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  • 1
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Subkutane Weichteilknoten ; Differentialdiagnose ; Alveolar soft part sarcoma ; Therapie ; Key words Subcutaneous mass ; Differential diagnosis ; Alveolar soft part sarcoma ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background: A slow growing indolent subcutaneous mass can be caused by a variety of benign and malignant soft tissue proliferations, however, it is often the first sign of soft tissue sarcomas. Radiological findings are unspecific and biopsy with histopathological analysis is needed. Method: Three female patients (age 9, 191/12 and 232/12 years) are presented with a slow growing subcutaneous mass, which was shown to be a malignant non-embryonal soft tissue sarcoma (alveolar soft part sarcoma). Results: Alveolar soft part sarcoma (ASPS) is a very rare malignancy. At diagnosis, 2 patients already had metastatic disease. One girl died before therapy, the other one suffers from slowly progressive pulmonary metastases 41/2 years after diagnosis, despite multi-modal treatment approaches. The third patient received polychemotherapy and local irradiation after complete tumor resection and is free of disease 8 months after diagnosis. Conclusion: ASPS is a rare slow growing malignancy with an extraordinary tendency to metastasize. The prognosis depends on wether the tumor is operable and whether there are metastases.
    Notes: Zusammenfassung Fragestellung: Langsam wachsende nicht schmerzhafte subkutane Knoten können durch unterschiedlichste gut- oder bösartige mesenchymale Proliferationen verursacht sein. Da sich hinter diesem Zeichen oft ein Malignom verbirgt und bildgebende Analysen nur selten den Weg zur Diagnose weisen, ist eine bioptische Klärung dringend erforderlich. Methode: Wir berichten über 3 Patientinnen (Alter 9, 191/12 und 231/6 Jahre) bei denen sich hinter einem langsam wachsenden subkutanen Knoten ein nicht embryonales Sarkom (Alveolar soft part sarcoma) verbarg. Ergebnisse: Das Alveolar soft part sarcoma (ASPS) ist ein ausgesprochenes seltenes Malignom. Zum Diagnosezeitpunkt lag bei 2 Patientinnen bereits eine Metastasierung vor. Eine Patientin verstarb noch vor Behandlungsbeginn. Bei der 2. sind Lungenmetastasen trotz multimodaler Therapie 41/2 Jahre nach Diagnosestellung langsam progredient. Die 3. Patientin erhielt nach Resektion eines lokalisierten ASPS am Oberarm postoperativ eine Polychemo- und lokale Strahlentherapie und ist 8 Monate nach der Diagnosestellung ohne Krankheitszeichen. Schlußfolgerung: Das ASPS ist ein langsam wachsender Tumor mit ausgeprägter Metastasierungstendenz. Die Prognose ist im wesentlichen von der Operabilität des Primärtumors und dem Vorliegen von Metastasen abhängig.
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  • 2
    Electronic Resource
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    Springer
    Der Urologe 39 (2000), S. 260-266 
    ISSN: 1433-0563
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Die kontralaterale Hodenbiopsie (Abb. 1) ist in Dänemark seit vielen Jahren ein obligater Bestandteil der Therapie des germinalen Hodentumors [36]. Auch im deutschsprachigen Raum hat es seit über zehn Jahren zahlreiche Empfehlungen zur routinemäßigen Durchführung der kontralateralen Biopsie gegeben [1, 14, 24, 28, 33, 41]. Im Jahre 1997 hat die interdisziplinäre Konsensuskonferenz zur Diagnostik und Therapie von Hodentumoren festgestellt, daß eine kontralaterale Hodenbiopsie bei der Therapie von Hodentumoren “durchzuführen ist” [40]. Trotz dieser vielfältigen und eindeutigen Empfehlungen ist die kontralaterale Biopsie ein kontroverses Thema geblieben.
