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Prasse T, Hofstetter CP, Heck VJ, Meyer C, Wetsch WA, Scheyerer MJ, Eysel P, Bredow J. Current Evidence on where to End a Fusion within the Thoracolumbar Junction Most Preferably - A Systematic Literature Review. Neurochirurgie 2022; 68:648-653. [PMID: 35817090 DOI: 10.1016/j.neuchi.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/25/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Abstract
Proximal junctional kyphosis (PJK) is one main complication in the surgical treatment of adult spinal deformities. Ending within the thoracolumbar junction (TLJ) should but cannot always be avoided to reduce the risk for PJK. With this systematic review we sought to define the most preferable vertebra within the TLJ to minimize the risk for PJK and establish recommendations based on our findings. We conducted a systematic literature review by scanning the MEDLINE database in accordance with the PRISMA criteria. All articles addressing primary long-distance dorsal thoracolumbar fusion of at least three segments to treat adult spinal deformities were included. 1385 articles were identified and three were included to this review. The first study showed significantly higher rates of PJK in patients where the construct was extended to T7 or higher when compared to an ending at T11 to L1. The second article stated that an expansion to the TLJ resulted in significantly less surgical revisions due to PJK reduction. On the other hand, the third article found that a fusion of the whole thoracic spine reduces the PJK incidence postoperatively. Even though the most favorable vertebra within the TLJ to avoid PJK best could not yet be determined, our study identifies several principles that represent the current state of evidence for surgical treatment of adult scoliosis. Proper preoperative decision making based on thorough analysis and interpretation of the patient's sagittal alignment parameters can improve the individual outcome critically.
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Affiliation(s)
- T Prasse
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany.
| | - C P Hofstetter
- University of Washington, Department of Neurological Surgery, 1959 NE Pacific Street, 98195 Seattle, USA
| | - V J Heck
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany
| | - C Meyer
- Center for Spinal Surgery, Helios Klinikum Bonn/Rhein-Sieg, Von-Hompesch-Straße 1, 53123 Bonn, Germany
| | - W A Wetsch
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anesthesiology and Intensive Care, Kerpener Street 62, 50937 Cologne, Germany
| | - M J Scheyerer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany
| | - P Eysel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany
| | - J Bredow
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Urbacher Weg 19, 51149 Cologne, Germany
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Lenz M, Oikonomidis S, Hartwig R, Gramse R, Meyer C, Scheyerer MJ, Hofstetter C, Eysel P, Bredow J. Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up. Arch Orthop Trauma Surg 2022; 142:721-727. [PMID: 33372234 PMCID: PMC8994725 DOI: 10.1007/s00402-020-03697-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lumbar spinal fusion surgery is a widely accepted surgical treatment in degenerative causes of lumbar spondylolisthesis. The benefit of reduction of anterior displacement and restoration of sagittal parameters is still controversially debated. Purpose of the underlying publication was to analyze the influence of radiographic sagittal parameters of the spine in aspects of changes in postoperative clinical outcome. MATERIALS AND METHODS By prospective analysis, we included patients with low-grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) with mono- or bisegmental fusion surgery with a minimum follow-up data of 3 years. For clinical outcome measures, COMI, ODI and EQ-5D were used. Spinopelvic parameters (sacral inclination, pelvic tilt, sacral slope and pelvic incidence, lumbar lordosis and lumbar index as well as anterior displacement and sagittal rotation) were measured on plain radiographs. RESULTS We could observe a significant benefit in clinical outcome after lumbar fusion surgery in low-grade spondylolisthesis in our mid-term follow-up data including 32 patients. By surgical reduction, we could see significant restoration of anterior displacement and sagittal rotation. Interestingly, a significant correlation between restoration of both sagittal rotation and sacral inclination and clinical outcome score was observed in the 3-year follow-up. CONCLUSION In low-grade spondylolisthesis, spinal fusion surgery is a well-established surgical procedure; however, the impact of sagittal parameters and reduction of anterior displacement remains controversial. Within our findings, restoration of sagittal parameters showed significant correlation to improvement in clinical outcome in our mid-term follow-up data.
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Affiliation(s)
- Maximilian Lenz
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - S. Oikonomidis
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - R. Hartwig
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - R. Gramse
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - C. Meyer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - M. J. Scheyerer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - C. Hofstetter
- Department of Neurological Surgery, UW Medicine Seattle, Seattle, WA USA
| | - P. Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - J. Bredow
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Ott N, Harland A, Scaal M, König J, Bredow J, Eysel P, Müller LP, Meyer C. The role of the transversal ligament on the atlantoaxial complex - Bending forces at C1/2 flexion limits in the elderly. Clin Biomech (Bristol, Avon) 2021; 84:105329. [PMID: 33765570 DOI: 10.1016/j.clinbiomech.2021.105329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Biomechanical functionality as well as trauma mechanisms of the atlantoaxial complex are still an issue of controversy. The transverse atlantal ligament is the strongest stabilizator. The present study aimed to analyze the bending forces of the transverse atlantal ligament and of the base of the odontoid in elderly specimens. METHODS In this biomechanical study five cadaveric specimen with a mean age of 72 at death and bone mineral density measuring for 555.3 Hounsfield units on average were used. To analyze the strain of the transverse atlantal ligament and the dense base, strain gauges were used. A custom biomechanical setup was used to test each specimen at C1/2 flexion and the strain of the transverse atlantal ligament and the dens base (μm/m) were measured. FINDINGS In four out of five, a rupture of the transverse atlantal ligament was observed, the mean force required for the ligament to fall was 175 N (min. 99.8 N; 249.2 N; SD 64.7) by a mean strain of 2102.9 μm/m (min. 1953.5 μm/m; max. 2272.3 μm/m; SD 189.7). In one specimen with the lowest Hounsfield units (155), the dens base fractured before the transverse atlantal ligament ruptured and no strain could be measured at the transversal ligament during movement afterwards. INTERPRETATION The transverse atlantal ligament fails at an average of 175 N in the elderly, which is less than the value reported previously. In osteoporotic specimen the generated force to rupture the transverse atlantal ligament can fracture the dens itself.
