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Zurloh M, Goetz M, Herold T, Treckmann J, Markus P, Schumacher B, Albers D, Rink A, Rosery V, Zaun G, Kostbade K, Pogorzelski M, Ting S, Schmidt H, Stiens R, Wiesweg M, Schuler M, Kasper S, Virchow I. Impact of encorafenib on survival of patients with BRAF V600E-mutant metastatic colorectal cancer in a real-world setting. J Cancer Res Clin Oncol 2023; 149:12903-12912. [PMID: 37466791 PMCID: PMC10587317 DOI: 10.1007/s00432-023-05141-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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Patients with BRAFV600E-mutant metastatic colorectal cancer (mCRC) have a dismal prognosis. The best strategies in these patients remain elusive. Against this background, we report the clinical course of patients with BRAFV600E-mutant mCRC to retrieve the best treatment strategy. PATIENTS AND METHODS Clinico-pathological data were extracted from the electronic health records. Kaplan-Meier method was used to estimate overall (OS) and progression-free survival (PFS). Objective response rate (ORR) was assessed according to RECIST 1.1. RESULTS In total, 51 patients were enrolled. FOLFOXIRI was administered to 12 patients; 29 patients received FOLFOX or FOLFIRI as first-line treatment. Median OS was 17.6 months. Median PFS with FOLFOXIRI (13.0 months) was significantly prolonged (HR 0.325) as compared to FOLFOX/FOLFIRI (4.3 months). However, this failed to translate into an OS benefit (p = 0.433). Interestingly, addition of a monoclonal antibody to chemotherapy associated with superior OS (HR 0.523). A total of 64.7% patients received further-line therapy, which included a BRAF inhibitor in 17 patients. Targeted therapy associated with very favourable OS (25.1 months). CONCLUSION Patients with BRAFV600E-mutated mCRC benefit from the addition of an antibody to first-line chemotherapy. Further-line treatment including a BRAF inhibitor has a dramatic impact on survival.
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Affiliation(s)
- M Zurloh
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Goetz
- West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany
| | - T Herold
- West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - J Treckmann
- West German Cancer Center, Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - P Markus
- Department of General Surgery and Traumatology, Elisabeth Hospital, Essen, Germany
| | - B Schumacher
- Department of Gastroenterology, Elisabeth Hospital, Essen, Germany
| | - D Albers
- Department of Gastroenterology, Elisabeth Hospital, Essen, Germany
| | - A Rink
- West German Cancer Center, Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - V Rosery
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - G Zaun
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - K Kostbade
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Pogorzelski
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - S Ting
- West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany
- Institute of Pathology Nordhessen, Kassel, Germany
| | - H Schmidt
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - R Stiens
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
- Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - I Virchow
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
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Reissig TM, Tzianopoulos I, Liffers ST, Rosery VK, Guyot M, Ting S, Wiesweg M, Kasper S, Meister P, Herold T, Schmidt HH, Schumacher B, Albers D, Markus P, Treckmann J, Schuler M, Schildhaus HU, Siveke JT. Smaller panel, similar results: genomic profiling and molecularly informed therapy in pancreatic cancer. ESMO Open 2023; 8:101539. [PMID: 37148593 DOI: 10.1016/j.esmoop.2023.101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Pancreatic cancer has a dismal prognosis. One reason is resistance to cytotoxic drugs. Molecularly matched therapies might overcome this resistance but the best approach to identify those patients who may benefit is unknown. Therefore, we sought to evaluate a molecularly guided treatment approach. MATERIALS AND METHODS We retrospectively analyzed the clinical outcome and mutational status of patients with pancreatic cancer who received molecular profiling at the West German Cancer Center Essen from 2016 to 2021. We carried out a 47-gene DNA next-generation sequencing (NGS) panel. Furthermore, we assessed microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) status and, sequentially and only in case of KRAS wild-type, gene fusions via RNA-based NGS. Patient data and treatment were retrieved from the electronic medical records. RESULTS Of 190 included patients, 171 had pancreatic ductal adenocarcinoma (90%). One hundred and three patients had stage IV pancreatic cancer at diagnosis (54%). MMR analysis in 94 patients (94/190, 49.5%) identified 3 patients with dMMR (3/94, 3.2%). Notably, we identified 32 patients with KRAS wild-type status (16.8%). To identify driver alterations in these patients, we conducted an RNA-based fusion assay on 13 assessable samples and identified 5 potentially actionable fusions (5/13, 38.5%). Overall, we identified 34 patients with potentially actionable alterations (34/190, 17.9%). Of these 34 patients, 10 patients (10/34, 29.4%) finally received at least one molecularly targeted treatment and 4 patients had an exceptional response (>9 months on treatment). CONCLUSIONS Here, we show that a small-sized gene panel can suffice to identify relevant therapeutic options for pancreatic cancer patients. Informally comparing with previous large-scale studies, this approach yields a similar detection rate of actionable targets. We propose molecular sequencing of pancreatic cancer as standard of care to identify KRAS wild-type and rare molecular subsets for targeted treatment strategies.
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Affiliation(s)
- T M Reissig
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - I Tzianopoulos
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - S-T Liffers
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - V K Rosery
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - M Guyot
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Department of Gastroenterology, Oncology und Hematology, Diabetology and Rheumatology, Marien-Hospital Wesel, Wesel, Germany
| | - S Ting
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - S Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - P Meister
- Department of General, Visceral and Transplantation Surgery, Hepatology, and Transplant Medicine, University Hospital Essen, Essen, Germany
| | - T Herold
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - H H Schmidt
- Department of Gastroenterology, Hepatology, and Transplant Medicine, University Hospital Essen, Essen, Germany
| | - B Schumacher
- Department of Gastroenterology, Visceral and Trauma Surgery, Elisabeth Hospital Essen, Essen, Germany
| | - D Albers
- Department of Gastroenterology, Visceral and Trauma Surgery, Elisabeth Hospital Essen, Essen, Germany
| | - P Markus
- Department of General, Visceral and Trauma Surgery, Elisabeth Hospital Essen, Essen, Germany
| | - J Treckmann
- Department of General, Visceral and Transplantation Surgery, Hepatology, and Transplant Medicine, University Hospital Essen, Essen, Germany
| | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - H-U Schildhaus
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany; Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - J T Siveke
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
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Schwermer M, Hiber M, Dreesmann S, Rieb A, Theißen J, Herold T, Schramm A, Temming P, Steenpass L. Corrigendum to “Comprehensive characterization of RB1 mutant and MYCN amplified retinoblastoma cell lines” [Exp. Cell Res. 375 (2019) 92–99]. Exp Cell Res 2023; 426:113569. [PMID: 36989729 DOI: 10.1016/j.yexcr.2023.113569] [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: 03/29/2023]
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Wiesweg M, Hense J, Darwiche K, Michels S, Hautzel H, Kobe C, Metzenmacher M, Herold T, Zaun G, Laue K, Drzezga A, Schildhaus HU, Wolf J, Herrmann K, Schuler M. 1171P A phase II theranostic study with osimertinib in patients with EGFR-mutated non-small cell lung cancer (NSCLC) progressing on EGFR tyrosine kinase inhibitors (TKI) and undetectable EGFR T790M (THEROS). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1294] [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: 11/01/2022] Open
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Schmid JP, Bahrami E, Becker M, Jayavelu AK, Wirth AK, Jurinovic V, Öllinger R, Vick B, Herold T, Jeremias I. ADAM10’s sheddase function augments the interaction of
leukemia cells with the bone marrow niche in PDX models in vivo. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748719] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- JP Schmid
- Helmholtz Zentrum München- German Research Center for
Environmental Health HMGU, Research Unit Apoptosis in Hematopoietic Stem Cells,
Munich, Germany
- German Cancer Consortium DKTK, partner site Munich, Munich,
Germany
| | - E Bahrami
- Helmholtz Zentrum München- German Research Center for
Environmental Health HMGU, Research Unit Apoptosis in Hematopoietic Stem Cells,
Munich, Germany
| | - M Becker
- Helmholtz Zentrum München- German Research Center for
Environmental Health HMGU, Research Unit Apoptosis in Hematopoietic Stem Cells,
Munich, Germany
| | - AK Jayavelu
