Search

Background The Doppler sonography technique known as "superb microvascular imaging" (SMI) is advancing sonographic micro vascularization imaging in various disciplines. In this study, we aimed to determine whether SMI could reliably reproduce the blood flow in thyroid nodes and whether malignancy could be diagnosed, based on vascularization properties. Immunhistochemical staining by CD34 and SMI where used to determine the vascularization of nodes in terms of quantified vascularization parameters gained by computational evaluation. Methods We used image analysis programs to investigate whether the quantitative value for vascularization strength in the thyroid node, measured with SMI, was correlated with the actual degree of vascularization, determined microscopically. We included 16 patients that underwent thyroid resections. We prepared thyroid gland tissue slices for immunohistochemistry and labelled endothelial cells with CD34 to visualize blood vessels microscopically. We used image analysis programs, ImageJ, to quantify SMI Doppler sonographic measurements and CellProfiler to quantify CD34 expression in histological sections. We evaluated the numeric values for diagnostic value in node differentiation. Furthermore, we compared these values to check for correlations. Results Among the 16 nodes studied, three harboured malignant tumours (18.75%): two papillary and one follicular carcinoma. Among the 13 benign lesions (81.25%), four harboured follicular adenomas. Malignant and benign nodes were not significantly different in sonographic (0.88 ± 0.89 vs. 1.13 ± 0.19; p = 0.2790) or immunohistochemical measurements of vascularization strength (0.05 ± 0.05 vs. 0.08 ± 0.06; p = 0.2260). Conclusion We found a positive, significant correlation (r = 0.55588; p = 0.0254) between SMI (quantitative values for vascularization strength) and immunohistochemistry (CD34 staining) evaluations of thyroid nodes.

Birt–Hogg–Dube syndrome (BHD) is a rare condition which was first described in 1977. The incidence of BHD syndrome is unknown. However, approximately 600 families have been identified worldwide. The inheritance is autosomal dominant and caused by different mutations in the folliculin (FLCN) gene on chromosome 17 which encodes FLCN protein. These mutations are small insertion/deletions, splice-site, and nonsense mutations, which lead in most cases to premature truncation and loss of function of the folliculin protein. The condition is clinically characterized by diffuse pulmonary cysts which lead to spontaneous pneumothorax (SP), increased risk of renal cancer, and benign skin hamartomas mostly in the head and neck. However, the disease shows a considerable clinical heterogeneity. Pulmonary manifestations of BHD are being detected in more than 80% of the patients and occur at a median age of 30–40 years. Nevertheless, pulmonary function is generally normal or show only mild airway obstruction. Patients present typically with recurrent SP. In this review, we describe a female patient who presented with recurrent (SP). BHD was suspected and later on genetically confirmed. The patient was managed with VATS pleurectomy as definitive treatment of the pneumothorax.

Introduction Determining the normal values for acoustic radiation force impulse (ARFI) shear wave elastography of the thoracolumbar fascia (TLF) and define possible factors of influence. Methods We measured the shear wave velocity (SWV) in m/s and the diameter (anterior-posterior) in mm of the TLF bilateral in 267 healthy participants with the Acuson S3000™ (Siemens) using the virtual touch image quantification mode (VTIQ). The parameters were tested for correlations with the anthropometric data of the participants, between different age groups and the genders, as well as information obtained from the history, such as smoking and sporting activities. Results We determined a mean SWV of 3.28 ± 0.55 m/s for the left thoracolumbar fascia and 3.44 ± 0.55 m/s for the right. The diameter on the right was 2.7 ± 0.8 mm. On the left, it was 2.7 ± 0.9 mm. Neither body mass index (BMI) nor gender had a significant effect on either of the measured parameters (p > 0.05). The same goes for regular medication, sporting activity or the consumption of alcohol (p > 0.05). The results concerning the effect of smoking and age were inconclusive as they only had a significant influence to either the right or the left side of the TLF but not on the other side. Conclusions We collected the normal value for ARFI shear wave elastography of the TLF in 267 healthy participants. Furthermore, neither gender, BMI, sports activity nor the consumption of alcohol affected the elasticity or the diameter of the thoracolumbar fascia.

BACKGROUND The main endemic areas of alveolar echinococcosis (AE) are in Central Europe and Western China. Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE. AIM To evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim. METHODS Consecutively, five experienced examiners evaluated contrast-enhanced abdominal computed tomography (CT) scans for 200 patients with hepatic AE of each of four locations (n = 50) in Germany, France and China. Therefore, we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center, performed because of hepatic AE from September 21, 2007 to March 21, 2018. AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT (EMUC-CT). Distant extrahepatic manifestations were documented either by whole body positron emission tomography–CT or with the addition of thoracic CT and cranial magnetic resonance imaging. Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion. Statistical analysis was performed using SAS Version 9.4 (SAS Institute Inc., Cary, NC, United States). RESULTS Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (P = 0.0091). A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size (P = 0.0075). Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe (P < 0.0001), and vascular/biliary involvement depended on lesion size. Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations: Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88% of type IV liver lesions to 100% among type III lesions. Type IV differed significantly in these associations from types I, II, and III (P < 0.0001). With respect to extrahepatic disease, the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease. In contrast, distant extrahepatic manifestations in types I–III were found to varying degrees, with a maximum of 22% for type III. CONCLUSION Different CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations. There are intercontinental differences regarding the characteristics of AE manifestation.

