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Jäger L, Burgstaller JM, Zechmann S, Senn O, Rosemann T, Markun S. Elevated TSH Levels: A Database Study of General Practitioners' Course of Action. Endocr Pract 2024; 30:187-193. [PMID: 38122933 DOI: 10.1016/j.eprac.2023.12.013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To investigate general practitioners' course of action after detection of elevated thyroid stimulating hormone (TSH) levels regarding repeat testing, direct levothyroxine replacement, or neither. METHODS We conducted a retrospective study of adults without prior evidence of thyroid disease and with a first detection of elevated TSH levels from January 1, 2015, to December 31, 2020, using data from electronic medical records of a Swiss primary care database. We determined the occurrence of either repeat TSH testing or direct levothyroxine initiation in primary care during 12-month follow-up and determined associations with demographic and clinical factors. RESULTS Of the 1 591 patients included (median age 65 years, 64.4% female, median TSH 5.7 mIU/L), 34.3% received repeat TSH testing and 12.4% received direct levothyroxine replacement in primary care during follow-up. Repeat TSH testing showed the strongest association with overt hypothyroidism and was more common among patients with high primary care utilization and among patients aged 40-64 years compared to patients aged <40 years. Direct levothyroxine initiation was more likely for TSH levels >7 mIU/L, overt hypothyroidism, female patients, and nonurban practices. CONCLUSIONS While the degree of thyroid dysfunction was the main driver of follow-up, we identified important gaps in the primary care-based monitoring of elevated TSH levels in young patients and in patients with infrequent consultations. We also observed potential overtreatment of women and patients in nonurban areas. Our findings highlight the need for standardization and dissemination of guidelines for the management of elevated TSH levels among general practitioners.
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Affiliation(s)
- Levy Jäger
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
| | - Jakob M Burgstaller
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Zechmann
- Division of Endocrinology, GZO - Zurich Regional Health Center, Wetzikon, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Markun
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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Meier R, Grischott T, Rachamin Y, Jäger L, Senn O, Rosemann T, Burgstaller JM, Markun S. Importance of different electronic medical record components for chronic disease identification in a Swiss primary care database: a cross-sectional study. Swiss Med Wkly 2023; 153:40107. [PMID: 37854021 DOI: 10.57187/smw.2023.40107] [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: 10/20/2023] Open
Abstract
BACKGROUND Primary care databases collect electronic medical records with routine data from primary care patients. The identification of chronic diseases in primary care databases often integrates information from various electronic medical record components (EMR-Cs) used by primary care providers. This study aimed to estimate the prevalence of selected chronic conditions using a large Swiss primary care database and to examine the importance of different EMR-Cs for case identification. METHODS Cross-sectional study with 120,608 patients of 128 general practitioners in the Swiss FIRE ("Family Medicine Research using Electronic Medical Records") primary care database in 2019. Sufficient criteria on three individual EMR-Cs, namely medication, clinical or laboratory parameters and reasons for encounters, were combined by logical disjunction into definitions of 49 chronic conditions; then prevalence estimates and measures of importance of the individual EMR-Cs for case identification were calculated. RESULTS A total of 185,535 cases (i.e. patients with a specific chronic condition) were identified. Prevalence estimates were 27.5% (95% CI: 27.3-27.8%) for hypertension, 13.5% (13.3-13.7%) for dyslipidaemia and 6.6% (6.4-6.7%) for diabetes mellitus. Of all cases, 87.1% (87.0-87.3%) were identified via medication, 22.1% (21.9-22.3%) via clinical or laboratory parameters and 19.3% (19.1-19.5%) via reasons for encounters. The majority (65.4%) of cases were identifiable solely through medication. Of the two other EMR-Cs, clinical or laboratory parameters was most important for identifying cases of chronic kidney disease, anorexia/bulimia nervosa and obesity whereas reasons for encounters was crucial for identifying many low-prevalence diseases as well as cancer, heart disease and osteoarthritis. CONCLUSIONS The EMR-C medication was most important for chronic disease identification overall, but identification varied strongly by disease. The analysis of the importance of different EMR-Cs for estimating prevalence revealed strengths and weaknesses of the disease definitions used within the FIRE primary care database. Although prioritising specificity over sensitivity in the EMR-C criteria may have led to underestimation of most prevalences, their sex- and age-specific patterns were consistent with published figures for Swiss general practice.
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Affiliation(s)
- Rahel Meier
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Grischott
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yael Rachamin
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Levy Jäger
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jakob M Burgstaller
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Markun
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Markun S, Jäger L. [Vaccination against the Infodemic]. Praxis (Bern 1994) 2023; 112:589-592. [PMID: 37971481] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Misinformation about vaccination leads to vaccination hesitancy. During the SARS-CoV-2 pandemic, different patterns were observed in how misinformation spread on social media, which coined the term "infodemic." There are different approaches to counter misinformation in vaccination, some of which can be implemented in medical practice. This article is an introduction and overview of the phenomenon of misinformation in social media. The article also aims to uncover individual mechanisms that make misinformation appear credible and thus the article aims to function as an "inoculation against the infodemic."
