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  • 1
    ISSN: 1433-8491
    Keywords: Amaurosis fugax attacks ; TIA ; 111In platelet scintigraphy ; Dual isotope carotid scintigraphy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A new dual isotope scintigraphic (DISC) examination of the carotid arteries consisting of simultaneous injections of 111In-labeled platelets and 99mTc-labeled red cells was performed on eight male patients suffering from amaurosis fugax attacks. In concordance with the angiographically proven high percentage of significant extracranial carotid disease in patients with amaurosis fugax, six of the eight patients examined had an increased platelet accumulation in the carotid artery clinically affected. In one patient with normal angiography and one amaurosis fugax attack the platelet scintigraphy even revealed a pathological platelet accumulation in the ipsilateral carotid artery. These findings confirm the hypothesis that most amaurosis fugax attacks are due to arterio-arterial emboli originating from atherosclerotic plaques of the carotid bifurcation.
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  • 2
    ISSN: 1433-8491
    Keywords: Doppler sonography ; Basilar artery thrombosis ; Doppler-Sonographie ; Basilaristhrombose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 6380 Doppler-Untersuchungen in den letzten $$3{\raise0.7ex\hbox{$1$} \!\mathord{\left/ {\vphantom {1 2}}\right.\kern-\nulldelimiterspace}\!\lower0.7ex\hbox{$2$}}$$ Jahren wurde in sieben Fällen eine hochgradige Zirkulationsstörung der A. basilaris bzw. beider distaler Vertebralarterien angenommen. Kriterium dafür war, daß die Vertebralarterien entweder beidseits nicht darstellbar waren oder keine diastolische Flußkomponente aufwiesen („externa-a-typische” Pulskurven). Die in sechs Fällen anschließend erfolgte Angiographie bestätigte die Diagnose: Viermal fand sich ein Basilarisverschluß, einmal eine langstreckige Basilarisstenose und einmal ein beidseitiger distaler Vertebralisverschluß. Drei weitere im gleichen Zeitraum angiographisch diagnostizierte Basilarisverschlüsse erfüllten bei der Doppler-sonographischen Erstuntersuchung nicht die oben genannten Kriterien, zwei davon auch nicht bei wiederholter Untersuchung. Die Doppler-Sonographie der Vertebralarterien kann somit als ein wesentliches diagnostisches Hilfsmittel beim Nachweis signifikanter Läsionen auch der distalen A. vertebralis und der A. basilaris gelten.
    Notes: Summary We have investigated 6,380 patients with directional c-w Doppler sonography within the last $$3{\raise0.7ex\hbox{$1$} \!\mathord{\left/ {\vphantom {1 2}}\right.\kern-\nulldelimiterspace}\!\lower0.7ex\hbox{$2$}}$$ years, and have suspected obstruction of the basilar artery or of both distal vertebral arteries in 7 cases. Either bilateral sonographic silence or an absent diastolic flow component of the vertebral arteries were employed as criteria in the sonographic evaluation. Angiography of the vertebro-basilar system, performed in 6 cases, confirmed the diagnoses: basilar artery occlusion was found in 4 patients, 1 patient revealed tight stenosis of the basilar artery in its entire length, and 1 patient exhibited occlusion of both distal vertebral arteries. Three further basilar artery occlusions were detected by means of angiography despite initially negative Doppler sonography within the same period of time; l of those patients, however, met the above criteria for basilar artery occlusion upon sonographic reevaluation on the following day. Thus, we believe that directional c-w Doppler sonography is very useful in the diagnosis of basilar artery obstruction.
