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T Krause

Publications and source records attributed to T Krause.

At least 37 records · Page 2Linked to original sources
PubMed2000

[New developments in diagnosis of coronary heart disease--3D fusion image].

The interpretation of three-dimensional (3D) structures of the coronary tree and the myocardium by a clinician demands a subjective visual integration of two-dimensional (2D) images of cardiac diagnostic procedures like coronary angiography and myocardial scintigraphy. Although in the conventional analysis of 2D display scintigraphic myocardial perfusion segments are arbitrarily assigned to three major coronary artery systems, the standard myocardial perfusion distribution territories correspond with the individual pathologic-anatomic coronary tree in only 50-60% of the patients. Hence, the mental integration of both 2D images of coronary angiography and myocardial scintigraphy does not necessarily allow an accurate assignment of particular myocardial perfusion regions to the corresponding vessels. For an objective assignment of each vessel segment of the coronary tree to the corresponding myocardial regions, we have developed a 3D "fusion image" technique and applied it to patients with coronary artery disease. Cause-and-effect relationships may be more obvious with 3D data fusion and may enable an easier comparison of anatomy and physiology. Preliminary results demonstrate that our newly developed 3D fusion image is useful for accurate assignment of coronary vessel segments to the corresponding myocardial perfusion regions and suggest that it may allow the clinician a comprehensive and accurate assessment of the patient's myocardial status.

Coronary Angiography↗
PubMed2000

A randomized comparison of the effects on vaginal and cervical epithelium of a placebo vaginal ring with non-use of a ring.

Little is known about the effects of contraceptive vaginal rings on the vaginal surface epithelium, although most studies have not demonstrated any significant deleterious effect. However, one study found that some medium-to-long-term levonorgestrel-releasing ring users developed chronic erythematous and ulcerative lesions in the posterior vaginal fornix. Subsequently, this ring was completely redesigned (IVR-2) with different dimensions and much greater flexibility. The first version of IVR-2 was designed as a placebo ring to explore effects on the vagina and cervix without addition of a progestogen. One-hundred-sixty-six healthy sexually active women volunteers were recruited in four centers and randomly assigned for 6 months to either placebo ring use or control (non-use) using a predetermined randomization code generated by WHO in a 2:1 ratio. Careful inspections of the vaginal and cervical epithelium were performed with a colposcope at admission and at 2-month intervals. No clinically significant lesions were detected in any center either among ring users or controls. However, a number of minor changes in appearance of the vaginal and cervical epithelium (erythema, petechiae, ecchymosis, and minor aceto-white changes) were described from the Sydney Center, some of which were present on admission and some of which were found on subsequent examination. Ten of eleven "red" changes on the cervix and vagina were noted in IVR-2 users, and only one in the controls, suggesting a contribution by the IVR-2 to minor epithelial surface changes. Five of ten resolved completely with continued ring use. There was no correlation in this study between epithelial changes and cigarette smoking or frequency of intercourse in the 14 days prior to colposcopic examination but a significant relationship between tampon use in the last 7 days and all epithelial changes (p = 0.05) and especially red changes (p = 0. 027) was noted. Red changes were significantly less likely to be found among condom users (p = 0.007). The IVR-2 placebo ring did not produce clinically significant changes in the vaginal epithelium and cervical mucosa and a carefully controlled and randomized study should be considered to compare the epithelial appearances in women using a placebo IVR-2 and one releasing 20 microg levonorgestrel.

Biopsy↗
PubMed2000

A comparison of inhaled nitric oxide and milrinone for the treatment of pulmonary hypertension in adult cardiac surgery patients.

OBJECTIVE: To investigate the relative effects of milrinone and nitric oxide on pulmonary and systemic hemodynamic responses in cardiac surgery patients with a history of pulmonary hypertension. DESIGN: Prospective and randomized. SETTING: University hospital. PARTICIPANTS: Forty-five adult cardiac surgery patients. INTERVENTIONS: Cardiac surgery patients with pulmonary hypertension were randomly assigned to one of three study groups: Group 1 patients (n = 15) were treated with intravenous milrinone on separation from cardiopulmonary bypass, group 2 patients (n = 15) with 20 ppm of inhaled nitric oxide, and group 3 patients (n = 15) with 40 ppm of inhaled nitric oxide. Heart rate, right ventricular ejection fraction, and pulmonary vascular resistance were measured throughout the perioperative period at specific data points. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in demographics, anesthesia, surgery, or baseline hemodynamics among the groups. The group receiving 40 ppm nitric oxide had a significantly higher (p<0.05) right ventricular ejection fraction on arrival in the intensive care unit (40% v. 30% for the milrinone group and 33% for the nitric oxide 20 ppm group). The milrinone group required significantly more phenylephrine in the intensive care unit (p<0.05). CONCLUSIONS: Treatment of pulmonary hypertension in adult cardiac surgery patients with inhaled nitric oxide compared with milrinone is associated with lower heart rates, higher right ventricular ejection fraction, and a lower requirement for treatment with vasopressor agents.