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Affiliation(s)
- Stefan Markun
- Institut für Hausarztmedizin, Universität und Universitätsspital Zürich, Pestalozzistr. 24, 8091 Zürich
| | - Levy Jäger
- Institut für Hausarztmedizin, Universität und Universitätsspital Zürich, Pestalozzistr. 24, 8091 Zürich
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Rachamin Y, Jäger L, Schweighoffer R, Signorell A, Bähler C, Huber CA, Blozik E, Seifritz E, Grischott T, Senn O. The Impact of COVID-19 on Mental Healthcare Utilization in Switzerland Was Strongest Among Young Females-Retrospective Study in 2018-2020. Int J Public Health 2023; 68:1605839. [PMID: 37273771 PMCID: PMC10235482 DOI: 10.3389/ijph.2023.1605839] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Objectives: To provide a thorough assessment of the impact of the COVID-19 pandemic on the utilization of inpatient and outpatient mental healthcare in Switzerland. Methods: Retrospective cohort study using nationwide hospital data (n > 8 million) and claims data from a large Swiss health insurer (n > 1 million) in 2018-2020. Incidence proportions of different types of psychiatric inpatient admissions, psychiatric consultations, and psychotropic medication claims were analyzed using interrupted time series models for the general population and for the vulnerable subgroup of young people. Results: Inpatient psychiatric admissions in the general population decreased by 16.2% (95% confidence interval: -19.2% to -13.2%) during the first and by 3.9% (-6.7% to -0.2%) during the second pandemic shutdown, whereas outpatient mental healthcare utilization was not substantially affected. We observed distinct patterns for young people, most strikingly, an increase in mental healthcare utilization among females aged <20 years. Conclusion: Mental healthcare provision for the majority of the population was largely maintained, but special attention should be paid to young people. Our findings highlight the importance of monitoring mental healthcare utilization among different populations.
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Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Campus Stiftung Lindenhof Bern (SLB), Bern, Switzerland
| | - Levy Jäger
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Reka Schweighoffer
- Institute for Clinical Research, Department of Medicine, University of Basel, Basel, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Caroline Bähler
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Carola A. Huber
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Eva Blozik
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- SWICA Health Services Research, Winterthur, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Thomas Grischott
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Rachamin Y, Nerlich SE, Jäger L, De Gani SM, Favre O, Senn O. Adolescents' self-reported health status, behaviours and health issues addressed during routine school doctor consultations in Switzerland: an observational study. Swiss Med Wkly 2023; 153:40078. [PMID: 37243976 DOI: 10.57187/smw.2023.40078] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND We aimed to investigate the self-reported health status and behaviours of 7th-grade adolescents, associations with gender and educational track, as well as health issues addressed during routine school doctor consultations in Switzerland. METHODS Data on health status and behaviours, specifically general well-being, stimulant and addictive substance use, bullying/violence, exercise, nutrition and health protection, and puberty/sexuality, were drawn from routinely collected self-assessment questionnaires from 1076 (of a total of 1126) students from 14 schools in the Swiss canton of Zug in 2020. Data on health issues addressed in school doctor consultations were collected by nine school doctors (for 595 individual consultations). Multilevel logistic regression analyses were used to investigate the association of gender and educational track with unfavourable health status or behaviours. RESULTS Although 92% (n = 989) of the students reported being happy or satisfied overall, 21% (n = 215) often or almost always felt sad, and 5-10% had repeatedly been seriously physically hurt (n = 67), sexually harassed with words (n = 88) or experienced uncomfortable physical contact (n = 60). Female gender and a lower educational track were associated with unfavourable health status. In 90% (n = 533) of the school doctor consultations, at least one topic of disease prevention or health promotion was addressed, whereby the topics addressed depended strongly on the individual school doctors. CONCLUSIONS Our findings revealed that unfavourable health status and behaviours were prevalent among adolescents but the health topics addressed in school doctor consultations were not tailored to students' self-reported health issues. A school-based approach that strengthens adolescents' health literacy and provides opportunities for patient-centred counselling has the potential to improve the current and future health of adolescents and, ultimately, adults. To realise this potential, it is essential for school doctors to be sensitised and trained to address students' health concerns. Emphasis should be placed on the importance of patient-centred counselling, the high prevalence of bullying, and gender and educational differences.
