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Matovu A, Löfgren J, Wladis A, Nordin P, Sandblom G, Pettersson HJ. Incidence of groin hernia repairs in women and parity: a population-based cohort study among women born in Sweden between 1956 and 1983. Hernia 2024:10.1007/s10029-024-03011-1. [PMID: 38520614 DOI: 10.1007/s10029-024-03011-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women. METHOD This study was based on two Swedish national registers, the Medical Birth Register (MBR), and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries. RESULTS A total of 1,535,379 women were born between 1956 and 1983. Among these, 1,417,237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100,000 person-year and 2.6 per 100,000 person-year, respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23-1.40) among women registered for two deliveries, 1.70 (1.58-1.82) among women registered for ≥ 3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14-1.49) and 1.70 (1.49-1.95) for FHR among women with two and ≥ 3 registered deliveries, respectively. CONCLUSION In the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.
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Affiliation(s)
- A Matovu
- Mubende Regional Referral Hospital, Plot 6, Kakumiro Road, P.O. Box 4, Mubende, Uganda.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - J Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Wladis
- Linköping University, Linköping, Sweden
| | - P Nordin
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - G Sandblom
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - H J Pettersson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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2
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Löfgren J, Ramsey-Musolf MJ, Schicho P, Tenkanen TVI. Nucleation at Finite Temperature: A Gauge-Invariant Perturbative Framework. Phys Rev Lett 2023; 130:251801. [PMID: 37418724 DOI: 10.1103/physrevlett.130.251801] [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] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/06/2023] [Accepted: 05/18/2023] [Indexed: 07/09/2023]
Abstract
We present a gauge-invariant framework for bubble nucleation in theories with radiative symmetry breaking at high temperature. As a procedure, this perturbative framework establishes a practical, gauge-invariant computation of the leading order nucleation rate, based on a consistent power counting in the high-temperature expansion. In model building and particle phenomenology, this framework has applications such as the computation of the bubble nucleation temperature and the rate for electroweak baryogenesis and gravitational wave signals from cosmic phase transitions.
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Affiliation(s)
- Johan Löfgren
- Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20 Uppsala, Sweden
| | - Michael J Ramsey-Musolf
- Amherst Center for Fundamental Interactions, Department of Physics, University of Massachusetts, Amherst, Massachusetts 01003, USA
- Kellogg Radiation Laboratory, California Institute of Technology, Pasadena, California 91125 USA
- Tsung-Dao Lee Institute and School of Physics and Astronomy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
- Shanghai Key Laboratory for Particle Physics and Cosmology, Key Laboratory for Particle Astrophysics & Cosmology (MOE), Shanghai Jiao Tong University, Shanghai 200240, China
| | - Philipp Schicho
- Department of Physics and Helsinki Institute of Physics, P.O. Box 64, FI-00014 University of Helsinki, Finland
| | - Tuomas V I Tenkanen
- Tsung-Dao Lee Institute and School of Physics and Astronomy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
- Shanghai Key Laboratory for Particle Physics and Cosmology, Key Laboratory for Particle Astrophysics & Cosmology (MOE), Shanghai Jiao Tong University, Shanghai 200240, China
- Nordita, KTH Royal Institute of Technology and Stockholm University, Roslagstullsbacken 23, SE-106 91 Stockholm, Sweden
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Bladin O, Young N, Nordquist J, Roy J, Järnbert Pettersson H, Sandblom G, Löfgren J. OC-047 LEARNING CURVE IN HERNIA SURGERY- A REGISTER BASED STUDY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.059] [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: 11/12/2022]
Abstract
Abstract
Aim
The purpose of this study was to investigate the learning curve of open anterior mesh repair for groin hernia by assessing hernia recurrence rates, surgical complications, and operative times in relation to the number of procedures performed by surgical trainees.
Materials & Methods
Nationwide data on open anterior mesh repair for groin hernia performed by surgical residents were collected from the Swedish Hernia Register between 2005 and 2020. Data were analyzed in a cohort of procedures carried out by surgeons performing their first registered repair as resident. Repairs performed by surgeons who had carried out less than 30 repairs or any repair 1992–2005 were excluded.
Results
The study group consisted of 38 854 repairs carried out by 663 surgeons. The complication rate increased from 298/9884 (3.0%) the first 15 repairs performed to 396/10978 (3.6%) repairs 31–60 and then decreased to 4/945 (0.4%) for repairs performed after the first 240 ones. Mean operation time decreased from 79 minutes (standard deciation [SD] 26 minutes) the first 15 repairs to 60 minutes (SD 23 minutes) for repairs performed after the first 240 ones. Recurrence rates remained unchanged during the learning curve.
Conclusions
It is safe for resident surgeons to perform uncomplicated, elective, anterior groin hernia mesh repair after having completed of at least 60 procedures.
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Affiliation(s)
- O Bladin
- Department of Molecular Medicine and Surgery, Karolinska Institute , Stockholm , Sweden
| | - N Young
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute , Stockholm , Sweden
| | - J Nordquist
- Department of Medicine, Karolinska Institute , Stockholm , Sweden
| | - J Roy
- Department of Molecular Medicine and Surgery, Karolinska Institute , Stockholm , Sweden
| | - H Järnbert Pettersson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute , Stockholm , Sweden
| | - G Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute , Stockholm , Sweden
| | - J Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institute , Stockholm , Sweden
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4
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Ekstedt A, Gould O, Löfgren J. Radiative first-order phase transitions to next-to-next-to-leading order. Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.106.036012] [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: 11/07/2022]
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Søberg S, Löfgren J, Philipsen FE, Jensen M, Hansen AE, Ahrens E, Nystrup KB, Nielsen RD, Sølling C, Wedell-Neergaard AS, Berntsen M, Loft A, Kjær A, Gerhart-Hines Z, Johannesen HH, Pedersen BK, Karstoft K, Scheele C. Altered brown fat thermoregulation and enhanced cold-induced thermogenesis in young, healthy, winter-swimming men. Cell Rep Med 2021; 2:100408. [PMID: 34755128 PMCID: PMC8561167 DOI: 10.1016/j.xcrm.2021.100408] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 07/13/2021] [Accepted: 09/17/2021] [Indexed: 12/18/2022]
Abstract
The Scandinavian winter-swimming culture combines brief dips in cold water with hot sauna sessions, with conceivable effects on body temperature. We study thermogenic brown adipose tissue (BAT) in experienced winter-swimming men performing this activity 2–3 times per week. Our data suggest a lower thermal comfort state in the winter swimmers compared with controls, with a lower core temperature and absence of BAT activity. In response to cold, we observe greater increases in cold-induced thermogenesis and supraclavicular skin temperature in the winter swimmers, whereas BAT glucose uptake and muscle activity increase similarly to those of the controls. All subjects demonstrate nocturnal reduction in supraclavicular skin temperature, whereas a distinct peak occurs at 4:30–5:30 a.m. in the winter swimmers. Our data leverage understanding of BAT in adult human thermoregulation, suggest both heat and cold acclimation in winter swimmers, and propose winter swimming as a potential strategy for increasing energy expenditure. Winter swimmers have a lower core temperature at a thermal comfort state than controls Winter swimmers had no BAT glucose uptake at a thermal comfort state Winter swimmers have higher cold-induced thermogenesis than control subjects Human supraclavicular skin temperature varies with a diurnal rhythm
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Affiliation(s)
- Susanna Søberg
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Frederik E Philipsen
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Michal Jensen
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Esben Ahrens
- Department of Neurophysiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Kristin B Nystrup
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Rune D Nielsen
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Christine Sølling
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Anne-Sophie Wedell-Neergaard
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Marianne Berntsen
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Zachary Gerhart-Hines
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Helle H Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Bente K Pedersen
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Kristian Karstoft
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen 2400, Denmark
| | - Camilla Scheele
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
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6
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Ahangari S, Hansen NL, Olin AB, Nøttrup TJ, Ryssel H, Berthelsen AK, Löfgren J, Loft A, Vogelius IR, Schnack T, Jakoby B, Kjaer A, Andersen FL, Fischer BM, Hansen AE. Toward PET/MRI as one-stop shop for radiotherapy planning in cervical cancer patients. Acta Oncol 2021; 60:1045-1053. [PMID: 34107847 DOI: 10.1080/0284186x.2021.1936164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Radiotherapy (RT) planning for cervical cancer patients entails the acquisition of both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Further, molecular imaging by Positron Emission Tomography (PET) could contribute to target volume delineation as well as treatment response monitoring. The objective of this study was to investigate the feasibility of a PET/MRI-only RT planning workflow of patients with cervical cancer. This includes attenuation correction (AC) of MRI hardware and dedicated positioning equipment as well as evaluating MRI-derived synthetic CT (sCT) of the pelvic region for positioning verification and dose calculation to enable a PET/MRI-only setup. MATERIAL AND METHODS 16 patients underwent PET/MRI using a dedicated RT setup after the routine CT (or PET/CT), including eight pilot patients and eight cervical cancer patients who were subsequently referred for RT. Data from 18 patients with gynecological cancer were added for training a deep convolutional neural network to generate sCT from Dixon MRI. The mean absolute difference between the dose distributions calculated on sCT and a reference CT was measured in the RT target volume and organs at risk. PET AC by sCT and a reference CT were compared in the tumor volume. RESULTS All patients completed the examination. sCT was inferred for each patient in less than 5 s. The dosimetric analysis of the sCT-based dose planning showed a mean absolute error (MAE) of 0.17 ± 0.12 Gy inside the planning target volumes (PTV). PET images reconstructed with sCT and CT had no significant difference in quantification for all patients. CONCLUSIONS These results suggest that multiparametric PET/MRI can be successfully integrated as a one-stop-shop in the RT workflow of patients with cervical cancer.
