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  • 1
    Digitale Medien
    Digitale Medien
    Time-resolved projection MRA: clinical application in intracranial vascular malformations (2000)
    Springer
    Neuroradiology 42 (2000), S. 104-107 
    Details
    ISSN: 1432-1920
    Schlagwort(e): Key words Magnetic resonance angiography, time resolved ; Malformations, vascular ; Embolisation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract We report preliminary results of imaging intracranial vascular malformations with time-resolved projection MRA after a bolus injection of contrast median before and after endovascular treatment. Projection angiograms are acquired with a slice-selective snapshot FLASH sequence with a time resolution of two images per second, 40–60 images being acquired consecutively after bolus injection of 15 ml Gd-DTPA. Postprocessing of images in 2D projection MRA by correlation analysis offers several advantages with significant improvement of signal-to-noise, leading to adequate anatomical resolution. Subsecond projection MRA is a reliable technique for imaging intracranial vessels and gives information about the haemodynamics of vascular malformations.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002340050024
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  • 2
    Digitale Medien
    Digitale Medien
    Hirnstammgliom (1998)
    Springer
    Der Radiologe 38 (1998), S. 904-912 
    Details
    ISSN: 1432-2102
    Schlagwort(e): Schlüsselwörter Hirnstammgliom ; CT ; MRT ; Klassifikation ; Prognose ; Key words Brain-stem glioma ; CT ; MRI ; Classification ; Prognosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Brain-stem gliomas occur mainly in childhood and are localized in the mesencephalon, pons and medulla oblongata. Diagnosis is a domain of MRI, requiring T2, T1 and KM. CT shows hemorrhage and calcification well. The criteria are the primary site, size, tumor growth, brain-stem enlargement, delineation, intralesional structure, exophytic components and enhancement. Secondary criteria are herniation, hydrocephalus and liquorgenic seeding. In CT glioma are hypodense, in MRI hyperintense in T2 and hypointense in T1. Enhancement is seen in 25–60% and does not allow differentiation of tumor vs nontumor or gradings. Factors influencing poor outcome are high grade, a short history, cranial nerve involvement, severe brain-stem enlargement, pontine site, diffuse growth and recurrency. The 5-year-survival rate is 30% (after radiation: focal tumors 85%, diffuse 20%). Most frequent are symptoms of brain pressure, cerebellum, cranial nerves and pyramidal tract. There is no agreement on whether biopsy is necessary or not. A diagnosis of tumor is highly suggestive if classical MRI findings fit the clinical history.
    Notizen: Zusammenfassung Hirnstammgliome treten überwiegend im Kindesalter auf und sind im Mesenzephalon, Pons und der Medulla oblongata lokalisiert. Die Diagnostik ist eine Domäne der MRT und erfordert T2-, T1-Sequenzen und Kontrastmittel (KM). Die CT ist zum Nachweis von Blutungen und Verkalkungen prädestiniert. Beurteilungskriterien sind Primärsitz, Tumorgröße, Ausdehnung, Hirnstammverbreiterung, Tumorränder, Binnenstruktur, exophytische Anteile und KM-Aufnahme. Sekundäre Kriterien sind Einklemmung, Liquoraufstau und liquorgene Aussaat. Hirnstammgliome sind im CT hypodens, im MRT in T2 hyperintens, in T1 meistens hypointens. Schrankenstörungen lassen sich in 25–60% der Fälle nachweisen und erlauben keine Differenzierung von Tumor/Nichttumor oder verschiedenen Gradierungen. Diskussion: Prognostisch ungünstig sind hohe Gradierung, kurzer klinischer Verlauf, Hirnnervenbefall, ausgeprägte Hirnstammverbreiterung, pontine Lokalisation, diffuse Ausbreitung und Rezidiv. Die 5-Jahres-Überlebensrate beträgt 30%, nach Strahlentherapie bei fokalen Tumoren 85%, bei diffusen 20%. Die häufigsten Symptome sind Hirndruckzeichen, zerebelläre Ataxie, Hirnnervenbefall und Pyramidenbahnzeichen – in ca. 40% Tortikollis. Die Biopsie wird kontrovers diskutiert. Zumindest ist bei klassischem MRT-Befund und passender Klinik die Diagnose Tumor hochwahrscheinlich.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001170050441
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  • 3
    Digitale Medien
    Digitale Medien
    c-erbB2 expression in correlation to other biological parameters of breast cancer (1990)
    Springer
    Journal of cancer research and clinical oncology 116 (1990), S. 15-20 
    Details
    ISSN: 1432-1335
    Schlagwort(e): Oncogene ; c-erbB2 expression ; Breast cancer ; Prognosis ; Proliferation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary On the prognostic value of c-erbB2-encoded protein p185 in breast cancer there are controversal opinions. With the outlook of an evaluation of the prognostic value of p185 expression in breast cancer the relationships between p185 expression and known prognosis factors were investigated. Using polyclonal antibody against p185 33% out of 163 primary breast carcinomas are p185-positive. Within the various histological types of tumors the percentage of p185 expression differs. It is suggested that p185 indicates a certain type of biological behavior and plays a role in the pathogenesis of breast cancer. Thus the determination of p185 could allow definition of biological subclasses. A statistically significant correlation between expression of p185 and the presence of lymph node metastases or tumor size can not be proved. Nevertheless p185 expression is increased in cases with more than three positive lymph nodes. Expression of p185 correlates statistically significantly positively with histological grade and epidermal growth factor receptor, and negatively with steroid receptor status. Furthermore, high-proliferating tumors are more common in p185-positive cases than in p185-negative cases. It is concluded that p185 may be associated with an increased malignancy and proliferation activity of tumors.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01612634
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  • 4
    Digitale Medien
    Digitale Medien
