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101.
Preoperative Evaluation of Pancreatic Masses with Positron Emission Tomography Using 18F-fluorodeoxyglucose: Diagnostic Limitations 总被引:7,自引:0,他引:7
Sendler A Avril N Helmberger H Stollfuss J Weber W Bengel F Schwaiger M Roder JD Siewert JR 《World journal of surgery》2000,24(9):1121-1129
Identification of pancreatic cancer in patients presenting with an enlarged pancreatic mass is a major diagnostic problem.
Positron emission tomography (PET) using the radiolabeled glucose analogue 18F-fluorodeoxyglucose (FDG) has been suggested to provide excellent accuracy for noninvasive determination of suspicious pancreatic
masses. We conducted a prospective study to verify these results. Forty-two patients admitted for pancreatic surgery underwent
PET scanning. Image analysis was based on visual film evaluation and quantification of regional tracer uptake. PET imaging
was visually analyzed by three observers blinded for the results of other diagnostic tests; they qualitatively graded the
scans using a five-point scale (I = low to V = high) for the presence and intensity of focal FDG uptake. Diagnosis was proven
by histology (n= 38) or follow-up (n= 4). Furthermore, the results of PET were compared with helical computed tomography (CT) and conventional ultrasonography
(US), done during the routine diagnostic workup before pancreatic cancer surgery. Regarding only the results with scores of
IV and V as positive for representing definite malignancy yielded a sensitivity of 71% and a specificity of 64% for film reading.
Quantification of regional tracer uptake contributed no significant diagnostic advantage for differentiation between benign
and malignant tumors. Helical CT revealed a sensitivity of 74% and a specificity of 45.5% and abdominal US 56% and 50%, respectively.
We concluded that PET imaging provides only fair diagnostic accuracy (69%) for characterizing enlarged pancreatic masses.
PET does not allow exclusion of malignant tumors. In doubtful cases, the method must be combined with other imaging modalities,
such as helical CT. The results indicate that the number of invasive procedures is not significantly reduced by PET imaging. 相似文献
102.
Udo Vanhoefer Mitra Tewes Federico Rojo Olaf Dirsch Norbert Schleucher Oliver Rosen Joachim Tillner Andreas Kovar Ada H Braun Tanja Trarbach Siegfried Seeber Andreas Harstrick José Baselga 《Journal of clinical oncology》2004,22(1):175-184
PURPOSE: To investigate the safety and tolerability and to explore the pharmacokinetic and pharmacodynamic profile of the humanized antiepidermal growth factor receptor monoclonal antibody EMD72000 in patients with solid tumors that express epidermal growth factor receptor (EGFR). PATIENTS AND METHODS: This was a phase I dose-escalation trial of EMD72000 in patients with advanced, EGFR-positive, solid malignancies that were not amenable to any established chemotherapy or radiotherapy treatment. EMD72000 was administered weekly without routine premedication until disease progression or unacceptable toxicity. RESULTS: Twenty-two patients were treated with EMD72000 at five different dose levels (400 to 2,000 mg/wk). National Cancer Institute common toxicity criteria grade 3 headache and fever occurring after the first infusion were dose limiting at 2,000 mg/wk; thus, the maximum-tolerated dose was 1,600 mg/wk. No other severe side effects, especially no allergic reactions or diarrhea, were observed. Acneiform skin reaction was the most common toxicity, but it was mild, with grade 1 in 11 patients (50%) and grade 2 in three patients (14%). Pharmacokinetic analyses demonstrated a predictable pharmacokinetic profile for EMD72000. Pharmacodynamic studies on serial skin biopsies revealed that EMD72000 effectively abrogated EGFR-mediated cell signaling (eg, reduced phosphorylation of EGFR and mitogen-activated protein kinase), with no alteration in total EGFR protein. Objective responses (23%; 95% CI, 8% to 45%) and disease stabilization (27%; 95% CI, 11% to 50%) were achieved at all dose levels, and responding patients received treatment for up to 18 months without cumulative toxicity. CONCLUSION: Treatment with EMD72000 was well tolerated and showed evidence of activity in heavily pretreated patients with EGFR-expressing tumors. EMD72000 at the investigated doses significantly inhibited downstream EGFR-dependent processes. 相似文献
103.
