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Esmaeilzadeh M, Bronzlik P, Solmaz H, Polemikos M, Heissler HE, Raab P, Lanfermann H, Krauss JK. Reducing radiation exposure and costs: CT body scout views with an enhanced protocol versus conventional radiography after shunt surgery. Clin Neurol Neurosurg 2024; 240:108281. [PMID: 38604085 DOI: 10.1016/j.clineuro.2024.108281] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Ventriculoperitoneal shunt implantation has become standard treatment for cerebrospinal fluid diversion, besides endoscopic third ventriculostomy for certain indications. Postoperative X-ray radiography series of skull, chest and abdomen combined with cranial CT are obtained routinely in many institutions to document the shunt position and valve settings in adult patients. Measures to reduce postoperative radiation exposure are needed, however, there is only limited experience with such efforts. Here, we aim to compare routine postoperative cranial CT plus conventional radiography series (retrospective arm) with cranial CT and body scout views only (prospective arm) concerning both diagnostic quality and radiation exposure. PATIENTS AND METHODS After introduction of an enhanced CT imaging protocol, routine skull and abdomen radiography was no longer obtained after VP shunt surgery. The image studies of 25 patients with routine postoperative cranial CT and conventional radiography (retrospective arm of study) were then compared to 25 patients with postoperative cranial CT and CT body scout views (prospective arm of study). Patient demographics such as age, sex and primary diagnosis were collected. The image quality of conventional radiographic images and computed tomography scout views images were independently analyzed by one neurosurgeon and one neuroradiologist. RESULTS There were no differences in quality assessments according to three different factors determined by two independent investigators for both groups. There was a statistically significant difference, however, between the conventional radiography series group and the CT body scout view imaging group with regard to radiation exposure. The effective dose estimation calculation yielded a difference of 0.05 mSv (two-tailed t-test, p = 0.044) in favor of CT body scout view imaging. Furthermore, the new enhanced protocol resulted in a reduction of cost and the use of human resources. CONCLUSION CT body scout view imaging provides sufficient imaging quality to determine shunt positioning and valve settings. With regard to radiation exposure and costs, we suggest that conventional postoperative shunt series may be abandoned.
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Affiliation(s)
| | - Paul Bronzlik
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Hüseyin Solmaz
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Manolis Polemikos
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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2
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Hong B, Lalk M, Wiese B, Merten R, Heissler HE, Raab P, Hartmann C, Krauss JK. Primary and secondary gliosarcoma: differences in treatment and outcome. Br J Neurosurg 2024; 38:332-339. [PMID: 33538191 DOI: 10.1080/02688697.2021.1872773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/15/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There are only few studies comparing differences in the outcome of primary versus secondary gliosarcoma. This study aimed to review the outcome and survival of patients with primary or secondary gliosarcoma following surgical resection and adjuvant treatment. The data were also matched with data of patients with primary and secondary glioblastoma (GBM). PATIENTS AND METHODS Treatment histories of 10 patients with primary gliosarcoma and 10 patients with secondary gliosarcoma were analysed and compared. Additionally, data of 20 patients with primary and 20 patients with secondary GBM were analysed and compared. All patients underwent surgical resection of the tumour in our department. Follow-up data, progression-free survival (PFS), and median overall survival (mOS) were evaluated. RESULTS The median PFS in patients with primary gliosarcoma was significantly higher than in patients with secondary gliosarcoma (p = 0.037). The 6-month PFS rates were 80.0% in patients with primary and 30.0% in patients with secondary gliosarcoma. Upon recurrence, five patients with primary gliosarcoma and four patients with secondary gliosarcoma underwent repeat surgical resection. The mOS of patients with primary gliosarcoma was significantly higher than that of patients with secondary gliosarcoma (p = 0.031). The percentage of patients surviving at 1-year/2-year follow-up in primary gliosarcoma was 70%/20%, while it was only 10%/10% in secondary gliosarcoma. When PFS and mOS of primary gliosarcoma was compared to primary GBM, there were no statistically differences (p = 0.509; p = 0.435). The PFS and mOS of secondary gliosarcoma and secondary GBM were also comparable (p = 0.290 and p = 0.390). CONCLUSION Patients with primary gliosarcoma have a higher PFS and mOS compared to those with secondary gliosarcoma. In the case of tumour recurrence, patients with secondary gliosarcoma harbour an unfavourable prognosis with limited further options. The outcome of patients with primary or secondary gliosarcoma is comparable to that of patients with primary or secondary GBM.
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Affiliation(s)
- Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
- Department of Neurosurgery, Brandenburg Medical School, Helios Medical Center, Bad Saarow, Germany
| | - Michael Lalk
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Bettina Wiese
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Roland Merten
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Department for Neuropathology, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Eidmann A, Lüdemann M, Raab P, Rudert M. [Individualized surgical treatment of sarcomas of the extremities]. Chirurgie (Heidelb) 2024; 95:288-293. [PMID: 38360873 DOI: 10.1007/s00104-024-02049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
Sarcomas of the extremities are rare entities, the treatment of which requires special expertise. Even if the treatment of patients is always interdisciplinary, the surgical R0 resection is the key point of each curatively intended treatment. In addition to resection in sano, the aim is to preserve the extremities and function, so that defect reconstruction after resection plays a decisive role. Due to the heterogeneity of tumors as well as their localization and extent, reconstruction is always an individually adapted treatment. Modular tumor endoprostheses are often used in this context, which can be constructed according to the size of the defect. The transplantation of autologous or allogeneic bone is also frequently used alone or as an additive procedure. Patient-specific (mega)prostheses are used particularly for pelvic tumors. Defect reconstruction using scaffold-based procedures from the field of tissue engineering is being tested as a promising procedure for the future. This article provides an overview of the treatment principles for sarcomas of the extremities and their individual reconstruction options.
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Affiliation(s)
- Annette Eidmann
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland.
| | - Martin Lüdemann
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
| | - Peter Raab
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
| | - Maximilian Rudert
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
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4
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Munawar U, Zhou X, Prommersberger S, Nerreter S, Vogt C, Steinhardt MJ, Truger M, Mersi J, Teufel E, Han S, Haertle L, Banholzer N, Eiring P, Danhof S, Navarro-Aguadero MA, Fernandez-Martin A, Ortiz-Ruiz A, Barrio S, Gallardo M, Valeri A, Castellano E, Raab P, Rudert M, Haferlach C, Sauer M, Hudecek M, Martinez-Lopez J, Waldschmidt J, Einsele H, Rasche L, Kortüm KM. Impaired FADD/BID signaling mediates cross-resistance to immunotherapy in Multiple Myeloma. Commun Biol 2023; 6:1299. [PMID: 38129580 PMCID: PMC10739907 DOI: 10.1038/s42003-023-05683-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
The treatment landscape in multiple myeloma (MM) is shifting from genotoxic drugs to immunotherapies. Monoclonal antibodies, immunoconjugates, T-cell engaging antibodies and CART cells have been incorporated into routine treatment algorithms, resulting in improved response rates. Nevertheless, patients continue to relapse and the underlying mechanisms of resistance remain poorly understood. While Impaired death receptor signaling has been reported to mediate resistance to CART in acute lymphoblastic leukemia, this mechanism yet remains to be elucidated in context of novel immunotherapies for MM. Here, we describe impaired death receptor signaling as a novel mechanism of resistance to T-cell mediated immunotherapies in MM. This resistance seems exclusive to novel immunotherapies while sensitivity to conventional anti-tumor therapies being preserved in vitro. As a proof of concept, we present a confirmatory clinical case indicating that the FADD/BID axis is required for meaningful responses to novel immunotherapies thus we report impaired death receptor signaling as a novel resistance mechanism to T-cell mediated immunotherapy in MM.
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Affiliation(s)
- Umair Munawar
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Xiang Zhou
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | | | - Silvia Nerreter
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Cornelia Vogt
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | | | | | - Julia Mersi
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Eva Teufel
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Seungbin Han
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Larissa Haertle
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
- Department of Hematology, Hospital Universitario 12 de Octubre, CNIO, Complutense University Madrid, Madrid, Spain
| | - Nicole Banholzer
- Department of Biotechnology and Biophysics, University of Würzburg, Würzburg, Germany
| | - Patrick Eiring
- Department of Biotechnology and Biophysics, University of Würzburg, Würzburg, Germany
| | - Sophia Danhof
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | | | - Adrian Fernandez-Martin
- Department of Hematology, Hospital Universitario 12 de Octubre, CNIO, Complutense University Madrid, Madrid, Spain
| | - Alejandra Ortiz-Ruiz
- Department of Hematology, Hospital Universitario 12 de Octubre, CNIO, Complutense University Madrid, Madrid, Spain
| | - Santiago Barrio
- Department of Hematology, Hospital Universitario 12 de Octubre, CNIO, Complutense University Madrid, Madrid, Spain
- Altum Sequencing Co., Madrid, Spain
| | - Miguel Gallardo
- Department of Hematology, Hospital Universitario 12 de Octubre, CNIO, Complutense University Madrid, Madrid, Spain
| | - Antonio Valeri
- Department of Hematology, Hospital Universitario 12 de Octubre, CNIO, Complutense University Madrid, Madrid, Spain
| | - Eva Castellano
- Department of Hematology, Hospital Universitario 12 de Octubre, CNIO, Complutense University Madrid, Madrid, Spain
| | - Peter Raab
- Department of Orthopaedic Surgery, König Ludwig Haus, University of Würzburg, Würzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König Ludwig Haus, University of Würzburg, Würzburg, Germany
| | | | - Markus Sauer
- Department of Hematology, Hospital Universitario 12 de Octubre, CNIO, Complutense University Madrid, Madrid, Spain
| | - Michael Hudecek
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - J Martinez-Lopez
- Department of Biotechnology and Biophysics, University of Würzburg, Würzburg, Germany
- Altum Sequencing Co., Madrid, Spain
| | - Johannes Waldschmidt
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - K Martin Kortüm
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany.
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Kümpers FMLM, Sinke C, Schippert C, Kollewe K, Körner S, Raab P, Meyer B, Maschke S, Karst M, Sperling C, Dalkeranidis E, Krüger THC. Clinical characterisation of women with persistent genital arousal disorder: the iPGAD-study. Sci Rep 2023; 13:22814. [PMID: 38129493 PMCID: PMC10739833 DOI: 10.1038/s41598-023-48790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
Persistent Genital Arousal Disorder (PGAD) is a rare condition-mostly in women-where patients perceive prolonged genital arousal without any sexual desire or stimulation. Etiopathological considerations reach from peripheral to central issues over local disturbance of the pudendal nerve to neuropathy, psychosocial, and pharmacological theories. Since well controlled clinical studies about PGAD in conjunction with a mental and somatic health status are missing, this study is a detailed clinical investigation of PGAD patients compared to healthy controls. 26 women who fulfilled diagnostic criteria for PGAD were compared to 26 age matched healthy controls. Investigations included comparison of vegetative, gynaecological and sexual history, psychiatric features as well as a (neuro-)radiological, neurophysiological and gynaecological examination. Moreover, a detailed clinical characterisation of PGAD symptoms was performed. PGAD symptoms were mostly characterised as tingling or prickling and were permanently present. In over 80%, PGAD symptoms were located in the clitoris. Almost 70% reported radiations to other regions of the body. Most frequent trigger factors were tight clothes, mental stress, driving a car/bus/bicycle and sexual intercourse. Relieving factors were mainly distraction, relaxation, physical exercise, masturbation and swimming. In group comparisons, PGAD presented with significant higher rates of sexual dysfunctions, spontaneous orgasms, swelling of the genitals, extraordinary lubrication as well as higher rates in depression, agoraphobia, generalized anxiety disorder and lifetime panic disorder. Significantly more PGAD patients were diagnosed with restless legs symptoms. In contrast childhood traumatization, somatization disorder, suicidality, gynaecological as well as neurophysiological examination of the pudendal nerve were not different between the groups. MRI of the brain, pelvis and spinal cord was unsuspicious and incidental findings - including Tarlov cysts or pelvic venous congestion - were equally distributed among the groups. In summary, our study provides a careful characterization of women with PGAD highlighting a serious mental burden, most probably as a consequence of PGAD. With the current set of clinical investigations there was no evidence of a clear causal relationship to a specific clinical finding as it has been previously discussed. Future studies and additional techniques will have to further explore where and how in the peripheral or central nervous systems PGAD develops.