Ultrasound as a non-ionizing imaging procedure is one of the most important diagnostic procedures in everyday clinical practice. The technology is widely used. Due to constant technical innovations, sonographic procedures, such as contrast-enhanced ultrasound (CEUS), sonoelastography, new microvascular Doppler modalities and, as an example of interventional procedures, sonographically controlled microwave ablation (MWA), are becoming increasingly important in diagnostic imaging and interventional medicine alongside CT and MRI. However, this also requires greater expertise, specialization and qualification on the part of users. This review article provides information about the range of technical innovations in ultrasound in recent years and describes the underlying technology, the clinical applications, and their diagnostic value. These are presented in the context of the current literature, explaining their advantages and disadvantages and their clinical value. Contrast-enhanced ultrasound (CEUS), microvascular Doppler modalities, fusion imaging and elastography complement B-scan ultrasound and conventional Doppler procedures for various problems. Microwave ablation (MWA) has a firm place as an ablative procedure for local tumor therapy in different organ systems and can be performed under ultrasound guidance. Thanks to new developments, the possibilities of ultrasound are now greater than ever. Knowledge of the technology, indications, and possible applications of newer procedures is essential for adequate patient care. · Contrast-enhanced ultrasound (CEUS) allows an increase in sensitivity and specificity in the assessment of parenchymal lesions.. · CEUS allows the microperfusion to be visualized and quantified. For larger vessels, CEUS is an important instrument in diagnosing endoleak after stenting.. · Microvascular Doppler techniques with clutter suppression algorithms allow a more accurate representation of the smallest vessels than regular color or power Doppler.. · Elastography of the liver in diffuse hepatopathies is a noninvasive diagnostic tool to exclude higher grade fibrosis/cirrhosis.. · Microwave ablation (MWA) also offers sonographically controlled ablation of tumors..· Kloth C, Kratzer W, Schmidberger J et al. Ultrasound 2020 - DiagnosticsTherapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography . Fortschr Röntgenstr 2021; 193: 23 - 32. Ultraschall als nichtionisierendes bildgebendes Verfahren stellt eines der wichtigsten diagnostischen Verfahren im Klinikalltag dar. Bei weiter Verbreitung findet es flächendeckenden Einsatz. Durch stetige technische Innovationen gewinnen sonografische Verfahren wie kontrastverstärkter Ultraschall (CEUS), Sono-Elastografie, neue mikrovaskuläre Dopplermodalitäten und als Beispiel für interventionelle Verfahren die sonografisch gesteuerte Mikrowellenablation (MWA) zunehmend an Bedeutung innerhalb der bildgebenden Diagnostik und Intervention neben der CT- und MRT-Schnittbildtechnik. Dies erfordert jedoch auch eine höhere Expertise, Spezialisierung und Qualifikation bei den Anwendern. Dieser Übersichtsartikel informiert über das Spektrum technischer Neuerungen im Ultraschall der letzten Jahre und beschreibt die zugrunde liegende Technik, die klinischen Anwendungsmöglichkeiten und deren diagnostischen Stellenwert. Diese werden unter Darlegung von Vor- und Nachteilen sowie ihrer klinischen Wertigkeit im Kontext der aktuellen Literatur vorgestellt. Die Verfahren des kontrastverstärkten Ultraschalls (CEUS), mikrovaskulärer Dopplermodalitäten, der Fusionsbildgebung und der Elastografie ergänzen den B-Bild-Ultraschall und konventionelle Doppler-Verfahren bei unterschiedlichen Fragestellungen. Die Mikrowellenablation (MWA) hat einen festen Stellenwert als ablatives Verfahren zur lokalen Tumortherapie an verschiedenen Organsystemen und kann ultraschallgesteuert erfolgen. Die Möglichkeiten des Ultraschalls sind dank neuer Entwicklungen heutzutage größer denn je. Die Kenntnis über Technik, Indikationen und Anwendungsmöglichkeiten neuerer Verfahren sind für eine adäquate Patientenversorgung obligat. · Kontrastverstärkter Ultraschall (CEUS) steigert die Sensitivität und Spezifität bei der Beurteilung von Parenchymläsionen.. · CEUS ermöglicht die Darstellung und Quantifizierung der Mikroperfusion. Für größere Gefäße ist CEUS ein wichtiges Instrument in der Endoleak-Diagnostik nach Stent-Versorgung.. · Mikrovaskuläre Doppler-Verfahren mit Störungsunterdrückungsalgorithmus erlauben eine genauere Darstellung kleinster Gefäße als der reguläre Farb- oder Powerdoppler.. · Die Elastografie stellt an der Leber bei diffusen Hepatopathien eine nichtinvasive Diagnostik zum Ausschluss einer höhergradigen Fibrose/Zirrhose dar.. · Die Mikrowellenablation (MWA) bietet auch sonografisch gesteuert die Möglichkeit zur Ablation von Tumoren..· Kloth C, Kratzer W, Schmidberger J et al. Ultrasound 2020 – DiagnosticsTherapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography . Fortschr Röntgenstr 2021; 193: 23 – 32.

Introduction: Cranial nonenhanced CT (NECT) imaging in hyperacute ischemic stroke is rarely used for assessing arterial obstruction of middle cerebral artery by identifying hyperdense artery sign (HAS). Considering, however, its growing importance due to its impact on the decision-making process of thrombolysis with or without mechanical thrombectomy improved sensitivity to HAS is necessary, particularly in the group of less experienced clinicians being frequently the first one assessing the presence of HAS on NECT. Objective: The present study aimed to investigate the effect of different NECT image reconstructions on the correct detection of hyperdense middle cerebral artery sign in a cohort of observers with lower experience level on NECT. Particularly, MIP image reconstructions were expected to be useful for less experienced observers due to both strengthening of the hyperdensity of HAS and streamlining to less image slices. Methods: Twenty-five of 100 patients’ NECT image data presented with HAS. Sixteen observers with lower practice level on NECT (10 radiologists and 6 neurologists) evaluated independently the 3 image reconstructions of each data set with thin slice 1.5 mm, thick slab 5 mm, and 6-mm maximum intensity projection (MIP) and rated the presence of HAS in middle cerebral artery. A GEE model with random observer effect was used to examine the influence of the 3 image reconstructions on sensitivity to HAS. A linear mixed effects regression model was used to investigate the ranking of detectability of HAS. Interrater reliability was determined by Fleiss’ kappa coefficient (κ). Results: Recognition of HAS and sensitivity to HAS significantly differed between the 3 image reconstructions (p = 0.0106). MIP and thin slice reconstructions yielded each on average the highest sensitivities with 73% compared to thick slab reconstruction with 45% sensitivity. The interobserver reliability was fair (κ, 0.3–0.4). Detectability of HAS was significantly easier and better visible ranked on MIP and thin slice reconstructions compared to thick slab (p < 0.05). Conclusion: MIP and thin slice reconstructions increased the sensitivity to HAS (73%), whereas thick slab reconstructions seemed to be less appropriate (45%).

To propose a modification of the Kodama classification to classify type III lesions of alveolar echinococcosis (AE) that do not have microcysts.200 magnetic resonance imaging (MRI) images of AE liver lesions from four endemic regions of the world were classified according to Kodama, distinguishing within type III those with microcysts from those without. Each center included 50 MRIs of patients with unoperated AA liver lesions. The first 50 cases were classified by a first reader in the presence of four second-line readers from each region. Then each second-line reader classified his or her 50 cases.In all centers, type III lesions were predominant: 58% of the total lesions and 23% of them were without microcysts. The average age of the patients was 47 years. In China, the patients were on average younger and the lesions larger. German patients had more lesions within the liver. Type I and II lesions, synonymous with earlier diagnosis, were more common in Europe.The Kodama classification needed to be modified because of the existence of a significant proportion of unclassifiable lesions. This is especially true since the presence of microcysts is an informative element of parasite activity. Therefore, this study proposes a Kodama-XUUB classification with type IIIa lesions having microcysts and type IIIb lesions not having microcysts.Kodama-XUUB : une classification informative des lésions hépatiques de l’échinococcose alvéolaire à l’Imagerie par Résonance Magnétique.Objectif : Proposer une modification de la classification de Kodama permettant de classer les lésions de type III qui ne présentent pas de microkystes. Matériels et Méthodes : 200 IRM de lésions hépatiques d’EA en provenance de quatre régions d’endémie dans le monde ont été classées selon Kodama, en distinguant au sein du type III celles qui présentaient des microkystes de celle qui n’en présentaient pas. Chaque centre a inclus 50 IRM de patients avec lésions hépatiques d’EA non opérées. Les 50 premiers cas ont été classés par un premier lecteur en présence des quatre seconds lecteurs issus de chacune des régions. Puis chaque second lecteur a classé ses 50 cas. Résultats : Dans tous les centres, les lésions de type III étaient largement prédominantes : 58 % du total des lésions et 23 % d’entre elles ne présentaient pas de microkystes. La moyenne d’âge des patients était de 47 ans. En Chine, les patients étaient en moyenne plus jeunes et les lésions plus larges. Les patients allemands présentaient plus de lésions au sein du foie. Les lésions de type I et II, synonymes de diagnostic plus précoce étaient plus fréquentes en Europe. Conclusion : La classification de Kodama nécessitait d’être modifiée du fait de l’existence d’une proportion non négligeable de lésions non classifiables. Ce d’autant que la présence de microkystes est un élément informatif de l’activité du parasite. C’est pourquoi cette étude propose une classification Kodama-XUUB avec un type IIIa de lésions avec microkystes et un type IIIb sans microkystes.

