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  • 1995-1999  (203)
  • 1985-1989
  • 1960-1964
  • 1999  (203)
  • breast cancer  (126)
  • CT  (77)
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  • 1995-1999  (203)
  • 1985-1989
  • 1960-1964
Year
  • 1
    ISSN: 1436-2813
    Keywords: Key Words: chemoendocrine therapy ; pure antiestrogen ; 5-fluorouracil ; nude mouse ; breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1436-2813
    Keywords: chemoendocrine therapy ; pure antiestrogen ; 5-fluorouracil ; nude mouse ; breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The antitumor effects of an experimental chemoendocrine therapy combining a new pure antiestrogen ICI 182780 and 5-fluorouracil (5-FU) were studied on MCF-7 human breast cancer cells implanted in nude mice. ICI 182780 had a dose-dependent antitumor activity, which was potentiated by the concomitant use of 5-FU. When compared with the control group, the estrogen receptor (ER) level in the ICI 182780 group was lower and that in the combination group was markedly lower. Cell cycle analysis by flow cytometry (FCM) resulted in a lower percentage of S-phase cells (%S) in the treated mice. No significant difference was observed in the 5-FU concentrations in tumor cells, while the 5-FU content in RNA was significantly higher in the combination group. The changes in free thymidylate synthetase (TS) concentration indicated TS synthesis after the administration of 5-FU to be more greatly suppressed in the combination group than in the 5-FU group. These results suggest that ICI 182780 and 5-FU exert their combination effect mainly on ER-positive cells, and that the suppression of TS synthesis in tumor cells and the potentiation of the 5-FU-induced metabolic dysfunction of RNA are thus involved in the mode of action of this combination therapy.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1569-8041
    Keywords: breast cancer ; old age ; vinorelbine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Older patients with advanced breast cancer are less likely to receive chemotherapy than younger patients. Vinorelbine is an attractive alternative in this setting because of its clinical activity and low frequency of side effects. This multicenter, phase II trial was designed to assess the safety and efficacy of intravenous vinorelbine as first-line therapy in women ≥60 years old. Patients and methods: Fifty-six women (median age, 72 years; range 60–84 years), with measurable advanced breast cancer and no prior chemotherapy for metastatic disease, were enrolled and included in the analysis. Vinorelbine 30 mg/m2 was administered weekly for 13 weeks and then every two weeks until development of progressive disease; doses were reduced or delayed to manage toxicity. Results: The objective response rate was 38% (95% confidence interval (95% CI): 24%–51%); median duration of response, nine months; median time to disease progression in all patients, six months. The major dose-limiting toxicity was hematologic, which led to a median dose intensity of 20.6 mg/m2/week. Grade 3–4 nonhematologic toxicity consisted of asthenia (7%); nausea and generalized pain (5%); vomiting, chest pain, abdominal pain, and elevated AST (4%); fever, diarrhea, constipation, and injection site reaction (2%). Neurotoxicity and alopecia were grade 1–2 and relatively infrequent. Conclusions: Vinorelbine offers a promising alternative for the management of advanced breast cancer in elderly patients who are concerned about the subjective side effects of cytotoxic chemotherapy. The dose-limiting toxicity is neutropenia, which is readily managed with dose adjustment. Nonhematologic toxicity, including gastrointestinal side effects, is minimal. Randomized studies are warranted to compare the activity of vinorelbine with that of other regimens in elderly patients.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1279-8517
    Keywords: Liver ; CT ; Neoplasms ; Arteries, therapeutic blockade
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The goals of this study were to delineate the boundary between the right and left hepatic artery territories by computed tomography (CT), to compare this boundary with the middle scissura of Couinaud’s segmental anatomy, and to discuss the clinical implications of these findings. The 18 patients who underwent transcatheter oily chemoembolization (TOCE) of liver tumors via the right or left hepatic artery, were examined with an immediate postembolization CT scan. We measured the orientation of the watershed line between the right and left hepatic artery territories and the orientation of the middle scissura on other available sectional imaging modalities, and then compared the middle scissura with the arterial watershed line. A part of segment IV was fed by the right hepatic artery in two of 18 (11.1%) patients. Moreover, one of 4 segment IV lesions was embolized via right hepatic artery infusion. Thus, in 11.1% of cases there was no coincidence between the arterial watershed line and the middle scissura. Some segment IV lesions may be fed and therefore embolized only via right hepatic artery infusion in TOCE for liver tumor.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1438-1435
    Keywords: Key words Hepatic lymphedema ; CT ; Hemopericardium ; CT ; Aneurysm ; rupture ; Aorta ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To correlate computed tomography (CT) findings with clinical-pathologic results and discuss the possible significance of periportal hypodensity in patients with clinical cardiac tamponade secondary to acute proximal thoracic aortic dissection, aneurysm, or heart rupture. Materials and methods: In a retrospective review of thoracoabdominal CT scans and records of 17 consecutive patients with hemopericardium, 10 patients with clinical signs of cardiac tamponade associated with hypodensity around the portal vein were selected; at surgery or autopsy all 10 patients had a thoracic aortic aneurysm, dissecting aneurysm, and heart rupture. The ratio of transverse inferior vena cava diameter to the diameter of the aorta at the level of the right adrenal gland was determined. Results: Abdominal CT scans showed focal (n = 1) or diffuse (n = 9) areas of hypodensity around the portal vein associated with pericaval hypodensity in four cases. Other abdominal abnormalities included persistent enhancement of renal parenchyma (n = 5), and gallbladder wall edema (n = 2); in nine cases the inferior vena cava diameter was significantly increased compared with that of patients with normal findings on CT scans (P 〈 0.01). Pathologic correlation, available in nine cases by autopsy, showed evidence of periportal lymphatic vessel dilatation and lymphedema. Conclusions: Periportal hypodensity on CT scans corresponds to the histopathologic picture of dilated lymphatic vessels or hepatic lymphedema; a diagnosis of hepatic lymphedema may be considered on the basis of CT scans in patients with pericardial effusion.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Emergency radiology 6 (1999), S. 113-120 
    ISSN: 1438-1435
    Keywords: Key words Computed tomography (CT) ; helical ; Pancreatitis ; Pancreas ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Acute pancreatitis represents one of the more commonly encountered etiologies of acute abdominal pain. Many complications can present emergently, including pancreatic abscess, necrosis, and hemorrhage. The purpose of this pictorial essay is to educate the reader about the spectrum of CT findings in patients with complications from pancreatitis. Emphasis is placed on evaluation with helical CT, stressing optimal technique and the imaging parameters essential for accurate diagnosis.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Emergency radiology 6 (1999), S. 204-209 
    ISSN: 1438-1435
    Keywords: Key words Neoplasms ; Hemorrhage ; Perforation ; CT ; Abdomen ; Pelvis.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Rupture of tumors is usually a critical and life-threatening condition. We demonstrate a wide variety of ruptured tumors with their imaging characteristics including gastric lymphoma, gastric leiomyosarcoma, leiomyosarcoma of the ileum, hepatocellular carcinoma, pancreatic pseudocyst, renal angiomyolipoma, renal cell carcinoma, ovarian endometrial cyst, ovarian corpus luteum cyst, and ovarian teratoma. Their imaging features are illustrated with an emphasis on clues to an accurate diagnosis.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Emergency radiology 6 (1999), S. 232-243 
    ISSN: 1438-1435
    Keywords: Key words Abdomen ; CT ; Abdomen ; acute conditions ; Retroperitoneal space ; CT ; Retroperitoneal space ; injuries
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The retroperitoneum is a common location for injury following blunt or penetrating trauma. Additionally, there are a wide variety of nontraumatic emergencies that involve the retroperitoneum. Patients with these entities may present with symptoms ranging from acute abdominal or back pain to hypotension and/or fever. Computed tomography (CT) is the imaging modality of choice to evaluate acute processes of the retroperitoneum, as sonography has been historically less sensitive than CT. Knowledge of the compartments of the retroperitoneal space as well as the fascial planes is crucial to diagnose and understand the pathway of spread of pathology in this region. In this pictorial essay the spectrum of both traumatic and nontraumatic retroperitoneal emergencies will be demonstrated, as well as their effect on the different compartments of the retroperitoneum.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1438-1435
    Keywords: Key words Pericardium ; Rupture ; Heart luxation ; Chest X-ray ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This report describes a patient who presented to our hospital in stable condition without signs of circulatory or respiratory failure following previous surgery for blunt abdominal trauma. The diagnosis of rupture of the pericardium with luxation of the heart was suggested on chest X-ray and CT. Left anterior thoracotomy revealed a 6-cm longitudinal left pericardial tear with herniation of the heart into the mediastinum.
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  • 10
    ISSN: 1569-8041
    Keywords: breast cancer ; fibroblast growth factor ; microvasculature
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Angiogenesis, the process whereby endothelial cells divide and migrate to form new blood capillaries, has been assessed in tumours by measuring microvessel density. High microvessel density is a significant adverse prognostic factor in breast cancer. The angiogenic factor, basic fibroblast growth factor (bFGF), has been associated with tumourigenesis and metastasis in several human cancers. There are few quantitative studies of bFGF expression in normal tissues compared to cancer. Patients and methods: We have measured bFGF levels in 149 human primary breast carcinomas and assessed the findings in relation to microvessel density, oestrogen receptor (ER) and epidermal growth factor receptor (EGFR). Basic FGF levels were measured by ELISA. Western blotting and immunohistochemistry were carreid out to confirm the presence of bFGF. Results: Levels of bFGF were more than 10-fold higher in tumour cytosols compared to reduction mammoplasty tissue and 3-fold compared to non neoplastic cytosols from the same breast as the tumour (P 〈 0.0001). Immunohistochemistry showed bFGF protein was localised exclusively in the stroma whereas no bFGF staining was observed in the epithelial cells. High bFGF levels were significantly related to high ER (P = 0.01). Similarly, high bFGF levels were significantly related to low grade (P = 0.046) and to small tumour size (P = 0.04). No significant relationship was observed between bFGF and microvessel count, EGFR or age. In univariate analysis and in a Cox proportional hazard model bFGF did not reach significance for overall or relapse free survival. Conclusions: Our results show that although bFGF is elevated in breast carcinomas compared to normal breast tissue it is not related to microvessel density and it is not an independent predictor of survival in breast cancer patients. Basic FGF may be one of multiple factors that synergise with other growth factors such as VEGF to enhance angiogenesis.
    Type of Medium: Electronic Resource
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  • 11
    ISSN: 1569-8041
    Keywords: breast cancer ; high-dose chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 12
    Electronic Resource
    Electronic Resource
    Springer
    Annals of oncology 10 (1999), S. 1163-1170 
    ISSN: 1569-8041
    Keywords: BRCA1 ; BRCA2 ; breast cancer ; family history ; survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Family history is a well recognized risk factor for breast cancer, but its impact in terms of breast cancer survival is uncertain. The recent identification of breast cancer predisposing genes has provided new clinical insights in this field. Design: English literature identified through Medline between 1976 and February 1999 was reviewed including search terms: breast cancer, survival, prognosis, family history, genetics, BRCA1, BRCA2, and related articles. Results: Publications were divided into three categories.Family history-based studies: eighteen articles were reviewed. Four studies showed a statistically significant better survival in patients with a family history of breast cancer, and two studies demonstrated a significantly worse prognosis in this context. The remaining articles showed no significant difference. Linkage studies: Two studies based on linkage to BRCA1 found that overall survival was better in linked families. A third one concluded to a worse outcome in BRCA2-linked tumors. Mutation-based studies: 10 studies looking at the association between germ-line mutations in BRCA1/BRCA2 and clinical outcomes were reviewed. Eight articles reported no significant difference in outcome, whereas two studies showed a worse outcome in patients with mutations. Conclusions: Conflicting data exist as to whether the prognosis of familial or hereditary breast cancer differs from that of sporadic cases. Some of the discrepancies may be explained by methodological differences or biases. However, no studies showed a survival advantage for BRCA1mutation carriers. This seems to indicate that BRCA1-related breast cancer is not associated with a survival advantage, and that in fact, certain BRCA1 germline mutations confer a worse prognosis. However, to adequately answer this question, more efficient molecular tools to identify all the genetic changes responsible for breast cancer predisposition, and large cohort studies to evaluate their clinical consequences, are needed.
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  • 13
    ISSN: 1569-8041
    Keywords: breast cancer ; chemotherapy ; margins ; radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Inadequate surgical excision with residual involvement of resection margins by tumour after breast conservation results in increased local recurrence rates. To reduce this risk positive margins are, therefore, usually excised. Systemic treatment with tamoxifen or chemotherapy reduces local recurrence, along with radiotherapy. However, no studies to date have examined the correlation between chemoendocrine treatment, together with radiotherapy, and local relapse in patients with unexcised involved resection margins, having had breast conservation treatment. Patients and methods: The histopathology reports were reviewed of 184 patients who were treated from June 1991 to August 1995 within our randomised study of neoadjuvant versus adjuvant chemoendocrine therapy with mitozantrone and methotrexate (2M) ± mitomycin-C (3M) and tamoxifen, used concurrently with radiation following conservation surgical treatment. Histological resection margin was considered positive if ductal carcinoma in situ (DCIS) or invasive carcinoma was present microscopically less than 1mm from the excision margin. Results: Although 38% of patients had unexcised microscopically involved margins, local relapse rate as first site of relapse was only 1.9% after a median follow up of 57 months. There was no difference in distant relapse (P = 0.2) and survival (P = 0.5) between the positive and negative margins groups. Conclusions: The presence of positive unexcised margins does not have a significant effect on outcome in patients who are treated with chemoendocrine therapy together with radiotherapy. Further clinical trials are required.
