Agaplesion Markus Hospital

Frankfurt am Main, Germany

Agaplesion Markus Hospital

Frankfurt am Main, Germany
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Blumenstein I.,Frankfurt University Hospital | Dignass A.,Crohn Colitis Center Rhein Main | Dignass A.,Agaplesion Markus Hospital | Vollmer S.,Gastroenterological Practice | And 4 more authors.
Journal of Crohn's and Colitis | Year: 2014

Background/aim: Anaemia is a common complication in inflammatory bowel disease (IBD), frequently resulting from iron deficiency. IBD guidelines advocate intravenous iron administration although some patients respond to oral supplementation. This non-interventional study investigates the current status of anaemia management in German IBD patients. Methods: Baseline data on pre-study treatment for anaemia were retrospectively analysed in IBD patients with anaemia participating in a prospective trial of the efficacy and safety of ferric carboxymaltose. Data were collected from 55 German gastroenterological centres up to August 2010. Subjects had received care at their centre for at least 12. months prior to baseline. Results: 193 cases of IBD-associated anaemia (115 Crohn's disease, 77 ulcerative colitis) were analysed (mean age: 39. years (18-83), 79 (41%) males). Anaemia and iron status were usually assessed by haemoglobin (100%), serum ferritin (97%), and transferrin saturation (82%). In the previous 6. months, only 84 patients (43.5%) had been treated for anaemia: 47 (56%) with oral iron, 13 (15%) parenteral iron, 16 (19%) oral plus parenteral iron and 8 (10%) transfusions. No patients received erythropoietin stimulating agents. Conclusion: Although intravenous iron supplementation is recommended in IBD patients, current German practice still relies on oral therapy, even in severe anaemia. The high incidence of severe anaemia in this cohort reflects inadequate iron replacement and status monitoring. While the proportion of IBD patients with inadequately treated anaemia/iron deficiency is unknown, greater awareness of existing guidelines for iron deficiency management in IBD patients appears necessary. © 2014 European Crohn's and Colitis Organisation.

Probert C.S.J.,University of Liverpool | Dignass A.U.,Agaplesion Markus Hospital | Lindgren S.,Lund University | Lindgren S.,Skåne University Hospital | And 3 more authors.
Journal of Crohn's and Colitis | Year: 2014

Background and aims: Mesalazine (5-aminosalicylic acid) is the standard first-line therapy for mild-to-moderate ulcerative colitis. In the PINCE study, remission rates were significantly greater with combined oral/enema vs. oral/placebo treatment at 8. weeks (64% vs. 43%, respectively; p= 0.030). In this analysis, we explored early response, mucosal healing rates, cessation of rectal bleeding, and quality of life in PINCE. Methods: Patients with extensive mild-to-moderately active ulcerative colitis received 8. weeks of oral mesalazine 4. g/day, plus 4. weeks of daily active (1. g mesalazine) or placebo enema. Early response was assessed using the abbreviated ulcerative colitis disease activity index. Mucosal healing was assessed by disease activity index endoscopic mucosal appearance score. Cessation of bleeding (patient diaries), quality of life (EQ-5D), and patient acceptability (questionnaire) were also assessed. Results: Combined mesalazine oral/enema treatment achieved a significantly higher rate of improvement in abbreviated ulcerative colitis disease activity index (score decrease. ≥. 2) within 2. weeks, compared with oral-only treatment (p= 0.032). Bleeding ceased significantly more quickly with combination vs. oral therapy (p= 0.003). More patients showed mucosal healing (disease activity index endoscopic mucosal appearance score 0/1) with combination vs. oral therapy, which was significantly different between groups at week 4 (p= 0.052). Both groups showed quality of life improvements, with a significant benefit for combination vs. oral therapy at week 4 in multiple domains. Most patients reported finding the treatment acceptable. Conclusions: Rapid cessation of symptoms was seen with combination therapy, which is particularly important to patients and may improve quality of life. © 2013 European Crohn's and Colitis Organisation.

