RESUMEN

PURPOSE: Modern cancer care is provided in highly specialized structures as certificated centres and comprehensive cancer center, as well as specialized practices. In contrast, the position of the general practitioner (GP) is less well characterised and there is a lack of information about his importance in the care for cancer patients. The aim of our survey was to assess the role of GPs in German cancer care from patients' perspective. METHODS: In several steps we developed a standardized anonymous questionnaire in cooperation with the German Association of General Practitioners and the Federal Association of German Self-Help Groups. This questionnaire was used in a print and an online version and distributed by the self-help organizations to their members. RESULTS: Seven hundred and forty participants took part in the survey, 66.5% women and 30.1% men. 71% had visited the GP during cancer therapy and 34.5% discussed decisions concerning diagnostics and therapy with him. The most relevant reasons to visit the GP during cancer therapy were to get a blood test (63.3%), comorbidities (42.7%) and complaints and side effects (38.3%). For the latter, most often a detailed discussion ensued (57%), fooled by a prescription (37.7%). In 63.4% the GP offered support when patients had some questions or worries concerning their cancer. Yet, 17% of the patients reported that the GP did not try to help. 85.5% of the participants thought that it is important that their GP is informed about the therapy on a regular basis. For 77.0%, a simultaneous care provided by the GP is important or very important. CONCLUSION: Our survey points to the importance of the GP during cancer therapy from the patient's point of view. Patients want their GP to take an active part in the cancer therapy. Furthermore, early integration of the GP may also enhance early integration of palliative care and also help family members and caregivers. A strategy to integrate GPs is the establishment of shared care models, in which GPs are supported by specialists and get additional training in cancer care.

Asunto(s)

Médicos Generales , Neoplasias/terapia , Satisfacción del Paciente , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Atención Primaria de Salud/métodos , Encuestas y Cuestionarios , Adulto Joven

RESUMEN

Oncology is a rapidly developing field with a growing number of publications every year. The main goal of this survey was to learn more about the information needs of oncologists and general practitioners. Data were collected using a standardised questionnaire developed in collaboration with the German Cancer Society (Deutsche Krebsgesellschaft) and the German Association of General Practitioners (Deutscher Hausärzteverband). A total of 495 questionnaires could be evaluated. Medical congresses were the preferred source of information for all participants. General practitioners preferred textbooks, while oncologists preferred journals and the Internet (all p < .001). Reasons for a lack of confidence during patient consultation were lack of time (60% of participants), lack of knowledge (61% of general practitioners and 26% of oncologists) and lack of data (>50%). Oncologists felt more confident in searching scientific databases than general practitioners did. Both groups required rapid access to transparent information. For general practitioners, reviews and comments by experts helped to put new information in the context of cancer treatment. Oncologists and general practitioners showed significantly different information needs and different ways to access specific information. In order to better integrate general practitioners while simultaneously serving the needs of oncologists, a database that is up to date, rapidly accessible and does not incur high costs would be helpful.

Asunto(s)

Acceso a la Información , Médicos Generales/psicología , Neoplasias/terapia , Oncólogos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Humanos , Servicios de Información , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Satisfacción Personal , Adulto Joven

RESUMEN

Up to now our knowledge of water mite diet has been fragmentary. It is derived from observations in the field and laboratory or from a few selective laboratory experiments on food choice. In the present study, we were able to detect chironomid DNA in water mite bodies for the first time using molecular methods. Prey DNA was detected in virtually all Hygrobates fluviatilis (Hygrobatidae) that were fed on chironomid larvae after a starvation period of up to approximately 1 week. From the shortest interval (1 h after feeding) to the longest period after feeding (50 h) the relative amount of detected prey DNA was significantly reduced. In addition, there was a relationship between the relative amount of prey DNA and the assumed amount of the ingested prey (classified in categories of the dead prey which reflect the increasing ingestion of the mites and the decreasing body content of the prey individuals). The results of our study indicate that similar molecular analyses will be a powerful tool for diet investigations of mites from the field on various taxonomic resolutions of prey taxa. Moreover, the results of food selection experiments from the laboratory could be compared to evidence of predation by individuals from the field. For many mite taxa, especially ones which turned out to be difficult to breed in the laboratory (e.g. by unknown diet), the new methods might enable us to gain the first ever data on diet and thus may help us to consider the role of water mites in food webs more adequately in the future.

