[Differential diagnosis of gallbladder abnormalities : Ultrasound, computed tomography, and magnetic resonance imaging]. / Differenzialdiagnose von Befunden an der Gallenblase : Ultraschall, Computertomographie und Magnetresonanztomographie.

CLINICAL ISSUE: Due to the high prevalence of clinically suspected cholecystitis or cholecystolithiasis the gallbladder is one of the organs examined the most by imaging. STANDARD RADIOLOGICAL METHODS: In most clinical settings ultrasound is the primary imaging method because of its wide availability, speed and superior spatial resolution. In cases of ambiguous findings or potential complications computed tomography (CT) and magnetic resonance imaging (MRI) are used. METHODICAL INNOVATIONS: When specific problems arise these imaging modalities may be enhanced by special techniques, e. g. contrast-enhanced ultrasound or dual-energy CT, and specific MRI sequences. PERFORMANCE: Special variants of cholecystitis, such as xanthogranulomatous cholecystitis and adenomyomatosis, may pose a particularly difficult diagnostic problem as they may resemble other diseases. Sequelae of cholecystolithiasis, such as the Mirizzi syndrome and acute bowel obstruction, may complicate the imaging algorithm as the location and the symptoms shift. Cases of neoplastic diseases of gallbladder cancer and other malignancies require a broad spectrum of imaging modalities. ACHIEVEMENTS: Although the gallbladder can easily be examined with ultrasound, some cases require a more thorough ultrasound examination. In some cases only a combination of multiple imaging modalities yield the diagnosis. Further developments regarding technical issues and the diagnostic algorithm can be expected. PRACTICAL RECOMMENDATIONS: Ultrasound is the best first imaging modality. In cases of ambiguous findings or clinical complications CT or MRI are recommended.

Postinterventional volume dynamics following endovascular treatment of infrarenal aortic aneurysms.

AIM: Endovascular treatment of infrarenal aortic aneurysms requires follow-up to rule out complications that would require renewed intervention. The aim of this study was to define those factors which, in the absence of such complications, could be relevant for the remaining risk. METHODS: The CT data sets of 55 patients (73.5+/-8 years; M: F ratio 49: 6) were evaluated volumetrically: immediately postinterventional, 6 months, and annually after the procedure. The median observation period was 30+/-19 months. RESULTS: Risk factors for a further increase in aneurysm volume were: short-term increase in volume >5%, medium-term growth >20%, one-time growth >20%, no decrease in volume, and an initial aneurysm volume >200 mL. Favorable factors were: a one-time decrease in volume >15% and no increase in volume at any follow-up visit. Indifferent factors were: initial decrease in volume, one-time growth <20%, one-time shrinkage <15%, and type II endoleak. Conclusion. Patients require particular attention whose aneurysm volume increased by more than 5% or increased medium-term or increased at once by more than 20%, and who either did not show a decrease in volume at any follow-up or who had a large initial volume. A one-time decrease in volume of more than 15% was positive, as was no increase in volume at any follow-up.

Selective nontemplated adsorption of organic molecules on nanofacets and the role of bonding patterns.

A key element of functionalizing nanocrystals with organic molecules is the nontemplated selective adsorption of different molecules on different facets. Here we report scanning-tunneling-microscopy images of perylene-3,4,9,10-tetracarboxylic-dianhydride and 2,5-dimethyl-N,N'-dicyanoquinonediimine on silver, demonstrating selective adsorption on different facets. We also report first-principles calculations that account for the data and show that bonding, which controls selectivity, occurs via the end atoms, while the molecule's midregion arches away from the substrate. The results are also consistent with data that have been interpreted in terms of bonding via the midregion.

Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience.

OBJECTIVE: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. MATERIAL AND METHODS: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. RESULTS: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. CONCLUSION: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions.

Ionic titanocene complexes: a new type of antitumor agent.

