Papers by Martin Biermann
Procedure guideline for radioiodine therapy and 131iodine whole-body scintigraphy in paediatric patients with differentiated thyroid cancer
Nuklearmedizin, 2007
The procedure guideline for radioiodine ((131)I) therapy and (131)I whole-body scintigraphy of di... more The procedure guideline for radioiodine ((131)I) therapy and (131)I whole-body scintigraphy of differentiated thyroid cancer in paediatric patients is the counterpart to the procedure guidelines (version 3) for adult patients and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Characteristics of thyroid cancer in children are the higher aggressiveness of papillary thyroid cancer, the higher frequency of extrathyroidal extension and of disseminated pulmonary metastases as well as the high risk of local recurrences. Radioiodine therapy is generally recommended in children, the (131)I activity depends on the children's body weight. Radioiodine ablation in children with small papillary cancer (< or =1 cm) should be considered. TSH stimulation is reached two weeks (children) or three weeks (adolescents) after withdrawal of thyroid hormones. Anti-emetic drugs are highly recommended. CT of the chest and examination of pulmonary function are clearly indicated if there is any suspicion on metastases. 3-6 months after (131)I ablation, the (131)I whole-body scintigraphy is highly recommended as lymph node metastases are frequently detected in paediatric patients. Follow-up care should be arranged in shorter intervals than in adults to test the compliance and to adapt dosage of thyroid hormones to the children's body weight. Reference values of fT3 are higher in children than in adults. Evidence is insufficient to describe in which constellation the TSH may be kept within the low normal level. Therefore, TSH suppression is generally recommended.
BMC Surgery, 2014
Background: Radioguided surgery using 99m-Technetium-methoxyisobutylisonitrile ( 99m Tc-MIBI) has... more Background: Radioguided surgery using 99m-Technetium-methoxyisobutylisonitrile ( 99m Tc-MIBI) has been recommended for the surgical treatment of mediastinal parathyroid adenomas. However, high myocardial 99m Tc-MIBI uptake may limit the feasibility of radioguided surgery in aortopulmonary window parathyroid adenoma. Case presentation: Two female patients aged 72 (#1) and 79 years (#2) with primary hyperparathyroidism caused by parathyroid adenomas in the aortopulmonary window were operated by transsternal radioguided surgery. After intravenous injection of 370 MBq 99m Tc-MIBI at start of surgery, the maximum radioactive intensity (as counts per second) was measured over several body regions using a gamma probe before and after removal of the parathyroid adenoma. Relative radioactivity was calculated in relation to the measured ex vivo radioactivity of the adenoma, which was set to 1.0. Both patients were cured by uneventful removal of aortopulmonary window parathyroid adenomas of 4400 (#1) and 985 mg (#2). Biochemical cure was documented by intraoperative measurement of parathyroid hormone as well as follow-up examination. Ex vivo radioactivity over the parathyroid adenomas was 196 (#1) and 855 counts per second (#2). Before parathyroidectomy, relative radioactivity over the aortopulmonary window versus the heart was found at 1.3 versus 2.6 (#1) and 1.8 versus 4.8 (#2). After removal of the adenomas, radioactivity within the aortopulmonary window was only slightly reduced.
Contrast Media & Molecular Imaging, 2010
Aim: The aim of this study is to show the practical use of, and to discuss the rationale for, hig... more Aim: The aim of this study is to show the practical use of, and to discuss the rationale for, high-end computed tomography (CT) integrated with intrinsic low-resolution single-photon emission tomography (SPECT). Materials and methods: All examinations performed on three new SPECT/CT systems with diagnostic CT capabilities were recorded retrospectively. The use of CT was classified as low-dose, using the CT with restraint as to the tube current and radiation dose, or diagnostic, with an optimum use of the CT, using CT protocols as used in ordinary radiological practice. The number of low-dose CT was compared with the number of diagnostic CT examinations. The report is based on 436 patient examinations from three hospitals in Norway with recently installed SPECT/CT systems, the time of use varying from 6 months to 2 years. The examinations performed were myocardial perfusion (45%), various tumors (thyroid, parathyroid, neuroendocrine 37%), malignant skeletal disease (12%), brain perfusion (4%), sentinel nodes in breast cancer (1%) and gastrointestinal bleeding (1%). Results: Of the 436 patients, 431 had a low-dose CT for attenuation correction, anatomic localisation and, also for diagnosis, whereas five patients had a diagnostic CT. In these series, as was found in recent literature, the diagnostic potential of the CT was seldom used to its capacity and always in predetermined diagnostic situations. Conclusion: There is a low degree of utilization of the diagnostic capabilities of the CT in the SPECT/CT context, for a number of reasons. This raises questions about the cost-benefit of investing in high-end CT for SPECT/CT applications.
Acta Radiologica, 2013
During the last decade, hybrid imaging has revolutionized nuclear medicine. Multimodal camera sys... more During the last decade, hybrid imaging has revolutionized nuclear medicine. Multimodal camera systems, integrating positron emission tomography (PET) or single photon emission computed tomography (SPECT) with computed tomography (CT) now combine the contrast provided by tumor-avid radioactive drugs with the anatomic precision of CT.