- Max-Planck-Institute of Biochemistry, Department of Proteomics and
Signal Transduction, Munich, Germany
| | - AK Wirth
- Helmholtz Zentrum München- German Research Center for
Environmental Health HMGU, Research Unit Apoptosis in Hematopoietic Stem Cells,
Munich, Germany
| | - V Jurinovic
- Helmholtz Zentrum München- German Research Center for
Environmental Health HMGU, Research Unit Apoptosis in Hematopoietic Stem Cells,
Munich, Germany
- Department of Medicine III – University Hospital – LMU
Munich, Laboratory for Leukemia Diagnostics, Munich, Germany
- University Hospital – Ludwig Maximilian University LMU,
Department of Pediatrics, Munich, Germany
| | - R Öllinger
- TUM School of Medicine – Technische Universität
München, Center for Translational Cancer Research TranslaTUM, Munich,
Germany
- Technische Universität München, Institute of Molecular
Oncology and Functional Genomics, Munich, Germany
- Klinikum rechts der Isar – Technische Universität
München, Department of Medicine II, Munich, Germany
| | - B Vick
- Helmholtz Zentrum München- German Research Center for
Environmental Health HMGU, Research Unit Apoptosis in Hematopoietic Stem Cells,
Munich, Germany
- German Cancer Consortium DKTK, partner site Munich, Munich,
Germany
| | - T Herold
- Helmholtz Zentrum München- German Research Center for
Environmental Health HMGU, Research Unit Apoptosis in Hematopoietic Stem Cells,
Munich, Germany
- Department of Medicine III – University Hospital – LMU
Munich, Laboratory for Leukemia Diagnostics, Munich, Germany
| | - I Jeremias
- Helmholtz Zentrum München- German Research Center for
Environmental Health HMGU, Research Unit Apoptosis in Hematopoietic Stem Cells,
Munich, Germany
- German Cancer Consortium DKTK, partner site Munich, Munich,
Germany
- University Hospital – Ludwig Maximilian University LMU,
Department of Pediatrics, Munich, Germany
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6
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Hunt K, Amend D, Ludwig R, Vick B, Wirth AK, Herold T, Jeremias I. Streamlining preclinical in vivo treatment trials by multiplexing
genetically labelled PDX models in a single mouse. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748721] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K Hunt
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum
München, German Research Center for Environmental Health (HMGU), Munich,
Germany
| | - D Amend
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum
München, German Research Center for Environmental Health (HMGU), Munich,
Germany
| | - R Ludwig
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum
München, German Research Center for Environmental Health (HMGU), Munich,
Germany
- German Cancer Consortium (DKTK), partner site Munich,
Germany
| | - B Vick
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum
München, German Research Center for Environmental Health (HMGU), Munich,
Germany
- German Cancer Consortium (DKTK), partner site Munich,
Germany
| | - AK Wirth
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum
München, German Research Center for Environmental Health (HMGU), Munich,
Germany
| | - T Herold
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum
München, German Research Center for Environmental Health (HMGU), Munich,
Germany
- Laboratory for Leukemia Diagnostics, Department of Medicine III,
University Hospital, LMU Munich, Munich, Germany
| | - I Jeremias
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum
München, German Research Center for Environmental Health (HMGU), Munich,
Germany
- German Cancer Consortium (DKTK), partner site Munich,
Germany
- Department of Pediatrics, University Hospital, Ludwig Maximilian
University (LMU), Munich, Germany
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Theurer S, Ingenwerth M, Herold T, Herrmann K, Schmid KW. Immunohistochemical Profile and 47-Gene Next-Generation Sequencing (NGS) Solid Tumor Panel Analysis of a Series of 13 Strumal Carcinoids. Endocr Pathol 2020; 31:101-107. [PMID: 32124226 PMCID: PMC7250806 DOI: 10.1007/s12022-020-09608-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Strumal carcinoid is an extraordinary rare tumor of the ovary consisting of thyroid tissue intermixed with neuroendocrine tumor component. The cellular origin of strumal carcinoids has been an area of debate. There is also little data on detailed immunohistochemical and molecular characteristics of these neoplasms. For this reason, this series investigated the characteristics of a series of 13 strumal carcinoids using immunohistochemical markers and a 47-gene next-generation sequencing (NGS) solid tumor panel analysis. Both cellular components showed thyroglobulin expression in all tumors. TTF-1 expression was noted in both cellular components of 11 cases. Chromogranin A was positive in both components of most tumors (n = 12, 92.3% in the neuroendocrine component and n = 10, 76.9% in the thyroid follicular component). Synaptophysin stained the neuroendocrine component of all cases, and it was also identified in the follicular thyroid component of a single case. All tumors were negative for CDX2 and calcitonin. ISLET1 was positive in the neuroendocrine component of 8 cases (6.5%). With the exception of one case, all tumors were positive for SSTR2a. The tumors were associated with a low Ki67 labeling index. All cases were microsatellite stable and no pathogenic mutations were identified using a 47-gene NGS solid tumor analysis. This series underscored that strumal carcinoids are distinct neuroendocrine tumors. The synchronous expression for thyroid follicular epithelial and neuroendocrine differentiation biomarkers may suggest a precursor cell origin displaying mixed-amphicrine differentiation. While strumal carcinoids can be diagnosed by their typical morphology and immunohistochemical profile, frequent SSTR expression may serve as a potential theranostic biomarker in the management of affected patients. In addition, the absence of common driver mutations in the NGS solid tumor panel may suggest that these neoplasms seem to be genetically unrelated to follicular epithelial-derived thyroid tumors and potentially different than other commonly identified well-differentiated neuroendocrine neoplasms. Therefore, further studies focusing on molecular characteristics of this entity are still needed.
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Affiliation(s)
- S Theurer
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr, 55, 45147, Essen, Germany.
| | - M Ingenwerth
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr, 55, 45147, Essen, Germany
| | - T Herold
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr, 55, 45147, Essen, Germany
| | - K Herrmann
- Institute of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - K W Schmid
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr, 55, 45147, Essen, Germany
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Herold T, Nitschmann S, von Bergwelt M. [New treatment for chronic lymphocytic leukemia]. Internist (Berl) 2019; 61:110-112. [PMID: 31848648 DOI: 10.1007/s00108-019-00706-x] [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: 10/25/2022]
Affiliation(s)
- T Herold
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München - Großhadern, München, Deutschland.
| | | | - M von Bergwelt
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München - Großhadern, München, Deutschland.
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9
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Rothenberg-Thurley M, Amler S, Goerlich D, Köhnke T, Konstandin NP, Schneider S, Sauerland MC, Herold T, Hubmann M, Ksienzyk B, Zellmeier E, Bohlander SK, Subklewe M, Faldum A, Hiddemann W, Braess J, Spiekermann K, Metzeler KH. Persistence of pre-leukemic clones during first remission and risk of relapse in acute myeloid leukemia. Leukemia 2017:leu2017350. [PMID: 29249818 DOI: 10.1038/leu.2017.350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/18/2017] [Accepted: 11/23/2017] [Indexed: 11/09/2022]
Abstract
Some patients with acute myeloid leukemia (AML) who are in complete remission after induction chemotherapy harbor persisting pre-leukemic clones, carrying a subset of leukemia-associated somatic mutations. There is conflicting evidence on the prognostic relevance of these clones for AML relapse. Here, we characterized paired pre-treatment and remission samples from 126 AML patients for mutations in 68 leukemia-associated genes. Fifty patients (40%) retained ⩾1 mutation during remission at a variant allele frequency of ⩾2%. Mutation persistence was most frequent in DNMT3A (65% of patients with mutations at diagnosis), SRSF2 (64%), TET2 (55%), and ASXL1 (46%), and significantly associated with older age (P<0.0001) and, in multivariate analyses adjusting for age, genetic risk, and allogeneic transplantation, with inferior relapse-free survival (hazard ratio, 2.34; P=0039) and overall survival (hazard ratio, 2.14; P=036). Patients with persisting mutations had a higher cumulative incidence of relapse before, but not after allogeneic stem cell transplantation. Our work underlines the relevance of mutation persistence during first remission as a novel risk factor in AML. Persistence of pre-leukemic clones may contribute to the inferior outcome of elderly AML patients. Allogeneic transplantation abrogated the increased relapse risk associated with persisting pre-leukemic clones, suggesting that mutation persistence may guide postremission treatment.Leukemia accepted article preview online, 18 December 2017. doi:10.1038/leu.2017.350.
