ABSTRACT
Primary central nervous system non-Hodgkin lymphomas (PCNS-NHLs) are extranodal B-cell lymphomas with poor prognosis. The role of high-dose therapy (HDT) followed by autologous blood stem cell transplantation (ASCT) as first-line therapy is still not clear. We retrospectively collected long-term follow up data of 61 consecutive patients with PCNS-NHL at the University Hospital Düsseldorf from January 2004 to December 2016. Thirty-six patients were treated with conventional chemoimmunotherapy (cCIT) only (CT-group). Seventeen patients received an induction cCIT followed by HDT and ASCT. In the CT-group, the overall response rate (ORR) was 61% (CR 47%, PR 14%), and there were 8% treatment-related deaths (TRD). Progression-free survival (PFS) was 31.8 months, and overall survival (OS) was 57.3 months. In the HDT-group, the ORR was 88% (59% CR, 29% PR), and there were 6% TRD. Median PFS and OS were not reached at 5 years. The 5-year PFS and OS were 64.7%. After a median follow up of 71 months, 10 patients (59%) were still alive in CR/PR following HDT and ASCT, one patient was treated for progressive disease (PD), and 7 had died (41%, 6 PD, 1 TRD). All patients achieving CR prior to HDT achieved durable CR. In the CT-group, 8 patients (22%) were alive in CR/PR after a median follow-up of 100 months. Twenty-eight patients died (78%, 24 PD, 2 TRD, 2 deaths in remission). In the univariate analysis, the HDT-group patients had significantly better PFS (not reached vs 31.8 months, p = 0.004) and OS (not reached vs 57.3 months, p = 0.021). The multivariate analysis showed HDT was not predictive for survival. Treatment with HDT + ASCT is feasible and offers the chance for long-term survival with low treatment-related mortality in younger patients. In this analysis, ORR, PFS and OS were better with HDT than with conventional cCIT alone. This result was not confirmed in the multivariate analysis, and further studies need to be done to examine the role of HDT in PCNSL.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Central Nervous System Neoplasms/therapy , Hematopoietic Stem Cell Transplantation , Lymphoma, Non-Hodgkin/therapy , Aged , Female , Humans , Male , Middle Aged , Progression-Free Survival , Retrospective Studies , Transplantation, AutologousABSTRACT
In obstructive jaundice PTCD plays an important role as a preoperative or a palliative therapeutic method inspite of the availability of biliary endoprostheses. This study was carried out to assess complications following PTCD, the effect on liver function (serum parameters) and the relationship between duration of preoperative drainage and postoperative complication rate. The results demonstrate that 11-hole pigtail-catheters are useful for intrahepatic location and 32-hole ringcatheters for extrahepatic location due to reduced dislocation rates. The effect of biliary drainage after 7 rsp. 25 days on liver function was significant (p less than 0.05). As a main complication fever episodes could be observed associated with pathologic bile-/bloodcultures in most cases; other complications were similar to those presented in the literature. A prophylactic antibiotic therapy following PTCD seems to be useful, a preoperative biliary drainage is recommended until serum bilirubin levels become constant or at least for 2 weeks.
Subject(s)
Bile Ducts/surgery , Cholestasis/surgery , Drainage/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Palliative Care , Postoperative Complications , Preoperative CareABSTRACT
Transvenous digital subtraction angiography (DSA) of the kidneys has shown to be useful in detection of renovascular abnormalities in hypertensive patients. In this study DSA was performed in 27 patients (fibrom. dyspl. n = 12, arterioscl. n = 15) following percutaneous transluminal angioplasty (PTA) of renal artery stenosis. Concerning PTA-effect on blood pressure, patients were classified in 3 groups (normal n = 13, improved n = 10, failure n = 4). DSA images and simultaneously determined effective renal plasma flow (ERPF) were correlated with response of blood pressure to PTA. The results demonstrate the usefulness and accuracy of transvenous renal DSA-imaging in follow-up studies. Normal ERPF correlated with a completely re-opened renal artery and normal renal parenchyma in DSA in normotensive patients. In patients with persistent or recurrent hypertension (n = 14) ERPF was reduced in 10 cases and DSA demonstrated disorders such as peripheral renal infarction or reduced renal size (n = 6) and re-stenosis (n = 2).