Objective: The surgical resection of pulmonary metastases is associated with a survival benefit in selected patients. The use of laser devices for pulmonary metastasectomy (PM) is believed to facilitate the complete resection of metastases while preserving a maximum of healthy parenchyma. This is a prospective study to evaluate surgical outcome including the changes of lung function after laser–assisted surgery (LAS).Methods: A total of 77 operations in 61 patients in which PM was carried out in a curative intent were analyzed. A 1.320 nm diode-pumped Nd: YAG-Laser was used for resection of the metastases. Surgical and clinical data were collected using a standardized form and postoperative lung function changes 3 and 6 months after surgery were assessed using whole body plethysmography and diffusion capacity for carbon monoxide (DLCO). Size and distance of metastases to the pleural surface were measured radiologically.Results: A median of two metastases were resected per operation (range 1–13). The median duration of postoperative air leak was 1 day (range 0–11). LAS associated postoperative minor and major complications were observed in 4 (5%) cases and 1 (1%) case, respectively; there were no mortalities. The analysis of perioperative lung function showed that mean VC 3 months after surgery was reduced by 11 %, FEV1 by 11% and median DLCO by 11% (all p < 0.0001). There was almost no recovery of lung function between 3 and 6 months in the whole cohort. Patients with two or less metastases showed a recovery of lung function after 3 months regarding DLCO (p = 0.003). Decline of DLCO in the whole cohort correlated with the number of resected metastases at 3 months (r = 0.45, p = 0.006) and at 6 months (r = 0.42, p = 0.02) as well as depth of metastases in the parenchyma at 6 months (r = 0.48, p = 0.001).Conclusions: LAS is a safe and effective method for PM even for higher numbers of metastases, with short duration of postoperative air leak and little morbidity. Number and depth, but not size of metastases affect lung function changes after resection.

Thymic hyperplasia (TH) with lymphoepithelial sialadenitis (LESA)-like features (LESA-like TH) has been described as a tumor-like, benign proliferation of thymic epithelial cells and lymphoid follicles. We aimed to determine the frequency of lymphoma and autoimmunity in LESA-like TH and performed retrospective analysis of cases with LESA-like TH and/or thymic MALT-lymphoma. Among 36 patients (21 males) with LESA-like TH (age 52 years, 32&ndash, 80, lesion diameter 7.0 cm, 1&ndash, 14.5, median, range), five (14%) showed associated lymphomas, including four (11%) thymic MALT lymphomas and one (3%) diffuse large B-cell lymphoma. One additional case showed a clonal B-cell-receptor rearrangement without evidence of lymphoma. Twelve (33%) patients (7 women) suffered from partially overlapping autoimmune diseases: systemic lupus erythematosus (n = 4, 11%), rheumatoid arthritis (n = 3, 8%), myasthenia gravis (n = 2, 6%), asthma (n = 2, 6%), scleroderma, Sj&ouml, gren syndrome, pure red cell aplasia, Grave&rsquo, s disease and anti-IgLON5 syndrome (each n = 1, 3%). Among 11 primary thymic MALT lymphomas, remnants of LESA-like TH were found in two cases (18%). In summary, LESA-like TH shows a striking association with autoimmunity and predisposes to lymphomas. Thus, a hematologic and rheumatologic workup should become standard in patients diagnosed with LESA-like TH. Radiologists and clinicians should be aware of LESA-like TH as a differential diagnosis for mediastinal mass lesions in patients with autoimmune diseases.

Background The main endemic areas of alveolar echinococcosis (AE) are in central Europe and western China. The infiltration of intrahepatic vascular and bile ducts as well as extrahepatic disease can lead to complications and may increase morbidity in AE. Purpose To evaluate the vascular/biliary involvement of hepatic alveolar echinococcosis (HAE) and distant extrahepatic disease at each of four locations in Germany, France, and China. Material and Methods Contrast-enhanced abdominal magnetic resonance imaging (MRI) scans of patients with HAE, 200 in total, were evaluated by five examiners. AE liver lesions were classified according to Kodama’s classification. Furthermore, distant extrahepatic manifestations were documented with additionally performed imaging modalities. Vascular/biliary involvement of hepatic manifestations as well as the presence of extrahepatic manifestations were correlated with the respective Kodama type of the liver lesion. Results Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (12/100 vs. 3/100; Fisher’s exact test: P=0.0286). A significant relationship exists between presence of distant extrahepatic disease manifestation and size of the AE liver lesion (132.53 ± 48.65 vs. 92.49 ± 50.06; P = 0.0030). Vascular/biliary involvement is significantly more frequent in China than in Europe (86/100 vs. 65/100; χ2 = 11.92; P = 0.0006). Vascular/biliary involvement depends on lesion size (111.10 ± 47.44 vs. 47.36 ± 24.36; P, publishedVersion

Alveolar echinococcosis (AE) is caused by the intermediate stage of Echinococcus multilocularis. We aimed to correlate computed tomography (CT) data with histology to identify distinct characteristics for different lesion types. We classified 45 samples into five types with the Echinococcus multilocularis Ulm Classification for Computed Tomography (EMUC-CT). The various CT lesions exhibited significantly different histological parameters, which led us to propose a progression model. The initial lesion fit the CT type IV classification, which comprises a single necrotic area with the central located laminated layer, a larger distance between laminated layer and border zone, a small fibrotic peripheral zone, and few small particles of Echinococcus multilocularis (spems). Lesions could progress through CT types I, II, and III, characterized by shorter distances between laminated layer and border zone, more spems inside and surrounding the lesion, and a pronounced fibrotic rim (mostly in type III). Alternatively, lesions could converge to a highly calcified, regressive state (type V). Our results suggest that the CT types mark sequential stages of the infection, which progress over time. These distinct histological patterns advance the understanding of interactions between AE and human host; moreover, they might become prognostically and therapeutically relevant., publishedVersion

Introduction In-depth genomic characterization of thymic epithelial tumors (TETs), comprising thymomas and thymic carcinomas (TCs), failed to identify targetable mutations and suggested unique biology of TETs, including KIT expression in most TCs. Recently, tuft cell–like medullary thymic epithelial cells were identified in the murine thymus, and our reanalysis of the published gene expression data revealed that these cells express KIT. In addition, recently, a minor subset of SCLCs with tuft cell–like features was described. Methods We interrogated mRNA expression data from our tumor cohorts (N = 60) and publicly available, independent data sets from TETs and NSCLC (N = 1199) for expression of tuft cell genes and KIT. Expression of KIT and of POU2F3 protein, the master regulator of tuft cells, was analyzed in cancer tissue (N = 344) by immunohistochemistry. Results Normal human thymic tuft cells and most TCs coexpressed KIT and known tuft cell genes, particularly POU2F3 and GFI1B. Unexpectedly, small subsets of tuft cell–like tumors coexpressing POU2F3, GFI1B, and KIT were also identified among pulmonary squamous cell carcinomas, adenocarcinomas, and large cell neuroendocrine carcinoma and clustered together in each histologic cohort. In addition to the tuft cell–like signature, both thymic and lung tuft cell–like carcinomas had distinct genetic, pathologic, and clinical features in each cohort. Conclusions We suggest that the tuft cell–like phenotype defines novel subsets of thymic and pulmonary carcinoma. Its high prevalence in thymic squamous cell carcinomas that have no known toxic or viral etiologies suggests a new mechanism of carcinogenesis that may lead to specific drug susceptibilities.