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Affiliation(s)
- Franziska M L M Kümpers
- Divison of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christopher Sinke
- Divison of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Cordula Schippert
- Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany
| | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Sonja Körner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Bernhard Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Sabine Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Matthias Karst
- Department of Anaesthesiology, Pain Clinic, Hannover Medical School, Hannover, Germany
| | - Christian Sperling
- Divison of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Eleni Dalkeranidis
- Divison of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tillmann H C Krüger
- Divison of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
- Center for Systems Neuroscience, Hannover, Germany.
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6
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Donnerstag F, Werlein C, Götz F, Fares OA, Raab P, Iglesias EC, Lanfermann H, Wattjes MP, Jonigk D. Adhesion of vessel wall to stentriever during combined technique for mechanical thrombectomy in acute ischemic stroke: A histomorphological study. Interv Neuroradiol 2023:15910199231216764. [PMID: 38056004 DOI: 10.1177/15910199231216764] [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: 12/08/2023] Open
Abstract
PURPOSE Detection of vessel wall tissue in thrombus material in patients with ischemic stroke is judged as vascular injury. So far, several studies investigated components of the free clots after mechanical thrombectomy. The aim of this retrospective study was to investigate the involvement and role of the stentriever in vessel wall injury by analysis of the composition of adherent tissue to the stentriever during combined aspiration thrombectomy with stentriever. METHODS Stentriever with adherent tissue and free clots in aspiration samples from patients undergoing mechanical thrombectomy (aspiration plus stentriever) were separately assessed for the occurrence of parts of vascular tissue together with clinical and interventional data as well as clinical outcome data. Specimens were analyzed histomorphologically and immunohistochemically. Findings, focused on parts of vessel wall were reported together with clinical data. RESULTS Specimens from 21 identified patients were available. Parts of the vessel wall were detected in 7 out 21 (33%) samples. All specimens revealed fresh thrombus material without signs of organization or atheromatous tissue. In 90% of patients mTICI was greater than 2b without signs of secondary vessel injury. No vascular tissue was found in free clots of the aspiration samples. CONCLUSION The examination of adherent tissue to the stentriever instead of the examination of free clots may affect the number of detected parts of vessel wall. Further studies in combination with vessel wall imaging may elucidate the origin of remnants of vessel wall.
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Affiliation(s)
- Frank Donnerstag
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Friedrich Götz
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Omar Abu Fares
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Heinrich Lanfermann
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mike P Wattjes
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Institute for Pathology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) of the German Center for Lung Research (DZL), Hannover, Germany
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7
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Eidmann A, Kamawal Y, Luedemann M, Raab P, Rudert M, Stratos I. Demographics and Etiology for Lower Extremity Amputations-Experiences of an University Orthopaedic Center in Germany. Medicina (Kaunas) 2023; 59:medicina59020200. [PMID: 36837401 PMCID: PMC9965459 DOI: 10.3390/medicina59020200] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023]
Abstract
Background and Objectives: Currently, the worldwide incidence of major amputations in the general population is decreasing whereas the incidence of minor amputations is increasing. The purpose of our study was to analyze whether this trend is reflected among orthopaedic patients treated with lower extremity amputation in our orthopaedic university institution. Materials and Methods: We conducted a single-center retrospective study and included patients referred to our orthopaedic department for lower extremity amputation (LEA) between January 2007 and December 2019. Acquired data were the year of amputation, age, sex, level of amputation and cause of amputation. T test and Chi² test were performed to compare age and amputation rates between males and females; significance was defined as p < 0.05. Linear regression and multivariate logistic regression models were used to test time trends and to calculate probabilities for LEA. Results: A total of 114 amputations of the lower extremity were performed, of which 60.5% were major amputations. The number of major amputations increased over time with a rate of 0.6 amputation/year. Men were significantly more often affected by LEA than women. Age of LEA for men was significantly below the age of LEA for women (men: 54.8 ± 2.8 years, women: 64.9 ± 3.2 years, p = 0.021). Main causes leading to LEA were tumors (28.9%) and implant-associated complications (25.4%). Implant-associated complications and age raised the probability for major amputation, whereas malformation, angiopathies and infections were more likely to cause a minor amputation. Conclusions: Among patients in our orthopaedic institution, etiology of amputations of the lower extremity is multifactorial and differs from other surgical specialties. The number of major amputations has increased continuously over the past years. Age and sex, as well as diagnosis, influence the type and level of amputation.
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8
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Haertle L, Barrio S, Munawar U, Han S, Zhou X, Simicek M, Vogt C, Truger M, Fernandez RA, Steinhardt M, Weingart J, Snaurova R, Nerreter S, Teufel E, Garitano-Trojaola A, Da Viá M, Ruiz-Heredia Y, Rosenwald A, Bolli N, Hajek R, Raab P, Raab MS, Weinhold N, Haferlach C, Haaf T, Martinez-Lopez J, Einsele H, Rasche L, Kortüm KM. Single-Nucleotide Variants and Epimutations Induce Proteasome Inhibitor Resistance in Multiple Myeloma. Clin Cancer Res 2023; 29:279-288. [PMID: 36282272 DOI: 10.1158/1078-0432.ccr-22-1161] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/08/2022] [Accepted: 10/21/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Proteasome inhibitors (PI) are the backbone of various treatment regimens in multiple myeloma. We recently described the first in-patient point mutations affecting the 20S subunit PSMB5 underlying PI resistance. Notably, in vivo, the incidence of mutations in PSMB5 and other proteasome encoding genes is too low to explain the development of resistance in most of the affected patients. Thus, additional genetic and epigenetic alterations need to be explored. EXPERIMENTAL DESIGN We performed DNA methylation profiling by Deep Bisulfite Sequencing in PSMB5, PSMC2, PSMC5, PSMC6, PSMD1, and PSMD5, a subset of proteasome subunits that have hitherto been associated with PI resistance, recruited from our own previous research, the literature, or a meta-analysis on the frequency of somatic mutations. Methylation was followed up on gene expression level and by dual-luciferase reporter assay. The KMS11 cell line served as a model to functionally test the impact of demethylating agents. RESULTS We identified PSMD5 promoter hypermethylation and subsequent epigenetic gene silencing in 24% of PI refractory patients. Hypermethylation correlated with decreased expression and the regulatory impact of this region was functionally confirmed. In contrast, patients with newly diagnosed multiple myeloma, along with peripheral blood mononuclear cells and CD138+ plasma cells from healthy donors, generally show unmethylated profiles. CONCLUSIONS Under the selective pressure of PI treatment, multiple myeloma cells acquire methylation of the PSMD5 promoter silencing the PSMD5 gene expression. PSMD5 acts as a key orchestrator of proteasome assembly and its downregulation was described to increase the cell's proteolytic capacity. PSMD5 hypermethylation, therefore, represents a novel mechanism of PI tolerance in multiple myeloma.
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Affiliation(s)
- Larissa Haertle
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Department of Hematology, Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Complutense University Madrid, Madrid, Spain
| | - Santiago Barrio
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Department of Hematology, Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Complutense University Madrid, Madrid, Spain.,Altum Sequencing Co., Madrid, Spain
| | - Umair Munawar
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Seungbin Han
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Xiang Zhou
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Michal Simicek
- Haematology, Ostrava University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Cornelia Vogt
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | - Rafael Alonso Fernandez
- Department of Hematology, Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Complutense University Madrid, Madrid, Spain
| | | | - Julia Weingart
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Renata Snaurova
- Haematology, Ostrava University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Silvia Nerreter
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Eva Teufel
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | - Matteo Da Viá
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yanira Ruiz-Heredia
- Department of Hematology, Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Complutense University Madrid, Madrid, Spain.,Altum Sequencing Co., Madrid, Spain
| | | | - Niccolò Bolli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roman Hajek
- Haematology, Ostrava University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Peter Raab
- Department of Orthopaedic Surgery, König Ludwig Haus, University of Würzburg, Würzburg, Germany
| | - Marc S Raab
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Niels Weinhold
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas Haaf
- Institute of Human Genetics, Julius Maximilians University Würzburg, Würzburg, Germany
| | - Joaquin Martinez-Lopez
- Department of Hematology, Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Complutense University Madrid, Madrid, Spain.,Altum Sequencing Co., Madrid, Spain
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - K Martin Kortüm
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
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Hounchonou FH, Runge J, Ganser A, Hartmann C, Raab P, Krauss JK. Stereotactic biopsy of a brain lesion caused by hormographiella aspergillata. Surg Neurol Int 2022; 13:596. [PMID: 36761261 PMCID: PMC9899447 DOI: 10.25259/sni_576_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/30/2022] [Indexed: 01/01/2023] Open
Abstract
Background Invasive fungal infections are an increasing problem in immunosuppressed patients. In patients with the central nervous system involvement, there is a high case fatality rate. There is a very limited experience with infections caused by Hormographiella aspergillata (HA) in such cases and most often diagnosis is only confirmed postmortem. Case Description We report the case of a 53-year-old woman with acute myeloid leukemia. After primary therapy with daunorubicin, cytarabine, and gemtuzumab ozogamicin, the patient developed pneumonia and later neurological symptoms caused by multiple gadolinium-enhancing brain lesions in magnetic resonance imaging (MRI). Stereotactic biopsy of a frontal precentral lesion was performed and revealed HA infection. The patient died in the further course secondary to cardiopulmonary problems. Conclusion Stereotactic biopsy is a safe way to establish the diagnosis of unclear lesions such as HA infection. We recommend to perform stereotactic biopsy early in immunocompromised patients with brain lesions to guide further treatment.
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Affiliation(s)
- F. H. Hounchonou
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.,Corresponding author: F. H. Hounchonou, Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
| | - Joachim Runge
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Arnold Ganser
- Department of Haematology, Haemostaseology, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Department of Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Joachim K. Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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10
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Lüdemann M, Sulastyanto S, Raab P, Schoen C, Rudert M. Periprosthetic joint infection: Comparison of automated multiplex-PCR Unyvero i60 ITI cartridge system with bacterial culture and real-time PCR. Technol Health Care 2022; 30:1005-1015. [DOI: 10.3233/thc-213248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: In the past, various efforts have been made to investigate diagnostic tools for periprosthetic-joint-infection (PJI). It is little-known about the diagnostic utility of polymerase-chain-reaction (PCR) in this context, especially concerning the role of multiplex-PCR assays comparing with conventional tissue culture. OBJECTIVE: Evaluation of an automated-multiplex-PCR cartridge system for patients with suspicion of PJI in comparison with conventional microbiological culture and 16S-rDNA-PCR. METHODS: On suspicion of PJI synovial fluid specimen were taken preoperatively or periprosthetic tissue was collected intraoperatively. Microbiological analysis included conventional culture, 16S-rDNA-PCR and automated-multiplex-PCR (Unyvero-i60-ITI®). The European-Bone-and-Joint-Infection-Society (EBJIS) criteria were used for PJI diagnosis. Positive and negative percent agreement was calculated. Total percentage agreement and Cohen’s kappa coefficient were calculated. Sensitivity, specificity and positive predictive value of conventional culture, 16S-rDNA-PCR and multiplex-PCR were calculated. Ten specimens of proved PJI were used as control group. RESULTS: Fifty specimen were suitable for culture. 14 (28%) were classified as PJI, 36 (72%) were aseptic. Coagulase-negative staphylococci was the most frequent detected pathogen. Concordance-rate between mPCR and culture results was 75.6% with a Cohen’s kappa of 0.28. Concordance-rate between mPCR and 16S-rDNA was 82.9%, Cohen’s kappa was 0.13. Concordance analysis between culture results and 16S-rDNA lead to a concordance-rate of 88.9%. Cohen’s kappa was calculated with 0.6. With regard to the microbiological culture as reference, sensitivity of the mPCR was 0.33 and specificity was 0.91. Sensitivity and specificity of the 16S-rDNA-PCR was 0.55 and 0.97. The positive predictive value was 0.57 for the mPCR and 0.83 for the 16S-rDNA-PCR. CONCLUSIONS: Due to fair agreement between mPCR and conventional microbiological culture, the tested multiplex-PCR could be an additional instrument for the detection of PJI but is not superior over the conventional culture.
