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Schacherer D, Decking D, Herold T, Obed A, Schlitt HJ, Gruene S, Schoelmerich J, Schlottmann K. [Localisation of hepatic lesions to liver segments according to sonography (US), computed tomography (CT) and surgery (OP): a comparative study]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2010; 48:241-5. [PMID: 20127599 DOI: 10.1055/s-0028-1109711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The localisation of focal liver lesions is usually performed according to the Couinaud classification system. The exact description of localisation and size of liver lesions is especially important for surgical procedures. The aim of this prospective study was the evaluation of differences and agreements in the localisation and size of hepatic lesions as found by ultrasound (US), computed tomography (CT) and according to the intraoperative status (OP). MATERIAL AND METHODS 32 patients (21 male, 11 female) were enrolled in the study. The results obtained from sonography, computed tomography and surgery were classified into 5 categories for localisation and for size, respectively. RESULTS According to the agreement between sonography and computed tomography, 25 % of all hepatic lesions were classified into category 1 (exact agreement), whereas 40.6 % were ranked into category 2 (almost exact agreement). Correlating sonography and intraoperative results, 31.3 % of the lesions were classified into category 1 and 46.9 % into category 2. In the comparison of CT with OP, 34.4 % of the lesions were found to be in category 1 and 43.8 % in category 2. Concerning the size of the lesions, almost half of the tumours (46.9 %) were classified into category 1 on the basis of the correlation between US and CT and 21.9 % on the basis of the correlation between US and OP. DISCUSSION The localisation and description of the size of hepatic lesions is mainly similar or even identical on the basis of the different methods. Further improvements might be achieved by the introduction of a consistent nomenclature.
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Jung EM, Prantl L, Schreyer AG, Schreyer CI, Rennert J, Walter M, Jung W, Hoffstetter P, Herold T, Zorger N, Feuerbach S, Fellner C. New perfusion imaging of tissue transplants with Contrast Harmonic Ultrasound Imaging (CHI) and Magnetic Resonance Imaging (MRI) in comparison with laser-induced Indocyanine Green (ICG) fluorescence angiography. Clin Hemorheol Microcirc 2010; 43:19-33. [PMID: 19713598 DOI: 10.3233/ch-2009-1218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Evaluation of post-surgery tissue perfusion of free flaps of the lower leg with contrast enhanced harmonic imaging (CHI), laser-induced indocyanine green (ICG) fluorescence angiography and magnetic resonance imaging (MRI). MATERIALS AND METHODS 10 patients with free flaps of the lower limb were evaluated with CHI, ICG-fluorescence angiography and perfusion weighted MRI. Perfusion weighted MRI was performed after intravenous bolus injection of 25 ml Gd-DTPA. The ICG fluorescence was detected by a near-infrared-laser device (lambda em = 780 nm). Ultrasound was carried out by an experienced examiner with a linear probe after intravenous bolus injection of 2.4 ml SonoVue. For MRI time intensity curves as well as color-coded blood volume maps of the whole free flap were qualitatively evaluated. For CHI and ICG time intensity curves in selected regions of interest were analyzed. A score from 1-5 (1 = low, 5 = excellent) was used for analysis of perfusion images by three independent readers. RESULTS In 3 cases (radialis, parascapular and lateral thigh flap) CHI, MRI and ICG perfusion imaging showed an excellent (score 4-5) contrast enhancement of the cutaneous and subcutaneous part of the free flaps. In 2 cases of osteocutaneous flaps perfusion in central and distal parts of the free flaps was reduced (score 2). Correlation between CHI, MRI and ICG was 0.69-0.83 for the distal parts of the free flaps and 0.74-0.87 for the center of the flaps (Spearman test). Perfusion in the center of the free flaps was significantly different for MRI and ICG and also for MRI and CHI (p<0.05, Wilcoxon test). CONCLUSION These first results introduce CHI and MRI perfusion imaging as a promising post-surgery monitoring in patients with free flaps.
