[Percutaneous CT-guided radiofrequency ablation for small renal masses : A retrospective, single center data analysis]. / Perkutane computertomographiegezielte Radiofrequenzablation bei kleinen Nierentumoren : Eine retrospektive, monozentrische Datenauswertung.

BACKGROUND: The incidence of small renal masses has increased in recent decades. Standard surgical treatment may not be applicable in patients with advanced age or severe comorbidities. Therefore, minimally invasive therapeutic approaches, such as radiofrequency ablation (RFA), may be a therapeutic option for such patients. OBJECTIVES: Assessment of oncological and functional outcomes of percutaneous RFA in small renal masses. MATERIALS AND METHODS: Single center evaluation of all RFA performed at the hospital Landesklinikum Baden from 2006-2016. RESULTS: A total of 98 RFA were performed in 85 patients. Mean patient age was 69.5 years. Median tumor size was 26.2 mm, while the length of hospital stay was 1.4 days. Overall, 96.8% of RFA procedures were considered to be technically complete. Recurrence rate was 17.5%. Most of the recurrences were treated via a second RFA. Complication rates were fairly low as the vast majority of ablations were free of complications (82.7%). Grade I, II and III complications (according to the Clavien-Dindo classification) occurred in 13.3%, 3% and 1%, respectively. A significant deterioration of renal function due to RFA was not observed. Cancer-specific survival rate for renal cell carcinoma was 100%; overall survival was 84.7% after an average follow-up period of more than 3 years. CONCLUSION: RFA is an adequate alternative treatment option for small renal masses in patients unfit to undergo surgical excision. Patients benefit from the low complication rates, preservation of renal function, and short hospital stays.

Clinical Practice Guideline for the prevention and early detection of breast and ovarian cancer in women from HBOC (hereditary breast and ovarian cancer) families.

An estimated 10% of breast cancer cases exhibit a higher familial incidence, and functional mutations in BRCA (breast cancer-gene) 1 or 2 are responsible for the development of malignant tumors in approximately half of these cases. Women with a germline mutation in either of the two genes have a lifetime risk of up to 85% to develop breast cancer, and of up to 60% risk to develop ovarian cancer. This clinical practice guideline defines the individual and familial tumor constellations that represent an indication for BRCA germline testing. It also describes the therapeutic options (early detection programme vs prophylactic surgery) that arise from the result of a BRCA mutational analysis. This guideline further includes recommendations regarding the use of multigene panels and therapeutic aspects that arise from the selective use of poly ADP ribose polymerase (PARP) inhibitors in patients with known BRCA1 or 2 mutations. It replaces the previous version of the "Clinical Practice Guideline for the Prevention and Early Detection of Breast- and Ovarian Cancer in women from HBOC (hereditary breast and ovarian cancer) families" which was published in 2012.

Chronic asymptomatic inflammation of the prostate type IV and carcinoma of the prostate: is there a correlation?

OBJECTIVE: The aim of this study was to detect possible correlations between chronic asymptomatic inflammation of the prostate type IV and prostate cancer in patients undergoing radical prostatectomy (RPE). MATERIAL AND METHODS: Between January and December 2010, 57 RPE specimens were prospectively evaluated with regard to histological signs of chronic inflammation. This RPE group was compared to specimens of 82 men undergoing transurethral resection of the prostate (TURP) or transvesical enucleation (TVE) of a benign prostate (BPH group). To characterize inflammatory changes, inflammatory "hot spots" were defined according to the histological criteria of Irani et al. (J Urol 1997;157:1301-3). Total prostate-specific antigen (PSA), cholesterol, triglycerides, uric acid, International Prostate Symptom Score and body mass index (BMI) were evaluated preoperatively and were correlated to the histological findings. RESULTS: Chronic inflammation was verified in 43.86% of the RPE group, compared to 70.74% of the BPH group (p < 0.001). Multivariate analysis found a significant correlation between older patients and the inflammation score (p < 0.03) and prostate volume (p < 0.03). There was no difference in the PSA values between the inflammation and non-inflammation groups: mean PSA was 5.7 vs 6.1 ng/ml in the RPE group (p < 0.89), and 2.8 vs 2.9 ng/ml in the BPH group (p < 0.94). Gleason score distribution (5-9) and tumour stage (TNM) were similar in the inflammation and non-inflammation groups (p < 0.99, p < 0.21). CONCLUSIONS: No significant correlation between chronic prostatic inflammation and carcinoma of the prostate was detected. Contrary to expectations, a significantly higher score of inflammatory changes was found in BPH patients; also, total PSA levels were lower in the inflammation group.

Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3).

PURPOSE: To determine the accuracy of a probably benign assessment of non-palpable breast lesions (BI-RADS category 3) at mammography and/or ultrasound with immediate histological work-up. MATERIALS AND METHODS: Stereotactic or ultrasound guided core needle breast biopsy (NBB) was performed to evaluate 288 lesions, which were prospectively assessed as BI-RADS category 3. Imaging findings included 195 masses, 73 calcification cases, 16 focal asymmetries, and four architectural distortion cases. After NBB, patients underwent either open surgical biopsy (OSB) (n=204) or mammographic follow-up (n=84) for at least 24 months. Histological results of NBB were compared with those of OSB. RESULTS: Three of the 288 lesions (1.0%) proved to be malignant at histological work-up, two of them were ductal carcinoma in situ (DCIS) and one of them was an invasive carcinoma. NBB revealed invasive carcinoma in 1/288 (0.35%) and atypical ductal hyperplasia (ADH) in 13/288 (4.5%) lesions. OSB revealed DCIS in 2/204 (1%) and invasive carcinoma in 1/204 (0.5%) lesions. The two DCIS were underestimated as ADH by NBB. The remaining 285 (99%) lesions proved to be benign at OSB or remained stable during follow-up. CONCLUSION: Confirmed by tissue diagnosis, the low likelihood of malignancy of prospectively assessed probably benign lesions is below the 2% threshold established for BI-RADS category 3. Imaging follow-up is a safe and effective alternative to immediate histological work-up for such lesions.

[Osteosarcoma of the prostate after radiotherapy]. / Osteosarkom der Prostata nach Strahlentherapie.

Osteosarcoma of the prostate is a rare finding. These tumours usually occur years after radiotherapy for prostate cancer. We report the case of a 74-year-old man with prostate cancer who had been treated with radiotherapy and androgen deprivation therapy. The man presented with urinary retention and his prostate was transurethrally resected. The histopathological investigation showed formations of a poorly differentiated osteosarcoma in the prostate. Because of serious comorbidities we decided to withhold chemotherapy considering its potential side effects. The man died a few months after the diagnosis of osteosarcoma in the prostate with the disease in a metastatic stage. In conclusion, osteosarcoma of the prostate is a rarely reported consequence of radiotherapy in patients with prostate cancer and is characterised by poor life expectancy.

[Imaging of molecular structures of breasts with new sonography techniques]. / Bildgebung molekularer Strukturen der Brust mit neuen Techniken der Sonographie.

Sonography has become one of the most important imaging methods in breast diagnostics. Through the development of high-frequency transducers and the use of ultrasound contrast agents, the number of indications for sonography of the breast has continued to increase in recent years. Visualization of very small vessels under 100 µm enables sensitive detection and quantification of tissue perfusion. Thus, breast ultrasound can play an essential role in answering questions about certain pathologies. Further technical advances, such as automated breast ultrasound systems, provide an essential step for standardization of investigations. Targeted ultrasound is a new important development of this technique. Specific markers which are conjugated with the surface of contrast medium microspheres allow targeted molecular endothelial structures to be selectively visualized and quantified. These developments will strengthen the role of sonography in the future as a non-invasive and easy to use method.

[New information on high risk breast screening]. / Neues zum Hochrisikomammascreening.

