1
|
Mujanovic A, Kurmann CC, Serrallach BL, Dobrocky T, Meinel TR, Windecker D, Grunder L, Beyeler M, Seiffge DJ, Pilgram-Pastor S, Arnold M, Piechowiak EI, Gralla J, Fischer U, Kaesmacher J. Intra-Arterial Thrombolysis is Associated with Delayed Reperfusion of Remaining Vessel Occlusions following Incomplete Thrombectomy. AJNR Am J Neuroradiol 2023; 44:1050-1056. [PMID: 37500281 PMCID: PMC10494949 DOI: 10.3174/ajnr.a7943] [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] [Received: 04/14/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND PURPOSE Intra-arterial thrombolytics may be used to treat distal vessel occlusions, which cause incomplete reperfusion following mechanical thrombectomy. Because immediate reperfusion after intra-arterial thrombolytics occurs rarely, the aim of this study was to assess the delayed effect of intra-arterial thrombolytics using follow-up perfusion imaging. MATERIALS AND METHODS We included patients from a prospective stroke registry (February 2015 to September 2022) who had undergone mechanical thrombectomy and had incomplete reperfusion (expanded TICI 2a-2c) and available 24 hour perfusion imaging. Perfusion imaging was rated as delayed reperfusion if time-sensitive perfusion maps did not show wedge-shaped delays suggestive of persisting occlusions corresponding to the post-mechanical thrombectomy angiographic deficit. Patients treated with intra-arterial thrombolytics were compared with controls using multivariable logistic regression and inverse probability of treatment weighting matching for baseline differences and factors associated with delayed reperfusion. RESULTS The median age of the final study population (n = 459) was 74 years (interquartile range, 63-81 years), and delayed reperfusion occurred in 61% of cases. Patients treated with additional intra-arterial thrombolytics (n = 40) were younger and had worse expanded TICI scores. After matching was performed, intra-arterial thrombolytics was associated with higher rates of delayed reperfusion (adjusted OR = 2.7; 95% CI, 1.1-6.4) and lower rates of new infarction in the residually hypoperfused territory after mechanical thrombectomy (adjusted OR = 0.3; 95% CI, 0.1-0.7). No difference was found in the rates of functional independence (90-day mRS, 0-2; adjusted OR = 1.4; 95% CI, 0.4-4.1). CONCLUSIONS Rescue intra-arterial thrombolytics is associated with delayed reperfusion of remaining vessel occlusions following incomplete mechanical thrombectomy. The value of intra-arterial thrombolytics as a potential therapy for incomplete reperfusions after mechanical thrombectomy should be assessed in the setting of randomized controlled trials.
Collapse
Affiliation(s)
- A Mujanovic
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - C C Kurmann
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology (C.C.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - B L Serrallach
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - T Dobrocky
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - T R Meinel
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - D Windecker
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - L Grunder
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - M Beyeler
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - D J Seiffge
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - S Pilgram-Pastor
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - M Arnold
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - E I Piechowiak
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - J Gralla
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - U Fischer
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology (U.F.), University Hospital Basel, University of Basel, Basel, Switzerland
| | - J Kaesmacher
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| |
Collapse
|
2
|
Stahel R, Riesterer O, Alexandros X, Opitz I, Beyeler M, Ochsenbein A, Früh M, Cathomas R, Nackaerts K, Peters S, Mamot C, Zippelius A, Mordasini C, Clemens K, Eckhardt K, Schmid R, Nagel W, Aebersold D, Gautschi O, Weder W. Neoadjuvant Chemotherapy and Extrapleural Pneumonectomy (Epp) of Malignant Pleural Mesothelioma (Mpm) with or Without Hemithoracic Radiotherapy: Final Results of the Randomized Multicenter Phase Ii Trial Sakk17/04. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
3
|
Barysch MJ, Eggmann N, Beyeler M, Panizzon RG, Seifert B, Dummer R. Long-term recurrence rate of large and difficult to treat cutaneous squamous cell carcinomas after superficial radiotherapy. Dermatology 2012; 224:59-65. [PMID: 22433440 DOI: 10.1159/000337027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 01/31/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Surgical excision is the gold standard for cutaneous squamous cell carcinoma (cSCC), however its application is limited in specific cases. Superficial radiotherapy (RTx) is an alternative treatment option, but long-term follow-up data are limited. OBJECTIVE To determine the outcome of superficial RTx of cSCC in correlation to histological differentiation grade and tumor localization. METHODS The outcome of 180 large cSCCs after superficial RTx between 1960 and 2004 was retrospectively reviewed. RESULTS Mean tumor size was 3.5 cm(2) (SD 7.5) and mean follow-up period was 4.9 years (SD 4.7). Relapse-free survival was 95.8 and 80.4% after 1 and 10 years. Two-year relapse-free survival was 94.8% for good, 88.9% for moderate and 85.7% for poor differentiated tumors. Five-year relapse-free survival was highest in cSCCs located around the eyes (100%) and cheeks (90.9%). CONCLUSION Superficial RTx is an effective alternative for cSCC if surgery is difficult due to localization or concomitant disease.
