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Lahmer T, Stock K, Rasch S, Porubsky S, Jeske S, Schustetter C, Protzer U, Heemann U, Schmid R, Weichert W, Weirich G, Slotta-Huspenina J. [Interdisciplinary ultrasound-guided, minimally invasive autopsy in COVID-19-deceased patients in the intensive care unit of a university hospital : A proof-of-concept study]. Pathologie (Heidelb) 2023; 44:193-197. [PMID: 38051339 PMCID: PMC10739551 DOI: 10.1007/s00292-023-01248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 12/07/2023]
Abstract
In this feasibility study, we carried out in an interdisciplinary team standardised, ultrasound-guided, minimally invasive autopsy (US-MIA) directly at the bedside of patients who died of COVID-19 in the intensive care unit of the Rechts der Isar Hospital of the Technical University Munich (TUM). The aim of the study was to verify the feasibility, time efficiency and infection hygiene aspects of the process, as well as the quality of the tissue samples. Our results show that bedside US-MIA is suitable for obtaining tissue samples before the onset of postmortem autolysis, and that it can also be carried out quickly and safely. The potential of US-MIA, which has gained little recognition so far, deserves special attention in the context of postmortem diagnosis, research and quality assurance. In the future, these strengths of US-MIA could help to lead postmortem diagnosis into the modern age of pathological deep analytics ("omics").
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Affiliation(s)
- T Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - K Stock
- Abteilung für Nephrologie - Nierenheilkunde, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - S Rasch
- Klinik und Poliklinik für Innere Medizin II, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - S Porubsky
- Institut für allgemeine Pathologie, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - S Jeske
- Institut für Virologie, Technische Universität München, München, Deutschland
| | - C Schustetter
- Institut für Allgemeine Pathologie und Pathologische Anatomie, TUM School of Medicine and Health, Technische Universität München, München, Deutschland, Trogerstr. 18, 81675
| | - U Protzer
- Institut für Virologie, Technische Universität München, München, Deutschland
| | - U Heemann
- Abteilung für Nephrologie - Nierenheilkunde, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - R Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - W Weichert
- Institut für Allgemeine Pathologie und Pathologische Anatomie, TUM School of Medicine and Health, Technische Universität München, München, Deutschland, Trogerstr. 18, 81675
| | - G Weirich
- Institut für Allgemeine Pathologie und Pathologische Anatomie, TUM School of Medicine and Health, Technische Universität München, München, Deutschland, Trogerstr. 18, 81675
| | - J Slotta-Huspenina
- Institut für Allgemeine Pathologie und Pathologische Anatomie, TUM School of Medicine and Health, Technische Universität München, München, Deutschland, Trogerstr. 18, 81675.
- Pathologie Starnberg MVZ GmbH, Starnberg, Deutschland.
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von Stillfried S, Freeborn B, Windeck S, Boor P, Böcker J, Schmidt J, Tholen P, Röhrig R, Majeed R, Wienströer J, Bremer J, Weis J, Knüchel R, Breitbach A, Bülow RD, Cacchi C, Wucherpfennig S, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Spring O, Braun G, Römmele C, Kling E, Kröncke T, Wittmann M, Hirschbühl K, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Friemann J, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Esposito I, Crudele G, Seidl M, Mahlke N, Hartmann A, Haller F, Eichhorn P, Lange F, Amann KU, Coras R, Ingenwerth M, Rawitzer J, Schmid KW, Theegarten D, Gradhand E, Smith K, Wild P, Birngruber CG, Schilling O, Werner M, Acker T, Gattenlöhner S, Franz J, Metz I, Stadelmann C, Stork L, Thomas C, Zechel S, Ströbel P, Fathke C, Harder A, Wickenhauser C, Glatzel M, Matschke J, Krasemann S, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Ondruschka B, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Jonigk D, Werlein C, Domke LM, Hartmann L, Klein I, Schirmacher P, Schwab C, Röcken C, Langer D, Roth W, Strobl S, Rudelius M, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weichert W, Weirich G, Stock K, Barth P, Schnepper A, Wardelmann E, Evert K, Evert M, Büttner A, Manhart J, Nigbur S, Bösmüller H, Fend F, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Vogt N, Kurz F. [Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]. Pathologie (Heidelb) 2022; 43:101-105. [PMID: 36114379 PMCID: PMC9483541 DOI: 10.1007/s00292-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Autopsies are a valuable tool for understanding disease, including COVID-19. MATERIALS AND METHODS The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs. RESULTS The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy. CONCLUSIONS Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.
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Affiliation(s)
- Saskia von Stillfried
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Benita Freeborn
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Svenja Windeck
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Peter Boor
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Medizinische Klinik II (Nephrologie und Immunologie), Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Elektronenmikroskopische Einrichtung, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
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Hochmayr C, Ndayisaba JP, Gande N, Staudt A, Bernar B, Stock K, Geiger R, Knoflach M, Kiechl-Kohlendorfer U. Prevalence and differences of ideal cardiovascular health in urban and rural adolescents in the Region of Tyrol: results from the EVA Tyrol study. BMC Cardiovasc Disord 2021; 21:338. [PMID: 34256716 PMCID: PMC8276470 DOI: 10.1186/s12872-021-02156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Early adoption of a healthy lifestyle has positive effects on cardiovascular health (CVH) in adulthood. In this study, we aimed to assess CVH metrics in a cohort of healthy teenagers with focus on differences between rural and urban areas.
Methods The Early Vascular Aging (EVA) Tyrol study is a population-based non-randomized controlled trial, which prospectively enrolled 14- to 19-year-old adolescents in North Tyrol, Austria and South Tyrol, Italy between 2015 and 2018. Data from the baseline and control group (prior to health intervention) are included in the current analysis. CVH determinants (smoking, body mass index, physical activity, dietary patterns, systolic and diastolic blood pressure, total cholesterol and fasting blood glucose) were assessed and analyzed for urban and rural subgroups separately by univariate testing. Significant variables were added in a generalized linear model adjusted for living in urban or rural area with age and sex as covariates. Ideal CVH is defined according to the guidelines of the American Heart Association. Results 2031 healthy adolescents were enrolled in the present study (56.2% female, mean age 16.5 years). 792 adolescents (39.0%) were from urban and 1239 (61.0%) from rural areas. In 1.3% of adolescents living in urban vs. 1.7% living in rural areas all CVH determinants were in an ideal range. Compared to the rural group, urban adolescents reported significantly longer periods of moderate to vigorous-intensive activity (median 50.0 min/day (interquartile range 30–80) vs. median 40.0 min/day (interquartile range 25–60), p < 0.01). This observation remained significant in a generalized linear model (p < 0.01). There were no significant differences between the study groups regarding all other CVH metrics. Conclusion The low prevalence of ideal CVH for adolescents living in urban as well as rural areas highlights the need for early health intervention. Geographic differences must be taken into account when defining targeted subgroups for health intervention programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02156-6.
