[Clinically relevant incidental cardiovascular findings in CT examinations]. / Klinisch relevante kardiovaskuläre Zufallsbefunde bei CT­Untersuchungen.

BACKGROUND AND METHOD: Incidental cardiovascular findings are a frequent phenomenon in computed tomography (CT) examinations. As the result of a dedicated PubMed search this article gives a systemic overview of the current literature on the most important incidental cardiovascular findings, their prevalence and clinical relevance. RESULTS: The majority of incidental cardiovascular findings are of only low clinical relevance; however, highly relevant incidental findings, such as aortic aneurysms, thromboses and thromboembolic events can also occasionally be found, especially in oncology patients. CONCLUSION: The scans from every CT examination should also be investigated for incidental findings as they can be of decisive importance for the further clinical management of patients, depending on their clinical relevance.

[Results of surveillance cultures on a neonatal intensive care unit: a retrospective analysis]. / Ergebnisse des mikrobiologischen Screenings auf einer neonatologischen Intensivstation: Retrospektive Analyse.

BACKGROUND: Microbiological screening (MS) is standard on neonatal intensive care units (NICU). Objectives are the collection of information regarding bacterial pathogens of the individual patient as well as of the NICU, especially of multidrug-resistant pathogens (MRE). The role of microbiological screening for preterm infants ≤32 weeks of gestational age has not been fully evaluated. PATIENTS AND METHODS: For preterm infants ≤32 weeks of gestational age admitted during a 41-month period the results of microbiological screening during the first 2 weeks of life were analysed retrospectively. The results were associated with documented septic episodes. RESULTS: Bacteria were isolated in 215/972 of postnatal and 416/862 of later swabs. Detection of bacteria in the initial MS was associated with vaginal birth, low gestational age, low APGAR values at 5 and 10 min and mechanical ventilation. The proportion of patients with positive microbiological screening in subsequent swabs was not influenced by gestational age, birth weight, sex, mode of delivery and APGAR score. During the observation period 52 cases of sepsis (28 clinic, 24 microbiological) occurred. The sepsis rate was increased in patients with positive postnatal swabs, low gestational age, low birth weight, low 5 min APGAR score, male sex or need for mechanical ventilation. CONCLUSIONS: Microbiological screening provides an overview of the NICU-specific pathogens but is of limited value in the prediction of septicaemias in preterm infants ≤32 weeks gestational age.

[Analysis of the quality of life of patients with osteoid osteoma before and after radiofrequency ablation treatment]. / Analyse der Lebensqualität von Patienten mit Osteoidosteom vor und nach Behandlung mittels Radiofrequenzablation.

BACKGROUND: The aim of this study was to investigate the effectiveness of the treatment of osteoid osteomas (OO) by radiofrequency ablation (RFA). In particular, the recurrence rate and the improvement in the quality of life as assessed by the reduction of pain intensity were evaluated. METHODS: Retrospective analysis of 26 patients after RFA of an OO and prospective analysis of 14 patients using a self-developed quality of life questionnaire. The questionnaire, the electronic patient file and the histopathological findings were processed. RESULTS: An average of 22 months passed between the first onset of complaints and the causative treatment by RFA. After RFA, there was a significant reduction in pain symptoms and thus an increase in the quality of life. These results confirm that RFA from OO is a safe and efficient treatment procedure. DISCUSSION: In order to avoid long-term conservative treatment attempts and to reduce effects on the musculoskeletal system, a timely RFA of OO should be performed after diagnosis.

Validating New Software for Semiautomated Liver Volumetry--Better than Manual Measurement?

