Caritas Hospital

Saarbrücken, Germany

Caritas Hospital

Saarbrücken, Germany

Time filter

Source Type

Warnke C.,Heinrich Heine University Düsseldorf | Von Geldern G.,U.S. National Institutes of Health | Markwerth P.,Heinrich Heine University Düsseldorf | Dehmel T.,Heinrich Heine University Düsseldorf | And 17 more authors.
Annals of Neurology | Year: 2014

Objective: Progressive multifocal leukoencephalopathy (PML), caused by JC virus (JCV), can occur in patients receiving natalizumab for multiple sclerosis (MS). JCV detection by quantitative polymerase chain reaction (qPCR) in cerebrospinal fluid (CSF), or brain biopsy, is required for probable or definite diagnosis of PML. However, in some patients only low levels of JCV DNA (<100 copies=ml) are present in CSF, making the diagnosis challenging. Our objective was to assess the complementary value of a CSF JCV antibody index (AIJCV) in the diagnosis of natalizumab-associated PMLMethods: AIJCV was assessed in 37 cases of natalizumab-associated PML and 89 MS-patients treated with natalizumab without PML. Sera and CSF were tested in a capture enzyme-linked immunosorbent assay, using JCV-VP1 fused to glutathione S-transferase as antigen. Albumin levels and total immunoglobulin G concentration were determined by immunonephelometry, and the AIJCV was calculated as publishedResults: Twenty-six of 37 (70%) patients with natalizumab-associated PML exhibited an AIJCV > 1.5, whereas this was seen in none of the controls (p < 0.0001). At time of the first positive qPCR for JCV DNA, 11 of 20 (55%) patients with natalizumab-associated PML had an AIJCV > 1.5. JCV DNA levels of <100 copies= ml were seen in 14 (70%) of these 20 patients, of whom 8 (57%) demonstrated an AIJCV > 1.5Interpretation: Determination of the AIJCV could be an added tool in the diagnostic workup for PML and should be included in the case definition of natalizumab-associated PML © 2014 American Neurological Association.


Horn H.,Robert Bosch GmbH | Staiger A.M.,Robert Bosch GmbH | Vohringer M.,Robert Bosch GmbH | Campo E.,University of Würzburg | And 3 more authors.
American Journal of Surgical Pathology | Year: 2015

The immunoblastic variant of diffuse large B-cell lymphoma (IB-DLBCL) has recently been recognized as an aggressive lymphoma type with inferior prognosis as compared with other DLBCL variants. At the same time, the presence of MYC rearrangements in DLBCL has been shown to indicate shorter survival in R-CHOP-treated patients. In this study, we investigated the occurrence of MYC gene rearrangements in IB-DLBCL versus non-IB-DLBCL in a large series. Using fluorescence in situ hybridization with an MYC break-apart andMYC-IGH fusion probe, we found that 13/39 evaluable IB-DLBCLs (33%) harbor translocations involving MYC, in contrast with only 5/68 (7%) in the non-IB-DLBCL group (P<0.01). The immunoglobulin heavy chain gene (IGH) was the translocation partner in all rearrangements (100%) involving MYC in IB-DLBCL, which is in contrast to what has been reported for DLBCL in the literature (50% to 70%). Moreover, MYC rearrangements occurred as the sole translocation in the majority of cases (77%), whereas across all DLBCLs the majority of MYC-rearranged cases carry additional rearrangements of either BCL2 and/or BCL6 genes (between 58% and 83% of cases). Finally, MYC-rearranged IB-DLBCLs were CD10 positive in 62% (8/13), whereas this was an uncommon feature in MYC germline IB-DLBCLs (15%). In conclusion, IBDLBCLs are genetically characterized by frequent MYC-IGH translocations that often occur without additional BCL2 and/or BCL6 translocations. The activation of MYC, therefore, may be an important pathogenetic feature in IB-DLBCL. Copyright © 2014 by Lippincott Williams & Wilkins.


