Medizin - Open Access LMU - Teil 20/22 Archiv

Background: Adenomas of the adrenal gland are rare causes ofvirilization in childhood. Case Report: A girl aged 2 years and 4 monthspresented with pubarche, distinct clitoral hypertrophy, tall stature,and increased height velocity. Plasma testosterone anddehydroepiandrosterone were elevated. Androgens remained unchanged afteradrenocorticotropic hormone, and dexamethasone administrations.Ultrasound examination and magnetic resonance imaging indicated anextra-adrenal mass adjacent to the left adrenal gland, which was removedby endoscopic surgery. However, plasma androgens remained elevated and131 I-iodomethyl-norcholesterol scintigraphy revealed tracer enhancementin the right adrenal gland, which was consecutively removed.Virilization regressed after extirpation of the adenomas and heightvelocity normalized. Results: Histology revealed a circumscribed adenomain the right adrenal gland and an epithelial mass with adrenal corticalcells in the left-sided ectopic tumor. In the ectopic tumor,melanocortin 2 receptor expression was augmented threefold compared tothe control, indicating adrenal origin. Conclusions: In this young girl,virilization is due to concomitant ectopic and intra-adrenal adenomas ofthe adrenal cortex. By melanocortin 2 receptor expression, it wasconfirmed that the ectopic adenoma derived from the adrenal cortex.Specific scintigraphy, if available, assists in allocating the source ofandrogen hypersecretion.

Background: Gait changes at older ages are a strong predictor of adecline in lower extremity functions. However, large population-basedstudies assessing gait parameters in various gait tasks are lacking.Objective: We investigated the relationship of age, the use of mobilityaids and being fitted with an endoprosthesis with selected gaitparameters, assessed in different walking tasks. Methods: In thepopulation-based KORA-Age study, data from 907 men and women aged 65-91years were obtained using the validated electronic walkway systemGAITRite, which quantifies spatiotemporal gait parameters in themeasurement range of a 488 x 61 cm walkway mat. Participants completedthree walking tasks at different speeds (normal, slow and fast) and afourth walking task at normal speed with the additional task of countingbackwards (dual-task walking). Additionally, the impact ofendoprostheses (hip or knee) and mobility aids was assessed.

Objective: To evaluate prospectively the value of the ‘repositioningtest’ (RT) in preoperative patient selection for the efficacy of malestress urinary incontinence (SUI) treatment using a retroluminartransobturator male sling (AdVance sling). Patients and Methods: 65consecutive patients with SUI after radical prostatectomy were includedin this single-center prospective study. Preoperatively, patients wereclassified into those with ‘positive’ and ‘negative’ RT. Postoperativeresults were analyzed and the association between the result of the RTand postoperative outcome was evaluated. Results: 53 patients (81.5%)showed preoperatively a positive RT and 12 patients (18.5%) a negativeRT. After a follow-up of 12 months, patients with positive RT showed acure rate (0 pads/day) of 83% and patients with a negative RT showedonly a cure rate of 25%. A positive RT significantly correlated withcure in outcome (p < 0.001). Conclusions: Patients with positive RT havea significantly better chance for successful AdVance sling implantation.The RT is minimally invasive, easy to learn and easy to perform.Therefore, the RT is a very useful tool for preoperative patientselection.