Thill M.,Agaplesion Markus Hospital | Dittmer C.,Hospital Essen Mitte | Baumann K.,University of Lübeck | Friedrichs K.,Mammazentrum Hamburg | Blohmer J.-U.,St Gertrauden Hospital
Breast | Year: 2013

The goal in breast conserving surgery (BCS) of ductal carcinoma in situ (DCIS) is removal of the tumor with a clear surgical margin. However, re-excision rates are regrettably high. To date, there are no adequate procedures for intraoperative margin assessment of DCIS. A multicenter, single arm study was conducted to evaluate the benefit of a novel device (MarginProbe®) in intraoperative margin assessment during BCS of DCIS, the associated reduction of re-excisions and the cosmetic outcome of the treated patients. We present results of 42 patients enrolled in 3 German institutions. The device was used as an adjunctive tool to standard of care. The device use was associated with a reduction in re-excision rates by 56%, from 39% to 17% (p=0.018). © 2013 Elsevier Ltd.

Thill M.,AGAPLESION Markus Hospital | Kraft C.,Helios Hospital Krefeld | Friedrich M.,Helios Hospital Krefeld
Oncology Research and Treatment | Year: 2016

Categorization, risk assessment, and treatment of breast cancer have been revolutionized by the original description of the human epidermal growth factor receptor 2 (HER2), first as a prognostic marker and then as a therapeutic target. The HER2-positive subtype of breast cancer represents less than approximately 20% of the incident breast cancers. Nevertheless, many lessons can be learned from the development of anti-HER2 therapies in early-stage disease. This review will comment on the key studies in both the (neo)adjuvant and metastatic settings and discusses some of the controversies that still remain today both in clinical care and as research questions. © 2016 S. Karger GmbH, Freiburg.

Thill M.,AGAPLESION Markus Hospital | Baumann K.,University of Lübeck | Barinoff J.,AGAPLESION Markus Hospital
Journal of Surgical Oncology | Year: 2014

A positive margin in breast conserving surgery is associated with an increased risk of local recurrence. Failure to achieve clear margins results in re-excision procedures. Methods for intraoperative assessment of margins have been developed, such as frozen section analysis, touch preparation cytology, near-infrared fluorescence optical imaging, x-ray diffraction technology, high-frequency ultrasound, micro-CT, and radiofrequency spectroscopy. In this article, options that might become the method of choice in the future are discussed. © 2014 Wiley Periodicals, Inc.

Thill M.,Agaplesion Markus Hospital | Kurylcio A.,Medical University of Lublin | Welter R.,The Interdisciplinary Center | van Haasteren V.,Agaplesion Markus Hospital | And 4 more authors.
Breast | Year: 2014

Sentinel lymph node biopsy (SLNB) is the standard surgical procedure for the axilla in early node-negative breast cancer. To date, the "gold standard" to localize the sentinel lymph node (SLN) is the radiotracer 99mTc with or without blue dye. The aim of this study was to evaluate potential equivalency of the new SentiMag® technique in comparison to the "gold standard". Within this prospective, multicentric and multinational non-inferiority study including 150 patients 99mTc was compared with the magnetic technique, using superparamagnetic iron oxide particles (SPIOs, Sienna+®) for localization of SLNs. The results showed a detection rate per patient of 97.3% (146/150) for 99mTc vs. 98.0% (147/150) for Sienna+® with a similar average number of removed SLNs per patient and a higher per patient malignancy detection rate for the SPIO tracer. We obtained convincing results that magnetic SLNB can be performed easily, safely and equivalently well in comparison to the radiotracer method. © 2014 The Authors.

Thill M.,University Hospital of Schleswig Holstein | Thill M.,Agaplesion Markus Hospital | Baumann K.,University Hospital of Schleswig Holstein
Breast Care | Year: 2012

Since breast-conserving surgery has become the gold standard for early breast cancer, the development of less radical or less burdensome technologies has been pressed for in order to preserve the patient from unnecessary harm through the operative procedure. Different technical approaches are under evaluation, and some of them are already being used in the clinical setting. The aim of this article is to present a perspective on future breast cancer surgery by shedding light on the current innovative and new techniques. © 2012 S. Karger GmbH, Freiburg.