New tools have recently emerged that further improve the diagnostic performance of high-end endosonography. Whilst elastography has been available for a while, contrast-enhancing techniques are still very young with little experience existing in this field. The latest development is contrast enhanced low mechanical index endosonography (CELMI-EUS) which became commercially available at the beginning of 2010. This technique requires contrast-specific software whereas the pre-existing technique of contrast-enhanced high mechanical index endosonography (CEHMI-EUS) does not. The aim of this study was to compare these techniques in discriminating between focal chronic pancreatitis and pancreatic carcinoma. Included in the study were 58 patients with a pancreatic lesion (19 pancreatic cancer and 39 chronic pancreatitis) with a mean age of 60±15 years. All patients were examined by one investigator (MH). All methods were performed within one examination and the result of each technique was noted before using the next. The gold standard was pathology following surgery, endoscopic fine-needle puncture, or one-year follow-up when chronic pancreatitis was suspected. The consecutive results of specificity and sensitivity were 73.7% and 61.5% for B-mode endosonography; 94.7% and 33.4% for elastography; 84.2% and 76.9% for CELMI-EUS; and 89.5% and 92.3% for CEHMI-EUS.A combination of 3 of those methods could not improve on the result of CEHMI-EUS alone. This study shows that, despite the availability of new technologies, CEHMI-EUS is still the most reliable method for the differentiation of focal chronic pancreatitis and pancreatic carcinoma. However, understanding the advantages of the different methods might help to find the optimal indications for the use of the new techniques. © Georg Thieme Verlag KG Stuttgart - New York.


Hofheinz R.-D.,University of Mannheim | Wenz F.,University of Mannheim | Post S.,University of Mannheim | Matzdorff A.,Caritas Hospital St Theresa | And 18 more authors.
The Lancet Oncology | Year: 2012

Background: Fluorouracil-based chemoradiotherapy is regarded as a standard perioperative treatment in locally advanced rectal cancer. We investigated the efficacy and safety of substituting fluorouracil with the oral prodrug capecitabine. Methods: This randomised, open-label, multicentre, non-inferiority, phase 3 trial began in March, 2002, as an adjuvant trial comparing capecitabine-based chemoradiotherapy with fluorouracil-based chemoradiotherapy, in patients aged 18 years or older with pathological stage II-III locally advanced rectal cancer from 35 German institutions. Patients in the capecitabine group were scheduled to receive two cycles of capecitabine (2500 mg/m2 days 1-14, repeated day 22), followed by chemoradiotherapy (50·4 Gy plus capecitabine 1650 mg/m2 days 1-38), then three cycles of capecitabine. Patients in the fluorouracil group received two cycles of bolus fluorouracil (500 mg/m2 days 1-5, repeated day 29), followed by chemoradiotherapy (50·4 Gy plus infusional fluorouracil 225 mg/m2 daily), then two cycles of bolus fluorouracil. The protocol was amended in March, 2005, to allow a neoadjuvant cohort in which patients in the capecitabine group received chemoradiotherapy (50·4 Gy plus capecitabine 1650 mg/m2 daily) followed by radical surgery and five cycles of capecitabine (2500 mg/m2 per day for 14 days) and patients in the fluorouracil group received chemoradiotherapy (50·4 Gy plus infusional fluorouracil 1000 mg/m2 days 1-5 and 29-33) followed by radical surgery and four cycles of bolus fluorouracil (500 mg/m2 for 5 days). Patients were randomly assigned to treatment group in a 1:1 ratio using permuted blocks, with stratification by centre and tumour stage. The primary endpoint was overall survival; analyses were done based on all patients with post-randomisation data. Non-inferiority of capecitabine in terms of 5-year overall survival was tested with a 12·5% margin. This trial is registered with ClinicalTrials.gov, number NCT01500993. Findings: Between March, 2002, and December, 2007, 401 patients were randomly allocated; 392 patients were evaluable (197 in the capecitabine group, 195 in the fluorouracil group), with a median follow-up of 52 months (IQR 41-72). 5-year overall survival in the capecitabine group was non-inferior to that in the fluorouracil group (76% [95% CI 67-82] . vs 67% [58-74]; p=0·0004; post-hoc test for superiority p=0·05). 3-year disease-free survival was 75% (95% CI 68-81) in the capecitabine group and 67% (59-73) in the fluorouracil group (p=0·07). Similar numbers of patients had local recurrences in each group (12 [6%] in the capecitabine group . vs 14 [7%] in the fluorouracil group, p=0·67), but fewer patients developed distant metastases in the capecitabine group (37 [19%] . vs 54 [28%]; p=0·04). Diarrhoea was the most common adverse event in both groups (any grade: 104 [53%] patients in the capecitabine group . vs 85 [44%] in the fluorouracil group; grade 3-4: 17 [9%] . vs four [2%]). Patients in the capecitabine group had more hand-foot skin reactions (62 [31%] any grade, four [2%] grade 3-4 . vs three [2%] any grade, no grade 3-4), fatigue (55 [28%] any grade, no grade 3-4 . vs 29 [15%], two [1%] grade 3-4), and proctitis (31 [16%] any grade, one [<1%] grade 3-4 . vs ten [5%], one [<1%] grade 3-4) than did those in the fluorouracil group, whereas leucopenia was more frequent with fluorouracil than with capecitabine (68 [35%] any grade, 16 [8%] grade 3-4 . vs 50 [25%] any grade, three [2%] grade 3-4). Interpretation: Capecitabine could replace fluorouracil in adjuvant or neoadjuvant chemoradiotherapy regimens for patients with locally advanced rectal cancer. Funding: Roche Pharma AG (Grenzach-Wyhlen, Germany). © 2012 Elsevier Ltd.


