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Dietrich C.F.,Caritas Krankenhaus | Ignee A.,Caritas Krankenhaus | Greis C.,Bracco Imaging Deutschland | Cui X.W.,Caritas Krankenhaus | Schreiber-Dietrich D.G.,Caritas Krankenhaus
Ultraschall in der Medizin | Year: 2014

Ultrasound technology is always connected to possible artefacts. Since introduction of ultrasound technology the knowledge of those artifacts is eminent to avoid misinterpretations. It is important to know that with the introduction of new ultrasound technology the possibility of artifacts are rising.Whereas artefacts initially were limited to B-mode sonography, every technological step (colour Doppler sonography, contrast enhanced sonography) comes with a range of new artefacts. This article is written to explain the technological basics of ultrasound artefacts and provide the reader with examples in daily practice and how to avoid them. © Georg Thieme Verlag KG Stuttgart New York.

Braden B.,John Radcliffe Hospital | Dietrich C.F.,Caritas Krankenhaus
Medical Ultrasonography | Year: 2011

Transabdominal ultrasound is clinically useful in detecting Crohn's disease (initial diagnosis) by evaluating bowel wall thickness and surrounding structures including periintestinal inflammatory reaction, extent and localization of involved bowel segments and detection of extraluminal complications such as fistula, abscesses, carcinoma and ileus. Transabdominal ultrasound presently is accepted as a clinically important first line tool in assessing patients with Crohn's disease irrespective of their clinical symptoms and/or disease activity. It helps to better characterize the disease course in individual patients and can guide therapeutic decisions. In this review the current literature will be analysed.

Ignee A.,Medical Clinic 2 | Straub B.,Caritas Krankenhaus | Brix D.,Caritas Krankenhaus | Schuessler G.,Medical Clinic 2 | And 2 more authors.
Clinical Hemorheology and Microcirculation | Year: 2010

Renal masses are frequently incidentally found on ultrasound. Contrast enhanced computed tomography (CECT) is regarded as the method of choice. Contrast enhanced ultrasound (CEUS) has a high impact for characterisation of hepatic lesions. Its use in renal masses has been less comprehensively studied. Two hundred and one patients referred for surgical treatment of a renal mass, 143 patients fulfilling inclusion criteria (histology and reference method). Baseline ultrasound and CEUS with BR1, histology obtained by surgery (89%) or biopsy (11%). Eighty-eight percent of the patients had renal lesions which were malignant and 12% benign lesions. Eighty percent had renal cell carcinoma (RCC). Seven percent of the lesions were cystic. Two patients were upgraded by CEUS from CECT Bosniak II into CEUS Bosniak III resp. IV. CEUS could predict malignancy with a sensitivity, specificity, positive, negative predictive value and accuracy in 97%, 45%, 91%, 75%, and 90%. The correct staging was diagnosed by CEUS (CECT) in 83% (69%). CEUS was superior to CECT in the staging and characterisation of RCC, also in the subgroup of patients with cystic lesions. CEUS can replace CECT e.g. in patients with allergies or contraindications against CECT. Multicentre studies are necessary to confirm the findings. © 2010 - IOS Press and the authors. All rights reserved.

Beyer-Enke S.A.,Caritas Krankenhaus | Hocke M.,Klinikum Meiningen | Ignee A.,Caritas Krankenhaus | Braden B.,John Radcliffe Hospital | Dietrich C.F.,Caritas Krankenhaus
Journal of the Pancreas | Year: 2010