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Affiliation(s)
- M Rothenberg-Thurley
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Amler
- Institute of Biostatistics and Clinical Research, WWU Münster, Münster, Germany
| | - D Goerlich
- Institute of Biostatistics and Clinical Research, WWU Münster, Münster, Germany
| | - T Köhnke
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
| | - N P Konstandin
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
| | - S Schneider
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
| | - M C Sauerland
- Institute of Biostatistics and Clinical Research, WWU Münster, Münster, Germany
| | - T Herold
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
| | - M Hubmann
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
| | - B Ksienzyk
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
| | - E Zellmeier
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
| | - S K Bohlander
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - M Subklewe
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Faldum
- Institute of Biostatistics and Clinical Research, WWU Münster, Münster, Germany
| | - W Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - K Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K H Metzeler
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Kasper S, Meiler J, Knipp H, Höhler T, Reimer P, Steinmetz H, Berger W, Linden G, Ting S, Markus P, Paul A, Dechêne A, Schumacher B, Kostbade K, Worm K, Schmid K, Herold T, Schuler M, Trarbach T. Cetuximab biweekly (q2w) plus mFOLFOX6 as 1st line therapy in patients (pts) with KRAS wild-type (wt) (exon 2) metastatic colorectal cancer (mCRC) – Primary endpoint and subgroup analysis of the CEBIFOX trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.56] [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: 11/12/2022] Open
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11
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Fransecky L, Neumann M, Heesch S, Schlee C, Ortiz-Tanchez J, Heller S, Mossner M, Schwartz S, Mochmann LH, Isaakidis K, Bastian L, Kees UR, Herold T, Spiekermann K, Gökbuget N, Baldus CD. Silencing of GATA3 defines a novel stem cell-like subgroup of ETP-ALL. J Hematol Oncol 2016; 9:95. [PMID: 27658391 PMCID: PMC5034449 DOI: 10.1186/s13045-016-0324-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 04/14/2016] [Accepted: 09/09/2016] [Indexed: 11/25/2022] Open
Abstract
Background GATA3 is pivotal for the development of T lymphocytes. While its effects in later stages of T cell differentiation are well recognized, the role of GATA3 in the generation of early T cell precursors (ETP) has only recently been explored. As aberrant GATA3 mRNA expression has been linked to cancerogenesis, we investigated the role of GATA3 in early T cell precursor acute lymphoblastic leukemia (ETP-ALL). Methods We analyzed GATA3 mRNA expression by RT-PCR (n = 182) in adult patients with T-ALL. Of these, we identified 70 of 182 patients with ETP-ALL by immunophenotyping. DNA methylation was assessed genome wide (Illumina Infinium® HumanMethylation450 BeadChip platform) in 12 patients and GATA3-specifically by pyrosequencing in 70 patients with ETP-ALL. The mutational landscape of ETP-ALL with respect to GATA3 expression was investigated in 18 patients and validated by Sanger sequencing in 65 patients with ETP-ALL. Gene expression profiles (Affymetrix Human genome U133 Plus 2.0) of an independent cohort of adult T-ALL (n = 83) were used to identify ETP-ALL and investigate GATA3low and GATA3high expressing T-ALL patients. In addition, the ETP-ALL cell line PER-117 was investigated for cytotoxicity, apoptosis, GATA3 mRNA expression, DNA methylation, and global gene expression before and after treatment with decitabine. Results In our cohort of 70 ETP-ALL patients, 33 % (23/70) lacked GATA3 expression and were thus defined as GATA3low. DNA methylation analysis revealed a high degree of GATA3 CpG island methylation in GATA3low compared with GATA3high ETP-ALL patients (mean 46 vs. 21 %, p < 0.0001). Genome-wide expression profiling of GATA3low ETP-ALL exhibited enrichment of myeloid/lymphoid progenitor (MLP) and granulocyte/monocyte progenitor (GMP) genes, while T cell-specific signatures were downregulated compared to GATA3high ETP-ALL. Among others, FLT3 expression was upregulated and mutational analyses demonstrated a high rate (79 %) of FLT3 mutations. Hypomethylating agents induced reversal of GATA3 silencing, and gene expression profiling revealed downregulation of hematopoietic stem cell genes and upregulation of T cell differentiation. Conclusions We propose GATA3low ETP-ALL as a novel stem cell-like leukemia with implications for the use of myeloid-derived therapies. Electronic supplementary material The online version of this article (doi:10.1186/s13045-016-0324-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Fransecky
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - M Neumann
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - S Heesch
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - C Schlee
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - J Ortiz-Tanchez
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - S Heller
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - M Mossner
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - S Schwartz
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - L H Mochmann
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - K Isaakidis
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - L Bastian
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - U R Kees
- Division of Children´s Leukaemia and Cancer, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - T Herold
- Department of Internal Medicine 3, University Hospital Grosshadern, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - K Spiekermann
- Department of Internal Medicine 3, University Hospital Grosshadern, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - N Gökbuget
- Department of Medicine II, Hematology/Oncology, Goethe University Hospital, Frankfurt/Main, Germany
| | - C D Baldus
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
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12
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Dutta S, Krause A, Vosberg S, Herold T, Ksienzyk B, Quintanilla-Martinez L, Tizazu B, Chopra M, Graf A, Krebs S, Blum H, Greif PA, Vetter A, Metzeler K, Rothenberg-Thurley M, Schneider MR, Dahlhoff M, Spiekermann K, Zimber-Strobl U, Wolf E, Bohlander SK. The target cell of transformation is distinct from the leukemia stem cell in murine CALM/AF10 leukemia models. Leukemia 2015; 30:1166-76. [PMID: 26686248 DOI: 10.1038/leu.2015.349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 11/09/2022]
Abstract
The CALM/AF10 fusion gene is found in various hematological malignancies including acute myeloid leukemia (AML), T-cell acute lymphoblastic leukemia and malignant lymphoma. We have previously identified the leukemia stem cell (LSC) in a CALM/AF10-driven murine bone marrow transplant AML model as B220+ lymphoid cells with B-cell characteristics. To identify the target cell for leukemic transformation or 'cell of origin of leukemia' (COL) in non-disturbed steady-state hematopoiesis, we inserted the CALM/AF10 fusion gene preceded by a loxP-flanked transcriptional stop cassette into the Rosa26 locus. Vav-Cre-induced panhematopoietic expression of the CALM/AF10 fusion gene led to acute leukemia with a median latency of 12 months. Mice expressing CALM/AF10 in the B-lymphoid compartment using Mb1-Cre or CD19-Cre inducer lines did not develop leukemia. Leukemias had a predominantly myeloid phenotype but showed coexpression of the B-cell marker B220, and had clonal B-cell receptor rearrangements. Using whole-exome sequencing, we identified an average of two to three additional mutations per leukemia, including activating mutations in known oncogenes such as FLT3 and PTPN11. Our results show that the COL for CALM/AF10 leukemia is a stem or early progenitor cell and not a cell of B-cell lineage with a phenotype similar to that of the LSC in CALM/AF10+ leukemia.
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Affiliation(s)
- S Dutta
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - A Krause
- Department of Small Animal Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - S Vosberg
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - T Herold
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - B Ksienzyk
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany
| | - L Quintanilla-Martinez
- Institute for Pathology, University Hospital and Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - B Tizazu
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - M Chopra
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - A Graf
- Laboratory for Functional Genome Analysis, Gene Center, Ludwig Maximilians-University, Munich, Germany
| | - S Krebs
- Laboratory for Functional Genome Analysis, Gene Center, Ludwig Maximilians-University, Munich, Germany
| | - H Blum
- Laboratory for Functional Genome Analysis, Gene Center, Ludwig Maximilians-University, Munich, Germany
| | - P A Greif
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Vetter
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Metzeler
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - M Rothenberg-Thurley
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - M R Schneider
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig Maximilians-University, Munich, Germany
| | - M Dahlhoff
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig Maximilians-University, Munich, Germany
| | - K Spiekermann
- Department of Medicine III, University Hospital Grosshadern, Ludwig Maximilians-University, Munich, Germany.,Clinical Cooperative Group Leukemia, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - U Zimber-Strobl
- Department of Gene Vectors, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - E Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig Maximilians-University, Munich, Germany
| | - S K Bohlander
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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13
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Altmann MM, Wrede CE, Peetz D, Höhne M, Stroszczynski C, Herold T. Age-Dependent D-dimer Cut-off to Avoid Unnecessary CT-Exams for Ruling-out Pulmonary Embolism. ROFO-FORTSCHR RONTG 2015; 187:795-800. [PMID: 26308535 DOI: 10.1055/s-0035-1553428] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effect of an age-dependent D-Dimer cut-off in patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected pulmonary embolism (PE) Material and Methods: Retrospective application of an age-dependent D-dimer cut-off (age/100 in patients aged over 50) in 530 consecutive patients, both in- and outpatients, aged over 18, who underwent CTPA for suspected PE according to the guidelines. RESULTS The application of an age-dependent D-dimer cut-off showed a now negative test-result in 17 of 530 patients (3.2%). The proportion was 4.1% (17 of 418) in patients aged over 50. None of these 17 cases was diagnosed with PE in CTPA, the false-negative rate was 0%. The effect could be seen in outpatients (14 of 377 [3.7%]) as well as in inpatients(3 of 153 [2.0%]) with no statistically significant difference (p > 0.05). CONCLUSION The application of an age-dependent D-dimer cut-off as part of the guidline-based algorithm for suspected PE reduced the number of necessary CTPA in outpatients as well as in inpatients. KEY POINTS The application of an age-dependent D-dimer cut-off reduces the number of CTPA as part of the diagnostic algorithm in patients suspected for PENo reduction in diagnostic safety was found. The age adjustement performed equally in outpatients and inpatients
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Affiliation(s)
- M M Altmann
- Radiology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - C E Wrede
- Emergency Department, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - D Peetz
- Laboratory Medicine, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - M Höhne
- Radiology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | | | - T Herold
- Radiology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
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14
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Mayer WJ, Hadjigoli A, Wolf A, Herold T, Haritoglou C. [Comparison of Intravitreal Dexamethasone Implant versus Intravitreal Ranibizumab as a First-Line Treatment of Macular Oedema due to Retinal Vein Occlusion]. Klin Monbl Augenheilkd 2015. [PMID: 26197958 DOI: 10.1055/s-0035-1546176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The present study investigated the treatment effect of dexamethasone implant (Ozurdex®, group 1) and anti-VEGF injection (Lucentis®, group 2) in course of macular oedema due to retinal vein occlusion in a retrospective, non-randomised case series. MATERIAL AND METHODS Group 1 comprised 60 patients (31 with CRVO and 29 with BRVO) and group 2 included 52 patients, 27 with CRVO and 25 with BRVO) and both groups were further treated in case of recurrence. Preoperative and in monthly intervals best corrected visual acuity (BCVA), central retinal thickness using SD-OCT (Spectralis, Heidelberg Engineering), intraocular pressure, biomicroscopy status and a fundus photo documentation (Optomap) were evaluated. The primary clinical endpoint was visual acuity 12 months after the first intravitreal therapy, while secondary endpoints included the central retinal thickness change and safety of therapy. RESULTS In group 1, an increase of BCVA (± standard deviation) of 8.4 (± 1.9) letters was observed in CRVO patients and a gain of 10.7 (± 3.8) letters in BRVO patients after 12 months, while in group 2, an increase of BCVA of 6.9 (± 1.9) letters (CRVO) compared to 12.5 (± 3.7) letters (BRVO) was observed after the same time span. In both groups a significant reduction in retinal thickness was achieved. An increase of intraocular pressure above 5 mmHg was observed in nearly half of the cases In group 1, but was well controlled by conservative antiglaucomatous therapy. We observed a progression of lens opacity in approximately 50 % of the cases in group 1. CONCLUSION The treatment with Ozurdex compared to Lucentis appears to provide a trend towards a better although not significant visual acuity increase after 12 months in CRVO patients. A similar trend favouring anti-VEGF treatment with Lucentis was seen in patients with BRVO. However, the lens status and age of the patient should be taken into account when considering a treatment with Ozurdex.
