Clinic for Internal Medicine

Koblenz, Germany

Clinic for Internal Medicine

Koblenz, Germany
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Girschikofsky M.,Elisabethinen Hospital | Arico M.,Azienda Ospedaliero Universitaria A. Meyer | Castillo D.,Hospital Of La Santa Creu I Sant Pau | Chu A.,Imperial College London | And 12 more authors.
Orphanet Journal of Rare Diseases | Year: 2013

Langerhans Cell Histiocytosis (LCH) is an orphan disease of clonal dendritic cells which may affect any organ of the body. Most of the knowledge about the diagnosis and therapy is based on pedriatic studies. Adult LCH patients are often evaluated by physicians who focus on only the most obviously affected organ without sufficient evaluation of other systems, resulting in patients being underdiagnosed and/or incompletely staged. Furthermore they may be treated with pediatric-based therapies which are less effective and sometimes more toxic for adults. The published literature on adult LCH cases lacks a comprehensive discussion on the differences between pediatric and adult patients and there are no recommendations for evaluation and comparative therapies. In order to fill this void, a number of experts in this field cooperated to develop the first recommendations for management of adult patients with LCH. Key questions were selected according to the clinical relevance focusing on diagnostic work up, therapy, and follow up. Based on the available literature up to December 2012, recommendations were established, drafts were commented by the entire group, and redrafted by the executive editor. The quality of evidence of the recommendations is predominantly attributed to the level of expert opinion. Final agreement was by consensus. © 2013 Girschikofsky et al.; licensee BioMed Central Ltd.

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, 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.

PubMed | Clinic for Internal Medicine, Kerckhoff Klinik and Royal Infirmary
Type: | Journal: Computers in biology and medicine | Year: 2015

This review summarizes several approaches for quantitative measurement in capsule endoscopy. Video capsule endoscopy (VCE) typically provides wireless imaging of small bowel. Currently, a variety of quantitative measurements are implemented in commercially available hardware/software. The majority is proprietary and hence undisclosed algorithms. Measurement of amount of luminal contamination allows calculating scores from whole VCE studies. Other scores express the severity of small bowel lesions in Crohns disease or the degree of villous atrophy in celiac disease. Image processing with numerous algorithms of textural and color feature extraction is further in the research focuses for automated image analysis. These tools aim to select single images with relevant lesions as blood, ulcers, polyps and tumors or to omit images showing only luminal contamination. Analysis of motility pattern, size measurement and determination of capsule localization are additional topics. Non-visual wireless capsules transmitting data acquired with specific sensors from the gastrointestinal (GI) tract are available for clinical routine. This includes pH measurement in the esophagus for the diagnosis of acid gastro-esophageal reflux. A wireless motility capsule provides GI motility analysis on the basis of pH, pressure, and temperature measurement. Electromagnetically tracking of another motility capsule allows visualization of motility. However, measurement of substances by GI capsules is of great interest but still at an early stage of development.

Egger M.,Clinic for Internal Medicine | Balmer F.,Clinic for Internal Medicine | Friedli-Wuthrich H.,Clinic for Internal Medicine | Muhlemann K.,University of Bern
Swiss Medical Weekly | Year: 2013

Principles: Unnecessary treatment of asymptomatic bacteriuria and overuse of urinary catheters in hospitals are of concern regarding antimicrobial resistance and patient safety, respectively. We investigated the effectiveness of a multifaceted intervention in reducing urinary catheter use and unnecessary prescription of antibiotics for asymptomatic bacteriuria in hospitalised patients in a clinic for internal medicine. METHODS: Data were collected retrospectively from all inpatients during a 3-month period both before and after a multifaceted intervention from the Clinic for Internal Medicine of our secondary care hospital. The intervention consisted of implementation of guidelines, establishment of a standard for urinary catheter management, introduction of restricted orders and a reminder of indwelling catheters, as well as lectures and internet-based learning focusing on asymptomatic bacteriuria. RESULTS: The incidence rate of urinary catheter days decreased significantly from 27 to 17 catheter days per 100 patient days (incidence rate ratio 0.61, 95% confidence interval 0.57-0.67). The incidence rate of unnecessary antibiotic treatment days for asymptomatic bacteriuria dropped significantly from 22 to 10 treatment days per 1,000 patient days (incidence rate ratio 0.46, 95% confidence interval 0.33-0.63). CONCLUSIONS: A multifaceted intervention was effective in reducing both urinary catheter days and inappropriate antibiotic use for asymptomatic bacteriuria.