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Affiliation(s)
- N Ott
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany.
| | - A Harland
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Martin Scaal
- Department of Anatomy, University of Cologne, Cologne, Germany
| | - J König
- Department of Orthopedic Surgery, Division of Spine Surgery, Schön-Kliniken Düsseldorf, Düsseldorf, Germany
| | - J Bredow
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - P Eysel
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - L P Müller
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - C Meyer
- Department of Orthopedic Surgery, Division of Spine Surgery, Schön-Kliniken Düsseldorf, Düsseldorf, Germany
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Wunderlich G, Liepach U, Koch R, Bredow J, Franke WG, Zöphel K. Recovery-test or immunoradiometric measurement of anti-thyroglobulinautoantibodies. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1623881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe determination of thyroglobulin (Tg) in the follow-up of differentiated thyroid carcinomas (DTC), is routinely used in nuclear medicine, although some problems, like a disturbed recovery-test (RT) or autoantibodies to thyroglobulin (TgAb), are well known. But it is a controversial issue in literature, whether the determination of TgAb should be performed beside or instead of the RT. Objective: The study compares the clinical value of the determination of both TgAb and RT with sensitive assays. Methods: 356 patients (pts) were investigated. The results were compared to the concentration of Tg in the sera of the pts. 288 pts stayed tumor-free, the remaining 68 pts showed a recurrence (local and/or metastatic) of their DTC. We measured Tg (with RT) using an immunoradiometric assay (Tg-IRMA; SELco® Tg; Fa. Medipan Diagnostica GmbH) and TgAb using a direct assay (CentAK® anti-Tg; also from Fa. Medipan). Results: The prevalence of TgAb, and of disturbed RT respectively, in the whole population of DTC-pts was 7,6%, in the subgroup of tumor-free pts 6,6%, and in the remaining pts with tumor-recurrence 11,8%, respectively 2,0%, 1,7% and 2,9%. In a significantly higher percentage of pts with local/metastatic recurrence, both a positive TgAb (p <0,001) and a disturbed RT (p <0,05) were found. 7/68 pts with tumor-recurrence but Tg <1 ng/ml showed positive TgAb, only 2/7 had a disturbed RT. In this group, no patient with Tg >1 ng/ ml demonstrated either positive TgAb or disturbed RT (p <0,001 and p <0,05). Conclusion: The determination of TgAb in the follow-up of DTC is necessary, because it supports a suspicion to tumor-recurrence in pts with negative Tg. Also the RT is of great value because of a possibly High dose hook-effect.
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Bredow J, Kretzschmar M, Wunderlich G, Dörr W, Pohl T, Franke WG, Kotzerke J. Therapy of malignant ascites in vivo by 211At-labelled microspheres. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1624060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: Determination of the biological effect of the alpha emitter 211At on cellular level as well as the assessment of dosimetric data in a tumour model in vivo. Methods: Transplantation of malignant ascitic cells in mice intraperitoneally and estimation of tumour characteristics (doubling time of the cells, mean survival of the animals following an i.p. application of a defined tumour cell number). 211At labelled human serum albumine microspheres B-20 (MSP) of variing activity were injected into tumour bearing mice intraperitoneally. The effectiveness of the therapy was evaluated by means of determination of the duration of cell cycle arrest as well as the microscopic analysis of the rate of abnormal mitotic cells due to radiation induced damage. Furthermore, dose dependence of survival was evaluated. Results: Three days following the intraperitoneally application of 8 x 106 tumour cells, 50-600 kBq 211At-MSP were applied into the abdominal cavity. Considering the volume of ascites at this time and the administered activity, dose calculations were performed. An activity of 50 kBq caused a dose of 0.84 Gy. The increase of radiation induced effect on ascitic tumour cells was correlated with the dose. Between the duration of the cell cycle arrest and the administered activity, a directly proportional correlation was found. The mean survival of non-treated animals was 16.9 ± 3.7 days. The prolongation of the survival was proportional to the activity administered. Using a dosage of 10 Gy, five animals out of 16 survived. Conclusion: Therapy of malignant ascitic cells using 211At-MSP was effective in vivo. For tumour therapy, the 211At represents a highly effective alternative to usually applied beta emitters.
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Stein G, Schiffer G, Bredow J, Meyer C. [3D Fluoroscopy-Navigated Magerl Fusion of the 1st and 2nd Cervical Vertebra]. Z Orthop Unfall 2016; 154:636-637. [PMID: 27975351 DOI: 10.1055/s-0042-118967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Treatment of type II fractures of the odontoid process is still controversial. Besides conservative treatment, there are surgical options, including anterior screw fixation, as first described by Böhler and Magerl, or procedures using a dorsal approach. Many authors prefer dorsal fusion of C1 and 2, due to the reliable, biomechanical stability. In this context, pedicle screw fixation, as described by Harms, and transarticular screw fixation of the atlantoaxial joints, as described by Magerl, have to be mentioned. With the use of intraoperative fluoroscopic navigation, the risk of neurovascular lesions caused by abortive drilling or malposition of screws has been significantly decreased. In 1993, Eysel and Roosen established a subclassification of type II fractures of the odontoid process and gave treatment recommendations for each of the three subtypes. While there was an outcome for type A and B fractures treated by anterior screw fixation, the authors recommended performing dorsal stabilisation at type C fractures. Indication: In accordance with the recommendations of Eysel and Roosen, an 82 year old man, suffering from a type II C fracture of the odontoid process, underwent navigated, transarticular screw fixation of C1 and C2. Method: Once the 3D-fluoroscopy scan had been performed, the correct drilling direction in the axial, coronary and sagittal views of C1 and 2 was found using the navigated drillguide. After K-wires had been inserted in this direction on both sides, a second 3D-scan was performed to recontrol placement of the K-wires. Cannulated screws were introduced and the rods were installed, bearing the atlas hook to fixate the posterior atlas. Conclusion: In summary, dorsal, transarticular fusion of C1 and C2 is a successful treatment option, rarely leading to complications and is accompanied by reduced radiation exposure to the operating team.