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  • 3
    ISSN: 1432-0584
    Keywords: Acute myelogenous leukemia ; Allogeneic marrow transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between February 1982 and April 1995, 62 patients (37 male, 25 female) with acute myelogenous leukemia (AML) with a median age of 32 years (19–51 years) received allogeneic marrow grafts from an HLA-identical sibling (n=60) or an HLA-mismatched family member (n=2). At the time of transplant, 35 patients were in first complete remission (CR), five in second CR, eight were primary refractory, eight were in untreated relapse and six in refractory relapse. The FAB subtypes were as follows: M1 (n=17), M2 (n=13), M3 (n=6), M4 (n=19), M5 (n=6), M6 (n=1). For conditioning most patients were given total body irradiation combined with cyclophosphamide (CY,n=50) or CY and busulfan (n=9). For graft-versus-host disease prophylaxis patients received cyclosporin A (CSA) and methotrexate (MTX) (n=32), MTX alone (n=12), CSA and methylprednisone (n=5), or CSA alone (n=13). As of April 1995, probability of leukemia-free survival projected at 10 years after BMT was 60% for patients transplanted in first CR compared with 10% for patients transplanted beyond first CR. Transplant-related mortality was 11% after BMT in first CR and 39% after BMT beyond first CR. Probability of relapse projected at 10 years after BMT is 32% for patients who received transplants in first CR and 81% for patients who received transplants beyond first CR. Thus, high-dose chemo/radiotherapy followed by allogeneic marrow infusion has a high curative potential for patients with AML who receive transplants in first CR and offers the chance of long-term disease-free survival for some patients with advanced disease.
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  • 4
    ISSN: 1432-0584
    Keywords: Key words Related and unrelated donor BMT ; CML ; Long-term follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Between January 1983 and December 1997, 88 patients (36 female, 52 male, median age 37 years, range 19–57) with chronic myelogenous leukemia (CML) underwent allogeneic bone marrow transplantation (BMT) at the University Hospital of Vienna. Sixty patients were in chronic phase, 18 in accelerated phase, and ten in blast crisis. Marrow donors were HLA-identical siblings for 64 patients (BM 58, PBSC 6), 2-antigen-mismatched related donors (RD) for two, HLA-identical unrelated donors (URD) for 17, and 1-antigen-mismatched URD for five. The median time from diagnosis to BMT was 22 months (range 2–91), and 63 patients had received prior interferon (IFN)-alpha therapy, 46 (73%) for more than 6 months. Conditioning therapy consisted of cyclophosphamide (CY) and total body irradiation (TBI) in 71 patients and CY and busulfan (BU) in 16. One patient received etoposide and TBI. For graft-versus-host disease (GVHD) prophylaxis methotrexate (MTX) was given to 12 patients, MTX and cyclosporin A (CSA) to 67, CSA alone to four, and CSA and methylprednisolone to five. Durable engraftment was documented in 80 of 82 patients (98%). As of December 31, 1997, 52 patients (59%) were alive, 38 (58%) after sibling transplantation with a median observation time of 73 months and 14 (64%) after URD transplantation with a median observation time of 12 months. Probability of overall survival is 59%, for patients undergoing transplantation in chronic phase and 44% for patients undergoing transplantation in advanced stage CML. Probability of disease-free survival (DFS) after sibling and URD BMT is 55% and 59%, respectively. Ten patients (12%) experienced relapse of CML. Transplant-related mortality was 32% both after RD and after URD transplantation. Acute GVHD occurred in 53 of 80 evaluable patients (66%), consisting of grade III or IV in 14 patients (18%). Chronic GVHD developed in 40 of 63 eligible patients (63%), including extensive disease in 26 patients (41%). Thus, sibling and URD BMT offer high cure rates with acceptable toxicity to patients with CML.
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  • 5
    ISSN: 1432-0649
    Keywords: PACS: 42.60.By; 42.50.Vk; 32.80.Pj
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract. We report on master-oscillator power amplification using a broad-area laser diode (BAL) emitting at a wavelength of λ =780 nm. The master oscillator is an injection-locked single-mode diode laser delivering a seeding beam of 35 mW, which is amplified in double pass through the BAL up to 410 mW. After beam shaping and spatial filtering by a single-mode fibre we obtain a clean Gaussian beam with a maximum power of 160 mW. There is no detectable contribution of the BAL eigenmodes in the spectrum of the output light. This laser system is employed for operation of a 87Rb magneto-optical trap (MOT) and for near-resonant absorption imaging in a Bose-Einstein condensation experiment.
