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Biomedical subjects

M Körner

Publications and source records attributed to M Körner.

At least 19 recordsLinked to original sources
PubMed2006

TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system.

The need for standards in the management of patients with endocrine tumors of the digestive system prompted the European Neuroendocrine Tumor Society (ENETS) to organize a first Consensus Conference, which was held in Frascati (Rome) and was based on the recently published ENETS guidelines on the diagnosis and treatment of digestive neuroendocrine tumors (NET). Here, we report the tumor-node-metastasis proposal for foregut NETs of the stomach, duodenum, and pancreas that was designed, discussed, and consensually approved at this conference. In addition, we report the proposal for a working formulation for the grading of digestive NETs based on mitotic count and Ki-67 index. This proposal, which needs to be validated, is meant to help clinicians in the stratification, treatment, and follow-up of patients.

Biomarkers, Tumor↗
PubMed2006

Development of an accelerated MSCT protocol (Triage MSCT) for mass casualty incidents: comparison to MSCT for single-trauma patients.

During multiple casualty incidents (MCI) emergency radiology departments have to deal with a large number of patients with suspected severe trauma within a short period of time. The aim of this study was to develop a suitable accelerated multislice computed tomography (MSCT) protocol to increase patient throughput for this kind of emergency situation. We presumed a scenario of 15 patients being admitted to the trauma service with suspicion of severe injuries after a MCI over a period of 2 h. An accelerated Triage MSCT protocol was developed and evaluated for MSCT scanner productivity (patients per hour) and time (minutes) needed for a total MSCT body workup using an anthropomorphic phantom. In addition, time (minutes) for transfer and preparation was measured. These timeframes were compared to a control group consisting of 144 single patients with multiple trauma undergoing standard MSCT according to our trauma room protocol. All MSCT studies were conducted using a 4-detector row scanner. (1) For the study group (Triage MSCT), average time for patient transfer and preparation was 2.9 min (2.5-4.3 min), mean CT examination time was 2.1 min (1.7-2.4 min); image reconstruction took 4.0 min (3.3-4.3 min). Total time in scanner room was 8.9 min (7.7-11.3 min), resulting in a maximal productivity of 6.7 patients per hour. Image transfer to the digital picture archive and communication system archive was completed after an average 9.5 min (8.9-10.8 min). (2) For the control group (single casualty MSCT), the mean time for patient transfer and preparation was 20.4 min (9.0-39.2 min), mean examination time was 6.0 min (3.1-11.3 min). Times for image reconstructions were not recorded in the patient series. Mean total time in scanner room was 25.3 min (11.0-72.4 min), resulting in a patient throughput of 2.4 patients per hour. MSCT has potential to serve as a powerful tool in triage of multiple casualty patients. The introduction of a Triage MSCT scanning protocol resulted in an increase of patient throughput per hour by a factor of almost 3.

Clinical Protocols↗
PubMed2006

[Tension pneumopericardium--a rare complication in multiply injured patients].

Thoracic injury is a relevant and common complication in multiply injured patients. Typical patterns of injury comprise rib fractures, serious lung trauma as well as diaphragmatic and aortic rupture. In contrast, posttraumatic tension pneumopericardium following blunt thoracic trauma is a very rare complication. However, if unrecognized it might provoke cardiac tamponade and death. For the development of a pneumopericardium, free air follows the vessel bundles up to the pericardium. Hence, if the number of ruptured alveoli is high, or these alveoli are placed close to the heart, and if additional risk factors, such as high inspiratory ventilation pressure, are present, a tension pneumopericardium can induce cardiac tamponade. The aim of this report is to illuminate diagnostic and therapeutic strategies for posttraumatic pneumopericardium by presentation of a case from our trauma centre and a critical discussion of the present literature.

Humans↗
PubMed2006

[Soft tissue manifestations of early rheumatic disease: imaging with MRI].

PURPOSE: The aim of this study was to evaluate typical magnetic resonance imaging (MRI) findings in early rheumatic diseases manifesting at the soft tissues of the hand using a retrospective analysis. MATERIAL AND METHODS: A total of 186 MRI examinations of patients with clinical suspicion of a rheumatic disease were evaluated in a consensus reading by two experienced radiologists. All imaging patterns were assessed with respect to their type and localization. Under blinded and non-blinded conditions diagnoses were correlated with final clinical diagnosis. RESULTS: The most frequent diagnoses were rheumatoid arthritis (RA, 45.7%) and psoriatic arthritis (PsA, 15.6%). The mean correlation between clinical and MRI diagnosis (r) was 0.75 in blinded and 0.853 in non-blinded reading (p <0.001). The following extra-articular imaging patterns were found: synovitis (59.1%), tendovaginitis (91.4%), dactylitis (14.5%), and bone marrow edema (18.3%). Only dactylitis was specific for a particular rheumatic disease (PsA; r=0.934; sensitivity 84.9%, specificity 82.4%). CONCLUSION: Inflammatory conditions of the hand can be reliably detected with MRI. In many cases the definite diagnosis can only be made when taking clinical, serological, and radiographic results into account (+13.7% increase of significance).

