1
|
Mittelstadt S, Stäbler A, Kolb M, Krämer B, Horvat H, Reisenauer C, Bachmann C. Acute endometriosis-related sigmoid perforation in pregnancy- case report. BMC Pregnancy Childbirth 2022; 22:647. [PMID: 35978302 PMCID: PMC9386915 DOI: 10.1186/s12884-022-04973-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background An acute abdomen is an emergency that requires accurate diagnosis and prompt treatment. In pregnancy, the process is even more challenging and sometimes the radiological findings are unclear. Moreover, endometriosis- related complications are rare, especially in previously unknown endometriosis. Case presentation We report on a case of acute endometriosis-related sigmoid perforation during pregnancy (34 weeks of gestation) due to a previously unknown deep intestinal infiltrating endometriosis with focal ulceration of the affected colonic mucosa. Conclusions Despite the low relative risk, clinicians should be aware of possible endometriosis-associated complications in pregnancy with potentially life-threatening events, even in previously unknown endometriosis. Further studies should evaluate intestinal complications during pregnancy in relation to previous treatment of intestinal endometriosis (conservative vs. surgical).
Collapse
Affiliation(s)
- S Mittelstadt
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - A Stäbler
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, 72076, Tübingen, Germany
| | - M Kolb
- Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - B Krämer
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - H Horvat
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Reisenauer
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Bachmann
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany.
| |
Collapse
|
2
|
Kolberg HC, Kühn T, Krajewska M, Bauerfeind I, Fehm TN, Fleige B, Helms G, Lebeau A, Stäbler A, Loibl S, Untch M, Kolberg-Liedtke C. Factors associated with axillary conversion after neoadjuvant chemotherapy (NAT) in initially node positive breast cancer patients – a transSENTINA analysis. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714579] [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: 03/22/2023] Open
Affiliation(s)
| | | | | | | | - TN Fehm
- Universitätsklinikum Düsseldorf
| | | | - G Helms
- Universitätsklinikum Tübingen
| | - A Lebeau
- Universitätsklinikum Hamburg - Eppendorf
| | | | | | | | | |
Collapse
|
3
|
Kolberg HC, Liedtke C, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Stäbler A, Loibl S, Untch M, Kühn T. Abstract PD8-02: Residual axillary involvement in early breast cancer in patients with positive sentinel nodes after neoadjuvant chemotherapy (NACT). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:The association between pathological complete remission (pCR) in the breast and clinical/pathological parameters is well established, whereas the role of these parameters in the prediction of residual axillary involvement after NACT is unclear. The goal is to identify a subset of patients who do not need axillary treatment. We used data from Arm B of the SENTINA trial to analyze this association.
Methods:Patients from arm B of the SENTINA trial with clinically and sonographically unsuspicious axillary nodes but with histologically proven involvement of SLNs prior to NACT were analyzed. All patients had SLNB and axillary dissection after NACT. Univariate analyses were performed to evaluate the association between clinical/pathological parameters and axillary involvement after NACT.
Results:Arm B of the SENTINA study contained 360 patients, 318 of which were evaluable with respect to the above parameters. After NACT 71/318 (22.3%) patients had involved SLNs or non-SLNs; 71/318 (22.3%) had a pCR in the breast. We observed a significant association between pCR in the breast and negative ER status, negative PR status, positive HER2 status, triple negative (TN) status, tumor size before and after NACT, multifocality, lobular morphology and axillary involvement after NACT. Regarding residual axillary burden only the associations with lobular morphology, extracapsular invasion, multifocality, positive HER2 status and pCR in the breast were statistically significant.
Conclusion:Our analysis demonstrates that patients enrolled in the SENTINA trial with clinically and sonographically unsuspicious axillary nodes but proven histological involvement of SLNs prior to NACT have positive axillary nodes in 22.3 % after NACT. This rate is confirming similar results from other groups. Although we found statistically significant associations between pCR in the breast and clinical/pathological parameters, only the association between lobular type, extracapsular invasion, positive HER2 status and pCR in the breast and residual axillary involvement after NACT were statistically significant. We cannot clearly identify a subset of patients for whom axillary treatment after NACT could be safely omitted if SLNs were positive. Our data are well in line with recently presented data demonstrating that the association between pCR in the breast and free axillary nodes after NACT is particularly strong in patients with TN and HER2 positive tumors. This question will be addressed in future trials currently under development.
Citation Format: Kolberg H-C, Liedtke C, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Stäbler A, Loibl S, Untch M, Kühn T. Residual axillary involvement in early breast cancer in patients with positive sentinel nodes after neoadjuvant chemotherapy (NACT) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-02.
