[Analysis of the quality of life of patients with osteoid osteoma before and after radiofrequency ablation treatment]

BACKGROUND

The aim of this study was to investigate the effectiveness of the treatment of osteoid osteomas (OO) by radiofrequency ablation (RFA). In particular, the recurrence rate and the improvement in the quality of life as assessed by the reduction of pain intensity were evaluated.

METHODS

Retrospective analysis of 26 patients after RFA of an OO and prospective analysis of 14 patients using a self-developed quality of life questionnaire. The questionnaire, the electronic patient file and the histopathological findings were processed.

RESULTS

An average of 22 months passed between the first onset of complaints and the causative treatment by RFA. After RFA, there was a significant reduction in pain symptoms and thus an increase in the quality of life. These results confirm that RFA from OO is a safe and efficient treatment procedure.

DISCUSSION

In order to avoid long-term conservative treatment attempts and to reduce effects on the musculoskeletal system, a timely RFA of OO should be performed after diagnosis.

[Clinically relevant incidental cardiovascular findings in CT examinations]

BACKGROUND AND METHOD

Incidental cardiovascular findings are a frequent phenomenon in computed tomography (CT) examinations. As the result of a dedicated PubMed search this article gives a systemic overview of the current literature on the most important incidental cardiovascular findings, their prevalence and clinical relevance.

RESULTS

The majority of incidental cardiovascular findings are of only low clinical relevance; however, highly relevant incidental findings, such as aortic aneurysms, thromboses and thromboembolic events can also occasionally be found, especially in oncology patients.

CONCLUSION

The scans from every CT examination should also be investigated for incidental findings as they can be of decisive importance for the further clinical management of patients, depending on their clinical relevance.

Validating New Software for Semiautomated Liver Volumetry--Better than Manual Measurement?

PURPOSE

This prospective study compared a manual program for liver volumetry with semiautomated software. The hypothesis was that the semiautomated software would be faster, more accurate and less dependent on the evaluator's experience.

MATERIALS AND METHODS

Ten patients undergoing hemihepatectomy were included in this IRB approved study after written informed consent. All patients underwent a preoperative abdominal 3-phase CT scan, which was used for whole liver volumetry and volume prediction for the liver part to be resected. Two different types of software were used: 1) manual method: borders of the liver had to be defined per slice by the user; 2) semiautomated software: automatic identification of liver volume with manual assistance for definition of Couinaud segments. Measurements were done by six observers with different experience levels. Water displacement volumetry immediately after partial liver resection served as the gold standard. The resected part was examined with a CT scan after displacement volumetry.

RESULTS

Volumetry of the resected liver scan showed excellent correlation to water displacement volumetry (manual: ρ = 0.997; semiautomated software: ρ = 0.995). The difference between the predicted volume and the real volume was significantly smaller with the semiautomated software than with the manual method (33% vs. 57%, p = 0.002). The semiautomated software was almost four times faster for volumetry of the whole liver (manual: 6:59 ± 3:04 min; semiautomated: 1:47 ± 1:11 min).

CONCLUSION

Both methods for liver volumetry give an estimated liver volume close to the real one. The tested semiautomated software is faster, more accurate in predicting the volume of the resected liver part, gives more reproducible results and is less dependent on the user's experience.

KEY POINTS

Both tested types of software allow exact volumetry of resected liver parts. Preoperative prediction can be performed more accurately with the semiautomated software. The semiautomated software is nearly four times faster than the tested manual program and less dependent on the user's experience.

Hyperintense basilar artery on FLAIR MR imaging: diagnostic accuracy and clinical impact in patients with acute brain stem stroke

BACKGROUND AND PURPOSE

FLAIR-hyperintense vessels are known to be a sign of sluggish collateral blood flow in hemispheric vessel occlusion. Additionally, they seem to have a prognostic implication. The aim of the current study was to evaluate the hyperintense configuration of the basilar artery (FLAIR-hyperintense basilar artery) as a marker of basilar artery occlusion and as a predictor of patient outcome.

