Biomedical subjects

Burkhardt Seifert

Publications and source records attributed to Burkhardt Seifert.

At least 37 records · Page 2Linked to original sources

PubMed2005

Patterns of changes in arterial PO2 during one-lung ventilation: a comparison between patients with severe pulmonary emphysema and patients with preserved lung function.

OBJECTIVES: One-lung ventilation (OLV) during thoracoscopic surgery is associated with a significant decline in arterial PO(2) in patients with severe pulmonary emphysema and patients with preserved lung function. The authors hypothesized that patterns of arterial PO(2) changes are different in these 2 patient groups. DESIGN: Prospective nonrandomized study. SETTING: University hospital. PARTICIPANTS: Twenty-five patients undergoing thoracoscopic interventions: 16 with severe pulmonary emphysema and 9 patients without emphysema. INTERVENTIONS: Continuous arterial blood gas measurement (PaO(2), PaCO(2), pHa) during OLV of the left lung in left lateral position using the Paratrend 7 blood gas monitoring system (PT7; Pfizer Hospital Products Group, High Wycombe, UK). MAIN RESULTS: The decrease of PaO(2) was delayed in patients with severe emphysema. Steady state (defined as DeltaPaO(2) <7.5 mmHg/min) was reached after 18 +/- 4 minutes compared with 11 +/- 3 minutes (mean +/- standard deviation) in patients with normal lung function (p = 0.0002). PaO(2) values at steady state were comparable (p = 0.49); the pattern of changes in PaO(2) for the first 15 minutes of left-sided OLV was significantly different between the groups (p = 0.0004). The difference of predicted versus measured PaO(2) at steady state was -48 +/- 160 mmHg for patients with emphysema and -51 +/- 60 mmHg for patients with normal lung function (p = 0.019). CONCLUSION: During OLV, oxygenation is better preserved for a longer period of time in patients with severe pulmonary emphysema as compared with patients with normal lung function. In contrast to patients without emphysema, prediction of oxygenation during OLV for the individual patient with emphysema is unreliable because of large interindividual differences.

Adolescent↗

PubMed2005

Patients with knee osteoarthritis have lower total hip bone mineral density in the symptomatic leg than in the contralateral hip.

Osteoarthritis (OA) of the knee is common in the aging population. In patients with OA, bone mineral density (BMD) is usually increased, but the fracture rate does not appear to be systematically lower than in age-matched healthy controls. The aim of our study was to describe hip BMD in patients presenting with unilateral symptomatic knee OA. Patients with painful knee OA were prospectively included in a single-center, randomized, double-blind, placebo-controlled clinical trial to evaluate the structure-modifying efficacy of an oral chondroitin sulfate treatment on the knee joint. The majority of these patients underwent additional measurements of BMD of their lumbar spine and both hips using dual-energy X-ray absorptiometry (DXA). The hip BMD values of the leg with symptomatic knee OA were compared with the contralateral hip. One-hundred and sixty-one patients (81 men and 80 women; aged 62.6 +/- 9.2 yr, range 40-82 yr) underwent DXA. The median total hip BMD was higher than in age-matched controls, but patients had a relatively lower hip BMD in the knee OA-affected leg (p = 0.001). Our knee OA patients rarely presented with concomitant osteoporosis, but usually had a relatively lower hip BMD on the affected leg. Therefore, we suggest that the hip of the leg with symptomatic knee OA should be measured if DXA is acquired only at one hip. Future studies have to assess whether the relative decrease of BMD at the hip of the leg with knee OA might influence fracture incidence.

Absorptiometry, Photon↗

PubMed2005

Acute psychological stress affects glucose concentrations in patients with type 1 diabetes following food intake but not in the fasting state.