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Rennert J, Herold T, Schreyer A, Banas B, Jung E, Feuerbach S, Lenhart M, Mueller-Wille R, Zorger N. Evaluation of a Liquid Embolization Agent (Onyx) for Transcatheter Embolization for Renal Vascular Lesions. ROFO-FORTSCHR RONTG 2009; 181:996-1001. [DOI: 10.1055/s-0028-1109741] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Müller-Wille R, Herold T, Jung E, Rennert J, Heiss P, Lenhart M, Paetzel C, Feuerbach S, Zorger N. Onyx (Ethylen-Vinyl-Alkohol-Kopolymer) – Ein neuer Anwendungsbereich in der endovaskulären Behandlung akuter peripherer Blutungen. ROFO-FORTSCHR RONTG 2009; 181:767-73. [DOI: 10.1055/s-0028-1109446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lenhart M, Schätzler S, Manke C, Strotzer M, Seitz J, Gmeinwieser J, Völk M, Zorger N, Feuerbach S, Herold T, Paetzel C. Radiologische Implantation zentralvenöser Portsysteme am Unterarm. ROFO-FORTSCHR RONTG 2009; 182:20-8. [DOI: 10.1055/s-0028-1109453] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rennert J, Herold T, Banas B, Jung EM, Feuerbach S, Schreyer AG, Mueller-Wille R, Zorger N. Endovaskuläre Behandlung akuter Nierenblutungen mit einem neuen Flüssigembolisat (Onyx): erste klinische Ergebnisse. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zorger N, Rennert J, Herold T, Jung EM, Schreyer AG, Paetzel C, Feuerbach S, Lenhart M. Transjuguläre Intrahepatische Portosystemische Shunts: Adjuvante Embolisation gastroösophagaler Kollateralgefäße mit einem neu entwickelten Flüssigembolisat (Onyx) zur Prävention der Varizen-Blutung. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Müller-Wille R, Herold T, Heiss P, Jung EM, Rennert J, Feuerbach S, Zorger N. Onyx (Ethylenvinyl Alkohol Kopolymer) – Endovaskuläre Behandlung akuter peripherer arterieller Blutungen mit neuartigem Flüssigembolisat. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Heiss P, Zorger N, Kaempfe I, Jung EM, Pfister K, Paetzel C, Feuerbach S, Herold T. [Stenting in the treatment of chronic mesenteric ischemia: technical and clinical success rates]. ROFO-FORTSCHR RONTG 2009; 180:906-14. [PMID: 19238641 DOI: 10.1055/s-2008-1027699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the technical and clinical success rates of percutaneous stent revascularization in the treatment of chronic mesenteric ischemia (CMI). PATIENTS AND METHODS 17 patients (12 female) with typical symptoms of CMI were treated by percutaneous stent placement for stenoses of the splanchnic arteries (celiac trunk; superior mesenteric artery, SMA; inferior mesenteric artery, IMA). The primary and secondary technical success, primary and secondary clinical success, and the long-term clinical outcome were determined. RESULTS A total of 24 stents were implanted in 21 splanchnic arteries (12 stents in the celiac trunk, 11 in the SMA and 1 in the IMA). The primary technical success rate was 91% (19/21 arteries), the secondary technical success rate was 95% (21/22 arteries). Clinical follow-up was available for 16 patients. The primary clinical success rate was 81% (13/16 patients). Following two secondary interventions, the secondary clinical success rate was 94% (15/16 patients). Long-term clinical success was achieved in 15 of 16 patients (94%) with a mean follow-up of 26 months. One patient died within 30 days of the intervention and two patients demonstrated major complications (1 dissection, 1 stent dislocation). None of the patients required surgical revascularization and none of the patients died due to recurrent mesenteric ischemia. CONCLUSION Percutaneous stent placement for the treatment of CMI can be performed with a high technical and clinical success rate as well as an excellent long-term clinical outcome.