Kasus illustrerer hvordan tett samarbeid mellom ulike spesialistgrener (nukleærmedisiner, cytolog... more Kasus illustrerer hvordan tett samarbeid mellom ulike spesialistgrener (nukleærmedisiner, cytolog, endokrinkirurg) hjelper til for å oppnå optimale behandlingsresultater gjennom et strømlinjeformet behandlingsforløp.
Impact of treatment guidelines on radioiodine therapy for differentiated thyroid carcinoma in German-speaking Europe
Percutaneous radiation therapy
[How many high-risk patients with differentiated thyroid cancer need a" Tumor Center" per year?]
Therapy monitoring in aspergillosis using F-18 FDG positron emission tomography
Clinical nuclear …, 2001
Chronic granulomatous disease is a primary immunodeficiency disorder that involves the malfunctio... more Chronic granulomatous disease is a primary immunodeficiency disorder that involves the malfunction or absence of the nicotinamide adenine dinucleotide phosphate oxidase in the phagocytic cells. This deficiency causes a defective microbiologic defense. Consecutive ...
Risk stratification of patients with locally aggressive differentiated thyroid cancer
Nuklearmedizin, 2010
The Multicentre Study Differentiated Thyroid Cancer (MSDS) collective represents a well defined g... more The Multicentre Study Differentiated Thyroid Cancer (MSDS) collective represents a well defined group of patients with locally aggressive thyroid carcinomas (pT4; AJCC/UICC 1997). The aim of the present study was to compare the survival of patients with minimum and extensive extrathyroidal growth according to the new AJCC/UICC TNM staging system 2009. The follow-up data of 347 patients were analysed. Patients were reclassified according to the current AJCC/UICC 2009 classification. The event-free and overall survival was evaluated using Kaplan-Meier analysis. In addition, postoperative complications and status of disease were documented. 327 patients were assigned to stage pT3 and 20 patients to stage pT4a, respectively. Median follow-up was 6.1 years (range 0.04-9.8 years). 92.5% of patients reached complete remission. There were 7.8 % recurrences in the thyroid bed, in locoregional lymph nodes and/or in distant sites. The overall survival was >98% both in pT3 and pT4a patients (p = n. s.). In contrast, the event-free survival was significantly less favourable in pT4a patients (p < 0.001). Using multivariate analysis the following parameters were significant predictors of event-free survival: histological tumour type, degree of extrathyroidal extension and nodal metastasis (p < 0.05). The MSDS patients with locally aggressive differentiated thyroid cancer showed an excellent overall survival during a median follow-up of 6.1 years. According to the current AJCC/UICC 2009 classification, pT3 patients with minimal extrathyroidal extension revealed a significantly better event-free survival than pT4a patients with extensive extrathyroidal growth.
Langenbeck's Archives of Surgery, 2012
Purpose In 2004, a Diagnosis Related Groups (DRG)-based hospital reimbursement system became mand... more Purpose In 2004, a Diagnosis Related Groups (DRG)-based hospital reimbursement system became mandatory in Germany. The aim of this study was to provide nationwide data on the surgery of thyroid cancer by analyzing DRG statistics of the years 2005 and 2006. Methods The unit of analysis was hospital admission with a diagnosis of thyroid cancer. We assessed the influence of age, sex and region on the relative frequency of thyroid cancer-related hospitalisations with surgery of the thyroid and we measured the association between hospitalisation rates and incidence rates of thyroid cancer among the Federal States of Germany. Results Over the period 2005 to 2006, 11,107 thyroid cancerassociated hospitalisations included surgical treatment of the thyroid. The age-standardised DRG-based hospitalisation rates and the corresponding cancer registry-based incidences of thyroid cancer were positively associated. Overall, 68% of the hospitalisations with thyroid surgery included a total thyroidectomy. The percentage of surgery of the thyroid with a total thyroidectomy was nearly identical among men and women, decreased among men aged over 60 and varied considerably by region (minimum, 48% in Saarland; maximum, 78% in Saxony-Anhalt). Conclusions Our analyses of DRG statistics provide for the first time representative population-based data of the surgical management of thyroid cancer patients in Germany. Despite an identical health care system all over Germany and existing guidelines for surgical treatment of thyroid cancer, we observed a considerable regional variation in the proportion of total thyroidectomies performed in Germany.
