Predictive value of computed tomography on surgical resectability in locally advanced pancreatic cancer treated with multiagent induction chemotherapy: Results from a prospective, multicentre phase 2 trial (NEOLAP-AIO-PAK-0113).

PURPOSE: To assess the role of current imaging-based resectability criteria and the degree of radiological downsizing in locally advanced pancreatic adenocarcinoma (LAPC) after multiagent induction chemotherapy (ICT) in multicentre, open-label, randomized phase 2 trial. METHOD: LAPC patients were prospectively treated with multiagent ICT followed by surgical exploration within the NEOLAP trial. All patients underwent CT scan at baseline and after ICT to assess resectability status according to national comprehensive cancer network guidelines (NCCN) criteria and response evaluation criteria in solid tumors (RECIST) at the local study center and retrospectively in a central review. Imaging results were compared in terms of local and central staging, downsizing and pathological resection status. RESULTS: 83 patients were evaluable for central review of baseline and restaging imaging results. Downstaging by central review was rarely seen after multiagent ICT (7.7%), whereas tumor downsizing was documented frequently (any downsizing 90.4%, downsizing to partial response (PR) according to RECIST: 26.5%). Patients with any downsizing showed no significant different R0 resection rate (37.3%) as patients that fulfilled the criteria of PR (40.9%). The sensitivity of any downsizing for predicting R0 resection was 97% with a negative predictive value (NPV) of 0.88. ROC-analysis revealed that tumor downsizing was a predictor of R0 resection (AUC 0.647, p = 0.028) with a best cut-off value of 22.5% downsizing yielding a sensitivity of 65% and a specificity of 61%. CONCLUSIONS: Imaging-based tumor downsizing and not downstaging can guide the selection of patients with a realistic chance of R0-resection in LAPC after multi-agent ICT.

Magnetic resonance imaging and magnetic resonance angiography in large-vessel vasculitides.

The role of imaging in diagnosis and monitoring of vasculitides has steadily become more important during the last years. As a result of the technological progress, its low invasiveness and its relatively good diagnostic reliability, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are increasingly used in the assessment of vasculitic changes of extra- and intra-cranial arteries. The aim of this review is to outline the significance of different imaging modalities, particularly the significance of MRI/MRA, in the context of large-vessel vasculitides, especially in regard to the first EULAR (The European League Against Rheumatism)-recommendations on the role of imaging in the process of diagnosis and monitoring of patients with suspected large-vessel vasculitides. Furthermore, some typical imaging findings as well as the basics of MRI technique are to be presented.

[MRI alterations in immunomodulation]. / MRT-Veränderungen bei Immunmodulation.

In this review article, typical imaging findings of diseases elicited by immunomodulatory drugs are presented. Progressive multifocal leucoencephalopathy (PML), a subacute infection due to reactivation of the JC virus, has a typical magnetic resonance imaging (MRI) pattern, which must be considered in the framework of immunomodulatory multiple sclerosis (MS) treatment with natalizumab, fingolimod, rituximab and fumarate and also in lymphoproliferative diseases or other forms of immunosuppression. Restoration of the immune system may result in an overlapping and overwhelming immune response in terms of an immune reconstitution inflammatory syndrome (IRIS). Further conditions with typical MRI patterns comprise methotrexate-associated leucoencephalopathy and posterior reversible encephalopathy syndrome (PRES). In immunotherapy with activation of T­lymphocytes, attention should always be paid to the fact that the T­lymphocytes activated by different processes not only target the diseased tissue but also normal brain tissue.

Efficiency of the polymerase chain reaction for the detection of human immunodeficiency virus type (HIV-1) DNA in the lymphocytes of infected persons: comparison to antigen-enzyme-linked immunosorbent assay and virus isolation.

Seventy-one human immunodeficiency virus type (HIV-1)-positive patients were investigated by polymerase chain reaction (PCR), virus isolation, and antigen detection for the existence of HIV in blood. The identification of HIV DNA by PCR, using three different pairs of primers, yielded a clearly higher detection rate (86%) than with two primer pairs (75%) and was far more sensitive than virus isolation (45%) and antigen ELISA (14%). The PCR-negative results were clearly correlated to asymptomatic clinical stages. However, there was a limited correlation between the clinical stage of disease and the amount of HIV DNA that could be detected in equal numbers of CD4+ cells from different patients, which might be due to their treatment with azido-thymidine (AZT).

[Electrodermal activity--"psychovegetative resonance" in AIDS patients]. / Elektrodermale Aktivität--"Psychovegetative Resonanz" bei AIDS-Patienten.

The habituation of the electrodermal reaction (EDR) is one of the most used variables among psychophysiological indicators in investigations in men. In our department a specific computer assisted technique for measuring habituation, mean amplitude, area underneath the line and "emotional reflection" was developed. 15 acoustic stimuli (500 Hz tone at 72 db intensity lasting for 500 msec) are presented to the patient. The habituation criterion is reached when there are no reactions to 3 consecutive stimuli. Since the first reports in 1981 AIDS has become an expanding major public health problem. Therefore the aim of our investigation was to study electrodermal activity in AIDS-patients, especially the habituation of the EDR. 37 addicted AIDS-patients participated in the study voluntarily and were compared to 30 drug addicted HIV-negative patients, 30 homosexual AIDS-patients and 20 healthy normals. Furthermore the patients were divided according to the stages of their disease. The drug addicted AIDS-patient group habituated earlier than the addicted HIV-negative group, the healthy normals, and the homosexual patients. The drug dependent AIDS-patients were more psychovegetatively suppressed. As compared to the healthy normals and addicted HIV-negative patients the homosexual AIDS-patients differed in emotional reflection; they showed a higher degree of excitement, while in drug dependent AIDS-patients a lower emotional reflection was found. Concerning emotional intensity similar results were obtained. Differences in the mean amplitudes reached the level of statistical significance between homosexual AIDS-patients and the healthy normals and addicted HIV-negative patients respectively. Within as well as between both groups differences concerning stage III and IV could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

High risk of acquired immune deficiency syndrome (AIDS) and of AIDS related complex (ARC) in hemophiliacs seropositive for more than 5 years.