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Affiliation(s)
- Martin Lüdemann
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Saskia Sulastyanto
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Peter Raab
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schoen
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
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11
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Raab P, Ropele S, Bültmann E, Salcher R, Lanfermann H, Wattjes MP. Analysis of deep grey nuclei susceptibility in early childhood: a quantitative susceptibility mapping and R2* study at 3 Tesla. Neuroradiology 2021; 64:1021-1031. [PMID: 34787698 PMCID: PMC9005446 DOI: 10.1007/s00234-021-02846-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/24/2021] [Indexed: 11/18/2022]
Abstract
Purpose Aging is the most significant determinant for brain iron accumulation in the deep grey matter. Data on brain iron evolution during brain maturation in early childhood are limited. The purpose of this study was to investigate age-related iron deposition in the deep grey matter in children using quantitative susceptibility (QSM) and R2* mapping. Methods We evaluated brain MRI scans of 74 children (age 6–154 months, mean 40 months). A multi-echo gradient-echo sequence obtained at 3 Tesla was used for the QSM and R2* calculation. Susceptibility of the pallidum, head of caudate nucleus, and putamen was correlated with age and compared between sexes. Results Susceptibility changes in all three nuclei correlated with age (correlation coefficients for QSM/R2*: globus pallidus 0.955/0.882, caudate nucleus 0.76/0.65, and putamen 0.643/0.611). During the first 2 years, the R2* values increased more rapidly than the QSM values, indicating a combined effect of iron deposition and myelination, followed by a likely dominating effect of iron deposition. There was no significant gender difference. Conclusion QSM and R2* can monitor myelin maturation processes and iron accumulation in the deep grey nuclei of the brain in early life and may be a promising tool for the detection of deviations of this normal process. Susceptibility in the deep nuclei is almost similar early after birth and increases more quickly in the pallidum. The combined use of QSM and R2* analysis is beneficial.
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Affiliation(s)
- Peter Raab
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Stefan Ropele
- Clinical Department of Neurology, Medical University of Graz, Graz, Austria
| | - Eva Bültmann
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rolf Salcher
- Clinic for Laryngology, Rhinology and Otology, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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12
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Weidauer S, Raab P, Hattingen E. Diagnostic approach in multiple sclerosis with MRI: an update. Clin Imaging 2021; 78:276-285. [PMID: 34174655 DOI: 10.1016/j.clinimag.2021.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/06/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
Although neurological examination and medical history are the first and most important steps towards the diagnosis of multiple sclerosis (MS), MRI has taken a prominent role in the diagnostic workflow especially since the implementation of McDonald criteria. However, before applying those on MR imaging features, other diseases must be excluded and MS should be favoured as the most likely diagnosis. For the prognosis the earliest possible and correct diagnosis of MS is crucial, since increasingly effective disease modifying therapies are available for the different forms of clinical manifestation and progression. This review deals with the significance of MRI in the diagnostic workup of MS with special regard to daily clinical practice. The recommended MRI protocols for baseline and follow-up examinations are summarized and typical MS lesion patterns ("green flags") in four defined CNS compartments are introduced. Pivotal is the recognition of neurological aspects as well as imaging findings atypical for MS ("red flags"). In addition, routinely assessment of Aquaporin-4-IgG antibodies specific for neuromyelitis optica spectrum disorders (NMOSD) as well as the knowledge of associated lesion patterns on MRI is recommended. Mistaken identity of such lesions with MS and consecutive implementation of disease modifying therapies for MS can worsen the course of NMOSD.
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Affiliation(s)
- Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe University, Seckbacher Landstraße 65, 60389 Frankfurt am Main, Germany.
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl Neuberg Straße 1, 30625 Hannover, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
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13
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Brensing KA, Raab P, Heidkamp P, Pöge U. MO732HD-PATIENTS WITH ATRIAL FIBRILLATION TREATED ADEQUATELY AND SAFE WITH DOAC BY INDIVIDUAL DOSING USING ROUTINE ANTI-XA DRUG-EFFECT MONITORING: LONG-TERM CLINICAL PRACTICE DATA. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab097.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Hemodialysis (HD) patients (Pts) with nonvalvular atrial fibrillation (AF) on anti-vitamin-K oral anticoagulation (VK-OAC) are at high risk for cardio-vascular events, major bleeding and rapid vascular/valvular calcification. Thus, current VK-OAC is debated since prospective studies are missing, but all direct oral anticoagulation drugs (DOACs) are not labeled for ESRD. We studied the clinical feasibility of long-term DOAC treatment in HD-pts using individual dosing by regular anticoagulant drug-effect monitoring.
Method
We analysed 9 HD-patients with AF (median age 77 yrs; range=R: 59-86; 7 Male) on DOAC therapy for at least 6 months (n=1 rivaroxaban=Riva, n=8 apixaban=Apix) initiated by cardiologist with patients informed consent with lower dose as in CKD-4 under regular (weekly) anti-Xa drug-effect monitoring (prior HD) using available routine laboratory test validated for low-molecular heparin: Target trough range (12-24h after drug) was 0.1-1.0 U/ml (=prophylactic to therapeutic anti-Xa levels; test range <0.1, >1.6 U/ml). Bleeding caused drug stop/reduction until anti-Xa control.
Results
Median study time was 14 months (R: 6-24). We analysed 310 anti-Xa levels on Apix and 83 levels on Riva. After dose adjustment finally 2 Apix-Pts (22%) received full CKD-4 dose (35 mg/week=wk) and 7 patients (78%) had median dose of 10 mg/wk (10-27 mg; 6x Apix) or 40 mg/wk Riva, i.e. 29% and 38% of usual CKD-4 dose. Two Pts with higher dose had clinical reasons: short-bowl-syndrome (less resorption) or high grade (3-4) left atrial sludge (therapeutic goal). Overall, median anti-Xa level was 0.47 U/ml (R: <0.1->1.6) and 80% were in center-accepted targets: 0.1-1.2 U/ml. Lower dose Pts had higher in-target-rate (83%) than the 2 high dose Pts (70%) by more exceeding the upper limit.
During our study we saw no cerebral/systemic thrombo-embolic event or major bleeding, but 2 pts had epistaxis (need out-patient intervention), 1x persistent macrohematuria (need catheterization) and 3 pts. had multiple subcutaneous hematoma, none needed event-related transfusion. We saw two non-cardiovascular deaths (22%; 2/9): 1x pneumonic sepsis, 1x advanced cancer.
Conclusion
We provide new clinical feasibility data on long-term DOACs therapy in HD-patients. Since DOACs are not labelled for ESRD we recommend strict indication plus regular anti-Xa drug-effect monitoring for adequate individual dosing. Our data support initial doses as for CKD-4 but applied only on HD-free days (4x/wk; =57% of usual) and adjustment in steady-state (1-2 wks): final individual doses were increased up to 100% in some patients, but mostly were reduced to 30-40% of usual CKD-4 doses. Overall, this individual dosing approach for DOACs provided adequate anti-Xa levels to prevent thrombo-embolic as well as major bleeding events. This initial data need to be confirmed in larger studies to improve evidence-based management of HD-patients with nonvalvular AF.
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Affiliation(s)
| | - Peter Raab
- Nierenzentrum Bonn, Dialysis Unit, Bonn, Germany
| | | | - Uwe Pöge
- Nierenzentrum Bonn, Dialysis Unit, Bonn, Germany
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14
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Avallone E, Raab P, Lenarz T, Willenborg KM. Temporal bone primary inverted papilloma - Case Report and review of the literature. Laryngorhinootologie 2021; 100:99-103. [PMID: 33525009 DOI: 10.1055/a-1286-5059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Inverted papilloma of middle ear is an extremely rare lesion of the respiratory epithelium that normally occurs in the nasal cavity and paranasal sinuses. So far less than 17 cases were described in literature. A 45-year-old patient was admitted in our Department with hearing loss, otorrhea and pulsing tinnitus on the right ear. The clinical examination showed a granulation tissue on the right eardrum. No tumor formation was seen in the nasal cavity. The MRI showed a tissue formation in the tympanic cavity with an extension in the middle cranial fossa. A mastoidectomy with antrotomy and duraplasty was performed. The histological diagnosis was inverted papilloma of the middle ear. In a second step occurred an eradication of the tumor with a subtotal petrosectomy. The etiology of the inverted papilloma of the middle ear is unknown. Our case is so far the 18nd case described.Our experience has shown that the eradication of the tumor with a subtotal petrosectomy resulted as reasonable procedure. A long-term follow-up is suggested in order to detect possible recurrence or malignant transformation.
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Affiliation(s)
- Emilio Avallone
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Germany
| | - Peter Raab
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Germany
| | - Thomas Lenarz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Germany
| | - Kerstin Marion Willenborg
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Germany
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15
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Donnerstag F, Götz F, Dadak M, Raab P, Iglesias EC, Werlein C, Lanfermann H, Jonigk D. Interventional stroke treatment - Is it also safe for arteries? Looking at thrombectomy wall damage through clot histology. Interv Neuroradiol 2020; 27:404-410. [PMID: 33269973 DOI: 10.1177/1591019920976673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to investigate whether morphological evidence of intracranial vascular injury can be found in the occluding thrombi of patients with ischemic stroke. METHODS From 2015 until 2018 specimens of thrombi from patients with large vessel occlusion treated either by stent-assisted aspiration thrombectomy (TE) or by aspiration thrombectomy were prospectively collected. Thrombus specimens were formalin-fixed, paraffin-embedded and stained. Architectural features, presence of parts of vessel wall or atheromatous material, organisation of the thrombi, technique and number of thrombectomy manoeuvers were evaluated. RESULTS Thrombus specimens from 302 patients were analyzed. 238 (80%) patients were treated with stent-assisted aspiration TE and 64 (20%) patients with aspiration TE only. 286 (95%) had fresh thrombi, 14 (4.6%) showed initial/complete thrombus organisation and multi-staged thrombi were found in 2 (<1%) patients. In 8 patients (2.6%) we found atypical thrombus content after a time interval longer 6 hours after onset and final thrombectomy manoeuvre: 4 with atheromatous material and 4 with parts of a vessel wall. In 1 patient with parts of vessel wall angiographically a dissection was detected. No parts of the vessel wall were found after sole aspiration thrombectomy. CONCLUSIONS The overall risk of arterial vessel wall injury aspiration thrombectomy was low in our study. Aspiration thrombectomy and the procedure related with a retrieving device together with an ischemia time longer than 6 hours may increase the risk of vessel injury through the thrombectomy procedure. Further investigations are necessary to elucidate the influence of the mentioned aspects.
