Quantification of coronary artery calcification in patients with FH using EBCT.

BACKGROUND: Calcification of the coronary vessel wall is regarded as a marker of advanced coronary atherosclerosis. METHODS: To test whether patients with heterozygous familial hypercholesterolemia (FH) exhibit excessive calcification of the coronary vessel wall, we quantified coronary artery calcium in LDL-apheresis treated FH-patients with known severe coronary artery disease (CAD) (n = 10), in patients with moderate hypercholesterolemia and known severe CAD (n = 10), and in asymptomatic controls (n = 10) using electronic beam CT. The total coronary calcium score (Agatston-Score), the number of calcified lesions and the calcified plaque volume were evaluated for this study. RESULTS: CAD-patients with FH, although on average 10 years younger, had a significantly higher total coronary calcium score (702/2018/2890), number of lesions (34/43/49) and calcified plaque volume (700/1818/2313) compared to patients with CAD only (480/641/1362, 10/16.5/22, 480/588/1209, respectively) and controls (10/47/137, 2/4/10, 15/50/144, respectively). Furthermore, we observed a significant correlation (r = 0.93; P < 0.01) between LDL-cholesterol levels (pretreatment levels of the CAD-FH group) and the total coronary calcium score in all three groups. Our results demonstrate that coronary artery calcification is more extensive in CAD-patients with FH than in CAD-patients with moderate hypercholesterolemia. In addition, we provide evidence that the amount of calcium in the coronary vessel wall in FH patients result from a long lasting history of elevated LDL-Cholesterol levels. CONCLUSION: These findings emphasize the significance of LDL-cholesterol as a risk factor for atherosclerosis and underline the importance of early diagnosis of CAD and early cholesterol lowering therapy in FH patients.

Nicergolina na demência senil do tipo Alzheimer e na demeência multi-infarto: um estudo clínico duplo-cego, controlado com placebo e de mapeamento do EEG/PRE / Nicergoline in senile dementia of Alzheimer type and multi-infarct dementia: a double-blind, placebo-controlled, clinical and EEG/ERP mapping study

Num estudo duplo-cego controlado com placebo sobre a eficácia terapêutica e os efeitos centrais da nicergolina, um alcalóide do Ergot com açäo metabólica, antitrombótica e vasoativa, foram incluídos 112 pacientes com demência leve e moderada, diagnosticada de acordo com os critérios do DSM III-R (MMS 13-25), que viviam em lares para aposentados. Cinqüenta e seis deles foram subdiagnosticados como demência senil do tipo Alzheimer (DSTA), 56 como demência multi-infarto (DMI), com base em tomogafia computadorizada e em avaliaçöes de Hachinski (menor ou igual 49 DSTA, maior ou igual 7 DMI). Eles receberam, após um período de tratamento de duas semanas (placebo), randomizados por oitos semanas, 2 x 30 mg de nicergolina (NIC) ou 2 x 1 de placebo (PLAC) via oral...

Nicergoline in senile dementia of Alzheimer type and multi-infarct dementia: a double-blind, placebo-controlled, clinical and EEG/ERP mapping study.