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Affiliation(s)
- Sahar Ahangari
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Naja Liv Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Beck Olin
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Trine Jakobi Nøttrup
- Department of Oncology, Section of Radiotherapy, University of Copenhagen, Rigshospitalet, Denmark
| | - Heidi Ryssel
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ivan Richter Vogelius
- Department of Oncology, Section of Radiotherapy, University of Copenhagen, Rigshospitalet, Denmark
| | - Tine Schnack
- Department of Gynecology, University of Copenhagen, Copenhagen, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | | | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Littrup Andersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Malene Fischer
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas’ Hospital, London, UK
| | - Adam Espe Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Diagnostic Radiology, Rigshospitalet, University of Copenhagen, Denmark Copenhagen
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7
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Svane MS, Johannesen HH, Martinussen C, Bojsen-Møller KN, Hansen ML, Hansen AE, Deacon CF, Hartmann B, Keller SH, Klausen TL, Loft A, Kjaer A, Madsbad S, Löfgren J, Holst JJ, Wewer Albrechtsen NJ. No effects of a 6-week intervention with a glucagon-like peptide-1 receptor agonist on pancreatic volume and oedema in obese men without diabetes. Diabetes Obes Metab 2020; 22:1837-1846. [PMID: 32495988 DOI: 10.1111/dom.14106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
AIM To investigate the effect of a glucagon-like peptide-1 receptor agonist (GLP-1RA), liraglutide, on pancreatic volume, oedema, cellularity and DNA synthesis in humans. MATERIALS AND METHODS We performed an open-label study in 14 obese men (age 38 ± 11 years, body mass index 32 ± 4 kg/m2 ) without diabetes. Subjects were examined at baseline, during titration (week 4) of liraglutide towards 3.0 mg/day, and 2 weeks after steady-state treatment (week 6) of a final dose of liraglutide. The primary endpoint was pancreatic volume determined by magnetic resonance imaging. Secondary endpoints included pancreatic oedema and cellularity, positron emission tomography-based [18 F]fluorothymidine (FLT) uptake (DNA synthesis) and plasma pancreatic enzymes. RESULTS Plasma amylase (+7 U/L [95% confidence intervals 3-11], P < .01) and lipase (+19 U/L [7-30], P < .01) increased during liraglutide treatment. Pancreatic volume did not change from baseline to steady state of treatment (+0.2 cm3 [-8-8], P = .96) and no change in pancreatic cellular infiltration was found (P = .22). During titration of liraglutide, FLT uptake in pancreatic tissue increased numerically (+0.08 [0.00-0.17], P = .0507). CONCLUSIONS Six weeks of treatment with liraglutide did not affect pancreatic volume, oedema or cellularity in obese men without diabetes.
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Affiliation(s)
- Maria S Svane
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helle H Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Martinussen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine N Bojsen-Møller
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carolyn F Deacon
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sune H Keller
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas L Klausen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Jensen JS, Christensen J, Hakansson K, Zamani M, Vogelius I, Löfgren J, Fischer B, Friborg J, Buchwald C, Rasmussen J. The Prognostic Value of Pretreatment FDG PET/CT in Patients with Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.158] [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: 10/24/2022]
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Christensen TN, Langer SW, Villumsen KE, Johannesen HH, Löfgren J, Keller SH, Hansen AE, Kjaer A, Fischer BM. 18F-fluorothymidine (FLT)-PET and diffusion-weighted MRI for early response evaluation in patients with small cell lung cancer: a pilot study. Eur J Hybrid Imaging 2020; 4:2. [PMID: 34191195 PMCID: PMC8218141 DOI: 10.1186/s41824-019-0071-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/23/2019] [Indexed: 12/25/2022] Open
Abstract
Background Small cell lung cancer (SCLC) is an aggressive cancer often presenting in an advanced stage and prognosis is poor. Early response evaluation may have impact on the treatment strategy. Aim We evaluated 18F-fluorothymidine-(FLT)-PET/diffusion-weighted-(DW)-MRI early after treatment start to describe biological changes during therapy, the potential of early response evaluation, and the added value of FLT-PET/DW-MRI. Methods Patients with SCLC referred for standard chemotherapy were eligible. FLT-PET/DW-MRI of the chest and brain was acquired within 14 days after treatment start. FLT-PET/DW-MRI was compared with pretreatment FDG-PET/CT. Standardized uptake value (SUV), apparent diffusion coefficient (ADC), and functional tumor volumes were measured. FDG-SUVpeak, FLT-SUVpeak, and ADCmedian; spatial distribution of aggressive areas; and voxel-by-voxel analyses were evaluated to compare the biological information derived from the three functional imaging modalities. FDG-SUVpeak, FLT-SUVpeak, and ADCmedian were also analyzed for ability to predict final treatment response. Results Twelve patients with SCLC completed FLT-PET/MRI 1–9 days after treatment start. In nine patients, pretreatment FDG-PET/CT was available for comparison. A total of 16 T-sites and 12 N-sites were identified. No brain metastases were detected. FDG-SUVpeak was 2.0–22.7 in T-sites and 5.5–17.3 in N-sites. FLT-SUVpeak was 0.6–11.5 in T-sites and 1.2–2.4 in N-sites. ADCmedian was 0.76–1.74 × 10− 3 mm2/s in T-sites and 0.88–2.09 × 10−3 mm2/s in N-sites. FLT-SUVpeak correlated with FDG-SUVpeak, and voxel-by-voxel correlation was positive, though the hottest regions were dissimilarly distributed in FLT-PET compared to FDG-PET. FLT-SUVpeak was not correlated with ADCmedian, and voxel-by-voxel analyses and spatial distribution of aggressive areas varied with no systematic relation. LT-SUVpeak was significantly lower in responding lesions than non-responding lesions (mean FLT-SUVpeak in T-sites: 1.5 vs. 5.7; p = 0.007, mean FLT-SUVpeak in N-sites: 1.6 vs. 2.2; p = 0.013). Conclusions FLT-PET and DW-MRI performed early after treatment start may add biological information in patients with SCLC. Proliferation early after treatment start measured by FLT-PET is a promising predictor for final treatment response that warrants further investigation. Trial registration Clinicaltrials.gov, NCT02995902. Registered 11 December 2014 - Retrospectively registered.
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Affiliation(s)
- Tine Nøhr Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark.
| | - Seppo W Langer
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Engholm Villumsen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Helle Hjorth Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Sune Høgild Keller
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Adam Espe Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Malene Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,PET Centre, School of Biomedical Engineering and Imaging Science, Kings College London, London, UK
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10
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Jensen JS, Christensen JT, Håkansson K, Zamani M, Vogelius IR, Löfgren J, Fischer BM, Friborg J, von Buchwald C, Rasmussen JH. High nodal FDG uptake increases risk of distant metastasis in patients with oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2019; 47:1039-1045. [PMID: 31720757 DOI: 10.1007/s00259-019-04572-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/10/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND The purpose of this study was to investigate if FDG uptake metrics in primary tumor and lymph node metastases in patients with oropharyngeal squamous cell carcinoma (OPSCC) has a prognostic value beyond UICC8 staging in a multiple endpoint model. METHODS Patients with OPSCC treated with primary radiotherapy at Rigshospitalet in the period 2010-2017 were included. All patients had a pretreatment FDG PET/CT scan performed. Four cause-specific Cox regression models were built for the hazard ratios (HR) of recurrence in T-, N-, M-site, and death with no evidence of disease (NED), respectively. The following variables were included: T-, N-stage, p16 status, metabolic tumor volume, and FDG uptake in both primary tumor and lymph nodes. A competing risk analysis was performed and absolute risk estimates were estimated using the Aalen-Johansen method. RESULTS Overall, 441 patients were included. Thirty-four patients had T-site recurrence, 31 N-site recurrence, 32 M-site recurrence, and 52 patients had death NED as event. Nodal FDG uptake had a significant impact on N- and M-site recurrence, with HRs of 2.13 (CI 1.20-3.77) and 2.18 (CI 1.16-4.10). The individual prognostication of absolute risk of the four events for any given patient can be assessed in the online tool (https://rasmussen.shinyapps.io/OPSCCmodelFDG_PET/). CONCLUSION High nodal FDG uptake increases the risk of N- and M-site recurrence in patients with OPSCC in a competing risk scenario. The reported results are available in an easy applicable online tool and can help identify relevant candidates for future trials testing treatment approaches.
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Affiliation(s)
- Jakob Schmidt Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Thor Christensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katrin Håkansson
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martin Zamani
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ivan R Vogelius
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Babara Malene Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The PET Centre, School of Biomedical Engineering and Imaging Sciences KCL St Thomas' Hospital, Bridge Road London, Westminster, SE1 7EH, UK
| | - Jeppe Friborg
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Høygaard Rasmussen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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11
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Passman J, Oresanya LB, Akoko L, Mwanga A, Mkony CA, O'Sullivan P, Dicker RA, Löfgren J, Beard JH. Survey of surgical training and experience of associate clinicians compared with medical officers to understand task-shifting in a low-income country. BJS Open 2019; 3:704-712. [PMID: 31592089 PMCID: PMC6773640 DOI: 10.1002/bjs5.50184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/25/2018] [Accepted: 04/23/2019] [Indexed: 11/07/2022] Open
Abstract
Background A workforce crisis exists in global surgery. One solution is task-shifting, the delegation of surgical tasks to non-physician clinicians or associate clinicians (ACs). Although several studies have shown that ACs have similar postoperative outcomes compared with physicians, little is known about their surgical training. This study aimed to characterize the surgical training and experience of ACs compared with medical officers (MOs) in Tanzania. Methods All surgical care providers in Pwani Region, Tanzania, were surveyed. Participants reported demographic data, years of training, and procedures assisted and performed during training. They answered open-ended questions about training and post-training surgical experience. The median number of training cases for commonly performed procedures was compared by cadre using Wilcoxon rank sum and Student's t tests. The researchers performed modified content analysis of participants' answers to open-ended questions on training needs and experiences. Results A total of 21 ACs and 12 MOs participated. ACs reported higher exposure than MOs to similar procedures before their first independent operation (median 40 versus 17 cases respectively; P = 0·031). There was no difference between ACs and MOs in total training surgical volume across common procedures (median 150 versus 171 cases; P = 0·995). Both groups reflected similarly upon their training. Each cadre relied on the other for support and teaching, but noted insufficient specialist supervision during training and independent practice. Conclusions ACs report similar training and operative experience compared with their physician colleagues in Tanzania.
