The purpose of this preliminary study was to evaluate whether laser-induced interstitial thermotherapy (LITT) may be used for palliative treatment of localized hepatocellular carcinomas (HCC). We applied LITT to two patients suffering from unresectable localized hepatocellular carcinomas of different sizes (2.5 and 4 cm). LITT was performed with an Nd:YAG laser (1,064 nm) at 5 W laser power (15-20 minutes). Thermometry during LITT was performed by MRI using a temperature-sensitive T1-weighted fast low-angle shot (FLASH) sequence. Follow-up for local tumor control was performed by MRI and ultrasound. LITT was well tolerated and no adverse events occurred during or after LITT; no secondary liver lesions were seen in the follow-up (11 or 12 months, respectively). Only minimal tumor growth was observed in the larger HCC (from 4 to 5 cm), whereas the smaller HCC remained unchanged in size during 11 months of follow-up. We conclude that LITT might be an effective minimally invasive palliative treatment option for patients with small unresectable HCC.

Aged↗

PubMedDate not supplied

Diagnosis of spinal arteriovenous malformations by MRI at 1.0 T.

Eight patients were examined by magnetic resonance imaging (MRI) at 1.0 T; seven had an angiographically proved spinal intradural arteriovenous malformation and one had a hemangioblastoma of the spinal cord. Myelography was also performed in five and computed tomography (CT) in four patients. The clinical and radiological findings are presented. MRI revealed the location and extent of the lesion. Myelomalacia, edema, and hematomyelia were demonstrated in three patients. In our opinion MRI is the method of choice for the diagnosis of spinal arteriovenous malformation and facilitates spinal angiography, whereas myelography and CT do not provide any further information.

Adolescent↗

PubMedDate not supplied

A new technical method of ventriculoatrial shunt implantation.

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Cerebrospinal Fluid Shunts↗

PubMedDate not supplied

Survival of glioma patients after complementary treatment with galactoside-specific lectin from mistletoe.

Malignant glioma patients were prospectively enrolled into a clinical trial. All the patients were provided with the internationally recommended oncologic standard treatment (neurosurgery, radiation, basic clinical care according to protocol and indication) and randomly divided into a treatment group (receiving complementary immunotherapy with a galactoside-specific lectin from mistletoe, ML-1) and a control group (without additional complementary treatment). Whereas the beneficial effects of ML-1 treatment on immunological rescue and quality of life have been recently shown, evaluation of relapse free/overall survival was performed after a 50 months follow up time. Non-stratified analysis of all the patients revealed non-relevant prolongation of relapse-free intervals/overall survival time for the treatment group. However, analysis of stratified stage III/IV glioma patients demonstrated: 1. a tendency for a prolongation of relapse-free survival for patients of the treatment group (17.43 +/- 8.2 months) vs. the control group (10.45 +/- 3.9 months) 2. a statistically significant (BRESLOW p = 0.035) prolongation of the overall survival for the treatment group (20.05 +/- 3.5 months) as compared to the control group (9.90 +/- 2.1 months). These promising data warrant confirmation in a GCP-based prospectively randomized (multicenter) study, which is currently under consideration.

Adjuvants, Immunologic↗

PubMedDate not supplied

Gallbladder bile tumor marker quantification for detection of pancreato-biliary malignancies.

BACKGROUND: The pre-operative differentiation of tumors of the pancreas, Papilla of Vater and the biliary tract is still unsatisfactory. Tumor marker analysis of the pancreatic juice did not improve the pre-operative diagnosis by a great deal. METHODS: Bile from resected gallbladders of patients suffering from carcinomas of the pancreato-biliary system was analysed for CA 19-9, CEA, CA 72-4, CA 125 and AFP concentrations. The results were compared to patients suffering from acute cholecystitis, cholecystolithiasis as well as those suffering from benign tumors of the pancreato-biliary region. RESULTS: Extreme high CA 19-9 concentrations were found in bile. Evaluations of the tumor-antigens CA 19-9, CA 72-4 and CEA in gallbladder bile were superior to any serum and pancreatic juice examination with respect to sensitivity and specificity. Observed sensitivities amounted to 100% for patients suffering from bile duct carcinoma (CA 19-9) and papillary carcinoma (CEA) at a specificity of 100%. CA 19-9 showed a sensitivity of 76.5% for pancreatic carcinomas at a specificity of 96.4%. CA 19-9 showed significant differences for the local tumor burden and for the degree of lymph node metastasis. Examination of tumor antigens in the gallbladder results in a high degree of discrimination for malignant and benign lesions of the subhepatic pancreato-biliary system. CONCLUSIONS: CA 19-9 must follow a entero-hepatic circulation, since it showed raised bile concentrations (factor: 10(4)) compared to serum analysis. Analysis of CA 19-9, CEA and CA 72-4 gives an opportunity for improvement in the detection of cancers of the pancreato-biliary system. Since the clinical important differentiation of tumors of the head of the pancreas (carcinoma vs. pancreatitis) remains unclear, an improvement by bile analyses must be assumed.

Antigens, Tumor-Associated, Carbohydrate↗

PubMedDate not supplied

Detection of collagenase-activity in RA synovial fluids using soluble 14C-labelled collagen.

14 RA synovial fluids and 7 non-RA synovial fluids were investigated as to their collagenase-activity using 14C-labelled type I human collagen in soluble form. Breakdown products were fractionated by gel filtration on Sephadex G 200 superfine. Cleavage of native and denatured labelled collagen was compared. 11 RA synovial fluids showed significant collagenase activity as manifested by degradation of native collagen, while only one synovial fluid of the control group displayed a significant collagenolytic activity. Results were compared with cleavage of reconstituted collagen fibrils. Influence of EDTA and KSCN on collagen degradation was also studied: EDTA completely blocked degradation of native or denatured collagen, while KSCN caused an increase of collagenolytic activity in two cases.