Collapse
Affiliation(s)
- Marjam J Barysch
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
4
|
Spieth K, Kaufmann R, Dummer R, Garbe C, Becker J, Hauschild A, Tilgen W, Ugurel S, Beyeler M, Bröcker E, Kaehler K, Pföhler C, Gille J, Leiter U, Schadendorf D. Temozolomide plus pegylated interferon alfa-2b as first-line treatment for stage IV melanoma: a multicenter phase II trial of the Dermatologic Cooperative Oncology Group (DeCOG). Ann Oncol 2008; 19:801-6. [DOI: 10.1093/annonc/mdm565] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
5
|
|
6
|
Beyeler M, Waldispuhl S, Strobel K, Joller-Jemelka HI, Burg G, Dummer R. Detection of Melanoma Relapse: First Comparative Analysis on Imaging Techniques versus S100 Protein. Dermatology 2006; 213:187-91. [PMID: 17033166 DOI: 10.1159/000095034] [Citation(s) in RCA: 27] [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: 02/23/2006] [Accepted: 03/17/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early detection of melanoma recurrence is essential for the patient's prognosis. The serum S100 level may be a useful tool to detect relapse early. OBJECTIVE To compare the efficacy of imaging techniques and serum S100 in the early detection of melanoma progression. This is the first report of a comparison of a serum marker with an imaging tool in the follow-up of melanoma patients. METHODS From 1992 to 2003, we screened 192 patients suffering from melanoma recurrence after a disease-free interval. Of those, 127 patients were identified whose S100 levels had been assessed parallel to imaging procedures. RESULTS Serum S100 was elevated in 37% of patients at the time of relapse. In stage III, 32% of the patients had elevated S100 levels whereas in case of progression to stage IV, 48% of the patients presented with increased S100. In 5.5% of patients, S100 was the first indicator of disease progression. Imaging procedures lead to detection of melanoma recurrence in 26.8%. CONCLUSION A rising level of serum S100 is a specific and sensitive marker of melanoma progression.
Collapse
Affiliation(s)
- Mirjam Beyeler
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
7
|
Abstract
Melanoma is the most important nonepithelial skin cancer. The diagnosis is usually made by clinical examination including dermatoscopy and histology. There are, however, variants of melanoma that miss the characteristic signs of pigmented lesions which are easily detectable when using the ABCD rule.
Collapse
Affiliation(s)
- Mirjam Beyeler
- Dermatologische Klinik, Universitätsspital Zürich, Switzerland
| | | |
Collapse
|
8
|
Abstract
Cutaneous T-cell lymphomas are a heterogeneous group of lymphoproliferative disorders, characterized by the accumulation of clonal lymphocytes in the skin. Skin-directed therapies are the preferred first-line modalities. There are interesting new developments in topical therapy using retinoids and gene-therapy products such as adenovirus- interferon (IFN)-gamma. Systemic treatment uses biologicals such as fusion molecules, monoclonal antibodies and immune response modifiers (IFNs and retinoids), and well-tolerated antiproliferative drugs such as methotrexate. Evidence-based treatment recommendation exists but is hampered by the lack of large multicenter randomized trials.