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  • 14
    ISSN: 1569-8041
    Keywords: breast cancer ; docetaxel
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Given as first- or second-line chemotherapy, docetaxel appears to have great potential in advanced breast cancer. Patients and methods: Three hundred and seventy-seven locally advanced or metastatic breast cancer patients received docetaxel (Taxotere®) as part of a named patient programme under the care of 108 oncologists from 61 cancer units across the UK. The recommended starting dose was 100 mg/m2, but patients at higher risk of toxicity started at 75 mg/m2. All patients received corticosteroid premedication. The modal number of prior chemotherapy regimens was 2 (range 1–7), 342 patients (91%) had at least one prior anthracycline-based regimen. Results: Response was graded according to the managing clinician's best judgement without formal criteria. The overall response rate (ORR) was 46% among the 331 evaluable patients, 46% among the 299 patients who were 'anthracycline resistant' and 35% among the 82 patients who were 'anthracycline refractory' (progressive disease being the best response obtained to the most recent anthracycline containing regimen). One hundred and ninety-three patients started at the full dose of 100 mg/m2 with an ORR of 55% and 129 started at 75 mg/m2 with an ORR of 33%. In October 1997, some two years after the programme had started, 26 of 377 patients were still alive, although no complete remissions have lasted to this date. Kaplan–Meier survival analysis yielded a median survival of 194 days (95% CI: 178–218 days). Haematological parameters were checked before each course of docetaxel and additionally as clinically indicated. The safety data confirmed that docetaxel has a manageable, predictable side effect profile; 29 of 377 (7.7%) patients were hospitalised as a result of neutropenic sepsis. Conclusions: The results of this named patient programme over a two year timespan confirm that docetaxel is an effective chemotherapy option in patients with locally advanced and/or metastatic breast cancer, including an 'anthracycline refractory' population.
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  • 15
    ISSN: 1569-8041
    Keywords: breast cancer ; dose-intensity ; epirubicin ; G-CS/kwd〉 ; vinorelbine ; weekly schedule
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: This study was designed to explore the effectiveness and tolerability of a weekly regimen of epirubicin and vinorelbine plus granulocyte colony-stimulating factor (G-CSF). Patients and methods: Fifty-two patients with previously untreated advanced breast cancer were treated with epirubicin (25 mg/m2/week) and vinorelbine (25 mg/m2/week) with G-CSF support, for 24 consecutive weeks. Results: The median number of courses per patient was 22 (range 10–24). The administered dose intensity was 23 mg/m2 for both epirubicin and vinorelbine. Ten complete responses (19%) and 30 partial responses (58%) were obtained, for an overall response rate of 77%. None of the patients progressed during treatment. The median response duration and time to progression were both 10 months. A total of 1065 courses were assessed for toxicity. Grade 3 neutropenia was the most common toxic manifestation, (39% of patients), without febrile neutropenia or neutropenic sepsis. Two patients had grade 3 cardiac toxicity, which regressed without sequelae. Median survival was 31 months, with a median follow-up of 24 months (range 9–40). Conclusions: Owing to its effectiveness and tolerability, the weekly regimen of epirubicin and vinorelbine plus G-CSF may represent an acceptable alternative for patients with untreated metastatic breast cancer. It could be tested in the adjuvant and neoadjuvant setting.
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  • 16
    ISSN: 1569-8041
    Keywords: breast cancer ; doxorubicin ; paclitaxel-anthracycline combination ; schedule
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: We and others have demonstrated the antineoplastic efficacy of paclitaxel as a single agent in metastatic breast cancer. We performed this phase I trial to evaluate the combination of paclitaxel with doxorubicin. Patients and methods: Eligible patients had measurable or evaluable metastatic breast cancer for which this was the initial cytotoxic treatment. They may have received adjuvant chemotherapy with other drugs. The study had four parts. In part 1, the patients received paclitaxel by 24-hour infusion followed by doxorubicin by 48-hour infusion. The paclitaxel dose was to be escalated from a starting dose of 125 mg/m2, and the doxorubicin dose was to remain constant at 60 mg/m2 with treatment repeated every three weeks. The results of part 1 prompted part 2 which was a study of the reverse sequence. Part 3 was a formal study of pharmacology and has been reported (J Clin Oncol 14: 2713–21, 1996). In part 4, patients received doxorubicin 50 mg/m2 by bolus followed by paclitaxel 150 mg/m2 by 24-hour infusion for courses 1 and 2. In all subsequent courses doxorubicin was administered by 48-hour infusion. All patients in all four parts of the study had baseline cardiac scans. All patients received standard premedication for paclitaxel. Results: Forty-eight patients were treated in all four parts of the study. In part 1 (10 patients), the maximum tolerated dose (MTD) was paclitaxel 125 mg/m2/24 hours followed by doxorubicin 48 mg/m2/48 hours as defined by dose-limiting mucositis and neutropenic fever which occurred at the starting dose. For part 2 (21 patients), the MTD was doxorubicin 60 mg/m2/48 hours followed by paclitaxel 160 mg/m2/24 hours. In part 4 (seven patients), the MTD was doxorubicin 50 mg/m2/bolus followed by paclitaxel 135 mg/m2/24 hours. In parts 2 and 4, the dose-limiting toxic effect was neutropenia. Of the entire cohort of 48 patients, seven (15%) had a complete response (one persists at five years without intervening therapy), 26 (54%) had a partial response for an objective response rate of 69% (95% confidence interval (95% CI): 54%–81%). The median follow-up of all living patients is 38+ months (range 20+ to 62+); the median response duration is seven months (range 2–33.7+); the median overall survival is 20.5 months (range 5–54+). The median time to progression is 9.6 months (range 1–33.7+ months). Two patients developed congestive heart failure, one at 24 months after her final dose of doxorubicin which amounted to a cumulative lifetime total doxorubicin dose of 870 mg/m2, one after a total of 660 mg/m2. In both, cardiac symptoms were controlled with medications. Conclusions: The combination of paclitaxel/24 hours with doxorubicin/48 hours is an effective antineoplastic treatment for metastatic breast cancer. However, the incidence of complete response, the median overall survival, and time to progression were not greater than for standard doxorubicin-based combinations. Additionally, a sequence-dependent interaction between paclitaxel and doxorubicin, given in the schedule described here, was defined. Other strategies and schedules should be evaluated to maximize the antineoplastic efficacy of these two potent agents.
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  • 17
    ISSN: 1569-8041
    Keywords: 5-fluorouracil ; breast cancer ; neoadjuvant ; primary chemotherapy ; vinorelbine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Biological considerations support the use of primary chemotherapy in operable breast cancer; and despite wide variations of used regimens, clinical studies consistently show a significant tumor response allowing breast conservation in many patients otherwise canditates for mastectomy. We investigated the efficacy and the acceptance of a combination chemotherapy with vinorelbine, 5-fluorouracil and high-dose folinic acid in operable breast cancer with favorable prognostic factors and tested the relationship of hormone receptor status, Ki67, p53, c-erbB2 and bcl-2 with treatment response. Patients and methods: Thirty-nine patients (median age 51 years, range 36–71 years), eight with T1, twenty-eight with T2 and two with T3 lesions, were treated with 5-fluorouracil (350 mg/m2, i.v. on day 1 to 3) preceded by folinic acid (100 mg/m2 i.v. on day 1 to 3) and vinorelbine, given on days 1 and 3 at the dose of 20 mg/m2 (FLN regimen). Therapy was administered on an outpatient basis every three weeks. Non responders had surgery after three courses, while complete or partial responders underwent surgery after six courses. All but one were evaluable for response and toxicity. Results: Objective responses were observed in 23 of the 38 evaluable patients (61%; 95% CI: 46%–76%): three complete responses (8%) and 20 partial responses (53%). Fifteen patients (39%) had stable disease, of whom nine (23%) had minor response. None of the patients had disease progression during treatment. Objective responses were significantly associated with no expression of estrogen and/or progesteron receptors and 〉50% decrease in Ki67 after induction chemotherapy. Tolerance was excellent and none of the patients experienced grade 2 alopecia. Conclusions: The ‘moderate’ efficacy of this regimen might be partially due to the selection of patients with high expression of steroid hormone receptors and low proliferation rate, which have an unfavorable impact on response to this chemotherapy.
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  • 18
    ISSN: 1569-8041
    Keywords: breast cancer ; cardiotoxicity ; cyclophosphamide ; epirubicin ; high dose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To prospectively evaluate the long term cardiac effects of high-dose epirubicin and cyclophosphamide given to women with early stage, poor prognosis breast cancer. Patients and methods: Women with stage 2 breast cancer and 10+ nodes or 4+ nodes and estrogen receptor negative tumor, or stage 3 breast cancer received three cycles of epirubicin 200 mg/m2 and cyclophosphamide 4 gm/m2 with peripheral blood progenitor cell and filgrastim support. Treatment was given every 28 days (n = 79) or 21 days (n = 20). Fifty patients received radiotherapy to the chest wall or breast, 25 of to the left side. Patients were assessed clinically regularly during chemotherapy and at least three times yearly after completion of treatment. Cardiac left ventricular ejection fraction (LVEF) was assessed by radionuclide scan before therapy, after each cycle of chemotherapy, three months and six months after completion of chemotherapy, and yearly thereafter until relapse. Results: Ninety-nine women were treated, and 92 completed all three cycles of chemotherapy. The median age was 43 years (range 24 to 60 years). All patients were included in this analysis. The median relapse-free survival was 39 months (11 to 68 months). There was a significant fall in LVEF during chemotherapy. In general, there was no further deterioration in cardiac function from the third month after cessation of treatment, however there was substantial variation between individuals. 35 patients had at least one LVEF measure less than normal (〈50%), but the LVEF returned to normal in 20 of these with further follow-up. Cardiac dysfunction was not increased in women who received radiotherapy and was not different between cohorts given chemotherapy every three or every four weeks. One patient died of acute myocardial necrosis following the third cycle of chemotherapy. Two patients developed clinical evidence of cardiac failure, and another had radiological signs but was asymptomatic. One woman died of progressive cardiac failure, one recovered clinically but also developed recurrent breast cancer, while the third recovered after commencement of medical therapy. Conclusions: During follow-up after high-dose epirubicin and cyclophosphamide as delivered in this study, the LVEF fell to below normal in approximately one third of patients. However, in over half of these patients the LVEF subsequently recovered to the normal range, and the incidence of clinically evident chronic cardiac failure was low. Further follow-up is required to assess the long- term safety. A randomized comparison with standard-dose anthracycline-based chemotherapy is needed to determine whether this regimen is associated with an increased risk of clinical cardiac toxicity.
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  • 19
    Electronic Resource
    Electronic Resource
    Springer
    Skeletal radiology 28 (1999), S. 33-40 
    ISSN: 1432-2161
    Keywords: Key words Osteoblastoma ; Spine ; Radiography ; CT ; MRI ; Pathology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objectives. To illustrate the CT and MRI features of spinal osteoblastomas and correlate the imaging with histological findings. Design. In a retrospective review the CT and MRI features of spinal osteoblastomas with respect to mineralisation, signal intensity (SI), adjacent reactive changes, enhancement following gadolinium-DTPA (5 cases) and adjacent soft tissue masses were compared and correlated with the histological findings including the degree of osteoid formation and matrix mineralisation, vascularity and surrounding reactive changes in bone and soft tissue. Patients. Eleven patients (7 males and 4 females; age range 8–43 years, mean age 19.5 years) with 12 osteoblastomas (1 patient suffered a recurrence) were studied. Results. All lesions showed classical features on CT with varying degrees of matrix mineralisation, whereas MRI identified mineralisation in only eight of 12 cases. MRI showed low signal intensity of the lesion on both T1- and T2-weighted sequences in several cases in the absence of heavy mineralisation. In these cases, histological examination revealed diffuse osteoid production by the tumour. All patients given gadolinium showed enhancement within the tumour on MRI. Reactive bone marrow changes were identified on MRI in 10 cases, and in five of these the changes were at multiple levels. An adjacent soft tissue mass was demonstrated in five cases, but extraosseous tumour was present histologically in only two of these. Conclusions. The MRI appearances of spinal osteoblastomas are varied and show no characteristic features. MRI may also overestimate the extent of the lesion due to extensive reactive changes and adjacent soft tissue masses. CT should continue to be the investigation of choice for the characterisation and local staging of suspected spinal osteoblastomas.
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  • 20
    Electronic Resource
    Electronic Resource
    Springer
    Skeletal radiology 28 (1999), S. 49-51 
    ISSN: 1432-2161
    Keywords: Key words Cryptococcoma ; sacrum ; Cryptococcoma ; immunocompromised ; MRI ; sacrum ; CT ; sacrum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Cryptococcoma of the sacrum was the initial presentation of systemic cryptococcosis in a patient on chronic steroid therapy for autoimmune hepatitis. The bone lesion was the only overt manifestation of systemic cryptococcal disease, which preceded other clinical manifestations and led to the subsequent diagnosis of systemic infection.
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  • 21
    ISSN: 1432-2161
    Keywords: Key words Osteosarcoma ; conventional ; Metastasis ; Soft tissues ; Retroperitoneum ; CT ; X-ray
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Osteosarcoma (osteogenic sarcoma) metastasizes primarily to the lung. With the introduction of neoadjuvant chemotherapy as part of the treatment, the overall and disease-free survival rates have dramatically improved. In this case report, a young man with multiple soft tissue and bone metastases, including a rare large bone-forming retroperitoneal metastasis, is described. Despite the extensive extrapulmonary metastases, the patient did not develop pulmonary metastases in the 4 years following initial presentation of the primary tumour.