Background: Future shortages in platelet supply are expected in Germanydue to demographic changes. A rising cancer incidence will lead to anincreasing demand for platelet concentrates (PCs) while the number ofpotential donors will decrease. Pathogen inactivation (PI) aims toinactivate various infectious agents including emerging pathogens toextend the shelf-life of PCs and reduce the frequency of acutetransfusion reactions (ATRs). In this context, the clinical and economicimpact of PI on platelet transfusion was evaluated. Material andMethods: Model calculations were conducted for 2 scenarios consideringdifferent production settings. Frequencies of ATRs were based onliterature analyses, platelet and ATR costs on cost analyses. Results:The estimated average costs for ATRs of grade 1 and 2, irrespective oforigin, and grade 3 (allergic) were (sic) 104, (sic) 238, and (sic)1,200, respectively. Approximately 400 PC-related ATRs per 10(5)transfusions can be avoided, with estimated savings amounting to (sic)77,000. The total cost increase was calculated to approximately (sic)30-50 per PI-treated PC. Conclusion: PI potentially saves plasma,prolongs shelf-life, decreases donor deferral, and reduces ATRs. Modelcalculations considering clinical and safety benefits of PI show arational cost increase. The impact of PI should be further evaluatedfrom a societal perspective regarding future blood supply and infectiousdisease globalization.

Background: Everolimus is approved for treatment of anti-vascularendothelial growth factor (VEGF)-refractory patients with metastaticrenal cell carcinoma (mRCC). Clinical trials rarely mirror treatmentreality. Thus, a broader evaluation of everolimus is valuable forroutine use. Patients and Methods: A German multicenternon-interventional study documented mRCC patients starting everolimusafter failure of initial VEGF-targeted therapy. Primary endpoint waseffectiveness, defined as time to progression (TIP) according toinvestigator assessment (time from first dose to progression). Results:Of 382 documented patients, 196 were included in this interim analysis.

Segmentation, condensation and bilateral symmetry of the nuclei ofpolymorphonuclear leukocytes seem related to their function.Segmentation of the nuclei into two or more lobes and their condensationfacilitate their passage (diapedesis) through the endothelial layer ofblood vessels to the extravasal space and subsequent locomotion throughthe interstitial compartment of different tissues. Bilateral symmetry ofthese nuclei along with their association to the cytoskeletal fiberscontribute to their efficiency in locomotion by alignment of the axis ofnuclear symmetry to the axis of cellular polarity, which orients towardsthe direction of locomotion in response to cytokines and other stimuli.Observations of the cytogenetic facets of intranuclear order supportthese assumptions.

Background/Aims: Surveillance colonoscopy is recommended afterpolypectomy of adenoma and surgery for colorectal cancer. The purpose ofthis study was to assess the frequency of advanced adenoma and cancer incolonoscopies performed for surveillance compared to screeningcolonoscopies. Methods: Analysis of relative frequencies of findings incolonoscopies performed for post-adenoma surveillance (post-ad),post-cancer surveillance (post-crc), screening, and follow-up of apositive fecal occult blood test (FOBT). Logistic regression was used toidentify the risk for advanced adenoma (adenoma mm, containinghigh-grade dysplasia, or villous histology) and cancer. Results: 324,912 colonoscopies were included in the analysis: 81,877 post-ad, 26,89 6post-crc, 178,305 screening, 37,834 positive FOBT. Advanced adenoma(cancer) was diagnosed in 8.0% (0.4%) of post-ad, 5.0% (1.0%) ofpost-crc, 7.4% (1.1%) of screening, and 11.7% (3.6%) of positiveFOBT colonoscopies. Compared to screening, the odds ratios for findingadvanced adenoma were 0.93 (95% CI 0.88-0.98) for post-ad, 0.96(0.86-1.08) for post-crc, and 1.18 (1.09-1.28) for positive FOBTcolonoscopies. The odds ratios for the diagnosis of cancer were 0.29(0.24-0.36) for post-ad, 0.81 (0.61-1.07) for post-crc, and 2.77(2.43-3.17) for positive FOBT. Conclusion: Colonoscopy for post-adsurveillance but not colonoscopy for post-crc surveillance is associatedwith a lower risk of diagnosis of advanced adenoma and cancer.