Collapse
Affiliation(s)
- H-C Kolberg
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - C Liedtke
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - I Bauerfeind
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Fehm
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - B Fleige
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Hauschild
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - G Helms
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Lebeau
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - S Schmatloch
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - P Schrenk
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - L Schwentner
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Stäbler
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - S Loibl
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Untch
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Kühn
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| |
Collapse
|
4
|
Liedtke C, Kolberg HC, Kerschke L, Görlich D, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Stäbler A, Schmatloch S, Hausschild M, Schwentner L, von Minckwitz G, Loibl S, Untch M, Kühn T. Systematic analysis of parameters predicting pathological axillary status (ypN0 vs. ypN+) in patients with breast cancer converting from cN+ to ycN0 through primary systemic therapy (PST). Clin Exp Metastasis 2018; 35:777-783. [PMID: 30324492 DOI: 10.1007/s10585-018-9938-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022]
Abstract
Optimization of axillary staging among patients converting from clinically node-positive disease to clinically node-negative disease through primary systemic therapy is needed. We aimed at developing a nomogram predicting the probability of positive axillary status after chemotherapy based on clinical/pathological parameters. Patients from study arm C of the SENTINA trial were included. Univariable/multivariable analyses were performed for 13 clinical/pathological parameters to predict a positive pathological axillary status after chemotherapy using logistic regression models. Odds ratios and 95%-confidence-intervals were reported. Model performance was assessed by leave-one-out cross-validation. Calculations were performed using the SAS Software (Version 9.4, SAS Institute Inc., Cary, NC, USA). 369 of 553 patients in Arm C were included in multivariable analysis. Stepwise backward variable selection based on a multivariable analysis resulted in a model including estrogen receptor (ER) status (odds ratio (OR) 3.916, 95% confidence interval (CI) 2.318-6.615, p < 0.001), multifocality (OR 2.106, 95% CI 1.203-3.689, p = 0.0092), lymphovascular invasion (OR 9.196, 95% CI 4.734-17.864, p < 0.001), and sonographic tumor diameter after PST (OR 1.034, 95% CI 1.010-1.059, p = 0.0051). When validated, our model demonstrated an accuracy of 70.2% using 0.5 as cut-point. An area under the curve of 0.81 was calculated. The use of individual parameters as predictors of lymph node status after chemotherapy resulted in an inferior accuracy. Our model was able to predict the probability of a positive axillary nodal status with a high accuracy. The use of individual parameters showed reduced predictive performance. Overall, tumor biology was the strongest parameter in our models.
Collapse
Affiliation(s)
- C Liedtke
- Department of Gynecology, Charité University Hospital Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | | | - L Kerschke
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität, Münster, Germany
| | - D Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität, Münster, Germany
| | - I Bauerfeind
- Department of Gynecology and Obstetrics, Klinikum Landshut, Landshut, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Dusseldorf, Germany
| | - B Fleige
- Department of Pathology, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - G Helms
- Department of Gynecology and Obstetrics, University Medical Centre Tübingen, Tübingen, Germany
| | - A Lebeau
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stäbler
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | | | - M Hausschild
- Klinikum Rheinfelden, Schweiz, Rheinfelden, Switzerland
| | - L Schwentner
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | | | - S Loibl
- German Breast Group, Neu Isenburg, Germany
| | - M Untch
- Department of Gynecology and Obstetrics, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - T Kühn
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Centre, Klinikum Esslingen, Esslingen, Germany
| |
Collapse
|
5
|
Gruber I, Oberlechner E, Böer B, Fugunt R, Gall C, Hartkopf A, Helms G, Hoopmann U, Ott C, Röhm C, Stäbler A, Brucker SY, Hahn M. Inwiefern beeinflussen Nadelgröße und Nutzung der Coaxialkanüle die Treffsicherheit bei sonographischen Mamma-Stanzbiopsien? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592828] [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] Open
|
6
|
Liaci ALS, Stäbler A, Hübner M, Brucker S, Reisenauer C. Diagnostik und Management von paravaginalen benignen Raumforderungen am Beispiel von 69 Fällen. Was sollte ein (Uro) Gynäkologe wissen? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592853] [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] Open
|
7
|
Stäbler A. Wirbelsäule. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551272] [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: 10/23/2022]
|
8
|
Gofferjé G, Stäbler A, Herfellner T, Schweiggert-Weisz U, Flöter E. Kinetics of enzymatic esterification of glycerol and free fatty acids in crude Jatropha oil by immobilized lipase from Rhizomucor miehei. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.molcatb.2014.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
9
|
Wietek BM, Schulze Temming-Hanhoff P, Baur A, Preibsch H, Bahrs SD, Speck S, Hattermann V, Siegmann-Luz KC, Fend F, Claussen CD, Stäbler A. DCIS: Diagnostische Genauigkeit hinsichtlich der Bestimmung der Tumorgröße in Mammografie und MR- Mammografie (MRM) im Vergleich zu der Histopathologie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346497] [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: 10/26/2022]
|
10
|
Gruber I, Hahn M, Fehm T, Hann von Weyhern C, Stäbler A, Winckelmann A, Wallwiener D, Kühn T. Relevance and methods of interventional breast sonography in preoperative axillary lymph node staging. Ultraschall Med 2012; 33:337-343. [PMID: 21618166 DOI: 10.1055/s-0031-1273317] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Reduction of therapy-induced morbidity is an important goal for the improvement of the quality of breast cancer treatment. The introduction of sentinel lymph node biopsy (SLNB) significantly contributed to the reduction of surgery-induced morbidity in the shoulder-arm region. However, a clinically positive nodal status is still considered a contra-indication for SLNB. The current data constellation clearly shows that the clinical and also the sonographic malignancy assessment is insufficient for the accurate identification of the nodal status. A merely clinical and/or image-based appraisal of the axillary lymph node status would lead to overtreatment due to unnecessary axillary dissection in approximately 40 % of patients. In order to reduce the rate of unnecessary axillary dissection (AD), pretreatment interventional clarification is necessary to provide more detailed information about the histological condition of the lymph node. Comparing the currently available methods, fine needle aspiration (FNA) is the best in terms of cost and time requirement, practicability and complication rate. However, considering the sensitivity, it is inferior to ultrasound-guided core needle biopsy (CNB). Thus, a negative FNA outcome requires further clarification, which possibly can be performed with CNB. With a specificity of nearly 100 % and therefore a low rate of false positive cases for FNA, complete AD can be indicated by a positive FNA result. In the context of the interventional procedure, it must be stressed that FNA requires a high level of expertise on the part of both the examiner and the cytologist. The prerequisite for optimal interventional diagnostics of lymph nodes is an adequate sonographic assessment on the basis of standardized sonomorphological criteria.