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Affiliation(s)
- G Stein
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln
| | - G Schiffer
- Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz-Pallotti Hospital, Bergisch Gladbach
| | - J Bredow
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln
| | - C Meyer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln
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Zarghooni K, Westermann L, Sobottke R, Röllinghoff M, Bredow J, Siewe J, Eysel P, Scheyerer MJ. Fracture risk of vertebral bodies after cryosurgery using a miniature cryoprobe: A biomechanical in-vitro analysis on human bones. Technol Health Care 2016; 25:343-351. [PMID: 27886022 DOI: 10.3233/thc-161277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Due to spinal instability and compressive neurologic deficits surgical management is sometimes necessary in patients with metastatic spinal lesions. However, in some cases open surgery is not possible and minimally invasive procedures, like cryoablation, are needed. The aim of the current study was to investigate whether a miniature cryoprobe provides adequate tissue cooling in vertebrae and to evaluate the direct impact of cryosurgery on vertebral body stability. MATERIALS AND METHODS Twelve thoracic vertebral bodies were harvested from fresh cadavers. After documenting bone density cryoablation was performed in six vertebral bodies according to a standardized procedure. Afterwards temperature inside the vertebral body and maximum breaking force were measured in the control and experimental groups. RESULTS Required temperature of -50° was reached in all areas. There was a significant correlation between maximum breaking force and measured bone density (p= 0.001). Mean breaking force within the experimental group was 5047 N (SD = 2955 N) compared to 4458 N (SD = 2554 N) in the control group. There were no observable differences in maximum breaking force between both groups. CONCLUSION Miniature cryoprobe can deliver adequate tissue cooling to -50°C in vertebral bodies. The procedure does not seem to influence breaking force of the treated bones in-vitro. Therefore, using miniature probes cryosurgery may provide a valuable alternative to conventional surgical resection of neoplastic diseases as well as of benign locally aggressive bone tumors.
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Affiliation(s)
- K Zarghooni
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - L Westermann
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - R Sobottke
- Department of Orthopedics, Medical Center City Aachen GmbH, Wuerselen, Germany
| | - M Röllinghoff
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany.,Centre for Orthopaedics, University Medical Centre, Halle (Saale), Germany
| | - J Bredow
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - J Siewe
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - P Eysel
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - M J Scheyerer
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
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Bredow J, Beyer F, Oppermann J, Kraus B, Meyer C, Stein G, Eysel P, Koy T. A novel classification of screw placement accuracy in the cervical spine. Technol Health Care 2016; 24:919-925. [DOI: 10.3233/thc-161246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J. Bredow
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - F. Beyer
- Department of Orthopedic and Trauma Surgery, Marien Krankenhaus gGmbH, Bergisch Gladbach, Germany
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - J. Oppermann
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - B. Kraus
- Department of Radiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - C. Meyer
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - G. Stein
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - P. Eysel
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - T. Koy
- Department of Spine Surgery, KLINIK am RING, Cologne, Germany
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Bredow J, Bloess K, Oppermann J, Boese CK, Löhrer L, Eysel P. [Erratum to: Conservative treatment of nonspecific, chronic low back pain. Evidence of the efficacy - a systematic literature review]. Orthopade 2016; 45:627. [PMID: 27294838 DOI: 10.1007/s00132-016-3281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- J Bredow
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland.
| | - K Bloess
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
| | - J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
| | - C K Boese
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
| | - L Löhrer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
| | - P Eysel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
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Stein G, Meyer C, Ingenhoff L, Bredow J, Müller LP, Eysel P, Schiffer G. [The biomechanics of hyperextension injuries of the subaxial cervical spine]. Unfallchirurg 2016; 120:590-594. [PMID: 27220520 DOI: 10.1007/s00113-016-0167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hyperextension injuries of the subaxial cervical spine are potentially hazardous due to relevant destabilization. Depending on the clinical condition, neurologic or vascular damage may occur. Therefore an exact knowledge of the factors leading to destabilization is essential. In a biomechanical investigation, 10 fresh human cadaver cervical spine specimens were tested in a spine simulator. The tested segments were C4 to 7. In the first step, physiologic motion was investigated. Afterwards, the three steps of injury were dissection of the anterior longitudinal ligament, removal of the intervertebral disc/posterior longitudinal ligament, and dissection of the interspinous ligaments/ligamentum flavum. After each step, the mobility was determined. Regarding flexion and extension, an increase in motion of 8.36 % after the first step, 90.45 % after the second step, and 121.67 % after the last step was observed. Testing of lateral bending showed an increase of mobility of 7.88 %/27.48 %/33.23 %; axial rotation increased by 2.87 %/31.16 %/45.80 %. Isolated dissection of the anterior longitudinal ligament led to minor destabilization, whereas the intervertebral disc has to be seen as a major stabilizer of the cervical spine. Few finite-element studies showed comparable results. If a transfer to clinical use is undertaken, an isolated rupture of the anterior longitudinal ligament can be treated without surgical stabilization.
