In acute myeloid leukemia (AML), assessment of minimal residual disease (MRD) by flow cytometry (flow MRD) after induction and consolidation therapy has been shown to provide independent prognostic ...information. However, data on the value of earlier flow MRD assessment are lacking. Therefore, the value of flow MRD detection was determined during aplasia in 178 patients achieving complete remission after treatment according to AMLCG (AML Cooperative Group) induction protocols. Flow MRD positivity during aplasia predicted poor outcome (5-year relapse-free survival (RFS) 16% vs 43%, P<0.001) independently from age and cytogenetic risk group (hazard ratio for MRD positivity 1.71; P=0.009). Importantly, the prognosis of patients without detectable MRD was neither impacted by morphological blast count during aplasia nor by MRD status postinduction. Early flow MRD was also evaluated in the context of existing risk factors. Flow MRD was prognostic within the intermediate cytogenetic risk group (5-year RFS 15% vs 37%, P=0.016) as well as for patients with normal karyotype and NPM1 mutations (5-year RFS 13% vs 49%, P=0.02) or FLT3-ITD (3-year RFS rates 9% vs 44%, P=0.016). Early flow MRD assessment can improve current risk stratification approaches by prediction of RFS in AML and might facilitate adaptation of postremission therapy for patients at high risk of relapse.
Injury of the internal carotid artery (ICA) during endonasal sinus surgery is rare but a life-threatening situation for the patient. For adequate treatment endovascular therapy as embolization or ...balloon occlusion is usually performed although there is a high risk of irreversible neurological deficits.
We report on a twenty-five-year-old female patient with acute exacerbated chronic polyposis nasi suffering from an injury of the ICA during endonasal sinus surgery. After intraoperative identification of the site of hemorrhage the massive bleeding could temporarily be controlled by a nasal pack. The woman was immediately transferred to a neuroradiological department. After angiographic localization of the vessel defect the bleeding could be stopped by application of a vascular stent without any neurological deficits during or after the procedure. Anatomical characteristics of the ICA in the sphenoid sinus, and recommended emergency treatment and preventive measures are discussed.
Although vascular stents are difficult to place in the intrasphenoidal course of the ICA, it provides an effective closure of the vascular injury and above all a sufficient cerebral perfusion, therefore, the risk of neurological defects can be reduced.
Isolated cranial nerve palsies in multiple sclerosis Thömke, Frank; Lensch, Eckart; Ringel, Kurt ...
Journal of neurology, neurosurgery and psychiatry,
11/1997, Letnik:
63, Številka:
5
Journal Article, Conference Proceeding
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During a 10 year period 24 patients with definite multiple sclerosis with isolated cranial nerve palsies were studied (third and fourth nerve: one patient each, sixth nerve: 12 patients, seventh ...nerve: three patients, eighth nerve: seven patients), in whom cranial nerve palsies were the presenting sign in 14 and the only clinical sign of an exacerbation in 10 patients. MRI was carried out in 20 patients and substantiated corresponding brainstem lesions in seven patients (third nerve: one patient, sixth nerve: four patients, eighth nerve: two patients). Additional abnormal findings of electro-oculography, or masseter reflex, or blink reflex, or combinations of these were found in 20 patients and interpreted in favour of a brainstem lesion at the level of the respective cranial nerve. In 11 of 14 patients with isolated cranial nerve palsies as the presenting sign of multiple sclerosis, dissemination in space was documented by MRI, and in the remaining three by evoked potentials. In patients with multiple sclerosis with isolated cranial nerve palsies, MRI is the most sensitive method of documenting dissemination in space and electrophysiological testing the most sensitive at disclosing brainstem lesions.
Recent experimental studies and a few case reports reveal that coiling may not lead to permanent occlusion of aneurysms by an organized thrombus. Therefore, biologic long-term prognosis seems to be ...doubtful, and the physical effect of coils may be important. The purpose of this study was to investigate the physical effect of coils on pressure and flow dynamics in aneurysms.
Bifurcation aneurysms were created in eight rabbits, explanted after 3 weeks, and tested in a model with pulsatile perfusion with 0.9% saline and heparinized blood. Before and after densely packing with coils, systemic and intraaneurysmal pressure, aneurysmal pulsation, and impact measurements were recorded.
The peak and shape of the pressure waves in the aneurysm and in the delivery system were not significantly different before and after coiling. Under physiological intraaneurysmal pressure (while being perfused with saline), significant reduction (P = .022) of aneurysmal wall pulsation after coil embolization was noted. Overall, the aneurysmal impact on surrounding structures was statistically unchanged after coiling. However, in a few cases, after coil embolization, the observed increase of impact was more than doubled compared with the original values before coiling.
Coils do not physically affect intraaneurysmal pressure. After coiling, there is no significant reduction of flow rates through the aneurysm and no reduction of aneurysmal impact, but aneurysmal wall pulsation may be decreased.
Knowledge regarding tissue reactions within coil-packed aneurysms is poor. The purpose of this study was to analyze histological changes in a chronic experimental bifurcation aneurysm model that ...might explain the protective effect of Guglielmi detachable coils.
The aneurysms were produced by means of a venous graft pouch at a surgically created bifurcation of the carotid artery in the neck of rabbits. After 3 weeks, embolization with Guglielmi detachable coils was performed in the treatment group but not in the control group (seven rabbits each). At the time of embolization, six of seven treated aneurysms were completely occluded according to radiological criteria. Twelve weeks later, all aneurysms were explanted after final angiography. Histological examinations were performed with coils in situ.
