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Steidl E, Rauch M, Hattingen E, Breuer S, Schüre JR, Grapengeter M, Shrestha M, Foerch C, Schaller-Paule MA. Qualitative and quantitative detectability of hypertrophic olivary degeneration in T2, FLAIR, PD, and DTI: A prospective MRI study. Front Neurol 2022; 13:950191. [PMID: 35989923 PMCID: PMC9381965 DOI: 10.3389/fneur.2022.950191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: Hypertrophic olivary degeneration (HOD) is a pathology of the inferior olivary nucleus (ION) that occurs after injuries to the Guillain-Mollaret triangle (GMT). Lacking a diagnostic gold standard, diagnosis is usually based on T2 or FLAIR imaging and expert rating. To facilitate precise HOD diagnosis in future studies, we assessed the reliability of this rater-based approach and explored alternative, quantitative analysis. Methods Patients who had suffered strokes in the GMT and a matched control group prospectively underwent an MRI examination including T2, FLAIR, and proton density (PD). Diffusion tensor imaging (DTI) was additionally performed in the patient group. The presence of HOD was assessed on FLAIR, T2, and PD separately by 3 blinded reviewers. Employing an easily reproducible segmentation approach, relative differences in intensity, fractional anisotropy (FA), and mean diffusivity (MD) between both IONs were calculated. Results In total, 15 patients were included in this study. The interrater reliability was best for FLAIR, followed by T2 and PD (Fleiss κ = 0.87 / 0.77 / 0.65). The 3 raters diagnosed HOD in 38–46% (FLAIR), 40–47% (T2), and 53–67% (PD) of patients. False-positive findings in the control group were less frequent in T2 than in PD and FLAIR (2.2% / 8.9% / 6.7%). In 53% of patients, the intensity difference between both IONs on PD was significantly increased in comparison with the control group. These patients also showed significantly decreased FA and increased MD. Conclusion While the rater-based approach yielded the best performance on T2 imaging, a quantitative, more sensitive HOD diagnosis based on ION intensities in PD and DTI imaging seems possible.
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Affiliation(s)
- Eike Steidl
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maximilian Rauch
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stella Breuer
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jan Rüdiger Schüre
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marike Grapengeter
- Brain Imaging Center (BIC), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Manoj Shrestha
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Christian Foerch
- Brain Imaging Center (BIC), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Martin A. Schaller-Paule
- Brain Imaging Center (BIC), Goethe-University Frankfurt, Frankfurt am Main, Germany
- *Correspondence: Martin A. Schaller-Paule
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Reitz SC, Behrens M, Lortz I, Conradi N, Rauch M, Filipski K, Voss M, Kell C, Czabanka M, Forster MT. Neurocognitive Outcome and Seizure Freedom After Awake Surgery of Gliomas. Front Oncol 2022; 12:815733. [PMID: 35463387 PMCID: PMC9023117 DOI: 10.3389/fonc.2022.815733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Gliomas are often diagnosed due to epileptic seizures as well as neurocognitive deficits. First treatment choice for patients with gliomas in speech-related areas is awake surgery, which aims at maximizing tumor resection while preserving or improving patient’s neurological status. The present study aimed at evaluating neurocognitive functioning and occurrence of epileptic seizures in patients suffering from gliomas located in language-related areas before and after awake surgery as well as during their follow up course of disease. Materials and Methods In this prospective study we included patients who underwent awake surgery for glioma in the inferior frontal gyrus, superior temporal gyrus, or anterior temporal lobe. Preoperatively, as well as in the short-term (median 4.1 months, IQR 2.1-6.0) and long-term (median 18.3 months, IQR 12.3-36.6) postoperative course, neurocognitive functioning, neurologic status, the occurrence of epileptic seizures and number of antiepileptic drugs were recorded. Results Between 09/2012 and 09/2019, a total of 27 glioma patients, aged 36.1 ± 11.8 years, were included. Tumor resection was complete in 15, subtotal in 6 and partial in 6 patients, respectively. While preoperatively impairment in at least one neurocognitive domain was found in 37.0% of patients, postoperatively, in the short-term, 36.4% of patients presented a significant deterioration in word fluency (p=0.009) and 34.8% of patients in executive functions (p=0.049). Over the long-term, scores improved to preoperative baseline levels. The number of patients with mood disturbances significantly declined from 66.7% to 34.8% after surgery (p=0.03). Regarding seizures, these were present in 18 (66.7%) patients prior to surgery. Postoperatively, 22 (81.5%) patients were treated with antiepileptic drugs with all patients presenting seizure-freedom. Conclusions In patients suffering from gliomas in eloquent areas, the combination of awake surgery, regular neurocognitive assessment - considering individual patients´ functional outcome and rehabilitation needs – and the individual adjustment of antiepileptic therapy results in excellent patient outcome in the long-term course.
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Affiliation(s)
- Sarah Christina Reitz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marion Behrens
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Irina Lortz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Maximilian Rauch
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Katharina Filipski
- Edinger Institute, Institute of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung), Partner Site Frankfurt/Mainz, Heidelberg, Germany.,German Cancer Research Center (Deutsches Krebsforschungszentrum), Heidelberg, Germany
| | - Martin Voss
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Christian Kell
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marie-Therese Forster
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
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Koch A, Sponholz S, Trainer S, Stratmann J, Sebastian M, Rauch M, Wolff R, Steinbach JP, Ronellenfitsch MW, Urban H. Pulmonary Resection after Radiosurgery and Neoadjuvant Immunochemotherapy for NSCLC Patients with Synchronous Brain Metastasis—A Case Series of Three Patients. Curr Oncol 2022; 29:2225-2239. [PMID: 35448155 PMCID: PMC9030832 DOI: 10.3390/curroncol29040181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In this short communication, we present three cases of patients with symptomatic, synchronous brain metastases of otherwise locally limited non-small cell lung cancer. The patients received local ablative treatment of the brain metastases followed by neoadjuvant immunochemotherapy with pemetrexed, cisplatin, and pembrolizumab, and resection of the pulmonary lesion with curative intent. With two of the patients still alive and maintaining a good quality of life with a progression-free survival and overall survival of 28 and 35 months, respectively, this case series illustrates the potential of novel combinatorial treatment approaches. Abstract Brain metastases are a common finding upon initial diagnosis of otherwise locally limited non-small cell lung cancer. We present a retrospective case series describing three cases of patients with symptomatic, synchronous brain metastases and resectable lung tumors. The patients received local ablative treatment of the brain metastases followed by neoadjuvant immunochemotherapy with pemetrexed, cisplatin, and pembrolizumab. Afterwards, resection of the pulmonary lesion with curative intent was performed. One patient showed progressive disease 12 months after initial diagnosis, and passed away 31 months after initial diagnosis. Two of the patients are still alive and maintain a good quality of life with a progression-free survival and overall survival of 28 and 35 months, respectively, illustrating the potential of novel combinatorial treatment approaches.
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Affiliation(s)
- Agnes Koch
- Department of Thoracic Surgery, Agaplesion Markuskrankenhaus, 60431 Frankfurt am Main, Germany; (S.S.); (S.T.)
- Correspondence: (A.K.); (H.U.)
| | - Stefan Sponholz
- Department of Thoracic Surgery, Agaplesion Markuskrankenhaus, 60431 Frankfurt am Main, Germany; (S.S.); (S.T.)
| | - Stephan Trainer
- Department of Thoracic Surgery, Agaplesion Markuskrankenhaus, 60431 Frankfurt am Main, Germany; (S.S.); (S.T.)
| | - Jan Stratmann
- Hematology/Oncology, Department of Medicine, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (J.S.); (M.S.)
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.R.); (J.P.S.); (M.W.R.)
- Frankfurt Cancer Institute (FCI), 60590 Frankfurt am Main, Germany
| | - Martin Sebastian
- Hematology/Oncology, Department of Medicine, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (J.S.); (M.S.)
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.R.); (J.P.S.); (M.W.R.)
- Frankfurt Cancer Institute (FCI), 60590 Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, German Cancer Research Center (DKFZ), Stiftung des Öffentlichen Rechts, 69120 Heidelberg, Germany
| | - Maximilian Rauch
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.R.); (J.P.S.); (M.W.R.)
- Frankfurt Cancer Institute (FCI), 60590 Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, German Cancer Research Center (DKFZ), Stiftung des Öffentlichen Rechts, 69120 Heidelberg, Germany
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Robert Wolff
- Saphir Radiosurgery Center, 60528 Frankfurt am Main, Germany;
| | - Joachim P. Steinbach
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.R.); (J.P.S.); (M.W.R.)
- Frankfurt Cancer Institute (FCI), 60590 Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, German Cancer Research Center (DKFZ), Stiftung des Öffentlichen Rechts, 69120 Heidelberg, Germany
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Michael W. Ronellenfitsch
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.R.); (J.P.S.); (M.W.R.)
- Frankfurt Cancer Institute (FCI), 60590 Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, German Cancer Research Center (DKFZ), Stiftung des Öffentlichen Rechts, 69120 Heidelberg, Germany
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Hans Urban
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.R.); (J.P.S.); (M.W.R.)
- German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, German Cancer Research Center (DKFZ), Stiftung des Öffentlichen Rechts, 69120 Heidelberg, Germany
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
- Correspondence: (A.K.); (H.U.)