Hirche T.O.,German Clinics for Diagnostics DKD | Hirche H.,University of Duisburg - Essen | Cui X.-W.,Caritas Hospital | Wagner T.O.,Goethe University Frankfurt | Dietrich C.F.,Caritas Hospital
Medical Ultrasonography | Year: 2014

Aim: Mediastinal lymphadenopathy is a typical feature of pulmonary sarcoidosis and an important parameter for diagnosis and follow-up. The present feasibility study is the first to elucidate the role of transthoracic mediastinal ultrasonography (US) for evaluation and staging of lymphadenopathy in patients with sarcoidosis. Material and method: Fifty patients with sarcoidosis were subjected to high-definition mediastinal US. The sonographic lymph node status was compared with the radiologic staging -the prevailing gold standard. Results: Mediastinal regions and landmarks could reliably be assessed by ultrasound in 45/50 (90%) of sarcoidosis patients. Lymphadenopathy was sonographically documented in 29/50 (58%) of the patients (sensitivity 89%, specificity 76%, PPV 86%, NPV 81%, accuracy 84%). There was a marked concordance between US confirmation of lymphadenopathy and radiologic staging (k=0.67, p<0.001). Conclusions: Transthoracic US qualifies for the demonstration of the mediastinal regions and lymphadenopathy in patients with sarcoidosis. The procedure is facilitated by frequent and distinct mediastinal lymph node enlargement due to sarcoidosis. Prospective studies are required to find out whether mediastinal US adds value to conventional radiologic staging and provides a clinically advantage, particularly in the follow-up of patients with sarcoidosis.


Horn H.,Robert Bosch GmbH | Schmelter C.,University of Würzburg | Leich E.,University of Würzburg | Salaverria I.,University of Kiel | And 7 more authors.
Haematologica | Year: 2011

Background According to the current World Health Organization Classification of Lymphoid Tumours, follicular lymphoma is subclassified into three grades according to the number of centroblasts. Follicular lymphoma grade 3 can be further divided into types A and B. Almost all available genetic data on grade 3B follicular lymphomas have been generated from tumors with an additional diffuse large B-cell lymphoma component. The purely follicular type of follicular lymphoma grade 3B is a rare neoplasm. Design and Methods We performed a detailed immunohistochemical (CD10, IRF4/MUM1, BCL2, Ig light chains) and genetic (translocations of BCL2, BCL6, MYC, IRF4) characterization of the largest series of purely follicular cases of grade 3B follicular lymphoma available to date, comprising 23 tumor samples. We also included 25 typical grade 1 or 2 follicular lymphomas, 9 follicular lymphomas with large centrocytes and/or high proliferation indices (FL/LCC), 12 cases of follicular lymphoma grade 3A, 16 cases of diffuse large B-cell lymphoma/follicular lymphoma grade 3B and 15 follicular lymphomas in which a straightforward distinction between grades 3A and 3B was not possible. Results Translocations affecting BCL2 and BCL6 genes are rare in grade 3B follicular lymphomas (2/23, 9% and 4/23, 17%) when compared with grade 1 or 2 follicular lymphomas (22/25, 88%, P<0.001 and 0/25, P<0.05), FL/LCC (7/9, 78%, P<0.001 and 2/9, 22%), grade 3A follicular lymphomas (7/12, 58%, P<0.01 and 2/12, 17%), unclassified grade 3 follicular lymphomas (6/15, 40% and 2/15, 13%) and diffuse large B-cell lymphoma/follicular lymphoma grade 3B (2/16, 13% and 8/16, 50%, P<0.05). MYC translocations were detected occasionally in FL/LCC, follicular lymphoma grade 3B, and diffuse large B-cell lymphoma/follicular lymphoma grade 3B (13%-22%), but not in grade 1, 2 or 3A follicular lymphomas (P<0.05 when compared with follicular lymphoma grade 3B). Both follicular lymphoma grade 3B and diffuse large B-cell lymphoma/ follicular lymphoma grade 3B were enriched in samples with a CD10-IRF4/MUM1+ immunophenotype (8/19, 42% and 7/16, 44%), with the vast majority of them lacking BCL2 translocations. In contrast, 42/46 grade 1 or 2 follicular lymphomas, FL/LCC and grade 3A follicular lymphomas were CD10+ (91%) while 0/46 expressed IRF4/MUM1. None of the tumor samples tested with increased IRF4/MUM1-expression harbored a translocation of the IRF4 gene locus. Conclusions Our results show that grade 3B follicular lymphomas form a distinct category of follicular lymphomas with infrequent BCL2 and BCL6 translocations, while grades 1, 2 and 3A follicular lymphomas and FL/LCC display homogeneous features with frequent BCL2 translocations and a CD10+IRF4/MUM1- immunophenotype. ©Ferrata Storti Foundation.


