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Biomedical subjects

L Diethelm

Publications and source records attributed to L Diethelm.

At least 19 recordsLinked to original sources
PubMed2001

Complicated persistent patent ductus arteriosus with acute pneumonia in an adult.

Patent ductus arteriosus (PDA) is a malady usually identified during childhood. Prompt surgical correction provides definitive therapy with long-term survival. When not corrected, PDA leads to significant morbidity and mortality, making it a rare condition in the adult population. We report the case of a 44-year-old man with a history of persistent PDA admitted for worsening dyspnea and fever. Radiographic studies are illustrative of this complex syndrome. We review the complications and treatment alternatives in these patients.

Acute Disease↗
PubMed1997

Percutaneous implantation of non-small-cell lung carcinoma: technique and observations.

RATIONALE AND OBJECTIVES: The authors performed this study to determine whether intrathoracic inoculation of non-small-cell lung carcinoma with fluoroscopic guidance would provide for more accurate implantation. MATERIALS AND METHODS: A tumor cell inoculum (2 x 10(6) cells per 0.15 mL) was injected percutaneously under fluoroscopic guidance at the posterior midaxillary line in 22 athymic nude mice. The mice underwent imaging with a mammographic unit at 3, 5, and 8 weeks after implantation. The mice were sacrificed at 8 weeks, and autopsy was performed to determine tumor yield. RESULTS: The use of a percutaneous technique under fluoroscopic guidance greatly facilitated the accurate implantation of xenografts. Tumor growth was seen at radiography in 18 of the 22 (82%) mice at 8 weeks. Necropsy revealed a 100% tumor yield. Histologic examination confirmed adenocarcinoma of the lung. The average number of tumors found in the lung parenchyma was 1.05 +/- 0.35; the average number of tumors found in the mediastinum was 0.59 +/- 0.67. The average tumor weight was 389 mg +/- 64.3. The average tumor size was 300 mm3 +/- 66.23. CONCLUSION: With fluoroscopic guidance, percutaneous implantation of tumor cells in athymic nude mice is simple and effective.

Adenocarcinoma↗
PubMed1995

Pulmonary involvement in rheumatoid arthritis.

Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis (RA) and includes pleurisy, parenchymal nodules, interstitial involvement, and airway disease. Rheumatoid pulmonary vasculitis is rare. Pulmonary disease also may be observed as a toxic event consequent to treatment for RA. Although RA is more common in women, rheumatoid lung disease occurs more frequently in men who have long-standing rheumatoid disease, positive rheumatoid factor and subcutaneous nodules. Pleural involvement, usually asymptomatic, is the most common manifestation of lung disease in RA and may occur concurrently with pulmonary nodulosis or interstitial disease. The clinical features and course of pulmonary fibrosis in RA are similar to those of idiopathic pulmonary fibrosis. Bronchiolitis obliterans organizing pneumonia (BOOP), which has been recently described in RA patients, has nonspecific clinical features. The histological patterns correspond to proliferative bronchiolitis in the airway and organizing pneumonia in the alveoli. Obstructive lung disease in RA includes obliterative bronchiolitis (OB) and bronchiectasis. OB is an acute illness characterized histologically by a constrictive bronchiolitis. It may be idiopathic or induced by D-penicillamine or intramuscular gold compounds. Methotrexate (MTX)-pneumonitis is an uncommon complication of MTX treatment. Its clinical presentation is not specific, and diagnosis must be made after exclusion of other causes of pulmonary diseases. It is uncertain if preexisting lung disease predisposes RA patients to MTX-pneumonitis. Treatment of lung disease in RA is empirical. Corticosteroids are usually administered and immunosuppressive drugs are often added when pulmonary disease progresses and/or steroid side-effects appear.

Arthritis, Rheumatoid↗
PubMed1992

Left ventricular segmental volume by conductance catheter and Cine-CT.

The ability of the conductance catheter method to measure left ventricular segmental and total volume was evaluated by comparison with the Cine-CT technique. In the seven dogs studied, 19 conductance catheter and simultaneous Cine-CT runs were obtained. High correlation coefficients were found for total volume and segmental volumes, except in the basal segment. However, in most cases there was a significant variability in slope and intercept between animals. Both methods are promising tools for estimating dynamic segmental left ventricular volume, each having specific advantages such as a continuous signal (conductance catheter) or anatomic detail (Cine-CT). However, the results also show the need for further improvement of both methods.

Animals↗
PubMed1990

Evaluation of complex congenital ventricular anomalies with magnetic resonance imaging.