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Schaller-Paule MA, Oeckel AM, Schüre JR, Keil F, Hattingen E, Foerch C, Rauch M. Isolated thalamic stroke - analysis of clinical characteristics and asymmetry of lesion distribution in a retrospective cohort study. Neurol Res Pract 2021; 3:49. [PMID: 34511109 PMCID: PMC8436465 DOI: 10.1186/s42466-021-00148-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022] Open
Abstract
Background More patients with left-hemispheric than right-hemispheric strokes are admitted to hospitals. This is due to the easier recognition of cortical symptoms of the dominant-hemisphere. The thalamus constitutes a “micro-model” of the brain cortex with structure-function relationships known to be asymmetric, especially for language, memory, and visuo-spatial neurocognitive functions. The goal of this study was to characterize clinical symptoms and lesion distribution patterns of patients with acute isolated thalamic stroke (ITS) and to evaluate whether left-sided lesions are overrepresented in the hospital. Methods We performed a radiological database search including all brain scans performed in the Center of Neurology and Neurosurgery of the University Hospital Frankfurt between 2010 and 2019. A total of 5733 patients presenting with acute ischemic stroke were screened for ITS. Based on the MRI data, a lesion-overlap map was then generated to visualize the ITS lesion distribution. Results Fifty-eight patients with unilateral ITS were identified. A majority of 38 patients (65.5%) showed left-sided ITS, whereas only 20 patients (34.5%) had right-sided ITS (p = 0.012). A particular difference was found for ITS lesions in the anterior thalamus of the anterolateral (n = 10) and anteromedian (n = 3) vascular territory, which were located in the left thalamus in 85% of patients (p = 0.011). No distribution difference was found for ITS lesions in the inferomedial (n = 7), central (n = 8), inferolateral (n = 23) and posterior (n = 7) vascular territories. The neuropsychological symptoms of thalamic aphasia (n = 8), neurocognitive impairment (n = 6), behavioral changes (n = 2), neglect (n = 2) and memory deficits (n = 3) were described predominantly in patients with left-sided ITS (p < 0.01). In contrast, other stroke symptoms (e.g., sensorimotor hemi-syndromes) did not reveal a side preponderance. Conclusions The better recognizability of left anterior compared to right anterior thalamic stroke symptoms may have an impact on the frequency in which ITS patients are admitted to the hospital. Clinical characteristics of right anterior thalamic stroke should therefore be further investigated, and diagnostic instruments towards their detection be identified.
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Affiliation(s)
- Martin A Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Schleusenweg 2 - 16, D-60528, Frankfurt am Main, Germany.
| | - Ariane Martinez Oeckel
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Schleusenweg 2 - 16, D-60528, Frankfurt am Main, Germany
| | - Jan-Rüdiger Schüre
- Brain Imaging Center, Goethe-University, Frankfurt am Main, Germany.,Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Fee Keil
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Schleusenweg 2 - 16, D-60528, Frankfurt am Main, Germany
| | - Maximilian Rauch
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
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5
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Dubinski D, Won SY, Rauch M, Behmanesh B, Ngassam LDC, Baumgarten P, Senft C, Harter PN, Bernstock JD, Freiman TM, Seifert V, Gessler F. Association of Isocitrate Dehydrogenase (IDH) Status With Edema to Tumor Ratio and Its Correlation With Immune Infiltration in Glioblastoma. Front Immunol 2021; 12:627650. [PMID: 33868245 PMCID: PMC8044904 DOI: 10.3389/fimmu.2021.627650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/09/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose The extent of preoperative peritumoral edema in glioblastoma (GBM) has been negatively correlated with patient outcome. As several ongoing studies are investigating T-cell based immunotherapy in GBM, we conducted this study to assess whether peritumoral edema with potentially increased intracranial pressure, disrupted tissue homeostasis and reduced local blood flow has influence on immune infiltration and affects survival. Methods A volumetric analysis of preoperative imaging (gadolinium enhanced T1 weighted MRI sequences for tumor size and T2 weighted sequences for extent of edema (including the infiltrative zone, gliosis etc.) was conducted in 144 patients using the Brainlab® software. Immunohistochemical staining was analyzed for lymphocytic- (CD 3+) and myelocytic (CD15+) tumor infiltration. A retrospective analysis of patient-, surgical-, and molecular characteristics was performed using medical records. Results The edema to tumor ratio was neither associated with progression-free nor overall survival (p=0.90, p=0.74). However, GBM patients displaying IDH-1 wildtype had significantly higher edema to tumor ratio than patients displaying an IDH-1 mutation (p=0.01). Immunohistopathological analysis did not show significant differences in lymphocytic or myelocytic tumor infiltration (p=0.78, p=0.74) between these groups. Conclusion In our cohort, edema to tumor ratio had no significant correlation with immune infiltration and outcome. However, patients with an IDH-1wildtype GBM had a significantly higher edema to tumor ratio compared to their IDH-1 mutated peer group. Further studies are necessary to elucidate the underlying mechanisms.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Maximilian Rauch
- Institute of Neuroradiology, Goethe University, Frankfurt, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Lionel D C Ngassam
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt, Germany
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Thomas M Freiman
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
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Rauch M, Tausch D, Stera S, Blanck O, Wolff R, Meissner M, Urban H, Hattingen E. MRI characteristics in treatment for cerebral melanoma metastasis using stereotactic radiosurgery and concomitant checkpoint inhibitors or targeted therapeutics. J Neurooncol 2021; 153:79-87. [PMID: 33761055 PMCID: PMC8131338 DOI: 10.1007/s11060-021-03744-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 11/04/2022]
Abstract
Introduction Combination therapy for melanoma brain metastases (MM) using stereotactic radiosurgery (SRS) and immune checkpoint-inhibition (ICI) or targeted therapy (TT) is currently of high interest. In this collective, time evolution and incidence of imaging findings indicative of pseudoprogression is sparsely researched. We therefore investigated time-course of MRI characteristics in these patients. Methods Data were obtained retrospectively from 27 patients (12 female, 15 male; mean 61 years, total of 169 MMs). Single lesion volumes, total MM burden and edema volumes were analyzed at baseline and follow-up MRIs in 2 months intervals after SRS up to 24 months. The occurrence of intralesional hemorrhages was recorded. Results 17 patients (80 MM) received ICI, 8 (62 MM) TT and 2 (27 MM) ICI + TT concomitantly to SRS. MM-localization was frontal (n = 89), temporal (n = 23), parietal (n = 20), occipital (n = 10), basal ganglia/thalamus/insula (n = 10) and cerebellar (n = 10). A volumetric progression of MM 2–4 months after SRS was observed in combined treatment with ICI (p = 0.028) and ICI + TT (p = 0.043), whereas MMs treated with TT showed an early volumetric regression (p = 0.004). Edema volumes moderately correlated with total MM volumes (r = 0.57; p < 0.0001). Volumetric behavior did not differ significantly over time regarding lesions’ initial sizes or localizations. No significant differences between groups were observed regarding rates of post-SRS intralesional hemorrhages. Conclusion Reversible volumetric increases in terms of pseudoprogression are observed 2–4 months after SRS in patients with MM concomitantly treated with ICI and ICI + TT, rarely after TT. Edema volumes mirror total MM volumes. Medical treatment type does not significantly affect rates of intralesional hemorrhage.
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Affiliation(s)
- Maximilian Rauch
- Institute for Neuroradiology, Johann Wolfgang Goethe-University, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
| | - Daniel Tausch
- Institute for Neuroradiology, Johann Wolfgang Goethe-University, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Susanne Stera
- Department of Radiation Oncology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Oliver Blanck
- Saphir Radiosurgery Center, Frankfurt am Main, Germany
| | - Robert Wolff
- Saphir Radiosurgery Center, Frankfurt am Main, Germany
| | - Markus Meissner
- Department of Dermatology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Hans Urban
- Institute for Neurooncology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute for Neuroradiology, Johann Wolfgang Goethe-University, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
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Forster MT, Behrens M, Lortz I, Conradi N, Senft C, Voss M, Rauch M, Seifert V. Benefits of glioma resection in the corpus callosum. Sci Rep 2020; 10:16630. [PMID: 33024247 PMCID: PMC7538917 DOI: 10.1038/s41598-020-73928-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/24/2020] [Indexed: 01/27/2023] Open
Abstract
Due to anticipated postoperative neuropsychological sequelae, patients with gliomas infiltrating the corpus callosum rarely undergo tumor resection and mostly present in a poor neurological state. We aimed at investigating the benefit of glioma resection in the corpus callosum, hypothesizing neuropsychological deficits were mainly caused by tumor presence. Between 01/2017 and 1/2020, 21 patients who underwent glioma resection in the corpus callosum were prospectively enrolled into this study. Neuropsychological function was assessed preoperatively, before discharge and after 6 months. Gross total tumor resection was possible in 15 patients, and in 6 patients subtotal tumor resection with a tumor reduction of 97.7% could be achieved. During a median observation time of 12.6 months 9 patients died from glioblastoma after a median of 17 months. Preoperatively, all cognitive domains were affected in up to two thirds of patients, who presented a median KPS of 100% (range 60–100%). After surgery, the proportion of impaired patients increased in all neurocognitive domains. Most interestingly, after 6 months, significantly fewer patients showed impairments in attention, executive functioning, memory and depression, which are domains considered crucial for everyday functionality. Thus, the results of our study strongly support our hypothesis that in patients with gliomas infiltrating the corpus callosum the benefit of tumor resection might outweigh morbidity.
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Affiliation(s)
- Marie-Therese Forster
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. .,University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
| | - Marion Behrens
- Department of Neurology, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Irina Lortz
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Nadine Conradi
- Department of Neurology, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Christian Senft
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Martin Voss
- University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.,Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Maximilian Rauch
- University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.,Department of Neuroradiology, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
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8
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Marinova M, Huxold HC, Henseler J, Mücke M, Conrad R, Rolke R, Ahmadzadehfar H, Rauch M, Fimmers R, Luechters G, Cuhls H, Radbruch L, Schild HH, Strunk H. Clinical Effectiveness and Potential Survival Benefit of US-Guided High-Intensity Focused Ultrasound Therapy in Patients with Advanced-Stage Pancreatic Cancer. Ultraschall Med 2019; 40:625-637. [PMID: 29665583 DOI: 10.1055/a-0591-3386] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Pancreatic cancer (PaC) is a life-limiting tumor with a wide range of incapacitating symptoms such as cancer pain in more than 80 % of patients. This prospective interventional study addresses the clinical effectiveness of ultrasound-guided high-intensity focused ultrasound (HIFU) treatment for patients with advanced-stage PaC, including pain perception, tumor size and survival benefit. MATERIALS AND METHODS 50 patients with late-stage PaC underwent HIFU. Clinical assessment included evaluation of tumor volume by imaging and pain burden (pain severity, pain sensation, interference with daily activities) using the Brief Pain Inventory at baseline and follow-up. Median overall survival, progression-free survival and time to local progression were estimated using Kaplan-Meier analysis. RESULTS In 84 % of patients, significant early relief of cancer-induced abdominal pain was achieved by HIFU independent of metastatic status; it persisted during follow-up. Tumor volume reduction was 37.8 ± 18.1 % after 6 weeks and 57.9 ± 25.9 % after 6 months. 21 % of HIFU-treated patients had local tumor progression with a median time of 14.4 months from intervention. The median overall survival and progression-free survival were 16.2 and 16.9 months from diagnosis and 8.3 and 6.8 months from intervention. CONCLUSION In patients with advanced pancreatic cancer and otherwise limited treatment options, HIFU resulted in significant early and long-lasting pain relief and tumor size reduction over time independent of metastatic status. Clinical data suggest an additional potential survival benefit.