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  • 6
    ISSN: 1432-0584
    Keywords: Key words Acute myelogenous leukemia ; Allogeneic marrow transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Between February 1982 and April 1995, 62 patients (37 male, 25 female) with acute myelogenous leukemia (AML) with a median age of 32 years (19–51 years) received allogeneic marrow grafts from an HLA-identical sibling (n=60) or an HLA-mismatched family member (n=2). At the time of transplant, 35 patients were in first complete remission (CR), five in second CR, eight were primary refractory, eight were in untreated relapse and six in refractory relapse. The FAB subtypes were as follows: M1 (n=17), M2 (n=13), M3 (n=6), M4 (n=19), M5 (n=6), M6 (n=1). For conditioning most patients were given total body irradiation combined with cyclophosphamide (CY, n=50) or CY and busulfan (n=9). For graft-versus-host disease prophylaxis patients received cyclosporin A (CSA) and methotrexate (MTX) (n=32), MTX alone (n=12), CSA and methylprednisone (n=5), or CSA alone (n=13). As of April 1995, probability of leukemia-free survival projected at 10 years after BMT was 60% for patients transplanted in first CR compared with 10% for patients transplanted beyond first CR. Transplant-related mortality was 11% after BMT in first CR and 39% after BMT beyond first CR. Probability of relapse projected at 10 years after BMT is 32% for patients who received transplants in first CR and 81% for patients who received transplants beyond first CR. Thus, high-dose chemo/radiotherapy followed by allogeneic marrow infusion has a high curative potential for patients with AML who receive transplants in first CR and offers the chance of long-term disease-free survival for some patients with advanced disease.
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  • 7
    ISSN: 1432-0584
    Keywords: Key words Acute myelogenous leukemia ; Stem-cell transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Between February 1982 and 1999, 118 consecutive patients (65 male, 53 female) with acute myelogenous leukemia (AML), with a median age of 35 years (range 17–56 years), received stem-cell grafts from a human leukocyte antigen-identical sibling (n=71), one-antigen-mismatched family member (n=2), matched unrelated donor (n=15), one-antigen-mismatched unrelated donor (n=4) or an autologous (n=26) graft. At the time of transplant, 56 patients were in the first complete remission (CR), 27 in the second CR, 6 in untreated relapse, 17 in primary refractory, and 12 in refractory relapse. The French-American-British classification (FAB) subtypes were as follows: M1 (n=25), M2 (n=28), M3 (n=11), M4 (n=32), M5 (n=16), M6 (n=6). For conditioning, most patients underwent total body irradiation-containing regimens. As of 28 February, 1999, probability of leukemia-free survival (LFS) is 58% for patients after related and 45% after unrelated stem-cell transplantation (SCT). The probability of LFS is 70% for patients given allogeneic transplants in the first CR compared with 33% for those beyond the first CR at SCT. In autologous stem-cell graft recipients, the probability of LFS is 37%. Transplant-related mortality was 28% after related, 20% after unrelated, and 4% after autologous SCT. Probability of relapse for patients given related-donor stem-cell grafts in the first CR and beyond the first CR is 30% and 67%, 55% after unrelated and 63% after autologous stem-cell grafting. Thus, myeloablative therapy followed by allogeneic stem-cell infusion has a high curative potential for patients with AML in remission and offers substantial benefits to patients in advanced disease.
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  • 8
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Contralateral biopsies from 1810 consecutive patients with testicular germ-cell tumor were examined immunohistologically by staining for placental alkaline phosphatase. Contralateral testicular intraepithelial neoplasia (TIN; carcinoma in situ) was found in 89 patients (4.9%; 95% confidence interval, 3.9%–5.9%). Testicular atrophy was present in 45.9% of patients with TIN and in 13.1% of those without TIN (P〈0.01). There was a history of cryptorchidism in 16.2% of patients with TIN versus only 8.5% of those without TIN (P〈0.05). Patients with contralateral TIN presented at an earlier age (30.8 versus 33.3 years). In all, 23 patients with contralateral TIN had no specific risk marker. In 14 patients with contralateral TIN who had received local radiotherapy of 18–20 Gy to the testis, rebiopsy revealed the disappearance of TIN in all cases. Serum testosterone levels were within or above the normal range in 7 of 13 patients examined after local radiotherapy. Of 9 patients with contralateral TIN who had received chemotherapy, 2 were shown to have persistent TIN at rebiopsy. We conclude that all patients with testicular germ-cell tumor should be offered a contralateral biopsy. Local radiotherapy of the testis is the treatment of choice in patients with contralateral TIN.