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Affiliation(s)
- J. Passman
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - L. B. Oresanya
- Department of SurgeryLewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
| | - L. Akoko
- Department of SurgeryMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - A. Mwanga
- Department of SurgeryMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - C. A. Mkony
- Department of SurgeryMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - P. O'Sullivan
- Department of SurgeryUniversity of California, San Francisco School of MedicineSan FranciscoUSA
| | - R. A. Dicker
- Department of SurgeryUniversity of California, Los Angeles David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - J. Löfgren
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - J. H. Beard
- Department of SurgeryLewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
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12
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Ludvigsen TP, Pedersen SF, Vegge A, Ripa RS, Johannesen HH, Hansen AE, Löfgren J, Schumacher-Petersen C, Kirk RK, Pedersen HD, Christoffersen BØ, Ørbæk M, Forman JL, Klausen TL, Olsen LH, Kjaer A. 18F-FDG PET/MR-imaging in a Göttingen Minipig model of atherosclerosis: Correlations with histology and quantitative gene expression. Atherosclerosis 2019; 285:55-63. [PMID: 31004968 DOI: 10.1016/j.atherosclerosis.2019.04.209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The advantage of combining molecular and morphological imaging, e.g. positron emission tomography and magnetic resonance imaging (PET/MRI), is reflected in the increased use of these modalities as surrogate end-points in clinical trials. This study aimed at evaluating plaque inflammation using 18F-fluorodeoxyglucose (18F-FDG)-PET/MRI, and gene expression in a minipig model of atherosclerosis. METHODS Göttingen Minipigs were fed for 60 weeks with fat/fructose/cholesterol-rich diet (FFC), chow (Control) or FFC-diet changed to chow midway (diet normalization group; DNO). In all groups, 18F-FDG-PET/MRI of the abdominal aorta was assessed midway and at study-end. The aorta was analyzed using histology and gene expression. RESULTS At study-end, FFC had significantly higher FDG-uptake compared to Control (target-to-background maximal uptake, TBRMax (95% confidence interval) CITBRMax: 0.092; 7.32) and DNO showed significantly decreased uptake compared to FFC (CITBRMax: -5.94;-0.07). No difference was observed between DNO and Control (CITBRMax: -2.71; 4.11). FFC displayed increased atherosclerosis and gene expression of inflammatory markers, including vascular cell adhesion molecule 1 (VCAM-1), cluster of differentiation 68 (CD68), matrix metalloproteinase 9 (MMP9), cathepsin K (CTSK) and secreted phosphoprotein 1 (SPP1) compared to Control and DNO (all, p < 0.05). FDG-uptake correlated with gene expression of inflammatory markers, including CD68, ρs = 0.58; MMP9, ρs = 0.46; SPP1, ρs = 0.44 and CTSK, ρs = 0.49; (p ≤ 0.01 for all). CONCLUSIONS In a model of atherosclerosis, 18F-FDG-PET/MRI technology allows for detection of inflammation in atherosclerotic plaques, consistent with increased inflammatory gene expression. Our findings corroborate clinical data and are important in pre-clinical drug development targeting plaque inflammation.
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Affiliation(s)
- Trine P Ludvigsen
- Global Drug Discovery, Novo Nordisk Park, Novo Nordisk A/S, DK-2760, Måløv, Denmark
| | - Sune F Pedersen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Andreas Vegge
- Global Drug Discovery, Novo Nordisk Park, Novo Nordisk A/S, DK-2760, Måløv, Denmark
| | - Rasmus S Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Helle H Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Camilla Schumacher-Petersen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Ridebanevej 9, DK-1870, Frederiksberg, Denmark
| | - Rikke K Kirk
- Global Drug Discovery, Novo Nordisk Park, Novo Nordisk A/S, DK-2760, Måløv, Denmark
| | - Henrik D Pedersen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Ridebanevej 9, DK-1870, Frederiksberg, Denmark; Ellegaard Göttingen Minipigs A/S, Sorø Landevej 302, DK-4261, Dalmose, Denmark
| | | | - Mathilde Ørbæk
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen, Denmark
| | - Thomas L Klausen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Lisbeth H Olsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Ridebanevej 9, DK-1870, Frederiksberg, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
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13
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Langer NH, Langer SW, Johannesen HH, Hansen AE, Costa J, Klausen TL, Forman J, Olin A, Rasmussen SH, Sørensen JB, Löfgren J, Kjær A, Fischer BM. Very Early Response Evaluation by PET/MR in Patients with Lung Cancer-Timing and Feasibility. Diagnostics (Basel) 2019; 9:diagnostics9010035. [PMID: 30917539 PMCID: PMC6468790 DOI: 10.3390/diagnostics9010035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/18/2019] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose: With the increasing number of therapy options available for patients with lung cancer, early response evaluation is needed. We performed this pilot study to assess the feasibility of early, repeated Positron emission tomography-magnetic resonance (PET/MR), the impact of timing and the capability for response prediction in lung tumors during chemotherapy. Methods: Patients with stage IV non-small cell lung cancer referred for chemotherapy were prospectively recruited. Fluorine-18-Fluorodeoxyglucose(18F-FDG)-PET/MR scans were performed prior to, during and after the first or second cycle of chemotherapy. Primary tumors were defined on all scans and size, FDG-uptake and apparent diffusion coefficient (ADC) were measured. Early response was described over time and a Standard Linear Mixed Model was applied to analyze changes over time. Results: 45 FDG-PET/MR scans were performed in 11 patients. Whereas the overall changes measured by ADC did not change significantly, there was an overall significant decrease in FDG-uptake from pre to post treatment scans. There was no difference in the FDG-uptake measured 1 or 3 weeks after therapy, but uptake measured 2 weeks after therapy differed from measurements at week 3. Changes measured in patients scanned during the first treatment cycle appeared more pronounced than during the second cycle. Conclusions: This pilot study indicates that response evaluation shortly after initiation of chemotherapy appears concordant with later evaluation and probably more reliable than evaluation midway between cycles. Responses during or after the first cycle of chemotherapy rather than during subsequent cycles are likely to be more readily measured.
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Affiliation(s)
- Natasha Hemicke Langer
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Seppo W Langer
- Dept. of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Helle Hjorth Johannesen
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Adam Espe Hansen
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Junia Costa
- Dept. of Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Thomas Levin Klausen
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Julie Forman
- Section of Biostatistics, Dept. of Public Health, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark.
| | - Anders Olin
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Sine Hvid Rasmussen
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jens Benn Sørensen
- Dept. of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Johan Löfgren
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Andreas Kjær
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Barbara Malene Fischer
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
- PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College Hospital, Guy's & St Thomas Hospital, SE1 9RT London, UK.
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14
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Petersen RJ, Nielsen NS, Johannesen HH, Hansen AE, Jespersen S, Arnbjerg CJ, Löfgren J, Kjær MS, Clausen MR, Kjær A, Nielsen SD, Fischer BM. PET/DW-MRI for evaluating treatment in chronic hepatitis C patients. Am J Nucl Med Mol Imaging 2019; 9:84-92. [PMID: 30911438 PMCID: PMC6420713] [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] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
This feasibility study set out to investigate the use of FDG-PET/DW-MRI in chronic hepatitis C patients to examine changes in local liver inflammation after treatment with direct-acting antivirals (DAA). Twelve patients with chronic hepatitis C were prospectively enrolled, performing FDG-PET/DW-MRI prior to and after DAA treatment. PET/DW-MRI included PET acquisition 60 and 90 min after FDG-injection, DIXON, for attenuation correction, T2- and DW-MRI with 10 b-values between 0-700 s/mm2. The following parameters were measured from fusion of 3 volumes of interest (VOIs) placed in the liver parenchyma: Mean standard uptake value after 60 and 90 minutes (SUVmean60 and SUVmean90), total Apparent Diffusion Coefficient (ADC), perfusion fraction (PF), pseudo-diffusion (D*) and perfusion-free diffusion (D). We found PET/DW-MRI of chronic hepatitis C patients to be feasible. Patients were cooperative, tolerated the scans well and the image quality was acceptable. A total of 10 patients were available for final analysis. All patients achieved sustained virologic response and normalized alanine-aminotransferase (ALAT) levels after treatment with DAA. Perfusion fraction measured by DW-MRI changed significantly after treatment, from mean 0.21 (± 0.04) to 0.26 (± 0.06), P=0.005 and D* from 0.50 (± 0.13) × 10-3 s/mm2 to 0.62 (± 0.15) × 10-3 s/mm2, P=0.028. All other parameters, including FDG-uptake, was unchanged. These results suggest that liver perfusion is changed shortly after DAA treatment, with no significant change in inflammation. The study concludes that PET/DW-MR is feasible in quantifying perfusion and possibly inflammation in chronic hepatitis C patients and may be used to follow treatment.