Waldkirch E.S.,Hannover Medical School | Uckert S.,Hannover Medical School | Sohn M.,AGAPLESION Markus Hospital | Kuczyk M.A.,Hannover Medical School | And 2 more authors.
Journal of Sexual Medicine | Year: 2012

Introduction. Rho kinases (ROKs) cause calcium-independent modulation of smooth muscle contraction. A significant role for the RhoA/ROK pathway in mediating the contraction of the penile erectile tissue has been suggested. Moreover, it has been postulated that ROK activity might represent a key factor in the pathophysiology of erectile dysfunction. Up until today, little is known on the significance of ROK and related proteins in the control of blood flow in the corpus cavernosum. Aim. To investigate by means of immunohistochemistry and organ bath studies the significance of the Rho pathway in human cavernous arteries. Main Outcome Measures. The expression of ROK1, ROK2, RhoA, and RhoGDI in human cavernous arteries was investigated by means of immunohistochemistry; myographic studies were conducted in order to characterize the effects of the ROK inhibitor Y27632 on isolated cavernous arteries. Methods. Specimens of human cavernous arteries were processed for immunohistochemistry for ROK1, ROK2, RhoA, and RhoGDI. Circular penile vascular segments were mounted in a tissue bath and the effects of increasing concentrations of the ROK inhibitor Y27632 on the tension induced by norepinephrine (NE, 1μM) were investigated. Results. Alpha-actin immunoreactive cavernous arterioles also presented abundant staining specific for ROK1, ROK2, RhoA, and RhoGDI in the smooth musculature of the vascular wall. Cumulative addition of Y27632 dose-dependently reversed the tension induced by NE of isolated arterial segments. Y27632 produced relaxant responses with a reversion of tension of 34.3±11.8% at a concentration of 1μM. Conclusion. The findings are in support for a role of the Rho/ROK-mediated signaling in the regulation of muscle tone of human cavernous arteries. © 2012 International Society for Sexual Medicine.

Thill M.,Agaplesion Markus Hospital
Expert Review of Medical Devices | Year: 2013

In breast conserving surgery, the tumor should be removed with a clean margin, a rim of healthy tissue surrounding. Failure to achieve clean margins in the initial surgery results in a re-excision procedure. Re-excision rates are reported as being 11-46% for invasive carcinoma and ductal carcinoma in situ (DCIS). Re-excisions can have negative consequences such as increased postoperative infections, negative impact on cosmesis, patient anxiety and increased medical costs. Therefore, the surgical margin of invasive and intraductal (DCIS) breast tissue is a subject of intense discussion. Different options for intraoperative assessment are available, but all in all, they are unsatisfying. Frozen section margin examination is possible but is time consuming and restricted to the assessment of invasive carcinoma. In the case of DCIS, there is no procedure for intraoperative margin assessment. Thus, a solution for efficient intraoperative surgical margin assessment is needed. For this purpose, an innovative, real-time, intraoperative margin-assessment device (MarginProbe®, Dune Medical Devices, Caesarea, Israel) was designed, and recent published clinical data reported a reduction of re-excisions by more than 50%. © 2013 Expert Reviews Ltd.

Thill M.,Agaplesion Markus Hospital
Expert Review of Anticancer Therapy | Year: 2015

Trastuzumab is a highly successful monoclonal antibody (mAb) that has been used primarily for the treatment of HER2-positive breast cancer. Because of its success and its impending patent expiry in Europe in 2014, a number of copy versions of trastuzumab have been developed and are currently undergoing a comparability exercise for marketing authorization. Although biosimilar products have been approved in Europe since 2006, including two biosimilar mAbs of infliximab approved in 2013, the use of mAbs such as trastuzumab in the cancer setting has raised a number of new concerns. The requirements for the approval of biosimilar mAbs published by the EMA will be discussed and examined in the context of trastuzumab biosimilars to highlight potential controversies. © 2015 Informa UK, Ltd..

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