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Obesity has substantially increased in recent decades and is now one of the major global health problems. The large obesity-related health burden negatively impacts many relevant health outcomes (e.g. quality of life, disability, mortality) and leads to increased healthcare utilization. This excess service use is the main driver behind high healthcare costs of obese individuals. Findings indicate that costs rise curvilinearly with increasing body mass index, especially among the obese. As more individuals of a country's population become obese, a larger share of total annual national healthcare expenditure is spent on obesity and obesity-related health problems. In addition to escalating healthcare costs, obesity goes along with indirect costs through decreases in workforce productivity. The empirical evidence has shown beyond doubt that obesity negatively impacts individuals, healthcare systems, employers, and the economy as a whole. This article provides a brief overview of selected economic consequences associated with excess-weight. [Copyright &y& Elsevier]

Enlargement and dysfunction of the right ventricle (RV) is a sign and outcome predictor of many cardiopulmonary diseases. Due to the complex geometry of the RV exact volumetry is cumbersome and time-consuming. We evaluated the performance of prototype software for fully automated RV segmentation and volumetry from cardiac CT data. In 50 retrospectively ECG-gated coronary CT angiography scans the endsystolic (RVVmin) and enddiastolic (RVVmax) volume of the right ventricle was calculated fully automatically by prototype software. Manual slice segmentation by two independent radiologists served as the reference standard. Measurement periods were compared for both methods. RV volumes calculated with the software were in strong agreement with the results from manual slice segmentation (Bland-Altman r = 0.95-0.98; p < 0.001; Lin's correlation Rho = 0.87-0.96, p < 0.001) for RVVmax and RVVmin with excellent interobserver agreement between both radiologists (r = 0.97; p < 0.001). The measurement period was significantly shorter with the software (153 ± 9 s) than with manual slice segmentation (658 ± 211 s). The prototype software demonstrated very good performance in comparison to the reference standard. It promises robust RV volume results and minimizes postprocessing time. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the change in volume in herniated lumbar disk after computed tomography (CT)-guided intradiscal and periganglionic ozone-oxygen injection and to assess the effects of patient age, sex, and initial disk volume on disk volume changes. Materials and Methods: A total of 283 patients with lumbar radiculopathy received a single intradiscal (3 mL) and periganglionic (7 mL) injection of an ozone-oxygen mixture (ratio, 3:97; ozone concentration, 30 μg/mL). Under CT guidance, intradiscal and periganglionic injection was performed through an extraspinal lateral approach with a 22-gauge spinal needle. All disk volume changes were evaluated on CT 6 months after the procedure in all patients. Results: Initial mean disk volume was 17.37 cm(3) ± 4.70 (standard deviation; range, 8.12-29.15 cm(3)). Disk volume reduction (mean, 7.70% ± 5.45; range, 0.29%-22.31%) was seen in 96.1% of treated disks (n = 272) at 6 months after treatment and was found to be statistically significant (P < .0001). In 3.9% of patients (n = 11), disk volume increased (mean, 0.59% ± 0.24; range, 0.11%-0.81%). Patient age correlated negatively with disk volume reduction (r = -0.505; P < .0001) at 6 months after treatment, whereas initial disk volume correlated positively with volume reduction (r = 0.225; P = .00014) after therapy. No correlation was noted between patient sex and disk volume reduction after treatment (P = .09). Conclusions: Intradiscal administration of medical ozone is associated with a statistically significant volume reduction of the herniated lumbar disk. The volume-reduction effect of ozone correlates negatively with the patient's age and positively with initial disk volume. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare test bolus and bolus tracking for the determination of scan delay of high-pitch dual-source CT pulmonary angiography in patients with suspected pulmonary embolism using 50ml of contrast material. Materials and methods: Data of 80 consecutive patients referred for CT pulmonary angiography were evaluated. All scans were performed on a 128-channel dual-source CT scanner with a high-pitch protocol (pitch 3.0, 100kV, 180mAs). Contrast enhancement was achieved by injecting 50ml of iomeprol followed by a saline chaser of 50ml injected at a rate of 4ml/s. The scan delay was determined using either the test bolus (n =40) or bolus tracking (n =40) technique. Test bolus required another 15ml CM to determine time to peak enhancement of the contrast bolus within the pulmonary trunk. Attenuation profiles in the pulmonary trunk and on segmental level as well as in the ascending aorta were measured to evaluate the timing techniques. Additionally, overall image quality was evaluated. Results: In all patients an adequate and homogeneous contrast enhancement of more than 250HU was achieved in the pulmonary arteries. No statistically significant difference between test bolus and bolus tracking was found regarding attenuation of the pulmonary arteries or overall image quality. However, using bolus tracking 15ml CM less was injected. Conclusion: A homogeneous opacification of the pulmonary arteries and sufficient image quality can be achieved with both the bolus tracking and test bolus techniques with significant lower contrast doses compared to conventional contrast material injection protocols. [Copyright &y& Elsevier]

