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  • 1
  • 2
    ISSN: 1432-1084
    Keywords: Key words: CT – High-resolution CT – Comparative studies – Lung – Lung function – Ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. This study was undertaken to determine prevalence, extent, and severity of focal airtrapping at expiratory high-resolution CT, and to compare focal airtrapping with age, gender, pulmonary function tests, and blood gas analysis. Two-hundred seventeen patients with and without pulmonary disease underwent paired inspiratory/expiratory high-resolution CT. Six scan pairs with corresponding scan levels were visually assessed for focal – not diffuse – airtrapping using a four-point scale. Pulmonary function tests and blood gas analysis were available for correlation in all patients (mean interval 5 days). Focal airtrapping with lower lung predominance was observed in 80 % of patients. Twenty-six of 26 patients with restrictive lung function impairment exhibited focal airtrapping (mean score 2.4), whereas only 72 of 98 (74 %) patients with obstruction did (mean score 1.5; p 〈 0.05). Fifty-eight of 70 (83 %) patients with normal lung function (mean score 1.8) and 19 of 23 (83 %) patients with mixed impairment (mean score 1.8) had focal airtrapping. Focal airtrapping showed negative correlations with static lung volumes (–0.27 to –0.37; p 〈 0.001) in all patients and moderate positive correlations with dynamic parameters (0.3–0.4; p 〈 0.001) in patients with obstruction. No significant correlations were found with age, gender, and blood gas analysis. Visual assessment of focal – not diffuse – airtrapping at expiratory high-resolution CT does not correlate with physiological evidence of obstruction as derived from pulmonary function tests since the perception of focal airtrapping requires an adequate expiratory increase in lung density.
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  • 3
    ISSN: 1432-1084
    Keywords: Key words: Aneurysm ; Abdominal ; Pulmonary ; Therapy ; Immunosuppression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We studied the value of contrast-enhanced CT in the detection of aneurysms in immunocompromised patients suffering from inflammatory diseases eventually complicated by hemorrhage. Contrast-enhanced spiral CT was applied in three patients with immunocompromise due to chemotherapy, alcohol abuse or HIV. They suffered from invasive aspergillosis, chronic pancreatitis with pseudocyst formation, and acute pancreatitis together with HIV-associated lymphadenopathy. Complicating hemorrhage was present in two cases. Contrast-enhanced CT showed aneurysms complicating the underlying inflammatory disease in all three cases. The feeding vessels were identified and the patients with signs of bleeding were subsequently referred for angiography and embolization. Contrast-enhanced spiral CT is suited to detect aneurysms in immunocompromised patients suffering from inflammatory disease. It is recommended in these patients prior to angiography and intervention.
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  • 4
    ISSN: 1432-1084
    Keywords: Key words: Coronary vessels ; Calcification ; CT ; Stenosis ; Coronary heart disease ; Coronary angiography ; Helical CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to evaluate the clinical relevance of coronary artery calcifications detected by spiral CT, congruence with fluoroscopy (FS) and coronary angiography, and comparison with studies reporting on application of double-helical CT and ultrafast CT. Forty patients underwent spiral CT (2-mm slice thickness, table feed 3 mm/s), coronary angiography, and FS (performed in the usual manner). Stenosis and calcifications were evaluated semiquantitatively. Nineteen patients suffering from a stenosis ≥ 75 % were verified at coronary angiography. All had coronary artery calcification on spiral CT. Fluoroscopy did not detect 8 of 19 patients with a stenosis ≥ 75 % (1 vessel: n = 1; 2 vessels: n = 3; 3 vessels: n = 4). In spiral CT sensitivity was 100 % and specificity was 33 % (FS: 58 and 48 %). Positive predictive value was 83 % for spiral CT (FS: 50 %), and negative predictive value was 100 % (FS: 56 %). A significant linear increase in the calcification score was found for increasing maximal stenosis (p 〈 0.005). Spiral CT is more sensitive than FS in the recognition of hemodynamic relevant stenoses using the detection of coronary artery calcifications. Statistical parameters are comparable to ultrafast-CT. Spiral CT is a suitable non-invasive diagnostic technique in coronary heart disease. Coronary calcifications found incidentally in symptomatic patients at chest CT should be reported to the referring physician for further cardiological workup.