Context Contrast enhanced ultrasound (CEUS) has been established for detection and characterisation of liver tumours and differential diagnosis of solid pancreatic lesions. The role of transabdominal CEUS in cystic pancreatic disease is less obvious. Objective We prospectively evaluated CEUS for characterization of undetermined cystic pancreatic lesions with respect to the differential diagnosis of pseudocysts and cystic neoplasia and differentiation between benign and malignant disease (gold standard: histology or cytology). Patients One-hundred and fourteen patients (63 males, 51 females; median age: 62 years, range: 33-87 years) were prospectively examined. Investigations Conventional B-mode and transabdominal CEUS. Main outcome measures Conventional B-mode (criteria: solid nodules, septae), and contrast enhancing features of cystic pancreatic lesions (microperfusion of solid nodules) were analysed. Final diagnoses were made by surgery (47 patients) or histology/cytology and follow-up of at least one year (67 patients). Results Fifty patients proved to have neoplastic lesions (37 malignant, 13 of benign origin). Sixty-four patients had pseudocysts caused by acute (27 patients) or chronic pancreatitis (37 patients). Conventional B-mode had a sensitivity of 94% and a low specificity of 44% in the differentiation of pseudocysts versus neoplasia. CEUS had a higher specificity of 77% with the same sensitivity of conventional B-mode ultrasound. The combination of conventional ultrasound and CEUS improved the specificity even more to 97% with an unchanged sensitivity. CEUS was not reliable in the differentiation of benign and malignant neoplasia. Conclusion CEUS improves the differentiation between pseudocysts and pancreatic neoplasia in comparison to the conventional B-mode imaging. The microvascularisation visualised using CEUS even in small nodules (with or without septae) associated with cystic lesions is an indicator for cystic pancreatic neoplasia.

Dietrich C.F.,Caritas Krankenhaus | Mathis G.,Rankweil | Cui X.-W.,Caritas Krankenhaus | Ignee A.,Caritas Krankenhaus | And 2 more authors.
Ultrasound in Medicine and Biology | Year: 2015

The value of ultrasound techniques in examination of the pleurae and lungs has been underestimated over recent decades. One explanation for this is the assumption that the ventilated lungs and the bones of the rib cage constitute impermeable obstacles to ultrasound. However, a variety of pathologies of the chest wall, pleurae and lungs result in altered tissue composition, providing substantially increased access and visibility for ultrasound examination. It is a great benefit that the pleurae and lungs can be non-invasively imaged repeatedly without discomfort or radiation exposure for the patient. Ultrasound is thus particularly valuable in follow-up of disease, differential diagnosis and detection of complications. Diagnostic and therapeutic interventions in patients with pathologic pleural and pulmonary findings can tolerably be performed under real-time ultrasound guidance. In this article, an updated overview is given presenting not only the benefits and indications, but also the limitations of pleural and pulmonary ultrasound. © 2015 World Federation for Ultrasound in Medicine & Biology.

Hocke M.,Friedrich - Schiller University of Jena | Ignee A.,Caritas Krankenhaus | Topalidis T.,Cytological Institute | Dietrich C.F.,Caritas Krankenhaus
Zeitschrift fur Gastroenterologie | Year: 2013

Background: Onsite cytology is widely recommended to improve cytological results in endoscopic ultrasound fine-needle punctures. The question is how well a gastroenterologist can be trained to perform an immediate bedside cytology. Patients and Methods: From September 2008 to May 2011 157 endosonographic fine-needle punctures with a 22 G needle where performed in a municipal hospital. A medium amount of 26 loaded slides resulted from every puncture and air drying was used to preserve the specimen. 2 promising slides were kept whereas the remaining slides were sent on to a professional laboratory for final examination. The preliminary diagnosis was compared with the results from the professional cytologist for final evaluation. Results: 152/157 fine-needle punctures were evaluable. In 6 cases the final result was regarded as uncertain. 73 malignant specimens and 73 benign specimens could be used for comparison. The gastroenterologist's evaluation achieved a sensitivity of 87.7 % and specificity of 90.4 % when the decision between a benign and malignant specimen was made. The specification of the tumour could not be done reliably by the gastroenterologist. Conclusion: Doing a delayed onsite diagnosis of the specimen by a gastroenterologist can help to speed up the diagnostic process with reasonable certainty. However, it cannot replace a professional cytological diagnosis because of the possible misevaluation and the uncertainty in tumour specification. Additionally, advanced methods like immunocytology cannot be performed in an onsite hospital setting. © Georg Thieme Verlag KG Stuttgart · New York.

