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Biomedical subjects

M Born

Publications and source records attributed to M Born.

At least 19 recordsLinked to original sources

[Duplication of the alimentary tract with ectopic gastric mucosa as cause of lower abdominal pain].

Duplications of the alimentary tract are rare congenital anomalies, which may be difficult to diagnose. They cause unspecific symptoms and may mimic appendicitis. The authors report the case of a 9-year-old boy with recurrent pain in the right lower abdomen who underwent laparoscopic appendectomy. The painful episodes were, however, caused by a duplication with ectopic gastric mucosa, which had lead to an ulceration and an intussusception. Sonographically using a high resolution linear probe (7.5 MHz) the ileal intussusception could be demonstrated.

Abdominal Pain↗

Prenatal protracted irradiation at very low dose rate induces severe neuronal loss in rat hippocampus and cerebellum.

Prenatal irradiation is known to damage the developing brain. However, little is known about the consequences of very low dose rate prenatal protracted irradiation over several days on neuron numbers in the offspring brain, and on volumes of the corresponding brain regions. Pregnant Wistar rats were exposed either to a protracted gamma irradiation from embryonic day (E) 13 to E16 (0.7 mGy/min; total cumulative dose approximately 3 Gy) or were sham-irradiated. Thirty months old male and female offspring were then analyzed for alterations in hippocampal and cerebellar morphology. Using design-based stereology and the analysis of sets of sections systematically and randomly sampled to span the entire brain region of interest, a statistically significant decrease in numbers of hippocampal pyramidal and granule cells as well as of cerebellar Purkinje and granule cells (approximately 50%) was found in male and female irradiated offspring. The volumes of these brain regions were comparably altered. The analysis of only a "representative" section per animal yielded mostly non-significant trends. Evaluation of neuron densities showed no differences between prenatally irradiated and sham-irradiated offspring. Most importantly, very low dose rate prenatal protracted gamma irradiation did not result in the same morphologic alterations in the offspring brain as previously observed after prenatal single irradiation such as derangement of the laminar structure of pyramidal cells within the hippocampus or malformation of cerebellar lobules.

Animals↗

[Influence of continuous positive airway pressure (CPAP) on blood flow velocity in the venous vascular system of the liver -- duplex sonographic investigations].

OBJECTIVE: In the last years, noninvasive techniques of artificial ventilation like continuous positive airway pressure (CPAP) have become more and more important. However, the effects of such procedures on the circulation of the hepatosplanchnic area are, except for the indocyanine green plasma clearance, not yet representative by means of noninvasive investigation methods. METHODS: We studied maximum blood flow velocity in defined areas of hepatic and portal veins by duplex ultrasonography in 20 healthy volunteers (12 male, 8 female; age: 24,7 +/- 4,7 years [mean +/- SD]) before, during and after application of CPAP (10 cm H(2)O). As many measurements as possible were taken in both vascular systems. After division into five minute intervals arithmetical mean values were calculated for each interval. The experiment was divided into a control interval ("before CPAP"), three "CPAP" intervals and finally two "after CPAP" intervals. Heart rate and blood pressure were taken at the beginning of these intervals. RESULTS: Compared with the control interval, maximum blood flow velocity in the area of the hepatic vein decreased significantly by 13,2 %, 16,8 % and 15,7 % (p < or = 0,001 in each case) during each of the three "CPAP" periods. In the portal venous area blood flow velocity decreased by 4,3 %, 8,8 % and 7,0 %, respectively, with a significant decrease only in the second "CPAP" interval (p < or = 0,005). After CPAP, changes returned to baseline within a few minutes. Heart rate and blood pressure showed no significant differences during the whole experiment. CONCLUSION: Parameters taken in both venous vascular areas of the liver show clear correspondence with the results of former studies, which have been determined by means of more invasive investigation methods. Maximum blood flow velocity seems to be useful for monitoring liver blood flow and its individual time course during CPAP, noninvasively and semiquantitatively. Further trials under conditions of controlled mechanical ventilation should be performed to optimize ventilation strategies for the critically ill.

Adult↗

[Is the renal excretion of orally applied diatrizoate (Gastrografin) a reliable marker of gastrointestinal perforation or dehiscence of a gastrointestinal anastomosis?].