Collapse
Affiliation(s)
- Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
9
|
Kohler T, Beyeler M, Webster D, Müller R. Compartmental bone morphometry in the mouse femur: reproducibility and resolution dependence of microtomographic measurements. Calcif Tissue Int 2005; 77:281-90. [PMID: 16283571 DOI: 10.1007/s00223-005-0039-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [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] [Received: 07/15/2005] [Accepted: 07/22/2005] [Indexed: 11/29/2022]
Abstract
Microcomputed tomography (microCT) is widely used for nondestructive bone phenotyping in small animals, especially in the mouse. Here, we investigated the reproducibility and resolution dependence of microCT analysis of microstructural parameters in three different compartments in the mouse femur. Reproducibility was assessed with respect to precision error (PE%CV) and intraclass correlation coefficient (ICC). We examined 14 left femurs isolated postmortem from two strains of mice (seven per group). Measurements and analyses were repeated five times on different days. In a second step, analysis was repeated again five times for a single measurement. Resolution dependence was assessed by high-resolution measurements (10 microm) in one strain and subsequent image degrading. Reproducibility was better in full bone compartment and in cortical bone compartment in the diaphysis (PE%CV = 0.06-2.16%) than in trabecular compartment in the distal metaphysis (PE(%CV) = 0.59-5.24%). Nevertheless, ICC (0.92-1.00) showed a very high reliability of the assessed parameters in all regions, indicating very small variances within repeated measurements compared to the population variances. Morphometric indices computed from lower- and higher-resolution images displayed in general only weak dependence and were highly correlated with each other (R2 = 0.91-0.99). The results show that parameters in the full and cortical compartments were very reproducible, whereas precision in the trabecular compartment was somewhat lower. Nevertheless, all compartmental analysis methods were very robust, as shown by the high ICC values, demonstrating high suitability for application in inbred strains, where highest precision is needed due to small population variances.
Collapse
Affiliation(s)
- T Kohler
- Institute for Biomedical Engineering, Swiss Federal Institute of Technology (ETH) and University of Zürich, Moussonstrasse 18, 8044 Zürich, Switzerland
| | | | | | | |
Collapse
|
10
|
Beyeler M, Hafner J, Beinder E, Fauchêre JC, Stoeckli SJ, Fehr M, Dummer R. Special Considerations for Stage IV Melanoma During Pregnancy. ACTA ACUST UNITED AC 2005; 141:1077-9. [PMID: 16172302 DOI: 10.1001/archderm.141.9.1077] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mirjam Beyeler
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | |
Collapse
|
11
|
Urosevic M, Dummer R, Conrad C, Beyeler M, Laine E, Burg G, Gilliet M. Disease-Independent Skin Recruitment and Activation of Plasmacytoid Predendritic Cells Following Imiquimod Treatment. ACTA ACUST UNITED AC 2005; 97:1143-53. [PMID: 16077073 DOI: 10.1093/jnci/dji207] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [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: 01/06/2023]
Abstract
BACKGROUND Imiquimod, an immune response modifier that is used topically to treat different types of skin cancer, induces the production of proinflammatory cytokines that stimulate an antitumor immune response. We assessed characteristics of the imiquimod-induced immune activation in epithelial and lymphoproliferative neoplasias of human skin. We focused on plasmacytoid predendritic cells (PDCs), the primary producer of interferon alpha (IFN-alpha) after imiquimod activation in vitro. METHODS We used Affymetrix oligonucleotide arrays to compare gene expression profiles from tumors from 16 patients, 10 with superficial basal cell carcinomas (sBCCs), five with cutaneous T-cell lymphomas (CTCLs), and one with Bowen's disease, before and after topical imiquimod treatment. We used quantitative immunohistochemistry with PDC-specific antibodies against BDCA-2 and CD123 to characterize the PDC population before and after imiquimod treatment in these specimens. Activation status of PDCs from four sBCC patients was assessed by intracellular IFN-alpha staining and flow cytometry. RESULTS Expression of various IFN-alpha-inducible genes (e.g., CIG5, G1P2, OASL, IFIT1, STAT1, IFI35, OAS1, ISG20, MxA, and IRF7), the so-called IFN-alpha signature, was increased similarly in both sBCC and CTCL lesions after imiquimod treatment. PDCs were recruited and activated in both lesion types, and they produced IFN-alpha after imiquimod treatment in vivo (mean percentage of PDCs producing IFN-alpha = 14.5%, 95% confidence interval [CI] = 4.9% to 24%; range = 3.3%-27%, n = 4 lesions). Imiquimod induced similar immune activation patterns in all three diseases, and these patterns were associated with the number of PDCs recruited to the treatment site. Two imiquimod-treated sBCC patients who did not mount an inflammatory response to imiquimod and whose lesions lacked the IFN-alpha signature after treatment had fewer PDCs in treated lesions compared with other treated patients with such a response. CONCLUSIONS Imiquimod induces immune activation patterns that relate to the number of the PDCs recruited to the treatment site, thus supporting the role of PDC in responsiveness to imiquimod in humans.