    Scoring system for nosocomial pneumonia in ICUs (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1155-1161 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Nosocomial pneumonia ; scoring system ; Risk factors ; Intensive care units
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective To develop a scoring system for stratifying patients in intensive care units (ICUs) by risk of developing nosocomial pneumonia (NP), based on variables generally available in an ICU, and to determine the probability of a patient developing NP in the ICU. Design and setting A 2-year prospective cohort study conducted in a medical and surgical ICU. Patients 756 patients admitted to the ICU for 48 h or more were followed up until the development of NP or death or discharge from the ICU. Measurements and results 129 (17.1%) patients developed NP, 106 (14%) in the first 2 weeks. The following independent risk factors were identified by multivariate analysis: no infection on admission [relative risk (RR)=3.1, 95% confidence intervals (CI)=2.0 to 4.8]; thorax drainage (RR=2.1, 95% CI=1.2 to 3.5); administration of antacids (RR=2.1, 95% CI=1.4 to 3.1); partial pressure of oxygen (PO2)〉110 mmHg (RR=1.6, 95% CI=1.0 to 2.6); administration of coagulation factors (RR=1.8, 95% CI=1.0 to 3.2); male gender (RR=2.7, 95% CI=1.2 to 6.3); urgent surgery (RR=2.4, 95% CI=0.9 to 6.4); and neurological diseases (RR=4.2, 95% CI=1.9 to 9.4). To obtain a predictive risk index for NP, a scoring system was developed using a multivariate model. The probability of developing NP varied between 11.0% in the lowest risk group and 42.3% in the highest risk group. The patients' risk of acquiring NP was seven times higher in the highest score category (IV) than in the lowest one (I). Conclusions ICU patients can be stratified into high- and low-risk groups for NP. No infection on admission, thorax drainage, administration of antacids, and PO2〉110 mmHg were associated with a higher risk of NP during the entire 2-week period.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01709329
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  • 5
    Digitale Medien
    Digitale Medien
    Scoring system for nosocomial pneumonia in ICUs (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1155-1161 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Nosocomial pneumonia ; Scoring system ; Risk factors ; Intensive care units
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective: To develop a scoring system for stratifying patients in intensive care units (ICUs) by risk of developing nosocomial pneumonia (NP), based on variables generally available in an ICU, and to determine the probability of a patient developing NP in the ICU. Design and setting: A 2-year prospective cohort study conducted in a medical and surgical ICU. Patients: 756 patients admitted to the ICU for 48 h or more were followed up until the development of NP or death or discharge from the ICU. Measurements and results: 129 (17.1%) patients developed NP, 106 (14%) in the first 2 weeks. The following independent risk factors were identified by multivariate analysis: no infection on admission [relative risk (RR)=3.1, 95% confidence intervals (CI)=2.0 to 4.8]; thorax drainage (RR=2.1, 95% CI=1.2 to 3.5); administration of antacids (RR=2.1, 95% CI=1.4 to 3.1); partial pressure of oxygen (PO2) 〉110 mmHg (RR=1.6, 95% CI=1.0 to 2.6); administration of coagulation factors (RR=1.8, 95% CI=1.0 to 3.2); male gender (RR=2.7, 95% CI=1.2 to 6.3); urgent surgery (RR=2.4, 95% CI=0.9 to 6.4); and neurological diseases (RR=4.2, 95% CI=1.9 to 9.4). To obtain a predictive risk index for NP, a scoring system was developed using a multivariate model. The probability of developing NP varied between 11.0% in the lowest risk group and 42.3% in the highest risk group. The patients‘ risk of acquiring NP was seven times higher in the highest score category (IV) than in the lowest one (I). Conclusions: ICU patients can be stratified into high- and low-risk groups for NP. No infection on admission, thorax drainage, administration of antacids, and PO2〉110 mmHg were associated with a higher risk of NP during the entire 2-week period.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01709329
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  • 6
    Digitale Medien
    Digitale Medien
    Techniken und Ergebnisse bei Meningeom-Embolisationen (1979)
    Springer
    European archives of psychiatry and clinical neuroscience 227 (1979), S. 241-260 
    Details
    ISSN: 1433-8491
    Schlagwort(e): Meningiomas ; Superselective angiography ; Tumor embolization ; Localization ; Vascularization ; Meningeome ; Superselektive Angiographie ; Embolisation ; Tumorlokalisation ; Tumorvascularisation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Zusammenfassung Bei 21 Patienten mit Meningeomen verschiedener Lokalisation und Größe werden unterschiedliche Embolisationstechniken und die Ergebnisse von insgesamt 25 präoperativen Tumorembolisationen beschrieben. Transfemorale Katheterisierungsmethoden waren dabei wegen der besseren Manipulierbarkeit der Katheter, der erzielbaren angiographischen Superselektivität und entsprechend exakteren Plazierung der Emboli direkten Techniken mit Punktion der Carotiden überlegen. Die Embolisationsresultate zeigten eine deutliche Abhängigkeit von der Meningeomlokalisation, wobei sich Konvexitätsmeningeome (6 Patienten) als besonders geeignet für eine vollständige Embolisation erwiesen. Bei Meningeomen der Falx mit größerer parasagittaler Ausdehnung, des lateralen Keilbeinflügels, der Sylvischen Fissur und des Cavum Meckeli (9 Patienten) waren operativ wie histologisch noch gute Embolisationseffekte nachweisbar. Dagegen waren Embolisationen bei ausschließlicher Tumorlokalisation an der Falx oder dem Tentorium sowie bei überwiegend internaversorgten Keilbeinflügelmeningeomen ohne therapeutischen Effekt. Bei Berücksichtigung der Tumorlokalisation und des Vascularisations-types sowie der Anwendung geeigneter superselektiver Angiographie- und Embolisationstechniken wird die präoperative Meningeomembolisation als wichtige Verbesserung der operativen Ausgangsbedingungen angesehen.