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  • 22
    Electronic Resource
    Electronic Resource
    Springer
    Skeletal radiology 28 (1999), S. 717-722 
    ISSN: 1432-2161
    Keywords: Key words Sarcoid ; vertebrae ; Sarcoid ; rib ; Sarcoid ; calvarium ; Osteolytic ; CT ; MRI ; Surgical fusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Skeletal sarcoidosis is rare. This report describes a 31-year-old African American man who presented with a destructive osteolytic lesion of C2 and another lesion in a rib. The lesion at C2 was treated with corpectomy and bone graft. Four months later the lesion recurred and a new lesion was discovered in the cervical vertebral column. The patient declined surgery for instability for another 3 months, choosing to remain in a halo. Seven months following the initial operation, a technetium bone scan showed spread of the disease to the calvarium and thoracic and lumbar vertebrae. The patient had no symptoms referable to these sites. The patient agreed to have his neck fused at this point. For the next 10 months, the patient was on steroids and a further new lesion appeared at L5 without localizing signs or symptoms. The patient declined further evaluation over the next 12 months and is now considered lost to follow-up.
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  • 23
    ISSN: 1432-2161
    Keywords: Key words Stress fractures ; CT ; MR imaging ; Radionuclide study ; Femur ; stress fractures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively.
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  • 24
    ISSN: 1432-2161
    Keywords: Key words Osteochondroma ; Chondroma ; Extraskeletal tumor ; Soft tissue tumor ; Foot ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A case of pathologically proven extraskeletal osteochondroma is presented with magnetic resonance imaging (MRI), computed tomography (CT), bone scan and radiographic findings. The diagnosis of extraskeletal osteochondroma should be considered when a discrete, ossified mass is localized in the soft tissues of the distal extremities. Nomenclature surrounding this entity is controversial and is discussed.
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  • 25
    ISSN: 1432-2161
    Keywords: Key words Chondroblastoma ; malignant ; recurrent ; p53 mutation ; Aneuploidy ; Pelvis ; Femur ; Xray ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report a rare case of malignant chondroblastoma, which presented in a 47-year-old man as a recurrent tumor, 18 years following wide excision of a typical pelvic chondroblastoma. Radiologic studies of the recurrent tumor showed a large, lytic, destructive lesion of the right pelvic bones and femur, with a pathologic fracture of the latter, a large pelvic soft tissue mass, and multiple pulmonary metastases. Biopsy tissue showed typical features of chondroblastoma, but also increased nuclear atypia, hyperchromasia, and pleomorphism, compared to the original tumor, and, most significantly, abnormal mitotic figures. Immunohistochemical studies of the recurrent tumor revealed p53 mutation and extensive proliferative activity, and flow cytometric studies showed DNA aneuploidy, none of which was present in the original tumor. The patient received chemotherapy and radiation, but died of disease eight months after presentation. We also review chondroblastoma in general, to assign this unusual lesion to a tumor subtype.
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  • 26
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    Skeletal radiology 28 (1999), S. 703-709 
    ISSN: 1432-2161
    Keywords: Key words Proliferative myositis ; Childhood ; Lumbar muscles ; Ossification ; X-ray ; CT ; MRI ; PET
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A case of proliferative myositis in the lumbar paraspinal muscles in a 14-year-old boy is presented. Imaging investigations including plain radiograph, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), bone scan and positron emission tomography (PET) were suggestive of an inflammatory process such as myositis ossificans. The diagnosis was made by incisional biopsy. More pronounced edema, more muscle fiber necrosis and a higher cellularity were found compared to adult cases. The karyotype of the lesion was normal. Clinically, the mass disappeared spontaneously. After 24 months, asymptomatic bridging ossification between the third and fourth lumbar vertebrae was noted.
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  • 27
    ISSN: 1432-2161
    Keywords: Key words Bone tumor ; Chondrosarcoma ; CT ; Magnetic resonance imaging ; Tumor of the ankle ; Tumor of the foot
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The foot is an uncommon location for chondrosarcoma. The presentation, diagnosis, pathological findings, surgical treatment and follow-up of three patients with chondrosarcoma in this rare location are presented. Though nonspecific, MR imaging findings were of aid in the diagnosis and treatment planning of these patients. If the diagnosis of this tumor is rapidly made, a tumor excision instead of limb amputation may be sufficient treatment at surgery.
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  • 28
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    Skeletal radiology 28 (1999), S. 159-162 
    ISSN: 1432-2161
    Keywords: Key words SAPHO syndrome ; CT ; Parosteal osteosarcoma ; Sternoclavicular joints
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Considerable attention has been paid in the past 10 years to the radiological spectrum of disease entities belonging to the SAPHO syndrome. We report an unusual case presenting with an extra-axial (femoral) lesion, prior to description of this syndrome, which was radiologically and histologically mistaken for a parosteal osteosarcoma. Nineteen years later, a further lesion developed in the scapula together with the typical sternoclavicular manifestations, at which stage the correct diagnosis of SAPHO syndrome was established.
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  • 29
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    European radiology 9 (1999), S. 208-210 
    ISSN: 1432-1084
    Keywords: Key words: Muscles ; diseases ; Neoplasms ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report a patient with rapidly progressive contractures due to metastatic infiltration of a carcinoma of unknown origin into the skeletal muscle. This 61-year-old man presented with a 1-month history of rapidly evolving, painful restriction of mobility of his right arm and his legs. Computed tomography showed diffuse metastatic nodules in all muscles, particularly in the hip abductors. Muscle biopsy revealed extensive infiltration of the muscle with carcinoma cells.
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  • 30
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    European radiology 9 (1999), S. 336-343 
    ISSN: 1432-1084
    Keywords: Key words: Cryptorchidism ; Scrotum ; US ; CT ; MRI ; Testis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Imaging evaluation of the patient with a non-palpable testis has evolved over recent decades. The rational explanation of imaging in these patients requires a clear understanding of the various causes of a non-palpable testis, and an appreciation of the utility and limitations of the available imaging modalities. This review describes the classification of non-palpable testis and discusses the role of modern imaging in evaluation. In particular, the relative accuracies of ultrasound, CT and MRI is reviewed.
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  • 31
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    European radiology 9 (1999), S. 244-249 
    ISSN: 1432-1084
    Keywords: Key words: Pancreas ; CT ; Injuries ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. In order to describe the CT findings in pancreatic injury and to evaluate the sensitivity of this technique, we performed a retrospective study. During a 5-year period (1993–1997), eight patients (five males and three females; age range 10–47 years) were investigated with CT. Endoscopicretrograde cholangiopancreatography (ERCP) was obtained in two patients, pre- and intra-operatively, respectively. Among the standard laboratory tests obtained at admission, the value of serum amylase was reviewed. The imaging findings, especially those obtained with CT, were correlated with the surgical findings, when available (in seven of eight patients). At admission, diagnosis of pancreatic injury was missed at CT in three of eight patients (37.5 %); thus, the sensitivity of CT for pancreatic injury was 62.5 %. ERCP showed rupture of the pancreatic duct in the two cases in which it was performed. Serum amylase was elevated at admission in four of eight patients, resulting in a sensitivity of 50 %. After surgery, an enterocutaneous fistula developed in one case, and was managed conservatively. One patient died from brain injury. Proper implementation of the CT technique and accurate film reading is mandatory to establish the diagnosis of pancreatic contusion. No correlation between CT features and type of outcome of surgical management could be established. On retrospective review of the CT examinations, it appeared that two of the three false-negative results could have been avoided. Therefore, proper CT technique and accurate film reading are mandatory in establishing the diagnosis of pancreatic injury.
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  • 32
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    Der Radiologe 39 (1999), S. 958-964 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Spiral-CT ; Mehrzeilen-Spiral-CT ; Pankreaskarzinom ; Tumorstaging ; 2D-/3D-Bildgebung ; Key words Computed tomography ; Computed tomography ; helical ; Computed tomography ; technology ; Computed tomography ; thin-section ; Pancreatic neoplasms ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose. Investigation of the capabilities of MSCT and its value for the staging of pancreatic carcinomas. Methods. 50 Patients with suspected pancreatic carcinoma were examined with a biphasic multislice-spiral-CT protocol: slice collimation 4×1 mm, Pitch 3.5–4 mm. After administation of 120 ml contrast medium and 50 ml NaCl with a flow rate of 3.0 ml/s the examination was started with a delay of 40 s (pancreatic phase) and 80 s (portalvenous phase). Results. Multislice spiral CT allows the examination of the whole upper abdomen with nearly isotropic data sets. This is the premise for the optimal assessment of the tumor extent in all planes, excellent demarcation of the tumor against the adjacent vessels and organs and the demarcation of small peripancreatic lymph nodes. Conclusions. Multislice spiral CT and the use of interactive multiplanar reconstructions improve the staging of pancreatic cancer.
    Notes: Zusammenfassung Ziel unserer Untersuchungen war es, die Möglichkeiten der Mehrzeilen-Detektor-Spiral-CT und ihre Bedeutung für das Staging von Pankreastumoren zu evaluieren. Bei insgesamt 50 Patienten, bei denen der Verdacht auf ein Pankreaskarzinom bestand, wurde im Rahmen der Tumorstagings ein biphasisches hochaufgelöstes Mehrzeilen-Spiral-CT mit einer Schichtkollimation von 4×1 mm, einem Pitch von 3,5–4, 120 ml Kontrastmittel, 50 ml 0,9%NaCl-Bolus, 3,0 ml/s Fluß und einem Startdelay von durchschnittlich 40 s (Pankreasparenchymphase) und 80 s (portalvenöse Phase) durchgeführt. Die Mehrzeilen-Spiral-CT ist in der Lage die gesamte Pankreasloge und auch die angrenzenden Organe mit hoher Ortsauflösung in allen Raumebenen abzubilden. Die nahezu isotrope multiplanare Bildgebung erlaubt die vollständige Erfassung der Tumorausdehnung in allen Raumebenen und eine bessere Abgrenzung der Tumoren gegenüber dem angrenzenden Fettgewebe, den benachbarten Organen (Gefäße, Duodenum, Magen) und einen sichereren Nachweis von peripankreatischen Lymphknoten. Die Mehrzeilen-Spiral-CT und der Einsatz von interaktiven multiplanaren Rekonstruktionen verbessern nachhaltig die Bestimmung der Ausdehnung von Pankreaskarzinomen.
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  • 33
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    Der Radiologe 39 (1999), S. 1027-1034 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Computertomographie ; Kiefer ; Dental-CT ; Software ; Key words Mandible ; Maxilla ; Computed tomography ; Software ; Dental-CT ; Jaws ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Traditionally oral surgeons and dentists have evaluated the jaws using intraoral films and panoramic radiographs. The involvement of radiologists has been limited. In the past few years dedicated CT-software-programs developed to evaluate dental implant patients have provided a new look at the jaws. The complex anatomy is described and identified on human skulls and on axial, panoramic, and cross-sectional images. With this anatomic description Dental-CT-scans are used to demonstrate the anatomy of maxilla and the mandible. An overview of the technique of Dental-CT is provided, furthermore the radiation dose of different organs is explained. Suggestions to reduce these doses by simple modifications of the recommended procols are given.
    Notes: Zusammenfassung Die Einführung im Bereich der Computertomographiesoftware (Dental-CT) ermöglicht dem Radiologen zusätzlich zu den üblichen, von den Zahnärzten durchgeführten Röntgenuntersuchungen eine überlagerungs- und verzerrungsfreie Darstellung des Ober- und Unterkiefers. In der Implantologie ist mit dieser Darstellung eine exakte Planung möglich. Weiterhin haben sich Dünnschicht-CT-Untersuchungen auch bei der Abklärung von Zysten, Tumoren, Frakturen, tiefen Parodontitiden und retinierten Zähnen bewährt. In dieser Arbeit wird ein Überblick über die Anatomie, die Untersuchungstechnik des Dental-CT und die auftretende Strahlenbelastung gegeben. Basierend auf rezente Literaturangaben kann eine Reduktion der absorbierten Dosis bei gleichbleibender Bildqualität durch einfache Protokollmodifikationen erzielt werden.
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  • 34
    ISSN: 1432-1084
    Keywords: Key words: Langerhans' cell histiocytosis ; Liver ; Spleen ; CT ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We present a case of Langerhans' cell histiocytosis (LCH) of the liver and spleen in an adult. The imaging features are different from those in the few previously reported cases of individual organ involvement by LCH.
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  • 35
    ISSN: 1432-1084
    Keywords: Key words: Stomach neoplasm ; Gastric lipoma ; Acute gastrointestinal hemorrhage ; Ultrasound ; CT ; MR imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We report a case of gastric lipoma which manifested with an episode of acute gastrointestinal hemorrhage. Preoperative diagnosis was based on the US, CT, and MRI findings, as the results of gastrointestinal endoscopy were inconclusive. The role of current imaging methods, and particularly of MRI, is discussed.
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  • 36
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    European radiology 9 (1999), S. 259-261 
    ISSN: 1432-1084
    Keywords: Key words: Liver neoplasms ; CT ; Fat ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Follow-up of two hepatic angiolipomas in a patient without evidence of tuberous sclerosis is reported. Initially, the lesions presented as homogenously enhancing masses, which were nearly isodense to normal liver tissue on plain CT scans. Focal nodular hyperplasia was assumed. One year later, fat was detected in the growing tumors and percutaneous core biopsy revealed hepatic angiolipomas. Natural history of these rare lesions is unknown, and this is to the best of our knowledge the first observation of fatty metamorphosis in such a benign, mesenchymal hepatic neoplasm.