Collapse
Affiliation(s)
- I Gruber
- Gynecology and Obstetrics, University Hospital Tübingen.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Stäbler A. Degeneration. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310917] [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: 10/28/2022]
|
12
|
Taran FA, Hartkopf A, Banys M, Krawczyk N, Becker S, Jakubowska J, Stäbler A, Wallwiener D, Rothmund R, Fehm T. The influence of removal of primary tumor on incidence and phenotype of circulating tumor cells in primary breast cancer. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286423] [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: 10/17/2022] Open
|
13
|
Taran FA, Joachim C, Rothmund R, Hartkopf A, Wagner P, Walter C, Stäbler A, Souchon R, Mayer F, Wallwiener D, Fehm T. The Clinical Registry of Uterine Sarcomas of the University Women's Clinic and the Comprehensive Cancer Center Tübingen. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286471] [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: 10/17/2022] Open
|
14
|
|
15
|
Siegmann KC, Baur A, Bahrs S, Hattermann V, Hahn M, Stäbler A, Claussen CD. Diagnostische Genauigkeit der stereotaktischen Vakuumbiopsie im Langzeit follow-up. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279378] [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]
|
16
|
|
17
|
Stäbler A. Extravertebrale Osteomyelitis Muskulo. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252344] [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]
|
18
|
Stäbler A, Menner M, Eisner P. Gewinnung eines partialglyceridhaltigen Biokraftstoffs durch enzymatische Teilethanolyse von Pflanzenöl. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200900066] [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: 11/10/2022]
|
19
|
Bachmann C, Bachmann S, Grischke EM, Fehm T, Wallwiener D, Stäbler A, Solomayer EF. Die Bedeutung des CA-125-Wertes bei Patientinnen mit Ovarialkarzinom. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238922] [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] Open
|
20
|
Heinemann B, Falter H, Fantz U, Franzen P, Fröschle M, Gutser R, Kraus W, Nocentini R, Riedl R, Speth E, Stäbler A, Wünderlich D, Agostinetti P, Jiang T. Design of the “half-size” ITER neutral beam source for the test facility ELISE. Fusion Engineering and Design 2009. [DOI: 10.1016/j.fusengdes.2008.11.076] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Stäbler A. Degenerative Diskopathie: Nomenklatur und Diagnostik. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221042] [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]
|
22
|
Stäbler A. MR-Tomographie der Hand. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221016] [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]
|
23
|
Siegmann K, Speck S, Baur A, Hahn M, Stäbler A, Hornscheidt D, Claussen C. Einsatz eines speziellen Clips (Tumark® Professional) zur postinterventionellen Markierung suspekter Mammaläsionen nach MRT-gestützter Vakuumbiopsie – erste Ergebnisse. ROFO-FORTSCHR RONTG 2009; 181:147-54. [DOI: 10.1055/s-2008-1027915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Staege B, Steinborn M, Stäbler A, Schöps P. Das akquirierte Hyperostosesyndrom (AHS): Ein Fallbericht. AKTUEL RHEUMATOL 2008. [DOI: 10.1055/s-2008-1043734] [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]
|
25
|
Bitterling H, Stäbler A, Brückmann H. [Mystery of alar ligament rupture: value of MRI in whiplash injuries--biomechanical, anatomical and clinical studies]. ROFO-FORTSCHR RONTG 2008; 179:1127-36. [PMID: 17948191 DOI: 10.1055/s-2007-963426] [Citation(s) in RCA: 11] [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: 10/22/2022]
Abstract
PURPOSE Whiplash injury of the cervical spine is a frequent issue in medical expertise and causes enormous consequential costs for motor insurance companies. Some authors accuse posttraumatic changes of alar ligaments to be causative for consequential disturbances. MATERIALS AND METHODS Review of recent studies on biomechanics, anatomical and clinical MR imaging. RESULTS Biomechanical experiments can not induce according injuries of alar ligaments. Although MRI provides excellent visualization of alar ligaments, the range of normal variants is high. CONCLUSION Biomechanical studies give no evidence of alar ligament involvement in whiplash disease. Using MRI, signal alterations of alar ligaments can hardly be differentiated from common normal variants. Functional MRI provides no diagnostic yield.
Collapse
Affiliation(s)
- H Bitterling
- Abteilung für Neuroradiologie, Klinikum der LMU, München.
| | | | | |
Collapse
|
26
|
Bitterling H, Stäbler A, Brückmann H. Stellenwert der MRT bei Beschleunigungsverletzungen der HWS: Überblick über anatomische, biomechanische und klinische Grundlagen. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1074061] [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]
|
27
|
Stäbler A, Szeimies U. Kristallinduzierte Arthropathien. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073316] [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]
|
28
|
Stäbler A, Szeimies U. Interaktive Falldiskussion I. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976700] [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]
|
29
|
Stäbler A, Koch S. Das HWS Trauma – Klassifikation und pathoanatomische Korrelation. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976562] [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]
|
30
|
Herrmann KA, Bonél HM, Stäbler A, Voelk M, Strotzer M, Zech CJ, Reiser MF. Should 3K zoom function be used for detection of pneumothorax in cesium iodide/amorphous silicon flat-panel detector radiographs presented on 1K-matrix soft copies? Eur Radiol 2006; 16:2768-74. [PMID: 16896703 DOI: 10.1007/s00330-006-0344-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Revised: 03/20/2006] [Accepted: 05/09/2006] [Indexed: 12/01/2022]
Abstract
The purpose of the study was to evaluate observer performance in the detection of pneumothorax with cesium iodide and amorphous silicon flat-panel detector radiography (CsI/a-Si FDR) presented as 1K and 3K soft-copy images. Forty patients with and 40 patients without pneumothorax diagnosed on previous and subsequent digital storage phosphor radiography (SPR, gold standard) had follow-up chest radiographs with CsI/a-Si FDR. Four observers confirmed or excluded the diagnosis of pneumothorax according to a five-point scale first on the 1K soft-copy image and then with help of 3K zoom function (1K monitor). Receiver operating characteristic (ROC) analysis was performed for each modality (1K and 3K). The area under the curve (AUC) values for each observer were 0.7815, 0.7779, 0.7946 and 0.7066 with 1K-matrix soft copies and 0.8123, 0.7997, 0.8078 and 0.7522 with 3K zoom. Overall detection of pneumothorax was better with 3K zoom. Differences between the two display methods were not statistically significant in 3 of 4 observers (p-values between 0.13 and 0.44; observer 4: p = 0.02). The detection of pneumothorax with 3K zoom is better than with 1K soft copy but not at a statistically significant level. Differences between both display methods may be subtle. Still, our results indicate that 3K zoom should be employed in clinical practice.