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Affiliation(s)
- C Hochmayr
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Medical University of Innsbruck, Innsbruck, Austria
| | - J P Ndayisaba
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - N Gande
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - A Staudt
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - B Bernar
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - K Stock
- Department of Pediatrics III (Cardiology), Medical University of Innsbruck, Innsbruck, Austria
| | - R Geiger
- Department of Pediatrics III (Cardiology), Medical University of Innsbruck, Innsbruck, Austria
| | - M Knoflach
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - U Kiechl-Kohlendorfer
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Kaiser P, Brueckner G, Kastenberger T, Schmidle G, Stock K, Arora R. Mid-term follow-up of surgically treated and healed scaphoid fractures. Hand Surg Rehabil 2021; 40:288-292. [PMID: 33549698 DOI: 10.1016/j.hansur.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 01/16/2023]
Abstract
The aim of this study was to evaluate the mid-term results of surgically treated scaphoid fractures since we were concerned that good results might deteriorate over time due to osteoarthritis or functional impairment. Thirty-three out of 121 surgically treated patients (isolated scaphoid fractures n = 23; scaphoid fractures with concomitant injuries n = 10) were evaluated retrospectively (47-138 months). Five patients (4%) had a non-union after internal fixation and were excluded because of additional treatment. The remaining 83 patients were not available for a follow-up examination. Patients with an isolated scaphoid fracture had a mean extension-flexion of 68°-0°-64°, a radial-ulnar deviation of 27°-0°-41° and a grip strength of 39 kg (corresponding to 87-98% of the uninjured contralateral wrist), while patients with concomitant injuries had a mean extension-flexion of 60°-0°-44°, radial-ulnar deviation of 22°-0°-38° and a grip strength of 42 kg (corresponding to 73-98% of the uninjured contralateral wrist). The Michigan Hand Questionnaire score was 85 and 75 and the Patient-Rated Wrist Evaluation score was 8 and 21, respectively. Fifteen patients had radiological signs of radiocarpal osteoarthritis with a significantly higher occurrence in those who had concomitant injuries compared to those with isolated scaphoid fractures (p < 0.01). There was no significant group difference in scaphotrapeziotrapezoid (STT) osteoarthritis (p = 0.968). One STT osteoarthritis case occurred after plate fixation, one after antegrade screw fixation and 10 after retrograde screw fixation. Surgical treatment of an acute isolated scaphoid fracture has excellent clinical, functional, and radiologic mid-term results, while scaphoid fractures with concomitant wrist injuries have slightly inferior results.
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Affiliation(s)
- P Kaiser
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - G Brueckner
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - T Kastenberger
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - G Schmidle
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - K Stock
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - R Arora
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
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Vergnano S, Bamford A, Bandi S, Chappel F, Demirjian A, Doerholt K, Emonts M, Ferreras-Antolin L, Goenka A, Jones L, Herberg JA, Hinds L, McGarrity O, Moriarty P, O'Riordan S, Patel M, Paulus S, Porter D, Stock K, Patel S. Paediatric antimicrobial stewardship programmes in the UK's regional children's hospitals. J Hosp Infect 2020; 105:736-740. [PMID: 32454075 DOI: 10.1016/j.jhin.2020.05.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022]
Abstract
A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. 'Audit and feedback' was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established.
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Affiliation(s)
- S Vergnano
- University of Bristol, Bristol, UK; Bristol Royal Hospital for Children, Bristol, UK.
| | - A Bamford
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - S Bandi
- Leicester Royal Infirmary, Leicester, UK
| | - F Chappel
- Evelina London Children's Hospital, London, UK
| | - A Demirjian
- Evelina London Children's Hospital, London, UK
| | | | - M Emonts
- The Great North Children's Hospital, Newcastle, UK
| | | | - A Goenka
- Royal Manchester Children's Hospital, Manchester, UK
| | - L Jones
- Royal Hospital for Sick Children, Edinburgh, UK
| | | | - L Hinds
- Sheffield Children's Hospital, London, UK
| | - O McGarrity
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - P Moriarty
- Royal Belfast Hospital for Sick Children, Northern Ireland, Belfast, UK
| | | | - M Patel
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - S Paulus
- John Radcliffe Hospital, Oxford, UK
| | - D Porter
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - K Stock
- Royal Hospital for Children, Glasgow, UK
| | - S Patel
- Southampton Children's Hospital, Southampton, UK
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Knipping S, Stock K, Keller J. [Unclear mass following sclerotherapy of cervical cyst]. Laryngorhinootologie 2019; 98:879-880. [PMID: 31519021 DOI: 10.1055/a-1007-1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Sarcomas count among the very rare malignancies of the orbit. Epithelioid sarcomas typically occur in the subcutaneous tissue of younger patients; an affected orbit constitutes a rarity. OBJECTIVES Only three cases of this extremely rare disease of the orbit, which is associated with marked aggressiveness and a very poor prognosis, have been analysed in the worldwide current literature. PATIENT AND METHODS We present a case report together with a literature review. A rapidly progressing painful proptosis with visual loss occurred in a 30-year-old patient. Imaging and invasive diagnostic procedures were initiated as a consequence of this. RESULTS Diagnostic imaging revealed an infiltrative process of the right orbit. Following endonasal decompression of the orbit and probe acquisition, histological and immunohistochemical tests showed the presence of a proximal type epithelioid sarcoma. Therapy consisted of orbit exenteration together with implantation of titanium miniplates for orbital prosthesis. During the course of disease, osseous metastases developed. The patient died during palliative chemotherapy, 14 months after the initial diagnosis. CONCLUSION Epithelioid sarcomas are extremely rare, difficult to treat tumours in the head and neck region. The associated mortality rates are high. Aggressive surgical therapy with intensive follow-up is recommended. The prognosis depends upon the resection status.