PURPOSE: This prospective study compared a manual program for liver volumetry with semiautomated software. The hypothesis was that the semiautomated software would be faster, more accurate and less dependent on the evaluator's experience. MATERIALS AND METHODS: Ten patients undergoing hemihepatectomy were included in this IRB approved study after written informed consent. All patients underwent a preoperative abdominal 3-phase CT scan, which was used for whole liver volumetry and volume prediction for the liver part to be resected. Two different types of software were used: 1) manual method: borders of the liver had to be defined per slice by the user; 2) semiautomated software: automatic identification of liver volume with manual assistance for definition of Couinaud segments. Measurements were done by six observers with different experience levels. Water displacement volumetry immediately after partial liver resection served as the gold standard. The resected part was examined with a CT scan after displacement volumetry. RESULTS: Volumetry of the resected liver scan showed excellent correlation to water displacement volumetry (manual: ρ = 0.997; semiautomated software: ρ = 0.995). The difference between the predicted volume and the real volume was significantly smaller with the semiautomated software than with the manual method (33% vs. 57%, p = 0.002). The semiautomated software was almost four times faster for volumetry of the whole liver (manual: 6:59 ± 3:04 min; semiautomated: 1:47 ± 1:11 min). CONCLUSION: Both methods for liver volumetry give an estimated liver volume close to the real one. The tested semiautomated software is faster, more accurate in predicting the volume of the resected liver part, gives more reproducible results and is less dependent on the user's experience. KEY POINTS: Both tested types of software allow exact volumetry of resected liver parts. Preoperative prediction can be performed more accurately with the semiautomated software. The semiautomated software is nearly four times faster than the tested manual program and less dependent on the user's experience.

Neural and glial-mediated effects of growth factors acting via tyrosine kinase receptors on luteinizing hormone-releasing hormone neurons.

It is becoming increasingly evident that the secretory activity of LHRH neurons is regulated not only by transsynaptic inputs but also by trophic molecules of glial and neuronal origin. The present experiments were undertaken to gain insights into the potential cell-cell mechanisms by which basic fibroblast growth factor (bFGF) and transforming growth factor-alpha (TGF alpha), two growth factors produced in the hypothalamus, may affect LHRH neuronal function. Northern blot analysis showed that the LHRH-producing cell line GT1-7 contains the messenger RNA (mRNA) encoding the type 1 fibroblast growth factor receptor (FGFR-1) but not that encoding the epidermal growth factor (EGF) receptors, which mediates the biological actions of both TGF alpha and EGF. Ligand-induced receptor phosphorylation experiments demonstrated that GT1-7 cells possess biologically active FGFR-1s but not EGF receptors. Exposure of the cells to bFGF resulted not only in FGFR-1 tyrosine phosphorylation, but also in tyrosine phosphorylation of phospholipase C gamma, one of the initial enzymes in the intracellular signaling cascade initiated by FGFR activation. GT1-7 cells proliferated in response to this activation. Despite the presence of biologically active receptors, bFGF did not significantly stimulate release of the mature LHRH decapeptide. Instead, bFGF increased the steady-state levels of the mRNA encoding the LHRH precursor processing endoprotease PC2, with a time course comparable to that of phorbol esters, suggesting that, as shown in the companion paper, the actions of the growth factor on LHRH neurons involve facilitation of the initial step in LHRH prohormone processing. The increase in PC2 gene expression was not accompanied by changes in LHRH mRNA levels. Unlike these direct actions of bFGF on GT-1 cells, TGF alpha appears to act indirectly via astroglial intermediacy. Exposure of GT1-7 cells to TGF alpha or EGF failed to affect several parameters of cellular activity including LHRH release, LHRH and PC2 mRNA levels, and cell proliferation. In contrast, astrocyte culture medium conditioned by treatment with TGF alpha led to sustained stimulation of LHRH release with no changes in LHRH gene expression and a transient increase in PC2 mRNA levels. Although no definitive evidence for the presence of FGFR-1 in normal LHRH neurons could be obtained by either double immunohistochemistry or double in situ hybridization procedures, fetal LHRH neurons in primary culture responded to bFGF with neurite outgrowth. Thus, normal LHRH neurons may have an FGFR-1 content too low for detection by regular histochemical procedures, and/or detectable expression of the receptor may be confined to a much earlier developmental stage. The mitogenic effect of bFGF on GT1-7 cells supports this possibility and suggests a role for FGF in the cell proliferation events that precede acquisition of the LHRH neuronal phenotype. It appears that once this phenotype is established, bFGF may promote the differentiation of LHRH neurons. The results also suggest that the secretory capacity of LHRH neurons develops under a dual trophic influence, one on peptide processing exerted directly by bFGF on early neurons, and another on LHRH release, exerted by TGF alpha via the intermediacy of astroglial cells.

