Three-dimensional fat-saturated T1-weighted Cartesian volumetric interpolated breath-hold examination (VIBE) for the diagnosis of aortitis in patients with suspected large vessel vasculitis: a comparative study with 18F-FDG PET applying fully integrated PET/MRI.

AIM: To evaluate the feasibility of T1-weighted (T1W) three-dimensional (3D) fat saturated Cartesian volumetric interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) sequence for the diagnosis of aortitis in patients with suspected large vessel vasculitis (LVV) applying fully integrated 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET)/MRI. MATERIAL AND METHODS: Fourteen patients with aortitis and 14 patients with a negative study for aortitis using 18F-FDG PET as the standard of reference for the evaluation of inflammatory aortic involvement were included retrospectively. All patients were imaged at 3 T using T1W VIBE pre- and post-contrast. Four aortic segments were evaluated for image quality (IQ), diagnostic confidence (DC), and the degree of inflammatory activity (IA) using a Likert scale. Binomial and generalised estimating equation model tests were used to assess the diagnostic performance of T1W VIBE. Cohen's k was applied to test for interobserver reproducibility with respect to IA. Spearman's rank correlation coefficient was calculated to examine correlations between IQ, DC, IA, and PET results. RESULTS: On a patient- and segment-based analysis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 85.7% and 59.8%, 100% and 100%, 100% and 100%, 87.5% and 68%, and 92.9% and 82.1%, respectively. IQ and DC were acceptable to good in all examinations and substantial interobserver agreement was observed for IA (Cohen's k = 0.69). IQ and DC as well as IA and 18F-FDG vessel wall uptake were significantly correlated (r=0.763 and 0.679, respectively; p<0.0001). CONCLUSION: T1W 3D fat saturated VIBE MRI allows diagnosis of aortitis and may aid in the management of patients with suspected LVV.

Association of time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected bacteria of patients after solid organ transplantation.

BACKGROUND: Aim of this study was to investigate the association of the time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected periodontal pathogenic bacteria of immunosuppressed patients after solid organ transplantation (SOT). MATERIAL AND METHODS: 169 Patients after SOT (lung, liver or kidney) were included and divided into subgroups according their time under (0-1, 1-3, 3-6, 6-10 and >10 years) and form of immunosuppression (Tacrolimus, Cyclosporine, Mycophenolate, Glucocorticoids, Sirolimus and monotherapy vs. combination). Periodontal probing depth (PPD) and clinical attachment loss (CAL) were assessed. Periodontal disease severity was classified as healthy/mild, moderate or severe periodontitis. Subgingival biofilm samples were investigated for eleven selected potentially periodontal pathogenic bacteria using polymerasechainreaction. RESULTS: The mean PPD and CAL as well as prevalence of Treponema denticola and Capnocytophaga species was shown to be different but heterogeneous depending on time under immunosuppression (p<0.05). Furthermore, only the medication with Cyclosporine was found to show worse periodontal condition compared to patients without Cyclosporine (p<0.05). Prevalence of Porphyromonas gingivalis, Tannerella forsythia and Fusobacterium nucleatum was reduced and prevalence of Parvimonas micra and Capnocytophaga species was increased in patients under immunosuppression with Glucocorticoids, Mycophenolate as well as combination therapy. CONCLUSION: Time under and form of immunosuppression might have an impact on the clinical periodontal and microbiological parameters of patients after SOT. Patients under Cyclosporine medication should receive increased attention. Differences in subgingival biofilm, but not in clinical parameters were found for Glucocorticoids, Mycophenolate and combination therapy, making the clinical relevance of this finding unclear.

Differences in patterns of peripheral arterial occlusive disease and eligibility for endovascular treatment.

