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Schreiber H, Hänze J, Nimphius W, Verburg FA, Luster M, Hofmann R, Hegele A. Prostate specific membrane antigen (PSMA) in urothelial cell carcinoma (UCC) is associated with tumor grading and staging. J Cancer Res Clin Oncol 2020; 146:305-313. [PMID: 31897687 DOI: 10.1007/s00432-019-03113-9] [Citation(s) in RCA: 9] [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] [Received: 10/21/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Prostate specific membrane antigen (PSMA) has become a target for radionuclide imaging and therapy. Previous studies have shown that the expression of PSMA is not specific to prostate tissue. In this study we examine the expression of PSMA in urothelial cell carcinoma (UCC). METHODS Immunhistochemical PSMA-staining was performed in 89 UCC samples. PSMA expression in tumor tissue, adjacent healthy tissue and blood vessels was examined. We furthermore analyzed PSMA-mRNA expression in nine human UCC cell lines. We correlated our findings with clinical data regarding recurrence and progression of UCC. RESULTS UCC tissue showed a significantly higher PSMA expression compared to healthy urothelial tissue (p < 0.001). Non muscle invasive bladder cancer revealed significantly higher PSMA expression compared to muscle invasive bladder cancer (p < 0.05). PSMA expression significantly differed between various T-stages (p < 0.05) and tumor differentiation (p < 0.001). In four human UCC cell lines PSMA-mRNA was detectable. Those patients who suffered recurrence showed a higher rate of PSMA expression but no correlation to recurrence-free survival was evident. Progression of disease correlated significantly with a higher PSMA expression (p = 0.036). CONCLUSIONS Both UCC tissue and healthy urothelial tissue express PSMA, with significantly higher levels in UCC. We confirmed these findings in human UCC cell lines. In this small first cohort expression of PSMA correlates significant with progression of disease but not with recurrence and recurrence-free survival. These first results make PSMA a promising target for future diagnosis and therapy of UCC.
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Affiliation(s)
- Henner Schreiber
- Department of Urology and Pediatric Urology, University Hospital Marburg, Marburg, Germany.
| | - Jörg Hänze
- Department of Urology and Pediatric Urology, University Hospital Marburg, Marburg, Germany
| | - Wilhelm Nimphius
- Department of Pathology, University Hospital Marburg, Marburg, Germany
| | | | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Rainer Hofmann
- Department of Urology and Pediatric Urology, University Hospital Marburg, Marburg, Germany
| | - Axel Hegele
- Department of Urology and Pediatric Urology, University Hospital Marburg, Marburg, Germany
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Hegele A, Wahl F, Rexin P, Nimphius W, Hofmann R, Haenze J. Programmed death-ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1) expression in bladder cancer (BC): Differences in recurrent, progressive, and metastatic disease. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16001] [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: 11/20/2022] Open
Abstract
e16001 Background: The significance of PD-L1/PD-1 expression in BC is still unclear. In the present study we evaluated the PD-L1/PD-1 expression in tumor tissue (TT) and immune cells (IC) in the primary BC tumor as well as in case of BC recurrence and/or metastasis to detect possible changes in PD-L1/PD-1 expression using immunohistochemstry. Methods: PD-L1/PD-1 expression was determined in histological specimens of 20 pat. with a recurrent non-muscle invasive BC (NMIBC – Cohort 1) as well as in 20 pat. with muscle-invasive BC (MIBC- Cohort 2) treated by radical cystectomy and appearance of metastases during follow up using commercial available assays (E1L3N, Cell Signaling/ Zytomed). Staining intensity was performed using the Cologne Score. PD-L1/PD-1 status was compared between primary tumor and metastatic/recurrent/progressive BC tissue and correlated with clinical data. Results: Cohort 1: In NMIBC (18m,2f) a recurrent tumor occurred after 25 mo (1-114). In the recurrent TT PD-L1 expression was higher compared to primary BC in 15%. In case of progression higher PD-L1 expression was detectable in 42.9%. IC showed higher PD-L1 expression in 50% of recurrent NMIBC and in 42% in case of progression. PD-1 expression on IC rose in 70% in recurrent and 71% in progressive NMIBC without correlation to time interval of appearance. Cohort 2: After curative cystectomy (17m,3f) metastases occurred after a median time of 20.5 mo (0-58). Comparing PD-L1 expression in cystectomy specimens and metastases we found differences in 52.9% (4x down/5x up). Expression of PD-L1 in primary BC tissue correlated significantly with the time to metastasis (p < 0.05). Conclusions: In case of metastasis after cystectomy as well as in recurrent/progressive NMIBC we found distinct variations in PD-L1/PD-1 expression in TT and IC. In MIBC primary PD-L1 status correlates with the time to metastasis. Whether PD-L1/PD-1 status can be helpful for clinical decisions (i.e. adjuvant therapy, instillation therapy) or as prognosticator have to be subject of further study.