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Affiliation(s)
- M Thranitz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
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Jackson J, Hamar B, Lazar E, Lim K, Rodriguez D, Stock K, Wolfberg AJ, Dunk R. Nuchal translucency measurement plus non-invasive prenatal testing to screen for aneuploidy in a community-based average-risk population. Ultrasound Obstet Gynecol 2014; 44:491. [PMID: 24890031 DOI: 10.1002/uog.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/12/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Affiliation(s)
- J Jackson
- South Shore Hospital, Boston, MA, USA
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Glass R, Stock K, Macas J, Kettenmann H, Momma S, Synowitz M. P17.36 * ENDOGENOUS NEURAL PRECURSOR CELLS INDUCE CELL DEATH OF HIGH-GRADE ASTROCYTOMAS AND HAVE A TROPISM TO TUMORS IN THE HUMAN BRAIN. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stock K, Rusner C. [82-year-old woman with acute abdomen]. Dtsch Med Wochenschr 2011; 137:27-8. [PMID: 22180280 DOI: 10.1055/s-0031-1297281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- K Stock
- Universitätsklinik und Poliklinik für Diagnostische Radiologie, Universitätsklinikum Halle (Saale), Halle, Germany
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Abstract
Sacroiliac (SI) screw fixation represents an effective method to stabilise pelvic injuries. However, to date neither reliable radiological landmarks nor effective anatomical classifications of the sacrum exist. This study investigates the influence of variability in sacral shape on secure transverse SI-screw positioning. Furthermore, consistent correlations of these anatomical conditions are analysed with respect to standard planar pelvic views. For shape analysis, 80 human computed tomography data sets were segmented with the software Amira 4.2 to obtain 3D reconstructions. We identified anatomical conditions (ACs) according to the extent of the effect on the bony screw pathway. Subsequently, the pelvis was spatially aligned using representative bone protuberances in order to create standard Matta projections. In each view, the ACs were described in terms of distance from bone landmarks. Three-dimensional shape analysis revealed the height of the pedicular isthmus (PH) as the limiting variable for secure screw insertion. The lateral and outlet views allowed an orthogonal projection of PH. In the lateral view, the ratio of the lateral sacral triangle framed by the S1 body height and width showed a high correlation to PH (p = 0.0001). A boundary ratio of 1.5 represented a reliable variable to determine whether or not a screw can be inserted (positive predictive value: 97%). In the outlet view, the distance between the S1 endplate and the SI joint top level (EJ) strongly correlated with PH (p = 0.0001). With EJ 0 mm, screw insertion was possible in all cases (100%). SI-screw insertion requires a well-planned procedure. Orientation of the sacral pedicle is of extreme relevance. A narrow sacroiliac channel and high sacral shape variability limit secure screw placement. However, no determining parameters exist, allowing accurate prediction of secure screw insertion based on X-rays or fluoroscopy. The lateral sacral triangle in the lateral view represents a simple and accurate preoperative method of support for the surgeon's decision to undertake this procedure. No additional technical effort is necessary. A boundary ratio of 1.5 predicts a sufficient bone stock for at least one 7.3 mm screw. Furthermore, the evaluation of the outlet projection can be used to assess the safety of the operation. Basically, a preoperative lateral pelvic image should be mandatory.
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Affiliation(s)
- T Mendel
- Department of Trauma Surgery, Employers' Liability Insurance Association Hospital Bergmannstrost, Merseburger Straße 165, D-06112 Halle (Saale), Germany.
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Thalhammer C, Aschwanden M, Husmann M, Jeanneret C, Jacomella V, Clemens RKJ, Stock K, Amann-Vesti BR. Clinical relevance of musical murmurs in color-coded duplex sonography of peripheral and visceral vessels. VASA 2011; 40:302-7. [PMID: 21780054 DOI: 10.1024/0301-1526/a000119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Musical murmurs (MMs) are Doppler phenomena which sound like high-frequency musical sounds. They reflect high and turbulent flow within relevant stenoses and were first described in degenerated bioprosthetic valves and later in intracranial vessels and were associated either with high-grade arterial stenosis, small collateral arteries or carotid cavernous fistulas. Objective of this article is to illustrate the spectrum of imaging of MMs observed in renal, intestinal and peripheral vessels. PATIENTS AND METHODS Four experienced vascular ultrasound laboratories had been asked to report their cases with documented musical tones in color coded duplex sonography (CCDS) within a two year observational period (2008 and 2009). Documented Doppler findings and corresponding clinical data were analyzed. RESULTS MMs were found in 18 patients with an incidence of 0.05 % and were observed in high grade stenosis in hemodialysis access (n = 5), in post-biopsy arteriovenous fistulas after renal transplantation (n = 3), in renal transplant artery (n = 1) and vein (n = 3), stenoses in peripheral (n = 2) and intestinal arterial disease (n = 2), and in peripheral veins (n = 2). CONCLUSIONS The so called musical murmurs are a rare but potentially relevant finding in CCDS. They are caused by a variety of underlying pathologies with different clinical implications, however correct interpretation is mandatory since urgent therapy might be necessary.
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Stock K, Hann von Weyhern C, Slotta-Huspenina J, Burian M, Clevert DA, Meining A, Prinz C, Pachmann C, Holzapfel K, Schmid RM, Lersch C. Microcirculation of subepithelial gastric tumors using contrast-enhanced ultrasound. Clin Hemorheol Microcirc 2010; 45:225-32. [PMID: 20675903 DOI: 10.3233/ch-2010-1302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The evaluation of subepithelial tumors of the stomach is normally the domain of gastroscopy and endoscopic ultrasound. We investigated these rare tumors using transabdominal B-mode ultrasound and performed perfusion analysis of these tumors with contrast enhanced ultrasound. METHODS Patients with gastrointestinal stromal tumors (GIST, n = 3), leiomyoma (n = 1) and schwannoma (n = 1) were routinely examined using conventional B-mode-ultrasound, colour Doppler ultrasound and contrast-enhanced ultrasound (contrast media: Sonovue; ultrasound device: Siemens Acuson Sequoia 512). Gastroscopy, endosonography with puncture of the subepithelial tumor and computed tomography were also performed in all patients. After surgery, the resected stomach tumors were correlated with the preoperative imaging findings. RESULTS All calculated tumor sizes using any imaging modalities showed a good correlation with the macroscopic tumor sizes ex-vivo. Histologically increased tumor size of the GISTs was correlated with large, central avascular areas. The GISTs and the leiomyoma presented with mixed echogenicity in B-mode-ultrasound. Colour Doppler ultrasound was able to detect some vessels in the periphery of the tumor only. Using contrast-enhanced ultrasound the GISTs and the leiomyoma presented hypervascular. The contrast pattern of these lesions was from the periphery to the centre or diffuse or a progressive centrifugal fill in during the arterial phase. We also registered slowly progressive washout starting at the end of the arterial phase and increasing into the late phase. The contrast media behaviour in the schwannoma was different from that describt above within the GISTs: it was noted to have a diffuse intralesional pattern at the start of the arterial phase followed by an early, rapidly progressing washout-phenomenon. CONCLUSION In our pilot study B-mode transabdominal ultrasound was able to visualise gastric subepithelial tumors larger than three centimetre. Contrast-enhanced ultrasound is a proven method in clinical practice for the perfusion analysis of gastric subepithelial tumors. It can also be used for the planning of ultrasound-guided biopsies to avoid punctures of necrotic tumor parts.
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Affiliation(s)
- K Stock
- II. Medizinische Klinik, Klinikum rechts der Isar der TU München, München, Germany.
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Mueller T, Kraya T, Stoltenburg G, Stock K, Deschauer M, Zierz S. P34-7 Matrin3 myopathy: Distal and axial myopathy without vocal cord involvement. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)61252-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Clevert DA, Kubisch C, Weckbach S, Frey U, Stock K, Reiser M. B-flow and color Doppler sonography findings in iatrogenic carotid-jugular arteriovenous fistula. Clin Hemorheol Microcirc 2010; 44:19-25. [PMID: 20134089 DOI: 10.3233/ch-2010-1247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the case of a 66-year-old woman with an aortic valve reconstruction. Subsequently she presented with an arteriovenous fistula (AVF) between the left common carotid artery and internal jugular vein following several attempts of jugular catheter insertion. Due to aliasing, correct visualization of the fistula track was hindered by conventional color Doppler. However, by using the B-flow imaging technique, the fistula track could be detected without aliasing or overwriting. Duplex examination revealed an AVF between both vessels with an arterialized waveform in the left jugular vein and a high-velocity turbulent flow inside the fistula. Due to these findings we will change our routine scanning protocol for extracranial vessels and will use B-flow in indistinctive or difficult conditions to obtain additional informations.