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Affiliation(s)
- W J Mayer
- Augenklinik der Ludwig-Maximilians-Universität München
| | - A Hadjigoli
- Augenklinik des Bürgerhospitals Frankfurt am Main
| | - A Wolf
- Augenklinik der Ludwig-Maximilians-Universität München
| | - T Herold
- Augenklinik der Ludwig-Maximilians-Universität München
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15
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Ponnusamy K, Kohrs N, Ptasinska A, Assi SA, Herold T, Hiddemann W, Lausen J, Bonifer C, Henschler R, Wichmann C. RUNX1/ETO blocks selectin-mediated adhesion via epigenetic silencing of PSGL-1. Oncogenesis 2015; 4:e146. [PMID: 25867177 PMCID: PMC5399174 DOI: 10.1038/oncsis.2015.6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 11/24/2014] [Revised: 02/08/2015] [Accepted: 02/11/2015] [Indexed: 12/21/2022] Open
Abstract
RUNX1/ETO (RE), the t(8;21)-derived leukemic transcription factor associated with acute myeloid leukemia (AML) development, deregulates genes involved in differentiation, self-renewal and proliferation. In addition, these cells show differences in cellular adhesion behavior whose molecular basis is not well understood. Here, we demonstrate that RE epigenetically silences the gene encoding P-Selectin Glycoprotein Ligand-1 (PSGL-1) and downregulates PSGL-1 expression in human CD34+ and murine lin− hematopoietic progenitor cells. Levels of PSGL-1 inversely and dose-dependently correlate with RE oncogene levels. However, a DNA-binding defective mutant fails to downregulate PSGL-1. We show by ChIP experiments that the PSGL-1 promoter is a direct target of RE and binding is accompanied by high levels of the repressive chromatin mark histone H3K27me3. In t(8;21)+ Kasumi-1 cells, PSGL-1 expression is completely restored at both the mRNA and cell surface protein levels following RE downregulation with short hairpin RNA (shRNA) or RE inhibition with tetramerization-blocking peptides, and at the promoter H3K27me3 is replaced by the activating chromatin mark H3K9ac as well as by RNA polymerase II. Upregulation of PSGL-1 restores the binding of cells to P- and E-selectin and re-establishes myeloid-specific cellular adhesion while it fails to bind to lymphocyte-specific L-selectin. Overall, our data suggest that the RE oncoprotein epigenetically represses PSGL-1 via binding to its promoter region and thus affects the adhesive behavior of t(8;21)+ AML cells.
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Affiliation(s)
- K Ponnusamy
- 1] Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, Ludwig-Maximilian University Hospital, Munich, Germany [2] Institute of Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - N Kohrs
- Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, Frankfurt, Germany
| | - A Ptasinska
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S A Assi
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - T Herold
- Department of Internal Medicine 3, Ludwig-Maximilian University Hospital, Munich, Germany
| | - W Hiddemann
- Department of Internal Medicine 3, Ludwig-Maximilian University Hospital, Munich, Germany
| | - J Lausen
- Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, Frankfurt, Germany
| | - C Bonifer
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - R Henschler
- 1] Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, Ludwig-Maximilian University Hospital, Munich, Germany [2] Institute of Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - C Wichmann
- 1] Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, Ludwig-Maximilian University Hospital, Munich, Germany [2] Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, Frankfurt, Germany
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16
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Tiedje V, Ting S, Herold T, Walter R, Mairinger F, Worm K, Zwanziger D, Schmid KW, Führer D. Prognostic markers and response to vandetanib therapy in sporadic medullary thyroid cancer patients. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547649] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Reis H, Herold T, Ting S, Worm K, Huber U, Christoph DC, Eberhardt WE, Kostbade K, Kasper S, Stamatis G, Welter S, Darwiche K, Karpf-Wissel R, Theegarten D, Schmid KW, Schuler M, Wiesweg M. HER2 expression and markers of phosphoinositide-3-kinase pathway activation define a favorable subgroup of metastatic pulmonary adenocarcinomas. Lung Cancer 2015; 88:34-41. [PMID: 25708529 DOI: 10.1016/j.lungcan.2015.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 10/01/2014] [Revised: 01/04/2015] [Accepted: 02/01/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pulmonary adenocarcinomas (ADC) can be sub-grouped based on dominant oncogenic drivers. EGFR mutations define an entity of metastatic ADC with favorable prognosis and high susceptibility to EGFR tyrosine kinase inhibition. In contrast, the clinical impact of additional ERBB family members in ADC is less defined. To this end we prospectively studied HER2 expression, gene amplification, and mutation in relation to outcome of patients with advanced or metastatic ADC. MATERIALS AND METHODS Diagnostic tumor biopsies from 193 sequential patients with stage III/IV ADC were prospectively studied for HER2 expression by immunohistochemistry (IHC). Cases with IHC scores 2+ or 3+ were analyzed by HER2 chromogenic in situ hybridization (CISH), and sequencing of HER2 exons 20 and 23. Additional prospectively determined biomarkers included PTEN, cMET, pAKT, and pERK expression, KRAS, EGFR, BRAF and PIK3CA mutations, and ALK fluorescence ISH (FISH). RESULTS AND CONCLUSION HER2-IHC was feasible in 176 (91.2%) cases. Of 53 (30%) cases with IHC scores 2+/3+, 45 (85%) could be studied by CISH and 34 (64%) by sequencing. The lower number of HER2-mutational analyses resulted from exhaustion of tumor tissue and DNA following mutational analysis of KRAS, EGFR, BRAF and PIK3CA. HER2 amplification was detected in 4 cases (2.3%), while no mutation was found. HER2 expression correlated with expression of pAKT and cMET. Expression of HER2 and pAKT was associated with favorable overall survival in stage IV disease. HER2-expressing ADC more frequently harbored KRAS mutations, while HER2 expression was absent in all 4 cases with BRAF mutation. HER2-IHC was not predictive of HER2 gene amplification or mutation, which both were rare events in prospectively studied patients with advanced or metastatic ADC. Expression of HER2 and pAKT define a population of patients with stage IV ADC with a distinct disease course, who could benefit from specifically tailored pharmacotherapies.
