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1.
Int J Colorectal Dis ; 34(11): 1895-1905, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31641849

RESUMO

PURPOSE: Therapy of anal cancer follows national and international guidelines that are mainly derived from randomized trials. This study aimed to analyze long-term results of stage-dependent treatment of anal cancer in a non-selected patient cohort. PATIENTS AND METHOD: All consecutive patients treated for anal cancer between 2000 and 2015 were retrieved from a prospective database. Risk-dependent screening for human immunodeficiency virus showed no infection. Main outcome measure was overall survival with respect to tumor site and treatment. Secondary endpoints were cause-specific survival, stoma free survival, and the rate of salvage operations. RESULTS: In total, 106 patients were treated for anal cancer. Of those, 69 (65.1%) suffered from anal canal cancer and 37 (34.9%) from anal margin cancer. Three patients with synchronous distant metastases were excluded from analysis. The majority of patients (n = 79, 76.7%) were treated by chemoradiotherapy in curative intention. Twenty-two patients underwent local surgery. Five-year overall survival was 73.1% and cause-specific survival at 5 years was 87.4%. Overall, 14 patients (13.6%) needed salvage surgery. Their 5-year cause-specific survival was 57.7%. A permanent ostomy was avoided in 77.7%. CONCLUSIONS: Treatment of anal cancer results in low rates of salvage surgery and permanent ostomies, when therapy was determined by a multidisciplinary team following national and international guidelines.

2.
J Surg Oncol ; 120(3): 438-445, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31168858

RESUMO

BACKGROUND: Synchronous metastases are considered a negative prognostic factor in patients with metastatic colorectal cancer (CRC). We investigated the outcomes of stage IV CRC patients undergoing complete gross resection (R0/1) of both the primary tumor and the metastases under the guidance of a multidisciplinary team (MDT). METHODS: All CRC patients with synchronous metastases were retrieved from a prospective database. Patients treated from 2006 to 2017 who underwent complete resection were analyzed. Various factors, including multiple metastatic sites and complex procedures, were investigated. Univariate and multivariate overall survival (OS) calculations were performed. RESULTS: Of 330 consecutive patients with synchronous metastases, 101 (30.6%) achieved an R0/1 status including 12 (11.9%) patients with multiple metastatic sites. Complex procedures were necessary in 45 (44.6%) patients. Five-year OS was 53.0% for the R0/1 patient group. Multivariate analysis could not detect factors associated with prognosis. CONCLUSIONS: With modern treatment, the prognosis of patients with synchronous CRC metastases can be improved. Decisions made by a MDT offered one-third of patients a potentially curative approach to their stage IV disease. Despite the treatment of a high rate of patients with complex metastases necessitating complex procedures, we achieved a favorable 5-year OS rate.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Primárias Múltiplas/secundário , Neoplasias Primárias Múltiplas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Estudos Retrospectivos
3.
Open Access Maced J Med Sci ; 5(4): 458-461, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28785332

RESUMO

BACKGROUND: Lentigo malignant melanoma is a melanoma subtype of chronic sun-damaged skin in elderly Caucasians. Amelanotic variants of lentigo malignant are extremely rare. CASE PRESENTATION: This is a case report of an 80-year-old male patient who presented with a non-pigmented exophytic tumour of his bald head. After complete surgical excision under the suspicion of squamous cell carcinoma, three-dimensional histologic examination confirmed an amelanotic lentigo malignant melanoma with a tumour thickness of 1.76 mm, resected R0. Five years later he developed the first relapse, the other year a satellite metastasis was surgically removed. One year later, this patient had developed a large relapsing lentigo malignant melanoma with skull roof invasion. There was no evidence of distant metastatic spread. Amelanotic lentigo malignant melanoma is a very rare tumour. CONCLUSIONS: Serial excision or slow Mohs and Mohs micrographic surgery are the treatments of choice especially in the head and neck area. These tumours may be locally very aggressive as it is shown by skull invasion in the present case.