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Affiliation(s)
- D-A Clevert
- Institute of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany.
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Müller TJ, Kraya T, Stoltenburg G, Stock K, Deschauer M, Weis J, Zierz S. Matrin3 myopathy: Distal and axial myopathy with pathology of the nucleus and the perinuclear region. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1251016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Clevert DA, Stock K, Klein B, Slotta-Huspenina J, Prantl L, Heemann U, Reiser M. Evaluation of Acoustic Radiation Force Impulse (ARFI) imaging and contrast-enhanced ultrasound in renal tumors of unknown etiology in comparison to histological findings. Clin Hemorheol Microcirc 2010; 43:95-107. [PMID: 19713604 DOI: 10.3233/ch-2009-1224] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE It was the aim of our study to combine the findings of contrast-enhanced ultrasound and ARFI-imaging in the evaluation of renal masses in comparison to the histological findings. MATERIALS AND METHODS Fifteen patients with unclear kidney lesions were analyzed. We used a high-end ultrasound machine (Siemens ACUSON S2000, Siemens Healthcare, Erlangen, Germany) with a multifrequency curved array 4 MHz or linear 9 MHz transducer. Contrast-enhanced ultrasound (bolus injection 1.6-2.4 ml SonoVue was carried out. We obtained fifteen ARFI measurements from each patient with at least five values for quantification. The ARFI-ROI (region of interest) was placed in the ventral margin of the kidney tumor and the whole ROI was covered by the tumor. The "reference-ROI" was placed in the ventral kidney parenchyma of the patient at a distance of at least two centimeters from the tumor. All renal tumors were surgically resected. In cases of complex renal cysts or anatomic variations mimicking renal tumors ("pseudo-tumors"), constant results of ultrasound examinations and additional MRI or multiphase CT over 6 months were required. RESULTS Fifteen patients were included in the study and were examined using the diagnostic ultrasound tools of our study The kidney tumors of our patients had diameters ranging from 1.5 to 8 cm and were located at depths ranging from 2 to 5.5 cm. ARFI imaging was also performed in all patients. A field up to a depth of 10 cm could be visualized for diagnostic use. Performing ARFI quantification using Siemens Virtual Touch Tissue Quantification we obtained minimum and maximum tissue shear velocities ranging from 1.6 to 3.42 m/s. The reference tissue ROIs showed values from 1.31 to 4.4 m/s. 12 cases were accepted for surgical resection. The visualization of lesions with Virtual Touch Tissue Imaging confirmed the measurements of ARFI quantification and were able to depict the different areas of stiffness in the kidney tissue. No infiltration of kidney veins or vena cava was detected by contrast-enhanced ultrasound. Of the 12 cases two "complicated" renal cysts were examined, and both showed Bosniak-III findings. CONCLUSION ARFI imaging improves visualization of unclear renal masses in comparison to fundamental B-scan and adds new information about the tissue stiffness in a less time-consuming and more reproducible way. CEUS with SonoVue allows an early evaluation of renal masses or complex cysts.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University of Munich - Grosshadern Campus, Munich, Germany.
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Clevert DA, Jung EM, Stock K, Weckbach S, Feuerbach S, Reiser M, Jung F. Evaluation of Malignant Liver Tumors: Biphasic MS-CT versus Quantitative Contrast Harmonic Imaging Ultrasound. Z Gastroenterol 2009; 47:1195-202. [DOI: 10.1055/s-0028-1109396] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wollschläger B, Bork I, Lemke J, Noack F, Stock K, Seufferlein T. Thorakales Aortenaneurysma als relevante Differenzialdiagnose einer pulmonalen Raumforderung. Pneumologie 2009. [DOI: 10.1055/s-2009-1242176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Westermann E, Stock K. Tierexperimentelle Untersuchungen über den Mechanismus der narkoseverkürzenden Wirkung von Monoaminoxydase-Hemmstoffen. Chemotherapy 2009. [DOI: 10.1159/000219927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Stock K, Hann von Weyhern C, Holzapfel K, Clevert DA, Schmid RM, Lersch C. [Endothelial adrenal cyst mimicking cystic echinococcosis in a Turkish woman]. Z Gastroenterol 2008; 46:1198-201. [PMID: 18937190 DOI: 10.1055/s-2008-1027295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cystic liver lesions include hepatic echinococcosis as an important differential diagnosis, especially in patients from endemic countries. Serology might be false negative in a relevant percentage of the patients. Thus, modern clinical imaging techniques are the most important non-invasive means for making or excluding the diagnosis of hepatic echinococcosis. CASE REPORT A 37-year-old Turkish woman was admitted to hospital because of abdominal pressure, lack of appetite and weight loss. The suspected radiological diagnosis of hepatic echinococcosis was made based on a septated, cystic liver process with calcifications seen in an already performed computered tomography. The physical examination and laboratory findings did not show any specific pathology. The serological tests for echinococcosis were negative. The MRI scan of the liver showed a 10 x 7.5 cm large, multi-segmented, cystic lesion between the right kidney and the right liver lobe. The cyst was discussed as possibly having an origin from the right adrenal gland and very unlikely from the liver or kidney. Ultrasonography (Siemens-Acuson Sequoia 512, Mountain View) showed a cystic lesion with septated structures and calcifications between the right kidney and the liver without a typical capsule. Contrast-enhanced ultrasound after fractionated injection of 4.8 mL Sonovue (Bracco, Milano) showed an intensive perfusion of the septa in the cyst. We admitted the patient for surgery. Interoperatively a right adrenalectomy and cystectomy was performed. Histology showed an epithelial adrenal cyst. The patient was asymptomatic twelve months after surgery. CONCLUSION High-end-ultrasonography with microbubble contrast media of the second generation is the primary diagnostic tool for the differential diagnosis of cystic lesions of the liver and adrenal glands. MRI or CT scans might be additionally indicated in the case of poor ultrasound conditions in a patient or before planned surgery, but can also fail to correct determine the origin of a cyst.
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Affiliation(s)
- K Stock
- II. Medizinische Klinik, Klinikum rechts der Isar der TU München, München.
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Krasnianski M, Müller T, Stock K, Zierz S. Bruns syndrome caused by intraventricular tumor. Eur J Med Res 2008; 13:179-181. [PMID: 18504174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The Bruns syndrome is an unusual phenomenon, characterized by attacks of sudden and severe headache, vomiting and vertigo, triggered by abrupt movement of the head. The presumptive cause of the Bruns syndrome is a mobile deformable intraventricular lesion leading to an episodic obstructive hydrocephalus resulted from an intermittent or positional CSF obstruction with elevation of intracranial pressure due to a ball-valve mechanism. Although the old neurological literature recognized tumors as well as neurocysticercosis as causes of the Bruns syndrome, during the last 60 years only intraventricular neurocysticercosis was reported to cause this symptom-complex. Here, we report a 38-year-old woman with relapsing attacks of headache, vertigo, nausea, vomiting, and ataxia provoked by head rotation corresponding to the classical Bruns syndrome. The cranial MRI revealed a tumor in the third ventricle and a further tumor in the fourth ventricle, which could cause a transient obstruction of the CSF pathways. This unusual observation of the Bruns syndrome in a non-parasitary disease of the CNS adds the syndrome to the differential diagnosis of paroxysmal vertigo.
