Invasive sonographische Diagnostik in der Hämatologie und Onkologie

Die histologische Diagnostik stellt in der Hämatologie und Onkologie die Voraussetzung einer differenzierten Therapie dar. Minimal-invasive Eingriffe mittels sonographisch-gesteuerter Punktion zur Gewinnung von zytologischen oder histologischen Material bedeutet sowohl einen zeitlichen Gewinn, als auch eine Herabsetzung des Risikos eines operativen Eingriffs. Mit dem gewonnenen Gewebe werden auch immunhistologische Untersuchungen möglich, die z.B. bei Non-Hodgkin Lymphomen notwendig sind. Zur intensiven Polychemotherapie bei malignen Erkrankungen werden oft zentral-venöse Katheter bzw. Port-Anlagen in große Venen eingeführt. Die Komplikationen und deren Management werden aufgezeigt und diskutiert. Eine sonographisch-gesteuerte Venenpunktionstechnik stellt eine Methode dar, die für die Patienten einen risikoarmen und schnelleren Weg bedeuten und als neu-entwickelte Ein-Personen-Technik auch für den Arzt ein innovatives Vorgehen bei einem potentiell komplikationsträchtigen Eingriff mit größerer Sicherheit durchzuführen.In hematology and oncology histological diagnosis is an important requirement before differential chemotherapy. Sonographically guided puncture techniques achieving cytological and histological material is a time-saving process with moderate risks for the patients. With this material even immunhistological procedures in malignancies like Non-Hodgkin lymphoma are possible. For intensified chemotherapies in malignant diseases central venous catheter such as port catheters are requiriered. In this thesis complications and their management are shown and discussed. The ultrasounically guided central venous puncture represents a method for fast and low risk procedure for our patients. The one-operator technique represents an innovative and save intervention in a potentially risky procedure for physicians

Intrasplenic Pancreatic Pseudocyst after Chemoradiation of a Pancreatic Adenocarcinoma Mimicking Progressive Disease: A Case Report and Review of the Literature

Chemoradiation is one of the therapeutic options in palliative treatment of locally advanced pancreatic adenocarcinoma, with a well-known safety profile. In this case report, we describe the treatment-related occurrence of an intrasplenic pancreatic pseudocyst which was successfully removed by gastrocystic drainage. This rare complication should be considered in the follow-up and clinical management of patients, particularly if left-sided complaints occur

A flow chamber assay for quantitative evaluation of bacterial surface colonization used to investigate the influence of temperature and surface hydrophilicity on the biofilm forming capacity of uropathogenic Escherichia coli

We have established a simple flow chamber-based procedure which provides an accurate and reproducible way to measure the amount of biofilm formed on an implantable biomaterial surface. The method enables the side-by-side evaluation of different materials under hydrodynamic flow conditions similar to those found on an implanted device. We have used the method to evaluate the biofilm forming capacity of clinically isolated Escherichia coli on silicone rubber and on silicone rubber containing a hydrophilic coating. It was found that the surface chemistry influenced the colonization of the isolates very differently. In addition, the temperature was found to have a considerable influence upon the adhesion and biofilm forming capacity of some of the isolates, and that the influence of surface chemistry depended on temperature. Our results suggest that the step from using E. coli laboratory strains to clinical isolates entails a significant rise in complexity and yields results that cannot be generalized. The results should be valuable information for researchers working with pre-clinical evaluation of device-associated E. coli infections

Decreased material-activation of the complement system using low-energy plasma polymerized poly(vinyl pyrrolidone) coatings

In the current study we investigate the activation of blood complement on medical device silicone rubber and present a plasma polymerized vinyl pyrrolidone (ppVP) coating which strongly decreases surface-activation of the blood complement system. We show that uncoated silicone and polystyrene are both potent activators of the complement system, measured both as activated, deposited C3b and quantifying fluid-phase release of the cleavage fragment C3c. The ppVP coated silicone exhibits approximately 90% reduced complement activation compared to untreated silicone. Quartz crystal microbalance with dissipation (QCM-D) measurements show relatively strong adsorption of blood proteins including native C3 to the ppVP surface, indicating that reduction of complement activation on ppVP is neither a result of low protein adsorption nor lower direct C3-binding, and is therefore possibly a consequence of differences in the adsorbed protein layer composition. The alternative and classical complement pathways are barely detectable on ppVP while the lectin pathway through MBL/ficolin-2 deposition remains active on ppVP suggesting this pathway is responsible for the remaining subtle activation on the ppVP coated surface. The ppVP surface is furthermore characterized physically and chemically using scanning electron microscopy (SEM), x-ray photoelectron spectroscopy (XPS) and Fourier transform infrared (FTIR), which indicates preservation of chemical functionality by the applied plasma process. Overall, the ppVP coating shows a potential for increasing complement compatibility of blood-contacting devices

Common clonal origin of an acute B-lymphoblastic leukemia and a Langerhans’ cell sarcoma: evidence for hematopoietic plasticity

Background. The hierarchical organization of the hematopoiesis with unidirectional lineage determination has become a questionable tenet in view of the experimental evidence for reprogramming and transdifferentiation of lineage determined cells. Clinical examples of hematopoietic lineage plasticity are rare. Here we report on a patient who presented with an acute B-lymphoblastic leukemia (B-ALL) and developed a Langerhans cell sarcoma (LCS) nine years later. We provide evidence that the second neoplasm is the result of a transdifferentiation. Design and Methods. B-ALL was diagnosed in an 11 year old boy in 1996. Treatment according to the ALL-BFM-1995 protocol resulted in a complete remission. Nine years later, in 2005, LCS was diagnosed in a supraclavicular lymph node. Despite treatment with different chemotherapy protocols the patient had progressive disease. Finally, he received an allogeneic peripheral blood stem cell transplantation and achieved a continuous remission. Molecular studies of IgH- and TCRgamma- gene rearrangements were performed with DNA from the LCS and the cryopreserved cells from the B-ALL. The expression of PAX5 and Id2 was analyzed with real-time RT-PCR. Results. Identical IgH-rearrangements in the B-ALL and the LCS were demonstrated. The key factors required for B-cell and dendritic cell development PAX5 and Id2 were differentially expressed, with a strong PAX5 signal in the B-ALL and only a weak expression in the LCS, whereas Id2 showed an opposite pattern. Conclusions. The identical IgH-rearrangement in both neoplasms indicates a transdifferentiation of the B-ALL into a LCS. Loss of PAX5 and the acquisition of Id2 suggest that these key factors are involved in the transdifferentiation from a B-cell phenotype into a Langerhans/dendritic cell phenotype