Asunto(s)

Chironomidae/genética , ADN/análisis , Ecología/métodos , Entomología/métodos , Cadena Alimentaria , Ácaros/fisiología , Conducta Predatoria , Animales , Dieta , Larva , Factores de Tiempo

RESUMEN

It has previously been demonstrated that zona pellucida imaging of human oocytes using polarized light microscopy is a clinically applicable method for the noninvasive assessment of oocyte quality. This study was designed to investigate whether zona pellucida characteristics of bovine oocytes and zygotes in polarized light may similarly serve as a useful marker for developmental competence in bovine reproductive biotechnologies. Zona birefringence intensity parameters of 2862 oocytes/zygotes were objectively evaluated with an automatic analysis system and correlated with oocyte/zygote quality. In detail, immature oocytes of good quality assessed with brilliant cresyl blue staining showed significantly lower zona birefringence than poor-quality counterparts (P<0.001). After in vitro maturation and classification according to maturational status, the birefringence intensity parameters were significantly different in those oocytes that reached metaphase II compared with arrested stages (P<0.001). Following either parthenogenetic activation or IVF with subsequent in vitro culture in a well-of-the-well system until day 9, superior development as determined by cleavage, blastocyst formation, and hatching ability was associated with lower zona birefringence intensity parameters. When early zygote-stage embryos were selected and assorted in groups based on zona birefringence (high/medium/low), the group of embryos derived from high-birefringence zygotes displayed a significantly compromised developmental potential compared with low-birefringence zygotes. These results clearly show that developmentally competent bovine oocytes/zygotes exhibit lower zona birefringence intensity parameters. Therefore, birefringence imaging of zona pellucida is a suitable technique to predict bovine preimplantation embryo development.

Asunto(s)

Microscopía de Polarización/veterinaria , Oocitos/patología , Técnicas Reproductivas Asistidas/veterinaria , Zona Pelúcida/patología , Cigoto/patología , Animales , Birrefringencia , Bovinos , Técnicas de Cultivo de Embriones/veterinaria , Desarrollo Embrionario , Femenino , Fertilización In Vitro/veterinaria , Edad Gestacional , Metafase , Partenogénesis

RESUMEN

Despite success of early islet allograft engraftment and survival in humans, late islet allograft loss has emerged as an important clinical problem. CD8+ T cells that are independent of CD4+ T cell help can damage allograft tissues and are resistant to conventional immunosuppressive therapies. Previous work demonstrates that islet allografts do not primarily initiate rejection by the (CD4-independent) CD8-dependent pathway. This study was performed to determine if activation of alloreactive CD4-independent, CD8+ T cells, by exogenous stimuli, can precipitate late loss of islet allografts. Recipients were induced to accept intrahepatic islet allografts (islet 'acceptors') by short-term immunotherapy with donor-specific transfusion (DST) and anti-CD154 mAb. Following the establishment of stable long-term islet allograft function for 60-90 days, recipients were challenged with donor-matched hepatocellular allografts, which are known to activate (CD4-independent) CD8+ T cells. Allogeneic islets engrafted long-term were vulnerable to damage when challenged locally with donor-matched hepatocytes. Islet allograft loss was due to allospecific immune damage, which was CD8- but not CD4-dependent. Selection of specific immunotherapy to suppress both CD4- and CD8-dependent immune pathways at the time of transplant protects islet allografts from both early and late immune damage.