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Affiliation(s)
- Frank Donnerstag
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Friedrich Götz
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mete Dadak
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany.,Clinic of Diagnostic and Interventional Radiology and Neuroradiology, St. Vincenz-Hospital, Paderborn, Germany
| | - Peter Raab
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Enrico Calvino Iglesias
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) of the German Center for Lung Research (DZL), Hannover, Germany
| | | | - Heinrich Lanfermann
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) of the German Center for Lung Research (DZL), Hannover, Germany.,Institute for Pathology, Hannover Medical School, Hannover, Germany
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16
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Basenach E, Förster A, Raab P, Alzein S, Schmidt G, Krauss J, Heidenreich F, Hartmann C, Auber B, Wiese B, Weber R. INNV-06. TREATMENT RESPONSE TO BEVACIZUMAB OVER TWO YEARS IN A PATIENT WITH GENETICALLY PROVEN SOMATIC NEUROFIBROMATOSIS TYPE 2 MOSAICISM. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Neurofibromatosis type 2 (NF2) is a tumor predisposition syndrome characterized by the development of schwannomas, especially bilateral vestibular schwannomas (VS), and meningiomas. Heterozygous pathogenic variants in the NF2 gene are known to cause NF2, whereby somatic mosaicism is present in ~25% of simplex patients. In schwannomatosis, a disorder phenotypically similar to NF2, heterozygous SMARCB1 or LZTR1 variants may be causative. Recently, bevacizumab has shown efficiency as therapy for VS in some NF2 patients. We report on a thirty-three-year-old patient with bilateral VS, fourteen additional schwannomas and one intracranial meningioma. Next generation sequencing using a cancer gene panel and Sanger sequencing of LZTR1 on blood and oral mucosa DNA revealed no pathogenic variants in NF2, SMARCB1 or LZTR1. Sanger sequencing on DNA from three schwannomas identified the known NF2 nonsense variant c.784C >T;p.(R262*) (NM_000268.3, GRCh37/hg19) in all tumors, leading to the diagnosis of somatic NF2 mosaicism. Because of hearing impairment and tumor progression the patient underwent an off-label therapy with 5mg/kg bevacizumab. To determine treatment response, we evaluated MRI scans from five pre-therapeutic and two therapeutic years as well as pure-tone audiometry. After 25 months of treatment, (i) the pure-tone average improved by 11.2 dB indicating a hearing benefit, (ii) four of seven non-vestibular schwannomas showed a volume reduction of ≥ 20%, (iii) the volume of three of seven schwannomas stabilized, and (iv) the growth rate of the meningioma decreased. In conclusion, in a patient with somatic NF2 mosaicism, an off-label therapy with bevacizumab was efficient with respect to hearing improvement and tumor shrinkage in over half of non-vestibular schwannomas over a period of two years.
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Affiliation(s)
- Elena Basenach
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Alisa Förster
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Gunnar Schmidt
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Joachim Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Fedor Heidenreich
- Department of Neurology, Henriettenstift, Diakovere Krankenhaus gGmbH, Hannover, Germany
| | - Christian Hartmann
- Division of Neuropathology, Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Bettina Wiese
- Department of Neurology, Henriettenstift, Diakovere Krankenhaus gGmbH, Hannover, Germany
| | - Ruthild Weber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
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17
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Pflugrad H, Tryc AB, Goldbecker A, Barg-Hock H, Strassburg C, Klempnauer J, Lanfermann H, Weissenborn K, Raab P. Cerebral metabolite alterations in patients with posttransplant encephalopathy after liver transplantation. PLoS One 2019; 14:e0221626. [PMID: 31442276 PMCID: PMC6707570 DOI: 10.1371/journal.pone.0221626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022] Open
Abstract
Background In the first weeks after liver transplantation about 30% of the patients develop a posttransplant encephalopathy. A posttransplant encephalopathy comprises metabolic-toxic caused symptoms such as disorientation, confusion, hallucinations, cognitive dysfunction and seizures. We hypothesize that alterations of cerebral metabolites before liver transplantation predispose posttransplant encephalopathy development after liver transplantation. Methods 31 patients with chronic liver disease underwent magnetic resonance spectroscopy (MRS) before liver transplantation to assess glutamine/glutamate (Glx), myo-Inositol (mI), choline (Cho), creatine/phosphocreatine- and N-acetyl-aspartate/N-acetyl-aspartate-glutamate concentrations in the thalamus, lentiform nucleus and white matter. Of these, 14 patients underwent MRS additionally after liver transplantation. Furthermore, 15 patients received MRS only after liver transplantation. Patients’ data were compared to 20 healthy age adjusted controls. Results Patients showed significantly increased Glx and decreased mI and Cho concentrations compared to controls before liver transplantation (p≤0.01). The MRS values before liver transplantation of patients with posttransplant encephalopathy showed no significant difference compared to patients without posttransplant encephalopathy. Patients after liver transplantation showed increased Glx concentrations (p≤0.01) compared to controls, however, patients with and without posttransplant encephalopathy did not differ. Patients with posttransplant encephalopathy who underwent MRS before and after liver transplantation showed a significant mI increase in all three brain regions (p<0.04) and Glx decrease in the lentiform nucleus after liver transplantation (p = 0.04) while patients without posttransplant encephalopathy only showed a mI increase in the thalamus (p = 0.04). Conclusion Patients with and without posttransplant encephalopathy showed no significant difference in cerebral metabolites before liver transplantation. However, the paired sub-analysis indicates that the extent of cerebral metabolite alterations in patients with liver cirrhosis might be critical for the development of posttransplant encephalopathy after liver transplantation.
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Affiliation(s)
- Henning Pflugrad
- Department of Neurology, Hannover Medical School, Hannover, Germany
- Integrated Research and Treatment Centre Transplantation, Hannover, Germany
- * E-mail:
| | - Anita Blanka Tryc
- Department of Neurology, Hannover Medical School, Hannover, Germany
- Integrated Research and Treatment Centre Transplantation, Hannover, Germany
| | - Annemarie Goldbecker
- Department of Neurology, Hannover Medical School, Hannover, Germany
- Integrated Research and Treatment Centre Transplantation, Hannover, Germany
| | - Hannelore Barg-Hock
- Clinic for Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Strassburg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- Integrated Research and Treatment Centre Transplantation, Hannover, Germany
- Clinic for Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Hannover, Germany
- Integrated Research and Treatment Centre Transplantation, Hannover, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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18
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Bönig L, Möhn N, Ahlbrecht J, Wurster U, Raab P, Puppe W, Sühs KW, Stangel M, Skripuletz T, Schwenkenbecher P. Leptomeningeal Metastasis: The Role of Cerebrospinal Fluid Diagnostics. Front Neurol 2019; 10:839. [PMID: 31481919 PMCID: PMC6710356 DOI: 10.3389/fneur.2019.00839] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/19/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Metastatic spread into the cerebrospinal fluid (CSF) represents a severe complication of malignant disease with poor prognosis. Although early diagnosis is crucial, broad spectrums of clinical manifestations, and pitfalls of magnetic resonance imaging (MRI) and CSF diagnostics can be challenging. Data are limited how CSF parameters and MRI findings relate to each other in patients with leptomeningeal metastasis. Methods: Patients with malignant cells in CSF cytology examination diagnosed between 1998 and 2016 at the Department of Neurology in the Hannover Medical School were included in this study. Clinical records, MRI findings and CSF parameters were retrospectively analyzed. Results: One hundred thirteen patients with leptomeningeal metastasis were identified. Seventy-six patients (67%) suffered from a solid malignancy while a hematological malignancy was found in 37 patients (33%). Cerebral signs and symptoms were most frequently found (78% in solid vs. 49% in hematological malignancies) followed by cranial nerve impairment (26% in solid vs. 46% in hematological malignancies) and spinal symptoms (26% in solid vs. 27% in hematological malignancies). In patients with malignant cells in CSF MRI detected signs of leptomeningeal metastasis in 62% of patients with solid and in only 33% of patients with hematological malignancies. Investigations of standard CSF parameters revealed a normal CSF cell count in 21% of patients with solid malignancies and in 8% of patients with hematological malignancies. Blood-CSF-barrier dysfunction was found in most patients (80% in solid vs. 92% in hematological malignancies). Elevated CSF lactate levels occurred in 68% of patients in solid and in 48% of patients with hematological malignancies. A high number of patients (30% in solid vs. 26% in hematological malignancies) exhibited oligoclonal bands in CSF. Significant correlations between the presence of leptomeningeal enhancement demonstrated by MRI and CSF parameters (cell count, lactate levels, and CSF/Serum albumin quotient) were not found in both malignancy groups. Conclusion: CSF examination is helpful to detect leptomeningeal metastasis since the diagnosis can be challenging especially when MRI is negative. CSF cytological investigation is mandatory whenever leptomeningeal metastasis is suspected, even when CSF cell count is normal.
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Affiliation(s)
- Lena Bönig
- Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hanover, Germany
| | - Nora Möhn
- Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hanover, Germany
| | - Jonas Ahlbrecht
- Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hanover, Germany
| | - Ulrich Wurster
- Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hanover, Germany
| | - Peter Raab
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Wolfram Puppe
- Department of Virology, Hannover Medical School, Hanover, Germany
| | - Kurt-Wolfram Sühs
- Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hanover, Germany
| | - Martin Stangel
- Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hanover, Germany
| | - Thomas Skripuletz
- Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hanover, Germany
| | - Philipp Schwenkenbecher
- Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hanover, Germany
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19
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Papathanassiou S, Koch T, Suhling MC, Lenarz T, Durisin M, Stolle SRO, Raab P. Computed Tomography Versus Dacryocystography for the Evaluation of the Nasolacrimal Duct-A Study With 72 Patients. Laryngoscope Investig Otolaryngol 2019; 4:393-398. [PMID: 31453347 PMCID: PMC6703110 DOI: 10.1002/lio2.293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives In patients with epiphora, imaging of the nasolacrimal duct is essential not only for differential diagnosis, but also for preoperative planning. Advances in imaging technology and introduction of cone beam computed tomography (CB‐CT) enable the combination of contrast agent‐based imaging with a three dimensional tomography with low radiation exposure. However, the value of CT/CB‐CT as an alternative to conventional dynamic dacryocystography (DCG) has not been evaluated yet. Study Design Retrospective study. Methods Conventional DCG was performed preoperatively in 72 consecutive patients treated for epiphora between 01/2013 and 04/2015 in our department. CB‐CT or conventional CT was performed afterward with the contrast media still in place. Three separate experts (two radiologists and one otorhinolaryngologist) analyzed the radiographic images without any information about the respective clinical or surgical findings. The presence of further findings in the CT/CB‐CT (eg, septal deviation, sinusitis) that were not detected in DCG and the overall visibility of the lacrimal duct system in both modalities were evaluated. Results Good delineations of bone, soft tissue, and contrast agent in the lacrimal system were achieved with both methods. No side effects were noted. Beside the pathology of the lacrimal duct, CT/CB‐CT scans enabled the additional diagnosis of pathologies in the nose and the sinus system in 65.7% of the patients. Accordance in the identified level of obstruction between the two modalities was achieved in 71.4% of the patients. Conclusion Thus, CT/CB‐CT should be used in conjunction with contrast agent to reliably identify the level of obstruction as preoperative standard and can be used as diagnostic tool in addition to or even instead of conventional DCG. Level of Evidence 4
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Affiliation(s)
- Serafim Papathanassiou
- Department of Otorhinolaryngology, Head and Neck Surgery Hannover Medical School Hannover Germany.,Radiologie im Silberturm St. Gallen Switzerland
| | | | - Marie Charlot Suhling
- Department of Otorhinolaryngology, Head and Neck Surgery Hannover Medical School Hannover Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery Hannover Medical School Hannover Germany
| | - Martin Durisin
- Department of Otorhinolaryngology, Head and Neck Surgery Hannover Medical School Hannover Germany
| | - Stefan R O Stolle
- Department of Otorhinolaryngology, Head and Neck Surgery Hannover Medical School Hannover Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology Hannover Medical School Hannover Germany
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20
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Krey L, Raab P, Sherzay R, Berding G, Stoll M, Stangel M, Wegner F. Severe Progressive Multifocal Leukoencephalopathy (PML) and Spontaneous Immune Reconstitution Inflammatory Syndrome (IRIS) in an Immunocompetent Patient. Front Immunol 2019; 10:1188. [PMID: 31191548 PMCID: PMC6546850 DOI: 10.3389/fimmu.2019.01188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/10/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection with JC-virus (JCV), a papova-virus, affecting mostly oligodendrocytes and the white matter of the central nervous system. Progressive Multifocal Leukoencephalopathy (PML) almost exclusively occurs in immunocompromised patients based on different underlying conditions of severe cellular immunodeficiency such as HIV/AIDS, secondary to neoplastic and autoimmune diseases, or during immunosuppressive therapy. Case presentation: We present the case of an otherwise healthy and immunocompetent patient without immunosuppressive therapy who was admitted with hemianopsia to the right side, sensory aphasia and changes of behavior. Magnet resonance imaging (MRI) and laboratory testing confirmed the diagnosis of PML, although functional tests did not show any evidence for cellular immunodeficiency. Extensive immunological tests did not reveal an apparent immunodeficiency. During symptomatic therapy the patient developed seizures which were assumed to be caused by a spontaneous immune reconstitution inflammatory syndrome (IRIS) demonstrated by MRI. We added a high dose of intravenous corticosteroids to the antiepileptic treatment and seizures ended shortly thereafter. However, the impairments of vision, behavior and language persisted. Conclusions: Our case report highlights that an apparently immunocompetent patient can develop PML and IRIS spontaneously. Therefore, MRI should be applied immediately whenever a rapid progression of PML symptoms occurs as treatment of IRIS with corticosteroids can result in a marked clinical improvement.
