Strongyloides stercoralis infection as a cause of acute granulomatous appendicitis in an HIV-positive patient in Athens,Greece

A case of acute granulomatous appendicitis due to Strongyloides stercoralis infection in an HIV-positive patient is described. To our knowledge this is the first case presented in the literature.     

18F-FET PET for planning of thermotherapy using magnetic nanoparticles in recurrent glioblastoma.

PURPOSE: Thermotherapy using magnetic nanoparticles (nano cancer therapy) is a new concept of local tumour therapy, which is based on controlled heating of intra-tumoural injected magnetic nanoparticles. The aim of this study was to evaluate the usefulness of PET with a recently introduced amino acid tracer O-(2-[18F]fluoroethyl)-]L-tyrosine (FET) for targeting the nanoparticles implantation. MATERIALS AND METHODS: Eleven patients with glioblastoma recurrences underwent MR and FET-PET imaging for planning of the nano cancer therapy. Thereafter, the gross tumour volumes (GTV) were defined, taking into consideration the results of both imaging tools. RESULTS: The MRI-based mean GTV was 24.3 cm3 (range 2.5-59.7) and the PET-based mean GTV 31.9 cm3 (range 5.2-77.9). On the average the MRI identified an additional 8.9 +/- 4.7 cm3 and the FET-PET scan-an additional 16.5 +/- 15.2 cm3 outside of the common GTV (15.4 +/- 11.0 cm3). The mean final GTV accounted to 33.8 cm3 (range, 5.2-77.9). The additional information of FET-PET led to an increase in GTV by 22-286% in eight patients and to a decrease of 23% and 26%, respectively, in two patients. In one patient, the final GTV was defined on the basis of MRI data only. CONCLUSIONS: FET-PET adds important information on the actual tumour volume in recurrent glioblastomas and is highly valuable for defining the target volume for the nano cancer therapy.     

Einige Probleme der Rechtsmedizin und der gerichtsmedizinischen Begutachtung

Zusammenfassung Folgende Fragen sollten auf internationaler Grundlage geregelt werden:1. Die Systemisierung des Wissensgebietes unseres Faches.2. Die medizinische Terminologie.3. Die Abgrenzung medizinischer Begriffe von Rechtsbegriffen.4. Fragen des Kausalzusammenhangs.5. Probleme der Nachweismöglichkeit.6. Die Kompetenz und Verantwortlichkeit des Experten.7. Forderungen der Ethik bei der Tätigkeit des gerichtsmedizinischen Sachverständigen.

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Summary The author has the opinion that it is necessary to describe and to define carefully the following areas of forensic medicine, preferably on the base of internationally accepted terminology:1. The system of our special discipline.2. Medical terminology.3. The delineation of medical and forensic concept.4. The problem of causality.5. The problem of evidence.6. The competence and responsibility of the expert.7. The ethical requirements of the forensic-science expert.

Herrn Prof. Dr. B. Mueller zum 75. Geburtstag gewidmet.     

Bile Duct Injuries Associated with Laparoscopic and Open Cholecystectomy: An 11-Year Experience in One Institute

Purpose Bile duct injury (BDI) represents the most serious complication of laparoscopic cholecystectomy (LC). The aim of this retrospective single-institution study was to evaluate the real incidence of BDI during laparoscopic and open cholecystectomy (OC) in a tertiary academic center in Athens, Greece.Methods Between January 1991 and December 2001, 3 637 patients underwent cholecystectomy in our department; as LC in 2 079 patients (LC group) and as OC in 1 558 patients (OC group). All the LCs were performed or supervised by five staff surgeons and all the OCs were performed or supervised by another five staff surgeons.Results There were 13 BDIs associated with LC (0.62%) and 6 associated with OC (0.38%) (P = 0.317). There was one death associated with BDI after LC. Only two (15.4%) of the BDIs associated with LC occurred within the proposed learning curve limit of 50 LCs per individual surgeon.Conclusion Laparoscopic cholecystectomy is safe and is not associated with a higher incidence of BDI than OC. Moreover, we did not find that the learning curve for LC affected BDI occurrence.     