Adult↗
PubMed2006

[Comparison of different review displays with respect to the detection of low-contrast details in digital radiographs].

PURPOSE: Assessment of low-contrast details in digital radiographs on different review displays (RD). MATERIALS AND METHODS: 20" flat screen panels (RD1: standard color LCD-TFT, RD2: monochrome LCD-TFT for radiological reading, RD1*: RD1 with optional image inversion; 205 cd/m (2) luminance, respectively) were evaluated. At 30 lx ambient lighting, 10 radiologists gradually increased the contrast (constant steps) for both a homogeneous picture and a cutout of a thorax radiography of n = 480 simulated nodules until they became recognizable. RESULTS: In the case of bright nodules on an anthropomorphic background, the use of image inversion produced significantly better results. No other significant differences were detected. CONCLUSION: Provided that the working environment is not bright, the results suggest that low-cost RD can be used for the recognition of low-contrast details in radiographies of the chest. Further studies including more display models are necessary. Among different ambient lighting and luminance settings, these studies should include a closer analysis of the special features of digital systems such as brightness/contrast adaptation, picture enlargement (zoom shot), and image inversion.

Equipment Design↗
PubMed2005

Retinoid receptors in ovarian cancer: expression and prognosis.

BACKGROUND: Ovarian cancer is frequently lethal despite aggressive multimodal therapy, and new therapies are therefore needed. Retinoids are potential candidate drugs: they prevent the development of ovarian carcinoma and enhance the efficacy of cytotoxic drugs in ovarian cancer cells. At present, little is known about the retinoid receptor expression in ovarian cancer. PATIENTS AND METHODS: The retinoid receptors comprise two classes, retinoic acid receptors (RARs) and retinoid X receptors (RXRs), each with three subclasses, alpha, beta and gamma. We investigated the expression of the subtypes RARalpha, RARgamma, RXRalpha and RXRbeta by immunohistochemistry in ovarian cancers of 80 patients, and assessed their prognostic significance. In addition, we quantified the expression of retinoid receptor mRNA using real-time PCR and correlated the results with clinical characteristics. RESULTS: RARalpha and RXRbeta were highly expressed in a majority of ovarian cancers, particularly in advanced stages. High expression of RARalpha was an independent negative prognostic factor of survival in addition to FIGO stage, age and p53 accumulation. The mRNA expression of retinoid receptors did not correlate with clinical properties of the tumors. CONCLUSIONS: Retinoic acid receptors are frequently and strongly expressed in epithelial ovarian cancer and may be indicators of an adverse prognosis. This study provides the molecular basis for the therapeutic use of retinoids in ovarian cancer.

Aged↗
PubMed2005

Initial clinical results with a new needle screen storage phosphor system in chest radiograms.

PURPOSE: To evaluate image quality and anatomical detail depiction in dose-reduced digital plain chest radiograms using a new needle screen storage phosphor (NIP) in comparison to full dose conventional powder screen storage phosphor (PIP) images. MATERIALS AND METHODS: 24 supine chest radiograms were obtained with PIP at standard dose and compared to follow-up studies of the same patients obtained with NIP with dose reduced to 50 % of the PIP dose (all imaging systems: AGFA-Gevaert, Mortsel, Belgium). In both systems identical versions of post-processing software supplied by the manufacturer were used with matched parameters. Six independent readers blinded to both modality and dose evaluated the images for depiction and differentiation of defined anatomical regions (peripheral lung parenchyma, central lung parenchyma, hilum, heart, diaphragm, upper mediastinum, and bone). All NIP images were compared to the corresponding PIP images using a five-point scale (- 2, clearly inferior to + 2, clearly superior). Overall image quality was rated for each PIP and NIP image separately (1, not usable to 5, excellent). RESULTS: PIP and dose reduced NIP images were rated equivalent. Mean image noise impression was only slightly higher on NIP images. Mean image quality for NIP showed no significant differences (p > 0.05, Mann-Whitney U test). CONCLUSION: With the use of the new needle structured storage phosphors in chest radiography, dose reduction of up to 50 % is possible without detracting from image quality or detail depiction. Especially in patients with multiple follow-up studies the overall dose can be decreased significantly.

