A commentary on the article "Prevalence of the mismatch repair-deficient phenotype in colonic adenomas arising in HNPCC patients--results of a 5-year follow-up study".
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Adenoma↗
Biomedical subjects
M Werner
Publications and source records attributed to M Werner.
[Bone damaging swelling of the side of the nose].
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Edema↗
[Fluorosis--a forgotten entity. Case report of a woman with coxarthrosis and newly diagnosed fluorosis].
The clinical manifestation of fluorosis has become rare over the past years. Although the use of fluoride medication in osteoporosis therapy remains controversial, past study results have led to a reduction in fluoride prescriptions. Several studies have shown minor biomechanical properties of newly built woven bone compared to original bone. Despite new prescription protocols, fluoride therapy should not be disregarded in the anamnesis of osteoporosis patients. In addition to conventional diagnostics in fluorosis, new techniques such as microanalysis and micro-CT-analysis show a diagnostic benefit. In this case, the edx-microanalysis results show an F concentration of over 1.0 wt% in bone. The ratio of bone to tissue volume, evaluated by micro-CT, is clearly elevated at 46% BV/TV. The histopathological preparation of the femoral head has made the possible effects of fluoride medication on bone visible and quantifiable. A direct causal relationship between coxarthrosis and fluoride medication, found both in our patient as well as in the literature, has not been demonstrated. In order to better understand the broad effects of fluoride medication in combination with coxarthrosis more studies are needed.
Aged↗
Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics.
PURPOSE: In this prospective, nonrandomized, ongoing study we evaluated the efficacy and safety of botulinum-A toxin injections in the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment, such as anticholinergic drugs. MATERIALS AND METHODS: A total of 23 men and 77 women with a mean age of 63 years (range 24 to 89) with nonneurogenic overactive bladder, including urgency-frequency syndrome, and incontinence despite the administration of maximal doses of anticholinergics were consecutively treated with injections of 100 U botulinum-A toxin in the detrusor muscle at 30 sites under cystoscopic guidance. Micturition diary, full urodynamics, neurological status and urine probes were performed in all participants before treatment. Bladder biopsies were done only in cases of suspected bladder fibrosis or unclear findings. Special attention was given to reflex volume, maximal bladder capacity, detrusor compliance, post-void residual urine, urgency and frequency/nocturia. Clinical, urodynamic and quality of life assessments were performed at baseline, and 4, 12 and 36 weeks after botulinum-A toxin treatment. RESULTS: Overall after 4 and 12 weeks 88% of our patients showed significant improvement in bladder function in regard to subjective symptoms, quality of life and urodynamic parameters (p <0.001). Urgency disappeared in 82% of the patients and incontinence resolved in 86% within 1 to 2 weeks after botulinum-A toxin injections. Mean frequency decreased from 14 to 7 micturitions daily (-50%) and nocturia decreased from 4 to 1.5 micturitions. Mean maximal bladder capacity increased 56% from 246 to 381 ml, mean detrusor compliance increased from 24 to 41 ml/cm H(2)O and pretreatment detrusor instability (mean reflex volume 169 ml) resolved in 74% of patients. Mean volume at first desire to void increased from 126 to 212 ml and mean urge volume increased from 214 to 309 ml. There were no severe side effects except temporary urine retention in 4 cases. Only in 8 patients was the clinical benefit poor and analysis revealed preoperative low detrusor compliance. Mean efficacy duration +/- SD was at least approximately 6 +/- 2 months and then symptoms began to increase. CONCLUSIONS: Our results show that intradetrusor botulinum-A toxin injections may be an efficient and safe treatment option in patients with severe overactive bladder resistant to all conventional treatments.
Adult↗
Association between interleukin-1 receptor antagonist gene and asthma-related traits in a German adult population.