Onkologe, 2005
Zusammenfassung Beim differenzierten Schilddrüsenkarzinom besteht bei nicht Organkapsel überschre... more Zusammenfassung Beim differenzierten Schilddrüsenkarzinom besteht bei nicht Organkapsel überschreitendem Tumorwachstum und adäquater Operation keine Indikation zur postoperativen Bestrahlung. Bei Patienten mit Organkapsel überschreitendem Wachstum wird nach vollständiger Resektion der Nutzen einer zusätzlichen perkutanen Radiotherapie kontrovers diskutiert. Die MSDS-Studie (Multizenterstudie Differenziertes Schilddrüsenkarzinom), die eine Randomisierung genau zu dieser Fragestellung durchführte, musste aufgrund der mangelnden Rekrutierung vorzeitig beendet werden. Beim anaplastischen Schilddrüsenkarzinom
GCP-konformes zentrales Management der Multizentrischen Studie Differenziertes Schilddrusenkarzinom (MSDS) mit einer relationalen Client-Server-Datenbank unter Oracle 8i
Onkologe, 2005
Zusammenfassung Die hoch dosierte Radiojodtherapie wird gemäß den Leitlinien der Deutschen Krebsg... more Zusammenfassung Die hoch dosierte Radiojodtherapie wird gemäß den Leitlinien der Deutschen Krebsgesellschaft bei allen differenzierten Schilddrüsenkarzinomen zur Ablation des nach Thyroidektomie verbliebenen Schilddrüsenrestgewebes durchgeführt. Einzige Ausnahme ist das auf die Schilddrüse beschränkte unifokale papilläre Mikrokarzinom ≤1 cm ohne Lymphknoten oder Fernmetastasen. Durch die Sterilisation (prä-)maligner Zellen im Schilddrüsenrestgewebe oder in zervikalen Lymphknoten wird die lokoregionäre Rezidivrate im Gegensatz zur ausschließlichen chirurgischen
A close link between metabolic activity and functional connectivity in the resting human brain
EJNMMI Physics, 2015
Universal mapping program for cardiac electrophysiology analyzes large volumes of data
Multizentrische Studie Differenziertes Schilddrüsen-karzinom (MSDS): verminderte Akzeptanz der adjuvanten perkutanen Strahlentherapie
Functional and morphological evidence for a ventricular conduction system in zebrafish and Xenopu... more Functional and morphological evidence for a ventricular conduction system in zebrafish and Xenopus hearts. Zebrafish and Xenopus have become popular model organisms for studying vertebrate development of many organ systems, including the heart. However, it is not clear whether the single ventricular hearts of these species possess any equivalent of the specialized ventricular conduction system found in higher vertebrates. Isolated hearts of adult zebrafish (Danio rerio) and African toads (Xenopus laevis) were stained with voltage-sensitive dye and optically mapped in spontaneous and paced rhythms followed by histological examination focusing on myocardial continuity between the atrium and the ventricle. Spread of the excitation wave through the atria was uniform with average activation times of 20 Ϯ 2 and 50 Ϯ 2 ms for zebrafish and Xenopus toads, respectively. After a delay of 47 Ϯ 8 and 414 Ϯ 16 ms, the ventricle became activated first in the apical region. Ectopic ventricular activation was propagated significantly more slowly (total ventricular activation times: 24 Ϯ 3 vs. 14 Ϯ 2 ms in zebrafish and 74 Ϯ 14 vs. 35 Ϯ 9 ms in Xenopus). Although we did not observe any histologically defined tracts of specialized conduction cells within the ventricle, there were trabecular bands with prominent polysialic acid-neural cell adhesion molecule staining forming direct myocardial continuity between the atrioventricular canal and the apex of the ventricle; i.e., the site of the epicardial breakthrough. We thus conclude that these hearts are able to achieve the apex-to-base ventricular activation pattern observed in higher vertebrates in the apparent absence of differentiated conduction fascicles, suggesting that the ventricular trabeculae serve as a functional equivalent of the His-Purkinje system. fish; frog; amphibian; electrophysiology; optical mapping; Rana; PSA-NCAM THE AFRICAN TOAD (Xenopus laevis) and zebrafish (Danio rerio) are becoming model organisms representing the Address for reprint requests and other correspondence: D. Sedmera,
Die adjuvante Radiotherapie kann durch Zerstörung von Mikrometastasen in Lymphknoten des Halses o... more Die adjuvante Radiotherapie kann durch Zerstörung von Mikrometastasen in Lymphknoten des Halses oder von möglicherweise verbliebenem Tumorrestgewebe im Schilddrüsenbett potenziell eine Erhöhung der lokalen Kontrolle und des Überlebens bewirken. Eine Verbesserung der Behandlungsergebnisse des o. g. Kollektivs mit Tumoren in den prognostisch günstigen Stadien pT-3 pN0 M0 (kein Kapsel überschreitendes Wachstum, TNM-Klassifikation, 5. Auflage 997) durch eine adjuvante Radiotherapie ist nicht zu erwarten. An einigen Zentren wird bei nodal-positiven Patienten und ungünstigen Prognosefaktoren, z. B. ausgedehnter Befall, geringer Differenzierungsgrad oder Patientenalter >45 Jahre, als Individualentscheidung eine adjuvante Radiotherapie durchgeführt [23, 25]. Eine dadurch erhöhte Rezidivfreiheit ist in diesem Kollektiv denkbar. Der Stellenwert dieses Vorgehens kann jedoch aufgrund fehlender Literaturdaten nicht belegt werden. Hingegen gibt es Daten aus retrospektiven Analysen, die auf eine Verbesserung der Behandlungsergebnisse des DTC mit organkapselüberschreitendem Wachstum hinweisen. Eine umfassende Übersicht über alle zu dieser Frage publizierten Studien erscheint in Kürze [3].
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Papers by Martin Biermann