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Affiliation(s)
- Milka Marinova
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Hannah C Huxold
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Jana Henseler
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Martin Mücke
- Department of Palliative Medicine, Department of General Practice and Family Medicine, Medical School and University Clinics Bonn, Germany
| | - Rupert Conrad
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Medical School and University Clinics Bonn, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical School and University Clinics Aachen, Germany
| | - Hojjat Ahmadzadehfar
- Department of Nuclear Medicine, Medical School and University Clinics Bonn, Germany
| | - Maximilian Rauch
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical biometry, Informatics and Epidemiology, Medical School and University Clinics Bonn, Germany
| | | | - Henning Cuhls
- Department of Palliative Medicine, Medical School and University Clinics Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, Medical School and University Clinics Bonn, Germany
| | - Hans H Schild
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Holger Strunk
- Department of Radiology, Medical School and University Clinics Bonn, Germany
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9
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Strunk HM, Lützow C, Henseler J, Mücke M, Rauch M, Marx C, Schild HH, Marinova M. Mesenteric Vessel Patency Following HIFU Therapy in Patients with Locally Invasive Pancreatic Cancer. Ultraschall Med 2018; 39:650-658. [PMID: 29346805 DOI: 10.1055/s-0043-125391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To evaluate the effects of HIFU therapy on visceral vessel patency in patients with inoperable locally invasive pancreatic cancer. MATERIALS AND METHODS 50 pancreatic cancer patients (26 men, 24 women) aged 41 - 82 years (65.0 ± 10.2) underwent ultrasonography (US) and computed tomography (CT) examinations before and within one day after HIFU treatment, as well as at follow-up at six weeks, three months and six months. Evaluation and grading were performed by two experienced independent radiologists according to a classification scheme based on vessel involvement, vessel diameter, patency, and defects in flow. RESULTS Before HIFU treatment, arterial vessel involvement was noted in 42 patients, venous involvement in 47, and 47 patients presented with both. Superior mesenteric artery occlusion was found in three carcinomas while nearly half of the cases (n = 24) displayed signs of superior mesenteric vein, portal vein, or splenic vein occlusion. High-grade tumor-associated arterial narrowing was seen in ten patients. Despite vessel encasement and partially extensive propagation of collateral vessels, it was possible to safely perform HIFU treatment in all patients without complications. US and CT studies performed within one day after therapy did not show any change in vessel patency in 47 patients (94 %). Follow-up controls at the six-week mark revealed increased vessel narrowing and finally occlusion after six months in 11 patients due to tumor progression. CONCLUSION This study demonstrates that HIFU treatment can be safely applied to pancreatic cancers enveloping large mesenteric vessels despite vessel narrowing or extensive collateral propagation. Most patients (94 %) did not experience adverse effects regarding vessel patency.
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Affiliation(s)
| | | | - Jana Henseler
- Department of Radiology, University Hospital, Bonn, Germany
| | - Martin Mücke
- Department of Palliative Medicine, University Hospital, Bonn, Germany
- Department of General Practice and Family Medicine, University Hospital, Bonn, Germany
| | | | - Christian Marx
- Department of Radiology, University Hospital, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University Hospital, Bonn, Germany
| | - Milka Marinova
- Department of Radiology, University Hospital, Bonn, Germany
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10
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Rauch M, Greschus S. Computertomografie des Auges. Augenheilkunde up2date 2018. [DOI: 10.1055/a-0634-7927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
ZusammenfassungCT-Befunde an den Augen sind häufig Nebenbefunde bei Hals- oder Schädeluntersuchungen. Eine gezielte CT der Augen ist z. B. bei einer vermuteten Bulbusperforation oder zur Suche intraokulärer Fremdkörper indiziert. Der vorliegende Artikel behandelt Veränderungen des Bulbus oculi, die in der CT festgestellt werden können und geht auch auf den Strahlenschutz ein, der bei jeder CT in besonderer Weise zu berücksichtigen ist.
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11
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Abstract
CLINICAL/METHODICAL ISSUE Embolization of the testicular veins (Gat-Goren technique) is an interventional procedure for the treatment of benign prostatic hyperplasia (BPH). STANDARD RADIOLOGICAL METHODS In addition to standard urological procedures, such as transurethral resection of the prostate (TUR-P), arterial embolization of the prostate is considered as the interventional radiological method of choice. METHODICAL INNOVATIONS Embolization of the testicular veins is technically identical to the embolization of varicoceles in infertile men and represents a less invasive treatment. PERFORMANCE Embolization of the testicular veins can be performed as a low-risk intervention with low side effects. Variants of the venous anatomy can make the procedure more difficult. In current studies a good reduction of symptoms could be achieved in intermediate-term follow-up. ACHIEVEMENTS The medium-term results are promising but data on long-term results and comparisons with alternative treatments are missing. PRACTICAL RECOMMENDATIONS Embolization of the testicular veins is a minimally invasive method for the treatment of BPH. The procedure can be performed in an outpatient setting. In the intermediate course up to 6 months after treatment, promising results were demonstrated in recent studies. Randomized studies, data on long-term results and comparisons to alternative methods (e. g. arterial prostatic embolization and surgical procedures) are missing.
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Affiliation(s)
- M Rauch
- Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland.
| | - H Strunk
- Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland
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12
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Lavie C, Rollot F, Durand-Dubief F, Marignier R, Ionescu I, Casey R, Moreau T, Tourniaire P, Hutchinson M, D’Hooghe MB, Laplaud DA, Clavelou P, De Sèze J, Debouverie M, Brassat D, Pelletier J, Lebrun-Frenay C, Le Page E, Castelnovo G, Berger E, Hautecoeur P, Heinzlef O, Durelli L, Clerico M, Trojano M, Patti F, Vukusic S, Alpérovitch A, Carton H, d’Hooghe M, Hommes O, Hutchinson M, Adeleine P, Biron A, Cortinovis-Tourniaire P, Grimaud J, Hours M, Moreau T, Vukusic S, Confavreux C, Chauplannaz G, Confavreux C, Cortinovis-Tourniaire P, Grimaud J, Latombe D, Moreau T, Clanet M, Lau G, Rumbach L, Goas J, Rouhart F, Mazingue A, Roullet E, Madigand M, Hautecoeur P, Brunet P, Edan G, Allaire C, Riffault G, Leche J, Benoit T, Simonin C, Ziegler F, Baron J, Rivrain Y, Dumas R, Loche D, Bourrin J, Huttin B, Delisse B, Gibert I, Boulay C, Verceletto M, Durand G, Bonneviot G, Gil R, Hedreville M, Belair C, Poitevin R, Devoize J, Wyremblewski P, Delestre F, Setiey A, Comi G, Filippi M, Ghezzi A, Martinelli V, Rossi P, Zaffaroni M, Tola M, Amato M, Fioretti C, Meucci G, Inglese M, Mancardi G, Gambi D, Thomas A, Cavazzuti M, Citterio A, Heltberg A, Hansen H, Fernandez O, Romero F, Arbizu T, Hernandez J, De Andres de Frutos C, Geffner Sclarky D, Aladro Benito Y, Reyes Yanes P, Aguilar M, Burguera J, Yaya R, Bonakim Dib W, Arzua-Mouronte D, d’Hooghe M, Sindic C, Carton H, Medaer R, Roose H, Geens K, Guillaume D, Van Zandycke M, Janssens J, Cornette M, Mol L, Weilbach F, Flachenecker P, Hartung H, Haas J, Tendolkar I, Sindrn E, Kölmel H, Reichel D, Rauch M, Preuss S, Poser S, Mauch E, Strausser-Fuchs S, Kolleger H, Hawkins S, Howell S, Rees J, Thompson A, Johnson M, Boggild M, Gregory R, Bates D, Bone I, Hutchinson M, Polman C, Frequin S, Jongen P, Hommes O, Correia de Sa J, Rio M, Huber S, Lechner-Scott J, Kappos L, Ionescu I, Cornu C, Confavreux C, Vukusic S, El-Etr M, Baulieu E, El-Etr M, Schumacher M, Ionescu I, Confavreux C, Cornu C, Vukusic S, Hartung H, Miller D, Hutchinson M, Pugeat M, d’Archangues C, Conard J, Ménard J, Sitruk-Ware R, Pelissier C, Dat S, Belaïsch-Allard J, Athéa N, Büschsenschutz D, Lyon-Caen O, Gonsette R, Boissel J, Ffrench P, Durand-Dubief F, Cotton F, Pachai C, Bracoud L, Vukusic S, Ionescu I, Androdias G, Marignier R, Chauplannaz G, Laplaud D, Wiertlewski S, Lanctin-Garcia C, Moreau T, Couvreur G, Madinier G, Clavelou P, Taithe F, Aufauvre D, Guy N, Ferrier A, De Sèze J, Collongues N, Debouverie M, Viala F, Brassat D, Gerdelat-Mas A, Henry P, Pelletier J, Rico-Lamy A, Lebrun-Frenay C, Lepage E, Deburghraeve V, Edan G, Castelnovo G, Berger E, Hautecoeur P, Blondiau M, Heinzlef O, Coustans M, Clerc C, Rieu L, Lauxerois M, Hinzelin G, Ouallet J, Minier D, Vion P, Gromaire-Fayolle N, Derache N, Thouvenot E, Sallansonnet-Froment M, Tourniaire P, Toureille L, Borgel F, Stankoff B, Grimaud J, Moroianu C, Guennoc A, Tournier-Gervason C, Peysson S, Trojano M, Patti F, D’Amico E, Motti L, Zaffaroni M, Durelli L, Tavella A. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS. Mult Scler 2018; 25:591-600. [DOI: 10.1177/1352458518763080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.