OBJECTIVE: To compare the effect of acute psychosocial stress on glucose concentrations in the fasting state and following food intake in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: In study 1, 20 patients were exposed to moderate psychosocial stress by means of the Trier Social Stress Test (TSST) in the fasting state. In study 2, the TSST was applied to 20 additional patients 75 min after intake of a standard meal. Glucose concentrations (by continuous glucose monitoring system), blood pressure, and heart rate were monitored on the control day and on the stress testing day. RESULTS: In both studies, blood pressure increased in response to TSST from 122/77 +/- 14/9 mmHg at baseline to a maximum of 152/93 +/- 21/13 mmHg (P < 0.001), and heart rate increased from 80 +/- 11 to 99 +/- 19 bpm (P < 0.001). In the fasting state (study 1), glucose concentrations remained unchanged during the control day as well as during the stress testing day. In study 2, glucose concentrations were similar on both days before and up to 75 min after the intake of the standard meal. However, a significant delay (of 45 min) in the decrease of glucose concentrations was induced by psychological stress. A two-factor repeated-measures ANOVA revealed a significant difference of glucose concentrations over time (F = 646.65/P < 0.001). CONCLUSIONS: In the postprandial period, acute psychological stress induced a significantly delayed decrease of glucose concentrations, whereas in the fasting state, no effect on poststress glucose concentrations was observed.

Adult↗

PubMed2004

Cortical and trabecular bone density and structure in anorexia nervosa.

The aim of the study was to examine bone density and architecture with three different measurement methods in a sample of young women with anorexia nervosa (AN) and in an age-matched control group of women. Three-dimensional periphery quantitative computer tomography (3D-pQCT) at the ultradistal radius, a new technology providing measures of cortical and trabecular bone density and architecture, was performed, as well as quantitative ultrasound (QUS) at the heel, and dual energy X-ray absorptiometry (DXA) at the spine and hip. Thirty-six women with AN aged 18-30 years (mean duration of AN: 5.8 years) and 30 age-matched women were assessed. Bone mineral density measured by DXA at the spine and hip, and broadband ultrasound attenuation measured by QUS at the heel were significantly lower in patients than controls. 3D-pQCT demonstrated a highly significant deficit in the absolute number of bone trabecules and a significant reduction of cortical thickness. Severity of underweight was significantly associated with bone deficits at the hip measured by DXA. 3D-pQCT revealed mostly deficits of cortical bone related with age of onset of eating disorder. Using three different methods to measure bone density and bone structure at the hip, spine, heel and ultradistal radius, significant deficits in bone mineral density both in trabecular and cortical bone, as well in trabecular structure could be demonstrated in the AN patients.

Absorptiometry, Photon↗

PubMed2004

Islets secretory capacity determines glucose homoeostasis in the face of insulin resistance.

BACKGROUND: Debate surrounds the relative importance of impaired beta-cell secretory function versus insulin resistance in type 2 diabetes. We therefore defined insulin secretion and sensitivity in patients with impaired glucose homoeostasis of varying aetiology and duration. METHODS: 126 consecutive patients undergoing an oral glucose tolerance test (OGTT) between 1999 and 2003 were included. Whole-body insulin sensitivity index (ISI) and insulinogenic index derived from the OGTT were determined in 32 healthy controls, 65 type 2 diabetic patients, 15 patients with acromegaly, 10 patients with insulinoma, and 4 patients with HAIRAN syndrome. RESULTS: Median ISI (quartiles Q25-Q75) of healthy controls and of patients with insulinoma were similar (3.5 [2.8-5.6] and 3.2 [1.7-4.2] respectively) but significantly decreased in patients with acromegaly, type 2 diabetes, and HAIRAN syndrome (2.8 [1.8-3.3], 1.9 [1.4-3], and 0.8 [0.6-1.3] respectively). Despite the decrease in ISI, patients with HAIRAN syndrome and acromegaly maintained normal glucose tolerance by adapting insulin secretion as reflected in the insulinogenic index (106.5 [90.4-127.5] and 49 [24.4-89] in HAIRAN and acromegaly respectively, versus 46.9 [27.3-66.7] in controls). In contrast, type 2 diabetic patients failed to adapt and displayed severely hampered insulin secretion (insulinogenic index of 7.6 [3.8-14.7]). Furthermore, the level of the insulinogenic index correlated significantly with duration of diabetes and HbA1c, which was not the case for the ISI. Insulinoma patients had a decreased insulinogenic index (38.7 [32-83.8]), leading to impaired glucose tolerance despite normal ISI. CONCLUSIONS: The data are compatible with the notion that beta-cell function rather than insulin sensitivity determines the evolution of hyperglycaemia.