Collapse
Affiliation(s)
- Karin A Herrmann
- Institute of Clinical Radiology, Ludwig-Maximilians-University of Munich, Grosshadern, Germany.
| | | | | | | | | | | | | |
Collapse
|
31
|
Stäbler A. Radiologische Diagnostik der Traumafolgen einschließlich Differentialdiagnostik. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940466] [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]
|
32
|
Stäbler A. Diagnostik der komprimierten Wurzel an LWS und HWS. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940425] [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]
|
33
|
Stäbler A. Diskoligamentäre Verletzungen. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940363] [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]
|
34
|
Ertl-Wagner BB, Helmchen C, Stäbler A, Fassmann F, Reiser MF. Hereditäre motorische und sensorische Neuropathie (HMSN) mit Hypertrophie der Cauda equina und demyelinisierenden Läsionen der weißen Substanz. Radiologe 2005; 45:593-6. [PMID: 16059655 DOI: 10.1007/s00117-003-0967-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hereditary motor and sensory neuropathy (HMSN) is thought to almost exclusively affect the peripheral nervous system. We report the case of a 48-year-old patient with a longstanding history of HMSN type I who developed signs and symptoms of a cauda equina compression and of a central nervous system relapsing-remitting demyelinating white matter disease. Gross enlargement of the cauda equina fibers was detected by MR imaging of the lumbar spine. Cranial MR imaging revealed demyelinating white matter lesions. This case suggests that peripheral neuropathic mechanisms may also affect the central myelin in HMSN type I.
Collapse
Affiliation(s)
- B B Ertl-Wagner
- Institut für klinische Radiologie, Klinikum Grosshadern, Universität München.
| | | | | | | | | |
Collapse
|
35
|
Schmidt GP, Baur A, Stäbler A, Schoenberg SO, Steinborn M, Baltin V, Reiser MF. [Estimation of diffuse bone marrow infiltration of the spine in multiple myeloma: correlation of MRT with histological results]. ROFO-FORTSCHR RONTG 2005; 177:745-50. [PMID: 15871089 DOI: 10.1055/s-2005-857869] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine the detection of diffuse bone marrow infiltration with MRI in comparison with histopathological findings. MATERIALS AND METHODS MRI was performed on 45 patients with histologically proven multiple myeloma and on 30 healthy individuals. Three experienced radiologists read separately Tl-weighted SE sequences, STIR sequences and the combination of Tl-weighted SE and STIR sequences of the spine. Additionally, Tl-weighted SE sequences were obtained after gadolinium administration and the percentage increase in signal intensity was calculated. Bone marrow histology was used as gold standard for assessing the grade of infiltration. A dichotomous decision (infiltration yes/no) was made when assessing the MRI examinations. RESULTS For the visual detection of diffuse infiltration, the best sensitivity was found with Tl-weighted SE sequences, achieving 71 % on average. The specificity was 89 %. The STIR sequences showed a sensitivity of 61 % and a specificity of 98 %, and the combination of Tl-weighted/STIR-sequences achieved a sensitivity of 65 % and a specificity of 94 %. In comparison with the histological findings, the sensitivity of the Tl-weighted sequences was 35 % for low-grade, 89 % for moderate and 100 % for high-grade infiltration. The application of contrast material with calculation of the percentage signal increase improved the detection by 7 %. CONCLUSION The sensitivity of the visual detection of diffuse multiple myeloma with unenhanced MRI is limited for low-grade or moderate infiltration, whereas the sensitivity for high grade infiltration is reliable. The specificity is high and the diagnostic confidence improves after application of contrast material with calculation of the percentage increase in signal intensity.
Collapse
Affiliation(s)
- G P Schmidt
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München.
