33 research outputs found
Comparison of cardiac volumetry using real-time MRI during free-breathing with standard cine MRI during breath-hold in children
Background Cardiac real-time magnetic resonance imaging (RT-MRI) provides high-quality images even during free- breathing. Difficulties in post-processing impede its use in clinical routine. Objective To demonstrate the feasibility of quantitative analysis of cardiac free-breathing RT-MRI and to compare image quality and volumetry during free-breathing RT-MRI in pediatric patients to standard breath-hold cine MRI. Materials and methods Pediatric patients (n= 22) received cardiac RT-MRI volumetry during free breathing (1.5 T; short axis; 30 frames per s) in addition to standard breath-hold cine imaging in end-expiration. Real-time images were binned retrospec- tively based on electrocardiography and respiratory bellows. Image quality and volumetry were compared using the European Cardiovascular Magnetic Resonance registry score, structure visibility rating, linear regression and BlandâAltman analyses. Results Additional time for binning of real-time images was 2 min. For both techniques, image quality was rated good to excellent. RT-MRI was significantly more robust against artifacts (P< 0.01). Linear regression revealed good correlations for the ventricular volumes. BlandâAltman plots showed a good limit of agreement (LoA) for end-diastolic volume (left ventricle [LV]: LoA -0.1 ± 2.7 ml/m2, right ventricle [RV]: LoA -1.9 ± 3.4 ml/m2), end-systolic volume (LV: LoA 0.4 ± 1.9 ml/m2, RV: LoA 0.6 ± 2.0 ml/m2), stroke volume (LV: LoA -0.5± 2.3 ml/m2, RV: LoA -2.6± 3.3 ml/m2) and ejection fraction (LV: LoA -0.5 ± 1.6%, RV: LoA -2.1 ± 2.8%). Conclusion Compared to standard cine MRI with breath hold, RT-MRI during free breathing with retrospective respiratory binning offers good image quality, reduced image artifacts enabling fast quantitative evaluations of ventricular volumes in clinical practice under physiological conditions
Spirometryâbased reconstruction of realâtime cardiac MRI: Motion control and quantification of heartâlung interactions
Apnea of prematurity: from cause to treatment
Apnea of prematurity (AOP) is a common problem affecting premature infants, likely secondary to a âphysiologicâ immaturity of respiratory control that may be exacerbated by neonatal disease. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain controversial. Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent positive pressure ventilation to prevent pharyngeal collapse and alveolar atelectasis, while methylxanthine therapy is a mainstay of treatment of central apnea by stimulating the central nervous system and respiratory muscle function. Other therapies, including kangaroo care, red blood cell transfusions, and CO2 inhalation, require further study. The physiology and pathophysiology behind AOP are discussed, including the laryngeal chemoreflex and sensitivity to inhibitory neurotransmitters, as are the mechanisms by which different therapies may work and the potential long-term neurodevelopmental consequences of AOP and its treatment
Phlebologie an deutschen Hautkliniken: eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft fĂŒr Phlebologie
Reich-Schupke S, Alm J, Altmeyer P, et al. Phlebologie an deutschen Hautkliniken: Eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft fĂŒr Phlebologie. Hautarzt. 2013;64(9):685-694.Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). To investigate the reasons for this development, we-on behalf of the DGP-sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.Hintergrund
Venenleiden sind eine Volkskrankheit und haben eine enorme sozioökonomische Bedeutung. Dennoch scheint der Anteil der phlebologisch tĂ€tigen Dermatologen entsprechend den Zahlen der Deutschen Gesellschaft fĂŒr Phlebologie (DGP) abzunehmen.
Methoden
Um die Ursachen dieser Entwicklung zu untersuchen, fĂŒhrten wir im Herbst 2012 im Auftrag der DGP eine Befragungsstudie zur Phlebologie an 120 deutschen Hautkliniken durch.
Ergebnisse
In 76 antwortenden Klinien gab es im Mittel 1,5 Phlebologen und 0,9 Ărzte mit Voraussetzungen zur WeiterbildungsermĂ€chtigung Phlebologie. In 71,1â% der Kliniken gab es einen Phlebologen, in 73,7â% eine phlebologische Sprechstunde. Zur Diagnostik wurden besonders die Doppler- (89,5â%) und Duplexsonographie (86,8â%) eingesetzt. In der Therapie fĂŒhrte die Kompressionstherapie (94,7â%), gefolgt von Sklerosierungstherapien (flĂŒssig 78,9â%, Schaum 63,2â%, Katheter 18,4â%), den endoluminalen thermischen Verfahren (Radiowelle 28,9â%, Laser 17,1â%) und den operativen Eingriffen (vor allem Cross- und Saphenektomie 67,1â%, Seitenastexhairese 75â%). Die durchschnittlichen Behandlungszahlen waren sehr heterogen.
Schlussfolgerung
Die Phlebologie spielt in der Dermatologie weiterhin eine wichtige Rolle. Mehrheitlich sind in den Kliniken die Möglichkeiten zur Weiterbildung Phlebologie gegeben. Es wird ein breites Spektrum an phlebologischen Techniken zur Diagnostik und Therapie angeboten
Occupational protein contact dermatitis caused by meat and fish
BACKGROUND: Protein contact dermatitis is a form of contact dermatitis possibly triggered by proteinaceous allergens. MATERIALS AND METHODS: We report two patients with a history of erythematous and urticarial skin reactions followed by transformation into prolonged papular symptoms upon contact with proteinaceous material. RESULTS: The symptoms reported by the patients were reproducible by skin testing with meat (cow) and fish (salmon). Both patients experienced extracutaneous manifestations after ingestion of meat and fish, as proven by oral challenge. Specific immunoglobulin E (IgE) antibodies were detected in the patients' blood. CONCLUSIONS: Both cases meet all major criteria of protein contact dermatitis, suggesting IgE-mediated immediate-type hypersensitivity with late-phase cutaneous reactions
Calcipotriol vs. tazarotene as combination therapy with narrowband ultraviolet B (311ânm): efficacy in patients with severe psoriasis
Radiation-induced late effects in two affected individuals of the Lilo radiation accident.
Radiation exposure leads to a risk for long-term deterministic and stochastic late effects. Two individuals exposed to protracted photon radiation in the radiological accident at the Lilo Military site in Georgia in 1997 received follow-up treatment and resection of several chronic radiation ulcers in the Bundeswehr Hospital Ulm, Germany, in 2003. Multi-parameter analysis revealed that spermatogenetic arrest and serum hormone levels in both patients had recovered compared to the status in 1997. However, we observed a persistence of altered T-cell ratios, increased ICAM1 and beta1-integrin expression, and aberrant bone marrow cells and lymphocytes with significantly increased translocations 6 years after the accident. This investigation thus identified altered end points still detectable years after the accident that suggest persistent genomic damage as well as epigenetic effects in these individuals, which may be associated with an elevated risk for the development of further late effects. Our observations further suggest the development of a chronic radiation syndrome and indicate follow-up parameters in radiation victims