Asunto(s)

Supervivencia de Injerto/inmunología , Trasplante de Islotes Pancreáticos/inmunología , Animales , Linfocitos T CD8-positivos , Células Cultivadas , Modelos Animales de Enfermedad , Hepatocitos/trasplante , Terapia de Inmunosupresión , Trasplante de Islotes Pancreáticos/métodos , Ratones

RESUMEN

The goal of this study was to determine the in vivo conditions that promote activation of the (CD4-independent) CD8+ T cell-mediated rejection pathway. We have previously noted that hepatocellular but not islet allografts readily activate this rejection pathway. In the current study, we utilized these two cell transplant models to investigate whether differences in host cell recruitment to the graft site, expression of T-cell activation markers by CD8+ graft infiltrating cells (GICs), and/or development of delayed-type hypersensitivity (DTH) and cytotoxic T lymphocyte cell-mediated effector functions could account for the differential transplant outcomes. The collective results demonstrate that recruitment of CD8+ T cells to the site of transplant, CD103 or CD69 expression on CD8+ GICs, and activation of alloreactive DTH responses are insufficient to initiate CD4-independent, CD8-dependent transplant rejection. Instead, rejection by alloreactive (CD4-independent) CD8+ T cells correlated with expression of CD25, CD154 and CD43 by CD8+ GICs, in vitro alloproliferation by recipient CD8+ T cells, and the development of in vivo allospecific cytolytic effector function. These results suggest that tissue-derived factors influence the activation and maturation of (CD4-independent) CD8+ T cells into cytolytic effectors, which correlates with transplant rejection.

Asunto(s)

Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Trasplante de Células , Inmunidad Celular , Activación de Linfocitos/fisiología , Subgrupos de Linfocitos T/inmunología , Linfocitos T Citotóxicos/inmunología , Animales , Modelos Animales de Enfermedad , Rechazo de Injerto/inmunología , Rechazo de Injerto/patología , Hepatocitos/trasplante , Trasplante de Islotes Pancreáticos/métodos , Ratones , Ratones Transgénicos

RESUMEN

Axons elongate and perform steering reactions with their growth cones constantly undergoing local collapse and stabilization. Our previous studies have shown that a type-1 phosphorylated form of microtubule-associated protein 1B, recognized by monoclonal antibody 1E11 (mab1E11), is present in stable regions and absent from unstable regions of turning growth cones of retinal ganglion cells. In contrast, the total population of microtubule-associated protein 1B is present in the entire growth cone. Here we demonstrate that inhibition of cyclin-dependent kinase 5 (Cdk5) results in loss of mab1E11 binding whereas inhibition of glycogen synthase kinase 3 has no such effect, revealing that mab1E11 recognizes a Cdk5 phosphorylation site on type-1 phosphorylated form of microtubule-associated protein 1B. We moreover show that kinase Cdk5 as well as its activator P35 is present in retinal ganglion cells in the early developing chick embryo retina and enriched in their extending axons. Cdk5 and P35 are concentrated in the youngest, distal axon region and the growth cone as also seen for Cdk5-phosphorylated type-1 phosphorylated form of microtubule-associated protein 1B. Inhibition of Cdk5 by antibodies or inhibitor Roscovitine results in growth cone collapse and axon retraction and prevents substantial axon outgrowth. In contrast, glycogen synthase kinase 3 inhibition causes only a transient axon retraction which is soon recovered and allows for axon formation. In growth cones induced to turn at substrate borders, where stable and instable parts of the growth cone are clearly defined, Cdk5 is present in the entire growth cone. P35, in contrast, is restricted to the stable parts of the growth cone, which do not collapse but instead transform into new distal axon. The local presence of Cdk5-phosphorylated type-1 phosphorylated form of microtubule-associated protein 1B in stabilized growth cone areas can be therefore attributed to the local activation of Cdk5 by P35 in these regions. Together our data demonstrate a crucial role of Cdk5 and its activator P35 in elongation and maintenance of axons as well as for stability and steering of their growth cones.

