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  • 1
    Language: English
    In: Langenbeck's Archives of Surgery, 2011, Vol.396(3), pp.379-387
    Description: Byline: Maciej Janusz Powerski (1,2), Dirk Henrich (1), Anna Sander (1), Daniel Wastl (1), Kendra Ludwig (1), Ingo Marzi (1) Keywords: Hematopoietic stem cells (HSCs); Stem cell mobilization; Wound healing; Stem cell adhesion Abstract: Purpose CD133+CD34+ hematopoietic stem cells (HSCs) have been shown to differentiate into cell types of nonhematopoietic lineage. It is unclear whether HSCs target and repair damaged musculoskeletal tissue. We aimed to analyze if HSCs are mobilized after musculoskeletal surgery to circulation, home to surgical wound fluid (SWF)-activated endothelium, and are chemoattracted by SWF under in vitro conditions. Methods Circulating HSC levels were measured at t=3, 8, 24, 48 h postoperatively using fluorescence-activated cell sorting (FACS) and compared with preoperative levels (t=0) and normal volunteers. For adhesion experiments, HSCs were incubated on SWF-activated human umbilical vein endothelial cells (HUVECs) and HSC/HUVEC ratios determined by FACS. Adhesion receptor expression on HSC (L-selectin, lymphocyte function-associated antigen 1 (LFA-1), very late antigen-4) and SWF-activated HUVECs (P-selectin, E-selectin, V-cell adhesion molecules (CAM), I-CAM) was determined and HSC adhesion measured again after blocking upregulated receptors. Using a modified Boyden chamber, HSC chemotaxis was analyzed for an SWF and cytokine-neutralized SWF (vascular endothelial growth factor (VEGF), stromal-derived factor-1, interleukin-8) gradient. Results Circulating HSCs were significantly increased 8 h after surgery. Increasing HSC adhesion to HUVECs was shown for SWF isolated at any postoperative time point, and chemoattraction was significantly induced in an SWF gradient with SWF isolated 8 and 24 h postoperatively. Receptor and cytokine blockade experiments with monoclonal antibodies revealed decreased HSC adhesion to SWF-activated endothelium and showed lower chemotaxis after blocking the LFA-1-I-CAM-1 receptor axis (adhesion) and neutralizing VEGF-165 (chemotaxis). Conclusions Our data demonstrate that HSCs are mobilized after trauma, target to wound-associated endothelium via the LFA-1-I-CAM-1 axis, and are chemoattracted by VEGF-165 under in vitro conditions. Author Affiliation: (1) Department of Trauma Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (2) Institut fur Radiologie, Klinik fur Strahlenheilkunde CC6, Charite--Universitatsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany Article History: Registration Date: 17/02/2010 Received Date: 03/01/2010 Accepted Date: 17/02/2010 Online Date: 07/03/2010 Article note: Contributions Study conception and design: Powerski, Marzi Acquisition of data: Powerski, Henrich, Sander, Wastl, Ludwig Analysis and interpretation of data: Powerski, Henrich Drafting manuscript: Powerski Critical revision of manuscript: Marzi, Henrich
    Keywords: Hematopoietic stem cells (HSCs) ; Stem cell mobilization ; Wound healing ; Stem cell adhesion
    ISSN: 1435-2443
    E-ISSN: 1435-2451
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  • 2
    Language: English
    In: CardioVascular and Interventional Radiology, 2015, Vol.38(3), pp.678-684
    Description: Byline: Maciej Powerski (1), Anke Busse (1), Max Seidensticker (1), Frank Fischbach (1), Ricarda Seidensticker (1), Katharina Strach (1), Oliver Dudeck (1), Jens Ricke (1), Maciej Pech (1,2) Keywords: Liver malignancies; Radioembolization; Cystic artery; Cholecystitis Abstract: Purpose Prior to radioembolization (RE) of hepatic tumors, many centers prophylactically occlude the cystic artery (CA) during evaluation angiography (EVA) to prevent radiation-induced cholecystitis. There is no conclusive evidence for the protective effect of CA embolization and it bears the risk of inducing ischemic cholecystitis. The aim of this study is to evaluate the justification for CA embolization by comparing clinical and morphologic imaging parameters between patients undergoing coil occlusion of the cystic artery (COCA) and those with uncoiled CA (UCCA). Materials and Methods Retrospective comparison of 37 patients with UCCA versus 68 patients with COCA in terms of clinical findings (CRP, leukocyte count, body temperature, upper abdominal