Collapse
MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/therapeutic use
- Administration, Cutaneous
- Aminoquinolines/administration & dosage
- Aminoquinolines/immunology
- Aminoquinolines/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/immunology
- Antineoplastic Agents/therapeutic use
- Bowen's Disease/drug therapy
- Bowen's Disease/immunology
- Carcinoma, Basal Cell/drug therapy
- Carcinoma, Basal Cell/immunology
- Clinical Trials as Topic
- Dendritic Cells/drug effects
- Dendritic Cells/immunology
- Flow Cytometry
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Humans
- Imiquimod
- Immunohistochemistry
- Interferon-alpha/metabolism
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/immunology
- Microscopy, Confocal
- Plasma Cells/drug effects
- Plasma Cells/immunology
- Polymerase Chain Reaction
- Skin Neoplasms/drug therapy
- Skin Neoplasms/immunology
Collapse
Affiliation(s)
- Mirjana Urosevic
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
12
|
Beyeler M, Urosevic M, Pestalozzi B, Dummer R. Successful imiquimod treatment of multiple basal cell carcinomas after radiation therapy for Hodgkin's disease. Eur J Dermatol 2005; 15:52-5. [PMID: 15701596] [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] [Accepted: 06/20/2004] [Indexed: 05/01/2023]
Abstract
We present a case of a 55-year-old male patient who developed five basal cell carcinomas 23 years after radiation therapy of Hodgkin's disease. In 1980 he received radiation therapy twice. Due to relapses, he was treated with aggressive polychemotherapy and underwent autologous stem cell transplantation, which then led to complete remission. Until now he is in complete remission. However, multiple superficial basal cell carcinomas have developed on irradiation fields that have been successfully treated by imiquimod.
Collapse
Affiliation(s)
- Mirjam Beyeler
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich Switzerland
| | | | | | | |
Collapse
|
13
|
Abstract
Mesenchymal tumors are a heterogeneous group of tumors often arising in the skin and soft tissue. The tumors have been reclassified by the WHO in 2002. Benign mesenchymal tumors are about a hundred times more frequent than malignant mesenchymal tumors. Clinically, mesenchymal tumors often present as skin-colored nodes. Overall, elderly persons are more affected than younger individuals. The etiology is often unknown, sometimes there is an association with insults such as radiation, scars, or lymphedematous or venous stasis. Whereas some years ago a wide excision with a margin of 3-5 cm was performed for malignant variants, today micrographic surgery is preferred, as it can avoid mutilating procedures. Early detection and removal is critical since mesenchymal skin tumors often cannot be cured by radiation or chemotherapy.
Collapse
Affiliation(s)
- M Beyeler
- Department of Dermatology, University Hospital of Zurich, Switzerland
| | | | | | | | | |
Collapse
|
14
|
Abstract
Cutaneous lymphomas are uncommon. They must be distinguished from secondary skin manifestations of primary nodal lymphomas. Primary cutaneous lymphomas are divided into B-cell- and T-cell cutaneous lymphoma and commonly have good prognosis. Therapy is based on the stage of the disease. Since cure is not possible, the aim of treatment is to control the disease and reduce symptoms. A variety of new and promising therapeutic modalities have been introduced in recent years.
Collapse
MESH Headings
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Combined Modality Therapy
- Diagnosis, Differential
- Humans
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/pathology
- Neoplasm Staging
- Prognosis
- Skin/pathology
- Skin Neoplasms/classification
- Skin Neoplasms/diagnosis
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
Collapse
Affiliation(s)
- M Beyeler
- Dermatologische Klinik, Universitätsspital Zürich
| | | | | |
Collapse
|
15
|
Beyeler M, Dummer R. [Standard and experimental therapy of cutaneous T-cell lymphoma]. Hautarzt 2003; 54:1177-84. [PMID: 14634747 DOI: 10.1007/s00105-003-0630-2] [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
Cutaneous T-cell lymphoma represent a heterogeneous group of diseases characterized by skin invasion of monoclonal T-lymphocytes. These cutaneous T-cell lymphomas are divided into 3 groups based on clinical, histological and immunohistological characteristics: Indolent with a survival time of over 10 years, aggressive with a survival time less than 10 years and provisional (EORTC classification). Standard treatments such as PUVA, total skin electron beam, methotrexate, polychemotherapy regimens, retinoids and photopheresis have been used for years. Bexarotene is a newly registered drug. To achieve better response rates, several new drugs are being evaluated in clinical trails, including imiquimod, denileukon-diftitox, liposomal doxorubicin, adeno-interferon-gamma and various combination approaches.