A group of 90 hemophiliacs who had been regularly treated with non virus-inactivated factor VIII or IX concentrates were studied in 1983. At that time 50 patients were HIV-1-antibody positive, 6 additional seroconversions occurred until 1985. 26 of the 50 patients seropositive in 1983 are currently asymptomatic. 4 patients have developed the lymphadenopathy syndrome, 9 patients AIDS and 11 patients ARC (CDC IV C 2). 6/9 cases of AIDS and 10/11 cases of ARC have occurred only after 1985. Patients, who subsequently became symptomatic, had significantly higher IgG levels in 1983, otherwise no predictive laboratory tests were identified. Patients with T4 counts above 500/microliters became symptomatic later, but after 5 years the incidence of AIDS was comparable in patients with original T4 counts of more than or below 500/microliters.

[Psychometric and psychophysiologic studies in AIDS patients with reference to the "declining performance syndrome"--level reduction]. / Psychometrische und psychophysiologische Untersuchungen bei AIDS-Patienten mit Berücksichtigung des "Denivellierungssyndromes"--Niveausenkung.

It has been reported that the acquired immune deficiency syndrome can present neuropsychiatric symptoms of major depressive disorders, adjustment disorder with depressed mood and organic brain syndromes with affective, delusional and demented features. The aim of the present study was to determine deficits in performance and to measure psychophysiological variables in drug addicted AIDS-patients. 28 drug addicted AIDS-patients and 17 homosexual AIDS-patients participated in the study voluntarily and were compared to healthy normals. 18 patients belonged to stage III, 27 to stage IV. Performance was measured by numerical memory test, Benton test, Alphabetic reaction test and computer-assisted rigidity test. Psychophysiological parameters were evaluated by computer-assisted "static" and "dynamic" pupillometry, computer-assisted measurements of skin conductance-level, -reaction and habituation; and critical flicker frequency analyses. Performance in drug addicted AIDS-patients differed from controls and especially from healthy normals within a minimal range ("Denivellierungssyndrom"--decline of level of performance). No AIDS-dementia could be objectivated. Furthermore drug-dependent AIDS-patients demonstrated autonomous desactivation, reduced pupillary reagibility and suppressed vegetative irritability.

[Initial clinical experiences in a large Austrian patient sample with immunodeficiency syndrome (AIDS): I. Type and course of encountered infections]. / Erste klinische Erfahrungen bei einem grösseren österreichischen Patientenkollektiv mit erworbenem Immunmangelsyndrom (AIDS): I. Art und Verlauf der aufgetretenen Infektionen.

This study presents a report on the first clinical experiences gained in 68 hospitalized HIV antibody-positive patients from Austria, covering a period of twelve months. 36 patients (52.9%) belonged to risk group I or Ib (homo- or bisexual), whereas 26 (38.2%) patients were i.v. drug abusers (risk group II). 5 (7.4%) patients fulfilled the criteria of stage II of the CDC classification of HIV-associated clinical symptoms, 10 (14.7%) were classified as stage III and the remaining 53 patients (78%) as stage IV. The most frequent and also the most serious problem was the development of opportunistic infections. Multiple infections were found in 45.7% of all cases. Kaposi's sarcoma was found in 9 patients who all belonged to risk group I. During the entire observation period 10 patients died as a consequence of HIV-1-induced immunodeficiency and the resulting opportunistic infections and/or neoplasms.

[Alkaptonuria (ochronosis)]. / Alkaptonurie (Ochronose).

A 39-year-old male patient observed an increasing bluish pigmentation of the ear cartilage associated with recurrent back-pain. Darkening of the urine after the addition of sodium hydroxide led to the suspected diagnosis of alkaptonuria. This diagnosis was confirmed by the detection of urinary homogentisic acid by thin-layer chromatography.

[An unusual clinical form of pemphigus vulgaris]. / Eine klinisch ungewöhnliche Erscheinungsform des Pemphigus vulgaris.

A 36-year-old woman developed bullous skin lesions which clinically seemed most likely to be dermatitis herpetiformis or bullous pemphigoid. However, histological examinations as well as immunofluorescence and electron microscopic observations substantiated the diagnosis of pemphigus vulgaris.

[Immunocytoma simulating chronic acrodermatitis atrophicans]. / Immunozytom unter dem Bild einer Acrodermatitis chronica atrophicans.

A 76 year old female developed an acrodermatitis-chronica-atrophicans-(ACA)-like lesion on her foot. Histological examination and quantitative determination of immunoglobulins in homogenates from the skin lesion revealed an immunocytoma of the IgM type. Malignant lymphoma originating in ACA lesions or concomitting ACA are well known. The case described here indicates that primary malignant lymphoma of the skin clinically can simulate ACA and creates diagnostic, therapeutic and prognostic problems.