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Affiliation(s)
- Michael Krasnianski
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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Surov A, Katzer M, Fornara P, Stock K. A rare cause of acute urinary retention. Arch Emerg Med 2008; 25:155. [DOI: 10.1136/emj.2007.048900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alsalameh S, Kalden J, Strohmaier M, Hiesche K, Stock K, Burmester G. Hyaluronsäure im Serum von Patienten mit entzündlichen und degenerativen Gelenkerkrankungen - Ergebnisse einer Studie und Übersichtsreferat. AKTUEL RHEUMATOL 2008. [DOI: 10.1055/s-2008-1047439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Clevert DA, Minaifar N, Weckbach S, Jung E, Stock K, Reiser M, Staehler M. Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 2008. [DOI: 10.3233/ch-2008-1083] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D.-A. Clevert
- Department of Clinical Radiology, University Hospitals–Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - N. Minaifar
- Department of Clinical Radiology, University Hospitals–Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - S. Weckbach
- Department of Clinical Radiology, University Hospitals–Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - E.M. Jung
- Department of Clinical Diagnostic Radiology, University of Regensburg, Regensburg, Germany
| | - K. Stock
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - M. Reiser
- Department of Clinical Radiology, University Hospitals–Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M. Staehler
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Clevert DA, Minaifar N, Weckbach S, Jung EM, Stock K, Reiser M, Staehler M. Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 2008; 39:171-178. [PMID: 18503122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
To assess the diagnostic performance of multislice computed tomography (MS-CT) in the classification of atypical or complex cystic renal masses using the Bosniak system in comparison to contrast-enhanced ultrasound (CEUS) and, in unclear cases, to the surgery findings.Thirty-two consecutive patients (14 women, 18 men; age range 39-72 years) with 37 atypical or complex cystic renal masses at MS-CT underwent conventional ultrasound (US) and CEUS. CEUS employed a low-MI technique using 1.6-2.4 ml SonoVue (Bracco, Italy) i.v. and a 2-4 MHz multifrequency transducer (Siemens, Sequoia, Acuson). Fourteen masses were resected, the remaining 23 lesions were followed up for periods ranging from 3 months to 2 years. Images and digital cine clips of all lesions were evaluated by blinded readers. On the basis of MS-CT appearance the lesions were assigned to the Bosniak classification. Similar criteria modified for US imaging were used to score atypical cysts at CEUS. In the Bosniak classification at MS-CT the lesions were scored as category II (n=15), IIF (n=7), III (n=8) and IV (n=7). At CEUS, masses were classified as Bosniak classification II (n=8), IIF (n=12), III (n=8) or IV (n=9). All type IV and 6/8 type III and 1/8 type IIF lesions were removed surgically. All category IV and 3/8 category III lesions of the surgical group were malignant, the one type IIF lesion was benign. All class II and IIF cysts except one were stable after a follow-up period ranging from 3 months to 2 years. In 7/37 lesions (19%) the MS-CT and CEUS scores were different, while in 30/37 (81%) they were equivalent. CEUS depicted more thin septa than MS-CT, or upgraded wall thickness, resulting in a Bosniak score upgrade from category II to IIF in 5 lesions. Two cystic renal masses could not be clearly assigned by MS-CT but were considered malignant due to the additional information from CEUS, which was confirmed by surgical removal (small cystic renal cancer).CEUS with SonoVue allows an early evaluation of atypical or complex cystic renal masses. It is an additional examination to MS-CT. Due to the dynamic examination, additional information about perfusion of the cystic septa or cystic renal cancer can be gained.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
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Stoevesandt D, Stock K, Grabitz R, Kunze C. Drei Koronarfisteln mit Mündung in einen hypoplastischen rechten Ventrikel – Nutzen einer Mehrzeilen Cardio-CT-Untersuchung. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Krasnianski M, Müller T, Stock K, Zierz S. Bruns syndrome caused by intraventricular tumor. Eur J Med Res 2007; 12:582-584. [PMID: 18024268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
The Bruns syndrome is an unusual phenomenon, characterized by attacks of sudden and severe headache, vomiting and vertigo, triggered by abrupt movement of the head. The presumptive cause of the Bruns syndrome is a mobile deformable intraventricular lesion leading to an episodic obstructive hydrocephalus resulted from an intermittent or positional CSF obstruction with elevation of intracranial pressure due to a ball-valve mechanism. Although the old neurological literature recognized tumors as well as neurocysticercosis as causes of the Bruns syndrome, during the last 60 years only intraventricular neurocysticercosis was reported to cause this symptom-complex. Here, we report a 38-year-old woman with relapsing attacks of headache, vertigo, nausea, vomiting, and ataxia provoked by head rotation corresponding to the classical Bruns syndrome. The cranial MRI revealed a tumor in the third ventricle and a further tumor in the fourth ventricle, which could cause a transient obstruction of the CSF pathways. This unusual observation of the Bruns syndrome in a non-parasitary disease of the CNS adds the syndrome to the differential diagnosis of paroxysmal vertigo.
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Affiliation(s)
- Michael Krasnianski
- Klinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
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Clevert DA, Jung EM, Pfister K, Stock K, Schulte-Altedorneburg G, Fink C, Clevert DA, Reiser M. [Modern ultrasound diagnostics of deep vein thrombosis in lung embolism of unknown origin]. Radiologe 2007; 47:673-84. [PMID: 17634909 DOI: 10.1007/s00117-007-1530-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We compared innovative ultrasound techniques such as tissue harmonic imaging (THI) and cross-beam technique with speckle reduction imaging (SRI) to conventional fundamental B scan in the diagnosis of deep vein thrombosis. MATERIAL AND METHODS We investigated a total number of 185 patients with clinical symptoms of acute vein thrombosis. We documented the thrombosis in the patients using multifrequency ultrasound probes (5-7 MHz, 6-9 MHz, 9-14 MHz, Logig 9, GE) and recorded ultrasound sequences in fundamental B scan, THI, and cross-beam technique with SRI (grade 2). Three blinded ultrasound investigators ranked the marking of the thrombosis in each of these image modalities and graded them with the numbers 5 = weak, 4 = moderate, 3 = satisfactory, 2 = good, and 1 = excellent. We calculated the median and a t-test for each of these image modalities. RESULTS We diagnosed 115 thromboses (62%) in 185 investigated patients. This group could be divided as follows: 11 patients (6%) with three-level thrombosis, 37 patients (20%) with two-level thrombosis, and 67 (36%) with one-level thrombosis. The one-level thrombosis group included five (3%) patients with muscle vein thromboses, seven (4%) cases of thrombophlebitis without involvement of the deep vein system, and three (2%) cases of thrombophlebitis with involvement of the deep vein system. The t-test for unconnected samples showed significant differences (p <0.05) in iliac veins and highly significant differences (p <0.001) in the veins of the lower extremity due to the superior capabilities for detection of thrombosis using the cross-beam technique with SRI compared to THI and the fundamental B scan. CONCLUSION The use of high-resolution linear ultrasound probes with the concomitant application of THI and cross-beam technique with SRI facilitates the diagnosis of deep vein thrombosis. The employment of these new ultrasound modalities is an advantage in distinguishing the veins from the surrounding tissue structures and helps in evaluating the compressibility of venous vessels.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany.
