Krefeld, Germany
Krefeld, Germany

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Terjung A.,Helios Klinikum Krefeld | Altgassen C.,Helios Klinikum Krefeld | Friedrich M.,Helios Klinikum Krefeld
European Journal of Gynaecological Oncology | Year: 2017

Background: Treatment of metastatic breast cancer experienced significant improvement in the past decades by introduction of highly effective therapies, but survival still remains poor. Nonetheless, in some patients, long-term survival can be achieved by sequent endocrine and chemotherapy treatment, although toxicity and resistance eventually occur, until no further suitable and approved therapies remain. If further therapy is needed, therapist may be forced to consider treatments which are promising but not approved, such as the alkylating agent treosulfan, which is approved for the treatment of ovarian cancer only. Thus, relevant clinical data on its use in human breast cancer are lacking. Case Report: The authors report the case of a 49-year-old woman with heavily pre-treated, metastatic breast cancer, who experienced complete remission of pulmonary and soft tissue metastases while under treatment with treosulfan. Treatment was generally well-tolerated. Conclusion: Treosulfan might be an effective and well-tolerated treatment even in heavily pre-treated patients with metastatic breast cancer. © 2017, S.O.G. Canada Inc. All rights reserved.


Blumenschein B.,Clinical Nutrition | Kalde S.,HELIOS Klinikum Krefeld | Heick V.,Agaplesion Diakoniekrankenhaus Rotenburg
Aktuelle Ernahrungsmedizin | Year: 2017

In Germany today there are neither basic scientific principles nor clinically adaptable recommendations for coding an adaquate nutrition intervention after identifying a disease-related malnutrition. Guidelines from national and international institutions in nutritional medicine recommend at least a screening for all clinical patients. Dietitians are able to support the identification of malnutrition and the associated nutrition intervention, which is requested in several guidelines. The knowledge about coding, the DRG-System in Germany, how to develop and argue a nutrition diagnosis, the nutrition intervention itself as well as the monitoring and evaluation of the treatment of malnutrition has become an integral part in nutritional medicine. Every member of a multiprofessional nutrition support team is suitable of indentifying malnutrition or malnutrition risk. Dietitians are frequently carrying out these respective assessments. Particularly due to their specialized qualifications in nutritional medicine and dietetics they build a bridge to other professions in the clinical setting between catering, pharmacy and hospital care, including the monitoring and education of the patients. The proportion of dietitians in nutrition support teams in German hospitals iss mall. The development and utilisation of a system identifying, encoding, managing and documenting disease-related malnutrition modern dietitians have the opportunity to create possibilities for adequate clinical ressources, to treat malnourished patients well and to reduce treatment costs. The present manual helps dietitians to manage an adaptable and consistent procedere in coding a disease-related malnutrition in hospital. © Georg Thieme Verlag KG Stuttgart.New York.


Buscher R.,University of Duisburg - Essen | Buscher A.K.,University of Duisburg - Essen | Weber S.,University of Duisburg - Essen | Mohr J.,HELIOS Klinikum Krefeld | And 3 more authors.
Pediatric Nephrology | Year: 2013

Autosomal recessive polycystic kidney disease (ARPKD), although less frequent than the dominant form, is a common, inherited ciliopathy of childhood that is caused by mutations in the PKHD1-gene on chromosome 6. The characteristic dilatation of the renal collecting ducts starts in utero and can present at any stage from infancy to adulthood. Renal insufficiency may already begin in utero and may lead to early abortion or oligohydramnios and lung hypoplasia in the newborn. However, there are also affected children who have no evidence of renal dysfunction in utero and who are born with normal renal function. Up to 30 % of patients die in the perinatal period, and those surviving the neonatal period reach end stage renal disease (ESRD) in infancy, early childhood or adolescence. In contrast, some affected patients have been diagnosed as adults with renal function ranging from normal to moderate renal insufficiency to ESRD. The clinical spectrum of ARPKD is broader than previously recognized. While bilateral renal enlargement with microcystic dilatation is the predominant clinical feature, arterial hypertension, intrahepatic biliary dysgenesis remain important manifestations that affect approximately 45 % of infants. All patients with ARPKD develop clinical findings of congenital hepatic fibrosis (CHF); however, non-obstructive dilation of the intrahepatic bile ducts in the liver (Caroli’s disease) is seen at the histological level in only a subset of patients. Cholangitis and variceal bleeding, sequelae of portal hypertension, are life-threatening complications that may occur more often in advanced cases of liver disease. In this review we focus on common and uncommon kidney-related and non-kidney-related phenotypes. Clinical management of ARPKD patients should include consideration of potential problems related to these manifestations. © 2013, IPNA.


Hoellen F.,University of Lübeck | Kelling K.,University of Lübeck | Dittmer C.,University of Lübeck | Diedrich K.,University of Lübeck | And 2 more authors.
Anticancer Research | Year: 2011

Prostaglandin metabolism plays a pivotal role in inflammatory processes and has also been demonstrated to have a role in carcinogenesis, tumor differentiation and tumor growth in breast cancer. Cyclooxygenase-2 (COX-2) is the key involved enzyme, as it triggers prostaglandin synthesis. We reviewed the current literature regarding the impact of prostaglandin metabolism on breast cancer and illustrated the current evidence of the COX-2 influence on breast cancer, delineating possible future prophylactic and therapeutic strategies.


