Früherkennung von Lungenkrebs – eine Übersicht über Chancen und Risiken

2013 ◽  
Vol 70 (4) ◽  
pp. 237-244 ◽  
Author(s):  
Benjamin Kasenda ◽  
Heike Raatz ◽  
Heiner C. Bucher
Keyword(s):  
Low Dose ◽  
Randomisierte Studien ◽  
Therapeutische Maßnahmen

Das Lungenkarzinom gehört weltweit zu den führenden Todesursachen. Bei Diagnosestellung ist es oft weit fortgeschritten und die betroffenen PatientInnen haben eine sehr schlechte Prognose. In der Schweiz ist das Lungenkarzinom bei Männern die häufigste und bei Frauen die zweithäufigste Krebstodesursache. Hauptrisikofaktor ist das Rauchen. Es wäre daher von großer Bedeutung, in Zukunft nicht nur Rauchstopp-Maßnahmen durchzuführen, sondern bei Menschen mit einem erhöhten Lungenkrebs-Risiko auch frühzeitig diagnostische und therapeutische Maßnahmen ergreifen zu können. In diesem Übersichtsartikel werden zuerst die Grundlagen des Lungenkarzinom-Screenings erläutert und anschließend aktuelle Studien zum Thema vorgestellt. Insgesamt liegen fünf randomisierte Studien vor. Eine dieser Studien konnte keinen Vorteil von regelmäßig durchgeführten konventionellen Thorax-Aufnahmen im Vergleich zur normalen Versorgung zeigen. In vier weiteren Studien wurde die Durchführung von Low-Dose-Computertomografien im Vergleich zu konventionellen Thorax-Aufnahmen und zur normalen Versorgung untersucht. Nur eine Studie aus den USA konnte einen kleinen Vorteil dieser Screening-Maßnahme im Vergleich zu regelmäßigen konventionellen Thorax-Aufnahmen nachweisen. Die drei anderen europäischen Studien zeigten keinerlei Vorteile für eine der Methoden. Das Ergebnis der US-Studie ist aus verschiedenen Gründen kritisch zu beurteilen. Hauptkritikpunkt ist die eingeschränkte Übertragbarkeit der Ergebnisse auf die alltägliche Versorgung. Die Rate der falsch positiven Befunde ist sehr hoch. Auch der Kosten-Nutzen-Effekt von solchen Lungenkrebs-Screening-Untersuchungen ist weiterhin unklar.

Kryptogener Hirnschlag und offenes Foramen ovale

2003 ◽  
Vol 60 (9) ◽  
pp. 553-561 ◽  
Author(s):  
S. Windecker ◽  
K. Nedeltchev ◽  
A. Wahl ◽  
B. Meier
Keyword(s):  
Medikamentöse Therapie ◽  
Randomisierte Studien ◽  
Medikamentöse Behandlung ◽  
Foramen Ovale ◽  
Offenes Foramen Ovale ◽  
Therapeutische Maßnahmen ◽  
Paradoxe Embolie

Hirnschläge unklarer Ätiologie werden als kryptogen klassifiziert und konstituieren eine beträchtliche Patienten-Population vor allem jüngeren Alters. Zahlreiche Fall-Kontroll-Studien haben eine deutliche Assoziation zwischen kryptogenem Hirnschlag und dem Vorhandensein eines offenen Foramen ovale aufgezeigt und damit eine paradoxe Embolie als mögliches pathophysiologisches Substrat nahegelegt. Das offene Foramen ovale ist bei etwa einem Viertel der Patienten mit kryptogenem Hirnschlag mit einem Vorhofseptumaneurysma vergesellschaftet, welches das Rezidivrisiko erheblich erhöht. Therapeutische Massnahmen zur Sekundärprävention umfassen eine medikamentöse Therapie mit Thrombozytenaggregationshemmern bzw. oraler Antikoagulation sowie der chirurgische oder perkutane Verschluss des offenen Foramen ovale. Zur Ermittlung der optimalen Behandlungsstrategie sind randomisierte Studien, welche die medikamentöse Behandlung mit einem Verschluss des offenen Foramen ovale vergleichen, notwendig.

