1
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Bassler MC, Rammler T, Wackenhut F, Zur Oven-Krockhaus S, Secic I, Ritz R, Meixner AJ, Brecht M. Accumulation and penetration behavior of hypericin in glioma tumor spheroids studied by fluorescence microscopy and confocal fluorescence lifetime imaging microscopy. Anal Bioanal Chem 2022; 414:4849-4860. [PMID: 35538227 PMCID: PMC9234035 DOI: 10.1007/s00216-022-04107-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/18/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 12/17/2022]
Abstract
Glioblastoma WHO IV belongs to a group of brain tumors that are still incurable. A promising treatment approach applies photodynamic therapy (PDT) with hypericin as a photosensitizer. To generate a comprehensive understanding of the photosensitizer-tumor interactions, the first part of our study is focused on investigating the distribution and penetration behavior of hypericin in glioma cell spheroids by fluorescence microscopy. In the second part, fluorescence lifetime imaging microscopy (FLIM) was used to correlate fluorescence lifetime (FLT) changes of hypericin to environmental effects inside the spheroids. In this context, 3D tumor spheroids are an excellent model system since they consider 3D cell-cell interactions and the extracellular matrix is similar to tumors in vivo. Our analytical approach considers hypericin as probe molecule for FLIM and as photosensitizer for PDT at the same time, making it possible to directly draw conclusions of the state and location of the drug in a biological system. The knowledge of both state and location of hypericin makes a fundamental understanding of the impact of hypericin PDT in brain tumors possible. Following different incubation conditions, the hypericin distribution in peripheral and central cryosections of the spheroids were analyzed. Both fluorescence microscopy and FLIM revealed a hypericin gradient towards the spheroid core for short incubation periods or small concentrations. On the other hand, a homogeneous hypericin distribution is observed for long incubation times and high concentrations. Especially, the observed FLT change is crucial for the PDT efficiency, since the triplet yield, and hence the O2 activation, is directly proportional to the FLT. Based on the FLT increase inside spheroids, an incubation time > 30 min is required to achieve most suitable conditions for an effective PDT.
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Affiliation(s)
- Miriam C Bassler
- Process Analysis and Technology (PA&T), Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany.,Institute of Physical and Theoretical Chemistry, University of Tübingen, Auf der Morgenstelle 18, 72076, Tübingen, Germany
| | - Tim Rammler
- Institute of Physical and Theoretical Chemistry, University of Tübingen, Auf der Morgenstelle 18, 72076, Tübingen, Germany
| | - Frank Wackenhut
- Process Analysis and Technology (PA&T), Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany.
| | - Sven Zur Oven-Krockhaus
- Institute of Physical and Theoretical Chemistry, University of Tübingen, Auf der Morgenstelle 18, 72076, Tübingen, Germany
| | - Ivona Secic
- Process Analysis and Technology (PA&T), Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, Schwarzwald-Baar Clinic, Klinikstr. 11, 78052, Villingen-Schwenningen, Germany
| | - Alfred J Meixner
- Institute of Physical and Theoretical Chemistry, University of Tübingen, Auf der Morgenstelle 18, 72076, Tübingen, Germany
| | - Marc Brecht
- Process Analysis and Technology (PA&T), Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany. .,Institute of Physical and Theoretical Chemistry, University of Tübingen, Auf der Morgenstelle 18, 72076, Tübingen, Germany.
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2
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Gäble A, AlMatter M, Armbruster M, Berndt M, Kuršumovic A, Mühlmann M, Kimmig H, Kumle B, Ritz R, Russo S, Schmid F, Wanner G, Wirth S. [Resuscitation room diagnostics]. Radiologe 2020; 60:642-651. [PMID: 32507969 DOI: 10.1007/s00117-020-00704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CLINICAL PROBLEM The indication for resuscitation room care is an acute (potentially) life-threatening patient condition. Typical causes for this are polytrauma, acute neurological symptoms, acute chest and abdominal pain or the cause remains unclear at first. The care is always provided in a suitably composed interdisciplinary team. This requires cause-specific standards tailored to the care facility and requires a mutual understanding of the partners involved with regard to specialist interests and care processes. STANDARD RADIOLOGICAL METHODS Whole-body CT is established for polytrauma imaging and usually each institution has already defined an institutional standard. For the other causes, first imaging with CT is just as common, but the protocols and procedures to be used are often not as clear as in the case of polytrauma. METHODICAL INNOVATION AND EVALUATION For polytrauma service, ATLS and procedures according to ABCDE already serve as a largely standardized framework in the resuscitation room. For every other group of causes, comparable concepts should be developed and institutionally strive for objectification of continuous improvement. This refers not only to the resuscitation room stay but also to the interfaces before and after resuscitation room service. PRACTICAL RECOMMENDATIONS After the patient has arrived, it has to be determined whether the assessment of a vital risk is retained. If so, institutionally defined care standards must be followed for the various causes. This concerns the interface logistics, the definition of a team leader including associated tasks, the supply processes including the CT examination protocols as well as the close communication.
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Affiliation(s)
- Alexander Gäble
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.
| | - Muhammad AlMatter
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland
| | - Marco Armbruster
- Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland
| | - Maria Berndt
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Adisa Kuršumovic
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.,Klinik für Neurochirurgie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Marc Mühlmann
- Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland
| | - Hubert Kimmig
- Klinik für Neurologie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Bernhard Kumle
- Zentrale Notaufnahme und Aufnahmestation, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Rainer Ritz
- Klinik für Neurochirurgie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Sebastian Russo
- Klinik für Anästhesiologie, Intensiv‑, Notfall- und Schmerzmedizin, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Frank Schmid
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland
| | - Guido Wanner
- Klinik für Unfallchirurgie und Orthopädie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Stefan Wirth
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.,Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland.,European Society of Emergency Radiology, Wien, Österreich
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3
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Liu Q, Wackenhut F, Hauler O, Scholz M, Zur Oven-Krockhaus S, Ritz R, Adam PM, Brecht M, Meixner AJ. Hypericin: Single Molecule Spectroscopy of an Active Natural Drug. J Phys Chem A 2020; 124:2497-2504. [PMID: 32126168 DOI: 10.1021/acs.jpca.9b11532] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hypericin is one of the most efficient photosensitizers used in photodynamic tumor therapy (PDT). The reported treatments of this drug reach from antidepressive, antineoplastic, antitumor and antiviral activity. We show that hypericin can be optically detected down to a single molecule at ambient conditions. Hypericin can even be observed inside of a cancer cell, which implies that this drug can be directly used for advanced microscopy techniques (PALM, spt-PALM, or FLIM). Its photostability is large enough to obtain single molecule fluorescence, surface enhanced Raman spectra (SERS), fluorescence lifetime, antibunching, and blinking dynamics. Sudden spectral changes can be associated with a reorientation of the molecule on the particle surface. These properties of hypericin are very sensitive to the local environment. Comparison of DFT calculations with SERS spectra show that both the neutral and deprotonated form of hypericin can be observed on the single molecule and ensemble level.
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Affiliation(s)
- Quan Liu
- Institute of Physical and Theoretical Chemistry, Eberhard Karls University Tübingen, Auf der Morgenstelle 18, 72076 Tübingen, Germany.,Laboratoire Lumière, nanomatériaux & nanotechnologies - L2n and CNRS ERL 7004, Université de Technologie de Troyes, 12 rue Marie Curie, 10000 Troyes, France
| | - Frank Wackenhut
- Institute of Physical and Theoretical Chemistry, Eberhard Karls University Tübingen, Auf der Morgenstelle 18, 72076 Tübingen, Germany
| | - Otto Hauler
- Institute of Physical and Theoretical Chemistry, Eberhard Karls University Tübingen, Auf der Morgenstelle 18, 72076 Tübingen, Germany.,Reutlingen Research Institute, Process Analysis and Technology (PA&T), Reutlingen University, Alteburgstraße 150, 72762 Reutlingen, Germany
| | - Miriam Scholz
- Institute of Physical and Theoretical Chemistry, Eberhard Karls University Tübingen, Auf der Morgenstelle 18, 72076 Tübingen, Germany.,Reutlingen Research Institute, Process Analysis and Technology (PA&T), Reutlingen University, Alteburgstraße 150, 72762 Reutlingen, Germany
| | - Sven Zur Oven-Krockhaus
- Institute of Physical and Theoretical Chemistry, Eberhard Karls University Tübingen, Auf der Morgenstelle 18, 72076 Tübingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, Schwarzwald-Baar Clinic, Klinikstraße 11, 78052 Villingen-Schwenningen, Germany
| | - Pierre-Michel Adam
- Laboratoire Lumière, nanomatériaux & nanotechnologies - L2n and CNRS ERL 7004, Université de Technologie de Troyes, 12 rue Marie Curie, 10000 Troyes, France
| | - Marc Brecht
- Institute of Physical and Theoretical Chemistry, Eberhard Karls University Tübingen, Auf der Morgenstelle 18, 72076 Tübingen, Germany.,Reutlingen Research Institute, Process Analysis and Technology (PA&T), Reutlingen University, Alteburgstraße 150, 72762 Reutlingen, Germany
| | - Alfred J Meixner
- Institute of Physical and Theoretical Chemistry, Eberhard Karls University Tübingen, Auf der Morgenstelle 18, 72076 Tübingen, Germany
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4
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Keßler AF, Ritz R. P14.59 Post-Market Surveillance Data of the EMEA region indicate good tolerability of TTFields in WHO Grade III Glioma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.294] [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
Despite considerable progress in molecular characterization and evidence for certain regimens, treatment of grade III gliomas is still ambiguous and, with surgery, radiotherapy and chemotherapy, in analogy to grade IV glioma treatment. Tumor treating fields (TTFields) therapy proved to be effective as an additional anti-mitotic treatment in glioblastoma and is available in several countries. While TTFields in grade III glioma are being investigated in several clinical trials, we report an analysis of surveillance safety data in patients with grade III glioma already treated with TTFields in the EMEA region.