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Affiliation(s)
- G Stein
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - C Meyer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L Ingenhoff
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - J Bredow
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Eysel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Schiffer
- Abteilung Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz-Palotti-Hospital, Bergisch-Gladbach, Deutschland
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Schreiter V, Steffen I, Huebner H, Bredow J, Heimann U, Kroencke TJ, Poellinger A, Doellinger F, Buchert R, Hamm B, Brenner W, Schreiter NF. Ventilation/perfusion SPECT/CT in patients with pulmonary emphysema. Evaluation of software-based analysing. Nuklearmedizin 2015; 54:31-5. [PMID: 25683108 DOI: 10.3413/nukmed-0704-14-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/01/2014] [Indexed: 01/15/2023]
Abstract
UNLABELLED The purpose of this study was to evaluate the reproducibility of a new software based analysing system for ventilation/perfusion single-photon emission computed tomography/computed tomography (V/P SPECT/CT) in patients with pulmonary emphysema and to compare it to the visual interpretation. PATIENTS, MATERIAL AND METHODS 19 patients (mean age: 68.1 years) with pulmonary emphysema who underwent V/P SPECT/CT were included. Data were analysed by two independent observers in visual interpretation (VI) and by software based analysis system (SBAS). SBAS PMOD version 3.4 (Technologies Ltd, Zurich, Switzerland) was used to assess counts and volume per lung lobe/per lung and to calculate the count density per lung, lobe ratio of counts and ratio of count density. VI was performed using a visual scale to assess the mean counts per lung lobe. Interobserver variability and association for SBAS and VI were analysed using Spearman's rho correlation coefficient. RESULTS Interobserver agreement correlated highly in perfusion (rho: 0.982, 0.957, 0.90, 0.979) and ventilation (rho: 0.972, 0.924, 0.941, 0.936) for count/count density per lobe and ratio of counts/count density in SBAS. Interobserver agreement correlated clearly for perfusion (rho: 0.655) and weakly for ventilation (rho: 0.458) in VI. CONCLUSIONS SBAS provides more reproducible measures than VI for the relative tracer uptake in V/P SPECT/CTs in patients with pulmonary emphysema. However, SBAS has to be improved for routine clinical use.
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Affiliation(s)
- V Schreiter
- Dr. N. F. Schreiter, Charité Universitätsmedizin Berlin - Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany, E-maiol:
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Beyer F, Geier F, Bredow J, Oppermann J, Eysel P, Sobottke R. Influence of spinopelvic parameters on non-operative treatment of lumbar spinal stenosis. Technol Health Care 2015; 23:871-9. [DOI: 10.3233/thc-151032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F. Beyer
- Department of Orthopedic and Trauma Surgery, Marien Krankenhaus gGmbH, Bergisch Gladbach, Germany
| | - F. Geier
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - J. Bredow
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - J. Oppermann
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - P. Eysel
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - R. Sobottke
- Department of Orthopedic and Trauma Surgery, Medizinisches Zentrum StädteRegion Aachen GmbH, Würselen, Germany
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Bredow J, Katinakis F, Schlüter-Brust K, Krug B, Pfau D, Eysel P, Dargel J, Wegmann K. Influence of hip replacement on sagittal alignment of the lumbar spine: An EOS study. Technol Health Care 2015; 23:847-54. [DOI: 10.3233/thc-151029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J. Bredow
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - F. Katinakis
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - K. Schlüter-Brust
- Department of Orthopedics, St. Franziskus Hospital, Cologne, Germany
| | - B. Krug
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - D. Pfau
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - P. Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - J. Dargel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - K. Wegmann
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
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Bredow J, Oppermann J, Kraus B, Schiller P, Schiffer G, Sobottke R, Eysel P, Koy T. The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine. Eur Spine J 2015; 24:2967-76. [DOI: 10.1007/s00586-015-3974-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
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Sobottka SB, Bredow J, Beuthien-baumann B, Reiss G, Schackert G, Steinmeier R. Comparison of Functional Brain PET Images and Intraoperative Brain-Mapping Data Using Image-Guided Surgery. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080209146520] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brogsitter C, Pinkert J, Bredow J, Kittner T, Kotzerke J. Verbesserte intratumorale Retention in neuroendokrinen Tumoren nach intraarterieller Applikation von 131I-MIBG. ACTA ACUST UNITED AC 2008. [DOI: 10.1055/s-2008-1004766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Beuthien-Baumann B, Strumpf A, Zessin J, Bredow J, Kotzerke J. Diagnostic impact of PET with 18F-FDG, 18F-DOPA and 3-O-methyl-6-[18F]fluoro-DOPA in recurrent or metastatic medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 2007; 34:1604-9. [PMID: 17435996 DOI: 10.1007/s00259-007-0425-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 02/12/2007] [Indexed: 01/01/2023]
Abstract
PURPOSE In patients with medullary thyroid carcinoma (MTC), rising levels of the tumour markers calcitonin and CEA after primary surgery indicate tumour recurrence or metastases. The only chance of cure is the resection of localised tumour tissue. For positron emission tomography (PET) with (18)F-fluorodeoxyglucose ((18)F-FDG) and (18)F-dihydroxyphenylalanine ((18)F-DOPA), sensitivities of 78% and 63% have been reported, but in a considerable percentage of MTC patients the source of tumour marker elevation is not detected. The aim of this retrospective data evaluation was to compare the value of PET with (18)F-FDG, (18)F-DOPA and the amino acid tracer 3-O-methyl-6-[(18)F]fluoro-DOPA ((18)F-OMFD) in the detection of MTC recurrence. METHODS Fifteen patients with elevated calcitonin were investigated with PET as part of their individual clinical work-up. All patients underwent (18)F-FDG PET and (18)F-DOPA PET, and ten patients underwent (18)F-OMFD PET. RESULTS With (18)F-FDG, seven patients showed foci in the neck, mediastinum, upper abdomen or bone. In seven patients, (18)F-DOPA revealed suspicious foci; five of these seven patients showed partially corresponding uptake of (18)F-FDG in the neck and mediastinum. Two of these patients underwent surgery and metastases were verified. With (18)F-OMFD, a small focus in the liver was suspected in one patient without a correlate on (18)F-FDG PET, (18)F-DOPA PET or conventional imaging. CONCLUSION (18)F-FDG and (18)F-DOPA showed foci that were highly suspicious for local recurrence or metastasis of MTC, although histological verification in these patients with numerous previous surgical interventions was performed in only two patients. The amino acid tracer (18)F-OMFD had no diagnostic impact in these patients.
