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Mannheim, Germany

Leclere F.M.,University of Bern | Mathys L.,University of Bern | Juon B.,University of Bern | Franz T.,University of Bern | And 2 more authors.
Archives of Orthopaedic and Trauma Surgery | Year: 2012

Introduction Micro- or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes. Materials and methods Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. The patients, one woman and ten men, had a mean age of 43.4 ± 18.2 years (range 19-76 years). There were two elbow, two proximal forearm, four mid-forearm, and three distal forearm amputations. The mechanism of injury was crush in four, crush-avulsion in five and guillotine amputation in two patients. The Chen classification was used to assess the postoperative outcomes. The mean follow-up after macroreplantation was 7.5 ± 6.3 years (range 2-21 years). Results All but one were successfully replanted and regained limb function: Chen I in four cases (36 %), Chen II in three cases (27 %), Chen III in two cases (18 %), and Chen IV in one patient (9 %). We discuss the steps of the macroreplantation technique, the need to minimize ischemic time and the risk of ischemia reperfusion injuries. Conclusion Thanks to improvements in technique, the indications for limb preservation after amputation can be expanded. However, because of their rarity, replantations should be performed at specialist replantation centers. © Springer-Verlag 2012.

Apfaltrer P.,University of Mannheim | Meyer M.,University of Mannheim | Meier C.,University of Mannheim | Henzler T.,University of Mannheim | And 6 more authors.
Investigative Radiology | Year: 2012

OBJECTIVES:: To assess the correlation of true nonenhanced (TNE) and virtually nonenhanced (VNE) images of abdominal dual-energy computed tomography (DECT) in patients with metastatic gastrointestinal stromal tumors (GIST), and further to investigate the correlation of iodine-related attenuation (IRA) of DECT with the Choi criteria. MATERIAL AND METHODS:: Twenty-four consecutive patients (5 women aged 61 ± 10 years) with metastatic GIST underwent DECT of the abdomen (80 kV, 140 kV) using first-generation dual-source computed tomography (CT). All patients had at least one or more liver lesions (median, 4; maximum, 9). Image data were processed with a dedicated DECT software algorithm designed for evaluation of iodine distribution in soft tissue lesions, and VNE CT images were generated. The tumor density (according to Choi criteria) and the maximum transverse diameter of the lesions (according to Response Evaluation Criteria in Solid Tumors [RECIST]) were determined. TNE and VNE lesion attenuation and Choi criteria and IRA were correlated with each other. RESULTS:: A total of 291 liver lesions were evaluated, of which 220 were cystic and 71 were solid. The mean lesion size was 4.5 ± 3.2 cm (1.1-18.7 cm). The mean attenuation of all lesions was significantly higher in the TNE images than in the VNE images (P=0.0001). Pearson statistics revealed an excellent correlation of r=0.843 (P=0.0001) between IRA and Choi criteria for all lesions. DECT showed significantly higher IRA in progressive (23.3 ± 9.5 HU) lesions compared with stable or regressive (17.8 ± 9.1 HU) lesions (P=0.0185). Similarly, the Choi criteria differed significantly between progressive (39.9 ± 12.8 HU) and stable/regressive (31.1 ± 10.3 HU) lesions (P=0.0003). CONCLUSIONS:: DECT is a promising imaging method for the assessment of treatment response in GIST, as IRA might be a more robust response parameter than the Choi criteria. VNE CT data calculated from DECT may eliminate the need for acquisition of a separate unenhanced data set. Copyright © 2012 by Lippincott Williams & Wilkins.

Boll H.,University of Heidelberg | Bag S.,University of Heidelberg | Nolte I.S.,University of Heidelberg | Wilhelm T.,University of Heidelberg | And 4 more authors.
International Journal of Colorectal Disease | Year: 2011

Purpose Models of colon cancer in small rodents are of particular interest as they most closely simulate the development and growth of colonic cancer in humans. Microcomputed tomography has been used for detection of polyps in murine models of colon cancer. The study was performed to evaluate whether a novel high-speed continuous-rotation, single-breath-hold scanning protocol in combination with double-contrasting of the colon can be successfully applied for colonoscopy of live mice at acquisition times of 40 s. Methods C57BL/6JApcMin/+ mice were intubated and ventilated. After double-contrasting the colon with barium and air, mice underwent continuous rotation micro-CT (mean resolution 41×41×53 ?m) during a single-breathhold period of 40 s. Sensitivity to detect colon polyps by four blinded radiologists was analysed. Number and location of polyps were verified in the excised colon. Radiation dose was measured using a thermoluminescence dosimeter placed within the distal colon. Results In six of sevenmice, a total of 12 polypswere detected in the explanted colon (one mouse without polyps). One tumor (8.3%) was located in the proximal third, seven tumors (58.1%) and four tumors (33.2%) were located in the middle and in the distal third of the colon, respectively. Mean tumor volume was 6.5±3.6 mm3. Sensitivity to detect colon polyps was 0.85±0.1. Mean radiation dose was 0.241±0.002 Gy. Conclusion Using a high-speed continuous rotationmicro-CT protocol, double-contrast single-breath-hold colonoscopy in mice is feasible and yields sufficient contrast to visualize the proximal colonic folds and to detect colonic polyps in vivo. © Springer-Verlag 2011.