Combination of interferons and cytostatic drugs for treatment of advanced colorectal cancer.

Three phase I/II trials were performed in patients with metastatic colorectal cancer using immunochemotherapy--a combination of recombinant interferon beta and gamma with low doses of cytostatic drugs. The third regimen, consisting of a cytostatic component containing 5-fluorouracil plus carboplatin plus mitomycin C besides the interferons, produced a high remission rate of 47%: 14/30 patients responded. The tolerability of this protocol was good and it could be administered on an out-patient basis.

Behaviour of the transgenic (mREN2)27 rat.

The first model of genetically engineered hypertension, the transgenic rat TGR (mREN2)27, provides a unique opportunity to study the behavioural effects of an altered brain renin-angiotensin system. The TGR (mREN2)27 rats, characterised by fulminant hypertension, show differences in both the peripheral and central angiotensin systems. The behaviour of male transgenic TGR (mREN2)27 and male Sprague-Dawley rats were determined by 4 behavioural tests. While on the elevated X-maze the TGR (mREN2)27 rat showed a greater 'anxiogenic' profile (fewer open arm entries) than the control Sprague-Dawley rats, this 'anxiogenic' profile increased further during a second exposure to the elevated X-maze 24 h later. In comparison the behaviour of the male Sprague-Dawley rats was not different between the two exposures to the elevated X-maze. Locomotor activity did not differ between either the TGR (mREN2)27 or Sprague-Dawley rats when placed in a 1 m2 open-field for 10 min. A short period of fluid-deprivation (3 h) reversed the 'anxiogenic' profile of the TGR (mREN2)27 on the elevated X-maze. Administration of captopril (20 mg . kg-1 body weight) in the drinking water of the TGR (mREN2)27 rats and Sprague-Dawley rats reversed the anxiogenic profile of the TGR (mREN2)27 rat on the elevated X-maze but did not alter the behaviour of the Sprague-Dawley rats.

[Urographic investigations on the effect of high dose progestagen therapy (author's transl)]. / Urographische Untersuchungen zur Wirkung einer hochdosierten Progestagentherapie

The relationship between high dose progestagen treatment and changes on the intravenous urogram were studied in 27 patients. For this purpose, six specific features in the urogram were examined. Our findings in the patients available to use indicate that there is no demonstrable dilatation of the renal pelves and ureters as a result of the administration of progestational substances alone. These results are discussed in relation to the relevant literature.

[Experimental studies on the effect of long-term oestrogens on contrast excretion during intravenous urography (author's transl)]. / Tierexperimentelle Studie zur Wirkung der Ostrogen-Langzeitapplikation auf die Kontrastmittelausscheidung im intravenösen Urogramm.

The possible connection between long continued oestrogen intake and dilatation of the upper urinary tract was examined urographically in nine female rabbits. The degree of dilatation was judged on eleven parameters. The results of the study indicate that oestrogens without simultaneous mechanical influence on the urinary tract does not lead to dilatation of the pelvis or ureter. The results are illustrated graphically and are compared with the findings in the literature.

[Experimental investigations on the effect of progesterone on contrast excretion (author's transl)]. / Tierexperimentelle Untersuchungen zur Frage der Beeinflussung der Kontrastmittelausscheidung durch Progesteronbehandlung.

The relationship between high dose progesterone treatment and pregnancy and dilatation of the upper urinary tract was investigated by doing intravenous urograms on eight female rabbits. Ten features of the urogram were studied. It was concluded that the administration of sex hormones to rabbits without any mechanical change in the ureters, did not lead to urographically demonstrable dilatation of the ureters. Negative findings in pregnant animals indicate that the mechanical situation in rabbits differs from that found in human pregnancy. The results are discussed with relation to the available literature.

[Reduction of radiation exposure for patient and investigator in interventional radiography]. / Reduktion der Strahlenexposition in der interventionellen Angiographie für Patient und Untersucher.

