Johannes Kirchner

Pulmonary lymphangioleiomyomatosis: high-resolution CT findings.

Abstract. Lymphangioleiomyomatosis (LAM) of the lung is a very rare disease. There are obvious discrepancies in the literature concerning the appearance of LAM on CT scans of the lung. This study adds the imaging findings of 11 patients and demonstrates how the imaging findings changed over time in four patients. Twenty-two CT examinations, and radiographs that had been obtained close to the CT examinations, of 11 patients with LAM confirmed by open lung biopsy were retrospectively evaluated with particular attention to the size of cystic lesions and wall thickness. Furthermore the CT scans were analysed for the type of pulmonary infiltration process and its distribution, presence or absence of pleural effusion, pneumothorax and lymph node enlargement. Clinical and CT follow-up studies were available in four patients. The CT scans revealed an increase in the interstitial pattern in all patients. Architectural distortion was seen in two patients and cystic lesions were present in all. The size of the cysts varied from small lesions to bullous emphysema. The cystic lesions revealed a wall thickness up to 2 mm but a wall was not perceptible in all. Pneumothorax was seen in only two patients; pleural effusion was seen in two patients. CT examination of patients with LAM reveals neither a uniform nor a pathognomonic appearance. In the early stages of LAM or in cases with interstitial changes the differential diagnosis of centrilobular emphysema or idiopathic pulmonary fibrosis seems to be more difficult than most authors believe.

CT findings in extensive tracheobronchial amyloidosis

Abstract. Primary pulmonary amyloidosis is a rare disorder that appears in three forms: tracheobronchial, nodular parenchymal, and diffuse parenchymal. We report the case of a 46-year-old women with extensive tracheobronchial amyloidosis which presented with a 2-year history of dyspnea and with signs of severe fixed obstruction in pulmonary function tests. Computed tomography of the thorax demonstrated marked thickening of the trachea and the central bronchial tree with substantial narrowing of the main, lobar, and segmental bronchi. Transbronchial specimen showed typical birefringence under polarizing microscope after staining with Congo Red. We did not find hints for systemic amyloidosis.

Value of a laser guidance system for CT interventions: a phantom study

Abstract. The aim of this study was to check the handling and usefulness of a laser puncture system. The laser has tacking optics and is fastened to a sledge with angle graduation. The sledge runs on a bar fixed to the computerized tomograph (CT) parallel to the scan level. By means of a phantom, three experienced and seven inexperienced physicians made punctures with and without laser, using varying angles in single and double angulation. The distance from needle tip to target was measured. The handling of the puncture system proved to be problem-free. With both single and double angulation, the measurement differences with and without support were so small among experienced puncturers that there was no significant difference, with the exception of one double angulation (10 °/45 °). Among the beginners, there was a significant difference (P < 0.001, P < 0.05), with both single and double angulation. The accuracy of the beginners improved with use of the laser; experienced puncturers may profit from practice with small and hard-to-reach focuses. In terms of educational benefits, the laser guidance system offers great advantages and increased confidence for beginners.