In a double-blind, placebo-controlled study on the therapeutic efficacy and central effects of nicergoline, an ergot alkaloid with metabolic, antithrombotic and vasoactive action, 112 patients with mild to moderate dementia, diagnosed according to DSM III-R criteria (MMS 13-25), living in pensioners' homes, were included. Fifty-six were subdiagnosed as senile dementia of the Alzheimer type (SDAT), 56 as multiinfarct dementia (MID), based on computed tomography and Hachinski scores (< or = 49 SDAT, > or = 7 MID). They received, after 2 weeks' run-in period (placebo), randomized for 8 weeks either 2 x 30 mg nicergoline (NIC) or 2 x 1 placebo (PLAC) orally. The four subgroups (SDAT/NIC. SDAT/PLAC, MID/NIC, MID/PLAC; 4 x 28 patients) were comparable in regard to age and sex. Only four, four, four and two patients of the respective groups did not finish the study for minor reasons. Confirmatory statistical analysis demonstrated in the target variable-the Clinical Global Impression (CGI)-a significant superiority of Global Impression (CGI)-a significant superiority of NIC over PLAC in both the SDAT and MID groups. Global improvement (CGI item 2) was seen in both nicergoline subgroups (3 and 3), while no changes occurred under placebo (4 and 4, respectively). The responder versus non-responder ratio was in the SDAT/NIC group 16/8, versus 8/16 in the SDAT/PLAC group (chi 2 = 4.1, P = 0.04); in the MID/NIC group 17/7, versus 7/19 in the MID/PLAC group (chi 2 = 7.96, P < 0.005). Furthermore, there was a significant improvement of the Mini-Mental State and the SCAG score in both the MID and SDAT group after 8 weeks of nicergoline, which was significantly superior to the minimal improvement or no change in placebo-treated SDAT and MID patients. EEG mapping demonstrated in NIC-treated SDAT and MID patients a significant decrease in delta and theta, increase in alpha 2 and beta activity and an acceleration of the centroid of the total power spectrum as compared with pretreatment, while opposite changes occurred in PLAC-treated SDAT and MID patients. The differences between PLAC and NIC reached the level of statistical significance. Event-related potential (ERP) recordings demonstrated a significantly shortened P300 latency under NIC treatment in both SDAT and MID patients, while there was a trend towards lengthening under PLAC. Thus, nicergoline improved vigilance and information processing at the neurophysiological level, which leads at the behavioural level to clinical improvement both in degenerative and vascular dementia.

[Bone marrow edema--an early form of femur head necrosis]. / Knochenmarködem--Frühform der Hüftkopfnekrose.

We examined 15 patients (16 hips) with painful hips whose radiographs were either normal (n = 9) or showed a minimal decrease in radiodensity (n = 7). The available bone scintigrams of 9 cases were positive. T1-weighted images visualised a diffuse signal loss of the bone marrow in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions were hyperintensive on T2-weighted images. Focal anomalies were not seen in any of the cases. All patients underwent core decompression treatment. Histology of 13 hips confirmed not only the presence of bone marrow oedema but of bone changes corresponding to those of avascular necrosis. Follow-up examinations with MR after core decompression showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for identifying bone marrow oedema. Due to our histological results bone marrow oedema should be included in the differential diagnosis as an early stage of necrosis of the hip.

EEG brain mapping in diagnostic and therapeutic assessment of dementia.

EEG brain mapping has been proven to be a valuable method in diagnostic and therapeutic assessment in dementia trials, because it is a readily available, inexpensive, high time-resolution method for objective and quantitative evaluation of the neurophysiological aspects of dementias. In 111 mildly to moderately demented patients diagnosed according to DSM-III as both degenerative [senile dementia of the Alzheimer type (SDAT)] and vascular [multi-infarct dementia (MID) type], we were interested in showing not only differences between SDAT and MID patients and normal controls but also the relationship between CT scans, EEG maps, clinical ratings and psychometric tests. CT measures included 10 cerebrospinal fluid (CSF) space variables as well as 17 cortical density measures (1.7 mm3 cubes, Hounsfield units). Clinical investigations consisted of the SCAG score/factors, the digit symbol substitution test, the trailmaking test and the digit span forward test. In brain maps, SDAT patients showed slightly to moderately more slow and less alpha and beta activity as well as a slowing of the dominant frequency (DF) and the centroid (C) than did normal controls. These findings were most prominent in parietal and temporal regions. MID patients exhibited markedly augmented delta/theta and attenuated alpha and beta activity and a slowing of the DF and C. These neurophysiological findings suggest a deterioration of vigilance. Differences between SDAT and MID patients were found mostly in measures concerning differences in the maps. Brain maps of correlation coefficients between CT and EEG variables demonstrated: the greater the anterior horn distance, lateral ventricle distance, and Evan's index, as well as the less cortical density, the more delta/theta and the less alpha and beta activity in the EEG. Moreover, the higher the delta/theta, the less alpha and beta activity, the higher the SCAG scores, and the worse the psychometric performance. From the pharmacological point of view, we observed a significant improvement in vigilance after administration of several nootropic drugs both in normal and pathologically aging subjects, which was associated also with improvement of psychopathometric scores. Based on multi-variante analysis of variance (MANOVA)/Hotlelling T2 we observed a drug's effect in different brain regions of MID and SDAT patients. Thus, pharmaco-EEG mapping mediates valuable information regarding if, how, when, in which dosage, and where a nootropic drug acts on its target organ--the aging human brain.