Meyer-Moock S.,University of Greifswald | Feng Y.-S.,University of Greifswald | Maeurer M.,Caritas Krankenhaus | Dippel F.-W.,University of Leipzig | Kohlmann T.,University of Greifswald
BMC Neurology | Year: 2014

Background: There are a number of instruments that describe severity and progression of multiple sclerosis and they are increasingly used as endpoints to assess the effectiveness of therapeutic interventions. We examined to what extent the psychometric properties of two accepted instruments - EDSS and MSFC - meet methodological standards and the value they have in clinical trials.Methods: We conducted a systematic literature search in relevant databases [MEDLINE (PubMed), ISI Web of Science, EMBASE, PsycINFO & PSYNDEX, CINAHL] yielding 3,860 results. Relevant full-text publications were identified using abstract and then full-text reviews, and the literature was reviewed.Results: For evaluation of psychometric properties (validity, reliability, sensitivity of change) of EDSS and MSFC, 120 relevant full-text publications were identified, 54 of them assessed the EDSS, 26 the MSFC and 40 included both instruments. The EDSS has some documented weaknesses in reliability and sensitivity to change. The main limitations of the MSFC are learning effects and the z-scores method used to calculate the total score. However, the methodological criterion of validity applies sufficiently for both instruments.For use in clinical studies, we found the EDSS to be preferred as a primary and secondary outcome measure in recent studies (50 EDSS, 9 MSFC).Conclusions: Recognizing their strengths and weaknesses, both EDSS and MSFC are suitable to detect the effectiveness of clinical interventions and to monitor disease progression. Almost all publications identify the EDSS as the most widely used tool to measure disease outcomes in clinical trials. Despite some limitations, both instruments are accepted as endpoints and neither are discussed as surrogate parameters in identified publications. A great advantage of the EDSS is its international acceptance (e.g. by EMA) as a primary endpoint in clinical trials and its broad use in trials, enabling cross-study comparisons. © 2014 Meyer-Moock et al.; licensee BioMed Central Ltd.

Buchhorn R.,Caritas Krankenhaus | Christian W.,Caritas Krankenhaus
Cardiology in the Young | Year: 2014

Objectives Potential side effects of stimulants for attention deficit disorder are in the focus of scientific discussions, intensified by the higher number of prescriptions. Children with known arrhythmias or other severe cardiac problems should not receive stimulants because of their sympathomimetic effects. Methods This is a retrospective analysis of 24-hour Holter electrocardiograms from 100 consecutive children with attention deficit disorder from January, 2006 to April, 2012. Results In all, nine children had significant ventricular arrhythmia (mean age 11.4 ± 3.1 years, 77% male, 77% received methylphenidate). All these children had ventricular parasystole-four of them with an accelerated idioventricular rhythm. A significant circadian rhythm of premature ventricular contractions in seven children and the effect of standing and exercise clearly indicate the influence of the autonomic nervous system. In these children, hourly analysis of circadian rhythm within a 24-hour period showed a highly significant correlation between premature ventricular contractions and the vagal tone indicated by the heart rate variability parameter RMSSD (r =-0.83; p < 0.001). Ventricular arrhythmia was unaffected in seven children who received methylphenidate before diagnosis and decreased during metoprolol treatment in two children. Conclusion By Holter electrocardiogram analysis, we observed a remarkably high incidence of ventricular parasystole and accelerated idioventricular rhythm in nine of 100 children with attention deficit disorder, which depends on autonomic imbalance and not on stimulant treatment. © 2013 Cambridge University Press.