Indications and contraindications for balloon dacryocystoplasty

SummaryPurpose: The aim of the study was to determine the indications and contraindications for balloon dacryocystoplasty. Material and methods: So far, 85 patients with severe epiphora because of relative stenosis (n = 47) or occlusion (n = 38) of the nasolacrimal duct have undergone dilation. The success rates were evaluated during the acute phase and the follow-up period of 6–12 months. Treatment failures and recurrence of stenosis were analyzed and compared to the clinical and dacryocystographic indications prior to treatment. Results: A recanalization success rate of 79 % was achieved in patients with isolated postsaccal stenoses or short-distance occlusions of the nasolacrimal duct. Patients with additional presaccal and saccal stenoses, filling defects in the duct lumen, or long-distance occlusions had lower initial recanalization rates (66 %). Main predictors for recurrent obstructions were active inflammation, filling defects due to calculi, extensive occlusion and post-traumatic lesions. In the absense of these factors 12-month patency rates of 80 % were proved. Conclusion: Dacryocystoplasty procedures should preferably be performed in patients with circumscribed functional postsaccal stenosis. In these cases a success rate of about 80 % is possible. Otherwise the value of the intervention is limited by high failure and recurrence rates.ZusammenfassungHintergrund: Die Ballondilatation zur Behandlung von Tränenwegsstenosen ist eine kontrovers diskutierte Methode. Ziel dieser Untersuchung war es, herauszufinden, welche Möglichkeiten und Grenzen diese neue Methode bietet. Indikationen und Kontraindikationen sollten ermittelt werden. Patienten und Methode: Bei bisher 85 Patienten mit einer deutlichen Epiphora auf Grund von relativen Stenosen (n = 47) oder kompletten Stenosen (n = 38) des Ductus nasolacrimalis wurde eine Ballondilatation (Ballondakryozystoplastie) durchgeführt. Die technischen, dakryozystographischen und klinischen Erfolgsraten wurden in der Akutphase und im Langzeitverlauf (6 bis 12 Monate) unter Berücksichtigung der jeweiligen Indikation ausgewertet. Ergebnisse: Die technische Erfolgsrate lag bei den relativen Stenosen mit 79 % höher als bei absoluten Stenosen mit 66 %. Probleme in der technischen Durchführbarkeit traten bei präsakkalen und sakkalen Stenosen, sowie bei Rekanalisation rigider Verschlüsse des Ductus nasolacrimalis auf. Wichtigste Kontraindikationen waren Dakryolithen oder floride Entzündungen. Hier kam es, wie auch bei posttraumatischen Stenosen und langgestreckten Verschlüssen, häufig zu Rezidiven (bis 90 %). Als günstige Indikation erwiesen sich umschriebene postsakkale Stenosen und kurzstreckige distale Verschlüsse im Bereich der Hasnerschen Klappe. Hierbei konnten Langzeit-Offenheitsraten bis ca. 80 % beobachtet werden. Schlußfolgerung: Die Ballondilatation ist primär für die Behandlung funktioneller kurzstreckiger postsakkaler Tränenwegsstenosen geeignet. Gute Resultate, die im Bereich der Erfolgsquote der bisherigen operativen Verfahren (z. B. Dakryozystorhinostomie) liegen, ergeben sich nur bei enger Indikationsstellung.

Efficacy of Daily Bedside Chest Radiography as Visualized by Digital Luminescence Radiography

To determine the diagnostic impact of daily bedside chest radiography in comparison with digital luminescence technique (DLR; storage phosphor radiography) and conventional film screen radiography, a prospective randomized study was completed in 210 mechanically ventilated patients with a total of 420 analysed radiographs. The patients were allocated to two groups: 150 patients underwent DLR, and 60 patients underwent conventional film screen radiography. Radiological analysis was performed consensually and therapeutic efficacy was assessed by the clinicians. There was no statistical significant difference between the frequency of abnormal findings seen on DLR and conventional film screen radiography. In total, 448 abnormal findings were present in 249 of 300 DLR and 97 of 120 conventional film screen radiographs. The most common findings were signs of overhydration (41%), pleural effusion (31%), partial collapse of the lung (11%) and pneumothorax (2%). One hundred and twenty-three of 448 (27%) of these abnormal findings were thought to have a considerable impact on patient management. The high rate of abnormal findings with significant impact on patient management suggests that the use of daily bedside chest radiography may be reasonable.