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  • 37
    ISSN: 1432-1084
    Keywords: Key words: Kidney ; Ureteropelvic junction obstruction ; CT ; Trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to present CT findings of occult ureteropelvic junction obstruction in patients with renal trauma and to describe the clinical signs and singular CT features that are characteristically observed with trauma and are relevant to management of these patients. We retrospectively reviewed 82 helical CT studies in patients with renal trauma referred to our institution. We found 13 cases of occult preexisting renal pathology, six of which were occult ureteropelvic junction obstructions. The clinical presentation, radiologic findings of trauma according to the Federle classification, and CT findings of obstructed ureteropelvic junction are presented. We found three category-I lesions (one in a horseshoe kidney), two of them treated with nephrostomy because of increased ureteropelvic junction obstruction due to pelvic clots; two category-II lesions (parenchymal and renal pelvis lacerations) that had presented only with microhematuria; and one category-IV lesion (pelvic laceration alone). Pelvic extension was demonstrated in all the cases with perirenal collections. The CT studies in all the cases with suspected ureteropelvic junction obstruction showed decreased parenchymal thickness and enhancement, and dilatation of the renal pelvis and calyx, with a normal ureter. Computed tomography can provide information to confidently diagnose underlying ureteropelvic junction obstruction in renal trauma, categorize the traumatic injury (at times clinically silent) and facilitate proper management according to the singularities observed, such us rupture of the renal pelvis alone (Federle category IV) and increasing ureteropelvic obstruction due to clots which can be decompressed by nephrostomy.
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  • 38
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    European radiology 9 (1999), S. 841-852 
    ISSN: 1432-1084
    Keywords: Key words: Liver transplantation ; Hepatocellular carcinoma ; Cholangiocarcinoma ; MR Imaging ; CT ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Hepatic transplantation has emerged as a potentially curative treatment of certain malignant hepatic neoplasms such as hepatocellular carcinoma, bile duct carcinoma, fibrolamellar hepatocellular carcinoma, metastases from neuroendocrine tumors, and epithelioid hemangioendothelioma. In the early years of hepatic transplantation, there was great enthusiasm to cure patients with unresectable hepatobiliary malignancy. This early enthusiasm was tempered by the unfavorable outcome of transplantation in advanced cases of malignancy and the organ-donor shortage. Presently, patients have to be selected with predictable likelihood for long-term survival. Pre-transplantation imaging is indispensable for detection, characterization, staging, and surgical road-mapping before the procedure. The present article focuses on the role of imaging modalities in these different aspects of preoperative assessment.
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  • 39
    ISSN: 1432-1084
    Keywords: Key words: Abdomen ; Neoplasms ; CT ; Lymphatic system ; Anatomy ; Metastases ; Omentum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to enhance our understanding of the pathways of lymphatic spread of primary carcinomas in the upper abdomen by recognizing the development, configuration, and frequency of nodal enlargement in discrete anatomic regions. The study included 417 patients with histologically confirmed carcinomas (CC) of the stomach (n = 267), liver (n = 98), gallbladder (n = 25), and bile ducts (n = 27). All patients were studied by high-resolution CT and tumor extension to the lymph nodes of the subperitoneal space was clearly identified in 59 patients [33 with CC of the stomach, 8 with CC of the gallbladder, 3 with CC of the bile ducts, and 15 with hepatocellular carcinoma (HCC)]. In 47 of 59 patients this extension was confirmed by surgery or aspiration biopsy. Three discrete anatomic groups of lymph nodes were recognized producing a relatively distinct CT configuration when involved: (a) the hepatoduodenal seen in 49 patients; (b) the peripancreatic demonstrated in 33 patients; and (c) the aortocaval recognized in 16 patients. These groups of lymph nodes can be seen individually involved or in combination. Recognition of involvement of these nodes is important for correct diagnosis and staging of upper abdominal malignancies. The development of this involvement follows the natural flow of lymph via the lesser omentum to the retroperitoneal space.
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  • 40
    ISSN: 1432-1084
    Keywords: Key words: Osteomyelitis ; Radiography ; Bone scintigraphy ; CT ; Ultrasound ; MR imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Conventional radiographs remain the initial imaging modality involved in the diagnosis of osteomyelitis. Bone scintigraphy and its specific agents did not only eliminate the problems of inherent low sensitivity of conventional radiographs, but also increased the specificity to higher degrees. Spiral CT, on the other hand, has solved several diagnostic problems, such as osteomyelitis of the sterno-clavicular junction and hidden areas in the pelvic bones. Magnetic resonance imaging with its multiplanar capability, greater anatomic details and excellent soft tissue bone marrow contrast resolution has a significant role in surgical planning and limb preservation. Ultrasound and US-guided aspiration has recently been involved in the diagnosis and management of osteomyelitis with several advantages particularly in children. Our goal in this review is to outline the ability of various imaging techniques by comparing their strengths and weaknesses in the diagnosis of osteomyelitis. Finally, we suggest various imaging algorithms for specific clinical scenarios. Spondylitis and septic arthritis are not discussed in this review.
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  • 41
    ISSN: 1432-1084
    Keywords: Key words: Vena cava ; Stenosis ; Obstruction ; Interventional procedure ; Neoplasm ; Grafts and prosthesis ; Thrombolysis ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to report our experience on the management of superior vena cava obstruction (SVCO) secondary to malignant disease, using endovascular procedures. Twenty-six patients with SVCO due to primary or secondary tumors of the lung or the mediastinum, or catheter inserted for treatment of an extra-thoracic neoplasm, had an endovascular therapy which consisted of stenting, angioplasty, thrombo-aspiration or local fibrinolysis. Immediately after the procedure, rapid relief of symptoms occurred in 24 (90 %) of the patients. The mean Kishi's score decreased from 5.5 to 0.96. Immediate complications included one death related to pericarditis bleeding following fibrinolysis. Three patients relapsed after 20 days, 4 months and 6 months, and needed a second stenting. At 6 months the primary patency rate was 83 % and the secondary patency rate was 89 %. Endovascular treatment of SVCOs is a simple and safe procedure to restore the patency of the superior vena cava in malignant SVCO. It should be indicated in most cases as first-line treatment and performed as early as possible.
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  • 42
    ISSN: 1432-1084
    Keywords: Key words: Diaphragm ; Hepatic hernia ; Blunt trauma ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We report a case of blunt traumatic right diaphragm rupture with hepatic hernia. The diagnosis was first suggested by an abnormal hepatic location depicted on axial CT. This finding can be considered as a potentially new indirect sign of right diaphragm rupture in patients with blunt trauma. The diagnosis was then confirmed by reformatted CT and MR images.
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  • 43
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    European radiology 9 (1999), S. 1104-1106 
    ISSN: 1432-1084
    Keywords: Key words: Tendinitis ; CT ; Tendons ; Calcification
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Two cases of calcific tendinitis of gluteus maximus muscle are presented. The CT findings, including amorphous calcification without soft tissue mass and possible cortical erosion at the femoral enthesis of the gluteus maximus muscle, are highly suggestive of calcific tendinitis at this unusual but classical location. Ossifying entheses with well-defined cortical defect are frequent at the femoral insertion of the gluteus maximus muscle in asymptomatic subjects and must be differentiated from a real cortical erosion sometimes associated with these calcific tendinitis.
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  • 44
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    European radiology 9 (1999), S. 1117-1119 
    ISSN: 1432-1084
    Keywords: Key words: Tuberculosis ; Skeletal ; CT ; MR imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Chest wall involvement is an uncommon manifestation of musculoskeletal tuberculosis. We present computed tomography and magnetic resonance imaging findings in a case with multifocal musculoskeletal tuberculosis presenting as a breast mass. These radiological modalities are not diagnostic without histopathological confirmation, but they are valuable guides to surgery in defining the extent of disease involvement.
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  • 45
    ISSN: 1432-1084
    Keywords: Key words: Lipoid pneumonia ; Diagnosis ; Lung ; Disease ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The objective of this study was to describe high-resolution CT (HRCT) and MR findings of exogenous lipoid pneumonia and to correlate them with pathologic findings. A retrospective review of the medical records of our institution revealed seven patients with a diagnosis of lipoid pneumonia based on clinical data, chest films, bronchoalveolar lavage, and follow-up. Both HRCT and MR imaging were reviewed by two readers. Pathologic examination of the resected specimen or surgical biopsies were also reviewed in the four available cases. The HRCT findings were pulmonary consolidations (n = 6) with fatty (n = 3) or unspecific but low attenuation values (n = 3), areas of ground-glass opacities (n = 5), septal lines, and centrilobular interstitial thickening (n = 5). In five of the seven cases, a crazy-paving pattern of various spread was also present, either isolated (n = 1) or surrounding a pulmonary consolidation. In two cases traction bronchiectasis and cystic changes consistent with fibrosis were seen. At MR imaging (n = 2) a pulmonary consolidation of high signal intensity on T1-weighted image consistent with lipid content was present in one case. Pathologic examination (n = 4) showed the coexistence of lobules with lesions of various ages, sometimes in contiguous lobules, within the same patient. Recent lesions were those with alveolar fill-in by spumous macrophages and almost normal alveolar walls and septae. In more advanced lesions, lobules were filled in with larger vacuoles often surrounded by inflammatory infiltrates of alveolar walls, bronchiolar walls, and septa. The oldest lesions were characterized by fibrosis and parenchymal distortion around large lipid-containing vacuoles. The HRCT findings reflect pathologic findings in exogenous lipoid pneumonia. Although non-specific, consolidation areas of low attenuation values and crazy-paving pattern are frequently associated in exogenous lipoid pneumonia and are indicative of the diagnosis.
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  • 46
    ISSN: 1432-1084
    Keywords: Key words: Lung nodule ; CT ; Inflammatory pseudotumor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Lung inflammatory myofibroblastic tumor is an uncommon cause of solitary lung nodule (0.7 % of lung tumors). The principal site of inflammatory pseudotumor is the lung, but it can also occur elsewhere in various organs. Although benign, they may be locally very aggressive. Recurrent and multifocal forms have been described. Since they are likely to mimic malignant neoplasms, accurate histopathologic diagnosis is necessary in order to guide appropriate surgical excision and avoid aggressive treatments. We report a case of lung involvement in a young adult with radiologic and pathologic correlations.
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  • 47
    ISSN: 1432-1084
    Keywords: Key words: Castleman disease ; CT ; MR imaging ; Paraneoplastic pemphigus ; Abdomen ; Neoplasms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We describe the CT and MRI features of a case of Castleman disease which was unusual by both its retroperitoneal location and its association with paraneoplastic pemphigus.
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  • 48
    ISSN: 1432-1084
    Keywords: Key words: Lung neoplasms ; Staging ; Pleura ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this investigation was to evaluate whether thin-sectional CT with different reconstruction algorithms can improve the diagnostic accuracy with regard to chest wall invasion in patients with peripheral bronchogenic carcinoma. Forty-one patients with intrapulmonary lesions and tumor contact to the thoracic wall as seen on CT staging underwent additional 1-mm CT slices with reconstruction in a high-resolution (HR) and an edge blurring, soft detail (SD) algorithm. Five criteria were applied and validated by histological findings. Using the criteria of the intact fat layer, HRCT had a sensitivity of 81 % and a specificity of 79 %, SD CT had a sensitivity of 96 % and a specificity of 78 %, and standard CT technique had a sensitivity of 50 % and a specificity of 71 %, respectively. Regarding changes of intercostal soft tissue, HRCT achieved a sensitivity of 71 % and a specificity of 96 %, SD CT had a sensitivity of 94 % and a specificity of 96 % (standard CT technique: sensitivity 50 % and specificity 96 %) . For the other criteria, such as pleural contact area, angle, and osseous destruction, no significant differences were found. Diagnostic accuracy of chest wall infiltration can be improved by using thin sectional CT. Especially the application of an edge-blurring (SD) algorithm increases sensitivity and specificity without additional costs.
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  • 49
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    European radiology 9 (1999), S. 1321-1323 
    ISSN: 1432-1084
    Keywords: Key words: Hydatid disease ; Chest ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The greatest difficulty in the CT diagnosis of perforated pulmonary hydatid cyst (PPHC) is the increase in the attenuation numbers following infection. Because of the solid density of infected hydatid cysts, the differentiation from an abscess or neoplasm is usually impossible. The aim of this study was to evaluate the value of “air bubble” as a new CT sign in the diagnosis of PPHC. Sixty-five patients (28 men and 37 women) with PPHC were included in the study. As a control group, 55 patients who had malignant (n = 36) or non-malignant (n = 19) pulmonary diseases were also examined. Radiological diagnosis with classical CT findings was made in only 38 of 65 patients (58.5 %) with PPHC. Air bubble sign was positive in 54 of the patients with PPHC (sensitivity 83.1 %) but only 3 of 55 patients in control group (specificity 94.5 %). When we analyzed the CT scans with classical CT findings including air bubble, the diagnosis of PPHC was made in 61 of patients (93.8 %). It is concluded that “air bubble sign” is a valuable CT finding in the diagnosis of PPHC.
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  • 50
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    European radiology 9 (1999), S. 1335-1338 
    ISSN: 1432-1084
    Keywords: Key words: Sclerosing stromal tumor ; MR imaging ; CT ; Dynamic study ; Ovarian tumor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Sclerosing stromal tumor is a rare ovarian neoplasm. We describe the radiologic findings of sclerosing stromal tumor in two patients. In both patients, MR and CT images showed a large mass in the left adnexal region. On dynamic contrast-enhanced images, the tumors showed early peripheral enhancement with centripetal progression.
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  • 51
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    European radiology 9 (1999), S. 1366-1375 
    ISSN: 1432-1084
    Keywords: Key words: Myelofibrosis ; Plain film ; Ultrasound ; CT ; MR imaging ; Extramedullary hematopoiesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The purpose of this review is to illustrate the wide range of radiological abnormalities in myelofibrosis. Myelofibrosis, also called myeloid metaplasia, is a myeloproliferative disorder of unknown etiology. The common imaging findings in patients with myelofibrosis are osteosclerosis, hepatosplenomegaly, and lymphadenopathies. In addition, extramedullary hematopoiesis may develop in multiple sites such as chest, abdomen, pelvis, and central nervous system, simulating malignant disease. Selected plain-film, CT, and MR images in patients with myelofibrosis are shown as pictorial essay to allow ready recognition of the most common imaging abnormalities of the disease.