PURPOSE: Renal excretion of orally or rectally applied Gastrografin is reported to be a reliable indicator of a perforation or a postoperative anastomotic dehiscence of the GI-tract. The study was conducted to determine whether increased attenuation of the urine measured by CT after oral or rectal application of Gastrografin can give reliable evidence of any leakage from the gastrointestinal tract. MATERIALS AND METHODS: Urine samples of 33 patients, who underwent a Gastrografin-enhanced fluoroscopic examination of the esophagus or the GI-tract for different clinical reasons, were examined by CT. The samples had been taken immediately before and 60 to 90 minutes after application of 100 ml Gastrografin. The results were compared with those of 5 healthy volunteers, who took urine samples before, 30, 60, 90, and 120 minutes after drinking 100 ml of Gastrografin. RESULTS: Maximal attenuation of the volunteers' urine samples was achieved 60 to 90 minutes after Gastrografin application with a mean of 50 Hounsfield units (HU), SD = 17 HU. The urine of three patients with radiologically proven fistula or dehiscence of a GI-tract anastomosis had no relevant increase in attenuation. Three other cases without any clinical or radiological evidence of an anastomotic leak had a substantial increase in the attenuation of the urine probes (87, 110, and 290 HU, respectively). CONCLUSION: The CT-measured urine samples as evidence of renal excretion of orally or rectally applied Gastrografin are not reliable for the detection of leaks from the GI-tract.

Administration, Oral↗

Sensitivity encoding (SENSE) for high spatial resolution time-of-flight MR angiography of the intracranial arteries at 3.0 T.

PURPOSE: 1) To evaluate feasibility of sensitivity encoding (SENSE) for high spatial resolution intracranial 3D time-of-flight (TOF) MR angiography at 3.0 T using a 1024 imaging matrix and 2) to compare image quality and diagnostic yield with 3.0 T TOF MRA without SENSE. METHODS: In a prospective study TOF MR angiography of the circle of Willis was performed with SENSE in 24 patients on a clinical whole body 3.0 T MR system (Intera, Philips Medical Systems, NL). In the SENSE protocol (S-MRA), a SENSE factor of 2.5 was used to shorten acquisition time and to increase the anatomic coverage (5:12 min.; 150 slices). A matrix of 832 x 572 was acquired and reconstructed to 1024 yielding a non-zerofilled voxel size of 0.30 x 0.44 x 1.00 mm(3) (0.13 mm(3)). Two readers were asked to review the images regarding the presence of vascular disease, and to rate, in consensus, the quality of the angiograms on a 5-point scale (5 = excellent through 1 = non-diagnostic). Results were compared with the results in 15 subjects who underwent intracranial TOF MRA at 3.0 T without SENSE (NS-MRA: acquisition time, 7:57 min.; 100 slices). Digital subtraction angiography (DSA) served as standard of reference in the 4/24 patients in whom vascular disease was identified. RESULTS: S-MRA at 3.0 T was judged to provide image quality that was adequate for diagnosis or better in 24/24. Median score of image quality of S-MRA and NS-MRA were 5 and 5, respectively. In the 4 patients with DSA correlation, a total of 8 pathologic findings (7 steno-occlusive diseases, 1 aneurysm) were correctly identified on S-MRA. CONCLUSION: The use of SENSE for intracranial TOF MRA at very high imaging matrix is feasible at 3.0 T. Compared to the imaging technique without SENSE, it allows TOF MRA with substantially reduced acquisition time, and with substantially increased anatomic coverage while maintaining image quality of NS-MRA.

Adolescent↗

[Gastric outlet obstruction in chronic granulomatous disease].

We report the case of a three year old dystrophic boy who suffered from vomiting, loss of weight and fever. In the history there were several episodes of severe infections which had repeatedly lead to hospitalisation. The cause of the actual disorder was a gastric manifestation of chronic granulomatous disease, which led by an inflammatory thickening of the gastric wall to a gastric outlet obstruction. Treatment with prednisone and gamma interferon normalised the thickness of the gastric wall and gastric outlet function. A prophylactic treatment with antibiotic and antifungeal agents was started. During the following 13 months no further severe infections were observed. We discuss incidence, kinds of manifestation, diagnostics and therapeutical options of the disease and give an overview of the literature.

Child, Preschool↗

[Aortic rupture in Behçet's disease].

Behçet's disease is a vasculitis of unknown aetiology, which becomes apparent by ocular and mucocutaneous symptoms. In rare cases, owing to vasculitis of the vasa vasorum of large arteries, necrosis of the vascular wall and thus spurious aneurysms occur. The case of a 41-year-old patient is described who presented with a rupture of an infrarenal aortic aneurysm due to Behçet's disease. Therapy consisted of placement of an aortic-aortic Dacron prosthesis. On the basis of the case report, the diagnostic approach, the therapy and the value of secondary prophylaxis of Behçet's disease are discussed.