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von Delius S, Lersch C, Mayr M, Stock K, Schulte-Frohlinde E, Schmid RM, Eckel F. Capecitabine for treatment of advanced hepatocellular carcinoma. Hepatogastroenterology 2007; 54:2310-2314. [PMID: 18265654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND/AIMS Patients with advanced hepatocellular carcinoma (HCC) face a dismal prognosis, as no effective palliative chemotherapy exists. Moreover, treatment of patients with hepatocellular carcinoma presents a major challenge, because associated cirrhosis limits the choice of chemotherapeutic agents. We evaluated the activity and toxicity of capecitabine in patients with advanced hepatocellular carcinomas. METHODOLOGY The authors performed a retrospective analysis of all patients with HCC who were treated with capecitabine. The medical records of patients with HCC who were treated at our institution between October 2002 and July 2005 were reviewed. RESULTS A total of eleven patients were treated with capecitabine. Eight patients had liver cirrhosis and Child-Pugh scores of A and B. Capecitabine was administered twice daily for 14 days at a total daily dose of 2000 mg/m2. Treatment was repeated every 21 days. Each patient received 2-16 treatment cycles. One partial response was observed (9%; 95% confidence interval (CI) 0.2-41.3%) and 3-month progression free survival rate was 27%. The median time to tumor progression and median overall survival were 2.2 months (95% CI 1.7-2.7 months) and 10.1 months (95% CI 3.0-17.2 months), respectively. The therapy was well tolerated, with hand-foot syndrome as the main toxicity. Grade 3 diarrhea occurred in one patient. Grade 3/4 hyperbilirubinemia was seen in five patients, but was mainly due to tumor progression. No other significant toxicities were observed. CONCLUSIONS Capecitabine was found to be safe for treatment of patients with HCC, including those with compensated cirrhosis. However, the objective response rate was limited.
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Affiliation(s)
- S von Delius
- Department of Internal Medicine II, Technical University of Munich, Klinikum rechts der Isar Munich, Germany.
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Moran AP, Stock K, Jenkins C, Uncles D, Panayiotou S, Spring C, O'Dwyer J, Kelley K, Venn R. Co-induction of anaesthesia with 0.75 mg kg propofol followed by sevoflurane: a randomized trial in the elderly with cardiovascular risk factors. Eur J Anaesthesiol 2007; 25:183-7. [PMID: 17888191 DOI: 10.1017/s026502150700138x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The induction of general anaesthesia is associated with the greatest cardiovascular changes in elderly patients. Induction can be performed either intravenously or with gaseous induction. Sevoflurane has advantages over propofol for induction of anaesthesia in the elderly, since the lower reduction in mean arterial pressure with sevoflurane is both statistically and clinically significant. This prospective randomized controlled trial investigated the cardiovascular benefits of co-induction of anaesthesia with 0.75 mg kg(-1) propofol and 8% sevoflurane, when compared with 8% sevoflurane alone in patients requiring surgery for fractured neck of femur. METHOD In total, 38 patients aged 75 or over were allocated into the two groups, receiving either 0.75 mg kg(-1) of propofol followed by 8% sevoflurane or 8% sevoflurane alone. Vital signs were recorded until successful insertion of a laryngeal mask. Induction times, induction events and patient satisfaction scores were also recorded. RESULTS Results showed that there were no differences in the cardiovascular parameters between the two groups. Induction times were faster in the propofol and sevoflurane group (62 vs. 81 s; P = 0.028). The postoperative questionnaire showed that the majority of patients in both groups were satisfied with the induction process. CONCLUSIONS We concluded that 0.75 mg kg(-1) of propofol followed by sevoflurane induction is an acceptable alternative to sevoflurane induction. It is associated with similar haemodynamic variables, faster induction times and is very well tolerated.
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MESH Headings
- Aged
- Aged, 80 and over
- Anesthesia, General/adverse effects
- Anesthesia, General/methods
- Anesthetics, Combined/adverse effects
- Anesthetics, Combined/therapeutic use
- Anesthetics, Inhalation/adverse effects
- Anesthetics, Inhalation/therapeutic use
- Anesthetics, Intravenous/adverse effects
- Anesthetics, Intravenous/therapeutic use
- Blood Pressure/drug effects
- Drug Therapy, Combination
- Female
- Femoral Neck Fractures/surgery
- Heart Rate/drug effects
- Humans
- Male
- Methyl Ethers/adverse effects
- Methyl Ethers/therapeutic use
- Oximetry
- Patient Satisfaction
- Propofol/adverse effects
- Propofol/therapeutic use
- Prospective Studies
- Risk Factors
- Sevoflurane
- Time Factors
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Affiliation(s)
- A P Moran
- Worthing Hospital, Department of Anaesthesia, West Sussex, UK
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Sailer R, Strauss WSL, Emmert H, Stock K, Steiner R, Schneckenburger H. Plasma Membrane Associated Location of Sulfonated meso-Tetraphenyl-porphyrins of Different Hydrophilicity Probed by Total Internal Reflection Fluorescence Spectroscopy. Photochem Photobiol 2007. [DOI: 10.1562/0031-8655(2000)0710460pmalos2.0.co2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Stock K, Stock S, Kunze C, Hoehne SO, Finke R, Spielmann RP. Das Supinationstrauma des oberen Sprunggelenks beim Kind – MRT im Vergleich mit klinischem Befund und Röntgenaufnahmen. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stoevesandt D, Spielmann RP, Stock K. Verwendung einer Computertomographie-Lern-CD im Vergleich zu anderen Lernangeboten (Vorlesung, Seminaren, Internet). ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-941108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Albert JG, Martiny F, Krummenerl A, Stock K, Lesske J, Göbel CM, Lotterer E, Nietsch HH, Behrmann C, Fleig WE. Diagnosis of small bowel Crohn's disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut 2005; 54:1721-7. [PMID: 16020490 PMCID: PMC1774782 DOI: 10.1136/gut.2005.069427] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/24/2005] [Accepted: 06/27/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The diagnostic yield of capsule endoscopy (CE) compared with magnetic resonance imaging (MRI) in small bowel Crohn's disease is not well established. We prospectively investigated CE, MRI, and double contrast fluoroscopy in patients with suspected small bowel Crohn's disease. METHODS Fifty two consecutive patients (39 females, 13 males) were investigated by MRI, fluoroscopy and--if bowel obstruction could be excluded--by CE. In 25, Crohn's disease was newly suspected while the diagnosis of Crohn's disease (non-small bowel) had been previously established in 27. RESULTS Small bowel Crohn's disease was diagnosed in 41 of 52 patients (79%). CE was not accomplished in 14 patients due to bowel strictures. Of the remaining 27 patients, CE, MRI, and fluoroscopy detected small bowel Crohn's disease in 25 (93%), 21 (78%), and 7 (of 21; 33%) cases, respectively. CE was the only diagnostic tool in four patients. CE was slightly more sensitive than MRI (12 v 10 of 13 in suspected Crohn's disease and 13 v 11 of 14 in established Crohn's disease). MRI detected inflammatory conglomerates and enteric fistulae in three and two cases, respectively. CONCLUSION CE and MRI are complementary methods for diagnosing small bowel Crohn's disease. CE is capable of detecting limited mucosal lesions that may be missed by MRI, but awareness of bowel obstruction is mandatory. In contrast, MRI is helpful in identifying transmural Crohn's disease and extraluminal lesions, and may exclude strictures.