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  • 3
    ISSN: 1433-8491
    Keywords: Ultrasonic Doppler ; Vertebral artery ; Basilar artery ; Vertebro-basilar insufficiency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have examined the vertebral and subclavian arteries in 1,205 patients using directional continuous-wave (c-w) Doppler sonography, and compared the sonographic findings with the results of unilateral or bilateral retrograde brachial arteriographies in the same patients. Doppler sonography revealed 33 false positives among 909 cases with normal angiographic findings. Some types of vertebral artery (VA) lesions allowed an excellent, others a fairly good differentiation by Doppler sonography: the complete subclavian steal syndrome with constant reversal of VA flow was reliably detected (16 cases). In the incomplete steal syndrome (5 cases) sonography was superior to angiography. Two bilateral distal VA occlusions and seven basilar artery occlusions — six in the proximal third and one in the rostral third — were detected sonographically; four basilar occlusions sparing the caudal third and one case exhibiting rete mirabile anastomoses were not identified by Doppler sonography. Our acoustically defined sonographic criteria did not permit an unequivocal assignment to an anatomical variant or a vascular lesion. The sensitivity in the detection of a severe stenosis at the VA origin amounted to 16 out of 31, and to 12 of 25 in cases with a proximal VA occlusion and reconstitution of the distal VA through cervical collaterals. Our results confirm that the conventional hand-held c-w Doppler sonography cannot replace angiography in the evaluation of vertebro-basilar insufficiency. It rather serves as an aid to the decision for or against angiography, and in the follow-up of angiographically proven lesions. However, several therapeutically important lesions are readily diagnosed by sonography.
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  • 4
    ISSN: 1433-8491
    Keywords: Basilar artery stenosis ; Basilar artery occlusion ; Continuous-wave Doppler sonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In the past 5 years we have investigated 29 patients with symptomatic basilar artery stenoses (14 cases) and occlusions (14) and a patent primitive trigeminal artery with thin-calibered basilar and vertebral arteries (1) using directional continuous-wave Doppler sonography of the vertebral arteries. A total of 19 patients survived, and 17 of them were clinically and sonographically reexamined after 40.4 ± 15.8 months (mean ± SD). Among the 8 patients with basilar stenoses, 6 — with no further transient ischemic attacks (TIAs) in the interval — exhibited an increase in the summed modified Pourcelot indices (relative end-diastolic flow velocities) of the vertebrals by 0.18 ± 0.16; the other 2 showed a decrease by 0.26 each, in 1 case temporally related to a TIA, in the 2nd case without further clinical deterioration. In the 8 survivors with basilar occlusions, 5 remained — by sonographic criteria — unchanged with summed modified Pourcelot indices of the vertebrals of 0.00, while 3 patients exhibited a slight increase in the summed modified Pourcelot indices of 0.13 ± 0.03. While the difference between the outcome of subsets of patients treated with regimens of 30,000–40,000 units heparin/day or phenprocoumon and less radical drugs were statistically not significant, the former regimen appeared clinically more efficacious in preventing further deterioration in approximately two-thirds of the patients affected. Due to the potential recurrence of neurological symptoms, a treatment period with phenprocoumon of 6 months after discharge from hospital appears justified. Due to these therapeutic efforts, approximately half of the patients initially affected survived with no or only a mild neurological deficit. Directional continuous-wave Doppler sonography is, in our opinion, a reliable technique for examining the short- and long-term changes in peripheral vascular resistance.
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  • 5
    ISSN: 1433-8491
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 6
    ISSN: 1433-8491
    Keywords: Cerebro-vascular disorders ; Traumatic thrombosis ; Angiography ; Cerebro-vasculäre Erkrankungen ; Traumatische Gefäßthrombosen ; Angiographie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Es wird über drei Kranke mit traumatischen Thrombosen im oberen Abschnitt der extrakraniellen Arteria carotis interna und A. vertebralis berichtet, bei denen sich die verletzungsbedingten Veränderungen im Kontroll-Angiogramm weitgehend zurückbildeten. Die Bedeutung dieses Befundes für die Differentialdiagnose gegenüber der fibromuskulären Dysplasie wird diskutiert.
    Notes: Summary Three cases of post-traumatic thrombosis of the distal extracranial internal carotid artery and vertebral artery are reported. Control angiograms showed considerable recession of changes caused by injury. Discussed is the significance of these findings for differentiation between post-traumatic artery changes and fibromuscular dysplasia.
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  • 7
    ISSN: 1433-8491
    Keywords: Disturbances of the pupil reflex ; Posterior cerebral artery infarction ; Pupillographic perimetry ; Störungen des Pupillenlichtreflexes ; Posteriorinfarkt ; pupillographische Perimetrie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Vier Fälle mit homonymer Hemianopsie infolge ausgedehnter Infarkte im Versorgungsgebiet der Arteria cerebri posterior zeigten bei der pupillographischen Perimetrie auf schwellennahe umschriebene Lichtreize einen Verlust von pupillomotorischer Empfindlichkeit im ausgefallenen Gesichtsfeld. Es bestand eine Parallelität zwischen sensorisch und pupillographisch gewonnenen Gesichtsfeldprofilen. Die Untersuchungen erfolgten mit einem Infrarot-Reflexpupillometer in Kombination mit einem Tübinger Perimeter.