Extrakorporale Behandlungsstrategien der Sepsis: die Rolle der Plasmapherese

2021 ◽  
Vol 56 (02) ◽  
pp. 101-110
Author(s):  
Klaus Stahl ◽  
Christian Bode ◽  
Sascha David
Keyword(s):  
Polymyxin B ◽  
Randomisierte Studien ◽  
Therapeutische Maßnahmen ◽  
Protektive Faktoren

Zusammenfassung Hintergrund Die Mortalität bei Sepsis bleibt hoch. Verschiedene Techniken zur extrakorporalen Zytokinelimination wurden als zusätzliche therapeutische Maßnahmen bei Sepsis und septischem Schock untersucht. Ziele Zusammenfassung einer Auswahl extrakorporaler Blutreinigungstechniken und der aktuellen Erkenntnisse in der klinischen Anwendung mit besonderem Schwerpunkt auf dem therapeutischen Plasmaaustausch. Methoden Nicht systematische Literaturrecherche. Ergebnisse Verschiedene extrakorporale Blutreinigungstechniken mit unterschiedlichen Evidenzniveaus hinsichtlich Zytokinelimination, Verbesserung der Hämodynamik und Verringerung der Mortalität werden derzeit klinisch eingesetzt. Die am ausführlichsten untersuchten Modalitäten umfassen die hochvolumige Hämofiltration/Dialyse mit und ohne High-Cut-off-Filter sowie Hämoadsorptionstechniken (einschließlich CytoSorb- und Polymyxin-B-Filter). Trotz teilweise ermutigender Beobachtungen bezüglich der Entfernung proinflammatorischer Zytokine und verbesserten Hämodynamik zeigten randomisierte Studien bislang keinen positiven Einfluss auf das Überleben. Aufgrund der Verwendung von Spenderplasma als Substitutionsflüssigkeit stellt der therapeutische Plasmaaustausch das einzige Verfahren dar, das zusätzlich verbrauchte protektive Faktoren ersetzen kann. Schlussfolgerungen Die Anwendung extrakorporaler Blutreinigungsmethoden kann für Sepsispatienten außerhalb klinischer Studien bisher nicht empfohlen werden, da derzeit keine Beweise für ihre Wirksamkeit vorliegen. Zukünftige Untersuchungen sollten darauf abzielen, das untersuchte Patientenkollektiv hinsichtlich des klinischen Schweregrads, des Zeitpunkts der Intervention und verschiedener inflammatorischer (Sub-)Phänotypen zu homogenisieren.

Ovarian Dysfunction in Fetally Irradiated Beagles

1977 ◽  
Vol 35 ◽  
pp. 658-659
Author(s):  
T. M. Seed ◽  
M. H. Sanderson ◽  
D. L. Gutzeit ◽  
T. E. Fritz ◽  
D. V. Tolle ◽  
...  
Keyword(s):  
Gamma Rays ◽  
Low Dose ◽  
Long Term Effects ◽  
Ovarian Dysfunction ◽  
Dose Rates ◽  
Highly Sensitive ◽  
Microscopic Evaluation ◽  
Ovarian Pathology ◽  
Normal Offspring

The developing mammalian fetus is thought to be highly sensitive to ionizing radiation. However, dose, dose-rate relationships are not well established, especially the long term effects of protracted, low-dose exposure. A previous report (1) has indicated that bred beagle bitches exposed to daily doses of 5 to 35 R 60Co gamma rays throughout gestation can produce viable, seemingly normal offspring. Puppies irradiated in utero are distinguishable from controls only by their smaller size, dental abnormalities, and, in adulthood, by their inability to bear young.We report here our preliminary microscopic evaluation of ovarian pathology in young pups continuously irradiated throughout gestation at daily (22 h/day) dose rates of either 0.4, 1.0, 2.5, or 5.0 R/day of gamma rays from an attenuated 60Co source. Pups from non-irradiated bitches served as controls. Experimental animals were evaluated clinically and hematologically (control + 5.0 R/day pups) at regular intervals.

High Resolution Microscopy of Multi-Layered Biological Crystals

1982 ◽  
Vol 40 ◽  
pp. 80-83
Author(s):  
H.A. Cohen ◽  
T.W. Jeng ◽  
W. Chiu
Keyword(s):  
High Resolution ◽  
Low Dose ◽  
Three Dimensional ◽  
Data Interpretation ◽  
Two Dimensional ◽  
Biological Objects ◽  
Density Maps ◽  
Density Map ◽  
Complex Crystal ◽  
High Resolution Microscopy

This tutorial will discuss the methodology of low dose electron diffraction and imaging of crystalline biological objects, the problems of data interpretation for two-dimensional projected density maps of glucose embedded protein crystals, the factors to be considered in combining tilt data from three-dimensional crystals, and finally, the prospects of achieving a high resolution three-dimensional density map of a biological crystal. This methodology will be illustrated using two proteins under investigation in our laboratory, the T4 DNA helix destabilizing protein gp32*I and the crotoxin complex crystal.