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Thoene S, Rawat VPS, Heilmeier B, Hoster E, Metzeler KH, Herold T, Hiddemann W, Gökbuget N, Hoelzer D, Bohlander SK, Feuring-Buske M, Buske C. The homeobox gene CDX2 is aberrantly expressed and associated with an inferior prognosis in patients with acute lymphoblastic leukemia. Leukemia 2009; 23:649-55. [DOI: 10.1038/leu.2008.355] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Müller-Wille R, Herold T, Schreyer AG. [Ainhum disease (dactylolysis spontanea)]. ROFO-FORTSCHR RONTG 2008; 180:348-50. [PMID: 18370349 DOI: 10.1055/s-2008-1027140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hoffstetter P, Herold T, Daneschnejad M, Zorger N, Jung E, Feuerbach S, Schreyer A. Nicht traumaassozierte Nebenbefunde bei Ganzkörpercomputertomografien im Rahmen der Polytraumadiagnostik. ROFO-FORTSCHR RONTG 2008; 180:120-6. [DOI: 10.1055/s-2007-963594] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Endlicher E, Troppmann M, Kullmann A, Golder S, Herold T, Herfarth H, Grossmann J, Schlottmann K, Kullmann F. Irinotecan plus gemcitabine and 5-fluorouracil in advanced pancreatic cancer: a phase II study. Oncology 2008; 72:279-84. [PMID: 18187949 DOI: 10.1159/000113039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 07/19/2007] [Indexed: 11/19/2022]
Abstract
AIMS The aim of the present study was to evaluate the 6-month survival rate of patients with inoperable or metastatic pancreatic cancer treated with irinotecan and gemcitabine plus 5-fluorouracil. Secondary efficacy end points included response rate, time to progression (TTP), overall survival (OS) and toxicity. PATIENTS AND METHODS 30 patients with histologically proven pancreatic carcinoma and at least one bidimensionally measurable lesion were enrolled. Of the patients, 83% had metastatic and 17% locally advanced disease. One cycle, lasting 21 days, comprised treatment on days 1 and 8 consisting of 75 mg/m(2) irinotecan i.v. for 90 min, 1,000 mg/m(2) gemcitabine i.v. for 30 min and 2,000 mg/m(2) fluorouracil (5-FU) for 24 h. A total of six cycles was planned for each patient. RESULTS 28 patients competed at least one treatment cycle and were therefore assessable for efficacy, and 75% of them achieved the primary end point of the study (survival after 6 months). One-year survival was 25%. Stabilization (partial response and stable disease) was observed in 35.7% (10/28) and partial remission in 7.1% (2/28). The objective response rate was 7.1% (2/28) after completion of the six cycles. Median TTP was 3.4 months (1.2-11.5), and median OS was 8.3 months (2.1-36.2). Regarding severe hematological toxicities, only neutropenia was observed (grade 3 20.7%, 6/29, and grade 4 3.5%, 1/29). In spite of anti-emetic supportive care, nausea affected most of the patients: 79.3% (23/29). Grade 3 vomiting was observed in 4 of the 29 patients (13.8%) and grade 4 in 1 patient (3.5%). Only 1 patient experienced diarrhea grade 3 (3.5%) and 1 patient (3.5%) suffered from a grade 3 peroneal nerve enervation. CONCLUSIONS A combination of irinotecan, gemcitabine and 5-FU is feasible and shows considerable efficacy in patients with inoperable or metastatic pancreatic cancer. Due to its low toxicity, this combination might be an interesting cytotoxic regimen in addition to targeted therapies.
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Zorger N, Jung EM, Hamer OW, Paetzel C, Schreyer A, Seitz J, Stehr A, Steinbauer M, Feuerbach S, Herold T. Intraarterial gadolinium-enhanced magnetic resonance angiography of the renal arteries in humans: feasibility, contrast agent reduction, and accuracy for detection of stenoses. Clin Hemorheol Microcirc 2008; 38:97-104. [PMID: 18198411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Feasibility of intraarterial MR angiography of the renal arteries and comparison of the accuracy of intraarterial MR angiography with selective intraarterial digital subtraction angiography (DSA) for detection of stenoses. MATERIALS AND METHODS Ten consecutive patients (mean, 68 years) with suspected renal artery stenosis underwent a digital subtraction angiography and an intraarterial gadolinium-enhanced MR angiography, performed on a 1.5-T system. For intraarterial MR angiography 60 ml diluted contrast agent (10 ml gadodiamide in 50 ml 0.9% saline solution) was injected through a conventional angiography catheter placed in the suprarenal abdominal aorta using a flow rate of 3.5 ml/s. A three-dimensional (3D) gradient-echo sequence was performed. Differences in the quantitative measurement of stenoses of lesions between DSA and intraarterial MR angiography were evaluated by three observers. Overall impression of the intraarterial MR angiography was documented on a four-point scale (1 = excellent to 4 = poor). Interobserver variability was calculated. RESULTS Intraarterial MR angiography of the renal arteries was feasible in all patients (100%) with a mean overall impression of all images of 1.8 (SD: 0.71). One of 9 accessory renal arteries was not visualized with intraarterial MR angiography. The overall sensitivity/specificity for detection of significant stenoses (>or=50% stenosis) were 83%/87%. Interobserver variability of intraarterial MR angiography ranged between fair and substantial (0.359-0.622). CONCLUSION Intraarterial MR angiography of the renal arteries in humans is feasible and has an acceptable sensitivity in detecting stenoses using injections of diluted contrast agent at concentrations as low as 17%.
