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Purpose To assess the value of magnetic resonance imaging (MRI) in detecting craniofacial fibrous dysplasia (CFD) and diagnosing and differentiating it from intraosseous meningioma. Additionally, the MRI appearance of the typical computed tomography (CT) imaging feature, the ground glass phenomenon, was evaluated. Material and methods MRI datasets of 32 patients with CFD were analysed retrospectively. Detectability in MRI was assessed by analysis of 10 randomly selected patients with CFD and 10 normal controls by two blinded readers. Changes of affected bone, internal lesion structure, T1 and T2 signal intensity, and contrast enhancement of the lesion in general and ground glass areas in particular were assessed. Ten patients with intraosseous meningioma (one in each) served as differential diagnosis for CFD. Results All 10 CFD lesions were reliably detected in MRI. In 32 patients 36 CFD lesions were evaluated. In 66.7% CFD were iso- to hypointense in T1 and hyperintense in T2; this proportion was similar for ground glass areas (65.7%). Ground glass areas were more homogeneously structured than the whole CFD lesion in both T1 (100% vs. 56%, respectively) and T2 (91% vs. 61%, respectively). Contrast enhancement was found in 97% of complete CFD lesions and 93% of ground glass areas. The accuracy for CFD vs. intraosseous meningioma was 100% for 'no soft-tissue component' and 98% for 'bone broadening' in MRI. Conclusions Distinct morphological changes of CFD are reliably detected in MRI and allow differentiation from intraosseous meningioma. Areas with ground glass phenomenon in CT show a predominantly homogenous internal structure in MRI with contrast enhancement.

Conference on Production Systems and Logistics : International Conference, CPSL 2021, digital event hosted via publish-Ing., August 10-11, 2021 : proceedings / editors: Dr.-Ing. David Herberger, M.Sc. Marco Hübner 2. Conference on Production Systems and Logistics, CPSL 2021, online, 10 Aug 2021 - 11 Aug 2021; Hannover : Institutionelles Repositorium der Leibniz Universität Hannover 288-298 (2021). doi:10.15488/11244, Published by Institutionelles Repositorium der Leibniz Universität Hannover, Hannover

Background: In contrast to the 3 major aeroallergens tree pollen, grass pollen, and house dust mites, allergic rhinitis caused by herbal pollen has received comparatively little attention in recent clinical studies. Since various weeds flower during summer until fall, allergic rhinitis to weeds may be underdiagnosed and/or mistakenly diagnosed as grass pollen allergy. Objective: To investigate (i) the currently most frequent weed allergy between mugwort, ragweed, plantain, chamomile, nettle, and oilseed rape and (ii) time trends in prevalence of sensitization to weed pollen in the middle of Germany over the last 20 years. Methods: This study, the largest of its kind to date, monocentrically evaluated the prick test results of a total of 6,220 patients with suspected RCA over a period of 20 years (1998–2017). Results: In the study cohort, sensitization rates to plantain almost doubled from 26.6% in the decade 1998–2007 to 50.5% in 2008–2017. Identical increases were observed for ragweed, while sensitization rates for mugwort stayed largely unchanged. The most prominent increase in positive skin prick tests to plantain and ragweed pollen was mainly observed in younger patients. Further, we identified a trend toward polysensitization, currently dominated by plantain and ragweed. Sensitization to weed pollen was found to be highly associated with additional sensitizations to grass and/or birch pollen. Conclusion: Plantain is currently the best choice to screen rhinitis patients for weed allergy which identifies 86% of all weed-sensitized individuals, at least in Germany. Over the last 20 years, we demonstrate a significant rise in the total number of weed pollen sensitization as well as increases in polysensitization, predominantly in younger patients.

BACKGROUND: Sodium lauryl sulfate (SLS) is the best-studied detergent in irritant contact dermatitis. In atopic dermatitis, the two major pathophysiological abnormalities concern skin barrier function and regulation of cutaneous immune responses. The probability of atopic skin diathesis can be assessed by comprehensive analysis of patient history, as well as clinical and laboratory findings, resulting in the Erlangen Atopy Score (EAS). OBJECTIVES: To investigate the impacts of (i) atopic skin diathesis according to the EAS and (ii) the physician-assessed diagnoses 'atopic dermatitis', 'allergic rhinitis' and 'allergic asthma' on SLS skin reactions. METHODS: This is a retrospective analysis of data from 2030 consecutive patients patch tested with SLS (0·25% aqueous) from two tertiary referral centres in Germany, from 2008 to 2014. RESULTS: Patients with a high probability of atopic skin diathesis showed no significant increase in positive SLS reactions compared with patients without atopic skin diathesis (14·2% vs. 16·8%). The grading of positive SLS skin reactions (1-4) revealed no differences in patients with or without atopic skin diathesis. Furthermore, diagnoses of atopic dermatitis, allergic rhinitis or allergic asthma had no impact on positive SLS skin reactions in multivariate logistic regression analysis. CONCLUSIONS: We found no association of increased skin irritability to SLS with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. It therefore seems that the test of skin irritability with SLS, which is currently common practice in many centres, does not allow prediction of susceptibility to irritant eczematous inflammation in atopic vs. nonatopic individuals. What's already known about this topic? Irritant contact dermatitis and atopic skin diathesis share impaired skin barrier function as a pathophysiological pattern. Sodium lauryl sulfate (SLS) is tested at 0·25% aqueous as an irritant control in patch testing, and hence the results might be affected by atopic skin diathesis. What does this study add? Challenging a long-standing paradigm, we found no association of increased reactivity to SLS patch tests in individuals with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. Thus, irritant control testing with SLS, which is useful in interpreting doubtful allergen patch test results, does not depend on individual atopy status. peerReviewed