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Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Campus Stiftung Lindenhof Bern (SLB), Bern, Switzerland
| | - Sofia Elena Nerlich
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Levy Jäger
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | | | - Olivier Favre
- Department of Child and Adolescent Health, Office of Public Health, Canton of Zug, Zug, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Abstract
IMPORTANCE Human papillomavirus vaccination coverage rates lie below desired thresholds in Switzerland. Because general practitioners are the main contact for the relatively rare health issues of many Swiss young adults, primary care offers an important opportunity to provide catch-up human papillomavirus vaccination. OBJECTIVE To examine the knowledge, experiences, and attitudes of Swiss university students in the context of receiving human papillomavirus vaccination during primary care visits. DESIGN, SETTING, AND PARTICIPANTS This self-administered, cross-sectional, web-based survey study was conducted among students of 3 universities and 1 educational institution for health professions in the Swiss Canton of Zurich. Specific questions about human papillomavirus vaccination experience were directed to respondents who had received at least 1 dose administered by a general practitioner. Responses were collected during 12-week intervals between November 11, 2020, and April 7, 2021, and data were analyzed from August 3 to August 30, 2022. MAIN OUTCOMES AND MEASURES The primary outcome was whether human papillomavirus vaccination had been administered on the patient's or the general practitioner's initiative. RESULTS The responses of 5524 participants (median [IQR] age, 23 [21-25] years; 3878 women [70.2%]) were analyzed. The survey completion rate was 90.9% (5524 of 6076 students who consented to participate). A total of 2029 respondents (1792 women [46.2%] and 237 men [14.6%]) reported having received at least 1 human papillomavirus vaccination dose, of whom 740 (36.5%) had received at least 1 dose administered by a general practitioner. Among these, 190 respondents (25.7%) reported that vaccine administration had occurred on their request rather than on their general practitioner's initiative. Among all respondents, 4778 (86.5%) wanted to obtain more information about human papillomavirus vaccination at a general practitioner's office, and 2569 (55.3%) rated acute consultations in general practice as inappropriate for addressing human papillomavirus vaccination. CONCLUSIONS AND RELEVANCE The findings of this survey study of Swiss university students suggest that primary care shows a high potential for increasing human papillomavirus vaccination coverage rates in Switzerland. However, there was room for improvement in the proactivity of general practitioners, especially with men, and in the attitudes of students toward the appropriateness of acute consultations in general practice for addressing human papillomavirus vaccination.
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Affiliation(s)
- Levy Jäger
- Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andreas Plate
- Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland
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Martínez-González NA, Plate A, Jäger L, Senn O, Neuner-Jehle S. The Role of Point-of-Care C-Reactive Protein Testing in Antibiotic Prescribing for Respiratory Tract Infections: A Survey among Swiss General Practitioners. Antibiotics (Basel) 2022; 11:antibiotics11050543. [PMID: 35625187 PMCID: PMC9137646 DOI: 10.3390/antibiotics11050543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023] Open
Abstract
Understanding the decision-making strategies of general practitioners (GPs) could help reduce suboptimal antibiotic prescribing. Respiratory tract infections (RTIs) are the most common reason for inappropriate antibiotic prescribing in primary care, a key driver of antibiotic resistance (ABR). We conducted a nationwide prospective web-based survey to explore: (1) The role of C-reactive protein (CRP) point-of-care testing (POCT) on antibiotic prescribing decision-making for RTIs using case vignettes; and (2) the knowledge, attitudes and barriers/facilitators of antibiotic prescribing using deductive analysis. Most GPs (92–98%) selected CRP-POCT alone or combined with other diagnostics. GPs would use lower CRP cut-offs to guide prescribing for (more) severe RTIs than for uncomplicated RTIs. Intermediate CRP ranges were significantly wider for uncomplicated than for (more) severe RTIs (p = 0.001). Amoxicillin/clavulanic acid was the most frequently recommended antibiotic across all RTI case scenarios (65–87%). Faced with intermediate CRP results, GPs preferred 3–5-day follow-up to delayed prescribing or other clinical approaches. Patient pressure, diagnostic uncertainty, fear of complications and lack of ABR understanding were the most GP-reported barriers to appropriate antibiotic prescribing. Stewardship interventions considering CRP-POCT and the barriers and facilitators to appropriate prescribing could guide antibiotic prescribing decisions at the point of care.
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Affiliation(s)
- Nahara Anani Martínez-González
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, CH-6002 Lucerne, Switzerland
- Correspondence: or
| | - Andreas Plate
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
| | - Levy Jäger
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
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Rachamin Y, Jäger L, Meier R, Grischott T, Senn O, Burgstaller JM, Markun S. Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice—A Cross-Sectional Database Study. Front Pharmacol 2022; 13:832994. [PMID: 35237170 PMCID: PMC8884695 DOI: 10.3389/fphar.2022.832994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose: The frequency of medication prescribing and polypharmacy has increased in recent years in different settings, including Swiss general practice. We aimed to describe patient age- and sex-specific rates of polypharmacy and of prescriptions of the most frequent medication classes, and to explore practitioner variability in prescribing. Methods: Retrospective cross-sectional study based on anonymized electronic medical records data of 111 811 adult patients presenting to 116 Swiss general practitioners in 2019. We used mixed-effects regression analyses to assess the association of patient age and sex with polypharmacy (≥5 medications) and with the prescription of specific medication classes (second level of the Anatomical Therapeutic Chemical Classification System). Practitioner variability was quantified in terms of the random effects distributions. Results: The prevalence of polypharmacy increased with age from 6.4% among patients aged 18–40 years to 19.7% (41–64 years), 45.3% (65–80 years), and 64.6% (81–92 years), and was higher in women than in men, particularly at younger ages. The most frequently prescribed medication classes were antiinflammatory and antirheumatic products (21.6% of patients), agents acting on the renin-angiotensin system (19.9%), analgesics (18.7%), and drugs for acid related disorders (18.3%). Men were more often prescribed agents targeting the cardiovascular system, whereas most other medications were more often prescribed to women. The highest practitioner variabilities were observed for vitamins, for antiinflammatory and antirheumatic products, and for mineral supplements. Conclusion: Based on practitioner variability, prevalence, and risk potential, antiinflammatory drugs and polypharmacy in older patients appear to be the most pressing issues in current drug prescribing routines.