Positron emission tomography-computed tomography (PET-CT) with 18F-fluorodesoxyglucose (FDG) is the imaging modality of choice for assessing inflammation surrounding hepatic alveolar echinococcosis (AE) lesions. This study is the first to evaluate FDG uptake in hepatic AE (n = 51) based on the standardized uptake value (SUV) and to correlate the SUVs with primary morphology and calcification patterns, based on the Echinococcus multilocularis Ulm Classification for Computed-Tomography (EMUC-CT). Our results show that the SUVs were increased for lesions with EMUC-CT types I-IV primary morphology, compared to the surrounding healthy liver tissue (SUV = 2.5 ± 0.4; p

Background Alveolar (AE) and cystic echinococcosis (CE) in humans are caused by the metacestode of the tapeworms Echinococcus multilocularis and Echinococcus granulosus sensu lato (s.l.). Immunohistochemistry with the monoclonal antibodies (mAb) Em2G11, specific for AE, and the mAb EmG3, specific for AE and CE, is an important pillar of the histological diagnosis of these two infections. Our aim was to further evaluate mAb EmG3 in a diagnostic setting and to analyze in detail the localization, distribution, and impact of small particles of Echinococcus multilocularis (spems) and small particles of Echinococcus granulosus s.l. (spegs) on lymph nodes. Methodology/principal findings We evaluated the mAb EmG3 in a cohort of formalin-fixed, paraffin embedded (FFPE) specimens of AE (n = 360) and CE (n = 178). These samples originated from 156 AE-patients and 77 CE-patients. mAb EmG3 showed a specific staining of the metacestode stadium of E. multilocularis and E. granulosus s.l. and had a higher sensitivity for spems than mAb Em2G11. Furthermore, we detected spegs in the surrounding host tissue and in almost all tested lymph nodes (39/41) of infected patients. 38/47 lymph nodes of AE showed a positive reaction for spems with mAb EmG3, whereas 29/47 tested positive when stained with mAb Em2G11. Spegs were detected in the germinal centers, co-located with CD23-positive follicular dendritic cells, and were present in the sinuses. Likewise, lymph nodes with spems and spegs in AE and CE were significantly enlarged in size in comparison to the control group. Conclusions/significance mAb EmG3 is specific for AE and CE and is a valuable tool in the histological diagnosis of echinococcosis. Based on the observed staining patterns, we hypothesize that the interaction between parasite and host is not restricted to the main lesion since spegs are detected in lymph nodes. Moreover, in AE the number of spems-affected lymph nodes is higher than previously assumed. The enlargement of lymph nodes with spems and spegs points to an immunological interaction with the small immunogenic particles (spems and spegs) of Echinococcus spp., Author summary Echinococcosis is a life-threatening disease in humans that is caused by the larval stages of the tapeworms Echinococcus multilocularis and Echinococcus granulosus s.l.. For the histological diagnosis of alveolar echinococcosis (AE) and cystic echinococcosis (CE) the two monoclonal antibodies (mAb) Em2G11, specific for AE, and the mAb EmG3, specific for AE and CE are available. We have analyzed a large cohort of formalin-fixed, paraffin embedded human tissue (FFPE) specimens of AE (n = 360) and CE (n = 178) using these two antibodies. We show that the mAb EmG3 has a specific staining pattern of the metacestode stadium of E. multilocularis and E. granulosus s.l. while staining of the larval state of E. multilocularis is limited to the mAb Em2G11. We further identified so called “small particles of Echinococcus multilocularis” (spems) and “small particles of Echinococcus granulosus” (spegs) not only in the main lesion of AE and CE, but also in the adjacent tissue and in the vast majority of lymph nodes analyzed draining the main lesion. The lymph nodes with these microparticles are enlarged as compared to a control group. We conclude that immunochemistry with these two antibodies is a valuable adjunct for the final histological diagnosis of AE und CE. The frequent detection of microparticles of E. multilocularis and E. granulosus in lymph nodes of patients with AE and CE argue for a larger interface of interaction of the parasite with the host`s immune system than previously assumed and point to further mechanisms of these infections in humans which may be the basis for immunological reactions in the host.

The main endemic areas for alveolar echinococcosis (AE) are in Central Europe and Western China, and in >98% of cases, AE manifests in the liver. The aim of this work was to compare European and Chinese patient groups for number, size, and computed tomography (CT) appearance of hepatic AE lesions. A total of 200 CT scans of patients with hepatic AE were evaluated by four blinded, experienced radiologists from two European (Besancon, Ulm) and two Chinese centres (Xining, Urumqi). In addition to noting the number, size, and localisation of the lesions, the radiologists evaluated morphological appearance using the Echinococcus multilocularis Ulm Classification – CT scheme. Chinese patients were younger than European patients (36.8 ± 13.2 vs. 63.5 ± 17.7; p, Highlights • This work compares patients with alveolar echinococcosis in Europe and China. • Liver lesion was classified by Echinococcus multilocularis Ulm Classification – CT. • Chinese patients were younger than European patients. • Chinese patients showed significantly larger lesions than European patients. • Lesion morphology and lesion number differed significantly between the two groups.

The diagnosis of an inguinal hernia is usually made clinically. Precise imaging appears to be necessary when the clinical examination is inconclusive. The aim of this study was to determine the diagnostic value of ultrasonography for inguinal hernias and whether it influences the decision for or against surgery. This study was a single-center retrospective study carried out from January 2012 to December 2016. All 326 patients had undergone ultrasound scanning of the groin as part of the diagnostic workup. Besides surgical findings being the gold standard, follow-up data and alternative ultrasound diagnoses were considered as references, allowing us to assess the accuracy of negative ultrasound findings as well. The findings on ultrasonography were positive in 248 patients and negative in 78 patients. In addition to 201 operated patients, we were able to validate a further 40 patients by means of a questionnaire and the alternative ultrasound diagnoses. The correlation with all three references resulted in a sensitivity of 97 %, a specificity of 77 %, a positive predictive value of 95 %, and a negative predictive value of 87 %. Ultrasonography is an accurate method for evaluating inguinal hernias. High sensitivity makes it particularly suitable for ruling out an inguinal hernia when the findings are negative. An ultrasound scan carried out in addition to clinical examination can therefore help to determine the right indication for surgical intervention.ZIEL: Leistenhernien werden primär klinisch diagnostiziert. Eine genaue Bildgebung erscheint notwendig, wenn die klinische Untersuchung kein eindeutiges Ergebnis liefert. Ziel dieser Studie war es, die Wertigkeit der Sonografie in der Diagnostik von Leistenhernien zu bestimmen und deren Einfluss in der Entscheidungsfindung für oder gegen eine Operation herauszuarbeiten. Es handelte sich bei dieser Studie um eine retrospektive Studie, die als Single-Center-Studie von Januar 2012 bis Dezember 2016 durchgeführt wurde. Untersucht wurden 326 Patienten, die zur differentialdiagnostischen Abklärung eine Ultraschalluntersuchung der Leiste erhalten hatten. Neben Operationsbefunden als Goldstandard wurden Angaben aus einem Follow-up und alternative sonografische Diagnosen als Referenz betrachtet, um den Stellenwert der Sonografie bei negativen Ultraschallbefunden möglichst genau einschätzen zu können. Die Sonografie war bei 248 Patienten positiv und bei 78 Patienten negativ. 201 Patienten wurden operiert und weitere 40 Patienten konnten durch einen Fragebogen und die alternativen sonografischen Diagnosen validiert werden. Die Korrelation mit diesen Referenzen ergab eine Sensitivität von 97 %, eine Spezifität von 77 %, einen positiv prädiktiven Wert von 95 % und einen negativ prädiktiven Wert von 87 %. Die Sonografie stellt eine sehr genaue Methode für die Evaluierung von Leistenhernien dar. Mit einer hohen Sensitivität eignet sie sich bei einem negativen Ultraschallbefund insbesondere gut zum Ausschluss einer Leistenhernie. Eine zusätzlich zur klinischen Untersuchung durchgeführte Sonografie kann daher die korrekte Indikation und Entscheidung für eine chirurgische Intervention vereinfachen.