Collapse
MESH Headings
- Adrenal Cortex Hormones/administration & dosage
- Adrenal Cortex Hormones/therapeutic use
- Aminoquinolines/therapeutic use
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/therapeutic use
- Anticarcinogenic Agents/administration & dosage
- Anticarcinogenic Agents/therapeutic use
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Alkylating/administration & dosage
- Antineoplastic Agents, Alkylating/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bexarotene
- Chlorambucil/administration & dosage
- Chlorambucil/therapeutic use
- Clinical Trials as Topic
- Cyclophosphamide/therapeutic use
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Humans
- Imiquimod
- Interferon alpha-2
- Interferon-alpha/administration & dosage
- Interferon-alpha/therapeutic use
- Lymphoma, T-Cell/classification
- Lymphoma, T-Cell/drug therapy
- Lymphoma, T-Cell/mortality
- Lymphoma, T-Cell/radiotherapy
- Lymphoma, T-Cell/therapy
- Methotrexate/administration & dosage
- Methotrexate/therapeutic use
- PUVA Therapy
- Photopheresis
- Prednisone/therapeutic use
- Radioisotope Teletherapy
- Radiotherapy Dosage
- Radiotherapy, High-Energy
- Recombinant Proteins
- Retinoids/administration & dosage
- Retinoids/therapeutic use
- Skin Neoplasms/classification
- Skin Neoplasms/drug therapy
- Skin Neoplasms/mortality
- Skin Neoplasms/radiotherapy
- Skin Neoplasms/therapy
- Tetrahydronaphthalenes/administration & dosage
- Tetrahydronaphthalenes/therapeutic use
- Vincristine/therapeutic use
Collapse
Affiliation(s)
- M Beyeler
- Dermatologische Klinik Universitätsspital Zürich, Zürich
| | | |
Collapse
|
16
|
Beyeler M, Dummer R. PEG-Intron: unsere Erfahrungen in der Behandlung des malignen Melanoms. Akt Dermatol 2003. [DOI: 10.1055/s-2003-822233] [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]
|
17
|
Beyeler M, Dummer R. Zytokintherapie bei malignen Hauterkrankungen und insbesondere beim malignen Melanom. Akt Dermatol 2003. [DOI: 10.1055/s-2003-41989] [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: 10/27/2022]
|
18
|
Dummer R, Beyeler M, Morcinek J, Burg G. [Cutaneous neoplasms]. Praxis (Bern 1994) 2003; 92:1470-1478. [PMID: 14526630 DOI: 10.1024/0369-8394.92.36.1470] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The skin is the organ most commonly affected by malignancies. Various cancers of the skin show a dramatic increase in incidence over the last decades. Epithelial skin tumors are most frequently, e.g., basal cell carcinoma and the squamous cell carcinoma with its precursors, the actinic keratoses. Melanoma, which is extremely difficult to treat in advanced tumor stages, is dreaded. Besides that, there are other epithelial malignant diseases, e.g. Morbus Bowen and adnexal tumors originating from the skin appendices. Mesenchymal malignant neoplasias such as Morbus Kaposi, angiosarcomas and other dermal sarcomas, are rare. Since the majority of malignant neoplasms is removable and curable by a simple surgical intervention, the knowledge of the different skin tumors is essential for non-dermatologist.