| | | | | | | | | | | | | |
Collapse
|
36
|
Stäbler A, Szeimies U. Radiologische Abklärung bei Wurzelkompression. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867354] [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]
|
37
|
Greb RR, Hauzman E, Paletta JRJ, Buchweitz O, Stäbler A, Buchwalow IB, Kiesel L. Angiogenesestatus von Endometrioseläsionen und von eutopem Endometrium – Einfluss des menstruellen Zyklus und einer GnRH-Vorbehandlung. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-815264] [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] Open
|
38
|
Abstract
The diagnosis of adnexal torsion is difficult to establish on the basis of symptoms, physical findings, or radiologic techniques. If possible, in pregnancy the diagnostic workup should avoid any risk of drug administration, and the indication for a surgical intervention needs to be severe. Between 10% and 20% of ovarian torsions are associated with pregnancy, but adnexal torsion in the third trimester is rare. We present the case of a 22-year-old female presenting with a sudden onset of severe right lower quadrant abdominal pain associated with nausea and vomiting. The presumptive diagnosis was appendicitis. Transvaginal sonography showed some free fluid in the pouch of Douglas, but could not define the accurate diagnosis. In transabdominal ultrasound, a predominantly hyperechogenic mass containing small cysts was found in the right lower abdomen. No blood flow within the mass was detected with color and power Doppler sonography. With ultrasound, the anatomic relation of the mass could not be precisely identified. Magnetic resonance imaging clearly delineated the mass, which was due to enlargement of the right ovary, with predominately hyperintense signal containing small areas with hypointense lesions in T2-weighted images, a potential sign of hemorrhagic infarction. The mesovarium was hyperintense in T2-weighted images and also enlarged. The left ovary seemed to be normal. Due to the displacement of the ovaries in the second and third trimesters, the diagnostic workup is very largely restricted when using transvaginal ultrasound. Especially in pregnancy, it is mandatory to obtain a reliable diagnosis to reduce any risk to the fetus. Our case report indicates that the combination of magnetic resonance imaging and Doppler sonography fulfills these requirements and allows for accurate and fast diagnosis of adnexal torsion.
Collapse
Affiliation(s)
- C Born
- Institute for Clinical Radiology, University Munich, Ziemssenstrasse 1, 80336 Munich, Germany.
| | | | | | | |
Collapse
|
39
|
Baur A, Stäbler A, Wendtner CM, Arbogast S, Rahman SA, Santl M, Issels R, Reiser M. MR-imaging changes of musculoskeletal soft-tissue sarcomas associated with neoadjuvant chemotherapy and hyperthermia. Int J Hyperthermia 2003; 19:391-401. [PMID: 12850925 DOI: 10.1080/0265673021000058366] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate early changes in musculoskeletal soft-tissue sarcomas under neoadjuvant chemotherapy combined with regional hyperthermia (RHT). PATIENTS AND METHODS Nineteen consecutive patients with high-grade soft-tissue sarcomas of the musculoskeletal system were treated with neoadjuvant chemotherapy combined with RHT. Patients were imaged, using a high field MR-scanner, before onset of therapy, immediately after one and after four cycles of therapy. The images were evaluated for volume reduction and development of tumour necrosis. In addition, side effects such as surrounding soft-tissue oedema, bleeding and muscle or bone marrow necrosis were analysed. RESULTS Tumour volume reduction was significant after the completion of neoadjuvant therapy (mean 49%, range 5-91%; (p < 0.001). Extent of tumour necrosis was also significantly different before (mean 22%) and after therapy (mean 58%, p < 0.001). Three patients showed strong tumour necrosis already after one cycle of treatment. Tumour volume reduction was not associated with the extent of pre-existing necrosis or necrosis development. The extent of tumour volume before start of therapy did not affect volume reduction or necrosis induction after therapy. Reduction of tumour oedema was significant after therapy (p < 0.001). No side effects were observed during thermochemotherapy. CONCLUSION Neoadjuvant chemotherapy combined with RHT resulted in significant tumour volume reduction and induction of tumour necrosis, which can be detected early and monitored closely with MRI.
Collapse
Affiliation(s)
- A Baur
- Department of Clinical Radiology, University of Munich, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Maier M, Maier-Bosse T, Eckermann M, Maier-Bosse E, Schulz CU, Steinborn M, Kleen M, Stäbler A. [The roentgenmorphologic aspects of symptomatic calcifications in patients with calcifying tendinitis of the shoulder: determination of intra- and interobserver variabilities of Gärtner's classification]. Unfallchirurg 2003; 106:185-9. [PMID: 12658335 DOI: 10.1007/s00113-002-0548-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM OF THE STUDY The roentgenologic morphology of symptomatic calcified deposits of the rotator cuff can be classified according Gärtner. This classification influences therapeutic procedures and prognosis of clinical outcome in these patients. In the present study intraoberserver-reproducibility and interobserver-reliability of Gärtner's classification were tested. METHODS Plane radiographs of 100 patients with calcifications of the supraspinatus tendon were classified according the criteria of Gärtner by 6 independent observers twice within 4 months. Intraoberserver-reproducibility and interobserver-reliability were calculated by means of Cohen's kappa-index. RESULTS kappa-values of intraoberserver-reproducibility had a mean of 0.4208 (SD 0.1299), kappa-values of interobserver-reliability were 0.490 for the first and 0.474 for the second classification. CONCLUSIONS Determination of intraoberserver-reproducibility gave insufficient to satisfactory results, interobserver-reliability was sufficient. The clinical use of Gärtner's classification to plan therapeutic procedures or to determine clinical prognosis in patients with calcifying tendinitis can be recommended only with limitations.