MATERIALS AND METHODS

We retrospectively identified 20 patients with basilar artery occlusion who initially underwent MR imaging with subsequent DSA. The diagnostic accuracy of the FLAIR-hyperintense basilar artery sign was tested by 4 independent readers in a case-control design, and the relation among FLAIR-hyperintense basilar artery and DWI posterior circulation-ASPECTS, patient outcome, and patient survival was evaluated. To grade the extent of the FLAIR-hyperintense basilar artery sign, we generated a score by counting the number of sections from the basilar tip to the foramen magnum in which a hyperintense signal in the vessel lumen was present multiplied by the section thickness.

RESULTS

The FLAIR-hyperintense basilar artery sign showed moderate sensitivity (65%-95%) but very good specificity (95%-100%) and accuracy (85%-93%) for the detection of basilar artery occlusion. Substantial or excellent inter-reader agreement was observed (Cohen κ, 0.64-0.85). The FLAIR-hyperintense basilar artery inversely correlated with the posterior circulation-ASPECTS (r = -0.67, P = .01). Higher FLAIR-hyperintense basilar artery scores were associated with patient death (28.3 ± 13.7 versus 13.4 ± 11.1, P < .05).

CONCLUSIONS

The FLAIR-hyperintense basilar artery sign proved to be a valuable marker of vessel occlusion and may substantially support the diagnosis of basilar artery occlusion. The established FLAIR-hyperintense basilar artery score may be helpful for the prediction of individual patient survival.

[Reduction of radiation exposure for patient and investigator in interventional radiography]

PURPOSE

In a retrospective analysis of vascular interventional procedures, relations between parameters of the examination and radiation exposure of patient and medical personnel are examined.

MATERIAL AND METHOD

1208 vascular interventional procedures are evaluated. Interventional procedures are divided into three groups: percutaneous transluminal angioplasty, implantation of a stent, thrombolysis.

RESULTS

Mean values of the radiation dose of patient and radiology personnel are reported for these examinations. The mean value of the radiation dose of the physician was 7 microSv (maximum 24 microSv), that of the patient 1548 cGy.cm2 (maximum 8485 cGy.cm2).

CONCLUSION

The quantity of X-rays to the patient may be lowered by using pulsed fluoroscopy and by reducing the number of radiographs. Reduction of the number of radiographs may be achieved by using the last-image hold and the road mapping mode. The operator's dose can be decreased by using additional radiation protection systems like a MAVIG-radiation protection wall. The radiation dose reduction was 61% for the physician and 17% for the patient.

Behaviour of the transgenic (mREN2)27 rat

The first model of genetically engineered hypertension, the transgenic rat TGR (mREN2)27, provides a unique opportunity to study the behavioural effects of an altered brain renin-angiotensin system. The TGR (mREN2)27 rats, characterised by fulminant hypertension, show differences in both the peripheral and central angiotensin systems. The behaviour of male transgenic TGR (mREN2)27 and male Sprague-Dawley rats were determined by 4 behavioural tests. While on the elevated X-maze the TGR (mREN2)27 rat showed a greater 'anxiogenic' profile (fewer open arm entries) than the control Sprague-Dawley rats, this 'anxiogenic' profile increased further during a second exposure to the elevated X-maze 24 h later. In comparison the behaviour of the male Sprague-Dawley rats was not different between the two exposures to the elevated X-maze. Locomotor activity did not differ between either the TGR (mREN2)27 or Sprague-Dawley rats when placed in a 1 m2 open-field for 10 min. A short period of fluid-deprivation (3 h) reversed the 'anxiogenic' profile of the TGR (mREN2)27 on the elevated X-maze. Administration of captopril (20 mg . kg-1 body weight) in the drinking water of the TGR (mREN2)27 rats and Sprague-Dawley rats reversed the anxiogenic profile of the TGR (mREN2)27 rat on the elevated X-maze but did not alter the behaviour of the Sprague-Dawley rats.