BACKGROUND: To analyze differences in morphological changes in the vascular tree among patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). In addition, suitability for endovascular treatment was evaluated. PATIENTS AND METHODS: Our study included 690 lower extremities with IC or CLI in 500 consecutive patients who were assessed by magnetic resonance angiography (MRA) according to the TASC II classification and in terms of the below the knee run-off status. Multivariable logistic regressions models adjusted for cardiovascular risk factors were used to evaluate differences in arteriosclerotic lesion patterns and eligibility for endovascular treatment. RESULTS: Multivariable analysis showed that compared with IC extremities, CLI extremities have significantly more severe arteriosclerotic lesions at the aortoiliac (p < 0.001), femoropopliteal (p < 0.001), and crural levels (p < 0.001), with a greater risk of multilevel disease (odds ratio [OR], 1.71; 95 % confidence interval [CI] 1.10 - 2.66; p = 0.018). More than 80 % of extremities with IC and more than 50 % of extremities with CLI appeared to be eligible for endovascular treatment in an isolated evaluation of the aortoiliac and femoropopliteal axis. For combined evaluation of the aortoiliac and femoropopliteal axis, the proportion of endovascular suitability (TASC A+B lesions) decreased to 65 % (IC) and 41 % (CLI). For TASC A+B+C lesions, the proportions were 79 % (IC) and 41 % (CLI). CONCLUSIONS: Lower extremities with IC and CLI significantly differ in terms of arteriosclerotic lesion morphology and patterns of lesion localization. The majority of IC and CLI extremities appear to be eligible for endovascular treatment. Because of further improvement in endovascular equipment, even more patients will be eligible for treatment.

Interobserver agreement of the TASC II classification for supra- and infrainguinal lesions.

OBJECTIVES: The Trans-Atlantic Inter-Society Document on Management of Peripheral Arterial Disease (TASC) gives treatment recommendations depending on the classification of aorto-iliacal or femoro-popliteal vascular pathologies. Therefore, the best treatment could only be offered if the right TASC classification was obtained. The purpose of this study was to assess the interobserver agreement of the evaluation of the TASC II classification for peripheral arterial occlusive disease (PAOD) in magnetic resonance angiography (MRA). PATIENTS AND METHODS: Three hundred arterial segments of 149 patients with a magnetic MRA for PAOD were evaluated according to the TASC II classification. A resident and a consultant for radiology and vascular surgery both performed independent grading. A comparative assessment of the consensus agreement was quantified by the marginal probabilities calculated by generalised estimation equation models, as well as by using the weighted kappa coefficient (kappa), classified according to Altman. RESULTS: In relation to the consensus, the overall agreement was good to excellent for the consultants of radiology and vascular surgery. The consultants obtained a statistically significant higher agreement than did the residents (Odds ratio (OR): 2.86, 95% confidence interval (CI): 2.21-3.69, p<0.001). A significantly higher consensus agreement probability was observed for the surgeons compared with the radiologists (OR: 1.43, 95% CI: 1.11-1.84, p=0.006) and for the femoro-popliteal regions compared with the aorto-iliacal regions (OR: 1.64, 95% CI: 1.12-2.14, p=0.012). CONCLUSION: Although good results can be achieved in the assessment of vascular lesions according to the TASC II document, a simplification of this classification could increase its practicability in a daily clinical routine.

Eligibility for endovascular technique and results of the surgical approach to popliteal artery aneurysms at a single center.

BACKGROUND: Less than 0.1% of the population experiences a popliteal aneurysm (PA), and the consequences of not treating PA include a significant risk of embolization, thrombosis, and limb loss. Surgical treatment for this vascular disease has produced excellent clinical results, but there remain an increasing number of published reports that continue to question the efficacy of endovascular therapies. METHODS: All consecutive patients operated on for PA at our hospital in the years 2000-2007 were reviewed retrospectively for clinicopathological data and applicability for endovascular treatment. RESULTS: Forty-six patients were surgically treated for 56 PAs (42 vein, 11 alloplastic material, and one composite graft). Overall survival rates after 2 and 5 years were 77% and 54%, respectively. Reintervention-free survival rates at 2 and 5 years were 71% and 43%, respectively. Graft patency for veins was significantly higher, with a hazard ratio of 0.025 (95% confidence interval 0.002-0.304, p=0.004). Twenty-two of the 37 patients (59.5%) with a sufficient angiograph appeared to be eligible for endovascular treatment. CONCLUSION: Despite the positive results of surgical repair shown in our study and in the existing literature, endovascular treatment has a high technical eligibility with good reported outcomes and represents an alternative for open surgery.

[The popliteal artery aneurysm - surgical and endovascular therapy]. / Das Poplitealarterienaneurysma - chirurgische und endovaskuläre Therapie.