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Affiliation(s)
- Rikke J Petersen
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen Denmark
| | - Nick S Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen Denmark
| | - Helle H Johannesen
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen Denmark
| | - Sofie Jespersen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen Denmark
| | - Caroline J Arnbjerg
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen Denmark
| | - Mette S Kjær
- Department of Hepatology, Rigshospitalet, University of Copenhagen Denmark
| | - Mette R Clausen
- Department of Hepatology, Rigshospitalet, University of Copenhagen Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen Denmark
| | - Barbara M Fischer
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen Denmark
- PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital Westminster Bridge Road, London, UK
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15
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Wladis A, Roy N, Löfgren J. Lessons for all from the early years of the global surgery initiative. Br J Surg 2019; 106:e14-e16. [DOI: 10.1002/bjs.11029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022]
Abstract
Six elements for future success
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Affiliation(s)
- A Wladis
- International Committee of the Red Cross, Avenue de la Paix 19, CH-1202 Geneva, Switzerland
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - N Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Surgical Unit, BARC Hospital, Mumbai, India
| | - J Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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16
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Egeland C, Baeksgaard L, Johannesen HH, Löfgren J, Plaschke CC, Svendsen LB, Gehl J, Achiam MP. Endoscopic electrochemotherapy for esophageal cancer: a phase I clinical study. Endosc Int Open 2018; 6:E727-E734. [PMID: 29868638 PMCID: PMC5979192 DOI: 10.1055/a-0590-4053] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Esophageal cancer is on the rise in the western world and the disease has a poor 5-year survival prognosis below 20 %. Electrochemotherapy is a treatment where a chemotherapeutic drug is combined with locally applied electrical pulses, in order to increase the drug's cytotoxicity in malignant cells. This study presents the first results with electrochemotherapy treatment in esophageal cancer. PATIENTS AND METHODS In this first-in-human trial, six patients with advanced esophageal cancer were treated with electrochemotherapy using intravenous bleomycin. All side effects and adverse events (AEs) were registered and the patients were later evaluated with gastroscopy and 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI). RESULTS Treatment were well tolerated, main AEs being nausea, vomiting, oral thrush, pneumonia, retrosternal pain, fever, and hoarseness. No serious complications were observed. Five patients had a visual tumor response confirmed by gastroscopy. In two cases, these findings were confirmed with 18F-FDG PET/MRI as it revealed a reduction of total tumor mass. CONCLUSION Electrochemotherapy in patients with advanced esophageal cancer was conducted without major safety concerns. This study paves the way for larger studies, which may further elucidate response rates for and side effects of this new treatment.
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Affiliation(s)
- Charlotte Egeland
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lene Baeksgaard
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Helle Hjorth Johannesen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
| | - Christina Caroline Plaschke
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Denmark
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Herlev University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Zealand University Hospital, University of Copenhagen, Denmark
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Denmark
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17
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Olin A, Ladefoged CN, Langer NH, Keller SH, Löfgren J, Hansen AE, Kjær A, Langer SW, Fischer BM, Andersen FL. Reproducibility of MR-Based Attenuation Maps in PET/MRI and the Impact on PET Quantification in Lung Cancer. J Nucl Med 2017; 59:999-1004. [PMID: 29123008 DOI: 10.2967/jnumed.117.198853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/30/2017] [Indexed: 11/16/2022] Open
Abstract
Quantitative PET/MRI is dependent on reliable and reproducible MR-based attenuation correction (MR-AC). In this study, we evaluated the quality of current vendor-provided thoracic MR-AC maps and further investigated the reproducibility of their impact on 18F-FDG PET quantification in patients with non-small cell lung cancer. Methods: Eleven patients with inoperable non-small cell lung cancer underwent 2-5 thoracic PET/MRI scan-rescan examinations within 22 d. 18F-FDG PET data were acquired along with 2 Dixon MR-AC maps for each examination. Two PET images (PETA and PETB) were reconstructed using identical PET emission data but with MR-AC from these intrasubject repeated attenuation maps. In total, 90 MR-AC maps were evaluated visually for quality and the occurrence of categorized artifacts by 2 PET/MRI-experienced physicians. Each tumor was outlined by a volume of interest (40% isocontour of maximum) on PETA, which was then projected onto the corresponding PETB SUVmean and SUVmax were assessed from the PET images. Within-examination coefficients of variation and Bland-Altman analyses were conducted for the assessment of SUV variations between PETA and PETBResults: Image artifacts were observed in 86% of the MR-AC maps, and 30% of the MR-AC maps were subjectively expected to affect the tumor SUV. SUVmean and SUVmax resulted in coefficients of variation of 5.6% and 6.6%, respectively, and scan-rescan SUV variations were within ±20% in 95% of the cases. Substantial SUV variations were seen mainly for scan-rescan examinations affected by respiratory motion. Conclusion: Artifacts occur frequently in standard thoracic MR-AC maps, affecting the reproducibility of PET/MRI. These, in combination with other well-known sources of error associated with PET/MRI examinations, lead to inconsistent SUV measurements in serial studies, which may affect the reliability of therapy response assessment. A thorough visual inspection of the thoracic MR-AC map and Dixon images from which it is derived remains crucial for the detection of MR-AC artifacts that may influence the reliability of SUV.
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Affiliation(s)
- Anders Olin
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Claes N Ladefoged
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Natasha H Langer
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Sune H Keller
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Seppo W Langer
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Barbara M Fischer
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Flemming L Andersen
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Löfgren J, Mortensen J, Rasmussen SH, Madsen C, Loft A, Hansen AE, Oturai P, Jensen KE, Mørk ML, Reichkendler M, Højgaard L, Fischer BM. A Prospective Study Comparing 99mTc-Hydroxyethylene-Diphosphonate Planar Bone Scintigraphy and Whole-Body SPECT/CT with 18F-Fluoride PET/CT and 18F-Fluoride PET/MRI for Diagnosing Bone Metastases. J Nucl Med 2017; 58:1778-1785. [PMID: 28798033 DOI: 10.2967/jnumed.116.189183] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 12/26/2016] [Accepted: 07/11/2017] [Indexed: 12/24/2022] Open
Abstract
We prospectively evaluated and compared the diagnostic performance of 99mTc-hydroxyethylene-diphosphonate (99mTc-HDP) planar bone scintigraphy (pBS), 99mTc-HDP SPECT/CT, 18F-NaF PET/CT, and 18F-NaF PET/MRI for the detection of bone metastases. Methods: One hundred seventeen patients with histologically proven malignancy referred for clinical pBS were prospectively enrolled. pBS and whole-body SPECT/CT were performed followed by 18F-NaF PET/CT within 9 d. 18F-NaF PET/MRI was also performed in 46 patients. Results: Bone metastases were confirmed in 16 patients and excluded in 101, which was lower than expected. The number of equivocal scans was significantly higher for pBS than for SPECT/CT and PET/CT (18 vs. 5 and 6, respectively; P = 0.004 and 0.01, respectively). When equivocal readings were excluded, no statistically significant difference in sensitivity, specificity, positive predictive value, negative predictive value, or overall accuracy were found when comparing the different imaging techniques. In the per-patient analysis, equivocal scans were either assumed positive for metastases ("pessimistic analysis") or assumed negative for metastases ("optimistic analysis"). The percentages of misdiagnosed patients for the pessimistic analysis were 21%, 15%, 9%, and 7% for pBS, SPECT/CT, PET/CT, and PET/MRI, respectively. Corresponding figures for the optimistic analysis were 9%, 12%, 5%, and 7%. In those patients identified as having bone metastases according to the reference standard, SPECT/CT, 18F-NaF PET/CT, and PET/MRI detected additional lesions compared with pBS in 31%, 63%, and 71%, respectively. Conclusion:18F-NaF PET/CT and whole-body SPECT/CT resulted in a significant reduction of equivocal readings compared with pBS, which implies an improved diagnostic confidence. However, the clinical benefit of using, for example, 18F-NaF PET/CT or PET/MRI as compared with SPECT/CT and pBS in this patient population with a relatively low prevalence of bone metastases (14%) is likely limited. This conclusion is influenced by the low prevalence of patients with osseous metastases. There may well be significant differences in the sensitivity of SPECT/CT, PET/CT, and PET/MRI compared with pBS, but a larger patient population or a patient population with a higher prevalence of bone metastases would have to be studied to demonstrate this.
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Affiliation(s)
- Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sine H Rasmussen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claus Madsen
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark; and
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karl Erik Jensen
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mette Louise Mørk
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michala Reichkendler
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Barbara M Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Löfgren J, Matovu A, Wladis A, Ibingira C, Nordin P, Galiwango E, Forsberg BC. Cost-effectiveness of groin hernia repair from a randomized clinical trial comparing commercial versus low-cost mesh in a low-income country. Br J Surg 2017; 104:695-703. [PMID: 28206682 DOI: 10.1002/bjs.10483] [Citation(s) in RCA: 10] [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] [Received: 08/08/2016] [Revised: 09/27/2016] [Accepted: 12/03/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Over 200 million people worldwide live with groin hernia and 20 million are operated on each year. In resource-scarce settings, the superior surgical technique using a synthetic mesh is not affordable. A low-cost alternative is needed. The objective of this study was to calculate and compare costs and cost-effectiveness of inguinal hernia mesh repair using a low-cost versus a commercial mesh in a rural setting in Uganda. METHODS This is a cost-effectiveness analysis of a double-blinded RCT comparing outcomes from groin hernia mesh repair using a low-cost mesh and a commercially available mesh. Cost-effectiveness was expressed in US dollars (with euros in parentheses, exchange rate 30 December 2016) per disability-adjusted life-year (DALY) averted and quality-adjusted life-year (QALY) gained. RESULTS The cost difference resulting from the choice of mesh was $124·7 (€118·1). In the low-cost mesh group, the cost per DALY averted and QALY gained were $16·8 (€15·9) and $7·6 (€7·2) respectively. The corresponding costs were $58·2 (€55·1) and $33·3 (€31·5) in the commercial mesh group. A sensitivity analysis was undertaken including cost variations and different health outcome scenarios. The maximum costs per DALY averted and QALY gained were $148·4 (€140·5) and $84·7 (€80·2) respectively. CONCLUSION Repair using both meshes was highly cost-effective in the study setting. A potential cost reduction of over $120 (nearly €120) per operation with use of the low-cost mesh is important if the mesh technique is to be made available to the many millions of patients in countries with limited resources. TRIAL REGISTRATION NUMBER ISRCTN20596933 (http://www.controlled-trials.com).