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  • 52
    ISSN: 1432-1084
    Keywords: Key words: Blood diseases ; CT ; Extramedullary haematopoiesis ; Presacral mass
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We present the case of a 60-year-old woman with no known blood disease who developed an extramedullary haematopoiesis of presacral localization that affected the right sciatic nerve. The diagnosis was made with imaging studies and CT-guided fine-needle aspiration.
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  • 53
    ISSN: 1432-1084
    Keywords: Key words: Esophageal varices ; CT ; Endoscopic variceal ligation ; MPR ; 3D image
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The purpose of this study was to demonstrate the utility of helical CT in assessing the therapeutic effects of endoscopic variceal ligation (EVL). Twenty-four patients with esophageal varices were examined. Helical scanning was initiated 60 s after intravenous injection (Iopamidol 300 mgI/ml, total 120 ml, 3 ml/s) was started. Esophageal varices were clearly depicted as high-density areas. Multiplanar reformation and 3D images demonstrated collateral circulation three-dimensionally. After EVL, mucosal high-density areas had diminished markedly, but collateral veins around the esophagus, and gastro- and/or spleno-renal shunts, were unchanged in all patients. Of 21 patients with collateral circulation, esophageal varices recurred endoscopically in 6 patients within 12 months. In 3 patients without collateral circulation, esophageal varices did not recur within 12 months. From these findings, we conclude that helical CT is a useful method for assessing the therapeutic effects of EVL.
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  • 54
    ISSN: 1432-1084
    Keywords: Key words: Coronary vessels ; anomalies ; Coronary vessels ; CT ; Coronary vessels ; MR studies ; Coronary angiography ; Electron-beam CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. An anomalous origin of the left coronary artery arising from the pulmonary artery is a congenital malformation rarely described in adults. We report the case of a 65-year-old patient with this anomaly. Clinical presentation, imaging identification (coronary angiogram, MRI and electron-beam CT), surgical treatment and angiographic long-term follow-up are described.
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  • 55
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    European radiology 9 (1999), S. 1590-1592 
    ISSN: 1432-1084
    Keywords: Key words: Kidney ; Kidney neoplasms ; CT ; Fat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The differential diagnosis of renal masses containing fatty foci is limited to a small number of well-defined tumors, angiomyolipoma being the most frequent. In recent years clear cell carcinomas with intratumoral fatty foci have been reported, due to either entrapment of local fat or to regressive adipose metaplasia. Demonstration of focal calcifications is a valuable sign, being relatively common in carcinomas while rare in more benign lesions. We report a case of a foreign-body granuloma of the kidney, containing both calcifications and foci of fat. The value of this case, in our opinion, is that it demonstrates that detection of the previously mentioned features in a renal mass does not necessarily imply a presumptive diagnosis of renal cell carcinoma.
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  • 56
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    European radiology 9 (1999), S. 1596-1598 
    ISSN: 1432-1084
    Keywords: Key words: Penile metastasis ; Corpus cavernosum ; Bladder cancer ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Metastases of the penis are uncommon, with only approximately 300 cases reported since 1870. In up to 70 % of patients, the primary tumour is located in the urogenital tract. Furthermore, isolated metastases of the penis are exceptionally rare. We report a case of solitary squamous cell metastasis of the penis presenting with painful swelling initially thought to be inflammatory in origin. The CT and MR imaging findings are presented with a short review of the literature.
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  • 57
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    European radiology 9 (1999), S. 1599-1601 
    ISSN: 1432-1084
    Keywords: Key words: Kidney ; US ; CT ; Lipomatosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Replacement lipomatosis of the kidney is the result of severe atrophy or destruction of the renal parenchyma often caused by calculous disease with secondary marked proliferation of renal sinus, renal hilus, and perirenal fatty tissue. The diagnosis is difficult to establish with conventional radiographic methods. Although ultrasonography may show highly suggestive findings, computed tomography seems to be the most accurate method for demonstrating the distinctive features of replacement lipomatosis. Ultrasonographic and computed tomographic features in three cases of replacement lipomatosis of the kidney are reported.
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  • 58
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    European radiology 9 (1999), S. 1638-1642 
    ISSN: 1432-1084
    Keywords: Key words: Bone ; Tuberculosis ; CT ; Rib ; Sternum ; Chest wall
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis, excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site) in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan findings were an abscess (n = 14) or a soft tissue mass (n = 2), osteolytic lesions (n = 13), periosteal reaction (n = 10), and sequestrum (n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan.
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  • 59
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    European radiology 9 (1999), S. 1650-1652 
    ISSN: 1432-1084
    Keywords: Key words: Bone tumors ; Cranial fasciitis ; CT ; MR imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Cranial fasciitis is a rare bone lesion in childhood. We report the first case in an adult, with CT and MR imaging, and suggest some diagnostic keys.
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  • 60
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    European radiology 9 (1999), S. 1653-1655 
    ISSN: 1432-1084
    Keywords: Key words: Plexiform schwannoma ; Soft tissue tumor ; Plexiform neurofibroma ; CT ; MR imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The present report describes a plexiform schwannoma involving the subcutis of the foot in an 8-year-old boy. Gross findings revealed thin fibrous septa in a multilobulated tumor that was partly separated into free body-like nodules in the subcutis. Preoperative CT and MRI failed to delineate this multinodular architecture or free bodies. This is a case presentation including the CT and MR findings associated with plexiform schwannoma.
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  • 61
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    European radiology 9 (1999), S. 1672-1674 
    ISSN: 1432-1084
    Keywords: Key words: Congenital diaphragmatic hernia ; Delayed presentation ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. A case of an 11-month-old infant with a delayed presentation of congenital diaphragmatic hernia is reported. Incarceration of the herniated colon caused a misleading appearance on the chest X-ray which was interpreted as massive pleuropneumonia. Computed tomography, performed because of continuing deterioration in the clinical condition, showed fluid-filled bowel loops in the chest and dilated bowel loops with air–fluid levels in the abdomen, suggesting the correct diagnosis.
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  • 62
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    European radiology 9 (1999), S. 1804-1809 
    ISSN: 1432-1084
    Keywords: Key words: Thalassemia ; Extramedullary hematopoiesis ; MRI ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Thalassemia is a kind of chronic, inherited, microcytic anemia characterized by defective hemoglobin synthesis and ineffective erythropoiesis. In all thalassemias clinical features that result from anemia, transfusional, and absorptive iron overload are similar but vary in severity. The radiographic features of β-thalassemia are due in large part to marrow hyperplasia. Markedly expanded marrow space lead to various skeletal manifestations including spine, skull, facial bones, and ribs. Extramedullary hematopoiesis (ExmH), hemosiderosis, and cholelithiasis are among the non-skeletal manifestations of thalassemia. The skeletal X-ray findings show characteristics of chronic overactivity of the marrow. In this article both skeletal and non-skeletal manifestations of thalassemia are discussed with an overview of X-ray findings, including MRI and CT findings.
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  • 63
    ISSN: 1432-1084
    Keywords: Key words: Aberrant left brachiocephalic vein ; CT ; Embryonic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Computed tomography was utilized to evaluate aberrant left brachiocephalic vein (ALBCV), an infrequently discussed congenital vascular anomaly among Chinese people. Associated vascular variation and possible embryonic correlation are discussed. Since 1990, a total of 14 cases of ALBCV have been reported in patients receiving CT scan of chest, and was mainly an incidental diagnosis. One case was confirmed angiographically and two others were confirmed by magnetic resonance imaging. Emphasis was placed on the entry of the azygos vein into the superior vena cava (SVC), the length of the SVC, and the presence of other cardiovascular abnormalities. Of the 14 cases of ALBCV, the level of azygos vein entry was higher than the origin of the SVC in 7 cases: 4 were approximately the same level and 3 were lower. The average length of the SVC was approximately 5.6 cm shorter than that of the general population, which is approximately 7.0 cm. Three cases had associated vascular anomaly. Most cases of ALBCV had azygos vein drainage level higher than or equal to the origin of the SVC. Right-sided aorta is one of the causes giving rise to the ALBCV during embryonic development. The CT scan remains a definitive diagnostic modality for ALBCV.
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  • 64
    ISSN: 1432-1084
    Keywords: Key words: Pharynx ; Larynx ; Neoplasms ; Radiography ; CT ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. In light of recent endoscopic techniques the current value of double-contrast pharyngography (DCP) and of CT for detection and staging of hypo-, oropharyngeal, and supraglottic tumors is evaluated. The DCP of 151 patients and CT obtained from 99 of these patients were retrospectively analyzed in a double-blinded manner. We used a standard protocol which comprised all relevant anatomical subregions. Results were compared with direct microlaryngoscopy (DL), indirect laryngoscopy (IL), and post-operative histopathological findings. Sensitivity and specificity of DCP was 75.0 % and 86.7 %, respectively. The DCP and IL techniques together yielded a higher sensitivity (96.7 %) than each method separately. Sensitivity and specificity of CT was 87.5 and 100 %, respectively. In 74.7 % CT provided correct staging. Subregional analysis revealed that the results of DCP and CT depend highly on the localization of the tumor. Our results indicate that DCP represents an important screening method for diagnosing hypo-, oropharyngeal, and supraglottic tumors to complete IL and DL. We show that CT is a reliable method for preoperative staging, although small superficial tumors may occasionally be missed by this method.
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  • 65
    ISSN: 1432-1084
    Keywords: Key words: Temporal bone ; CT ; Ear ; middle ; Ear ; labyrinth ; Three-dimensional CT ; hybrid rendering ; Virtual endoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Recent developments in 3D reconstructions can enhance the quality and diagnostic value of axial 2D image data sets with direct benefits for clinical practice. To show the possible advantages of a hybrid rendering method [color-coded 3D shaded-surface display (SSD)- and volume rendering method] with the possibility of virtual endoscopy we have specifically highlighted the use in relation to the middle and inner ear structures. We examined 12 patients with both normal findings and postoperative changes, using image data sets from high-resolution spiral computed tomography (HRSCT). The middle and inner ear was segmented using an interactive threshold interval density volume-growing method and visualized with a color-coded SSD rendering method. The temporal bone was visualized using a transparent volume rendering method. The 3D- and virtual reconstructions were compared with the axial 2D source images. The evaluated middle and inner ear structures could be seen in their complete form and correct topographical relationship, and the 3D- and virtual reconstructions indicated an improved representation and spatial orientation of these structures. A hybrid and virtual endoscopic method could add information and improve the value of imaging in the diagnosis and management of patients with middle or inner ear diseases making the understanding and interpretation of axial 2D CT image data sets easier. The introduction of an improved rendering algorithm aids radiological diagnostics, medical education, surgical planning, surgical training, and postoperative assessment.
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  • 66
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    European radiology 9 (1999), S. 1873-1875 
    ISSN: 1432-1084
    Keywords: Key words: Fibroepithelial polyp ; Kidney cyst ; CT ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Fibroepithelial polyps are the most frequently observed mesenchymal tumors of the renal pelvis. We report on one case of fibroepithelial polyp of the renal pelvis with unusual CT findings of totally cystic structure with septations.
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  • 67
    ISSN: 1432-1084
    Keywords: Key words: Duodenal cyst ; CT ; Endoscopic ultrasonography ; Duodenal diverticulum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Intraluminal duodenal diverticulum is a rare congenital web of membrane which may be symptomatic when it becomes distended. This report describes a case revealed by presenting as an acute pancreatitis. The radiological findings are reported. The findings at CT, upper gastro-intestinal series, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography are described and differential diagnostic features from choledochocele and duodenal duplication are discussed. By endoscopic ultrasonography, observation of a thin wall, without different layers such as choledochocele or duodenal duplication, may be useful for diagnosis.
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  • 68
    ISSN: 1432-1084
    Keywords: Key words: Computed tomography (CT) ; spiral technology ; Carotid arteries ; CT ; Vertebral arteries ; CT ; Computed tomography (CT) ; image processing ; Computed tomography (CT) ; threedimensional visualization ; Computed tomography (CT) ; comparative studies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Objective: The purpose of this study was to develop a method for three-dimensional (3D) visualization of the whole vascular system of the carotid and vertebral arteries using spiral computed tomographic angiography (SCTA), that allows accurate, qualitative and quantitative evaluation, of anatomical abnormalities, including detection of additional lesions, and estimation of degree of stenosis. Materials and methods: Fifteen patients with anatomical and pathological abnormalities of the arterial vascular system detected by color-coded duplex ultrasound were studied using intraarterial digital subtraction angiography (IA-DSA) with aortic arch injection, and SCTA. The carotid and vertebral arteries were segmented using an interactive threshold interval density volume-growing method and visualized with a color-coded shaded-surface display (SSD) rendering method. The adjacent bone structures were visualized using a transparent volume rendering method. Results: In all cases, the entire volume of the vascular system of the carotid and vertebral arteries could be visualized on SCTA, and the anatomical and pathological abnormalities on 3D SCTA correlated well with that seen on IA-DSA. Conclusion: Results of 3D SCTA had a high degree of correlation with results of IA-DSA in the evaluation of the vascular system of the carotid and vertebral arteries. The 3D SCTA with a subsecond spiral CT scanner is useful for the visualization of anatomical and pathological abnormalities in the circulation in the carotid and vertebral arteries and offer a promising minimally invasive alternative compared with other diagnostic procedures.
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  • 69
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    European radiology 9 (1999), S. 3-15 
    ISSN: 1432-1084
    Keywords: Key words: Cervical carcinoma ; Endometrial carcinoma ; Leiomyoma ; Adenomyosis ; Benign adnexal masses ; Ovarian carcinoma ; Female pelvis ; MR imaging ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. For imaging of the female pelvis, transvaginal ultrasound is the method of choice. Magnetic resonance imaging and CT provide important additional information in various disorders. Magnetic resonance imaging is superior to CT in diagnosing benign and malignant disorders of the uterus. The same holds for the characterization of adnexal masses, where MR imaging reliably differentiates dermoids, ovarian fibromas, and most endometriomas. Differentiation of other benign and malignant ovarian tumors by CT and MR imaging is based on identical morphological criteria; no superiority of MR imaging over CT has been established. Computed tomography is still the preferred imaging modality for staging ovarian cancer. A thorough knowledge of the pathomorphological changes associated with the different disorders of the female pelvis not only helps to choose the proper imaging modality and examination protocol, but also improves image interpretation.