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Jäger L, Senn O, Rosemann T, Plate A. Awareness, Attitudes and Clinical Practices Regarding Human Papillomavirus Vaccination among General Practitioners and Pediatricians in Switzerland. Vaccines (Basel) 2021; 9:vaccines9040332. [PMID: 33915931 PMCID: PMC8065954 DOI: 10.3390/vaccines9040332] [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: 03/02/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
In Switzerland, the human papillomavirus vaccination (HPVv) coverage rate lies below a desirable threshold. General practitioners (GPs) and pediatricians have been recognized as important providers of the HPVv, but there is little known about their self-attributed role and its relationship with their actual HPVv behavior. Therefore, the objective of this study was to explore the awareness, attitudes, and clinical practices of Swiss GPs and pediatricians concerning HPVv by means of a web-based questionnaire. We analyzed the responses of 422 physicians (72% GPs, 28% pediatricians). A substantial proportion of respondents considered the HPVv “absolutely essential” (54.2% of pediatricians, 30.6% of GPs). GPs indicated spending more time and effort on HPVv counseling for female rather than male patients more often compared to pediatricians (44.0% versus 13.9%, p < 0.001). The weekly number of patients aged 18–26 years seen in practice (p = 0.002) and whether the HPVv was deemed “absolutely essential” (adjusted odds ratio 2.39, 95% confidence interval 1.12–5.08) were factors associated with GPs administering HPVv in their practice. Shortcomings in terms of awareness, effort in the identification of potential vaccination candidates, and the role of male patients were revealed. By addressing these gaps, Swiss primary care providers could contribute to an increase in the national HPVv coverage rate.
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Affiliation(s)
- Levy Jäger
- Correspondence: ; Tel.: +41-44-255-75-06
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Avci-Adali M, Weber M, Fech A, Jäger L, Martirosian P, Enderle MD, Wendel HP, Salewski C, Popov AF, Linzenbold W, Schlensak C. Hydrojet-Based Delivery of IPSC-Derived Autologous Cardiomyocytes into the Myocardium. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725844] [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: 10/21/2022]
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11
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Gall M, van Sluijs R, Kohn B, Wiesmeyr C, Wilhelm E, Rondei Q, Jäger L, Achermann P, Landolt HP, Jenni O, Riener R, Garn H, Hill C. Analysis of sleep-related rhythmic movement disorder in children using automatic 3D detections. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.337] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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van Sluijs R, Rondei Q, Schluep D, Jäger L, Achermann P, Riener R, Wilhelm E. Effect of the intensity of rocking movements on nap sleep. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1112] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Trzesniewski J, Altmann S, Jäger L, Kapfhammer JP. Reduced Purkinje cell size is compatible with near normal morphology and function of the cerebellar cortex in a mouse model of spinocerebellar ataxia. Exp Neurol 2018; 311:205-212. [PMID: 30312605 DOI: 10.1016/j.expneurol.2018.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/01/2018] [Revised: 09/27/2018] [Accepted: 10/09/2018] [Indexed: 12/20/2022]
Abstract
Spinocerebellar ataxia type 14 (SCA14) is a dominantly inherited neurodegenerative disease caused by diverse mutations in the Protein Kinase C gamma (PKCγ) gene which is one of the crucial signaling molecules of Purkinje cells. We have previously created a mouse model of SCA14 by transgenic expression of a mutated PKCγ gene causing SCA14 with a mutation in the catalytic domain. Purkinje cells from the mutated mice have a strong reduction of their dendritic tree in organotypic slice cultures typical for increased PKC activity. There was no overt degeneration of Purkinje cells in vivo and the cerebellum appeared morphologically normal with the exception of lobule 7 where abnormal Purkinje cells were present. Besides from mild motor deficits the mice have no major phenotype. We have now done a more extensive study of cerebellar morphology in these mice and show by rapid Golgi staining that there is a marked reduction of Purkinje cell dendritic tree size throughout the cerebellum. Despite this reduction in dendritic tree size, climbing fiber innervation of Purkinje cells as visualized by immunostaining for the vesicular glutamate transporter 2 (vGlut2) appeared normal in most parts of the cerebellum. The same was true for the expression of the activity and plasticity markers pS6, c-Fos and Arc. These finding suggest that the cerebellar cortex in the transgenic mice is functioning fairly normal and that the reduction of dendritic tree size and the increased PKC activity can be compensated in most Purkinje cells. Around cerebellar lobule 7 there was high transgene expression from the L7 promotor and Purkinje cells showed abnormal morphologies. Climbing fiber innervation as well as the expression of the activity and plasticity markers was strongly disturbed in this area. Our results show that there is substantial potential for functional compensation in the cerebellar cortex. In lobule 7, an area with high transgene expression, compensation failed resulting in Purkinje cell degeneration and dysfunction.
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Affiliation(s)
- Jakub Trzesniewski
- Anatomical Institute, Department of Biomedicine Basel, University of Basel, Pestalozzistrasse 20, CH - 4056 Basel, Switzerland
| | - Sandrine Altmann
- Anatomical Institute, Department of Biomedicine Basel, University of Basel, Pestalozzistrasse 20, CH - 4056 Basel, Switzerland
| | - Levy Jäger
- Anatomical Institute, Department of Biomedicine Basel, University of Basel, Pestalozzistrasse 20, CH - 4056 Basel, Switzerland
| | - Josef P Kapfhammer
- Anatomical Institute, Department of Biomedicine Basel, University of Basel, Pestalozzistrasse 20, CH - 4056 Basel, Switzerland.