pain) and morphologic imaging parameters associated with cholecystitis (gallbladder (GB) wall thickness, free fluid in GB bed, bremsstrahlung SPECT) after EVA, after RE, and at 6-week follow-up. Results At none of the 3 time points (EVA, RE, 6-week follow-up) was there any significant difference in CRP, leukocyte count, body temperature, or upper abdominal pain between the UCCA and COCA group. There was also no significant difference between the two groups with regard to GB wall thickness, fluid in the GB bed, and bremsstrahlung in SPECT. One patient of the UCCA group and two patients of the COCA developed cholecystitis requiring treatment. Conclusion Comparison of clinical and imaging findings between patients with and without CA embolization prior to RE identified no predictors of radiogenic or ischemic cholecystitis after RE. Our study provides no evidence for a benefit of prophylactic CA embolization before RE. Author Affiliation: (1) Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany (2) 2nd Department of Radiology, Medical University of GdaAsk, Mariana Smoluchowskiego 17, 80-214, GdaAsk, Poland Article History: Registration Date: 17/03/2015 Received Date: 04/12/2014 Accepted Date: 28/02/2015 Online Date: 01/04/2015
    Keywords: Liver malignancies ; Radioembolization ; Cystic artery ; Cholecystitis
    ISSN: 0174-1551
    E-ISSN: 1432-086X
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  • 3
    Language: English
    In: CardioVascular and Interventional Radiology, 2018, Vol.41(6), pp.890-897
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00270-017-1873-0 Byline: Maciej Powerski (1), Bartosz Bascik (2), Jazan Omari (1), Shahen El-Sanosy (1), Oliver S. Grosser (1), Max Seidensticker (3), Frank Fischbach (1), Maciej Pech (1,2) Keywords: Radioembolization; SIRT; TARE; 3&9 o'clock arteries Abstract: Purpose 3 and 9 o'clock arteries (3&9As) which supply the common hepatic duct connect hepatic with duodenal/pancreatic territories. The study purpose is to describe the angiographic anatomy of 3&9As and discuss their relevance when performing radioembolization (RE) of liver malignancies. Materials and Methods The anatomy of the 3&9As was systematically investigated by a retrospective analysis of angiograms, technetium Tc-99 m-macroaggregated albumin (MAA) scintigrams, yttrium-90 (Y90) Bremsstrahlung-SPECT/CT datasets, and clinical data of 153 patients who underwent RE between 2010 and 2013. Results Analysis of preprocedural angiograms identified 3&9As in 36 (24%) of the 153 patients. Following embolization of the gastroduodenal artery, 3&9As were seen in 53 cases (35%). The three most common origins of the 3&9As were the right hepatic artery (n = 14), the cystic artery (n = 11), and S5 and S6 segmental arteries (n = 5 each). Extrahepatic Tc-99 m-MAA deposition in the territory of the 3&9As was significantly more frequent when 3&9As were detectable on preprocedural angiograms (28%.sub.visible vs. 11%.sub.not visible p = 0.001) and especially when the 3&9As were not embolized or bridged prior to RE (50%.sub.not occluded/bridged vs. 19%.sub.occupied/bridged p = 0.043). The presence of extrahepatic Y90 Bremsstrahlung after RE (n = 17) was attributable to microsphere diversion via the 3&9A territory in four patients and possible diversion via this territory in nine patients. Five of these 13 patients presented with epigastric pain, nausea, or vomiting (CTCAE severity grade a[currency] 3) (p = 0.014). Conclusion 3&9As are commonly detectable during evaluation angiography prior to RE, have a variable angioanatomic origin, and should be prophylactically occluded to prevent complications. Author Affiliation: (1) 0000 0001 1018 4307, grid.5807.a, Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany (2) 0000 0001 0531 3426, grid.11451.30, 2nd Department of Radiology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214, GdaAsk, Poland (3) 0000 0004 0477 2585, grid.411095.8, Klinik und Poliklinik fur Radiologie, Klinikum der Universitat Munchen, 81377, Munich, Germany Article History: Registration Date: 30/12/2017 Received Date: 23/09/2017 Accepted Date: 29/12/2017 Online Date: 17/01/2018
    Keywords: Radioembolization ; SIRT ; TARE ; 3&9 o’clock arteries
    ISSN: 0174-1551
    E-ISSN: 1432-086X
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  • 4
    Language: English