Willaschek C.,Caritas Krankenhaus | Meint S.,Caritas Krankenhaus | Rager K.,Caritas Krankenhaus | Buchhorn R.,Caritas Krankenhaus
PLoS ONE | Year: 2015

Introduction The association between short stature and increased risk of ischemic heart disease has been subject to studies for decades. The recent discussion of cardiovascular risk during growth hormone therapy has given new importance to this question. We have hypothesized that the autonomic system is a crucial element relating to this subject. Methods Heart rate variability calculated from 24-hour electrocardiogram data is providing insight into the regulatory state of the autonomous nervous system and is an approved surrogate parameter for estimating cardiovascular risk. We have calculated heart rate variability during clonidine testing for growth hormone stimulation of 56 children. As clonidine is a well-known effector of the autonomous system, stimulating vagal tone and decreasing sympathetic activ-ity, we compared the autonomous reactions of children with constitutional growth delay (CGD), growth hormone deficiency (GHD) and former small for gestational age (SGA). Results During clonidine testing children with CGD showed the expected α2 -adrenoreceptor mediated autonomous response of vagal stimulation for several hours. This vagal reaction was significantly reduced in the SGA group and nearly non- existent in the GHD group. Discussion Children with GHD show a reduced autonomous response to clonidine indicating α2 -adre-noreceptor sub sensitivity. This can be found prior to the start of growth hormone treatment. Since reduction of HRV is an approved surrogate parameter, increased cardiovascular risk has to be assumed for patients with GHD. In the SGA group a similar but less severe reduction of the autonomous response to clonidine was found. These findings may enrich the interpretation of the data on growth hormone therapy, which are being collected by the SAGhE study group. © 2015 Willaschek et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Buchhorn R.,Caritas Krankenhaus | Conzelmann A.,University of Würzburg | Willaschek C.,Caritas Krankenhaus | Stork D.,University of Würzburg | And 2 more authors.
ADHD Attention Deficit and Hyperactivity Disorders | Year: 2012

Although an extensive number of studies support the efficacy and tolerability of stimulants in the treatment of attention deficit/hyperactivity disorder (ADHD), in recent years, increasing concerns have been raised about their cardiovascular safety. We investigated whether a time domain analysis of heart rate variability (HRV) recordings in 24-h ECG under medication with stimulants yielded new information about therapy control in ADHD. We analysed the HRV parameter standard deviation of all normal sinus RR intervals over 24 h (SDNN), percentage of successive normal sinus RR intervals > 50 ms (pNN50) and root-mean-square of the successive normal sinus RR interval difference (rMSSD) from 23 children diagnosed by ADHD (19 boys and 4 girls), aged 10. 5 ± 2. 2 years, who were consecutively referred to our outpatient clinic for paediatric cardiology. Eleven children received medication with methylphenidate (MPH), while twelve children were initially examined without medication. Of these, eight probands were re-examined after therapy with MPH was established. Controls comprised 19 children (10 boys, 9 girls) from our Holter ECG data base without any cardiac or circulatory disease. Compared to healthy controls, the ADHD children with and without MPH treatment showed significantly higher mean heart rates (ADHD without MPH: 94. 3 ± 2. 2; ADHD with MPH: 90. 5 ± 1. 8, controls: 84. 7 ± 1. 8). pNN50 (ADHD without MPH: 6. 5 ± 2. 7; ADHD with MPH: 14. 2 ± 6. 9, controls: 21. 5 ± 9. 0) and rMSSD (ADHD without MPH: 26. 1 ± 4. 1; ADHD with MPH: 36. 7 ± 8. 3, controls: 44. 5 ± 10. 1) were lowest in ADHD children without MPH, middle in ADHD children with MPH and highest in controls. SDNN values were not significantly different. The hourly analysis shows highly significant reduced pNN50 and rMSSD values in untreated ADHD children between 5:00 pm and 6:00 am while the pattern approaches to levels of controls during MPH treatment. Data of this pilot study indicate a decreased vagal tone with significantly diminished HRV and higher heart rates in unmedicated ADHD children. These parameters of autonomic activation are ameliorated by MPH treatment. No evidence for negative impact of MPH on HRV was detected. Further studies will clarify a potential cardio-protective effect of MPH in ADHD. © 2012 Springer-Verlag.

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