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Jäger L. Dentale Erkrankungen. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310927] [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: 10/28/2022]
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Juckel G, Karch S, Kawohl W, Kirsch V, Jäger L, Leicht G, Lutz J, Stammel A, Pogarell O, Ertl M, Reiser M, Hegerl U, Möller HJ, Mulert C. Age effects on the P300 potential and the corresponding fMRI BOLD-signal. Neuroimage 2012; 60:2027-34. [PMID: 22366332 DOI: 10.1016/j.neuroimage.2012.02.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 10/31/2011] [Accepted: 02/08/2012] [Indexed: 10/28/2022] Open
Abstract
Age has been reported to influence amplitude and latency of the P300 potential. Nevertheless, it is not yet fully understood which brain regions are responsible for these effects. The aim of this study was to investigate age-effects on the P300 potential and the simultaneously acquired BOLD signal of functional MRI. 32 healthy male subjects were investigated using an auditory oddball paradigm. The functional MRI data were acquired in temporal synchrony to the task. The evoked potential data were recorded during the intervals in between MR image acquisitions in order to reduce the influence of the scanner noise on the presentation of the tones and to reduce gradient artifacts. The age-effects were calculated by means of regression analyses. In addition, brain regions modulated by the task-induced amplitude variation of the P300 were identified (single trial analysis). The results indicated an age effect on the P300 amplitude. Younger subjects demonstrated increased parietal P300 amplitudes and increased BOLD responses in a network of brain regions including the anterior and posterior cingulate cortex, the insula, the temporo-parietal junction, the superior temporal gyrus, the caudate body, the amygdala and the parahippocampal gyrus. Single trial coupling of EEG and fMRI indicated that P300 amplitudes were predominantly associated with neural responses in the anterior cingulate cortex, the putamen and temporal brain areas. Taken together, the results indicate diminished neural responses in older compared to younger subjects especially in frontal, temporo-parietal and subcortical brain regions.
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Affiliation(s)
- G Juckel
- Department of Psychiatry, Ruhr-University Bochum, Bochum, Germany.
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Jäger L. Aktuelles zur DVT. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252465] [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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Karch S, Leicht G, Giegling I, Lutz J, Kunz J, Buselmeier M, Hey P, Jäger L, Meindl T, Pogarell O, Hegerl U, Rujescu D, Mulert C. PW01-146 - Neuronal correlates of working memory deficits in patients with schizophrenia and their relatives. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71545-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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18
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Arbusow V, Dieterich M, Strupp M, Dreher A, Jäger L, Brandt T. Herpes zoster neuritis involving superior and inferior parts of the vestibular nerve causes ocular tilt reaction. Neuroophthalmology 2009. [DOI: 10.1076/noph.19.1.17.3693] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Karch S, Leicht G, Giegling I, Lutz J, Kunz J, Buselmeier M, Hey P, Spörl A, Jäger L, Meindl T, Pogarell O, Hegerl U, Rujescu D, Mulert C. Inefficient working memory-related neural activity in patients with schizophrenia and their relatives. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)72086-5] [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] Open
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20
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Abstract
Spontaneous retropharyngeal hematoma is a rare but potentially fatal disease. It occurs with no underlying medical condition such as trauma, hemorrhagic diathesis, or medically induced anticoagulation.We report a case of a 48-year-old man who presented with progressive dysphagia, signs of inflammation, and a reduced general health status. There was distinct hemorrhagic swelling of the posterior and lateral walls of the nasopharynx, oropharynx, and hypopharynx, as well as red discoloration of the neck. No underlying medical conditions, medications, or trauma were reported.In light of the current case and the available literature, we present the necessary diagnostic procedures and treatment options. Because the course of this disease might be fatal due to rapid airway obstruction and progressive internal blood loss, it is of utmost importance to keep this diagnosis in mind for differential diagnostic considerations.
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Affiliation(s)
- N Rotter
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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Abstract
In 1904 Guiseppe Gradenigo described an infection of the apex of the petrous part of the temporal bone from acute otitis media with the clinical symptoms of unilateral pain around the eye, diplopia due to sixth nerve paralysis and persistant otorrhea. While this infection became evident by inward extension from petrositis in the majority of fatal cases from acute otitis media in the preantibiotic era, it has now become very rare. Today, cases mainly derive from cholesteatomas or chronic osteomyelitis of the petrous bone. However, due to intense antibiotic treatment in acute otitis media clinical signs of petrositis may be less typical compared to former times. We report on a 12-year-old boy with rapid onset of sixth nerve paralysis without clinical signs of acute otitis media or mastoiditis. CT and NMR imaging confirmed infection of the petrous apex. He was treated by mastoidectomy with exploration of a posterior cell group from the epitympanon around the semicircular canals and subsequent high dose intravenous antibiotics. The patient recovered without any loss of inner ear or facial nerve function. The paralysis of the sixth nerve disappeared completely within 6 weeks.