Data on gastroenteropancreatic neuroendocrine neoplasms (NEN) G3 (well-differentiated neuroendocrine tumors (NET G3) and neuroendocrine carcinoma (NEC)) are limited. We retrospectively study patients with NET G3 and NEC from eight European centers. Data examined included clinical and pathological characteristics at diagnosis, therapies and outcomes. Two hundred and four patients were analyzed (37 NET G3 and 167 NEC). Median age was 64 (21–89) years. Tumor origin included pancreas (32%) and colon-rectum (27%). The primary tumor was resected in 82 (40%) patients. Metastatic disease was evident at diagnosis in 88% (liver metastases: 67%). Median Ki-67 index was 70% (30% in NET G3 and 80% in NEC;PPPP=0.003). Second- and third-line therapies (mainly FOLFIRI and FOLFOX) were given in 79 and 39 of NEC patients; median PFS and OS were 3.0 and 7.6 months respectively after second-line and 2.5 and 6.2 months after third-line chemotherapy. In conclusion, NET G3 and NEC are characterized by significant differences in Ki-67 index and outcomes. While platinum-based chemotherapy is effective in NEC, it seems to have limited value in NET G3.

Introduction: The WHO classification of 2010 defines neuroendocrine carcinoma (NEC) G3 as poorly differentiated neuroendocrine neoplasm (NEN) with a proliferation rate exceeding 20%. The subgroup of NEC account for 10-20% of the rare disease of neuroendocrine neoplasms and usually show a poor prognosis. Based on WHO classification NEC G3 are only classified by its grading. However, there is evidence of well differentiated neuroendocrine tumors with a proliferation rate exceeding twenty percent. This subgroup of well differentiated neuroendocrine tumors with a G3 grading (NET G3) is not defined by the WHO classification so far. The aim of this retrospective, multicentric study was the assessment and characterization of NEN G3 and the differentiation of NET G3 and NEC with regard to biological behavior, prognosis and response to treatment. Methods: Eight European centers specialized in NET assessed clinical and pathological features of NET G3 and NEC. Finally, 204 patients were analyzed (37 NET G3 and 167 NEC). Results: Median age was 64 (21-89) years. Tumor origin included pancreas (32%) and colon-rectum (27%). Median Ki-67 index was 70% and was significantly lower in NET G3 compared to NEC (30% vs. 80%, P, Einführung: Nach der WHO Klassifikation von 2010 werden gastroenteropankreatische neuroendokrine Karzinome (NEC) G3 als schlecht differenzierte neuroendokrine Neoplasien (NENs) mit einer Wachstumsfraktion von über 20% definiert. Die Subgruppe der NEC macht lediglich 10-20% der ohnehin seltenen neuroendokrinen Neoplasien aus und zeigen eine schlechte Prognose. Basierend auf der WHO Klassifikation werden NEC G3 lediglich durch das Grading klassifiziert. Es gibt jedoch Hinweise, dass auch gut differenzierte neuroendokrine Tumore eine Proliferationsrate von über 20% aufweisen können. Die Subgruppe gut differenzierter neuroendokriner Tumore mit einer G3 Wachstumsfraktion (NET G3) ist bisher durch die WHO Klassifikation nicht definiert. Das Ziel dieser retrospektiven, multizentrischen Studie war die Erfassung und Charakterisierung der NEN G3 sowie der Vergleich von NET G3 und NEC bezüglich des biologischen Verhaltens, der Prognose und des Therapieansprechens. Methodik: In acht europäischen spezialisierten NET - Zentren erfolgte die Erfassung klinischer und pathologischer Charakteristika von NET G3 und NEC. Es wurden 204 Patienten untersucht (37 NET G3 und 167 NEC). Ergebnisse: Das mediane Alter betrug 64 (21-89) Jahre. Der Primarius war überwiegend im Pankreas (32%) und Kolon bzw. Rektum (27%) lokalisiert. Der mediane Ki-67 Index betrug 70% und war bei NET G3 signifikant niedriger als bei NEC (30% vs. 80%, P