Adult↗
PubMed2005

[ICF and social medicine evaluation of capability of gainful activity: is everything clear?--a discussion article].

The ICF (International Classification of Functioning, Disability and Health) calls attention to the complexities associated with disturbances of health. The question raised is how the various constituents and the resulting network as defined by this Classification can gain importance for medical expertise under the statutory pension insurance scheme concerning work-related capacity. Possible variations of strategy are discussed: clinical intuition, algorithmic pathways, proved medical diagnostics, particular diagnostics of activity according to ICF. A genuine "silver bullet" is not in evidence thus far. It cannot be expected that diagnostics relating to a certain sector of the ICF will basically eclipse the rest. Future standards of medical expertise should specify as clearly as possible the impact of the diverse diagnostic findings on the assessment of work-related capacity. Framing emphasis in this way cannot be performed by the ICF on its own.

Activities of Daily Living↗
PubMed2004

[Priority-oriented shock trauma room management with the integration of multiple-view spiral computed tomography].

In major trauma it is essential to immediately recognize and treat life-threatening problems and conditions. Most trauma protocols reserve the use of computed tomography for the secondary survey, as patients cannot be attended to during the examination and must be transferred from the emergency room to the CT suite. The relevant reduction in the scanning time of multidetector computed tomography (MDCT) or multislice computed tomography (MSCT) justifies its use as the major diagnostic adjunct for primary trauma survey and initial resuscitation. According to our ATLS((R))-based trauma algorithm, the multidetector scanner situated in the emergency department is utilized immediately after the correction of respiratory problems to detect causes of bleeding or intracranial hematomas. In a prospective series a total of 125 consecutive major trauma patients were evaluated. After focused sonography in trauma (FAST) and plain chest films in intubated patients, whole body MDCT was performed. By retrieving data from our trauma registry and a picture archiving and communication system (PACS), time from trauma room admission to the end of head CT scan for the entire MDCT study and calculation of multiplanar reconstruction (MPR) was analyzed. Additionally, relevant complications such as untreated tension pneumothorax or circulatory arrest during MDCT examination were recorded. The time from admission to the trauma room until completion of head CT scan without contrast was 21:12 min (median, IQR 18:13-27:52). The entire contrast-enhanced MDCT study, including pilot scan and contrast application, required 6:08 min (median, IQR 4:33-8:14) with a total scanning time of 0:59 min (median, IQR 0:55-1:03). MPR calculation of the spine and bony pelvis was performed in 11:37 min (median, IQR 8:03-16:41). A relevant life-threatening complication due to CT scanning during primary trauma survey was not observed in the 125 cases (0/125 CI 95% 0%-3%). Complete diagnostic imaging can be performed within 30 min after trauma room admission by using MDCT. During the primary survey, treatment of the patient is interrupted just for the few minutes of the CT scan and contrast application. An adequate survey of injuries can be achieved earlier and a targeted therapy can be initiated ahead of time. Integration of MDCT scanners in the primary trauma survey provides a high standard of imaging in a very short time without endangering the patient. When dealing with multiple casualties, MDCT could be used also as an accurate and time-efficient means of hospital triage to diagnose and prioritize patients and to plan further surgical interventions and intensive care.

Critical Care↗
PubMed2004

[Teamwork and team success in multi- and interdisciplinary teams in medical rehabilitation].

Multidisciplinary or interdisciplinary team models are often used to describe teams in medical rehabilitation. There is only little evidence whether these models are used in the daily routine of medical rehabilitation and to what extent the quality (team work) and effectiveness (team success) differ between the models. For the present study an interview guide was designed to assess the team models. In each of the six clinics phone interviews were conducted with one member of the management. Data on teamwork and team success were collected with a staff questionnaire. The questionnaires were distributed to all employees (n = 266; response rate n = 127, 48%) of the six teams. Two teams were classified as interdisciplinary teams and four teams as multidisciplinary. The comparison between the two models shows better results for the interdisciplinary team model. Several methodical restrictions (e. g. unconsidered moderator variables, representativeness of the sample) need to be considered. Systematic analyses of teamwork as presented are essential to identify the conditions of successful teamwork and also form the basis for implementation of team development measures in medical rehabilitation.

Data Collection↗
PubMed2003

Clinical significance of human intestinal spirochetosis--a morphologic approach.