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Affiliation(s)
- Lea Krey
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Peter Raab
- Hannover Medical School, Institute of Neuroradiology, Hanover, Germany
| | - Romilda Sherzay
- Department of Nuclear Medicine, Hannover Medical School, Hanover, Germany
| | - Georg Berding
- Department of Nuclear Medicine, Hannover Medical School, Hanover, Germany
| | - Matthias Stoll
- Clinic for Immunology and Rheumatology, Unit for Infectious Diseases, Hannover Medical School, Hanover, Germany
| | - Martin Stangel
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hanover, Germany
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21
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Abstract
Intravascular B‑cell lymphomas (IVL) are rare neoplasms that can manifest at any age (mean age ~62-63 years). About half of the cases are associated with Epstein-Barr virus. The most common sites of manifestation are the brain, skin, and bone marrow. The diagnosis is difficult due to unspecific clinical presentation and laboratory changes. FACS (fluorescence-activated cell sorting) and clonality analysis from peripheral blood and radiological findings are often not diagnostic. The most sensitive and most specific diagnostic method is the histopathological and immunohistochemical evaluation of a tissue biopsy. Because of the rarity of this disease, little is known about therapy and prognosis, whereby therapy is mainly similar to non-IVL lymphomas. The prognosis is poor; median survival after diagnosis is approximately one year.
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Affiliation(s)
- L Abraham
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - P Raab
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Hussein
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
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22
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Worthmann H, Li N, Martens-Lobenhoffer J, Dirks M, Schuppner R, Lichtinghagen R, Kielstein JT, Raab P, Lanfermann H, Bode-Böger SM, Weissenborn K. Dimethylarginines in patients with intracerebral hemorrhage: association with outcome, hematoma enlargement, and edema. J Neuroinflammation 2017; 14:247. [PMID: 29237474 PMCID: PMC5729507 DOI: 10.1186/s12974-017-1016-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/28/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Asymmetric dimethylarginine (ADMA)--the most potent endogenous NO-synthase inhibitor, has been regarded as mediator of endothelial dysfunction and oxidative stress. Considering experimental data, levels of ADMA and its structural isomer symmetric dimethylarginine (SDMA) might be elevated after intracerebral hemorrhage (ICH) and associated with clinical outcome and secondary brain injury. METHODS Blood samples from 20 patients with acute ICH were taken at ≤ 24 h and 3 and 7 days after the event. Nine patients had favorable (modified Rankin Scale (mRS) at 90 days 0-2) outcome, and 11 patients unfavorable outcome (mRS 3-6). Patients' serum ADMA, SDMA, and L-arginine levels were determined by high-performance liquid chromatography-tandem mass spectrometry. Levels were compared to those of 30 control subjects without ICH. For further analysis, patients were grouped according to outcome, hematoma and perihematomal edema volumes, occurrence of hematoma enlargement, and cytotoxic edema as measured by computed tomography and serial magnetic resonance imaging. RESULTS Levels of ADMA--but not SDMA and L-arginine--were elevated in ICH patients compared to controls (binary logistic regression analysis: ADMA ≤ 24 h, p = 0.003; 3 days p = 0.005; 7 days p = 0.004). If patients were grouped according to outcome, dimethylarginines were increased in patients with unfavorable outcome. The binary logistic regression analysis confirmed an association of SDMA levels ≤ 24 h (p = 0.048) and at 3 days (p = 0.028) with unfavorable outcome. ADMA ≤ 24 h was increased in patients with hematoma enlargement (p = 0.003), while SDMA ≤ 24 h was increased in patients with large hematoma (p = 0.029) and perihematomal edema volume (p = 0.023). CONCLUSIONS Our data demonstrate an association between dimethylarginines and outcome of ICH. However, further studies are needed to confirm this relationship and elucidate the mechanisms behind.
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Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany.
| | - Na Li
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jens Martens-Lobenhoffer
- Department of Clinical Pharmacology, Otto-von-Guericke-University of Magdeburg, University Hospital, Magdeburg, Germany
| | - Meike Dirks
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Medical Clinic V, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Stefanie M Bode-Böger
- Department of Clinical Pharmacology, Otto-von-Guericke-University of Magdeburg, University Hospital, Magdeburg, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
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23
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Beyer U, Brand F, Martens H, Weder J, Christians A, Elyan N, Hentschel B, Westphal M, Schackert G, Pietsch T, Hong B, Krauss JK, Samii A, Raab P, Das A, Dumitru CA, Sandalcioglu IE, Hakenberg OW, Erbersdobler A, Lehmann U, Reifenberger G, Weller M, Reijns MAM, Preller M, Wiese B, Hartmann C, Weber RG. Rare ADAR and RNASEH2B variants and a type I interferon signature in glioma and prostate carcinoma risk and tumorigenesis. Acta Neuropathol 2017; 134:905-922. [PMID: 29030706 DOI: 10.1007/s00401-017-1774-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/22/2022]
Abstract
In search of novel germline alterations predisposing to tumors, in particular to gliomas, we studied a family with two brothers affected by anaplastic gliomas, and their father and paternal great-uncle diagnosed with prostate carcinoma. In this family, whole-exome sequencing yielded rare, simultaneously heterozygous variants in the Aicardi-Goutières syndrome (AGS) genes ADAR and RNASEH2B co-segregating with the tumor phenotype. AGS is a genetically induced inflammatory disease particularly of the brain, which has not been associated with a consistently increased cancer risk to date. By targeted sequencing, we identified novel ADAR and RNASEH2B variants, and a 3- to 17-fold frequency increase of the AGS mutations ADAR,c.577C>G;p.(P193A) and RNASEH2B,c.529G>A;p.(A177T) in the germline of familial glioma patients as well as in test and validation cohorts of glioblastomas and prostate carcinomas versus ethnicity-matched controls, whereby rare RNASEH2B variants were significantly more frequent in familial glioma patients. Tumors with ADAR or RNASEH2B variants recapitulated features of AGS, such as calcification and increased type I interferon expression. Patients carrying ADAR or RNASEH2B variants showed upregulation of interferon-stimulated gene (ISG) transcripts in peripheral blood as seen in AGS. An increased ISG expression was also induced by ADAR and RNASEH2B variants in tumor cells and was blocked by the JAK inhibitor Ruxolitinib. Our data implicate rare variants in the AGS genes ADAR and RNASEH2B and a type I interferon signature in glioma and prostate carcinoma risk and tumorigenesis, consistent with a genetic basis underlying inflammation-driven malignant transformation in glioma and prostate carcinoma development.
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24
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Kamawal Y, Raab P, Rudert M, Konrads C. [Targeted injections can relieve pain]. MMW Fortschr Med 2017; 159:58-62. [PMID: 29124580 DOI: 10.1007/s15006-017-0280-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Yama Kamawal
- Orthopädische Universitätsklinik König-Ludwig-Haus, Brettreichstr. 11, D-97074, Würzburg, Deutschland.
| | - Peter Raab
- Orthopädische Universitätsklinik König-Ludwig-Haus, Brettreichstr. 11, D-97074, Würzburg, Deutschland
| | - Maximilian Rudert
- Orthopädische Universitätsklinik König-Ludwig-Haus, Brettreichstr. 11, D-97074, Würzburg, Deutschland
| | - Christian Konrads
- Orthopädische Universitätsklinik König-Ludwig-Haus, Brettreichstr. 11, D-97074, Würzburg, Deutschland
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25
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Wattjes M, Raab P. Zerebrale und spinale Bildgebung der Multiplen Sklerose: ein Update. Akt Neurol 2017. [DOI: 10.1055/s-0043-118215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie Magnetresonanztomografie spielt in der Diagnostik der Multiplen Sklerose (MS) eine entscheidende Rolle und wurde deshalb innerhalb der MS-Diagnosekriterien verankert. Insbesondere für den Ausschluss wichtiger Differenzialdiagnosen werden immer neue MRT-Marker etabliert, wie beispielsweise das sogenannte „central vein sign“. Neben der Diagnostik hat die MRT in der MS-Verlaufsbeobachtung, und hierbei insbesondere bei der Pharmakovigilanz, eine zunehmende klinische Relevanz erlangt. Dies beinhaltet nicht nur die Erfassung der Behandlungseffektivität, sondern auch die Prädiktion des Behandlungserfolges und das Sicherheitsmonitoring. Quantitative MRT-Methoden sowie der Einsatz der (Ultra-)Hochfeld-MRT bieten uns in zunehmendem Maße die Möglichkeit, die MS-Pathologie insbesondere in auf dem konventionellen MRT-Bild normal erscheinendem Gewebe zu erfassen und zu quantifizieren. Dennoch wird die Standardisierung dieser Techniken für die MS-Diagnostik und Verlaufsbeobachtung zu den großen Herausforderungen in der Zukunft zählen, um damit diese vielversprechenden Methoden in die klinische Routine zu implementieren und zu etablieren.
