Tumor-like Lesions, unter besonderer Berücksichtigung der spinalen aneurysmatischen Knochenzyste

2021 ◽  
Vol 05 (04) ◽  
pp. 230-241
Author(s):  
Yu-Mi Ryang
Keyword(s):  
Chirurgische Therapie ◽  
Adjuvante Therapie ◽  
Aneurysmatische Knochenzyste ◽  
En Bloc ◽  
Off Label ◽  
Tumor Like Lesions

ZusammenfassungDie aneurysmatische Knochenzyste (AKZ) ist ein lokal aggressiv wachsender gutartiger primärer osteoklastischer Riesenzell-reicher Tumor, der in 10-30% die Wirbelsäule betrifft. Lange Zeit wurde angenommen, dass es sich um eine Tumor-ähnliche Läsion handelt. Durch den Nachweis einer chromosomalen Translokation des USP (Ubiquitin-spezifische Protease) 6 Gens auf Chromosom 17p13 entspricht die primäre AKZ jedoch einer echten Neoplasie 4 5 6 7 8. Die Prognose ist sehr gut mit Heilungsraten von > 90% nach intraläsionaler Resektion und Gesamtüberlebensraten von ≥98% 11 12. Die Einteilung erfolgt nach ihrem Wachstumsverhalten in die Enneking Stadien S1 bis S3. Die chirurgische Therapie galt bisher als Goldstandard für die Therapie der AKZ: die intraläsionale Kürettage ± adjuvante Therapie bei Enneking S1 und S2 Tumoren und die extraläsionale en bloc Resektion bei S3 Tumoren. In neueren Studien ist ein Trend erkennbar S2 Tumore zunehmend primär mittels serieller selektiver arterieller Embolisationen zu behandeln mit erfolgsversprechenden Ergebnissen 11. Bei S3 Tumoren gibt es Expertenmeinungen, die die en bloc Resektionen aufgrund der primären Gutartigkeit des Tumors, der guten Ergebnisse nach intraläsionaler Resektion und der hohen perioperativen Morbidität als Übertherapie betrachten 11. Eine Besonderheit bei der Therapie sind die vielfältigen nicht chirurgischen primären und adjuvanten Therapieansätze, die i.d.R. auf kleinen Fallserien beruhen. Bei lokal fortgeschrittenen, inoperablen oder Rezidivtumoren gibt es neuerdings Therapieansätze mit dem off-Label Einsatz von Denosumab primär, adjuvant oder neoadjuvant mit vielversprechenden ersten Ergebnissen.

Barrett-Ösophagus – Ösophagus-Karzinom: Chirurgische Therapie

Praxis ◽  
2002 ◽  
Vol 91 (20) ◽  
pp. 886-891
Author(s):  
Thon
Keyword(s):  
Chirurgische Therapie ◽  
Low Grade ◽  
High Grade ◽  
En Bloc ◽  
Antireflux Operation ◽  
Barrett Ösophagus ◽  
Limitierte Resektion ◽  
Ösophagealer Reflux

Chronischer gastro-ösophagealer Reflux führt zur Zylinderzell-Metaplasie in der distalen Speiseröhre und zum Barrett-Ösophagus. Besteht der Reflux weiter, kann sich innerhalb der intestinalen Metaplasie über eine «low grade»- und nachfolgende «high grade»-Dysplasie ein Barrett-Karzinom entwickeln. Der Refluxverhütung kommt daher überragende Bedeutung zu. Eine Antireflux-Operation (z.B. Fundoplikatio) ist diesbezüglich einer medikamentösen Langzeittherapie überlegen. Liegt bereits ein Karzinom vor, gilt die Resektionsbehandlung als therapeutischer Goldstandard. Nach klassischer subtotaler transhiataler Ösophagektomie mit en bloc-Resektion des Fundus und systematischer Lymphadenektomie erfolgt die Passagerekonstruktion über eine posteromediastinale Magentransposition mit Anastomosierung zwischen Schlauchmagen und zervikalem Speiseröhrenrest. Beim Barrett-Frühkarzinom (pT1) bietet heute die limitierte Resektion der distalen Speiseröhre mit ösophagogastraler Jejunuminterposition eine vermutlich onkologisch gleichwertige Alternative mit geringerer Letalität und Morbitität und einer Heilungschance beim nodal negativen Patienten von 90%. Dies gilt auch bei submuköser Tumorinfiltration, wo endoskopische Ablationsverfahren versagen.

scholarly journals Off-label use of 0.4 % sodium hyaluronate teardrops: a safe and effective solution for submucosal injection in gastric endoscopic submucosal dissection