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Affiliation(s)
- H Reis
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - T Herold
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Research Center, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - S Ting
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - K Worm
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - U Huber
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - D C Christoph
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - W E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, 45239 Essen, Germany
| | - K Kostbade
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - S Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - G Stamatis
- Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University Hospital Essen, 45239 Essen, Germany
| | - S Welter
- Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University Hospital Essen, 45239 Essen, Germany
| | - K Darwiche
- Division of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, 45239 Essen, Germany
| | - R Karpf-Wissel
- Division of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, 45239 Essen, Germany
| | - D Theegarten
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - K W Schmid
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - M Schuler
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, 45239 Essen, Germany.
| | - M Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
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18
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Zoellner AK, Fritsch S, Prevalsek D, Engel N, Hubmann M, Reibke R, Rieger CT, Hellmuth JC, Haas M, Mumm F, Herold T, Ledderose G, Hiddemann W, Dreyling M, Hausmann A, Tischer J. Sequential therapy combining clofarabine and T-cell-replete HLA-haploidentical haematopoietic SCT is feasible and shows efficacy in the treatment of refractory or relapsed aggressive lymphoma. Bone Marrow Transplant 2015; 50:679-84. [PMID: 25642765 DOI: 10.1038/bmt.2014.328] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/04/2014] [Accepted: 12/17/2014] [Indexed: 01/25/2023]
Abstract
Prognosis is poor for patients with biologically aggressive Non-Hodgkin lymphoma (NHL), refractory to chemotherapy or relapsed after autologous transplantation, especially when no disease control before allogeneic transplantation is achieved. In 16 patients (median age 53, median prior regimes 5) with relapsed or refractory non-remission NHL, we analysed retrospectively the efficacy of a sequential therapy comprising clofarabine re-induction followed by a reduced-intensity conditioning with fludarabine, CY and melphalan, and T-cell-replete HLA-haploidentical transplantation. High-dose CY was utilized post-transplantation. All patients engrafted. Early response (day +30) was achieved in 94%. Treatment-related grade III-IV toxicity occurred in 56%, most commonly transient elevation of transaminases (36%), while there was a low incidence of infections (19% CMV reactivation, 19% invasive fungal infection) and GVHD (GVHD: acute III-IV: 6%; mild chronic: 25%). One-year non-relapse mortality was 19%. After a median follow-up of 21 months, estimated 1- and 2-year PFS was 56 and 50%, respectively, with 11 patients (69%) still alive after 2 years. In summary, sequential therapy is feasible and effective and provides an acceptable toxicity profile in high-risk non-remission NHL. Presumably, cytotoxic reinduction with clofarabine provides enough remission time for the graft-versus lymphoma effect of HLA-haploidentical transplantation to kick in, even in lymphomas that are otherwise chemo-refractory.
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Affiliation(s)
- A-K Zoellner
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - S Fritsch
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - D Prevalsek
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - N Engel
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - M Hubmann
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - R Reibke
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - C T Rieger
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - J C Hellmuth
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - M Haas
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - F Mumm
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - T Herold
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - G Ledderose
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - W Hiddemann
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - M Dreyling
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - A Hausmann
- 1] Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany [2] Department I of Internal Medicine, Klinikum München-Schwabing, Munich, Germany
| | - J Tischer
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
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Ross C, Hoffstetter P, Fellner C, Herold T, Nerlich M, Huber MKI. [Detection of intrinsic ligament and TFCC lesions of the wrist. Direct versus indirect MRI arthrography]. Unfallchirurg 2014; 118:251-5. [PMID: 25294560 DOI: 10.1007/s00113-014-2662-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to validate the diagnostic value of direct magnetic resonance imaging (dMRI) arthrography and indirect MRI (iMRI) arthrography concerning intrinsic ligament injuries and tears of the triangular fibrocartilage complex (TFCC). PATIENTS AND METHODS A randomized prospective trial was conducted with patients who presented with wrist pain potentially due to carpal lesions and 10 patients aged 19-60 years (3 female and 7 male) were included. Between the clinical examination and the diagnostic and therapeutic arthroscopy, dMRI and iMRI arthrography were performed for the diagnostics of injuries of the intrinsic ligaments or the TFCC. The results of dMRI and iMRI arthrography were evaluated by two radiologists blinded to the injuries of the patients and a consensus was reached. The results were compared with the findings obtained by arthroscopy. RESULTS In the arthroscopy five lesions of the scapholunate ligament (SL), one of the lunotriquetral ligament (LT) and seven of the TFCC were identified. The sensitivity of iMRI and dMRI for carpal ligament lesions (SL and LT) was low (50 %) whereas the specificity was high (93 %). For injuries of the TFCC the sensitivity (up to 100 %) and the specificity (100 %) were both excellent. The area under the curve (AUC) in the receiver operating characteristics (ROC) analysis was high for TFCC lesions in both dMRI and iMRI arthrography. CONCLUSION Indirect MRI arthrography is a suitable method for detection of injuries of the TFCC and intrinsic ligaments of the wrist with good sensitivity and specificity. Despite the low number of patients the results of this study showed that there were no essential differences between dMRI and iMRI arthrography with respect to the diagnostic value for carpal injuries of the wrist.
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Affiliation(s)
- C Ross
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Herold T, Jurinovic V, Metzeler KH, Boulesteix AL, Bergmann M, Seiler T, Mulaw M, Thoene S, Dufour A, Pasalic Z, Schmidberger M, Schmidt M, Schneider S, Kakadia PM, Feuring-Buske M, Braess J, Spiekermann K, Mansmann U, Hiddemann W, Buske C, Bohlander SK. An eight-gene expression signature for the prediction of survival and time to treatment in chronic lymphocytic leukemia. Leukemia 2011; 25:1639-45. [PMID: 21625232 DOI: 10.1038/leu.2011.125] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Dumitrescu AS, Herold T. [Endometriosis of the abdominal wall: a difficult differential diagnosis]. ROFO-FORTSCHR RONTG 2011; 183:861-4. [PMID: 21442567 DOI: 10.1055/s-0031-1273242] [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: 10/18/2022]
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Müller-Wille R, Heiss P, Herold T, Jung EM, Schreyer AG, Hamer OW, Rennert J, Hoffstetter P, Stroszczynski C, Zorger N. Endovascular Treatment of Acute Arterial Hemorrhage in Trauma Patients Using Ethylene Vinyl Alcohol Copolymer (Onyx). Cardiovasc Intervent Radiol 2011; 35:65-75. [DOI: 10.1007/s00270-011-0134-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
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Lenhart M, Haueis A, Schneider H, Jung EM, Herold T, Feuerbach S, Schöffl V, Zorger N. [PACS: acceptance by orthopedic surgeons]. Orthopade 2010; 39:994-1002. [PMID: 20383490 DOI: 10.1007/s00132-010-1616-2] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The goal of the study was to evaluate the acceptance of a web-based picture archiving and communication system (PACS) by orthopedic surgeons 1 year after implementation. MATERIALS AND METHODS One year after the implementation of a web-based PACS all physicians were surveyed with a standardized questionnaire. Questions included: speed of PACS, quality of clinicoradiological meetings, quality of monitors, PACS training, and performance. Data were evaluated separately for the Department of Orthopedic Surgery and the reference group of all other physicians. RESULTS Among the respondents, 92% of the orthopedic surgeons stated there was a reduction of time required to receive images, and 64% concluded that patient care was faster. Archived images were received in less than 5 min in 82% after PACS and in 8% before PACS. The clinicoradiological meetings improved with PACS in 100% due to beamer presentation. All would recommend a PACS. The equipment to view images in the operating theater was assessed as being good or very good by 83%; monitor quality was judged better for the outpatient clinics (100% good or very good). Conventional radiograms were missed at the ward rounds by 56%. Training for PACS was considered sufficient by 67%, and 15% asked for refresher courses. In the reference group 60% asked for refresher courses. In the comparison of orthopedic surgeons with the reference group PACS was judged better especially concerning the viewing software and quality of monitors. CONCLUSION There is an over all acceptance of PACS by physicians outside the radiology department. The availability of images was not only facilitated it was faster as well. However, the quality of monitors in the operating theater should be improved. To achieve sustained success of PACS consistent training on PACS and its features is necessary. Conventional radiograms were often missed at the ward rounds.
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Affiliation(s)
- M Lenhart
- Klinik für Diagnostische und Interventionelle Radiologie, Sozialstiftung Bamberg, Buger Straße 80, 96049 Bamberg, Deutschland.