Alveolar echinococcosis (AE) is a life-threatening helminthic disease. In humans, AE mostly affects the liver; the regional hepatic lymph nodes may be involved, indicating dissemination of AE from the liver. To achieve complete removal of the disease, enlarged hepatic lymph nodes may be resected during surgical treatment. We evaluated the frequency of affected lymph nodes by conventional microscopic and immunohistochemical analyses including detection of small particles of Echinococcus multilocularis (spem). Furthermore, we analyzed the association of resection of enlarged and affected lymph nodes with long-term outcome after surgical therapy of patients who underwent surgery with curative intent. We identified 43 patients who underwent hepatic surgery with curative intent with lymph node resection for AE. We analyzed the cohort for the manifestation of the parasite in the resected lymph nodes by conventional histology and by immunohistochemistry and compared these data with the further course of AE. Microscopically infected lymph nodes (laminar layer visible) were found in 7 out of these 43 patients (16%). In more than three quarters (25/32) of all specimens investigated, lymph nodes showed spems when stained with antibody against Em2G11, a monoclonal antibody specific for the Em2 antigen of the Echinococcus multilocularis metacestode. Most frequently, lymph nodes were resected due to enlargement. The median size of microscopically affected lymph nodes was 2 cm (range, 1.2 to 2.5 cm), the median size of immunohistochemically and non-affected lymph nodes was 1.3 cm each (range, “small” to 2.3 or 2.5 cm, respectively). Median follow-up was 8 years for all patients, 5 years for patients with lymph node resection, and 4 years for patients with infested lymph nodes. Overall, recurrent disease was seen in ten patients (10/109; 9%) after a median period of 1.5 years (range, 4 months to 4 years). None of the seven patients with conventionally microscopically affected lymph nodes suffered from recurrent disease. One patient with negative resected nodes and one patient with spems showed recurrent disease after 4 and 35 months, respectively. Lymph node involvement in AE is frequent, particularly when evaluated by immunohistochemical examination of lymph nodes with the monoclonal antibody Em2G11. Affected lymph nodes tend to be larger in size. Lymph node involvement is not associated with recurrent disease and therefore warrants further analysis of the biological significance of lymph node involvement.

Background To determine normal values for acoustic radiation force impulse (ARFI) shear wave elastography of the Achilles tendon. Methods Using the VTIQ mode with the Acuson S3000™ (Siemens Healthcare, Erlangen, Germany), we measured the shear wave velocity (SWV) in m/s and the diameter in mm of both Achilles tendons in 182 healthy volunteers. The tendon was displayed in a sagittal view with a relaxed tendon. The parameters were tested for correlations with the anthropometric data of the subjects, between the genders and different age groups, as well as information obtained from the history, such as smoking and sporting activities. Results Using a sagittal acoustic window, we determined a mean SWV of 9.09 ± 0.71 m/s for the left Achilles tendon and 9.17 ± 0.61 m/s for the right. There was a significant difference between the results for the right and left side (p 0.05). The same goes for the consumption of tobacco and alcohol (p > 0.05). Conclusions Age, gender, BMI, smoking or the consumption of alcohol did not affect either the elasticity or the diameter of the Achilles tendon.

We report a case of successful intravenous thrombolysis for a distal middle cerebral artery occlusion shortly after traumatic cardiopulmonary resuscitation due to an episode of ventricular tachycardia. A high prevalence of fatal cardiac arrhythmias in acute stroke patients raises the question of safety when administrating thrombolytic therapy after traumatic cardiopulmonary resuscitation; guidelines do not provide a satisfactory statement about this. Our case suggests that intravenous tissue-type plasminogen activator for acute ischemic stroke can be administered after a thorough risk-to-benefit evaluation without major adverse effects in patients after traumatic cardiopulmonary resuscitation, as bleeding complications seem rare and can be monitored and treated.

In humans, alveolar echinococcosis (AE) is a serious helminthic disease. Additionally to a long-term medical treatment, in all suitable cases a complete surgical resection with a 20-mm safe distance (minimal distance of larval tissue to resection margin) is recommended. We analyzed the influence of the safe distance and the effect of the postoperative anthelmintic prophylaxis on the long-term outcome of patients who underwent surgery with curative intent. Ninety-two operated patients were evaluated regarding the safe distance, the duration of medical therapy with benzimidazole derivates, and the further course of AE. Median follow-up after surgical procedure was 8.3 years. Twelve patients had a safe distance of 20 mm or more, 16 patients between 10 and 19 mm, 21 patients between 1 and 10 mm, and 10 patients 1 mm. In a further 33 patients, the affected liver was resected without any safe distance. Recurrence of AE was seen in 15 patients between 4 months and 24 years after initial operation. Safe distances of patients with recurrent disease were: 13 × no safe distance, one patient with 1-mm and one patient with 13-mm safe distance. In all patients except one with recurrent AE, postoperative therapy with benzimidazole derivates was stopped. A safe distance of at least 1 mm in combination with medical anthelmintic treatment continuing for two years might offer a good chance of being disease-free long term, but the exact period of medical treatment needed is not defined. The therapy regime should be determined through an interdisciplinary approach in specialized centers.

Background. Alveolar echinococcosis (AE) is a rare zoonosis caused by the larval stage of the tapeworm Echinococcus multilocularis. AE lesions affect the liver in more than 98% of cases. AE lesions have various morphological characteristics that are described in the Echinococcus multilocularis Ulm classification for computed tomography (EMUC-CT). One of these characteristics is a cystoid portion. The aim of the study was to compare the density of simple hepatic cysts with cystoid portions of AE lesions classified on the basis of the EMUC-CT. Results. Hounsfield Unit (HU) measurements of the cystoid portions of all EMUC-CT type I–IV AE lesions (n = 155) gave a mean of 21.8 ± 17.6, which was significantly different from that of 2.9 ± 4.5 for the simple hepatic cysts (p p Conclusions. The significantly higher density measured in the cystoid portions of hepatic AE lesions offers a good means of differentiation from simple hepatic cysts.

Purpose Contrast-enhanced ultrasound (CEUS) has been established for many years and has become an increasingly important cornerstone of the diagnostic imaging of various organ systems. However, this modality is rarely performed by radiologists and is primarily employed by other medical disciplines. The goal of this questionnaire study is to present the current value of CEUS in radiology and to encourage reevaluation of the method within this medical discipline. Materials and Methods 560 directors of radiology departments throughout Germany were contacted and given a 3-page questionnaire. The questionnaire included 37 questions on 5 different topics (general structures, CEUS and interdisciplinarity, CEUS in pediatric radiology, education/professional development, outlook) to assess the value of ultrasound (US) and in particular CEUS in radiology. Results The response rate was 42.3 %. A statistical analysis of the answers was performed, including subgroup analysis. Overall, it could be shown that CEUS is performed in comparatively few radiology departments (26.6 %), while the current value of the modality is given an average to high range of importance even by radiologists. More than half of all participating radiologists (54.9 %) would like this method to be included in the requirements catalog for the specialist examination. Conclusion The nationwide questionnaire to evaluate CEUS within radiology departments in Germany had a very high response rate, which reflects the assessment of this topic by radiologists. There is a substantial discrepancy between the currently low utilization of CEUS in radiology and the high ranking of CEUS by many radiologists. The analyses of the replies point out important aspects of professional policy regarding this topic within the radiology community. Key points Citation Format

Die Behandlung von Patienten mit pulmonalen Metastasen bei kolorektalem Karzinom befindet sich in einer kontinuierlichen Weiterentwicklung. Dieses betrifft im Wesentlichen neue Substanzen im Bereich der systemischen Therapie. Fur sorgfaltig ausgewahlte Patienten ist die chirurgische Entfernung von pulmonalen Metastasen ein wichtiger Bestandteil des interdisziplinaren Therapiekonzepts; sie ist in den Leitlinien als primare Therapie verankert. Publiziert sind 5-Jahres-Uberlebensraten von bis zu 60 % nach pulmonaler Metastasektomie. Das parenchymsparende Entfernen der Metastasen hat sich hierbei als relativ risikoarmes Vorgehen etabliert. Prognostische Faktoren sind u. a. die komplette Resektion, positive thorakale Lymphknoten, die Anzahl der Metastasen, aber auch das krankheitsfreie Intervall. Diese Faktoren werden bei der Indikationsstellung genutzt, konnten allerdings bisher lediglich in retrospektiven Studien herausgearbeitet werden.