Acanthosis Nigricans↗

PubMed2004

Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging--do we need contrast-enhanced CT?

PURPOSE: To retrospectively compare diagnostic value of coregistered fluorine 18 fluorodeoxyglucose positron emission tomographic (PET) and computed tomographic (CT) scans obtained with low-dose nonenhanced CT (PET/CT) with those routinely obtained with contrast material-enhanced CT for staging and restaging of disease in patients with Hodgkin disease or high-grade non-Hodgkin lymphoma. MATERIALS AND METHODS: Sixty patients (mean age, 39.6 years +/- 17.1 [standard deviation]) with Hodgkin disease (n = 42) or high-grade non-Hodgkin lymphoma (n = 18) were included in this retrospective study. All patients underwent PET/CT and contrast-enhanced CT within a maximum of 24 days (mean, 9.1 days +/- 7.0) of each other for staging (n = 19) or first follow-up examination (n = 41). Findings were extracted from original written reports (PET/CT, contrast-enhanced CT) and compared with findings of reference standard, which included biopsy or follow-up with clinical, laboratory, or other imaging findings. For statistical analysis, sensitivity and specificity were calculated with findings of the reference standard. Agreement of both methods was determined with Cohen kappa and McNemar tests on a per-patient basis. RESULTS: For evaluation of lymph node involvement, sensitivity of PET/CT and contrast-enhanced CT was 94% and 88%, and specificity was 100% and 86%, respectively. For evaluation of organ involvement, sensitivity of PET/CT and contrast-enhanced CT was 88% and 50%, and specificity was 100% and 90%, respectively. Agreement of both methods was excellent (kappa = 0.84) for assignment of lymph node involvement but only fair (kappa = 0.50) for extranodal disease. A difference with P <.05 (McNemar test) was considered significant in regard to exclusion of disease with PET/CT, compared with contrast-enhanced CT. CONCLUSION: PET/CT performed with nonenhanced CT is more sensitive and specific than is contrast-enhanced CT for evaluation of lymph node and organ involvement, especially regarding exclusion of disease, in patients with Hodgkin disease and high-grade non-Hodgkin lymphoma.

Adolescent↗

PubMed2004

Coronary artery bypass grafts: ECG-gated multi-detector row CT angiography--influence of image reconstruction interval on graft visibility.

PURPOSE: To evaluate the influence of different reconstruction intervals of retrospectively electrocardiographically (ECG)-gated multi-detector row computed tomographic (CT) angiography on image quality of different segments of various types of coronary artery bypass grafts. MATERIALS AND METHODS: Twenty consecutive patients with 62 grafts underwent retrospectively ECG-gated four-channel multi-detector row CT angiography and conventional coronary angiography. Raw helical CT data were reconstructed at 0%-90% of the cardiac cycle in increments of 10%. Each graft was separated into three segments (proximal segment, graft body, and distal anastomosis). Three graft types were identified according to site of distal anastomosis. Two readers assessed image quality of segments and graft types. Effective radiation dose was calculated. RESULTS: Best image quality of all segments was obtained at a reconstruction interval of 50%-70% of the cardiac cycle. Image quality of the proximal segment did not vary significantly with different reconstruction intervals (analysis of variance, P =.8), whereas image quality of the graft body and distal anastomosis changed significantly with varying reconstruction intervals (P <.001). Distal anastomosis and body of types 1 and 2 grafts were best seen at 60%-70% of the cardiac cycle, whereas distal anastomosis and body of type 3 grafts were best visualized at 50%. Accuracy of CT angiography for detection of graft patency was 94% for reader 1 and 95% for reader 2. Effective dose for CT was 11.4 mSv for both men and women. Mean effective dose for angiography was 2.1 mSv for men and women. CONCLUSION: Optimal selection of reconstruction interval improves image quality of the graft body and of distal anastomosis in particular.