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  • 5
    ISSN: 1432-1084
    Keywords: Key words: Helical CT ; Dynamic MR imaging ; Kidney ; Inflammation ; AIDS ; Aspergillosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Renal insufficiency or allergic reactions for X-ray contrast agents are frequent limitations in immunocompromised hosts such as neutropenic or AIDS patients. Due to a better tolerance of contrast agents in MRI, this technique is well suited for investigation of parenchymal organs. We demonstrate an allergic AIDS patient who presented with fever and flank pain. At sonography, anechoic renal lesions were supposed to be non-complicated cysts; however, on T2-weighted MRI, the center was of high signal. Dynamic contrast-enhanced MRI of the kidneys demonstrated an enhancing rim with ill-defined margins. The lesions were supposed to be multiple bilateral abscesses. Due to the multiple dynamic contrast series, a delayed enhancement of renal parenchyma was detectable adjacent to the lesion. This was suggested as accompanying local pyelonephritis and an infectious etiology became more reliable. Aspergillus fumigatus was identified by CT-guided biopsy as the underlying microorganism. The MR appearance of this manifestation has not been described previously.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    European radiology 9 (1999), S. 262-275 
    ISSN: 1432-1084
    Keywords: Key words: Pulmonary embolism ; Pulmonary arteries ; Helical CT ; MR ; Vascular studies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Acute pulmonary embolism is a frequent disease with non-specific findings, high mortality, and multiple therapeutic options. A definitive diagnosis must be established by accurate, non-invasive, easily performed, cost-effective, and widely available imaging modalities. Conventional diagnostic strategies have relied on ventilation-perfusion scintigraphy complemented by venous imaging. If the results are inconclusive, pulmonary angiography, which is regarded as the gold standard, is to be performed. Recently, marked improvements in CT and MRI and shortcomings of scintigraphy led to an update of the diagnostic strategy. Spiral CT is successfully employed as a second-line procedure to clarify indeterminate scintigraphic results avoiding pulmonary angiography. It can also be used as a first-line screening tool if service and expertise is provided. Venous imaging is indicated if CT is inconclusive. The MRI technique can be applied as an alternative second-line test if spiral CT is not available or is contraindicated. It has the greatest potential for further developments and refinements. Echocardiography should be used as a first-line bedside examination in critical patients. If inconclusive stabilized patients undergo spiral CT, unstable patients should be referred for pulmonary angiography. Chronic thromboembolic pulmonary hypertension is a rare sequela of acute pulmonary embolism which can be cured surgically. Morphology, complications, and differential diagnoses are better illustrated by spiral CT and MRA, whereas invasive acquisition of hemodynamic data is the sole advantage of angiography.
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  • 7
    ISSN: 1432-1084
    Keywords: Key words: Computed tomography ; Therapeutic radiology ; Gene therapy ; p53
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The objective of this study was to prove the principle of CT-guided gene therapy by intratumoral injection of a tumor suppressor gene as an alternative treatment approach of incurable non-small-cell lung cancer. In a prospective clinical phase I trial six patients with non-small-cell lung cancer and a mutation of the tumor suppressor gene p53 were treated by CT-guided intratumoral gene therapy. Ten milliliters of a vector solution (replication-defective adenovirus with complete wild-type p53 cDNA) were injected under CT guidance. In four cases the vector solution was completely applied to the tumor center, whereas in two cases 2 ml aliquots were injected into different tumor areas. For the procedure the scan room had been approved as a biosafety cabinet. Gene transfer was assessed by reverse transcription and polymerase chain reaction in biopsy specimens obtained under CT guidance 24–48 h after therapy. Potential therapeutic efficacy was evaluated on day 28 after treatment using spiral CT. The CT-guided gene therapy was easily performed in all six patients without intervention-related complications. Besides flu-like symptoms, no significant adverse effects of gene therapy were noted. Three of the four patients with central injection exhibited gene transfer in the posttreatment biopsy. Gene transfer could not be proven in the two patients with multiple 2 ml injections. After 28 days, four of the six patients showed stable disease at the treated tumor site, whereas other tumor manifestations progressed. Computed tomography-guided injections are an adequate and easy-to-perform procedure for intratumoral gene therapy.