Arthritis, Rheumatoid↗

PubMedDate not supplied

Collagenase-induced experimental arthritis.

Rabbits were injected intraarticularly three times with 0.5 ml of 10, 50 or 100 mg% purified rheumatoid synovial collagenase or with identical amounts of trypsin. 18 hours after the last injection the collagenase-injected animals showed distinct cellular exudation into the synovial fluid and acute arthritis; one week later there was a decrease of the cell count in the synovial fluid and appearance of proliferative synovitis, while 3 weeks later there was no exudation and less chronic inflammation but distinct fibrosis of the synovium. A direct action of collagenase on the connective tissue components would seem to be responsible for these changes. No pathologic alteration of the cartilage was observed. Trypsin-injected control animals showed negligible cellular exudation and no pathologic alteration of the synovium.

Animals↗

PubMedDate not supplied

The 'incidentaloma' of the pituitary gland. Is neurosurgery required?

We describe a series of 18 patients with an intrasellar mass incidentally discovered by computed tomography or magnetic resonance imaging. The average size of the mass was 13 mm, with a range from 5 to 25 mm. Initial ophthalmologic examination revealed bitemporal hemianopia in 2 patients. Results of routine endocrine testing showed partial hypopituitarism in 5 patients and growth hormone hypersecretion without signs and symptoms of acromegaly in 1 patient. Four patients underwent neurosurgery. Histologically, one chondroid chordoma and three pituitary adenomas were found. In the remaining 14 patients treated conservatively, repeated computed tomography and magnetic resonance imaging revealed no significant change in tumor size at the time of follow-up (median, 22 months). Our results suggest that the "incidentaloma" of the pituitary gland is a benign condition that does not necessarily require neurosurgical intervention.

Adenoma↗

PubMedDate not supplied

[IgA rheumatoid factors in ankylosing spondylitis].

151 cases of ankylosing spondylitis, arranged in clinical stages I-IV, were investigated by immunological methods (determination of HLA-B27, immunocomplexes: conglutinin-, Clq-assay; IgG-, IgM-, IgA-rheumatoid factors) and with regard to acute phase proteins (CRP, C3/C4, alpha 1-acid glycoprotein). IgA-rheumatoid factors were demonstrated as dependent upon the stage of the disease in 23-41% of cases and appeared in 20-23% of cases simultaneously with immunocomplexes. Immunocomplexes appeared in 20-23% of cases. With regard to investigations of acute phase proteins, sedimentation rate and CRP correlated best. The frequent appearance of IgA-rheumatoid factors allows a definition of ankylosing spondylitis as seronegative only as far as the determination of IgG- and IgM- rheumatoid factors is concerned.

Acute-Phase Proteins↗

PubMedDate not supplied

[Enzyme therapy in comparison with immune complex determinations in chronic polyarthritis].

42 patients with definite or classic rheumatoid arthritis were treated with an enzyme mixture (Wobenzym) for 6 weeks. Circulating immune complexes were investigated with a Clq-solid phase RIA in weekly intervals and also rheumatoid factors were determined together with other routine laboratory tests. The condition of patients after therapy was recorded together with amount of circulating immune complexes during treatment. 26 (61.9%) patients improved, 13 (30.9%) patients remained unchanged, and 3 (17.1%) showed impairment. No side effects were observed. Patients who primarily showed no immune complexes or patients who had immune complexes which became negative during enzyme therapy, showed improvement more often than patients which had immune complexes and remained positive during the entire course of therapy.

Adult↗

PubMedDate not supplied

[Antigen induced experimental arthritis as a testing method for anti-inflammatory effects of orally administered substances].

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Amylases↗

PubMedDate not supplied

Demonstration of C1q - binding to collagen - anticollagen immune complexes in synovial fluids of RA-patients.

Collagen-anticollagen immune complexes were demonstrated indirectly in RA synovial fluids by digestion with collagenase and subsequent antibody determination. Elimination of C1q was performed by affinity chromatography using an anti-C1q column. Binding of C1q to collagen-anticollagen complexes was proven by demonstrating that collagenase-caused liberation of collagen antibodies was abolished or distinctly reduced after passage through the anti-C1q column. Binding of C1q to collagen-anticollagen immune complexes was proven via the fixation of these aggregates onto the anti-C1q column. This was achieved in those 7 RA synovial fluids which contained distinctly demonstrable collagen-anticollagen complexes.

Antibodies↗

PubMedDate not supplied

Immunogenicity of human insulin (Novo) or pork monocomponent insulin in HLA-DR-typed insulin-dependent diabetic individuals.

The immunogenicity of human insulin (Novo, Monotard, Actrapid) or pork monocomponent (MC) insulin (Monotard, Actrapid) was studied in 102 HLA-DR-typed patients with newly diagnosed insulin-dependent diabetes mellitus (type I diabetes). After 6 mo of treatment, IgG-insulin antibodies were found in only 14% of the patients receiving homologous MC insulins, but in 29% of the patients on heterologous MC insulins. IgG-insulin antibody titers were significantly lower in patients treated with human insulin compared with diabetic patients who received the corresponding pork MC insulin preparations from the onset of their disease. The previously reported strong influence of immunogenetic factors in determining the magnitude of the anti-insulin immune response was supported by the findings obtained in the pork MC insulin-treated diabetic individuals. Incidence of circulating immune complexes was 14% and 5% after 3 and 6 mo, respectively, of treatment with human insulin, which is considerably lower than previously reported in patients using heterologous non-monocomponent insulin preparations.

Adolescent↗