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Biomedical subjects

P Prager

Publications and source records attributed to P Prager.

At least 19 recordsLinked to original sources
PubMed2001

[Rare complication of a heparin-induced thrombocytopenia type II].

HISTORY AND CLINICAL FINDINGS: A 63-year-old man was admitted to a surgery department with fracture of the acetabulum and luxation of the hip joint. Eight days after intracondylar nail-extension during subcutaneous heparin prophylaxis he developed a dramatic deterioration of his condition with severe abdominal pain and fever and was admitted to our hospital. INVESTIGATIONS: White cell count was 12,000/microliter, C-reactive protein 7.90 mg/dl. CT-scan, abdominal ultrasound, mesenteric angiography and exploratory laparotomy revealed no pathological findings. At day 13 abdominal ultrasound showed adrenal haemorrhages on the right. Together with a drop in platelet count below 50,000/microliter, adrenal haemorrhage caused by heparin-induced thrombocytopenia (type II; immunological [HIT II]) was suggested. THERAPY: After discontinuation of heparin and starting therapy with recombinant hirudin and hydrocortisone, a dramatic clinical recovery followed within 24 hours. One year after the initial diagnosis the patient is in a good condition. CONCLUSION: When abdominal pain, hypotension and fever occurs with a drop in platelet count during heparin therapy HIT II should be considered. An early diagnosis is essential for treatment of this life-threatening complication at an early stage.

Acetabulum↗
PubMed2000

Toxic shock syndrome associated with newly diagnosed type I diabetes.

Studies of two post-mortem pancreata of children at the onset of type I diabetes have suggested activation and expansion of islet infiltrating T cells by a superantigen. We present the first reported case of a superantigen mediated disease, toxic shock syndrome (TSS), occurring at the diagnosis of type I diabetes. A 12-year-old girl presented with TSS and newly diagnosed diabetes with ketoacidosis. At presentation she was unconscious, febrile and hypotensive, with a desquamating erythematous rash and Kussmaul breathing. During resuscitation, her renal impairment, diarrhoea, thrombocytopaenia and ketoacidosis resolved. Vaginal discharge and blood cultures grew Staphylococcus aureus. T cell studies at 2 weeks after diagnosis detected a high level of spontaneous and islet antigen-specific proliferation with associated interleukin-10 production compared to human leucocyte antigen DR matched controls.

Anti-Bacterial Agents↗
PubMed1990

Model of redox regulation of hyper- or hypothyreoidism.

Since the triiodothyronine (T3) shifts the tissue metabolism to oxidative direction, one should await that in hyperthyreoidism caused by T3 an oxidosis will be formed, whilst in hypothyreoidism called forth by subtotal thyreoidectomy, redosis will be emerged. However, according to our experiments these interrelationships proved to be inverse. These "paradoxal" changes of redox-state are the consequences of the flowing redox compensations elicited by the tissue redox-buffer capacity (RBC). The pathomechanism can be modelled with differential equation (computer analysis). The redox-state changes are characteristics in each tissues. Between the RBC of the tissue and the shift of redox-state potential (E'0) there is a negative correlation. As an autoregulatory mechanims, the redosis formed in hyperthyreoidism will increase the hormone synthesis in the thyroid gland, while the oxidosis after hypothyreoidism will decrease the synthesis. In other words, these processes strengthen each other. Changes of the heart frequency show correlation with the E'0, and can be described by differential equation. Our theoretical model for the redox regulation might answer also the question of the reversibility-irreversibility range of the autoregulation in the pathomechanism.

Animals↗
PubMed1986

[Intra-arterial DSA of the pelvic/leg vasculature using a 57 cm image intensifier].

100 consecutive intraarterial DSA's of the lower extremities obtained with a 57 cm image intensifier were evaluated retrospectively by 2 radiologists and 3 surgeons. The studies were considered diagnostic in 95% of the cases. The results, advantages and possible disadvantages are presented and compared to those associated with conventional film angiography and with i.v. DSA.

Angiography↗
PubMed1986

Computer processed fluoroscopic images for digital intravenous renal angiography.

We investigated intravenous digital angiography using computer processed fluoroscopic images. Computer processed fluoroscopy (CPF) was compared to conventional digital subtraction angiography (DSA) in 39 patients referred for renal vessel evaluation. For assessment of CPF the anterior-posterior images were compared with the corresponding digital subtraction angiograms. 79% percent of DSA and 71% of CPF studies were diagnostic. Peripheral injection of contrast medium caused deterioration of CPF images. Skin dose measurements were obtained in 24 patients. The median dose for DSA was 8.2 rad, compared to 1.1 rad for CPF. It is concluded that sophisticated algorithms should be investigated for digital angiography, so that high image quality can be achieved with a reduced radiation exposure.

