACKGROUND: High iodine uptake levels are widely accepted as a condition for successful treatment with radioiodine (RAI). However, the existing data are controversial and the correlation of pretherapeutic RAI uptake level and outcome of RAI therapy has not yet been quantified. The aim of this study was to analyze the influence of RAI uptake on the outcome after RAI treatment and to estimate uptake-dependent success rates. MATERIALS AND METHODS: We retrospectively analyzed 229 patients (m = 53, f = 176; age 64 +/- 14 years) suffering from toxic adenoma, multinodular goitre or Graves' disease, respectively. Clinical status and T3, fT4 and TSH levels were assessed 3, 6, 12 and 18 months after treatment. Successful treatment was defined as loss of hyperthyroidism 18 months after radioiodine therapy. Logistic regression was used to assess the relation between the maximum iodine uptake and the rate of success and hypothyroidism, respectively, after RAI treatment. RESULTS: Overall, patients presented with pretherapeutic RAI uptake values between 17% and 100%. Eighteen months after RAI treatment, an euthyroid state was achieved in 136 patients (60%), hypothyroidism occurred in 47 patients (20%) and 46 patients (20%) remained hyperthyroid. The patients with the lowest pretherapeutic RAI uptakes showed the highest success rates. The overall success rate significantly decreased from 92% at low RAI uptakes to 57% at high uptakes (P = 0.002). This effect was found in the patients suffering from multinodular goitre as well as in the patients with Graves' disease. CONCLUSION: In contrast to the current opinion, our results provide evidence that the pretherapeutic iodine uptake level and post-therapeutic outcome are inversely correlated.

Adenoma↗
PubMed2002

[Noninvasive cardiac diagnosis for quantifying scarring, ischemia and pump function within the scope of a study. 20 useful facets in routine cardiology nuclear medicine practice].

Myocardial perfusion SPECT (MPS) commonly is interpreted qualitatively and not quantitatively. Most of the prognostic literature is based on a semi-quantitative visual analysis (SQA) of MPS. However, data about the comparison between the SQA and coronary angiography (cath) is lacking. We therefore evaluated 167 patients who underwent MPS and subsequent cath. SQA using a 20 segment model was used for MPS interpretation. Patients with a small to moderate amount of ischemia (SDS < or = 4; mean 1.2 +/- 1.5) and with extensive ischemia (SDS > 4; mean 9.6 +/- 4.7) were then compared with respect to clinical and cath variables. Patients with extensive ischemia had more advanced CAD as demonstrated by several cath variables (more often triple vessel and LAD-disease). SQA therefore is a useful tool for MPS interpretation and decision making in patients with (suspected) CAD.

Aged↗
PubMed2001

Radionuclide-labeled somatostatin analogues for diagnostic and therapeutic purposes in nonmedullary thyroid cancer.

Despite the fact that several recent studies report an expression of somatostatin receptors in nonmedullary thyroid cancer (non-MTC), there is still no consensus concerning the diagnostic and therapeutic usefulness of radionuclide-labeled somatostatin analogues in non-MTC. We present the results of 50 scintigraphic studies with (111)In-Pentetreotide ((111)In-P) in 48 patients with metastasizing non-MTC (n = 9 papillary, n = 9 follicular, n = 29 Hurthle cell, n = 1 insular carcinoma). The findings were compared with histology and with other imaging modalities. (111)In-P provided unequivocally positive results in 37 of 50 (74%) of the patients (27% in the 11 patients with current thyroglobulin levels <10 ng/mL and 85% in the patients with thyroglobulin >10 ng/mL). Histopathology demonstrated that maximal uptake was observed in Hurthle cell carcinoma (95% positive examinations if thyroglobulin exceeds 10 ng/mL). We also describe for the first time dosimetric and clinical data from the courses of 90Y-DOTATOC therapy in three patients with progressive, somatostatin-receptor-positive non-MTC (up to 9.3 GBq per 4 cycles). Tumor progression could not be stopped in any of the patients treated with 90Y-DOTATOC. We conclude that (111)In-P is a promising tool for whole-body diagnosis in nonradioiodine-accumulating non-MTC, especially in Hürthle cell cancer, and if 2-[18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) is not available. Although the number of patients treated with 90Y-DOTATOC is still limited, our applied treatment protocol appears to be ineffective in metastasizing non-MTC.

Adult↗
PubMed2000

Chronic post-traumatic osteomyelitis of the lower extremity: comparison of magnetic resonance imaging and combined bone scintigraphy/immunoscintigraphy with radiolabelled monoclonal antigranulocyte antibodies.