Ignee A.,Caritas Hospital | Jedrejczyk M.,Medical Faculty | Schuessler G.,Caritas Hospital | Jakubowski W.,Medical Faculty | Dietrich C.F.,Caritas Hospital
European Journal of Radiology | Year: 2010

Introduction: Time intensity curves for real-time contrast enhanced low MI ultrasound is a promising technique since it adds objective data to the more subjective conventional contrast enhanced technique. Current developments showed that the amount of uptake in modern targeted therapy strategies correlates with therapy response. Nevertheless no basic research has been done concerning the reliability and validity of the method. Patients and methods: Videos sequences of 31 consecutive patients for at least 60 s were recorded. Parameters analysed: area under the curve, maximum intensity, mean transit time, perfusion index, time to peak, rise time. The influence of depth, lateral shift as well as size and shape of the region of interest was analysed. Results: The parameters time to peak and rise time showed a good stability in different depths. Overall there was a variation >50% for all other parameters. Mean transit time, time to peak and rise time were stable from 3 to 10 cm depths, whereas all other parameters showed only satisfying results at 4-6 cm. Time to peak and rise time were stable as well against lateral shifting whereas all other parameters had again variations over 50%. Size and shape of the region of interest did not influence the results. Discussion: (1) It is important to compare regions of interest, e.g. in a tumour vs. representative parenchyma in the same depths. (2) Time intensity curves should not be analysed in a depth of less than 4 cm. (3) The parameters area under the curve, perfusion index and maximum intensity should not be analysed in a depth more than 6 cm. (4) Size and shape of a region of interest in liver parenchyma do not affect time intensity curves. © 2008 Elsevier Ireland Ltd. All rights reserved.


Zoran M.,Romanian National Institute for Optoelectronics | Dida M.R.,Caritas Hospital
European Space Agency, (Special Publication) ESA SP | Year: 2016

The adverse health effects from aerosol particulate matter PM pollution, especially with aerodynamic diameter ≤2.5 μm PM2.5 must be considered in developing policies to improve air quality. Epidemiologic studies demonstrated that exposure to ambient particulate matter PM is associated with increased morbidity and mortality, particularly associated with cardiopulmonary disease and asthma of which children are most exposed for the rapid increase of asthma disease. Very early exposure to certain components of air pollution can increase the risk of developing of different allergies by age 7. The present study attempts to retrieve the aerosol load in terms of aerosol optical depth (AOD) related to air quality in the Bucharest metropolitan area. In this study is presented a spatio-temporal analysis of the aerosol concentrations in relation with meteorological parameters in two size fractions (PM10 and PM2.5) and Air Qualiy Index and possible health effects on children's asthma.


Braden B.,University of Oxford | Dietrich C.F.,Caritas Hospital
World Journal of Gastroenterology | Year: 2014

In the last decades, the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions. Surgical procedures can be avoided in many cases by using endoscopically placed, Endoscopic ultrasonography-guided techniques and drainages. Endoscopic ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid collections. The development of selfexpanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid collections. This review will discuss available therapeutic techniques and new developments. © 2014 Baishideng Publishing Group Inc.


Hocke M.,Meiningen Hospital | Ignee A.,Caritas Hospital | Dietrich C.F.,Caritas Hospital
Endoscopy | Year: 2011

Autoimmune pancreatitis is a rare condition which can mimic pancreatic carcinoma. We report the cases of 10 patients with autoimmune pancreatitis investigated in two different centers using contrast-enhanced endosonography. In these patients, contrast-enhanced endosonography showed a unique vascularization pattern which makes it easy to discriminate between autoimmune pancreatitis and lesions caused by pancreatic cancer. Lesions caused by autoimmune pancreatitis and the surrounding pancreas typically showed hypervascularization, whereas lesions caused by pancreatic cancer were hypovascularized. This was true for all patients with the exception of one who showed a normal vascularization pattern in comparison with normal patients and no signs of hypovascularization. Final diagnosis was achieved either by transcutaneous biopsy or a combination of endoscopic fine-needle aspiration with IgG4 immunostaining of the sample. All patients were followed up over a period of at least 12 months to rule out pancreatic carcinoma. © Georg Thieme Verlag KG Stuttgart - New York.

Loading Caritas Hospital collaborators
Loading Caritas Hospital collaborators