    In: European Journal of Radiology, July 2012, Vol.81(7), pp.e804-e811
    Description: A survey was conducted to give an overview about the practice of radioembolization in malignant liver tumors by European centers. A questionnaire of 23 questions about the interventional center, preinterventional patient evaluation, the radioembolization procedure and aftercare were sent to 45 European centers. The response rate was 62.2% (28/45). The centers performed 1000 (median = 26) radioembolizations in 2009 and 1292 (median = 40) in 2010. Most centers perform preinterventional evaluation and radioembolization on an inpatient basis. An arterioportal shunt not amendable to preinterventional embolization is considered a contraindication. During preinterventional angiography, the gastroduodenal artery is embolized by 71%, the right gastric artery by 59%, and the cystic artery by 41%. In case of bilobar disease, yttrium-90 microspheres are infused into the common hepatic artery (14%) or separately into left and right hepatic artery (86%). 33% prefer a time interval between right and left liver lobe radioembolization to prevent radiation induced liver disease. 43% of the respondents do not prescribe prophylactic medication after radioembolization. In case of iatrogenic manipulation to the biliary duct system most centers perform radioembolization with prophylactic antibiotics. Despite standardization of the procedure, there are some differences in how radioembolization of liver tumors is performed in Europe.
    Keywords: Interventional Radiology ; Radioembolization ; Selective Internal Radiation Therapy ; Sirt ; Liver Tumor ; Liver Metastases ; Medicine
    ISSN: 0720-048X
    E-ISSN: 1872-7727
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  • 5
    Language: English
    In: Artificial Cells, Blood Substitutes, and Biotechnology, 01 August 2011, Vol.39(4), pp.214-222
    Description: Injection of endothelial progenitor cells (EPCs) into arteries for cell therapy is a promising field in regenerative medicine. However, adhesion of EPCs during capillary passage is restricted, and non-adhering cells are lost into circulation. Here we demonstrate that it is possible to achieve a three-...
    Keywords: Endothelial Progenitor Cells ; Manipulation of Cell Adhesion ; Human Vein Endothelial Cells ; Extracellular Matrix Proteins ; Phorbol Myristate Acetate ; Regenerative Medicine ; Medicine ; Engineering
    ISSN: 1073-1199
    E-ISSN: 1532-4184
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  • 6
    Language: English
    In: CardioVascular and Interventional Radiology, 2015, Vol.38(3), pp.613-622
    Description: Byline: Christian Scheurig-Muenkler (1), Maciej J. Powerski (2), Johann-Christoph Mueller (1), Thomas J. Kroencke (3) Keywords: Uterine artery embolization; Radiation dose; Uterine leiomyoma; Dose area product; Pulsed fluoroscopy; Flat-panel detector Abstract: Purpose Evaluation of patient radiation exposure during uterine artery embolization (UAE) and literature review to identify techniques minimizing required dose. Methods A total of 224 of all included 286 (78 %) women underwent UAE according to a standard UAE-protocol (bilateral UAE from unilateral approach using a Rosch inferior mesenteric and a microcatheter, no aortography, no ovarian artery catheterization or embolization) and were analyzed for radiation exposure. Treatment was performed on three different generations of angiography systems: (I) new generation flat-panel detector (N = 108/151) (II) classical image amplifier and pulsed fluoroscopy (N = 79/98) (III) classical image amplifier and continuous fluoroscopy (N = 37/37). Fluoroscopy time (FT) and dose-area product (DAP) were documented. Whenever possible, the following dose-saving measures were applied: optimized source-object, source-image, and object-image distances, pulsed fluoroscopy, angiographic runs in posterior-anterior direction with 0.5 frames per second, no magnification, tight collimation, no additional aortography. Results In a standard bilateral UAE, the use of the new generation flat-panel detector in group I led to a significantly lower DAP of 3,156 cGy x cm.sup.2 (544--45,980) compared with 4,000 cGy x cm.sup.2 (1,400--13,000) in group II (P = 0.033). Both doses were significantly lower than those of group III with 8,547 cGy x cm.sup.2 (3,324--35,729 P 〈 0.001). Other reasons for dose