Adult↗
PubMed1986

[Digital image intensifier radiography: imaging qualities and initial use in the gastrointestinal area].

We determined the quality of digital radiographs delivered by a large image intensifier (diameter 54 cm) and by a conventional fluoroscopic unit with a 33 cm image intensifier, and compared them to that of 100 mm spot films obtained from the same units. A special image processor was available allowing 25 images/s using a 512/512 matrix or 7.5 images/s with a 1024 X 1024 matrix. The spatial resolution of digital radiographs was well below that of the spot films, while no difference was found in contrast resolution. Images of colon specimens and gastrointestinal studies demonstrate that digital radiography does not imply a loss in diagnostic information inspite of the lower spatial resolution. Gastrointestinal studies using digital radiographs will reduce the amount of irradiation exposure of the patient and could represent an additional use for an existing equipment for DSA.

Colon↗
PubMed1985

[1 year's experience with a 57-cm image intensifier in a universal roentgen work station].

3342 patients were examined by means of a 57 cm image intensifier during one year. The installation permits examination with the patient standing or lying. The resolution was measured with a lead grid under conditions resembling actual practice and were found to be similar to those obtained with angiographic equipment. Using a medium format technique for examining the gut and vascular system resulted in radiographic quality which was not significantly different from the use of a large format technique. For examination of the skeleton, radiographic quality, using the intensifier, was markedly poorer than that resulting from Bucky examinations. There was no diagnostic difference when carrying out lymphograms. The large intensifier window of 53 cm was particularly advantageous for DSA of the pelvic and lower limb vessels when compared with smaller intensifiers. Possible savings of film and contrast medium costs are discussed.

Adult↗
PubMed1985

[Experimental and clinical determination of renal size after intravenous and intra-arterial administration of ionic and non-ionic contrast media].

A quantitative comparison of changes in renal size after the intravenous injection of contrast media showed no difference between ionic and non-ionic contrast medium. Contrast media of similar osmolarity (Metrizamide and Ioxaglate with 470 and 490 mosn/kg H2O) did show significant variations. Evidently properties of the contrast medium, other that their osmotic behaviour, are of significance (chemical structure, viscosity, iodine content, specific toxicity, and the effect on the permeability of biological membranes, calcium-binding activity, effect on coagulation). Changes in renal size could be reproduced by repeating the contrast injection at 24 to 48 hours.

Animals↗
PubMed1985

[Contribution of digital subtraction angiography to the diagnosis of rejection reactions after kidney transplantation].

The ability to diagnose rejection changes in renal transplants using DSA was evaluated retrospectively taking intrarenal vascular changes into consideration. The findings obtained with DSA were compared to those of scintigraphy in 26 graft recipients, on whom both methods had been performed within a narrow time period for evaluation of hypertensive disease. The scintigraphic diagnosis was based on function and perfusion studies. The intrarenal vascular tree was demonstrated on DSA better by intraarterial than by intravenous contrast media injection, however both techniques delivered useful diagnostic information. The status of the graft was evaluated with comparable results by DSA and scintigraphy in 73% of the cases. In our experience, functional effects produced by morphological changes demonstrated by DSA, can be defined better with the help of scintigraphy. On the other hand, by performing DSA it is possible to clarify morphologically functional findings, which may be detected by scintigraphy but often are diagnostically nonspecific. The availability of both morphological and functional data increases the diagnostic accuracy which can be obtained with these two low invasive procedures in the assessment of vascular changes in renal transplants.

Adolescent↗
PubMed1985

[Causes of hypertension following kidney transplantation with special reference to arterial stenoses].

Hypertension is regarded as a significant complication in renal transplant recipients. Its frequency was 48,1% after cadaver donor and 40,6% after living donor transplantation. The etiology is multifactorial. A correlation could be demonstrated between blood pressure and graft function or presence or absence of the diseased kidneys while no influence was found with regard to steroid dosage in patients with long term graft function. After 575 renal transplantations with 147 angiographies arterial stenoses were observed in nine patients (1,6%) and corrected surgically.

Adolescent↗
PubMed1985

[Results of transvenous digital subtraction angiography with a 57 cm image intensifier in circulatory disorders of the lower extremities].