METHODS
We reviewed post-marketing surveillance data of the EMEA region. Using the MedDRA body system with system organ class and preferred terms, adverse events reported in the subgroup of patients with grade III glioma treated with TTFields were systematically analysed. Patients with diagnosis of anaplastic astrocytoma and anaplastic oligodendroglioma were included.
RESULTS
This analysis includes 142 patients with grade III glioma treated with TTFields in the EMEA region. Median age was 47 years (range 5–78 years). 64% of the patients reported at least one adverse event. With an incidence of 35%, skin reaction was the most common reported adverse event, none of them were severe. 29 % of the patients reported general disorders, including general health deterioration (15%) and fatigue/malaise (6%). Adverse events related to the nervous system were reported in 26% of patients; seizures were noted in 9% and headache in 7% of patients.
CONCLUSION
The retrospective analysis of available post-market surveillance data of EMEA patients with grade III glioma showed no occurrence of serious adverse events that were associated with TTFields. Skin reaction, as the most commonly reported adverse event, but also other reported adverse events had comparable incidences to the rates observed in the phase III trials for patients with recurrent (EF-11) and newly diagnosed GBM (EF-14). In summary, this analysis identifies no additional safety signals on the use of TTFields in the treatment of patients with grade III glioma. Future results of clinical trials in these indications will give further insight into safety and efficacy in this subgroup.
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Affiliation(s)
- A F Keßler
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - R Ritz
- Klinik für Neurochirurgie, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
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5
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Feigl GC, Heckl S, Kullmann M, Filip Z, Decker K, Klein J, Ernemann U, Tatagiba M, Velnar T, Ritz R. Review of first clinical experiences with a 1.5 Tesla ceiling-mounted moveable intraoperative MRI system in Europe. Bosn J Basic Med Sci 2019; 19:24-30. [PMID: 30589401 DOI: 10.17305/bjbms.2018.3777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 07/29/2018] [Indexed: 11/16/2022] Open
Abstract
High-field intraoperative MRI (iMRI) systems provide excellent imaging quality and are used for resection control and update of image guidance systems in a number of centers. A ceiling-mounted intraoperative MRI system has several advantages compared to a conventional iMRI system. In this article, we report on first clinical experience with using such a state-of-the-art, the 1.5T iMRI system, in Europe. A total of 50 consecutive patients with intracranial tumors and vascular lesions were operated in the iMRI unit. We analyzed the patients' data, surgery preparation times, intraoperative scans, surgical time, and radicality of tumor removal. Patients' mean age was 46 years (range 8 to 77 years) and the median surgical procedure time was 5 hours (range 1 to 11 hours). The lesions included 6 low-grade gliomas, 8 grade III astrocytomas, 10 glioblastomas, 7 metastases, 7 pituitary adenomas, 2 cavernomas, 2 lymphomas, 1 cortical dysplasia, 3 aneurysms, 1 arterio-venous malformation and 1 extracranial-intracranial bypass, 1 clival chordoma, and 1 Chiari malformation. In the surgical treatment of tumor lesions, intraoperative imaging depicted tumor remnant in 29.7% of the cases, which led to a change in the intraoperative strategy. The mobile 1.5T iMRI system proved to be safe and allowed an optimal workflow in the iMRI unit. Due to the fact that the MRI scanner is moved into the operating room only for imaging, the working environment is comparable to a regular operating room.
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Affiliation(s)
- Guenther C Feigl
- Department of Neurosurgery, University of Tuebingen Medical Center, Germany.
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6
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van de Loo JCW, Kriessmann A, Trübestein G, Knoch K, de Swart CAM, Asbeck F, Marbet GA, Schmitt HE, Sewell AF, Duckert F, Theiss W, Ritz R. Controlled Multicenter Pilot Study of Urokinase – Heparin and Streptokinase in Deep Vein Thrombosis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1665281] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThirty-three patients with acute iliofemoral thrombosis were randomly assigned to three treatment groups in a pilot doseranging study of thrombolytic therapy in deep vein thrombosis. One group received tissue culture urokinase in a dose of 2,200 I.U./kg/hr, and a second group in a dose of 1,100 I.U./kg/hr following a loading dose of 4,400 I.U./kg given in ten min. Urokinase was administered for 12 hr periods, alternating with 12 hr periods of heparin. A third group received an initial dose of 250,0001.U. of streptokinase in 20 min, followed by 100,000 I.U./hr. Treatment of all patients continued for three days. At the end of this period little improvement, evaluated by “blinded” interpretation of pre- and post-treatment phlebograms, was found in five out of ten of the higher-dose urokinase patients, seven out of eleven of lower-dosage urokinase patients, and six out of ten of streptokinase patients. Optional treatment for another three days showed little further improvement of urokinase-patients and moderate further improvement in the streptokinase-patients. – Neither of the 2 dosage schemes at intermittent application of urokinase appeared to be advantageous. Urokinase treated patients experienced fewer adverse reactions.
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Affiliation(s)
| | - A Kriessmann
- The Medizinische Klinik, Technische Universität Rechts der Isar, München, FRG
| | - G Trübestein
- The Medizinische Universitäts-Poliklinik Bonn, FRG
| | - K Knoch
- The Medizinische Klinik, Städtische Krankenanstalten, Krefeld, FRG
| | - C A M de Swart
- The Kliniek voor Inwendige Geneeskunde, Afdeling Haematologie, Akademisch Ziekenhuis, Utrecht, the Netherlands
| | - F Asbeck
- The Medizinische Universitätsklinik, Abteilung Innere Medizin A, Münster, FRG
| | - G A Marbet
- The Gerinnungslaboratorium, Kantonsspital, Basel, Switzerland
| | - H E Schmitt
- The Universitäts-Institut für Medizinische Radiologie, Kantonsspital, Basel
| | - A F Sewell
- The Abbott Laboratories, North Chicago, III., USA
| | - F Duckert
- The Gerinnungslaboratorium, Kantonsspital, Basel, Switzerland
| | - W Theiss
- The Medizinische Klinik, Technische Universität Rechts der Isar, München, FRG
| | - R Ritz
- The Departement für Innere Medizin, Kantonsspital, Basel, Switzerland
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7
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Marbet GA, Eichlisberger R, Duckert F, Ritz R, da Silva MA, Biland L, Widmer LK, Schmitt HE. Side Effects of Thrombolytic Treatment with Porcine Plasmin and Low Dose Streptokinase. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn the sequential thrombolytic therapy with porcine plasmin and low dose streptokinase side effects are mainly due to bleeding, intolerance reactions are less important. Treatment had to be prematurely stopped in 42 (37%) of 114 DVT cases because of severe bleeding and in 12 (10%) due to intolerance reactions. The corresponding figures for the 45 cases with arterial occlusions are 15 (33%) and 2 (4%) respectively. The intensity of systemic proteolysis as represented by the thromboplastin time is significantly correlated with haemorrhagic manifestations. Macrohaematuria and bleeding from puncture sites are the most frequent haemorrhagic complications followed by spontaneous bleeding into skin and muscles. Non-fatal intracranial bleeding occurred in 1 DVT case (0.9%) and in 2 patients with arterial occlusions (4.4%). The benefit of this potent thrombolytic regimen would greatly improve if a strong reduction of premature treatment stop could be achieved.
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Affiliation(s)
- G A Marbet
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Intensivmedizin, Abteilung für Angiologie, Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - R Eichlisberger
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Intensivmedizin, Abteilung für Angiologie, Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - F Duckert
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Intensivmedizin, Abteilung für Angiologie, Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - R Ritz
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Intensivmedizin, Abteilung für Angiologie, Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - M A da Silva
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Intensivmedizin, Abteilung für Angiologie, Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - L Biland
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Intensivmedizin, Abteilung für Angiologie, Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - L K Widmer
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Intensivmedizin, Abteilung für Angiologie, Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - H E Schmitt
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Intensivmedizin, Abteilung für Angiologie, Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
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8
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Marbet GA, Eichlisberger R, Duckert F, de Silva MA, Biland L, Widmer LK, Ritz R, Schmitt HE. Sequential Treatment of Deep Leg Vein Thrombosis with Porcine Plasmin and Low Dose Streptokinase. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657254] [Citation(s) in RCA: 4] [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: 10/28/2022]
Abstract
SummarySequential treatment of deep leg vein thrombosis with porcine plasmin and low dose streptokinase (10,000-20,000 U/h) produces strong systemic fibrinolysis as demonstrated by the sustained decrease of euglobulin lysis time, of thromboplastin time values in percent, fibrinogen and factor V levels. There is a statistically significant negative correlation between thrombolytic results and euglobulin lysis time. Treatment periods below 3 days are unlikely to give satisfactory results. Occluded vein segments with an apparent median age of 4 days including thrombi older than 10 days (20% of cases) are cleared with an average chance of 50%. Complete dissolution of all thrombi proximal to the crural veins has been demonstrated in 47/114 = 41.2%, some thrombolytic effect in 31/114 = 27.2% and treatment failure in 36/114 = 31.6%. The data favour laboratory monitoring of thrombolytic therapy.
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Affiliation(s)
- G A Marbet
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - R Eichlisberger
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - F Duckert
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - M A de Silva
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - L Biland
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - L K Widmer
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - R Ritz
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - H E Schmitt
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
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9
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Marbet GA, Eichlisberger R, Duckert F, da Silva MA, Biland L, Widmer LK, Ritz R, Schmitt HE. Sequential Treatment of Arterial Occlusions with Porcine Plasmin and Low Dose Streptokinase. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657253] [Citation(s) in RCA: 4] [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: 10/28/2022]
Abstract
SummarySequential treatment of arterial occlusions of the leg with porcine plasmin and low dose streptokinase results in a strong systemic proteolysis as already seen in deep leg vein thrombosis. In 31 of 45 patients the blood flow through major arterial segments could be restored. Thrombolytic success is possible within the first two treatment days but for the majority of the cases fibrinolytic therapy for 3-6 days is needed. On the average treatment was 1 day shorter than in DVT cases. No statistical relationship between local thrombolysis and systemic proteolysis was detected.The thrombolytic efficacy of this regimen compares favourably with earlier experience on fibrinolytic therapy in arterial occlusions.