Aged↗

PubMed2004

Renal dimensions measured by ultrasonography in children: variations as a function of the imaging plane and patient position.

The purpose of this study was to determine the effect of patient positioning on sonographic renal measurements and to test if the patient position alters the three-dimensional shape of the kidneys. The maximum longitudinal renal length and transverse renal width and depth were measured in the supine and prone position in 100 children (200 kidneys). Age ranged from 6 months to 16 years (mean age 5 years). The results were compared for statistically significant differences. The maximum measured longitudinal renal length was statistically significantly larger in the supine than in the prone position (supine position, left: 8.0 cm; right: 7.7 cm; prone position, left: 7.9 cm, right: 7.6 cm; P<0.001). There was no statistically significant change in the transverse diameters (width and depth, P>0.001) and renal volume ( P>0.001) in the supine vs. prone positions. Our results show that position-induced reshaping of the kidneys is unlikely to be responsible for the discrepancy in maximum longitudinal renal measurements comparing supine with prone positions. Position-dependent changes in the degree of filling of the renal calyces and pelvis as well as errors in caliper distance measurements for the different scan depths (supine vs. prone) are more likely to be responsible for the encountered differences. Consequently, we recommend to add prone renal length measurements in addition to the supine measurements. In follow-up examinations, renal length measurements should only be compared that have been collected in the same patient position.

Adolescent↗

PubMed2004

MR assessment of fetal lung development using lung volumes and signal intensities.

The purpose of this study was to evaluate the monitoring and diagnostic potential of MRI in fetal lung development and disease using lung volume and signal intensity changes through gestation. Thirty-five healthy fetuses (22-42 weeks) were examined on a 1.5- T MR system using sagittal T2w single-shot fast spin-echo imaging (TR indefinite, TE 90 ms, slice thickness/gap 3-5/0 mm, FOV 26-40 cm, NEX 0.5). Fetal body and lung were segmented manually and volumes calculated. Signal intensities (SI) of fetal lung and three reference values were measured on the section best displaying the lung. Regions of interests were defined by including the maximal organ area possible. The following SI ratios were generated: lung/liver, lung/amniotic fluid, lung/muscle, liver/fluid and liver/muscle. Volumes and ratios were correlated with gestational age. Data from seven fetuses with pulmonary pathology were compared with these normative values. Absolute lung volume varied from 12.3 to 143.5 cm(3) in correlation with gestational age ( P<0.001); lung volume relative to total body volume ranged from 1.6 to 5.0%, decreasing with gestational age ( P=0.001). All SI ratios measured were unrelated to gestational age. Diagnoses in the seven abnormal fetuses were hydrothorax ( n=2), congenital cystic adenomatoid malformation ( n=2), diaphragmatic hernia ( n=2) and pulmonary sequestration ( n=1); their absolute and relative lung volumes were below normal ( P<0.001). The SI ratios did not differ significantly from those in the normal population. Normative MR fetal lung volumes may have important clinical applications in confirming and quantifying intrauterine pulmonary hypoplasia and in complementing ultrasound in the planning of fetal and post-natal surgery. No clinical relevance was found for fetal lung SI values.

Fetal Organ Maturity↗

PubMed2004

The cartilage-sparing versus the cartilage-cutting technique: a retrospective quality control comparison of the Francesconi and Converse otoplasties.