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Affiliation(s)
- B Beuthien-Baumann
- Department of Nuclear Medicine, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden and PET-Center Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden, Germany.
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Bredow J, Kretzschmar M, Wunderlich G, Dörr W, Pohl T, Franke WG, Kotzerke J. [Therapy of malignant ascites in vivo by 211At-labelled microspheres]. Nuklearmedizin 2004; 43:63-8. [PMID: 15029267 DOI: 10.1267/nukl04020063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM Determination of the biological effect of the alpha emitter (211)At on cellular level as well as the assessment of dosimetric data in a tumour model in vivo. METHODS Transplantation of malignant ascitic cells in mice intraperitoneally and estimation of tumour characteristics (doubling time of the cells, mean survival of the animals following an i.p. application of a defined tumour cell number). (211)At labelled human serum albumin microspheres B-20 (MSP) of varying activity were injected into tumour bearing mice intraperitoneally. The effectiveness of the therapy was evaluated by means of determination of the duration of cell cycle arrest as well as the microscopic analysis of the rate of abnormal mitotic cells due to radiation induced damage. Furthermore, dose dependence of survival was evaluated. RESULTS Three days following the intraperitoneally application of 8 x 10(6) tumour cells, 50-600 kBq (211)At-MSP were applied into the abdominal cavity. Considering the volume of ascites at this time and the administered activity, dose calculations were performed. An activity of 50 kBq caused a dose of 0.84 Gy. The increase of radiation induced effect on ascitic tumour cells was correlated with the dose. Between the duration of the cell cycle arrest and the administered activity, a directly proportional correlation was found. The mean survival of non-treated animals was 16.9 +/- 3.7 days. The prolongation of the survival was proportional to the activity administered. Using a dosage of 10 Gy, five animals out of 16 survived. CONCLUSION Therapy of malignant ascitic cells using (211)At-MSP was effective in vivo. For tumour therapy, the (211)At represents a highly effective alternative to usually applied beta emitters.
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Affiliation(s)
- J Bredow
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum, Dresden
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Naumann R, Beuthien-Baumann B, Reiss A, Schulze J, Hänel A, Bredow J, Kühnel G, Kropp J, Hänel M, Laniado M, Kotzerke J, Ehninger G. Substantial impact of FDG PET imaging on the therapy decision in patients with early-stage Hodgkin's lymphoma. Br J Cancer 2004; 90:620-5. [PMID: 14760374 PMCID: PMC2409608 DOI: 10.1038/sj.bjc.6601561] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This prospective study assessed the impact of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the staging and possible consequential changes of treatment regimen in patients with Hodgkin's lymphoma (HL). A total of 88 consecutive patients with histologically verified Hodgkin's lymphoma underwent a PET scan in addition to conventional staging procedures. Treatment was based on the conventional staging only, and the results of the FDG-PET did not affect the treatment strategy. The evaluation focused on the suggested change in clinical stage according to the Ann Arbor classification and on the suggested change in treatment strategy rather than on a lesion-by-lesion analysis. Using all the methods performed as the standard of reference, (18)F-FDG-PET staging was concordant with conventional staging in 70 out of 88 patients (80%). (18)F-fluorodeoxyglucose positron emission tomography suggested a change to a different clinical stage in 18 patients (20%). Management would have been changed in 16 patients (18%): intensification of treatment in nine patients (10%) and minimisation of treatment in seven patients (8%). In the 44 patients with early disease (stage IA-IIB), treatment would have been intensified in nine out of 44 patients (20%). (18)F-fluorodeoxyglucose positron emission tomography is a relevant noninvasive method that supplements conventional staging procedures and should therefore be used routinely to stage Hodgkin's lymphoma, particularly in patients with an early stage.
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Affiliation(s)
- R Naumann
- Department of Medicine I, University Hospital Carl Gustav Carus at the Dresden University of Technology, Fetscherstr. 74, 01307 Dresden, Germany.
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20
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Beuthien-Baumann B, Bredow J, Burchert W, Füchtner F, Bergmann R, Alheit HD, Reiss G, Hliscs R, Steinmeier R, Franke WG, Johannsen B, Kotzerke J. 3-O-methyl-6-[18F]fluoro-L-DOPA and its evaluation in brain tumour imaging. Eur J Nucl Med Mol Imaging 2003; 30:1004-8. [PMID: 12768333 DOI: 10.1007/s00259-003-1205-2] [Citation(s) in RCA: 37] [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] [Received: 12/16/2002] [Accepted: 03/27/2003] [Indexed: 11/26/2022]
Abstract
3-O-Methyl-6-[(18)F]fluoro-L-DOPA (OMFD) is a major metabolite of 6-[(18)F]fluoro-L-DOPA. Although synthesis of OFMD was primarily established to study the dopaminergic system, as it is an amino acid analogue, uptake in experimental tumours has been found. The aim of this study was to evaluate the applicability of OMFD for brain tumour imaging and to obtain initial estimates of whole-body biodistribution and radiation dosimetry in humans. Nineteen patients with suspected or confirmed brain tumours were investigated with OMFD and dynamic brain PET, complemented by whole-body PET in seven patients. Tracer kinetics were compared for normal brain and intracerebral lesions. Tissue accumulation was quantified with standardised uptake values (SUVs). Whole-body distribution in combination with tracer kinetics from animal experiments was used for the calculation of radiation dosimetry data. On the basis of OMFD PET, viable brain tumour was suspected in 16 patients with SUVs of 3.0+/-0.8 and a tumour to non-tumour ratio of 1.9+/-0.5. Highest tumour and normal brain uptake occurred between 15 and 30 min, with a subsequent slow decrease. Late whole-body tracer distribution was uniform without specific organ accumulation. Elimination occurred via urine. The mean radiation dose to the whole body was estimated at 0.016 mSv/MBq, with the kidneys as dose-critical organ (0.033 mGy/MBq). In conclusion, OMFD enables the visualisation of brain tumours with SUVs similar to other fluorinated amino acids. The whole-body radiation exposure from OMFD is comparable to that from FDG imaging.