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Affiliation(s)
- Mike Wattjes
- Dept. of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Peter Raab
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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26
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Raab P, Sedlacek L, Buchholz S, Stolle S, Lanfermann H. Imaging Patterns of Rhino-Orbital-Cerebral Mucormycosis in Immunocompromised Patients : When to Suspect Complicated Mucormycosis. Clin Neuroradiol 2017; 27:469-475. [PMID: 29026931 DOI: 10.1007/s00062-017-0629-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/13/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to describe radiological imaging findings of a complicated sinusitis, which should raise the suspicion of rhino-orbital-cerebral mucormycosis as being the underlying cause. METHODS In this retrospective analysis, we describe the cases and imaging findings of 8 patients with proven mucormycosis. These patients presented mostly with new facial or orbital swelling and were referred for imaging to our institution. Magnetic resonance imaging and computed tomography images were classified as abnormal or normal with respect to orbital, paranasal and cerebral signal results. Special emphasis was placed on the distribution of the signal abnormalities regarding involvement of the skull base and the cavernous sinus. RESULTS Out of a pool of 43 patients with colonization or proven Mucorales infection at different sites of the body, we identified 8 patients with infiltration of the midface and skull base. Unexpectedly seven out of the eight patients with abnormal findings of the paranasal sinuses and the adjacent tissues showed no bony sinus wall destruction. Of the eight patients seven showed inflammatory changes involving the infratemporal fossa and facial/periorbital tissues, three of the eight patients suffered from fungal invasion of the cavernous sinus and the carotid artery and one of the eight patients had a local infection of the hard palate only. CONCLUSION Imaging findings of inflammatory tissue infiltration adjacent to the paranasal sinuses with possible extension into the pterygopalatine fossa, infratemporal fossa and orbit or the cavernous sinus should raise the suspicion of a mucormycosis, especially in immunocompromised patients.
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Affiliation(s)
- Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefanie Buchholz
- Praxis Dr. Buchholz, Goslarsche Str. 14, 38304, Wolfenbüttel, Germany
| | - Stefan Stolle
- Department of ENT, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - H Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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27
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Hatipoglu Majernik G, Hermann EJ, Hartmann C, Raab P, Krauss JK. Severe Subarachnoid Hemorrhage Due to Fusiform Lateral Anterior (A1) Artery Perforator Aneurysm with "Spontaneous Resolution". World Neurosurg 2017; 109:179-181. [PMID: 28987841 DOI: 10.1016/j.wneu.2017.09.191] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/19/2022]
Abstract
Perforating arteries are thin and long vessels which originate from the main cerebral arteries. Subarachnoidal hemorrhage from a perforator aneurysm is rare. Here, we report on a 70-year-old woman who presented with severe subarachnoid hemorrhage from a fusiform lateral anterior (A1) artery perforator aneurysm. Unexpectedly, digital subtraction angiography was non-diagnostic. MR imaging, however, demonstrated occlusion of the aneurysm secondary to thrombosis. Surgery was performed to remove the associated hematoma, and histopathological examination verified intraaneurysmal thrombosis.
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Affiliation(s)
| | - Elvis J Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Institute of Neuropathology, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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28
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Pirayesh A, Petrakakis I, Raab P, Polemikos M, Krauss JK, Nakamura M. Petroclival meningiomas: Magnetic resonance imaging factors predict tumor resectability and clinical outcome. Clin Neurol Neurosurg 2016; 147:90-7. [PMID: 27315034 DOI: 10.1016/j.clineuro.2016.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 05/02/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite advances in skull base surgery, surgical removal of petroclival meningiomas (PCM) still poses a considerable neurosurgical challenge with regard to postoperative morbidity and the patients' long-term outcome. Knowledge of imaging features for PCM that might help to predict common risk factors encountered with tumor resection preoperatively is limited. The aim of this study was to clarify whether MRI features of PCM might predict tumor resectability and clinical outcome. METHODS A retrospective analysis of 18 cases of PCM treated surgically in our department between 2007 and 2013 was performed. Following radiological tumor features were compared to the extent of tumor resection and the patients' outcome: a) tumor diameter, b) calcification, c) tumor margin towards the brainstem, d) presence of an arachnoidal cleavage plane, e) brainstem edema, f) brainstem compression and g) tumor signal intensity on T2WI. RESULTS There was an excellent correlation between tumor resectability and preoperative findings with regard to the presence or absence of an arachnoidal cleavage plane and an irregular tumor margin towards the brainstem. Additionally, the presence of brainstem edema was significantly related to surgical morbidity, whereas a high tumor intensity on T2WI correlated significantly with soft tumor consistency and/or vascularity encountered during surgery. CONCLUSION As demonstrated in our series, PCM with an irregular tumor margin and absence of an arachnoidal plane towards the brainstem should be considered a high-risk group. In these cases, especially when additional brainstem edema is present, limited resection of tumor may be aspired to avoid postoperative morbidity.
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Affiliation(s)
- Ariyan Pirayesh
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
| | | | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Manolis Polemikos
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Makoto Nakamura
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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29
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Pflugrad H, Meyer GJ, Dirks M, Raab P, Tryc AB, Goldbecker A, Worthmann H, Wilke F, Boellaard R, Yaqub M, Berding G, Weissenborn K. Cerebral microglia activation in hepatitis C virus infection correlates to cognitive dysfunction. J Viral Hepat 2016; 23:348-57. [PMID: 26768955 DOI: 10.1111/jvh.12496] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 08/28/2015] [Accepted: 11/02/2015] [Indexed: 01/16/2023]
Abstract
Hepatitis C virus (HCV) infection may induce chronic fatigue and cognitive dysfunction. Virus replication was proven within the brain and HCV-positive cells were identified as microglia and astrocytes. We hypothesized that cerebral dysfunction in HCV-afflicted patients is associated with microglia activation. Microglia activation was assessed in vivo in 22 patients with chronic HCV infection compared to six healthy controls using [(11) C]-PK11195 Positron Emission Tomography (PET) combined with magnetic resonance tomography for anatomical localization. Patients were subdivided with regard to their PCR status, Fatigue Impact Scale score (FIS) and attention test sum score (ATS). A total of 12 patients (54.5%) were HCV PCR positive [of which 7 (58.3%) had an abnormal FIS and 7 (58.3%) an abnormal ATS], 10 patients (45.5%) were HCV PCR negative (5 (50%) each with an abnormal FIS or ATS). Patients without attention deficits showed a significantly higher accumulation of [(11) C]-PK11195 in the putamen (P = 0.05), caudate nucleus (P = 0.03) and thalamus (P = 0.04) compared to controls. Patients with and without fatigue did not differ significantly with regard to their specific tracer binding in positron emission tomography. Preserved cognitive function was associated with significantly increased microglia activation with predominance in the basal ganglia. This indicates a probably neuroprotective effect of microglia activation in HCV-infected patients.
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Affiliation(s)
- H Pflugrad
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
| | - G-J Meyer
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - M Dirks
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - P Raab
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - A B Tryc
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
| | - A Goldbecker
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
| | - H Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - F Wilke
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M Yaqub
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - G Berding
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - K Weissenborn
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
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Lanfermann H, Schindler C, Jordan J, Krug N, Raab P. Pharmacological MRI (phMRI) of the Human Central Nervous System. Clin Neuroradiol 2015; 25 Suppl 2:259-66. [DOI: 10.1007/s00062-015-0457-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/12/2015] [Indexed: 01/09/2023]
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Abstract
CT-angiography (CTA) has been accredited as an additional technical method for the detection of the cessation of cerebral blood circulation in the updated German guidelines for the determination of irreversible loss of brain function. A standardized CTA protocol was defined. The evaluation of the CTA has to be done by radiologists with several years of experience in neuroradiology, preferably by radiologists certified as neuroradiologists. The so-called "stasis filling", a slow progressive spread of contrast media into the cerebral arteries despite cessation of cerebral blood circulation, has to be considered.
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Affiliation(s)
- H Lanfermann
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland,
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Sühs KW, Wegner F, Skripuletz T, Trebst C, Tayeb SB, Raab P, Stangel M. Heterogeneity of clinical features and corresponding antibodies in seven patients with anti-NMDA receptor encephalitis. Exp Ther Med 2015; 10:1283-1292. [PMID: 26622479 PMCID: PMC4577954 DOI: 10.3892/etm.2015.2689] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 07/10/2015] [Indexed: 12/25/2022] Open
Abstract
Anti-N-methyl D-aspartate (NMDA) receptor encephalitis is the most common type of encephalitis in the spectrum of autoimmune encephalitis defined by antibodies targeting neuronal surface antigens. In the present study, the clinical spectrum of this disease is presented using instructive cases in correlation with the anti-NMDA receptor antibody titers in the cerebrospinal fluid (CSF) and serum. A total of 7 female patients admitted to the hospital of Hannover Medical School (Hannover, Germany) between 2008 and 2014 were diagnosed with anti-NMDA receptor encephalitis. Among these patients, 3 cases were selected to illustrate the range of similar and distinct clinical features across the spectrum of the disease and to compare anti-NMDA antibody levels throughout the disease course. All patients received immunosuppressive treatment with methylprednisolone, intravenous immunoglobulin and/or plasmapheresis, followed in the majority of patients by second-line therapy with rituximab and cyclophosphamide. The disease course correlated with NMDA receptor antibody titers, and to a greater extent with the ratio between antibody titer and protein concentration. A favorable clinical outcome with a modified Rankin Scale (mRS) score of ≤1 was achieved in 4 patients, 1 patient had an mRS score of 2 after 3 months of observation only, whereas 2 patients remained severely impaired (mRS score 4). Early and aggressive immunosuppressive treatment appears to support a good clinical outcome; however, the clinical signs and symptoms differ distinctively and treatment decisions have to be made on an individual basis.
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Affiliation(s)
- Kurt-Wolfram Sühs
- Department of Neurology, Hannover Medical School, Hannover D-30625, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hannover D-30625, Germany
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, Hannover D-30625, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover D-30625, Germany
| | - Said Ben Tayeb
- Department of Neurology, Hannover Medical School, Hannover D-30625, Germany
| | - Peter Raab
- Department of Neuroradiology, Hannover Medical School, Hannover D-30625, Germany
| | - Martin Stangel
- Department of Neurology, Hannover Medical School, Hannover D-30625, Germany
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Wesselsky V, Kitz C, Jakob F, Eulert J, Raab P. Description and evaluation of operative deformity correction in calcium-deficiency rickets in Kaduna, northern Nigeria. Int Orthop 2015. [PMID: 26224615 DOI: 10.1007/s00264-015-2911-7] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Rickets is a recurrent disease worldwide, especially in countries with limited resources (Nield et al Am Fam Physician 74(4):619-626, 2006; Thacher et al Ann Trop Paediatr 26(1):1-16, 2006). Medical therapy including orally administered calcium substitution is shown to improve a patients clinical symptoms and positively impact bone deformities, especially in the lower extremity. Even though orthopaedic intervention is necessary in a significant percentage of patients, few reports exist about operative deformity correction in patients wtih rickets. METHODS We describe our concept of operative treatment by single-stage, three-dimensional closing-wedge osteotomies on 45 deformed legs in 27 patients from the rural area of Kaduna, North Nigeria, with calcium-deficiency rickets and evaluate the early results in a 1.5-year follow-up. RESULTS We found a significant improvement in parameters of quality of life, functionality, clinical and radiological angulation and angles following the definition of Paley et al., with a complication rate of 4 % under 88 osteotomies (Paley et al Orthop Clin North Am 25(3):425-65, 1994). CONCLUSION The described operative therapy shows to be sufficient and with satisfactory results in correcting rickets-related leg deformities under rural circumstances with low availability of medical resources.
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Affiliation(s)
- Viktor Wesselsky
- Department of Orthopaedics and Traumatology, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13596, Berlin, Germany. .,Department of Orthopaedics, University of Wuerzburg, König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany.
| | - Christa Kitz
- Department of Tropical Medicine, Medical Mission Hospital, Salvatorstr. 7, 97074, Würzburg, Germany
| | - Franz Jakob
- Department of Orthopaedics, University of Wuerzburg, König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Jochen Eulert
- Department of Orthopaedics, University of Wuerzburg, König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Peter Raab
- Department of Orthopaedics, University of Wuerzburg, König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany.
