MRI-guided percutaneous thermoablation as first-line treatment of recurrent hepatic malignancies following hepatic resection: single center long-term experience.

PURPOSE: Hepatic recurrence of liver malignancies is a leading problem in patients after liver resection with curative intention. Thermoablation is a promising treatment approach for patients after hepatic resection, especially in liver-limited conditions. This study aimed to investigate safety, survival, and local tumor control rates of MRI-guided percutaneous thermoablation of recurrent hepatic malignancies following hepatic resection. MATERIAL AND METHODS: Data from patients with primary or secondary hepatic malignancies treated between 2004 and 2018 with MRI-guided percutaneous thermoablation of hepatic recurrence after prior hepatic resection were retrospectively analyzed. Disease-free survival and overall survival rates were calculated using the Kaplan-Meier method. RESULTS: A total of 57 patients with hepatic recurrence (mean tumor size = 18.9 ± 9.1 mm) of colorectal cancer liver metastases (n = 27), hepatocellular carcinoma (n = 17), intrahepatic recurrence of cholangiocellular carcinoma (n = 9), or other primary malignant tumor entities (n = 4) were treated once or several times with MR-guided percutaneous radiofrequency (n = 52) or microwave ablation (n = 5) (range: 1-4 times). Disease progression occurred due to local recurrence at the ablation site in nine patients (15.8%), non-local hepatic recurrence in 33 patients (57.9%), and distant malignancy in 18 patients (31.6%). The median overall survival for the total cohort was 40 months and 49 months for the colorectal cancer group, with a 5-year overall survival rate of 40.7 and 42.5%, respectively. The median disease-free survival was 10 months for both the total cohort and the colorectal cancer group with a 5-year disease-free survival rate of 15.1 and 14.8%, respectively. The mean follow-up time was 39.6 ± 35.7 months. CONCLUSION: MR-guided thermoablation is an effective and safe approach in the treatment of hepatic recurrences in liver-limited conditions and can achieve long-term survival.

Non-competitive cyclic peptides for targeting enzyme-substrate complexes.

Affinity reagents are of central importance for selectively identifying proteins and investigating their interactions. We report on the development and use of cyclic peptides, identified by mRNA display-based RaPID methodology, that are selective for, and tight binders of, the human hypoxia inducible factor prolyl hydroxylases (PHDs) - enzymes crucial in hypoxia sensing. Biophysical analyses reveal the cyclic peptides to bind in a distinct site, away from the enzyme active site pocket, enabling conservation of substrate binding and catalysis. A biotinylated cyclic peptide captures not only the PHDs, but also their primary substrate hypoxia inducible factor HIF1-α. Our work highlights the potential for tight, non-active site binding cyclic peptides to act as promising affinity reagents for studying protein-protein interactions.

Investigation of counterion influence on an octahedral IrH6-complex in the solid state hydrides AAeIrH6 (A = Na, K and Ae = Ca, Sr, Ba, and Eu) with a new structure type.

A number of new quaternary iridium based hydrides and deuterides AAeIrH/D(6) (where A = Na and K; Ae = Ca, Ba, Sr, and Eu) have been synthesized by direct combination of the alkali, alkaline earth or europium binary hydrides/deuterides and iridium powder. The crystal structures were determined by Guinier-Hägg X-ray and neutron powder diffraction and a new cubic structure type was found. The structure is described in space group F43m, but related to the K(2)PtCl(6) type structure. The new structure can be described as consisting of cubes of A(+) and Ae(2+) ions, where the A(+) and Ae(2+) ions alternates so that they occupy opposite corners in the cube. Every second cube contains a regular octahedral [Ir(III)H(6)](-3)-complex and the adjacent is empty. Solid-state IR spectroscopy was used to determine the Ir-allowed stretching and bending frequencies for the [Ir(III)H(6)](-3) complex with different counterions. These were also compared with the corresponding stretching frequencies for Fe(II)H(6), Ru(II)H(6), Os(II)H(6), and Ir(II)H(5) complexes in similar solid state hydrides, which increased when going from Fe through Ru, Os to Ir. The frequencies scaled almost linearly with the inverse of size of the cube surrounding the complexes but showed no significant dependence of the formal oxidation state or the experimentally obtained Ir-D distances. However, this was mainly because of difficulties in obtaining enough accurate atomic positions. The ab initio DFT calculations could reproduce the stretching frequencies within a few 10 cm(-1), indicating that experimental vibrational frequencies offer a sensitive test of DFT results.

[Mycoses of the paranasal sinus system]. / Mykosen des Nasennebenhöhlensystems.

BACKGROUND: During the last few years, in increasing number of fungal infections in the paranasal sinus system has been observed. Aspergillus species as well as mucor and candida albicans are especially responsible for these mycoses. PATIENTS: Twenty-seven cases of a fungal infection of the paranasal sinuses were observed between 1986 and 1997. The majority of the patients showed a chronic noninvasive form with affection of the maxillary sinus. Other forms (fulminant invasive form, chronic invasive form, allergic fungal sinusitis) are described. Typical features for fungal infection do exist in MRI and CT. CONCLUSIONS: A flexible therapeutic strategy is required in which appropriate pharmacologic and surgical options are tailored to the respective clinical picture.

