0000000000581203
AUTHOR
E. Mayer
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
Abstract Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in su…
Das Pulmonalarteriensarkom - Prä- und postoperative radiologische Befunde bei der Tumorerstmanifestation und beim Rezidiv
Purpose Primary pulmonary artery sarcomas are very rare tumors. Their diagnosis is difficult due to their unspecific symptoms. Still, an early preoperative diagnosis is the only possibility for a potential therapy. Patients and methods 4 pre- and 5 postoperative CT- and three pre- and one postoperative MRT-examination(s) have been evaluated with respect to surgical and histological findings. Results The presence of a convex intraluminal bulging mass spreading mostly from the pulmonary trunc continuously into the peripheral pulmonary artery branches the filling and dilatation of the vessels, the tumor's inhomogeneity indicating hemorrhages and necrosis and the appearance of intrapulmonary no…
Erfassung hämodynamischer Parameter bei Patienten mit chronischer thromboembolischer pulmonaler Hypertonie mittels MRT vor und nach Thrombendarteriektomie
Purpose: To evaluate the potential of MRI to grade cardiac impairment and pulmonary hypertension in patients with chronic thromboembolic pulmonary hypertension (CTEPH) in comparison with invasive pressure measurements before and after surgery. Materials and Methods: We examined 35 patients with CTEPH before and after pulmonary thromboendarterectomy (PTE). For assessment of hemodynamics, velocity-encoded segmented GE-sequences (pulmonary arteries and ascending aorta) and segmented cine GE-sequences along the short axis of the heart were performed. The analysis comprised calculation of ejection fractions, peak velocities, mean pulmonary arterial flow and vessel diameter. 10 volunteers served …
Computertomographische Funktionsuntersuchung der Lunge nach einseitiger Lungentransplantation mit axialer und koronarer Akquisition
After single-lung transplantation in a patient suffering from obstructive emphysema lung function parameters worsened during follow-up. To complement the routine high-resolution CT (HRCT) scans acquired in inspiration, additional scans were obtained to evaluate regional lung function. The comparison of HRCT scans acquired in inspiration and in expiration revealed different ventilation conditions of both lungs, continuous acquisition in a single slice (dynamic multiscan acquisition) in the axial and coronal plane demonstrated mediastinal shifting and the movement of the diaphragm during the whole breathing cycle. Both modalities can provide important information concerning regional differenc…
Persistent Legionella Infection in a Patient after Bone Marrow Transplantation
ABSTRACT We report on a patient who developed Legionella pneumonia after bone marrow transplantation. Despite appropriate antibiotic treatment, disease progressed. The patient developed a lung abscess from which Legionella and Prevotella were isolated. Cure was achieved by surgical resection. The resected material was sterile, but 16S ribosomal DNA analysis revealed Legionella DNA.
Kontrastmittelverstärkte dreidimensionale MR-Angiographie der Lungenarterien bei Patienten mit chronisch-rezidivierender Lungenembolie - Vergleich mit der selektiven intraarteriellen DSA∗ *
Purpose: This study compares contrast-enhanced 3D-MR angiography (MRA) of the pulmonary arteries with selective intraarterial DSA in patients with chronic thromboembolic pulmonary hypertension. Materials and Methods: 20 patients preoperatively underwent a contrast-enhanced 3D-MRA of the pulmonary arteries at 1.5T using the phased-array body coil. For MRA, we used a 3D-Flash-sequence after bolus timing. 2 radiologists analyzed the acquired image material in consensus with respect to the detection of central thromboembolic material and the visualization of the pulmonary arterial tree. Finally, the MR angiograms were compared with selective DSA images using surgical findings as the definitive …
Akute oder chronische Transplantat-Abstoßung? - HRCT des Thorax bei Patienten nach Lungentransplantation
Purpose: Aim of the study was to evaluate the postoperative changes in patients with single (SLTX) or double lung transplantation (DLTX) with HRCT and to correlate those findings with the clinical diagnosis. Material and methods: 29 patients with SLTX (n = 14) or DLTX (n=15) were observed for more than 6 years after transplantation by HRCT (n =82). CT examinations were performed in inspiration and expiration (n=70) with a slice thickness of 1 mm and a feed of 10 mm. The image material was evaluated by 2 experienced radiologists in consensus. Criteria for acute rejection at HRCT were: ground glass opacities and focal air trapping in expiration. Criteria for chronic transplant rejection were:…
Pulmonary balloon angioplasty of chronic thromboembolic pulmonary hypertension (CTEPH) in surgically inaccessible cases.