2020 ◽  
Vol 08 (12) ◽  
pp. E1741-E1747
Author(s):  
Vitor Arantes ◽  
Josue Aliaga Ramos ◽  
Rafiz Abdul Rani ◽  
Naohisa Yoshida
Keyword(s):  
Clinical Outcome ◽  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
Sodium Hyaluronate ◽  
Off Label Use ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Injection ◽  
Off Label

Abstract Background and study aims Submucosal (SM) injection is a critical step in endoscopic submucosal dissection (ESD). In Japan, use of viscous solutions such as sodium hyaluronate are recommended; the commercially product available is MucoUp (Seikagaku Co. and Boston Scientific Japan Co., Japan). Nevertheless, MucoUp is expensive and unavailable in many Western countries. For the past 8 years, we have been using low-cost sterile teardrops solution composed of 0.4 % sodium hyaluronate (Adaptis Fresh, Legrand Laboratory, Brazil). This solution is readily available in drugstores with a cost of approximately US$ 10.00 for each 10-cc bottle. The aim of this study was to present the clinical outcome with off-label sodium hyaluronate use for SM injection in gastric ESD. Patients and methods A single-center retrospective study of collected data investigating consecutive patients that underwent gastric ESD between 2012 and 2019. ESD was performed using 0.4 % sodium hyaluronate teardrop for SM injection and Flush Knife BT 2.5 (Fujifilm Co., Japan). The following data were analyzed: clinical-pathological features, en-bloc, R0 and curative resection rate, procedure duration, adverse events, and clinical outcome. Results ESD was performed with sodium hyaluronate for submucosal injection in 78 patients. The en-bloc resection rate and R0 resection rate were 96.1 % and 92.3 %, respectively. The curative resection rate for epithelial lesions was 83.8 %. Adverse events occurred in 5 cases (6.3 %): delayed bleeding (3.8 %, 3 cases) and perforation (2.5 %, 2 cases); all managed successfully by clipping and thermal coagulation. The mean volume of sodium hyaluronate solution used per patient was 10 cc (SD: ± 8 cc). During follow-up (mean: 17 months; SD: ± 14.5 months), two patients developed metachronous lesions (2.5 %). Conclusions Off-label use of teardrops with 0.4 % sodium hyaluronate for submucosal injection was demonstrated to be safe and able to provide an effective submucosal cushion that facilitates SM dissection in gastric ESD procedures.

Knochentumoren der Wirbelsäule

2010 ◽  
Vol 19 (04) ◽  
pp. 332-339
Author(s):  
B. Habermann ◽  
M. Tonak ◽  
A. A. Kurth ◽  
K. Kafchitsas
Keyword(s):  
Aneurysmatische Knochenzyste ◽  
En Bloc ◽  
Oder Eine ◽  
Primäre Knochentumoren ◽  
Ewing Sarkom

ZusammenfassungPrimäre Knochentumoren der Wirbelsäule stellen eine Seltenheit dar. Aus diesem Grund ist es wichtig, dass der Wirbelsäulenchirurg frühzeitig die klinischen Zeichen deutet und darüber hinaus die richtigen Untersuchungen sowohl in der Klinik als auch in der Bildgebung einleitet, so dass eine adäquate Therapie frühzeitig beginnen kann. Die unspezifischen Rückenschmerzen der Patienten erklären die lange Zeit zwischen Initialsymptomen und definitiver Erstdiagnose. Neben der konventionellen Röntgenaufnahme spielen CT und MRT eine wichtige Rolle in der diagnostischen Bildgebung der Knochentumoren. Schlussendlich wird die Verdachtsdiagnose durch eine Biopsie erhärtet. Die „häufigsten seltenen” gutartigen Vertreter der primären Knochentumoren an der Wirbelsäule sind das Osteoidosteom, das Osteoblastom, das Osteo-chondrom, das Hämangiom, die aneurysmatische Knochenzyste und das eosinophile Granulom. Je nach Rezidivfreudigkeit und Aggressivität des Tumors sollte entsprechend eine intraläsionale Kürettage oder eine marginale Enbloc-Resektion angestrebt werden. Da letztere antomisch nicht immer möglich ist sollten Strahlen-und Chemotherapie assistiv berücksichtigt werden. Hauptvertreter der bösartigen Tumoren sind das multiple Myelom, das Plasmozytom, das Ewing-Sarkom, das Osteosarkom, das Chordom und das Chondrosarkom. Eine marginale oder weite En-bloc-Resektion sollte angestrebt werden, wobei die Einführung der neoadjuvanten Chemotherapie neue Möglichkeiten eröffnet hat.