From a total of 281 patients with protruding ears who underwent a bilateral otoplasty between 1990 and 2001, a group of 28 (10%) was selected for a retrospective quality control study. The goal was to compare two methods of otoplasty, the Francesconi, a cartilage-sparing technique, and the Converse, a cartilage-cutting technique, in terms of objectively measurable and subjectively discernable differences in results. Objective parameters included measurement of the three cephaloauricular distances and the conchoscapal angle. An independent plastic surgeon performed the evaluation by means of a systematic evaluation system for rating cosmetic surgical procedures and a 5-point visual analog scale for rating satisfaction. The patients' subjective rate of satisfaction also was investigated using the 5-point scale. The mean medial and inferior cephaloauricular distances were significantly smaller in the Francesconi group. The concoscaphal angle was 90 degrees, or less in all the patients of the Francesconi group, but more than 90 degrees in eight patients (57%) of the Converse group (p = 0.041). Accordingly, the independent surgeon found adequate correction of protrusion in 86% of the Francesconi group and 50% of the Converse group (p = 0.050). His satisfaction rate was significantly in favor of the Francesconi technique (p = 0.006). Not unexpectedly, the patients' satisfaction rate was comparably high in both groups, and there was no statistical difference between them. In conclusion, the quality control led to a clear preference of the Francesconi over the Converse otoplasty. In addition, the assessment of the postoperative results with the systematic evaluation system offered an excellent information base by which to judge the results of otoplasty. Consequent use of this evaluation system will lead to progress in the surgical procedure.

Adolescent↗

PubMed2004

Non-surgical risk factors for condylar resorption after orthognathic surgery.

BACKGROUND: Condylar resorption following orthognathic surgery is an important cause of late skeletal relapse. However, its pathogenesis is not well understood. The purpose of this study was to find non-surgical risk factors for condylar resorption after orthognathic surgery. PATIENTS: In this retrospective study, 17 patients (Group I) who developed postoperative condylar resorption were selected. These patients were compared with 22 patients (Group II) without postoperative condylar resorption, but who showed mandibular hypoplasia with a preoperative high mandibular plane angle of more than 40 degrees. METHODS: Possible non-surgical risk factors were sought by analysing clinical and radiological data collected preoperatively and immediately, 6 weeks, and 1 and 2 years postoperatively. RESULTS: There was no significant difference of gender distribution between the two groups. Patients in Group I were significantly younger (p=0.02) than those in Group II. The incidence of temporomandibular joint dysfunction in both groups was similar preoperatively, but was significantly higher (p=0.001) postoperatively in Group I. The posterior inclination of the condylar neck in Group I was also significantly greater (p<0.001). The preoperative mandibular plane angle in Group I (mean value: 49.4 degrees ) was significantly greater (p=0.005) than in Group II (mean value: 44.9 degrees ). The preoperative SNB angle, overbite, and posterior facial height and ratio (posterior/anterior facial heights) in Group I were significantly smaller (p<0.05). CONCLUSION: The present study suggests that the posteriorly inclined condylar neck should be considered as a relevant non-surgical risk factor.

Adolescent↗

PubMed2004

Ventricular mapping during atrial and right ventricular pacing: relation of electrogram parameters to ventricular tachycardia reentry circuits after myocardial infarction.