Women with an elevated risk for breast cancer require intensified screening beginning at an early age. Such high risk screening differs considerably from screening in the general population. After an expert has evaluated the exact risk a breast MRI examination should be offered at least once a year and beginning latest at the age of 30 depending on the patients risk category. Complementary mammograms should not be performed before the age of 35. An additional ultrasound examination is no longer recommended. To ensure a high sensitivity and specificity high risk screening should be performed only at a nationally or regionally approved and audited service. Adequate knowledge about the phenotypical characteristics of familial breast cancer is essential. Besides the common malignant phenotypes, benign morphologies (round or oval shape and smooth margins) as well as a low prevalence of calcifications have been described. Using MRI benign contrast media kinetics as well as non-solid lesions with focal, regional and segmental enhancement can often be visualized.

[Perspectives of the digital mammography platform]. / Perspektiven der digitalen Mammographieplattform.

In Europe one out of every nine women suffers from breast cancer during her lifetime. Since the introduction of mammography screening programs more breast cancers are being diagnosed when they are still small and early stage cancers with a favourable prognosis. The introduction of digital mammography systems has led to a continuous reduction of breast cancer mortality especially in specific patient subgroups. Furthermore, the digital mammography platform enables the development of new, innovative breast imaging methods to increase sensitivity and decrease breast cancer mortality. This digital mammography platform includes digital breast tomosynthesis, digital contrast medium mammography and digital contrast medium breast tomosynthesis as well as fused data sets from digital mammography with ultrasound or MRI. The following article summarizes these new applications, describes the strengths of the digital platform and illustrates the potential advantages of an improved breast cancer diagnosis by digital mammography.

Epitaxial graphene on SiC(0001) and [Formula: see text]: from surface reconstructions to carbon electronics.

Graphene with its unconventional two-dimensional electron gas properties promises a pathway towards nanoscaled carbon electronics. Large scale graphene layers for a possible application can be grown epitaxially on SiC by Si sublimation. Here we report on the initial growth of graphene on SiC basal plane surfaces and its relation to surface reconstructions. The surfaces were investigated by scanning tunneling microscopy (STM), low energy electron diffraction (LEED), angle-resolved ultraviolet photoelectron spectroscopy (ARUPS) and x-ray photoelectron spectroscopy (XPS). On SiC(0001) the interface is characterized by the so-called [Formula: see text] reconstruction. The homogeneity of this phase is influenced by the preparation procedure. Yet, it appears to be crucial for the quality of further graphene growth. We discuss the role of three structures with periodicities [Formula: see text], (6 × 6) and (5 × 5) present in this phase. The graphitization process can be observed by distinct features in the STM images with atomic resolution. The number of graphene layers grown can be controlled by the conical band structure of the π-bands around the [Formula: see text] point of the graphene Brillouin zone as measured by laboratory-based ARUPS using UV light from He II excitation. In addition we show that the spot intensity spectra in LEED can also be used as fingerprints for the exact determination of the number of layers for the first three graphene layers. LEED data correlated to the ARUPS results allow for an easy and practical method for the thickness analysis of epitaxial graphene on SiC(0001) that can be applied continuously during the preparation procedure, thus paving the way for a large variety of experiments to tune the electronic structure of graphene for future applications in carbon electronics. On [Formula: see text] graphene grows without the presence of an interface layer. The initial graphene layer develops in coexistence with intrinsic surface reconstructions of the [Formula: see text] surface. In high resolution STM measurements we show atomically resolved graphene layers on top of the (3 × 3) reconstruction with a Moiré type modulation by a large superlattice periodicity that indicates a weak coupling between the graphene layer and the substrate.

Quasi-free-standing epitaxial graphene on SiC obtained by hydrogen intercalation.

Quasi-free-standing epitaxial graphene is obtained on SiC(0001) by hydrogen intercalation. The hydrogen moves between the (6 square root(3) x 6 square root(3))R30 degrees reconstructed initial carbon layer and the SiC substrate. The topmost Si atoms which for epitaxial graphene are covalently bound to this buffer layer, are now saturated by hydrogen bonds. The buffer layer is turned into a quasi-free-standing graphene monolayer with its typical linear pi bands. Similarly, epitaxial monolayer graphene turns into a decoupled bilayer. The intercalation is stable in air and can be reversed by annealing to around 900 degrees C.