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Affiliation(s)
- Axel Hegele
- Department of Urology and Pediatric Urology, University of Marburg, Marburg, Germany
| | - Franziska Wahl
- Department of Urology, Philipps University Marburg, Marburg, Germany
| | - Peter Rexin
- Institute of Pathology, Philipps University, Marburg, Germany
| | - W Nimphius
- Institute of Pathology, Phlipps-University, Marburg, Germany
| | - Rainer Hofmann
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | - Joerg Haenze
- Department of Urology, Philipps University, Marburg, Germany
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3
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Vogt S, Detert M, Wagner D, Wessel J, Ramzan R, Nimphius W, Ramaswamy A, Guha S, Wenger C, Jamal FI, Eissa MH, Schumann U, Schmidt B, Rose G, Dahl C, Rolfes I, Notzon G, Baer C, Musch T. A Newly Developed mm-Wave Sensor for Detecting Plaques of Arterial Vessels. Thorac Cardiovasc Surg 2017; 66:91-98. [PMID: 28922670 DOI: 10.1055/s-0037-1606318] [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: 10/18/2022]
Abstract
BACKGROUND Microcalcifications within the fibrous cap of the arteriosclerotic plaques lead to the accrual of plaque-destabilizing mechanical stress. New techniques for plaque screening with small detectors and the ability to differentiate between the smooth and hard elements of plaque formation are necessary. METHOD Vascular plaque formations are characterized as calcium phosphate containing structures organized as hydroxylapatite resembling the mineral whitlockite. In transmission and reflexion studies with a simple millimeter wave (mm-wave)-demonstrator, we found that there is a narrow window for plaque detection in arterial vessels because of the tissue water content, the differentiation to fatty tissue, and the dielectric property of air or water, respectively. RESULT The new sensor is based on a sensing oscillator working around 27 GHz. The open-stub capacitance determines the operating frequency of the sensor oscillator. The capacitance depends on the dielectric properties of the surrounding material. The sensor components were completely built up in surface mount technique. CONCLUSION Completed with a catheter, the sensor based on microwave technology appears as a robust tool ready for further clinical use.
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Affiliation(s)
- Sebastian Vogt
- Department of Heart Surgery, Philipps University, Marburg, Germany.,Biochemical Pharmacological Center, Cardiovascular Res Lab, Philipps University, Marburg, Germany
| | - Markus Detert
- Fakultät für Elektrotechnik und Informationstechnik, Otto-von-Guericke-Universität Magdeburg, Insititut für Mikro- und Sensorsysteme, Magdeburg, Germany
| | - David Wagner
- Fakultät für Elektrotechnik und Informationstechnik, Otto-von-Guericke-Universität Magdeburg, Insititut für Mikro- und Sensorsysteme, Magdeburg, Germany
| | - Jan Wessel
- Leibniz-Institut für innovative Mikroelektronik, IHP GmbH, Frankfurt (O), Germany
| | - Rabia Ramzan
- Department of Heart Surgery, Philipps University, Marburg, Germany
| | - Wilhelm Nimphius
- Institut für Pathologie, Philipps-Universität Marburg, Marburg, Germany
| | - Anette Ramaswamy
- Institut für Pathologie, Philipps-Universität Marburg, Marburg, Germany
| | - Subhajit Guha
- Leibniz-Institut für innovative Mikroelektronik, IHP GmbH, Frankfurt (O), Germany