Subject(s)
Angiography/methods , Angioplasty, Balloon , Hypertension, Renovascular/therapy , Adult , Aged , Blood Pressure , Female , Follow-Up Studies , Humans , Hypertension, Renovascular/diagnostic imaging , Male , Middle Aged , Renal Circulation , Subtraction Technique , Time FactorsABSTRACT
Percutaneous transluminal angioplasty (PTA) is more and more accepted for interventional management of renal artery stenosis in hypertensive patients. This study was carried out to assess the behaviour of arterial blood-pressure, renal plasma flow and renal venous renin activity in renovascular hypertension following catheter dilatation. Using the data the possibility is calculated to predict the effect of PTA on blood pressure preinterventionally. The results demonstrate that a successful employment of PTA depends on a normal contralateral renal plasma flow and a normalization of plasma flow of the post-stenotic kidney. Determination of plasma renin activity is only of restricted value.
Subject(s)
Angioplasty, Balloon/methods , Blood Pressure , Hypertension, Renal/therapy , Hypertension, Renovascular/therapy , Renal Artery Obstruction/therapy , Renal Circulation , Renin/blood , Adult , Female , Humans , Hypertension, Renovascular/diagnostic imaging , Male , Middle Aged , Radiography , Renal Artery Obstruction/diagnostic imagingABSTRACT
In 30 patients with decompensated autonomous adenoma of the thyroid gland, the possibility was investigated whether sonography of the thyroid gland could replace the thyroid stimulation scintigram or a diagnostically insufficient, saturated scintigram. It was found that the thyroid sonogram--which has a lower specificity--has a markedly higher sensitivity than the saturated scintigram of the thyroid gland.
Subject(s)
Adenoma/diagnosis , Thyroid Function Tests , Thyroid Neoplasms/diagnosis , Ultrasonography , Adenoma/blood , Adult , Aged , Diagnosis, Differential , Female , Humans , Hyperthyroidism/blood , Male , Middle Aged , Thyroid Neoplasms/bloodABSTRACT
The localised patella defects in our material of 90 patients were largely unchanged up to nine months after surgical treatment. Persistence of soft tissue swelling round the knee correlates with continuing pain. In some cases there has been remineralisation of the patella, which can be regarded as a stage in healing. Unchanged or deteriorating radiological findings may be associated with clinical improvement or deterioration.
Subject(s)
Osteochondritis/diagnostic imaging , Patella/diagnostic imaging , Humans , Osteochondritis/surgery , Patella/pathology , Patella/surgery , RadiographyABSTRACT
A case of an aneurysm of the portal vein is discussed. With regard to the reported case the different possibilities of the aetiology are discussed. We consider that an aneurysm of the portal vein may be caused by liver diseases, as f.e. portal hypertension, as well as by congenital dysplasia.
Subject(s)
Aneurysm/etiology , Portal Vein , Adult , Female , Humans , Liver Cirrhosis, Alcoholic/complicationsABSTRACT
Within the framework of a clinical study, subjective and objective data were compiled on the low-osmolar contrast medium ioxaglinic acid. In 213 angiographies performed on 134 patients in the Department of Radiology I of the Ulm University Clinic from October 1979 to February 1980, it was established that unfavourable subjective symptoms were missing to a major extent. Hence, we believe that it is not justified to subject the patients to the additional stress of general narcosis when performing peripheral and cerebral angiographies. In more than 50% of the patients, the contrast medium produced either an increase or a drop in blood pressure; a state of collapse requiring treatment never occurred in any of the patients.
Subject(s)
Angiography , Contrast Media , Iodobenzoates , Triiodobenzoic Acids , Angiography/adverse effects , Angiography/methods , Blood Pressure/drug effects , Contrast Media/adverse effects , Humans , Ioxaglic Acid , Triiodobenzoic Acids/adverse effectsABSTRACT
From 1974 to April 1979 5571 mammographies were made in the Department of Radiology of the University of Ulm. In 319 cases (5,7 %) we observed calcifications of the mammarian arteries. The incidence of arterial calcifications in mammography in patients up to 60 years of age was higher than coronary calcifications could be diagnosed by chest fluoroscopy or in an autopsy series by other authors. As the small mammarian arteries show an equal histological structure as the coronary arteries, they must show the same type of calcification. Therefore we consider that calcifications of the mammarian arteries could be a sign of general atherosclerosis.
Subject(s)
Arteriosclerosis/diagnosis , Adolescent , Calcinosis , Cholesterol/blood , Coronary Angiography , Female , Humans , Male , Mammary Arteries/diagnostic imaging , MammographyABSTRACT
The article reports on a case of involvement of the stomach, duodenum, terminal ileum, colon and rectum within the overall pattern of a lymphocytotic well-differentiated malignant lymphoma. Following the casuistic presentation the article discusses the literature published on this subject.