BACKGROUND: A recent study in German and Italian families associated variants in the interleukin-1 receptor antagonist (IL1RA) gene with asthma. The aim of the present study was to further investigate the role of single nucleotide polymorphisms (SNPs) in the IL1RA gene in the development of atopy and lifelong asthma in a population-based study. METHODS: DNA samples from the German centres of the European Community Respiratory Health Survey were analysed for genetic variants in the IL1RA gene and the development of asthma, atopy and bronchial hyperreactivity. RESULTS: Carriers of the rare G allele of SNP rs447713 had a significantly increased risk of developing asthma (P = 0.0013) and allergic sensitization (P = 0.0119). Carriers of the rare C allele of SNP rs3087271 had an increased risk of asthma (P = 0.0227) and high immunoglobulin E (IgE) levels (P = 0.0232). A haplotype built from eight SNPs in the IL1RA gene (A-C-A-G-A-C-G-A) was associated with a higher prevalence of asthma (P = 0.007) and high total IgE (P = 0.02). Bronchial hyperreactivity was positively associated with the haplotype A-C-G-G-A-C-G-C (P = 0.02) and negatively with the A-C-G-G-A-C-T-C (P = 0.03). CONCLUSION: A previously described association between IL1RA and asthma in families could be reproduced in a population-based sample. The genetic variants of IL1RA gene do not to seem to affect asthma alone, but to act as modulators of asthma-related traits as well, where different haplotypes drive the development of different phenotypes.
Adult↗
GRIP deuterium excess reveals rapid and orbital-scale changes in Greenland moisture origin.
The Northern Hemisphere hydrological cycle is a key factor coupling ice sheets, ocean circulation, and polar amplification of climate change. Here we present a Northern Hemisphere deuterium excess profile covering one climatic cycle, constructed with the use of delta18O and deltaD Greenland Ice Core Project (GRIP) records. Past changes in Greenland source and site temperatures are quantified with precipitation seasonality taken into account. The imprint of obliquity is evidenced in the site-to-source temperature gradient at orbital scale. At the millennial time scale, GRIP source temperature changes reflect southward shifts of the geographical locations of moisture sources during cold events, and these rapid shifts are associated with large-scale changes in atmospheric circulation.
Journal Article↗
Dedifferentiated chondrosarcoma--a fatal disease.
BACKGROUND: We report on 13 patients with dedifferentiated chondrosarcomas. The mean age of the patients at diagnosis was 59.8 years. Nine patients were classified as stage IIB and four as stage III. METHODS: In 11/13 cases surgery was performed. Mostly, limb salvage with tumour resection and implantation of a megaprosthesis was done; three patients needed amputation or disarticulation. In one out of three patients with a pelvic tumour resection was followed by implantation of a pelvic replacement; the other two patients received tumour resection with autologous stabilisation of the pelvis. Surgical margins were wide in six patients, marginal in two and intralesional in three. Adjuvant chemotherapy was given to five patients. RESULTS: Recurrence was detected in 5/11 of the patients operated on: in two with wide, in one with marginal, and in two with intralesional resection. No recurrence was seen in 5/11 patients: in four after wide and in one after marginal resection. In one patient the stage was unknown. At follow-up 11 patients were dead of disease (DOD), one dead of unknown reason (DOU) and one alive with disease (AWD). The mean survival time was 9.7 months. Metastasis to different anatomical sites was evident after a period of 10 months. CONCLUSIONS: Our results resemble those reported in the literature. DDCS is rare and is the primary malignant bone tumour with the worst prognosis. Surgery is the most important procedure, although it is unclear whether a radical resection improves the long-term results. Information regarding neoadjuvant and/or adjuvant therapy with chemotherapy is very limited.
Adult↗
Holographic recording with reduced intermodulation noise in periodically poled lithium niobate.
We show that the use of periodically poled lithium niobate doped with Fe and Y ensures a considerable improvement in the quality of reconstructed images compared with the use of single-domain crystals. This improvement is due to inhibition of intermodulation noise and elimination of optical damage.