Characterization of microtubules by dark-field STEM and replication

1991 ◽  
Vol 49 ◽  
pp. 152-153
Author(s):  
S.B. Andrews ◽  
R.D. Leapman ◽  
P.E. Gallant ◽  
T.S. Reese
Keyword(s):  
Protein Interactions ◽  
Low Dose ◽  
Unit Length ◽  
Dark Field ◽  
Carbon Films ◽  
Microtubule Associated Proteins ◽  
Molecular Weights ◽  
Freeze Dried ◽  
Protein Motors ◽  
Associated Proteins

As part of a study on protein interactions involved in microtubule (MT)-based transport, we used the VG HB501 field-emission STEM to obtain low-dose dark-field mass maps of isolated, taxol-stabilized MTs and correlated these micrographs with detailed stereo images from replicas of the same MTs. This approach promises to be useful for determining how protein motors interact with MTs. MTs prepared from bovine and squid brain tubulin were purified and free from microtubule-associated proteins (MAPs). These MTs (0.1-1 mg/ml tubulin) were adsorbed to 3-nm evaporated carbon films supported over Formvar nets on 600-m copper grids. Following adsorption, the grids were washed twice in buffer and then in either distilled water or in isotonic or hypotonic ammonium acetate, blotted, and plunge-frozen in ethane/propane cryogen (ca. -185 C). After cryotransfer into the STEM, specimens were freeze-dried and recooled to ca.-160 C for low-dose (<3000 e/nm2) dark-field mapping. The molecular weights per unit length of MT were determined relative to tobacco mosaic virus standards from elastic scattering intensities. Parallel grids were freeze-dried and rotary shadowed with Pt/C at 14°.

Structural analysis of the surface-layer protein of spirillum serpens by high-resolution electron microscopy

1983 ◽  
Vol 41 ◽  
pp. 738-739
Author(s):  
W. H. Wu ◽  
R. M. Glaeser
Keyword(s):  
Electron Microscopy ◽  
Surface Layer ◽  
Structural Analysis ◽  
High Resolution ◽  
Low Dose ◽  
High Resolution Electron Microscopy ◽  
Optical Diffraction ◽  
Surface Layer Protein ◽  
Morphological Unit ◽  
Resolution Electron

Spirillum serpens possesses a surface layer protein which exhibits a regular hexagonal packing of the morphological subunits. A morphological model of the structure of the protein has been proposed at a resolution of about 25 Å, in which the morphological unit might be described as having the appearance of a flared-out, hollow cylinder with six ÅspokesÅ at the flared end. In order to understand the detailed association of the macromolecules, it is necessary to do a high resolution structural analysis. Large, single layered arrays of the surface layer protein have been obtained for this purpose by means of extensive heating in high CaCl2, a procedure derived from that of Buckmire and Murray. Low dose, low temperature electron microscopy has been applied to the large arrays.As a first step, the samples were negatively stained with neutralized phosphotungstic acid, and the specimens were imaged at 40,000 magnification by use of a high resolution cold stage on a JE0L 100B. Low dose images were recorded with exposures of 7-9 electrons/Å2. The micrographs obtained (Fig. 1) were examined by use of optical diffraction (Fig. 2) to tell what areas were especially well ordered.

The Response of Testis Cells to Low Dose X-Irradiation

1981 ◽  
Vol 39 ◽  
pp. 542-543
Author(s):  
D. E. Philpott ◽  
W. Sapp ◽  
C. Williams ◽  
Joann Stevenson ◽  
S. Black
Keyword(s):  
Electron Microscopy ◽  
Stem Cell ◽  
Light Microscopy ◽  
Dose Level ◽  
Cross Sections ◽  
Low Dose ◽  
Light And Electron Microscopy ◽  
Cellular Responses ◽  
Post Irradiation ◽  
X Irradiation

The response of spermatogonial cells to X-irradiation is well documented. It has been shown that there is a radiation resistent stem cell (As) which, after irradiation, replenishes the seminiferous epithelium. Most investigations in this area have dealt with radiation dosages of 100R or more. This study was undertaken to observe cellular responses at doses less than 100R of X-irradiation utilizing a system in which the tissue can be used for light and electron microscopy.Brown B6D2F1 mice aged 16 weeks were exposed to X-irradiation (225KeV; 15mA; filter 0.35 Cu; 50-60 R/min). Four mice were irradiated at each dose level between 1 and 100 rads. Testes were removed 3 days post-irradiation, fixed, and embedded. Sections were cut at 2 microns for light microscopy. After staining, surviving spermatogonia were identified and counted in tubule cross sections. The surviving fraction of spermatogonia compared to control, S/S0, was plotted against dose to give the curve shown in Fig. 1.