OBJECTIVE: A retrospective study of the validity of combined bone scintigraphy (BS) and immunoscintigraphy (IS) using (99m)Tc-labelled murine antigranulocyte antibodies (MAB) and magnetic resonance imaging (MRI) in chronic posttraumatic osteomyelitis. DESIGN AND PATIENTS: The results of MRI and combined BS/IS of 19 lesions in 18 patients (13 men, 5 women; mean age 45 years, range 27-65 years) were independently evaluated by two radiologists and one nuclear medicine physician with regard to bone infection activity and extent. The patient group was a highly selective collection of clinical cases: the average number of operations conducted because of relapsing infection was eight (range 2-27), the average time interval between the last surgical intervention and the present study was 6.5 years (range 3 months to 39 years), and from the first operation was 14 years (range 1.5-42 years). Interobserver agreement on MRI was measured by kappa statistics. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for MRI and the nuclear medicine studies. RESULTS: For MRI/nuclear medicine, a sensitivity of 100%/77%, a specificity of 60%/50%, an accuracy of 79%/61%, a PPV of 69%/58% and a NPV of 100%/71% were calculated. Four MR examinations were false positives because of postsurgical granulation tissue. A high degree of interobserver agreement was found on MRI (kappa=0.88). A low-grade infection was missed on two scintigrams, while four were false positive because of ectopic haematopoietic bone marrow, and in one examination the anatomical distortion resulted in an inaccurate assignment of the uptake leading to false positive findings. Image analysis was frequently hindered by susceptibility artefacts due to residual abrasions of metallic implants after removal of orthopaedic devices (15/18 patients); this led to limited assessment in 17% (3/18 patients). CONCLUSION: Acute activity in a chronic osteomyelitis can be excluded with high probability if the MRI findings are negative. In the first postoperative year fibrovascular scar cannot be distinguished accurately from reactivated infection on MRI and scintigraphy may improve the accuracy of diagnosis. MRI is more sensitive in low-grade infection during the later course than combined BS/IS. Scintigraphic errors due to ectopic, peripheral, haematopoietic bone marrow can be corrected by MRI.

Adult↗
PubMed2000

[Validation study of the sentinel lymph node (SLN) method in invasive breast carcinoma. Personal data and review of the literature].

BACKGROUND: Axillary lymph node dissection (ALND) is an integral part in the therapy of breast cancer. Axillary lymph node involvement and tumour size are the most important prognostic factors. Restriction of ALND to level I and II (Berg) reduced high morbidity. The increasing proportion of patients with early breast cancer and negative axillary nodes led to a more selective method to avoid unnecessary ALND. The sentinel lymph node (SLN)--the first draining lymph node of a tumour--represents the status of the axilla. A negative SLN prevents from further completion ALND. PATIENTS AND METHODS: From 9/97 to 1/99 44 patients with invasive breast cancer underwent a prospective trial of lymphatic mapping with isosulfanblue and/or lymphoscintigraphy with 99m technetium-labelled human colloid. During the operation a hand-held gamma probe was used for detection. The SLN was removed selectively and examined by routine histopathology (H&E) and immunohistochemistry (IHC). ALND of level I and II was performed in all patients for correlation. RESULTS: The SLN were identified in 41 of 44 patients (93%). 2.4 SLN per patient were harvested, overall 17.6 axillary lymph nodes. Of the 41 patients, 21 patients had positive, 20 patients negative SLN. In the 20 patients with negative SLN only one patient (5%) had metastatic disease on complete dissection (negative predictive value of 95%). In 17 patients with positive axillary lymph nodes 16 were found to have positive SLN, only one SLN was negative (false negative rate of 5.9%). In two of 41 patients micrometastases were detected by IHC. Lymphoscintigraphy revealed drainage to the axilla and internal mammary nodes in two of 28 cases (7%). SUMMARY: Our validation study proves the reproducibility and reliability of the SLN procedure. A multidisciplinary approach is indispensable. The SLN procedure has the potency for becoming the selection criterion whether to perform an ALND or not. Multiple sections and IHC staining improve the detection rate of metastatic disease. Ongoing long time investigations will determine the impact on overall survival. Our own data are discussed in an extended review of the literature.

Adult↗
PubMed1999

[Yttrium 90 DOTATOC: a new somatostatin analog for cancer therapy of neuroendocrine tumors].

Current concepts for the treatment of somatostatin receptor positive tumours have not been very motivating up to now. A promising alternative could be the new peptidic vector DOTA-D-Phe1-Tyr3-Octreotide (DOTATOC) recently developed in Basel. It may be labelled with the beta-emitter yttrium-90 (90Y) for internal radiotherapy after systemic application. Pilot therapy studies have shown convincing results with this new radiopharmaceutical. These studies are presented with regard to efficacy and possible toxicity. In summary, the new receptor-mediated 90Y-DOTATOC therapy led to tumour response in the majority of patients, and only in some receiving high cumulative doses of > 200 mCi per m2 body surface renal and hematological toxicity due to irradiation occurred. For the reduction of renal accretion, concepts with concomitant amino acid infusions containing L-lysine in a higher concentration are currently under way.