Objectives: To assess whether conservative treatment of pediatric patients with neurogenic detrusor overactivity (NDO) results in lower bladder pressure and increased expected bladder volume (EBV), we investigated the clinical and urodynamic effects of long-term intravesical oxybutynin instillation compared with a standard treatment of oral anticholinergic medication in patients with clean intermittent catheterization (CIC). Methods: A retrospective study was performed including 21 patients suffering from myelomeningocele and NDO. Initially, all patients were treated with oral anticholinergics and CIC. Ten of the 21 patients showed a sufficient response to the treatment and were included in group I (anticholinergics and CIC). The other 11 patients responded poorly to the initial treatment or developed side effects to oral medication. These patients were included in group II and treated with intravesical oxybutynin and CIC. The two groups were compared using clinical, sonographic and urodynamic examinations performed prior to starting treatment and repeated on an annual basis. Changes from baseline were analyzed with the Mann-Whitney U test. Results: Ten patients in group I and 11 in group II were investigated. Two of the 11 patients in group II stopped the treatment. The mean starting age was 8.1 (±6.6) years in group I and 12.5 (±4.5) years in group II. The mean follow-up time was 7.1 (±5.5) years in group I and 3.6 (±1.8) years in group II. Bladder capacity increased from 173 (±99) to 371 (±115) ml in group I and from 245 (±133) to 370 (±156) ml in group II. Six of the 10 patients in group I and 6/9 patients in group II reached normal EBV. Three of the 10 subjects in group I and 6/9 in group II had bladder compliance values >10 ml/cm HO. At final follow-up, the overall rate of urinary tract infections was equal. Social continence was achieved in 6/10 in group I and 7/9 in group II. Altogether, 19/21 patients responded to conservative management. Conclusions: In children with NDO, conservative medical treatment combined with CIC is feasible and provides an improved pattern of bladder function, which could help avoid bladder surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate local tumor control and survival rate after repeated transarterial chemoembolization using two different protocols in hepatocellular carcinoma (HCC) patients. Materials and Methods: A total of 190 patients (mean, 68 years) with HCC were repeatedly treated with transarterial chemoembolization in 4-week intervals. The chemotherapy protocol consisted of mitomycin C alone (n = 111) and mitomycin C with gemcitabine (n = 79). Embolization was performed with lipiodol and microspheres. Tumor response was evaluated by magnetic resonance imaging using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Survival rates were calculated using Kaplan-Meier method. Results: In the mitomycin C–only group, we observed partial response in 38.8% (43/111), stable disease in 27% (30/111), and progressive disease in 34.2% (38/111). In the mitomycin C/gemcitabine group (n = 79), partial response was observed in 43% (34/79), stable disease in 16.5% (13/79) and progressive disease in 40.5% (32/79). The overall 1- and 2-year survival rates were 56% and 28%, respectively. The overall median survival time from the start of transarterial chemoembolization treatment was 15 months. The median survival of patients treated with mitomycin C was 16.5 months and it was 12 months for patients treated with a combination of mitomycin C and gemcitabine. No statistically significant difference between the two groups was observed (P = .7). Conclusion: Chemoembolization is an effective minimally invasive therapy option for palliative treatment of HCC patients. Mitomycin C only proves to be effective, the addition of gemcitabine was not advantageous. [ABSTRACT FROM AUTHOR]

Objective: To compare dose and image quality of 64-slice, first and second generation dual-energy CT (DECT) for CT pulmonary angiography (CTPA).Methods: Totally 120 patients, 30 in each group, underwent CTPA on a first generation (group 1: single-energy, 120 kV/145 mAs; group 2: DE, 140/80 kV, 70/350 mAs) or second generation dual-source DECT device (group 3: DE, 100/Sn140 kV, 120/102 mAs; group 4: DE, 80/Sn140 kV, 202/86 mAs). CTDIvol, DLP, background noise (BN), thorax diameter and attenuation in the pulmonary trunk were compared.Results: Thorax diameter and attenuation in the pulmonary trunk did not differ significantly (p > 0.4 and >0.19) between the groups. Mean CTDIvol and DLP were significantly lower (p < 0.003) in group 4 (6.2 ± 1.6 mGy/170 ± 41 mGycm) compared to group 1 (8.5 ± 2.6 mGy/235 ± 117 mGycm), group 2 (9.2 ± 3.3 mGy/224 ± 122 mGycm) and group 3 (8.7 ± 2.8 mGy/246 ± 86 mGycm). BN was significantly lower (p < 0.0001) in group 4 (12 ± 3 HU) and group 1 (13 ± 6 HU) compared to group 3 and 2 (16 ± 6 HU and 23 ± 9).Conclusion: The use of second generation DECT in 80/Sn140 kV configuration allows for significant dose reduction with image quality similar to 120 kV CTPA. [ABSTRACT FROM AUTHOR]

Objective: To investigate the role of perfusion defect (PD) size on dual energy CT pulmonary blood volume assessment as predictor of right heart strain and patient outcome and its correlation with d-dimer levels in acute pulmonary embolism (PE).Methods: 53 patients with acute PE who underwent DECT pulmonary angiography were retrospectively analyzed. Pulmonary PD size caused by PE was measured on DE iodine maps and quantified absolutely (VolPD) and relatively to the total lung volume (RelPD). Signs of right heart strain (RHS) on CT were determined. Information on d-dimer levels and readmission for recurrent onset of PE and death was collected.Results: D-dimer level was mildly (r = 0.43-0.47) correlated with PD size. Patients with RHS had significantly higher VolPD (215 vs. 73 ml) and RelPD (9.9 vs. 2.9%) than patients without RHS (p < 0.003). There were 2 deaths and 1 readmission due of PE in 18 patients with >5% RelPD, while no such events were found for patients with <5% RelPD.Conclusion: Pulmonary blood volume on DECT in acute PE correlates with RHS and appears to be a predictor of patient outcome in this pilot study. [ABSTRACT FROM AUTHOR]