Search mode for rapid detection of virus particles

1991 ◽  
Vol 49 ◽  
pp. 286-287
Author(s):  
O. E. Bradfute
Keyword(s):  
Electron Microscopy ◽  
Rapid Detection ◽  
Plant Virus ◽  
Low Dose ◽  
Search Mode ◽  
Virus Diseases ◽  
Virus Particles ◽  
Focus Image ◽  
Time Required ◽  
Rapid Switching

Electron microscopy is frequently used in preliminary diagnosis of plant virus diseases by surveying negatively stained preparations of crude extracts of leaf samples. A major limitation of this method is the time required to survey grids when the concentration of virus particles (VPs) is low. A rapid survey of grids for VPs is reported here; the method employs a low magnification, out-of-focus Search Mode similar to that used for low dose electron microscopy of radiation sensitive specimens. A higher magnification, in-focus Confirm Mode is used to photograph or confirm the detection of VPs. Setting up the Search Mode by obtaining an out-of-focus image of the specimen in diffraction (K. H. Downing and W. Chiu, private communications) and pre-aligning the image in Search Mode with the image in Confirm Mode facilitates rapid switching between Modes.

Digital Processing of STEM Images

1981 ◽  
Vol 39 ◽  
pp. 236-237
Author(s):  
A. V. Crewe ◽  
M. Ohtsuki
Keyword(s):  
High Resolution ◽  
Low Dose ◽  
Assembly Language ◽  
Processing System ◽  
Principal Component ◽  
Digital Processing ◽  
Image Analysis System ◽  
Black And White ◽  
Analysis System ◽  
Dose Imaging

We have assembled an image processing system for use with our high resolution STEM for the particular purpose of working with low dose images of biological specimens. The system is quite flexible, however, and can be used for a wide variety of images.The original images are stored on magnetic tape at the microscope using the digitized signals from the detectors. For low dose imaging, these are “first scan” exposures using an automatic montage system. One Nova minicomputer and one tape drive are dedicated to this task.The principal component of the image analysis system is a Lexidata 3400 frame store memory. This memory is arranged in a 640 x 512 x 16 bit configuration. Images are displayed simultaneously on two high resolution monitors, one color and one black and white. Interaction with the memory is obtained using a Nova 4 (32K) computer and a trackball and switch unit provided by Lexidata.The language used is BASIC and uses a variety of assembly language Calls, some provided by Lexidata, but the majority written by students (D. Kopf and N. Townes).

Removal of inelastically scattered electrons substantially increases phase contrast on frozen-hydrated molecules

1987 ◽  
Vol 45 ◽  
pp. 652-653
Author(s):  
John P. Langmore ◽  
Brian D. Athey
Keyword(s):  
Electron Diffraction ◽  
Phase Contrast ◽  
Low Dose ◽  
Dark Field ◽  
Biological Structure ◽  
Bright Field ◽  
Low Contrast ◽  
Negative Stain ◽  
The Difference ◽  
Better Than

Although electron diffraction indicates better than 0.3nm preservation of biological structure in vitreous ice, the imaging of molecules in ice is limited by low contrast. Thus, low-dose images of frozen-hydrated molecules have significantly more noise than images of air-dried or negatively-stained molecules. We have addressed the question of the origins of this loss of contrast. One unavoidable effect is the reduction in scattering contrast between a molecule and the background. In effect, the difference in scattering power between a molecule and its background is 2-5 times less in a layer of ice than in vacuum or negative stain. A second, previously unrecognized, effect is the large, incoherent background of inelastic scattering from the ice. This background reduces both scattering and phase contrast by an additional factor of about 3, as shown in this paper. We have used energy filtration on the Zeiss EM902 in order to eliminate this second effect, and also increase scattering contrast in bright-field and dark-field.

Sign in / Sign up

Export Citation Format

Share Document