Outcome of treatment in adults with acute lymphoblastic leukemia: analysis of the LALA-94 trial. 总被引:21,自引:0,他引:21
Xavier Thomas Jean-Michel Boiron Fran?oise Huguet Hervé Dombret Ken Bradstock Norbert Vey Tibor Kovacsovics André Delannoy Nathalie Fegueux Pierre Fenaux Aspasia Stamatoullas Jean-Paul Vernant Olivier Tournilhac Agnès Buzyn Oumedaly Reman Christiane Charrin Claude Boucheix Jean Gabert Véronique Lhéritier Denis Fiere 《Journal of clinical oncology》2004,22(20):4075-4086
PURPOSE: We analyzed the benefits of a risk-adapted postremission strategy in adult lymphoblastic leukemia (ALL), and re-evaluated stem-cell transplantation (SCT) for high-risk ALL. PATIENTS AND METHODS: A total of 922 adult patients entered onto the trial according to risk groups: standard-risk ALL (group 1), high-risk ALL (group 2), Philadelphia chromosome-positive ALL (group 3), and CNS-positive ALL (group 4). All received a standard four-drug/4-week induction course. Patients from group 1 who achieved a complete remission (CR) after one course of induction therapy were randomly assigned between intensive and less intensive postremission chemotherapy, whereas those who achieved CR after salvage therapy were then included in group 2. Patients in groups 2, 3, and 4 with an HLA-identical sibling were assigned to allogeneic SCT. In groups 3 and 4, autologous SCT was offered to all other patients, whereas in group 2 they were randomly assigned between chemotherapy and autologous SCT. RESULTS: Overall, 771 patients achieved CR (84%). Median disease-free survival (DFS) was 17.5 months, with 3-year DFS at 37%. In group 1, the 3-year DFS rate was 41%, with no difference between arms of postremission randomization. In groups 2 and 4, the 3-year DFS rates were 38% and 44%, respectively. In group 2, autologous SCT and chemotherapy resulted in comparable median DFS. Patients with an HLA-matched sibling (groups 2 and 4) had improved DFS. Three-year DFS was 24% in group 3. CONCLUSION: Allogeneic SCT improved DFS in high-risk ALL in the first CR. Autologous SCT did not confer a significant benefit over chemotherapy for high-risk ALL. 相似文献
104.
Toshifumi Ozaki Silke Flege Matthias Kevric Norbert Lindner Rainer Maas Günter Delling Rudolf Schwarz Arthur R von Hochstetter Mechthild Salzer-Kuntschik Wolfgang E Berdel Heribert Jürgens G Ulrich Exner Peter Reichardt Regine Mayer-Steinacker Volker Ewerbeck Rainer Kotz Winfried Winkelmann Stefan S Bielack 《Journal of clinical oncology》2003,21(2):334-341
PURPOSE: To define patients and tumor characteristics as well as therapy results, patients with pelvic osteosarcoma who were registered in the Cooperative Osteosarcoma Study Group (COSS) were analyzed. PATIENTS AND METHODS: Sixty-seven patients with a high-grade pelvic osteosarcoma were eligible for this analysis. Fifteen patients had primary metastases. All patients received chemotherapy according to COSS protocols. Thirty-eight patients underwent limb-sparing surgery, 12 patients underwent hemipelvectomy, and 17 patients did not undergo definitive surgery. Eleven patients received irradiation to the primary tumor site: four postoperatively and seven as the only form of local therapy. RESULTS: Local failure occurred in 47 of all 67 patients (70%) and in 31 of 50 patients (62%) who underwent definitive surgery. Five-year overall survival (OS) and progression-free survival rates were 27% and 19%, respectively. Large tumor size (P =.0137), primary metastases (P =.0001), and no or intralesional surgery (P <.0001) were poor prognostic factors. In 30 patients with no or intralesional surgery, 11 patients with radiotherapy had better OS than 19 patients without radiotherapy (P =.0033). Among the variables, primary metastasis, large tumor, no or intralesional surgery, no radiotherapy, existence of primary metastasis (relative risk [RR] = 3.456; P =.0009), surgical margin (intralesional or no surgical excision; RR = 5.619; P <.0001), and no radiotherapy (RR = 4.196; P =.0059) were independent poor prognostic factors. CONCLUSION: An operative approach with wide or marginal margins improves local control and OS. If the surgical margin is intralesional or excision is impossible, additional radiotherapy has a positive influence on prognosis. 相似文献
105.