    Notes: Summary Four cases of homonymous hemianopia due to cerebral infarction in the posterior cerebral artery territory showed loss of pupillomotor sensitivity within the hemianopic defects, using small threshold-stimuli under perimetric conditions. Sensory and pupillographic profiles paralleled each other. The recordings were done with a portable pupillograph measuring the infrared light reflected from the iris. A Tübinger perimeter served as stimulator.
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  • 8
    ISSN: 1433-8491
    Keywords: Disturbances of the pupil reflex ; Homonymous hemianopic paracentral scotoma ; Pupillographic perimetry ; Störungen des Pupillenlichtreflexes ; homonyme Parazentralskotome ; pupillographische Perimetrie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Vier Fälle mit umschriebenen polnahen Infarkten im Versorgungsgebiet der Arteria cerebri posterior und homonymen Parazentralskotom zeigten einen Verlust von pupillomotorischer Empfindlichkeit innerhalb der Skotome. Dies unterstützt frühere gleichartige Befunde bei Patienten mit homonymer Hemianopsie infolge ausgedehnter Posteriorinfarkte.
    Notes: Summary Four cases with isolated cerebral infarction near the occipital pole resulting in homonymous hemianopic paracentral scotoma showed loss of pupillomotor sensitivity within the scotomatous defects. This supports previous similar findings in patients with homonymous hemianopia due to larger infarctions in the posterior cerebral artery territory.
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  • 9
    ISSN: 1432-1904
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology , Natural Sciences in General
    Notes: Abstract The chronological development of environmental pollution in the Western Baltic Sea for the past hundred years was investigated in dated sediment cores. An artificial radionuclide (137Cs), nutrients, heavy metals, chlorinated hydrocarbons (PCB, DDT, Lindane) and plasticizers (phthalate esters) show characteristic distribution patterns within the various cores. They can be related to the production and use of specific chemicals and goods, to emissions associated with the increased combustion of coal parallel to industrialization and —in the case of 137Cs — to emissions associated with atomic weapons tests in the high atmosphere. Characteristic trends in the general development of pollution may be superimposed by specific emissions from local sources.
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  • 10
    ISSN: 1432-1920
    Keywords: Doppler sonography ; Intracranial carotid artery disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have investigated 6,587 patients with directional continuous-wave (c-w) Doppler sonography of the carotid arteries during the last 33 months, and have developed criteria for the diagnosis of a significant increase in peripheral resistance of the internal carotid artery in conjunction with 1,671 retrograde brachial and direct carotid angiograms. We distinguished stenoses proximal (15 cases) and distal (4) to the origin of the ophthalmic artery, supraclinoid internal carotid artery occlusions (8), stenoses (2) and acute occlusions (10) of the middle cerebral artery. Stenoses in the carotid siphon (proximal or distal to the origin of the ophthalmic artery) of at least 60% reduction in lumen diameter showed a reduction of the relative end-diastolic flow velocity (modified Pourcelot's index) of more than 40%; additionally, stenoses proximal to the origin of the ophthalmic artery exhibited a variable alternating flow, or flow reversal, in the supratrochlear artery. Stenoses distal to the origin of the ophthalmic artery rarely revealed the theoretically expected increase in orthograde flow velocity in the supratrochlear artery. Stenoses of the middle cerebral artery consisting of more than atherosclerotic irregularities proved to be an exception. Supraclinoid occlusions of the internal carotid artery were reliably demonstrated by Doppler sonography. However, the majority of acute occlusions of the middle cerebral artery could not be detected by this means, probably due to anastomoses between the anterior and the middle cerebral arteries, which were detected by angiography. Thus, we believe that c-w Doppler sonography is a reliable tool to detect stenoses of the carotid siphon of more than 60% reduction in lumen diameter and supraclinoid carotid artery occlusions. Barriers to the cerebral blood flow located more peripherally cannot be diagnosed reliably with this technique.
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