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Affiliation(s)
- Caroline Lavie
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Fabien Rollot
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | | | - Romain Marignier
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Centre de Recherche en Neurosciences de Lyon,
INSERM U1028, CNRS UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France;
Université de Lyon 1, Lyon, France
| | - Iuliana Ionescu
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Romain Casey
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | - Thibault Moreau
- Department of Neurology, EA4184, University Hospital of
Dijon, Dijon, France
| | | | - Michael Hutchinson
- School of Medicine and Medical Science, University College
Dublin, Dublin, Ireland/Department of Neurology, St Vincent’s University Hospital,
Dublin, Ireland
| | - Marie Béatrice D’Hooghe
- National MS Center Melsbroek, Melsbroek, Belgium; Center
for Neurosciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - David-Axel Laplaud
- Service de Neurologie, CHU de Nantes, CIC015 INSERM,
Nantes, France/INSERM UMR1064, Nantes, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand,
Clermont-Ferrand, France/INSERM UMR1107, Clermont Université, Université d’Auvergne,
Neuro-Dol, Clermont-Ferrand, France
| | - Jérôme De Sèze
- Department of Neurology, Clinical Investigation Center
INSERM 1434, Hôpitaux Universitaires de Strasbourg, FMTS INSERM 1119, Strasbourg,
France
| | - Marc Debouverie
- EA 4360 APEMAC, University of Lorraine, Nancy,
France/Department of Neurology, Nancy University Hospital, Nancy, France
| | - David Brassat
- Pôle Neurosciences, CHU Toulouse Purpan, Toulouse,
France/INSERM U1043, CNRS UMR 5282, Université Toulouse III, Toulouse, France
| | - Jean Pelletier
- Service de Neurologie, Hôpital de la Timone, Pôle de
Neurosciences Cliniques, AP-HM, Aix-Marseille Université, Marseille, France/CNRS,
Aix-Marseille Université, CRMBM UMR7339, Marseille, France
| | | | - Emmanuelle Le Page
- Clinical Neuroscience Centre, CIC-P 1414 INSERM, Rennes
University Hospital, Rennes, France
| | | | - Eric Berger
- Department of Neurology, CHU Besançon, Besançon,
France
| | - Patrick Hautecoeur
- Service de Neurologie, Groupement des Hôpitaux de
l’Institut Catholique de Lille, Lille, France
| | - Olivier Heinzlef
- Department of Neurology, Hôpital CHI de
Poissy/Saint-Germain-en-Laye, Paris, France
| | - Luca Durelli
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Marinella Clerico
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and
Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences, and Advanced
Technologies, G.F. Ingrassia, Multiple Sclerosis Center, University of Catania, Catania,
Italy
| | - Sandra Vukusic
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques
(OFSEP), Lyon, France/Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS
UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France/Université de Lyon
1, Lyon, France
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Marinova M, Strunk HM, Rauch M, Henseler J, Clarens T, Brüx L, Dolscheid-Pommerich R, Conrad R, Cuhls H, Radbruch L, Schild HH, Mücke M. [High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer : Evaluation with the pain sensation scale (SES)]. Schmerz 2018; 31:31-39. [PMID: 27402264 DOI: 10.1007/s00482-016-0140-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer. OBJECTIVE Evaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries. MATERIAL AND METHODS In this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6 stage III, 12 stage IV according to UICC and 2 with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS). RESULTS The average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3 % compared to the mean baseline score (n = 15, 75 %) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (n = 2) or the analgesic dosage could be reduced (n = 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1 week after HIFU, p < 0.05 for all pain scales). CONCLUSION US-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.
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Affiliation(s)
- M Marinova
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland.
| | - H M Strunk
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - M Rauch
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - J Henseler
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - T Clarens
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - L Brüx
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - R Dolscheid-Pommerich
- Institut für Klinische Chemie und Pharmakologie, Universitätsklinikum, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum, Bonn, Deutschland
| | - H Cuhls
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum, Bonn, Deutschland
| | - L Radbruch
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum, Bonn, Deutschland
| | - H H Schild
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - M Mücke
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum, Bonn, Deutschland
- Institut für Hausarztmedizin, Universitätsklinikum, Bonn, Deutschland
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Rauch M, Marinova M, Schild HH, Strunk H. Cardiovascular Computed Tomography Findings after Pneumonectomy: Comparison to Lobectomy. Acad Radiol 2017; 24:860-866. [PMID: 28242102 DOI: 10.1016/j.acra.2017.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To identify and compare cardiovascular findings on computed tomography (CT) scans after pneumonectomy (PNX) with those after lobectomy (LOBX). MATERIALS AND METHODS Pre- and postoperative CT scans from 25 PNX patients were retrospectively analyzed and compared to those from 30 LOBX patients. The diameter of the main pulmonary artery (PA) and its ratio to the ascending aorta (PA/Ao) were determined. Cardiac morphometry values were ascertained by measuring maximum diameters of the right and left ventricle on axial (RVaxial, LVaxial) and four-chamber (RV4-ch, LV4-ch) views. RVaxial/LVaxial and RV4-ch/LV4-ch ratios were calculated. Vessel stumps were evaluated for thrombosis. RESULTS After PNX, PA (31.1 ± 5.8 mm vs 28.7 ± 5.4 mm, P = 0.003), PA/Ao (0.97 ± 0.15 vs 0.86 ± 0.12, P = 0.0001), and cardiac morphometry values significantly increased (RVaxial 43.6 ± 7.4 vs 39.4 ± 7.1, P = 0.029; RV4-ch 41.1 ± 6.3 vs 37.6 ± 5.7, P = 0.041; RVaxial/LVaxial 1.18 ± 0.27 vs 1.03 ± 0.22, P = 0.04; RV4-ch/LV4-ch 1.17 ± 0.21 vs 1.02 ± 0.16, P = 0.03). There were no significant differences between right and left PNX. One case of PA stump thrombosis was identified after right PNX. LOBX resulted in a significant increase in PA (30.6 ± 4.3 vs 28.7 ± 3.5, P = 0.005) and PA/Ao (0.90 ± 0.09 vs 0.85 ± 0.10, P = 0.017), whereas cardiac morphometry values were not significantly changed compared to baseline values. No vessel stump thrombosis was observed after LOBX. In comparison to LOBX, all ascertained values were significantly elevated after PNX. CONCLUSIONS Morphologic alterations of the cardiovascular system following PNX can be identified on CT scans. Alterations are more distinct after PNX compared to LOBX.
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Affiliation(s)
- Maximilian Rauch
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
| | - Milka Marinova
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
| | - Hans Heinz Schild
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
| | - Holger Strunk
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
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Hadizadeh D, Jost G, Keil V, Marx C, Rauch M, Schmeel F, Pietsch H, Schild H, Willinek W. Intra-individuelle quantitative und qualitative Bolus-Analyse von Dreiphasen-3D- und 4D-MRA mit Gadobutrol und Gadoterate Meglumine bei 1,5T und 3Tesla bei Minipigs. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - G Jost
- Bayer Pharma AG, MR und CT Kontrastmittel-Forschung, Berlin
| | - V Keil
- Universität Bonn, Radiologie, Bonn
| | - C Marx
- Universität Bonn, Radiologie, Bonn
| | - M Rauch
- Universität Bonn, Radiologie, Bonn
| | | | - H Pietsch
- Bayer Pharma AG, MR und CT Kontrastmittel-Forschung, Berlin
| | - H Schild
- Universität Bonn, Radiologie, Bonn
| | - W Willinek
- Krankenhaus der barmherzigen Brüder Trier, Radiologie, Neuroradiologie, Sonografie und Nuklearmedizin, Trier
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16
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Meier-Schroers M, Marx C, Schmeel F, Rauch M, Wolter K, Block W, Sprinkart A, Träber F, Willinek W, Schild H, Kukuk G. MultiVane XD für T2-gewichtete MRT-Aufnahmen der Prostata bei 3 Tesla: Auswirkungen auf die Abgrenzbarkeit von Läsionen, auf die PI-RADS-Klassifikation und auf Artefakte und Bildqualität. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - C Marx
- Uniklinik Bonn, Radiologie, Bonn
| | | | - M Rauch
- Uniklinik Bonn, Radiologie, Bonn
| | - K Wolter
- Uniklinik Bonn, Radiologie, Bonn
| | - W Block
- Uniklinik Bonn, Radiologie, Bonn
| | | | - F Träber
- Uniklinik Bonn, Radiologie, Bonn
| | - W Willinek
- Brüderkrankenhaus Trier, Radiologie, Neuroradiologie, Sonografie und Nuklearmedizin, Trier
| | - H Schild
- Uniklinik Bonn, Radiologie, Bonn
| | - G Kukuk
- Uniklinik Bonn, Radiologie, Bonn
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Moulder S, Hess K, Rauch M, Astrada B, Litton J, Mittendorf E, Ueno N, Tripathy D, Lim B, Piwnica-Worms H, Thompson A, Symmans WF. Abstract OT2-01-22: NCT02456857: A phase II trial of liposomal doxorubicin, bevacizumab and everolimus (DAE) in patients (pts) with localized triple-negative breast cancer (TNBC) with tumors predicted insensitive to standard neoadjuvant chemotherapy (NACT). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Approximately 50% of TNBC pts treated with standard taxane/anthracycline-based NACT will have chemo-insensitive disease (CID) manifested as extensive residual disease (RCB-II or III) at the time of surgery. 40-80% of these pts will develop recurrence within 3 years of initial diagnosis. Recent advances in molecular profiling have identified subsets of TNBC with distinct, targetable molecular features. We developed a clinical trial to identify and characterize CID (ARTEMIS: A Randomized, TNBC Enrolling trial to confirm Molecular profiling Improves Survival). In the ARTEMIS trial, treatment naïve pts with localized TNBC undergo a pretreatment biopsy and then immediately start their initial phase of anthracycline-based chemotherapy so that the results of the molecular characterization are used in combination with response assessment (clinical exam/diagnostic imaging) to identify CID and inform the second phase of NACT, thus using a 'second hit' strategy in the middle of NACT to overcome drug resistance. The mesenchymal subtypes of TNBC have a high incidence of PI3K pathway activation. Preclinical models demonstrated response to PI3K inhibitors in this subtype. Metaplastic breast cancers make up ∼30% of tumors characterized as 'claudin-low/mesenchymal' by gene signature and are also associated with a high rate of PI3K activating molecular aberrations. A combination regimen of liposomal doxorubicin, bevacizumab and the mTOR inhibitors temsirolimus or everolimus (DAT or DAE) demonstrated response (including durable complete responses) in metastatic metaplastic breast cancer.
