[High resolution contrast-enhanced 3D MR-angiography of renal arteries using parallel imaging (SENSE)]. / Hochauflösende Kontrastmittel-gestützte 3D-MR-Angiographie (MRA) der Nierenarterien mit paralleler Bildgebung (SENSE).

PURPOSE: To compare three dimensional contrast enhanced MR angiography with parallel imaging technique (sensitivity encoding) to standard MR angiography technique. MATERIAL AND METHODS: CE-3D MRA of renal arteries was performed in 22 patients (23 examinations) on a 1.5 T MR- scanner (Gyroscan Intera, Philips, Netherlands). For contrast enhanced MRA a single dose of Gd-DTPA (0.1 mmol/kg b.w.) was administered. Group I: The following standard 3D gradient echo (GE) sequence was performed in 9 of the 22 patients: TR: 4.3 ms, TE: 1.5 ms, flip angle: 40, 40 slices, scan duration: 19 seconds. A spatial resolution of 1.96 x 1.76 x 3.0 mm (3) (1.76 x 1.76 x 1.5 mm (3) interpolated) was obtained. Group II: 14 examinations were acquired in 13 patients: TR, TE and flip angle were equal compared to the first protocol. The k-space lines were acquired with CENTRA (contrast-enhanced time robust angiography) and parallel imaging technique (SENSE). 60 slices were acquired, scan duration was 24 seconds. The spatial resolution of this sequence was 1.19 x 1.08 x 2.0 mm (3) (0,84 x 0,84 x 1,0 mm (3) interpolated). Original images and calculated maximum intensity projection (MIP) images were analysed by two radiologists. Image quality and the visibility of renal arteries were rated on a four-point scale. RESULTS: In the first group the image quality was rated "good" in 8/9 patients. The renal arteries were detected in all cases and rated "good". The anterior and posterior segments were rated "good" in only 5/9 and the lobar arteries were detectable only in 3 of 9 cases. The interlobar arteries could not be seen in these patients. In the second group the image quality was rated excellent in 5 examinations and good in 9 of 14 examinations. The rating for the renal arteries was excellent in all examinations (14/14). The results of the anterior and posterior segment were as followed: excellent 5/14, good 7/14, insufficient 2/14; the lobar arteries: good 6/14, insufficient 6/14 and not detectable 2/14. Interlobar arteries could be seen in 7/14 examinations, but the quality was insufficient. In 7/14 the interlobar arteries could not be detected. CONCLUSION: The use of parallel imaging technique improves image quality and the delineation of small vessels in renal MRA.

[MR angiography of pelvic and leg vessels with automatic table movement technique ("Mobi-Trak")--clinical experience with 450 studies]. / MR-Angiographie der Becken-Beingefässe mit automatischer Tischverschiebung ("MobiTrak")--Klinische Erfahrung mit 450 Untersuchungen.

PURPOSE: By a retrospective clinical evaluation of 450 MR angiograms of the lower extremity arteries the question was posed of whether MR angiography can replace i.a. DSA. MATERIAL AND METHODS: Image quality of 450 MR angiograms was graded by 4 radiologists; in 102 patients who underwent radiological intervention a comparison between MR angiogram and i.a. DSA was done. Additionally, MR angiography was compared with the results of surgical intervention in 106 cases. RESULTS: 6% of 450 examinations showed a significant limitation of diagnostic information. 5 examinations (1%) had to be redone by i.a. DSA. In all cases the diagnosis from MRA was proven by the results of the following i.a. DSA or surgical procedure. CONCLUSION: The retrospective clinical evaluation of 450 examinations demonstrated that MR angiography of the lower extremity arteries can replace i.a. DSA in routine use.

[MR angiography of the lower extremities with an automatic table translation (Mobitrak) compared to i.a. DSA]. / MR-Angiographie der unteren Extremitäten mit automatischer Tischverschiebung ("MobiTrak") im Vergleich zur i.a. DSA.