Purpose: To compare the dose estimates and image quality of Dual Energy CT (DECT), Dual Source CT (DSCT) and 16-slice CT for coronary CT angiography (cCTA).Methods: Sixty-eight patients were examined with 16 - slice MDCT (group 1), 68 patients with DSCT (group 2) and 68 patients using DSCT in dual energy mode (DECT group 3). CT dose index volume, dose length product, effective dose, signal-to-noise, and contrast-to-noise ratio were compared. Subjective image quality was rated by two observers, blinded to technique.Results: The mean estimated radiation dose of all patients investigated on a 16 - slice MDCT was 12 ± 3.59 mSv, for DSCT in single energy 9.8 ± 4.77 mSv and for DECT 4.54 ± 1.87 mSv. Dose for CTA was significantly lower in group 3 compared to group 1 and 2. The image noise was significantly lower in Group 2 in comparison to group 1 and group 3. There was no significant difference in diagnostic image quality comparing DECT and DSCT.Conclusion: cCTA shows better dose levels at both DECT and DSCT compared to 16-slice CT. Further, DECT delivers significantly less dose than regular DSCT or single source single energy cCTA while maintaining diagnostic image quality. [ABSTRACT FROM AUTHOR]

Objective: Computed tomography (CT) of the paranasal sinus is the standard diagnostic tool for a wide range of indications in mostly younger patients. This study aims to assess the image quality of CT of the sinus by using a high-pitch dual-source technique with special regard to the radiation dose.Methods: Examinations were performed on a second-generation dual-source CT with a pitch factor of 3.0 (dual-source mode). Images were compared with those with a pitch factor of 0.9 on the same system (single-source mode) and with those of 16-slice CT. Image quality was evaluated by four blinded readers using a 5-point scale (1=poor, 5=excellent). Comparison of the dose length product (DLP) was used to estimate radiation exposure.Results: Seventy-three consecutive patients underwent imaging with the proposed CT protocols. The viewers rated the image quality of the dual-source image sets as nearly as good (3.62) as the single-source images on the same device (4.18) and those on 16-slice CT (3.7). DLP was cut to half of the dose [51 mGycm vs. 97.8 mGycm vs. 116.9 mGycm (p<0.01)].Conclusions: Using the proposed dual-source mode when examining the paranasal sinus, diagnostic image quality can be achieved while drastically lowering the patient's radiation exposure. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (RCT) Level of Evidence 1b OBJECTIVE To evaluate the efficacy of different modes of combined therapy in children with monosymptomatic nocturnal enuresis (MNE). PATIENTS AND METHODS A randomized prospective study was performed to compare the order of two types of combined therapy in children with MNE. Group A was treated with primary desmopressin treatment that was combined with alarm treatment after 3 months, while group B was treated with primary alarm treatment that was combined with desmopressin after 3 months. RESULTS Within a period of 18 months, 43 previously untreated children fulfilled the inclusion criteria. Thirteen children achieved dryness after initial monotherapy or discontinued the study. Group A consisted of 16 children and group B of 14 children. After the standardized treatment course of 6 months, 11/16 children in group A and 11/14 children in group B became dry (<3 wet nights/month). Altogether, 22/30 (73%) children were dry after combined treatment, consisting of 12/18 boys and 10/12 girls. Of the children with a normal maximum voided volume, 79% (19/24) achieved dryness, whereas only three of six children with small maximum voided volumes became dry. In all, 13/19 (68%) children with nocturnal polyuria and nine of 11 without nocturnal polyuria became dry. Only one child relapsed (group A). CONCLUSIONS Combined therapy proved effective in children with MNE after 6 months, with no statistically significant differences between the two different orders of treatment. [ABSTRACT FROM AUTHOR]

Purpose: To study the changes in uterine leiomyoma volume after uterine artery embolization (UAE) and to correlate these changes with the initial tumor volume and location within the uterus. Materials and Methods: The study was performed retrospectively on 28 consecutive patients (age, 37–57 years; mean, 48 y ± 4.81) with 84 uterine leiomyomas. UAE was performed between June 2006 and August 2007. All tumors in all patients were evaluated. Magnetic resonance imaging was performed before UAE and 3 months and 1 year after UAE. The volume and location of each tumor were evaluated in consensus by two radiologists. Results: The mean pre-UAE volume of the leiomyomas was 51.6 cm3 (range, 0.72–371.1 cm3; SD, 79.3). Seven tumors were submucous, 28 intramural, and 49 subserous. At 3-month follow-up, 83 tumors (98.8%) showed volume reduction (mean, 52.62% ± 21.85%; range, 12.79%–96.67%) and one (1.2%) increased in volume. At 1-year follow-up, five tumors (6%) were undetectable, 72 (85.7%) showed a further volume reduction of 20.5% ± 11.92% (range, 2.52%–58.72%) relative to the 3-month volume, and seven (8.3%) increased in volume. A statistically significant difference (P = .026 at 3 months and P = .0046 at 1 year) in percentage of volume change was observed based on tumor location; submucous tumors showed the greatest volume reduction and subserous tumors the least reduction. The initial tumor volume showed a weak negative correlation (Spearman correlation coefficients, −0.35 at 3 months and −0.36 at 1 year) with tumor volume change. Conclusions: UAE results in leiomyoma volume reduction at 3-month and 1-year follow-up. The tumor location plays an important role in volume changes and the initial tumor volume plays a minor role. Further studies with larger numbers of submucous leiomyomas are needed. [Copyright &y& Elsevier]