Adult↗

Defective post-transcriptional processing of MUC2 mucin in ulcerative colitis and in Crohn's disease increases detectability of the MUC2 protein core.

Ulcerative colitis (UC) and, to a lesser extent, Crohn's disease (CD) are associated with a reduction of the protective mucus layer in the large intestine; the role of this alteration in the pathogenesis of either disease is, however, not clear. To learn more about the molecular mechanism of the alteration of the mucus layer, the expression of the main intestinal mucin, MUC2, was investigated in relation to inflammation and dysplasia. Formalin-fixed, paraffin-embedded biopsies from 70 patients with UC and 16 patients with CD, and 13 biopsies from normal colonic mucosa, were used for detection of MUC2 mRNA by in situ hybridization with the SMUC41 probe, and MUC2 protein by immunohistochemistry with the antibody CCP58. The steady-state concentration of MUC2 mRNA was not affected by UC or CD. By contrast, the amount of the detectable MUC2 protein, assessed as the immunoreactive score (IRS), was significantly (p<0. 0001) increased in UC (IRS=8.0+/-3.8) and CD (8.0+/-3.7), compared with the normal colonic mucosa (IRS=2.0+/-1.5). This alteration occurred in the inactive phase of inflammation and persisted in the active phase of the disease. It was also observed during bacterial or protozoal inflammation (n=7). The IRS values did not correlate with the grade of inflammation or dysplasia. Simultaneous histochemistry with high iron diamine and immunohistochemistry indicated that the increase of detectable MUC2 is concomitant with low mucin sulphation in the same cells. These data indicate that the strong MUC2 protein staining in colonic mucosa of patients with UC or CD is due to a long-term alteration of the post-transcriptional modification of the MUC2 molecule, leading to its better detectability by the anti-MUC2 antibody CCP58. This alteration, induced by the inflammatory process, may affect the gel thickness and may contribute to a protracted autoimmune response.

Acute Disease↗

[The MRT of focal liver lesions: the value of gadolinium-enhanced dynamic studies of the whole organ with a fast 3D-turbo-gradient echo sequence].

PURPOSE: To determine the value of a dynamic Gd-enhanced ultrafast T1-weighted 3D-turbo-gradient-echo sequence (3D-TFE) in the detection and characterization of focal liver lesions. MATERIALS AND METHODS: 51 patients with 124 focal liver lesions (35 hemangiomas, 30 HCC, 24 metastases, 22 cysts, 5 FNH/adenoma, 8 other lesions) were examined using a 1.5 T system. The dynamic 3D-TFE sequence, achieving 40 slices with a thickness of 4.5 mm in a 17-s breath-hold, was compared with a fat-suppressed T2-weighted fast-spin-echo sequence (TSE SPIR), unenhanced and Gd-enhanced T1-weighted spin-echo sequences (SE), and a T1-weighted gradient-echo sequence (FFE). RESULTS: On 3D-TFE images more lesions (107/124) were identified than on T1-weighted SE (101/124) and T1-weighted FFE images (106/124), but less compared to T2-weighted TSE SPIR images (115/124). The 3D-TFE-sequence provided additional information in 65/107 (61%) detected lesions by delineating the dynamic enhancement pattern, most valuable in patients with HCCs in 90%. CONCLUSIONS: On dynamic 3D-TFE images more lesions could be depicted than on conventional T1-weighted SE and T1-weighted FFE images. Visualization of the dynamic enhancement pattern provided additional information for tumor characterization in 61% of the detected lesions on the 3D-TFE images.

Artifacts↗

ET-1-induced pulmonary vasoconstriction shifts from ET(A)- to ET(B)-receptor-mediated reaction after preconstriction.