Outpatient surgery is increasingly being performed on patients with pre-existing cardiovascular and pulmonary disorders. These are relevant for anesthesia because of the inherent risk of hemodynamic instability. This study compared the hemodynamic course in ASA III patients undergoing knee arthroscopy with either peripheral block of the femoral and sciatic nerves or general anesthesia. We searched our patient database for ASA III patients who had undergone knee arthroscopy between 2005 and 2010. This is routinely performed in either regional or general anesthesia, and the patients were stratified according to the anesthetic. Hemodynamic parameters, process times, complications and postoperative pain documented in the charts were evaluated and compared. 130 ASA III outpatients underwent knee arthroscopy during the observation period. Regional anesthesia alone (n=65) was sufficient in 96%. Heart rate was more stable and blood pressure decreased less under regional than under general anesthesia (systolic pressure − 11 ± 8% versus - 28 ± 9%; p < 0.001). Patients with general anesthesia (n=65) required more circulatory support. Establishing the nerve block takes longer than inducing general anesthesia, but this was performed ahead of time and thus had no effect on work flow. The groups did not differ with regard to complication rates, and intensity of postoperative pain or satisfaction with the anesthetic. No patient showed evidence of nerve damage or neurological deficits. Peripheral nerve block provides a more stable hemodynamic course than general anesthesia in ASA III patients undergoing knee arthroscopy.

[for full text, please go to the a.m. URL], 27. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie (DGPP)

295 Background: The role of systemic chemotherapy for advanced pancreatic neuroendocrine tumours (pNETs) is controversially discussed. Objective response rates (RR) with streptozocin(STZ)-based chemotherapy range between 6% and 69%. Novel targeted drugs have recently been approved, however sequence of treatment remains unclear. We aimed to evaluate efficacy of STZ+5-FU chemotherapy in a large pNET cohort. Methods: Clinical data of 95 patients (pts) with advanced pNET who had been treated with STZ+5-FU between Aug 1998 and Sept 2013 were analyzed retrospectively. RR, time to tumour progression (TTP) and overall survival (OS) were assessed. Assessment of RR was judged by tumour board involving an experienced radiologist (TD). Results: Median age at start of chemotherapy was 60 years (range 32-80). 74 pts (77.9%) had non-functional pNETs. In 52 pts (54.7%) STZ+5-FU was 1st line systemic therapy. 11.6% had G1, 78.9% G2 and 6.3% G3 tumours. Baseline progression was evident in 75.8% of cases. Mean number of therapy cycles was 6 (range 1-18). Treatment was discontinued for toxicity in 15.8% of the cases. Partial response was seen in 43.2% of pts, stable disease in 32.6% and disease progression as best response in 18.9% of cases. Overall TTP was 13.7 months and was independent of prior systemic treatment (1st line vs. >1st line, 13.6 vs. 25.3 months, P= 0.54). Functionality had no impact on median TTP. There was no difference between pts with G1 and G2 NET (TTP 21.3 vs. 16.4 months, P=0.78). Median OS was 27.6 months (range 0.8-174 months). In pts with at least two extrapancreatic disease sites (34.7%) median OS was inferior compared to pts with one disease site involvement (37.3 vs. 70.5 months, P=0.02). Conclusions: The combination of STZ and 5FU was associated with a considerable objective response rate in advanced G1/G2 pNETs who had prior disease progression. Efficacy of treatment was not depending on therapy line or grading (G1 vs. G2). Objective response rate is higher than those observed with targeted drugs. This finding along with good tolerability of the treatment strengthens the durable value of this chemotherapy in the era of targeted drugs for the outcome of pts with pNETs.

e15071 Background: Poorly differentiated neuroendocrine carcinomas (NEC G3) represent a subgroup of neuroendocrine neoplasms with aggressive clinical behavior and poor prognosis, but showing quite variable clinical courses. In metastatic disease objective response to first-line therapy with cisplatin/ etoposide ranges between 40-67%, however median duration of response is short (4 to 9 months). There is no established second-line therapy. Methods: Clinical data of 42 patients with gastro-entero-pancreatic NEC G3 were analyzed in retrospect. In 26 cases tissue was analyzed for cell size, expression of p-mTOR and downstream effectors (p-eIF4E and p-4EBP1), somatostatin receptor (SSTR)-subtypes and growth factor receptors (EGFR and IGF-1R). Histopathological findings were analyzed using Kaplan-Meier curve, log rank test and Cox regression. Results: Patients with large cell NEC showed a more favorable survival than patients with small cell NEC. Median overall survival (mOS) was 31 versus 11 months (P=0.034). Expression of p-mTOR and p-eIF4E was seen in 64% and 24% of cases. High expression levels of p-mTOR (mOS 9 vs 25 months, P=0.026) and expression of p-eIF4E (mOS 9 vs 25 months, P=0.015) was significantly associated with shorter survival. In multivariate Cox regression p-mTOR and p-eIF4E proved to be independent prognostic factors for survival taking cell size and TNM staging into account. EGFR (cytoplasmatic and nuclear) and IGF-1R expression was found in 73.1%, 65.4% and 69.2% of the cases respectively, without significant association to survival. Expression of SSTR subtypes, Ki67 value and response to first line chemotherapy was not of prognostic value analyzed by log rank test. Conclusions: The clinical impact of cell size discrimination requires further evaluation in NEC G3. The mTOR pathway seems to play a role in tumor growth in some NEC and may represent a novel therapeutic target.