Asunto(s)

Axones/enzimología , Quinasas Ciclina-Dependientes/metabolismo , Células Ganglionares de la Retina/enzimología , Animales , Anticuerpos Monoclonales , Axones/ultraestructura , Embrión de Pollo , Quinasa 5 Dependiente de la Ciclina , Activación Enzimática , Inhibidores Enzimáticos/farmacología , Conos de Crecimiento/enzimología , Conos de Crecimiento/metabolismo , Conos de Crecimiento/ultraestructura , Inmunohistoquímica , Proteínas Asociadas a Microtúbulos/metabolismo , Purinas/farmacología , Retina/embriología , Roscovitina , Especificidad por Sustrato

RESUMEN

We report the case of a 33 year-old female with a history of 16 years of oral contraception who had been admitted to hospital for further diagnosis of multiple focal liver lesions; laboratory findings showed elevated levels of gamma-GT und AP. Diagnostic procedures showed no primary malignancy as possible reason for metastasis. All further imaging procedures compared with doppler-enhanced ultrasound did not help in diagnosis and lead to inconsistent results. Transcutaneous liver-biopsy showed normal liver histology. In laparoscopic biopsy the result was multifocal adenoma. Because of the rupture risk and potential malignant transformation and no change of sonomorphologic appearance within 12 months a liver-segment resection has been undertaken. Pathology revealed the diagnosis of a multifocal hyperplastic-adenomateous focal-nodular hyperplasia. This case shows that there is no need to use different methods of medical imaging redundantly. We favor a fine-needle double-puncture (lesion and extra-lesion) and tissue examination through an experienced pathologist. A total resection of the lesion is necessary in case of resting uncertainty to characterize its tissue characteristics.

Asunto(s)

Adenoma de Células Hepáticas/diagnóstico , Hiperplasia Nodular Focal/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Adenoma de Células Hepáticas/cirugía , Adulto , Diagnóstico Diferencial , Femenino , Hiperplasia Nodular Focal/cirugía , Humanos , Hallazgos Incidentales , Neoplasias Hepáticas/cirugía

RESUMEN

Hereditary hemorrhagic teleangiectasia (HHT or Rendu-Osler-Weber Syndrome) is an inherited autosomal dominant disorder of the vascular connective tissue. The resulting vascular malformations can occur in virtually any organ. Nosebleeds can massively impact on the quality of life of those afflicted. However, visceral manifestations are likely to be more serious, and may be comparable with a "ticking time bomb". Most commonly affected are the vascular systems of the lungs, liver, brain and gastrointestinal tract. Screening is recommended--at least with regard to the lungs. Difficult constellations of this complex condition may be successfully managed by an interdisciplinary approach.

Asunto(s)

Telangiectasia Hemorrágica Hereditaria , Adulto , Anciano , Malformaciones Arteriovenosas/diagnóstico , Absceso Encefálico/diagnóstico , Absceso Encefálico/etiología , Diagnóstico Diferencial , Epistaxis/etiología , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Hígado/irrigación sanguínea , Pulmón/irrigación sanguínea , Angiografía por Resonancia Magnética , Masculino , Grupo de Atención al Paciente , Prevalencia , Calidad de Vida , Radiografía , Grupos de Autoayuda , Telangiectasia Hemorrágica Hereditaria/complicaciones , Telangiectasia Hemorrágica Hereditaria/diagnóstico , Telangiectasia Hemorrágica Hereditaria/diagnóstico por imagen , Telangiectasia Hemorrágica Hereditaria/epidemiología , Telangiectasia Hemorrágica Hereditaria/genética

