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The aim of this study was to assess the role of videofluoroscopy in the detection of structural abnormalities of the pharynx and esophagus in patients with different symptoms of impaired deglutition. Dynamic radiographic recording of deglutition was performed in 3193 consecutive patients (1578 men, 1615 women; mean age 54 years) suffering from dysphagia, suspicion of aspiration, globus sensation, and non-cardiac chest pain. We assessed different structural lesions from the oral cavity to the esophagus and classified them into eight categories. Their frequency and association with the different clinical symptoms were evaluated. Videofluoroscopy revealed 1040 structural abnormalities in 833 patients (26%) including mass lesions from the oral cavity to hyoid/larynx ( n=66), pharyngeal diverticula ( n=181), pharyngeal masses ( n=78), other pharyngeal narrowings ( n=71), webs ( n=98), masses ( n=39), and other narrowings ( n=73) of the upper esophageal sphincter, esophageal diverticula ( n=80), esophageal webs, rings and strictures ( n=194), and intrinsic and extrinsic esophageal lesions ( n=160). There was a considerable variance of findings for different symptoms. In a large proportion of symptomatic patients videofluoroscopy detects morphological abnormalities along pharynx and esophagus often combined with functional disorders. This fact underlines the role of videofluoroscopy as a diagnostic test for function as well as morphology.

The presented evaluation of the relative uncertainty (δ’CCC) of the (choline + creatine)/citrate (CC/C) ratios can provide objective information about the quality and diagnostic value of prostate MR spectroscopic imaging data. This information can be combined with the numeric values of CC/C ratios and provides metabolic-quality maps enabling accurate cancer detection and user-independent data evaluation. In addition, the prostate areas suffering most from the low precision of CC/C ratios (e. g., prostate base) were identified.

Tumor size is a prognostic marker and correlates to survival after surgical therapy. Of 287 patients with small (or=4 cm) renal tumors, 19.5% had a benign lesion and thus harmless. All others were renal cell cancers; 4.9% of tumors were detected because of metastases and consecutively treated. Tumors with a diameteror=3 cm showed a tumor stageor=pT3a in 10.9%, a high Fuhrman gradeor=3, multifocality in 8.5%, and metastases in 2.4%. Tumors with a diameter of 3.1-4 cm showed dramatically more aggressive parameters; 35.7% had stageor=pT3a, 25.5% Fuhrman gradeor=G3, and 8.4% metastases (M+). However, evaluation of the tumor diameter on CT has an error of about +/-0.3 cm, which will lead to an even more pronounced error in volume determination. Therefore, determination of growth in follow-up imaging is unreliable. With the exception of the typical angiomyolipoma, determination of dignity for small solid kidney lesions is unreliable even with modern imaging. Only 17% of 80 benign lesions in our series were assessed as benign on preoperative CT. Thus, preoperative evaluation not only based on imaging seems to be valuable, especially in patients with higher surgical risk. Percutaneous renal mass biopsy has an accuracy of over 90% for detecting benign lesions and can influence therapeutic decisions, especially in patients with higher surgical risk.

To report the false-negative rate, sensitivity, and specificity of 14-gauge ultrasound-guided large-core needle biopsy (14-G USSB) performed on breast lesions at our institution and, furthermore, to compare and discuss our own results with those reported in the literature.This study includes 399 lesions examined by 14-G USSB. The results of the 14-G USSB were compared with the results of the surgical biopsy or, in cases of benign histology, were followed clinically. A key word search in two medical databases was undertaken to compare our data with those reported in the literature. The search was limited to the period from January 1990 to February 2002 and only original investigations published in English and German were included in our comparison.At our institution, 238 (59.6 %) benign and 161 (40.4 %) malignant lesions were diagnosed by 14-G USSB. The 14-G USSB was false-negative in 5 (1.25 %) of 399 cases. It has a sensitivity of 95.7 %, and specificity 100%. The literature reports false-negative rates between 0 % and 1.26 %, sensitivities between 86% and 100%, and specificities between 99.7 % and 100 %. On the basis of 3880 results from seven selected original papers and our own study, the false-negative rate for 14-G USSB was calculated to be 0.4 % (16 of 3880).Based on our results and those reported in the literature, 14-G USSB can be considered safe and reliable in the assessment of breast lesions.