4.
Int J Colorectal Dis ; 31(10): 1729-37, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27631643

RESUMO

PURPOSE: Extralevator abdominoperineal excision (ELAPE) was introduced to improve outcomes for low-lying locally advanced rectal cancers (LARC) not amenable to sphincter preserving procedures. This study investigates prospectively outcomes of patients operated on with ELAPE compared with a similar cohort of patients operated on with conventional APE. METHODS: After the exclusion of patients without neoadjuvant therapy, in-hospital mortality, and incomplete metastatectomy, we identified 72 consecutive patients who had undergone either conventional APE (n = 36) or ELAPE (n = 36) for LARC ≤6 cm from the anal verge. The primary outcome measure was local recurrence at 5 years, and secondary outcome measures were cause-specific and overall survival. RESULTS: Median distance from the anal verge was significantly lower in the ELAPE group (2 vs. 4 cm, p = 0.029). Inadvertent bowel perforation could be completely avoided in the ELAPE group, but amounted to 16.7 % in the conventional APE group (p = 0.025). Cumulative local recurrence rate at 5 years was 18.2 % in the APE group compared to 5.9 % in the ELAPE group (p = 0.153). Local recurrence without distant metastases occurred in 15.5 % in the APE group but was not observed in the ELAPE group (p = 0.039). We did not detect significant differences in cause-specific nor in overall survival. CONCLUSION: ELAPE results in lower local recurrence rates as compared with conventional APE. We conclude that the extralevator approach should be the procedure of choice for advanced low rectal cancer not amenable to sphincter preserving procedures.


Assuntos
Abdome/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Períneo/cirurgia , Neoplasias Retais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
6.
Int J Colorectal Dis ; 30(6): 797-806, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25922143

RESUMO

PURPOSE: This study aimed to investigate the outcome for stage II and III rectal cancer patients compared to stage II and III colonic cancer patients with regard to 5-year cause-specific survival (CSS), overall survival, and local and combined recurrence rates over time. METHODS: This prospective cohort study identified 3,355 consecutive patients with adenocarcinoma of the colon or rectum and treated in our colorectal unit between 1981 and 2011, for investigation. The study was restricted to International Union Against Cancer (UICC) stages II and III. Postoperative mortality and histological incomplete resection were excluded, which left 995 patients with colonic cancer and 726 patients with rectal cancer for further analysis. RESULTS: Five-year CSS rates improved for colonic cancer from 65.0% for patients treated between 1981 and 1986 to 88.1% for patients treated between 2007 and 2011. For rectal cancer patients, the respective 5-year CSS rates improved from 53.4% in the first observation period to 89.8% in the second one. The local recurrence rate for rectal cancer dropped from 34.2% in the years 1981-1986 to 2.1% in the years 2007-2011. In the last decade of observation, prognosis for rectal cancer was equal to that for colon cancer (CSS 88.6 vs. 86.7%, p = 0.409). CONCLUSION: Survival of patients with colon and rectal cancer has continued to improve over the last three decades. After major changes in treatment strategy including introduction of total mesorectal excision and neoadjuvant (radio)chemotherapy, prognosis for stage II and III rectal cancer is at least as good as for stage II and III colonic cancer.


Assuntos
Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Neoplasias do Colo/mortalidade , Neoplasias do Colo/cirurgia , Neoplasias Retais/mortalidade , Neoplasias Retais/cirurgia , Adenocarcinoma/patologia , Idoso , Neoplasias do Colo/patologia , Humanos , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Prospectivos , Neoplasias Retais/patologia , Taxa de Sobrevida , Resultado do Tratamento
7.
Int J Dermatol ; 52(10): 1189-97, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23829640

RESUMO

BACKGROUND: Mesenchymal neoplasms (sarcomas) of skin are rare. Patients with sarcomas were analyzed over the last decade. METHODS: Over a 10-year period, we conducted a retrospective analysis of patients diagnosed and treated in an urban academic teaching hospital in Saxony, Germany. Clinical and pathologic files were used. RESULTS: We identified 65 adult patients with 67 primary cutaneous sarcomas. The mean age was 73.1 (± 15.5) years with a male predominance (78.5%). None of the sarcomas was detected by a skin cancer screening program. The diagnosis was atypical fibroxanthoma (n = 41 patients with 43 tumors), cutaneous angiosarcoma (eight), dermatofibrosarcoma protuberans (two), nodular epithelioid cell sarcoma (one), Kaposi sarcoma (three), leiomyosarcoma (five), malignant fibrous histiocytoma (two), fibromyxoid sarcoma (one), and cutaneous angiomyxoma (two). The preferred tumor localization was the head and neck area (44 patients). Follow-up was 0.5-5.5 years (mean 18 ± 12 months). We observed metastatic spread of atypical fibroxanthoma in 12.5%, demonstrating that this type of sarcoma can run an aggressive course. Mohs surgery is still the cornerstone of treatment, although new options in palliative or adjuvant treatment are available. CONCLUSIONS: Mesenchymal neoplasms (sarcomas) are an important group of cutaneous malignancies. Awareness needs to be improved.