Intestinal spirochetosis (IS) is a condition defined morphologically by the presence of spirochetal microorganisms attached to the apical cell membrane of the colonic and rectal epithelium. Intestinal spirochetes comprise a heterogeneous group of bacteria. In humans Brachyspira aalborgi and Brachyspira pilosicoli predominate. Prevalence rates of IS are low where living standards are high, in contrast to poorly developed areas where IS is common. Homosexuals and HIV-infected individuals are at high risk of being colonized. Clinical significance in individual cases has remained unclear up to now. A review of the literature reveals that invasion of spirochetes beyond the surface epithelium is associated with gastrointestinal symptoms which respond to antibiotic treatment (metronidazole), whereas patients lacking this feature are mostly asymptomatic. Homosexual and HIV-positive men are more likely to be symptomatic irrespective of invasion. Rare cases of spirochetemia and multiple organ failure have been reported in critically ill patients.

Bacteremia↗
PubMed2002

[Hexadactyly of hand and feet in a patient with basal cell nevus syndrome].

A 35-year-old male patient with hexadactyly on the right hand and both feet presented with multiple basal cell carcinomas of the skin. The results of further investigations led to the diagnosis of basal cell nevus syndrome (BCNS). The basal cell nevus syndrome (Gorlin-Goltz syndrome) characterized by multiple basal cell carcinomas, odontogenic cysts, skeletal abnormalities and associated neoplasms belongs to the group of genodermatoses. Reviewing the current literature we discuss aspects of the pathogenesis of the basal cell nevus syndrome as well as diagnosis criteria and treatment options.

Acitretin↗
PubMed2002

[Focal secondary malignant liver lesions: MnDPDP-enhanced MRT at 0.2 tesla vs. helical CT-arterioportography].

PURPOSE: Prospective evaluation of the efficacy of MnDPDP- enhanced MRI using an open low-field scanner for the detection of focal malignant liver lesions in comparison with helical CT- arterioportography (CT AP). MATERIAL AND METHODS: As part of a phase III study, 27 consecutive patients we enrolled for comparison, with seven patients later eliminated for failing the inclusion criteria. Native and MnDPDP-enhanced MRI of the liver at a field-strength of 0.2 Tesla (Siemens Magnetom Open) and DSA with helical CT AP (Siemens Somatom Plus 4) were performed within one week. The lesions were compared collectively and after categorization by size: (a) < 1 cm, (b) 1 - 2 cm, and (c) > 2 cm. For statistical evaluation, the sign test with a significance level of p < 0.05 was used. RESULTS: CT AP depicted 114 lesions, whereas native MRI detected 62 and MnDPDP-enhanced MRI revealed 69 lesions. Significant differences were shown for collective comparison and for selective comparison of category (b), and of categories (a) and (b) combined. No significant differences were found between native and contrast-enhanced MRI. CONCLUSION: MnDPDP should be reserved for high-field strengths since low field strengths cannot be expected to confirm or exclude malignant liver lesions reliably.

Adult↗
PubMed2001

Novel anti-inflammatory effects of the inhaled corticosteroid fluticasone propionate during lung myofibroblastic differentiation.

Asthma is characterized by an irreversible subepithelial fibrosis with the appearance of myofibroblasts, which can be now considered important early participants in inflammatory responses as well as potential targets for anti-inflammatory drugs. In this study, we show that fluticasone propionate (FP), a powerful inhaled corticosteroid (ICS), displays novel anti-inflammatory effects on human lung fibroblasts during their myofibroblastic differentiation. Indeed, FP inhibits in lung myofibroblasts, at a very early stage of differentiation, the activation of Janus kinase/STAT pathways induced by IL-13 (tyrosine kinase 2, STAT1, STAT3, STAT6, mitogen-activated protein kinase). Contrarily, in mildly or fully differentiated myofibroblastic cultures, FP still displays a potential anti-inflammatory activity even if it only inhibits tyrosine kinase 2 phosphorylation. Moreover, FP inhibits constitutive and TGF-beta-induced expression of alpha-smooth muscle actin, the main marker of myofibroblastic differentiation, both in very early and in mild differentiated myofibroblasts. Finally, FP displays an additional powerful anti-inflammatory effect, decreasing nuclear translocation of NF-kappaB independent of the degree of myofibroblastic differentiation. These data 1) suggest that myofibroblasts are priority targets for ICS, which is able to revert them to a normal phenotype even if they appear to be already engaged in their differentiation, and 2) may help to explain why asthma is improved by an early ICS treatment, whereas advanced asthma is more resistant to these drugs.

Actins↗