Collapse
Affiliation(s)
- M Maier
- Orthopädische Klinik, and Institut für Chirurgische Forschung, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Munich.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Maier M, Milz S, Tischer T, Münzing W, Manthey N, Stäbler A, Holzknecht N, Weiler C, Nerlich A, Refior HJ, Schmitz C. Influence of extracorporeal shock-wave application on normal bone in an animal model in vivo. Scintigraphy, MRI and histopathology. J Bone Joint Surg Br 2002; 84:592-9. [PMID: 12043786 DOI: 10.1302/0301-620x.84b4.11621] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is little information about the effects of extracorporeal shock-wave application (ESWA) on normal bone physiology. We have therefore investigated the effects of ESWA on intact distal rabbit femora in vivo. The animals received 1500 shock-wave pulses each of different energy flux densities (EFD) on either the left or right femur or remained untreated. The effects were studied by bone scintigraphy, MRI and histopathological examination. Ten days after ESWA (0.5 mJ/mm2 and 0.9 mJ/mm2 EFD), local blood flow and bone metabolism were decreased, but were increased 28 days after ESWA (0.9 mJ/mm2). One day after ESWA with 0.9 mJ/mm2 EFD but not with 0.5 mJ/mm2, there were signs of soft-tissue oedema, epiperiosteal fluid and bone-marrow oedema on MRI. In addition, deposits of haemosiderin were found epiperiosteally and within the marrow cavity ten days after ESWA. We conclude that ESWA with both 0.5 mJ/mm2 and 0.9 mJ/mm2 EFD affected the normal bone physiology in the distal rabbit femur. Considerable damaging side-effects were observed with 0.9 mJ/mm2 EFD on periosteal soft tissue and tissue within the bone-marrow cavity.
Collapse
Affiliation(s)
- M Maier
- Department of Orthopaedic Surgery, Ludwig-Maximilians University, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Maier M, Milz S, Tischer T, Münzing W, Manthey N, Stäbler A, Holzknecht N, Weiler C, Nerlich A, Refior HJ, Schmitz C. Influence of extracorporeal shock-wave application on normal bone in an animal model in vivo. ACTA ACUST UNITED AC 2002. [DOI: 10.1302/0301-620x.84b4.0840592] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is little information about the effects of extracorporeal shock-wave about application the effects (ESWA) of on normal bone physiology. We have therefore investigated the effects of ESWA on intact distal rabbit femora in vivo. The animals received 1500 shock-wave pulses each of different energy flux densities (EFD) on either the left or right femur or remained untreated. The effects were studied by bone scintigraphy, MRI and histopathological examination. Ten days after ESWA (0.5 mJ/mm2 and 0.9 mJ/mm2 EFD), local blood flow and bone metabolism were decreased, but were increased 28 days after ESWA (0.9 mJ/mm2). One day after ESWA with 0.9 mJ/mm2 EFD but not with 0.5 mJ/mm2, there were signs of soft-tissue oedema, epiperiosteal fluid and bone-marrow oedema on MRI. In addition, deposits of haemosiderin were found epiperiosteally and within the marrow cavity ten days after ESWA. We conclude that ESWA with both 0.5 mJ/mm2 and 0.9 mJ/mm2 EFD affected the normal bone physiology in the distal rabbit femur. Considerable damaging side-effects were observed with 0.9 mJ/mm2 EFD on periosteal soft tissue and tissue within the bone-marrow cavity.
Collapse
Affiliation(s)
- M. Maier
- Department of Orthopaedic Surgery
| | | | | | | | | | | | | | - C. Weiler
- Institute of Pathology, Ludwig-Maximilians University, Marchioninistrasse 15, D-81377 Munich, Germany
| | - A. Nerlich
- Institute of Pathology, Ludwig-Maximilians University, Marchioninistrasse 15, D-81377 Munich, Germany
| | | | - C. Schmitz
- Department of Anatomy and Cell Biology, RWTH University of Aachen, Pauwelsstrasse, Wendlingweg 2, 52057 Aachen, Germany
| |
Collapse
|
43
|
Herrmann A, Bonél H, Stäbler A, Kulinna C, Glaser C, Holzknecht N, Geiger B, Schätzl M, Reiser F. Chest imaging with flat-panel detector at low and standard doses: comparison with storage phosphor technology in normal patients. Eur Radiol 2002; 12:385-90. [PMID: 11870439 DOI: 10.1007/s00330-001-1166-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2000] [Revised: 08/02/2001] [Accepted: 08/24/2001] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to evaluate the performance of standard-dose and low-dose cesium iodide (CsI)-doted amorphous silicon (a-Si) flat-panel detector technology (FDT) as compared with storage-phosphor technology (SPT) in the depiction of relevant anatomical structures in chest radiography. In 75 patients referred for thoracic CT, digital chest radiographs were randomly obtained with either SPT at a standard dose (speed class S400, n=25), standard-dose FDT (S400, n=25) or FDT at a low dose (S800, n=25). Five radiologists evaluated the visibility of eight pulmonary and mediastinal anatomical structures using a five-point rating scale. To determine statistically significant differences between the three groups, the Mann-Whitney U-test was employed. No statistically significant differences were found in the depiction of eight criteria between SPT and standard-dose or low-dose FDT chest radiographs. The performance of FDT S400 was equal to SPT for most criteria and better for retrocardiac structures and soft tissue. FDT S800 was inferior to both SPT and FDT S400. Standard-dose FDT is equivalent to SPT in the depiction of relevant anatomical structures of the chest. Our results also indicate that a dose reduction of 50% with FDT may result in small but not significant decrease of image quality.