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Herold T. Indirekte MR-Arthrographie. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Prantl L, Schmitt S, Gais S, Tsui TY, Lamby P, Babilas P, Nerlich M, Kubale R, Zorger N, Herold T, Feuerbach S, Jung EM. Contrast harmonic ultrasound and indocyanine-green fluorescence video angiography for evaluation of dermal and subdermal microcirculation in free parascapular flaps. Clin Hemorheol Microcirc 2008; 38:31-44. [PMID: 18094456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Contrast harmonic ultrasound (CHI) with a linear transducer is a new diagnostic approach that allows dynamic and quantitative flow detection of tissue perfusion in microsurgery. The aim of the study was the evaluation of perfusion of the dermal and subdermal layers of microvascular tissue transplants with CHI in comparison to ICG-fluorescence angiography. MATERIAL AND METHOD In a prospective clinical study indocyanine-green fluorescence video angiography and contrast enhanced high resolution ultrasound (5-10 MHz; linear transducer; Logiq 9; GE) were used for evaluation of the microcirculation in 10 transplanted free parascapular flaps. Two regions were analysed, the centre of the flap and the region of the anastomosis. The perfusion patterns of both methods were compared. RESULTS The perfusion indexes measured by ICG-fluorescence angiography correlated very precisely in all patients with the quantitative perfusion curves of contrast-enhanced US with CHI. Two flaps with slow filling and low dye intensity showed low contrast enhancement in CHI with modified perfusion curves with slow increase. In two cases a reduced perfusion and filling were found. There were no statistical differences between the two diagnostic methods (p>0.01). CONCLUSION CHI improves US detections of dermal and subdermal microcirculation in comparison to ICG fluorescence angiography. CHI is a new diagnostic method for postoperative monitoring of free flaps.
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Zorger N, Herold T. Intervention bei Typ-B-Dissektionen: Stenting und Fensterung. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Prantl L, Schmitt S, Geis S, Tsui TY, Lamby P, Nerlich M, Kubale R, Zorger N, Herold T, Feuerbach S, Jung EM. Contrast harmonic ultrasound and indocyanine-green fluorescence video angiography for evaluation of dermal and subdermal microcirculation in free parascapular flaps. Clin Hemorheol Microcirc 2008; 38:105-118. [PMID: 18198412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Contrast harmonic ultrasound (CHI) with a linear transducer is a new diagnostic approach that allows dynamic and quantitative flow detection of tissue perfusion in microsurgery. The aim of the study was the evaluation of perfusion of the dermal and subdermal layers of microvascular tissue transplants with CHI in comparison to ICG-fluorescence angiography. MATERIAL AND METHOD In a prospective clinical study Indocyanine-Green Fluorescence Video Angiography and Contrast Enhanced High Resolution Ultrasound (5-10 MHz; linear transducer; Logiq 9; GE) were used for evaluation of the microcirculation in 10 transplanted free parascapular flaps. Two regions were analysed, the centre of the flap and the region of the anastomosis. The perfusion patterns of both methods were compared. RESULTS The perfusion indexes measured by ICG-fluorescence angiography correlated very precisely in all patients with the quantitative perfusion curves of contrast-enhanced US with CHI. Two flaps with slow filling and low dye intensity showed low contrast enhancement in CHI with modified perfusion curves with slow increase. In two cases a reduced perfusion and filling were found. There were no statistical differences between the two diagnostic methods (p>0.01). CONCLUSION CHI improves US detections of dermal and subdermal microcirculation in comparison to ICG fluorescence angiography. CHI is a new diagnostic method for postoperative monitoring of free flaps.