[Cine-MR for the quantification of regurgitation defects by a volume method]. / Cine-MR zur Quantifizierung von Regurgitationsvitien mittels Volumenmethode.

We have examined 46 patients with angiographically confirmed regurgitant lesions (26 mitral insufficiency, 20 aortic insufficiency) using a 0.5 Tesla magnet. In each patient, multiplane and multiphase spin-echo sequences were obtained in a plane angled in the sagittal and coronal direction in the long axis of the heart; left and right ventricular volumes, ejection fractions and regurgitation fractions were calculated. In addition, a blood-flow sensitive gradient echo sequence was obtained in order to determine the direction and extent of the regurgitant jet. The data was compared with the results of angiography and echocardiography. By means of the gradient echo technique, MRI was able to show the regurgitant jet in every patient. There was a linear correlation between volumes determined by MRI and angiography. The best agreement was found for left ventricular contraction volume (R = 0.82, p is less than 0.0001). Comparison of the noninvasive and angiographic method showed a linear correlation for AI patients of R = 0.91 (p is less than 0.001), which is somewhat better than for patients with MI (R = 0.84, p less than 0.001). Semiquantitative grading of MI with a gradient echo technique showed a linear correlation with angiography of R = 0.73 (p less than 0.001), for AI there was agreement between both methods in 72% of cases. A comparison between MRI and colour Doppler sonography showed only moderately good correlation R = 0.69 (p less than 0.01).

[Results of magnetic resonance and computerized tomography studies of augmentation plastic surgery of the anterior cruciate ligament using carbon fibers. II]. / Ergebnisse der magnetresonanz- und computertomographischen Untersuchung von Augmentations-plastiken am vorderen Kreuzband mit Kohlestoffasern. Teil II.

19 patients out of those described in part I were examined by MRI and CT. We quote MRI as an excellent new mean of imaging without exposure to ionising radiation which renders sufficient information about the internal knee-structures without surgical invasion. The signal density for the neoligament as well intraarticular as in the "over the top"-position gives evidence for the ingrowth of mesenchymal structures. The MRI diagnosis was proved by histological examination in 2 cases. Very good correspondence between clinic examination and the CT-images could be found. On top of that the tibial drilling holes could be shown in an excellent way. The CT-scan is a fine instrument to judge the postoperative state of the anterior cruciate ligament. The density measurement inside and outside the bone gives evidence for mesenchymal growth inside the carbon fibre structure and the existence of a new natural ligament.

[MRT of the status following augmentation plasty of the anterior cruciate ligament using carbon fibers]. / MRT bei Zustand nach Augmentationsplastiken am vorderen Kreuzband mit Kohlenstoffasern.

In 19 patients treated with carbon-fiber ligament augmentation for the anterior cruciate ligament, the clinical findings were compared via MRI. Visualization of the intra- and extra-articular portion of the graft was possible in 84%. The integrity of the ligaments was be shown in an equal percentage. Thus, MRI is a useful diagnostic tool for non-invasive imaging for repeated follow-ups in patients with carbon-fiber ligament augmentation.

[Comparison of the value of magnetic resonance tomography and computerized tomography in the follow-up of augmentation-plasties with carbon fiber ligaments of the anterior cruciate ligament]. / Vergleich der Aussagekraft von Magnetresonanztomographie und Computertomographie bei der Nachuntersuchung von Augmentationsplastiken mit Kohlefaserbändern am vorderen Kreuzband.

17 patients--treated with unidirectional carbon-fibre-ligaments augmentation for the anterior cruciate ligament--have been followed-up by MRI and CT. The question has been, whether both methods show comparable results. The interval between operation and follow-up has been 34 months in average (43 to 30). Significance was put on the probants bedding. MR-Imaging in two planes seems to be essential to show the artificial ligament's integrity in its extraarticular "over the top"-position. Satisfying corresponding results could be found in MRI and CT.