Assuntos
Dermatofibrossarcoma/diagnóstico , Hemangiossarcoma/diagnóstico , Leiomiossarcoma/diagnóstico , Sarcoma de Kaposi/diagnóstico , Sarcoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Dermatofibrossarcoma/cirurgia , Feminino , Seguimentos , Hemangiossarcoma/cirurgia , Histiocitoma/diagnóstico , Histiocitoma/cirurgia , Humanos , Leiomiossarcoma/cirurgia , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs , Estudos Retrospectivos , Sarcoma/cirurgia , Sarcoma de Kaposi/cirurgia , Neoplasias Cutâneas/cirurgia
8.
Indian Dermatol Online J ; 4(1): 2-11, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23439959

RESUMO

Acne inversa (AI) is a disabilitating chronic inflammatory disease with major negative impact on quality of life and significant co-morbidities. This is an important link to insights into immune dysfunction, which stimulated therapeutic approaches like tumor necrosis-α inhibitor therapy. This new off-label drug treatment is particularly beneficial when used in combination with wide excision of inflamed skin and subcutaneous tissue. Retinoids have been reported to be helpful in secondary prevention. The standard of therapy in advanced cases is surgery with wide excisions and healing by secondary intention. This treatment results in significant reduction of complaints and achieves satisfactory body contouring.

9.
J Clin Aesthet Dermatol ; 4(4): 34-7, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21532876

RESUMO

Tricholemmal squamous cell carcinoma is a rare variant of squamous cell carcinoma thought to follow a more benign course. The authors present the case of a 67-year-old man with a giant tricholemmal squamous cell carcinoma on his scalp. Further investigations demonstrated a skull destruction and cranial invasion. Curative treatment was impossible, but tumor mass reduction and wound closure by sandwich split-thickness skin mesh graft transplantation using a dermal template was performed. Problems of advanced squamous cell carcinoma on the scalp are discussed.

10.
Dermatol Ther ; 23(2): 123-36, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20415819

RESUMO

Psoriatic arthritis (PSA) is an entity of inflammatory joint disease associated with psoriasis. PSA belongs to the heterogeneous group of seronegative spondylarthropathies. Both peripheral joints and axial skeleton can be affected in a characteristic pattern. In addition to that, enthesitis and dactylitis are important extracutaneous manifestations. Uveitis anterior is temporarily seen in about one quarter of PSA patients. There is a closer relationship of nail and joint disease. This review provides data on drug and physical treatment options. In particular DMARDS and inhibitors of tumor necrosis factor alpha are established therapies with importance for quality of life and long term outcome. New drugs are tested in various trials.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/patologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Idoso , Artrite Psoriásica/reabilitação , Feminino , Humanos , Masculino , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
J Magn Reson Imaging ; 31(2): 356-64, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20099349

RESUMO

PURPOSE: To compare enhancement of liver parenchyma in MR imaging after injection of hepatocyte-specific contrast media. MATERIALS AND METHODS: Patients (n = 295) with known/suspected focal liver lesions randomly received 0.025 mmol gadoxetic acid/kg body weight or 0.05 mmol gadobenate dimeglumine/kg body weight by means of bolus injection. MR imaging was performed before and immediately after injection, and in the delayed phase at approved time points (20 min after injection of gadoxetic acid and 40 min after injection of gadobenate dimeglumine). The relative liver enhancement for the overall population and a cirrhotic subgroup was compared in T1-weighted GRE sequences. An independent radiologist performed signal intensity measurements. Enhancement ratios were compared using confidence intervals (CIs). RESULTS: The relative liver enhancement in the overall population was superior with gadoxetic acid (57.24%) versus gadobenate dimeglumine (32.77%) in the delayed-imaging phase. The enhancement ratio between the contrast media was statistically significant at 1.75 (95% CI: 1.46-2.13). In the delayed phase, the enhancement of cirrhotic liver with gadoxetic acid (57.00%) was comparable to that in the overall population. Enhancement with gadobenate dimeglumine was inferior in cirrhotic liver parenchyma (26.85%). CONCLUSION: In the delayed, hepatocyte-specific phase, liver enhancement after injection of gadoxetic acid was superior to that obtained with gadobenate dimeglumine.