Neural and glial-mediated effects of growth factors acting via tyrosine kinase receptors on luteinizing hormone-releasing hormone neurons

It is becoming increasingly evident that the secretory activity of LHRH neurons is regulated not only by transsynaptic inputs but also by trophic molecules of glial and neuronal origin. The present experiments were undertaken to gain insights into the potential cell-cell mechanisms by which basic fibroblast growth factor (bFGF) and transforming growth factor-alpha (TGF alpha), two growth factors produced in the hypothalamus, may affect LHRH neuronal function. Northern blot analysis showed that the LHRH-producing cell line GT1-7 contains the messenger RNA (mRNA) encoding the type 1 fibroblast growth factor receptor (FGFR-1) but not that encoding the epidermal growth factor (EGF) receptors, which mediates the biological actions of both TGF alpha and EGF. Ligand-induced receptor phosphorylation experiments demonstrated that GT1-7 cells possess biologically active FGFR-1s but not EGF receptors. Exposure of the cells to bFGF resulted not only in FGFR-1 tyrosine phosphorylation, but also in tyrosine phosphorylation of phospholipase C gamma, one of the initial enzymes in the intracellular signaling cascade initiated by FGFR activation. GT1-7 cells proliferated in response to this activation. Despite the presence of biologically active receptors, bFGF did not significantly stimulate release of the mature LHRH decapeptide. Instead, bFGF increased the steady-state levels of the mRNA encoding the LHRH precursor processing endoprotease PC2, with a time course comparable to that of phorbol esters, suggesting that, as shown in the companion paper, the actions of the growth factor on LHRH neurons involve facilitation of the initial step in LHRH prohormone processing. The increase in PC2 gene expression was not accompanied by changes in LHRH mRNA levels. Unlike these direct actions of bFGF on GT-1 cells, TGF alpha appears to act indirectly via astroglial intermediacy. Exposure of GT1-7 cells to TGF alpha or EGF failed to affect several parameters of cellular activity including LHRH release, LHRH and PC2 mRNA levels, and cell proliferation. In contrast, astrocyte culture medium conditioned by treatment with TGF alpha led to sustained stimulation of LHRH release with no changes in LHRH gene expression and a transient increase in PC2 mRNA levels. Although no definitive evidence for the presence of FGFR-1 in normal LHRH neurons could be obtained by either double immunohistochemistry or double in situ hybridization procedures, fetal LHRH neurons in primary culture responded to bFGF with neurite outgrowth. Thus, normal LHRH neurons may have an FGFR-1 content too low for detection by regular histochemical procedures, and/or detectable expression of the receptor may be confined to a much earlier developmental stage. The mitogenic effect of bFGF on GT1-7 cells supports this possibility and suggests a role for FGF in the cell proliferation events that precede acquisition of the LHRH neuronal phenotype. It appears that once this phenotype is established, bFGF may promote the differentiation of LHRH neurons. The results also suggest that the secretory capacity of LHRH neurons develops under a dual trophic influence, one on peptide processing exerted directly by bFGF on early neurons, and another on LHRH release, exerted by TGF alpha via the intermediacy of astroglial cells.

[Urogynecologic follow-up after conservative therapy of stress incontinence with a vaginal cone (Femcon)]

The conservative treatment of women suffering from stress incontinence is very often highly successful. Vaginal cones (Femcon) are widely used for training the pelvic floor muscles. We investigated 60 women (mean age 50.7 years). After an exercise course with cones of 3 to 4 months, 75% of these patients reported good results with respect to pelvic floor function and stress incontinence. We found no differences between the parameters of cystometry and urethrocystometry at rest. The uroflow is also not affected. Objectively, we could only determine a statistically significant increase of the transmission ratio. This fact can be explained by the active contraction of the pelvic floor muscles, which are trained by means of the cones.