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Affiliation(s)
- J Löfgren
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - A Matovu
- Mubende Regional Referral Hospital, Makerere University, Kampala, Uganda
| | - A Wladis
- Department of Surgery, St Göran's Hospital, Stockholm, Sweden
| | - C Ibingira
- School of Biomedical Sciences, Makerere University, Kampala, Uganda
| | - P Nordin
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - E Galiwango
- School of Public Health, Iganga/Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
| | - B C Forsberg
- Department of Public Health Sciences, The Karolinska Institute, Solna, Sweden
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Abstract
The experience with embolization of intracerebral arteriovenous malformations (AVMs) with bucrylate (isobutyl-2-cyanoacrylate) in 29 patients is reported. In 9 cases (31%) less than 1/3 of the AVM nidus was occluded, in 12 (41%) 1/3 to 2/3, in 4 (14%) more than 2/3, and total occlusion was only seen in 3 cases (10%). One patient was never embolized, owing to procedure complications. At follow-up angiography in 20 patients, partial revascularization was found in 11 AVMs and further occlusion in 2. Complications occurred in 11 cases (38%). Five patients (17%) suffered from hemorrhage: 2 died, one deteriorated severely and 2 recovered. Unintentional embolization or edema resulted in neurologic deficits in 6 patients (21%), permanent in 3 and reversible in 3. Symptomatic improvement was initially found in 13 patients (45%) but was stable only in 9. In 9 patients (38%) embolization was followed by elective surgery or irradiation. The best results were obtained in small and medium-sized AVMs (<6 cm) while there was a high risk of complications and an uncertain palliative effect in large AVMs.
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Johannesen HH, Löfgren J, Donkin I, Hansen AE, Loft A, Højgaard L, Kjær A. Identification and characterization of human brown adipose tissue (BAT) content and metabolism in adults using [(18)F]-FDG PET/MR - a pilot study. EJNMMI Phys 2015; 1:A68. [PMID: 26501658 PMCID: PMC4546015 DOI: 10.1186/2197-7364-1-s1-a68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Helle H Johannesen
- Dept.of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Kragujevac, Denmark
| | - Johan Löfgren
- Dept.of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Kragujevac, Denmark
| | - Ida Donkin
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Kragujevac, Denmark
| | - Adam E Hansen
- Dept.of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Kragujevac, Denmark
| | - Annika Loft
- Dept.of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Kragujevac, Denmark
| | - Liselotte Højgaard
- Dept.of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Kragujevac, Denmark
| | - Andreas Kjær
- Dept.of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Kragujevac, Denmark
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Löfgren J, Loft A, Barbosa de Lima VA, Østerlind K, von Benzon E, Højgaard L. Clinical importance of re-interpretation of PET/CT scanning in patients referred to a tertiary care medical centre. Clin Physiol Funct Imaging 2015. [PMID: 26211508 DOI: 10.1111/cpf.12278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate, in a controlled prospective manner with double-blind read, whether there are differences in interpretations of PET/CT scans at our tertiary medical centre, Rigshospitalet, compared to the external hospitals. METHODS Ninety consecutive patients referred to our department who had an external F-18-FDG PET/CT scan were included. Only information that had been available at the time of the initial reading at the external hospital was available at re-interpretation. Teams with one radiologist and one nuclear medicine physician working side by side performed the re-interpretation in consensus. Two oncologists subsequently and independently compared the original reports with the re-interpretation reports. In case of 'major discordance', the oncologists assessed the respective reports validities. RESULTS The interpretations were graded as 'accordant' in 43 patients (48%), 'minor discordance' in 30 patients (33%) and 'major discordance' in 17 patients (19%). In 11 (65%) of the 17 cases graded as 'major discordance', it was possible to determine which report that was most correct. In 9 of these 11 cases (82%), the re-interpretation was most correct; in one case, the original report and in another case, both interpretations were incorrect. CONCLUSIONS Major discordant interpretations were frequent [19% (17 of 90 cases)]. In those cases where follow-up could assess the validity, the re-interpretation at Rigshospitalet was most correct in 9 of 11 cases (82%), indicating that there is a difference in expertise in interpreting PET/CT at a tertiary referral hospital compared to primary local hospitals.
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Affiliation(s)
- Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Kell Østerlind
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eric von Benzon
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Rasmussen JH, Fischer BM, Aznar MC, Hansen AE, Vogelius IR, Löfgren J, Andersen FL, Loft A, Kjaer A, Højgaard L, Specht L. Reproducibility of (18)F-FDG PET uptake measurements in head and neck squamous cell carcinoma on both PET/CT and PET/MR. Br J Radiol 2015; 88:20140655. [PMID: 25634069 DOI: 10.1259/bjr.20140655] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To investigate reproducibility of fluorine-18 fludeoxyglucose ((18)F-FDG) uptake on (18)F-FDG positron emission tomography (PET)/CT and (18)F-FDG PET/MR scans in patients with head and neck squamous cell carcinoma (HNSCC). METHODS 30 patients with HNSCC were included in this prospective study. The patients were scanned twice before radiotherapy treatment with both PET/CT and PET/MR. Patients were scanned on the same scanners, 3 days apart and according to the same protocol. Metabolic tumour activity was measured by the maximum and peak standardized uptake value (SUVmax and SUVpeak, respectively), and total lesion glycolysis from the metabolic tumour volume defined from ≥50% SUVmax. Bland-Altman analysis with limits of agreement, coefficient of variation (CV) from the two modalities were performed in order to test the reproducibility. Furthermore, CVs from SUVmax and SUVpeak were compared. The area under the curve from cumulative SUV-volume histograms were measured and tested for reproducibility of the distribution of (18)F-FDG uptake. RESULTS 24 patients had two pre-treatment PET/CT scans and 21 patients had two pre-treatment PET/MR scans available for further analyses. Mean difference for SUVmax, peak and mean was approximately 4% for PET/CT and 3% for PET/MR, with 95% limits of agreement less than ±20%. CV was small (5-7%) for both modalities. There was no significant difference in CVs between PET/CT and PET/MR (p = 0.31). SUVmax was not more reproducible than SUVpeak (p = 0.09). CONCLUSION (18)F-FDG uptake in PET/CT and PET/MR is highly reproducible and we found no difference in reproducibility between PET/CT and PET/MR. ADVANCES IN KNOWLEDGE This is the first report to test reproducibility of PET/CT and PET/MR.
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Affiliation(s)
- J H Rasmussen
- 1 Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Pedersen SF, Ludvigsen TP, Johannesen HH, Löfgren J, Ripa RS, Hansen AE, Ettrup AJ, Christoffersen BØ, Pedersen HD, Olsen LH, Højgaard L, Kjær A. Feasibility of simultaneous PET/MR in diet-induced atherosclerotic minipig: a pilot study for translational imaging. Am J Nucl Med Mol Imaging 2014; 4:448-458. [PMID: 25143863 PMCID: PMC4138139] [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] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 05/22/2014] [Indexed: 06/03/2023]
Abstract
Novel hybrid 18-fluoro-deoxy-D-glucose ((18)F-FDG) based positron emission tomography (PET) and magnetic resonance imaging (MRI) has shown promise for characterization of atherosclerotic plaques clinically. The purpose of this study was to evaluate the method in a pre-clinical model of diet-induced atherosclerosis, based on the Göttingen minipig. Using (18)F-FDG PET/MRI the goal was to develop and create a new imaging method in an in vivo animal model for translational studies of atherosclerosis. We used a strategy of multisequence MRI for optimal anatomical imaging of the abdominal aortas of the pigs (n=4): T1-weighted turbo spin-echo (T1-TSE), T2-weighted turbo spin-echo (T2-TSE) and proton density imaging with and without fat saturation. (18)F-FDG PET emission data were collected from a single bed position of the abdominal aorta in 3D mode for either 10 (n=4) or 10 and 20 minutes (n=2) to measure glycolysis as given by standardized uptake values (SUV). Ex vivo en face evaluation of aortas from an atherosclerotic animal illustrated plaque distribution macroscopically, compared to a lean control animal. Although T2-TSE weighted imaging was most consistent, no one MRI sequence was preferable and superior to another for visualization and identification of the abdominal aorta. We found poor correlation between SUVs obtained from 10 and 20 minutes of reconstructed PET emission data. This can most likely be ascribed to intestinal movement. In conclusion multisequence MRI is recommended for optimal imaging of the abdominal aorta using MRI. Furthermore we found that 10 minutes of PET emission data seems adequate. This is the first study to demonstrate that the method of (18)F-FDG PET/MRI is feasible in minipig models of atherosclerosis, and therefore relevant in larger prospective studies. Perspectives of the method include correlation to e.g. aortic immunohistochemistry findings and a range of genomic and proteomic analyses.
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Affiliation(s)
- Sune F Pedersen
- Cluster for Molecular Imaging, University of Copenhagen; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Trine P Ludvigsen
- Department of Veterinary Disease Biology, University of Copenhagen Frederiksberg, Denmark
| | - Helle H Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Rasmus S Ripa
- Cluster for Molecular Imaging, University of Copenhagen; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Anders J Ettrup
- Neurobiology Research Unit, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | | | | | - Lisbeth H Olsen
- Department of Veterinary Disease Biology, University of Copenhagen Frederiksberg, Denmark
| | - Liselotte Højgaard
- Cluster for Molecular Imaging, University of Copenhagen; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Andreas Kjær
- Cluster for Molecular Imaging, University of Copenhagen; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
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Engelmann BE, Loft A, Kjær A, Nielsen HJ, Gerds TA, Benzon EV, Brünner N, Christensen IJ, Hansson SH, Holländer NH, Kristensen MH, Löfgren J, Markova E, Sloth C, Højgaard L. Positron emission tomography/computed tomography and biomarkers for early treatment response evaluation in metastatic colon cancer. Oncologist 2014; 19:164-72. [PMID: 24451199 DOI: 10.1634/theoncologist.2013-0229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Treatment options for metastatic colon cancer (mCC) are widening. We prospectively evaluated serial 2-deoxy-2-[18F]fluoro-d-glucose positron-emission tomography/computed tomography (PET/CT) and measurements of tissue inhibitor of metalloproteinases-1 (TIMP-1), carcinoembryonic antigen (CEA), and liberated domain I of urokinase plasminogen activator receptor (uPAR(I)) for early assessment of treatment response in mCC patients. METHODS Thirty-three mCC patients scheduled for first-line chemotherapy with capecitabine and oxaliplatin (CAPOX) and bevacizumab participated; 27 were evaluated by PET/CT before treatment, after one and four treatment series. Morphological and metabolic response was independently assessed according to Response Evaluation Criteria in Solid Tumors and European Organization for Research and Treatment of Cancer PET criteria. Plasma TIMP-1, plasma uPAR(I), and serum CEA were determined. RESULTS Metabolic response after one treatment course predicted the ability of CAPOX and bevacizumab to induce morphological response after four treatment series with a sensitivity of 80%, specificity of 69%, and odds ratio of 13.9 (95% confidence interval [CI] 1.9; 182). Early metabolically stable or progressive disease was associated with shorter progression-free survival (hazard ratio [HR] = 3.2 [CI 1.3; 7.8]). Biomarker levels at early evaluation were associated with shorter OS (TIMP-1 per unit increase on a log-2-transformed ng/mL scale: HR = 2.6 [CI 1.4; 4.9]; uPAR(I) per 25 fmol/mL increase: HR = 1.5 [CI 1.1; 2.1]). CONCLUSION This monocentric study demonstrated predictive value of early metabolic PET response and prognostic value of TIMP-1 and uPAR(I) levels in mCC treated with CAPOX and bevacizumab. Results support investigation of PET/CT, TIMP-1, and uPAR(I) guided early treatment adaptation in mCC.