Stucki A.,Clinic for Pneumology and Rehabilitation | Cottagnoud M.,Ziegler | Acosta F.,Ziegler | Egerman U.,Clinic for Internal Medicine | And 2 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2012

Objectives: In this study the efficacy of doripenem, a new broad-spectrum carbapenem, was tested against an Escherichia coli strain and a Klebsiella pneumoniae strain in an experimental animal model. The comparator was cefepime monotherapy. Methods: The rabbit meningitis model was used in this study and the penetration of doripenem through uninflamed and inflamed meninges was determined. Results: Doripenem, injected three times (75 mg/kg), led to serum peak levels around 100 mg/L and trough levels around 5 mg/L, resulting in a penetration rate of 14% through inflamed meninges and 7% through uninflamed meninges. Against K. pneumoniae, doripenem was slightly but not significantly more efficacious than cefepime over 8 h (5.40±1.37 log 10 cfu/mL versus 3.59±0.89 log 10 cfu/mL for cefepime). Also against the E. coli strain doripenem was slightly superior to the comparator (5.55±0.87 log 10 cfu/mL versus 3.80±1.10 log 10 cfu/mL for cefepime), although the difference was not significant. Conclusions: Doripenem is a potential monotherapy for the treatment of meningitis due to Gram-negative microorganisms. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Stucki A.,Clinic for Pneumology and Rehabilitation | Cottagnoud M.,Ziegler | Acosta F.,Ziegler | Egerman U.,Clinic for Internal Medicine | And 2 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2012

Ceftobiprole medocaril, a new cephalosporin, is highly active against a broad spectrum of Gram-positive and Gram-negative clinical pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant pneumococci. In this study, we tested ceftobiprole against various Gram-negative pathogens in a rabbit meningitis model and determined its penetration into the cerebrospinal fluid (CSF). In this animal model, ceftobiprole produced an antibacterial activity similar to that of cefepime against an Escherichia coli strain, a Klebsiella pneumoniae strain, and a β-lactamase-negative Haemophilus influenzae strain. Against a β-lactamase-positive H. influenzae strain, ceftobiprole was significantly superior. The penetration of ceftobiprole through inflamed meninges reached about 16% of serum levels compared to about 2% of serum levels through uninflamed meninges. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

Burkhalter F.,University of Basel | Sannon H.,Clinic for Internal Medicine | Mayr M.,University of Basel | Dickenmann M.,University of Basel | Ernst S.,Clinic for Internal Medicine
Swiss medical weekly | Year: 2014

BACKGROUND: In the Caribbean region chronic kidney disease (CKD) is an increasing challenge. High rates of non-communicable and infectious diseases and the rise in people suffering from diabetes and hypertension explain the observed and further expected increase of CKD. However, data about the magnitude of the problem are rare and in some countries such as Haiti completely lacking. The aim of our study was to generate data about the prevalence and risk factors for CKD in a rural region in Haiti.METHODS: In this prospective cross-sectional study, adult patients visiting the medical outpatient clinic of the Hôpital Albert Schweitzer (HAS) in Deschapelles Haiti were included. CKD was assessed by estimated glomerular filtration rate (eGFR) and measurement of proteinuria by dipstick test. Risk factors for CKD were assessed by clinical examinations and questionnaires.RESULTS: Overall 608 patients were screened for CKD, of whom 27% had CKD. CKD stages 1 to 2 were found in 15.3% and stages 3 to 5 in 11.7%. The prevalence of hypertension and diabetes mellitus was 49.2% and 36.3%, respectively. Risk factors independently associated with CKD were hypertension (p = 0.0002) and HIV infection (p = 0.019) and age >60 years (p = 0.0052), whereas diabetes mellitus was not independently associated (p = 0.72).CONCLUSION: Our data show a high prevalence of CKD and traditional risk factors, and their association with CKD in Haiti. These findings have now to be confirmed in other regions in longitudinal analyses as a basic step to build up screening and prevention programmes for CKD.