Female↗
PubMed1999

Prospective evaluation of an algorithm for the functional assessment of lung resection candidates.

Patients with impaired pulmonary function are at increased risk for the development of postoperative complications. Recently exercise testing and predicted postoperative (ppo) function have gained increasing importance in the evaluation of lung resection candidates. We prospectively evaluated an algorithm for the preoperative functional evaluation that was developed at our institution. This algorithm incorporated the cardiac history including an electrocardiogram (ECG), and the three parameters FEV1, diffusing capacity of the lungs for carbon monoxide (DLCO), and maximal oxygen uptake (VO2max), as well as their respective ppo values (FEV1-ppo, DLCO-ppo, and VO2max-ppo) calculated based on radionuclide perfusion scans. A consecutive group of 137 patients (mean age 62 yr; range 23 to 81; 102 males, 35 females) with clinically resectable lesions underwent assessment according to our algorithm. Five patients were deemed functionally inoperable, 132 passed the algorithm and underwent pulmonary resections with standard thoracotomy: 9 segmental or wedge resections, 85 lobectomies (inclusive 3 bilobectomies), and 38 pneumonectomies. All patients were extubated within 24 h. The mean stay in the ICU was 1.4 (+/- 1.8) d, and the mean hospital stay was 14.6 (+/- 5) d. Postoperative complications (within 30 d) occurred in 15 patients (11%), of whom two died (overall mortality rate 1.5%). In comparison to our previous series this meant a 50% reduction in complications whereas the percentage of inoperable patients remained unchanged (4% now, 5% before). We conclude that adherence to our algorithm resulted in a very low complication rate (morbidity and mortality), and excluded more rigorous patient selection as a bias for the improved results.

Aged↗
PubMed1999

Locoregional regulatory peptide receptor targeting with the diffusible somatostatin analogue 90Y-labeled DOTA0-D-Phe1-Tyr3-octreotide (DOTATOC): a pilot study in human gliomas.

Human gliomas, especially of low-grade type, have been shown to express high-affinity somatostatin receptor type 2 (J-C. Reubi et al., Am. J. Pathol, 134: 337-344, 1989). We enrolled seven low-grade and four anaplastic glioma patients in a pilot study using the diffusible peptidic vector 90Y-labeled DOTA0-D-Phe1-Tyr3-octreotide (DOTATOC) for receptor targeting. The radiopharmakon was locoregionally injected into a stereotactically inserted Port-a-cath. DOTATOC competes specifically with somatostatin binding to somatostatin receptor type 2 in the low nanomolar range as shown by a displacement curve of 125I-[Tyr3]-octreotide in tumor tissue sections. Diagnostic (111)In-labeled DOTATOC-scintigraphy following local injection displayed homogeneous to nodular intratumoral vector distribution. The cumulative activity of regionally injected peptide-bound 90Y amounted to 370-3300 MBq, which is equivalent to an effective dose range between 60 +/- 15 and 550 +/- 110 Gy. Activity was injected in one to four fractions according to tumor volumes; 1110 MBq of 90Y-labeled DOTATOC was the maximum activity per single injection. We obtained six disease stabilizations and shrinking of a cystic low-grade astrocytoma component. The only toxicity observed was secondary perifocal edema. The activity:dose ratio (MBq:Gy) represents a measure for the stability of peptide retention in receptor-positive tissue and might predict the clinical course. We conclude that SR-positive human gliomas, especially of low-grade type, can be successfully targeted by intratumoral injection of the metabolically stable small regulatory peptide DOTATOC.

Adult↗
PubMed1999

[Marine-Lenhart syndrome: a case observation upon 18 years].

After a hyperthyroidism of Graves' disease with strongly positive antithyroid antibodies treated sufficiently by radioiodine therapy a 46-year old woman developed a consecutive bifocal autonomous nodule within 13 years. This phenomenon is known as Marine-Lenhart-syndrome. In this particular case it seems that autonomous nodules are a consequence of Graves' disease treatment with radioiodine. Our case report is a 18 year follow up. In contrast to most studies known today the simultaneous occurrence of active Graves' disease and active autonomous nodules could be demonstrated by means of serology and suppressive scintigraphy, respectively. In addition, this case shows the possible dependence of an acute beginning of Graves' disease and the occurrence of autonomous nodules.

Female↗