RESUMEN

Up to 45% of all adults in the industrialized countries are afflicted by noises in the ears--approximately one million people require treatment in Germany alone. Classification of tinnitus is oriented to the duration of symptoms and their severity, the latter taking into account the victim's distress both at work and during leisure time. Acute tinnitus is often caused by an ear condition or psychosocial stress. Chronic tinnitus can be caused by persistent exposure to noise, whiplash injuries or functional disorders of the cervical spine. The diagnosis is based on audiometric and otoneurologic investigations, possibly magnetic resonance tomography and serology when an infection is suspected. Acute tinnitus is treated with infusions--mostly with cortisone or pentoxifylline--or a short-term oral medication with these substances. Since no causal therapy is available for chronictinnitus, therapeutic counseling has a particular role to play with emphasis on informing the patient on the results of investigations and suggesting coping strategies. Following an appropriate diagnostic work-up, the patient should be advised of the harmless nature of the noises and encouraged to adopt a positively motivated approach to the symptoms. Tinnitus retraining therapy aims to permanently suppress conscious awareness of the noises in the ear. For this purpose, a noise generator, generally worn within the ear auricle, is employed among other things. The prognosis is dependent not only on the presence or otherwise of organic disease but also--almost always--on such aspects as perception and coping by the individual patient.

Asunto(s)

Acúfeno , Enfermedad Aguda , Adaptación Fisiológica , Administración Oral , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Audiometría , Enfermedad Crónica , Cortisona/administración & dosificación , Cortisona/uso terapéutico , Consejo , Humanos , Imagen por Resonancia Magnética , Pentoxifilina/administración & dosificación , Pentoxifilina/uso terapéutico , Enmascaramiento Perceptual , Pronóstico , Factores de Tiempo , Acúfeno/diagnóstico , Acúfeno/tratamiento farmacológico , Acúfeno/etiología , Acúfeno/psicología , Acúfeno/terapia , Vasodilatadores/administración & dosificación , Vasodilatadores/uso terapéutico

RESUMEN

Problems with swallowing (dysphagia) occur in association with numerous illnesses. In many cases, however, they are either not recognized or considered not to require clarification, since other symptoms are of greater importance. In elderly, often multimorbid patients, neurodegenerative diseases, such as apoplexy, are the most common causes of dysphagia, but medications with central nervous side effects may also impair swallowing. The difficulty may be localized either in the oropharyngeal region or in the esophagus. There is considerable danger that such complications as aspiration pneumonia and malnutrition may occur and thus increase morbidity and mortality. In addition, the quality of life of the patient may also be diminished. The family doctor has the important task of initiating a differentiated diagnosis based on careful history-taking and a clinical examination that should include an inspection of the oral cavity and the nerves supplying the brain. Early treatment, for example, involving a logopedist, can be effective.

Asunto(s)

Enfermedad de Alzheimer/diagnóstico , Trastornos de Deglución/etiología , Divertículo Esofágico/diagnóstico , Accidente Cerebrovascular/diagnóstico , Anciano , Diagnóstico Diferencial , Humanos , Grupo de Atención al Paciente

RESUMEN

Esthesioneuroblastoma is a rare tumor, which in many cases is diagnosed at an advanced stage with an high recurrence rate and incidence of metastases. Regionary metastases predict a poor prognosis. There is no standard therapy approach for these tumors. The most widly accepted primary therapy is radical craniofacial enbloc resection followed by radiation therapy. Today chemotherapy is getting more important and is administered with curative intention. Multidisciplinary management results in significantly longer survival in advanced tumor stages and recurrence. A clinical staging system as well as histopathological grading according of Hyams could be from importance for selection and timing of the different therapeutic modalities. We present a case of a 34-year-old female patient who was diagnosed with an advanced olfactory neuroblastoma of the upper nasal cavity with bilateral cervical lymph node metastasis (modified Kadish-stage D). Craniofacial resection and bilateral neck dissection was performed, followed by postoperative radiotherapy. Reviewing the recent literature the different therapeutic approaches are compared and discussed.