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Pflugrad H, Bronzlik P, Raab P, Tryc AB, Goldbecker A, Barg-Hock H, Strassburg CP, Ding XQ, Lanfermann H, Weissenborn K. Cerebral white matter lesions in patients with cirrhosis - causative for hepatic encephalopathy or bystanders? Liver Int 2015; 35:1816-23. [PMID: 25546380 DOI: 10.1111/liv.12771] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 08/15/2014] [Accepted: 12/15/2014] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Focal white matter lesions mimicking microvascular lesions were connected to the development of hepatic encephalopathy (HE) in patients with cirrhosis. This study aims to assess the relationship between cerebrovascular risk factors and the prevalence and extent of these lesions in patients with cirrhosis, as well as their impact upon cognitive function. METHODS 55 cirrhotic patients underwent neurological examination, psychometric testing and magnetic resonance imaging. T2-weighted images were reviewed for white matter lesions by a neuroradiologist and a neurologist, independently. Patients were allocated into three groups: (i) no or <5, (ii) 6-15 and (iii) more than 15 lesions. Allocation was confirmed by a senior neuroradiologist blinded for the clinical data. The patient groups were compared concerning age, underlying liver disease, mortality, MELD Score, history of HE, treatment for HE, cerebrovascular risk factors and psychometric test results. Regression analysis was performed to identify risk factors for the presence and extent of white matter lesions. RESULTS Patient groups 2 and 3 were older and showed worse results in the psychometric tests than group 1 (P < 0.05). Correlation analyses showed a significant relationship between the number of white matter lesions and the grade of HE (P < 0.001) and cognitive function (P < 0.05), but no interrelationship between the lesions and cerebrovascular risk factors or other factors tested. CONCLUSIONS Focal white matter lesions in patients with cirrhosis do not represent cerebrovascular small-vessel disease but are related to the pathology of HE. Further studies are needed to clarify the mechanisms behind in detail.
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Affiliation(s)
- Henning Pflugrad
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover, Germany
| | - Paul Bronzlik
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Anita B Tryc
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover, Germany
| | - Annemarie Goldbecker
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover, Germany
| | - Hannelore Barg-Hock
- Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Christian P Strassburg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Xiao-Qi Ding
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover, Germany
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35
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Hong B, Biertz F, Raab P, Scheinichen D, Ertl P, Grosshennig A, Nakamura M, Hermann EJ, Lang JM, Lanfermann H, Krauss JK. Normobaric hyperoxia for treatment of pneumocephalus after posterior fossa surgery in the semisitting position: a prospective randomized controlled trial. PLoS One 2015; 10:e0125710. [PMID: 25992622 PMCID: PMC4439020 DOI: 10.1371/journal.pone.0125710] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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] [Received: 07/07/2014] [Accepted: 01/21/2015] [Indexed: 11/18/2022] Open
Abstract
Background Supratentorial pneumocephalus after posterior fossa surgery in the semisitting position may lead to decreased alertness and other symptoms. We here aimed to prove the efficacy of normobaric hyperoxia on the absorption of postoperative pneumocephalus according to a standardized treatment protocol. Methods and Findings We enrolled 44 patients with postoperative supratentorial pneumocephalus (> 30 ml) after posterior fossa surgery in a semisitting position. After randomisation procedure, patients received either normobaric hyperoxia at FiO2 100% over an endotracheal tube for 3 hours (treatment arm) or room air (control arm). Routine cranial CT scans were performed immediately (CT1) and 24 hours (CT2) after completion of surgery and were rated without knowledge of the therapy arm. Two co-primary endpoints were assessed: (i) mean change of pneumocephalus volume, and (ii) air resorption rate in 24 hours. Secondary endpoints were subjective alertness (Stanford Sleepiness Scale) postoperatively and attention (Stroop test), which were evaluated preoperatively and 24 hours after surgery. The mean change in pneumocephalus volume was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.001). The air resorption rate was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.0015). Differences were more pronounced in patients aged 52 years and older. No difference between patients in treatment arm and control arm was observed for the Stroop test. The distribution of scores in the Stanford Sleepiness Scale differed in the treatment arm as compared to the control arm, and there was a difference in mean values (p = 0.015). Conclusions Administration of normobaric hyperoxia at FiO2 100% via an endotracheal tube for 3 hours is safe and efficacious in the treatment of pneumocephalus after posterior fossa surgery in the semisitting position. Largest benefit was found in elderly patients and particularly in older men. Trial Registration German Clinical Trials Register DRKS00006273
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Affiliation(s)
- Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Dirk Scheinichen
- Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
| | - Philipp Ertl
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Anika Grosshennig
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Makoto Nakamura
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Elvis J. Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Josef M. Lang
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Joachim K. Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Hoepner R, Ahlbrecht J, Faissner S, Schneider R, Dahlhaus S, Adams O, Raab P, Lukas C, Chan A, Stangel M, Gold R. Clinical and paraclinical findings in natalizumab-associated infratentorial progressive multifocal leukoencephalopathy patients. J Neurol Neurosurg Psychiatry 2014; 85:1177-8. [PMID: 24700881 DOI: 10.1136/jnnp-2014-307582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Hoepner
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University, Bochum, Germany
| | - J Ahlbrecht
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - S Faissner
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University, Bochum, Germany
| | - R Schneider
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University, Bochum, Germany
| | - S Dahlhaus
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University, Bochum, Germany
| | - O Adams
- Department of Virology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - P Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - C Lukas
- Institute of Diagnostic and Interventional Neuroradiology, St. Josef Hospital Bochum, Ruhr University, Bochum, Germany
| | - A Chan
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University, Bochum, Germany
| | - M Stangel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - R Gold
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University, Bochum, Germany
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Wegner F, Wilke F, Raab P, Tayeb SB, Boeck AL, Haense C, Trebst C, Voss E, Schrader C, Logemann F, Ahrens J, Leffler A, Rodriguez-Raecke R, Dengler R, Geworski L, Bengel FM, Berding G, Stangel M, Nabavi E. Anti-leucine rich glioma inactivated 1 protein and anti-N-methyl-D-aspartate receptor encephalitis show distinct patterns of brain glucose metabolism in 18F-fluoro-2-deoxy-d-glucose positron emission tomography. BMC Neurol 2014; 14:136. [PMID: 24950993 PMCID: PMC4076767 DOI: 10.1186/1471-2377-14-136] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 06/17/2014] [Indexed: 01/17/2023] Open
Abstract
Background Pathogenic autoantibodies targeting the recently identified leucine rich glioma inactivated 1 protein and the subunit 1 of the N-methyl-D-aspartate receptor induce autoimmune encephalitis. A comparison of brain metabolic patterns in 18F-fluoro-2-deoxy-d-glucose positron emission tomography of anti-leucine rich glioma inactivated 1 protein and anti-N-methyl-D-aspartate receptor encephalitis patients has not been performed yet and shall be helpful in differentiating these two most common forms of autoimmune encephalitis. Methods The brain 18F-fluoro-2-deoxy-d-glucose uptake from whole-body positron emission tomography of six anti-N-methyl-D-aspartate receptor encephalitis patients and four patients with anti-leucine rich glioma inactivated 1 protein encephalitis admitted to Hannover Medical School between 2008 and 2012 was retrospectively analyzed and compared to matched controls. Results Group analysis of anti-N-methyl-D-aspartate encephalitis patients demonstrated regionally limited hypermetabolism in frontotemporal areas contrasting an extensive hypometabolism in parietal lobes, whereas the anti-leucine rich glioma inactivated 1 protein syndrome was characterized by hypermetabolism in cerebellar, basal ganglia, occipital and precentral areas and minor frontomesial hypometabolism. Conclusions This retrospective 18F-fluoro-2-deoxy-d-glucose positron emission tomography study provides novel evidence for distinct brain metabolic patterns in patients with anti-leucine rich glioma inactivated 1 protein and anti-N-methyl-D-aspartate receptor encephalitis.
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Affiliation(s)
- Florian Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany.
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Henkenberens C, Franzke A, Raab P, Oschlies I, Klapper W, Christiansen H. Primary EBV-positive Hodgkin's lymphoma of the CNS under azathioprine treatment: case report and review of the literature. Strahlenther Onkol 2014; 190:847-52. [PMID: 24823896 DOI: 10.1007/s00066-014-0670-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/08/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Retrospective and prospective cohort studies suggest that central nervous system involvement occurs in approximately 0.5% of patients with advanced Hodgkin's lymphoma. The isolated primary intracranial manifestation of Hodgkin's lymphoma is an extremely rare finding, with few cases reported in the literature. Little is known about the optimal treatment and prognosis of these tumors. Here, we present a case report with a review of the literature. CASE PRESENTATION A 47-year-old Caucasian man with persistent frontal headache and unspecific vertigo for half a month was diagnosed with nodular space-occupying lesions in the cerebellum. His medical history included multiple sclerosis, which was treated for 20 years with the immunosuppressive drug azathioprine. Further staging revealed no additional lesions suspected of being malignant. The patient underwent total tumor resection. Immunohistopathological examination showed Epstein-Barr virus-associated classic Hodgkin's lymphoma. Diagnostic bone marrow punction excluded lymphoma involvement of the bone marrow. The patient had no B symptoms. Consequently, the patient was classified as having stage IEA disease according to the Modified Ann Arbor Classification of Hodgkin Lymphoma and received systemic chemotherapy followed by radiation therapy for the former cerebellar tumor region. He was in complete clinical remission at the last follow-up 9 months after the initial diagnosis. CONCLUSION This case report and literature review suggest that multimodal treatment leads to a remarkable clinical outcome in Hodgkin's lymphoma with intracranial involvement.
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Affiliation(s)
- Christoph Henkenberens
- Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
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Grewe J, Thiele C, Mojallal H, Raab P, Sankowsky-Rothe T, Lenarz T, Blau M, Teschner M. New HRCT-based measurement of the human outer ear canal as a basis for acoustical methods. Am J Audiol 2014; 22:65-73. [PMID: 23064418 DOI: 10.1044/1059-0889(2012/12-0039)] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE As the form and size of the external auditory canal determine its transmitting function and hence the sound pressure in front of the eardrum, it is important to understand its anatomy in order to develop, optimize, and compare acoustical methods. METHOD High-resolution computed tomography (HRCT) data were measured retrospectively for 100 patients who had received a cochlear implant. In order to visualize the anatomy of the auditory canal, its length, radius, and the angle at which it runs were determined for the patients’ right and left ears. The canal’s volume was calculated, and a radius function was created. RESULTS The determined length of the auditory canal averaged 23.6 mm for the right ear and 23.5 mm for the left ear. The calculated auditory canal volume (Vtotal) was 0.7 ml for the right ear and 0.69 ml for the left ear. The auditory canal was found to be significantly longer in men than in women, and the volume greater. CONCLUSION The values obtained can be employed to develop a method that represents the shape of the auditory canal as accurately as possible to allow the best possible outcomes for hearing aid fitting.