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Affiliation(s)
- P Zengel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München
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Karch S, Mulert C, Jäger L, Hermisson I, Reiser M, Möller H, Hegerl U, Pogarell O. Temporal (EEG) and spatial (fMRI) aspects of functional brain dysfunctions in schizophrenic patients. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.131] [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: 10/23/2022]
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Mulert C, Jäger L, Seifert C, Karch S, Leicht G, Möller H, Hegerl U, Pogarell O. Trial by trial coupling of simultaneous 61-channel EEG and fMRI: The N1-effect revisited. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.177] [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: 10/23/2022]
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Sokollu F, Leicht G, Lutz J, Giegling I, Kirsch V, Körner K, Lang M, Karch S, Jäger L, Pogarell O, Hegerl U, Rujescu D, Mulert C. Verminderte Kapazität zur belohnungsabhängigen Leistungssteigerung und gestörte ACC-Funktion bei Patienten mit Schizophrenie: Eine simultane EEG/fMRT-Studie. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976367] [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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25
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Kirsch V, Karch S, Jäger L, Leicht G, Stammel A, Lutz J, Hegerl U, Pogarell O, Reiser M, Juckel G, Mulert C. Einfluss von Alter und Reaktionszeit auf P300-Potentiale und BOLD-Korrelate: Simultane Messung mit 61-Kanal-EEG und fMRT. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976368] [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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26
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Stammel A, Karch S, Jäger L, Graz C, Karamatskos E, Holtschmidt-Täschner B, Flatz W, Lutz J, Leicht G, Genius J, Pogarell O, Hegerl U, Möller HJ, Reiser M, Soyka M, Mulert C. Aufmerksamkeitsdefizit bei alkoholabhängigen Patienten – Eine simultane fMRT/EEG-Studie mit dem auditorischen oddball-Paradigma. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976366] [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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Karamatskos E, Karch S, Jäger L, Graz C, Stammel A, Flatz W, Lutz J, Holtschmidt-Täschner B, Genius J, Leicht G, Pogarell O, Reiser M, Möller HJ, Hegerl U, Soyka M, Mulert C. Einfluss von Angst auf die Fähigkeit zur Verhaltensinhibition bei alkoholabhängigen Patienten. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976361] [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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Mulert C, Seifert C, Jäger L, Karch S, Leicht G, Pogarell O, Moosmann M, Sokollu F, Matte O, Lutz J, Reiser M, Möller HJ, Hegerl U. Single trial Kopplung von fMRT und EEG – Analyse des N1-spezifischen BOLD-Korrelats während einer Wahlreaktionsaufgabe. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976365] [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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Buselmeier M, Karch S, Leicht G, Giegling I, Lutz J, Jäger L, Hey P, Spörl A, Pogarell O, Möller HJ, Hegerl U, Reiser M, Rujescu D, Mulert C. Arbeitsgedächtnis bei schizophrenen Patienten: Eine fMRT Studie. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976363] [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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Thalmeier T, Karch S, Jäger L, Cerovecki A, Hock B, Lutz J, Leicht G, Hegerl U, Möller HJ, Riedel M, Reiser M, Mulert C, Pogarell O. Neurophysiologische und funktionell bildgebende Untersuchungen von Verhaltenskontrollprozessen bei Patienten mit Aufmerksamkeitsdefizit- und Hyperaktivitätsstörung. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976442] [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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31
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Seifert C, Mulert C, Jäger L, Karch S, Leicht G, Pogarell O, Moosmann M, Matte O, Lutz J, Reiser M, Möller HJ, Hegerl U. Mediale Frontallappenaktivierungen bei einer auditorischen Wahlreaktionsaufgabe im Vergleich zu einem auditorischen Go-/Nogo-Paradigma: Eine simultane EEG/fMRT- Studie. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976364] [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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32
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Hey P, Karch S, Leicht G, Giegling I, Jäger L, Lutz J, Spörl A, Buselmeier M, Möller HJ, Pogarell O, Hegerl U, Reiser M, Rujescu D, Mulert C. Frontallapentätigkeit bei Patienten mit Schizophrenie und gesunden Angehörigen: Eine simultane EEG/fMRT-Untersuchung mit dem n-back Paradigma. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976369] [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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Kitzelmann IA, Feurstein A, Schiemer A, Jäger L, Menz W, Simma B. Vernetzungsarbeit der Kinderschutzgruppe Feldkirch in Vorarlberg, Österreich. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-005-1241-z] [Citation(s) in RCA: 1] [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: 11/30/2022]
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Jäger L. Entzündungen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976741] [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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35
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Mulert C, Jäger L, Seifert C, Karch S, Leicht G, Möller HJ, Hegerl U, Pogarell O. Trial by trial coupling of simultaneous 61-channel EEG and fMRI: The N1-effect revisited. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939239] [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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36
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Karch S, Mulert C, Jäger L, Hermisson I, Reiser M, Möller HJ, Hegerl U, Pogarell O. Temporal (EEG) and spatial (fMRI) aspects of functional brain dysfunctions in schizophrenic patients. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939193] [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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37
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Lutz J, Jäger L. Entzündungen des Hirnstamms und des Kleinhirnbrückenwinkels. Radiologe 2006; 46:205-15. [PMID: 16450145 DOI: 10.1007/s00117-006-1339-x] [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: 11/27/2022]
Abstract
Inflammatory lesions of the brainstem and the cerebellopontine angle are often critical for the patient, because crucial neuronal and vascular structures are found in this region. The patient's prognosis mainly depends on rapid identification of the inflammation site and the radiological evaluation of the inflammation pathogenesis to develop therapeutic strategies. Therefore, cross-sectional imaging is complementary to laboratory and CSF analysis as well as biopsies. This article gives a survey of inflammatory lesions of the brainstem and the cerebellopontine angle.