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  • 8
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Die moderne Tumortherapie ist durch die zunehmende Zahl von Hochdosisprotokollen immer häufiger mit einer lang andauernden Neutropenie und der daraus resultierenden Immunabwehrschäche verbunden [11, 16, 24]. Die Infektionshäufigkeit liegt bei einer Neutropeniedauer von mehr als 8–10 Tagen bei über 85% [23]. Bei etwa der Hälfte der Patienten kommt es nach empirischer Therapie und initialer Entfieberung im weiteren Verlauf erneut zu einem Temperaturanstieg und damit wiederum zu einem Infektionsverdacht [16, 38, 47]. Dabei sind neben disseminierten Infektionen hauptsächlich Lunge, Nasennebenhöhlen, Darm, Leber, Milz, Gehirn und Nieren betroffen [23, 24].
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 70 (1999), S. 1357-1360 
    ISSN: 1433-0385
    Keywords: Key words: Elastofibroma dorsi ; Bilateral ; Literature review. ; Schlüsselwörter: Elastofibroma dorsi ; bilateral ; Literaturübersicht.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Ein 75 jähriger Patient stellte sich mit seit 2 Jahren langsam größenprogredienten Raumforderungen unterhalb beider Schulterblätter vor. Anamnestisch bestand ein Zustand nach proximaler Oberarmamputation linksseitig mit folgender prothetischer Versorgung. Klinisch zeigten sich direkt unter den Schulterblattspitzen beidseits 2 faustgroße Tumoren, die fest mit dem tiefer gelegenen Gewebe verwachsen waren. Sowohl magnetresonanztomographisch als auch intraoperativ stellte sich ein infiltratives Wachstum dieser Raumforderungen in die seitliche Thoraxmuskulatur und das Periost der Rippen sowie des Schulterblatts dar, so daß ein maligner Tumor vermutet wurde. Histopathologisch zeigte sich Bindegewebe mit zahlreichen eingelagerten fragmentierten und unregelmäßig konfigurierten elastischen Fasern und unscharfer Begrenzung zum umgebenden Fettgewebe, typisch für ein Elastofibrom. Für Malignität bestand kein Anhalt. Im vorliegenden Fall erscheint es wahrscheinlich, daß eine unphysiologische Belastung der oberen Extremitäten bei dem mit einer linksseitigen Oberarmprothese versorgten Patienten die Entstehung der beidseitigen Elastofibrome begünstigt hat. Das Elastofibrom ist ein seltener, gutartiger, fast immer subscapulär gelegener Weichteiltumor, der bevorzugt bei älteren Frauen auftritt. In etwa 10 % der Fälle findet sich ein bilaterales, meist asynchrones Wachstum. Klinisch und radiologisch stellen Lipome sowie Weichteilsarkome die wichtigsten Differentialdiagnosen dar. Andere seltene Elastofibromlokalisationen an Rumpf, Kopf und Extremitäten werden in der vorliegenden Arbeit aufgeführt.
    Notes: Summary. A 75-year-old man had painless, slowly enlarging tumors in the right and left infrascapular regions. Clinically, the tumors were nontender and semimobile. MR imaging and the operative exploration revealed tumors infiltrating the lateral thoracic muscles and periost of the scapula and underlying ribs. At surgery, the tumors were thought to be malignant, most likely liposarcomas. The histological examination showed the characteristic appearance of elastofibromas with spindle-shaped fibroblasts, which were separated by thick eosinophilic collagenous and elastic fibers. Elastofibromas are benign mesenchymal soft-tissue lesions that mainly affect elderly women. In 10 % of the patients bilateral, often asynchronous tumors are seen. Ninety-nine percent of the lesions are located in the subscapular region. Occasional elastofibromas have been described in the extremities, head, and in the abdominal and thoracic cavities.
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  • 10
    ISSN: 1432-2102
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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