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Affiliation(s)
- G A Marbet
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - R Eichlisberger
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - F Duckert
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - M A da Silva
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - L Biland
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - L K Widmer
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - R Ritz
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
| | - H E Schmitt
- The Gerinnungs- und Fibrinolyselabor, Abteilung für Angiologie, Abteilung für Intensivmedizin and Institut für medizinische Radiologie, Kantonsspital, Basel, Switzerland
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Conrad C, Götte M, Schlomann U, Roessler M, Pagenstecher A, Anderson P, Preston J, Pruessmeyer J, Ludwig A, Li R, Kamm RD, Ritz R, Carl B, Nimsky C, Bartsch JW. ADAM8 expression in breast cancer derived brain metastases: Functional implications on MMP-9 expression and transendothelial migration in breast cancer cells. Int J Cancer 2017; 142:779-791. [DOI: 10.1002/ijc.31090] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/14/2017] [Accepted: 09/18/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Catharina Conrad
- Department of Neurosurgery; Philipps University Marburg, Baldingerstr; Marburg, 35033 Germany
- Department of Anesthesiology; Intensive Care, and Pain Medicine, University of Münster, Albert-Schweitzer Campus 1; Münster 48149 Germany
| | - Malena Götte
- Department of Neurosurgery; Philipps University Marburg, Baldingerstr; Marburg, 35033 Germany
| | - Uwe Schlomann
- Department of Neurosurgery; Philipps University Marburg, Baldingerstr; Marburg, 35033 Germany
| | - Marion Roessler
- Department of Pathology; Philipps University Marburg, Baldingerstr; Marburg 35033 Germany
| | - Axel Pagenstecher
- Department of Neuropathology; Philipps University Marburg, Baldingerstr; Marburg 35033 Germany
| | - Peter Anderson
- King's College London, Institute of Pharmaceutical Science, 150 Stamford Street; London SE1 9NH United Kingdom
| | - Jane Preston
- King's College London, Institute of Pharmaceutical Science, 150 Stamford Street; London SE1 9NH United Kingdom
| | | | - Andreas Ludwig
- Institute for Pharmacological Research, Aachen University; Aachen Germany
| | - Ran Li
- MIT Department of Biological Engineering; Cambridge MA
| | - Roger D. Kamm
- MIT Department of Biological Engineering; Cambridge MA
| | - Rainer Ritz
- Department of Neurosurgery; Philipps University Marburg, Baldingerstr; Marburg, 35033 Germany
| | - Barbara Carl
- Department of Neurosurgery; Philipps University Marburg, Baldingerstr; Marburg, 35033 Germany
| | - Christopher Nimsky
- Department of Neurosurgery; Philipps University Marburg, Baldingerstr; Marburg, 35033 Germany
| | - Jörg W. Bartsch
- Department of Neurosurgery; Philipps University Marburg, Baldingerstr; Marburg, 35033 Germany
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Skardelly M, Dangel E, Gohde J, Noell S, Behling F, Lepski G, Borchers C, Koch M, Schittenhelm J, Bisdas S, Naumann A, Paulsen F, Zips D, von Hehn U, Ritz R, Tatagiba MS, Tabatabai G. Prolonged Temozolomide Maintenance Therapy in Newly Diagnosed Glioblastoma. Oncologist 2017; 22:570-575. [PMID: 28360216 PMCID: PMC5423504 DOI: 10.1634/theoncologist.2016-0347] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 09/13/2016] [Accepted: 11/12/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The impact of prolonging temozolomide (TMZ) maintenance beyond six cycles in newly diagnosed glioblastoma (GBM) remains a topic of discussion. We investigated the effects of prolonged TMZ maintenance on progression-free survival (PFS) and overall survival (OS). PATIENTS AND METHODS In this retrospective single-center cohort study, we included patients with GBM who were treated with radiation therapy with concomitant and adjuvant TMZ. For analysis, patients were considered who either completed six TMZ maintenance cycles (group B), continued with TMZ therapy beyond six cycles (group C), or stopped TMZ maintenance therapy within the first six cycles (group A). Patients with progression during the first six TMZ maintenance cycles were excluded. RESULTS Clinical data from 107 patients were included for Kaplan-Meier analyses and 102 for Cox regressions. Median PFS times were 8.1 months (95% confidence interval [CI] 6.1-12.4) in group A, 13.7 months (95% CI 10.6-17.5) in group B, and 20.9 months (95% CI 15.2-43.5) in group C. At first progression, response rates of TMZ/lomustine rechallenge were 47% in group B and 13% in group C. Median OS times were 12.7 months (95% CI 10.3-16.8) in group A, 25.2 months (95% CI 17.7-55.5) in group B, and 28.6 months (95% CI 24.4-open) in group C. Nevertheless, multivariate Cox regression for patients in group C compared with group B that accounted for imbalances of other risk factors showed no different relative risk (RR) for OS (RR 0.77, p = .46). CONCLUSION Our data do not support a general extension of TMZ maintenance therapy beyond six cycles. The Oncologist 2017;22:570-575 IMPLICATIONS FOR PRACTICE: Radiation therapy with concomitant and adjuvant temozolomide (TMZ) maintenance therapy is still the standard of care in patients below the age of 65 years in newly diagnosed glioblastoma. However, in clinical practice, many centers continue TMZ maintenance therapy beyond six cycles. The impact of this continuation is controversial and has not yet been addressed in prospective randomized clinical trials. We compared the effect of more than six cycles of TMZ in comparison with exactly six cycles on overall survival (OS) and progression-free survival (PFS) by multivariate analysis and found a benefit in PFS but not OS. Thus, our data do not suggest prolonging TMZ maintenance therapy beyond six cycles, which should be considered in neurooncological practice.
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Affiliation(s)
- Marco Skardelly
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Center for CNS Tumors, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Elena Dangel
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Julia Gohde
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Susan Noell
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Felix Behling
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Center for CNS Tumors, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Guilherme Lepski
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Borchers
- Department of Vascular Neurology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Center for CNS Tumors, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marilin Koch
- Department of Vascular Neurology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Center for CNS Tumors, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jens Schittenhelm
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Vascular Neurology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Institute of Pathology and Neuropathology, Division of Neuropathology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sotirios Bisdas
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Vascular Neurology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Aline Naumann
- Department of Institute of Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Center for CNS Tumors, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Center for CNS Tumors, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Tübingen, Germany
- Center for Personalized Medicine, Eberhard Karls University of Tübingen, Tübingen, Germany
| | | | - Rainer Ritz
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marcos Soares Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Center for CNS Tumors, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Vascular Neurology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Center for CNS Tumors, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Tübingen, Germany
- Center for Personalized Medicine, Eberhard Karls University of Tübingen, Tübingen, Germany
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Noell S, Fallier-Becker P, Mack AF, Hoffmeister M, Beschorner R, Ritz R. Water Channels Aquaporin 4 and -1 Expression in Subependymoma Depends on the Localization of the Tumors. PLoS One 2015; 10:e0131367. [PMID: 26115524 PMCID: PMC4482577 DOI: 10.1371/journal.pone.0131367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 01/07/2015] [Accepted: 06/01/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We analyzed aquaporin 4 and -1 expression in subependymomas, benign and slow growing brain tumors WHO grade I. Ten subependymoma cases were investigated, five of the fossa inferior and five of the fossa superior. METHODS AND RESULTS Using immunohistochemistry, we observed different aquaporin expression patterns depending on localization: aquaporin 4 and -1 were detected in infratentorial subependymomas in the entire tumor tissue. In contrast, supratentorial subependymomas revealed aquaporin 4 and -1 expression only in border areas of the tumor. PCR analyses however showed no difference in aquaporin 4 expression between all subependymomas independent of localization but at higher levels than in normal brain. In contrast, aquaporin 1 RNA levels were found to be higher only in infratentorial samples compared to supratentorial and normal brain samples. The reason for the different distribution pattern of aquaporin 4 in subependymomas still remains unclear. On the cellular level, aquaporin 4 was redistributed on the surface of the tumor cells, and in freeze fracture replicas no orthogonal arrays of particles were found. This was similar to our previous findings in malignant glioblastomas. From these studies, we know that extracellular matrix molecules within the tumor like agrin and its receptor alpha-dystroglycan are involved in forming orthogonal arrays of particles. In subependymomas neither agrin nor alpha-dystroglycan were detected around blood vessels. CONCLUSIONS Taken together, we show in this study that in the benign subependymomas aquaporins 1 and 4 are dramatically redistributed and upregulated. We speculate that extracellular environments of infra- and supratentorial subependymomas are different and lead to different distribution patterns of aquaporin 4 and -1.