Journal Article↗
[DRG and OPS-301: effects on the acquisition performance in radiology].
Reimbursement for inpatient services rendered based on comparable daily care rates, case-based flat rates, and special fees as practiced until now has been replaced by the system of diagnosis-related groups. Up until 2004, operation and procedure system (OPS 301) codes could be processed completely automatically by appropriate adaptation of the radiology information system (RIS). Because of further differentiation of OPS codes in the 2005 version, it is no longer possible to unambiguously determine OPS codes automatically. Our goal was to fulfill these additional requirements with as little extra effort as possible. In 36 of 2138 procedures during an observation period of 12 days, i.e., 4/day, manual input on the part of the radiology technical assistant and quality assurance by the diagnosing physician were necessary. This is only needed in complicated procedures for which the minor added effort is negligible in comparison to the entire effort expended for the procedure. We were thus able to achieve the goal of near automation of ascertaining OPS codes.
Databases, Factual↗
[Garden I femoral neck fractures: conservative vs operative therapy].
INTRODUCTION: Treatment recommendations vary for Garden I fractures of the proximal femur. The aim of our retrospective study was to determine the results of functional treatment of these injuries. MATERIAL AND METHODS: A total of 54 consecutive patients were enrolled, and their data (age, comorbidities, treatment, complications, etc.) were ascertained and stored in a database. Initial treatment consisted in early mobilization and weight bearing in all patients. RESULTS: In 24 cases (44%) no complications at all were observed in the course of conservative treatment. In 28 cases (52%) surgical treatment was necessary due to early fracture dislocation. Analysis of the X-ray images showed that in 9 of these 28 cases the functional treatment had not been clearly indicated, i.e., incomplete impaction of the fragments. When these patients are excluded the success rate of conservative treatment was 53%, as two additional late complications occurred and were treated surgically (1x AVN, 1x nonunion). With reference to the survival rate, score, and patient satisfaction, there was no difference between conservative and operative treatment (p=0.478). The risk of a secondary dislocation increases with the number of risk factors (p=0.008). DISCUSSION: An attempt at functional treatment with close X-ray monitoring is appropriate in these fractures, since this makes it possible to avoid surgery in about half of the patients while achieving functional results comparable to those yielded by surgery.
Aged↗
[Cartilage tumors. Classification, conditions for biopsy and histologic characteristics].
Primary cartilage-forming tumors of the bone are a large group among the rare bone tumors. The clinical and radiographic findings of the different entities show similar findings. Bone biopsy is still the most relevant examination in the final diagnosis of the lesion. The requirements for a correct biopsy and the main features of the macroscopic and histologic findings of cartilage tumors are presented from the viewpoint of the pathologist. Differentiation between benign enchondroma and grade I chondrosarcoma requires close interdisciplinary cooperation to avoid over-treatment and relapse. Rare low-grade malignant cartilage tumors such as clear-cell chondrosarcoma need to be diagnosed in specialized centres to arrive at the correct therapy. The morphologic features of mesenchymal chondrosarcoma, clear-cell chondrosarcoma and secondary chondrosarcoma in osteochondroma are demonstrated. The aim is to correlate the morphologic and radiographic features. The same applies to benign entities such as osteochondroma, chondroblastoma and chondromyxoid fibroma.
Biopsy↗
Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions.
This article provides an overview of the histopathologically defined nonneoplastic and neoplastic entities involved in submucosal lesions (SMLs) of the gastrointestinal tract, particularly those in the upper gastrointestinal tract. The gross appearance and the histomorphological and cytomorphological features of the most frequent SMLs are described, including gastrointestinal stromal tumor (GIST), leiomyoma, lipoma, carcinoid, granular-cell tumor, glomus tumor, schwannoma, submucosal metastases, Brunner's gland hamartoma, pancreatic rests, and cysts. The current state of important technical aspects of biopsy processing and the role of histology and cytology in the diagnosis of SMLs are discussed.