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  • 9
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A total of 385 patients (83% men, 52% aged 16–30) with urogenital (UG) trauma were treated in 19 urological clinics between April 1984 and December 1986. In all, 41% of the accidents were due to traffic; 13% to work and sports each; 8% to sexual activities; and 6% to violence. The distribution of injury severity included 40% light, 21% moderate and 39% severe. Of 427 UG lesions, 27% were combined with intraabdominal and 24% with pelvic injuries. The kidneys were involved in 51% of cases and the bladder, urethra, penis and scrotum, including its content, in ca. 10% each. Of the renal traumas, 49% were ruptures; 48% contusions; and 7% hilar lesions,a nd in 6% the complete destruction of the organ occurred. In all, 76% of these traumas were treated conservatively, whereas 8% each required reconstruction or nephrectomy. Amongst the urethral ruptures, 46% were complete; 39% partial posterior; and 11% ruptures of the penile urethra. In 43% of cases the treatment was conservative and in 41% a primary reconstruction was carried out. All intraperitoneal (43%) and 2/3 of the extraperitoneal bladder ruptures (57%) were operated on. Gross hematuria was found in 73% of the renal, 83% of the vesical and 73% of the urethral injuries. Microhematuria occurred in 24%, 9% and 13% of cases, whereas no hematuria was found in 3%, 5% and 13% of the kidney, bladder and urethral injuries, respectively. The injury-relevant sensitivity of the imaging methods was computed to be 95% for cystograms, 91% for urethrograms and 83% for angiograms. When used to screen trauma patients, the sensitivity proved to be 69% for the CT scan, 55% for the intravenous pyelogram (IVP) and 54% for sonography. Overall, 37% of 161 complications involved the UG tract, followed by neurological complications, those due to the operation or treatment, to infections or to organ failure. In all, 11% of patients remained in the hospital for only 1 day; 50% for up to 13 days; 20% for 14–60 days; and 17% for 〉60 days.
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  • 10
    ISSN: 0942-0940
    Keywords: Keywords: Brain metastasis; stereotactic radiosurgery; surgery.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Stereotactic radiosurgery (RS) and surgery have proved to be effective treatment modalities for brain metastasis. We followed 133 patients whose treatment for intracranial disease was either RS or a single surgical resection at the University of Vienna from August 1992 through October 1996. All patients who received additional Whole Brain Radiotherapy were included. This was a retrospective, case-control study comparing these treatment modalities.  Sixty-seven patients were treated by RS and 66 patients were treated by microsurgery. The median size of the treated lesions for RS patients was 7800 mm3, and 12500 mm3 for microsurgery patients, respectively. The median dose delivered to the tumour margin for RS patients was 17 gray.  The median survival for patients after RS was 12 months, and 9 months for patients after microsurgery. This difference was not statistically significant (p=0.19). Comparison of local tumour control, defined as absence of regrowth of a treated lesion, showed that tumours following RS had a preferred local control rate (p〈0.05). Univariate and multivariate analysis showed that this fact was due to a greater response rate of “radioresistant” metastasis to RS (p〈0.005). Postradiosurgical complications included the onset of peritumoural oedema (n=5) and radiation necrosis (n=1). Two patients after microsurgery experienced local wound infection. One postoperative death occurred due to pulmonary embolism in this group.  On the basis of our data we conclude that RS and microsurgery combined with Whole Brain Radiotherapy are comparable modalities in treating single brain metastasis. Concerning morbidity and local tumour control, in particular in cases of “radioresistant” primary tumours, RS is superior. Therefore we advocate RS except for cases of large tumours (〉3 cm in maximum diameter) and for those with mass effect.
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