John K.,Hannover Medical School | Hadem J.,Hannover Medical School | Krech T.,Hannover Medical School | Wahl K.,Hannover Medical School | And 8 more authors.
Hepatology | Year: 2014

Acute liver failure (ALF) represents a life-threatening situation characterized by sudden and massive liver cell death in the absence of preexisting liver disease. Although most patients require liver transplantation to prevent mortality, some recover spontaneously and show complete liver regeneration. Because of the rarity of this disease, the molecular mechanisms regulating liver regeneration in ALF patients remain largely unknown. In this study, we investigated the role of microRNAs (miRs) that have been implicated in liver injury and regeneration in sera from ALF patients (n=63). Patients with spontaneous recovery from ALF showed significantly higher serum levels of miR-122, miR-21, and miR-221, compared to nonrecovered patients. In liver biopsies, miR-21 and miR-221 displayed a reciprocal expression pattern and were found at lower levels in the spontaneous survivors, whereas miR-122 was elevated in both serum and liver tissue of those patients. As compared to nonrecovered patients, liver tissue of spontaneous survivors revealed not only increased hepatocyte proliferation, but also a strong down-regulation of miRNA target genes that impair liver regeneration, including heme oxygenase-1, programmed cell death 4, and the cyclin-dependent kinase inhibitors p21, p27, and p57. Conclusion: Our data suggest that miR-122, miR-21, and miR-221 are involved in liver regeneration and might contribute to spontaneous recovery from ALF. Prospective studies will show whether serological detection of those miRNAs might be of prognostic value to predict ALF outcome. (Hepatology 2014;60:1346-1355) © 2014 by the American Association for the Study of Liver Diseases.

Schmid-Bindert G.,Medical Faculty Mannheim | Engel-Riedel W.,Kliniken der Stadt Cologne | Reck M.,Airway Research Center North | Schuette W.,Krankenhaus Martha Maria Halle Doelau | And 10 more authors.
Lung Cancer | Year: 2015

Objectives: We investigated the feasibility of cisplatin or carboplatin combined with pemetrexed as adjuvant treatment in patients with completely resected Stage IB/II Non-Small-Cell Lung Cancer (NSCLC). Materials and methods: Patients in this multicenter, open-label, parallel-group, non-comparative Phase 2 study were randomized (1:1) to pemetrexed (500mg/m2) with either cisplatin (75mg/m2) or carboplatin (AUC5) for 4 cycles of 21 days. The primary endpoint was treatment feasibility (defined as 4 cycles completed with no cycle delay >42 days and ≤2 dose reductions, with a median relative dose intensity (RDI) ≥95% [overall]; and no Grade ≥3 toxicities at the follow-up visit 30 days after last drug administration). Secondary objectives included overall survival (OS) and safety. Results: We randomized 122 patients and treated 118. 71.9% (46/64) of patients in pemetrexed + cisplatin and 88.9% (48/54) in pemetrexed + carboplatin completed 4 cycles (median RDI >97% for all compounds). Neither treatment met the pre-defined feasibility level >60% of patients: 59.4% (95% confidence interval [CI]: 46.4;71.5) pemetrexed + cisplatin; 50.0% (95%CI: 36.1;63.9) in pemetrexed + carboplatin. In a post-hoc analysis considering only safety, both regimens were feasible with 81.3% (95%CI: 69.5;89.9) in pemetrexed + cisplatin and 90.7% (95%CI: 79.7;96.9) in pemetrexed + carboplatin. OS rates for both groups were 82-83% after 3 years and 80-83% after 5 years. Treatment-related Grade ≥3 adverse events (mostly hematological) were experienced by approximately 30% of patients in each group. Conclusion: Although the study did not meet the primary objective, both treatment groups demonstrated good safety-related feasibility and tolerability as adjuvant treatment in patients with completely resected Stage IB/II NSCLC. © 2015 Elsevier Ireland Ltd.

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