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Affiliation(s)
- J Lutz
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München
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38
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Jäger L. Bildgebende Diagnostik angeborener Veränderungen. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940390] [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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39
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Abstract
PURPOSE To examine the influence of cardiac activity-related head movements and varying blood pulse frequencies on the shape of electroencephalography (EEG) recordings in a high magnetic field, and to implement a post-processing technique to eliminate cardiac activity-related artifacts. MATERIAL AND METHODS Respiratory thoracic movements, changes of blood pulse frequency and passive head movements of 20 healthy subjects were examined outside and inside an MR magnet at rest in a simultaneously recorded 21-channel surface EEG. An electrocardiogram (ECG) was recorded simultaneously. On the basis of the correlation of the left ventricular ejection time (LVET) with the heart-rate, a post-processing heart-rate dependent subtraction of the cardiac activity-related artifacts of the EEG was developed. The quality of the post-processed EEG was tested by detecting alpha-activity in the pre- and post-processed EEGs. RESULTS Inside the magnet, passive head motion but not respiratory thoracic movements resulted in EEG artifacts that correlated strongly with cardiac activity-related artifacts of the EEG. The blood pulse frequency influenced the appearance of the cardiac activity-related artifacts of the EEG. The removal of the cardiac activity-related artifacts of the EEG by the implemented post-processing algorithm resulted in an EEG of diagnostic quality with detected alpha-activity. CONCLUSION When recording an EEG in MR environment, heart rate-dependent subtraction of EEG artifacts caused by ballistocardiogram contamination is essential to obtain EEG recordings of diagnostic quality and reliability.
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Affiliation(s)
- L Jäger
- Institut für Klinische Radiologie, Klinikum Grosshadern, Universität München.
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Flatz H, Jäger L, Hempel MJ, Brüning R, Helmberger R, Schoenberg S, Reiser M. Detektion and Abgrenzung laryngealer und hypopharyngealer Tumoren mittels Multidetektor-CT und MRT mit paralleler Bildgebung. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867836] [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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41
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Jäger L, Mulert C, Propp S, Karch S, Reiser M. Lautstärkeabhängigkeit des primären Hörkortex: Simultane fMRT- und EEG-Messung. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867621] [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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42
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Jäger L, Lutz J, Stahl R, Dietrich O, Schelling G, Schoenberg S, Reiser M. Kortikale und subkortikale Veränderungen bei Patienten mit CRPS (Complex Regional Pain Syndrome): Eine DTI-Studie. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867606] [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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Abstract
Niikawa-Kuroki syndrome (Kabuki make-up syndrome) is a congenital disorder with characteristic facial features and possibly anomalies of the skeletal system and internal organs. There is an increasing number of reports of patients with combined hearing impairment, inner ear deformities or sensorineural hearing impairment. In addition, the patients often suffer from therapy-resistant chronic otitis media. In addition to multiple cardiac and renal deformities, our 3 year old patient has a hearing impairment due to chronic otitis media with chronic otorrhea, and requires a hearing aid. A high-definition CT scan of the petrosal bone revealed, for the first time in a patient with Niikawa-Kuroki syndrome, a large vestibular aqueduct syndrome and deformities of the vestibular system. We examine the problems involved with treating chronic otorrhea in chronic otitis media and providing patients with BTE hearing aids.
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Affiliation(s)
- J M Hempel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde der Ludwig-Maximilians-Universität München.
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Karch S, Mulert C, Jäger L, Teutsch M, Seifert C, Propp S, Pogarell O, Möller H, Hegerl U. Neurobiological Correlates of Disturbed Cognitive Functions in Patients with Schizophrenia: A Simultaneous EEG + fMRI Study. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832037] [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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45
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Mulert C, Jäger L, Propp S, Leicht G, Pogarell O, Juckel G, Hegerl U. Loudness dependency of the primary auditory cortex as an indicator of central serotonergic transmission: Combination of EEG and fMRI. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825444] [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: 10/25/2022]
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46
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Flatz W, Jäger L, Teipel SJ, Stöckel S, Dietrich O, Schönberg SO, Leinsinger G, Reiser M. Poster zum Thema „Neuroradiologie“ (MRT, Andere) MR-Analyse der Substantia Innominata bei Alzheimerscher Krankheit und normalem Altern. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828545] [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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47
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Abstract
A patient sought treatment for vertical oscillopsia and impaired vision during locomotion, and unsteadiness of gait. Positive fistula tests and CT of the temporal bones confirmed a diagnosis of bilateral superior canal dehiscence. An impairment of the superior canal vestibulo-ocular reflex, documented by three-dimensional search coil eye movement recordings for oblique (single) and downward pitch head motion (bilateral canal testing), is proposed to induce vertical rather than torsional-vertical oscillopsia during locomotion.