Endoscopy, Digestive System↗
Solitary fibrous tumour of the liver: case report and review of the literature.
BACKGROUND: Solitary fibrous tumours (SFTs) of the liver are very rare entities. Although firstly described to be tumours of pleural origin, SFTs have been reported in various organs such as the meninges, orbit, upper respiratory tract, thyroid, peritoneum, retroperitoneum and soft tissues. Histologically, this tumour often shows alternating cellular and relatively acellular areas. The cellular areas show a wide variety of patterns, making it difficult for it to be differentiated from other mesenchymal tumours. Its immunohistochemical positivity for CD34 and vimentin is believed to be unique. Histiogenesis of SFTs, however, is not yet fully understood. They are known to be usually benign, with only few reports indicating their ability to metastasize. PATIENTS AND METHODS: We review the literature on SFTs of the liver and report on the case of a 63-year-old female patient with a large SFT of the right liver. CONCLUSIONS: Surgical resection seems to be the treatment of choice. Local recurrence is scarce. Due to the very limited number of cases, data regarding the long-term survival of patients are lacking.
Female↗
[Chemotherapy-induced changes in high grade central osteosarcomas-experiences gained through the assignment as reference-pathologists of the COSS-studies].
High-grade central osteosarcomas are the most frequent malignant bone neoplasms in childhood and adolescence. Their prognosis has been substantially improved using neoadjuvant chemotherapy. The morphological examination of surgical specimens reveals important information regarding the success of treatment. The histological determined degree of regression represents one of the most reliable therapy-related prognostical factor. Thus pathological analysis of the surgical specimens is of great importance notwithstanding the improved clinical and radiological diagnostic of osteosarcoma.
Adolescent↗
Responders benefit from neoadjuvant radiochemotherapy in esophageal squamous cell carcinoma: results of a prospective phase-II trial.
BACKGROUND: We present the results of a prospective phase-II-study of neoadjuvant combined radiochemotherapy followed by surgical resection in patients with histological proven locally advanced squamous cell carcinoma of the esophagus located at or above the level of the tracheal bifurcation. METHODOLOGY: Between February 1995 and March 2000 a total of 76 patients with esophageal squamous cell carcinoma (uT3/4N0/+-categories) received simultaneous combined neoadjuvant radiochemotherapy consisting of a continuous intravenous infusion of 5-fluorouracil (300 mg/m2/day) 7 day per week concurrently with conventional fractioned external beam radiation therapy (2 Gy/day), five fractions per week up to a total dose of 30 Gy. RESULTS: Radiochemotherapy related acute severe toxicity rate (CTC-grade-III) occurred in 34 patients, two patients died. Sixty-four patients underwent surgery with a complete resection in 48 patients. Three patients died during a 90-day post-operative course. The histopathological workup revealed no viable residual tumour cells in eight patients (ypCR) and according to the modified criteria of Mandard in 26 patients a histopathological response. Twenty-two of these patients underwent a R0-resection. The median follow-up time was 5.4 years with an overall median survival time of 20.6 months. The median survival in the 26 responders was 32.3 months versus 19.5 months in 38 non-responders (p=0.03). CONCLUSIONS: Patients with locally advanced squamous cell carcinoma of the esophagus, who respond to preoperative neoadjuvant combined radiochemotherapy, seem to have more benefit from subsequent resection than non-responding patients.
Adult↗
B-cell-specific transgene expression using a self-inactivating retroviral vector with human CD19 promoter and viral post-transcriptional regulatory element.