Brodimoprim in maxillary sinusitis.

Recent studies on bacteriological findings in chronic maxillary sinusitis show a great variety of aerobic as well as anaerobic germs. For these reasons adequate chemotherapy has to support the necessary surgical procedure. In this study, the author reports about 60 adult patients suffering from chronic maxillary sinusitis. All of them had to undergo surgical treatment by the Caldwell-Luc procedure. Postoperatively, 30 of them were treated with brodimoprim, the others with doxycycline for 7 days. Bacteriological investigations have been performed during and at several days after surgery. At the same time, a number of laboratory data and the complications observed were registered. In this way, a comparative study of the two antibiotic drugs concerning the therapy of chronic maxillary sinusitis was established.

[Allergic Aspergillus sinusitis]. / Die allergische Aspergillus-Sinusitis.

The leading symptom of the allergic aspergillus sinusitis is the accumulation of mucoid material, Charcot-Leyden crystals and scattered aspergillus hyphae can usually be found. The mucosa itself shows a typically allergic reaction with distinct eosinophilia and additional inflammatory infiltrates. The histological and serological appearance of the allergic aspergillus sinusitis resembles that of allergic bronchopulmonary aspergillosis. The relation between these syndrome, as well as the treatment of allergic aspergillus sinusitis, are discussed.

[Clinical and etiologic aspects of rupture of the membrane of the round window]. / Klinische und ätiologische Aspekte zur Ruptur der Membran des runden Fensters.

For more than 15 years, rupture of the round window membrane has been discussed as a possible cause of sudden sensineural hearing loss. With regard to the pathophysiological basis for such a rupture, an abnormality in the width of the aquaeductus cochlearis as well as anatomical variations of the round window membrane itself are presumed as causative factors. The authors report on six cases concerning this incidence. The indication for tympanoscopy and the technique for the closure of the round window fistula are reported. In 5 of the 6 patients treated in this manner, surgery the resulted in a significant and lasting hearing gain.

[Laryngeal cancer and asbestosis]. / Kehlkopfkarzinom und Asbestose.

The article deals with the connection between an exposure to asbestos and the development of a laryngeal carcinoma. In accordance with case reports and epidemiological studies from literature, the above mentioned causality can be presumed in certain cases. Although at present there is usually no legal compensation for a laryngeal carcinoma if someone has been exposed to asbestos, the reports from literature as mentioned above should be taken into consideration in every single case: In detail, this means that anamnestical facts of exposure to asbestos, pulmological status and the latency up to the development of the laryngeal carcinoma must be taken into consideration.

[Otologic manifestation of Wegener granulomatosis]. / Die otologische Manifestation der Wegenerschen Granulomatose.

Ever since Wegener first described the granulomatosis named after him, involvement of the middle ear tracts as a consequence of inflammatory changes in the nose and the nasopharynx has been known. In recent years there have been a remarkable number of reports on a primary affection of the mucosa of the middle ear with Wegener's granulomatosis. The corresponding symptoms clearly precede the affection of the typical parts of predilection in the upper respiratory tract. A 37-year old woman patient is reported to have fallen ill with a primary left-sided serous otitis media. Only several months later the changes typical of Wegener's granulomatosis concerning the nasal mucosa, trachea and especially the kidneys set in. The differential diagnostic difficulties appear with respect to the classification of inflammatory granulomatosis of the mucosa of the middle ear. The now valid concept of chemotherapy regarding treatment with cyclophosphamide and corticosteroids. Premature therapy can achieve encouragingly long remission of a relatively high number of cases of this disease.

[Aspergillosis of the nasal sinuses]. / Die Aspergillose der Nasennebenhöhlen.

Aspergillosis of the paranasal sinuses is located mainly in the maxillary sinus, in a few cases in the sphenoid sinus. In typical cases the infection is unilateral. As a rule, the infection leads to a concrement formation in the diseased sinus. This concrement is sometimes characterised by dense masses of calcium phosphate, which seem like metallic structures on x-ray film. With regard to the course of aspergillosis in the paranasal sinuses, we must distinguish between an invasive-destructive form and a non-invasive form. The non-invasive form can be healed by removing the mycotic masses by surgical procedures. In the course of the invasive-destructive form, surgical procedures must be supported by systemic antimycotic treatment. Nevertheless, prognosis in these cases is poor. Finally, it is pointed out that aspergillus infections of the paranasal sinuses can occur even without clearly established immunological deficiencies.

[Occult sinusitis in childhood (author's transl)]. / Die okkulte Sinusitis im Kindesalter.