MRI evaluation of pigmented skin tumors. Preliminary study.

Magnetic resonance imaging (MRI) was performed in 16 patients with pigmented skin lesions, seven with nodular melanomas, two with superficial spreading melanomas, two with subcutaneous melanoma metastases, and five with different benign pigmented nodular skin lesions. The results of MRI were compared with the histologic diagnoses. Signal intensities of the lesions were compared with subcutaneous fat, revealing a lower signal intensity of all lesions on T1-weighted images. Intensity measurements showed a significant (P less than .01) difference between benign and malignant lesions on T2-weighted images.

[Osteopoikilosis in magnetic resonance tomography (case report)]. / Osteopoikilie in der Magnetresonanztomographie (Fallbericht).

A case report shows the differential diagnosis of osteopoikilosis ("spotted bones")--beside X-ray and scintigraphic results--in Magnetic Resonance Imaging (MRI).

[Magnetic resonance tomography in the assessment of questionable aneurysm of the thoracic aorta with or without dissection of the intima]. / Magnetresonanztomographie in der Abklärung von fraglichen Aneurysmen der Aorta thoracalis mit oder ohne Dissektion der Intima.

To assess the value of MRI in the diagnosis of aneurysm of the thoracic aorta with suspected or known dissection 23 patients were imaged with cardiac gating. Seven patients (group 1) had known dissection of the thoracic aorta; in 16 patients (group 2) an aneurysm was suspected by chest x-ray or 2D-echocardiography. Reference methods were: x-ray, 2D-echocardiography, angiography, and computered tomography. In the first group MRI clearly identified the intimal flap, could differentiate between true and false lumen, slow flow, and thrombus, respectively. In the second group MRI could exclude a dissection of the ectatic part of the thoracic aorta in 11 patients and demonstrate paracardiac or mediastinal mass in five patients. MRI can serve as an important diagnostic tool in known or suspected aneurysm of the thoracic aorta.

Diagnostic imaging of the occipito-cervical junction in patients with rheumatoid arthritis. Plain films, computed tomography, magnetic resonance imaging.

Fifty-five patients with confirmed chronic polyarthritis were admitted to this prospective study. The occipito-cervical region was visualized by plain radiography, computed tomography (CT) and magnetic resonance (MR) imaging. These modalities and the results are compared. In the presence of chronic polyarthritis, radiography of the occipito-cervical region visualized only bone lesions, while CT provided a good picture of both bone lesions and soft-tissue alterations. CT is an effective modality for the diagnosis of chronic polyarthritis in the occipito-cervical region. MR imaging was less sensitive in depicting bone lesions. In comparison with CT, however, MR images produced more frequent and more impressive visualization of soft-tissue alterations. MR imaging is most suitable for visualizing complications of the spinal cord.

[Taybi-Rubinstein syndrome: the value of the x-ray picture]. / Taybi-Rubinstein-Syndrome: Der Stellenwert des Röntgenbildes.

28 cases of Taybi-Rubinstein syndrome with different radiological appearances are presented along with radiological differential diagnosis. Broadening of the distal phalanx of the thumb (68%) and great toe (64%) was the most common radiological sign followed by incomplete fissures of the distal phalanges of the thumb and first toes. Radiological examination in association with clinical signs and laboratory investigations is an essential part in the diagnosis of the Taybi-Rubinstein syndrome.

Magnetic resonance imaging of the lower vertebral column in patients with multiple myeloma.