Summary Background Overt or subclinical hypothyroidism is a common finding in adult populations affected by non-alcoholic fatty liver disease (NAFLD). Currently, there are only sparse data available on the association of thyroid dysfunction and NAFLD in obese children and adolescents. Objective The study aims to investigate the association of thyroid function test values with NAFLD and metabolic risk factors in a population of obese children and adolescents. Methods A total of 332 overweight and obese children and adolescents (170 girls) aged between 10 and 19 years were analysed. Subjects underwent ultrasound examination of the liver. Thyroid function was evaluated by laboratory determination of thyroid-stimulating hormone (TSH), total triiodothyronine (T3) and total thyroxine levels. All included subjects were either euthyroid or had subclinical hypothyroidism (TSH > 4 μU mL−1, normal thyroxine). Further metabolic profiling included the determination of lipid status, insulin and liver function tests. Anthropometric parameters body mass index, waist and hip circumference were documented. Results The prevalence of hepatic steatosis was 29.8%. Subjects with NAFLD had significantly higher TSH levels than those without (p = 0.0007). After dividing TSH values into quartiles, both univariate and multivariate analyses (adjusted for age, body mass index–standard deviation scores and stage of puberty) showed a significant association with hepatic steatosis (p

Background: Patients with a forced expiratory volume in 1 s (FEV1) below 20% of the predicted normal values (pred.) and either homogeneous emphysema or low diffusing capacity for carbon monoxide (DLCO) have a high risk for adverse events including death when undergoing surgical lung volume reduction. Objectives: We hypothesized that selected patients can benefit from endoscopic lung volume reduction (eLVR) despite a very low FEV1. Methods: This study is a retrospective analysis of consecutive patients with severe airflow obstruction, an FEV1 ≤20% of pred., and low DLCO who were treated by eLVR with endobronchial valves (EBV) between June 2012 and January 2015. Pre- and postinterventional lung function parameters, the 6-min walking test (6-MWT) distance, adverse events, and follow-up were recorded. Results: In 20 patients, there was an overall improvement in lung function with an increase in FEV1 (16.97-21.03% of pred.) and a decrease in residual volume (322-270% of pred.) and total lung capacity (144-129.06% of pred.). The 6-MWT distance improved (from 239 ± 77 to 267± 97 m overall, and from 184 ± 50 to 237 ± 101 m if patients developed an atelectasis of the target lobe). Pneumothorax occurred in 5 of the 20 patients (25%). 30-day mortality was 0%, and all patients survived to discharge. Conclusions: The patients benefitted moderately from EBV treatment despite an initially low FEV1. Some patients improved remarkably. EBV treatment in patients with an FEV1 ≤20% of pred. is generally feasible and safe. The greatest risk is pneumothorax with prolonged chest tube duration.

Granulocytes are key effector cells of the innate immune system that cause substantial by-stander tissue damage in a broad range of inflammatory disorders. Specific antibodies with the potential to regulate granulocyte survival are present in polyclonal intravenous immunoglobulin (IVIG) preparations and may contribute to the anti-inflammatory effects of high-dose IVIG therapy. Here, we discuss idiosyncratic characteristics of antibodies to FAS and Siglecs contained in IVIG pertaining to granulocyte death regulation and highlight implications for research and clinical practice.

Manifestations of cystic fibrosis in the pancreas are gaining in clinical importance as patients live longer. Conventional ultrasonography and point shear wave elastography (pSWE) imaging are non-invasive and readily available diagnostic methods that are easy to perform. The aim of this study was to perform conventional ultrasonography and obtain pSWE values in the pancreases of patients with cystic fibrosis and to compare the findings with those of healthy controls. 27 patients with cystic fibrosis (13 women/14 men; mean age 27.7 ± 13.7 years; range 9–58 years) and 60 healthy control subjects (30 women/30 men; mean age 30.3 ± 10.0 years; range 22–55 years) underwent examinations of the pancreas with conventional ultrasound and pSWE imaging. Patients with cystic fibrosis have an echogenic pancreatic parenchyma. We found cystic lesions of the pancreas in six patients. pSWE imaging of the pancreatic parenchyma gave significantly lower shear wave velocities in patients with cystic fibrosis than in the control group (1.01 m/s vs 1.30 m/s; p

β-Thalassemia is an inherited hematological disorder caused by mutations in the human hemoglobin beta (HBB) gene that reduce or abrogate β-globin expression. Although lentiviral-mediated expression of β-globin and autologous transplantation is a promising therapeutic approach, the risk of insertional mutagenesis or low transgene expression is apparent. However, targeted gene correction of HBB mutations with programmable nucleases such as CRISPR/Cas9, TALENs, and ZFNs with non-viral repair templates ensures a higher safety profile and endogenous expression control. We have compared three different gene-editing tools (CRISPR/Cas9, TALENs, and ZFNs) for their targeting efficiency of the HBB gene locus. As a proof of concept, we studied the personalized gene-correction therapy for a common β-thalassemia splicing variant HBBIVS1–110 using Cas9 mRNA and several optimally designed single-stranded oligonucleotide (ssODN) donors in K562 and CD34+ hematopoietic stem cells (HSCs). Our results exhibited that indel frequency of CRISPR/Cas9 was superior to TALENs and ZFNs (P

Pulmonary metastasectomy (PM) is an accepted treatment modality in colorectal cancer (CRC) patients with pulmonary tumor spread. Positive intrathoracic lymph nodes at the time of PM are associated with a poor prognosis and 5-year survival rates of

SummaryObjective of our study is qualitative and quantitative comparison of contrast enhanced ultrasound (CEUS) and 18F-FDG PETCT in monitoring hepatic alveolar echinococcosis (HAE). Parasitic liver lesions were examined regarding number, size, morphology, vascularization and metabolic activity. Patients, methods: 36 patients with medicallytreated HAE were included in this prospective clinical study. Abdominal ultrasound and CEUS were carried out using ultrasound contrast amplifier SonoVue®. As part of monitoring, patients were examined by 18F-FDG-PET-CT. Quantitative analysis of CEUS was performed using the Software Vue- Box™ Quantification Toolbox. Maximum contrast enhancement in lesions peak enhancement (PE) was used as parameter. For quantification of 18F-FDG PET-CT, maximum Standardized Uptake Value (SUVmax) of lesions was specified and statistically compared with PE. Results: 18F-FDG uptake in parasitic liver lesions was diagnosed by 18F-FDG PET-CT in 32 of 36 patients. Vascularization of liver lesions was detected by CEUS in 22 of 32 FDG-positive patients with sensitivity of 69% and specificity of 100%. Mean maximum diameter of lesions was 69.5mm in CEUS and 63.7mm in B-scan ultrasound (p < 0.0001). No significant correlation was found between SUVmax and PE (p = 0.8879). Conclusion: In comparison to FDG PET-CT, the gold standard for detecting viable lesions by depicting metabolism, CEUS detects viable lesions with high specificity and moderate sensitivity by showing vascularization. CEUS must be regarded as an important tool in monitoring HAE. Dimensions of parasitic lesions are displayed more precisely through CEUS than in B-scan. With currently available methods, CEUS quantification has no benefit in monitoring HAE lesions in daily clinical practice.