INTRODUCTION: Ventricular tachycardia (VT) late after myocardial infarction is usually due to reentry in the border zone of the infarct area. Identification of critical parts of the VT reentry circuit by catheter mapping without needing to induce VT is a desirable goal for VT ablation. The aim of this study was to develop a model to predict reentry circuit locations based on characteristics of sinus or paced electrograms and pace mapping (PM) recorded from the infarct region. METHODS: Left ventricular electroanatomic mapping with the CARTO mapping system was performed in 16 male patients with recurrent VT late after myocardial infarction. A total of 1072 left ventricular sites were recorded during atrial pacing (AP) and right ventricular pacing (RVP), and the corresponding electrograms were analyzed for their local activation time (LAT), onset (ONS), end (END), duration (DUR), and amplitude (AMP) in each pacing sequence. At 1041 of these sites, PM was performed; the resulting stimulus to QRS intervals (S-QRS) was determined at 931 sites, the remaining 110 sites did not capture. All the obtained parameters were compared with the location of 18 ablation target areas with a radius of 2 cm defined by success of radiofrequency (RF) ablation or entrainment during VT, or both. RESULTS: Of 1072 sites, 227 (21%) were in the target and 845 (79%) were outside the target. All parameters were significantly different (p < 0.05) in AP and in RVP between inside and outside the target in a univariate analysis. In a multivariate analysis LAT, END, DUR, and AMP in AP, END and AMP in RVP, and S-QRS were independent predictors for the target (p < 0.05). A combination of selected parameters of these predictors (DUR in AP, AMP in RVP, and S-QRS) had a specificity of 64% with a sensitivity of 80% for the target. CONCLUSION: The observations suggest that ablation guided by a combination of abnormal electrograms in different rhythms can be useful to ablate VT and reduce the necessity of VT induction. Anatomically fixed regions of block may be important for reentry and be identifiable during sinus rhythm.

Aged↗

PubMed2004

Functional, electrophysiologic, and morphometric evaluation of nerve regeneration from coaptation on regenerated nerve fibers: experimental study in rabbits.

The importance of a sufficient number of nerve fibers at a proximal coaptation site is indisputable for the successful repair of nerves; however, the quality of nerve fibers required at this site has yet to be defined. The present study deals with the question of whether it is necessary to trim nerves back to unaffected neuronal tissue or whether the coaptation on recently regenerated nerve fibers, commonly believed to produce a poor quality of repair can, in fact, produce adequate nerve regeneration. Twenty New Zealand White rabbits received a standardized crush lesion on the peroneal nerves of both hind legs. Four weeks later, the nerves of the left hind legs (n = 20) were transected 10 mm distal to the previous crush lesion and coapted to the freshly regenerated nerve fibers. For comparison, on 10 right hind legs, the nerves were transected at the site of previous crushing (Group A, superimposition) or 10 mm proximal to the site of crushing on unscathed nerve fibers (Group B). Eleven weeks later, the quality of nerve regeneration was assessed by the toe-spreading reflex, electrophysiologic data, muscle weight, and histomorphologic evaluation. In the animals of Group A, the quality of nerve regeneration following coaptation on the regrown axons did not differ in any of the examined parameters from the quality of nerve fibers outgrown from the site of the superimposed lesion. Both lesions led to a completely functional reinnervation. Also in Group B, nerve action potential recording and histologic data on both sides did not reveal a significant difference between the number and maturation of nerve fibers equidistant from the suture site, shortly before muscle entrance. With this coaptation model, it could be demonstrated in the peroneal nerve of rabbits, that coaptation to recently regenerated nerve fibers leads to a significant functional regeneration.

Anastomosis, Surgical↗

PubMed2004

Surgical treatment of infective mitral valve endocarditis.