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Affiliation(s)
- A Deutschländer
- Department of Neurology, Institute of Clinical Radiology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
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Mulert C, Jäger L, Pogarell O, Bussfeld P, Schmitt R, Juckel G, Hegerl U. Simultaneous ERP and event-related fMRI: focus on the time course of brain activity in target detection. Methods Find Exp Clin Pharmacol 2003; 24 Suppl D:17-20. [PMID: 12575464] [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: 02/28/2023]
Abstract
The event-related P300 potential has been widely used in neurophysiological research. It is usually evoked with an oddball paradigm. One main reason for its broad application in neurophysiological research is the fact that in several brain/mental diseases, such as Alzheimer's disease or schizophrenia, attenuations of the P300 amplitude and latency have been described. However, a precise correlation of the scalp data to the underlying brain regions was not possible, as the correct localization of the generators of scalp-measured electroencephalogram (EEG) data was limited, due to the low spatial resolution of EEG-data. With the availability of modern imaging technologies, functional Magnetic Resonance Imaging (fMRI) in particular, the underlying brain activations could be detected using an oddball task. Although the spatial resolution of fMRI is excellent, the time resolution is restricted. For a comprehensive understanding of the brain activity underlying the P300 paradigm, we have used a combination of EEG and fMRI to get a precise localization and a high-time resolution of the underlying brain activity.
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Affiliation(s)
- C Mulert
- Laboratory for Clinical Neurophysiology, Department of Psychiatry, LMU, Munich, Germany.
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Pöpperl G, Lang S, Dagdelen O, Jäger L, Tiling R, Hahn K, Tatsch K. [Correlation of FDG-PET and MRI/CT with histopathology in primary diagnosis, lymph node staging and diagnosis of recurrency of head and neck cancer]. ROFO-FORTSCHR RONTG 2002; 174:714-20. [PMID: 12063600 DOI: 10.1055/s-2002-32215] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [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: 10/17/2022]
Abstract
AIM Correct staging of head and neck cancer is important for the patient's prognosis and further therapeutic strategies. Aim of the present study was to investigate the diagnostic value of FDG-PET regarding the pre-surgical diagnosis of primary tumor and cervical lymph node metastases, the diagnosis of tumour recurrence, and the localisation of unknown primary, further to compare the results to those of morphological imaging modalities (CT/MRI) and to correlate the results of both methods with histopathological findings. PATIENTS/METHODS 115 patients (pts) (72 x primary diagnosis, 37 x recurrence, and 6 x unknown primary) underwent FDG-PET (ECAT EXACT HR+) and CT or MRI. Results were correlated with histopathological findings in terms of detection of primary and recurrent tumors as well as lymph node metastases. RESULTS Regarding the pre-surgical diagnosis, sensitivity and specificity for identifying primary tumors were 85 % and 100 % for PET and 88 % and 75 % for CT/MRI, respectively. Accuracy was 86 % for PET and 87 % for CT/MRI. Sensitivity and specificity for detecting primary lymph node involvement were 71 %/86 % for PET and 74 %/57 % for CT/MRI, resulting in an accuracy of 77 % with PET and 68 % with morphological imaging. In 23 pts histopathology revealed pT1 stages with tumor diameters < 12 mm. In 8 pts CT/MRI and in 10 pts PET failed to identify these small primary lesions. Detecting tumor recurrence (n = 37) PET showed a higher sensitivity (83 %), specificity (76 %) and accuracy (78 %) compared to CT/MRI (sensitivity: 67 %; specificity: 52 %; accuracy: 57 %). In 4/6 pts with unknown primary, imaging was able to identify a primary lesion (3/4 in FDG-PET, 2/4 in CT/MRI), in 2/6 patients even in the follow-up no primary tumor was found. CONCLUSIONS FDG-PET provides only minor additional information to morphological imaging concerning diagnosis of primary tumors. At a similar level of sensitivity, however, it seems to be more specific regarding the lymph node involvement. PET seems to be superior to CT/MRI in detecting tumor recurrence as well as occult primary tumors in pts with known cervical lymph node metastases.
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Affiliation(s)
- G Pöpperl
- Klinik und Poliklinik für Nuklearmedizin; München, Germany.
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Abstract
INTRODUCTION Before sinus surgery, computed tomography (CT) of the paranasal sinuses and anterior skull base is a standard procedure in the diagnostic evaluation. However, coronal sections necessary for the analysis of the complex anatomy of this region are often not applicable in multiple injured or elderly patients due to the impossibility to maintain the required position for the coronal scans. Secondary coronal reconstruction of primary axially acquired scans could help to overcome this problem. This technique was, however, hampered so far by an insufficient resolution in case of conventional CT. We therefore compared the quality of primary coronally acquired conventional CT images with the resolution of multiplanar reformatted coronal images of primary axially acquired scans by means of a new CT generation, the Multidetector Computed Tomography (MDCT). MATERIAL AND METHODS 10 patients were each examined with conventional CT or MDCT respectively. The quality of primary coronally acquired conventional scans (CT) versus secondary coronal reconstructions (MDCT) was compared by evaluating typical anatomic landmarks. RESULTS As compared to conventional CT, the coronal reconstruction of primary axially acquired scans by means of MDCT revealed an equal resolution and additionally no essential impairment by amalgam artefacts. CONCLUSION Our results demonstrate the excellent quality of secondary coronal reconstructions by means of MDCT in the CT evaluation of the paranasal sinuses and the anterior skull base as compared to primary coronally acquired images via conventional CT.
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Affiliation(s)
- S Lang
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkranke, Germany
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