Complex ventricular anomalies are frequently associated with abnormalities of thoracic and abdominal situs, arterioventricular connection, and venous connection. The definition of all components of these anomalies is difficult to accomplish with imaging techniques. This study compared the effectiveness of electrocardiographic (ECG) gated spin-echo magnetic resonance imaging (MRI) with cardiac angiography for the evaluation of all components of central cardiovascular anatomy in patients with the clinical diagnosis of single or common ventricle or complete atrioventricular (AV) septal (canal) defect. MRI studies and angiograms of 29 patients were evaluated independently. A sequential approach was used to define cardiac anatomy assessing nine anatomic features in each patient. MRI provided 261 observations and angiography provided 209 observations. In the mutual 209 observations, only 17 discrepancies were found. Comparison of MRI and angiography in individual cases showed that MRI was as effective as angiography in the depiction of ventricular anomalies, including determination of morphology and evaluation of the size of the ventricles, the orientation of the ventricular septum relative to the AV valves, as well as the origins and spatial relationships of the great arteries. MRI was more informative for the determination of thoracic and abdominal situs and systemic and pulmonary venoatrial connections, but was not as effective for the evaluation of semilunar valves. Thus MRI provides complete evaluation of central cardiovascular anatomy and is effective in the anatomic assessment of most components of complex ventricular anomalies.

Adolescent↗
PubMed1989

Magnetic resonance imaging of congenital heart disease: sensitivity and specificity using receiver operating characteristic curve analysis.

MRI has shown promise for the evaluation of various congenital heart lesions. The current study was designed to assess the sensitivity and specificity of the technique for the evaluation of all major anatomic elements of the heart affected in simple and complex congenital heart disease. MR images of 51 patients (31 males and 20 females, ages 3 to 69 years) with a total of 110 congenital heart lesions were reviewed by a panel of two cardiac radiologists and one pediatric cardiologist, who assessed the cardiac pathoanatomy without knowledge of clinical details and assigned a confidence level to each diagnosis. The true diagnosis was established independently by the findings of angiocardiography and catheterization as well as by surgery, where applicable. ROC curves were generated from the responses, and the sensitivity at a specificity level of 90% was determined. MRI was shown to have a high sensitivity in evaluating great vessel relationships (100%), thoracic aorta abnormalities (94%), ASDs (91%) and VSDs (100%), visceroatrial situs (100%), and loop (100%). Three of five anomalies of the pulmonary and systemic veins were diagnosed by MRI. Right ventricular outflow obstructions (95%) were detected with a much higher sensitivity than lesions of the other valves (aortic valve 52%, mitral valve 62%, tricuspid valve 76%). Spin-echo MRI is a sensitive and specific method for the noninvasive assessment of congenital heart disease, with limitations in the evaluation of some valvular anomalies.

Adolescent↗
PubMed1989

Determination of left ventricular mass with ultrafast CT and two-dimensional echocardiography.

Conventional methods for determining mass of the left ventricle (LV) require geometric assumptions. Eleven patients were studied with ultrafast computed tomography (CT) and with two-dimensional echocardiography (2-D echo) for calculation of LV mass. With ultrafast CT, calculations were performed on end-systole images and end-diastole images for each patient. Comparisons of the results from ultrafast CT with those from 2-D echo were made with linear, Spearman rank, and interclass correlation coefficients, as well as with slope and intercept values of regression lines. Adequate ultrafast CT and 2-D echo studies were obtained in nine of the 11 patients. After the systolic and diastolic ultrafast CT determinations of LV mass were averaged, the results demonstrated excellent agreement with the 2-D echo determinations (slope = 1.0 +/- 0.20, r = .89, P less than .002).

Adult↗
PubMed1987

Atrial-level shunts: sensitivity and specificity of MR in diagnosis.

Gated transverse cardiac magnetic resonance (MR) images from 31 patients with proved atrial septal defect (ASD) and from 33 control subjects were reviewed retrospectively by a panel of cardiac radiologists. The panel, by consensus, determined the presence and the type of ASD and assigned a confidence level for each diagnosis. A total of 97% of ASDs were correctly identified at high levels of specificity (primum, 100%; secundum, 96%; common atrium, 100%). Sensitivity and specificity are illustrated by receiver operating characteristic curves. Pulmonary veins were demonstrated at rates exceeding those reported for echocardiography. Further, all cases of anomalous pulmonary venous connection proved by angiography were also demonstrated by MR. Thus, MR has high sensitivity and specificity in the diagnosis and location of atrial-level shunts and is at least as accurate as, and possibly more accurate than, traditional techniques for the diagnosis of anomalous pulmonary venous connection.