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Rieger C, Geiger S, Herold T, Nickenig C, Ostermann H. Breakthrough infection of Trichosporon asahii during posaconazole treatment in a patient with acute myeloid leukaemia. Eur J Clin Microbiol Infect Dis 2007; 26:843-5. [PMID: 17690928 DOI: 10.1007/s10096-007-0366-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A neutropenic patient with acute myeloid leukaemia experienced a breakthrough infection of Trichosporon asahii during posaconazole treatment. After treatment was changed to a combination therapy with voriconazole and liposomal amphotericin B, the infection resolved. Posaconazole works effectively as an antifungal prophylaxis and salvage therapy in rare invasive fungal infections. This case however illustrates that breakthrough infections with T. asahii may occur during posaconazole treatment.
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Stehr A, Steinbauer M, Pfister K, Töpel I, Herold T, Zorger N, Kasprzak PM. Diagnostik und endovaskuläre Behandlung einer proximalen Endograft-Instabilität nach thorakalem Endostent. Zentralbl Chir 2007; 132:211-5. [PMID: 17610191 DOI: 10.1055/s-2007-960754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Four cases of proximal endostent instability after endovascular tube graft treatment of thoracic aortic disease using the TAG Gore system are reported. This potentially hazardous complication is characterized by a lack of attachment of the device to the small curvature of the aortic arch. Towering up against the hemodynamic forces in this area, the endograft could collapse and occlude the aorta. To identify this complication we recommend to perform an early postinterventional CT-scan with parasagittal reconstruction and an observation of the proximal endograft by fluorography. Endovascular solutions for the treatment of this complication may be either a proximal extension by another endograft or fixation of the proximal endograft by a balloon expandable Palmaz stent.
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Wiest R, Jurzik L, Herold T, Straub RH, Schölmerich J. Role of NPY for vasoregulation in the splanchnic circulation during portal hypertension. Peptides 2007; 28:396-404. [PMID: 17194504 DOI: 10.1016/j.peptides.2006.08.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 08/02/2006] [Indexed: 11/25/2022]
Abstract
Vascular dysfunction in the splanchnic circulation during portal hypertension is characterized by enhanced NO-mediated vasorelaxation and vascular hyporeactivity to norepinephrine that lead to arterial vasodilation. NPY most likely counteracts both of these key features. Firstly, NPY appears to inhibit Ach- and PNS-induced vasorelaxation in mesenteric arteries. This effect is more pronounced in portal hypertensive rats as compared to control, and most likely reflects the inhibition of increased e- and nNOS-derived NO-synthesis during portal hypertensive conditions. Secondly, NPY sensitizes the mesenteric vasculature to alpha(1)-adrenergic vasoconstriction. Most importantly, in portal hypertensive rats but not in sham rats NPY markedly augments vascular contractility and thereby corrects vascular hyporeactivity. Both actions of NPY increase vascular tone and may well act synergistically in the splanchnic circulation during portal hypertension. Moreover, the vasoconstrictive effects of NPY are most pronounced at particularly high levels of alpha(1)-adrenergic activity. Therefore, it appears that NPY becomes increasingly important for optimizing adrenergic vasoconstriction at particularly high adrenergic drive and also for playing a predominant role for vascular homeostasis. Cirrhotic patients present with elevated circulating plasma levels of NPY, which appears to be independent from the severity of liver dysfunction and to correlate with portal pressure. This finding indicates enhanced NPY release during portal hypertension that may represent a compensatory mechanism aimed at counterbalancing arterial vasodilation by restoring the efficacy of endogenous catecholamines and inhibiting vasodilative drive in the splanchnic circulation.