Background: In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+. Methods: Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed. Results: Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care. Conclusions: While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous. [ABSTRACT FROM AUTHOR]

Background: Due to demographic change, the advanced elderly represent the fastest growing population group in Europe. Health problems tend to be frequent and increasing with age within this cohort. Aims of the study: To describe and compare health status of the elderly population in six European countries and to analyze the impact of socio-demographic variables on health. Methods: In the European Study of the Epidemiology of Mental Disorders (ESEMeD), representative noninstitutionalized population samples completed the EQ-5D and Short Form-12 (SF-12) questionnaires as part of personal computer-based home interviews in 2001-2003. This study is based on a subsample of 1659 respondents aged ≥ 75 years from Belgium (n = 194), France (n = 168), Germany (n = 244), Italy (n = 317), the Netherlands (n = 164) and Spain (n = 572). Descriptive statistics, bivariate- (chi-square tests) and multivariate methods (linear regressions) were used to examine differences in population health. Results: 68.8% of respondents reported problems in one or more EQ-5D dimensions, most frequently pain/ discomfort (55.2%), followed by mobility (50.0%), usual activities (36.6%), self-care (18.1%) and anxiety/depression (11.6%). The proportion of respondents reporting any problems increased significantly with age in bivariate analyses (age 75-79: 65.4%; age 80-84: 69.2%; age ≥ 85: 81.1%) and differed between countries, ranging from 58.7% in the Netherlands to 72.3% in Italy. The mean EQ VAS score was 61.9, decreasing with age (age 75-79: 64.1; age 80-84: 59.8; age ≥ 85: 56.7) and ranging from 60.0 in Italy to 72.9 in the Netherlands. SF-12 derived Physical Component Summary (PCS) and Mental Component Summary (MCS) scores varied little by age and country. Age and low educational level were associated with lower EQ VAS and PCS scores. After controlling for sociodemographic variables and reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and Belgium, and lower in Germany than the grand mean. Conclusions: More than two thirds of the advanced elderly report impairment of health status. Impairment increases rapidly with age but differs considerably between countries. In all countries, health status is significantly associated with socio-demographic variables. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the clinical presentation, diagnosis and management of patients with intussusception, with special regard to the duration of symptoms, referral from other hospitals, outcome and complications related to delayed diagnosis. This retrospective study was performed using hospital charts, ultrasound and radiological reports and surgical notes from patients treated in our institution from 1996–2005. Altogether 98 patients were included in the study. The study revealed idiopathic intussusception in 95% of the cases. The remaining patients presented with Meckel’s diverticulum and schwannoma of the small bowel. We used ultrasound as the primary modality for diagnosis in all the patients, with a diagnostic accuracy of 100% in our study. Conservative treatment using an air enema was successful in 79.5% of cases. A higher rate of surgical intervention was found in patients who had symptoms for more than 24 h and in referred patients. Particular attention needs to be paid to the rapid diagnosis and appropriate treatment of intussusception. Uncertain cases should be urgently referred to specialised paediatric centres. Ultrasound should be the diagnostic method of choice, since it is very effective in making this diagnosis. The first treatment option for intussusception remains the enema. Delayed diagnosis leads to an increased number of open surgeries. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility of three-dimensional (3D) reconstructed contrast-enhanced (CE) magnetic resonance (MR) angiography in mapping the pelvic arteries in women before uterine artery embolization (UAE). Materials and Methods: CE MR angiography studies before UAE in 49 women (age range, 38–57 years; mean, 47.04 y ± 4.7 [SD]) who underwent UAE for uterine leiomyomas between February 2005 and February 2007 were retrospectively evaluated by two radiologists in consensus. Studies were performed on a 1.5-T MR unit with a 3D fast low-angle shot sequence in the coronal direction. Reconstruction was performed with 3D computed tomographic angiography reconstruction software. Results: In the current study, 98 internal iliac arteries (IIAs) from 49 women were studied. The superior and inferior gluteal arteries were visualized in all cases (N = 98; 100%), the lateral sacral artery in 86 cases (88%), the iliolumbar artery in 84 (86%), the obturator artery in 81 (83%), the internal pudendal artery in 96 (98%), and the uterine artery in 95 (97%). The superior vesical and middle rectal arteries were seen in 21 (21%) and 11 (11%) cases, respectively. The mean length of the uterine artery was 12.56 cm (range, 4.6–22.2 cm), and it showed the longest traceable length among all branches. The uterine artery showed five patterns of origin. The superior gluteal artery showed constant origin from the posterior division of the IIA, whereas the iliolumbar and obturator arteries showed the most variations in origin. Conclusions: Three-dimensional reconstructed CE MR angiography can detect most branches of the IIA in addition to their point of origin. Therefore, it can be used as a mapping tool of the pelvic arterial tree before UAE. [Copyright &y& Elsevier]