Background Pulmonary metastasectomy is widely accepted for different malignant diseases. The role of mediastinal lymph node (LN) dissection in these procedures is discussed controversially. We evaluated our results of LN removal at the time of pulmonary metastasectomy with respect to the frequency of unexpected LN disease. Methods This was a retrospective analysis of 313 resections performed in 209 patients. Operations were performed in curative intention. Patients with known thoracic LN involvement and those without lymphadenectomy (n = 43) were excluded. Patients were analyzed according the type of LN dissection. Subgroups of different primary cancers were evaluated separately. Results Sublobar resections were performed in 256 procedures with lymphadenectomy, and 14 patients underwent lobectomy. Patients underwent radical lymphadenectomy (n = 158) or LN sampling (n = 112). The overall incidence of unexpected tumor in LN was 17% (radical lymphadenectomy, 15.8%; sampling, 18.8%). Unexpected LN involvement was found in 17 patients (35.5%) with breast cancer, in 120 (9.2%) with colorectal cancer, and in 53 (20.8%) with renal cell carcinoma. The 5-year survival was 30.2% if LN were tumor negative and 25% if positive ( p = 0.19). LN sampling vs radical removal had no significant effect on 5-year survival (23.6% vs 30.9%; p = 0.29). Conclusions Dissection of mediastinal LN in resection of lung metastases will reveal unexpected LN involvement in a relevant proportion of patients, in particular in breast and renal cancer. Routine LN dissection appears necessary and may become important for further therapeutic decisions. On the basis of our data, LN sampling seems to be sufficient.

Blast injuries are very common among soldiers deployed in politically unstable regions such as Afghanistan and Iraq, and also in a battle field anywhere in the world. Understanding the mechanics of interaction of blasts with the skin and bone at various parts of the human body is the key to designing effective personal protective equipment (PPE's) which can mitigate blast impacts. In the current work, subject-specific 3D computational models of the skin (with the three layers namely the epidermis, dermis and the hypodermis (muscles)) and bone sections from various parts of the human body (such as the elbow, finger, wrist, cheek bone, forehead, shin etc.) have been developed to study the effect of blast loading. Non-linear material properties have been adopted for the skin and stress impulses at the different skin layers and bone sections are estimated. To date, such an extensive study on the effect of blast loading on the human skin and bone has not been attempted. The results of this study would be indispensable for medical practitioners to understand the effect of blast trauma and plan effective post-traumatic surgical strategies, and also for developing better PPE designs for the military in the future.

Das therapeutische Vorgehen bei NSCLC und Infiltration der Vena cava superior (VCS) wird haufig kontrovers diskutiert. Der Ersatz oder die Rekonstruktion der VCS ist unter Einbeziehung multimodaler Therapieverfahren heute eine therapeutische, aber technisch anspruchsvolle Option. Unsere heutige Vorgehensweise, deren Anderung im Lauf der Zeit und die jeweiligen Ergebnisse werden prasentiert. Zwischen 1998 und 2013 erfolgte bei 17 Patienten ein alloplastischer Ersatz oder die Rekonstruktion (n = 5) der VCS bei NSCLC im Rahmen einer Lobektomie (n = 8) oder Pneumonektomie (n = 14). Eine adjuvante Strahlentherapie erhielten 16, eine induktive Chemotherapie 3 Patienten. Retrospektiv ausgewertet wurden der klinische Verlauf und das Uberleben. Therapierelevante postoperative Komplikationen traten bei 13 Patienten auf. Ein Verschluss des Interponats fand sich bei keinem Patienten. Die 30-Tage-Letalitat nach Pneumonektomie betrug 7 %, nach Lobektomie 0 %. Die Lokalrezidivrate betrug 4,5 %, das Auftreten von Fernmetastasen lag bei 54,5 % ( p = 0,0008). Die Uberlebenskurve fur das Gesamtkollektiv zeigte ein 1-Jahres-Uberleben von 63,6 %, ein 5-Jahres-Uberleben von 27,9 %. Patienten mit VCS-Rekonstruktion haben eine etwas bessere Prognose als Patienten mit VCS-Ersatz im 5-Jahres-Vergleich (33 % vs. 25 %, p = 0,22). Patienten mit einer Lobektomie zeigten ein 5-Jahres-Uberleben von 37,5 % (n = 8), nach Pneumonektomie lag dieses bei 21,4 % (n = 14, p = 0,18). Bei NSCLC und Infiltration der Vena cava superior kann man mit Resektion und adjuvanter Strahlentherapie eine gute lokale Kontrolle erzielen. Aufgrund der hohen Rate an Fernmetastasen sollten induktive und adjuvante chemotherapeutische Moglichkeiten sorgfaltig erwogen werden.

Manual segmentation of hepatic metastases in ultrasound images acquired from patients suffering from pancreatic cancer is common practice. Semiautomatic measurements promising assistance in this process are often assessed using a small number of lesions performed by examiners who already know the algorithm. In this work, we present the application of an algorithm for the segmentation of liver metastases due to pancreatic cancer using a set of 105 different images of metastases. The algorithm and the two examiners had never assessed the images before. The examiners first performed a manual segmentation and, after five weeks, a semiautomatic segmentation using the algorithm. They were satisfied in up to 90% of the cases with the semiautomatic segmentation results. Using the algorithm was significantly faster and resulted in a median Dice similarity score of over 80%. Estimation of the inter-operator variability by using the intra class correlation coefficient was good with 0.8. In conclusion, the algorithm facilitates fast and accurate segmentation of liver metastases, comparable to the current gold standard of manual segmentation., Comment: 7 pages, 3 Figures, 3 Tables, 46 References

Intravenous immunoglobulin (IVIG) are purified IgG preparations made from the pooled plasma from thousands of healthy donors and are being tested in preclinical mouse models. Inherent challenges, however, are the pluripotency of IVIG and its xenogeneicity in animals. IVIG can alter the viability of human neutrophils via agonistic antibodies to Fas and Siglec-9. In this study, we compared the effects of IVIG on human and mouse neutrophils using different death assays. Different commercial IVIG preparations similarly induced cytokine-dependent death in human neutrophils, whereas they had no effects on the survival of either peripheral blood or bone marrow neutrophils from C57BL/6 or BALB/c mice. F(ab’)2 but not Fc fragments of IVIG induced death of human neutrophils, whereas neither of these IVIG fragments, nor agonistic monoclonal antibodies to human Fas or Siglec-9 affected the viability of mouse neutrophils. Pooled mouse IgG, which exhibited a different immunoprofile compared to IVIG, also had no effect on mouse cells. Together, these observations demonstrate that effects of IVIG on neutrophil survival are not adequately reflected in current mouse models, despite the key role of these cells in human inflammatory and autoimmune diseases.

Background/Aims: Cystic echinococcosis (CE) is the most widespread zoonosis worldwide. The objective of the present study was to compare diagnostic methods in the work-up of suspected cystic echinococcosis of the liver. Materials and Methods: Data from a total of 68 patients were compiled and analyzed. Results: A diagnosis of cystic echinococcosis was made in 36.8% of patients. Broken down according to WHO criteria, patients with at least one echinococcus cyst were determined in 12.0% of cases to exhibit cysts consistent with stage 1 disease (CE1), while in 24.0%, cysts consistent with CE2 and CE3 were identified. CE4 and CE5 cysts were identified in 32.0% and 8.0% of patients, respectively. Solitary cysts were found in 60.0% of patients with cystic echinococcosis, while in patients with at least one cystic lesion, there were most often multiple cysts. The indirect hemagglutination test (IHA) and echinococcus-specific immunoglobulin E (IgE) concentration showed a higher sensitivity (60.9%, 68.4%) than did the enzyme-linked immunosorbent assay (ELISA) for Echinococcus multilocularis (Em2 + ) and total IgE (11.1%, 38.9%). The respective specificities of all four serological methods lay between 83.9% and 88.9%. Conclusion: Our data show that ultrasound remains the diagnostic method of choice in the work-up of cystic lesions of the liver suspected to be due to Echinococcus granulosus. Serological methods can serve an adjunctive role.