Collapse
Affiliation(s)
- A Herrmann
- Institute of Clinical Radiology, Ludwig Maximilians University of Munich, Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Baur A, Huber A, Dürr HR, Nikolaou K, Stäbler A, Deimling M, Reiser M. [Differentiation of benign osteoporotic and neoplastic vertebral compression fractures with a diffusion-weighted, steady-state free precession sequence]. ROFO-FORTSCHR RONTG 2002; 174:70-5. [PMID: 11793288 DOI: 10.1055/s-2002-19534] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of a diffusion-weighted, steady-state free precession (SSFP) sequence for the differentiation of acute benign osteoporotic and neoplastic vertebral compression fractures. METHODS 85 patients with 102 vertebral compression fractures were examined with MR imaging using a spine array surface coil (Siemens, Vision, 1.5 Tesla). The following sequences were performed in sagittal orientation: T1-weighted spin echo (SE), short-tau inversion recovery (STIR) and a diffusion-weighted SSFP sequence (TR = 25 msec, diffusion pulse length delta = 3 msec). The SSFP images were evaluated qualitatively on a 5-grade scale from strongly hypointense to strongly hyperintense. Quantitative analysis was performed with region of interest measurements (ROI) and calculation of a bone marrow ratio. RESULTS 60 fractures were due to osteoporosis and 42 fractures were caused by malignancy. "Hyperintensity" in a vertebral fracture on a SSFP sequence provided a sensitivity of 100 % and a specificity of 93 %. The positive predictive value was 91 %, the negative predictive value was 100 %. Quantitative analysis of the bone marrow ratio showed a statistically significant difference between the osteoporosis and the tumor group (p < 0.001). The mean value for the osteoporotic fractures was - 0.32 (SD 0.33) and + 2.07 (SD 1.37) for the tumor group. CONCLUSION The SSFP sequence provides a high accuracy in the differentiation of benign osteoporotic and neoplastic vertebral compression fractures.
Collapse
Affiliation(s)
- A Baur
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians, Universität, München, Germany.
| | | | | | | | | | | | | |
Collapse
|
45
|
Stäbler A, Eck J, Penning R, Milz SP, Bartl R, Resnick D, Reiser M. Cervical spine: postmortem assessment of accident injuries--comparison of radiographic, MR imaging, anatomic, and pathologic findings. Radiology 2001; 221:340-6. [PMID: 11687673 DOI: 10.1148/radiol.2212010336] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the ability of postmortem radiography and magnetic resonance (MR) imaging to depict occult cervical spine injuries as compared with anatomic and pathologic findings. MATERIALS AND METHODS The cervical spines of 10 adult accident victims underwent radiography and MR imaging, with T1-weighted, fast spin-echo T2-weighted, and four gradient-echo pulse sequences. The frozen specimens were cut into 3-mm-thick slices (sagittal plane) and photographed, and microfocus radiographs were obtained. Imaging findings were compared with the anatomic and pathologic findings. RESULTS Eight of the 10 specimens had 28 posttraumatic lesions: three fractures (two missed at the initial MR imaging reading), 10 facet joint capsule lesions with bleeding, five soft-tissue and ligament lesions, eight disk lesions, and two spinal cord lesions. Radiography depicted one lesion (4%). Two partial ruptures of the anterior annulus fibrosus were depicted at only MR imaging. Initially, 11 of 28 lesions were detected on MR images; retrospectively, 17 of 28 lesions were correlated with anatomic findings. CONCLUSION Soft-tissue and intervertebral disk and ligament injuries account for 89% (25 of 28) of posttraumatic cervical spine lesions detected on postmortem images. Occult lesions, including apophyseal joint injuries, were found in clinically noninjured cervical spines. MR imaging was limited in the depiction of discrete lesions when T1-weighted non-fat-saturated, fast spin-echo T2-weighted, and gradient-echo pulse sequences were used.
Collapse
Affiliation(s)
- A Stäbler
- Department of Clinical Radiology, University Hospital Ludwig-Maximilians-University Munich, Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
46
|
Ertl-Wagner BB, Stäbler A, Brossmann J, Trudell D, Resnick D. Assessment of the position of the distal portion of the ulna in lateral projection radiographs of the wrist: analysis of the influence of pronation-supination and flexion-extension on the pisoscaphoid and the ulnotriquetral distances: a cadaver study. Invest Radiol 2001; 36:612-8. [PMID: 11577272 DOI: 10.1097/00004424-200110000-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Accurate assessment of the distal radioulnar joint is of paramount importance for the detection of possible dislocation or subluxation. Using a cadaveric model, the authors attempted to establish a quantitative method that would allow identification of normal and abnormal distal radioulnar joint anatomy on well-positioned and rotated conventional radiographs. METHODS Four cadaveric wrists, in which subsequent sectioning confirmed the absence of disease, and one cadaveric wrist with a circumscribed lesion of the triangular fibrocartilaginous complex were studied. Defined movements in flexion and extension (+/- 10 degrees, 20 degrees, 30 degrees ) and in pronation and supination (+/- 10 degrees, 20 degrees, 30 degrees ) as well as combined flexion/extension and pronation/supination were performed. The ulnotriquetral and the pisoscaphoid distances were assessed in each position. Correlation with cryosections was achieved. RESULTS A strong linear correlation between the degree of pronation or supination and the pisoscaphoid and ulnotriquetral distances was noted. Flexion and extension produced no significant effect on the pisoscaphoid distance, but a defined shift of the ulnotriquetral distance occurred with increasing flexion and extension. CONCLUSIONS If all parameters are taken into account, this correlation aids in estimating the degree of possible malpositioning of the wrist during radiography and the degree of subluxation of the distal radioulnar joint. Tabular data with parameters to correct for instances of malrotated images and to estimate the extent of dislocation or malrotation of the distal radioulnar joint are provided.
