Mapping distribution of brain metastases: does the primary tumor matter?

PURPOSE: Prior reports on the location and sizes of brain metastases almost entirely focus on patients with primary breast and pulmonary cancer. This is the first study comparing multiple other types of cancer that metastasize to the brain. METHODS: This monocentric retrospective study includes 369 untreated patients with 3313 intraaxial brain metastases. Following semi-manual segmentation of metastases on post-contrast T1WI, cumulative spatial probability distribution maps of brain metastases were created for the whole group and for all primary tumors. Furthermore, mixed effects logistic regression model analysis was performed to determine if the primary tumor, patient age, and patient sex influence lesion location. RESULTS: The cerebellum as location of brain metastases was proportionally overrepresented. Breast and pulmonary cancer caused higher number of brain metastases to what would normally be expected. Multivariate analyses revealed a significant accumulation of brain metastases from skin cancer in a frontal and from breast and gastrointestinal cancer in a cerebellar location. CONCLUSION: Distribution of brain metastases is very heterogeneous for the distinct primaries, possibly reflecting the diversity of mechanisms involved in brain metastases formation. In daily clinical practice distribution patters may be beneficial to predict the primary cancer site, if unknown.

[Hiatus hernia : Standards and controversies in diagnostics and treatment]. / Hiatushernie : Standards und Kontroversen in Diagnostik und Therapie.

A hiatus hernia is defined as a transdiaphragmatic protrusion/migration of the intrabdominal contents through the esophageal hiatus of the diaphragm. The classification of hiatus hernias is based on anatomical morphological differentiation (types I-IV). The leading symptoms and psychological stress vary with respect to the symptoms, e. g. reflux and compression symptoms. Gastroscopy and multichannel intraluminal impedance pH measurement are obligatory preoperative functional diagnostics. A distinction is made between frequent type I hernia (antireflux surgery), symptomatic paraesophageal, thoracic and mixed hernia types (II-IV). Surgical indications exist in symptomatic type II-IV hernias. Hiatal mesh augmentation reduces recurrences. The complication potential of synthetic meshes must be taken into account. Biological implants show no advantages.

Induction and inhibition of Friend erythroleukemia cell differentiation by pyrimidine analogs: analysis of the requirement for intracellular accumulation and incorporation into DNA.

Alkyldeoxyuridines which differ from thymidine by a C5 substitution of straight or branched alkyl chains of two to six carbon atoms have been tested for their ability to be taken up, phosphorylated, and incorporated into DNA. Analysis of the uptake of 5-ethyl-2'-deoxyuridine and 5-propyl-2'-deoxyuridine (n-PrdU)--similar to both thymidine and 5-bromo-2'-deoxyuridine--indicates that transport is dependent upon a functional cellular thymidine kinase. All of the aforementioned pyrimidines with the exception of n-PrdU are phosphorylated to the triphosphate and incorporated into DNA. The homologs 5-iso-propyl-2'-deoxyuridine (iso-PrdU) and 5-hexyl-2'-deoxyuridine are neither transported into the cell, phosphorylated, nor incorporated into DNA. These analogs were tested (i) for their ability to induce in the absence of dimethyl sulfoxide and (ii) to determine whether they enhance or inhibit dimethyl sulfoxide-induced differentiation of Friend erythroleukemia cells. Inhibition of erythroid differentiation appears to require the incorporation of thymidine analogs into DNA, and thus only 5-ethyl-2'-deoxyuridine and 5-bromo-2'-deoxyuridine were effective in inhibiting dimethyl sulfoxide-induced differentiation. The observation that iso-PrdU, and to a lesser extent n-PrdU and 5-propyldeoxyuridine monophosphate, induce differentiation under conditions in which they are not detectable intracellularly is strong evidence that this class of inducer acts at the cell membrane.

Local Mode Analysis: Decoding IR Spectra by Visualizing Molecular Details.