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Affiliation(s)
- J G Albert
- First Department of Medicine, Martin-Luther-University Hospital and Clinics, D-06097 Halle (Saale), Germany
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Huber W, Umgelter A, Schmidt C, Reindl W, Wagner K, Stock K, Delius S, Algül H, Geisler F, Eckel F, Schmid RM. Einschätzung des Volumen-Defizits bei nekrotisierender Pankreatitis: Vergleich von Intrathorakalem Blutvolumen-Index (ITBI), ZVD und Hämatokrit. Z Gastroenterol 2005. [DOI: 10.1055/s-2005-921852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Surov A, Stock K. Jejunal diverticulosis. Eur J Med Res 2005; 10:358-60. [PMID: 16131478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Although often incidentally found in the radiological examination of the small intestine, some patients with diverticula suffer from complications, that may lead to surgical intervention. Contrast study of the small intestine by enteroclysis is the method of choice to determine jejunal diverticula. We report a case of symptomatic proximal jejunal diverticulosis in a 74 year old patient who presented with diffuse abdominal pain. The clinical significance, diagnostic evaluation and treatment of jejunal diverticulosis are reviewed.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Germany.
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Lochbrunner S, Szeghalmi A, Stock K, Schmitt M. Ultrafast proton transfer of 1-hydroxy-2-acetonaphthone: Reaction path from resonance Raman and transient absorption studies. J Chem Phys 2005; 122:244315. [PMID: 16035765 DOI: 10.1063/1.1914764] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The intramolecular degrees of freedom contributing to the ultrafast excited-state intramolecular proton transfer of 1-hydroxy-2-acetonaphthone are determined. Thereto, resonance Raman studies are combined with transient absorption measurements with 30-fs time resolution. Enhanced Raman intensity is found in coordinates that are dominantly associated with deformations and bond length changes in the naphthalene chromophore. This indicates that the primary changes after the optical excitation are a geometric relaxation of the chromophore. A ringing of the molecule after the ultrafast proton transfer is observed by the transient absorption measurements. It reveals the nuclear coordinates contributing to the reaction path beyond the Franck-Condon region. There, planar H-chelate ring deformations changing the donor-acceptor distance are found to dominate. The difference in the observed vibrational signatures indicates a significant turn in the reaction path.
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Affiliation(s)
- S Lochbrunner
- Lehrstuhl für BioMolekulare Optik, Department für Physik, Ludwig-Maximilians-Universität, München, Germany.
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Knörgen M, Lehmann N, Stock K, Marx T, Schönfeld R. Paradigmenauswahl und -steuerung bei der präoperativen f-MRT des auditorischen Kortex unter Berücksichtigung des Einflusses des MRT-Störschalls. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-868267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schmidt C, Huber W, Umgelter A, Hollweck R, Mayr M, Geisler F, Retzer-lidl M, Bajbouj M, Reichenberger J, Reindl W, Stock K, Wagner K, von Delius S, Schmid R. Crit Care 2005; 9:P58. [DOI: 10.1186/cc3121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Stock K. Multiple cerebral aneurysms in a patient with recurrent cardiac myxomas. A case report. Interv Neuroradiol 2004; 10:335-40. [PMID: 20587218 PMCID: PMC3463294 DOI: 10.1177/159101990401000408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 11/07/2004] [Indexed: 12/13/2022] Open
Abstract
SUMMARY A 22 year old female presented in 1987 a cardiac myxoma, removed in 1991. In 1992 catheter angiography showed bilateral aneurysms. Conservative treatment was elected. In 2000 recurrence of the myxoma and subsequent removal, prompted new angiography. All aneurysms had decreased in size, some had spontaneously disappeared.
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Affiliation(s)
- K Stock
- Department of Diagnostic Radiology of the Martin-Luther-University Halle-Wittenberg; Germany -
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Krasnianski M, Schlüter A, Neudecker S, Spielmann RP, Stock K. Serial magnet resonance angiography in patients with vasculitis and vasculitis-like angiopathy of the central nervous system. Eur J Med Res 2004; 9:247-55. [PMID: 15257878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
The purpose of the study was to examine the value of the non-invasive magnet resonance angiography (MRA) in the follow-up of cerebral vasculitis (CV) and vasculitis-like angiopathy. We performed follow-up MRA (TOF 3D), MRI and transcranial doppler ultrasound (TCD) in the patients with isolated angiitis of the CNS (2/6), Crohn-disease-associated CV (1/6), and reversible arterial vasoconstriction (RAV) of the CNS (1 migraine, 1 eclampsia and 1 toxic encephalopathy) (3/6). In all patients with RAV MRA showed a complete remission of the vascular alterations after treatment. In the patients with isolated angiitis of the CNS and Crohn-disease-associated CV, partly regressive and partly progressive changes were demonstrated. The MR-angiographically detectable vascular alterations corresponded to the clinical course of the disease, as well as to TCD in all our patients. Success of therapeutic procedures, the need and the intensity of further drug administration could be estimated. The MRA appears to be a valuable non-invasive method in the follow-up of patients with CV and RAV.
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Affiliation(s)
- Michael Krasnianski
- Departmetn of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle (Saale), Germany.