AICAR inhibits NFκB DNA binding independently of AMPK to attenuate LPS-triggered inflammatory responses in human macrophages

Abstract5-aminoimidazole-4-carboxamide-1-β-D-ribofuranoside (AICAR) is an established pharmacological activator of AMP-activated protein kinase (AMPK). Both, AICAR and AMPK were reported to attenuate inflammation. However, AICAR is known for many AMPK-independent effects, although the mechanisms remain incompletely understood. Here we report a potent suppression of lipopolysaccharide (LPS)-induced inflammatory gene expression by AICAR in primary human macrophages, which occurred independently of its conversion to AMPK-activating 5-aminoimidazole-4-carboxamide-1-β-D-ribofuranosyl monophosphate. Although AICAR did not interfere with activation of cytosolic signalling cascades and nuclear translocation of nuclear factor - κB (NFκB) by LPS, it prevented the recruitment of NFκB and RNA polymerase II to target gene promoters. AICAR also inhibited signal transducer and activator of transcription 3 (STAT3)-dependent induction of interleukin (IL) IL-6 and IL-10 targets, while leaving STAT6 and HIF1α-dependent gene expression in IL-4 and dimethyloxalylgylcine-treated macrophages intact. This points to a transcription factor-specific mode of action. Attenuated gene expression correlated with impaired NFκB and STAT3, but not HIF-binding in electrophoretic mobility shift assays in vitro. Conclusively, AICAR interferes with DNA binding of NFκB and STAT3 to modulate inflammatory responses.

Stellenwert der kernspintomographie bei der epiphysiolysis capitis femoris

ZusammenfassungDie Diagnose der im Jugendalter spontan auftretenden Epiphysiolysis capitis femoris wurde bislang anhand der klinischen Beschwerden sowie der Bestimmung des Abrutschwinkels in konventionellen Aufnahmen (Beckenübersicht, Aufnahme nach Rippstein) gestellt. Für die Diagnose der Frühformen der Epiphysiolysis capitis femoris exsistiert kein allseits akzeptierter Goldstandard. Ziel der vorliegenden Arbeit war es herauszuarbeiten, inwieweit die Epiphysiolysis capitis femoris charakteristische Zeichen in der Kernspintomographie bietet und ob die MRT in der Lage ist, früher Veränderungen als die konventionellen Methoden zu erkennen.Die Kernspintomographien (1,5-T-, T1- und T2-SE-Sequenzen koronar, sagittal, paraaxial, fakultativ STIR-, TIRM-, FLASH-2D-Sequenzen) von fünf gesunden Kindern wurden standardisiert analysiert und mit den magnetresonanztomographischen Untersuchungen von neun Patienten mit vermuteter Epiphysiolysis capitis femoris verglichen. Bei den neun Patienten lagen zusätzlich konventionelle Röntgenaufnahmen nach Rippstein vor. Im Normalkollektiv stellte sich die Epiphysenfuge homogen signalarm bzw. signalfrei dar. Sie wies eine konstante Weite bis zu 3 mm auf und war gegenüber den angrenzenden knöchernen Strukturen scharf abgegrenzt. Das Grenzflächensignal erschien homogen und gezähnelt. Patienten mit vermuteter Epiphysiolysis capitis femoris zeigten eine Erweiterung der Epiphysenfuge auf mehr als 3 mm in sechs von neun Fällen. Bei allen klinisch verdächtigen Fällen konnte ein Gelenkerguß abgegrenzt werden. Es fand sich zusätzlich eine Verschiebung oder Abflachung der Verzähnelung. Ein Signalanstieg im Bereich des Knorpels fand sich kernspintomographisch in nur zwei Fällen.AbstractDiagnosis and determination of severity of chronic slipped capital femoral epiphysis (SCFE) is usually made from clinical history, physical examination and radiographic measurement of the degree of slippage. Aim of the present study is to evaluate the diagnostic impact of magnetic resonance imaging in early detection of SCFE.We evaluated magnetic resonance imaging of the hips of 5 healthy children in comparison to the findings in conventional radiographs and magnetic resonance imaging of 9 patients with suspected SCFE.The growth plate of healthy objects shows homogenous low signal intensity, constant width up to 3 mm, and is clearly defined against the surrounding osseous structures. The adjacent surface appears homogenous. Patients with suspected SCFE showed widened growth plate (> 3 mm) in 6 of 9 cases. Articular effusion was seen in all cases of clinical suspected disease. Incongruence of the ondulate surfaces was seen. Here we found flattening of denticulation of the growth plate in addition. Growth plate showed increase of signal intensity in 2 cases.