The size of conventional image intensifiers is a limiting factor in performing transvenous digital subtraction angiography of the lower extremities. The results of transvenous digital subtraction angiography using a 57 cm image intensifier on 205 patients with vasoocclusive disease of the legs are presented. Two exposed fields sufficed in most cases for demonstration of all arteries, from the aortic bifurcation to the trifurcation at the lower leg. The principal advantages were the reduction of the contrast medium volume and the decrease in examination time. The reduced resolving power was a limiting factor in evaluating discrete wall lesions and of small vessels, but this did not induce diagnostic difficulties. The studies were evaluated retrospectively by an experienced vascular surgeon and in 85% of the cases were considered to be of diagnostic value.

Adult↗
PubMed1984

Digital subtraction angiography in the preoperative evaluation of patients with a renal tumor.

Inguinal intravenous digital subtraction angiography (DSA) was performed in 14 patients referred for preoperative evaluation of a renal tumor previously diagnosed by CT and ultrasound. Conventional cavography and aortography were used as reference methods for comparison. Both DSA and conventional angiography were carried out following selective arterial injection to the abnormal kidney. The diagnostic value of DSA in examination of the inferior vena cava was generally comparable to that of conventional cavography. Intravenous aortography was unsuccessful in 2 patients due to motion artifacts. In all other patients, the information provided by DSA regarding the aorta, renal arteries and renal veins was similar to that of conventional aortography. Intrarenal vascular detail, however, was far superior on conventional films and was only useful with DSA when intra-arterial injection was implemented. In one of the 12 diagnostic examinations, localization of the renal mass could not be established by intravenous DSA, but was possible in all others. The inguinal approach advocated permits simultaneous inferior vena cavography and intravenous aortography with one single injection of contrast medium; the method is less traumatic than aortography , and does not require hospitalization of the patient. DSA may also be of value in those cases still requiring selective catheterization of the renal arteries, i.e. for angiotherapy . Intra-arterial DSA then allows reduction of the amount of contrast medium and a rapid processing of the images without detriment to the quality of the examination.

Aged↗
PubMed1984

[Supine thoracic images with a mobile roentgen unit: comparison between the soft-ray and hard-ray technics].

To compare the influence of kilovoltage on the quality of supine chest roentgenograms obtained with a mobile x-ray unit, we examined the films of 50 patients on whom supine chest radiographs had been taken incidentally within a period of 24 hours both with high and with low-kVp technique. For evaluation of the image quality, a total of 11 criteria were compared and quantitated by 5 observers using a simple score method. The same advantages that have been attributed to the high-kVp technique on upright films were found on the corresponding supine examinations. These films showed a more balanced penetration and greater sharpness than those taken with low-kVp. The wider latitude of the high-kVp technique simplifies the exposure, and fewer repeat takes will therefore be necessary. The diagnostic gain outweights the few disadvantages, which are mostly coupled to the increase in scattered radiation. This, as well as the availability of more powerful and efficient mobile generators, should promote routine application of high-kVp technique for supine chest examinations.

Humans↗
PubMed1982

Detection of neoplastic lymph node involvement in the retroperitoneal space. Diagnostic value of CT, echography and lymphography.

The diagnostic value of echography, computerized tomography and lymphography in the detection of infiltrating retroperitoneal lymph nodes was assessed in a prospective study. Ninety-six patients suffering from Hodgkin's disease, non-Hodgkin lymphoma, seminomatous and and non-seminomatous tumours of the testis were examined with all three methods. Sixty-two (30 non-seminomas, 32 Hodgkin's diseases) had an exploratory laparotomy at least one week after the diagnostic examinations. Sensitivity and specificity were assessed on the basis of the pathohistological findings. The sensitivity was 92% for CT, 79% for echography and 83% for lymphography. The specificity was 89% for CT, 95% for echography and 84% for lymphography. The presented findings suggest that a re-evaluation of the diagnostic strategy in assessment of lesions involving retroperitoneal lymph node is required.

Humans↗
PubMed1981

Spontaneous pneumatocele during radiation of a giant meningosarcoma.

A man, aged 66 years, sustained a pneumatocele after radiotherapy for a frontabasal meningeal sarcoma. There was improvement initially, but a fall was experienced without injury to the head and the condition worsened. X-rays of the skull revealed a pneumatocele which was treated conservatively and disappeared within 4 weeks. The literature on spontaneous pneumatocele is reviewed briefly and the etiology discussed.

Aged↗