Assuntos
Gadolínio DTPA , Neoplasias Hepáticas/patologia , Fígado/patologia , Imagem por Ressonância Magnética/métodos , Meglumina/análogos & derivados , Compostos Organometálicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Método Duplo-Cego , Europa (Continente) , Humanos , Injeções Intra-Arteriais , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
J Magn Reson Imaging ; 31(2): 390-7, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20099352

RESUMO

PURPOSE: To evaluate the efficacy and safety of 0.1 mmol/kg gadodiamide administration for contrast-enhanced magnetic resonance angiography (MRA) in detecting hemodynamically relevant renal artery stenosis (RAS) when compared with intraarterial digital subtraction angiography (IA-DSA) as the gold standard. MATERIALS AND METHODS: In a multicenter, controlled study, 395 patients with suspected or known RAS were included. Three independent readers evaluated the MRA images. Two readers evaluated the IA-DSA images and subsequently achieved consensus. The sensitivities and specificities of gadodiamide-enhanced MRA were analyzed at the per-patient and per-vessel levels (exact 1-sided binomial test at alpha = 0.025 with 95% confidence interval). RESULTS: A total of 335 patients who had available standard of truth and MRA tests were included in the all-subjects efficacy population: 55.5% (186/335) men and 44.5% women with a mean age of 63 +/- 13 years (range 17-85 years). The sensitivities and specificities ranged from 81% to 86% for all independent readers at the per-patient analysis based on subjects with the diagnostic images. Similar results were achieved with per-vessel level analysis. Fewer than 1% of patients had adverse event associated with gadodiamide administration. There were no cases of nephrogenic systemic fibrosis (NSF) reported. CONCLUSION: Gadodiamide administration at the labeled dose of 0.1 mmol/kg for contrast-enhanced MRA achieved equivalent results compared to IA-DSA in evaluation of RAS and was well tolerated.


Assuntos
Angiografia Digital/métodos , Gadolínio DTPA , Aumento da Imagem/métodos , Angiografia por Ressonância Magnética/métodos , Obstrução da Artéria Renal/diagnóstico , Meios de Contraste , Feminino , Humanos , Internacionalidade , Masculino , Modelos Biológicos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
13.
Int J Low Extrem Wounds ; 8(3): 165-8, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19703954

RESUMO

The authors present a rare case of panniculitis ossificans (PO) in a 30-year-old woman. Differential diagnoses and treatment are discussed. PO is an important differential diagnosis to sarcomas.


Assuntos
Calcinose/diagnóstico , Perna (Membro) , Paniculite/diagnóstico , Adulto , Calcinose/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Paniculite/cirurgia
14.
Dermatol Surg ; 35(3): 457-61, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19243405

RESUMO

BACKGROUND: Dystrophic calcification (DC) is a risk factor for conservative treatment failure in chronic leg ulcers of various pathologies. PATIENTS AND METHODS: We performed a retrospective noncontrolled trial of 212 patients with 362 chronic leg ulcers who underwent ulcer shave excision with subsequent skin grafting. The ulcers existed for at least 3 months, and no healing was achieved with good ulcer care. Tissue was subjected to histopathology (hematoxylin-eosin and van Kossa stains). RESULTS: DC was evident in 39 patients (18%). Metaplastic subcutaneous bone formation was observed in 15 patients (7%). Clinical symptoms associated with DC were resistance to good ulcer care, pain, and ineffective effects of compression therapy (in venous ulcers). Ulcers were treated with deep dermatome shaving of the ulcer bed and surgical removal of DC. In the same setting, defects were closed using mesh graft transplantation. The procedure achieved a complete take rate in 80% and a significant decrease of pain in 95% of cases. When comparing the take rates in patients with and without DC, DC had a negative effect on outcome (take rate: 91% without DC vs 80% with DC, p<.05). CONCLUSIONS: DC is resistant to conservative treatment. The first-line treatment is deep ulcer dermatome shaving and complete removal of calcifications whenever possible.