PRIMARY OBJECTIVE: Determine the rate of pathologic complete response (pCR/RCB-0) or minimal residual disease (RCB-I) after 4 cycles of DAE for treatment of mesenchymal TNBC deemed to be CID through the ARTEMIS trial
TRIAL DESIGN AND STATISTICAL METHODS: Only pts deemed to have mesenchymal CID on the ARTEMIS trial can enter this non-randomized phase II study. Realizing that pts without response to their initial cycles of chemotherapy have very low chance (5%) of achieving pCR with additional cycles of chemotherapy, it would be clinically meaningful to see pCR in this pt population improved to 20%. Counting pCR (RCB-0) or RCB-I as response, a two-stage Gehan-type design will be employed with 14 pts in the first stage. If at least one pt responds, 23 more pts will be added for a total of 37 pts. This design has a 49% chance of terminating after the first stage if the true response rate is 0.05, 23% chance if the true rate is 0.10, 10% if the true rate is 0.15 and 4% if the true rate is 0.20. If accrual continues to the second stage and a total of 37 pts are enrolled, the 95% confidence interval for a 0.20 response rate will extend from 0.10 to 0.35.
BRIEF ELIGIBILITY CRITERIA: Inclusion: localized TNBC enrolled onto ARTEMIS trial, adequate organ, bone marrow and cardiac parameters Exclusion: metastatic disease, pregnant or lactating pts, medical illness that increases chance of moderate to severe toxicity
CORRELATIVE SCIENCE: Correlate vimentin expression by IHC, mesenchymal signatures and PI3K pathway aberrations with response.
Citation Format: Moulder S, Hess K, Rauch M, Astrada B, Litton J, Mittendorf E, Ueno N, Tripathy D, Lim B, Piwnica-Worms H, Thompson A, Symmans WF. NCT02456857: A phase II trial of liposomal doxorubicin, bevacizumab and everolimus (DAE) in patients (pts) with localized triple-negative breast cancer (TNBC) with tumors predicted insensitive to standard neoadjuvant chemotherapy (NACT) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-22.
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Affiliation(s)
- S Moulder
- University of Texas, MD Anderson Cancer Center
| | - K Hess
- University of Texas, MD Anderson Cancer Center
| | - M Rauch
- University of Texas, MD Anderson Cancer Center
| | - B Astrada
- University of Texas, MD Anderson Cancer Center
| | - J Litton
- University of Texas, MD Anderson Cancer Center
| | | | - N Ueno
- University of Texas, MD Anderson Cancer Center
| | - D Tripathy
- University of Texas, MD Anderson Cancer Center
| | - B Lim
- University of Texas, MD Anderson Cancer Center
| | | | - A Thompson
- University of Texas, MD Anderson Cancer Center
| | - WF Symmans
- University of Texas, MD Anderson Cancer Center
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Homsi R, Gieseke J, Luetkens J, Kupczyk P, Maedler B, Kukuk G, Träber F, Agha B, Rauch M, Rajakaruna N, Willinek W, Schild H, Hadizadeh D. Three-Dimensional Isotropic Fat-Suppressed Proton Density-Weighted MRI at 3 Tesla Using a T/R-Coil Can Replace Multiple Plane Two-Dimensional Sequences in Knee Imaging. ROFO-FORTSCHR RONTG 2016; 188:949-56. [DOI: 10.1055/s-0042-111826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- R. Homsi
- Department of Radiology, University of Bonn, Germany
| | | | - J. Luetkens
- Department of Radiology, University of Bonn, Germany
| | - P. Kupczyk
- Department of Radiology, University of Bonn, Germany
| | | | - G. Kukuk
- Department of Radiology, University of Bonn, Germany
| | - F. Träber
- Center for Radiology, Neuroradiology, Sonography and Nuclear Medicine, Krankenhaus der Barmherzigen Brueder Trier, Germany
| | - B. Agha
- Department of Radiology, University of Bonn, Germany
| | - M. Rauch
- Department of Radiology, University of Bonn, Germany
| | - N. Rajakaruna
- Department of Radiology, University of Bonn, Germany
| | - W. Willinek
- Department of Radiology, University of Bonn, Germany
| | - H. Schild
- Department of Radiology, University of Bonn, Germany
| | - D. Hadizadeh
- Department of Radiology, University of Bonn, Germany
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Strunk HM, Henseler J, Rauch M, Mücke M, Kukuk G, Cuhls H, Radbruch L, Zhang L, Schild HH, Marinova M. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. ROFO-FORTSCHR RONTG 2016; 188:662-70. [PMID: 27272685 DOI: 10.1055/s-0042-105517] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Evaluation of ultrasound-guided high-intensity focused ultrasound (HIFU) used for the first time in Germany in patients with inoperable pancreatic cancer for reduction of tumor volume and relief of tumor-associated pain. MATERIALS AND METHODS 15 patients with locally advanced inoperable pancreatic cancer and tumor-related pain symptoms were treated by HIFU (n = 6 UICC stage III, n = 9 UICC stage IV). 13 patients underwent simultaneous standard chemotherapy. Ablation was performed using the JC HIFU system (Chongqing, China HAIFU Company) with an ultrasonic device for real-time imaging. Imaging follow-up (US, CT, MRI) and clinical assessment using validated questionnaires (NRS, BPI) was performed before and up to 15 months after HIFU. RESULTS Despite biliary or duodenal stents (4/15) and encasement of visceral vessels (15/15), HIFU treatment was performed successfully in all patients. Treatment time and sonication time were 111 min and 1103 s, respectively. The applied total energy was 386 768 J. After HIFU ablation, contrast-enhanced imaging showed devascularization of treated tumor regions with a significant average volume reduction of 63.8 % after 3 months. Considerable pain relief was achieved in 12 patients after HIFU (complete or partial pain reduction in 6 patients). CONCLUSION US-guided HIFU with a suitable acoustic pathway can be used for local tumor control and relief of tumor-associated pain in patients with locally advanced pancreatic cancer. KEY POINTS • US-guided HIFU allows an additive treatment of unresectable pancreatic cancer.• HIFU can be used for tumor volume reduction.• Using HIFU, a significant reduction of cancer-related pain was achieved.• HIFU provides clinical benefit in patients with pancreatic cancer. Citation Format: • Strunk HM, Henseler J, Rauch M et al. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. Fortschr Röntgenstr 2016; 188: 662 - 670.
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Affiliation(s)
| | | | - M Rauch
- Department of Radiology, Medical School & Hospital, University of Bonn
| | - M Mücke
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn
| | - G Kukuk
- Department of Radiology, Medical School & Hospital, University of Bonn
| | - H Cuhls
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn
| | - L Radbruch
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn
| | - L Zhang
- Chongqing Key Laboratory of Ultrasound in Medicine and Engineeríng, Chongqing Medical University, China
| | - H H Schild
- Department of Radiology, Medical School & Hospital, University of Bonn
| | - M Marinova
- Department of Radiology, Medical School & Hospital, University of Bonn
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Marinova M, Rauch M, Mücke M, Rolke R, Gonzalez-Carmona MA, Henseler J, Cuhls H, Radbruch L, Strassburg CP, Zhang L, Schild HH, Strunk HM. High-intensity focused ultrasound (HIFU) for pancreatic carcinoma: evaluation of feasibility, reduction of tumour volume and pain intensity. Eur Radiol 2016; 26:4047-4056. [PMID: 26886904 DOI: 10.1007/s00330-016-4239-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/08/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Prognosis of patients with locally advanced pancreatic adenocarcinoma is extremely poor. They often suffer from cancer-related pain reducing their quality of life. This prospective observational study aimed to evaluate feasibility, local tumour response, and changes in quality of life and symptoms in Caucasian patients with locally advanced pancreatic cancer treated by ultrasound-guided high-intensity focused ultrasound (HIFU). METHODS Thirteen patients underwent HIFU, five with stage III, eight with stage IV UICC disease. Ten patients received simultaneous palliative chemotherapy. Postinterventional clinical assessment included evaluation of quality of life and symptom changes using standardized questionnaires. CT and MRI follow-up evaluated the local tumour response. RESULTS HIFU was successfully performed in all patients. Average tumour reduction was 34.2 % at 6 weeks and 63.9 % at 3 months. Complete or partial relief of cancer-related pain was achieved in 10 patients (77 %), five of whom required less analgesics for pain control. Quality of life was improved revealing increased global health status and alleviated symptoms. HIFU treatment was well tolerated. Eight patients experienced transient abdominal pain directly after HIFU. CONCLUSIONS HIFU ablation of pancreatic carcinoma is a feasible, safe and effective treatment with a crucial benefit in terms of reduction of tumour volume and pain intensity. KEY POINTS • US-guided HIFU is feasible and safe for patients with unresectable pancreatic cancer. • HIFU can considerably reduce tumour volume and cancer-related pain. • Patients treated with HIFU experienced significant and lasting reduction of pain intensity. • HIFU has a crucial clinical benefit for patients with pancreatic cancer.
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Affiliation(s)
- Milka Marinova
- Department of Radiology, Medical School & Hospital, University of Bonn, Siegmund-Freud-Str. 25, D-53105, Bonn, Germany.
| | - Maximilian Rauch
- Department of Radiology, Medical School & Hospital, University of Bonn, Siegmund-Freud-Str. 25, D-53105, Bonn, Germany
| | - Martin Mücke
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn, Bonn, Germany.,Department of General Practice and Family Medicine, Medical School & Hospital, University of Bonn, Bonn, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | | | - Jana Henseler
- Department of Radiology, Medical School & Hospital, University of Bonn, Siegmund-Freud-Str. 25, D-53105, Bonn, Germany
| | - Henning Cuhls
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, Medical School & Hospital, University of Bonn, Bonn, Germany
| | - Lian Zhang
- Clinical Center of Tumor Therapy Chongqing, Chongqing, China
| | - Hans H Schild
- Department of Radiology, Medical School & Hospital, University of Bonn, Siegmund-Freud-Str. 25, D-53105, Bonn, Germany
| | - Holger M Strunk
- Department of Radiology, Medical School & Hospital, University of Bonn, Siegmund-Freud-Str. 25, D-53105, Bonn, Germany
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Kosulin K, Geiger E, Vécsei A, Huber WD, Rauch M, Brenner E, Wrba F, Hammer K, Innerhofer A, Pötschger U, Lawitschka A, Matthes-Leodolter S, Fritsch G, Lion T. Persistence and reactivation of human adenoviruses in the gastrointestinal tract. Clin Microbiol Infect 2015; 22:381.e1-381.e8. [PMID: 26711435 DOI: 10.1016/j.cmi.2015.12.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 11/25/2022]
Abstract
Reactivation of persistent human adenoviruses (HAdVs) is associated with high morbidity and mortality in paediatric haematopoietic stem cell transplant (HSCT) recipients. Although invasive HAdV infections mainly arise from the gastrointestinal (GI) tract, the specific sites of HAdV persistence are not well characterised. We prospectively screened biopsies from 143 non-HSCT paediatric patients undergoing GI endoscopy and monitored serial stool specimens from 148 paediatric HSCT recipients for the presence of HAdV by real-time PCR. Persistence of HAdV in the GI tract was identified in 31% of children, with the highest prevalence in the terminal ileum. In situ hybridisation and immunohistochemistry identified HAdV persistence in lymphoid cells of the lamina propria, whereas biopsies from five transplant recipients revealed high numbers of replicating HAdV in intestinal epithelial cells. The prevalence of HAdV species, the frequencies of persistence in the GI tract and reactivations post transplant indicated a correlation of intestinal HAdV shedding pre-transplant with high risk of invasive infection. HAdV persistence in the GI tract is a likely origin of infectious complications in immunocompromised children. Intestinal lymphocytes represent a reservoir for HAdV persistence and reactivation, whereas the intestinal epithelium is the main site of viral proliferation preceding dissemination. The findings have important implications for assessing the risk of life-threatening invasive HAdV infections.
