Mediastinale Hodgkin-Lymphome in der Computertomographie Vergleich von exakter CT-gestützter Volumetrie und Volumenabschätzung mit Hilfe einfacher geometrischer Modelle

BACKGROUND: The importance of the size of the primary tumor in lymphomas and its size after treatment is still uncertain. Assuming a prognostic relevance, an assessment of tumor volume before and after induction of chemotherapy has been performed in the pediatric Hodgkin's disease study (HD-90). Since an exact CT-scan-based volumetric tumor assessment is time-consuming and in some centers not possible, the tumor volume is often estimated based on simple geometric approximations. Aim of this study was the development of an easy to apply and nearly exact model of volume estimation compared to CT-scan-based tumor volume measurements. MATERIAL AND METHODS: Thirty computed tomographies (CT) of mediastinal Hodgkin lymphomas of children aged 5 to 16 years have been examined. The CT scans were digitalized using a CCD camera combined with a frame grabber. Applying the Global Lab image software, the true tumor volume was determined excluding local organs, which did not belong to the lymphoma. Subsequently, volumes were assessed using simple geometric models (block, ellipsoid, octaeder) by using the maximum diameters of the tumor. The differences between the volume of the geometric models and the true volume, based on the CT scan evaluation, were compared. RESULTS: The maximum diameters of a tumor can be used to calculate its volume based on simple geometric models. The model "block" overestimates the volume by 89 to 268%. The model "ellipsoid" overestimates the volume on average by 29%. The model "octaeder" underestimates the volume on average by 18%. A division of the block volume by 2.3 approximated the geometric closest to the true volume: the average volume was overestimated by 2% in tumors with a volume larger than 20 ml. No model was sufficient to approximate tumors with a volume of less than 20 ml. CONCLUSIONS: For the estimation of tumor volumes in mediastinal Hodgkin lymphomas exceeding 20 ml, the formula "block/2.3" results in the closest approximation compared to the true volume. In the course of clinical studies it might be helpful to apply this formula to determine the prognostic relevance of the tumor size and its development under therapy.     

Temperature-Acclimated Brown Adipose Tissue Modulates Insulin Sensitivity in Humans

In rodents, brown adipose tissue (BAT) regulates cold- and diet-induced thermogenesis (CIT; DIT). Whether BAT recruitment is reversible and how it impacts on energy metabolism have not been investigated in humans. We examined the effects of temperature acclimation on BAT, energy balance, and substrate metabolism in a prospective crossover study of 4-month duration, consisting of four consecutive blocks of 1-month overnight temperature acclimation (24°C [month 1] → 19°C [month 2] → 24°C [month 3] → 27°C [month 4]) of five healthy men in a temperature-controlled research facility. Sequential monthly acclimation modulated BAT reversibly, boosting and suppressing its abundance and activity in mild cold and warm conditions (P < 0.05), respectively, independent of seasonal fluctuations (P < 0.01). BAT acclimation did not alter CIT but was accompanied by DIT (P < 0.05) and postprandial insulin sensitivity enhancement (P < 0.05), evident only after cold acclimation. Circulating and adipose tissue, but not skeletal muscle, expression levels of leptin and adiponectin displayed reciprocal changes concordant with cold-acclimated insulin sensitization. These results suggest regulatory links between BAT thermal plasticity and glucose metabolism in humans, opening avenues to harnessing BAT for metabolic benefits.     

Laser-assisted cryopreservation of single human spermatozoa in cell-free zona pellucida

Improved procedure for efficient cryopreservation of single human spermatozoa in cell-free human zona pellucida is reported. We used a diode laser system for efficient and precise creation of a single hole into the zona pellucida of a degenerated or immature human oocyte. This allowed the extraction of the cytoplasm using a micropipette with a diameter of 10–15  μm. Through the same opening, human spermatozoa were inserted into the empty zona. We used motile and laser immobilized spermatozoa. Immobilized sperm were obtained by a single laser irradiation delivered in the vicinity of the sperm tail prior to insertion. This new immobilization procedure was shown to have no deleterious effect on membrane integrity and sperm viability. Following sperm transfer into the zona, the laser-drilled hole was closed with an oil droplet which was expelled from the micropipette during withdrawal to avoid loss of spermatozoa. This facilitated detection of the otherwise translucent zona during the cryopreservation procedure. After thawing, all cryopreserved zonae (20/20) could be successfully retrieved. Spermatozoa were recovered from the zona pellucida through the hole used for insertion. The rate of sperm recovery for initially motile spermatozoa was 80% vs. 92% for laser immobilized spermatozoa. Sperm viability was 81% and 84%, respectively, detected by a Hoechst stain. This technique makes cryopreservation of single human spermatozoa easy and feasible and appears beneficial for couples with severe male infertility and for those facing repeated surgical sperm extraction.     

Influence of hysterectomy on the results of the Zödler Sling Procedure in stress incontinent women

Zödler's sling procedure was done from 1984 to 1986 at our Department in 108 patients suffering from stress incontinence. Eighty-four patients could be interviewed presently; 51 had been hysterectomized prior to our operation whereas 33 had not been hysterectomized. We evaluated the influence of hysterectomy on the early and late outcome of our operation. There were no significant differences between the two groups.     

Testicular tumors: presentation and role of diagnostic delay

180 patients with testicular germ cell tumors were evaluated in a retrospective study concerning the features of presentation and diagnostic delay. Mean duration of symptoms was 170 days, being different for seminoma and nonseminoma, and showing a continuous decrease since 1969. Duration of symptoms was longest in stage I seminoma. In the nonseminoma group the longest interval was observed in stage III. It is concluded that only in nonseminoma a prolonged delay exerts adverse effects on prognosis. Short delay (cryosperm conservation) does not seem to cause any harm. A plea is made for periodic testicular self-examination.     

HLA typing in familial testicular cancer

Support is given to the theory of genetic influence in the etiology and pathogenesis of testicular germ cell tumors by the report of four new familial clusters of testicular cancer. One pair of brothers both afflicted with seminoma underwent HLA typing and they were shown to share one complete haplotype. A review of 119 families of the literature with aggregation of germ cell tumors is given. The evaluation of eight previously reported familial clusters of germ cell tumors with HLA-typing results in conjunction with the present case shows a haplotype sharing in all cases which is more than expected. This finding is another piece of evidence for the theory of genetic anticipation of germ cell tumors.