| | - Christian Wenger
- Leibniz-Institut für innovative Mikroelektronik, IHP GmbH, Frankfurt (O), Germany
| | - Farabi Ibne Jamal
- Leibniz-Institut für innovative Mikroelektronik, IHP GmbH, Frankfurt (O), Germany
| | | | - Ulrich Schumann
- Fakultät für Elektrotechnik und Informationstechnik, Otto-von-Guericke-Universität Magdeburg, Insititut für Mikro- und Sensorsysteme, Magdeburg, Germany
| | - Betram Schmidt
- Fakultät für Elektrotechnik und Informationstechnik, Otto-von-Guericke-Universität Magdeburg, Insititut für Mikro- und Sensorsysteme, Magdeburg, Germany
| | - Georg Rose
- Fakultät für Elektrotechnik und Informationstechnik, Otto-von-Guericke-Universität Magdeburg, Insititut für Mikro- und Sensorsysteme, Magdeburg, Germany
| | - Christoph Dahl
- Institut für Hochfrequenzsysteme, Ruhr-Universität Bochum, Bochum, Germany
| | - Ilona Rolfes
- Institut für Hochfrequenzsysteme, Ruhr-Universität Bochum, Bochum, Germany
| | - Gordon Notzon
- Institut für Hochfrequenzsysteme, Ruhr-Universität Bochum, Bochum, Germany
| | - Christoph Baer
- Institut für Hochfrequenzsysteme, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Musch
- Institut für Hochfrequenzsysteme, Ruhr-Universität Bochum, Bochum, Germany
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Sikic D, Keck B, Wach S, Taubert H, Wullich B, Goebell PJ, Kahlmeyer A, Olbert P, Isfort P, Nimphius W, Hartmann A, Giedl J. Immunohistochemiocal subtyping using CK20 and CK5 can identify urothelial carcinomas of the upper urinary tract with a poor prognosis. PLoS One 2017. [PMID: 28632777 PMCID: PMC5478149 DOI: 10.1371/journal.pone.0179602] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose Genome-wide analyses revealed basal and luminal subtypes of urothelial carcinomas of the bladder. It is unknown if this subtyping can also be applied to upper tract urothelial carcinomas. Materials and methods Tumor samples from 222 patients with upper tract urothelial carcinomas who were treated with radical nephroureterectomy were analyzed for the expression of seven basal/luminal immunohistochemical markers (CK5, EGFR, CD44, CK20, p63, GATA3, FOXA1). Results Hierarchical clustering revealed a basal-like subtype (enrichment of CK5, EGFR and CD44) in 23.9% and a luminal-like subtype (enrichment of CK20, GATA3, p63 and FOXA1) in 13.1% of the patients. In 60.8%, little to no markers were expressed, whereas markers of both subtypes were expressed in 2.2%. By using CK5 and CK20 as surrogate markers for the basal and luminal subtypes, we defined four subtypes of upper tract urothelial carcinomas: (i) exclusively CK20 positive and CK5 negative (CK20+/CK5-), (ii) exclusively CK5 positive and CK20 negative (CK20-/ CK5+), (iii) both markers positive (CK20+/CK5+) and (iv) both markers negative (CK20-/CK5-). A receiver-operator analysis provided the optimal cut-off values for this discrimination. An immunoreactive score >1 for CK5 and >6 for CK20 were defined as positive. In multivariate Cox’s regression analysis, the CK20+/CK5- subtype was an independent negative prognostic marker with a 3.83-fold increased risk of cancer-specific death (p = 0.02) compared to the other three subtypes. Conclusions Immunohistochemical subgrouping of upper tract urothelial carcinomas by analyzing CK5 and CK20 expression can be performed in a routine setting and can identify tumors with a significantly worse cancer-specific survival prognosis.