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Jobke B, Andreou D, Werner M, Herold T. Knochentumore: Radiologisch-Pathologische Übersicht der häufigsten malignen u. benignen Entitäten. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1253076] [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: 10/19/2022]
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Rennert J, Herold T, Jung EM, Schreyer AG, Bachthaler M, Müller-Wille R, Feuerbach S, Zorger N. Vergleich zwischen MR-AP und MRT mit leberspezifischem Kontrastmittel hinsichtlich Nutzen und Effektivität bei der Detektion und Beurteilung des HCC. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252729] [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: 10/19/2022]
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Schacherer D, Decking D, Herold T, Obed A, Schlitt HJ, Gruene S, Schoelmerich J, Schlottmann K. [Localisation of hepatic lesions to liver segments according to sonography (US), computed tomography (CT) and surgery (OP): a comparative study]. Z Gastroenterol 2010; 48:241-5. [PMID: 20127599 DOI: 10.1055/s-0028-1109711] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The localisation of focal liver lesions is usually performed according to the Couinaud classification system. The exact description of localisation and size of liver lesions is especially important for surgical procedures. The aim of this prospective study was the evaluation of differences and agreements in the localisation and size of hepatic lesions as found by ultrasound (US), computed tomography (CT) and according to the intraoperative status (OP). MATERIAL AND METHODS 32 patients (21 male, 11 female) were enrolled in the study. The results obtained from sonography, computed tomography and surgery were classified into 5 categories for localisation and for size, respectively. RESULTS According to the agreement between sonography and computed tomography, 25 % of all hepatic lesions were classified into category 1 (exact agreement), whereas 40.6 % were ranked into category 2 (almost exact agreement). Correlating sonography and intraoperative results, 31.3 % of the lesions were classified into category 1 and 46.9 % into category 2. In the comparison of CT with OP, 34.4 % of the lesions were found to be in category 1 and 43.8 % in category 2. Concerning the size of the lesions, almost half of the tumours (46.9 %) were classified into category 1 on the basis of the correlation between US and CT and 21.9 % on the basis of the correlation between US and OP. DISCUSSION The localisation and description of the size of hepatic lesions is mainly similar or even identical on the basis of the different methods. Further improvements might be achieved by the introduction of a consistent nomenclature.
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Affiliation(s)
- D Schacherer
- Klinik und Poliklinik für Innere Medizin I, Universität Regensburg, Germany.
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Jung EM, Prantl L, Schreyer AG, Schreyer CI, Rennert J, Walter M, Jung W, Hoffstetter P, Herold T, Zorger N, Feuerbach S, Fellner C. New perfusion imaging of tissue transplants with Contrast Harmonic Ultrasound Imaging (CHI) and Magnetic Resonance Imaging (MRI) in comparison with laser-induced Indocyanine Green (ICG) fluorescence angiography. Clin Hemorheol Microcirc 2010; 43:19-33. [PMID: 19713598 DOI: 10.3233/ch-2009-1218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Evaluation of post-surgery tissue perfusion of free flaps of the lower leg with contrast enhanced harmonic imaging (CHI), laser-induced indocyanine green (ICG) fluorescence angiography and magnetic resonance imaging (MRI). MATERIALS AND METHODS 10 patients with free flaps of the lower limb were evaluated with CHI, ICG-fluorescence angiography and perfusion weighted MRI. Perfusion weighted MRI was performed after intravenous bolus injection of 25 ml Gd-DTPA. The ICG fluorescence was detected by a near-infrared-laser device (lambda em = 780 nm). Ultrasound was carried out by an experienced examiner with a linear probe after intravenous bolus injection of 2.4 ml SonoVue. For MRI time intensity curves as well as color-coded blood volume maps of the whole free flap were qualitatively evaluated. For CHI and ICG time intensity curves in selected regions of interest were analyzed. A score from 1-5 (1 = low, 5 = excellent) was used for analysis of perfusion images by three independent readers. RESULTS In 3 cases (radialis, parascapular and lateral thigh flap) CHI, MRI and ICG perfusion imaging showed an excellent (score 4-5) contrast enhancement of the cutaneous and subcutaneous part of the free flaps. In 2 cases of osteocutaneous flaps perfusion in central and distal parts of the free flaps was reduced (score 2). Correlation between CHI, MRI and ICG was 0.69-0.83 for the distal parts of the free flaps and 0.74-0.87 for the center of the flaps (Spearman test). Perfusion in the center of the free flaps was significantly different for MRI and ICG and also for MRI and CHI (p<0.05, Wilcoxon test). CONCLUSION These first results introduce CHI and MRI perfusion imaging as a promising post-surgery monitoring in patients with free flaps.
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Affiliation(s)
- E M Jung
- Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany.
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Rennert J, Herold T, Schreyer A, Banas B, Jung E, Feuerbach S, Lenhart M, Mueller-Wille R, Zorger N. Evaluation of a Liquid Embolization Agent (Onyx) for Transcatheter Embolization for Renal Vascular Lesions. ROFO-FORTSCHR RONTG 2009; 181:996-1001. [DOI: 10.1055/s-0028-1109741] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Müller-Wille R, Herold T, Jung E, Rennert J, Heiss P, Lenhart M, Paetzel C, Feuerbach S, Zorger N. Onyx (Ethylen-Vinyl-Alkohol-Kopolymer) – Ein neuer Anwendungsbereich in der endovaskulären Behandlung akuter peripherer Blutungen. ROFO-FORTSCHR RONTG 2009; 181:767-73. [DOI: 10.1055/s-0028-1109446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lenhart M, Schätzler S, Manke C, Strotzer M, Seitz J, Gmeinwieser J, Völk M, Zorger N, Feuerbach S, Herold T, Paetzel C. Radiologische Implantation zentralvenöser Portsysteme am Unterarm. ROFO-FORTSCHR RONTG 2009; 182:20-8. [DOI: 10.1055/s-0028-1109453] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rennert J, Herold T, Banas B, Jung EM, Feuerbach S, Schreyer AG, Mueller-Wille R, Zorger N. Endovaskuläre Behandlung akuter Nierenblutungen mit einem neuen Flüssigembolisat (Onyx): erste klinische Ergebnisse. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221738] [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: 10/20/2022]
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Zorger N, Rennert J, Herold T, Jung EM, Schreyer AG, Paetzel C, Feuerbach S, Lenhart M. Transjuguläre Intrahepatische Portosystemische Shunts: Adjuvante Embolisation gastroösophagaler Kollateralgefäße mit einem neu entwickelten Flüssigembolisat (Onyx) zur Prävention der Varizen-Blutung. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221739] [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: 10/20/2022]
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Müller-Wille R, Herold T, Heiss P, Jung EM, Rennert J, Feuerbach S, Zorger N. Onyx (Ethylenvinyl Alkohol Kopolymer) – Endovaskuläre Behandlung akuter peripherer arterieller Blutungen mit neuartigem Flüssigembolisat. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221304] [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: 10/20/2022]
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Heiss P, Zorger N, Kaempfe I, Jung EM, Pfister K, Paetzel C, Feuerbach S, Herold T. [Stenting in the treatment of chronic mesenteric ischemia: technical and clinical success rates]. ROFO-FORTSCHR RONTG 2009; 180:906-14. [PMID: 19238641 DOI: 10.1055/s-2008-1027699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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 To evaluate the technical and clinical success rates of percutaneous stent revascularization in the treatment of chronic mesenteric ischemia (CMI). PATIENTS AND METHODS 17 patients (12 female) with typical symptoms of CMI were treated by percutaneous stent placement for stenoses of the splanchnic arteries (celiac trunk; superior mesenteric artery, SMA; inferior mesenteric artery, IMA). The primary and secondary technical success, primary and secondary clinical success, and the long-term clinical outcome were determined. RESULTS A total of 24 stents were implanted in 21 splanchnic arteries (12 stents in the celiac trunk, 11 in the SMA and 1 in the IMA). The primary technical success rate was 91% (19/21 arteries), the secondary technical success rate was 95% (21/22 arteries). Clinical follow-up was available for 16 patients. The primary clinical success rate was 81% (13/16 patients). Following two secondary interventions, the secondary clinical success rate was 94% (15/16 patients). Long-term clinical success was achieved in 15 of 16 patients (94%) with a mean follow-up of 26 months. One patient died within 30 days of the intervention and two patients demonstrated major complications (1 dissection, 1 stent dislocation). None of the patients required surgical revascularization and none of the patients died due to recurrent mesenteric ischemia. CONCLUSION Percutaneous stent placement for the treatment of CMI can be performed with a high technical and clinical success rate as well as an excellent long-term clinical outcome.
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Affiliation(s)
- P Heiss
- Institut für Röntgendiagnostik, Universität Regensburg.