Baltes P.,Clinic for Internal Medicine | Kurniawan N.,Clinic for Internal Medicine | Keuchel M.,Clinic for Internal Medicine
Techniques in Gastrointestinal Endoscopy | Year: 2015

Small bowel tumors (SBTs) are rare. Their diagnosis by small bowel capsule endoscopy (SBCE) is usually made during the evaluation of obscure gastrointestinal tract bleeding or unexplained iron-deficiency anemia. SBCE has a good sensitivity for the detection of SBT. However, submucosal tumors, large or proximally located SBTs, have a higher risk of being missed by SBCE. SBCE should be considered in patients with complicated or refractory celiac sprue and those with advanced melanoma, as these patients are at risk for SBT. The retention rate of a video capsule in patients with SBT is slightly higher than in those with obscure gastrointestinal tract bleeding, but rarely causes obstruction and typically can be resolved during resection of the tumor. In patients with familial adenomatous polyposis and duodenal adenomas, SBCE is useful in detecting additional intestinal polyps, although a beneficial effect on clinical outcome has not yet been demonstrated. SBCE in the surveillance of Peutz-Jeghers syndrome is feasible and well tolerated, although MR enterography seems to have a higher accuracy. © 2015 Elsevier Inc.

Fritzsch J.,Clinic for Internal Medicine | Splettstoesser W.D.,University of Federal Defense Munich
Journal of Medical Microbiology | Year: 2010

This case of pneumonic tularaemia elucidates two aspects: it is believed to be the first documented case of bacteraemia caused by Francisella tularensis subsp. holarctica biovar II; furthermore, it illustrates the remission of septic pneumonic tularaemia without appropriate antiinfective therapy. A blood culture from a patient with community-acquired pneumonia was found to be positive for F. tularensis subsp. holarctica biovar II after 10 days of cultivation. Meanwhile, the patient had been treated with ceftriaxone, followed by sultamicillin and clindamycin. The patient continued suffering from fever of up to 40.7 °C and rising C-reactive protein (CRP) for 4 days before the fever and CRP declined. The isolated strain was later tested and found to be resistant to the antibiotics used. The present case underlines that F. tularensis subsp. holarctica infections may cause severe symptoms but mostly have a favourable outcome. © 2010 SGM.

PubMed | Clinic for Internal Medicine and University of Regensburg
Type: Journal Article | Journal: Biochimica et biophysica acta | Year: 2016

Lipoprotein X (Lp-X) is an abnormal lipoprotein that may typically be formed in intra- and extrahepatic cholestasis and potentially interfere with lipid analysis in the routine lab. To gain insight into lipid class and species composition, Lp-X, LDL and HDL from cholestatic and control serum samples were subjected to mass spectrometric analysis including phospholipids (PL), sphingolipids, free cholesterol (FC), cholesteryl esters (CE) and bile acids. Our analysis of Lp-X revealed a content of 46% FC, 49% PL with 34% phosphatidylcholine (PC) as main PL component. The lipid species pattern of Lp-X showed remarkable high fractions of mono-unsaturated species including PC 32:1 and PC 34:1 and phosphatidylethanolamine (PE) 32:1 and 34:1. LDL and HDL lipid composition in the same specimens strongly reflected the lipid composition of Lp-X with increased PC 32:1, PC 34:1, PE 32:1, PE 34:1 and FC accompanied by decreased CE compared to controls. Comparison of Lp-X and biliary lipid composition clearly indicates that Lp-X does not originate from a sole release of bile lipids. Moreover, these data present evidence for increased hepatic fatty acid and PL synthesis which may represent a reaction to high hepatic FC level observed during cholestasis.

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