[The pediatric pelvic kidney--a retrospective analysis]. / Die kindliche Beckenniere--eine retrospektive Analyse.

OBJECTIVES: We evaluated children with pelvic kidney and their follow-up according to initial renal function and the appearance of concomitant urological pathologies. PATIENTS AND METHODS: In a retrospective analysis of our case notes, we studied 17 children (8 female, 9 male) who had been referred to our department for further investigation between 1994 and 2002 in whom we found a pelvic ectopic kidney. RESULTS: The mean age of the patients at the initial investigation was 72.5 months (range, 2 - 156 months); 10/17 were referred to our department for further investigation and clarification of a suspected renal agenesis, the remaining 7/17 children presented with urinary tract infection (1/17), nocturnal enuresis (3/17), hypertension (1/17) and phimosis (2/17). The nuclear medicine scan performed at the initial investigation in 14/17 children revealed that the function of the ectopic kidney had been reduced to one-third in contrast to two-thirds for the orthotopic kidney (p = 0.002). Overall global renal clearance was normal in all children. In 8/17 patients, the ongoing control nuclear investigations, on average 26.2 months later, revealed unchanged overall function of the kidney, we did, however, find a slight improvement of the ectopic renal function as compared to initial investigation which was not statistically significant (p = 0.683). In the period of this retrospective analysis, surgical correction of an accompanying pathology was performed in 23.5 % (4/17) of the children (vesico-ureteteric reflux operation in two cases, surgery for pelvic ureteric junction obstruction in one case, and nephroureterectomy in one case of a nonfunctioning-kidney). A left-sided pelvic kidney was seen in 64.7 % (11/17) of cases, a right-sided ectopic kidney in 23.5 % (4/17), a pelvic fused kidney in 11.7 % (2/17), and a solitary left-sided pelvic ectopia with right-sided agenesis in 5.8 % (1/17) of cases. CONCLUSION: In the event of suspected renal agenesis on ultrasonography, the possibility of a pelvic ectopic kidney should always be included in the range of diagnoses. On ultrasonography, the pelvic kidney is best visualized inferior to the iliac vessels, in the presence of a filled bladder. It is more frequently encountered on the left side. Nearly one-thirds of our patients presented with concomitant pathologies and one quarter needed surgical intervention. Although the function of the ectopic kidney alone was reduced by (2/3), the overall renal clearance was normal and remained stable in the course of the observation period.

[Melanosis of the urinary bladder--a case report with 10 years of follow-up and review of literature]. / Melanose der Harnblase--Fallbericht mit Langzeitverlauf über 10 Jahre und Literaturübersicht.

INTRODUCTION: Extradermal melanotic lesions are found predominantly in the oral cavity, colon or conjunctiva, and by far less frequently in other organs. We report for the first time a case of solitary melanosis of the urinary bladder with a follow-up of more than 10 years. CASE REPORT: A 48-year old man presented with symptoms of frequency, urge incontinence, obstructive voiding symptoms and nocturia. On urethrocystoscopy under general anaesthesia, melanosis of the bladder with visibly reduced bladder capacity was diagnosed and confirmed on biopsy. The patient was treated for his micturation problems with alpha-blockers, intravesical electrostimulation and GAG-substitution therapy, without success. The chronic progression of bladder symptoms and shrinkage eventually led to cystoprostatectomy and bladder replacement by an orthotopic ileal neobladder, 10 years after primary diagnosis. CONCLUSION: The very low number of reported cases accounts for the lack of management guidelines for this disease. Symptomatic treatment as well as repeated cystoscopic monitoring are logical therapeutic recommendations. Since the development of malignant disease can only be ruled out microscopically, repeated biopsies or prophylactic cystectomy need to be considered.

[The impact of ALA (5-aminolevulinic acid)-fluorescence detection on the prognosis of superficial bladder cancer]. / Der Stellenwert der ALA-(5-Amino-Lävulinsäure)-Fluoreszenzdetektion für die Prognose des oberflächlichen Blasenkarzinoms. Eine 1-Jahres-Uberlebensanalyse.