BACKGROUND AND AIM OF THE STUDY: The approach to mitral valve endocarditis is a surgical challenge, and the optimal procedure remains a matter of debate. In this condition, mitral valve repair appears feasible, but its long-term effects--as opposed to more often practiced valve replacement--have not yet been determined. Herein, the authors' experience of surgical treatment of infective mitral valve endocarditis is presented, with reference to surgical replacement or reconstruction. METHODS: A retrospective analysis was performed of all patients with infective native mitral valve endocarditis treated surgically at the University Hospital Zurich and the City Hospital Triemli Zurich between 1980 and 1996. Of 154 patients, 97 (63%) underwent mitral valve replacement, and 57 (37%) mitral valve reconstruction. RESULTS: The 30-day mortality was 3.2% (5/154); 4% (4/97) after replacement and 1.7% (1/57) after reconstruction (p = 0.67). Survival (Kaplan-Meier) was 93%, 81% and 61% after one, five and 10 years, respectively. There was no significant difference between valve replacement and reconstruction in terms of long-term survival (p = 0.15), but there was a trend towards better survival after reconstruction than replacement if only cardiac deaths were considered (p = 0.1). At follow up, reconstruction patients were significantly less frequently symptomatic (NYHA class III/IV) than replacement patients (0% versus 29%; p = 0.002), had a lower incidence of atrial fibrillation and need for pacemaker implantation (29% versus 47%; p = 0.04), and tended to have less dyspnea in daily life (20% versus 38%; p = 0.07). Reoperation in patients surviving more than 30 days was more common in replacement than in reconstruction patients. CONCLUSION: The present data suggest a trend for better clinical outcome after mitral valve reconstruction than after replacement when treating mitral valve endocarditis. These results encourage mitral valve reconstruction in mitral valve endocarditis, but recommendations to clinicians undertaking surgery on mitral valve endocarditis must be made with caution.

Adolescent↗

PubMed2003

Clinical evaluation of a breathing protocol for PET/CT.

The aim of this study was to assess the frequency and severity of respiration-induced curvilinear respiration artifacts (RICA) on co-registered positron emission tomography/computed tomography (PET/CT) images acquired on a combined PET/CT scanner before and after modifying the respiration protocol for CT scanning, with retrospective analysis of two groups of 100 patients each, before and after implementing a respiration protocol with breath-hold (BH) in the normal expiration position for the acquisition of the CT images. The CT data were used as attenuation map and for image co-registration. A ranking of co-registered PET/CT and PET images (including maximum intensity projection) was done by two observers in consensus using a scale from 0 to 3. Zero indicated that no RICA was visible and 1, 2, and 3 described artifact with increasing severity. A significant difference in RICA occurrence was found between the two groups ( p<0.0001). There was a 45% decrease of artifact frequency when using the normal expiration protocol and a 68% decrease of grade-2 and grade-3 artifacts ( p=0.004). The results of this study suggest that BH during the normal expiration position for CT scanning can be recommended to reduce the occurrence and the severity of RICA on PET/CT.

Adolescent↗

PubMed2003

Superficial radiotherapy for patients with basal cell carcinoma: recurrence rates, histologic subtypes, and expression of p53 and Bcl-2.

BACKGROUND: The histologic subtype of a basal cell carcinoma (BCC) may be an important factor for the success of a certain treatment modality. In the current article, the authors report recurrence rates among patients with BCC after superficial radiotherapy as well as Bcl-2 and p53 expression levels stratified by BCC subtype. METHODS: The authors performed a retrospective study of 175 BCCs in 148 patients (64 female patients and 84 male patients; mean age, 69 years) who were treated with radiotherapy. According to their histologic patterns, BCCs were classified as nodular (n = 103), superficial (n = 25), and sclerosing (n = 47). In addition, six patients with metatypic BCC were reviewed. Bcl-2 and p53 protein expression was examined on a tissue microarray of 60 BCC samples (18 nodular tumors, 12 superficial tumors, and 30 sclerosing tumors). RESULTS: The estimated 5-year recurrence rate for all patients with BCC was 15.8%: 8.2% for patients with the nodular subtype, 26.1% for patients with the superficial subtype, and 27.7% for patients with the sclerosing subtype (Kaplan-Meier analysis: P = 0.055). The median follow-up was 48 months. The mean time to recurrence was 20 months, and 86.4% of all recurrences occurred within 3 years after treatment. No gender-specific differences were observed. In addition, one of six metatypic BCCs recurred. Nuclear p53 immunoreactivity and low Bcl-2 expression were significantly correlated with the sclerosing subtype. Overall, 61.5% of patients developed additional neoplasms during follow-up (76 developed additional BCCs, 15 developed squamous cell carcinomas, and 6 developed Bowen disease). CONCLUSIONS: The sclerosing subtype of BCC was a risk factor for recurrence after radiotherapy. In contrast, excellent results were achieved for patients with predominant nodular subtype. Nevertheless, radiotherapy may be the therapy of choice for patients with all BCC subtypes, depending on the individual patient's characteristics. Expression analyses confirmed that p53 and Bcl-2 levels may be used as indicators for the aggressiveness of a BCC subtype. Due to the high incidence of additional skin malignancies, patients with BCC need careful follow-up.