PURPOSE: Comparison of the diagnostic information obtained by MRA using a moving bed ("MobiTrak") with i.a.DSA for angiography of the lower extremities. MATERIALS AND METHODS: In 20 patients, i.a.DSA and MRA were performed within a few days. The image quality and diagnostic information were evaluated by two radiologists and two surgeons. RESULTS: The radiologists assessed the quality of MRA higher for 18%, for 79% image quality was equal, for 3% the quality was graded as lower in comparison to i.a.DSA. The surgeons found the quality of MRA higher for 16%, equal for 75% and lower for 9%. In all cases, MRA was sufficient for planning of further treatment. CONCLUSIONS: For examinations of the arterial vessels of the lower extremities, MRA with a moving bed ("MobiTrak") can be used instead of i.a.DSA. The diagnostic information from MRA is sufficient for planning the further treatment. The advantages of MRA (no radiation, no i.a. puncture, no contrast medium with iodine) will lead to an increasing application of this method.

Circulating haematopoietic progenitors during treatment of renal anaemia with recombinant human erythropoietin.

The effect of recombinant human erythropoietin (rhEPO) and interleukin 3 (IL3) on circulating haematopoietic progenitors consisting mainly of immature burst-forming-units-erythrocytes (BFU-E), was investigated in ten paediatric patients treated by regular haemodialysis. During a 30-week study rhEPO treatment resulted in a rise of median haemoglobin levels from 6.7 g/dl to > 10 g/dl in all patients. Before initiating rhEPO treatment the number of circulating BFU-E in chronic renal failure patients responded to grading doses of rhEPO in vitro similar to that in control children; however, the dose-response curves were not predictive for the in vivo response to rhEPO. After an initial rise in five patients BFU-E numbers declined by week 30 of rhEPO treatment. BFU-E numbers decreased to 35% of pretreatment values. The number of granulocyte-macrophage colony forming cells (GM-CFC) also decreased during rhEPO treatment. Addition of IL3 to the culture medium containing saturating concentrations of granulocyte-macrophage colony stimulating factor did not stimulate BFU-E numbers of patients before rhEPO treatment or those of controls. However, 2 weeks after start of rhEPO treatment IL3 increased the growth of patient's BFU-E in vitro to 220% of pretreatment levels, followed by a gradual decrease of stimulation until the end of observation. These findings indicate that: (1) long-term recruitment of circulating haematopoietic progenitors during rhEPO treatment is low in children with renal anaemia; (2) rhEPO sensitivity of circulating BFU-E is not predictive for the in vivo response; (3) rhEPO treatment results in enhanced sensitivity of BFU-E to IL3.

[Inferences from data obtained by enzyme immunoassay of Toxoplasma IgG and IgM antibodies]. / Aussagekraft von Befunden, erhoben durch Enzymimmunoassays auf Toxoplasma-IgG- und IgM-Antikörper.

The enzyme-linked immunosorbent assay for Toxoplasma IgG antibodies is useful for the detection of infections. The quantitative test results do not allow any conclusion on the stadium of infection. A positive test result of the enzyme-linked immunosorbent assay for Toxoplasma IgM antibodies (EIA-IgM) may indicate an active but can be observed also in chronic infections. For the separation of the phases of infections other tests should be applied and follow-up studies by EIA-IgM should be performed.

Modulation of gonadotropin-releasing hormone receptor concentration in cultured female rat pituitary cells by estradiol treatment.

Short-term (0.5-4 h) treatment of rat pituitary cells in culture with estradiol (E2) results in a significant decrease of Gonadotropin-Releasing Hormone (GnRH) induced LH-release. We studied whether changes in the concentrations of GnRH-receptors (GnRH-R) might account for this phenomenon: pituitary cells from adult female rats were incubated for 4 or 24 h in the presence or absence of 10(-9) M E2. Then saturation curves of D-Ala6-des-Gly10-GnRH ethylamide binding were obtained. In addition, binding studies were carried out in cultures incubated for 0.5, 1, 2 or 4 h with or without 10(-9) M E2 using a near saturating concentration of GnRH-analog. No changes of GnRH-R affinity occurred (4 h experiments: Ka in vehicle treated cells: 0.94 +/- 0.2 x 10(9) M-1, Ka in E2 treated cells: 1.06 +/- 0.3 x 10(9) M-1; 24 h experiments: Ka vehicle: 0.95 +/- 0.2 x 10(9) M-1, Ka E2: 0.82 +/- 0.3 x 10(9) M-1). The GnRH-R concentrations, however, were significantly reduced (44 +/- 3%; P less than 0.001) by 4 h E2 treatment and increased (by 68 +/- 8%; P less than 0.01) by 24 h of E2 treatment. The GnRH induced LH-release in aliquots of the same cell preparations was significantly reduced after 4 h and markedly increased after 24 h of E2 treatment. The experiments on the time-course of the reduction of D-Ala6-GnRH-binding by E2 treatment showed that the number of GnRH-R was significantly decreased (24 +/- 1%; P less than 0.05) already after 0.5 h of exposure to the estrogen. This is also the time period after which the negative E2-effect on GnRH-induced LH-release becomes significant. These data provide first evidence that the short-term negative E2-effect on GnRH induced LH-release by rat pituitary cells in culture could be mediated via a reduction of available GnRH-R.

