Nadine Abanador-Kamper

Diffusion-weighted MRI findings of treated and untreated retroperitoneal fibrosis

PURPOSE We aimed to evaluate diffusion-weighted imaging (DWI) findings in patients with treated and untreated retroperitoneal fibrosis (RPF). METHODS We analyzed magnetic resonance imaging examinations of 44 RPF patients (36 male, 8 female), of which 15 were untreated and 29 were under therapy. Qualitative DWI and T1 postcontrast signal intensities and the largest perivascular extent of RPF were compared between treated and untreated groups and correlated to erythrocyte sedimentation rate and C-reactive protein values. Quantitative DWI signal intensities and apparent-diffusion-coefficients were calculated in regions-of-interest, together with a relative index between signal intensities of RPF and psoas muscle in 15 untreated patients and 14 patients under treatment with remaining perivascular fibrosis of more than 5 mm. RESULTS The extent of RPF in untreated patients was significantly larger compared with the extent of RPF in treated patients (P <0.0001). DWI signal intensities were significantly higher in untreated patients than in patients under therapy (mean, 27 s/mm2 vs. 20 s/mm2; P = 0.009). The calculated DWI-index was significantly higher in untreated patients than in patients under therapy (P = 0.003). CONCLUSION Our data show significant differences in the DWI findings (b800 signal intensities and relative DWI-index) of patients with treated and untreated RPF. DWI is a promising technique in the assessment of disease activity and the selection of patients suitable for medical therapy.

Influence of algorithm-based analgesia and sedation in patients after sudden cardiac arrest

PurposeThe aim of this study was to analyse the effect of an algorithm-based analgesic-sedative management on mechanical ventilation time and length of stay in a cardiological ICU with critical ill patients after sudden cardiac arrest.MethodsWe examined 100 patients after successful resuscitation in a retrospective-prospective single-centre trial by introducing an algorithm-based sedation management. Demographic data, severity of illness classified by APACHE II score (Acute Physiology and Chronic Health Evaluation II), neurological outcome and data for mechanical ventilation time and length of stay were acquired for both groups.ResultsWe found a shorter ventilation time for young patients without severe illness, whereby significant longer ventilation time was observed for patients with higher APACHE II score. Between both groups, we found no significant differences in mechanical ventilation time and length of stay.ConclusionsOur results demonstrate a tendency towards a reduction of mechanical ventilation time for patients without severe illness after sudden cardiac arrest achieved by implementation of a new sedation management, whereby significant longer ventilation time was observed for severe ill patients. Because of lack of statistical significance of our present study, a randomized study with sufficient power is necessary to demonstrate positive effects of a standardized sedation management and its influence on severity of illness.

Multimodal visualization of a retrocardial bronchial artery aneurysm with rare origin from the distal descending aorta

An 89-year-old woman in good clinical condition was admitted with intermittent thoracic pain and chronic hypertension. Clinical examination and laboratory tests revealed no significant results. Because of a suspicious retrocardial mass on the routine chest radiograph, a contrast-enhanced cardiac MR examination (1.5 T) was conducted. The MR images displayed a vascular structure between the right atrium and the spine with a diameter of three centimeter and eccentric thrombosis (Fig. 1a). The perfused lumen was 1-cm-wide. A vascular connection between the descending aorta into the aneurysm was detected by MR angiography (Fig. 1b). We, therefore, raised the diagnosis of a bronchial artery aneurysm with an atypical origin from the distal descending aorta, whereas almost all hitherto described aneurysms originate from the aortic arch or the proximal descending aorta [1–3]. The contrast-enhanced multislice CT-scan confirmed the diagnosis of a retrocardial bronchial artery aneurysm originating from the distal descending aorta with arteriosclerosic calcifications. The complete course of the bronchial artery through the aneurysm into the pulmonary parenchyma was displayed by the curved reformation (Fig. 2). There were no signs of active bleeding or perforation. In addition, pulmonary indurations were diagnosed in the basal right lung, probably as residuum of recurrent pulmonary infections. To prevent the future rupture of the aneurysm and secondary complications, we recommended a percutaneous

Disseminated intracardiac thrombosis: a rare manifestation of antiphospholipid syndrome

A 39-year-old severely obese male (body mass index 39 kg/m²) patient was referred to our department with suspected endocarditis. He presented with dyspnoea and recurrent fever of unknown origin. Infection parameters were found to be positive (C-reactive protein 24 mg/dL, reference <0.5 mg/dL; white blood cells 12 900/nL) and platelet count was low (16 000/µL). Other blood tests including troponin and blood cultures were normal. Transthoracic echocardiography showed a complex and irregular mass adherent to the endocardial surface of the right outflow tract and smaller floating structures of the right atrium (RA) and right ventricle (RV). Transoesophageal …

Clinical predictors for the manifestation of late gadolinium enhancement after acute myocardial infarction