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Affiliation(s)
- Bodil E Engelmann
- Departments of Clinical Physiology and Nuclear Medicine, Hematology and Oncology, Clinical Pathology, and Radiology, Næstved Hospital, Næstved, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark; Department of Public Health, Core Biostatistics, University of Copenhagen, Copenhagen, Denmark; Institute of Veterinary Disease Biology, University of Copenhagen, Frederiksberg, Denmark; Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark, and Biotech Research and Innovation Center, University of Copenhagen, Copenhagen, Denmark
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Engelmann BE, Loft A, Kjær A, Nielsen HJ, von Benzon E, Brünner N, Christensen IJ, Gerds TA, Hansson SH, Hollander NH, Kristensen MH, Löfgren J, Markova E, Sloth C, Højgaard L. Positron emission tomography/computed tomography for early treatment response evaluation in metastatic colon cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.614] [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: 11/20/2022] Open
Abstract
614 Background: Treatment options for metastatic colon cancer (mCC) are widening. We prospectively evaluated serial 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography/ computed tomography (PET/CT) and measurements of tissue inhibitor of metalloproteinases type 1 (TIMP-1), carcinoembryonic antigen (CEA) and urokinase plasminogen activator receptor domain I [uPAR(I)] for early assessment of treatment response in mCC patients. Methods: Thirty-three mCC patients scheduled for first line chemotherapy with capecitabine, oxaliplatin (CAPOX) and bevacizumab participated; 27 were evaluated by PET/CT before treatment, after one and four treatment series. Morphological and metabolic response was independently assessed according to Response Evaluation Criteria In Solid Tumours (RECIST1.1) and EORTC PET criteria. Plasma TIMP-1, plasma uPAR(I) and serum CEA were determined. Results: Metabolic response after one treatment course predicted the ability of CAPOX and bevacizumab to induce morphological response after four treatment series with a sensitivity of 80 %, specificity of 69 % and an Odds Ratio of 13.9 [CI 1.9; 182]. Early metabolically stable or progressive disease was associated with shorter progression-free survival (PFS) (hazard ratio (HR) = 3.2 [CI 1.3; 7.8]). Biomarker levels at early evaluation were associated to shorter PFS (TIMP-1 per unit increase on a log-2 transformed ng/mL scale: HR = 2.23 [CI 1.20; 4.14]; uPAR(I) per 25 fmol/mL increase: HR = 1.36 [CI 1.03; 1.79]). Conclusions: This monocentric study demonstrated predictive value of early metabolic PET response and prognostic value of TIMP-1 and uPAR(I) levels in mCC treated with CAPOX and bevacizumab. Results support investigation of PET/CT, TIMP-1 and uPAR(I) guided early treatment adaptation in mCC.
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Affiliation(s)
- Bodil E. Engelmann
- Department of Clinical Physiology and Nuclear Medicine, Næstved Hospital, Næstved, Denmark
| | - Annika Loft
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans J. Nielsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Eric von Benzon
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Nils Brünner
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Ib Jarle Christensen
- The Finsen Laboratory, Rigshospitalet and Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark
| | - Thomas A. Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Susanne H. Hansson
- Department of Clinical Physiology and Nuclear Medicine, Næstved Hospital, Næstved, Denmark
| | | | | | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Elena Markova
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Sloth
- Department of Radiology, Næstved Hospital, Næstved, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Pyszniak A, Calén H, Fransson K, Hejny V, Johansson T, Löfgren J, Rudy Z, Wolke M, Wüstner P. Studies on implementation of pellet tracking in hadron physics experiments. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20148106008] [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: 11/14/2022] Open
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Balyasnikova S, Löfgren J, de Nijs R, Zamogilnaya Y, Højgaard L, Fischer BM. PET/MR in oncology: an introduction with focus on MR and future perspectives for hybrid imaging. Am J Nucl Med Mol Imaging 2012; 2:458-474. [PMID: 23145362 PMCID: PMC3484424] [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] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/21/2012] [Indexed: 06/01/2023]
Abstract
After more than 20 years of research, a fully integrated PET/MR scanner was launched in 2010 enabling simultaneous acquisition of PET and MR imaging. Currently, no clinical indication for combined PET/MR has been established, however the expectations are high. In this paper we will discuss some of the challenges inherent in this new technology, but focus on potential applications for simultaneous PET/MR in the field of oncology. Methods and tracers for use with the PET technology will be familiar to most readers of this journal; thus this paper aims to provide a short and basic introduction to a number of different MRI techniques, such as DWI-MR (diffusion weighted imaging MR), DCE-MR (dynamic contrast enhanced MR), MRS (MR spectroscopy) and MR for attenuation correction of PET. All MR techniques presented in this paper have shown promising results in the treatment of patients with solid tumors and could be applied together with PET increasing the amount of information about the tissues of interest. The potential clinical benefit of applying PET/MR in staging, radiotherapy planning and treatment evaluation in oncology, as well as the research perspectives for the use of PET/MR in the development of new tracers and drugs will be discussed.
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Affiliation(s)
- Svetlana Balyasnikova
- Department of Radiology, The N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences 24, Kashirskoe Shosse, Moscow, 115478, Russia
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Abstract
The respiratory syncytial virus (RSV) antigen serves as ligand for Toll-like receptor (TLR) 4 that is a transmembrane signaling receptor in macrophages and dendritic cells. According to current evidence single nucleotide polymorphism involving amino acid 299 influences the susceptibility to severe RSV infections. The Asp299Gly allele has been shown to influence the TLR4-mediated signaling causing conformational change in the extracellular domain that recognizes pathogen-associated molecular patterns. The aim was to study the association between the TLR4 Asp299Gly polymorphism and the susceptibility to severe RSV bronchiolitis in infants. Altogether 312 cases and 356 controls, selected on the basis place of residence, date of birth, gender, and gestation at birth, were studied. When adjusted for multiple dependent variables, no allele or genotype frequency difference was found between the cases and the controls. Post hoc analysis revealed that during the year 2000 epidemics, the Gly299Gly genotype associated with protection against severe RSV and during 2004 epidemics Gly299Gly genotype and 299Gly allele associated with severe RSV. To conclude, we could not confirm the association of the Gly299 allele with severe RSV. This is consistent with the evidence that the susceptibility to severe RSV infection is principally dependent on environmental and constitutional factors. We propose that the risk of severe RSV infection may additionally depend on the interaction between individual TLR4 genotype and the particular RSV group causing bronchiolitis.
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Affiliation(s)
- Johan Löfgren
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
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Löfgren J. Effects of variations in arterial pressure and arterial carbon dioxide tension on the cerebrospinal fluid pressure-volume relationships. Acta Neurol Scand 2009; 49:586-98. [PMID: 4770654 DOI: 10.1111/j.1600-0404.1973.tb01332.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Marttila R, Haataja R, Rämet M, Löfgren J, Hallman M. Surfactant protein B polymorphism and respiratory distress syndrome in premature twins. Hum Genet 2003; 112:18-23. [PMID: 12483294 DOI: 10.1007/s00439-002-0835-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2002] [Accepted: 08/18/2002] [Indexed: 11/30/2022]
Abstract
Recent evidence suggests that the susceptibility to respiratory distress syndrome (RDS) is partly explained by genetic variation in the surfactant proteins (SP) SP-A and SP-B. The present study was designed to evaluate the concordance difference method and candidate gene analysis, in parallel, for the investigation of genetic susceptibility to RDS. We studied 100 same-sex twin pairs with established RDS in at least one twin. The difference in RDS concordance rates between the monozygotic (MZ) and dizygotic (DZ) twin pairs as evidence of a genetic influence was evaluated, and the SP-A and SP-B genes were investigated for potential associations with the susceptibility to RDS. The concordance rates of RDS were 54 and 44% in the MZ and DZ pairs, respectively. The concordance difference of 10% was not significant [95% confidence interval (CI) -0.1 to +0.3, P=0.32], suggesting a low hereditary impact. However, the SP-B Ile131Thr polymorphism was associated with RDS. The threonine allele was associated with an increased risk of RDS [odds ratio (OR) 2.2, 95% CI 1.4-3.5, P=0.0014]. This was particularly apparent in first-born male infants (OR 6.2, 95% CI 2.4-16.3, P<0.001). The degree of prematurity (<32 weeks OR 2.0, 95% CI 1.1-3.7, P=0.021) and birth order (second-born OR 3.1, 95% CI 1.3-7.4, P=0.009) were the clinical variables affecting the risk of RDS. An association between the SP-B Ile131Thr polymorphism and RDS was found. The threonine allele was associated with the risk of RDS, particularly in the first-born twin infants. The concordance difference between MZ and DZ twin pairs underestimates the genetic impact on the risk of RDS. The traditional twin concordance study is insufficient to evaluate genetic predisposition to RDS or other diseases that are confounded by the birth order or multiple pregnancy in itself.