escalation were longer FT due to difficult anatomy or a large leiomyoma load, additional angiographic runs, supplementary ovarian artery embolization, and obesity. Conclusions The use of modern angiographic units with flat panel detectors and strict application of methods of radiation reduction lead to a significantly lower radiation exposure. Target DAP for UAE should be kept below 5,000 cGy x cm.sup.2. Author Affiliation: (1) Department of Diagnostic and Interventional Radiology, Charite Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany (2) Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany (3) Department of Radiology, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany Article History: Registration Date: 19/07/2014 Received Date: 08/02/2014 Accepted Date: 30/06/2014 Online Date: 23/08/2014
    Keywords: Uterine artery embolization ; Radiation dose ; Uterine leiomyoma ; Dose area product ; Pulsed fluoroscopy ; Flat-panel detector
    ISSN: 0174-1551
    E-ISSN: 1432-086X
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  • 7
    Language: English
    In: Global Spine Journal, August 2014, Vol.4(3), pp.187-190
    Description: Study Design Case report and review of the literature. Objectives Case report of a traumatic dissection of all major brain-supplying arteries resulting from a horseback-riding accident. Overview of the literature on diagnostic and therapeutic recommendations. Methods Case presentation. For the discussion, handpicked articles and PubMed database research with the keywords “dissection,” “vertebral artery,” “spine trauma,” “computed tomography,” “magnetic resonance imaging,” and “angiography” were used. Results Despite high-energy induced acute lesion of all four cervical arteries, this 45-year-old patient did not demonstrate signs of microemboli nor suffer from stroke. Conclusion In case of high-energy trauma of the head and/or the neck, emergency physicians must consider traumatic cervical artery dissection (TCAD). Thus, emergency care algorithms should routinely include computed tomography angiography and magnetic resonance imaging. Although the incidence of TCAD-induced stroke is low, antiplatelet therapy is recommended in the presence of TCAD.
    Keywords: Arterial Dissection ; Spine Trauma ; Anticoagulation ; Computed Tomography ; Angiography ; Magnetic Resonance Imaging
    ISSN: 2192-5682
    E-ISSN: 2192-5690
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  • 8
    In: Journal of Medical Imaging and Radiation Oncology, August 2014, Vol.58(4), pp.472-480
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/1754-9485.12187/abstract Byline: Maciej Janusz Powerski, Christian Scheurig-Munkler, Bernd Hamm, Bernhard Gebauer Keywords: Gd-EOB-DTPA uptake; liver tumour; MRI; radioembolisation (RE; SIRT) Abstract Introduction To evaluate the uptake of the liver-specific magnetic resonance imaging (MRI) contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) by functional liver parenchyma after radioembolisation (RE) of hepatic malignancies. Methods Uptake of Gd-EOB-DTPA prior to RE versus 60+/-24d and 126+/-32d after RE was compared in a group of 33 patients with primary or secondary hepatic malignancies. In patients who underwent single-lobe treatment, left and right lobes were compared 59+/-24 days after RE. Gd-EOB-DTPA uptake was determined as follows: ratio of mean signal intensity in liver parenchyma to muscle in Gd-EOB-DTPA-enhanced T1-weighted MRI was subtracted from ratio of mean intensity in liver parenchyma to muscle in unenhanced T1-weighted MRI. Results Gd-EOB-DTPA uptake in liver parenchyma was 0.845+/-0.29 before RE, 0.615+/-0.38 (P=0.0022) at day 60+/-24, and 0.739+/-0.30 at day 126+/-32 after RE. In cases of single-lobe treatment, Gd-EOB-DTPA uptake was 0.581+/-0.256 for treated and 0.828+/-0.32 (P=0.0164) for untreated hepatic lobes. Conclusions Uptake of Gd-EOB-DTPA by liver parenchyma is impaired after RE, indicating dysfunction of the local hepatic system. These findings suggest that Gd-EOB-DTPA-enhanced MRI has the potential to be used for monitoring liver damage after RE. Article Note: MJ Powerski MD; C Scheurig-Munkler MD; B Hamm MD; B Gebauer MD. Conflict of interest: Bernhard Gebauer declares he is proctor for Sirtex Medical and received funding for congress and scientific meetings. The other authors declare no conflicts of interest.