Collapse
MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/therapeutic use
- Aminoquinolines/administration & dosage
- Aminoquinolines/therapeutic use
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Biopsy
- Bowen's Disease/diagnosis
- Bowen's Disease/drug therapy
- Bowen's Disease/radiotherapy
- Bowen's Disease/surgery
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/drug therapy
- Carcinoma, Basal Cell/radiotherapy
- Carcinoma, Basal Cell/surgery
- Carcinoma, Merkel Cell/diagnosis
- Carcinoma, Merkel Cell/drug therapy
- Carcinoma, Merkel Cell/surgery
- Carcinoma, Merkel Cell/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Clinical Trials as Topic
- Combined Modality Therapy
- Cryotherapy
- Diagnosis, Differential
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/therapeutic use
- HIV Infections/complications
- Hemangiosarcoma/diagnosis
- Humans
- Imiquimod
- Immunotherapy
- Keratosis/diagnosis
- Keratosis/drug therapy
- Keratosis/surgery
- Lymph Node Excision
- Lymphatic Metastasis
- Lymphoma/classification
- Lymphoma/diagnosis
- Lymphoma/drug therapy
- Lymphoma/radiotherapy
- Lymphoma/surgery
- Male
- Melanoma/diagnosis
- Melanoma/drug therapy
- Melanoma/pathology
- Melanoma/surgery
- Neoplasm Recurrence, Local
- Photochemotherapy
- Randomized Controlled Trials as Topic
- Sarcoma, Kaposi/diagnosis
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/surgery
- Skin/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
- Skin Neoplasms/radiotherapy
- Skin Neoplasms/surgery
- Skin Neoplasms/therapy
- Time Factors
Collapse
Affiliation(s)
- R Dummer
- Dermatologische Klinik, UniversitätsSpital Zürich.
| | | | | | | |
Collapse
|
19
|
Häberle M, Beyeler M, Scheurer P, Hohl M. Day 2 Versus Day 5 Transfer With Equal Number of Embryos: A Controlled “Matched-Pair” Analysis. Fertil Steril 2000. [DOI: 10.1016/s0015-0282(00)01219-x] [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]
|
20
|
Reimmann C, Beyeler M, Latifi A, Winteler H, Foglino M, Lazdunski A, Haas D. The global activator GacA of Pseudomonas aeruginosa PAO positively controls the production of the autoinducer N-butyryl-homoserine lactone and the formation of the virulence factors pyocyanin, cyanide, and lipase. Mol Microbiol 1997; 24:309-19. [PMID: 9159518 DOI: 10.1046/j.1365-2958.1997.3291701.x] [Citation(s) in RCA: 335] [Impact Index Per Article: 12.4] [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: 02/04/2023]
Abstract
The global activator GacA, a highly conserved response regulator in Gram-negative bacteria, is required for the production of exoenzymes and secondary metabolites in Pseudomonas spp. The gacA gene of Pseudomonas aeruginosa PAO1 was isolated and its role in cell-density-dependent gene expression was characterized. Mutational inactivation of gacA resulted in delayed and reduced formation of the cell-density signal N-butyryl-L-homoserine lactone (BHL), of the cognate transcriptional activator RhIR (VsmR), and of the transcriptional activator LasR, which is known to positively regulate RhIR expression. Amplification of gacA on a multicopy plasmid caused precocious and enhanced production of BHL, RhIR and LasR. In parallel, the gacA gene dosage markedly influenced the BHL/RhIR-dependent formation of the cytotoxic compounds pyocyanin and cyanide and the exoenzyme lipase. However, the concentrations of another known cell-density signal of P. aeruginosa, N-oxododecanoyl-L-homoserine lactone, did not always match BHL concentrations. A model accounting for these observations places GacA function upstream of LasR and RhIR in the complex, cell-density-dependent signal-transduction pathway regulating several exoproducts and virulence factors of P. aeruginosa via BHL.