To evaluate tumor response after treating unresectable lung metastases with transpulmonary chemoembolization (TPCE) in palliative intention. From 2001 to 2005, 52 patients (mean: 59.8 years; 32 males/20 females) suffering from 106 unresectable lung metastases (mean:6 metastases/patient; range,1-21) were treated with 2-10 TPCE-sessions (mean: 3.3 sessions/patient). Metastases originated from primaries, including colorectal carcinoma (n = 20), breast cancer (n = 6), renal cellular carcinoma (n = 5), thyroid cancer (n = 4), cholangiocellular carcinoma (n = 2), leiomyosarcoma (n = 2), and others (n = 13). Tumor-feeding pulmonary arteries were selectively probed after puncturing the femoral vein, and administering 10 ml lipiodol, mitomycin C, and microspheres (Spherex) each via balloon catheter over pulmonary approach. During therapy, follow-up was accomplished at 4-week intervals using unenhanced and contrast-enhanced CT. After sequential therapy, follow-up was performed every 3 months for a period of 6 months up to 2.25 years. All patients tolerated the treatments well without major side effects or complications. In 24% (n = 13) moderate to high lipiodol uptake was found, while 75% (n = 39) of the tumors showed a low uptake. According to the RECIST criteria, "partial response" was achieved in 16 cases, "stable disease" in 11 cases, and "progressive disease" in 25 cases [mean survival: 17 months/median: 21.1 months (Kaplan-Meyer)]. According to these findings, TPCE is a well-tolerated procedure for palliative treatment of unresectable lung metastases. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the feasibility, safety and effectiveness of CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy (LITT) in adrenal metastases. Nine patients (seven male, two female; average age 65.0 years; range 58.7-75.0 years) with nine unilateral adrenal metastases (mean diameter 4.3 cm) from primaries comprising colorectal carcinoma (n = 5), renal cell carcinoma (n = 1), oesophageal carcinoma (n = 1), carcinoid (n = 1), and hepatocellular carcinoma (n = 1) underwent CT-guided, MR-thermometry-controlled LITT using a 0.5 T MR unit. LITT was performed with an internally irrigated power laser application system with an Nd:YAG laser. A thermosensitive, fast low-angle shot 2D sequence was used for real-time monitoring. Follow-up studies were performed at 24 h and 3 months and, thereafter, at 6-month intervals (median 14 months). All patients tolerated the procedure well under local anaesthesia. No complications occurred. Average number of laser applicators per tumour: 1.9 (range 1-4); mean applied laser energy 33 kJ (range 15.3-94.6 kJ), mean diameter of the laser-induced coagulation necrosis 4.5 cm (range 2.5-7.5 cm). Complete ablation was achieved in seven lesions, verified by MR imaging; progression was detected in two lesions in the follow-up. The preliminary results suggest that CT-guided, MR-thermometry-controlled LITT is a safe, minimally invasive and promising procedure for treating adrenal metastases. [ABSTRACT FROM AUTHOR]

This article describes the technique of transpulmonary chemoembolization for the palliative treatment of unresectable lung tumors. Early utilization of this method has resulted in reduction in tumor volume and alleviation of patient symptoms. After superselective catheterization, cytotoxic agents are administered, and the pulmonary arterial supply of the tumor is occluded by injection of microspheres and ethiodized oil. Emerging data suggest that this approach is well tolerated. [Copyright &y& Elsevier]

