CA19-9 values are regularly measured in patients with pancreatic cancer. Certainly, its potential as a biomarker has been compromised by false negative results in CA19-9 negative patients and false positive results in benign pancreatico-biliary diseases. For detection of PDAC recurrence, however, CA19-9 might play an important role. The aim of this study is to analyze the accuracy of CA19-9 for detecting recurrence of pancreatic cancer. All included patients were treated either at the University Medical Center Goettingen, or at the Department of Interdisciplinary Oncology and Pneumonology, DRK-Kliniken Nordhessen, Kassel. We analyzed data of 93 patients with pancreatic cancer in the training set and 41 in the validation set, both retrospectively. Pre- and postoperative CA19-9 values and results of imaging techniques were compared. We performed ROC-analysis. The association between longitudinally measured CA19-9 values and relapse was studied with a joint model between a random effects model for the longitudinal CA19-9 measurements and a Cox proportional hazards models for the survival data. In the test set (n = 93 patients) the median follow-up time was 644 days (22 months). Overall, 71 patients (76.3%) developed recurrence during follow-up. Patients with CA19-9 values of <10kU/l were considered as CA19-9 negative patients (n = 11) and excluded from further analysis. Among the rest, approximately 60% of the patients showed significantly elevated CA19-9 prior to detection of recurrence by imaging techniques. Recurrence was shown by 2.45 times elevated CA19-9 values with 90% positive predictive value. In the validation set, 2.45 times elevated CA19-9 values showed recurrence with 90% sensitivity and 83,33% specificity, with an area under the curve of 95%. Based on measured CA19-9 values during follow-up care, the joint model estimates in recurrence-free patients the probability of recurrence-free survival. CA19-9 elevation is an early and reliable sign for PDAC recurrence. On the strength of a very high accuracy in CA19-9 positive patients, it should be considered to use CA19-9 for therapy decision even without a correlate of imaging technics. Using the joint model, follow-up care of PDAC patients after curative therapy can be stratified.

Background: To assess prospectively the safety and efficacy of Yttrium-90 microspheres in patients with unresectable liver metastases from neuroendocrine tumors. Materials and Methods: Microspheres were administered via a temporarily placed hepatic catheter. Patients were monitored prospectively. All patients were followed with laboratory and imaging studies at regular intervals to determine response rates. Toxicity and quality of life scores were measured. Results: Nine patients (7 female) with a mean age of 58.8 years were enrolled in this prospective trial. The mean tumor load was 58.8%. The estimated percentage shunting to the lungs on MAA scans was 5.04 ± 2.4%. Visceral artery embolization of extrahepatic arteries before treatment was performed in 6 patients. The median dose of microspheres was 2.1 ± 0.4 GBq. A total of 12 therapy sessions was performed. The mean follow-up was 21.7 months. Technical success was 100%. No major complications occurred. Survival rates were 100, 57 and 57% for 1, 2 and 3 years, respectively. Three months after SIRT therapy partial response (PR) was seen in 6 patients (66%). Calculated reduction of liver metastasis volume was 49%. In 3 patients (33%) stable disease was seen with a calculated tumor reduction of 13%. The estimated time to progression was 11.1 months. Conclusion: Radioembolization with ⁹⁰Y microspheres is safe and produces high response rates even with extensive tumor replacement for up to 1 year. Acute and late toxicity was very low. Further investigations compared with other local ablative techniques is warranted.

Four cases are presented, in whom cerebellar haemorrhages appeared as a complication following supratentorial craniotomy for a giant aneurysm, for tumours in three cases. Two patients died. Intracranial hypotension in combination with disturbed blood coagulation is discussed as possible pathogenesis. Because this seems to be a rare complication--similar cases have not yet been described in the literature--its timely diagnosis may be missed.

Neuroendocrine tumors of the thymus (tNET) and mediastinum are very rare neoplasms with scarce available data. All subtypes [typical and atypical carcinoid tumors (TC and AC), large cell neuroendocrine and small cell carcinoma (SCC)] observed elsewhere in the body occur also in the mediastinum and show only few if any organ-specific morphological differences. Although all available data suggest that the broad principles that govern the biology (and hence) the classification of these tumors in general apply also to tNET, there are a few noteworthy peculiarities related e.g., to risk factors, relative frequency and also to molecular genetic features. In this review, we will briefly summarize current knowledge on tNET with a special emphasis on shared and private features in comparison e.g., with pulmonary NET, which have traditionally been regarded the next closely related NET group.

