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ABSTRACT: Here, we report the case of a patient, who showed an antitumour response to a new combination therapy of sorafenib and the histon deacetylase inhibitor panobinostat (LBH-589). D-CEUS (Dynamic contrast-enhanced ultrasonography) was able to predict response to the new therapy regime and may be an interesting tool in the early evaluation of response to therapy. It might be especially useful to differentiate between responders and non-responders of new-targeted pharmaceuticals like multikinase inhibitors in hepatocellular carcinomas.
Case Reports 01/2012; 2012.
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ABSTRACT: Diagnosis of chronic inflammatory bowel diseases (IBD) is based on a combination of clinical symptoms, laboratory tests and imaging data. Imaging of the morphological characteristics of IBD includes the assessment of mucosal alterations, transmural involvement and extraintestinal manifestations. No single imaging technique serves as a diagnostic gold standard to encompass all disease manifestations. Ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) allow cross-sectional imaging of the transmural alterations and extraintestinal manifestations. While in the USA the technique of choice is CT, in Europe the focus is more on MRI and ultrasound (US). Most patients with chronic IBD are diagnosed at a young age. After baseline diagnosis many of these young patients have to undergo repetitive imaging procedures during the variable clinical course of the disease, characterized by alternate periods of remission and active disease, and in monitoring the response to treatment. US has the advantage of being noninvasive, less costly, and easily repeatable, and thus can be very useful in following up patients with IBD. In addition, rising concern about radiation exposure in young adults indicates the demand for radiation-sparing techniques like US and MRI. This article focuses on the current clinical practice of US in IBD, describing the current technologies used in transabdominal intestinal US and the characteristic sonographic findings in Crohn´s disease and ulcerative colitis.
World Journal of Gastroenterology 07/2011; 17(27):3192-7. · 2.47 Impact Factor
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ABSTRACT: To compare software-based quantification of contrast-enhanced ultrasound (CEUS) examinations of focal liver lesions in the arterial and late phases with the enhancement patterns established by the sonologist.
The study cohort comprised 12 malignant and 21 benign hepatic lesions in 33 patients (18 female and 15 male; aged 57 +/- 13 years). All underwent dynamic real-time low mechanical index (<0.3) CEUS, which was stored as video sequences of the various enhancement phases. A software was used for analysis by using different regions of interest (ROI) in a double-blinded manner. The software generated and the visual enhancement patterns were compared, and the t-test was performed.
The videos containing the arterial phase had a mean length of 37.5 +/- 36.7 s and the late phase sequences a mean length of 15.2 +/- 9.2 s. In the arterial phase complete agreement between software and sonologist was 100%, 93.9% and 87.9% with regard to the entire lesion, its centre and its periphery, respectively. The late phase analysis revealed corresponding figures of 90.9%, 87.9% and 90.9%. In the late phase, benign lesions revealed a mean relative enhancement of +65.1 +/- 103.6% and malignant lesions -56.9 +/- 26.3% (p=0.0005) vis-à-vis liver parenchyma. All the malignant and 14% of the benign tumors showed hypo-enhancement of less than -10%.
The complete agreement between the quantitative analysis and the sonologist within the arterial and late phase showed excellent results. Software analysis of the late phase could dichotomise benign and malignant lesions. Objective establishment of iso-enhancement in the late phase excludes malignancy.
European journal of radiology 12/2009; 75(2):e22-6. · 2.65 Impact Factor
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ABSTRACT: Liposarcoma is one of the most common soft-tissue sarcomas. Unless it grows to massive proportions, it rarely causes symptoms. A 64-year-old man presented with weight loss, asthenia, and increasing abdominal girth caused by a large liposarcoma in the left retroperitoneum. Despite resection with sarcoma-free margins and intensive follow-up evaluation, he died of a tumor recurrence 2 years later. Complete surgical resection of the liposarcoma is the only curative option, but establishing a prognosis remains a challenge.
American journal of surgery 04/2009; 197(6):e59-60. · 2.36 Impact Factor
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ABSTRACT: In 40% of all cases of Crohn's disease fistulas emerge during the course of disease. Nevertheless, acne inversa has to be taken into account as an infrequent differential diagnosis. Infliximab as an antibody against the pro-inflammatory mediator TNF-alpha is active in cases of acute Crohn's disease, concomitant fistulas and cutaneous manifestations.
We report on the case of a 54-year-old patient suffering for five years from a severe suppurative fistuling cutaneous disease concomitant to Crohn's disease. At the start of treatment the histological findings of a specimen presented chronically fibrosing lymphoplasmacellular dermatitis with both a very high number of plasma cells and a burrow-like fistula system. Due to superinfection the treatment was at first based on the administration of intravenous and oral doses of antibiotic agents, followed by a treatment course of 14 months with methotrexate and seven applications of infliximab. During the Crohn's disease, which was accompanied by persisting concomitant discomforts, an extensive surgical sanitation of the fistulous tracts was performed. Acne inversa was diagnosed in the subsequent histological analysis of the operative specimen.
Acne inversa is a very rare cutaneous disease. Several case reports describe the successful treatment of acne inversa concomitant to Crohn's disease using anti-TNF-alpha-antibodies. The long-term course of the case presented here shows that the non-response to infliximab might be caused by both the long duration and the distinct grade of seriousness of the acne inversa.
Medical science monitor: international medical journal of experimental and clinical research 02/2009; 15(1):CS14-8. · 1.70 Impact Factor
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ABSTRACT: Endorectal ultrasound is a well-established method for the preoperative staging of rectal tumors. This prospective study was performed to establish whether obtaining a biopsy before endorectal ultrasound has an influence on staging accuracy.
Between 1990 and 2003, a total of 333 rectal tumors were examined preoperatively by using endorectal ultrasound. All patients underwent rectal resection, and the specimens were sent for histologic evaluation. Thirty-three were not biopsied, the remaining at various times before endorectal ultrasound. The chi-squared test or Fisher's exact test were used for statistical analysis to compare the accuracies.
The overall staging accuracy was 71 percent but differed significantly (P = 0.004) between the groups as a function of time elapsed since biopsy. The best results were seen in tumors that were not biopsied before endorectal ultrasound, which were correctly staged in 85 percent of the cases. The least accurate staging (53 percent) was noted when endorectal ultrasound was performed in the third week after biopsy, mostly as a result of overstaging. Biopsy did not have a significant effect on nodal staging.
Biopsy before endorectal ultrasound significantly affects its accuracy. To achieve the most accurate staging, biopsy should be performed after endorectal ultrasound. Endorectal ultrasound staging performed in the first week after biopsy is the second best option but should be interpreted with caution in the second or third week.
Diseases of the Colon & Rectum 08/2008; 51(7):1125-9. · 3.13 Impact Factor