Asunto(s)

Estesioneuroblastoma Olfatorio/cirugía , Metástasis Linfática , Metástasis Linfática/radioterapia , Disección del Cuello , Neoplasias Nasales/cirugía , Grupo de Atención al Paciente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Terapia Combinada , Estesioneuroblastoma Olfatorio/tratamiento farmacológico , Estesioneuroblastoma Olfatorio/patología , Estesioneuroblastoma Olfatorio/radioterapia , Femenino , Humanos , Irradiación Linfática , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Imagen por Resonancia Magnética , Invasividad Neoplásica , Estadificación de Neoplasias , Nariz/patología , Nariz/cirugía , Neoplasias Nasales/tratamiento farmacológico , Neoplasias Nasales/patología , Neoplasias Nasales/radioterapia , Radioterapia Adyuvante , Tomografía Computarizada por Rayos X

RESUMEN

The etiology of stuttering is multifactorial. Developmental disturbances in "speech flow" usually clear up within six months. However, inappropriate reactions on the part of the child's surroundings (parents, unqualified physicians), but also psychosocial problems, may consolidate the disorder. Chronic stuttering may, under certain circumstances have far-reaching consequences for communication and social behavior, and even impact negatively on the victim's subsequent occupational life. A qualified diagnostic work-up leading to appropriate early pedaudiological and logopedic therapeutic measures can prevent this negative development.

Asunto(s)

Trastornos del Habla/terapia , Logopedia , Tartamudeo/terapia , Niño , Preescolar , Diagnóstico Diferencial , Humanos , Grupo de Atención al Paciente , Especialización , Trastornos del Habla/etiología , Tartamudeo/etiología

RESUMEN

Noise during leisure time is increasingly leading to temporary and permanent hearing loss, with most victims being adolescents and young adults. Particularly harmful is permanent exposure to noise, since the highly sensitive ear is not designed to tolerate it. On average, youngsters aged between 14 and 20 years spend 3 hours and more listening to music. In discos, concerts in particular, as well as listening to music via headphones, sound levels of 100 dB are regularly reached and exceeded, and levels of 90 dB are already considered to represent a definite risk. Noise is, however, experienced as offensive and painful at levels of about 120-140 dB, and this leads to the danger of its harmful effects being underestimated. Treatment of hearing loss depends on whether it is acute or chronic and comprises infusion therapy, stress reduction, acoustic rest or interposed periods free of noise and, where indicated the fitting of a suitable hearing aid. In view of the immense significance of hearing impairment for the economy, public health, and society at large, its prevention--not only by protective, but also preventive, measures--warrants greater attention.

Asunto(s)

Pérdida Auditiva Provocada por Ruido/etiología , Actividades Recreativas , Música , Alemania , Pérdida Auditiva Provocada por Ruido/prevención & control , Humanos , Factores de Riesgo , Espectrografía del Sonido

RESUMEN

Early diagnosis of a hearing impairment, follow-up and timely effective intervention are the aims of optimal management of the hard-of-hearing patient. Today, every fifth adult has a hearing problem. This means that the general practitioner not only faces a diagnostic challenge, but also needs to concern himself with the prevention of a hearing loss or its further progression. In the event of a hearing aid being required, the individual needs of the patient must be taken into account. Currently available are behind-the-ear and in-the-ear, both as digital and analog devices. The most expensive, smallest and most modern device is not necessarily the best option for the individual patient, and fitting should be a cooperative effort on the part of the ENT physician and the hearing aid specialist. Required is a specific history, comprehensive counseling of the patient, a phase of testing at home and, where necessary, concomitant acoustic training. The German Society for the Hard-of-Hearing has advice centres in many towns and cities that provide information and counseling on rehabilitation and the legal rights of the deaf.