Six of seven embolized aneurysms demonstrated complete occlusion in final angiography. But gross pathology revealed that all specimens had differently sized open cavities between the coils. In only two cases, these spaces were very small and the aneurysmal sacs were filled with coils and tissue by more than 90%. Light microscopy demonstrated intraluminal granulation tissue and strong chronic inflammatory wall thickening with numerous foreign body cells at the interface between coils and tissue. Coils were partially incorporated into the aneurysmal wall, sometimes close to the surface and occasionally even outside the wall within the surrounding tissue.
The protective effect of Guglielmi detachable coil treatment in our chronic experimental bifurcation aneurysms results from formation of intraluminal granulation tissue and wall thickening attributable to chronic inflammation.
Ioversol is a new nonionic, triiodinated, water-soluble contrast medium. In a controlled double-blind study, ioversol 320 versus iopamidol-300 was tested on 60 patients in cerebral angiography. The ...safety of the contrast medium, the general and local tolerance, as well as the contrast quality were tested. In this study, ioversol 320 displayed no differences from iopamidol-300 in terms of contrast quality, neurologic status, and liver and kidney tolerance. In the local tolerance test, patients receiving ioversol 320 perceived significantly less heat than patients receiving iopamidol-300 when all injections were considered.
Isolated unilateral superior oblique palsies resulting from brainstem lesions occurred in three patients. MRI documented contralateral tegmental lesions of the trochlear nucleus and adjacent ...intraaxial trochlear nerve. Lacunar infarct was the cause in two patients and a small hemorrhage in a third.
Ziele:
Hämangiomwirbel sind häufige benigne, spinale Läsionen. In 11% werden sie im autoptischen Krankengut gefunden. Sie sind häufiger an der Halswirbelsäule, seltener thorakal oder lumbal ...lokalisiert. In der Regel sind sie klinisch stumm. Weniger als 1% aller Wirbelhämangiome zeigen einen aggressiven klinischen Verlauf mit Kompressionsfrakturen oder neurologischen Ausfallserscheinungen. Solche Läsionen bedürfen der Therapie. Wegen der hohen perioperativen Morbidität und Mortalität ist ein chirurgisches Vorgehen problematisch. Die Kombinationstherapie mit intraläsionaler Alkoholinstillation und Vertebroplastie verspricht aufgrund der bisherigen Erfahrung ausgezeichnete Ergebnisse.
Methode:
8 Patienten mit symptomatischen (Rückenmarkskompression, radikuläre Symptome) Hämangiomwirbeln (2 zervikal, 3 thorakal, 3 lumbal) wurden kombiniert mit intraläsionaler Alkoholinjektion (95%, Fa. Braun) und Polymethylmethacrylat (Fa. Howmedica) behandelt. Die Wirbelkörperpunktion erfolgte CT- oder Durchleuchtungs-gesteuert. Durch KM-Bolusgabe in der CT/Angiographie wurde die zur Sklerose erforderliche Alkoholmenge abgeschätzt. Der Therapieerfolg wurde durch CT und MRT kontrolliert.
Ergebnis:
Alle Hämangiomwirbel wurden durch die Behandlung obliteriert. Insbesondere durch die Alkoholsklerose (5–12ml) erfolgte ein Verschluss der extraossären Hämangiomanteile. In allen Fällen erzielte man eine Beeinflussung der Klinik (5 komplett, 3 deutlich gebessert) innerhalb der Nachbeobachtungszeit bis zu 3 Jahren. Komplikationen durch die Therapie traten nicht auf
Schlussfolgerung:
Die Kombinationsbehandlung -intraläsionale Alkoholinjektion und Vertebroplastie- ist ein effektives und sicheres Behandlungsregime bei der Therapie des symptomatischen, aggressiven Hämangiomwirbels.
Morbus Anderson-Fabry: MRI-Untersuchung des ZNS Ringel, K; Whybra, C; Mengel, M ...
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren,
05/2004
Conference Proceeding
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Ziele:
M. Anderson-Fabry (McKusick 301 500) ist eine seltene X-chromosomal übertragene Lipidspeichererkrankung. Der Mangel der lysosomalen Alpha-Galaktosidase A ist die Ursache. Aufgrund der ...Beobachtung verschiedener Autoren (Beck M et al. 2001) manifestiert sich die Erkrankung nicht nur bei heterozygoten Männern, sondern auch bei hemizygoten Frauen. 8 Patienten mit neurologischer Symptomatik wurden mit MRI abgeklärt.
Methode:
Klinische Symptome der Patienten (2 ♀, 6 ♂, 31–62 Jahre) waren Angiokeratome, Parästhesien der Akren, Nierenfunktionsstörungen und EEG-Veränderungen. Kopfschmerzen, Tinnitus und Halbseitensymptomatik waren die neurologischen Manifestationen.
Ergebnis:
Die T2-W Bilder zeigten subkortikale Infarkte, ischämische Defekte im Thalamus, Hirnstamm und diffuse Läsionen der weißen Substanz. Bei 3 Patienten fanden sich Verkalkungen. Bei allen Patienten wurde der zerebrale Befall der Erkrankung erst im Erwachsenenalter im MRT manifest
Schlussfolgerung:
Die fortschreitende Ablagerung von Glykosphingolipiden in kleinen Hirngefäßen kann zu unterschiedlichen ischämischen Substanzdefekten führen. Sorgfältige Abklärung der manifest Erkrankten und der klinisch symptomlosen Familienmitglieder durch MRI ist wichtig, um einerseits den natürlichen Verlauf der Erkrankung besser verstehen zu lernen und andererseits eine frühzeitige Therapie einzuleiten, da jetzt eine erfolgversprechende Enzymersatztherapie zur Verfügung steht.
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