To compare the accuracy of wire and carbon localization in stereotactically localized open breast biopsy.From June 1995 to December 1997, a total of 725 stereotactic wire or carbon dye localizations were performed in 698 female patients. Success of localization was evaluated either by a malignant histopathological diagnosis or by mammographic follow-up. A lesion was considered to be missed if it could be still seen on follow-up mammography.In 703 of 725 cases, the success of localization could be evaluated with 427 (61 %) lesions localized with a wire and 276 (39 %) with carbon. Seven (1 %) out of 703 lesions were missed at open biopsy. Three lesions of these had been localized with wire and three lesions with carbon. The miss rates were 0.9 % and 1.1 %, respectively (p = 1.0).Both wire and carbon localization are reliable and accurate in the localization of non-palpable breast lesions. Concerning efficiency and costs, carbon dye seems to offer a promising compromise.

To compare quality of harvested tissue, false-negative rate, and complication rate of large-core needle breast biopsy (LCNBB) and directional, vacuum-assisted breast biopsy (DVABB) in non-palpable breast lesions.From 1994 to 1999, in 580 non-palpable breast lesions a stereotactically-guided breast biopsy was performed. 14-G LCNBB was used in 168 lesions (29 %). DVABB was used in 412 lesions (71 %; 11-G DVABB: 134 lesions 32.5 %, 14-G DVABB: 278 lesions 67.5 %). Following biopsy, patients underwent either surgical excision (n = 533; 93.8 %) or mammographical follow-up (n = 36; 6.2 %). Histological results of LCNBB, DVABB, surgical breast biopsy and follow-up results were compared and scored for their tissue quality on a three-point scale (1 = disagreement between biopsy and surgery; 2 = partial agreement; 3 = complete agreement). In addition, we determined the false negative and complication rate for both systems.Histological examination after surgery and follow-up proved 262 (45.2 %) to be benign, 15 (2.6 %) to be high-risk lesions and 303 (52.5 %) to be malignant. In the tissue quality there was no significant difference between 14-G LCNBB (score = 2.94), 11-G DVABB (score = 2.92) and 14-G DVABB (score = 2.91) (p0.05). Particularly, in calcifications 11-G DVABB scored better (score = 2.92) than 14-G DVABB (score = 2.88) (p0.05). 14-G LCNBB had a lower false negative rate (1.8 %) than 11-G DVABB (3 %) and 14-G DVABB (3.2 %) (p0.05). There was no difference in the complication rate between the different needle types.Our results indicate that both LCNBB and DVABB are reliable and safe techniques in the diagnosis of non-palpable breast lesions. However, the use of 14-G LCNBB seems to be advantageous in masses, the use of 11-G DVABB seems to be advantageous in asymmetric densities and calcifications.

OBJECTIVE/MATERIAL AND METHODS: In a prospective randomized study, the techniques of stereotactic breast biopsies in prone and sitting position were compared. Part of the data has already been published. A total of 103 women underwent stereotactic breast biopsies, either prone (n = 51; using TRC-Mammotest, Sweden) or in the sitting position (n = 52; using Stereotix 2, General Electric Medical Systems, Milwaukee, Wisconsin, USA). With the help of pre- and post-biopsy questionnaires, anxiety, pain, and subjective experience were recorded in all patients. Vasovagal reactions were scored from 0 to 2 according to their severity. All biopsy results were verified by surgery. The specificities and sensitivities for the two positions were calculated and statistically compared.With regard to overall tolerance no statistically significant difference between biopsies performed in the sitting or the prone position was noted. Significantly more patients (p = 0.04) in the prone position stated they would prefer premedication prior to a repeat biopsy. Three patients (prone; n = 1; sitting; n = 2) fainted during the procedure. There was no statistically significant difference between the two biopsy positions regarding sensitivity (95%) and specificity (100%).More attention should be paid to patient care and, especially, preintervention information. Biopsies in the prone or sitting position are equally well tolerated. Somatic reactions are not a major problem during breast biopsy. Success and validity are independent of the biopsy position.

Interference with T-cell function increases the risk of infections, especially during the early post-transplant period. Belatacept, a costimulation blocker, is currently being tested in phase III clinical trials. Here we report a renal transplant recipient who received belatacept and developed severe Pneumocystis jirovecii pneumonia (PCP) with fatal superinfections 4 years post transplant. Cytomegalovirus infection preceded PCP, which typically occurs in overimmunosuppressed patients, but has not yet been reported under T-cell costimulation blockade in transplant patients. This case illustrates the possibility of excessive immunosuppression even with a lymphocyte-specific regimen.