Platinum Compounds as Stains for Electron Microscopy

1974 ◽  
Vol 32 ◽  
pp. 230-231
Author(s):  
S. K. Aggarwal ◽  
P. McAllister ◽  
R. W. Wagner ◽  
B. Rosenberg
Keyword(s):  
Electron Microscopy ◽  
Hela Cells ◽  
Uranyl Acetate ◽  
Sarcoma 180 ◽  
Platinum Compounds ◽  
Kb Cells ◽  
En Bloc ◽  
Human Lymphoma ◽  
Ultrathin Sections ◽  
Blue Coloration

Uranyl acetate has been used as an electron stain for en bloc staining as well as for staining ultrathin sections in conjunction with various lead stains (Fig. 1). Present studies reveal that various platinum compounds also show promise as electron stains. Certain platinum compounds have been shown to be effective anti-tumor agents. Of particular interest are the compounds with either uracil or thymine as one of the ligands (cis-Pt(II)-uracil; cis-Pt(II)-thymine). These compounds are amorphous, highly soluble in water and often exhibit an intense blue coloration. These compounds show enough electron density to be used as stains for electron microscopy. Most of the studies are based on various cell lines (human AV, cells, human lymphoma cells, KB cells, Sarcoma-180 ascites cells, chick fibroblasts and HeLa cells) while studies on tissue blocks are in progress.

Cellular Contacts Within the Interhemal Membrane of the Rat Placenta at Term

1974 ◽  
Vol 32 ◽  
pp. 146-147
Author(s):  
William P. Jollie
Keyword(s):  
Osmium Tetroxide ◽  
Uranyl Acetate ◽  
Capillary Endothelium ◽  
En Bloc ◽  
Aldehyde Fixation ◽  
Chorioallantoic Placenta

By routine EM preparative techniques, the tissues which, collectively, separate maternal and fetal bloods in the fully formed chorioallantoic placenta of the rat have been shown to consist of three chorionic layers, or trophoblast, and a layer of allantoic capillary endothelium [Fig. 1]. Relationships between these layers are best demonstrated by special techniques, viz., cacodylate-buffered aldehyde fixation, collidine-buffered osmium tetroxide postfixation, and en bloc staining with uranyl acetate. By using this method on placentas at term, the cells of the outermost chorionic layer (Trophoblast 1) appear to be attached to each other by means of maculae adherentes which sometimes occur in clusters [Fig. 2].

Localization of pancreatic enzymes in ultrathin frozen sections stained with metal labeled antibody

1978 ◽  
Vol 36 (2) ◽  
pp. 90-91
Author(s):  
Kenjiro Yasuda
Keyword(s):  
Fluorescent Antibody ◽  
Pancreatic Enzymes ◽  
Tissue Preparation ◽  
Zymogen Granules ◽  
Frozen Sections ◽  
En Bloc ◽  
Antibody Method ◽  
Ultrathin Frozen Sections ◽  
Fluorescent Antibody Method

Localization of amylase,chymotrypsinogen and trypsinogen in pancreas was demonstrated by Yasuda and Coons (1966), by using fluorescent antibody method. These enzymes were naturally found in the zymogen granules. Among them, amylase showed a diffuse localization around the nucleus, in addition to the zymogen granules. Using ferritin antibody method, scattered ferritin granules were also found around the Golgi area (Yasuda et al.,1967). The recent advance in the tissue preparation enables the antigen to be localized in the ultrathin frozen sections, by applying the labeled antibodies onto the sections instead of staining the tissue en bloc.The present study deals with the comparison of the localization of amylase and lipase demonstrated by applying the bismuth-labeled, peroxidase-labeled and ferritin-labeled antibody methods on the ultrathin frozen sections of pancreas, and on the blocks of the same tissue.

Lead aspartate: a new en bloc stain for electron microscopy

1978 ◽  
Vol 36 (2) ◽  
pp. 34-35
Author(s):  
J.R. Walton
Keyword(s):  
Electron Microscopy ◽  
Calcium Ion ◽  
Enzyme Reaction ◽  
Lead Citrate ◽  
Reaction Products ◽  
En Bloc ◽  
Thin Sections ◽  
Lead Salts ◽  
Thin Sectioning ◽  
High Alkalinity

In electron microscopy, lead is the metal most widely used for enhancing specimen contrast. Lead citrate requires a pH of 12 to stain thin sections of epoxy-embedded material rapidly and intensively. However, this high alkalinity tends to leach out enzyme reaction products, making lead citrate unsuitable for many cytochemical studies. Substitution of the chelator aspartate for citrate allows staining to be carried out at pH 6 or 7 without apparent effect on cytochemical products. Moreover, due to the low, controlled level of free lead ions, contamination-free staining can be carried out en bloc, prior to dehydration and embedding. En bloc use of lead aspartate permits the grid-staining step to be bypassed, allowing samples to be examined immediately after thin-sectioning.Procedures. To prevent precipitation of lead salts, double- or glass-distilled H20 used in the stain and rinses should be boiled to drive off carbon dioxide and glassware should be carefully rinsed to remove any persisting traces of calcium ion.