Popliteal artery aneurysm is defined as an enlargement of the popliteal artery of more than 50 % of the original diameter. In more than 95 % of the cases, arteriosclerosis is the cause. The prevalence of asymptomatic and symptomatic popliteal artery aneurysms is less than 0.5 % of the population but rises in the age group of the 65-80-year-olds up to 1 %. About one-third of all diagnosed popliteal artery aneurysms are asymptomatic incidental findings, whereas the other two-thirds are noticed due to their symptoms (acute or chronic ischaemia, local compression syndrome, rupture). The indication for invasive treatment is considered for asymptomatic popliteal artery aneurysms at a diameter of more than 2 cm. Symptomatic popliteal artery aneurysms are always an indication for treatment, but acute and chronic ischaemia is associated with a high morbidity. Since the middle of the last century surgical techniques have been used in the therapy for popliteal artery aneurysms and represent the gold standard in treatment strategies. Nevertheless, a growing number of reports about endovascular interventions for popliteal artery aneurysms are being published. In this review the state of knowledge about indications, applicability and results of invasive therapies for the treatment of popliteal artery aneurysms are presented.

Insulin release in response to calcium in the diagnosis of insulinoma.

A calcium infusion (4 mg Ca++/kg/hr) significantly increased plasma insulin levels and reduced blood glucose in 4 patients with insulin-secreting pancreatic islet cell tumors. These parameters were not altered by a similar infusion of calcium in normal volunteers, 2 patients with alimentary hypoglycemia, and 2 with functional hypoglycemia. No difference in response was observed between patients with benign and malignant beta-cell tumors. Infusion of diazoxide (600 mg) with calcium blocked the stimulation of the latter on insulin secretion. The results indicate the usefulness of calcium infusion in the diagnosis of insulin-secreting tumor.

Significance of ankle brachial index and collaterals for prediction of critical limb ischemia in infrainguinal peripheral arterial occlusive disease.

PURPOSE: Chronic limb ischemia (CLI) is a clinical diagnosis, but should be approved by technical tests like the ankle-brachial index (ABI). Although the ABI is well established, less is known about the influence of collateralization on clinical stage. MATERIAL/METHODS: Magnetic resonance angiographies (MRA) of 129 lower extremities were searched for morphological changes and for the number of collateral vessels according to Sorlie. Ankle pressures were recorded as higher (APmax) and lower (APmin) systolic blood pressures of the two ankle arteries with consecutive calculation of ABImax and ABImin. RESULTS: In comparisons of ROC curves, APmax (AUC=0.749) did significantly better as a prognostic marker than APmin (AUC=0.642) (p=0.005) and ABImax (AUC=0.744) did significantly better than ABImin (AUC=0.650) (p=0.019). APmax showed a positive likelihood ratio (+LR) of 5.79 and a negative likelihood ratio (-LR) of 0.47 (cutoff ≤55 mmHg). For the number of collateral vessels a +LR 2.27 and a -LR of 0.09 and in patients with an APmax ≤55 mmHg a +LR of 5.50 and a -LR of 0.00 were calculated (cutoff ≤1 collateral vessel). CONCLUSION: Whereas APmax is more eligible for verification of CLI, collateral count is better in exclusion of CLI. Both seem to be independent factors for validating the clinical diagnosis of CLI.

Differential response of cultured parsley cells to elicitors from two non-pathogenic strains of fungi. Microsomal conversion of (+)marmesin into psoralen.

Microsomal fractions isolated from parsley cell suspension cultures, which had been challenged with an elicitor from either Alternaria carthami or Phytophthora megasperma f. sp. glycinea, catalyzed the formation of psoralen from synthetic [3-14C](+)marmesin. Whereas psoralen was the only product formed in incubations with Alternaria-induced microsomes, another unidentified product was isolated from incubations with Phytophthora-induced microsomes. The latter product is neither a precursor nor a product of psoralen. In contrast, microsomes isolated from non-induced parsley cells lacked both of these catalytic activities. The formation of psoralen depends on NADPH as a cofactor and molecular oxygen. Blue-light-reversible CO inhibition and inhibition by various synthetic chemicals known to bind to cytochromes P450 indicated that the reaction is catalyzed by an elicitor-inducible cytochrome P450-dependent psoralen synthase. Fractionation of microsomal preparations by centrifugation revealed that psoralen synthase is associated with the endoplasmic reticulum. Our results suggest that the endoplasmic reticulum of cultured parsley cells is the primary target in the previously reported differential induction by elicitors from these two non-pathogenic strains of fungi.