This study aims to evaluate the efficacy and safety of a neoadjuvant treatment protocol with repeated transarterial chemoembolization (TACE) before MR-guided laser-induced thermotherapy (LITT) for large-sized hepatocellular carcinomas (HCC). Repeated TACE (mean, 3.5 treatments per patient) was performed in 48 patients with neoadjuvant intention (the largest lesion was between 50 and 80 mm in diameter, and there were no more than five lesions). For the TACE treatment, we used 10 mg/m(2) mitomycin, 10 ml/m(2) Lipiodol and microspheres. The tumor volume was measured by MRI. Lipiodol retention of the tumors was evaluated with CT. After the diameter of the tumors had decreased to less than 50 mm, the patients were treated with MR-guided LITT 4 to 6 weeks after embolization. Repeated TACE reduced the tumor size in 32 patients (66.7%), forming the basis for performing MR-guided LITT procedures. These patients received one to four laser treatments (mean, 1.9 per patient) for tumor ablation, resulting in a median survival of 36.0 months after the first treatment. For the remaining patients, no reduction in tumor size was achieved in 12 patients and disease progression in 4 patients. Neoadjuvant TACE appears to be an effective treatment of large-sized HCC, which extends the indication for MR-guided LITT. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Surgery has been the only effective therapy. However, many patients still eventually die of disease recurrence. Chemotherapy and radiation therapy have been of limited value. Imatinib mesylate (Glivec®) is an orally administered competitive inhibitor of tyrosine kinases associated with the KIT, ABL protein, licensed for the treatment of metastatic GIST since 2002 in Germany. Methods: We summarized the data of 16 patients with advanced or metastatic GIST treated with imatinib mesylate in palliative and neoadjuvant settings. Results: Overall response was 81%, with no evidence of disease (NED) in 3/16 (19%), partial response (PR) in 9/16 (56%) and stable disease (SD) in 1/16 (6%), whereas 3/16 patients (19%) suffered from progressive disease (PD). Mean follow-up was 18.6 months [range: 4–30]. Mean progression-free survival (PFS) was 17.6 months [range: 0–30], mean overall survival (OS) from initial diagnosis was 32.3 months [range: 5–122]. Most common side effects were periorbital edema and skin rash. Conclusion: Imatinib mesylate is well tolerated in a dose of up to 800 mg/day and has significant activity during long- term treatment of patients with advanced or metastatic GIST. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Interventional therapeutic methods are presented in Carney triad, which is a syndrome defined as the simultaneous presence of gastric leiomyosarcoma, extra-adrenal paraganglioma, and pulmonary chondroma. The paragangliomas in the carotid bifurcation and the mediastinum were successfully treated via transarterial embolization with particles. Three intrapulmonary chondromas were ablated using MRI-guided laser-induced thermotherapy (LITT) after previous devascularization via transvenous pulmonary particle embolization. In summary, interventional techniques could be a therapeutic option in patients suffering from Carney triad. [ABSTRACT FROM AUTHOR]

To assess the benefit of routinely used three-dimensional 1H-spectroscopy of the prostate combined with magnetic resonance imaging in patients with elevated prostate-specific antigen (PSA) levels and negative or no previous prostate biopsies. Fifty-four patients were examined with our combined imaging protocol, which consisted of transversal, coronal and sagittal T2-weighted fast spin echo sequences. For spectroscopy, we used a three-dimensional chemical shift imaging spin echo (3D-CSI-SE) sequence. The study population consisted of patients with elevated PSA levels and histologically proven prostate carcinoma and patients with elevated PSA levels and negative or no previous prostate biopsies. Examination time was 31 min, a time feasible for routine use. Eighty-eight tumour voxels and 67 control voxels of 27 patients with histologically proven prostate carcinoma were analysed. Ratios of (choline + creatine)/citrate [(Cho + Crea)/Cit] below 0.6 were classified as normal and above 0.6 as pathological. Applying this classification to 20 patients with tumour-suspicious lesions of the prostate and negative or no previous prostate biopsies, we could obtain a sensitivity and specificity for tumour detection of 100% and 69%, respectively. Our combined imaging protocol is feasible for routine use and can add valuable information for the diagnostic management of patients with negative or no previous prostate biopsies. [ABSTRACT FROM AUTHOR]

To assess the benefit of routinely used three-dimensional 1H-spectroscopy of the prostate combined with magnetic resonance imaging in patients with elevated prostate-specific antigen (PSA) levels and negative or no previous prostate biopsies. Fifty-four patients were examined with our combined imaging protocol, which consisted of transversal, coronal and sagittal T2-weighted fast spin echo sequences. For spectroscopy, we used a three-dimensional chemical shift imaging spin echo (3D-CSI-SE) sequence. The study population consisted of patients with elevated PSA levels and histologically proven prostate carcinoma and patients with elevated PSA levels and negative or no previous prostate biopsies. Examination time was 31 min, a time feasible for routine use. Eighty-eight tumour voxels and 67 control voxels of 27 patients with histologically proven prostate carcinoma were analysed. Ratios of (choline + creatine)/citrate [(Cho + Crea)/Cit] below 0.6 were classified as normal and above 0.6 as pathological. Applying this classification to 20 patients with tumour-suspicious lesions of the prostate and negative or no previous prostate biopsies, we could obtain a sensitivity and specificity for tumour detection of 100% and 69%, respectively. Our combined imaging protocol is feasible for routine use and can add valuable information for the diagnostic management of patients with negative or no previous prostate biopsies. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the feasibility and safety of MR-guided biopsies with a transgluteal approach in patients with uncertain or suspicious prostate lesions. Twenty-five patients with uncertain or suspicious focal prostate lesions detected by high-field MR imaging of the prostate gland using endorectal coil imaging were biopsied with a transgluteal approach in a low-field MRI system (0.2 T, Concerto, Siemens). The procedures were guided using T1-weighted FLASH sequences. The prostate gland was biopsied repeatedly with a coaxial technique through a 15-gauge pencil tip with a 16-gauge biopsy handy (median 3.8 samples per patient). Complications and biopsy findings were documented retrospectively. Using T1-weighted sequences biopsy procedures were performed successfully with MR guidance in all cases without any side effects or complications. The median intervention time was 11.3 min. Pathological findings revealed ten cases of hyperplasia or atrophy, three cases of prostatitis, ten cases of carcinoma and two cases of normal tissue. The clinical follow-up showed that in two patients prostate cancer was missed at MR-guided biopsy. Transgluteal MR-guided biopsy of the prostate gland is a safe and promising approach for histological clarification of uncertain or suspicious lesions. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumours (GISTs), the most common mesenchymal tumours of the digestive tract, are largely resistant to chemo- and radiotherapy. They are currently defined by their overexpression of the KIT receptor tyrosine kinase (CD117), a member of the family of receptor tyrosine kinases (RTKs), and exhibit KIT mutations in more than 85% of cases. Additionally, in more than one-third of KIT wild-type GISTs, mutations of platelet-derived growth factor receptor alpha (PDGF-R alpha), which also belongs to the family of RTKs, were recently found. Since these data indicate that uncontrolled RTK signalling may be implicated in the pathogenesis of GISTs, RTKs and the activated downstream signalling cascades are attractive targets in the therapy of these tumours. Imatinib is a small-molecule inhibitor that selectively blocks the activity of the PDGF-R, ABL and KIT receptor tyrosine kinases by competitive binding to the adenosine triphosphate binding site of their catalytic domains. We herein review the molecular pathological, preclinical and clinical data that identify imatinib as a valuable new agent in the treatment of GISTs. [ABSTRACT FROM AUTHOR]