Adult↗

PubMed2003

Thin-section CT of the lung: does electrocardiographic triggering influence diagnosis?

PURPOSE: To determine the impact of prospective electrocardiographic (ECG) triggering on image quality and diagnostic outcome of thin-section computed tomography (CT) of the lung. MATERIALS AND METHODS: Forty-five consecutive patients referred for thin-section CT of the lung were examined with prospectively ECG-triggered and nontriggered thin-section CT of the lung with a multi-detector row helical CT scanner. Subjective image quality criteria (image noise, motion artifacts, and diagnostic accessibility) were rated by three radiologists in consensus for the upper lobe, middle lobe and/or lingula, and lower lobe. Pathologic changes were assessed for the various lobes, and a diagnosis was assigned. The diagnoses were compared by two radiologists in consensus to determine the effects of CT technique on diagnostic outcome. Quantitative measurements were performed, including determination of image noise and signal-to-noise ratios in different anatomic regions. The Wilcoxon signed rank test and paired sign test (both with Bonferroni correction) were used for statistical analysis. RESULTS: Subjective assessment showed significant differences in motion artifact reduction in the middle lobe, lingula, and left lower lobe. The diagnostic assessibility of triggered CT was rated significantly higher only for the left lower lobe compared with nontriggered data acquisition. No differences in diagnostic outcome were determined between triggered and nontriggered techniques. Mean image noise in tracheal air was 68.2 +/- 17 (SD) for triggered CT versus 37.4 +/- 9 for nontriggered CT (P <.05). Mean signal-to-noise ratio in the upper versus lower lobes was 22.5 +/- 8 versus 25.4 +/- 10 for triggered and 35.6 +/- 9 versus 39.2 +/- 10 for nontriggered techniques (P <.05). CONCLUSION: Given the lack of improvement in diagnostic accuracy and the need for additional resources, ECG-triggered thin-section CT of the lung is not recommended for routine clinical practice.

Adult↗

PubMed2003

Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography.

BACKGROUND: We compared the diagnostic accuracy of integrated positron-emission tomography (PET) and computed tomography (CT) with that of CT alone, that of PET alone, and that of conventional visual correlation of PET and CT in determining the stage of disease in non-small-cell lung cancer. METHODS: In a prospective study, integrated PET-CT was performed in 50 patients with proven or suspected non-small-cell lung cancer. CT and PET alone, visually correlated PET and CT, and integrated PET-CT were evaluated separately, and a tumor-node-metastasis (TNM) stage was assigned on the basis of image analysis. Nodal stations were identified according to the mapping system of the American Thoracic Society. The standard of reference was histopathological assessment of tumor stage and node stage. Extrathoracic metastases were confirmed histopathologically or by at least one other imaging method. A paired sign test was used to compare integrated PET-CT with the other imaging methods. RESULTS: Integrated PET-CT provided additional information in 20 of 49 patients (41 percent), beyond that provided by conventional visual correlation of PET and CT. Integrated PET-CT had better diagnostic accuracy than the other imaging methods. Tumor staging was significantly more accurate with integrated PET-CT than with CT alone (P=0.001), PET alone (P<0.001), or visual correlation of PET and CT (P=0.013); node staging was also significantly more accurate with integrated PET-CT than with PET alone (P=0.013). In metastasis staging, integrated PET-CT increased the diagnostic certainty in two of eight patients. CONCLUSIONS: Integrated PET-CT improves the diagnostic accuracy of the staging of non-small-cell lung cancer.

Aged↗