Endothelin-1 (ET-1) has been reported to induce pulmonary vasoconstriction via either ET(A) or ET(B) receptors, and vasorelaxation after ET-1 injection has been observed. Our study investigated the effects of ET-1 in isolated rabbit lungs, which were studied at basal tone (part I) and after preconstriction (U-46619; part II). Pulmonary arterial pressure (PAP) and lung weight gain were monitored continuously. In part I, ET-1 (10(-8) M; n = 6; control) was injected after pretreatment with the ET(A)-receptor antagonist BQ-123 (10(-6) M; n = 6) or the ET(B)-receptor antagonist BQ-788 (10(-6) M; n = 6). The same protocol was carried out in part II after elevation of pulmonary vascular tone. ET-1 induced an immediate PAP increase (DeltaPAP 4.3 +/- 0.4 mmHg at 10 min) that was attenuated by pretreatment with BQ-123 (P < 0.05 at 10 min and P < 0.01 thereafter) and that was more pronounced after BQ-788 (P < 0.01 at 10 min and P < 0.001 thereafter). In part II, ET-1 induced an immediate rise in PAP with a maximum after 5 min (DeltaPAP 6.3 +/- 1.4 mmHg), leveling off at DeltaPAP 3.2 +/- 0.2 mmHg after 15 min. Pretreatment with BQ-123 failed to attenuate the increase. BQ-788 significantly reduced the peak pressure at 5 min (0.75 +/- 0.4 mmHg; P < 0.001) as well as the plateau pressure thereafter (P < 0.01). We conclude that ET-1 administration causes pulmonary vasoconstriction independent of basal vascular tone, and, at normal vascular tone, the vasoconstriction seems to be mediated via ET(A) receptors. BQ-788 treatment resulted in even more pronounced vasoconstriction. After pulmonary preconstriction, ET(A) antagonism exerted no effects on PAP, whereas ET(B) antagonism blocked the PAP increase. Therefore, ET-1-induced pulmonary vasoconstriction is shifted from an ET(A)-related to an ET(B)-mediated mechanism after pulmonary vascular preconstriction.

Animals↗

[MRI, CT and CT arterial portography in the diagnosis of malignant liver tumors in liver cirrhosis].

PURPOSE: To determine the value of magnetic resonance imaging (MRI), computed tomography (CT) and CT arterial portography (CTAP) in detecting malignant liver lesions in cirrhosis patients. MATERIALS AND METHODS: The radiological examinations (CT, MRI and CTAP) of 47 patients suffering from cirrhosis having undergone an orthotopic liver transplantation (OLTX) were analysed retrospectively. The number of detected liver lesions was compared with the results of the histopathological findings after OLTX. RESULTS: 13/21, 11/18 and 7/12 of the malignant lesions were detected by MRI, CT and CTAP respectively. In MRI one false positive case was shown, two in CT and three in CTAP. Almost the same lesions were identified by all three procedures. The examination of the liver with MRI and CT and CTAP did not bring additional information. Most of the lesions that were missed were less than 2 cm in diameter. CONCLUSIONS: The rate of detection of HCC in patients with cirrhosis was about 60%. MRI and CT yielded similar results.

Adult↗

[Aortic rupture and retroperitoneal bleeding im Behcet disease].

Although retroperitoneal hemorrhage is a rather seldom complication of Behçet's syndrome it is in no way unusual. Younger patients in particular those from the eastern Mediterranean or east Asian regions in whom a retroperitoneal hemorrhage or an aneurysm in the aorto-iliaco-femoral flow region has be diagnosed must be considered for the differential diagnosis of Behçet's syndrome. The consequences for the surgeon are resection deep into healthy tissue and in general an appropriately close follow-up with strict avoidance of arterial angiography.

Aorta, Abdominal↗

Resilience, desistance and delinquent career of adolescent offenders.

This study examines resilience and desistance from delinquent behaviours and attempts to identify factors which predict persistent or increased or decreased delinquency between adolescence and early childhood. A sample of 363 young people was obtained from the population of five public institutions in 1987 and 1992. Their delinquent trajectories were described on the basis of legal records. These suggested that resilience is a rare phenomenon and is associated with stable relationships, absence of diagnostic label and good adaptation to the institution. Two axes were identified which can be used to describe the population, the family background and the psychological characteristics of the individual. Information which predicted desistance from a delinquent career was identified by means of a stepwise multiple regression. Analyses were conducted separately for each age group to take account of differences in time after the placement. The results indicated that there are important age-related differences in the characteristics which influence desistance or risk. They also show length of stay in an institution to be a predictor. Desistance from further delinquency seems to depend on the time spent in the residential environment associated with an increase of guilt, an improvement of self-image and of attachment to one or more other people.

Adolescent↗

[The nitinol stent as a palliative measure in inoperable carcinoma of the esophagus and cardia. Possibilities and limitations of the procedure].

Nitinol stents were used in ten patients as palliative treatment for carcinoma of the esophagus and the cardia. Following insertion of the stent the severity of dysphagia decreased on average from 3.2 to 1.5 (on a scale from 0-4). Difficulties with stent opening and passage through the gut were found particularly in the region of metal sutures at esophago-jejunal anastomoses. One stent, which had been obstructed by mucosal folds, had to be removed and replaced. One stent which had been incorrectly placed was extended by introducing a second stent by a coaxial technique. During the period of observation, six patients died after an average of 4.6 months. The palliative effect of the stent lasted on average for eleven weeks. In two patients the tumour grew beyond the stent and in three there was tumour growth into the stent.

Adenocarcinoma↗