Comments on a study which investigated the frequency of circulating tumor cells in mesenteric venous blood samples compared with central and peripheral venous blood samples of patients undergoing resection of colorectal cancer. Results of the study; Details of the surgical concept of no-touch-isolation technique; Ability of the CK 20 RT-PCR system to detect tumor cells in blood.

Background: Operation planning in liver surgery depends on the precise understanding of the 3-dimensional (D) relation of the tumor to the intrahepatic vascular trees. To our knowledge, the impact of anatomical 3-D reconstructions on precision in operation planning has not yet been studied. Hypothesis: Three-dimensional reconstruction leads to an improvement of the ability to localize the tumor and an increased precision in operation planning in liver surgery. Design: We developed a new interactive computer-based quantitative 3-D operation planning system for liver surgery, which is being introduced to the clinical routine. To evaluate whether 3-D reconstruction leads to improved operation planning, we conducted a clinical trial. The data sets of 7 virtual patients were presented to a total of 81 surgeons in different levels of training. The tumors had to be assigned to a liver segment and subsequently drawn together with the operation proposal into a given liver model. The precision of the assignment to a liver segment according to Couinaud classification and the operation proposal were measured quantitatively for each surgeon and stratified concerning 2-D and different types of 3-D presentations. Results: The ability of correct tumor assignment to a liver segment was significantly correlated to the level of training (P<.05). Compared with 2-D computed tomography scans, 3-D reconstruction leads to a significant increase of precision in tumor localization by 37%. The target area of the resection proposal was improved by up to 31%. Conclusion: Three-dimensional reconstruction leads to a significant improvement of tumor localization ability and to an increased precision of operation planning in liver surgery. [ABSTRACT FROM AUTHOR]

Five southern German university centers cooperated in comparing the effect of surgical vs. nonsurgical therapy strategies on survival and sphincter preservation in the treatment of anal cancer. A standardized questionnaire was used to evaluate retrospectively (mean follow-up 30 months) treatment strategy and outcome (survival, colostomy rate, colostomy-free survival) in patients treated between 1987 and 1996. Of the 142 patients 65% had squamous cell, 20% basaloid, 6% adeno-, and 1% undifferentiated carcinoma (8% histology not recorded); 9% were classified in UICC stage I, 37% in stage II, 25% in stage III, and 4% in stage IV (25% not recorded). Primary treatment consisted of local excision (10%), excision plus radio- and/or chemotherapy (17%), radiotherapy (20%), radio-chemotherapy (28%), or colostomy with or without resection, radiotherapy, and chemotherapy (23%). We observed no difference between these treatment groups in overall (P=0.43) or colostomy-free survival (P=0.14, log-rank). Primary colostomy was prevented in 77% of cases and decreased over the years. Mean overall survival (in months) was 42 in stage I, 38 in stage II, and 25 in stage III (P=0.0013); mean colostomy-free survival was 36 in stage I, 26 in stage II, and 16 in stage III (P=0.0021, log-rank). Outcome was not significantly related to therapeutic strategy (surgery or radio-chemotherapy. Primary surgical and nonsurgical strategies in treating anal cancer thus produced similar results, although radio-chemotherapy is usually recommended for sphincter-endangering anal cancer. Challenges to be met in the future include the prevention of metastasis and long-term preservation of anal sphincter function. [ABSTRACT FROM AUTHOR]