Administration, Inhalation↗
PubMed2000

[Non-invasive diagnostic procedures for heart failure: echocardiography, myocardial perfusion scintigraphy and radionuclide ventriculography].

Even though the diagnosis of heart failure can often be made at bedside from the patient's history and a thorough physical examination, some mechanical examinations are needed to objectify the clinical symptoms. Due to the chronic and progressive character of heart failure with repeated periods of clinical treatment, non-invasive and reproducible methods are of great importance. Thanks to technical progress in data-acquisition and -processing, echocardiography has become one of the most important diagnostic tools in clinical cardiology. Many questions associated with the diagnosis and treatment of heart failure can be answered with the aid of the wide spectrum of echocardiography, including morphological description in conventional M- or B-Mode and functional analysis based on Dopplertechnique. On the other hand well-established nuclear techniques like myocardial perfusion scintigraphy and radionuclide ventriculography profit from recent technical development. In addition, the modification, specification and standardisation of examination protocols improve the diagnostic reliability of nuclear medical techniques. Performed by a specialist, both principles of examination--ultrasound and scintigraphy--are valid in the diagnosis of heart failure and in therapy-management.

Cardiac Output, Low↗
PubMed2000

Inositol 1,4,5-trisphosphate synthesis in mononuclear white blood cells of malignant hyperthermia-susceptible and normal human beings, following in vitro exposure to halothane, caffeine and ryanodine.

Despite a plethora of findings associated with the pathophysiology of malignant hyperthermia (MH), the in vitro contracture test (IVCT) is the only reliable test for diagnosis of this heterogeneous syndrome in man. An increase of 1,4,5-IP3 (inositol 1,4,5-trisphosphate), a second messenger involved in cellular calcium homeostasis, has been observed in muscle tissue of MH susceptible (MHS) patients. The aim of this study was to evaluate if the known differences of 1,4,5-IP3 content in muscle tissue might be reproduced in mononucleated white blood cells (MWBCs). Subsequently, MWBCs of 23 healthy controls and 12 patients with a clinical suspicion for MH disposition were isolated and screened for 1,4,5-IP3 content. An IVCT according to the protocol of the European Malignant Hyperpyrexia Group (EMHG) was performed on muscle specimens of 12 patients. Eight MHN and four MHS individuals were diagnosed. Additionally, 1,4,5-IP3 synthesis in MWBCs was detected following in vitro exposure to IVCT test substances halothane (2%), caffeine (1-30mM), and ryanodine (1-5 microM). A broad inter-individual variability of 1,4,5-IP3 content was observed in MWBCs of all volunteers, but no differences were detected between MHS and MHN individuals. These findings are in strong contrast to those observed in muscle tissue. In vitro exposure of isolated MWBCs to halothane, caffeine and ryanodine yielded no statistically significant differences between groups. A time- and concentration-dependent increase in cellular 1,4,5-IP3 content could be induced in some but not all individuals of both groups. Since no correlation was obtained between induction of 1,4,5-IP3-synthesis following in vitro exposure of MWBCs to MH test substances and MH disposition, this study was terminated. We conclude from our data that the detection of 1,4,5-IP3 synthesis in MWBCs is not suitable for diagnosis of MH disposition. It remains questionable whether an altered 1,4,5-IP3 metabolism in MWBCs is involved in pathologic cascades of MH. Therefore, other cell tissues should be evaluated in further studies to clarify the role of the 1,4,5-IP3 metabolism in MH.

Anesthetics, Inhalation↗
PubMed2000

A prospective comparison of three heat preservation methods for patients undergoing hypothermic cardiopulmonary bypass.