Hintergrund und Fragestellung: Die chronisch-thromboembolische pulmonale Hypertonie (CTEPH) ist eine ernsthafte Komplikation nach akuter Lungenembolie. Sie hat unbehandelt eine schlechte Prognose. Therapie der Wahl ist die pulmonale Thrombendarteriektomie. Die Prognose ist abhangig vom WHO-Funktionsstadium. Eine verzogerte Diagnosesicherung konnte sich negativ auf die Prognose auswirken. In der vorliegenden Studie wurden die Latenz zwischen Symptombeginn und Diagnosesicherung sowie die WHO-Funktionsklasse der Patienten bei Diagnosestellung untersucht. Patienten und Methoden: Retrospektive Analyse der Daten von 70 monozentrisch erfassten Patienten (48 Frauen, 22 Manner, mittleres Alter 66,2 ± 13,8 Jahre) mit gesicherter CTEPH aus dem Lungenhochdruckzentrum Missionsarztliche Klinik. Alle Patienten waren zuvor einer Leitlinien-gemasen Diagnostik unterzogen worden. Ergebnisse: Die mittlere Latenz vom Beginn der Symptome zur Diagnosesicherung einer CTEPH betrug 18 ± 26 Monate und war bei Patienten mit gesichertem Lungenembolie-Akutereignis in der Vorgeschichte (n = 56; 81 %) mit 16,9 ± 23,8 Monaten kurzer als bei Patienten ohne ein solches Ereignis (23,5 ± 36,9 Monate; n = 13; 19 %). Eine hohere Latenz fand sich bei Patienten, die bereits andernorts unter Annahme einer pulmonalarteriellen Hypertonie (PAH) behandelt wurden, und bei Patienten, die im Expertenzentrum als nicht operabel eingestuft werden. 38 Patienten mit Lungenembolie in der Vorgeschichte hatten kein beschwerdefreies Intervall zwischen Lungenembolie und CTEPH, bei 18 Patienten bestand ein beschwerdefreies Intervall zwischen Lungenembolie und CTEPH. Mehr als 70 % der Patienten befanden sich bei Diagnosesicherung im fortgeschrittenen WHO-Funktionsstadium III oder IV. Folgerung: Die Latenz zwischen Beschwerdebeginn und Diagnosesicherung einer CTEPH ist lang und die Mehrzahl der Patienten befindet sich bei Diagnose in einem fortgeschrittenen WHO-Funktionsstadium. Da die Prognose bei unbehandelter CTEPH ungunstig ist und sich bei fortgeschrittenem WHO-Funktionsstadium weiter verschlechtert, andererseits aber mit der Thrombendarteriektomie potenziell eine Heilung zu erzielen ist, muss bei Verdacht auf eine pulmonale Hypertonie eine CTEPH immer zeitnah durch Vorstellung in einem PH-Zentrum ausgeschlossen werden.

To calculate the prevalence, localization, and growth of sporadic angiomyolipomas and to identify the predominant sex in the largest patient population reviewed to date.Abdominal ultrasound analyses of 61,389 patients (49.7% women; 50.3% men) were consecutively collected using a PC-based, standardized documentation system from September 1999 to December 2012. The present study evaluates and presents this data.The population studied includes 270 cases of sporadic angiomyolipoma (184 females; 86 males). This represents an overall prevalence of 0.44%, with 0.60% in the female and 0.28% in the male subpopulations. Mean tumor size was 10.8 ± 5.8 mm. Fifty-seven percent of cases involved the right kidney and 43.0% the left kidney. Only 14 of the 270 patients presented with multiple angiomyolipomas, four of which were bilateral. Sixty-one cases were followed over a mean period of 25 months (range: 1-105 months) and showed no significant increase in tumor size during the period of observation.The analysis of 61,389 patients revealed a higher prevalence of sporadic angiomyolipoma than previously observed in smaller studies. There was a significantly higher prevalence in females than in males. Multiple and bilateral angiomyolipomas were rare, and tumor growth was marginal.

Background To determine liver span sonographically in a randomly selected population sample and identify factors that affect liver size. Methods A total of 1,789 subjects (963 females, 826 males; mean age 41.8 ± 12.8 years) underwent sonographic examination of the liver in the midclavicular line to determine liver span. Subjects underwent physical examination and blood tests and completed a standardized interview questionnaire. Results The average liver span in the midclavicular line for the overall collective was 15.0 ± 1.5 cm; the average for females was 14.9 ± 1.6 cm and 15.1 ± 1.5 cm for males. Liver span exceeded 16 cm in 24.3% of subjects. Results of the multivariate analysis showed that, of the factors potentially influencing liver span, gender, age, body mass index, body height, fatty liver (p

TRPV5 and TRPV6 are two major calcium transport pathways in the human body maintaining calcium homeostasis. TRPV5 is mainly expressed in the distal convoluted and connecting tubule where it is the major, regulated pathway for calcium reabsorption. TRPV6 serves as an important calcium entry pathway in the duodenum and the placenta. Previously, we showed that human TRPV6 (hTRPV6) transports several heavy metals. In this study we tested whether human TRPV5 (hTRPV5) also transports cadmium and zinc, and whether hTRPV5 together with hTRPV6 are involved in cadmium and zinc toxicity. The hTRPV5 mRNA and protein were expressed in HEK293 cells transiently transfected with pTagRFP-C1-hTRPV5. The overexpression of the hTRPV5 protein at the plasma membrane was revealed by cell surface biotinylation and immunofluorescence techniques. We observed that both cadmium and zinc permeate hTRPV5 in ion imaging experiments using Fura-2 or Newport Green DCF. Our results were further confirmed using whole-cell patch clamp technique. Transient overexpression of hTRPV5 or hTRPV6 sensitized cells to cadmium and zinc. Toxicity curves of cadmium and zinc were also shifted in hTRPV6 expressing HEK293 cells clones. Our results suggest that TRPV5 and TRPV6 are crucial gates controlling cadmium and zinc levels in the human body especially under low calcium dietary conditions, when these channels are maximally upregulated.

Sex hormone binding globulin (SHBG) is a glycoprotein expressed predominantly in the hepatocytes. It regulates the transport of sex steroid hormones in the blood stream to their target tissues. The expression of the SHBG gene is subject to multifactorial regulation including hormonal, metabolic, and nutritional aspects. Against this background, we investigated the effect of fatty liver and metabolic syndrome, together with other parameters, on serum SHBG concentrations in a population-based cohort in Germany. This cross-sectional study included 870 women and 787 men (average age 42.3±12.8 years), who underwent ultrasound screening for fatty liver in addition to providing a complete medical history and undergoing physical and laboratory examination. Fatty liver was diagnosed on ultrasound criteria in 159 women (18.3%) and 287 men (36.5%). Fatty liver was shown to exert a significant influence on serum SHBG concentrations in men and in premenopausal women. Men with grade 1 fatty liver had a 1.96-fold increased risk (95%-confidence interval=1.28-3.02; p=0.0022) and postmenopausal women with grade 1 fatty liver a 2.4-fold risk (95%-confidence interval=1.11-5.27; p=0.0267) for low SHBG concentrations. Among metabolic parameters, HDL-C represented as affecting factor in men (p=0.0058) and premenopausal women (p=0.0002), while cholesterol only showed an association in premenopausal women (p=0.0439) and triglyceride in postmenopausal women (p=0.0436). No association of concentrations of SHBG and metabolic syndrome was observed. Age, BMI and waist-to-hip ratio also influence the SHBG concentration. Based on these findings, we conclude that fat accumulation in the liver influences SHBG concentrations in men and premenopausal women.