    Notizen: Summary The different techniques and results are described for a total of 25 preoperative tumor embolizations in 21 patients with meningiomas of diverse localizations and extents. Transfemoral catheter techniques were superior to direct punctures of the carotid arteries because of the easier handling of the catheters, the better superselectivity of angiography, and, consequently, the more exact placement of the emboli. The results of the embolizations depended on the localization of the meningiomas. Meningiomas of the convexities (six patients) turned out to be particularly susceptible to complete embolizations. Satisfactory results were achieved operatively and histologically through embolization in meningiomas of the falx with large parasagittal expansion as well as in those of the lateral sphenoid wing, the sylvian fissure, and the cavum Meckeli (nine patients). Embolization of tumors which were localized exclusively at the falx, the tentorium, or of more medially situated meningiomas of the sphenoid wing were without beneficial effect, since these are predominantly vascularized by branches of the internal carotid arteries. Provided the localization and vascularization of a tumor are favourable, the application of superselective angiography and preoperative embolization represents an important improvement of the basic conditions for a later operation.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00367394
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  • 7
    Digitale Medien
    Digitale Medien
    Management eines großen bilateralen Glomus jugulare Tumors (1999)
    Springer
    HNO 47 (1999), S. 816-820 
    Details
    ISSN: 1433-0458
    Schlagwort(e): Schlüsselwörter Glomus jugulare ; Bilateral ; Embolisation ; Key words Bilateral glomus jugulare tumors ; Paragangliomas ; Tumor embolization
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Bilateral glomus jugulare tumors are rare. However, their treatment should preserve not only the function of the facial nerve but also the caudal cranial nerves and the middle ears in order to avoid bilateral hearing losses. Further, venous cerebral drainage has to be ensured in order to avoid cerebral hypertension and hemorrhagic infarction after bilateral jugular ligations. In the case presented bilateral glomus jugulare tumors required super-selective angiography and embolization. Complete tumor removal on both sides was then possible by a transmastoid-transcervical approach without any further functional deteriorations. Middle ear function was preserved on both sides by temporary ventral translocation of the posterior wall of the auditory meatus. As the sigmoid sinus and internal jugular vein had been ligated during initial previous surgery, venous drainage was tested one year later by angiography and compression of the remaining internal jugular vein. A sufficient collateral circulation was found and permitted surgery on the second side.
    Notizen: Zusammenfassung Beidseitige Glomus-jugulare-Tumoren stellen eine Rarität dar. Neben der Funktion des N. facialis muß bei ihrer Entfernung auch die Funktion der kaudalen Hirnnerven berücksichtigt werden. Die Funktionserhaltung des Mittelohrs ist ebenfalls anzustreben, um einen beidseitigen Schalleitungsblock zu vermeiden. Die venöse zerebrale Drainage muß gesichert werden, da eine beidseitige Ligatur des Sinus sigmoideus zur zerebralen venösen Hypertension führen würde. Am Beispiel eines großen bilateralen Glomus-jugulare-Tumors der Klasse C2 ermöglichte die superselektive Angiographie und Embolisation die beidseitige vollständige Tumorentfernung ohne Funktionseinschränkungen über einen transmastoidalen-transzervikalen Zugang. Durch temporäre Ventralverlagerung der hinteren Gehörgangswand gelang auch die Erhaltung der Mittelohrfunktion. Wegen der Ligatur der V. jugularis interna und des Sinus sigmoideus auf der 1. Seite konnte die 2. Seite erst 1 Jahr später operiert werden, nachdem die Angiographie und Kompression der verbliebenen V. jugularis interna ausreichende venöse Kollateralen bestätigt hatte.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001060050465
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