Five ionic cyclopentadienyltitanium (IV) derivatives were investigated for their activity against fluid Ehrlich ascites tumor. Four compounds were built up by the intact bis(cyclopentadienyl)titanium(IV) ("titanocene") unit, forming the cationic moiety together with two covalently bound ligands, with certain anions being bonded via electrostatic forces: the acetonitrile complex [(C5H5)2TiCl(NCCH3)]+[FeC14]- (I), the 2'2'-bipyridyl derivative [(C5H5)2Ti(bipy)]2+[CF3SO3]2 (II), the o-phenanthroline complex [(C5H5)2Ti(phen)]2+[CF3SO3]2 (III), and the N-methyl-o-aminothiophenolate derivative [(C5H5)2Ti[o-S(NACH3)C6H4]]+I- (IV). Another ionic cyclopentadienyltitanium derivative investigated was the five-coordinate bis(dithiolene) chelate (C5H5)Ti(1,2,4-S2C6H3CH3)2]-N(C2H5)4)+ (V), the cyclopentadienyltitanium moiety representing the anionic part of the complex salt. All complexes were ionic, salt-like compounds, distinguished by good water solubility. Whereas complexes I, III, and V, given at optimal dose levels, effected maximal cure rates of only 70%-80%, all animals were cured after receiving complexes II and IV at dose ranges of 200-220 and 240-300 mg/kg, respectively. The antitumor activity of complex I was confirmed against solid experimental tumor systems B16 melanoma, colon 38 carcinoma, and Lewis lung carcinosarcoma. Because of their improved solubility in water and pronounced antitumor activity (especially that of II and IV against fluid Ehrlich ascites tumor), ionic cyclopentadienyl titanium complexes are considered to be an interesting new type of antitumor agent.

Tumor inhibition by titanocene complexes. Activity against B16 melanoma and colon 38 carcinoma.

In the present study, the antitumor activity of some titanocene derivatives (C5H5)2TiX2 (I, X = Cl; II, X = Br; III, X = cis-OOCCH = CHCOOH; IV, X = p-SC6H4NH3+Cl-) was investigated against B16 melanoma and colon 38 carcinoma. Both tumors grew subcutaneously as solid tumors in mice. Substances were applied intraperitoneally either as single, triple or 5-fold injections. Against both tumors, satisfactory results were observed for the chloro, bromo and aminothiophenolato derivatives I, II and IV, resp. They reduced tumor growth by 60-80% to 40-20% of control values. These effects underline the antitumor potency of titanocene complexes and show that titanocene dihalides as well as titanocene derivatives containing hydrophilic ligands X are able to inhibit the growth of various solid experimental tumors.

[Cytostatic platinum complexes: an unexpected discovery with considerable consequences]. / Cytostatische Platin-Komplexe: eine unerwartete Entdeckung mit weitreichenden Konsequenzen.

Antineoplastic platinum complexes represent new-developed inorganic cytostatics, which interfere with intracellular nucleic acids, especially with DNA. The main representative is cis-diamminedichloroplatinum (II) (cis-platin, DDP). It has proven effective against human urogenital tumors and against carcinomas of the head and neck. The most severe side effects are nephrotoxicity and gastrointestinal irritation. Stimulated by the clinical success of cisplatin, a series of platinum complexes of the second generation has been recently developed. Moreover, anti-tumor properties were detected for various organometallic complexes containing titanium, vanadium, tin, or iron as central atoms.

Antitumor metallocenes: new developments and toxicologic features.

Recent results concerning new antitumor metallocene derivatives have shown that not only numerous titanocene dihalides and bis(pseudohalides) exhibit antiproliferative activity, but that also some titanocene complexes (C5H5)2TiX2 containing carboxylates or hydrochlorinated aminothiophenolates as ligands X, are characterized by pronounced antineoplastic efficacy. Whereas antitumor activity of metallocene derivatives has originally been established against Ehrlich ascites tumor, recent experimental results demonstrate antiproliferative activity also against B16 melanoma, sarcoma 180, as well as against human tumors heterotransplanted to athymic mice. Studies upon the organ toxicity of titanocene dichloride indicate a pattern of toxicity markedly differing from that observed after treatment with cytostatic platinum compounds.