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Affiliation(s)
- Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
- * E-mail:
| | - Bastian Keck
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Helge Taubert
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Peter J. Goebell
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Kahlmeyer
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Peter Olbert
- Department of Urology and Pediatric Urology, Philipps University of Marburg, Marburg, Germany
| | - Philipp Isfort
- Department of Urology and Pediatric Urology, Philipps University of Marburg, Marburg, Germany
| | - Wilhelm Nimphius
- Institute of Pathology, Philipps University of Marburg, Marburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Johannes Giedl
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
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Wiesmann T, Steinfeldt T, Exner M, Nimphius W, De Andres J, Wulf H, Schwemmer U. Intraneural injection of a test dose of local anesthetic in peripheral nerves - does it induce histological changes in nerve tissue? Acta Anaesthesiol Scand 2017; 61:91-98. [PMID: 27778324 DOI: 10.1111/aas.12825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/01/2016] [Accepted: 09/29/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND & OBJECTIVES Most anesthesiologists use the injection of a test dose of local anesthetic in order to evaluate the final needle tip position. Thus, the intraneural injection of a full dose can be avoided. The aim of this study was to analyze whether an intraneural injection of a test dose of bupivacaine could trigger histological changes. METHODS Intraneural injections under direct vision were performed in 40 brachial plexus nerves in seven anesthetized pigs. Tibial nerves served as positive and negative controls. Two milliliter of bupivacaine 0.5% was injected in three nerves on the left brachial plexus. For control of local anesthetic's toxicity Ringer's solution was applied intraneurally on the right side. After maintaining 48 h of general anesthesia, the nerves were resected. The specimens were processed for histological examination and assessed for inflammation (hematoxylin and eosin stain, CD68-immunohistochemistry) and myelin damage (Kluver-Barrera stain). The degree of nerve injury was rated on a scale from 0 (no injury) to 4 (severe injury). RESULTS Statistical analysis showed no significant differences between the bupivacaine group [median (interquartile range) 1 (1-1.5)] and the Ringer's solution group [1 (0.5-2) P = 0.772]. Mild myelin alteration was found in 12.5% of all specimens following intraneural injection, irrespective of the applied substance. CONCLUSIONS "In our experimental study, intraneural injection of 2 ml of bupivacaine or Ringer's solution showed comparable mild inflammation. Nevertheless, inflammation can only be prevented by strictly avoiding nerve perforation followed by intraneural injection, as mechanical nerve perforation is a key factor for evolving inflammation.
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Affiliation(s)
- T. Wiesmann
- Department of Anesthesia and Intensive Care; University Hospital Marburg; Marburg Germany
| | - T. Steinfeldt
- Department of Anesthesia and Intensive Care; University Hospital Marburg; Marburg Germany
- Department of Anesthesia and Intensive Care Medicine; Diakonie-Klinikum Schwaebisch Hall; Schwaebisch Hall Germany
| | - M. Exner
- Department of Anesthesia and Intensive Care; University Hospital Marburg; Marburg Germany
| | - W. Nimphius
- Department of Pathology; University Hospital Marburg; Marburg Germany
| | - J. De Andres
- Anesthesia Division; Department of Surgery; Valencia School of Medicine; Valencia Spain
| | - H. Wulf
- Department of Anesthesia and Intensive Care; University Hospital Marburg; Marburg Germany
| | - U. Schwemmer
- Department of Anesthesiology & Critical Care; Klinikum Neumarkt; Neumarkt i.d.OPf. Germany
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Krug S, Boch M, Nimphius W, Gress TM, Michl P, Rinke A. Relevance of dihydropyrimidine-dehydrogenase and thymidylate-synthase in patients with pancreatic neuroendocrine neoplasms treated with 5-FU-based chemotherapy. Pancreatology 2016; 17:139-145. [PMID: 28027897 DOI: 10.1016/j.pan.2016.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chemotherapy with 5-FU and Streptozotocin (STZ) is recommended as first-line treatment in patients with metastatic pancreatic neuroendocrine neoplasms (PNEN). However, data about biomarkers involved in the 5-FU metabolism to predict response are still limited. OBJECTIVES Evaluation of clinicopathological features and potential predictive and prognostic markers of patients with PNEN treated with 5-FU based regimens. PATIENTS AND METHODS We retrospectively analyzed 41 patients with PNEN who were treated at the University Hospital Marburg between 2000 and 2013. Dihydropyrimidine-Dehydrogenase (DPD) and Thymidylate-Synthase (TS) expression was correlated with treatment response in 19 patients who had available tumour tissue and response data. The median overall survival (OS) and progression free survival (PFS) were calculated using Kaplan-Meier and Cox regression methods, respectively. RESULTS The median PFS in patients receiving 5-FU/STZ was 17 months with a median OS of 50 months. Objective response rate (ORR) and disease control rate (DCR) were 32% and 73%, respectively. Biochemical response (p = 0.005) and high DPD expression (p = 0.018) were predictive markers of response to 5-FU-based chemotherapy. Univariate analysis identified Ki-67 > 10%, no biochemical response, positive 5-HIAA levels and TS deficiency as independent risk factors for shorter PFS. Moreover, performance status (PS) ≥1 was an independent risk factors for impaired OS. CONCLUSIONS DPD expression and biochemical response represent promising predictive biomarkers for response to 5-FU based chemotherapy. Moreover, Ki-67, PS and TS are independent prognostic markers of OS and PFS in patients with PNEN.