Adolescent↗
PubMed1979

[Radiotherapy of esophageal cancer (author's transl)].

There is general agreement on the effectiveness of radiotherapy in the treatment of squamous cell carcinoma of the esophagus and the advantage of rotation technique with conventional as well as supervoltage therapy. The use of small fields in order to reduce the possibility of damage to neighbouring structures requires a more accurate positioning of the target than the use of large fields. In kilovoltage therapy this was guaranteed by controlling the field by fluoroscopy and by the possibility for correction during irradiation. This accuracy and possibility for correction is not yet reliably obtainable in supervoltage therapy as demonstrated by the number of complications reported. In the future, more fractionation, possibly using a higher initial dose, followed by hyperthermia, should be contemplated in order to reduce the total dose. The combination with chemotherapy deserves further development as well. For the treatment of operable tumors, preoperative irradiation with 2000-3000 rads immediately followed by resection is again recommended.

Aged↗
PubMed1978

[Pathological and roentgenographic morphology in different stages of pulmonary shock (author's transl)].

Pulmonary shock syndrome may be better understood by comparing morphological and patho-physiological alterations in different stages. In the very early stage only fine structural tracer studies in experimental animals elicit morphological alterations of the microcirculation in the alveolar wall. These findings can be related to changes of ventilatory and blood-gas parameters. After a short interval microscopic and radiological features correspond. Interstitial pulmonary edema is the main syndrome of shock lung.

Adult↗
PubMed1976

Diagnosis and surgical treatment of mediastinal parathyroid tumors.

Experience and problems in the localization, diagnosis and surgical treatment of mediastinal parathyroid tumors are reported. Arteriography, pneumomediastinum and, especially, selective blood withdrawal with assay of parathyroid hormone, have proven valuable to the authors. Scintigram, intravital staining methods and venography are less productive. Retrosternal parathyroid tumors that can be removed from a Kocher incision should not, for practical reasons, be classified with the mediastinal tumors. The authors recommend the one-phase operation. If, after an intensive search of the neck and behind the sternum, no tumor has been found, it is advisable to incise the sternum step by step and revise the anterior mediastinum in the same session.

Angiography↗
PubMed1976

[Synovectomy in rheumatoid arthritis of the knee, radiologic investigations (author's transl)].

Pathologic and radiologic investigations of rheumatoid arthritis are compared with regard to their development. Radiologic demonstration of several cases prior to and following synovectomy shows improvement as well as exacerbation of the disease. An increasing mineral content signifies an improvement of the bone lesion. The mineral content depends on reduction of inflammatory activity, increasing motility, and postoperative discontinuation of cortisone therapy. In some cases various lesions at the border line between bone and cartilage as blurring, notching and destructions are disappearing. Reduction of cartilage accompanied with narrowing of the joint spaces will subside postoperatively, too. We have to suppose a regeneration of cartilage under increasing physical strain by functional stimulation. Following synovectomy the structure of subcartilage spongiosa becomes more organized as a sign of regression of inflammatory activity, improved motility and load capacity. Following synovectomy, exacerbation of radiologic symptoms occur mainly in advanced stages of rheumatoid arthritis. We may often see progression of secondary osteoarthritis existing preoperatively in contrast to clinical recovery. The increasing load capacity may cause an identation of the articular surface in cases of extreme osteoporosis. This might result in a false position. These lesions might necessitate further surgical treatment as possibly total joint prosthesis. Following synovectomy in rheumatoid arthritis of the knee, dissolving radiologic symptoms in addition to improvement of the clinical picture may be observed. The poor results of synovectomy in advanced rheumatoid arthritis favours the of early synovectomy during the proliferative and destructive stage of the disease.

Adult↗
PubMed1976

[Current status of preoperative localization in primary hyperparathyroidism (author's transl)].

Since Seldinger demonstrated in 1953 parathyroid adenomas by arteriography, numerous localizing procedures have been advocated. Based on our experience with selective venous sampling for measurement of parathyroid hormone by radioimmunoassay, selective arteriography, pneumomediastinography and scanning with 75Se-selenomethionine, a survey on localization techniques used up to now is given and their value and applications are discussed. Preoperative localization of parathyroid tissue should be limited to patients with previous unsuccessful surgery. In these cases we perform selective venous sampling following selective arteriography for demonstration of the venous drainage pattern and subsequent venous catheterization. Pneumomediastinography is recommended in suspected mediastinal parathyroid adenoma. Scanning with 75Se-selenomethionine is not in use because of its limited success.

Adenoma↗