Gisela Bischoff

Integrated FDG-PET-CT: its role in the assessment of bone and soft tissue tumors

PurposeThe purpose of this study was to evaluate prospectively, whether integrated 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography-computed tomography (FDG-PET-CT) is more accurate for determination musculoskeletal tumors compared with separate interpretation of CT and FDG-PET, because most of the current clinical data come from patients studied with PET.MethodsEighty patients with newly diagnosed musculoskeletal tumors underwent FDG-PET-CT. CT, FDG-PET, and FDG-PET-CT were interpreted separately to determine the performance of each imaging modality.ResultsAssuming that equivocal lesions are benign, performance of diagnostic tests was as follows: sensitivity, specificity and accuracy for CT alone was 81, 84, 83%, for PET 71, 82, 76, and for PET-CT 80, 83 and 86%. Assuming that equivocal lesions are malignant, sensitivity, specificity, and accuracy for CT was 61, 100, 70%, for PET 69, 100, 79, and for PET-CT 69, 100 and 79%.ConclusionsCombined FDG-PET-CT reliably differentiates soft tissue and bone tumors from benign lesions. The value of the information provided by FDG-PET-CT for planning surgical procedures must be evaluated in further studies.

Hybrid Procedures for Complex Thoracoabdominal Aortic Aneurysms: Early Results and Secondary Interventions

Background: Hybrid procedures for thoracoabdominal aortic aneurysms (TAAA) have been previously described as an attractive alternative to open reconstruction. Patients and Methods: Between 1999 and 2009, 16 patients with a median age of 67years underwent hybrid repair of a TAAA (Crawford type I: 3, type II: 3, type III: 1, and type IV: 9). In 94%, 3 and more severe comorbidities were present, with previous aortic surgery in 56% of the patients; elective/urgent repair was done in 10 and emergent surgery in 6 patients. Results: Primary technical success was 100%, with 31 vessels grafted. Elective/urgent mortality was 20% (2 of 10) and emergent mortality 50% (3 of 6). During follow-up time (median: 12 months) 2 patients died and 2 patients had to undergo secondary interventions. Conclusion: In high-risk patients especially after prior aortic surgery hybrid repair of TAAA is feasible. However, due to high mortality rates especially in the emergent situation this procedure should be reserved only for decidedly selected patients.

Effect of statin therapy on serum activity of proteinases and cytokines in patients with abdominal aortic aneurysm.

Background and aims: Metalloproteinases (MMPs) are considered to be key enzymes in the pathogenesis of abdominal aortic aneurysms (AAA), with elevated levels in diseased aorta and in patient sera. Statins seem to exert an inhibitory effect on MMP activity in the aortic wall. No data exist on the effect of statins on serum activity of MMPs and inflammatory cytokines (interleukins, IL). Methods: The serum activities of MMP2 and MMP9, osteoprotegerin (OPG), and IL6 and IL10 in 63 patients undergoing elective infrarenal aneurysm repair were measured on the day before surgery. Levels were correlated to statin therapy and aneurysm diameter. Results: There was no significant difference between the two groups in the activity of circulating levels of MMP2/9, OPG, and IL6/10 in patients with infrarenal aortic aneurysm. IL6 levels in patients with AAA larger than 6 cm were significantly elevated; differences in serum activities of MMP2/9, OPG, and IL10 were not related to AAA diameter. Conclusion: Serum activities of MMP2/9, OPG, and IL6/10 are not correlated to statin therapy; IL6 levels are higher in patients with large aneurysms. Hence the effect of statin therapy in the treatment of aneurismal disease remains to be elucidated.

Adipositas – Diätetische und medikamentöse Behandlungsmöglichkeiten

ZusammenfassungDie diätetische Therapie der Adipositas muss in ein langfristiges Ernährungs- und Lifestylekonzept eingebettet sein. Durch eine erfolgreiche diätetische Therapie können Morbidität und Mortalität signifikant gesenkt werden. Adipositastherapie ist aber nur dann erfolgreich, wenn sie in einem Therapiekonzept mit interdisziplinärem Programm und fachlicher Kompetenz von Ärzten, Psychologen, Bewegungstherapeuten und Ernährungsspezialisten durchgeführt wird. In dieser Konstellation ist die Kombination von Formuladiät, gefolgt von Reduktionsdiät mit einem intensiven Lifestyletraining außerordentlich erfolgreich. Die Erfolge derart strukturierter und leitliniengerechter Programme sind mit Ergebnissen der chirurgischen Adipositasbehandlung vergleichbar. Die medikamentöse Therapie der Adipositas hat zurzeit nur marginale Bedeutung.AbstractDiet therapy for obesity must be incorporated into a long-term nutrition and lifestyle concept. Morbidity and mortality can be significantly reduced by a successful diet therapy but can only be successful when carried out in a therapy concept with an interdisciplinary program and specialist competence of physicians, psychologists, movement therapists and nutrition experts. In this constellation the combination of formula diet followed by reduction diet with intensive lifestyle training is extraordinarily successful. The success of such a structured and guideline conform program is comparable with surgical treatment of obesity. The medicinal treatment of obesity is presently only of marginal significance.