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  • 70
    ISSN: 1432-1084
    Keywords: Key words: Lymphangioleiomyomatosis ; Lymphangiomyomatosis ; CT ; Lung ; CT ; comparative studies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Lymphangioleiomyomatosis (LAM) of the lung is a very rare disease. There are obvious discrepancies in the literature concerning the appearance of LAM on CT scans of the lung. This study adds the imaging findings of 11 patients and demonstrates how the imaging findings changed over time in four patients. Twenty-two CT examinations, and radiographs that had been obtained close to the CT examinations, of 11 patients with LAM confirmed by open lung biopsy were retrospectively evaluated with particular attention to the size of cystic lesions and wall thickness. Furthermore the CT scans were analysed for the type of pulmonary infiltration process and its distribution, presence or absence of pleural effusion, pneumothorax and lymph node enlargement. Clinical and CT follow-up studies were available in four patients. The CT scans revealed an increase in the interstitial pattern in all patients. Architectural distortion was seen in two patients and cystic lesions were present in all. The size of the cysts varied from small lesions to bullous emphysema. The cystic lesions revealed a wall thickness up to 2 mm but a wall was not perceptible in all. Pneumothorax was seen in only two patients; pleural effusion was seen in two patients. CT examination of patients with LAM reveals neither a uniform nor a pathognomonic appearance. In the early stages of LAM or in cases with interstitial changes the differential diagnosis of centrilobular emphysema or idiopathic pulmonary fibrosis seems to be more difficult than most authors believe.
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  • 71
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    European radiology 9 (1999), S. 68-72 
    ISSN: 1432-1084
    Keywords: Key words: Gastrointestinal tract ; Neoplasms ; Stomach ; Neoplasms ; CT
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The purpose of this study was to evaluate the capabilities of subsecond spiral CT in detecting and staging of gastric cancer. Our study included 40 patients with endoscopically detected gastric carcinomas. Two-phase spiral CT was performed within one breathhold each. Distension of the stomach was achieved by intravenous application of scopolamine and drinking of 500 ml water. After bolus injection of contrast medium, scanning was performed in the arterial and venous phase. Gastric tumour extention and lymph node involvement was assessed. Gastric cancer was detected in 39 of 40 cases (sensitivity 97.5 %). Location of the tumour was correctly assessed in all cases. In 31 of the 39 cases (79.4 %) CT staging was accordant with pathological staging. One hundred two (70 %) of 145 nodes infiltrated by tumour tissue were detected and 144 (42.8 %) of 336 nodes free of metastatic involvement were found. The predictive values of positive and negative results for the detection of lymph node metastases were 67.1 and 75 %, respectively. Spiral CT is recommended for staging of gastric cancer.
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  • 72
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    European radiology 9 (1999), S. 205-207 
    ISSN: 1432-1084
    Keywords: Key words: Extramedullary hematopoiesis ; Paget's disease ; Thorax ; Neoplasm ; CT ; MR imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Extramedullary hematopoiesis usually occurs in hematological diseases but may also be found as an uncommon complication of Paget's disease, probably due to bone effraction mechanism. We present a case of intrathoracic extramedullary hematopoiesis related to Paget's disease. To our knowledge, this is the seventh case reported in the literature. We describe and correlate the conventional X-ray, CT, MR imaging, and cytological findings.
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  • 73
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    European radiology 9 (1999), S. 287-291 
    ISSN: 1432-1084
    Keywords: Key words: Lung ; CT ; Pneumonia ; Aspiration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to assess high-resolution computed tomography (HRCT) findings of exogenous lipoid pneumonia. High-resolution computed tomography was obtained in 25 patients with proven exogenous lipoid pneumonia resulting from aspiration of squalene (derived from shark liver oil). Diagnosis was based on biopsy (n = 9), bronchoalveolar lavage (n = 8), or sputum cytology and clinical findings (n = 8). The clinical history of taking squalene was confirmed in all patients. The CT findings were classified into three patterns: diffuse ground-glass opacity, consolidation, and interstitial abnormalities. Distribution of the abnormalities, duration of taking squalene, predisposing factors for aspiration, and route of administration were analyzed. Ten patients showed diffuse ground-glass opacity pattern. Seven of 10 patients had predisposing conditions such as unconsciousness, pharyngeal dysmotility, or motor disturbances, and 6 patients had a recent history of taking large amount of squalene through nasal route. Seven patients who had consolidation pattern had a history of taking squalene for several months and did not have any predisposing factor. All of the 5 patients who had a pattern of interstitial abnormalities had a history of taking squalene longer than 1 year and showed segmental distribution of interstitial thickening with interposing ground-glass opacities. Three patients simultaneously had two different patterns at different lobes of the lung. The HRCT findings of lipoid pneumonia are ground-glass opacities, consolidation, and interstitial abnormalities. These HRCT findings with appropriate inquiries could be useful for diagnosis of exogeneous lipoid pneumonia.
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  • 74
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    European radiology 9 (1999), S. 643-647 
    ISSN: 1432-1084
    Keywords: Key words: MRI ; CT ; Lumbar vertebrae ; Osteoporosis ; Trabeculae
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of the study was to assess the relative number of bone trabeculae in different orientations by using magnetic inhomogeneity measurements by MR imaging. Twelve defatted human vertebrae (L2–L4) were studied by MR imaging and CT. In the MR measurements the reversible transaxial decay rate, R2', was determined using the GESFIDE sequence. The relative contribution to R2' of bone trabeculae oriented along the x (R2'x), y (R2'y) and z (R2'y) axes was assessed, by rotation of the specimen in the magnetic field. The results were validated by CT measurements of trabecular structure at a resolution of 0.2 × 0.2 × 1 mm, using custom-made software. R2' ranged from 4.9 to 32 s–1. After separation, theoretical R2'x ranged from 2.3 to 10.7 s–1, R2'y ranged from 2.6 to 14.0 s–1 and R2'z ranged from 4.7 to 17.9 s–1. The number of bone trabeculae per millimeter identified in axial CT images ranged from 0.15 to 0.38 and from 0.039 to 0.22 per millimeter in sagittal images. The difference between axial and sagittal CT images was statistically significant and due to anisotropic voxels. The correlation between R2' and the number of bone trabeculae per millimeter was statistically significant (r = 0.83, p 〈 0.001 for x orientation; r = 0.63 for y orientation, and r = 0.59 for z orientation, p 〈 0.05 for both). The relative amount of bone trabeculae in different orientations can be assessed in vitro using R2' measurements.
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  • 75
    ISSN: 1432-1084
    Keywords: Key words: Appendicitis ; Diverticulitis ; US ; CT ; Pitfalls
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We describe four patients in whom ultrasound (US) and/or computed tomography (CT) demonstrated a thickened appendix, secondarily enlarged due to perforated sigmoid diverticulitis (n = 2) or carcinoma (n = 2). The underlying pathology was correctly recognized in all cases. Secondary thickening of the appendix due to perforated sigmoid disease provides a potential pitfall mainly on US and may lead to an incorrect diagnosis and thus to unnecessary surgery or a wrong surgical intervention. Although US alone is enough to diagnose periappendicitis and sigmoid disease, combined use of US and CT may improve assessment of its origin and extension.
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  • 76
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    European spine journal 8 (1999), S. 261-265 
    ISSN: 1432-0932
    Keywords: Key words Vertebral rotation ; Idiopathic scoliosis ; CT ; Method
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract CT measurement methods have good reliability for idiopathic scoliosis transverse plane deformity evaluation. However, because of application difficulties and variations in how these methods are applied, more sensitive methods are needed. This paper presents a new method for measurement of vertebral rotation from tomographic scans. First, the method was subject to clinical, intra-observer and inter-observer analysis. Twenty-three patients with adolescent idiopathic scoliosis were studied to test the clinical reliability of this method. There were no statistical differences between the results of the new method and Ho’s method (P = 0.3380) in the clinical study. Intra-observer and inter-observer analysis showed that this method was reliable. An experimental study was then conducted to show the confidence limits of our new method, which were found to be ± 1.6°, and there was no significant difference between the mean rotation value obtained from CT scans using our new method and that obtained using the mechanical method. These results suggest that our new method is a simple, practical and reliable method for measurement of vertebral rotation from CT scans.
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  • 77
    ISSN: 1432-0932
    Keywords: Key words Synovial cyst ; CT ; MRI ; Surgical treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors describe the case of a 58-year-old man with a 6-month history of severe myelopathy. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at a right posterolateral site at the level of the articular facet. At operation the mass appeared to originate from the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. Once the mass had been removed, there was a significant amelioration of the patient’s symptoms. As previously suspected, histological aspect was synovial cyst. Cervical synovial cysts are extremely rare and, as far as we know, only 22 cases have so far been described in the literature. Diagnostic radiological investigations used were CT scan and MRI. At CT scan the most important diagnostic findings are a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst. At MRI the contents of the cyst are iso/hypointense on T1- and hyperintense on T2-weighted images. There may also be a hypointense rim on T2-weighted images, which enhances after i.v. administration of gadolinium. Surgical treatment consists of removal of the mass. Fixation of the vertebral segments involved is not always necessary.
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  • 78
    ISSN: 1432-2161
    Keywords: Key words Malignant peripheral nerve sheath tumor ; Schwannoma ; Neurofibroma ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To distinguish between benign and malignant tumors in the peripheral nerves. Design and patients. The clinical, imaging and histologic findings of 99 benign and 16 malignant tumors in the peripheral nerves were reviewed retrospectively. Results. Preoperative motor weakness was observed in only six of 99 benign tumors and was mild, while slight to severe motor weakness was present in 15 of 16 malignant lesions. Pain at rest was present in five of 99 benign tumors and in 15 of 16 malignant tumors. All benign lesions showed a smooth tumoral margin, while half the malignant lesions showed an invasive margin on CT or MRI. Thirteen of 28 benign lesions on CT and nine of 23 on MRI showed round to geographic central enhancement, but this pattern was not seen in malignant lesions. Conclusion. Absence of severe motor weakness and a central enhancement pattern strongly suggest a benign nature, while severe rest pain and invasive tumor margin suggest malignant lesions in peripheral nerve tumors.
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  • 79
    ISSN: 1432-2161
    Keywords: Key words Chronic expanding hematoma ; Ancient hematoma ; CT ; MRI ; Soft tissue mass
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To identify the characteristic MRI findings of chronic expanding hematoma correlated with the pathology. Design and patients. Three patients who had a chronic expanding hematoma involving the musculoskeletal system were reviewed retrospectively. Results and conclusion. Huge soft tissue masses suggestive of malignancy with destruction of the bony structure were revealed on radiography and computed tomography. MRI showed the masses to exhibit heterogeneous signal intensity on both T1- and T2-weighted images with a peripheral rim of low signal intensity, reflecting the central zones of fluid collection due to fresh and altered blood with a wall of collagenous fibrous tissue. These MRI findings were seen in all three patients and are considered to be characteristic; they assist in differentiation from neoplasm in consideration of the history of trauma or surgery.
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  • 80
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    Skeletal radiology 28 (1999), S. 470-472 
    ISSN: 1432-2161
    Keywords: Key words Telangiectatic osteosarcoma ; CT ; Paget’s disease ; skull
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Sarcomatous transformation is the most dreaded complication of Paget’s disease. We report on a case of post-Paget telangiectatic osteosarcoma of the skull, a variant of osteogenic osteosarcoma, in a 79-year-old woman. We discuss the radiological pattern in relationship to the differential diagnosis.
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  • 81
    ISSN: 1432-2161
    Keywords: Key words Chondrosarcoma ; Osteochondroma ; Bursa ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Multiple hereditary osteochondromatosis is an uncommon autosomal dominant condition in which patients are predisposed to the development of chondrosarcoma. We report a case of a patient who developed a secondary low-grade chondrosarcoma in this setting. The tumor was associated with an unusual multinodular invasive growth pattern into a pre-existing bursa that was present overlying the osteochondroma.
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  • 82
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    Skeletal radiology 28 (1999), S. 584-589 
    ISSN: 1432-2161
    Keywords: Key words Myxopapillary ependymoma ; Sacrum ; Osteolysis ; X ray ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed.
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  • 83
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Multidetektor ; CT ; MSCT ; Larynx ; Tumoren ; Multiplanare Rekonstruktion ; Key words Computer tomography ; Larynx Head and neck tumors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The purpose of the study was to preoperatively investigate small laryngeal carcinomas using multi-slice spiral CT (MSCT) and subsequent multiplanar reconstructions (MPR) and to compare the results to the detailed spread found at surgery and histology. Nine patients with small (T1, T2) laryngeal cancer were investigated on a MSCT scanner (Siemens plus 4 Volume Zoom, Siemens). A 4×1 mm collimation, 120 kV, 200 mAs and a 0.5 seconds rotation time were used, allowing a coverage of the entire larynx in approximately 10 seconds within a single breathhold. Multiplanar reconstruction’s (MPR) in sagittal and coronal plane were reconstructed in all patients and rated in consensus reading. In 8 of nine patients, the glottic spread was detected by MSCT, in one cause of a supraglottic tumor a glottic invasion was excluded. The infiltration of the anterior commissure, the infiltration into the subglottic space and the extension into the hypopharynx was correctly assessed in all patients. MSCT was not able to predict infiltration of the arythnoids in two patients. The use of multi-slice spiral CT for the preoperative assessment of small laryngeal tumors shows great promise. The detection or exclusion of subtle spread of these tumors into the supra- or subglottic space and along the glottic level was possible with high accuracy. As the examination time is short, artifacts are rare and multiplanar reconstructions gain in clinical importance.