[Ciprofloxacin in Salmonella infection and abdominal typhoid]. / Ciprofloxacin bei Salmonelleninfektion und Typhus abdominalis.

Ten patients - two with Salmonella septicaemia associated with AIDS; one each Salmonella excretors in the convalescence stage and with Salmonella osteomyelitis; three with abdominal typhoid, and three with Salmonella enteritis - were treated with the gyrase inhibitor ciprofloxacin. The drug was given for 3-33 days, at a dosage of 250-750 mg orally in most cases. Clinical and bacteriological cure was achieved in nine patients. There were no significant side effects. One patient developed a macular rash, which is within the usual side-effect rate.

[Current aspects of pseudomonas meningitis]. / Aktuelle Aspekte der Pseudomonasmeningitis.

The article reports on the incidence, the conditions of occurrence, possibilities and successes of treatment with certain (combinations of) antibiotics, in dealing with cases of pseudomonas meningitis. The various possible substances used for treatment are discussed. Rates of penetration and CSF concentrations of azlocillin and cefsulodin are stated. Alternative possibilities for treatment are pointed out.

Syphilis, hepatitis A and hepatitis B seromarkers in homosexual men.

Two hundred homosexual men were investigated for prevalence rates of syphilis, hepatitis A (HAV) and hepatitis B (HBV). A reactive Treponema pallidum haemagglutination test (TPHA) was found in 56.3% of the participants. In 81.7% HBV seromarkers were detected. Hepatitis B surface antigen (HBsAG) was present in 6.6%. Anti-HAV was found in 51.0%. Risk factors for acquisition of these infections are discussed.

Detection of respiratory virus antigens in nasopharyngeal secretions from patients with acute respiratory disease by radio-immunoassay and tissue culture isolation.

An investigation was made of the sensitivity and specificity of four-layer radio-immunoassays (RIA) in the detection of adenovirus, respiratory syncytial virus, influenza virus types A and B, as well as para-influenza virus types 1, 2 and 3 from nasopharyngeal aspirates of 146 patients with acute respiratory disease. The sensitivity of RIA was comparable with that of tissue culture isolation if the total number of positives is considered. The difference may have been caused both by a higher efficiency of the RIA for detection of inactivated or non-cultivable agents and by a higher efficiency of tissue culture methods if the samples contained only small amounts of antigen. Differences between the two antigen detection systems were found in particular with respiratory syncytial virus and influenza B virus. At present, the use of tissue culture isolation together with RIA is the optimal routine laboratory procedure for the diagnosis of respiratory infections.

[Metronidazole concentration of the cerebrospinal fluid from slightly inflamed meninges]. / Metronidazol-Konzentration im Liquor bei gering entzündeten Hirnhäuten.

The concentrations of metronidazole (Clont i.v.) in the cerebrospinal fluid were measured in 12 patients with viral meningitis or subsiding bacterial meningitis after a single infusion of 500 mg lasting 20 min. 1 h after infusion the CSF-concentrations were between 2,3 micrograms/ml and 7,4 micrograms/ml and 2 h after infusion between 6,5 micrograms/ml and 8,6 micrograms/ml. They attained 45,9% respectively 75,9% of the corresponding serum concentrations. Because the minimal inhibitory concentrations of the most important obligate anaerobic gram-negative bacteria are attained, it appears that metronidazole can be used for the treatment of bacterial meningitis caused by these pathogens.

[Falciparum malaria in East African tourists in spite of fansidar prevention. A contribution on increased chloroquine and pyrimethamine-sulfadoxine resistance in areas of East Africa]. / Falciparum-Malaria bei Ostafrika-Touristen trotz Fansidar-Prophylaxe. Ein Beitrag zur wachsenden Chloroquin- und Pyrimethamin-Sulfadoxin-Resistenz in Gebieten Ostafrikas.