Integration of experimental and computational approaches to investigate chemical reactions in proteins has proven to be very successful. Experimentally, time-resolved FTIR difference-spectroscopy monitors chemical reactions at atomic detail. To decode detailed structural information encoded in IR spectra, QM/MM calculations are performed. Here, we present a novel method which we call local mode analysis (LMA) for calculating IR spectra and assigning spectral IR-bands on the basis of movements of nuclei and partial charges from just a single QM/MM trajectory. Through LMA the decoding of IR spectra no longer requires several simulations or optimizations. The novel approach correlates the motions of atoms of a single simulation with the corresponding IR bands and provides direct access to the structural information encoded in IR spectra. Either the contributions of a particular atom or atom group to the complete IR spectrum of the molecule are visualized, or an IR-band is selected to visualize the corresponding structural motions. Thus, LMA decodes the detailed information contained in IR spectra and provides an intuitive approach for structural biologists and biochemists. The unique feature of LMA is the bidirectional analysis connecting structural details to spectral features and vice versa spectral features to molecular motions.

Indomethacin and oxaprozin lower seminal prostaglandin levels but do not influence sperm motion characteristics and serum hormones of young healthy men in a placebo-controlled double-blind trial.

To evaluate the influence of indomethacin and oxaprozin on reproductive function in healthy young men, 34 volunteers with normal semen parameters were recruited. In a randomized double-blind design, 12 men were treated with placebo, 12 received 600 mg/day of oxaprozin and 10 took indomethacin 25 mg t.i.d. This treatment phase lasted for 14 days after which a follow-up period extended for another 10 weeks. Sperm counts, percentage of motile and normally formed sperm cells, sperm velocity, linearity, lateral head displacement and beat frequency were evaluated by computerized image analysis once before treatment and at weekly intervals during the rest of the study. Prostaglandin levels in seminal plasma were significantly reduced after 2 weeks of treatment and remained suppressed for at least 2 additional weeks. In spite of this long lasting impairment of physiologic prostaglandin concentrations, no changes in any of the measured parameters were detectable when compared with the placebo group. Basal levels of testosterone, estradiol, LH, FSH, TSH and prolactin were unchanged. The response of hypophyseal hormones to a combined GnRH/TRH test before, during and after the treatment also was not affected. Overall, no negative influence of indomethacin or oxaprozin treatment on male reproductive function could be found in healthy volunteers. Since the active treatment phase was only 14 days, one can only speculate about long term effects of the tested drugs on reproductive parameters in men.

Alterations in plasma-membrane functions after poliovirus infection.

After exposure of HeLa cells to poliovirus there is a rapid decline (within minutes) in fluorescence polarization of DPH (1,6-diphenyl-1,3,5-hexatriene). Within one hour after infection the (Na+/K+)ATPase activity of an isolated plasma-membrane-rich fraction is enhanced, the cell volume decreases, and the intracellular concentration of a potent low-molecular-weight inhibitor of host protein synthesis increases.

Rod receptors in the retina of Tupaia belangeri.

The retina of Tupaia belangeri was studied by transmission electron microscopy. - Among a vast majority of cones a few typical rods have been found as a distinctly different class of photoreceptors. The outer segments of the rods measure 10 microns X 1.5 microns versus 6 microns X 2 microns in the cones. The repeating unit of the rod discs is 18 nm versus 22 nm in the cone discs. Rod discs tend to lose their continuity with the ciliary membrane, while cone discs do not. Rods lack the highly specialized giant mitochondria of the cone inner segment of Tupaia. The rods of Tupaia show other distinctive characters of mammalian rods as well. However, the rods of Tupaia are relatively short and do not develop a rod fiber.

[Scintigraphic control and x-ray findings following the cement-free implantation of the PM shaft in connection with hip joint allo-arthroplasty]. / Szintigraphische Verläufe und röntgenologische Befunde nach zementfreier Implantation des PM-Schaftes im Rahmen der Hüftgelenksalloarthroplastik.

147 bone scans with 99mTc-MDP following 60 cementless hip arthroplasties were analysed at 3 to 160 weeks after operation. Results are compared to clinical evaluation according to Merle d'Aubigné. X-ray changes in a number of patients are included. In uncomplicated cases, bone scan activity decreased quickly within 26 weeks postoperatively. Decrease of scintigraphic activity was markedly delayed in patients with low Merle d'Aubigné values or persisting pain. In 4 cases, bone scan activity increased again. In these cases, reoperation revealed rotational instability of the shaft endoprostheses. Unusual x-ray phenomena such as development of a bony cup at the tip of the prosthesis or seams were found mainly in patients with less satisfying results. We consider nuclear imaging an important additional examination to evaluate bony integration of PM shaft endoprostheses after hip replacement, especially as interpretation of x-ray features alone is still doubtful.