Assuntos
Úlcera da Perna/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Comorbidade , Feminino , Humanos , Úlcera da Perna/epidemiologia , Úlcera da Perna/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerodermia Localizada/patologia , Esclerodermia Localizada/cirurgia , Transplante de Pele
15.
J Dtsch Dermatol Ges ; 7(1): 46-9, 2009 Jan.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-18759738

RESUMO

A 52-year-old woman with pulmonary sarcoidosis on immunosuppressive therapy developed pulmonary infiltrates and cutaneous granulomatous abscesses after a trip to the USA in April 2005. A hyphomycete was identified, further characterized by a gene probe as Coccidioides spp. and then definitively identified as Coccidioides posadasii by polymerase chain reaction and sequencing. Antibodies towards Coccidioides spp. were detected. The infection was successfully treated with posaconazole (Noxafil), 2 x 400 mg/d.


Assuntos
Antifúngicos/administração & dosagem , Coccidioidomicose/diagnóstico , Coccidioidomicose/prevenção & controle , Dermatomicoses/diagnóstico , Dermatomicoses/prevenção & controle , Triazóis/administração & dosagem , Coccidioidomicose/tratamento farmacológico , Dermatomicoses/tratamento farmacológico , Humanos , Técnicas In Vitro , Pessoa de Meia-Idade , Prevenção Secundária , Resultado do Tratamento
16.
Int Wound J ; 5(5): 655-9, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18808430

RESUMO

We report a 53-year-old farmer who developed subcutaneous and cerebral masses 24 years after penetrating trauma during a tropic storm. Computed tomography scans, magnetic resonance imaging and histopathology disclosed actinomycetoma, a disease that rarely develops after trauma and is only occasionally seen with intracranial manifestation. Clinically, the cutaneous manifestation resembled acne keloidalis nuchae or dissecting folliculitis of the scalp. He was treated by neurosurgery and antibiosis.


Assuntos
Abscesso Encefálico , Traumatismos Cranianos Penetrantes/complicações , Micetoma , Dermatoses do Couro Cabeludo , Antibacterianos/uso terapêutico , Biópsia , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/etiologia , Abscesso Encefálico/terapia , Craniotomia , Tempestades Ciclônicas , Desastres , Humanos , Índia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Micetoma/diagnóstico , Micetoma/etiologia , Micetoma/terapia , Lobo Occipital , Lobo Parietal , Doenças Raras , Fatores de Risco , Dermatoses do Couro Cabeludo/diagnóstico , Dermatoses do Couro Cabeludo/etiologia , Dermatoses do Couro Cabeludo/terapia , Supuração , Fatores de Tempo , Tomografia Computadorizada por Raios X
17.
Eur Radiol ; 18(11): 2610-9, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18607594

RESUMO

The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy, sensitivity, and specificity to correctly classify focal lesions of the kidney. To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading. The average diagnostic accuracy across the three blinded readers ('average reader') was 83.7% for gadobutrol and 87.3% for gadopentate dimeglumine. The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0% for gadobutrol and 6.9% for gadopentate dimeglumine. Sensitivity of the average reader was 85.2% for gadobutrol and 88.7% for gadopentate dimeglumine. Specificity of the average reader was 82.1% for gadobutrol and 86.1% for gadopentate dimeglumine. In conclusion, this study documents evidence for the noninferiority of a single i.v. bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI.


Assuntos
Gadolínio DTPA , Aumento da Imagem/métodos , Neoplasias Renais/diagnóstico , Neoplasias Renais/epidemiologia , Imagem por Ressonância Magnética/métodos , Compostos Organometálicos , Meios de Contraste , Europa (Continente)/epidemiologia , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Método Simples-Cego
18.
Urol Oncol ; 25(3): 201-6, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17483016

RESUMO

OBJECTIVE: To investigate the role of magnetic resonance imaging (MRI) of bone metastases in nonseminomatous germ cell tumors. METHODS AND MATERIALS: There were 5 consecutive patients with bone metastases from nonseminomatous germ cell tumors treated between 2003 and 2006 who underwent imaging studies, including MRI. The characteristic imaging findings are discussed in the light of the clinical course. RESULTS: Of the 5 patients, 3 had symptoms related to bone involvement at diagnosis. All patients received conventional x-ray of their bony lesions, but only 1 of them was considered abnormal. Skeletal MRI was obtained in all patients. A bone scan was available in 3 cases with spinal involvement. It was normal in 1 case and detected only a minority of the lesions visible on MRI in the other 2 cases. Follow-up MRIs were available in all patients. A partial resolution of bone involvement during chemotherapy was observed in only 1 of them. In 2 cases, there was a slight progression of a diffuse alteration of the bone marrow during treatment. In 1 patient, severe spinal bone marrow changes were visible on MRI 2 years after cessation of treatment without evidence of disease recurrence. CONCLUSIONS: MRI may disclose bone metastases in nonseminomatous germ cell tumors, which otherwise may be missed. MRI findings of bone lesions during treatment do not directly reflect the course of the disease and have to be interpreted with caution using clinical information.


Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/secundário , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Embrionárias de Células Germinativas/patologia , Tomografia por Emissão de Pósitrons/métodos , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/patologia
19.
Eur J Radiol ; 64(3): 456-64, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17412546

RESUMO

PURPOSE: To determine the most efficacious dose of gadodiamide for three-dimensional (3D) contrast-enhanced (CE) magnetic resonance angiography (MRA) of the renal arteries on a patient level based on the sensitivity in detecting the main hemodynamically relevant (> or =50% or occlusion) renal artery stenosis (RAS) using intra-arterial digital subtraction angiography (IA DSA) as the gold standard. MATERIALS AND METHODS: This prospective, randomized, double-blind, parallel-group, multicenter study included 273 patients referred to IA DSA for suspected RAS. Patients underwent 3D CE MRA after injection of 0.01, 0.05, 0.1, or 0.2mmol/kg of body weight gadodiamide (0.5mmol/ml). The images were assessed for location and degree of RAS by independent blinded readers (MRA: three readers, IA DSA: one reader). Hypothesis testing for a significant trend in sensitivity across dose groups was based on the one-sided Cochran-Armitage style trend test for each independent MRA reader. RESULTS: The lowest dose group (0.01mmol/kg) proved non-efficacious in detecting hemodynamically relevant (i.e., > or =50% or occlusion) RAS. A statistically significant dose trend (p<0.001) was shown for each of the three independent readers. Depending on reader, the sensitivity obtained with 0.05, 0.1, and 0.2mmol/kg was 63.9-86.1%, 75.8-91.4% and 80.6-90.6%, the specificity was 66.7-73.9%, 59.3-75.0%, and 59.3-75.0% and accuracy was 67.8-78.9%, 75.4-77.4%, and 76.3-81.0%, for the three dose groups, respectively. There were eight non-severe adverse events (AEs). Three serious AEs occurring in one patient were judged not related to gadodiamide by the on-site investigator. CONCLUSION: A significant dose trend between the four doses examined was observed. The lowest dose (0.01mmol/kg) differed significantly from those of the other three doses. Based on the analysis of the primary and secondary endpoints, 0.1mmol/kg gadodiamide appears to be the most suitable dose in diagnosing hemodynamically relevant RAS. The present study also demonstrated gadodiamide to be safe and well tolerated.


Assuntos
Meios de Contraste , Gadolínio DTPA , Aumento da Imagem/métodos , Imagem Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Obstrução da Artéria Renal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Gadolínio DTPA/administração & dosagem , Gadolínio DTPA/efeitos adversos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Segurança , Sensibilidade e Especificidade , Resultado do Tratamento
20.
J Interv Cardiol ; 19(2): 166-9, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16650247

RESUMO

Transesophageal echocardiography (TEE) revealed a 3-mm-large patent foramen ovale (PFO). No other reason for these neurological events could be found and the patient underwent percutaneous closure of the PFO with a CARDIA Star 03/30 device without periprocedural complications. Four weeks later, the patient underwent a routine control of device without any adverse clinical symptoms. Surprisingly, echocardiography revealed a perforation of the aortic root by an umbrella strut with a small shunt from the aortic root to the right atrium. Magnetic resonance imaging (MRI) confirmed the diagnosis of device malposition. Consecutively, the patient underwent minimal invasive surgery. After removal of the single perforating strut, the bleeding lesion was closed. The patient remained free of any additional complications during the postoperative course and up until now has had uneventful follow-ups.


Assuntos
Ruptura Aórtica/diagnóstico , Comunicação Interatrial/cirurgia , Próteses e Implantes , Implantação de Prótese/efeitos adversos , Adulto , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/patologia , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Implantação de Prótese/instrumentação
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