Collapse
Affiliation(s)
- C Reimmann
- Laboratoire de Biologie Microbienne, Université de Lausanne, Switzerland
| | | | | | | | | | | | | |
Collapse
|
21
|
Serino L, Reimmann C, Visca P, Beyeler M, Chiesa VD, Haas D. Biosynthesis of pyochelin and dihydroaeruginoic acid requires the iron-regulated pchDCBA operon in Pseudomonas aeruginosa. J Bacteriol 1997; 179:248-57. [PMID: 8982005 PMCID: PMC178686 DOI: 10.1128/jb.179.1.248-257.1997] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.4] [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: 02/03/2023] Open
Abstract
The high-affinity siderophore salicylate is an intermediate in the biosynthetic pathway of pyochelin, another siderophore and chelator of transition metal ions, in Pseudomonas aeruginosa. The 2.5-kb region upstream of the salicylate biosynthetic genes pchBA was sequenced and found to contain two additional, contiguous genes, pchD and pchC, having the same orientation. The deduced amino acid sequence of the 60-kDa PchD protein was similar to those of the EntE protein (2,3-dihydroxybenzoate-AMP ligase) of Escherichia coli and other adenylate-forming enzymes, suggesting that salicylate might be adenylated at the carboxyl group by PchD. The 28-kDa PchC protein showed similarities to thioesterases of prokaryotic and eukaryotic origin and might participate in the release of the product(s) formed from activated salicylate. One potential product, dihydroaeruginoate (Dha), was identified in culture supernatants of iron-limited P. aeruginosa cells. The antifungal antibiotic Dha is thought to arise from the reaction of salicylate with cysteine, followed by cyclization of cysteine. Inactivation of the chromosomal pchD gene by insertion of the transcription and translation stop element omega Sm/Sp abolished the production of Dha and pyochelin, implying that PchD-mediated activation of salicylate may be a common first step in the synthesis of both metabolites. Furthermore, the pchD::omega Sm/Sp mutation had a strong polar effect on the expression of the pchBA genes, i.e., on salicylate synthesis, indicating that the pchDCBA genes constitute a transcriptional unit. A full-length pchDCBA transcript of ca. 4.4 kb could be detected in iron-deprived, growing cells of P. aeruginosa. Transcription of pchD started at tandemly arranged promoters, which overlapped with two Fur boxes (binding sites for the ferric uptake regulator) and the promoter of the divergently transcribed pchR gene encoding an activator of pyochelin biosynthesis. This promoter arrangement allows tight iron-mediated repression of the pchDCBA operon.
Collapse
Affiliation(s)
- L Serino
- Laboratoire de Biologie Microbienne, Université de Lausanne, Switzerland
| | | | | | | | | | | |
Collapse
|
22
|
Serino L, Reimmann C, Baur H, Beyeler M, Visca P, Haas D. Structural genes for salicylate biosynthesis from chorismate in Pseudomonas aeruginosa. Mol Gen Genet 1995; 249:217-28. [PMID: 7500944 DOI: 10.1007/bf00290369] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Salicylate is a precursor of pyochelin in Pseudomonas aeruginosa and both compounds display siderophore activity. To elucidate the salicylate biosynthetic pathway, we have cloned and sequenced a chromosomal region of P. aeruginosa PAO1 containing two adjacent genes, designated pchB and pchA, which are necessary for salicylate formation. The pchA gene encodes a protein of 52 kDa with extensive similarity to the chorismate-utilizing enzymes isochorismate synthase, anthranilate synthase (component I) and p-aminobenzoate synthase (component I), whereas the 11 kDa protein encoded by pchB does not show significant similarity with other proteins. The pchB stop codon overlaps the presumed pchA start codon. Expression of the pchA gene in P. aeruginosa appears to depend on the transcription and translation of the upstream pchB gene. The pchBA genes are the first salicylate biosynthetic genes to be reported. Salicylate formation was demonstrated in an Escherichia coli entC mutant lacking isochorismate synthase when this strain expressed both the pchBA genes, but not when it expressed pchB alone. By contrast, an entB mutant of E. coli blocked in the conversion of isochorismate to 2,3-dihydro-2,3-dihydroxybenzoate formed salicylate when transformed with a pchB expression construct. Salicylate formation could also be demonstrated in vitro when chorismate was incubated with a crude extract of P. aeruginosa containing overproduced PchA and PchB proteins; salicylate and pyruvate were formed in equimolar amounts. Furthermore, salicylate-forming activity could be detected in extracts from a P. aeruginosa pyoverdin-negative mutant when grown under iron limitation, but not with iron excess. Our results are consistent with a pathway leading from chorismate to isochorismate and then to salicylate plus pyruvate, catalyzed consecutively by the iron-repressible PchA and PchB proteins in P. aeruginosa.
Collapse
Affiliation(s)
- L Serino
- Laboratoire de Biologie Microbienne, Université de Lausanne, Switzerland
| | | | | | | | | | | |
Collapse
|
23
|
Beyeler M. [Principles for angle measurement on models]. Dent Rev 1985:20-4. [PMID: 3912151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
24
|
|
25
|
|