Combination of interferons and cytostatic drugs for treatment of advanced colorectal cancer

Three phase I/II trials were performed in patients with metastatic colorectal cancer using immunochemotherapy--a combination of recombinant interferon beta and gamma with low doses of cytostatic drugs. The third regimen, consisting of a cytostatic component containing 5-fluorouracil plus carboplatin plus mitomycin C besides the interferons, produced a high remission rate of 47%: 14/30 patients responded. The tolerability of this protocol was good and it could be administered on an out-patient basis.

[Anal manometric studies following 3d degree perineal tear]

This study shows clinical and manometric data of fecal continence following third degree tears in correlation to anamnestic findings. The results are discussed with reference to the literature.

[Relation of the static urethral pressure profile and symptoms of urinary urgency in the female]

In a retrospective study of 463 stationary urethral-pressure profiles the coherence between clinical relevant changes of the urethral pressure and bladder instability is discussed. It is shown, that clinical important pressure changes in the stationary urethral-pressure profile appear significantly more frequently in female patients with signs of bladder instability. The results and the definition of urethral-pressure changes are compared with the literature.

Preclinical and early clinical trial with mafosfamide as immune modulator

Low doses of cyclophosphamide (CPA) modulate immune responses and induce complete tumor regression and cures in mice. The mechanism of action is related to the development of a T-cell-dependent immune reaction. We started a trial with mafosfamide (MAF), the active metabolite of CPA and found that the response of Ehrlich ascites-tumor (EAT) cells in vivo to this compound is biphasic. The highest cure rate (70%) is obtained with a low i.p. dose of 7 mg/kg/d. Hematologic side effects were not observed. Arguments for an immune mechanism involved are that (1) mice treated with MAF showed a statistically significant increase in spleen weight compared with untreated controls, (2) after treatment large numbers of mononuclear cells appeared in the ascites, and (3) long-term surviving mice were resistant to further challenge with large inocula of EAT. We started a pilot trial in patients with metastasizing and advanced renal cell carcinoma - a disease which can be considered to be influenced by the immunologic response of the tumor host. The starting dose of MAF was 24 mg/m2/d administered i.v. Therapy was repeated at 14 days interval on an out-patient basis. Monitoring of mononuclear cells in the peripheral blood with monoclonal antibodies using a FACS IV were performed two times a week. There are eleven patients on study. Up to now, four out of them have been fully evaluated with respect to toxicity, immune modulation and tumor response. With respect to response to treatment, 2 patients had no change of disease, 1 patient had a mixed and 1 patient a partial response. No hematological or other toxicities could be observed. All patients showed an increase in monocytes/macrophages as well as NK-cells--clearly related to therapy.

[Personal experiences with conservative drug therapy of urgency symptoms in the female]

On the basis of clinical and urodynamic results the authors adopt a definite attitude to the treatment of the urgency syndrome in the woman with the anticholinergic drug propiverin hydrochloride (Mictonorm). The results show a satisfactory improvement in 42 of 68 women (= 62%), whereas 24 of 68 women (= 35%) reported a subjective improvement of the clinical symptoms. These results correspond with the data from literature. In 15 women with no satisfactory effect the beta 2-sympathicomimetic drug clenbuterol (Contraspasmin) was additionally applied. There was a satisfactory success under this medication in 11 of the 15 women (= 72%). The results are discussed with the references of the literature to the conservative therapy of the urgency syndrome.

[Treatment of urinary urgency symptoms in the female with the beta-2-sympathomimetic clenbuterol]

Aside from parasympatheticolytis, calcium antagonists, musculotropic relaxants and tricyclic antidepressants, beta 2-sympatheticomimetics are also used in the treatment of urgency. The beta 2-sympatheticomimetic Clenbuterol, which has relatively slight cardiological side effects, was administered per os to 30 women. Prior to and six weeks after the commencement of daily medication with 2 x 20 micrograms of Clenbuterol, the therapeutic effect of the drug was tested by means of a urogynecological examination (history, gynecological findings, cystometrography, urethrocystometrography, uroflowmetry and pretherapeutic urethrocystometrography). An improvement rate of 65% was found. The parameters of urethrocystometrography and uroflowmetry were not altered under medication with Clenbuterol. Cystometrographic parameters, on the other hand, improved (minimal desire to urinate, maximal desire to urinate, compliance). The results of this study are discussed with reference to the literature. For the beta 2-sympatheticomimetic Clenbuterol, a good level of efficacy can be established in women patients on whom parasympatheticolytics alone failed to have a satisfactory effect.