Embolization for gastrointestinal hemorrhages 总被引:11,自引:0,他引:11
Krämer SC Görich J Rilinger N Siech M Aschoff AJ Vogel J Brambs HJ 《European radiology》2000,10(5):802-805
Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term
observation period from 1989 to 1997. Included in the study were 35 patients (age range 18–89 years) with gastrointestinal
bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources
of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations
of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles,
a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35
cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized.
In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications
was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction
of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients,
including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional
techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications.
Received: 21 June 1999; Revised: 24 August 1999; Accepted: 28 September 1999 相似文献
106.
Allergic airway diseases induced by low molecular weight (LMW) chemicals, including trimellitic anhydride (TMA), are characterized by airway mucus hypersecretion and an infiltration of eosinophils and lymphocytes. Many experimental models have linked LMW chemical-induced allergic airway disease to Th2 cytokines. Most murine models, however, use dermal exposure to sensitize mice. The present study was designed to test the hypothesis that intranasal sensitization and challenge with the known chemical respiratory allergen TMA, but not the nonrespiratory sensitizers dinitrochlorobenzene (DNCB) and oxazolone (OXA), will induce characteristic features of LMW chemical-induced allergic airway disease in the nasal and pulmonary airways. A/J mice were intranasally sensitized and challenged with TMA, DNCB, or OXA. Only mice that were intranasally sensitized and challenged with TMA had a marked allergic rhinitis with an influx of eosinophils, lymphocytes, and plasma cells, increased intraepithelial mucusubstances, and a regenerative hyperplasia. Cytokine mRNA levels in the nasal airway of TMA treated mice also revealed an increase in the mRNA levels of the Th2 cytokines IL-4, IL-5, and IL-13, but no change in the level of the Th1 cytokine IFN-gamma. No lesions were found in the nasal airways of mice exposed to DNCB or OXA. TMA increased lung-derived IL-5 mRNA while DNCB and OXA caused no change in lung-derived cytokine mRNA levels. Both TMA and DNCB caused increases in total serum IgE, unlike OXA-exposed mice. However, no adverse alterations were found microscopically in the lungs of mice treated with TMA, DNCB, or OXA. This study is the first to demonstrate that intranasal administration of a known chemical respiratory allergen is an effective method of sensitization resulting in the hallmark features of allergic rhinitis after challenge with a concomitant increase in nasal airway-derived Th2 cytokine mRNA, lung-derived IL-5 mRNA, and total serum IgE. In contrast, DNCB and OXA failed to elicit the pathologic changes in the nasal airways and cytokine changes in the lung. This model may be useful for identifying other chemical respiratory allergens. 相似文献
107.
Steffen Robert Tornieporth Nadia Costa Clemens Sue-Ann Chatterjee Santanu Cavalcanti Ana-Maria Collard Françoise De Clercq Norbert DuPont Herbert L. von Sonnenburg Frank 《Journal of travel medicine》2004,11(4):231-238
Background Recent epidemiologic data on travelers— diarrhea (TD) are essential for the evaluation of conventional and future prophylactic and therapeutic measures.
Methods To determine the epidemiology, including risk factors, impact and quality-of-life evaluation of TD, a cross-sectional survey was conducted over 12 months at the airports of Mombasa (Kenya), Goa (India), Montego Bay (Jamaica) and Fortaleza (Brazil) by distributing questionnaires to visitors just prior to their flying home. The study period was March 1996 to July 1998.