Role of selectins in the intestinal epithelial migration of eosinophils

Understanding the mechanisms by which eosinophils migrate into and across the intestinal epithelium can provide alternative therapeutic targets for conditions characterized by eosinophilic cryptitis and crypt abscesses. Eosinophil migration is dependent on adhesion molecules such as selectins. Human eosinophils express L-selectin and P-selectin counterligand P-selectin glycoprotein ligand-1 (PSGL-1). The tetrasaccharide sialyl Lewis(x) (sLe(x)) binds to all three selectins, so compounds that mimic sLe(x), such as TBC1269, are potential antagonists. We hypothesized that eosinophils migrate from the basolateral to the apical surface of intestinal epithelium through the orchestrated effects of selectins. TBC1269 was added to fluorescently labeled HL-60 clone 15 eosinophils as well as human blood eosinophils, in incremental amounts. Subsequently, blocking antibodies toward L-selectin and PSGL-1 were used in a similar manner. HL-60 eosinophils were allowed to migrate into T-84 monolayers. The number of migrated HL-60 cells was calculated by comparing fluorescence with known cell densities. HL-60 and human eosinophils that were undergoing migration were significantly lower in the presence of TBC1269. This effect was concentration dependent, and near complete inhibition of migration was seen at a TBC1269 concentration of 10 mg/mL. In addition, HL-60 eosinophil migration was significantly lower in the presence of the blocking antibodies to PSGL-1 and L-selectin (39.2 and 51.6% inhibition, respectively). Simultaneous blocking of PSGL-1 and L-selectin resulted in inhibition of 76.0% of the migration. The results of this study suggest a major role for selectins in the intestinal epithelial migration of differentiated eosinophils. sLe(x), L-selectin, and the P-selectin counterligand PSGL-1 can be potential therapeutic targets.     

Value of 123I-IMT SPECT for diagnosis of recurrent non-astrocytic intracranial tumours

The value of single-photon emission tomography (SPECT) using iodine-123-alpha-methyl-tyrosine (IMT) for the diagnosis of recurrent or residual gliomas is well established. In the current study we investigated whether IMT-SPECT could also be useful in the follow-up of brain metastases and other intracranial tumours of non-astrocytic origin. The study included 22 patients with suspected recurrent intracranial tumours of non-astrocytic origin (12 brain metastases, one supratentorial primitive neuroendocrine tumour (PNET), one rhabdoid tumour, two clivus chordomas, three ependymomas, two pituitary tumours, one anaplastic meningioma) who had previously been treated by surgery and/or radio/chemotherapy. SPECT results were correlated with clinical and MRI follow-up data. The study was true positive in 13 patients, true negative in five, false positive in one and false negative in three patients. Notably, all false negative findings were <13 mm. The resulting sensitivity of the IMT-SPECT was 81%. We concluded that the IMT-SPECT is a promising complementary imaging tool for the detection of recurrences of non-astrocytic intracranial tumours and their distinguishing from treatment-induced changes. The limitation of the IMT-SPECT is its low sensitivity for the detection of small lesions.     

Pregnancy associated breast cancer: a case report

Despite its infrequency, pregnancy associated breast cancer implies multiple therapeutic dilemmas. Our patient, a 32-year-old Caucasian, gravida 2, para 2, was diagnosed with cancer of the left breast in the 19th week of gestation. Shortly after she underwent quadrantectomy plus axillary lymph node dissection. Chemotherapy was initiated in the 22(+6) week--four cycles of a combination of endoxan, farmorubicin, and fluorouracil. The patient gave birth in the 35(+6) week to a healthy baby with no apparent malformations. During puerperium she received two more cycles of chemotherapy. She is currently undergoing radiotherapy with tangential fields. Although it is too early to draw conclusions, the malignancy seems to be inactive.