A demonstrator for a low-cost, cordless, multi-carrier spread-spectrum system.

Because of the need for spectrally efficient systems for wireless communication, many research activities have been carried out in the area of spread-spectrum techniques. Multi-carrier spread-spectrum (MC-SS) is a new modulation technique with better spectral properties than direct-sequence spread-spectrum (DS-SS). In this paper, a new MC-SS system is introduced. A customized surface acoustic wave (SAW) filter has been designed as a fast analog correlator. A demonstrator testbed has been developed for the 2.4-GHz industrial, scientific, and medical (ISM) band. Experimental measurements of the intermediate frequency (IF) and baseband correlation are presented.

Magnetic resonance imaging and knee stability following ACL reconstruction.

This study was undertaken to determine whether there is a correlation between magnetic resonance imaging (MRI) and clinical success after reconstruction of the anterior cruciate ligament (ACL). In a prospective study, 28 patients underwent clinical and MRI examination 3 to 5 years after ACL reconstruction with either the semitendinosus tendon (n = 15) or patellar ligament (n = 13). Knee stability was assessed both clinically and by KT-1000 arthrometer testing. Magnetic resonance imaging was performed with a 0.2-T dedicated system (Artoscan, Esaote, Italy) including sagittal and oblique coronal T1 and T2-weighted images. Magnetic resonance images were evaluated by two readers with regard to signal intensity and continuity of the ACL reconstruction and presence or absence of posterior cruciate ligament buckling. Knee stability and MRI evaluation were each summarized in a 6-point score. Statistical correlation was checked with the Spearman ranked correlation for testing non-normal distributed samples. Statistical testing of all patients' results together showed a significant correlation with a prediction value of 12%, indicating no significant correlation between clinical results and MRI evaluation. Separate statistical testing of the patellar ligament and semitendinosus patients' results showed no significant correlation in either group at all. Thus, no correlation between clinical stability and MRI could be established. Magnetic resonance images after ACL reconstruction using the techniques mentioned above should be interpreted with caution, as they may not relate to the clinical function of the ligament.

[Distal finger joint destruction after frostbite in childhood]. / Fingerendgelenkdestruktion nach Erfrierung im Kindesalter.

Destruction of the DIP-joint and of the growth plate of the distal phalanx after frostbite is shown in the case of a 13-year-old boy. Clinical symptoms, therapy, and result of treatment are presented and literature reviewed.

[Reconstruction of acute anterior cruciate ligament rupture by suture and semitendinosus tendon augmentation.]. / Die Rekonstruktion frischer vorderer Kreuzbandrupturen durch Naht und Semitendinosusaugmentation.

GOAL OF SURGERY: Restoration of normal knee function. INDICATIONS: Acute avulsion of the anterior cruciate ligament (ACL) from its femoral origin. CONTRAINDICATIONS: Mid substance and remote tears. POSITIONING AND ANAESTHESIA: Supine. Knee flexed, hip bent to 30 degrees . General or regional anaesthesia. SURGICAL TECHNIQUE: Step 1: Arthroscopy to confirm site of rupture, meniscus repair if necessary. Step 2: Mobilisation of semitendinosus tendon, left attached distally. Step 3: Mini-arthrotomy, securing of ACL stump with atraumatic suture. Step 4: Transfer of ST-tendon through 5 mm drill holes through tibial head and lateral femoral condyle. Step 5: Fixation of tendon and ACL-sutures with staple at the exit of the femoral drill hole. POSTOPERATIVE MANAGEMENT: Knee orthosis for 6 weeks, CPM, physiotherapy. ROM day 0-2: 0-10-10 degrees ; day 3-11: 0-0-60 degrees , day 12-42: 0-0-90 degrees . Increase of weight bearing 10 kg/week from operation date. Bicycling and running permitted 3 months post-op. Full sport activity after muscle power has reached that of opposite side. LMW heparin until full weight bearing. POSSIBLE COMPLICATIONS: Thrombosis. Embolism. Infection. Failure of reconstruction. Osteoarthritis. RESULTS: During 1 year, 116 patients were operated. Follow-up after 42 to 57 months (average 52 months) included 95 patients (82%). Of these, 76 underwent full examination (average age 33 1/2 years, 20-49 years), 11 answered a questionnaire, 8 had suffered re-injury. Average Lysholm score was 92 points (+/-13). Tegner activity scale amounted to 7.2 points pre-injury, 7.1 points at follow-up. Anterior translation (KT 1000 arthrometer testing at 89 N) was identical to opposite side in 25 patients, less than 2 mm in 14, up to 4 mm in 19, up to 6 mm in 15, more that 6 mm in 3 patients. Pivot shift was negative or trace 73 times, and positive in 3 patients. ROM was full in 54 patients, 17 times the flexion was limited up to 10 degrees . Ten times extension lag was less than 5 degrees , and twice between 5 and 10 degrees .