Retroviral gene transfer resulting in transgene expression selectively restricted to specific cell lineages would be desirable for many gene therapeutic applications. Such transcriptional targeting of retroviruses can be accomplished by employing eukaryotic control elements in self-inactivating (SIN) retroviral vectors, but use of these vectors is complicated by an accompanying reduction in viral titers. To overcome this restriction and address the influence of the post-transcriptional regulatory element of the Woodchuck hepatitis virus (WPRE) on viral titers and transgene expression, we developed SIN-vectors with and without WPRE. Using the enhancer-promoter of the Spleen Focus Forming virus (SFFV) to direct eGFP expression to multiple hematopoietic lineages, we show that WPRE significantly (>10 x) increased viral titers (>10(6) per ml of unconcentrated supernatant) and transgene expression in NIH3T3 cells in vitro. Gene expression in vivo was significantly lowered in lymphoid cells, but not in myeloid cells when WPRE was present. Furthermore, the use of WPRE in combination with the B-cell lineage-specific CD19 promoter significantly increased viral titers and allowed targeting of transgene expression by SIN-vectors specifically to B cells throughout their development in primary and secondary lymphoid organs.
Animals↗
Endoscopic measurement of Barrett's esophagus length is unreliable - a prospective comparative biopsy study.
BACKGROUND AND AIMS: Endoscopic assessment of the length and area of Barrett's esophagus (BE) has become crucial in assessing its spontaneous course as well as any effect of pharmacological or endoscopic treatment. Little, however, is known about the extent to which the endoscopic assessment of BE length and area correlates with the histopathological confirmation of BE epithelium. PATIENTS AND METHODS: 75 consecutive patients (mean age 60 years; 58 men, 17 women) were included in a prospective study on the basis of the endoscopic suspicion of BE. BE was endoscopically defined as gastric-type epithelium between the proximal cardiac folds and the Z line, on moderate air insufflation. Stepwise four-quadrant biopsies (4QB) were then taken, beginning at the proximal cardiac folds and then every 2 cm up to the Z line. RESULTS: Among the 75 study patients, BE was histologically verified in 57 cases (group 1) and not confirmed in any of the endoscopic biopsy samples in 18 cases (group 2). In group 1, the mean difference between the endoscopic and histological assessment of BE length was + 1 cm (range 0 - 5 cm); when determining the BE area histologically from 4QB the mean difference to the endoscopic determination was + 36 % (range 0 - 93 %). These differences were independent of the presence and degree of hiatal hernia or the presence of long or short BE. CONCLUSIONS: In the majority of patients, there is only a moderate correlation between the endoscopic and the histological extent of BE. However, we also found a substantial individual variability in endoscopic-histological correlation; therefore studies on the effects of treatment on BE must consider both the endoscopic and histopathological BE lengths.
Adult↗
The cell wall-modifying xyloglucan endotransglycosylase/hydrolase LeXTH1 is expressed during the defence reaction of tomato against the plant parasite Cuscuta reflexa.
A suppressive subtractive hybridization technique was used to identify genes, which were induced during the early phases of the interaction between dodder (Cuscuta reflexa), a phanerogamic parasite, and its incompatible host plant tomato. One of the identified genes encodes a tomato xyloglucan endotransglycosylase/hydrolase (XTH)--an enzyme involved in cell wall elongation and restructuring. The corresponding LeXTH1 mRNA accumulated 6 h after attachment of the parasite. In contrast, wounding did not influence the expression level. Subsequent to LeXTH1 mRNA accumulation, an increase in XTH activity at the infection sites as well as in adjacent tissues was observed. The effect of IAA on LeXTH1 expression was analyzed because the concentration of this phytohormone is known to increase in the tomato tissue during the interaction with the parasite. LeXTH1 mRNA accumulation was in fact induced by external application of auxin. However, in the auxin-insensitive tomato mutant diageotropica, Cuscuta induced LeXTH1-mRNA accumulated with a time course similar to wild type tomato. Thus, auxin appears not to be an essential signal for infection-induced LeXTH1 activation. Our data suggest a role for xyloglucan transglycosylation in defence reactions associated with the incompatible tomato- Cuscuta interaction.
Cell Wall↗