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Thoene S, Rawat VPS, Heilmeier B, Hoster E, Metzeler KH, Herold T, Hiddemann W, Gökbuget N, Hoelzer D, Bohlander SK, Feuring-Buske M, Buske C. The homeobox gene CDX2 is aberrantly expressed and associated with an inferior prognosis in patients with acute lymphoblastic leukemia. Leukemia 2009; 23:649-55. [DOI: 10.1038/leu.2008.355] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Müller-Wille R, Herold T, Schreyer AG. [Ainhum disease (dactylolysis spontanea)]. ROFO-FORTSCHR RONTG 2008; 180:348-50. [PMID: 18370349 DOI: 10.1055/s-2008-1027140] [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: 10/22/2022]
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Hoffstetter P, Herold T, Daneschnejad M, Zorger N, Jung E, Feuerbach S, Schreyer A. Nicht traumaassozierte Nebenbefunde bei Ganzkörpercomputertomografien im Rahmen der Polytraumadiagnostik. ROFO-FORTSCHR RONTG 2008; 180:120-6. [DOI: 10.1055/s-2007-963594] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [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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Endlicher E, Troppmann M, Kullmann A, Golder S, Herold T, Herfarth H, Grossmann J, Schlottmann K, Kullmann F. Irinotecan plus gemcitabine and 5-fluorouracil in advanced pancreatic cancer: a phase II study. Oncology 2008; 72:279-84. [PMID: 18187949 DOI: 10.1159/000113039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 07/19/2007] [Indexed: 11/19/2022]
Abstract
AIMS The aim of the present study was to evaluate the 6-month survival rate of patients with inoperable or metastatic pancreatic cancer treated with irinotecan and gemcitabine plus 5-fluorouracil. Secondary efficacy end points included response rate, time to progression (TTP), overall survival (OS) and toxicity. PATIENTS AND METHODS 30 patients with histologically proven pancreatic carcinoma and at least one bidimensionally measurable lesion were enrolled. Of the patients, 83% had metastatic and 17% locally advanced disease. One cycle, lasting 21 days, comprised treatment on days 1 and 8 consisting of 75 mg/m(2) irinotecan i.v. for 90 min, 1,000 mg/m(2) gemcitabine i.v. for 30 min and 2,000 mg/m(2) fluorouracil (5-FU) for 24 h. A total of six cycles was planned for each patient. RESULTS 28 patients competed at least one treatment cycle and were therefore assessable for efficacy, and 75% of them achieved the primary end point of the study (survival after 6 months). One-year survival was 25%. Stabilization (partial response and stable disease) was observed in 35.7% (10/28) and partial remission in 7.1% (2/28). The objective response rate was 7.1% (2/28) after completion of the six cycles. Median TTP was 3.4 months (1.2-11.5), and median OS was 8.3 months (2.1-36.2). Regarding severe hematological toxicities, only neutropenia was observed (grade 3 20.7%, 6/29, and grade 4 3.5%, 1/29). In spite of anti-emetic supportive care, nausea affected most of the patients: 79.3% (23/29). Grade 3 vomiting was observed in 4 of the 29 patients (13.8%) and grade 4 in 1 patient (3.5%). Only 1 patient experienced diarrhea grade 3 (3.5%) and 1 patient (3.5%) suffered from a grade 3 peroneal nerve enervation. CONCLUSIONS A combination of irinotecan, gemcitabine and 5-FU is feasible and shows considerable efficacy in patients with inoperable or metastatic pancreatic cancer. Due to its low toxicity, this combination might be an interesting cytotoxic regimen in addition to targeted therapies.
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Affiliation(s)
- E Endlicher
- Department of Internal Medicine I, University of Regensburg, Regensburg, Germany
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Zorger N, Jung EM, Hamer OW, Paetzel C, Schreyer A, Seitz J, Stehr A, Steinbauer M, Feuerbach S, Herold T. Intraarterial gadolinium-enhanced magnetic resonance angiography of the renal arteries in humans: feasibility, contrast agent reduction, and accuracy for detection of stenoses. Clin Hemorheol Microcirc 2008; 38:97-104. [PMID: 18198411] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Feasibility of intraarterial MR angiography of the renal arteries and comparison of the accuracy of intraarterial MR angiography with selective intraarterial digital subtraction angiography (DSA) for detection of stenoses. MATERIALS AND METHODS Ten consecutive patients (mean, 68 years) with suspected renal artery stenosis underwent a digital subtraction angiography and an intraarterial gadolinium-enhanced MR angiography, performed on a 1.5-T system. For intraarterial MR angiography 60 ml diluted contrast agent (10 ml gadodiamide in 50 ml 0.9% saline solution) was injected through a conventional angiography catheter placed in the suprarenal abdominal aorta using a flow rate of 3.5 ml/s. A three-dimensional (3D) gradient-echo sequence was performed. Differences in the quantitative measurement of stenoses of lesions between DSA and intraarterial MR angiography were evaluated by three observers. Overall impression of the intraarterial MR angiography was documented on a four-point scale (1 = excellent to 4 = poor). Interobserver variability was calculated. RESULTS Intraarterial MR angiography of the renal arteries was feasible in all patients (100%) with a mean overall impression of all images of 1.8 (SD: 0.71). One of 9 accessory renal arteries was not visualized with intraarterial MR angiography. The overall sensitivity/specificity for detection of significant stenoses (>or=50% stenosis) were 83%/87%. Interobserver variability of intraarterial MR angiography ranged between fair and substantial (0.359-0.622). CONCLUSION Intraarterial MR angiography of the renal arteries in humans is feasible and has an acceptable sensitivity in detecting stenoses using injections of diluted contrast agent at concentrations as low as 17%.
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Affiliation(s)
- N Zorger
- Department of Diagnostic Radiology, University of Regensburg, Klinikum, Germany.
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Herold T. Indirekte MR-Arthrographie. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073411] [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: 10/21/2022]
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Prantl L, Schmitt S, Gais S, Tsui TY, Lamby P, Babilas P, Nerlich M, Kubale R, Zorger N, Herold T, Feuerbach S, Jung EM. Contrast harmonic ultrasound and indocyanine-green fluorescence video angiography for evaluation of dermal and subdermal microcirculation in free parascapular flaps. Clin Hemorheol Microcirc 2008; 38:31-44. [PMID: 18094456] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Contrast harmonic ultrasound (CHI) with a linear transducer is a new diagnostic approach that allows dynamic and quantitative flow detection of tissue perfusion in microsurgery. The aim of the study was the evaluation of perfusion of the dermal and subdermal layers of microvascular tissue transplants with CHI in comparison to ICG-fluorescence angiography. MATERIAL AND METHOD In a prospective clinical study indocyanine-green fluorescence video angiography and contrast enhanced high resolution ultrasound (5-10 MHz; linear transducer; Logiq 9; GE) were used for evaluation of the microcirculation in 10 transplanted free parascapular flaps. Two regions were analysed, the centre of the flap and the region of the anastomosis. The perfusion patterns of both methods were compared. RESULTS The perfusion indexes measured by ICG-fluorescence angiography correlated very precisely in all patients with the quantitative perfusion curves of contrast-enhanced US with CHI. Two flaps with slow filling and low dye intensity showed low contrast enhancement in CHI with modified perfusion curves with slow increase. In two cases a reduced perfusion and filling were found. There were no statistical differences between the two diagnostic methods (p>0.01). CONCLUSION CHI improves US detections of dermal and subdermal microcirculation in comparison to ICG fluorescence angiography. CHI is a new diagnostic method for postoperative monitoring of free flaps.
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Affiliation(s)
- L Prantl
- Institute of Trauma, Plastic and Reconstructive Surgery, University Hospital Regensburg, Germany.
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Zorger N, Herold T. Intervention bei Typ-B-Dissektionen: Stenting und Fensterung. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073240] [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: 10/21/2022]
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Prantl L, Schmitt S, Geis S, Tsui TY, Lamby P, Nerlich M, Kubale R, Zorger N, Herold T, Feuerbach S, Jung EM. Contrast harmonic ultrasound and indocyanine-green fluorescence video angiography for evaluation of dermal and subdermal microcirculation in free parascapular flaps. Clin Hemorheol Microcirc 2008; 38:105-118. [PMID: 18198412] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Contrast harmonic ultrasound (CHI) with a linear transducer is a new diagnostic approach that allows dynamic and quantitative flow detection of tissue perfusion in microsurgery. The aim of the study was the evaluation of perfusion of the dermal and subdermal layers of microvascular tissue transplants with CHI in comparison to ICG-fluorescence angiography. MATERIAL AND METHOD In a prospective clinical study Indocyanine-Green Fluorescence Video Angiography and Contrast Enhanced High Resolution Ultrasound (5-10 MHz; linear transducer; Logiq 9; GE) were used for evaluation of the microcirculation in 10 transplanted free parascapular flaps. Two regions were analysed, the centre of the flap and the region of the anastomosis. The perfusion patterns of both methods were compared. RESULTS The perfusion indexes measured by ICG-fluorescence angiography correlated very precisely in all patients with the quantitative perfusion curves of contrast-enhanced US with CHI. Two flaps with slow filling and low dye intensity showed low contrast enhancement in CHI with modified perfusion curves with slow increase. In two cases a reduced perfusion and filling were found. There were no statistical differences between the two diagnostic methods (p>0.01). CONCLUSION CHI improves US detections of dermal and subdermal microcirculation in comparison to ICG fluorescence angiography. CHI is a new diagnostic method for postoperative monitoring of free flaps.
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Affiliation(s)
- L Prantl
- Institute of Trauma, Plastic and Reconstructive Surgery, University Hospital Regensburg, Germany.
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Rieger C, Geiger S, Herold T, Nickenig C, Ostermann H. Breakthrough infection of Trichosporon asahii during posaconazole treatment in a patient with acute myeloid leukaemia. Eur J Clin Microbiol Infect Dis 2007; 26:843-5. [PMID: 17690928 DOI: 10.1007/s10096-007-0366-5] [Citation(s) in RCA: 19] [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: 10/23/2022]
Abstract
A neutropenic patient with acute myeloid leukaemia experienced a breakthrough infection of Trichosporon asahii during posaconazole treatment. After treatment was changed to a combination therapy with voriconazole and liposomal amphotericin B, the infection resolved. Posaconazole works effectively as an antifungal prophylaxis and salvage therapy in rare invasive fungal infections. This case however illustrates that breakthrough infections with T. asahii may occur during posaconazole treatment.