Asunto(s)

Audífonos/estadística & datos numéricos , Pérdida Auditiva Conductiva/rehabilitación , Pérdida Auditiva Sensorineural/rehabilitación , Adulto , Anciano , Femenino , Alemania , Pérdida Auditiva Conductiva/epidemiología , Pérdida Auditiva Conductiva/etiología , Pérdida Auditiva Sensorineural/epidemiología , Pérdida Auditiva Sensorineural/etiología , Humanos , Incidencia , Masculino , Microcomputadores , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Grupo de Atención al Paciente , Diseño de Prótesis , Ajuste de Prótesis

Asunto(s)

Trastornos de la Audición/congénito , Tamizaje Neonatal , Emisiones Otoacústicas Espontáneas/fisiología , Alemania , Células Ciliadas Auditivas Externas/fisiopatología , Trastornos de la Audición/diagnóstico , Trastornos de la Audición/fisiopatología , Humanos , Recién Nacido , Factores de Riesgo

Asunto(s)

Mareo/etiología , Enfermedad de Meniere/diagnóstico , Nistagmo Patológico/diagnóstico , Diagnóstico Diferencial , Humanos , Pruebas de Función Vestibular

Asunto(s)

Anatomía Transversal/métodos , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Cabeza/diagnóstico por imagen , Imagenología Tridimensional/métodos , Cuello/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Tomografía Computarizada Espiral/métodos , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Evaluación de la Tecnología Biomédica

RESUMEN

OBJECTIVE: To evaluate criteria for detection of tumor recurrence and post-treatment changes in patients with head and neck malignancies in computed tomography (CT) and magnetic resonance imaging (MRI). METHODS AND MATERIALS: Thirty-nine patients with head and neck carcinoma receiving radiochemotherapy were examined before, during and after therapy with MRI. Changes in signal intensity were correlated to histology or clinical course. Three hundred and thirty-one patients with head and neck malignancies were examined with CT after therapy. CT diagnoses were correlated with histology or clinical course. RESULTS: Main criteria for recurrent/residual tumor in MRI was infiltrative mass with high signal intensity in T2-weighted images and enhancement after Gd-DTPA in T1-weighted images. Radiation-induced changes led to false positive diagnosis in 46% in the interval up to 3 months after therapy and in 58% in the interval 3-6 months after therapy. The combination of a circumscribed, infiltrative mass with contrast enhancement in CT had a sensitivity of 86% and a specificity of 80%. CONCLUSION: CT could accurately demonstrate postoperative changes and tumor recurrence. MRI had advantages in differentiation of tumor and scar, but edema after radiation therapy can spoil diagnosis.

Asunto(s)

Neoplasias de Cabeza y Cuello/diagnóstico , Imagen por Resonancia Magnética/métodos , Recurrencia Local de Neoplasia/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Terapia Combinada , Medios de Contraste , Estudios de Seguimiento , Gadolinio DTPA , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/terapia , Humanos , Metástasis Linfática , Imagen por Resonancia Magnética/instrumentación , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/terapia

RESUMEN

For the development of the nervous system it is crucial that growth cones detect environmental information and react by altering their growth direction. The latter process is thought to depend on local stabilization of growth cone microtubules. We have obtained evidence of a role for the microtubule-associated protein MAP1B, in particular a mode 1 phosphoisoform of the molecule, P1-MAP1B, in this process. P1-MAP1B is tightly associated with the cytoskeleton and is present at highest concentrations in the distal axon and the growth cone of chick retinal ganglion cells. In growth cones turning at nonpermissive substrate borders, P1-MAP1B is restricted to regions which are stabilized. Unilateral neutralization of P1-MAP1B in one-half the growth cone by microscale chromophore-assisted laser inactivation changes growth cone motility, morphology, and growth direction. The results indicate a functional role for P1-MAP1B in local growth cone stabilization and thus growth cone steering.

Asunto(s)

Axones/fisiología , Citoesqueleto/fisiología , Proteínas Asociadas a Microtúbulos/metabolismo , Células Ganglionares de la Retina/fisiología , Animales , Axones/ultraestructura , Encéfalo/fisiología , Células Cultivadas , Embrión de Pollo , Citoesqueleto/ultraestructura , Técnicas de Cultivo de Órganos , Isoformas de Proteínas/metabolismo