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Affiliation(s)
- Susan Noell
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
- * E-mail: (SN); (PFB)
| | - Petra Fallier-Becker
- Institute of Pathology and Neuropathology, University of Tuebingen, Tuebingen, Germany
- * E-mail: (SN); (PFB)
| | - Andreas F. Mack
- Institute of Clinical Anatomy and Cell Analysis, University of Tuebingen, Tuebingen, Germany
| | - Maike Hoffmeister
- Institute of Pathology and Neuropathology, University of Tuebingen, Tuebingen, Germany
| | - Rudi Beschorner
- Institute of Pathology and Neuropathology, University of Tuebingen, Tuebingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, University of Marburg, Marburg, Germany
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Noell S, Feigl GC, Naros G, Barking S, Tatagiba M, Ritz R. Experiences in surgery of primary malignant brain tumours in the primary sensori-motor cortex practical recommendations and results of a single institution. Clin Neurol Neurosurg 2015; 136:41-50. [PMID: 26056811 DOI: 10.1016/j.clineuro.2015.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 03/13/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Tumour resection in the Rolandic region is a challenge. Aim of this study is to review a series of patients malignant glioma surgery in the Rolandic region which was performed by combinations of neuronavigation, sonography, 5-aminolevulinic acid fluorescence guided (5-ALA) surgery and intraoperative electrophysiological monitoring (IOM). METHODS 29 patients suffering malignant gliomas in the motor cortex (17) and sensory cortex (12) were analyzed with respect to functional outcome and grade of resections. RESULTS Improvement of motor function was seen in 41.5% one week after surgery, 41.5% were stable, only 17% deteriorated. After three months patients had an improvement of motor function in 56%, of Karnofsky Score (KPS) 27% and sensory function was improved in 8%. Deterioration of motor function was seen in 16%, in sensory function 4% and in KPS 28% after three months. 25% showed no residual tumour in early post surgical contrast enhanced MRI. 10% had less than 2% residual tumour and 15% had 2-5% residual tumour. CONCLUSIONS Preoperative functional neuroimaging, neuronavigation for planning the surgical approach and resection margins, intraoperative sonography and 5-ALA guided surgery in combination with the application of IOM shows that functional outcome and total to subtotal resection of malignant glioma in the Rolandic region is feasible.
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Affiliation(s)
- Susan Noell
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Guenther C Feigl
- Department of Neurosurgery, Bamberg Hospital, Huger Straße 80, 96049 Bamberg, Germany
| | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Susanne Barking
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; Department of Neurosurgery, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany.
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Noell S, Beschorner R, Bisdas S, Beyer U, Weber RG, Fallier-Becker P, Ritz R. Simultaneous subependymomas in monozygotic female twins: further evidence for a common genetic or developmental disorder background. J Neurosurg 2014; 121:570-5. [DOI: 10.3171/2014.2.jns122179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper, a rare case of subependymoma of the fourth ventricle in identical female twins is reported. Magnetic resonance imaging and CT showed nearly identical locations of the tumors in the fourth ventricle and similar growth patterns of the tumors in both sisters. Likewise, postoperative histopathological analysis of both tumors revealed the typical histological appearance of subependymomas. Subependymoma is a rare, low-grade glioma of the CNS, slowly growing and usually asymptomatic. If symptomatic, a subependymoma can in some cases lead to sudden death caused by pressure on the brainstem or decompensated secondary hydrocephalus. This case demonstrates the importance of detecting tumors early and thereby preventing symptoms arising from increasing intracranial pressure, and optimizing therapy options.
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Affiliation(s)
| | | | | | - Ulrike Beyer
- 4Department of Human Genetics, Hannover Medical School, Hannover; and
| | - Ruthild G. Weber
- 4Department of Human Genetics, Hannover Medical School, Hannover; and
| | | | - Rainer Ritz
- 1Departments of Neurosurgery,
- 5Department of Neurosurgery, University of Marburg, Germany
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Franz C, Freimuth F, Bauer A, Ritz R, Schnarr C, Duvinage C, Adams T, Blügel S, Rosch A, Mokrousov Y, Pfleiderer C. Real-space and reciprocal-space Berry phases in the Hall effect of Mn(1-x)Fe(x)Si. Phys Rev Lett 2014; 112:186601. [PMID: 24856709 DOI: 10.1103/physrevlett.112.186601] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Indexed: 06/03/2023]
Abstract
We report an experimental and computational study of the Hall effect in Mn(1-x)Fe(x)Si, as complemented by measurements in Mn(1-x)Co(x)Si, when helimagnetic order is suppressed under substitutional doping. For small x the anomalous Hall effect (AHE) and the topological Hall effect (THE) change sign. Under larger doping the AHE remains small and consistent with the magnetization, while the THE grows by over a factor of 10. Both the sign and the magnitude of the AHE and the THE are in excellent agreement with calculations based on density functional theory. Our study provides the long-sought material-specific microscopic justification that, while the AHE is due to the reciprocal-space Berry curvature, the THE originates in real-space Berry phases.
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Affiliation(s)
- C Franz
- Physik-Department, Technische Universität München, James-Franck-Straße, D-85748 Garching, Germany
| | - F Freimuth
- Institute for Advanced Simulation and Peter Grünberg Institut, Forschungszentrum Jülich and JARA, D-52425 Jülich, Germany
| | - A Bauer
- Physik-Department, Technische Universität München, James-Franck-Straße, D-85748 Garching, Germany
| | - R Ritz
- Physik-Department, Technische Universität München, James-Franck-Straße, D-85748 Garching, Germany
| | - C Schnarr
- Physik-Department, Technische Universität München, James-Franck-Straße, D-85748 Garching, Germany
| | - C Duvinage
- Physik-Department, Technische Universität München, James-Franck-Straße, D-85748 Garching, Germany
| | - T Adams
- Physik-Department, Technische Universität München, James-Franck-Straße, D-85748 Garching, Germany
| | - S Blügel
- Institute for Advanced Simulation and Peter Grünberg Institut, Forschungszentrum Jülich and JARA, D-52425 Jülich, Germany
| | - A Rosch
- Institute for Theoretical Physics, Universität zu Köln, Zülpicher Straße 77, D-50937 Köln, Germany
| | - Y Mokrousov
- Institute for Advanced Simulation and Peter Grünberg Institut, Forschungszentrum Jülich and JARA, D-52425 Jülich, Germany
| | - C Pfleiderer
- Physik-Department, Technische Universität München, James-Franck-Straße, D-85748 Garching, Germany
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Feigl GC, Krischek B, Ritz R, Thaher F, Marquardt JS, Hirt B, Korn A, Schumann M, Tatagiba M, Ebner FH. Evaluation of a 3-Dimensional Voxel-Based Neuronavigation System with Perspective Image Rendering for Keyhole Approaches to the Skull Base: An Anatomical Study. World Neurosurg 2014; 81:609-16. [DOI: 10.1016/j.wneu.2013.10.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/17/2013] [Accepted: 10/12/2013] [Indexed: 11/26/2022]
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Skardelly M, Pantazis G, Bisdas S, Feigl GC, Schuhmann MU, Tatagiba MS, Ritz R. Primary cerebral low-grade B-cell lymphoma, monoclonal immunoglobulin deposition disease, cerebral light chain deposition disease and "aggregoma": an update on classification and diagnosis. BMC Neurol 2013; 13:107. [PMID: 23947787 PMCID: PMC3751626 DOI: 10.1186/1471-2377-13-107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 08/06/2013] [Indexed: 11/17/2022] Open
Abstract
Background This work aims to add evidence and provide an update on the classification and diagnosis of monoclonal immunoglobulin deposition disease (MIDD) and primary central nervous system low-grade lymphomas. MIDD is characterized by the deposition of light and heavy chain proteins. Depending on the spatial arrangement of the secreted proteins, light chain-derived amyloidosis (AL) can be distinguished from non-amyloid light chain deposition disease (LCDD). We present a case of an extremely rare tumoral presentation of LCDD (aggregoma) and review the 3 previously published LCDD cases and discuss their presentation with respect to AL. Case presentation A 61-year-old woman presented with a 3½-year history of neurologic symptoms due to a progressive white matter lesion of the left subcortical parieto-insular lobe and basal ganglia. 2 former stereotactic biopsies conducted at different hospitals revealed no evidence of malignancy or inflammation; thus, no therapy had been initiated. After performing physiological and functional magnetic resonance imaging (MRI), the tumor was removed under intraoperative monitoring at our department. Histological analysis revealed large amorphous deposits and small islands of lymphoid cells. Conclusion LCCD is a very rare and obscure manifestation of primary central nervous system low-grade lymphomas that can be easily misdiagnosed by stereotactic biopsy sampling. If stereotactic biopsy does not reveal a definite result, a “wait-and-see” strategy can delay possible therapy for this disease. The impact of surgical removal, radiotherapy and chemotherapy in LCDD obviously remains controversial because of the low number of relevant cases.
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Affiliation(s)
- Marco Skardelly
- Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Baden-Wuerttemberg, Germany.
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Roder C, Bender B, Ritz R, Honegger J, Feigl G, Naegele T, Tatagiba MS, Ernemann U, Bisdas S. Intraoperative Visualization of Residual Tumor: The Role of Perfusion-Weighted Imaging in a High-Field Intraoperative Magnetic Resonance Scanner. Oper Neurosurg (Hagerstown) 2013; 72:ons151-8; discussion ons158. [DOI: 10.1227/neu.0b013e318277c606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractBACKGROUND:High-field, intraoperative magnetic resonance imaging (iMRI) achieves free tumor margins in glioma surgery by involving anatomic neuronavigation and sophisticated functional imaging.OBJECTIVE:To evaluate the role of perfusion-weighted iMRI as an aid to detect residual tumor and to guide its resection.METHODS:Twenty-two patients undergoing intraoperative scanning (in a dual-room 1.5-T magnet setting) during the resection of high-grade gliomas were examined with perfusion-weighted iMRI. The generated relative cerebral blood volume (rCBV) maps were scrutinized for any hot spots indicative of tumor remnants, and region-of-interest analysis was performed. Differences among the rCBV region-of-interest estimates in residual tumor, free tumor margins, and normal white matter were analyzed. Histopathology of the tissue specimens and the neurosurgeon's intraoperative macroscopic estimations were considered the reference standards.RESULTS:In all cases, diagnostic rCBV perfusion maps were generated. Interpretation of perfusion maps demonstrated that gross total resection of gliomas was achieved in 4 of 22 cases (18%), which was macroscopically and histopathologically verified, whereas in 18 of 22 cases (82%), the perfusion-weighted iMRI revealed hot spots indicating subtotal tumor removal. The latter proved to be true in all but 1 case. The receiver-operating characteristic curves of the qualitative visual and quantitative analyses showed excellent sensitivity and specificity rates. Statistical analysis demonstrated statistically significant differences for the mean rCBV and maximum rCBV between residual disease and tumor-free margins (P = .002 for both).CONCLUSION:Perfusion-weighted iMRI may be implemented easily into imaging protocols and may assist the surgeon in detecting residual tumor volume.