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Affiliation(s)
- K Kosulin
- Children's Cancer Research Institute, Vienna, Austria
| | - E Geiger
- Children's Cancer Research Institute, Vienna, Austria
| | - A Vécsei
- St Anna Children's Hospital, Vienna, Austria
| | - W-D Huber
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - M Rauch
- Children's Cancer Research Institute, Vienna, Austria
| | - E Brenner
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - F Wrba
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - K Hammer
- St Anna Children's Hospital, Vienna, Austria
| | | | - U Pötschger
- Children's Cancer Research Institute, Vienna, Austria
| | | | | | - G Fritsch
- Children's Cancer Research Institute, Vienna, Austria
| | - T Lion
- Children's Cancer Research Institute, Vienna, Austria; Department of Paediatrics, Medical University of Vienna, Vienna, Austria.
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Affiliation(s)
- Maximilian Rauch
- University Hospital Bonn, Department of Radiology, Bonn, Germany.
| | - Milka Marinova
- University Hospital Bonn, Department of Radiology, Bonn, Germany
| | | | - Holger Strunk
- University Hospital Bonn, Department of Radiology, Bonn, Germany
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Marinova M, Rauch M, Schild HH, Strunk HM. Novel Non-invasive Treatment With High-intensity Focused Ultrasound (HIFU). Ultraschall Med 2015; 37:46-55. [PMID: 26251996 DOI: 10.1055/s-0035-1553318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ultrasound is not only used for diagnostic purposes but it also can be applied therapeutically so far that nowadays high-intensity focused ultrasound (HIFU) even represents a novel non-invasive treatment modality for various solid tumors. HIFU works by causing selectively deep tissue destruction of target lesions within the body without harming adjacent and overlying structures. In this article, we present an overview on both the mode of action and requirements for a HIFU treatment as well as on the safety and the current status of indications and possible applications with regard to benign and malignant gynecological diseases. Based on numerous studies and original articles, HIFU proved to be an effective and low-risk treatment option particularly for uterine fibroids and adenomyosis, but it also seems to be effective for breast fibroadenomas or even for breast cancer in special cases and other rare entities.
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Marinova M, Rauch M, Lakghomi A, Henseler J, Zhang L, Schild H, Strunk H. Nicht-invasive Tumorablation mit hoch-intensivem fokussierten Ultraschall (HIFU): erste klinische Therapieerfahrungen bei Patienten mit inoperablem Pankreaskarzinom. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Strunk H, Meier M, Schild H, Rauch M. Embolisation der Testikularvenen zur Behandlung der benignen Prostatahyperplasie – eine Zwischenbilanz. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Marinova M, Rauch M, Strunk H. Ultrasound-based therapies not mentioned. Dtsch Arztebl Int 2015; 112:60. [PMID: 25797427 DOI: 10.3238/arztebl.2015.0060a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Strunk H, Meier M, Schild H, Rauch M. Treatment of Benign Prostatic Hyperplasia by Occlusion of the Impaired Urogenital Venous System – First Experience. ROFO-FORTSCHR RONTG 2014; 187:180-6. [DOI: 10.1055/s-0034-1385353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Weller M, Thiel E, Martus P, Mohle R, Griesinger F, Rauch M, Roeth A, Hertenstein B, Fischer T, Hundsberger T, Mergenthaler HG, Junghanss C, Birnbaum T, Fischer L, Jahnke K, Herrlinger U, Pietsch T, Roth P, Bamberg M, Korfel A. AT-59 * HIGH-DOSE MTX-BASED CHEMOTHERAPY FOR PRIMARY CNS LYMPHOMA: WITH OR WITHOUT WHOLE BRAIN RADIOTHERAPY? FINAL ANALYSIS OF G-PCNSL-SG-1. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lenz K, Dieplinger B, Buder R, Piringer P, Rauch M, Voglmayr M. Successful treatment of partial portal vein thrombosis (PVT) with low dose rivaroxaban. Z Gastroenterol 2014; 52:1175-7. [PMID: 25313630 DOI: 10.1055/s-0034-1385171] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In a 63-year-old cirrhotic patient, recanalisation of a partial portal vein thrombosis was achieved by a low dose of rivaroxaban (10 mg daily). After anticoagulant therapy was stopped, partial vein thrombosis recurred. Restarting rivaroxaban at a dose of 10 mg led to recanalisation. The patient did not suffer any complications; in particular no bleeding occurred during 8 months of treatment.
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Affiliation(s)
- K Lenz
- Internal and Intensive Care Medicine, Konventhospital Barmherzige Brüder, Linz
| | - B Dieplinger
- Central Laboratory, Konventhospital Barmherzige Brüder, Linz
| | - R Buder
- Internal and Intensive Care Medicine, Konventhospital Barmherzige Brüder, Linz
| | - P Piringer
- Internal and Intensive Care Medicine, Konventhospital Barmherzige Brüder, Linz
| | - M Rauch
- Radiology, Konventhospital Barmherzige Brüder, Linz
| | - M Voglmayr
- Internal and Intensive Care Medicine, Konventhospital Barmherzige Brüder, Linz
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Abstract
Diagnostic imaging of angiosarcoma and angiosarcoma metastasis has been described as confusing and challenging. We present a rare case of hepatic soft tissue angiosarcoma metastasis, which was diagnosed by contrast enhanced ultrasound (CEUS). The case further exemplifies the ability of CEUS to solve discrepancies between other imaging modalities.
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Affiliation(s)
| | - Hans H Schild
- Department of Radiology, University Hospital Bonn, Germany
| | - Holger Strunk
- Department of Radiology, University Hospital Bonn, Germany
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31
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Arshad M, Patrat-Delon SD, L’Helgoualc’h A, Rauch M, Lucas-Clerc CC, Girard JP, Piquet-Pellorce C, Samson M. P094 NKT cells and TRAIL induce hepatocyte IL-33 in murine acute hepatitis. Cytokine 2012. [DOI: 10.1016/j.cyto.2012.06.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Korfel A, Weller M, Martus P, Roth P, Klasen HA, Roeth A, Rauch M, Hertenstein B, Fischer T, Hundsberger T, Leithäuser M, Birnbaum T, Kirchen H, Mergenthaler HG, Schubert J, Berdel W, Birkmann J, Hummel M, Thiel E, Fischer L. Prognostic impact of meningeal dissemination in primary CNS lymphoma (PCNSL): experience from the G-PCNSL-SG1 trial. Ann Oncol 2012; 23:2374-2380. [PMID: 22396446 DOI: 10.1093/annonc/mdr627] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We evaluated the frequency and prognostic impact of meningeal dissemination (MD) in immunocompetent adult patients with primary central nervous system lymphoma treated in a randomized phase III trial. PATIENTS AND METHODS MD was evaluated at study entry and defined by lymphoma proof in the meningeal compartment detected by at least one of the following methods: cerebrospinal fluid (CSF) cytomorphology, detection of clonal B cells by IgH PCR in CSF or contrast enhancement of the leptomeninges on magnetic resonance imaging (MRI). RESULTS Data on MD were available in 415 patients, of those, MD was detected in 65 (15.7%): in 44/361 (12.2%) by CSF cytomorphology, in 16/152 (10.5%) by PCR and in 17/415 (4.1%) by MRI. Major patients' characteristics and therapy did not significantly differ between patients with MD (MD+) versus those without MD (MD-). There was a significant correlation of MD with CSF pleocytosis (>5/μl; P < 0.0001), but no correlation with CSF protein elevation (>45 mg/dl). Median progression-free survival was 6.7 months [95% confidence interval (CI) 0-14.5] in MD+ and 8.3 months (5.7-10.8) in MD- patients (P = 0.95); median overall survival was 21.5 months (95% CI 16.8-26.1) and 24.9 months (17.5-32.3), respectively (P = 0.98). CONCLUSION MD was detected infrequently and had no impact on outcome in this trial.
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Affiliation(s)
- A Korfel
- Department of Hematology & Oncology, Campus Benjamin Franklin, Charite Berlin, Berlin, Germany.