[Changes in the parameters of the urethral pressure profile by measuring the patient in supine and sitting position]

For testing the influence of the examination position on the parameters of the urethrocystometry 124 findings of urethrocystometry of 103 female patients were evaluated in 3 groups. In these cases slight alterations develop when changing between lying and sitting position, whereby in sitting position a greater differentiation of an existing component of stress incontinence becomes possible. On the basis of our examination findings and the references in literature it seems to be advisable to perform the urethrocystometry in the same session both in lying and in sitting position for further improvement of the indication for therapy.

[Urological investigation in women with stress incontinence prior and following anterior colporrhaphy and in control patients (author's transl)]

The pre-operative and post-operative findings in 56 patients with urinary stress incontinence are compared amongst each other and with the result of 24 continent control patients. The 56 patients were selected prospectively. The urethral closure pressure with stress and the stress quotient in urethral cystometry are significantly improved by the operations. The compliance as a cystometric criterium was significantly raised. The sizes of the angle in the urethrocystogram are at times significantly changed after operation. They are not lower than the values described in the literature. This shows good correlation with the results in the control groups, which have angles higher than those described in the literature. The time parameters of the uroflowmetry show prolongation after the anterior colporrhaphy. The times to the maximum, the waiting time, the urine flow time and the duration of micturition are longer. The mean volume of urine per second is not significantly changed. Our results are compared with other investigations. The findings in healthy continent women are considered to be possible parameters for a reference.

[Interpretation and meaning of urethrocystographic findings in the diagnosis of urinary incontinence in women]

In this study the author adopts a definite attitude to the diagnostic evidence of the urethrocystography in the urinary incontinence of the female. In these cases female patients were controlled before and after the stress incontinence operation as well as before and during the conservative treatment of the urge-urinary incontinence. As criteria for the evaluation the inclination angle of the urethra, the pubourethral angle and the posterior vesico-urethral angle were used. The final urethrocystographic findings as well as the parameters after the therapy were statistically treated and discussed with the results of literature.

[Comparison of preoperative and postoperative findings after stress incontinence surgery in women (author's transl)]

The authors attempt to assess success of surgery in 44 women with stress incontinence treated with colporrhaphia ant. et post. with/without vaginal hysterectomy, by evaluating preoperative and postoperative findings. Examination comprised, after detailed anamnesis, besides general gynaecological examination and examination of urine for pathological constituents, the following methods: simultaneous urethrocystometry, cystometry, urethrocystography, electromyography of the sphincter system, as well as uroflowmetry. It was found that despite subjectively reported success of operation there was often no direct correlation to the actual, objective findings. This underlines once again that assessment of the result of surgery is possible only via application of a wide range of diagnostic procedures postoperatively with the same methods. The results obtained are discussed with reference to reports published in medical literature.

[Urodynamic examination results for the determination of urge urinary incontinence in the woman]

Before the beginning of the treatment of incontinent females a clarification of the cause of the disease is in every case necessary, since a stress incontinence indicates quite another therapy than an urge-incontinence. In the present study the results of altogether 21 females are demonstrated, whose diseases were classified as urge-urine incontinence on the basis of the anamnestic data as well as the findings of the examination. The results are compared with the references of literature concerning the possibilities of the evidence of the individual investigation methods (cystometry, urethrocystometry, urethrocystography) as well as discussed with the results of an own control group of healthy women.

[Electromyographic investigations of the sphincter systems in the diagnosis of female urinary incontinence (author's transl)]

Electromyographic investigations of the sphincters of bladder and rectum allow reproduceable and objective signs of possible lesions of this region. That's why we use this method to identify preoperatively the pathogenesis of female urinary incontinence.