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Altiner A, Sielk M, Düllmann A, Fiegen J, Groll A, Stock K, Wilm S, Brockmann S. Auswirkungen des GMG (GKV-Modernisierungs-Gesetz) auf hausärztliche Verordnungen am Beispiel des akuten Hustens. ACTA ACUST UNITED AC 2004. [DOI: 10.1055/s-2004-820384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stock K, Sailer R, Strauss WSL, Lyttek M, Steiner R, Schneckenburger H. Variable-angle total internal reflection fluorescence microscopy (VA-TIRFM): realization and application of a compact illumination device. J Microsc 2003; 211:19-29. [PMID: 12839547 DOI: 10.1046/j.1365-2818.2003.01200.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A novel compact illumination device in variable-angle total internal reflection fluorescence microscopy (VA-TIRFM) is described. This device replaces the standard condensor of an upright microscope. Light from different laser sources is delivered via a monomode fibre and focused onto identical parts of a sample under variable angles of total internal reflection. Thus, fluorophores in close proximity to a cell-substrate interface are excited by an evanescent wave with variable penetration depth, and localized with high (nanometre) axial resolution. In addition to quantitative measurements in solution, fluorescence markers of the cytoplasm and the plasma membrane, i.e. calcein and laurdan, were examined using cultivated endothelial cells. Distances between the glass substrate and the plasma membrane were determined using the mathematical algorithm of a four-layer model, as well as a Gaussian-shaped intensity profile of the illumination spot on the samples. Distances between 0 and 30 nm in focal contacts and between 100 and 300 nm in other parts of the cell were thus determined. In addition to measurements of cell-substrate topology, the illumination device appears appropriate for numerous applications in which high axial resolution is required, e.g. experiments on endocytosis or exocytosis, as well as measurements of ion concentrations proximal to the plasma membrane. The compact illumination device is also suitable for combining TIRFM with further innovative techniques, e.g. time-resolved fluorescence spectroscopy, fluorescence lifetime imaging (FLIM) or fluorescence resonance energy transfer (FRET).
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Affiliation(s)
- K Stock
- Institut für Lasertechnologien in der Medizin und Messtechnik an der Universität Ulm, Ulm, Germany
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Schneckenburger H, Stock K, Strauss WSL, Eickholz J, Sailer R. Time-gated total internal reflection fluorescence spectroscopy (TG-TIRFS): application to the membrane marker laurdan. J Microsc 2003; 211:30-6. [PMID: 12839548 DOI: 10.1046/j.1365-2818.2003.01201.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A novel setup for total internal reflection fluorescence microscopy with spectral and temporal (nanosecond) resolution was used to measure the emission spectra of the membrane marker laurdan either selectively within the plasma membrane or in whole living cells, depending on the incident angle of the excitation light. With increasing temperature, the intensity of the fluorescence band around 490 nm increased in comparison with the band around 440 nm, which has previously been assigned to a phase transition of membrane lipids from gel to liquid crystalline phase. For a better separation of the overlapping spectral bands, time-gated detection with a delay of 10-15 ns with respect to the exciting laser pulse was used. As a parameter of membrane dynamics the so-called generalized polarization GP = (I440 - I490)/(I440 + I490) was evaluated at temperatures between 24 and 41 degrees C and variable angles of the incident light permitting to excite laurdan molecules either within the plasma membrane or in the whole cell. A decrease of the GP values by approximately 0.2 units between 28 and 41 degrees C indicated an increase in membrane fluidity or a decrease in membrane stiffness with increasing temperature. In addition, higher GP values were observed for the plasma membrane as compared with intracellular membranes, probably due to a higher amount of cholesterol. Because properties of the plasma membrane have a large influence on the uptake or release of certain pharmaceutical agents or metabolites, the direct assessment of the dynamics of the plasma membrane by total internal reflection fluorescence spectroscopy appears to be important for pharmacology.
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Affiliation(s)
- H Schneckenburger
- Institut für Lasertechnologien in der Medizin und Messtechnik an der Universität Ulm, Ulm, Germany.
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Kampmeier J, Bentele A, Stock K, Wagner P, Hibst R, Lang GE, Steiner R, Lang GK. [Intracanalicular trabeculostomy with the Er:YAG laser]. Ophthalmologe 2002; 99:927-32. [PMID: 12478379 DOI: 10.1007/s00347-002-0683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To develop a new ab externo technique for glaucoma trabecular surgery using the infrared Er:YAG laser radiation (2.9 micrometer) guided into Schlemm's canal by an optical fiber. MATERIAL AND METHODS In order to create a drainage canal to the anterior chamber, a quartz fiber (core diameter: 100 micrometer) coupled to an Er:YAG laser was shielded by a metal canula (diameter: 280 micrometer) bent in conformance to the curvature of Schlemm's canal. A 45 degrees -mirror enabled the laser radiation to exit the canula perpendicular to the fiber axis. The complete surgery device was tested on agar medium and enucleated human eyes. RESULTS Using the unshielded quartz fiber, eight pulses of 8 mJ (frequency: 7 Hz, pulse duration: 150 microseconds) were sufficient to perforate the trabecular meshwork of the human eye. Histology showed a rippled canal with 50 micrometer average diameter and a surrounding necrosis zone of 15-35 micrometer. The complete device could be easily inserted into Schlemm's canal similar to the classic trabeculostomy probe and a conical-shaped canal with a length of 2-3 mm could be created in agar medium within a few seconds. CONCLUSIONS Initial experience in an experimental set-up show the ab externo creation of a draining canal between Schlemm's canal and the anterior chamber with only minimal irritation of the surrounding tissue. Further refinements of the laser parameters and the biomechanical set-up resulted in a new hand-held device with improved function. The Er:YAG laser intracanalicular trabeculostomy could become a new ab externo technique for minimal invasive therapy of open angle glaucoma.
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Affiliation(s)
- J Kampmeier
- Universitätsklinikum Ulm, Augenklinik, Germany.
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Braun-Falco M, Stock K, Ring J, Hein R. Topical platelet-derived growth factor accelerates healing of myelodysplastic syndrome-associated pyoderma gangrenosum. Br J Dermatol 2002; 147:829-31. [PMID: 12366451 DOI: 10.1046/j.1365-2133.2002.495514.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stock K, Peters S, Behrmann C, Spielmann RP. [Bilateral carotid dissection. A not to underestimate cause of neurological loss after road accident]. Unfallchirurg 2002; 105:919-22. [PMID: 12376897 DOI: 10.1007/s00113-002-0431-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The dissection of the internal carotid artery is a rare complication of acceleration traumas of the upper spine. 30% of these dissections are caused by road accidents and again less than 30% of these occur bilateral as shown here. The symptoms are fronto-temporal and periorbital starting headaches spreading out to the occiput and Horner's syndrome. Complete hemiplegia as in our case is an impressive exception but the doctor in attendance should think of the carotid dissection. The exclusion of this complication is obligatory because treatment and outcome depend on it.The dynamic effects of bilateral carotid dissections may, as shown here, lead to relapsing cerebral infarctions with persisting neurologic deficits up to manifest hemiparesis. But restitution can be accomplished if early diagnosed by DSA and/or MRI. Therapy of choice is early prevention of persisting neurologic deficits using effective dosed heparin and depending on the residual lumen of the vessel oral anticoagulants or platelet antagonists for one year.
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MESH Headings
- Accidents, Traffic
- Adult
- Angiography, Digital Subtraction
- Anticoagulants/therapeutic use
- Brain/diagnostic imaging
- Carotid Artery, Internal, Dissection/complications
- Carotid Artery, Internal, Dissection/diagnosis
- Carotid Artery, Internal, Dissection/drug therapy
- Carotid Artery, Internal, Dissection/etiology
- Female
- Fibrinolytic Agents/therapeutic use
- Hemiplegia/etiology
- Heparin/therapeutic use
- Humans
- Magnetic Resonance Imaging
- Time Factors
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Affiliation(s)
- K Stock
- Klinik für diagnostische Radiologie der Martin-Luther-Universität Halle-Wittenberg, Germany
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