Biweekly pegylated liposomal doxorubicin in patients with relapsed ovarian cancer: results of a multicenter phase-II trial.

BACKGROUND: The obvious benefit of pegylated liposomal doxorubicin (PLD) for tumour control in recurrent ovarian cancer is frequently offset by severe palmar-plantar erythrodysesthesia (PPE). There is evidence that dose reduction from 50 to 40 mg/m(2) reduces the incidence of PPE without compromising cytotoxic activity. We set out to investigate whether biweekly application further improves the therapeutic index of PLD. PATIENTS AND METHODS: Patients with recurrent ovarian cancer after surgery and adjuvant chemotherapy with platinum and taxane compounds were eligible to participate in this multi-institutional phase II study. PLD was administered at a dose of 20 mg/m(2) every two weeks. Eligible patients had ECOG performance status of < or =2, and sufficient organ function. We employed an optimized two-stage design to test the hypothesis that biweekly application of PLD reduces the frequency of grade III and IV PPE from 25% to 10%. Response and survival were addressed descriptively. RESULTS: Between October 2001 and February 2004, 64 patients with median age of 59 (range 38-81) years were recruited onto this trial. We evaluated 553 (median 7, range 1-25) courses of PLD treatment. Most patients were in their third or fourth line of chemotherapy. PPE was noted in 30 patients (47.6%), but only three participants progressed to grade 3 severity (4.7%, 95% confidence interval 1.0-13.1%). Partial response, stable disease, and tumour progression were observed in 5, 13, and 24 patients, respectively. Median overall and progression-free survival were 18.2 (range, 1.4-34.0) and 4.3 (range 0.5-22.3) months. CONCLUSIONS: Biweekly PLD may reduce the incidence of PPE while retaining efficacy in relapsed ovarian cancer. Our data support the need for a randomized trial to strengthen these assumptions.

[Differences in hip prosthesis implantation in a non-urban region]. / Unterschiede in der Hüftendoprothetik in einer Nicht-Grossstadt-Region.

AIM: The aim of the study was to analyse differences of early results after total hip replacement performed at various hospitals. METHOD: A total of 37 consecutive patients submitted for postoperative rehabilitation were examined. These patients were referred from 18 different hospitals. In an assessment sheet, personal data, age, indication, operating department (surgical or orthopedic), side, length of skin incision and early X-ray presentation with regard to cup angle, position of greater trochanter in relation to head of prosthesis, varus/valgus angle of femoral prosthesis, and cementation were recorded. RESULTS: Of the 37 patients, 26 were female, 11 male. Average age was 62.9 +/- 10.4 years. Degenerative osteoarthritis was present in 23 cases, fractures in 6 cases, there were 6 patients with osteoarthritis following hip dysplasia, 1 pathological fracture, and 1 aseptic necrosis of the femoral head. The skin incision length varied from 8 to 31 cm, averaging to 16.8 +/- 5.3 cm. Implantations were cementless in 20 cases, cemented in 12, and partly cemented in 5 cases. Using a THR-Early-Result-Score of 25 points maximum, # 7 implantations were scored as normal, 16 subnormal, 10 atypical, and 4 highly atypical. CONCLUSION: The data presented show an incidence of 81% non-ideal implantations which is considered surprisingly high. Potential reasons are discussed. It is suggested that efforts to improve the quality of total hip replacements should be made.

[Post-traumatic rotational deformity of the femur in a patient with paraplegia]. / Posttraumatische Rotationsfehlstellung des Femurs bei einer Patientin mit Paraplegie.

A 37-year old woman with paraplegia sustained a posttraumatic rotational deformity of the femur of 40 degrees after the osteosynthesis of a femur fracture. In the consequence she got several problems in her everyday life, such as problems in handling the wheel-chair and in catheterism. The determination of anteversion of the femoral neck by computed tomography is necessary for quantifying rotational faults and planning of corrective osteotomy. Our patient recuperated as the same level of independence after a subtrochanteric corrective osteotomy as before the fracture of the femur.