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Affiliation(s)
- B Beuthien-Baumann
- Klinik und Poliklinik für Nuklearmedizin, Technische Universität Dresden und PET Zentrum Rossendorf, Fetscherstrasse 74, 01307, Dresden, Germany
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Sobottka SB, Bredow J, Beuthien-Baumann B, Reiss G, Schackert G, Steinmeier R. Comparison of functional brain PET images and intraoperative brain-mapping data using image-guided surgery. Comput Aided Surg 2003; 7:317-25. [PMID: 12731094 DOI: 10.1002/igs.10060] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Knowledge about the spatial localization of eloquent brain areas is essential for resecting lesions in the vicinity of these areas. The classical approach is to perform surgery on the awake patient under local anesthesia using brain-mapping techniques. As an alternative, the location of eloquent areas can be visualized by preoperative functional brain-imaging techniques, for example, positron emission tomography (PET), functional magnetic resonance imaging (fMRI), or magnetoencephalography (MEG). Using functional activation PET, both methods were combined by integration into a frameless navigation system (BrainLAB) and used to map speech-eloquent areas. PATIENTS AND METHODS Speech-eloquent areas were localized preoperatively in seven patients with a left-sided glioma using 2-[(18)F]-2-desoxy-D-glucose PET. Patients were scanned under silence conditions (i.e., with the patient remaining silent in a sound-proof cabin), and speech was activated using a verb-generation paradigm. The PET data were transferred to the neuronavigation workstation and matched with a preoperative 3D-MRI using an automatic image-fusion algorithm. Intraoperative speech localization was performed using brain-mapping techniques under local anesthesia with bipolar cortical stimulation. The stimulator position was mapped into the MRI/PET data set by neuronavigational tracking of the instrument. RESULTS Functional PET images were integrated into the MRI-based neuronavigational system and could be transferred exactly to the operative field. By the additional integration of cortical stimulation, intraoperative electrophysiological findings can be directly compared with preoperative functional images. Seven patients with left-sided glioma were operated on using this protocol, confirming the technical feasibility. In three of seven patients, preoperative PET findings were not supported by intraoperative mapping. CONCLUSIONS This matching and mapping technique is suitable for monitoring eloquent speech areas during surgical resection of extensive left-sided low-grade gliomas, allowing a direct comparison between intraoperative electrophysiological brain mapping and preoperative functional brain-imaging findings. The sensitivity and specificity of functional imaging techniques can now be evaluated by reconciling the data with the intraoperative stimulation results.
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Affiliation(s)
- S B Sobottka
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
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Steinmeier R, Sobottka SB, Reiss G, Bredow J, Gerber J, Schackert G. Surgery of low-grade gliomas near speech-eloquent regions: brainmapping versus preoperative functional imaging. Oncol Res Treat 2002; 25:552-7. [PMID: 12566901 DOI: 10.1159/000068627] [Citation(s) in RCA: 2] [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] [Indexed: 11/19/2022]
Abstract
The identification of eloquent areas is of utmost importance in the surgery of tumors located near speech-eloquent brain areas, since the classical concept of a constant localization was proven to be untrue and the spatial localization of these areas may show large interindividual differences. Some neurosurgical centers apply intraoperative electrophysiological methods that, however, necessitate the performance of surgery in the awake patient. This might be a severe burden both for the patient and the operating team in a procedure that lasts several hours; in addition, electrical stimulation may generate epileptic seizures. Alternatively, methods of functional brain imaging (e.g., PET, fMRI, MEG) may be applied, which allow individual localization of speech-eloquent areas. Matching of these image data with a conventional 3D-CT or MRI now allows the exact transfer of this information into the surgical field by neuronavigation. Whereas standards concerning electrophysiological stimulation techniques that could prevent a permanent postoperative worsening of language are available, until now it remains unclear whether the resection of regions shown to be active in functional brain imaging will cause a permanent postoperative deficit.
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Affiliation(s)
- R Steinmeier
- Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany.
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23
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Naumann R, Vaic A, Beuthien-Baumann B, Bredow J, Kropp J, Kittner T, Franke WG, Ehninger G. Prognostic value of positron emission tomography in the evaluation of post-treatment residual mass in patients with Hodgkin's disease and non-Hodgkin's lymphoma. Br J Haematol 2001; 115:793-800. [PMID: 11843811 DOI: 10.1046/j.1365-2141.2001.03147.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the assessment of post-treatment residual masses in patients with Hodgkin's disease (HD) or non-Hodgkin's lymphomas (NHL) was evaluated. We prospectively studied 58 patients with HD (n = 43) or NHL (n = 15) who had post-therapeutic complete remission with residual masses (CRu) indicated by computerized tomography. Analysis of 62 residual locations by FDG-PET was performed separately for HD and NHL. Patients with a PET-positive residual mass [standardized uptake value (SUV) > 3] had a recurrence rate of 62.5% (5/8 patients), whereas patients with PET-negative residual mass (SUV < or =3.0) showed a recurrence rate of 4% (2/50 patients, P = 0.004). A positive FDG-PET study correlated with a significantly poorer progression-free survival (P < 0.00001). No recurrence occurred in any of the 39 HD patients with a negative PET scan (negative predictive value, 100%). Four out of four NHL patients with a positive PET study relapsed (positive predictive value, 100%). In conclusion, FDG-PET is a suitable non-invasive method with a high degree of accuracy in the prediction of early recurrence in lymphoma patients with CRu.
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Affiliation(s)
- R Naumann
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Dresden University of Technology, Fetscherstrasse 74, D-01307 Dresden, Germany.