OBJECTIVE: To prospectively compare 3 methods of body heat preservation in patients undergoing surgery requiring the use of hypothermic cardiopulmonary bypass (CPB). DESIGN: Prospective, randomized, and nonblinded. SETTING: University teaching hospital. PARTICIPANTS: Adult cardiac surgery patients (n = 101). INTERVENTIONS: Subjects were randomly assigned to 1 of 3 treatment groups: Group 1 (n = 33) used a fluid-filled warming blanket, group 2 (n = 31) used a heated and humidified breathing circuit, and group 3 (n = 37) used intravenous fluid warmers for the administration of all fluids. Treatments started on separation from CPB and concluded at the end of the intraoperative experience. Anesthetic technique, minute ventilation, conduct of CPB, and room temperature in the operating room were standardized. MEASUREMENTS AND MAIN RESULTS: Blood temperature was measured at its nadir on CPB, on separation from CPB, and just before departure from the operating room. No differences were found among groups for CPB duration, coldest venous temperature on CPB, rewarming time, rate of rewarming, room temperature, or blood temperature on separation from CPB. There were no significant differences found in post-CPB temperature afterdrop among groups. CONCLUSIONS: This study suggests that there is no statistically significant disparity in the effectiveness of these 3 intraoperative heat preservation methods. Ease of use and cost-effectiveness should guide the choice of warming method post-CPB.

Adult↗
PubMed1999

Fusion imaging: combined visualization of 3D reconstructed coronary artery tree and 3D myocardial scintigraphic image in coronary artery disease.

BACKGROUND: In patients with coronary artery disease, coronary angiography is performed for assessment of epicardial coronary artery stenoses. In addition, myocardial scintigraphy is commonly used to evaluate regional myocardial perfusion. These two-dimensional (2D) imaging modalities are typically reviewed through a subjective, visual observation by a physician. Even though on the analysis of 2D display scintigraphic myocardial perfusion segments are arbitrarily assigned to three major coronary artery systems, the standard myocardial distribution territories of the coronary tree correspond only in 50-60% of patients. On the other hand, the mental integration of both 2D images of coronary angiography and myocardial scintigraphy does not allow an accurate assignment of particular myocardial perfusion regions to the corresponding vessels. To achieve an objective assignment of each vessel segment of the coronary artery tree to the corresponding myocardial regions, we have developed a 3D 'fusion image' technique and applied it to patients with coronary artery disease. The morphological data (coronary angiography) and perfusion data (myocardial scintigraphy) are displayed in a 3D format, and these two 3D data sets are merged into one 3D image. RESULTS: Seventy-eight patients with coronary artery disease were studied with this new 3D fusion technique. Of 162 significant coronary lesions, 120 (74%) showed good coincidence with regional myocardial perfusion abnormality on 3D fusion image. No regional myocardial perfusion abnormality was found in 44 (26%) lesions. Furthermore, the 3D fusion image revealed 24 ischemic myocardial regions that could not be related to angiographically significant coronary artery lesions. CONCLUSION: The results of this study demonstrate that our newly developed 3D fusion technique is useful for an accurate assignment of coronary vessel segments to the corresponding myocardial perfusion regions, and suggest that it may be helpful to improve the interpretative and decision-making process in the treatment of patients with coronary artery disease.

Aged↗
PubMed1999

Cardiac phase contrast gradient echo MRI: measurement of myocardial wall motion in healthy volunteers and patients.

A number of methods have been proposed for the noninvasive measurement of myocardial wall motion. The paper describes a strategy for assessing myocardial motion based on the sensitivity of the phase of the MR-signal to motion using a breath-hold phase contrast technique. A motion-sensitized and a motion-compensated MR-signal are measured during successive scans. The difference between the two MR-signals is used to calculate myocardial velocity in all three spatial dimensions. Postprocessing includes the transformation of the measured velocities into an internal coordinate system of the left ventricle. Also various presentation modes and further processing of the received velocity information are provided including calculation of global motion parameters. We examined 20 patients suffering from myocardial infarction. The overall left ventricular motion can be characterized by appropriate parameters describing the rotation and contraction or expansion, respectively. Regional motional disturbances are visualized using parametric images. Contrary to the highly consistent interindividual data in normal volunteers, patients showed significant localized motion deficits.

Adult↗
PubMed1999

Are selectins involved in metastasis?

The selectins are a family of intercellular adhesion molecules that mediate the attachment of leukocytes to the endothelial lining of blood vessels. Another biological process that may involve selectins is the adhesion of circulating tumour cells to endothelium in cancer metastasis. This review discusses the evidence for the involvement of E-, P- and L-selectin in the metastasis of different tumour types. It is concluded that, with certain reservations and qualifications, selectins can play a role in metastasis. For example, the evidence for the involvement of E-selectin in breast and colon cancer metastasis is very strong. For the other selectins and tumour types the evidence is less convincing and further investigations are required to clarify the situation. Certainly, selectins are not the only mechanism available for tumours to metastasise. In the future, measurement of selectins could be useful prognostically and manipulation of their levels could lead to new cancer therapies.