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Affiliation(s)
- Constantin Roder
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Tübingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| | - Jürgen Honegger
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| | - Günther Feigl
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| | - Thomas Naegele
- Department of Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Tübingen, Germany
| | | | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Tübingen, Germany
| | - Sotirios Bisdas
- Department of Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Tübingen, Germany
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Suesskind D, Scheiderbauer J, Buchgeister M, Partsch M, Budach W, Bartz-Schmidt KU, Ritz R, Grisanti S, Paulsen F. Retrospective Evaluation of Patients With Uveal Melanoma Treated by Stereotactic Radiosurgery With and Without Tumor Resection. JAMA Ophthalmol 2013; 131:630-7. [DOI: 10.1001/jamaophthalmol.2013.697] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kirschbaum A, Ritz R, Pehl A, Bartsch D. Giant intrathoracic left-sided vagal schwannoma. Thorac Cardiovasc Surg Rep 2013; 2:19-22. [PMID: 25360405 PMCID: PMC4176068 DOI: 10.1055/s-0033-1337368] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/18/2013] [Indexed: 10/29/2022] Open
Abstract
Extensive intrathoracic tumors are rarely diagnosed radiologically without pre-existing symptoms. If located in the posterior mediastinum, it is most probably a neurogenic tumor. Schwannoma is the most frequent neurogenic neoplasia in this location, and most schwannomas are benign. To specify the diagnosis, a thoracic computed tomography must be done; if the growth is close to the medullary canal, a magnetic resonance tomography of the spinal column is necessary to detect neuroforamen infiltration. Our surgical goal was complete excision of the tumor, although many authors favor a minimally invasive approach. In our patient we performed open, en bloc removal of the tumor; removal of parts of the intraforamen was also necessary, which necessitated revision of the affected neuroforamen. Histologically this was a very rare case of vagal schwannoma (which has an incidence of less than 6% of all neurogenic tumors). This patient has a very promising prognosis following complete tumor resection.
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Affiliation(s)
| | - Rainer Ritz
- Department of Neurosurgery, Marburg University Hospital, Marburg, Germany
| | - Anika Pehl
- Department of Pathology, Marburg University Hospital, Marburg, Germany
| | - Detlef Bartsch
- Department of Surgery, Marburg University Hospital, Marburg, Germany
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Feigl GC, Decker K, Wurms M, Krischek B, Ritz R, Unertl K, Tatagiba M. Neurosurgical procedures in the semisitting position: evaluation of the risk of paradoxical venous air embolism in patients with a patent foramen ovale. World Neurosurg 2013; 81:159-64. [PMID: 23295634 DOI: 10.1016/j.wneu.2013.01.003] [Citation(s) in RCA: 38] [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] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 08/05/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To analyze the actual risk for patients with a patent foramen ovale (PFO) to experience a clinically relevant venous air embolism (VAE) during surgery performed in the semisitting position. METHODS All procedures were performed between January 2008 and December 2009, under general anesthesia and in the semisitting position. Transesophageal echocardiography (TEE) and capnometry were used intraoperatively to monitor for air bubbles in the venous system. RESULTS Of 200 consecutive patients who all were operated on in the semisitting position, 52 patients (26%) had a diagnosis of PFO. Rates of VAE in patients were graded as follows: grade 0 (no air bubbles visible, no air embolism), 23 patients (44.2%); grade I (air bubbles on TEE), 22 patients (42.3%); grade II (air bubbles on TEE with decrease of end-tidal carbon dioxide [ETCO2] ≤ 3 mm Hg), 2 patients (3.8%); grade III, air bubbles on TEE with decrease of ETCO2 >3 mm Hg, 4 patients (7.7%); grade IV, air bubbles on TEE with decrease of ETCO2 >3 mm Hg and decrease of mean arterial pressure ≥ 20% or increase of heart rate ≥ 40% (or both), 1 patient (1.9%); and grade V, VAE causing arrhythmia with hemodynamic instability requiring cardiopulmonary resuscitation, 0 patients (0%). There were no deaths in this series, and no new or unexplained, mild or severe neurologic deficits were caused by a VAE. CONCLUSIONS Under standardized anesthesia and neurosurgical protocols, patients with a PFO can be operated on safely in the semisitting position.
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Affiliation(s)
- Guenther C Feigl
- Department of Neurosurgery, University of Tübingen Medical Center, Tübingen, Germany.
| | - Karlheinz Decker
- Department of Anesthesiology, University of Tübingen Medical Center, Tübingen, Germany
| | - Max Wurms
- Department of Neurosurgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Boris Krischek
- Department of Neurosurgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Klaus Unertl
- Department of Anesthesiology, University of Tübingen Medical Center, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen Medical Center, Tübingen, Germany
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Ritz R, Scheidle C, Noell S, Roser F, Schenk M, Dietz K, Strauss WSL. In vitro comparison of hypericin and 5-aminolevulinic acid-derived protoporphyrin IX for photodynamic inactivation of medulloblastoma cells. PLoS One 2012; 7:e51974. [PMID: 23251668 PMCID: PMC3522623 DOI: 10.1371/journal.pone.0051974] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 11/21/2011] [Accepted: 11/12/2012] [Indexed: 11/25/2022] Open
Abstract
Background Hypericin (HYP) is a naturally occurring photosensitizer. Cellular uptake and photodynamic inactivation after incubation with this photosensitizer have neither been examined in medulloblastoma cells in vitro, nor compared with 5-aminolevulinic acid-derived protoporphyrin IX (5-ALA-derived PpIX). Methods In 3 medulloblastoma cell lines (D283 Med, Daoy, and D341 Med) the time- and concentration-dependent intracellular accumulation of HYP and 5-ALA-derived PpIX was analyzed by fluorescence microscopy (FM) and FACS. Photocytotoxicity was measured after illumination at 595 nm (HYP) and 635 nm (5-ALA-derived PpIX) in D283 Med cells and compared to U373 MG glioma cells. Results All medulloblastoma cell lines exhibited concentration- and time-dependent uptake of HYP. Incubation with HYP up to 10 µM resulted in a rapid increase in fluorescence intensity, which peaked between 2 and 4 hours. 5-ALA-derived PpIX accumulation increased in D283 Med cells by 22% over baseline after 5-ALA incubation up to 1.2 mM. Photocytotoxicity of 5-ALA-derived PpIX was higher in D283 Med medulloblastoma compared to U373MG glioma. The [lethal dose (light dose that is required to reduce cell survival to 50% of control)] of 5-ALA-derived PpIX was 3.8 J/cm2 in D283 Med cells versus 5.7 J/cm2 in U373MG glioma cells. Photocytotoxicity of HYP in D283 Med cells was determined at 2.5 µM after an incubation time of 2 h and an illumination wavelength of 595 nm. The value was 0.47 J/cm2. Conclusion By its 5-fold increase in fluorescence over autofluorescence levels HYP has excellent properties for tumor visualization in medulloblastomas. The high photocytotoxicity of HYP, compared to 5-ALA-derived PpIX, is convincingly demonstrated by its 8- to 13-fold lower . Therefore HYP might be a promising molecule for intraoperative visualization and photodynamic treatment of medulloblastomas.
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Affiliation(s)
- Rainer Ritz
- Department of Neurosurgery, Eberhard Karls University Tübingen, Tübingen, Germany.
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Noell S, Ritz R, Wolburg-Buchholz K, Wolburg H, Fallier-Becker P. An allograft glioma model reveals the dependence of aquaporin-4 expression on the brain microenvironment. PLoS One 2012; 7:e36555. [PMID: 22590566 PMCID: PMC3348884 DOI: 10.1371/journal.pone.0036555] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 02/20/2012] [Accepted: 04/06/2012] [Indexed: 11/18/2022] Open
Abstract
Aquaporin-4 (AQP4), the main water channel of the brain, is highly expressed in animal glioma and human glioblastoma in situ. In contrast, most cultivated glioma cell lines don’t express AQP4, and primary cell cultures of human glioblastoma lose it during the first passages. Accordingly, in C6 cells and RG2 cells, two glioma cell lines of the rat, and in SMA mouse glioma cell lines, we found no AQP4 expression. We confirmed an AQP4 loss in primary human glioblastoma cell cultures after a few passages. RG-2 glioma cells if grafted into the brain developed AQP4 expression. This led us consider the possibility of AQP4 expression depends on brain microenvironment. In previous studies, we observed that the typical morphological conformation of AQP4 as orthogonal arrays of particles (OAP) depended on the extracellular matrix component agrin. In this study, we showed for the first time implanted AQP4 negative glioma cells in animal brain or flank to express AQP4 specifically in the intracerebral gliomas but neither in the extracranial nor in the flank gliomas. AQP4 expression in intracerebral gliomas went along with an OAP loss, compared to normal brain tissue. AQP4 staining in vivo normally is polarized in the astrocytic endfoot membranes at the glia limitans superficialis and perivascularis, but in C6 and RG2 tumors the AQP4 staining is redistributed over the whole glioma cell as in human glioblastoma. In contrast, primary rat or mouse astrocytes in culture did not lose their ability to express AQP4, and they were able to form few OAPs.