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Diehl M, Risse JH, Brandt-Mainz K, Dietlein M, Bohuslavizki KH, Matheja P, Lange H, Bredow J, Körber C, Grünwald F. Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer: results of a multicentre study. Eur J Nucl Med 2001; 28:1671-6. [PMID: 11702109 DOI: 10.1007/s002590100614] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the clinical use of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in medullary thyroid cancer (MTC) on the basis of comparison with findings obtained using indium-111 pentetreotide (SMS), pentavalent technetium-99m dimercaptosuccinic acid (DMSA), technetium-99m sestamibi (MIBI), computed tomography (CT) and magnetic resonance imaging (MRI). One hundred FDG-PET examinations in 85 patients (40 males, 45 females) with elevated tumour marker levels and/or pathological findings on other imaging methods were evaluated retrospectively. Eighty-two patients were examined after total thyroidectomy, and the remaining three patients prior to surgery. Overall, 181 lesions could be identified with at least one of the imaging techniques. Fifty-five lesions were confirmed histologically. FDG-PET detected 123 of 181 sites, which is a lesion detection probability of 68%. In the 55 cases with histological confirmation, we found 32 true positive, 3 false positive, 11 true negative and 9 false negative lesions using FDG-PET, resulting in a sensitivity of 78% and a specificity of 79%. Sensitivity and specificity were, respectively, 25% and 92% for SMS, 33% and 78% for DMSA, 25% and 100% for MIBI, 50% and 20% for CT and 82% and 67% for MRI. Compared with morphological techniques and functional imaging methods with single-photon emitters, FDG-PET showed the highest lesion detection probability for MTC tissue, with a high sensitivity and specificity. It is concluded that FDG-PET is a useful method in the staging and follow-up of MTC.
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Affiliation(s)
- M Diehl
- Department of Nuclear Medicine, University of Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
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25
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Zöphel K, Wunderlich G, Liepach U, Koch R, Bredow J, Franke WG. [Recovery test or immunoradiometric measurement of anti-thyroglobulin autoantibodies for interpretation of thyroglobulin determination in the follow-up of different thyroid carcinoma]. Nuklearmedizin 2001; 40:155-63. [PMID: 11727628] [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: 02/22/2023]
Abstract
UNLABELLED The determination of thyroglobulin (Tg) in the follow-up of differentiated thyroid carcinomas (DTC), is routinely used in nuclear medicine, although some problems, like a disturbed recovery-test (RT) or autoantibodies to thyroglobulin (TgAb), are well known. But it is a controversial issue in literature, whether the determination of TgAb should be performed beside or instead of the RT. OBJECTIVE The study compares the clinical value of the determination of both TgAb and RT with sensitive assays. METHODS 356 patients (pts) were investigated. The results were compared to the concentration of Tg in the sera of the pts. 288 pts stayed tumor-free, the remaining 68 pts showed a recurrence (local and/or metastatic) of their DTC. We measured Tg (with RT) using an immunoradiometric assay (Tg-IRMA; SELco Tg; Fa. Medipan Diagnostica GmbH) and TgAb using a direct assay (CentAK anti-Tg; also from Fa. Medipan). RESULTS The prevalence of TgAb, and of disturbed RT respectively, in the whole population of DTC-pts was 7.6%, in the subgroup of tumor-free pts 6.6%, and in the remaining pts with tumor-recurrence 11.8%, respectively 2.0%, 1.7% and 2.9%. In a significantly higher percentage of pts with local/metastatic recurrence, both a positive TgAb (p < 0.001) and a disturbed RT (p < 0.05) were found. 7/68 pts with tumor-recurrence but Tg < 1 ng/ml showed positive TgAb, only 2/7 had a disturbed RT. In this group, no patient with Tg > 1 ng/ml demonstrated either positive TgAb or disturbed RT (p < 0.001 and p < 0.05). CONCLUSION The determination of TgAb in the follow-up of DTC is necessary, because it supports a suspicion to tumor-recurrence in pts with negative Tg. Also the RT is of great value because of a possibly High dose hook-effect.
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Affiliation(s)
- K Zöphel
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Deutschland.
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Wunderlich G, Füchtner F, Bergmann R, Bredow J, Steinbach J, Johannsen B, Franke WG. 3-O-methyl-6-[123I]IODO-L-DOPA (OMID) - an amino acid derivative for tumour imaging with spect. J Labelled Comp Radiopharm 2001. [DOI: 10.1002/jlcr.25804401127] [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: 11/06/2022]
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Franke WG, Zöphel K, Wunderlich GR, Mat R, Kühne A, Schimming C, Kropp J, Bredow J. Thyroperoxidase: a tumor marker for post-therapeutic follow-up of differentiated thyroid carcinomas? Results of a time course study. Cancer Detect Prev 2001; 24:524-30. [PMID: 11198265] [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: 02/19/2023]
Abstract
Serum thyroperoxidase (TPO) and serum human thyroglobulin (hTg) were studied in 80 patients with differentiated thyroid carcinoma after thyroidectomy before and after the first therapeutic radioiodine application ("radioiodine thyroid ablation") and, in some cases, after the second radioiodine application. Eighteen patients with an autonomous adenoma were studied in the same manner. The values of TPO and hTg in 25 persons without thyroid impairment were used as controls. In 34 of 50 evaluable cases, TPO levels behaved as hTg during follow-up studies: The majority (n= 30) of these patients showed an increase in TPO and hTg serum levels immediately after radioiodine therapy, followed by a decrease approximately 3 days later. However, in 16 of 50 patients, the TPO and hTg serum levels showed different patterns of change both before and after radioiodine therapy. In six of seven patients with extensive postoperative residues and high anti-hTg levels, distinctly elevated TPO values were associated only by slightly elevated thyroglobulin values. There was no rise of TPO in autonomous adenoma except in patients treated with thyroid depressants. We assumed that TPO levels could serve as an "indicator" for destruction of thyroid cells or thyroid carcinoma cells and an aid in screening cases of false-negative hTg values.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/radiotherapy