Background: Patients with hepatocellular carcinoma (HCC) often develop recurrences after curative resection or liver transplantation. Therefore, tumor cell dissemination must have occurred preoperatively or intraoperatively. Current staging methods cannot reliably detect micrometastasis. Reverse transcription–polymerase chain reaction (RT-PCR) for α-fetoprotein (AFP) has been used to detect circulating liver cancer cells, but results in blood samples have been contradictory. Hypothesis: AFP–RT-PCR is a specific and sensitive assay for the detection of disseminated tumor cells in central venous blood and bone marrow samples of patients with HCC and has prognostic relevance. Design: Prospective consecutive series. Setting: University hospital. Patients and Methods: We performed preoperative, intraoperative, and postoperative analyses of central venous blood samples and preoperative analysis of bone marrow samples of patients with HCC and patients without malignant disease, using a modified AFP–RT-PCR method. Preoperative serum AFP levels were measured. Clinical follow-up ranged from 4 to 20 months. Main Outcome Measures: Sensitivity and specificity of AFP–RT-PCR, correlation of AFP–RT-PCR results to tumor stage and tumor recurrence. Results: In serial dilution experiments, 50 AFP-expressing HepG2 cells were detected in 10 mL of blood. Peripheral blood samples of 20 healthy volunteers and bone marrow samples of 21 patients with benign diseases consistently tested negative for AFP, whereas 4 of 24 patients with HCC showed AFP expression in bone marrow samples. All these patients had advanced disease; however, correlation of positive RT-PCR results to tumor stage was not significant (P = .07). One of the 4 AFP-positive patients developed an intrahepatic recurrence soon after liver transplantation. Central venous blood of patients with HCC (n = 24) and patients with benign liver diseases (n = 13) equally demonstrated AFP-... [ABSTRACT FROM AUTHOR]

Caenorhabditiselegans (C. elegans) has gained importance as a model for studying host-microbiota interactions and bacterial infections related to human pathogens. Assessing the fate of ingested bacteria in the worm's intestine is therefore of great interest, in particular with respect to normal bacterial digestion or intestinal colonization by pathogens. Here, we report an in vivo study of bacteria in the gut of C. elegans. We take advantage of a polydimethylsiloxane (PDMS) microfluidic device enabling passive immobilization of adult worms under physiological conditions. Non-pathogenic Escherichia coli (E. coli) bacteria expressing either pH-sensitive or pH-insensitive fluorescence reporters as well as fluorescently marked indigestible microbeads were used for the different assays. Dynamic fluorescence patterns of the bacterial load in the worm gut were conveniently monitored by time-lapse imaging. Cyclic motion of the bacterial load due to peristaltic activity of the gut was observed and biochemical digestion of E. coli was characterized by high-resolution fluorescence imaging of the worm's intestine. We could discriminate between individual intact bacteria and diffuse signals related to disrupted bacteria that can be digested. From the decay of the diffuse fluorescent signal, we determined a digestion time constant of 14 ± 4 s. In order to evaluate the possibility to perform infection assays with our platform, immobilized C. elegans worms were fed pathogenic Mycobacterium marinum (M. marinum) bacteria. We analyzed bacterial fate and accumulation in the gut of N2 worms and mitochondrial stress response in a hsp-6::gfp mutant. [ABSTRACT FROM AUTHOR]

Male Wistar rats were treated concurrently with a combination of the carcinogen N-methyl- N′-nitro- N-nitrosoguanidine (MNNG; CAS 70-25-7) and the polyamine-synthesis inhibitor α-difluoromethylornithine (DFMO) at two different doses of 0.5% and 1.0% (w/v). Experimental groups were treated with (I) MNNG alone ( n=25), (II) MNNG plus 0.5% (w/v) DFMO ( n=25), (III) MNNG plus 1.0% (w/v) DFMO ( n=25), (IV) 1.0% (w/v) DFMO alone ( n=25). Group V represented untreated controls ( n=20). Both the carcinogen and DFMO were administered in drinking water. The treatment time with the carcinogen and DFMO was 35 weeks. After treatment was completed animals were followed for an additional 50 weeks to cover a total observation time of 85 weeks. Significantly fewer animals developed gastric adenocarcinoma in the two groups of animals that received a combined treatment of MNNG plus DFMO compared to animals treated with the carcinogen alone ( P<0.05 and 0.005). No benign or malignant neoplastic lesions were observed in the stomach or duodenum of animals treated with DFMO alone or in untreated controls. It is concluded that concurrent treatment with DFMO prevents the development of malignant gastric epithelial tumors induced by MNNG in rats. [ABSTRACT FROM AUTHOR]

The effect of N-methyl- N'-nitro- N-nitrosoguanidine (MNNG) on the mucin phenotype of non-metaplastic gastric mucosa in the rat was studied histochemically. Animals were exposed to MNNG in drinking water (83 mg/l) for 12 weeks. Carcinogen treatment was then discontinued and the animals (27 in the treatment group and 25 in the control group) were examined after another 44 weeks. Glycosylation was analysed with histochemical stains for sialomucins and sulphomucins and with peroxidase-conjugated lectins (GS-II, SBA, DBA, UEA-I, and WGA). Sialo-and sulphomucins remained quantitatively unchanged, only a slight increase of acid mucins in the antral glands was observed. The analysis of the lectin binding patterns, however, revealed a significant increase for WGA-binding glycoproteins in the surface mucous cells and gastric pits, while DBA binding was significantly decreased ( P<0.05). GS-II lectin bound specifically to the proliferative compartment in the gastric fundus, consisting of mucous neck cells, and was significantly increased after MNNG treatment. No specific alterations were detected in lectin binding to parietal or chief cells. It is concluded, therefore, that treatment of gastric mucosa with MNNG alters the glycoprotein metabolism before intestinal metaplasia can be observed. [ABSTRACT FROM AUTHOR]