| | - M Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Tuebingen, Tuebingen
| | - P Martus
- Institute of Biostatistics, University Tuebingen, Tuebingen; Institute of Biostatistics, University Hospital Tuebingen, Tuebingen
| | - P Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Tuebingen, Tuebingen
| | - H A Klasen
- Department of Hematology & Oncology, Pius Hospital, Oldenburg
| | - A Roeth
- Department of Hematology, West German Cancer Center, University Hospital Essen, Essen
| | - M Rauch
- Department of Hematology & Oncology, Evangelisches Krankenhaus Bielefeld, Bielefeld
| | - B Hertenstein
- Department of Hematology & Oncology, Klinikum Bremen Mitte, Bremen
| | - T Fischer
- Department of Hematology & Oncology, University of Magdeburg, Magdeburg
| | - T Hundsberger
- Department of Hematology & Oncology, University Hospital Mainz, Mainz, Germany; Department of Neurology, Cantonal Hospital, St Gallen, Switzerland
| | - M Leithäuser
- Department of Hematology & Oncology, University Hospital Rostock, Rostock
| | - T Birnbaum
- Department of Neurology, University Hospital Grosshadern, Munich
| | - H Kirchen
- Department of Hematology & Oncology, Hospital Trier, Trier
| | - H-G Mergenthaler
- Department of Oncology & Hematology, Klinikum Stuttgart, Stuttgart
| | - J Schubert
- Department of Neurology, Hospital Minden, Minden
| | - W Berdel
- Department of Medicine A, University Hospital Muenster, Muenster
| | - J Birkmann
- Department of Hematology & Oncology, Hospital Nürnberg, Nürnberg
| | - M Hummel
- Department of Pathology, Campus Benjamin Franklin, Charite Berlin, Germany
| | - E Thiel
- Department of Hematology & Oncology, Campus Benjamin Franklin, Charite Berlin, Berlin, Germany
| | - L Fischer
- Department of Hematology & Oncology, Campus Benjamin Franklin, Charite Berlin, Berlin, Germany
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Szardien S, Nef HM, Voss S, Troidl C, Liebetrau C, Hoffmann J, Rauch M, Mayer K, Kimmich K, Rolf A, Rixe J, Troidl K, Kojonazarov B, Schermuly RT, Kostin S, Elsässer A, Hamm CW, Möllmann H. Regression of cardiac hypertrophy by granulocyte colony-stimulating factor-stimulated interleukin-1β synthesis. Eur Heart J 2011; 33:595-605. [PMID: 22106340 DOI: 10.1093/eurheartj/ehr434] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIMS Aortic stenosis causes cardiac hypertrophy and fibrosis, which often persists despite pressure unloading after aortic valve replacement. The persistence of myocardial fibrosis in particular leads to impaired cardiac function and increased mortality. We investigated whether granulocyte colony-stimulating factor (G-CSF) beneficially influences cardiac remodelling after pressure unloading. METHODS AND RESULTS Left ventricular hypertrophy was induced by transverse aortic constriction in C57bl6 mice followed by debanding after 8 weeks. This model closely mimics aortic stenosis and subsequent aortic valve replacement. After debanding, mice were treated with either G-CSF or saline injection. Granulocyte colony-stimulating factor treatment significantly improved systolic (ejection fraction 70.48 ± 1.17 vs. 58.41 ± 1.56%, P < 0.001) and diastolic (E/E' 26.0 ± 1.0 vs. 32.6 ± 0.8, P < 0.05) function. Furthermore, cardiac fibrosis was significantly reduced in G-CSF-treated mice (collagen-I area fraction 7.96 ± 0.47 vs. 11.64 ± 1.22%, P < 0.05; collagen-III area fraction 10.73 ± 0.99 vs. 18.46 ± 0.71%, P < 0.001). Direct effects of G-CSF on cardiac fibroblasts or a relevant transdifferentiation of mobilized bone marrow cells could be excluded. However, a considerable infiltration of neutrophils was observed in G-CSF-treated mice. This sterile inflammation was accompanied by a selective release of interleukin-1 β (IL-1β) in the absence of other proinflammatory cytokines. In vitro experiments confirmed an increased expression of IL-1β in neutrophils after G-CSF treatment. Interleukin-1β directly induced the expression of the gelatinases matrix metalloproteinase-2 (MMP-2) and MMP-9 in cardiac fibroblasts thereby providing the regression of cardiac fibrosis. CONCLUSION Granulocyte colony-stimulating factor treatment improves the cardiac function and leads to the regression of myocardial fibrosis after pressure unloading. These findings reveal a previously unknown mechanism of fibrosis regression. Granulocyte colony-stimulating factor might be a potential pharmacological treatment approach for patients suffering from congestive heart failure after aortic valve replacement, although further basic research and clinical trials are required in order to prove beneficial effects of G-CSF in the human organism.
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Affiliation(s)
- Sebastian Szardien
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, D-61231 Bad Nauheim, Germany
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Martus P, Jahnke K, Korfel A, Rose T, Fischer L, Moehle R, Klasen HA, Rauch M, Roeth A, Hertenstein B, Fischer T, Hundsberger T, Mergenthaler H, Leithäuser M, Birnbaum T, Herrlinger U, Schubert J, Birkmann J, Weller M, Thiel E. Prognostic factors for chemotherapy-related toxicity in primary central nervous system lymphoma (PCNSL) treated with high-dose methotrexate (HDMTX) with or without ifosfamide: Results from a German phase III trial (G-PCNSL-SG-1). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jahnke K, Korfel A, Martus P, Lokka S, Moehle R, Griesinger F, Rauch M, Roeth A, Hertenstein B, Fischer T, Hundsberger T, Mergenthaler H, Leithäuser M, Birnbaum T, Herrlinger U, Schubert J, Florschütz A, Fischer L, Weller M, Thiel E. Prognostic factors for response and survival in primary central nervous system lymphoma (PCNSL) from a randomized phase III trial (G-PCNSL-SG-1). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Korfel A, Fischer L, Martus P, Moehle R, Klasen HA, Rauch M, Roeth A, Hertenstein B, Fischer T, Mergenthaler H, Hundsberger T, Leithäuser M, Birnbaum T, Florschütz A, Jahnke K, Herrlinger U, Weller M, Thiel E. Impact of meningeal dissemination (MD) on outcome in primary CNS lymphoma in the G-PCNSL-SG1 trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lichtenauer M, Werba G, Mildner M, Hasun M, Baumgartner A, Nickl S, Mitterbauer A, Rauch M, Zimmermann M, Podesser B, Klepetko W, Ankersmit H. 258 Administration of Anti-Thymocyte Globulin (ATG) Preserves Cardiac Function after Experimental Myocardial Infarction. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Thiel E, Korfel A, Martus P, Kanz L, Griesinger F, Rauch M, Fischer L, Pietsch T, Bamberg M, Weller M. Should whole-brain radiotherapy be considered standard of care in newly diagnosed primary central nervous system lymphoma? The G-PCNSL-SG1 randomized phase IV trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nath P, Nelson B, Davoudiasl H, Dutta B, Feldman D, Liu Z, Han T, Langacker P, Mohapatra R, Valle J, Pilaftsis A, Zerwas D, AbdusSalam S, Adam-Bourdarios C, Aguilar-Saavedra J, Allanach B, Altunkaynak B, Anchordoqui LA, Baer H, Bajc B, Buchmueller O, Carena M, Cavanaugh R, Chang S, Choi K, Csáki C, Dawson S, de Campos F, De Roeck A, Dührssen M, Éboli O, Ellis J, Flächer H, Goldberg H, Grimus W, Haisch U, Heinemeyer S, Hirsch M, Holmes M, Ibrahim T, Isidori G, Kane G, Kong K, Lafaye R, Landsberg G, Lavoura L, Lee JS, Lee SJ, Lisanti M, Lüst D, Magro M, Mahbubani R, Malinsky M, Maltoni F, Morisi S, Mühlleitner M, Mukhopadhyaya B, Neubert M, Olive K, Perez G, Pérez PF, Plehn T, Pontón E, Porod W, Quevedo F, Rauch M, Restrepo D, Rizzo T, Romão J, Ronga F, Santiago J, Schechter J, Senjanović G, Shao J, Spira M, Stieberger S, Sullivan Z, Tait TM, Tata X, Taylor T, Toharia M, Wacker J, Wagner C, Wang LT, Weiglein G, Zeppenfeld D, Zurek K. The Hunt for New Physics at the Large Hadron Collider. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.nuclphysbps.2010.03.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lion T, Kosulin K, Landlinger C, Rauch M, Preuner S, Jugovic D, Pötschger U, Lawitschka A, Peters C, Fritsch G, Matthes-Martin S. Monitoring of adenovirus load in stool by real-time PCR permits early detection of impending invasive infection in patients after allogeneic stem cell transplantation. Leukemia 2010; 24:706-14. [PMID: 20147979 DOI: 10.1038/leu.2010.4] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Invasive adenovirus (AdV) infections are associated with high morbidity and mortality in allogeneic stem cell transplant recipients. We observed that molecular detection of the virus in stool specimens commonly precedes AdV viremia, suggesting that intestinal infections may represent a common source of virus dissemination. To address this notion, we have investigated 153 consecutive allogeneic transplantations in 138 pediatric patients by quantitative monitoring of AdV in stool specimens and peripheral blood by a pan-adenovirus real-time (RQ)-PCR approach. AdV was detectable in serial stool specimens in all cases of AdV viremia during the post-transplant course (P<0.0001). The incidence of AdV viremia in individuals with peak virus levels in stool specimens above 1 x 10E6 copies per gram (n=22) was 73% vs 0% in patients with AdV levels in stool specimens below this threshold (n=29; P<0.0001). Serial measurement of AdV levels in stool specimens by RQ-PCR permitted early diagnosis of impending invasive infection with a sensitivity and specificity of 100% (95% confidence interval (CI) 96-100%) and 83% (95% CI 67-92%), respectively. The median time span between detection of AdV loads in stool specimens above 1 x 10E6 copies per gram and first observation of viremia was 11 days (range 0-192). Quantitative monitoring of the AdV load in stool specimens therefore provides a rationale for early initiation of antiviral treatment with the aim of preventing progression to life-threatening invasive infection.
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Affiliation(s)
- T Lion
- Children's Cancer Research Institute, Vienna, Austria.
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Nef HM, Möllmann H, Joseph A, Troidl C, Voss S, Rauch M, Kinscherf R, Vogt A, Weber M, Hamm CW, Elsässer A. Reduction of neointimal hyperplasia in porcine coronary arteries by 2-deoxy-D-glucose. Clin Res Cardiol 2009; 98:355-61. [PMID: 19543785 DOI: 10.1007/s00392-009-0020-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 04/16/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The drug eluting stents have been shown to play a substantial role in preventing in-stent restenosis. This study was initiated to determine the efficacy of 2-deoxy-D-glucose (2-DG) in an in-stent restenosis model for reducing neointimal hyperplasia after coronary stent placement. METHODS In a porcine overstretch model, three kinds of stents were investigated (n = 12 per group): bare metal stents (BMS), rapamycin-eluted stents (RES), and BMS after intracoronary short-term application of 2-DG (DGS). After 42 days histomorphometric and histopathological analyses were performed. RESULTS Neointimal thickness (BMS: 0.38 +/- 0.08, RES: 0.24 +/- 0.11, DGS: 0.15 +/- 0.01), area stenosis (BMS: 47.39 +/- 2.76, RES: 32.2 +/- 2.08, DGS: 29.30 +/- 2.98) did not differ after 42 days between the RES and DGS but were significantly lower as compared to BMS only. Lumen area (BMS: 3.15 +/- 1.53, RES: 4.37 +/- 1.72, DGS: 4.77 +/- 2.14) was significantly higher in the DGS group in comparison to the BMS group. The calculated injury and inflammation scores were similar and re-endothelialization was confirmed in all groups. CONCLUSIONS This study could demonstrate that in porcine stent model neointimal hyperplasia and re-endothelialization after application of 2-DG are comparable to those seen in RES. Thus, 2-DG might be a promising clinical application for coronary stent coating.