Occult sinusitis in childhood is a special form of chronic rhinosinusitis. The symptoms of chronic sinusitis are not clear in these patients, but the diagnosis can be confirmed both radiologically and endoscopically. Aetiologically, an immunoincompetence or mucoviscidosis should be remembered. As well as conservative measures, treatment by antral lavage or antrostomy is recommended.

Tympanoplasty and tuberculosis of the middle ear.

This report concerns 6 cases of middle ear tuberculosis. Typical clinical signs for this infection nowadays consist in a pale-coloured mucosa, spontaneous facial paresis, pneumatization of the mastoid and in a changing performation of the tympanic membrane. These signs can occur single or in combination. Under a specific chemotherapeutic treatment even in tuberculous infection of the middle ear tympanoplasty can be performed without danger for the newly transplanted tympanic membrane. One should consider tuberculous infection especially in cases when for apparently inexplicable reasons necrosis of the transplant occurs postoperatively.

[Neurogenic tumor of the larynx (author's transl)]. / Neurogener Kehlkopftumor.

The authors report a case of a 13-year old girl with a neurogenic tumor of the larynx. The tumor was localized in the submucosal region of the arytenoid and aryepiglottic area on the left side of the larynx. Histologically, it was classified as a neurinoma. As it was impossible to remove the tumor totally by endoscopic way, a lateral hypopharyngotomy had to be performed. Two years after this procedure, there are no functional defects or signs of recurrency.

[On the ligation of Stenon's duct in chronic-recurrent parotitis (author's transl)]. / Zur Ligatur des Stenonschen Ganges bei der chronisch-rezidivierenden Parotitis.

Ligation of Stenon's duct represents a possibility for treatment of chronic-recurrent parotitis. This procedure leads to an atrophy of the gland parenchyma. In one case, observed by us as a complication of this method ligation of the duct was followed by the formation of a great parotid gland cyst. Under respect of this casuistic report, possibilities are discussed to prevent similar and other complications. They consist in the section of the preganglionic fibers of the tympanic plexus respectively in a simultaneous radiation therapy of the diseased gland.

[Endoscopic surgery in bilateral vocal cord paralysis (author's transl)]. / Endoskopische Eingriffe zur Glottiserweiterung bei beiderseitiger Stimmbandlähmung.

The surgical treatments of bilateral vocal cord paralysis are briefly described, and the various endoscopic excisions of the arytenoid are presented. For this latter surgery careful preoperative assessment is necessary. Problems related to the optimal time for surgery and to the surgical technique itself are discussed.

[The proteincomposition of human parotid saliva in acute and chronic parotitis. Quantitativ densitometry of single protein-fractions in comparison to normal secretions]. / Uber die Proteinzusammensetzung des menschlichen Parotissekretes bei akuten und chronischen Entzüdungen Quantitative denistometrische Bestimmung der einzelnen Proteinfraktionen im Vergleich zu normalen Drüsensekreten

By means of acrylamidgelectrophoresis parotid secretions of patients with acute and chronic parotitis were examined. Thereby significant changes in protein patterns of electrophoretic separation were found. Especially two bands are described in detail. One in the cathodal near gel region, the isoamylases, and the otherone in the anodal part of the gel, identified as albumin. In rest and under stimulation these bands show signficant changes compared to normal secretions. Furthermore information about the capacity of the parotid gland parenchyma is won by observing the changes of amylase bands in rest and under stimulation in chronic parotitis without actute exacerbations. The amylase shows a remarked decreased secretion in chronic parotitis under stimulation corresponding to parenchymalteration. The same happens with the albuminexcretion as parameter for ductlesions. In chronic parotitis albmuninexcretion goes parallel to duct changes in sialography. Therefore by discelectrophoretic separation of native parotid saliva a helpful mean for diagnostic use is given, besides sialography and scintigraphy.

[Subepithelial changes in simple leukoplakic hyperplasia of the laryngeal mucosa (author's transl)]. / Subepitheliale Veränderungen bei der einfachen leukoplakischen Hyperplasie der Kehlkopfschleimhaut

Subepithelial changes in hyperplasia of the laryngeal mucosa consist in edema and cellular inflammatory reaction. 150 cases of epithelial hyperplasia without atypia have been investigated histologically in regard to these subepithelial changes. The cases were subdivided into 3 categories, according to the degree of hyperplasia. The degree of inflammatory reaction in the subepithelial compartment also was classfied into 3 groups. A, B and C. There was evidence of a positive correlation between the increase in the epithelial hyperplasia and the increase of a positive correlation between the increase in the inflammatory process in the subepithelial layer. It could not be decided, which one of these two pathological changes was primary and which secondary. The therapy, however, should aim at both, epithelial proliferation, as well as, subepithelial inflammation.

The diagnostic value of intranasal tests in allergic rhinopathy.

The method of the intranasal test, used by us, is described. It consists in a direct application of the allergen, which is presumed after a pilot-skin-test. The resulting reaction is documented by rhinomanometry. The special technical aspects of the test and the sources of error are emphasized.