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Affiliation(s)
- S Krug
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany; Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany
| | - M Boch
- Institute of Pathology, Philipps-University, Marburg, Germany
| | - W Nimphius
- Institute of Pathology, Philipps-University, Marburg, Germany
| | - T M Gress
- Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany
| | - P Michl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany.
| | - A Rinke
- Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany
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7
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Hegele A, Kalisch M, Rexin P, Wischmann V, Hofmann R, Nimphius W. Changes of PD-1 expressing tumor infiltrating lymphocytes (TILs) in primary and metastatic tumor in renal cell carcinoma (RCC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16128] [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: 11/20/2022] Open
Affiliation(s)
| | - Mareike Kalisch
- Department of Urology, Philipps University, Marburg, Germany
| | - Peter Rexin
- Institute of pathology, Phlipps University, Marburg, Germany
| | - V Wischmann
- Institute of Pathology, Philipps University, Marburg, Germany
| | | | - W Nimphius
- Institute of Pathology, Phlipps-University, Marburg, Germany
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Krug S, Boch M, Daniel H, Nimphius W, Müller D, Michl P, Rinke A, Gress TM. Streptozocin-Based Chemotherapy in Patients with Advanced Neuroendocrine Neoplasms--Predictive and Prognostic Markers for Treatment Stratification. PLoS One 2015; 10:e0143822. [PMID: 26630134 PMCID: PMC4668106 DOI: 10.1371/journal.pone.0143822] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 07/02/2015] [Accepted: 11/09/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIM Chemotherapy with streptozocin (STZ) in combination with 5-FU or doxorubicin (Dox) represents a standard of care for patients with metastatic pancreatic neuroendocrine neoplasms (pNEN). However, predictive markers for patient selection are still missing. The aim of this study was a retrospective evaluation of the clinicopathological characteristics of pNEN patients receiving STZ-based chemotherapies and to identify predictive and prognostic markers. PATIENTS AND METHODS We retrospectively analyzed 77 patients treated at our center between 1995 and 2013. The median overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier and Cox regression methods, respectively. Uni- and multivariate analyses were performed. RESULTS The median PFS (mPFS) in patients receiving STZ/5-FU/Dox was 16 months with a median OS (mOS) of 28 months. Objective response rate (ORR) and disease control rate (DCR) were 34% and 72%, respectively. Biochemical response and positive octreotide scintigraphy predicted objective response. Univariate analysis revealed Ki-67 > 10% and the absence of biochemical or objective response by imaging as independent risk factors for shorter PFS. Additionally, performance status (PS) and resection of the primary tumor were observed to influence mOS. Treatment was well tolerated with less than 10% grade 3 and 4 toxicities. CONCLUSIONS STZ-based chemotherapy is an effective and well-tolerated treatment option in patients with well differentiated neuroendocrine neoplasms. Positive octreotide scintigraphy and biochemical response predict objective response.