PURPOSE: Throughout the past years, several studies have shown that fluorescence cystoscopy with ALA (5-aminolevulinic acid) improves the detection rate of superficial bladder tumors by approximately 20 % compared to standard white light cystoscopy. These results suggest a reduced rate of residual/recurrent tumors with the routine use of ALA fluorescence technique prior to bladder tumor resection. The present prospectively randomized study was performed to verify this hypothesis. MATERIALS AND METHODS: A total of 115 bladder tumor patients were randomized for initial resection under white light or ALA fluorescence. After 6 to 8 weeks, a second-look resection was performed in all patients guided by ALA fluorescence. Additional white light cystoscopies were performed after 3, 6 and 12 months. RESULTS: The second-look resection did not find a tumor in 31 of 51 (59 %) patients initially resected under white light guidance compared to 43 of 51 (84 %) patients in the fluorescence group. This difference was statistically significant (p = 0.005). At 12 months, a tumor was not found in 17 of 48 patients from the white light group vs. 25 of 47 patients from the fluorescence group (p = 0.03). Seven patients were lost to follow-up. CONCLUSIONS: By reducing otherwise inevitable re-operations, fluorescence cystoscopy decreases morbidity and lowers treatment costs.

Value of negative spiral CT angiography in patients with suspected acute PE: analysis of PE occurrence and outcome.

The aim of this study was to analyze pulmonary embolism (PE) occurrence and retrospective clinical outcome in patients with clinically suspected acute PE and a negative spiral CT angiography (SCTA) of the pulmonary arteries. Within a 35-month period, 485 consecutive patients with clinical symptoms of acute PE underwent SCTA of the pulmonary arteries. Patients with a negative SCTA and without anticoagulation treatment were followed-up and formed the study group. Patient outcome and recurrence of PE was evaluated retrospectively during a period of 6 months after the initial SCTA, and included a review of computerized patient records, and interviews with physicians and patients. Patients were asked to fill out a questionnaire concerning all relevant questions about their medical history and clinical course during the follow-up period. Special attention was focused on symptoms indicating recurrent PE, as well as later confirmation and therapy of PE. Of the 485 patients, 325 patients (67%) had a negative scan, 134 (27.6%) had radiological signs of PE, and 26 (5.4%) had an indeterminant result. Of 325 patients with a negative scan, 269 (83%) were available for follow-up. The main reasons for loss to follow-up were change of address, name, or phone number, or non-resident patients who left abroad. Of 269 patients available for follow-up, 49 patients (18.2% of 269) received anticoagulant treatment because of prior or recent deep venous thrombosis (32.6%) or a history of PE (34.7%), cardiovascular disease (18.4%), high clinical probability (8.2%), positive ventilation-perfusion scan (4.2%), and elevated D-dimer test (2%). The remaining 220 patients, who did not receive anticoagulant medication, formed the study group. Of this study group, 1 patient died from myocardial infarction 6 weeks after the initial SCTA, and the postmortem examination also detected multiple peripheral emboli in both lungs ( p=0.45%; 0.01-2.5, 95% confidence interval). The PE did not occur in any other patient. In patients with suspected PE and negative SCTA without anticoagulant therapy, the risk of recurrent PE in this study was less than 1% and similar to that in patients after a negative pulmonary angiogram. Therefore, we conclude that patients can be managed safely without anticoagulation therapy; however, this approach may not be appropriate for critically ill patients and those with persistent high clinical suspicion of acute PE.

[Value of 14-gauge ultrasound-guided large-core needle biopsy of breast lesions: own results in comparison with the literature]. / Die Wertigkeit der 14-Gauge Ultraschall-gezielten Stanzbiopsie bei Brustläsionen: Eigene Resultate im Vergleich mit der Literatur.