Eighteen patients with multiple myeloma (clinical stages 1-3) and a control group of 21 persons underwent magnetic resonance imaging (MRI) studies of the lower thoracic and lumbar spine. This was done to determine the potential benefit of MRI in addition to conventional radiographs, tomograms, computed tomography and nuclear scans. In addition to focal fatty replacement of normal hematopoietic marrow, which presented as focal hyperintense lesions on T1-weighted images (T1-WI) and on T2-weighted images (T2-WI), two types of myelomatous lesions were found: (1) focal areas with reduced signal intensity when compared with normal bone marrow on T1-WI and enhanced signal intensity on T2-WI, mainly found in untreated myelomas; and (2) focal areas of decreased signal intensity on T1-WI and on T2-WI, which were predominantly detected after previous radiation therapy. MRI surpassed conventional radiography in detecting abnormal focal marrow infiltration in 41 of 247 vertebrae. Radiographs identified only 11 of the 41 as pathologic, based on shape and structure of the vertebral bodies; however, 15 other collapsed vertebrae showed no signal abnormalities of the marrow on MR images. Discrimination of normals and abnormals by statistical analysis of intensity measurements of the bone marrow was not possible.

[Focal fatty deposits in spinal bone marrow--MR findings. MRI of focal fatty deposits]. / Fokale Fetteinschlüsse im Knochenmark der Wirbelsäule--MR-Befunde. MRI fokaler Fetteinschlüsse.

MR tomograms of the spines of 121 patients were reviewed in order to assess the incidence and distribution of focal fat deposits in axial bone marrow. In addition, three cadaver spines were examined and cut with a band saw for macroscopic and histologic correlation. Yellow areas, histologically representing fatty replacement of hematopoetic marrow, were found macroscopically; their location was in precise correspondence to areas of focal enhanced signal intensity on T1-WI as well as T2-WI. The incidence of those focal fat spots was related to age, but not to sex; in different diseases like scoliosis, porosis and after cytostatic therapy of different malignomas they were found more frequently than in the average of the sample. Focal fatty replacement of hematopoetic bone marrow is obviously a normal phenomenon and should not be misinterpreted as a pathologic condition.

[MR effects of x-ray contrast media]. / MR-Effekte von Röntgenkontrastmittel.

Although Pantopaque has now been widely replaced by water-soluble contrast media for intrathecal application, retained residuals of oily contrast media are still a very common finding. Whereas other contrast media, e.g. barium in the GI tract, are inert in magnetic resonance imaging, the signal behaviour of Pantopaque may lead to false interpretations. Similar to fat, the T1 and T2 relaxation times of Pantopaque are short. Conventional radiographs of the spine are recommended in patients with intradural MRI findings similar to fat in case of previous myelography.

[Therapy of multi-infarct dementia with nicergoline: double-blind, clinical, psychometric and EEG imaging studies with 2 dosage schedules]. / Zur Therapie der Multiinfarktdemenz mit Nicergolin1): doppelblinde, klinische, psychometrische und EEG-Imaginguntersuchungen mit 2 Dosierungsschemata.

In a double-blind study, clinical, psychometric and neurophysiological changes were investigated in patients with MID treated by two different drug administration schedules of nicergoline (20 mg evenings versus 10 mg b.i.d.). 24 hospitalized patients (4 males, 20 females) with a mean age of 78 years were included according to the criteria of DSM-III, an Ischemic-Score of at least 7 points and a specific computed tomogram (CT). After a placebo-period of 2 weeks all patients were randomly assigned to an 8-weeks-treatment with either 20 mg nicergoline h.s. or 2 x 10 mg b.i.d. The evaluation of the detailed psychopathology by means of SCAG, CGI, NOSIE, Hamilton-Depressions-Scale and Mini-Mental-Status, as well as psychometric investigations by means of the Nuremberg-Aging-Inventory (NAI), thymophysic and psychophysiological measurements showed a significant improvement in both groups as compared with pre-treatment. This improvement was observed slightly earlier in patients with 20 mg h.s. than in those on the b.i.d. schedule. However inter-group-differences reached the level of statistical significance in only 2 variables. Neurophysiological investigations by means of topographic brain-mapping showed interesting relations between functional EEG-images and morphological CT-images. Vigilance-improving patients showed a better therapeutic response than those who did not show neurophysiological changes indicative of improvement in vigilance. Our findings suggest, that a single dose once daily was at least equal to the b.i.d. administration as far as therapeutic efficacy was concerned, even more so in the light of an expected improvement of compliance.