The aims of the study were to evaluate therapeutic efficacy and to determine the prognostic factors for treatment success in patients with liver metastases from colorectal cancer (CRC) treated with transarterial chemoembolization (TACE). A total of 564 patients (mean age, 60.3 years) with liver metastases of CRC were repeatedly treated with TACE. In total, 3,384 TACE procedures were performed (mean, six sessions per patient). The local chemotherapy protocol consisted of mitomycin C alone (43.1%), mitomycin C with gemcitabine (27.1%), mitomycin C with irinotecan (15.6%) or mitomycin C with irinotecan and cisplatin (15.6%). Embolization was performed with lipiodol and starch microspheres. Tumor response was evaluated using magnetic resonance imaging or computed tomography. The change in tumor size was calculated and the response was evaluated according to the RECIST-Criteria. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors for patient's survival were evaluated using log-rank test. Evaluation of local tumor control showed partial response in 16.7%, stable disease in 48.2% and progressive disease in 16.7%. The 1-year survival rate after chemoembolization was 62%, the 2-year survival rate was 28% and the 3-year survival rate was 7%. Median survival from the start of chemoembolization treatment was 14.3 months. The indication (p 5 0.001) and initial tumor response (p 5 0.015) were statistically significant factors for patient's survival. TACE is a minimally invasive therapy option for controlling local metastases and improving survival time in patients with hepatic metastases from CRC. TN stage, extrahepatic metastases, number of lesions, tumor location within the liver and choice of chemotherapy protocol of TACE are none significant factors for patient's survival.The development of liver metastases in patients with colorectal cancer (CRC) substantially affects the prognosis of the patient. At the time of first diagnosis of CRC, 20-50% of all patients already present with synchronous liver metastases. Liver metastases develop in about 60-70% of CRC patients during the course of their disease and are the most common cause of death of patients with CRC. [1][2][3] Resection is the only potentially curative therapy for patients with liver metastases from CRC. 4,5 Only 20% of patients with liver metastases will be candidates for resection. With modern oncosurgical approaches, patients with resected liver metastases can experience up to 50-60% 5-year overall survival and a median survival of 46-64 months.6-8 Systemic chemotherapy may achieve this goal in 10-20% of initially unresectable patients. 9,10 The high rate of inoperable patients and intrahepatic recurrence rates are another relevant problem. Currently, the standard first-line treatment of metastatic CRC is a combination of infusional 5-FU, folinic acid with either irinotecan (FOLFIRI) or oxaliplatin (FOLFOX). The response rate to these schedules is 50%, and 50% of patients will progress within 10 months. In second-line therap...

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The cochlear nerve size and the cochlear to facial nerve size ratio are significantly smaller in patients with acquired long-standing SNHL. Advances in knowledge: The facial nerve can be used as a reference for assessment of the cochlear nerve in patients with acquired long-standing SNHL.

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The purpose of this study was to evaluate the scope of sub-millimeter collimation reconstruction parameters using 16-row computer tomography and ECG triggering on image quality in virtual bronchoscopy. Thirty-two patients (5 women, 27 men, mean age 66.6+/-1.4) who had been admitted for coronary artery bypass graft surgery underwent CT examination of the thorax (Sensation 16, Siemens, Inc., Forchheim, Germany). All patients were examined with 16x0.75-mm collimation. Image reconstruction was performed for two groups. In group A ( n=32), slice thickness of 1.5 mm and an overlap of 0.75 mm were used. In group B ( n=32), slice thickness of 0.75 mm and an overlap of 0.4 mm were applied. Retrospective ECG triggering was performed in all patients. The maximum order of recognizable bronchi was determined in each data set. In addition to assessing the maximum order of bronchial bifurcation, bronchial diameter was determined in truly perpendicular sections in each patient. For every segment proximal to a bifurcation, image quality was subjectively graded as poor (grade 1), moderate (grade 2) or good (grade 3). The observers were asked to identify the minimum cardiac movement ECG-triggered image sets assuming that they would be of better quality than the maximum cardiac movement ECG-triggered image sets. The Mann-Whitney U-test and the Fisher's Exact Test were used for statistical evaluation. In group A, a mean of 4.8+/-0.2 bifurcations was ascertained vs. 6.5+/-0.3 bifurcations in group B [ P<0.0003]. For bronchial diameters in group A, a mean of 7.5+/-0.4 mm was determined vs. 4.6+/-0.4 mm in group B [ P<0.0001]. In group B, two independent radiologists observed a significant shift to better image quality in all segments evaluated [ P<0.006 to P<0.000001]. Motion artifacts were judged as being significantly reduced by minimum cardiac movement ECG-triggering in group B [observer 1: P=0.0007 (20/32); observer 2: P=0.008 (18/32)], but not in group A [observer 1: P=0.286 (13/32); observer 2: P=0.123 (16/32)]. Sub-millimeter collimation and minimum cardiac movement ECG-triggered data acquisition allow deeper penetration into the tracheo-bronchial system allowing visualization of the bronchial surface down to diameters below 5 mm in certain cases up to the eighth bifurcation. Along with an enhanced visualization as such, better image quality is acquired in all segments evaluated. Trade off between better image quality, of doubtful diagnostic consequence, and much higher irradiation dose must be made.