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Affiliation(s)
- Susan Noell
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | | | - Hartwig Wolburg
- Institute of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Petra Fallier-Becker
- Institute of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
- * E-mail:
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Feigl G, Krischek B, Ritz R, Ramina K, Korn A, Tatagiba M. Navigated Transconjunctival Endoscopic Approaches to the Orbit. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312089] [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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Ritz R, Daniels R, Noell S, Feigl GC, Schmidt V, Bornemann A, Ramina K, Mayer D, Dietz K, Strauss WSL, Tatagiba M. Hypericin for visualization of high grade gliomas: first clinical experience. Eur J Surg Oncol 2012; 38:352-60. [PMID: 22284346 DOI: 10.1016/j.ejso.2011.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 09/19/2011] [Accepted: 12/19/2011] [Indexed: 11/30/2022] Open
Abstract
AIMS We aimed to demonstrate that Hypericin, a component of St. Johns Wort, selectively visualizes malignant gliomas. Hypericin is known as one of the most powerful photosensitizers in nature with excellent fluorescent properties. METHODS In five patients with a recurrence of a malignant glioma a newly developed water soluble formulation of hypericin was given intravenously (0.1 mg/kg body weight) 6 h before the surgical procedure. Tumor resection was performed under white light and fluorescence mode. The intensity grade of the tissue fluorescence was categorisized by the surgeon in three grades, highly fluorescent, weakly fluorescent and not fluorescent. In these areas tissue samples were taken and investigated by two blinded independent neuropathologists. Tissue samples were histologically classified differentiating between tumor tissue, tumor necrosis, tissue with scattered tumor cells and normal brain tissue. RESULTS In all patients tumor tissue was clearly distinguishable by its typically red fluorescence color from normal brain tissue which was colored blue under a special fluorescent filter. Histological evaluation of the 110 tissue samples showed a specificity of 100% and sensitivity of 91% for one of the two neuropathologists, whereas specificity for second pathologist was 90% and sensitivity 94%. The i.v. application of Hypericin proofed to be safe in all cases and there were no side effects observed. CONCLUSION Hypericin in its water soluble form is a well tolerated drug. In addition to its high photosensitizing properties hypericin will open up interesting new therapeutic possibilities especially when used in combination with fluorescence detection and simultaneously photodynamic therapy.
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Affiliation(s)
- R Ritz
- Klinik für Neurochirurgie, Eberhard Karls Universität Tübingen, Germany.
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Horger M, Ritz R, Beschorner R, Fenchel M, Nägele T, Danz S, Ernemann U. Spinal pilocytic astrocytoma: MR imaging findings at first presentation and following surgery. Eur J Radiol 2011; 79:389-99. [DOI: 10.1016/j.ejrad.2010.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 04/15/2010] [Accepted: 04/15/2010] [Indexed: 11/15/2022]
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Bisdas S, Naegele T, Ritz R, Dimostheni A, Pfannenberg C, Reimold M, Koh TS, Ernemann U. Distinguishing recurrent high-grade gliomas from radiation injury: a pilot study using dynamic contrast-enhanced MR imaging. Acad Radiol 2011; 18:575-83. [PMID: 21419671 DOI: 10.1016/j.acra.2011.01.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The accurate delineation of tumor recurrence and its differentiation from radiation injury in the follow-up of adjuvantly treated high-grade gliomas presents a significant problem in neuro-oncology. The aim of this study was to investigate whether hemodynamic parameters derived from dynamic contrast-enhanced (DCE) T1-weighted magnetic resonance imaging (MRI) can be used to distinguish recurrent gliomas from radiation necrosis. MATERIALS AND METHODS Eighteen patients who were being treated for glial neoplasms underwent prospectively conventional and DCE-MRI using a 3T scanner. The pharmacokinetic modelling was based on a two-compartment model that allows for the calculation of K(trans) (transfer constant between intra- and extravascular, extracellular space), v(e) (extravascular, extracellular space), k(ep) (transfer constant from the extracellular, extravascular space into the plasma), and iAUC (initial area under the signal intensity-time curve). Regions of interest (ROIs) were drawn around the entire recurrence-suspected contrast-enhanced region. A definitive diagnosis was established at subsequent surgical resection or clinicoradiologic follow-up. The hemodynamic parameters in the contralateral normal white matter, the radiation injury sites, and the tumor recurrent lesions were compared using nonparametric tests. RESULTS The K(trans), v(e), k(ep), and iAUC values in the normal white matter were significantly different than those in the radiation necrosis and recurrent gliomas (0.01, <P < .0001). The only significantly different hemodynamic parameter between the recurrent tumor lesions and the radiation-induced necrotic sites were K(trans) and iAUC, which were significantly higher in the recurrent glioma group than in the radiation necrosis group (P ≤ .0184). A K(trans) cutoff value higher than 0.19 showed 100% sensitivity and 83% specificity for detecting the recurrent gliomas, whereas an iAUC cutoff value higher than 15.35 had 71% sensitivity and 71% specificity. The v(e) and k(ep) values in recurrent tumors were not significantly higher than those in radiation-induced necrotic lesions. CONCLUSIONS These findings suggest that DCE-MRI may be used to distinguish between recurrent gliomas and radiation injury and thus, assist in follow-up patient management strategy.
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Ritz R, Feigl GC, Schuhmann MU, Ehrhardt A, Danz S, Noell S, Bornemann A, Tatagiba MS. Use of 5-ALA fluorescence guided endoscopic biopsy of a deep-seated primary malignant brain tumor. J Neurosurg 2011; 114:1410-3. [DOI: 10.3171/2010.11.jns10250] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The introduction of fluorescence-guided resection of primary malignant brain tumors was a milestone in neurosurgery. Deep-seated malignant brain tumors are often not approachable for microsurgical resection. For diagnosis and therapy, new strategies are recommended. The combination of endoscopy and 5-aminolevulinic acid–induced protoporphyrin IX (5-ALA-induced Pp IX) fluorescence–guided procedures supported by neuronavigation seems an interesting option. Here the authors report on a combined approach for 5-ALA fluorescence–guided biopsy in which they use an endoscopy system based on an Xe lamp (excitation approximately λ = 407 nm; dichroic filter system λ = 380–430 nm) to treat a malignant tumor of the thalamus and perform a ventriculostomy and septostomy. The excitation filter and emission filter are adapted to ensure that the remaining visible blue remission is sufficient to superimpose on or suppress the excited red fluorescence of the endogenous fluorochromes. The authors report that the lesion was easily detectable in the fluorescence mode and that biopsy led to histological diagnosis.
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Affiliation(s)
| | | | | | | | | | | | - Antje Bornemann
- 4Institute of Brain Research, University of Tübingen Medical Center, Tübingen; and
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Noell S, Mayer D, Strauss WSL, Tatagiba MS, Ritz R. Selective enrichment of hypericin in malignant glioma: pioneering in vivo results. Int J Oncol 2011; 38:1343-8. [PMID: 21399870 DOI: 10.3892/ijo.2011.968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 01/18/2011] [Indexed: 11/05/2022] Open
Abstract
Malignant gliomas are diffuse infiltrative growing tumors with a poor prognosis despite treatment with a combination of surgery, radiotherapy and chemotherapy. It has been shown recently that complete tumor resection improves the survival time significantly. Hypericin, a component of St. Johns Wort, is one of the most powerful photosensitizers in nature. The aim of the present study was to investigate accumulation of hypericin in intracerebral implanted malignant glioma in vivo. Rats underwent stereotactic implantation of C6 glioma cells. After intravenous administration of hypericin (5 mg per kg body weight), accumulation of the compound was studied in tumor, the infiltration zone surrounding the tumor and healthy brain (contralateral hemisphere) by fluorescence microscopy between 0 and 48 h after injection. Results were compared by one-way analysis of variance. For post hoc pair-wise comparison the Tukey-Kramer HSD test was used. Accumulation of hypericin was significantly higher in C6 glioma as compared to normal tissue. Maximum hypericin uptake was achieved at 24 h after injection. Ratios of fluorescence intensity between tumor and normal tissue as well as infiltration zone and normal tissue of about 6.1:1 and 1.4:1 were found. Considering tissue auto-fluorescence, fluorescence ratios of about 19.8:1 and 2.5:1 were calculated, respectively. Therefore, hypericin seems to be quite an effective fluorescence marker for the detection of glioma in vivo. To the best of our knowledge, the present study demonstrates for the first time that hypericin accumulates selectively in intracerebral implanted C6 glioma in vivo after systemic (intravenous) administration.