Abstract The clinical course of patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) depends on the distribution pattern of the thromboembolic material. In patients with thromboembolic findings in the central pulmonary segments pulmonary thrombendarterectomy (PTE) has excellent results and acceptable operative risk. This paper presents two surgically inaccessible cases that were successfully treated with balloon pulmonary angioplasty. Balloon angioplasty improved parenchymal perfusion, increased cardiac index (Delta CI +19.2 % [Case 1], and +15.4 % [2]), reduced pulmonary vascular resistance during follow-up (Delta PVRI -25.0 % [1] and -15.9 % [2]), and is discussed…
Chronische thromboembolische pulmonale Hypertonie: Diagnostische Wertigkeit von Mehrschicht-CT und selektiver Pulmonalis-DSA
Purpose To evaluate the diagnostic impact of multislice-CT and selective pulmonary DSA in chronic thromboembolic pulmonary hypertension (CTEPH). Methods 994 vessel segments of 14 consecutive patients with CTEPH were investigated with multislice-CT (slice thickness 3 mm, collimation 2.5 mm, reconstruction intervall 2 mm) and selective pulmonary DSA (posterior-anterior, 45 degrees oblique, and lateral projection. Analysis was performed by 2 investigators independently for CT and DSA. Diagnostic criteria were occlusions and non-occlusive changes like webs and bands, irregularities of the vessel wall, diameter reduction and thromboembolic depositions at different levels from central pulmonary a…
Visuelle Abschätzung der funktionellen Lungenanteile in der HRCT und 3He-MRT bei Patienten nach Einzel-Lungentransplantation: Vergleich mit der absoluten Volumetrie
Purpose: Visual assessment of the ventilation using HRCT and 3 He-MRI in patients after single lung transplantation (SLTX). Analysis of specific ventilation defects found with 3 He-MRI and morphological changes found with HRCT. Materials and Methods: We evaluated 8male patients (54 ′ 6 years) suffering from emphysema and six patients (3males and 3 females, 58 ′ 9.5 years) suffering from idiopathic pulmonary fibrosis (IPF) after SLTX. The morphological changes at HRCT were classified and localized. In 3 He-MRI (2D FLASH), 10 to 14 slices (slice thickness 10 mm, gap 5 mm) were acquired in coronal orientation to cover the whole lung. Ventilation defects were localized and characterized. The vi…
Auswirkungen der Sauerstoffinhalation auf die Hämodynamik bei chronischer thromboembolischer pulmonaler Hypertonie
PURPOSE This study evaluates the haemodynamic effects of oxygen inhalation on pulmonary artery pressure and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. METHOD In 47 patients with chronic thromboembolic pulmonary hypertension haemodynamic parameters were measured before and after oxygen inhalation. RESULTS In moderately severe and severe pulmonary hypertension oxygen inhalation significantly reduced mean pulmonary artery pressure by about 11.1% and 4.6%, respectively. However, pulmonary vascular resistance was not significantly affected. Oxygen saturation improved and heart rate was reduced. Cardiac index decreased in severe pulmonary hyperte…
Chronische thromboembolische pulmonale Hypertonie: Hämodynamische Auswirkungen der selektiven Pulmonalis-DSA mit nicht-ionischem Kontrastmittel
PURPOSE This study evaluates the effects of pulmonary bolus injection of nonionic contrast medium on pulmonary artery pressure and resistance in patients with chronic thromboembolic pulmonary hypertension. METHODS In 39 patients (age 52 +/- 15) haemodynamic measurements were performed during bolus injection of nonionic contrast medium in a control group (I), in moderately severe (II) and severe pulmonary hypertension (III). RESULTS Initial inspiratory arrest caused significant pressure increase in all groups prior to bolus injection (delta PAsyst: 7.1 +/- 6.7 [I], 6.8 +/- 3.9 [II] und 7.2 +/- 7.9 mmHg p < 0.05). However, contrast bolus injection (25.1 +/- 2.3 ml iopamidol, 13.0 ml/s) caused…