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Affiliation(s)
- Riitta Marttila
- Department of Paediatrics and Biocenter Oulu, University of Oulu, Finland.
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Löfgren J, Rämet M, Renko M, Marttila R, Hallman M. Association between surfactant protein A gene locus and severe respiratory syncytial virus infection in infants. J Infect Dis 2002; 185:283-9. [PMID: 11807709 DOI: 10.1086/338473] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2001] [Revised: 08/29/2001] [Indexed: 11/03/2022] Open
Abstract
Respiratory syncytial virus (RSV) causes seasonal epidemics of bronchiolitis among susceptible infants. Surfactant protein A (SP-A), a lung C-type lectin involved in innate host defense, opsonizes RSV and enhances phagocytosis. The candidate gene approach was used to investigate association of SP-A polymorphism with susceptibility to severe RSV infection. Genotype analysis was done for 86 infants with severe RSV infection and 95 matched control subjects. A significant difference in the frequency of SP-A2 was observed. The SP-A2 allele 1A(3) was overrepresented in RSV-infected infants, compared with control subjects (5% vs. 0.5%; P =.006), whereas allele 1A was underrepresented (1% vs. 6%; P =.011). The allele pool in which lysine was amino acid 223 was overrepresented in infants with severe RSV infection (28% vs. 18%; P =.023), whereas the allele pool in which proline was amino acid 99 was underrepresented (5% vs. 16%; P =.001). These results indicate that a genetic association exists between SP-A gene locus and severe RSV infection.
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Affiliation(s)
- Johan Löfgren
- Department of Pediatrics and Biocenter Oulu, University of Oulu, Oulu, FIN-90014 Finland.
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Haataja R, Marttila R, Uimari P, Löfgren J, Rämet M, Hallman M. Respiratory distress syndrome: evaluation of genetic susceptibility and protection by transmission disequilibrium test. Hum Genet 2001; 109:351-5. [PMID: 11702216 DOI: 10.1007/s004390100574] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2001] [Accepted: 06/25/2001] [Indexed: 11/29/2022]
Abstract
Based on epidemiological data and genetic association studies, neonatal respiratory distress syndrome (RDS) is a complex disease with a multigenic background. The genes coding for surfactant proteins (SP) A and B have been assigned as the most likely genes in the etiology of RDS. The major factor predisposing to RDS is prematurity, and thus the phenotype of a very premature newborn infant that does not develop the disease can be regarded as hypernormal. Altogether 107 father-mother-offspring trios were divided into two sets according to the proband's phenotype, to evaluate familial segregation of candidate gene polymorphisms by the transmission disequilibrium test. A set of 76 trios were analyzed for transmission disequilibrium from parents to affected offspring. Another set of 31 trios were studied for allele transmission from parents to hypernormal offspring born very prematurely before the gestational age of 32 weeks. SP-A1-A2 haplotype 6A(2)-1A(0) showed significant excess transmission to affected infants and SP-A1 allele 6A(2) decreased transmission to the hypernormals. The present family study provides strong support for a direct or indirect role of the SP-A alleles as genetic predisposers to RDS in premature infants. The inclusion of parent-hypernormal offspring trios in transmission disequilibrium test is a useful approach to test for genetic protection against a disease.
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Affiliation(s)
- R Haataja
- Department of Pediatrics and Biocenter Oulu, P.O. Box 5000, 90014 Oulu, Finland
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36
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Abstract
Surfactant protein-A, which plays a role in innate host defense in the lung, is also expressed in the Eustachian tube. We report that the frequency of specific surfactant protein-A haplotypes and genotypes differs between children with recurrent otitis media compared with a control population.
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Affiliation(s)
- M Rämet
- Department of Pediatrics, University Central Hospital, and Biocenter Oulu, University of Oulu, Oulu, Finland
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37
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Abstract
BACKGROUND AND PURPOSE The cerebral arteries present an optimum blood flow/vessel radius relation. However, branch angles may vary widely in the cerebral arteries because the parametric optimization of branch angles is irrelevant in terms of energy cost. The position of the flow divider in extracranial arteries has been suggested to be optimum in flow orderliness. No data exist on the flow divider of cerebral arteries. Thus, we hypothesized that in the cerebral arteries the apex of the bifurcations, which is known to be the site of maximum hemodynamic stress in a vascular network, may normally lie in a non-optimum position relative to the dividing flow streamline in the parent vessel, leading to disturbed laminar flow and increased vessel wall shear stress at the apical region despite the optimum blood flow/vessel radius relation. The objective of this study was to test our hypothesis. METHODS We measured the branch angles and diameters of parent and branch segments of the anterior cerebral artery system from lateral projections to minimize the measurement error on angiographs chosen at random from normal sets. The position of the apex of the bifurcations in relation to the ostium of the parent artery (gamma) and the ratio of the branch diameters (d2/d1) were compared. Optimum curves for these parameters were calculated by a mathematical model. In addition, the separation of flow streamlines according to gamma was calculated for each bifurcation and related to the division of flow required by each branch according to the optimum blood flow/vessel radius relation. RESULTS The data points on gamma and d2/d1 and the separation of flow according to gamma and the division of flow required by the branches were found to scatter around the optimum curves. However, a trend toward the theoretical optimum is discernible. The data points are suggested to be a random sample from a normal distribution around the optimum (.40 < P < .50). CONCLUSIONS The bifurcations of the cerebral arteries appear to be optimized to avoid increased hemodynamic stresses both globally and locally in the same manner as extracranial arteries.
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Affiliation(s)
- S Rossitti
- Department of Neurosurgery, University of Göteborg, Sahlgrenska Hospital, Sweden
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Abstract
BACKGROUND AND PURPOSE The principle of minimum work is a parametric optimization model for the growth and adaptation of arterial trees. It establishes a balance between energy dissipation due to frictional resistance of laminar flow (shear stress) and the minimum volume of the vascular system, implying that the radius of the vessel is adjusted to the cube root of the volumetric flow. The purpose of this study is to verify whether the internal carotid artery system obeys the principle of minimum work. METHODS Measurements of the radius of parent and branch segments of the internal carotid, anterior, and middle cerebral arteries were performed on analog angiographs chosen at random from a set classified as normal. The branch angles were measured from lateral projections in bifurcations of the anterior cerebral artery. The relation of the calibers of parent and branch vessels was analyzed. RESULTS The area ratio of the bifurcations (N = 174) was 1.2 +/- 0.4 (mean +/- SD). The equation (r0)n = (r1)n + (r2)n was solved for n, resulting in n = 2.9 +/- 0.7 (mean +/- SD, N = 157). Optimum proportions between the radii of parent (r0) and branch (r1 and r2) vessels in the internal carotid artery system were verified in normal carotid angiographs up to four branch generations, according to the theoretical equation r0(3) = r1(3) + r2(3) (r = 0.989, N = 174). No clear correlation was found between the measured branch angles, the relative branch cross-sectional area, and the theoretical optimum angles. CONCLUSIONS This study demonstrates that the process of branching of the internal carotid artery system obeys the principle of minimum work, as the diameter exponent approximates 3. The principle of minimum work establishes strict functional relations between volumetric flow, flow velocity, and vessel radius. This model was extended to parametric optimization of branch angles, which has proved irrelevant in terms of functional optimization. Our results corroborate this finding. Shear stress-induced endothelial mediation seems to be the regulating mechanism for the maintenance of this optimum vessel design. The magnitude of wall shear stress is the same at every point in a vascular network obeying the principle of minimum work, because the flow rate influences the shear stress proportionally to the third power of the vessel radius. This observation has implications for understanding the remodeling of the cerebral vascular network in the presence of arteriovenous malformations and for the pathogenesis of saccular aneurysms.
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Affiliation(s)
- S Rossitti
- Department of Neurosurgery, University of Göteborg, Sahlgrenska Hospital, Sweden
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Svendsen P, Wikholm G, Löfgren J, Frisén L. [Craniotomy is not necessary. Embolization with detachable balloons is the most suitable treatment of direct carotid-cavernous fistulas]. Lakartidningen 1992; 89:2431-3. [PMID: 1507960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- P Svendsen
- Radiologiska kliniken, Sahlgrenska sjukhuset, Göteborg
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Jakobsson KE, Löfgren J, Zwetnow NN, Mörkrid L. Cerebral blood flow in experimental intracranial mass lesions. Part II: The postdecompression phase. Neurol Res 1990; 12:153-7. [PMID: 1979844 DOI: 10.1080/01616412.1990.11739935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cerebral haemodynamics were evaluated after a period of cerebral compression produced by subarachnoid fluid infusion or inflation of an epidural balloon. Release of the compression resulted in a marked cerebral hyperperfusion which was generalized in the case of hydrostatically raised pressure but restricted to supratentorial structures after balloon compression. A rebound of intracranial pressure (ICP) occurred only after balloon compression, indicating that loss of vasomotor tone per se was not the primary reason for the rebound of ICP. In the balloon compression experiments the hyperaemia passed into a stage of hypoperfusion attributable in part to a reduction in cerebral perfusion pressure due to the rebound of ICP and in part to an increase in flow resistance probably related to external compression of the vascular bed by the accumulation of brain oedema. The observed flow changes, i.e. delayed hypoperfusion preceded by hyperaemia, were similar to those after temporary ischaemia, indicating that the rebound response is a non-specific postischaemic phenomenon.
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Affiliation(s)
- K E Jakobsson
- Department of Neurosurgery, Sahlgrenska Hospital, Gothenburg University, Sweden
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Abstract
We have shown that a rebound of intracranial pressure (ICP) occurring after decompression of an intracranial mass lesion is a threshold phenomenon dependent upon the cerebral perfusion pressure (CPP) during compression and the duration of the compression. In the present study regional cerebral blood flow (rCBF) was measured during balloon compression of a degree critical for the development of a postdecompression rebound. The effects were compared with those of hydrostatically raised pressure which under similar conditions rarely produces a rebound of ICP. Disproportionately marked reductions in flow occurred in the hemisphere ipsilateral to the balloon, especially in white matter and in cortex adjacent to the balloon with flow values of, respectively, 1.1 +/- 0.9 and 6.4 +/- 3.4 ml 100 g-1 min-1. The differences in flow between balloon and hydrostatic compression were found to be due to an increased cerebrovascular resistance (CVR) caused by a direct compressive effect by the balloon overriding the generalized vasodilation which occurs in response to the raised ICP. Thus the increase in CVR attributable to compression by the balloon added to the reduction in CPP caused by the diffuse increase in ICP. As a consequence flow in large regions of the brain was reduced below the thresholds for structural infarction and for ischaemic damage to the blood-brain barrier.