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Affiliation(s)
| | | | | | - Peter Raab
- Hannover Medical School, Hannover, Germany
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40
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Güresir E, Vasiliadis N, Konczalla J, Raab P, Hattingen E, Seifert V, Vatter H. Erythropoietin prevents delayed hemodynamic dysfunction after subarachnoid hemorrhage in a randomized controlled experimental setting. J Neurol Sci 2013; 332:128-35. [DOI: 10.1016/j.jns.2013.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 06/30/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
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Giesemann AM, Raab P, Lyutenski S, Dettmer S, Bültmann E, Frömke C, Lenarz T, Lanfermann H, Goetz F. Improved imaging of Cochlear nerve hypoplasia using a 3-tesla variable flip-angle turbo spin-echo sequence and a 7-cm surface coil. Laryngoscope 2013; 124:751-4. [DOI: 10.1002/lary.24300] [Citation(s) in RCA: 13] [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] [Received: 02/19/2013] [Revised: 04/23/2013] [Accepted: 06/18/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Anja M. Giesemann
- Department of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Hannover Germany
| | - Peter Raab
- Department of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Hannover Germany
| | - Stefan Lyutenski
- Department of Otorhinolaryngology; Hannover Medical School; Hannover Germany
| | - Sabine Dettmer
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
| | - Eva Bültmann
- Department of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Hannover Germany
| | - Cornelia Frömke
- Institute of Biostatistics; Hannover Medical School; Hannover Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology; Hannover Medical School; Hannover Germany
| | - Heinrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Hannover Germany
| | - Friedrich Goetz
- Department of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Hannover Germany
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Hattingen E, Delic O, Franz K, Pilatus U, Raab P, Lanfermann H, Gerlach R. 1H MRSI and progression-free survival in patients with WHO grades II and III gliomas. Neurol Res 2013; 32:593-602. [DOI: 10.1179/016164109x12478302362770] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lanfermann H, Raab P. Spektroskopie - Was sagen die Peaks aus? ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Li N, Liu YF, Ma L, Worthmann H, Wang YL, Wang YJ, Gao YP, Raab P, Dengler R, Weissenborn K, Zhao XQ. Association of Molecular Markers With Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage. Stroke 2013; 44:658-63. [DOI: 10.1161/strokeaha.112.673590] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Na Li
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Yan Fang Liu
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Li Ma
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Hans Worthmann
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Yi Long Wang
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Yong Jun Wang
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Yi Pei Gao
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Peter Raab
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Reinhard Dengler
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Karin Weissenborn
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Xing Quan Zhao
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
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Nedopil A, Raab P, Rudert M. Desmoplastic fibroma: a case report with three years of clinical and radiographic observation and review of the literature. Open Orthop J 2013; 8:40-6. [PMID: 23459513 PMCID: PMC3583030 DOI: 10.2174/1874325001307010040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 10/07/2012] [Revised: 12/12/2012] [Accepted: 12/15/2012] [Indexed: 11/22/2022] Open
Abstract
Background: Desmoplastic fibroma (DF) is an extremely rare locally aggressive bone tumor with an incidence of 0.11% of all primary bone tumors. The typical clinical presentation is pain and swelling above the affected area. The most common sites of involvement are the mandible and the metaphysis of long bones. Histologically and biologically, desmoplastic fibroma mimics extra-abdominal desmoid tumor of soft tissue. Case Presentation and Literature Review: A case of a 27-year old man with DF in the ilium, including the clinical, radiological and histological findings over a 4-year period is presented here. CT scans performed in 3-year intervals prior to surgical intervention were compared with respect to tumor extension and cortical breakthrough. The patient was treated with curettage and grafting based on anatomical considerations. Follow-up CT scans over 18-months are also documented here. Additionally, a review and analysis of 271 cases including the presented case with particular emphasis on imaging patterns in MRI and CT as well as treatment modalities and outcomes are presented. Conclusion: In patients with desmoplastic fibroma, CT is the preferred imaging technique for both the diagnosis of intraosseus tumor extension and assessment of cortical involvement, whereas MRI is favored for the assessment of extraosseus tumor growth and preoperative planning. While tumor resection remains the preferred treatment for DF, curettage and grafting prove to be an acceptable alternative treatment modality with close follow-up when resection is not possible. Curettage and grafting have been shown to provide good clinical results and are associated with long recurrence free intervals.
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Affiliation(s)
- Alexander Nedopil
- Department of Orthopaedic Surgery at the University of Würzburg, König Ludwig Haus, Germany
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Li N, Worthmann H, Heeren M, Schuppner R, Deb M, Tryc AB, Bueltmann E, Lanfermann H, Donnerstag F, Weissenborn K, Raab P. Temporal pattern of cytotoxic edema in the perihematomal region after intracerebral hemorrhage: a serial magnetic resonance imaging study. Stroke 2013; 44:1144-6. [PMID: 23391767 DOI: 10.1161/strokeaha.111.000056] [Citation(s) in RCA: 29] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Knowledge about cytotoxic edema (CE) in intracerebral hemorrhage is still limited. We aimed to analyze its presence, temporal pattern, and prognostic meaning. METHODS Twenty-one patients with primary intracerebral hemorrhage underwent magnetic resonance imaging at days 1, 3, and 7 after symptom onset. CE was identified using diffusion-weighted imaging. Hematoma and perihematomal edema volumes were measured on fluid-attenuated inversion recovery images. National Institutes of Health Stroke Scale score was assessed at admission and with each magnetic resonance imaging. Clinical outcome was assessed by modified Rankin scale at 90 days. RESULTS CE appeared in half of the patients within the first 24 hours. The apparent diffusion coefficient values decreased until day 3 and were significantly reversed from days 3 through 7 (P<0.01). Patients with CE showed significantly faster perihematomal edema growth from day 0 to 1 (P=0.036) than those without. Larger 3-day perihematomal edema volume (P=0.02) and presence of CE on day 3 (P=0.07) were associated with poor clinical outcome. CONCLUSIONS CE is associated with stroke severity, perihematomal edema volume, and poor outcome. It is considered to indicate ongoing neuronal injury and, thus, might emerge as new treatment target.
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Affiliation(s)
- Na Li
- Department of Neurology, Hannover Medical School, Hannover, Germany.
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Li N, Liu YF, Ma L, Worthmann H, Raab P, Wang Y, Wang Y, Gao YP, Dengler R, Weissenborn K, Zhao X. Abstract WP309: Association of Molecular Markers with Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.awp309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Perihematomal edema (PHE) contributes to secondary brain injury in intracerebral hemorrhage (ICH). Increase of matrix metalloproteinases (MMPs) and growth factors (GFs) is considerably involved in blood-brain barrier disruption and neuronal cell death in ICH models. We therefore hypothesized that increased levels of these molecular markers are associated with PHE and clinical outcome in ICH patients.
Methods:
Fifty-nine patients with spontaneous ICH admitted within 24 hours of symptom onset were prospectively investigated. Noncontrast CT was performed on admission for diagnosis of ICH and quantification of initial hematoma volume. MRI was performed on day 3 in order to evaluate PHE. Concentrations of MMP-3, MMP-9, as well as vascular endothelial growth factor (VEGF) and Angiopoietin-1(Ang-1) on admission were determined by enzyme-linked immunosorbent assays. Clinical outcome was assessed by modified Rankin Scale (mRS) at 90days.
Results:
Increased MMP-3 levels were independently associated with PHE volume (P<0.05). Cytotoxic edema (CE) surrounding the hematoma was seen in 36 (61%) cases on 3-day MRI. CE did not correlate with the level of any of the biomarkers studied. Levels of MMP-3 ≥12.4 ng/ml and MMP-9 ≥192.4 ng/ml but not VEGF and Ang-1 predicted poor clinical outcome at 90 days (mRS>3) independent of stroke severity and hematoma volume at baseline (OR 25.3, P=0.035; OR 68.9, P=0.023; respectively).
Conclusion:
Metalloproteinases 3 and 9 seem to be significantly involved in secondary brain injury and outcome after primary ICH in humans and thus should be further evaluated as targets for therapeutic strategies in this devastating disorder.
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Affiliation(s)
- Na Li
- Dept of Neurology, Beijing Tiantan Hosp, Beijing, China
| | - Yan Fang Liu
- Dept of Neurology, Beijing Tiantan Hosp, Beijing, China
| | - Li Ma
- Dept of Neuroradiology, Beijing Tiantan Hosp, Beijing, China
| | | | - Peter Raab
- Dept of Interventional and Diagnostic Neuroradiology, Hannover Med Sch, Hannover, Germany
| | - Yilong Wang
- Dept of Neurology, Beijing Tiantan Hosp, Beijing, China
| | - Yongjun Wang
- Dept of Neurology, Beijing Tiantan Hosp, Beijing, China
| | - Yi Pei Gao
- Dept of Neuroradiology, Beijing Tiantan Hosp, Beijing, China
| | | | | | - Xingquan Zhao
- Dept of Neurology, Beijing Tiantan Hosp, Beijing, China
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Weissenborn K, Donnerstag F, Kielstein JT, Heeren M, Worthmann H, Hecker H, Schmitt R, Schiffer M, Pasedag T, Schuppner R, Tryc AB, Raab P, Hartmann H, Ding XQ, Hafer C, Menne J, Schmidt BMW, Bültmann E, Haller H, Dengler R, Lanfermann H, Giesemann AM. Neurologic manifestations of E coli infection-induced hemolytic-uremic syndrome in adults. Neurology 2012; 79:1466-73. [PMID: 22993286 DOI: 10.1212/wnl.0b013e31826d5f26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the neurologic and neuroradiologic complications of Shiga toxin producing Escherichia coli infection (STEC)-associated hemolytic-uremic syndrome (HUS) in adults. METHODS All 52 adult patients with STEC O104:H4 infection cared for at Hannover Medical School during the outbreak in Germany through May-July 2011 are considered in this observational study. Forty-three of the 52 patients underwent a standard neurologic diagnostic procedure including clinical examination, Mini-Mental State Examination, and Glasgow Coma Scale Score. Thirty-six patients underwent EEG, and 26 had cerebral MRI, 9 of them repeatedly. Case records of 9 patients who had not been seen by a neurologist were analyzed retrospectively. RESULTS Forty-eight of the 52 patients had HUS. All but 1 of these showed neurologic symptoms. Focal neurologic signs like double vision, difficulties in finding words, or hyperreflexia were present in 23, additional deficits in orientation, attention, memory, or constructive abilities in 9, and marked impairment of consciousness in 15. MRI showed brainstem, midbrain, thalamus, corpus callosum, and white matter lesions in half of the patients, predominantly in diffusion-weighted images. The extent of MRI lesions did not correlate with clinical symptoms. General slowing but no focal alteration was found in half of the patients examined by EEG. CONCLUSION Our findings suggest a toxic-metabolic pathology behind the neurologic impairment instead of multiple infarction due to microthrombosis. Future studies should aim to clarify if early antibiotic therapy or bowel cleansing might help to decrease the rate of neurologic complications in STEC-HUS.
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Morbach H, Schneider P, Schwarz T, Hofmann C, Raab P, Neubauer H, Düren C, Beer M, Girschick HJ. Comparison of magnetic resonance imaging and 99mTechnetium-labelled methylene diphosphonate bone scintigraphy in the initial assessment of chronic non-bacterial osteomyelitis of childhood and adolescents. Clin Exp Rheumatol 2012; 30:578-582. [PMID: 22765947] [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] [Received: 06/14/2011] [Accepted: 11/29/2011] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To compare sensitivity of bone scintigraphy using 99mTechnetium-labelled methylene diphosphonate (Tc-99m MDP) and magnetic resonance imaging (MRI) in the detection of inflammatory bone lesions in patients with chronic non-bacterial osteomyelitis (CNO). METHODS Tc-99m MDP bone scintigraphy and MRI were performed in 32 CNO patients at the time of diagnosis and compared regarding their sensitivity in detecting inflammatory lesions in symptomatic regions of the body. RESULTS Inflammatory lesions could be detected in 40 out of the 54 (74.1%) symptomatic regions by bone scintigraphy and in 53 (98.1%) of these regions by MRI (p<0.001). Sensitivity of MRI compared to bone scintigraphy was superior in detecting lesions in the long bones of the thigh and the lower legs (100% vs. 78.4%, respectively, p<0.05). CONCLUSIONS Bone scintigraphy does not seem to display the whole extent of the inflammatory process in CNO. Therefore, depending on clinical relevance, MRI rather than planar bone scintigraphy should be considered for the detection of CNO lesions at diagnosis.
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Affiliation(s)
- Henner Morbach
- Department of Paediatrics, University of Würzburg, Germany.
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Lanfermann H, Raab P. Tumoröse Erkrankungen. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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