PURPOSE: In a retrospective analysis of vascular interventional procedures, relations between parameters of the examination and radiation exposure of patient and medical personnel are examined. MATERIAL AND METHOD: 1208 vascular interventional procedures are evaluated. Interventional procedures are divided into three groups: percutaneous transluminal angioplasty, implantation of a stent, thrombolysis. RESULTS: Mean values of the radiation dose of patient and radiology personnel are reported for these examinations. The mean value of the radiation dose of the physician was 7 microSv (maximum 24 microSv), that of the patient 1548 cGy.cm2 (maximum 8485 cGy.cm2). CONCLUSION: The quantity of X-rays to the patient may be lowered by using pulsed fluoroscopy and by reducing the number of radiographs. Reduction of the number of radiographs may be achieved by using the last-image hold and the road mapping mode. The operator's dose can be decreased by using additional radiation protection systems like a MAVIG-radiation protection wall. The radiation dose reduction was 61% for the physician and 17% for the patient.

Preclinical and early clinical trial with mafosfamide as immune modulator.

Low doses of cyclophosphamide (CPA) modulate immune responses and induce complete tumor regression and cures in mice. The mechanism of action is related to the development of a T-cell-dependent immune reaction. We started a trial with mafosfamide (MAF), the active metabolite of CPA and found that the response of Ehrlich ascites-tumor (EAT) cells in vivo to this compound is biphasic. The highest cure rate (70%) is obtained with a low i.p. dose of 7 mg/kg/d. Hematologic side effects were not observed. Arguments for an immune mechanism involved are that (1) mice treated with MAF showed a statistically significant increase in spleen weight compared with untreated controls, (2) after treatment large numbers of mononuclear cells appeared in the ascites, and (3) long-term surviving mice were resistant to further challenge with large inocula of EAT. We started a pilot trial in patients with metastasizing and advanced renal cell carcinoma - a disease which can be considered to be influenced by the immunologic response of the tumor host. The starting dose of MAF was 24 mg/m2/d administered i.v. Therapy was repeated at 14 days interval on an out-patient basis. Monitoring of mononuclear cells in the peripheral blood with monoclonal antibodies using a FACS IV were performed two times a week. There are eleven patients on study. Up to now, four out of them have been fully evaluated with respect to toxicity, immune modulation and tumor response. With respect to response to treatment, 2 patients had no change of disease, 1 patient had a mixed and 1 patient a partial response. No hematological or other toxicities could be observed. All patients showed an increase in monocytes/macrophages as well as NK-cells--clearly related to therapy.

Hyperintense basilar artery on FLAIR MR imaging: diagnostic accuracy and clinical impact in patients with acute brain stem stroke.

BACKGROUND AND PURPOSE: FLAIR-hyperintense vessels are known to be a sign of sluggish collateral blood flow in hemispheric vessel occlusion. Additionally, they seem to have a prognostic implication. The aim of the current study was to evaluate the hyperintense configuration of the basilar artery (FLAIR-hyperintense basilar artery) as a marker of basilar artery occlusion and as a predictor of patient outcome. MATERIALS AND METHODS: We retrospectively identified 20 patients with basilar artery occlusion who initially underwent MR imaging with subsequent DSA. The diagnostic accuracy of the FLAIR-hyperintense basilar artery sign was tested by 4 independent readers in a case-control design, and the relation among FLAIR-hyperintense basilar artery and DWI posterior circulation-ASPECTS, patient outcome, and patient survival was evaluated. To grade the extent of the FLAIR-hyperintense basilar artery sign, we generated a score by counting the number of sections from the basilar tip to the foramen magnum in which a hyperintense signal in the vessel lumen was present multiplied by the section thickness. RESULTS: The FLAIR-hyperintense basilar artery sign showed moderate sensitivity (65%-95%) but very good specificity (95%-100%) and accuracy (85%-93%) for the detection of basilar artery occlusion. Substantial or excellent inter-reader agreement was observed (Cohen κ, 0.64-0.85). The FLAIR-hyperintense basilar artery inversely correlated with the posterior circulation-ASPECTS (r = -0.67, P = .01). Higher FLAIR-hyperintense basilar artery scores were associated with patient death (28.3 ± 13.7 versus 13.4 ± 11.1, P < .05). CONCLUSIONS: The FLAIR-hyperintense basilar artery sign proved to be a valuable marker of vessel occlusion and may substantially support the diagnosis of basilar artery occlusion. The established FLAIR-hyperintense basilar artery score may be helpful for the prediction of individual patient survival.