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Affiliation(s)
- Holger M Nef
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
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Hau P, Koch D, Hundsberger T, Marg E, Bauer B, Rudolph R, Rauch M, Brenner A, Rieckmann P, Schuth J, Jauch T, Koch H, Bogdahn U. Safety and feasibility of long-term temozolomide treatment in patients with high-grade glioma. Neurology 2007; 68:688-90. [PMID: 17325277 DOI: 10.1212/01.wnl.0000255937.27012.ee] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We surveyed neuro-oncologists regarding patients treated with temozolomide for at least 12 cycles or 12 months. Patients receiving first-line temozolomide for a median 13 cycles had a median progression-free survival (PFS) of 14 months. Patients with recurrent disease receiving a median 14 cycles had a median PFS of 15.5 months. A small percentage of patients experienced grade III to IV toxicity. These results suggest that long-term treatment with temozolomide is feasible and well tolerated.
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Affiliation(s)
- P Hau
- Department of Neurology, District Medical Center, University of Regensburg, Regensburg, Germany.
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Rauch M, Léna H, Brinchault G, Leveiller G, Delaval P. 283 Rupture de prothèse endotrachéale : à propos de trois cas dans la trachéobronchomalacie. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72659-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fox DB, Frail DA, Price PA, Kulkarni SR, Berger E, Piran T, Soderberg AM, Cenko SB, Cameron PB, Gal-Yam A, Kasliwal MM, Moon DS, Harrison FA, Nakar E, Schmidt BP, Penprase B, Chevalier RA, Kumar P, Roth K, Watson D, Lee BL, Shectman S, Phillips MM, Roth M, McCarthy PJ, Rauch M, Cowie L, Peterson BA, Rich J, Kawai N, Aoki K, Kosugi G, Totani T, Park HS, MacFadyen A, Hurley KC. The afterglow of GRB 050709 and the nature of the short-hard gamma-ray bursts. Nature 2005; 437:845-50. [PMID: 16208362 DOI: 10.1038/nature04189] [Citation(s) in RCA: 391] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 08/30/2005] [Indexed: 11/09/2022]
Abstract
The final chapter in the long-standing mystery of the gamma-ray bursts (GRBs) centres on the origin of the short-hard class of bursts, which are suspected on theoretical grounds to result from the coalescence of neutron-star or black-hole binary systems. Numerous searches for the afterglows of short-hard bursts have been made, galvanized by the revolution in our understanding of long-duration GRBs that followed the discovery in 1997 of their broadband (X-ray, optical and radio) afterglow emission. Here we present the discovery of the X-ray afterglow of a short-hard burst, GRB 050709, whose accurate position allows us to associate it unambiguously with a star-forming galaxy at redshift z = 0.160, and whose optical lightcurve definitively excludes a supernova association. Together with results from three other recent short-hard bursts, this suggests that short-hard bursts release much less energy than the long-duration GRBs. Models requiring young stellar populations, such as magnetars and collapsars, are ruled out, while coalescing degenerate binaries remain the most promising progenitor candidates.
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Affiliation(s)
- D B Fox
- Division of Physics, Mathematics and Astronomy, California Institute of Technology, Pasadena, California 91125, USA.
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Dupont M, Mignard S, Rauch M, Depatureaux A, Donnio P, Tattevin P, Michelet C. G-16 Intérêt de l'amplification de l'arn 16S pour le diagnostic de la maladie des griffes du chat. 4 observations. Med Mal Infect 2004. [DOI: 10.1016/s0399-077x(04)90239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ohlerth S, Busato A, Rauch M, Weber U, Lang J. Comparison of three distraction methods and conventional radiography for early diagnosis of canine hip dysplasia. J Small Anim Pract 2003; 44:524-9. [PMID: 14692548 DOI: 10.1111/j.1748-5827.2003.tb00114.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two radiographic distraction techniques (one employing a wooden lath and, the other, a PennHip distractor), an ultrasonographic distraction method and conventional radiographic Fédération Cynologique Internationale (FCI) hip score were evaluated in eight-month-old Labrador retrievers to determine the most reliable method for predicting radiographic FCI hip score at the age of one year. With reference to the FCI hip score, sensitivity and specificity of the PennHip method were 100 per cent and 54 per cent; sensitivity and specificity of the lath technique were 85 per cent and 71 per cent; whereas they were 62 per cent and 67 per cent for the ultrasonographic method. For all distraction methods, the positive predictive value (PPV) was moderate and the negative predictive value (NPV) was high. Sensitivity, specificity, PPV and NPV were 100 per cent for the FCI hip score. It is concluded that, at the age of eight months, FCI hip score is the most reliable method for predicting FCI hip score at the age of one year in the colony of dogs investigated. Both the PennHip and lath method were also clinically reliable techniques in predicting true negatives. The ultrasonographic distraction method was moderately reliable.
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Affiliation(s)
- S Ohlerth
- Section of Radiology, Department of Veterinary Clinical Sciences, University of Bern, Langgasse 124, 3001 Bern, Switzerland
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Abstract
In the psychiatric clinic, delirious states are rare as the first symptoms of paraneoplastic syndrome, and the aetiology can only be clarified by consequent differential diagnostic efforts. We report the case of a 49-year-old man who was admitted to our psychiatric unit with delirium. Laboratory investigations showed hyponatraemia, serum hypo-osmolality, and urine hyperosmolality characterising the syndrome of inappropriate antidiuresis (SIADH). As a paraneoplastic syndrome, SIADH is most frequently associated with small-cell lung cancer (SCLC). Whereas chest X-ray was negative, chest CT scan and bronchoscopy including histology revealed a SCLC at an early stage of limited disease. Early oncological therapy made it possible for our patient to return to work with a satisfactory quality of life. Twenty-one months after first admission, he died as a result of recurrent SCLC metastases.
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Affiliation(s)
- A Günther
- Zentrum für Psychiatrie und Psychotherapeutische Medizin, Krankenanstalten Gilead, Bethel, Bielefeld.
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Sunn N, Egli M, Burazin TCD, Burns P, Colvill L, Davern P, Denton DA, Oldfield BJ, Weisinger RS, Rauch M, Schmid HA, McKinley MJ. Circulating relaxin acts on subfornical organ neurons to stimulate water drinking in the rat. Proc Natl Acad Sci U S A 2002; 99:1701-6. [PMID: 11830674 PMCID: PMC122254 DOI: 10.1073/pnas.022647699] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Relaxin, a peptide hormone secreted by the corpus luteum during pregnancy, exerts actions on reproductive tissues such as the pubic symphysis, uterus, and cervix. It may also influence body fluid balance by actions on the brain to stimulate thirst and vasopressin secretion. We mapped the sites in the brain that are activated by i.v. infusion of a dipsogenic dose of relaxin (25 microg/h) by immunohistochemically detecting Fos expression. Relaxin administration resulted in increased Fos expression in the subfornical organ (SFO), organum vasculosum of the lamina terminalis (OVLT), median preoptic nucleus, and magnocellular neurons in the supraoptic and paraventricular nuclei. Ablation of the SFO abolished relaxin-induced water drinking, but did not prevent increased Fos expression in the OVLT, supraoptic or paraventricular nuclei. Although ablation of the OVLT did not inhibit relaxin-induced drinking, it did cause a large reduction in Fos expression in the supraoptic nucleus and posterior magnocellular subdivision of the paraventricular nucleus. In vitro single-unit recording of electrical activity of neurons in isolated slices of the SFO showed that relaxin (10(-7) M) added to the perfusion medium caused marked and prolonged increase in neuronal activity. Most of these neurons also responded to 10(-7) M angiotensin II. The data indicate that blood-borne relaxin can directly stimulate neurons in the SFO to initiate water drinking. It is likely that circulating relaxin also stimulates neurons in the OVLT that influence vasopressin secretion. These two circumventricular organs that lack a blood-brain barrier may have regulatory influences on fluid balance during pregnancy in rats.
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Affiliation(s)
- N Sunn
- Howard Florey Institute of Experimental Physiology and Medicine, University of Melbourne, Victoria 3010, Australia
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Hubbard C, Singleton D, Rauch M, Jayasinghe S, Cafiso D, Castle D. The secretory carrier membrane protein family: structure and membrane topology. Mol Biol Cell 2000; 11:2933-47. [PMID: 10982391 PMCID: PMC14966 DOI: 10.1091/mbc.11.9.2933] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Secretory carrier membrane proteins (SCAMPs) are integral membrane proteins found in secretory and endocytic carriers implicated to function in membrane trafficking. Using expressed sequence tag database and library screens and DNA sequencing, we have characterized several new SCAMPs spanning the plant and animal kingdoms and have defined a broadly conserved protein family. No obvious fungal homologue has been identified, however. We have found that SCAMPs share several structural motifs. These include NPF repeats, a leucine heptad repeat enriched in charged residues, and a proline-rich SH3-like and/or WW domain-binding site in the N-terminal domain, which is followed by a membrane core containing four putative transmembrane spans and three amphiphilic segments that are the most highly conserved structural elements. All SCAMPs are 32-38 kDa except mammalian SCAMP4, which is approximately 25 kDa and lacks most of the N-terminal hydrophilic domain of other SCAMPs. SCAMP4 is authentic as determined by Northern and Western blotting, suggesting that this portion of the larger SCAMPs encodes the functional domain. Focusing on SCAMP1, we have characterized its structure further by limited proteolysis and Western blotting with the use of isolated secretory granules as a uniformly oriented source of antigen and by topology mapping through expression of alkaline phosphatase gene fusions in Escherichia coli. Results show that SCAMP1 is degraded sequentially from the N terminus and then the C terminus, yielding an approximately 20-kDa membrane core that contains four transmembrane spans. Using synthetic peptides corresponding to the three conserved amphiphilic segments of the membrane core, we have demonstrated their binding to phospholipid membranes and shown by circular dichroism spectroscopy that the central amphiphilic segment linking transmembrane spans 2 and 3 is alpha-helical. In the intact protein, these segments are likely to reside in the cytoplasm-facing membrane interface. The current model of SCAMP1 suggests that the N and C termini form the cytoplasmic surface of the protein overlying a membrane core, which contains a functional domain located at the cytoplasmic interface with little exposure of the protein on the ectodomain.
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Affiliation(s)
- C Hubbard
- Department of Cell Biology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA
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