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Affiliation(s)
- Susan Noell
- Department of Neurosurgery, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
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Feigl GC, Ritz R, Moraes M, Klein J, Ramina K, Gharabaghi A, Krischek B, Danz S, Bornemann A, Liebsch M, Tatagiba MS. Resection of malignant brain tumors in eloquent cortical areas: a new multimodal approach combining 5-aminolevulinic acid and intraoperative monitoring. J Neurosurg 2010; 113:352-7. [PMID: 19911888 DOI: 10.3171/2009.10.jns09447] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Several studies have revealed that the gross-total resection (GTR) of malignant brain tumors has a significant influence on patient survival. Frequently, however, GTR cannot be achieved because the borders between healthy brain and diseased tissue are blurred in the infiltration zones of malignant brain tumors. Especially in eloquent cortical areas, resection is frequently stopped before total removal is achieved to avoid causing neurological deficits. Interestingly, 5-aminolevulinic acid (5-ALA) has been shown to help visualize tumor tissue intraoperatively and, thus, can significantly improve the possibility of achieving GTR of primary malignant brain tumors. The aim of this study was to go one step further and evaluate the utility and limitations of fluorescence-guided resections of primary malignant brain tumors in eloquent cortical areas in combination with intraoperative monitoring based on multimodal functional imaging data. METHODS Eighteen patients with primary malignant brain tumors in eloquent areas were included in this prospective study. Preoperative neuroradiological examinations included MR imaging with magnetization-prepared rapid gradient echo (MPRAGE), functional MR, and diffusion tensor imaging sequences to visualize functional areas and fiber tracts. Imaging data were analyzed offline, loaded into a neuronavigational system, and used intraoperatively during resections. All patients received 5-ALA 6 hours before surgery. Fluorescence-guided tumor resections were combined with intraoperative monitoring and cortical as well as subcortical stimulation to localize functional areas and fiber tracts during surgery. RESULTS Twenty-five procedures were performed in 18 consecutive patients. In 24% of all surgeries, resection was stopped because a functional area or cortical tract was identified in the resection area or because motor evoked potential amplitudes were reduced in an area where fluorescent tumor cells were still seen intraoperatively. Grosstotal resection could be achieved in 16 (64%) of the surgeries with preservation of all functional areas and fiber tracts. In 2 patients presurgical hemiparesis became accentuated postoperatively, and 1 of these patients also suffered from a new homonymous hemianopia following a second resection. CONCLUSIONS The authors' first results show that tumor resections with 5-ALA in combination with intraoperative cortical stimulation have the advantages of both methods and, thus, provide additional safety for the neurosurgeon during resections of primary malignant brain tumors in eloquent areas. Nonetheless, more cases and additional studies are necessary to further prove the advantages of this multimodal strategy.
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Affiliation(s)
- Guenther C Feigl
- Department of Neurosurgery, University of Tuebingen Medical Center, Tuebingen, Germany.
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Pfleiderer C, Adams T, Bauer A, Biberacher W, Binz B, Birkelbach F, Böni P, Franz C, Georgii R, Janoschek M, Jonietz F, Keller T, Ritz R, Mühlbauer S, Münzer W, Neubauer A, Pedersen B, Rosch A. Skyrmion lattices in metallic and semiconducting B20 transition metal compounds. J Phys Condens Matter 2010; 22:164207. [PMID: 21386413 DOI: 10.1088/0953-8984/22/16/164207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
High pressure studies in MnSi suggest the existence of a non-Fermi liquid state without quantum criticality. The observation of partial magnetic order in a small pocket of the pressure versus temperature phase diagram of MnSi has additionally inspired several proposals of complex spin textures in chiral magnets. We used neutron scattering to observe the formation of a two-dimensional lattice of skyrmion lines, a type of magnetic vortices, under applied magnetic fields in metallic and semiconducting B20 compounds. In strongly disordered systems the skyrmion lattice is hysteretic and extends over a large temperature range. Our study experimentally establishes magnetic materials lacking inversion symmetry as an arena for new forms of spin order composed of topologically stable spin textures.
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Affiliation(s)
- C Pfleiderer
- Physik Department E21, TU München, D-85748 Garching, Germany.
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Zuber M, Ritz R. Fall 1508. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0029-1235988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pfister C, Ritz R, Endemann E, Schittenhelm J, Bornemann A, Tatagiba MS, Roser F. Evidence of ubiquitous in vivo and in vitro expression of pro-apoptotic Smac/DIABLO protein in meningioma cell lines. Oncol Rep 2009; 21:1181-8. [PMID: 19360292 DOI: 10.3892/or_00000339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Although meningiomas are one of the most common tumors in the central nervous system, the adjuvant treatment for recurrent or malignant meningiomas is not satisfactory. An intense interest in evaluating new molecular markers that may serve as potential therapeutic targets exists. Changes in apoptosis mechanisms play important roles in tumor pathogenesis. One pro-apoptotic protein is Smac/DIABLO, which neutralizes the inhibitors of apoptosis (IAPs). As Smac/DIABLO has not been previously analyzed in meningiomas, We investigated the expression of Smac/DIABLO and survivin in primary meningioma cultures in vivo and in vitro. Expression of Smac/DIABLO, survivin and single-stranded (ss)DNA in vivo were determined immunohistochemically in 100 meningioma surgical specimens, dura and normal human cortex. The expression of the apoptotic enzymes in vitro was analyzed after RNA and protein isolation of all meningiomas via Western blotting and PCR. All examined meningiomas and normal cerebral cortex displayed intense positive cytoplasmic Smac/DIABLO immunoreactivity. Survivin and ssDNA were expressed in all surgical specimens and showed weak staining overall. Examination of Smac/DIABLO protein via Western blotting showed distinct signals in the cytoplasmic extracts. PCR analysis displayed no changes of Smac/DIABLO and survivin expression in different meningioma grades, normal human cortical cortex or dura. Constant high-level Smac/DIABLO respectively low-level survivin expression in meningiomas and normal brain demonstrate similar apoptotic behavior of meningiomas compared to normal brain tissue. These findings indicate no pathological overexpression of survivin in meningiomas as is evident in several other cancer types impeding apoptosis.
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Affiliation(s)
- Christina Pfister
- Department of Neurosurgery, University of Tübingen, D-72076 Tübingen, Germany
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Zuber M, Ritz R. Fall 1418. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0029-1236214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Gonon M, Ritz R. Fall 2090. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0029-1235250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ritz R. Patientenüberwachung - aus klinischer Sicht. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.1988.33.s2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Neubauer A, Pfleiderer C, Binz B, Rosch A, Ritz R, Niklowitz PG, Böni P. Topological Hall effect in the A phase of MnSi. Phys Rev Lett 2009; 102:186602. [PMID: 19518895 DOI: 10.1103/physrevlett.102.186602] [Citation(s) in RCA: 342] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Indexed: 05/12/2023]
Abstract
Recent small angle neutron scattering suggests that the spin structure in the A phase of MnSi is a so-called triple-Q state, i.e., a superposition of three helices under 120 degrees. Model calculations indicate that this structure in fact is a lattice of so-called Skyrmions, i.e., a lattice of topologically stable knots in the spin structure. We report a distinct additional contribution to the Hall effect in the temperature and magnetic field range of the proposed Skyrmion lattice, where such a contribution is neither seen nor expected for a normal helical state. Our Hall effect measurements constitute a direct observation of a topologically quantized Berry phase that identifies the spin structure seen in neutron scattering as the proposed Skyrmion lattice.
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Affiliation(s)
- A Neubauer
- Physik Department E21, Technische Universität München, James-Franck-Strasse, D-85748 Garching, Germany
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Pfleiderer C, Neubauer A, Mühlbauer S, Jonietz F, Janoschek M, Legl S, Ritz R, Münzer W, Franz C, Niklowitz PG, Keller T, Georgii R, Böni P, Binz B, Rosch A, Rößler UK, Bogdanov AN. Quantum order in the chiral magnet MnSi. J Phys Condens Matter 2009; 21:164215. [PMID: 21825395 DOI: 10.1088/0953-8984/21/16/164215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Systems lacking inversion symmetry, such as selected three-dimensional compounds, multilayers and surfaces support Dzyaloshinsky-Moriya (DM) spin-orbit interactions. In recent years DM interactions have attracted great interest, because they may stabilize magnetic structures with a unique chirality and non-trivial topology. The inherent coupling between the various properties provided by DM interactions is potentially relevant for a variety of applications including, for instance, multiferroic and spintronic devices. The, perhaps, most extensively studied material in which DM interactions are important is the cubic B20 compound MnSi. We review the magnetic field and pressure dependence of the magnetic properties of MnSi. At ambient pressure this material displays helical order. Under hydrostatic pressure a non-Fermi liquid state emerges, where a partial magnetic order, reminiscent of liquid crystals, is observed in a small pocket. Recent experiments strongly suggest that the non-Fermi liquid state is not due to quantum criticality. Instead it may be the signature of spin textures and spin excitations with a non-trivial topology.
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Affiliation(s)
- C Pfleiderer
- Physik Department E21, Technische Universität München, D-85748 Garching, Germany
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Abstract
BACKGROUND Myocardial infarction (MI) in young adults is a rare event. In the Framingham study, the 10-year incidence rate of MI per 1,000 was 12.9 in men 30-34 years old. Overall, 4-8% of patients with acute MI are < or = 40 years old. HYPOTHESIS It was the purpose of this study to assess the in-hospital and long-term morbidity and mortality in patients < or = 40 years old with acute myocardial infarction compared with older patients in the thrombolytic era. METHODS A consecutive series of 75 patients aged < or = 40 years (mean 35.0 +/- 4.8) with acute myocardial infarction was compared with an equally sized group of patients aged > 40 years (mean 65.1 +/- 9.8). RESULTS Thrombolysis or direct percutaneous transluminal coronary angioplasty was performed in 52 versus 24% (p = 0.0004) and 5.3 versus 2.7% (p = NS) in younger and older patients, respectively. Significantly fewer young patients had multivessel disease (28 vs. 64%, p < 0.004). No in-hospital mortality was observed in patients with reperfusion therapy irrespective of age. After a mean followup time of 47 +/- 35 months, cardiac mortality was 0 and 11% (p < 0.03), respectively, in young and older patients with, and 3 versus 24% (p < 0.02) without reperfusion therapy, respectively. In addition, significantly fewer patients in the younger age group developed recurrent angina pectoris (12 vs. 39%, p = 0.0004) or congestive heart failure (9 vs. 34%, p = 0.0005) irrespective of reperfusion therapy. CONCLUSION Our observations demonstrate that long-term prognosis after myocardial infarction in young patients is excellent in the thrombolytic era.
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Affiliation(s)
- J U Füllhaas
- Department of Internal Medicine, University Hospital, Basel, Switzerland
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Abstract
Extragonadal teratomas in adulthood are exceptionally rare and usually not located within the cerebellum. We here report on a 66-year-old male patient clinically presenting with chronic occipital headache and episodes of severe vertigo. Neuroradiological investigations revealed a hemorrhagic tumor mass in the cerebellar vermis which was surgically removed and histologically diagnosed as mature teratoma. Hence, the presented case is extraordinary with regard to age, late clinical onset of symptoms and cerebellar location. Late clinical manifestation of the tumor in this case is probably due to an acute late-onset hemorrhage within the tumor.