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Affiliation(s)
- Sebastian Krug
- Department of Gastroenterology, University of Marburg, Marburg, Germany
| | - Michael Boch
- Department of Gastroenterology, University of Marburg, Marburg, Germany
| | - Hanna Daniel
- Institute of Medical Biometry, University of Marburg, Marburg, Germany
| | | | - Daniela Müller
- Department of Gastroenterology, University of Marburg, Marburg, Germany
| | - Patrick Michl
- Department of Gastroenterology and Hepatology, University of Halle, Halle, Germany
| | - Anja Rinke
- Department of Gastroenterology, University of Marburg, Marburg, Germany
- * E-mail:
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Neesse A, Nimphius W, Schoppet M, Gress TM. Abdominal pain following percutaneous mitral valve repair (MitraClip). Pneumatosis intestinalis (PI) of the ascending colon. Gut 2015; 64:458, 494. [PMID: 25360035 DOI: 10.1136/gutjnl-2014-308495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Albrecht Neesse
- Department of Gastroenterology II, University Medicine Goettingen, Goettingen, Germany
| | - Wilhelm Nimphius
- Department of Pathology, University Hospital Giessen und Marburg GmbH, Standort Marburg, Marburg, Germany
| | - Michael Schoppet
- Department of Cardiology, University Hospital Giessen und Marburg GmbH, Standort Marburg, Marburg, Germany
| | - Thomas M Gress
- Department of Gastroenterology, Endocrinology, Infectiology and Metabolism, University Hospital Giessen und Marburg GmbH, Standort Marburg, Marburg, Germany
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Scharf M, Mueller D, Koenig U, Pfestroff A, Nimphius W, Figiel J, Rinke A, Koenig A, Gress T. Management of a metastasized high grade insulinoma (G3) with refractory hypoglycemia: case report and review of the literature. Pancreatology 2014; 14:542-5. [PMID: 25459566 DOI: 10.1016/j.pan.2014.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 12/11/2022]
Abstract
Insulinomas represent the most common functional neuroendocrine tumor of the pancreas. They are usually solitary, benign, well differentiated (G1/G2) and curable by surgery. We describe the case of a 45 year old male Caucasian with a unique malignant, metastasized pancreatic insulinoma (Ki 67 of 70%, G3). To control excessive insulin production emanating in refractory hypoglycemia and growth of the highly proliferating tumor a multimodal therapeutic approach including the consecutive use of tumor debulking surgery, chemotherapy, TACE, SIRT, PRRT as well as a drug therapy with diazoxide, somatostatin analogs and everolimus was employed. Chemotherapy with carboplatin/etoposide plus everolimus provided the longest normoglycemic period. After progress chemotherapy with dacarbazine had the most positive effect, while debulking approaches such as surgery and liver directed therapies, as well as PRRT were less efficient with only transient success.
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Affiliation(s)
- Michael Scharf
- Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany
| | - Daniela Mueller
- Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany
| | - Ute Koenig
- Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany
| | - Andreas Pfestroff
- Department of Nuclear Medicine, Philipps-University, Marburg, Germany
| | | | - Jens Figiel
- Department of Radiology, Philipps-University, Marburg, Germany
| | - Anja Rinke
- Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany
| | - Alexander Koenig
- Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany
| | - Thomas Gress
- Department of Gastroenterology and Endocrinology, Philipps-University, Marburg, Germany.
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Steinfeldt T, Poeschl S, Nimphius W, Graf J, Zoremba M, Mueller HH, Wulf H, Dette F. Forced Needle Advancement During Needle-Nerve Contact in a Porcine Model. Anesth Analg 2011; 113:417-20. [DOI: 10.1213/ane.0b013e31821b2227] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Steinfeldt T, Werner T, Nimphius W, Wiesmann T, Kill C, Müller HH, Wulf H, Graf J. Histological Analysis After Peripheral Nerve Puncture with Pencil-Point or Tuohy Needletip. Anesth Analg 2011; 112:465-70. [DOI: 10.1213/ane.0b013e318202cb9c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Steinfeldt T, Nimphius W, Wurps M, Eberhart L, Vassiliou T, Kill C, Wulf H, Graf J. Nerve perforation with pencil point or short bevelled needles: histological outcome. Acta Anaesthesiol Scand 2010; 54:993-9. [PMID: 20701598 DOI: 10.1111/j.1399-6576.2010.02279.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 11/29/2022]
Abstract
BACKGROUND In the case of needle nerve contact during peripheral blocks, pencil point needles are considered less traumatic compared with bevelled needles. However, there are not enough data to prove this notion. Therefore, the aim of this study was to challenge the hypothesis that nerve perforation with short bevelled needles is associated with major nerve damage compared with pencil point needles. METHODS In five anaesthetised pigs, the brachial plexus was exposed bilaterally. Up to eight nerves underwent needle nerve perforation using a pencil point needles cannula or an short bevelled needle. After 48 h, the nerves were resected. The specimens were processed for visual examination and the detection of inflammatory cells (haematoxylin-eosin, i.e. CD68-immunohistochemistry to detect macrophages), myelin damage (Kluver-Barrera staining) and intraneural haematoma. The grade of nerve injury was characterised by an objective score ranging from 0 (no injury) to 4 (severe injury). RESULTS Fifty nerves were examined. According to the injury score applied, there was no significant difference between the pencil point needles [median (inter-quartile range) 2.0 (2.0-2.0)] and the short bevelled-needle group [median 2.0 (2.0-2.0) P=0.23]. No myelin damage was observed. Signs of post-traumatic inflammation were equally distributed among both groups. CONCLUSIONS In the present study, the magnitude of nerve injury after needle nerve perforation was not related to one of the applied needle types. Post-traumatic inflammation rather than structural damage of nerve tissue is the only notable sign of nerve injury after needle nerve perforation with either needle type. However, neither the pencil point- nor the short bevelled needle can be designated a less traumatic device.