Tumor inhibition by titanocene complexes: activity against sarcoma 180.

The antitumor activity of various titanocene derivatives was examined against ascitic and solid, subcutaneously growing sarcoma 180. The complexes investigated were two dihalide compounds, (C5H5)2TiCl2 (I) and (C5H5)2TiBr2 (II), two carboxylato complexes, (C5H5)2Ti (cis-OOCCH = CHCOOH)2(III) and (C5H5)2Ti(OOCCCl3)2(IV), and the p-aminothiophenolate hydrochloride (C5H5)2Ti(p-SC6H4NH3+Cl-)2(V). Against ascitic sarcoma 180, best results were obtained for I; an injection of 50 mg/kg resulted in the survival of 40-50% of the animals (ILS, 161-184%). A similar result was recorded for cis-diamminedichloroplatinum(II), whereas the compounds II-IV induced a maximum cure rate of 20% (ILS, 95-139%). Against solid sarcoma 180, triple injections of I-V caused reduction of mean tumor weight to 23-53% of control values, the dichloro complex I exhibiting most pronounced activity. These results clearly underline antitumor potency for titanocene complexes (C5H5)2TiX2 modified at the acido ligand X.

Activity of titanocene dihalides against a human colon carcinoma heterotransplanted to athymic mice.

The antitumor activity of cis-diamminedichloroplatinum (II) and of two metallocene derivatives, titanocene dichloride (C5H5)2TiCl2 and titanocene dibromide (C5H5)2TiBr2, was investigated against a human colon adenocarcinoma heterotransplanted to athymic mice. The substances were administered at various doses on a Q2DX5 or a Q3DX5 schedule. Whereas cis-diamminedichloroplatinum (II) induced an only marginal tumor-inhibiting effect, both titanocenes markedly suppressed tumor development (T/C values: 23-40%) and caused stagnation and relative decrease of tumor growth, when they were applied in subtoxic doses far below the LD10 level. The results are remarkable with respect to the general insensitivity of human colorectal carcinomas to cytostatic agents.

Ferricenium complexes: a new type of water-soluble antitumor agent.

The antitumor activity of a series of iron complexes, i.e., of ferrocene [Cp2Fe], of tetrachloroferrates(III) [R4N]+[FeCl4]-, and of ferricenium complexes [Cp2Fe]+X- (X- = [FeCl4]-, 1/2 [Cl3FeOFeCl3]2-, [H5Mo7O24]- X 2H2O, [2,4,6-(NO2)3C6H2O]-, or [CCl3COO]- X 2 CCl3COOH) was investigated against EAT in CF1 mice. Whereas ferrocene and the ammonium tetrachloroferrates(III) did not show recognizable tumor-inhibiting activity, such activity was exhibited by the water-soluble, salt-like ferricenium complexes; the best antineoplastic properties, with optimum cure rates of 100%, were found for ferricenium picrate and ferricenium trichloroacetate. The ferricenium compounds are the first iron complexes for which antineoplastic activity has now been shown. They represent a new type of antitumor agent insofar as they differ fundamentally from known inorganic and organometallic antitumor agents (a) by their ionic, salt-like character, which is responsible for their high water solubility, and (b) by the absence of a cis-dihalometal moiety; this moiety has been recognized as important for the intracellular action of other known inorganic cytostatics.

Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction.

An increase in the recovery of Aspergillus flavus from respiratory specimens occurred among hospitalized patients during a several-month period in 1977. Notably, 86% of the patients with positive culture results were located in an older hospital section adjacent to a building construction site that created great amounts of dust in the hospital's vicinity. Airborne contamination was suspected and results of air sampling showed A. flavus in 80% of old wing patient rooms (average, 8 A. flavus/positive room) compared with only 23% of the contiguous newer wing patient rooms (average, 1 A. flavus/positive room). Inspection of the main mechanical ventilation units in the two hospital sections disclosed numerous defects in the unit in the old wing and a properly functioning unit in the new wing. After repairing the defective unit, a significant reduction in the recovery of A. flavus from clinical and environmental specimens was noted.