Collapse
Affiliation(s)
- B B Ertl-Wagner
- Institute of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany.
| | | | | | | | | |
Collapse
|
47
|
Franzen P, Obermayer S, Schäffler J, Stäbler A, Speth E, Vollmer O. Beam current feedback regulation of the RF neutral beam sources of ASDEX Upgrade. Fusion Engineering and Design 2001. [DOI: 10.1016/s0920-3796(01)00331-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
Herrmann KA, Bonél HM, Stäbler A, Matzko M, Waggershauser T, Sittek H, Reiser MF. [Time needs in evaluating digital thoracic images on the monitor in comparison with alternator]. Rontgenpraxis 2001; 53:260-5. [PMID: 11402875] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE Evaluation of time efficiency in softcopy reading versus hardcopy reading of digital chest x-rays. MATERIAL AND METHODS 130 normal and pathologic chest x-rays in two plains were analyzed by 4 experienced radiologist at both a digital workstation and the light box. Reading time and switch time between two patient folders were measured as well as the frequency of post-processing at the monitor. RESULTS Reading time at the workstation slightly exceeded reading time at the light box; differences were not statistically significant. Post-processing (frequency between 2% and 83%) did not significantly prolong reading time. Mean switch time between two patient folders was 4.3 sec at the workstation and 13.7 sec at the light box. CONCLUSION As compared to hardcopy reading, softcopy reading of digital chest x-rays does not significantly increase reading time. Switch time between patient folders can be reduced at the workstation by a factor of two to four.
Collapse
Affiliation(s)
- K A Herrmann
- Institut für Klinische Radiologie Ludwig-Maximilians-Universität München, Grosshadern.
| | | | | | | | | | | | | |
Collapse
|
49
|
Maier M, Stäbler A, Schmitz C, Lienemann A, Köhler S, Dürr HR, Pfahler M, Refior HJ. On the impact of calcified deposits within the rotator cuff tendons in shoulders of patients with shoulder pain and dysfunction. Arch Orthop Trauma Surg 2001; 121:371-8. [PMID: 11510900 DOI: 10.1007/s004020000255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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] [Indexed: 12/01/2022]
Abstract
We wanted to prove the hypothesis that calcified deposits within the rotator cuff tendons are merely an epiphenomenon of complex morphological alterations in the shoulders of patients with shoulder pain and dysfunction. The shoulders of 92 patients with calcified deposits within the rotator cuff tendons as noted on plain radiographs were investigated by means of magnetic resonance imaging (MRI; mean age of patient 51.1 years), as well as the shoulders of 28 age- and sex-matched patients with similar clinical symptoms but without any signs of such calcified deposits on plain radiographs. The MRI protocol comprised a coronal, oblique, T1-weighted, spin-echo sequence, a T2-weighted, turbo spin-echo sequence, a sagittal, oblique, T2-weighted, turbo spin-echo sequence, and an axial, T1-weighted, spin-echo sequence. Furthermore, a coronal, oblique, short tau-inversion recovery sequence and a gradient echo sequence were used. The results were compared with data from healthy, asymptomatic volunteers as reported in the literature. The MRI investigations showed no substantial differences between patients with or without calcified deposits within the rotator cuff tendons, but distinct differences between such patients and healthy, asymptomatic volunteers. For patients with shoulder pain, shoulder dysfunction, and calcified deposits within the rotator cuff tendons, these calcified deposits are most probably not the main cause of the clinical symptoms. Rather, it seems to be useful to consider the results of MRI investigations whenever planning therapeutic procedures for patients with shoulder pain and dysfunction, irrespective of whether or not there are signs of calcified deposits within the rotator cuff tendons on plain radiographs.
Collapse
Affiliation(s)
- M Maier
- Department of Orthopaedic Surgery, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Dürr HR, Stäbler A, Maier M, Refior HJ. Pigmented villonodular synovitis. Review of 20 cases. J Rheumatol 2001; 28:1620-30. [PMID: 11469471] [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: 02/20/2023]
Abstract
OBJECTIVE Pigmented villonodular synovitis (PVS) is a rare aggressive lesion. Inclusion of this disease in the differential diagnosis of rheumatoid arthritis can lead to early diagnosis and treatment. In this retrospective study we evaluated diagnostic procedures, therapies, and outcomes of PVS. METHODS Twenty surgically treated cases of PVS were evaluated: joint, 16; tenosynovial, 3; and bursa, one. The 20 patients had undergone the following surgeries: 4 total synovectomies, 2 subtotal synovectomies, eight arthroscopically assisted resections, 4 resections of extraarticular lesions, and 2 arthroplasties. The mean followup was 17.5 mo (1-54). RESULTS At diagnosis, pain was present in 19 of 20 cases. Joint swelling or a tumor was found in 11 cases, and 12 patients complained of repeated joint effusions. The mean duration of symptoms was 23.8 mo (range 1-144). Half the cases had a nodular pattern and the other half a diffuse pattern. The most common location of PVS was the knee (14 patients). Surgical treatment before admission did not always lead to an accurate diagnosis. For example, in 2 patients, arthroscopy did not reveal PVS. In 2 patients a soft tissue sarcoma was suggested. In 3 patients, the diagnosis was made incidentally with arthroscopy or arthroplasty. On radiographs, bone lesions were seen in 8 cases; in 13 of 17 cases the diagnosis was by magnetic resonance imaging (MRI). After surgery 17 patients stayed free of recurrence, 14 without symptoms. One patient who had an incidental diagnosis of PVS has a synovectomy planned as a second procedure. One patient awaits a second dorsal procedure after a ventral knee synovectomy. One patient shows recurrent disease 33 mo after resection of a nodular knee lesion. CONCLUSION PVS should be included in the differential diagnosis of any arthritis. MRI is the most effective diagnostic tool in identifying PVS. The treatment of PVS consists of surgical excision in sound tissue. A total synovectomy should be the treatment of choice in diffuse disease. From the literature, nonsurgical therapies, such as steroid injections, 90Y synoviorthesis, or external beam radiation, seem to be of benefit in selected patients.
Collapse
Affiliation(s)
- H R Dürr
- Department of Orthopedics and Orthopedic Surgery, Ludwig Maximilians University, Munich, Germany.
| | | | | | | |
Collapse
|