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Affiliation(s)
- T Steinfeldt
- Department of Anaesthesiology and Intensive Care Therapy, Philipps University Marburg, Marburg, Germany.
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Steinfeldt T, Graf J, Vassiliou T, Nimphius W, Sturm K, Kill C, Wiesmann T, Wulf H, Müller HH. Systematic evaluation of the highest current threshold for regional anaesthesia in a porcine model. Acta Anaesthesiol Scand 2010; 54:770-6. [PMID: 20397982 DOI: 10.1111/j.1399-6576.2010.02235.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to determine systematically the highest minimal stimulation current threshold for regional anaesthesia in pigs. METHODS In an established pig model for regional anaesthesia, needle placements applying electric nerve stimulation were performed. The primary outcome was the frequency of close needle to nerve placements as assessed by resin injects and subsequent anatomical evaluation. Following a statistical model (continual reassessment method), the applied output currents were selected to limit the necessary number of punctures, while providing guidance towards the highest output current range. RESULTS Altogether 186 punctures were performed in 11 pigs. Within the range of 0.3-1.4 mA, no distant needle to nerve placement was found. In the range of 1.5-4.1 mA, 43 distant needle to nerve placements occurred. The range of 1.2-1.4 mA was the highest interval that resulted in a close needle to nerve placement rate of > or =95%. CONCLUSIONS In the range of 0.3-1.4 mA, all resin deposition was found to be adjacent to nerve epineurium. The application of minimal current intensities up to 1.4 mA does not obviously lead to a reduction of epineural injectate contacts in pigs. These findings suggest that stimulation current thresholds up to 1.4 mA result in equivalent needle tip localisation in pigs.
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Affiliation(s)
- T Steinfeldt
- Department of Anaesthesiology and Intensive Care Therapy, Philipps-University Marburg, Marburg, Germany.
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Steinfeldt T, Nimphius W, Werner T, Vassiliou T, Kill C, Karakas E, Wulf H, Graf J. Nerve injury by needle nerve perforation in regional anaesthesia: does size matter? Br J Anaesth 2010; 104:245-53. [DOI: 10.1093/bja/aep366] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Steinfeldt T, Graf J, Vassiliou T, Morin A, Feldmann K, Nimphius W, De Andres J, Wulf H. High or low current threshold for nerve stimulation for regional anaesthesia. Acta Anaesthesiol Scand 2009; 53:1275-81. [PMID: 19719818 DOI: 10.1111/j.1399-6576.2009.02087.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether the application of high stimulation current thresholds (SCT) leads to a distant needle to nerve proximity (NNP) compared with low SCT during nerve localization for regional anaesthesia in pigs. METHODS A minimal motor response to the stimulation of femoral or brachial plexus nerves in 16 anaesthetized pigs was triggered either by a minimal SCT of a low (0.01-0.3 mA) or a high (0.8-1.0 mA) current in a random order. After eliciting a motor response with a predetermined SCT, synthetic resin was injected via the needle. After postmortem dissection of the injection site, the localization of the resin deposition was determined verifying the final position of the needle tip. Depending on the proximity of resin deposition to the nerve epineurium, the needle tip placement was considered either as a close or a distant NNP. RESULTS A total of 235 punctures were performed. Ninety-one punctures were carried out with low SCT and 92 with a high SCT. Fifty-two punctures served as a control (1.8-2.0 mA). All injectates following both high or low SCT were considered 'close needle tip to nerve placement', whereas 27 of 52 injectates of the control group appeared distant to nerve epineurium. CONCLUSION Regardless of the applied SCT, i.e. high or low, all resin deposition was found adjacent to nerve epineurium. These findings suggest that high and low SCT result in equivalent needle tip localization in pigs.