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Affiliation(s)
- C Rieger
- Department of Hematology/Oncology, University Hospital Grosshadern, Ludwig Maximilian University, Marchioninistrasse 15, 81377, Munich, Germany.
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Stehr A, Steinbauer M, Pfister K, Töpel I, Herold T, Zorger N, Kasprzak PM. Diagnostik und endovaskuläre Behandlung einer proximalen Endograft-Instabilität nach thorakalem Endostent. Zentralbl Chir 2007; 132:211-5. [PMID: 17610191 DOI: 10.1055/s-2007-960754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/23/2022]
Abstract
Four cases of proximal endostent instability after endovascular tube graft treatment of thoracic aortic disease using the TAG Gore system are reported. This potentially hazardous complication is characterized by a lack of attachment of the device to the small curvature of the aortic arch. Towering up against the hemodynamic forces in this area, the endograft could collapse and occlude the aorta. To identify this complication we recommend to perform an early postinterventional CT-scan with parasagittal reconstruction and an observation of the proximal endograft by fluorography. Endovascular solutions for the treatment of this complication may be either a proximal extension by another endograft or fixation of the proximal endograft by a balloon expandable Palmaz stent.
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Affiliation(s)
- A Stehr
- Gefässchirurgie und Endovaskuläre Chirurgie, Klinik und Poliklinik für Chirurgie, Universität Regensburg, Regensburg
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Wiest R, Jurzik L, Herold T, Straub RH, Schölmerich J. Role of NPY for vasoregulation in the splanchnic circulation during portal hypertension. Peptides 2007; 28:396-404. [PMID: 17194504 DOI: 10.1016/j.peptides.2006.08.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 08/02/2006] [Indexed: 11/25/2022]
Abstract
Vascular dysfunction in the splanchnic circulation during portal hypertension is characterized by enhanced NO-mediated vasorelaxation and vascular hyporeactivity to norepinephrine that lead to arterial vasodilation. NPY most likely counteracts both of these key features. Firstly, NPY appears to inhibit Ach- and PNS-induced vasorelaxation in mesenteric arteries. This effect is more pronounced in portal hypertensive rats as compared to control, and most likely reflects the inhibition of increased e- and nNOS-derived NO-synthesis during portal hypertensive conditions. Secondly, NPY sensitizes the mesenteric vasculature to alpha(1)-adrenergic vasoconstriction. Most importantly, in portal hypertensive rats but not in sham rats NPY markedly augments vascular contractility and thereby corrects vascular hyporeactivity. Both actions of NPY increase vascular tone and may well act synergistically in the splanchnic circulation during portal hypertension. Moreover, the vasoconstrictive effects of NPY are most pronounced at particularly high levels of alpha(1)-adrenergic activity. Therefore, it appears that NPY becomes increasingly important for optimizing adrenergic vasoconstriction at particularly high adrenergic drive and also for playing a predominant role for vascular homeostasis. Cirrhotic patients present with elevated circulating plasma levels of NPY, which appears to be independent from the severity of liver dysfunction and to correlate with portal pressure. This finding indicates enhanced NPY release during portal hypertension that may represent a compensatory mechanism aimed at counterbalancing arterial vasodilation by restoring the efficacy of endogenous catecholamines and inhibiting vasodilative drive in the splanchnic circulation.
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Affiliation(s)
- R Wiest
- Department of Internal Medicine, School of Medicine, University Hospital, Regensburg 93042, Germany.
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Heiss P, Zorger N, Jung M, Bachthaler M, Braun J, Feuerbach S, Herold T. Perkutane Stent-Angioplastie bei chronischer mesenterialer Ischämie: Technische und klinische Erfolgrate. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977222] [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: 10/21/2022]
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Poschenrieder F, Herold T, Borisch I, Schleicher T, Butz B, Daneschnejad M, Heiss P, Feuerbach S, Zorger N. Vergleich einer neu entwickelten intraarteriellen MR-Angiographie mit der intravenösen MR-Angiographie der Becken-/Bein-Gefäße zur Beurteilung von Stenosen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977202] [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: 10/21/2022]
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Jung EM, Kubale R, Clevert DA, Weskott HP, Prantl L, Herold T, Renz M, Rupp N, Tacke J. B-flow and B-flow with 3D and SRI postprocessing before intervention and monitoring after stenting of the internal carotid artery. Clin Hemorheol Microcirc 2007; 36:35-46. [PMID: 17211060] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To investigate the extent to which B-flow and B-flow with 3D postprocessing and speckle reduction imaging (SRI) have advantages in appraising the morphology of a high-grade stenosis of the internal carotid artery (ICA) for preinterventional planning and for postinterventional ultrasonographic follow-up. MATERIALS/METHODS A comparative appraisal of flow with CCDS, power Doppler, B-flow and 3D B-Flow with SRI were carried out prospectively in 50 patients with >70% stenosis according to NASCET criteria in contrast medium-enhanced MRA before and after the intervention. After stenting of the internal carotid artery (ICA), i.a. digital substraction angiography (DSA) served as an additional reference method. RESULTS In >70% ICA stenosis, simultaneous imaging of the pre-stenotic, intra-stenotic and post-stenotic flow was attained with B-flow in 45/90 cases (90%), with power Doppler in 39/50 cases (78%) and with CCDS in only 31/50 cases (62%). After intervention, a complete detection of flow without overwriting or blooming artifacts was achieved in all 50 patients only by B-flow. The intrastenotic flow (p<0.05) could be better demarcated against the lumen and the vessel wall before the intervention, whereas the flow within the stent could be very much better appraised after the intervention (p<0.01) using 3D postprocessing of B-flow with additional SRI. Re-stenoses with hypoechoic vascular wall changes (3/50 patients) were detected at an early stage using B-flow. CONCLUSIONS B-flow technique with SRI and 3D postprocessing can facilitate the intrastenotic detection of flow in >70% ICA stenosis with fewer flow artifacts. After stenting, the perfused vascular lumen shows less flow artifacts compared with CCDS and power Doppler. In order to elucidate hemodynamic changes, additional Doppler examinations are still necessary.
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Affiliation(s)
- E M Jung
- Institute of Diagnostic, Interventional Radiology and Neuroradiology, Klinikum Passau, Innstrasse 76, D-94032 Passau, Germany.
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Prantl L, Pfister K, Kubale R, Schmitt S, Stockhammer V, Jung W, Zorger N, Herold T, Nerlich M, Stehr A, Jung EM. Value of high resolution ultrasound and contrast enhanced US pulse inversion imaging for the evaluation of the vascular integrity of free-flap grafts. Clin Hemorheol Microcirc 2007; 36:203-16. [PMID: 17361023] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical value of color coded Doppler sonography (CCDS) and contrast-enhanced harmonic imaging (CHI) for ultrasound (US) monitoring the integrity of free-flap vascular grafts. Patency of microvascular anastomoses and perfusion as well as microcirculation of the transplanted tissue were analysed. PATIENTS AND METHODS Fifteen free parascapular flap grafts performed over a period of three years by a single surgeon were examined with CCDS and CHI. The patients (12 male, 3 female) ranged in age from 16 to 60 years (average age 40+/-12). The follow-up period ranged from two weeks to 2.5 years. CCDS were performed with a multifrequency linear transducer (5-10 MHz, Logiq 9, GE) with 3D flow detection. For detection and characterization, B scan of the flap tissue was compared to tissue harmonic imaging (THI) and Cross Beam with Speckle Reduction Imaging (SRI). US Pulse Inversion Harmonic Imaging (PIHI) after bolus injection of 2.5 ml Sonovue was used for contrast enhancement. RESULTS Border and tissue structure of the flaps could be detected best in all 15/15 cases using Cross Beam Technology with SRI and THI. Correlations were found for flow parameters of the common femoral artery, popliteal artery and lower leg artery to the anastomotic vessels. 3D imaging with CCDS facilitated flow detection of elongated and small anastomotic vessels in 4/15 cases. Contrast-enhanced US with PIHI allowed dynamic flow detection of the microcirculation of the transplanted tissue over a depth of up to 3 cm with quantitative perfusion curves of the tissue microcirculation. Reduced US contrast enhancement with modified perfusion curves was seen in 2/15 cases with low anastomic flow in CCDS. CONCLUSION Assessment of microvascular perfusion with contrast-enhanced ultrasound can provide valuable information on free flap viability. Contrast-enhanced US enables dynamic and quantitative flow detection of free flap tissue.
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Affiliation(s)
- L Prantl
- Institute of Plastic and Reconstructive Surgery, University Hospital Regensburg, Germany.
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