- Adenocarcinoma, Follicular/surgery
- Adenoma/diagnosis
- Adenoma/pathology
- Adenoma/surgery
- Aged
- Antithyroid Agents/therapeutic use
- Biomarkers, Tumor/blood
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Cell Differentiation
- Clinical Enzyme Tests
- Combined Modality Therapy
- False Negative Reactions
- Female
- Follow-Up Studies
- Humans
- Iodide Peroxidase/blood
- Iodine Radioisotopes/administration & dosage
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasm Metastasis/diagnosis
- Neoplasm Proteins/blood
- Neoplasm Recurrence, Local/diagnosis
- Neoplasms, Multiple Primary/enzymology
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Postoperative Period
- Radiotherapy, Adjuvant
- Sensitivity and Specificity
- Thyroglobulin/blood
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/radiotherapy
- Thyroid Neoplasms/surgery
- Thyroidectomy
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Affiliation(s)
- W G Franke
- Technische Universität Dresden, Universitätsklinikum, Klinik und Poliklinik für Nuklearmedizin, Germany
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Franke WG, Pinkert J, Runge R, Bredow J, Wunderlich G, Koch R. Chromogranin A: an additional tumor marker for postoperative recurrence and metastases of medullary thyroid carcinomas? Anticancer Res 2000; 20:5257-60. [PMID: 11326706] [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: 02/19/2023]
Abstract
In this study, plasma concentrations of chromogranin A, calcitonin and carcinoembryonic antigen (CEA) were measured in 40 healthy volunteers as well as in 129 patients with recurrences and/or metastases of neuroendocrine tumors and of medullary thyroid carcinomas (MTCs). A double antibody assay was employed using polyclonal rabbit antibodies to a C-terminal fragment of the protein for detection of human chromogranin A. Using ROC analysis, a cutoff at 22 U/l chromogranin A was calculated. In patients with neuroendocrine tumours, much higher serum concentrations of chromogranin A than for patients with MTC (80% vs. 46%) were measured. The following sensitivities were found: chromogranin A; 46%, calcitonin 100%, CEA 52%. Furthermore, the mean values of chromogranin A concentrations correlated with the tumour mass and/or number of metastases in MTC and neuroendocrine tumours. Evaluation of follow-up studies remains to be completed; however, preliminary results showed similarities regarding the behaviour of chromogranin A and calcitonin. Despite the findings of this study, the observations could not confirm chromogranin A as a reliable marker for metastazing or recurrent MTC.
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Affiliation(s)
- W G Franke
- Department for Nuclear Medicine, University Hospital Carl Custav Carus, Dresden University of Technology, Germany.
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29
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Tiepolt C, Beuthien-Baumann B, Hliscs R, Bredow J, Kühne A, Kropp J, Burchert W, Franke WG. 18F-FDG for the staging of patients with differentiated thyroid cancer: comparison of a dual-head coincidence gamma camera with dedicated PET. Ann Nucl Med 2000; 14:339-45. [PMID: 11108162 DOI: 10.1007/bf02988693] [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: 11/29/2022]
Abstract
Coincidence imaging with a dual-head gamma camera may offer a cost-effective alternative to dedicated PET. The aim of this study was to compare the diagnostic accuracy of coincidence imaging and PET in patients with differentiated thyroid cancer. Thirty-one patients were studied after thyroidectomy and radioiodine ablation. They were injected with a single dose of 300 MBq 18F-FDG. Scanning was performed on a dedicated PET system after 1 hr, and on a coincidence gamma camera after 4 hrs. Based on a lesion-by-lesion comparison, coincidence imaging and PET concurred in 69% of 118 lesions. Based on lesion size, concurrence was 96% in lesions larger than 1.5 cm, and 62% in those between 1 and 1.5 cm. Lesions smaller than 1 cm could not be identified with coincidence imaging. Identical staging was obtained with coincidence imaging and PET in 26/31 patients (84%). In four patients FDG accumulating lesions were shown by both the coincidence camera and the dedicated scanner, but not detectable with any other imaging means and were confirmed histologically on surgery. Although a coincidence camera is technically inferior to a dedicated PET scanner, it may provide clinically useful results in situations were a lesion of sufficient size and FDG uptake is to be expected, e.g. when evaluating a known lesion for malignancy.
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Affiliation(s)
- C Tiepolt
- Department of Nuclear Medicine, Carl Gustav Carus Medical School, University of Dresden, Germany.
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Franke WG, Zöphel K, Wunderlich G, Kühne A, Schimming C, Kropp J, Bredow J. Thyroid peroxidase (TPO) as a tumor marker in the follow-up of differentiated thyroid carcinomas with surgical and ablative radioiodine therapy. An assessment after evaluation. Anticancer Res 1999; 19:2711-6. [PMID: 10470226] [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: 02/13/2023]
Abstract
The clinical significance of serum thyroid peroxidase (TPO) for differentiated thyroid carcinomas(DTA) is estimated differently. In our preliminary studies it was found that TPO presented information extending those that from hTG. For further clarification a prospective follow-up study was performed including 66 female and 14 male total thyroidectomized patients with DTA for the time course of TPO and human thyroglobulin (hTg) in relation to the ablative radioidine therapy (ART). In 34/50 evaluable cases TPO levels showed an approximately analogous time course with hTg. In relation to the extension of residues, some cases presented increasing of TPO and hTG after radioiodine treatment. 6/7 patients suffering from extended postoperative residues with high anti hTg levels but without elevated TPO concentrations showed distinctly elevated TPO values. Therefore, TPO seems to be an indicator for the destruction of normal thyroid cells or thyroid tumor cells. The clinical value of TPO seems to be in the time being limited to DTA due to false negative hTg values. However, it should be possible that TPO can did the evaluation of thyroid specific therapy.
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Affiliation(s)
- W G Franke
- Universitätsklinikum der Technischen Universität Dresden/Klinik und Poliklinik für Nuklearmedizin, Germany
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