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Affiliation(s)
- T Steinfeldt
- Department of Anaesthesiology and Intensive Care Therapy, University Hospital Giessen-Marburg, Campus Marburg, Baldingerstrasse 1, Marburg, Germany.
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Irqsusi M, Vogt S, Nimphius W, Pankuweit S, Kalinowski M, Barth PJ, Moll R, Moosdorf R. Arrhythmogenic right ventricular cardiomyopathy as lethal complication factor after cardiac surgery. Herz 2009; 34:485-8. [PMID: 19784568 DOI: 10.1007/s00059-009-3192-y] [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] [Received: 11/06/2008] [Accepted: 03/03/2009] [Indexed: 11/30/2022]
Abstract
In patients with arrhythmogenic right ventricular dysplasia (ARVD), the right ventricular myocardium histologically discloses atrophy paralleled by fibrofatty or fatty replacement. Apoptosis is believed to be a putative major pathogenetic mechanism. Altogether, our knowledge of genetics, etiology and pathophysiology of ARVD has increased impressively in the last few years, and effective genetic tests now principally would be possible. Nevertheless, due to often uncharacteristic or even lacking symptoms, clinical diagnosis may be very difficult and could not be made during lifetime of patient presented here, partly due to additional, independent cardiac problems. The question of an effective preoperative diagnostic regimen for cardiosurgical interventions remains and seems to be currently open.
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Affiliation(s)
- Marc Irqsusi
- Department of Cardiac and Thoracovascular Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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Steinfeldt T, Sturm K, Wulf H, Wiesmann T, Nimphius W, Vassiliou T, Müller HH. 322. Minimal Output Current Intensity Finding for Nerve Stimulator Guided Peripheral Nerve Detection in Pigs. Reg Anesth Pain Med 2008. [DOI: 10.1136/rapm-00115550-200809001-00132] [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: 11/03/2022]
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Steinfeldt T, Wurps M, Schneider J, Vassiliou T, Wulf H, Nimphius W. 317. Inflammatory Response to Peripheral Nerve Trauma by a Facette or a Pencil Point Needle Tip in a Porcine Model. Reg Anesth Pain Med 2008. [DOI: 10.1136/rapm-00115550-200809001-00004] [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: 11/03/2022]
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Nimphius W, Moll R, Olbert P, Ramaswamy A, Barth PJ. CD34+ fibrocytes in chronic cystitis and noninvasive and invasive urothelial carcinomas of the urinary bladder. Virchows Arch 2007; 450:179-85. [PMID: 17149610 DOI: 10.1007/s00428-006-0347-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 10/31/2006] [Indexed: 01/12/2023]
Abstract
CD34+ fibrocytes are constitutive elements of the connective tissue where they play a role in matrix synthesis and tumor-associated stromal remodeling. Secreted protein, acidic, and rich in cysteine (SPARC) is a pivotal mediator of stromal remodeling precipitated by invasive carcinomas. The present study was undertaken to investigate CD34+ fibrocytes in the stroma of the tumor-free urinary bladder, chronic cystitis, and urothelial carcinomas together with stromal expression of alpha-smooth muscle actin (alpha-SMA), CD117, and SPARC. In tumor-free urinary bladder and chronic cystitis, CD34+ fibrocytes were found in the deep lamina propria and tunica muscularis, whereas the superficial lamina propria disclosed a CD34-negative and alpha-SMA-positive fibrocyte-like cell. Invasive urothelial carcinomas revealed a complete loss of CD34+ fibrocytes and concomitant appearance of alpha-SMA-reactive myofibroblasts which showed strong expression of SPARC. CD117 expression of tumor-free and tumor-associated stroma revealed no differences. We in this study for the first time describe CD34+ fibrocytes in the urinary bladder and an up-to-now unknown population of alpha-SMA-positive fibrocytes exclusively occurring in the superficial lamina propria. Stromal remodeling associated with invasive carcinomas in the urinary bladder is characterized by a loss of CD34+ fibrocytes paralleled by a gain of alpha-SMA-positive myofibroblasts and increased expression of SPARC.
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Affiliation(s)
- Wilhelm Nimphius
- Institute of Pathology, University Hospital Giessen and Marburg GmbH, Location Marburg, Medical Faculty of Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany
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