The results of transnasal-transsphenoidal surgery in 31 patients with craniopharyngioma are evaluated. To assess the value of transnasal surgery in cases with visual impairment, the results are compared to cases operated transcranially. There was only one death occurred on the 5th postoperative day. Two patients developed rhinoliquorrhoea, and one a transient oculomotor palsy. Recurrences leading to re-operation occurred frequently after mere cyst aspiration and only once after subtotal tumour removal. Normal glandotrope functions of the hypophysis were preserved in 75%, disturbed functions were normalized in 19% of primary transnasal surgery. Visual disturbances were normalized or improved in 94% cases after transnasal surgery, whereas an improvement was observed in only 65% after transcranial surgery. A deterioration never appeared after transnasal surgery, but in 26% after transcranial operations.

ABSTR AC TPurpose Local ablative therapies have become an established treatment option in interventional oncology. Radiofrequency ablation (RFA) and microwave ablation (MWA) are a standard of care in the treatment of hepatocellular carcinoma (HCC). Currently, there is an increasing interest in cryotherapy, one of the oldest ablation techniques. It has some unique characteristics with regard to technology and mechanism of action.Materials and Methods A systematic literature search using the terms cryotherapy, cryosurgery and cryoablation was performed. Selected studies are presented dealing with the mechanism of action, cryobiology and clinical use of percutaneous, image-guided cryoablation. Recent developments and perspectives are presented.Results Cryotherapy is increasingly used and has been included in guidelines for selected tumor entities such as renal cell carcinoma. Cryo-immunotherapy and combination treatments are future areas of interest.Conclusion Cryoabalation may be used in many indications.Its major advantages are its unique visualization and the anesthesiologic effects of cold. While there are only a few prospectively randomized trials, the existing data on the use of cryoablation is promising. Its use appears to be justified in selected tumors, oligometastatic patients and for palliative indications.

BackgroundAging involves reductions in exercise total limb blood flow and exercise capacity. We hypothesized that this may involve early age-related impairments of skeletal muscle microvascular responsiveness as previously reported for insulin but not for exercise stimuli in humans.MethodsUsing an isometric exercise model, we studied the effect of age on contrast-enhanced ultrasound (CEUS) parameters, i.e. microvascular blood volume (MBV), flow velocity (MFV) and blood flow (MBF) calculated from replenishment of Sonovue contrast-agent microbubbles after their destruction. CEUS was applied to the vastus lateralis (VLat) and intermedius (VInt) muscle in 15 middle-aged (MA, 43.6±1.5 years) and 11 young (YG, 24.1±0.6 years) healthy males before, during, and after 2 min of isometric knee extension at 15% of peak torque (PT). In addition, total leg blood flow as recorded by femoral artery Doppler-flow. Moreover, fiber-type-specific and overall capillarisation as well as fiber composition were additionally assessed in Vlat biopsies obtained from CEUS site. MA and YG had similar quadriceps muscle MRT-volume or PT and maximal oxygen uptake as well as a normal cardiovascular risk factors and intima-media-thickness.ResultsDuring isometric exercise MA compared to YG reached significantly lower levels in MFV (0.123±0.016 vs. 0.208±0.036 a.u.) and MBF (0.007±0.001 vs. 0.012±0.002 a.u.). In the VInt the (post-occlusive hyperemia) post-exercise peaks in MBV and MBF were significantly lower in MA vs. YG. Capillary density, capillary fiber contacts and femoral artery Doppler were similar between MA and YG.ConclusionsIn the absence of significant age-related reductions in capillarisation, total leg blood flow or muscle mass, healthy middle-aged males reveal impaired skeletal muscle microcirculatory responses to isometric exercise. Whether this limits isometric muscle performance remains to be assessed.

Background The increasing number of minimally invasive fluoroscopy-guided interventions is likely to result in higher radiation exposure for interventional radiologists and medical staff. Not only the number of procedures but also the complexity of these procedures and therefore the exposure time as well are growing. There are various radiation protection means for protecting medical staff against scatter radiation. This article will provide an overview of the different protection devices, their efficacy in terms of radiation protection and the corresponding dosimetry. Method The following key words were used to search the literature: radiation protection, eye lens dose, radiation exposure in interventional radiology, cataract, cancer risk, dosimetry in interventional radiology, radiation dosimetry. Results and Conclusion Optimal radiation protection always requires a combination of different radiation protection devices. Radiation protection and monitoring of the head and neck, especially of the eye lenses, is not yet sufficiently accepted and further development is needed in this field. To reduce the risk of cataract, new protection glasses with an integrated dosimeter are to be introduced in clinical routine practice. Key Points:  Citation Format