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Affiliation(s)
- K E Jakobsson
- Department of Neurosurgery, Sahlgrenska Hospital, Gothenburg University, Sweden
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Berthelsen B, Löfgren J, Svendsen P. Embolization of cerebral arteriovenous malformations with bucrylate. Experience in a first series of 29 patients. Acta Radiol 1990; 31:13-21. [PMID: 2340219] [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: 12/31/2022]
Abstract
The experience with embolization of intracerebral arteriovenous malformations (AVMs) with bucrylate (isobutyl-2-cyanoacrylate) in 29 patients is reported. In 9 cases (31%) less than 1/3 of the AVM nidus was occluded, in 12 (41%) 1/3 to 2/3, in 4 (14%) more than 2/3, and total occlusion was only seen in 3 cases (10%). One patient was never embolized, owing to procedure complications. At follow-up angiography in 20 patients, partial revascularization was found in 11 AVMs and further occlusion in 2. Complications occurred in 11 cases (38%). Five patients (17%) suffered from hemorrhage: 2 died, one deteriorated severely and 2 recovered. Unintentional embolization or edema resulted in neurologic deficits in 6 patients (21%), permanent in 3 and reversible in 3. Symptomatic improvement was initially found in 13 patients (45%) but was stable only in 9. In 9 patients (38%) embolization was followed by elective surgery or irradiation. The best results were obtained in small and medium-sized AVMs (less than 6 cm) while there was a high risk of complications and an uncertain palliative effect in large AVMs.
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Affiliation(s)
- B Berthelsen
- Department of Diagnostic Radiology, University of Gothenburg, Sweden
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Zwetnow NN, Schrader H, Löfgren J. Effects of continuously expanding intracranial lesions on vital physiological parameters. An experimental animal study. Acta Neurochir (Wien) 1986; 80:47-56. [PMID: 3706013 DOI: 10.1007/bf01809557] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The work described in this report confirms and extends the results described in a preliminary communication (Löfgren, J. and Zwetnow, N.N., Acta Neurol. Scand. (1970, 625) which examined the effects in cats of an expanding mass, in the form of an intracranial supratentorial balloon, on vital physiological parameters. In the present study, particular emphasis was placed on the possible significance of the rate of expansion of the mass in the range usually encountered in the clinical situation of intracranial haemorrhages. Results from the experiments on 37 cats and 8 dogs showed that changes in vital parameters appeared when the balloon had reached a volume of about 5% of the intracranial volume (the "reaction volume") while respiratory arrest occurred at an intracranial volume of about 10% (the "apnoea volume"). Both threshold volumes were independent of the rate of expansion within the range used. Alterations in EEG, heart rate, respiratory rate and systemic arterial pressure usually occurred simultaneously with the development of a transtentorial pressure gradient. When respiratory arrest occurred, the cerebral perfusion pressure was markedly reduced, usually to a value of about 30 mm Hg, suggesting that brain tissue ischaemia is an important component in the lethal mechanism underlying intracranial expanding lesions. It is proposed that the volume load tolerance of the organism towards an expanding intracranial lesion, as expressed by the reaction volume and the apnoea volume, may represent a biologically useful parameter potentially suitable for quantitative evaluation of adverse agents and therapeutic procedures.
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Löfgren J. Traumatic intracranial hematomas: pathophysiological aspects on their course and treatment. Acta Neurochir Suppl (Wien) 1986; 36:151-4. [PMID: 3467549 DOI: 10.1007/978-3-7091-8859-0_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hematomas in head injuries as a general rule reach their definite size within minutes after the trauma, the bleeding being effectively checked by an interaction of an increased intracranial pressure and the natural hemostatic processes. In epidural hemorrhage the development of arteriovenous shunting in the epidural space may result in continuing bleeding. In special circumstances vascular injury may produce delayed hemorrhage related to increased transmural pressure in the vascular bed and the development of a hyperfibrinolysis syndrome. The clinical effect of a hematoma is quantitatively related to its volume, but modified to a considerable degree in the particular case by the size of the extraaxial space and the arterial blood pressure. Some implications for treatment are commented upon.
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Andersen O, Andersson M, Berthelsen B, Lundqvist C, Löfgren J, Svendsen P. [Neurological syndrome in dural vascular malformations with drainage into the venous system of the spinal cord]. Lakartidningen 1985; 82:4414-7. [PMID: 4079613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Schrader H, Löfgren J, Zwetnow NN. Regional cerebral blood flow and CSF pressures during the Cushing response induced by an infratentorial expanding mass. Acta Neurol Scand 1985; 72:273-82. [PMID: 4061049 DOI: 10.1111/j.1600-0404.1985.tb00871.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
An experimental study was carried out in eight dogs to investigate whether the Cushing response (CR) during intracranial hypertension is due to pressure per se, tissue distortion, or ischemia in the brain stem. To minimize the effects of rostrocaudal displacement, intracranial pressure was raised by an expanding mass lesion located in the posterior fossa. Regional cerebral blood flow (rCBF) was measured with radioactive microspheres and compartmental cerebrospinal fluid (CSF) pressures were recorded during the CR which was induced by the continuous inflation at a constant rate of an infratentorial epidural rubber balloon in two groups of four dogs. In one group (A) rCBF was measured at the onset of the CR and in the other group (B) at the peak of the systemic blood pressure rise. In the animals of group A blood flow in the mesencephalon, pons and upper medulla oblongata was reduced from control values by 32%, 57% and 85% respectively. In group B blood flow in the same areas did not differ significantly from pre-inflation values. In contrast, the recorded balloon volume, which was assumed to be an index of mechanical distortion of the brain stem, varied considerably at the beginning of the blood pressure rise (from 2.5 to 4.7% of the calculated intracranial space). Similarly, CSF pressure in the posterior fossa at the onset of the CR also varied considerably (from 52 to 117 mmHg). Thus, the large quantitative variations meant that both absolute pressure and tissue distortion were poor predictors of the onset of the CR. The findings suggest that ischemia, rather than brain stem distortion per se or pressure by itself, is responsible for the initiation of the CR. The rise in blood pressure elicited during the CR seems capable of restoring blood flow in the brain stem back to control values.
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Abstract
The incidence and prevalence of antimitochondrial antibody-positive primary biliary cirrhosis (PBC) has been studied within a defined area in Sweden served by one hospital. During the period 1976-1983 the yearly incidence of PBC was 1.4/10(5) inhabitants, and on 31 December 1983 the prevalence was 12.8/10(5) inhabitants. The prevalence is the highest reported so far. At the time of diagnosis half of the patients were clinically asymptomatic. Two of the patients also had celiac disease with osteomalacia responding to a gluten-free diet. Gallstone disease occurred in 30% of the patients. Four patients died--two of liver-related complications, one of colonic carcinoma, and one of staphylococcal septicemia and endocarditis. One further patient, who is still alive, developed hypernephroma. Our results indicate that PBC is a fairly benign disease in most patients, with a slow progress during which they lead a fairly normal life.
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Abstract
In 3 groups of 4 dogs with normotensive, induced-hypotensive and induced-hypertensive blood pressure respectively, continuous expansion of an extradural supratentorial balloon led to respiratory arrest at inflation volumes which increased with increasing blood pressure. This positive correlation between the volume tolerance to an expanding lesion and blood pressure was also found in similar experiments on 4 hypotensive and 4 hypertensive cats. Monitoring cerebrospinal fluid pressures in the cerebral lateral ventricles, in the posterior fossa and in the spinal subarachnoid space showed that absolute pressures in the various compartments as well as the intercompartmental pressure gradients at the moment of respiratory arrest were increased in proportion to the level of the systemic arterial pressure in each case. These observations do not support current concepts that brain-stem distortion alone or that stimulation of baroreceptors in the posterior fossa are responsible for eliciting the Cushing response. The fact that the supratentorial perfusion pressure was the only parameter which did not differ significantly under the different experimental conditions suggests that the mechanism responsible for the respiratory arrest is local brain tissue ischemia, probably near the tentorial incisure. The magnitude of gain in volume tolerance, when mean arterial pressure was varied from 60 mmHg to 190 mmHg, was 87% suggesting that the blood pressure may have a critical role in an intracranial lesion. These findings have clinical implications.
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Habash AH, Zwetnow NN, Ericson K, Löfgren J. Arterio-venous epidural shunting in epidural bleeding radiological and physiological characteristics. An experimental study in dogs. Acta Neurochir (Wien) 1983; 67:291-313. [PMID: 6846085 DOI: 10.1007/bf01401431] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In order to test the possibility suggested in previous studies that the long bleeding time and the large bleeding volume observed in experimental epidural bleeding can be explained by the development of an arterio-venous shunt, water soluble X-ray contrast was injected into the epidural space in dogs during an epidural bleeding in progress. It was found that the contrast medium left the epidural space through diploic veins in the cranial bone to the neck veins. By draining off epidural blood the arterio-venous shunt counteracts the intracranial pressure tamponade developing in intradural bleeds and thus prolongs bleeding. Perfusion experiments showed the absorption capacity for saline to be about 20 times as large in the epidural space as in the CSF space. While there was no apparent absorption limit for blood in the epidural space the absorption capacity for blood of the subarachnoid space became progressively saturated, leading to a continuously increasing CSF outflow resistance and CSF steady-state pressure. A theory for the formation of epidural haematoma is proposed which in essence implies that the epidural shunt is a major determinant of the clinical outcome of an epidural bleeding.
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