    Keywords: Uptake ; Liver Tumour ; Mri ; Radioembolisation
    ISSN: 1754-9477
    E-ISSN: 1754-9485
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  • 9
    Language: English
    In: Journal of Pediatric Surgery, 2009, Vol.44(8), pp.e17-e19
    Description: We present here an unfortunate long-lasting case of sever osteitis after elastic intramedullary nailing of a radial bone shaft fracture in a 13-year-old adolescent girl and the final treatment by using a modified Masquelet technique (Palacos spacer and cancellous bone graft in a second session in addition to a plate osteosynthesis) to reconstruct the severely destroyed proximal radial bone.
    Keywords: Elastic Intramedullary Nailing (Esin) ; Osteitis ; Radial Bone Shaft Fracture ; Masquelet Technique ; Medicine
    ISSN: 0022-3468
    E-ISSN: 1531-5037
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  • 10
    Language: English
    In: CardioVascular and Interventional Radiology, 2014, Vol.37(5), pp.1251-1258
    Description: Byline: Dominik Geisel (1), Maciej Malinowski (2), Maciej-Janusz Powerski (1), Joost Wustefeld (1), Victoria Heller (2), Timm Denecke (1), Martin Stockmann (2), Bernhard Gebauer (1) Keywords: Future remnant liver; Hypertrophy; Portal vein embolization; Vascular plug; Volumetry Abstract: Purpose To retrospectively analyze efficacy as measured by volume gain of future remnant liver (FRL) after right portal vein embolization (PVE) using particles only versus particles and additional central plug and/or coil (CP/C) embolization. Methods All patients who underwent PVE between July 2011 and December 2012 were retrospectively analyzed. Right PVE was performed either with particle-only (PO) embolization or additional CP/C embolization. All enrolled patients underwent computed tomography or magnetic resonance imaging before PVE and surgery. The images were used for volumetry of the FRL. Results Of 75 patients, 40 had PO and 35 CP/C embolization. Age, sex, and tumor entities did not differ significantly between the two groups. Tumor entities included cholangiocarcinoma (n = 52), metastasis from colorectal cancer (n = 14), hepatocellular carcinoma (n = 2), and others (n = 7). Time from PVE to preoperative imaging was similar in both groups. FRL volume before PVE was 329 [+ or -] 121 ml in the PO group and 333 [+ or -] 135 ml in the CP/C group, and 419 [+ or -] 135 ml and 492 [+ or -] 165 ml before operation. The average percentage volume gain was significantly higher in the CP/C group than in the PO group, with 53.3 [+ or -] 34.5 % versus 30.9 [+ or -] 28.8 % (p = 0.002). Conclusion Right PVE with additional CP/C embolization leads to a significantly higher gain in FRL volume than embolization with particles alone. Author Affiliation: (1) Department of Diagnostic and Interventional Radiology, Charite, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany (2) Department of General, Visceral and Transplantation Surgery, Charite, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany Article History: Registration Date: 27/11/2013 Received Date: 10/09/2013 Accepted Date: 10/11/2013 Online Date: 06/12/2013 Article note: Dominik Geisel, Maciej Malinowski, Martin Stockmann and Bernhard Gebauer have contributed equally to this work.
    Keywords: Future remnant liver ; Hypertrophy ; Portal vein embolization ; Vascular plug ; Volumetry
    ISSN: 0174-1551
    E-ISSN: 1432-086X
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