A decreased chloroquine (Resochin) sensitivity of strains of Plasmodium falciparum in certain areas of East Africa has given rise to an inappropriate change of chemoprophylaxis to pyrimethamine-sulfadoxine (Fansidar). Falciparum malaria occurred in five tourists during or after Fansidar prophylaxis. A therapeutic chloroquine-R2-resistance was observed in one seriously ill patient. In some patients the course of disease was prolonged to such an extent that the diagnosis could be established only after as much as 4 months after the end of the journey. This was in part surely caused by intake of anti-plasmodial drugs such as sulfonamides, tetracyclines and co-trimoxazol. The high mortality of falciparum malaria of nearly 10% in this country does not depend on the choice of drug prophylaxis or on problems of resistance, but still on a missed or delayed diagnosis.

[CSF levels of amikacin following systemic application in patients with slightly and severely impaired blood cerebrospinal barrier (author's transl)]. / Liquorkonzentrationen von amikacin nach systemischer gabe bei patienten mit gering und stark gestörter blut-liquor-schranke.

Levels of amikacin after systemic application of 350 mg were determined by the agar well diffusion method in 12 samples of CSF and serum of 7 patients with bacterial meningitis and in 2 samples of 2 patients with viral meningitis. Only in 2 samples of CSF drawn after the first systemic application of 350 mg i.m. no antibiotic activity was detectable. In 7 specimens of CSF levels of amikacin were greater than or equal to 3 microgram/ml. In 12 tests of CSF of neurosurgical patients with only slight impairment of the blood-CSF-barrier, taken for comparison reasons, only in 6 samples antibiotic activity was found. Only one test revealed CSF-concentration of amikacin higher then 3 microgram/ml.

Cefotaxime in treatment of meningitis and ventriculitis? Evaluation of drug concentrations in human cerebrospinal fluid.

In three groups of patients levels of cefotaxime in serumand cerebrospinal fluid were determined. Therapeutic value and efficacy are discussed in meningitis patients. Nine concentrations of cefotaxime in lumbar and ventricular CSF out of 19 in a group of seven neurosurgical patients with mild to moderate impairment of the blood-CSF-barrier were higher than 0.5 micrograms/ml. In seven determinations in a second group of six patients with no or very little dysfunction of the blood-cerebrospinal-fluid barrier only twice cefotaxime was not detectable in lumbar CSF. Concentrations of cefotaxime in 25 determinations of lumbar or ventricular CSF in six patients with bacterial meningitis ranged from 1.1 micrograms/ml to 19.2 micrograms/ml. Treatment with cefotaxime alone was successful in a patient with E. coli meningitis and ventriculitis after infection of a ventriculo-atrial shunt and in another patient with pneumococcal meningitis and penicillin allergy. The other four patients with bacterial meningitis were treated successfully by antibiotics including cefotaxime.

[Eosinophilic meningomyelitis (author's transl)]. / Eosinophile Meningomyelitis.

Eosinophilia of more than 50% was observed for a period of ten days in the cerebrospinal fluid (CSF) of a patient with acute meningomyelitis and paraplegia. Serologic studies suggested the simultaneous infection with mycoplasma pneumoniae and Coxsackie A 09 as being a likely cause of meningomyelitis. This case demonstrates that pronounced CSF eosinophilia may be observed for a short period in non-parasitic infections of the central nervous system. parasitic infestation may be assumed only when eosinophilia persists for several months.

Failure to detect naturally occurring serum inhibitors of hepatitis B virus deoxyribonucleic acid polymerase.

Sera of patients with past or ongoing hepatitis -B virus infection were tested for the presence of inhibitors of hepatitis -B virus-specific deoxyribonucleic acid (DNA) polymerase activity. None of the sera tested, which included those from anti-hepatitis B surface- and anti-hepatitis B core antigen-positive hemophiliacs, anti-hepatitis Bc antigen-positive hepatitis B surface antigen carriers, patients with hepatitis B surface antigen-positive chronic active hepatitis, hepatitis B surface antigen-positive hemodialysis patients, tumor patients with minimal hepatitis, patients with acute type B, type A, and type non-A, non-B hepatitis and individuals with autoimmune phenomena, contained inhibitors of DNA polymerase activity. This implies that the DNA polymerase test is not affected when utilized to quantitate DNA-containing Dane particles. In addition, there is no evidence that inhibitors of DNA polymerase activity play some pathogenic role in the course of hepatitis B virus infection.