Results Overall, 73,630 short-term visitors completed a questionnaire. The total diarrhea attack rate varied between a high of 54.6% in Mombasa and a low of 13.6% in Fortaleza, but only between 31.5% and 5.4% of all travelers had classic TD. The 14-day incidence rates varied between 19.5% and 65.7%. Few travelers meticulously avoided potentially dangerous food items, although in India and Kenya most travelers avoided those considered most dangerous. Risk factors were stays exceeding 1 week, age between 15 and 30 years, and residence in the UK. The impact, measured as incapacity or quality-of-life scores, was very considerable.
Conclusions TD continues to affect vacationers and business travelers as frequently as it did some 20 years ago. Compliance with recommendations to reduce exposure to pathogens by avoiding dangerous food items is poor among travelers from all countries. Implementation of food safety education programs may be difficult to achieve. 相似文献
Methods To determine the epidemiology, including risk factors, impact and quality-of-life evaluation of TD, a cross-sectional survey was conducted over 12 months at the airports of Mombasa (Kenya), Goa (India), Montego Bay (Jamaica) and Fortaleza (Brazil) by distributing questionnaires to visitors just prior to their flying home. The study period was March 1996 to July 1998.
Results Overall, 73,630 short-term visitors completed a questionnaire. The total diarrhea attack rate varied between a high of 54.6% in Mombasa and a low of 13.6% in Fortaleza, but only between 31.5% and 5.4% of all travelers had classic TD. The 14-day incidence rates varied between 19.5% and 65.7%. Few travelers meticulously avoided potentially dangerous food items, although in India and Kenya most travelers avoided those considered most dangerous. Risk factors were stays exceeding 1 week, age between 15 and 30 years, and residence in the UK. The impact, measured as incapacity or quality-of-life scores, was very considerable.
Conclusions TD continues to affect vacationers and business travelers as frequently as it did some 20 years ago. Compliance with recommendations to reduce exposure to pathogens by avoiding dangerous food items is poor among travelers from all countries. Implementation of food safety education programs may be difficult to achieve. 相似文献
108.
Prof. Dr. med. Uwe Janssens Prof. Dr. med. Hilmar Burchardi Univ.-Prof. Dr. med. Gunnar Duttge Renate Erchinger Dr. med. Peter Gretenkort Prof. Dr. med. Michael Mohr Univ.-Prof. Dr. med. Friedemann Nauck Sonja Roth?rmel Prof. Dr. med. Fred Salomon Univ.-Prof. Dr. med. P. Schmucker PD Dr. phil. Alfred Simon Prof. Dr. med. Herwig Stopfkuchen Prof. Dr. med. Andreas Valentin Univ.-Prof. Dr. med. Norbert Weiler Dr. med. Gerald Neitzke 《MedR Medizinrecht》2012,30(10):647-650
109.
Paul Störchle Wolfram Müller Marietta Sengeis Helmut Ahammer Alfred Fürhapter-Rieger Norbert Bachl Sonja Lackner Sabrina Mörkl Sandra Holasek 《Ultrasound in medicine & biology》2017,43(2):427-438
A recently standardized ultrasound technique for measuring subcutaneous adipose tissue (SAT) was applied to normal-weight, overweight and obese persons. Eight measurement sites were used: upper abdomen, lower abdomen, erector spinae, distal triceps, brachioradialis, lateral thigh, front thigh and medial calf. Fat compression was avoided. Fat patterning in 38 participants (body mass index: 18.6–40.3 kgm?2; SAT thickness sums from eight sites: 12–245 mm) was evaluated using a software specifically designed for semi-automatic multiple thickness measurements in SAT (sound speed: 1450 m/s) that also quantifies embedded fibrous structures. With respect to ultrasound intra-observer results, the correlation coefficient ρ = 0.999 (p < 0.01), standard error of the estimate = 1.1 mm and 95% of measurements were within ±2.2 mm. For the normal-weight subgroup, the median measurement deviation was 0.43 mm (1.1% of mean thickness), and for the obese/overweight subgroup it was 0.89 mm (0.5%). The eight sites used here are suggested to represent inter-individual differences in SAT patterning. High measurement accuracy and reliability can be obtained in all groups, from lean to overweight and obese, provided that measurers are trained appropriately. 相似文献