    Notes: Zusammenfassung Zielsetzung war, kleine Larynxkarzinome mit der Mehrschicht-Spiral-CT (MSCT) und nachfolgenden multiplanaren Rekonstruktionen (MPR) präoperativ zu untersuchen. 9 Patienten mit histologisch gesichertem Larynxkarzinom der Stadien T1 und T2 wurden untersucht. Alle Untersuchungen wurden an einem Mehrschicht-Spiral-CT (Somatom Plus 4 Volume Zoom, Siemens, Forchheim) durchgeführt. Die Abtastung erfolgte mit 4×1 mm Kollimation, 120 kV, 200 mAs bei einer Rotationszeit der Röhre von 0,5 s. Die Beurteilung einer Infiltration erfolgte durch die Bewertung aller drei Ebenen. Das glottische Wachstum entlang der Stimmlippen konnte in 8 von 9 Patienten richtig-positiv nachgewiesen werden. In einem Fall eines supraglottischen Tumors konnte eine glottische Infiltration ausgeschlossen werden. Die Infiltration der vorderen Kommissur, die Infiltration in den subglottischen Raum und die Ausdehnung in den Hypopharynx konnte ebenfalls sicher nachgewiesen bzw. ausgeschlossen werden. Die Infiltration der Aryknorpel konnte in 7 von 9 Fällen korrekt durch die MSCT vorhergesagt werden. Der Einsatz der Mehrschicht-Spiral-CT bei kleinen Larynxkarzinomen zeigt eine hohe Genauigkeit zum Nachweis bzw. zum Ausschluß von Infiltrationen sowohl in der glottischen Ebene, wie auch in den supra- oder subglottischen Raum. Bedingt durch die kurze Untersuchungszeit sind Bewegungsartefakte selten. Multiplanare Rekonstruktionen (MPR) sind klinisch sehr wertvoll.
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  • 84
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    Der Radiologe 39 (1999), S. 562-567 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Kolorektales Karzinom ; Präoperatives Staging ; Endosonographie ; CT ; MRT ; Key words Colorectal cancer ; Preoperative staging ; Endosonography ; Computed tomography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Carcinoma of the colorectum is one of the most frequent neoplasias, with an incidence of 40 in 100 000. For the effective use of new, differentiated, less invasive treatment options, exact preoperative staging of the tumor is essential. The introduction of endosonography in rectal tumor staging allows for exact differentiation of the rectal wall layers and thus of tumor stages 1–3 with median accuracy of 89%. Magnetic resonance imaging of the rectum, especially in double-contrast technique, can also be employed in high and stenosing tumors and leads to an average accuracy of 85% for the stages 1–4. Computed tomography is the method of choice in screening for metastases. In lymph node staging, all modalities show only moderate accuracy around 75%.
    Notes: Zusammenfassung Das kolorektale Karzinom stellt mit einer Inzidenz von 40 auf 100000 eine der häufigsten Neoplasien dar. Für den effektiven Einsatz neuer differenzierter Therapien mit geringerer Invasivität ist ein exaktes präoperatives Staging erforderlich. Die Einführung der Endosonographie im Tumorstaging erlaubt eine exakte Differenzierung der Wandschichten und damit der Tumorstadien 1–3 mit einer mittleren Genauigkeit von 89%, die Magnetresonanztomographie des Rektums, insbesondere in Doppelkontrasttechnik, kann auch bei hohen und stenosierenden Tumoren angewendet werden, bei einer Genauigkeit von durchschnittlich 85% für die Stadien 1–4. Die Computertomographie ist Methode der Wahl im Metastasenscreening. Im Lymphknotenstaging zeigen alle Modalitäten nur bescheidene Genauigkeiten um 75%.
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  • 85
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    Der Radiologe 39 (1999), S. 610-618 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Staging ; Gynäkologische Karzinome ; Schnittbildverfahren ; Computertomographie (CT) ; Magnetresonanztomographie (MRT) ; Sonographie (US) ; Key words Staging ; Gynecologic neoplasm ; Cross-sectional imaging modalities ; CT ; MRI ; Sonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The prognosis in patients with gynecologic cancers depends not only on the stage but also on a wide spectrum of other findings. Cross-sectional imaging modalities, including sonography, CT and MRI, have increasingly been used for optimal treatment planning in gynecologic cancers. Their staging criteria are based on the well-established FIGO staging system. CT and MRI compete with sonography, which plays a pivotal role in the evaluation of the female pelvis. This paper reviews the role of sonography, CT and MRI in the staging of gynecologic malignancies. It puts the emphasis on MRI, which has been established as imaging modality of choice in the preoperative evaluation of cervical and endometrial cancer, and which seems slightly superior to CT in the staging of ovarian cancer.
    Notes: Zusammenfassung Die Prognose gynäkologischer Karzinome hängt nicht nur vom Stadium, sondern von einem breiten Spektrum anerkannter Kriterien ab. Zur optimierten Therapieplanung werden heute zunehmend die Schnittbildverfahren Sonographie, CT und MRT für die morphologische Charakterisierung der Veränderungen eingesetzt. Die Stagingkriterien der bildgebenden Verfahren orientieren sich an der anerkannten FIGO-Klasssifikation. CT und MRT konkurrieren mit der Sonographie, die als anerkannte und weitverbreitete Modalität in der Gynäkologie etabliert ist. In dieser Übersichtsarbeit werden die Schnittbildverfahren Sonographie, CT und MRT im Staging gynäkologischer Karzinome einander gegenübergestellt. Der Schwerpunkt der Ausführungen liegt dabei auf der MRT, die als Methode der Wahl zum Staging des Zervix- und Endometriumkarzinoms gilt, beim Ovarialkarzinom der CT ebenbürtig und in manchen Fragestellung tendentiell überlegen ist.
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  • 86
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    Annals of oncology 10 (1999), S. 197-203 
    ISSN: 1569-8041
    Keywords: breast cancer ; cost-effectiveness ; mammography ; screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Mammography screening is a promising method for improving prognosis in breast cancer. Patients and methods: In this economic analysis, data from the Norwegian Mammography Project (NMP), the National Health Administration (NMA) and the Norwegian Medical Association (NMA) were employed in a model for cost-effectiveness analysis. According to the annual report of the NMP for 1996, 60,147 women aged 50–69 years had been invited to a two-yearly mammographic screening programme. 46,329 (77%) had been screened and 337 (0.7%) breast cancers had been revealed. The use of breast conserving surgery (BCS) was in this study estimated raised by 17% due to screening, the breast cancer mortality decreased by 30% and the number of life years saved per prevented breast cancer death was calculated 15 years. Results: The cost per woman screened was calculated £75.4, the cost per cancer detected £10,365 and the cost per life year (LY) saved £8,561. A raised frequency of BCS, diagnosis and adjuvant chemotherapy brought two years forward, follow-up costs and costs/savings due to prevented breast cancer deaths were all included in the analysis. A sensitivity analysis documented mammography screening cost-effective in Norway when four to nine years are gained per prevented breast cancer death. Conclusion: Mammography screening in Norway looks cost- effective. Time has come to encourage national screening programmes.
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  • 87
    ISSN: 1569-8041
    Keywords: anastrozole ; aromatase inhibitors ; breast cancer ; hormonal therapy ; letrozole ; review ; vorozole
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Three new aromatase inhibitors have recently completed phase III evaluation as treatment of metastatic breast cancer in post-menopausal women whose disease has progressed despite tamoxifen therapy: anastrozole (ARIMIDEX, Zeneca), letrozole (FEMARA, Novartis) and vorozole (RIVIZOR, Janssen). All belong to the third generation of non-steroidal aromatase inhibitors, and each is superior to previous generations in terms of potency and selectivity. The trials that have been performed compare each agent to megestrol acetate, and letrozole and vorozole to aminoglutethimide. Although the studies are not directly comparable due to differing study designs and patient populations, it has been demonstrated each of these drugs provides single agent, once-daily, oral palliation of hormone-responsive, post-menopausal metastatic breast cancer. Letrozole is clearly more effective than megestrol acetate, and anastrozole and vorozole are possibly so. All three are better tolerated than the progestin, particularly in terms of weight gain. Both letrozole and vorozole are significantly more effective, and better tolerated than aminoglutethimide. Overall, this most recent generation of aromatase inhibitors is a clear improvement on our current standard second-line therapies. In 1999, tamoxifen remains the first choice in the hormonal therapy of breast cancer. Following tamoxifen failure, the optimal second-line hormonal therapy remains undefined, but aminoglutethimide and megestrol acetate are no longer optimal therapy in this setting. The third-generation non-steroidal aromatase inhibitors must now be compared to each other, to the steroidal aromatase inhibitors, to the pure anti-oestrogens, and to tamoxifen.
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  • 88
    ISSN: 1569-8041
    Keywords: breast cancer ; cisplatin ; ovarian cancer ; paclitaxel
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Despite the known association of these malignancies, the incidence of a synchronous presentation of breast and ovarian cancer is low, and the current literature does not address an approach to this clinical problem directly. We report a greater than 2.5 year disease-free survival in a patient treated for synchronous stage IIIB inflammatory breast cancer and stage IIIC epithelial ovarian cancer. The prolonged disease-free survival in our case may provide some guidance in this unusual clinical situation.
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  • 89
    ISSN: 1569-8041
    Keywords: breast cancer ; local regional therapy ; stem-cell transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: High-dose chemotherapy with autologous stem-cell transplantation is used increasingly in the treatment of poor-prognosis primary breast cancer. Because these patients may be cured with standard multimodality therapy, it is important to address both the efficacy of transplantation, and its effect on the delivery of standard treatments including local radiation therapy. Patients and methods: Patients with high risk primary breast cancer were treated with high-dose cyclophosphamide and thiotepa and stem-cell transplant following surgery and conventional-dose adjuvant chemotherapy. Outcome, including sites of failure and delivery of local radiation therapy, was assessed for 103 patients. Results: Overall and disease-free survival rates at 18 months were 83% (± 4%) and 77% (± 4%) respectively. Twenty patients (19.4%) received radiation therapy prior to transplant. Of the remaining 83, 77 received radiation therapy after transplant. Overall, 5 (19.2%) of 26 first sites of recurrence were local alone. For patients receiving radiation prior to transplant, 3 of 7 (43%, 95% CI: 6%–80%) sites of first recurrence were local, while 2 of 19 (10.5%, 95% CI: 0%–24.5%) sites of first recurrence were local alone in patients receiving post-transplant radiation or no radiation. Conclusion: Transplantation does not appear to significantly compromise the delivery or outcome of local radiation therapy for primary breast cancer.
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  • 90
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    Annals of oncology 10 (1999), S. 129-137 
    ISSN: 1569-8041
    Keywords: adjuvant treatment ; breast cancer ; systemic therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The theoretical prediction that breast cancer is a systemic disease, and that patients may benefit from addition of systemic therapy to local treatment, has now been confirmed by three decades of clinical investigations. A long-term follow up of individual trials and the International Overview based on meta-analyses clearly showed the potential of both hormonal therapies and chemotherapy to prolong disease-free and overall survival in nearly all groups of patients. The benefits have been demonstrated for both premenopausal and postmenopausal patients, with both node-negative and node-positive disease. However, there is still considerable uncertainty regarding the most appropriate treatment for each individual patient. In the present review, the results of meta-analysis are highlighted in the context of the new trials supporting the value of chemoendocrine therapy and anthracycline-based therapy. The results of prospective randomised trials evaluating the role of dose intensification, drug sequencing and dose density are discussed. Also presented are new treatment strategies, such as preoperative chemotherapy and high-dose chemotherapy with stem cell support, the value of which remains to be confirmed. Future possibilities opened by inclusion of biologics into adjuvant therapy are discussed.
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  • 91
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    Annals of oncology 10 (1999), S. 139-146 
    ISSN: 1569-8041
    Keywords: anthracycline ; breast cancer ; chemotherapy ; HER-2 antibody ; N,N-diethyl-2[4-(phenylmethyl)-phenoxy] ethanamine.HCl (DPPE, BMS-217380-01) ; paclitaxel
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Anthracyclines and taxanes are the two most active classes of chemotherapy for the treatment of advanced breast cancer. Recent studies have investigated combination therapy including doxorubicin (Dox) and paclitaxel. The efficacy of this combination has been established in a phase III study conducted by ECOG, comparing Dox/paclitaxel versus Dox versus paclitaxel. The combination is superior to Dox or paclitaxel with respect to response rate and time to disease progression, indicating that the combination provides a new standard for the first line treatment of metastatic breast cancer [1]. Phase II studies using higher doses of Dox and using shorter infusions of paclitaxel have suggested the combination can be further optimised; Gianni reported a 94% objective response rate using Dox 60 mg/m2 followed by paclitaxel 175 mg/m2 given over three hours [2]. The more active regimens are associated with enhanced cardiotoxicity; this toxicity can be avoided, however, by limiting the exposure to doxorubicin. The newer regimens have now been moved into phase III studies. Future progress for this disease will depend on the introduction of new agents. Two novel drugs are currently being investigated in randomised phase III trials as potentiators of Dox and/or paclitaxel. One is a monoclonal antibody from Genentech (Herceptin, trastuzumab) directed at the HER-2/neu oncogene, which is overexpressed in 〉25% of breast cancers [3]. Recent results indicate that Herceptin in combination with paclitaxel (or with a Dox plus cyclophosphamide regimen) induces a higher response rate (RR) and prolongs the time to disease progression when compared to chemotherapy alone. The second agent N,N-diethyl-2[4-(phenylmethyl)-phenoxyl] ethanamine.HCl (DPPE, BMS-217380-01), when combined with Dox, was associated with a higher RR than previously observed with Dox alone [4]. A randomised trial of Dox versus Dox plus DPPE is ongoing. The possible mechanisms underlying chemo-potentiation by these agents are discussed. As new anthracycline/taxane combinations establish themselves in earlier stages of the disease, the need for effective, non-cross resistant salvage regimens will emerge.