Abstract Despite prompt revascularization, some patients with acute myocardial infarction (AMI) develop myocardial scars, which can be visualized by late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMR). Our goal was to identify angiographic findings that were predictive for scar development in patients after reperfused AMI. We examined 136 patients after first ST-elevated myocardial infarction by CMR after a median of 4 days (range: 2–7). Patients with manifestation of LGE were matched to patients without LGE by means of age and gender. Clinical follow-up with a combined primary endpoint including myocardial reinfarction, congestive heart failure, stroke, death and development of left ventricular thrombus was reported after 24 months. Patients with manifestation of LGE had a significant longer time of symptom-to-intervention, a higher prevalence of anterior AMI, and more proximal culprit lesions. Furthermore, left ventricular ejection fraction was significantly decreased, and peak values of infarct markers were significantly higher in these patients. Preinterventional thrombolysis in myocardial infarction-0-flow was significantly more frequent in patients with LGE manifestation. The presence of 3-vessel disease (odds ratio 53.99, 95% confidence interval 8.22–354.63, P <.001), a proximal culprit lesion, and high creatine kinase myocardial band (CK-MB) values were identified as independent predictors of LGE. Follow-up demonstrated a higher incidence of clinical events in the group with LGE, with the most common cause of heart failure (38.2% vs 7.4%, P <.001). The extent of angiographic findings in AMI plays a major role in the manifestation of LGE. The presence of a multivessel disease, a proximal culprit lesion, and high values of CK-MB are strong independent predictors for LGE manifestation.

Impact of coronary flow on the risk of microvascular obstruction in acute myocardial infarction

Background Microvascular obstruction (MO) and coronary flow have been independently described to have a high prognostic impact in patients after acute myocardial infarction. The interdependence of these facts has not been elucidated, so far. Aim of this study was to investigate the impact of preand post-interventional coronary flow on the occurrence of MO in patients with acute myocardial infarction.

Temporal course of microvascular obstruction after myocardial infarction assessed by MRI

PURPOSE We aimed to analyze the extent of microvascular obstruction (MO) after the index event compared with the follow-up at a median of three months. METHODS We identified 31 patients with MO after primary percutaneous coronary intervention of acute myocardial infarction by cardiac magnetic resonance imaging. The initial examination was performed after the index event, and 27 patients had the follow-up exam after a median of three months (interquartile range, 2-4 months). In addition, we examined 10 patients without MO after transmural myocardial infarction, as a control group. RESULTS MO disappeared in 23 of 27 patients (85%) in the follow-up and transformed into transmural late gadolinium enhancement. In patients with persistent MO, mean MO size decreased from 2.25% to 1.25%. In patients with MO, mean infarct size decreased significantly from 20.8% to 14.7% (P < 0.001). In the control group, mean infarct size decreased from 12.7% to 10.5% in the follow-up scan (P = 0.137). CONCLUSION MO is significantly reduced during the follow-up after acute myocardial infarction.

Long-term Effect of Optimized Sedation and Pain Management after Sudden Cardiac Arrest

Background and Aims: Appropriate use of sedatives and analgesics is essential to keep critically ill patients comfortable and to prevent prolonged mechanical ventilation time and length of stay in ICU. Aim of this study was to analyse the long-term effect of an algorithm-based individual analgesic-sedative protocol on mechanical ventilation time and ICU length of stay in critically ill patients after sudden cardiac arrest due to ST-elevated myocardial infarction. Subject and Methods: We examined a total of 109 patients before and after implementation of an algorithm-based sedation management. Our sedation protocol included individual defined sedation goals achieved by standardized sedation strategies. Mechanical ventilation time and ICU length of stay were analysed for three groups of patients: before and after the intervention and in the long-term follow-up. Results: We observed shorter median mechanical ventilation time and ICU length of stay in the interventional and longterm follow-up group compared to the standard-care group without statistical significance. Conclusion: Our results demonstrate a long-term reduction of mechanical ventilation time and ICU length of stay achieved by implementation of an individual sedation management. This suggests sedation guidelines as effective tools to reduce the mechanical ventilation time and ICU length of stay in patients after sudden cardiac arrest in ST-elevated myocardial infarction. Investigations with a larger patient number and higher statistical power are required to confirm these findings.

Coronary Aneurysm With Stent Dislocation Leading to the Diagnosis of Marfan Syndrome

A 50-year-old male patient presented with unstable angina in our chest pain unit. He had a history of successful resuscitation after sudden cardiac arrest attributable to acute myocardial infarction 3 years ago. Coronary angiography at that time demonstrated acute proximal occlusion of the right coronary artery (Figure 1A) treated by balloon dilatation and implantation of 2 bare metal stents (Figure 1B). The second overlapping stent was necessary because of insufficient coverage of the diseased ostium after the first stent. Figure 1. Coronary angiography with acute occlusion of the proximal right coronary artery ( A ) and result after implantation of stents (arrows) in the left anterior oblique view …

Gezielte Diagnostik der Mesenterialischämie

D akute thromboembolische Form der Mesenterialischamie stellt aufgrund der geringen Ischamietoleranz intestinaler Organe ein lebensbedrohliches Krankheitsbild dar. Unbehandelt uberlebt bei dieser Form nur jeder zehnte Patient die ersten 24 h, und auch bei entsprechender Diagnostik und Therapie innerhalb dieser ersten 24 h verstirbt noch jeder zweite Patient. Die chronische Mesenterialischamie (Angina abdominalis) basiert dagegen auf arteriellen Stenosen und Verschlussen der viszeralen Gefase im Rahmen einer generalisierten Arteriosklerose. Daher kommt einer an die jeweilige Ischamieform angepassten Diagnostik eine besondere Bedeutung zu.