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Affiliation(s)
- Rudi Beschorner
- Institute for Brain Research, University Hospital of Tuebingen, Tuebingen, Germany.
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Ritz R, Roser F, Radomski N, Strauss WSL, Tatagiba M, Gharabaghi A. Subcellular colocalization of hypericin with respect to endoplasmic reticulum and Golgi apparatus in glioblastoma cells. Anticancer Res 2008; 28:2033-2038. [PMID: 18751371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND To improve the poor prognosis of patients suffering from malignant glioma, hypericin (HYP)-based photodynamic therapy might be a promising approach. Intracellular localization of HYP was investigated by quantitative colocalization analysis with respect to endoplasmic reticulum (ER) and Golgi apparatus (GA) by double staining experiments with fluorescence microscopy. MATERIALS AND METHODS U373 MG glioblastoma cells were stained with HYP and costainings were applied for specific organelle markers for ER and GA. RESULTS In cells double-stained with HYP and ER-Tracker, 57% of HYP signals were found within the ER and 52% of the ER compartment showed HYP signals. The colocalization fraction of HYP found in the GA was 36% and 46% of the GA showed HYP signals. CONCLUSION In glioblastoma cells, a considerable fraction of HYP is localized in the ER; in addition, a significant amount of the photosensitizer shows colocalization with the GA.
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Affiliation(s)
- Rainer Ritz
- Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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Ritz R, Müller M, Dietz K, Duffner F, Bornemann A, Roser F, Tatagiba M. Hypericin uptake: A prognostic marker for survival in high-grade glioma. J Clin Neurosci 2008; 15:778-83. [DOI: 10.1016/j.jocn.2007.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Revised: 02/12/2007] [Accepted: 03/20/2007] [Indexed: 11/25/2022]
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Roser F, Ebner FH, Danz S, Riether F, Ritz R, Dietz K, Naegele T, Tatagiba MS. Three-dimensional constructive interference in steady-state magnetic resonance imaging in syringomyelia: advantages over conventional imaging. J Neurosurg Spine 2008; 8:429-35. [PMID: 18447688 DOI: 10.3171/spi/2008/8/5/429] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Neuroradiology has become indispensable in detecting the pathophysiology in syringomyelia. Constructive interference in steady-state (CISS) magnetic resonance (MR) imaging can provide superior contrast at the sub-arachnoid tissue borders. As this region is critical in preoperative evaluation, the authors hypothesized that CISS imaging would provide superior assessment of syrinx pathology and surgical planning. METHODS Based on records collected from a database of 130 patients with syringomyelia treated at the authors' institution, 59 patients were prospectively evaluated with complete neuroradiological examinations. In addition to routine acquisitions with FLAIR, T1- and T2-weighted, and contrast-enhanced MR imaging series, the authors obtained sagittal cardiac-gated sequences to visualize cerebrospinal fluid (CSF) pulsations and axial 3D CISS MR sequences to detect focal arachnoid webs. Statistical qualitative and quantitative evaluations of spinal cord/CSF contrast, spinal cord/CSF delineation, motion artifacts, and artifacts induced by pulsatile CSF flow were performed. RESULTS The 3D CISS MR sequences demonstrated a contrast-to-noise ratio significantly better than any other routine imaging sequence (p < 0.001). Moreover, 3D CISS imaging can detect more subarachnoid webs and cavitations in the syrinx than T2-weighted MR imaging with less flow-void artifact. The limitation of 3D CISS imaging is a susceptibility to motion artifacts that can cause reduced spatial resolution. Lengthy acquisition times for axial segments can be reduced with multiplanar reconstruction of 3D CISS-generated sagittal images. CONCLUSIONS Constructive interference in steady-state imaging is the MR sequence of choice in the preoperative evaluation of syringomyelia, allowing significantly higher detection rates of focal subarachnoid webs, whereas standard T2-weighted MR imaging shows turbulent CSF flow voids. Constructive interference in steady-state MR imaging enables the neurosurgeon to accurately identify cases requiring decompression for obstructed CSF. Motion artifacts can be eliminated with technical variations.
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Affiliation(s)
- Florian Roser
- Department of Neurosurgery, University of Tübingen, Germany.
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Ritz R, Heckl S, Safavi-Abbasi S, Feigl GC, Krischek B, Lüdemann W, Mirzayan JM, Koerbel A, Samii M, Tatagiba M, Gharabaghi A. Predictive factors for beneficial application of high-frequency electromagnetics for tumour vaporization and coagulation in neurosurgery. World J Surg Oncol 2008; 6:45. [PMID: 18445296 PMCID: PMC2408575 DOI: 10.1186/1477-7819-6-45] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 04/29/2008] [Indexed: 12/03/2022] Open
Abstract
Objective To identify preoperative and intraoperative factors and conditions that predicts the beneficial application of a high-frequency electromagnetic field (EMF) system for tumor vaporization and coagulation. Methods One hundred three subsequent patients with brain tumors were microsurgically treated using the EMF system in addition to the standard neurosurgical instrumentarium. A multivariate analysis was performed regarding the usefulness (ineffective/useful/very helpful/essential) of the new technology for tumor vaporization and coagulation, with respect to tumor histology and location, tissue consistency and texture, patients' age and sex. Results The EMF system could be used effectively during tumor surgery in 83 cases with an essential contribution to the overall success in 14 cases. In the advanced category of effectiveness (very helpful/essential), there was a significant difference between hard and soft tissue consistency (50 of 66 cases vs. 3 of 37 cases). The coagulation function worked well (very helpful/essential) for surface (73 of 103 cases) and spot (46 of 103 cases) coagulation when vessels with a diameter of less than one millimeter were involved. The light-weight bayonet hand piece and long malleable electrodes made the system especially suited for the resection of deep-seated lesions (34 of 52 cases) compared to superficial tumors (19 of 50 cases). The EMF system was less effective than traditional electrosurgical devices in reducing soft glial tumors. Standard methods where also required for coagulation of larger vessels. Conclusion It is possible to identify factors and conditions that predict a beneficial application of high-frequency electromagnetics for tumor vaporization and coagulation. This allows focusing the use of this technology on selective indications.
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Affiliation(s)
- Rainer Ritz
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany.
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Essen RV, Merx W, Neis W, Ritz R. Wirkung von Metoprolol auf die Infarkfgröße beim akuten Myokardinfarkt: Doppelblindstudie. Dtsch Med Wochenschr 2008. [DOI: 10.1055/s-2008-1070113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Planta MV, Ritz R. Konservative Prinzipien in der Therapie der Subarachnoidalblutung. Dtsch Med Wochenschr 2008. [DOI: 10.1055/s-2008-1068631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weiss P, Ritz R. Analgetische Wirkung und Nebenwirkungen von Buprenorphin bei der akuten koronaren Herzkrankheit. Anasthesiol Intensivmed Notfallmed Schmerzther 2008. [DOI: 10.1055/s-2007-1001637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pfister C, Ritz R, Pfrommer H, Bornemann A, Tatagiba MS, Roser F. Are there attacking points in the eicosanoid cascade for chemotherapeutic options in benign meningiomas? Neurosurg Focus 2007; 23:E8. [DOI: 10.3171/foc-07/10/e8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The current treatment for recurrent or malignant meningiomas with adjuvant therapies has not been satisfactory, and there is an intense interest in evaluating new molecular markers to act as therapeutic targets. Enzymes of the arachidonic acid (AA) cascade such as cyclooxygenase (COX)–2 or 5-lipoxygenase (5-LO) are upregulated in a number of epithelial tumors, but to date there are hardly any data about the expression of these markers in meningiomas. To find possible targets for chemotherapeutic intervention, the authors evaluated the expression of AA derivatives at different molecular levels in meningiomas.
Methods
One hundred and twenty-four meningioma surgical specimens and normal human cortical tissue samples were immunohistochemically and cytochemically stained for COX-2, COX-1, 5-LO, and prostaglandin E receptor 4 (PTGER4). In addition, Western blot and polymerase chain reaction (PCR) analyses were performed to detect the presence of eicosanoids in vivo and in vitro.
Results
Sixty (63%) of 95 benign meningiomas, 21 (88%) of 24 atypical meningiomas, all five malignant meningiomas, and all normal human cortex samples displayed high COX-2 immunoreactivity. All cultured specimens and IOMM-Lee cells stained positive for COX-2, COX-1, 5-LO, and PTGER4. The PCR analysis demonstrated no changes in eicosanoid expression among meningiomas of different World Health Organization grades and in normal human cortical and dura mater tissue.
Conclusions
Eicosanoid derivatives COX-1, COX-2, 5-LO, and PTGER4 enzymes show a high universal expression in meningiomas but are not upregulated in normal human cortex and dura tissue. This finding of the ubiquitous presence of these enzymes in meningiomas offers an excellent baseline for testing upcoming chemotherapeutic treatments.
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Affiliation(s)
| | | | | | - Antje Bornemann
- 2the Institute of Brain Research, University of Tübingen, Germany
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Mittelbronn M, Schittenhelm J, Lemke D, Ritz R, Nägele T, Weller M, Meyermann R, Beschorner R. Low grade ganglioglioma rapidly progressing to a WHO grade IV tumor showing malignant transformation in both astroglial and neuronal cell components. Neuropathology 2007; 27:463-7. [PMID: 18018481 DOI: 10.1111/j.1440-1789.2007.00800.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michel Mittelbronn
- Institute of Brain Research, University of Tuebingen, Tuebingen, Germany.
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