Quantitative EM of gap junction distribution in mutant drosophila wing discs

1983 ◽  
Vol 41 ◽  
pp. 720-721
Author(s):  
J.S. Ryerse
Keyword(s):  
Gap Junctions ◽  
Growth Control ◽  
Intercellular Junctions ◽  
Wing Disc ◽  
En Bloc ◽  
Metabolic Cooperation ◽  
Drosophila Wing ◽  
Adult Wing ◽  
Wing Discs ◽  
Wing Pouch

Gap junctions are intercellular junctions found in both vertebrates and invertebrates through which ions and small molecules can pass. Their distribution in tissues could be of critical importance for ionic coupling or metabolic cooperation between cells or for regulating the intracellular movement of growth control and pattern formation factors. Studies of the distribution of gap junctions in mutants which develop abnormally may shed light upon their role in normal development. I report here the distribution of gap junctions in the wing pouch of 3 Drosophila wing disc mutants, vg (vestigial) a cell death mutant, 1(2)gd (lethal giant disc) a pattern abnormality mutant and 1(2)gl (lethal giant larva) a neoplastic mutant and compare these with wildtype wing discs.The wing pouch (the anlagen of the adult wing blade) of a wild-type wing disc is shown in Fig. 1 and consists of columnar cells (Fig. 5) joined by gap junctions (Fig. 6). 14000x EMs of conventionally processed, UA en bloc stained, longitudinally sectioned wing pouches were enlarged to 45000x with a projector and tracings were made on which the lateral plasma membrane (LPM) and gap junctions were marked.

Ultrastructural comparison of prolactin adenomas of pituitary in men and women

1988 ◽  
Vol 46 ◽  
pp. 346-347
Author(s):  
R.C. Caughey ◽  
U.P. Kalyan-Raman
Keyword(s):  
Endoplasmic Reticulum ◽  
Electron Microscope ◽  
Phosphate Buffer ◽  
Pituitary Adenomas ◽  
Osmium Tetroxide ◽  
Secretory Granules ◽  
Uranyl Acetate ◽  
En Bloc ◽  
Men And Women ◽  
Transmission Electron

Prolactin producing pituitary adenomas are ultrastructurally characterized by secretory granules varying in size (150-300nm), abundance of endoplasmic reticulum, and misplaced exocytosis. They are also subclassified as sparsely or densely granulated according to the amount of granules present. The hormone levels in men and women vary, being higher in men; so also the symptoms vary between both sexes. In order to understand this variation, we studied 21 prolactin producing pituitary adenomas by transmission electron microscope. This was out of a total of 80 pituitary adenomas. There were 6 men and 15 women in this group of 21 prolactinomas.All of the pituitary adenomas were fixed in 2.5% glutaraldehyde, rinsed in Millonig's phosphate buffer, and post fixed with 1% osmium tetroxide. They were then en bloc stained with 0.5% uranyl acetate, rinsed with Walpole's non-phosphate buffer, dehydrated with graded series of ethanols and embedded with Epon 812 epoxy resin.

Ruthenium red and alcian blue effects on outer structures of methanotrophic bacteria

1988 ◽  
Vol 46 ◽  
pp. 72-73
Author(s):  
T.A. Fassel ◽  
M.J. Schaller ◽  
C.C. Remsen
Keyword(s):  
Research Effort ◽  
Ruthenium Red ◽  
Outer Cell ◽  
Methanotrophic Bacteria ◽  
En Bloc ◽  
Methylosinus Trichosporium ◽  
Wall Structures ◽  
Methylomonas Albus ◽  
Type Strains ◽  
Outer Cell Wall

Methane, a contributor to the “greenhouse effect”, is oxidized in the natural environment by methanotrophic bacteria. As part of a comprehensive research effort, we have been examining the ultrastructure of methanotrophs. These microorganisms have complex outer cell wall structures similar to those frequently found in other chemol itho- trophic bacteria. (1,2)In our work, we have focused on the “type” strains of Methylomonas albus BG8 and Methylosinus trichosporium OB3b. Between Spurr and LR White embedding resins, we found a difference 1n the preservation of an outer cup layer of BG8 external to the peripheral membranes. Cells from the same sample embedded in Spurr consistently lacked this feature (FIG. 1). This effect was overcome by an en bloc ruthenium red (RR) protocol that resulted in successful retention of the cup layer in Spurr resin (FIG. 2). For OB3b cells, the en bloc RR protocol resulted in an exterior bead feature distinguishable in thin section (FIG. 4) that previously was seen only by SEM.

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