TY  - JOUR
A1  - Megas, Ioannis-Fivos
A1  - Simons, David
A1  - Kim, Bong-Sung
A1  - Stoppe, Christian
A1  - Piatkowski, Andrzej
A1  - Fikatas, Panagiotis
A1  - Fuchs, Paul Christian
A1  - Bastiaanse, Jacqueline
A1  - Pallua, Norbert
A1  - Bernhagen, Jürgen
A1  - Grieb, Gerrit
T1  - Macrophage migration inhibitory factor — an innovative indicator for free flap ischemia after microsurgical reconstruction
JF  - Healthcare
N2  - (1) Background: Nowadays, the use of microsurgical free flaps is a standard operative procedure in reconstructive surgery. Still, thrombosis of the microanastomosis is one of the most fatal postoperative complications. Clinical evaluation, different technical devices and laboratory markers are used to monitor critical flap perfusion. Macrophage migration inhibitory factor (MIF), a structurally unique cytokine with chemokine-like characteristics, could play a role in predicting vascular problems and the failure of flap perfusion. (2) Methods: In this prospective observational study, 26 subjects that underwent microsurgical reconstruction were observed. Besides clinical data, the number of blood leukocytes, CRP and MIF were monitored. (3) Results: Blood levels of MIF, C-reactive protein (CRP) and leukocytes increased directly after surgery. Subjects that needed surgical revision due to thrombosis of the microanastomosis showed significantly higher blood levels of MIF than subjects without revision. (4) Conclusion: We conclude that MIF is a potential and innovative indicator for thrombosis of the microanastomosis after free flap surgery. Since it is easy to obtain diagnostically, MIF could be an additional tool to monitor flap perfusion besides clinical and technical assessments.
KW  - macrophage migration inhibitory factor (MIF)
KW  - free flap surgery
KW  - innovative surgical methods
KW  - microanastomosis
KW  - ischemia
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239632
SN  - 2227-9032
VL  - 9
IS  - 6
ER  - 
TY  - JOUR
A1  - Scheer, Monika
A1  - Vokuhl, Christian
A1  - Blank, Bernd
A1  - Hallmen, Erika
A1  - von Kalle, Thekla
A1  - Münter, Marc
A1  - Wessalowski, Rüdiger
A1  - Hartwig, Maite
A1  - Sparber-Sauer, Monika
A1  - Schlegel, Paul-Gerhardt
A1  - Kramm, Christof M.
A1  - Kontny, Udo
A1  - Spriewald, Bernd
A1  - Kegel, Thomas
A1  - Bauer, Sebastian
A1  - Kazanowska, Bernarda
A1  - Niggli, Felix
A1  - Ladenstein, Ruth
A1  - Ljungman, Gustaf
A1  - Jahnukainen, Kirsi
A1  - Fuchs, Jörg
A1  - Bielack, Stefan S.
A1  - Klingebiel, Thomas
A1  - Koscielniak, Ewa
T1  - Desmoplastic small round cell tumors: Multimodality treatment and new risk factors
JF  - Cancer Medicine
N2  - Background

To evaluate optimal therapy and potential risk factors.

Methods

Data of DSRCT patients <40 years treated in prospective CWS trials 1997-2015 were analyzed.

Results

Median age of 60 patients was 14.5 years. Male:female ratio was 4:1. Tumors were abdominal/retroperitoneal in 56/60 (93%). 6/60 (10%) presented with a localized mass, 16/60 (27%) regionally disseminated nodes, and 38/60 (63%) with extraperitoneal metastases. At diagnosis, 23/60 (38%) patients had effusions, 4/60 (7%) a thrombosis, and 37/54 (69%) elevated CRP. 40/60 (67%) patients underwent tumor resection, 21/60 (35%) macroscopically complete. 37/60 (62%) received chemotherapy according to CEVAIE (ifosfamide, vincristine, actinomycin D, carboplatin, epirubicin, etoposide), 15/60 (25%) VAIA (ifosfamide, vincristine, adriamycin, actinomycin D) and, 5/60 (8%) P6 (cyclophosphamide, doxorubicin, vincristine, ifosfamide, etoposide). Nine received high-dose chemotherapy, 6 received regional hyperthermia, and 20 received radiotherapy. Among 25 patients achieving complete remission, 18 (72%) received metronomic therapies. Three-year event-free (EFS) and overall survival (OS) were 11% (±8 confidence interval [CI] 95%) and 30% (±12 CI 95%), respectively, for all patients and 26.7% (±18.0 CI 95%) and 56.9% (±20.4 CI 95%) for 25 patients achieving remission. Extra-abdominal site, localized disease, no effusion or ascites only, absence of thrombosis, normal CRP, complete tumor resection, and chemotherapy with VAIA correlated with EFS in univariate analysis. In multivariate analysis, significant factors were no thrombosis and chemotherapy with VAIA. In patients achieving complete remission, metronomic therapy with cyclophosphamide/vinblastine correlated with prolonged time to relapse.

Conclusion

Pleural effusions, venous thrombosis, and CRP elevation were identified as potential risk factors. The VAIA scheme showed best outcome. Maintenance therapy should be investigated further.
KW  - C-reactive protein
KW  - desmoplastic small round cell tumor
KW  - maintenance therapy
KW  - soft tissue sarcoma
KW  - Trousseau's syndrome
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228444
VL  - 8
IS  - 2
ER  -