PURPOSE: To report the false-negative rate, sensitivity, and specificity of 14-gauge ultrasound-guided large-core needle biopsy (14-G USSB) performed on breast lesions at our institution and, furthermore, to compare and discuss our own results with those reported in the literature. MATERIALS AND METHODS: This study includes 399 lesions examined by 14-G USSB. The results of the 14-G USSB were compared with the results of the surgical biopsy or, in cases of benign histology, were followed clinically. A key word search in two medical databases was undertaken to compare our data with those reported in the literature. The search was limited to the period from January 1990 to February 2002 and only original investigations published in English and German were included in our comparison. RESULTS: At our institution, 238 (59.6 %) benign and 161 (40.4 %) malignant lesions were diagnosed by 14-G USSB. The 14-G USSB was false-negative in 5 (1.25 %) of 399 cases. It has a sensitivity of 95.7 %, and specificity 100%. The literature reports false-negative rates between 0 % and 1.26 %, sensitivities between 86% and 100%, and specificities between 99.7 % and 100 %. On the basis of 3880 results from seven selected original papers and our own study, the false-negative rate for 14-G USSB was calculated to be 0.4 % (16 of 3880). CONCLUSION: Based on our results and those reported in the literature, 14-G USSB can be considered safe and reliable in the assessment of breast lesions.

[Electrical impedance scanning in the differentiation of suspicious breast lesions: comparison with mammography, ultrasound and histopathology]. / Elektrische Impedanzmessung in der Abklärung von Brustläsionen: Vergleich mit Mammographie, Sonographie und Histopathologie.

PURPOSE: To assess the value of Electrical Impedance Scanning (EIS) in the differentiation of suspicious breast lesions in comparison to mammography (MG) and ultrasound (US). METHODS: In 95 female patients (median 53.1 ys) 95 suspicious breast lesions (BI-RADS TM III - V) in MG or US underwent targeted EIS (TransScan TS 2000(R); TransScan Medical, Israel; Siemens Elema, Sweden). Histopathologic proof (vacuum-assisted biopsy or surgical biopsy) was obtained in all cases. MG, US and EIS were independently assessed by two radiologists in consensus. Chi-square tests as well as variance-analysis for ROC-statistics were performed. RESULTS: Of 95 lesions, 44 were benign, 51 malignant. Sensitivity, specificity, positive and negative predictive values were, respectively for MG 95.3 %, 23.5 %, 51.3 % and 85.7 %, for US 86.5 %, 44.2 %, 57.1 % and 79.1 %, for EIS 77.3 %, 82.3 %, 79.1 % and 80.8 %. The ROC-analysis revealed a significant greater area under the curve for EIS than for MG and US. The sensitivity for EIS was higher in lesions < 10 mm (n = 26; 100 %) and in invasive cancers (n = 31; 80.6 %). The negative predictive value of EIS was higher in BI-RADS TM-IV-lesions (83.9 %) as well as in dense breast parenchyma on the mammogram (86.7 %). CONCLUSION: EIS shows potential adjunctive value to MG and US in the differentiation of suspicious breast lesions.

[Comparison of wire versus carbon localization of non-palpable breast lesions]. / Vergleich Häkchen versus Kohlefarbstoff bei präoperativer Markierung von nicht-tastbaren Brustläsionen.

PURPOSE: To compare the accuracy of wire and carbon localization in stereotactically localized open breast biopsy. PATIENTS AND METHODS: From June 1995 to December 1997, a total of 725 stereotactic wire or carbon dye localizations were performed in 698 female patients. Success of localization was evaluated either by a malignant histopathological diagnosis or by mammographic follow-up. A lesion was considered to be missed if it could be still seen on follow-up mammography. RESULTS: In 703 of 725 cases, the success of localization could be evaluated with 427 (61 %) lesions localized with a wire and 276 (39 %) with carbon. Seven (1 %) out of 703 lesions were missed at open biopsy. Three lesions of these had been localized with wire and three lesions with carbon. The miss rates were 0.9 % and 1.1 %, respectively (p = 1.0). CONCLUSION: Both wire and carbon localization are reliable and accurate in the localization of non-palpable breast lesions. Concerning efficiency and costs, carbon dye seems to offer a promising compromise.