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Heiss P, Zorger N, Jung M, Bachthaler M, Braun J, Feuerbach S, Herold T. Perkutane Stent-Angioplastie bei chronischer mesenterialer Ischämie: Technische und klinische Erfolgrate. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Poschenrieder F, Herold T, Borisch I, Schleicher T, Butz B, Daneschnejad M, Heiss P, Feuerbach S, Zorger N. Vergleich einer neu entwickelten intraarteriellen MR-Angiographie mit der intravenösen MR-Angiographie der Becken-/Bein-Gefäße zur Beurteilung von Stenosen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jung EM, Kubale R, Clevert DA, Weskott HP, Prantl L, Herold T, Renz M, Rupp N, Tacke J. B-flow and B-flow with 3D and SRI postprocessing before intervention and monitoring after stenting of the internal carotid artery. Clin Hemorheol Microcirc 2007; 36:35-46. [PMID: 17211060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To investigate the extent to which B-flow and B-flow with 3D postprocessing and speckle reduction imaging (SRI) have advantages in appraising the morphology of a high-grade stenosis of the internal carotid artery (ICA) for preinterventional planning and for postinterventional ultrasonographic follow-up. MATERIALS/METHODS A comparative appraisal of flow with CCDS, power Doppler, B-flow and 3D B-Flow with SRI were carried out prospectively in 50 patients with >70% stenosis according to NASCET criteria in contrast medium-enhanced MRA before and after the intervention. After stenting of the internal carotid artery (ICA), i.a. digital substraction angiography (DSA) served as an additional reference method. RESULTS In >70% ICA stenosis, simultaneous imaging of the pre-stenotic, intra-stenotic and post-stenotic flow was attained with B-flow in 45/90 cases (90%), with power Doppler in 39/50 cases (78%) and with CCDS in only 31/50 cases (62%). After intervention, a complete detection of flow without overwriting or blooming artifacts was achieved in all 50 patients only by B-flow. The intrastenotic flow (p<0.05) could be better demarcated against the lumen and the vessel wall before the intervention, whereas the flow within the stent could be very much better appraised after the intervention (p<0.01) using 3D postprocessing of B-flow with additional SRI. Re-stenoses with hypoechoic vascular wall changes (3/50 patients) were detected at an early stage using B-flow. CONCLUSIONS B-flow technique with SRI and 3D postprocessing can facilitate the intrastenotic detection of flow in >70% ICA stenosis with fewer flow artifacts. After stenting, the perfused vascular lumen shows less flow artifacts compared with CCDS and power Doppler. In order to elucidate hemodynamic changes, additional Doppler examinations are still necessary.
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Prantl L, Pfister K, Kubale R, Schmitt S, Stockhammer V, Jung W, Zorger N, Herold T, Nerlich M, Stehr A, Jung EM. Value of high resolution ultrasound and contrast enhanced US pulse inversion imaging for the evaluation of the vascular integrity of free-flap grafts. Clin Hemorheol Microcirc 2007; 36:203-16. [PMID: 17361023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical value of color coded Doppler sonography (CCDS) and contrast-enhanced harmonic imaging (CHI) for ultrasound (US) monitoring the integrity of free-flap vascular grafts. Patency of microvascular anastomoses and perfusion as well as microcirculation of the transplanted tissue were analysed. PATIENTS AND METHODS Fifteen free parascapular flap grafts performed over a period of three years by a single surgeon were examined with CCDS and CHI. The patients (12 male, 3 female) ranged in age from 16 to 60 years (average age 40+/-12). The follow-up period ranged from two weeks to 2.5 years. CCDS were performed with a multifrequency linear transducer (5-10 MHz, Logiq 9, GE) with 3D flow detection. For detection and characterization, B scan of the flap tissue was compared to tissue harmonic imaging (THI) and Cross Beam with Speckle Reduction Imaging (SRI). US Pulse Inversion Harmonic Imaging (PIHI) after bolus injection of 2.5 ml Sonovue was used for contrast enhancement. RESULTS Border and tissue structure of the flaps could be detected best in all 15/15 cases using Cross Beam Technology with SRI and THI. Correlations were found for flow parameters of the common femoral artery, popliteal artery and lower leg artery to the anastomotic vessels. 3D imaging with CCDS facilitated flow detection of elongated and small anastomotic vessels in 4/15 cases. Contrast-enhanced US with PIHI allowed dynamic flow detection of the microcirculation of the transplanted tissue over a depth of up to 3 cm with quantitative perfusion curves of the tissue microcirculation. Reduced US contrast enhancement with modified perfusion curves was seen in 2/15 cases with low anastomic flow in CCDS. CONCLUSION Assessment of microvascular perfusion with contrast-enhanced ultrasound can provide valuable information on free flap viability. Contrast-enhanced US enables dynamic and quantitative flow detection of free flap tissue.
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