Abnormal lysozyme production of peritoneal macrophages from mastocytoma P-815 bearing C3D2F1-mice.

Sodium thioglycollate-induced peritoneal macrophages from C3D2F1 mice were examined for their ability to produce and secrete lysozyme in vitro. Lysozyme was quantitated by use of a "lysoplate assay", in which lyophilized Micrococcus lysodeicticus suspended in agar were lysed by the enzyme. The ability to secrete lysozyme decreased in mice bearing a subcutaneous or intraperitoneal mastocytoma P-815 with progressive tumour growth.

[Possibilities for HIV inactivation in homologous bone transplants]. / Möglichkeiten zur HIV-Inaktivierung homologer Knochentransplantate.

Recently, the availability of bone allografts has declined dramatically, due to the three-month HIV test which is often difficult to obtain. Accordingly, there is a search for methods to inactivate HIV in bone allografts without compromising the biologic quality of the grafts. Chemical substances require long exposure and desorption times, to ensure that no toxic agents remain within the bone before actual transplantation. X-ray inactivation leads to complete loss of any osteoinductive properties of the allografts, according to some authors. In addition, the high doses that are necessary are difficult to apply. Autoclaving has been practiced in some instances, but all experimental results and some more recent clinical observations warn that osteoinductive properties of the allografts are lost during the autoclaving process. Lower temperatures (56 degrees C) are sufficient to warrant inactivation of HIV, and some experimental results and preliminary clinical observations indicate that moderate heat treatment of bone allografts in a water bath may become a useful method for virus inactivation of bone allografts.

[Current aspects of knee joint arthrolysis]. / Neue Aspekte zum Thema Kniegelenksarthrolysen.

Recently we observed a change of problems with patients suffering from impaired movement of the knee joint. Among 24 arthrolysis performed in 16 male and 7 female patients from 1983 to 1987, ligamentous injuries had preceded in 13 cases. Extension deficits of more than 10 degrees were the leading problem in 10 cases, flexion deficits in 5 cases, combined deficits in 8 cases. Combined intra- and extraarticular procedures were necessary in most operations. Posteromedial capsular dissection was successfully performed in 12 cases to improve extension. 23 results were evaluated with an average interval of 39 months after operation. Improvement of motion averaged to 62%. Careful preoperative evaluation, systematic operative technique and intensive postoperative physiotherapy are of equal importance to obtain satisfying results with knee joint arthrolysis.

[Retroperitoneal hygroma following nucleotomy with temporary obstruction of the ureter and common iliac vein and consequent deep venous thrombosis]. / Retroperitoneales Hygrom nach Nucleotomie mit temporärer Pelottierung von Ureter und Vena iliaca communis und konsekutiver Beinvenenthrombose.

In a 40 year old male, retroperitoneal effusion occurred on the 4th day after nucleotomy. CAT scan revealed a large tumor, apparently deriving from the operated disc, bulging against ureter and later obstructing the iliac vein with consecutive deep vein thrombosis. Under close monitoring, management was conservative, including intravenous anticoagulation. Follow-up after 6 months showed complete restoration. Literature on complications of lumbar disc surgery is discussed. The presented case draws attention to the phenomenon that retroperitoneal complications may occur not only peracutely or as late complications, but also subacutely presenting with a symptom-free interval of some days.

[Primary suture of the anterior cruciate ligament. A critical analysis]. / Die primäre Naht des vorderen Kreuzbands. Eine kritische Analyse.

Recently some authors have claimed that primary repair of an acute tear in the anterior cruciate ligament will fail in the long run. A review of the literature reveals that this opinion is mainly based on an American study in 1976. However, the poor results presented in this study were never reproduced. The study is critically analyzed, and 14 more papers presenting successful primary reconstructions of the anterior cruciate ligament are discussed. Preserving proprioceptive structures may be an important advantage of this technique, as it is hypothesized that the anterior cruciate ligament functions as a significant sensory organ, not only providing proprioceptive information, but also initiating protective and stabilizing muscular reflexes. In conclusion, it is recommended that primary suture be used combined with intra-articular semitendinosus tendon augmentation for rapid rehabilitation in cases of acute tears in the anterior cruciate ligament.