We report a case of histopathologically proven autoimmune pancreatitis in an 11-year-old boy. Abdominal US and MRI showed a focal swelling of the pancreatic head, the latter also showing delayed contrast enhancement. There was diffuse irregular pancreatic duct narrowing, compression of the intrapancreatic common bile duct, and mild proximal biliary dilatation on MR cholangiopancreatography. Laboratory results revealed normal serum IgG and subclass 4 with negative autoimmune antibodies, and slightly elevated carbohydrate antigen 19-9. This highlights the differentiation of autoimmune pancreatitis from pancreatic head cancer and, to a lesser extent, other forms of pancreatitis in children.

Vismodegib hedgehog signaling inhibition treatment has potential for reducing the burden of multiple skin basal cell carcinomas and jaw keratocystic odontogenic tumors. They are major criteria for the diagnosis of Gorlin syndrome, also called nevoid basal cell carcinoma syndrome. Clinical features of Gorlin syndrome are reported, and the relevance of hedgehog signaling pathway inhibition by oral vismodegib for maxillofacial surgeons is highlighted. In summary, progressed basal cell carcinoma lesions are virtually inoperable. Keratocystic odontogenic tumors have an aggressive behavior including rapid growth and extension into adjacent tissues. Interestingly, nearly complete regression of multiple Gorlin syndrome-associated keratocystic odontogenic tumors following treatment with vismodegib. Due to radio-hypersensitivity in Gorlin syndrome, avoidance of treatment by radiotherapy is strongly recommended for all affected individuals. Vismodegib can help in those instances where radiation is contra-indicated, or the lesions are inoperable. The effect of vismodegib on basal cell carcinomas was associated with a significant decrease in hedgehog-signaling and tumor proliferation. Vismodegib, a new and approved drug for the treatment of advanced basal cell carcinoma, is a specific oncogene inhibitor. It also seems to be effective for treatment of keratocystic odontogenic tumors and basal cell carcinomas in Gorlin syndrome, rendering the surgical resections less challenging.

1 Long-term treatment with b 2 -adrenoceptor agonists can lead to a decreased therapeutic e cacy of bronchodilatation in patients with obstructive pulmonary disease. In order to examine whether or not this is due to b-adrenoceptor desensitization, human bronchial muscle relaxation was studied in isolated bronchial rings after pretreatment with b 2 -adrenoceptor agonists. Additionally, the in¯uence of pretreatment with dexamethasone on desensitization was studied.2 The e ect of b 2 -agonist incubation alone and after coincubation with dexamethasone on density and a nity of b-adrenoceptors was investigated by radioligand binding experiments. 3 In human isolated bronchi, isoprenaline induces a time-and concentration-dependent b-adrenoceptor desensitization as judged from maximal reduction in potency by a factor of 7 and reduction of 73+4% in e cacy of isoprenaline to relax human bronchial smooth muscle. 4 After an incubation period of 60 min with 100 mmol l 71 terbutaline, a signi®cant decline in its relaxing e cacy (81+8%) and potency (by a factor 5.5) occurred. 5 Incubation with 30 mmol l 71 isoprenaline for 60 min did not impair the maximal e ect of a subsequent aminophylline response but led to an increase in potency (factor 4.4). 6 Coincubation of dexamethasone with isoprenaline (120 min; 30 mmol l 71 ) preserved the e ect of isoprenaline on relaxation (129+15%). In conclusion, pretreatment of human bronchi with b-adrenoceptor agonists leads to functional desensitization and, in lung tissue, to down-regulation of b-adrenoceptors. This e ect can be counteracted by additional administration of dexamethasone. Our model of desensitization has proved useful for the identi®cation of mechanisms of b-adrenoceptor desensitization and could be relevant for the evaluation of therapeutic strategies to counteract undesirable e ects of long-term b-adrenoceptor stimulation.