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  • 92
    ISSN: 1569-8041
    Keywords: breast cancer ; Cowden disease ; Lhermitte Duclos
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 93
    ISSN: 1569-8041
    Keywords: anastrozole ; Arimidex® ; aromatase inhibitor ; breast cancer ; formestane ; oestradiol ; tolerability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: This study provides a direct randomized comparison of a new-generation, non-steroidal aromatase inhibitor, anastrozole (Arimidex®), with a steroidal aromatase inhibitor (formestane) with respect to oestrogen (oestradiol, oestrone, and oestrone sulphate) suppression and tolerability. Patients and methods: Sixty postmenopausal women with advanced breast cancer were randomized to receive either anastrozole 1 mg once daily orally (n = 29), or formestane 250 mg once every two weeks by intramuscular injection (n = 31). Treatment was continued until progression of disease or withdrawal from the study. The primary endpoints of this study were oestradiol suppression and tolerability. The secondary endpoints included oestrone and oestrone sulphate suppression. All laboratory analyses were conducted ‘blind’ of the randomized drug treatment. Results: Anastrozole produced a greater and more consistent suppression of oestradiol levels compared with formestane. Based on two- and four-week measurements, the mean fall from baseline (pre-dose) in oestradiol level was 79% and 58% in the anastrozole and formestane groups, respectively (P = 0.0001). After four weeks of treatment, oestrone and oestrone sulphate levels were also suppressed to a greater extent by anastrozole compared with formestane (oestrone: 85% versus67%, respectively, P = 0.0043; oestrone sulphate: 92% versus 67%, respectively, P = 0.0007). No statistical differences were seen between the two drugs in the incidence of adverse events. Conclusions: Anastrozole provides a more consistent and significantly more effective suppression of oestradiol compared with formestane. Similar results were observed for oestrone and oestrone sulphate. The clinical significance of these differences in total oestrogen suppression remains to be established.
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  • 94
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    Annals of oncology 10 (1999), S. 121-127 
    ISSN: 1569-8041
    Keywords: breast cancer ; mammography ; prevention ; screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From numerous studies on breast cancer it can be concluded that no single measure can lessen the burden of this frequent cancer in women in all developed countries. Complex strategies including primary prevention by identification of risk factors and their modification, secondary prevention by earlier detection and tertiary prevention by improving treatment outcome are needed to control the disease. Besides age, the established breast cancer risk factors include certain benign breast diseases, family history, ionising radiation, some reproductive factors and obesity. Primary prevention includes general recommendation for healthy lifestyle, e.g., avoidance of obesity, proper diet, physical activity and moderate alcohol consumption. Randomised controlled trials conducted in the USA, Canada, Scotland and Sweden have shown that regular mammography, alone or in combination with clinical examination, is effective in reducing mortality for about 30% in women over the age of 50, and much less in younger population. However, mammography screening has several drawbacks, the major being its tendency towards false positive and false negative results with all their potential psychosocial consequences. High quality assurance and control, as well as effective and readily available treatment, all of which demand high investments, are indispensable for good results. Even in the absence of organised screening, the availability of effective treatment may contribute to reduction in breast cancer mortality.
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  • 95
    ISSN: 1569-8041
    Keywords: breast cancer ; cytomegalovirus pneumonia ; dexamethasone ; ganciclovir ; standard dose chemotherapy regimen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cytomegalovirus (CMV) pneumonia in the setting of non-transplantation patients is a rarity. We present a case of CMV pneumonitis in a woman with stage IV breast cancer, with brain metastases, receiving both chemotherapy and systemic corticosteroids. A review of the literature reveals this as a unique case. Potential viral etiologies should therefore be considered in cancer patients with pneumonia receiving non-transplantation chemotherapy-regimens, particularly if steroids are a component of their therapy.
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  • 96
    ISSN: 1569-8041
    Keywords: breast cancer ; docetaxel ; epirubicin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To determine the maximum tolerable dose (MTD) and the dose-limiting toxicity (DLT) of docetaxel (D) in combination with epirubicin (Epi) in patients with advanced breast cancer. Patients and methods: Forty-seven chemotherapy-naïve metastatic breast cancer patients aged 〈75 years with PS (WHO) 0–2 and adequate bone marrow, renal, liver and cardiac function, were enrolled in the study. Epi was given as a five-min bolus i.v. infusion on day 1 (d1) in escalated doses with increments of 10 mg/m2; D was given in a one-hour infusion after appropriate premedication on either day 1 or on day 2 in escalated doses with increments of 10 mg/m2. The patients' median age was 60 years, 42 (89%) had a PS (WHO) 0–1, 16 (34%) were premenopausal and 25 (53%) had visceral disease. Results: When the two drugs were given on the same day, the MTD1 was reached at the doses of Epi 60 mg/m2 and D 80 mg/m2; administration of G-CSF could not result in a dose intensification. When the drugs were given on two consecutive days, the MTD2 was reached at the doses of Epi 80 mg/m2 (d1) and D 90 mg/m2 (d2). The dose-limiting events were febrile neutropenia and grade 4 neutropenia, which developed in 30 (64%) patients during the study; among 227 delivered cycles grade 3–4 neutropenia occurred in 64 (28%) cycles but only 22 (10%) of them were complicated by fever. There were no septic deaths. Grade 1–2 neurosensory toxicity occurred in nine (19%) patients, mild edema in eight (17%) and allergic reactions in five (11%). Four (9%) patients presented a greater than 10% decrease of LVEF and treatment discontinuation was required in two of them; none of the patients developed congestive heart failure. Nevertheless, one patient suddenly died 10 days after treatment initiation of myocardial ischemia, and this death is considered treatment-related. Five (14.7%) complete and thirteen (38.2%) partial responses (ORR: 53.9%; 95% confidence interval: 36.1%–69.7%) were observed in 34 evaluable patients. Ten (29.4%) and six (17.6%) patients had stable and progressive disease, respectively. The median duration of response and time to tumor progression were five and seven months, respectively. The median survival has not yet been reached. Conclusions: The combination of epirubicin and docetaxel is a feasible and well tolerated regimen, but the MTD depends on the administration schedule of the drugs.
    Type of Medium: Electronic Resource
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  • 97
    Electronic Resource
    Electronic Resource
    Springer
    Annals of oncology 10 (1999), S. 627-636 
    ISSN: 1569-8041
    Keywords: breast cancer ; depression ; diagnosis ; treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 98
    ISSN: 1569-8041
    Keywords: breast cancer ; paclitaxel ; phase I ; vinorelbine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: In vitro experiments suggest that administration of vinorelbine preceding paclitaxel results in synergistic cytotoxic effects. A phase I dose escalation trial of vinorelbine daily × 3 with paclitaxel on day 3 repeated every 28 days in metastatic breast cancer patients was completed. Patients and methods: Female patients, PS 0–2, without evidence of CNS disease or prior neuropathies were treated with vinorelbine at dose levels 7, 10, 13 mg/m2 per day and paclitaxel over three hours at dose levels of 135, 175, and 200 mg/m2. Results: Twenty-eight patients with six dose levels were studied. At dose level 1, patients developed intolerable but reversible neutropenia. Subsequent dose levels required filgrastim. Dose limiting toxicities were myalgia and fatigue at vinorelbine 13 mg/m2 /day and paclitaxel 200 mg/m2. Neuropathy was minor. Twelve of twenty-five patients with measurable disease had a rapid response which did not correlate with dose level. Conclusions: Sequential administration of these two agents demonstrates activity in breast cancer patients. Phase II dosing on this schedule should be vinorelbine 13 mg/m2/day × 3 and paclitaxel 175 mg/m2. With proper selection of patients, concern about neurologic toxicity should not impede future trials of vinorelbine with paclitaxel.
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  • 99
    Electronic Resource
    Electronic Resource
    Springer
    Strahlentherapie und Onkologie 175 (1999), S. 419-427 
    ISSN: 1439-099X
    Keywords: Key Words: Interstitial HDR brachytherapy ; CT ; Conformal treatment ; Schlüsselwörter: Interstitielle HDR-Brachytherapie ; CT ; Konformale Therapie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Ziel: Entwicklung, Anwendung und Evaluierung einer CT-gesteuerten Implantationstechnik und einer vollständig CT-gestützten Behandlungsplanung für Brachytherapie. Material und Methoden: Es wurde ein Brachytherapieverfahren, basierend auf einer CT-gesteuerten Implantationstechnik und CT-gestützter Bestrahlungsplanung, entwickelt und klinisch evaluiert. Für diese Zielsetzung wurde ein Softwaresystem (PROMETHEUS) zur 3D-Rekonstruktion der Applikatoren und der individuellen anatomischen Verhältnisse unter ausschließlicher Verwendung von CT-Schnittbildern entwickelt. Hierzu wurde ein Interface für das Nucletron-PLATO-BPS-Planungssystem zur Optimierung und Berechnung der Dosisverteilung realisiert. Das Zielvolumen (PTV) wird definiert und zur Optimierung der dreidimensionalen Dosisverteilung verwendet. Die Analyse der Dosisverteilung mittels Dosisvolumenhistogrammen (COIN) ermöglicht eine klinische Bewertung des Brachytherapieverfahrens. Die CT-gesteuerte Katheterimplantation und die CT-gestützte Bestrahlungsplanung zur Behandlung unterschiedlicher Tumoren in verschiedenen anatomischen Regionen wurden bei 197 Patienten in dem Zeitraum 1996 bis 1997 durchgeführt. Ergebnisse: Die Genauigkeit der CT-Rekonstruktion wurde mit Hilfe eines Brachytherapie-QA-Phantoms und eines Implantats mit zwölf Nadeln überprüft. Die Ergebnisse wurden mit denen der konventionellen Rekonstruktion aus Röntgenaufnahmen verglichen. Beide Methoden ergaben vergleichbare Ergebnisse in Hinblick auf die Rekonstruktionsgenauigkeit. Die CT-gestützte Rekonstruktion war jedoch schneller. In der klinischen Anwendung wurden Tumorvolumina zwischen 5,1 und 2 741 cm3 behandelt. Die Auswertung der Bestrahlungspläne ergab einen geringfügig signifikant geringeren COIN-Wert für die Knochenimplantate, aber keine Unterschiede hinsichtlich des Tumorvolumens. Schlußfolgerung: Die entwickelte Offenbacher Methode hat sich in der klinischen Routine zur Durchführung einer CT-gestützten Brachytherapie in unterschiedlichen Tumorlokalisationen bewährt. Unsere CT-gesteuerte Implantationstechnik zusammen mit dem CT-gestützten Planungssystem ermöglicht uns eine konformale Brachytherapiebehandlung.
    Notes: Purpose: Development, application and evaluation of a CT-guided implantation technique and a fully CT-based treatment planning procedure for brachytherapy. Methods and Materials: A brachytherapy procedure based on CT-guided implantation technique and CT-based treatment planning has been developed and clinical evaluated. For this purpose a software system (PROMETHEUS) for the 3D reconstruction of brachytherapy catheters and patient anatomy using only CT scans has been developed. An interface for the Nucletron PLATO BPS treatment planning system for optimization and calculation of dose distribution has been devised. The planning target volume(s) are defined as sets of points using contouring tools and are used for optimization of the 3D dose distribution. Dose-volume histogram based analysis of the dose distribution (COIN analysis) enables a clinically realistic evaluation of the brachytherapy application to be made. The CT-guided implantation of catheters and the CT-based treatment planning procedure has been performed for interstitial brachytherapy and for different tumor sites in 197 patients between 1996 and 1997. Results: The accuracy of the CT reconstruction was tested using first a quality assurance phantom and second, a simulated interstitial implant of 12 needles. These were compared with the results of reconstruction using radiographs. Both methods gave comparable results with regard to accuracy, but the CT based reconstruction was faster. Clinical feasibility was proved in pre-irradiated recurrences of brain tumors, in pretreated recurrences or metastatic disease, and in breast carcinomas. The tumor volumes treated were in the range 5.1 to 2,741 cm3. Analysis of implant quality showed a slightly significant lower COIN value for the bone implants, but no differences with respect to the planning target volume. Conclusions: The Offenbach system, incorporating the PROMETHEUS software for interstitial HDR brachytherapy has proved to be extremely valuable in routine clinical practice for many tumor sites. Our CT-guided implantation technique together with a fully CT-based planning system has enabled conformal brachytherapy treatment to become routine.
    Type of Medium: Electronic Resource
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  • 100
    ISSN: 1573-4919
    Keywords: protein kinase A ; site-directed mutagenesis ; breast cancer ; growth arrest ; cAMP response element
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: Abstract Expression of the RIα regulatory subunit of protein kinase A type I is increased in human cancer cell lines, in primary tumors, in cells after transformation, and in cells upon stimulation of growth. Ala99 (the pseudophosphorylation site) of human RIα was replaced with Ser (RIα-p) for the structure-function analysis of RIα. MCF-7 hormone- dependent breast cancer cells were transfected with an expression vector for the wild-type RIα or mutant RIα-p. Overexpression of RIα-P resulted in suppression of protein kinase A type II, the isozyme of type I kinase, production of kinase exhibiting reduced cAMP activation, and inhibition of cell growth showing an increase in G0/G1 phase of the cell cycle and apoptosis. The wild-type RIα overexpression had no effect on protein kinase A isozyme distribution or cell growth. Overexpression of protein kinase A type II regulatory subunit, RIIβ, suppressed RIα and protein kinase A type I and inhibited cell growth. These results show that the growth of hormone-dependent breast cancer cells is dependent on the functional protein kinase A type I.
    Type of Medium: Electronic Resource
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