Animals↗
PubMed1999

Bone marrow scintigraphy using technetium-99m antigranulocyte antibody in malignant lymphomas.

BACKGROUND: The purpose of this study was to elucidate the clinical reliability of immunoscintigraphy (IS) to detect infiltration of the bone marrow in patients with malignant lymphoma. PATIENTS AND METHODS: Whole body IS was performed in 103 patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) using Tc-99m labelled anti-NCA-95 which allows visualization of the granulopoietic bone marrow. Of these, 52% were studied prior to any therapy. Findings were compared to posterior iliac crest biopsy as well as MRI and/or follow-up examination. Criteria of marrow infiltration were a positive biopsy, positive follow-up, or positive results of MRI. RESULTS: Comparison of IS and biospy revealed concordant findings in 69 and discordant findings in 34 of 103 patients. Of the 34 patients with discordant results, IS showed lesions suspicious of bone marrow infiltration in 29 patients despite normal biopsy findings. When follow-up and additional examinations were taken into consideration, 10 patients remained with probably false positive and five with false negative IS findings. IS proved to be highly sensitive and specific in patients with HD (100% and 84%, respectively) and high-grade NHL (93% and 84%, respectively). Moderate sensitivity (60%) was found in low-grade NHL. This was possibly due to false negative IS in three to five patients with chemotherapy in contrast to one of five false negative results in patients without chemotherapy. CONCLUSION: Bone marrow scintigraphy using antigranulocyte antibodies is highly sensitive in HD and high-grade NHL. Positive findings in IS subsequent to a negative biopsy should be followed by guided re-biopsy or MRI.

Adolescent↗
PubMed1999

[Interactions of intravenous anesthetics with cerebral alpha-2-adrenoceptors].

OBJECTIVE: Up to date the exact mechanisms of action of anaesthetics on structures of the central nervous system have not been elucidated. Agents acting on central alpha 2-adrenoceptors have been demonstrated to possess potent sedative properties. Beside the classical agonists, general anaesthetics that are currently in clinical use e.g. etomidate have also been shown to act on alpha 2-adrenoceptors. Thus, the aim of this study was to study the effect of the intravenous anaesthetic agents propofol and ketamine on the binding of the specific alpha 2-adrenoceptor agonist paraiodoclonidine at cerebral alpha 2 adrenoceptors. METHODS: After approval of the local animal care committee brain tissue of six Wistar rats was removed and frozen at -80 degrees C. The tissue was sectioned in 15-20 microns thick slices. After washing in TRIS-buffer (pH = 7.5) the slices were incubated with 2.5 nM 125I-paraiodoclonidine (PIC) for determination of specific binding. Unspecific binding was determined in presence of 200 microM unlabeled clonidine. Displacement experiments were performed in presence of propofol (11-530 microM) and ketamine (52-1100 microM) and evaluated autoradiographically. Average exposure time was three days. All films were then analysed by densitometry. Statistical significance calculated by Student's t-test was assumed at a level of p < 0.05. RESULTS: Only at the highest concentration of propofol and ketamine an effect on PIC binding was noticeable. Neither propofol nor ketamine was able to displace PIC completely from cerebral alpha 2-adrenoceptors. CONCLUSION: In contrast to other anaesthetics such as etomidate which was demonstrated to displace PIC completely from alpha 2-adrenoceptors, propofol and ketamine exerted only minor effects on the binding of PIC even at concentrations that exceeded clinical concentrations. These data suggest that an additional site of action of these anaesthetics at cerebral alpha 2-adrenoceptors beside the known actions on GABA receptors or NMDA receptors is unlikely.

Adrenergic alpha-Agonists↗
PubMed1999

Photopenic lesions in bone marrow scintigraphy using technetium-99m labeled antigranulocyte antibody without known tumour.