Background/Aims: Chronic hypercortisolism in Cushing’s disease (CD) hasbeen suggested to contribute to an altered personality profile in thesepatients. We aimed to test this hypothesis and attempted to determinethe effects of disease- and treatment-related factors that mightmoderate an altered personality in CD. Methods: We assessed 50 patientswith CD (74% biochemically controlled) and compared them to 60 patientswith non-functioning pituitary adenomas (NFPA) and 100 age-andgender-matched mentally healthy controls. Personality was measured bytwo standardized personality questionnaires, TPQ (Cloninger PersonalityQuestionnaire) and EPQ-RK (Eysenck Personality Questionnaire-RK).Results: Compared to mentally healthy controls, CD patients reportedsignificantly less novelty-seeking behaviour, including less exploratoryexcitability and less extravagance. On harm avoidant subscales, theypresented with more anticipatory worries and pessimism, higher fear ofuncertainty, shyness with strangers, fatigability and asthenia.Moreover, CD patients appeared to be less extraverted, more neurotic andsocially desirable. CD patients differed from NFPA patients in terms ofhigher neuroticism scores, and NFPA patients did not show alterednovelty-seeking behaviour or extraversion. In the subgroup analysis, CDpatients with persistent hypercortisolism displayed significantly higherfear of uncertainty, fatigability and asthenia, indicating high harmavoidance in total, than those in biochemical remission. Conclusion:Patients with CD showed a distinct pattern of personality traitsassociated with high anxiety in combination with traits of lowexternalizing behaviour. Such personality changes should be taken intoaccount in the diagnosis and treatment of CD patients, as they mightinterfere with the patient-physician communication and/or challenge thepatients’ social and psychological functioning.

Purpose: The purpose of this preliminary and descriptive study was toevaluate a biodegradable drug delivery system in combination with aninnovative ceramic implant. Methods: The delivery of gentamicin ofstandardized samples was measured in the laboratory usingultra-high-performance liquid chromatography. Biocompatibility andbiodegradation of the materials was investigated in an animal experimentin sheep up to 14 months. As carrier epsilon-caprolactone, 1:1 mixedwith gentamicin, intruded into micro-chambered beta-tricalcium-phosphatebeads (MCB (R)) was studied. Results and Discussion: Gentamicin wasreleased in calculable concentrations during the first 30 days. Therelease from epsilon-caprolactone was higher than that frompolymethylmethacrylate and more predictable. The caprolactone carrierwas reabsorbed by osteoclasts.

Accumulation of classical monocytes is imperative for the progression ofatherosclerosis. Hence, therapeutic interference with mechanisms oflesional monocyte recruitment, the primary mechanism controllingmacrophage accumulation, may allow for targeting atheroprogression andits clinical complications. Here, we review the important role ofclassical monocytes in atheroprogression as well as their routes ofarterial recruitment. We specifically highlight the role of celladhesion molecules as well as of platelet-derived chemokines andneutrophil-borne alarmins.

Background: Our objective was to assess the auditory function ofgynaecological tumour patients who had received cytotoxic agents and todetermine their associated risk of ototoxicity. Patients and Methods: 87patients who had undergone chemotherapy for gynaecological malignancieswere investigated. Of these patients, 79% had breast cancer, and 14%ovarian cancer. All of the patients had a subjective assessment of theirhearing function on a visual analogue scale. Audiometric tests wereperformed before and at 9 weeks, 18 weeks and 3 months after completionof chemotherapy. Results: The age of the patients ranged from 32 to 71years (mean age of 53.5 +/- 10.5 years). The average subjective ratingof the patients’ hearing function was 83.0 +/- 17.2 before and 84.8 +/-16.9 3 months after completion of chemotherapy. No significantaudiometric change at either the speech hearing frequency range (0.5-2KHz) or high frequencies was observed in the patients afterchemotherapy. There was also no significant difference in the hearingthreshold of the patients who had received platinum analogue-basedchemotherapy compared to non-platinum analogue-based chemotherapy.Conclusion: Hearing loss is uncommon in patients treated with thetypical gynaecological chemotherapy protocols. Hence, routineaudiometric testing in these patients is not necessary.