AIM: The purpose of this study was to elucidate the frequency of photopenic lesions in patients without known tumour disease by using bone marrow scintigraphy with Tc-99m labeled anti-NCA-95. METHODS: Whole body immunoscintigraphy (IS) was performed in 141 consecutive patients with fever of unknown origin. The age ranged between 20 and 88 years with a mean age of 57 years. None of the patients had known tumour disease. Scans were evaluated with respect to photopenic lesions and to bone marrow distribution. RESULTS: IS showed bone marrow defects in the axial skeleton in 16 patients (11%). With the help of the typical scintigraphic defect pattern, the cause of the lesions was clearly identified as degenerative changes in four patients and in one patient as due to prior sternotomy. In the remaining 11 patients the origin of the defects became evident when the case history or additional imaging was consulted. The mean age of these 16 patients was 69 years ranging from 50 to 88 years. There was an age-related frequency of defects. 10% of the patients from 50 to 59 years showed defects, 60-69 years 9%, 70-79 years 30%, and 33% of the patients from 80 to 89 years had defects. IS was not hampered by tracer uptake to liver or spleen in 93 patients. Left caudal ribs were obscured in 48 patients with intense tracer uptake to the spleen. No or markedly reduced tracer uptake was found in caput humeri and caput femori in 94 and 82 patients, respectively. Patchy tracer uptake to the bone marrow of the limbs was seen in 13/62 patients showing marrow expansion in the lower limbs and 14/55 with marrow expansion in the upper limbs. The patchy pattern was asymmetric in 12 of these patients. CONCLUSION: The results of the present study reveal that using Tc-99m NCA-95, photopenic lesions of the bone marrow are rarely seen in patients without known malignant disease. The occurrence of benign lesions is age-related. The benign cause of the lesion was obvious from location and pattern of the lesion in about 30% of the cases. Evaluation of lesions in the upper and lower limbs may be hindered due to physiological variation of marrow distribution. Nevertheless, IS appears to be well-suited for the detection and localization of bone marrow metastases.

Adult↗
PubMed1998

Diagnosis of idiopathic myositis: value of 99mtechnetium pyrophosphate muscle scintigraphy and magnetic resonance imaging in targeted muscle biopsy.

Our objective was to study the value of 99mtechnetium-pyrophosphate (99mTc-PYP) muscle scintigraphy and magnetic resonance imaging (MRI) in detecting areas of likely muscle inflammation and in increasing the rate of positive muscle biopsies in patients with suspected myositis. The results showed that in 13 out of 13 patients with clinical and/or signs of inflammatory muscle disease, increased 99mTc-PYP uptake was demonstrated at different muscle sites 3 h after isotope injection. Subsequent MRI of symmetric muscle areas with enhanced 99mTc-PYP uptake revealed signal patterns suggesting inflammation in all cases. Biopsy of these targeted muscles demonstrated characteristic histopathologic signs of muscle inflammation in 9 out of 13 patients. Four of these 9 patients had clinically atypical disease or did not show elevated creatine phosphokinase levels. Seven of these 9 patients had not been pretreated with corticosteroids. In 4 patients only muscle fiber atrophy and/or necrosis without cellular infiltrations was seen. These 4 patients had received either high doses of corticosteroids or low doses over longer periods of time before muscle biopsy. In conclusion, the combination of 99mTc-PYP muscle scintigraphy and MRI demonstrated muscle areas with maximum inflammatory signal patterns. Targeting of muscles by MRI only will probably yield reliable results of muscle biopsy in cases of clinically and serologically characteristic myositis. 99mTc-PYP muscle scintigraphy may provide useful initial information about localization of inflamed muscle tissue, especially in atypical disease. Treatment with corticosteroids prior to histologic diagnosis may abolish inflammatory infiltrations in affected muscle tissue.

Adolescent↗
PubMed1998

Myositis of small foot muscles.

Idiopathic focal myositis is a rare clinical entity and is mostly localized in the neck and thigh muscles presenting as a pseudotumor. We describe a 49-year-old patient with inflammation restricted to the small muscles of one forefoot. Systemic disease was not present and progression to polymyositis did not occur within 2 years of follow-up. The myositis improved promptly after initiation of immunosuppressive therapy with corticosteroids and azathioprine. This unusual location of focal myositis has not been previously reported.

Adrenal Cortex Hormones↗
PubMed1998

Degradation of and intraosseous reactions to biodegradable poly-L-lactide screws: a study in minipigs.

In 20 minipigs an osteotomy of the lumbar spine was done at L3 and fixed with resorbable implants (plate and screws) made of poly-L-lactide. For 24 months postoperatively the cancellous bone surrounding the screws was examined histologically. Specimens from the body of lumbar spine L2 and L4, carrying the screws, were fixed in a series of ethanol immersions and then embedded in methylmethacrylate. Longitudinal and transverse sections were cut with a microtome at 4-5 microns and stained by the Masson-Goldner and Giemsa method for light microscopy. Our investigation confirmed a long degradation period of poly-L-lactide and little inflammatory reaction within the bone during the whole period of observation. For poly-L-lactide the degradation time exceeded the longest follow-up time in this study, 24 months. Polymorphonuclear granulocytes and mononuclear round cells were scarce in all follow-up groups. Osteolytic changes or the emergence of seroma was not observed. Textured bone was evident early close to a thin fibrous capsule surrounding the screws. The remodelling of the bone close to the screws ensues by the formation of osteons.

Absorbable Implants↗