Heilmaier C.,Stadtspital Triemli | Koester A.,Helios Klinikum Krefeld | Moysidis T.,Helios Klinikum Krefeld | Weishaupt D.,Stadtspital Triemli | Kroger K.,Helios Klinikum Krefeld
Vasa - Journal of Vascular Diseases | Year: 2014

Background: Multi-detector computed tomography (MDCT) is more and more used for evaluation and quantification of coronary artery calcification, but correlation between the degree of calcification and occurrence of clinical events is also known for other vascular beds such as the aorta. Purpose: To assess possible differences in amount and pattern of calcification in aneurysmatic and non-aneurysmatic abdominal aortas. Patients and methods: Thirty-four subjects displayed infra-renal abdominal aneurysm (AAA) and were compared to 33 patients with normal-sized aortas using MDCT. Quantitative and qualitative analysis was performed by two radiologists. Calcium scores were assessed for the whole abdominal aorta as well as separately for the supra- and infrarenal segments. Moreover, plaque patterns were evaluated and classified according to their thickness and size. Furthermore, calcium scores were correlated with a number of cardiovascular risk factors. Results: Total calcium scores were comparable in patients with and without AAA (1,213 ± 1,351 and 1,211 ± 1,535, respectively), but significant differences were found regarding plaque density that was considerably higher both in the supra- and infrarenal segments in the non-aneurysmatic group (AAA: suprarenal, 0.01, infrarenal, 0.07; non-AAA: suprarenal, 0.06, infrarenal, 0.16). Plaque pattern were considerably different in the infrarenal segments in aneurysmatic aortas: they were thinner (1 and 2 mm) and smaller (< 100 mm2) than in normal-sized aortas (mainly > 3mm and > 100 mm2). Distribution of risk factors was similar in both groups with the highest mean calcium score being present in patients with 4 risk factors. Pearson's correlation coefficient indicating correlation between total calcium score and number of risk factors was almost the same in both groups: AAA, r = 0.67; non-AAA, r = 0.65. Conclusions: Compared to normal-sized aortas thinner and smaller plaques are present in AAA, which may be due to degenerative processes. © 2014 Hans Huber Publishers, Hogrefe AG, Bern.


Niehues T.,HELIOS Klinikum Krefeld
Nature Reviews Rheumatology | Year: 2015

Treatment of children with cancer, in particular with acute lymphoblastic leukaemia (ALL), has been highly successful in the past two decades owing to the implementation of treatment optimization studies. Study centres appointed by scientific societies design treatment optimization study protocols (TOSPs) that address an investigator-initiated research question and detail treatment procedures according to these aims. Nearly all children with malignant diseases are treated within TOSPs, whereas children with juvenile idiopathic arthritis (JIA) and other common paediatric rheumatic diseases are mostly treated outside TOSPs and clinical trials. Despite the differences in natural course and prognosis between malignant and inflammatory diseases, aiming for the recruitment of all children with defined rheumatic diseases into TOSPs or similar protocols would enable the longitudinal collection of crucial clinical data and improve evidence-based approaches. Successful research networks already exist in paediatric rheumatology that could facilitate the implementation of this approach. Paediatric rheumatic diseases have a considerable impact on patients and their families; thus, I propose that research networks in paediatric rheumatology should recruit most - if not all - children with rheumatic diseases into study protocols with standardized treatment and outcome measures. © 2015 Macmillan Publishers Limited. All rights reserved.


Mamopoulos A.,HELIOS Klinikum Krefeld | Luther B.,HELIOS Klinikum Krefeld
Annals of Vascular Surgery | Year: 2015

Congenital dysplastic aortic syndromes range from coarctation at the aortic isthmus to more extended aortic disease (midaortic syndrome). The latter is usually restricted to dysplastic aortic segments of up to 15 cm. Long segment dysplasia of the entire abdominal or thoracic aorta is extremely rare. This case of a 30-year-old patient with a very long segment congenital thoracoabdominal aortic coarctation and infrarenal aortobi-iliac and cavobi-iliac aplasia represents to our knowledge the most extended congenital vascular malformation in a surviving adult patient. The developed extensive collateral pathways ensured the survival of the patient, so that the main clinical manifestation was a refractory hypertension. Because of the extent of the disease, open surgery represented the only viable option. Interestingly, after 30 years of uncontrollable hypertension, the patient's blood pressure promptly responded to surgical treatment. A concomitant infrarenal aplasia of both the aorta and cava vein is also very unusual and points to a major developmental deficit during vascular embryogenesis. © 2015 Elsevier Inc. All rights reserved.


Mamopoulos A.,HELIOS Klinikum Krefeld | Luther B.,HELIOS Klinikum Krefeld
Annals of vascular surgery | Year: 2015

Congenital dysplastic aortic syndromes range from coarctation at the aortic isthmus to more extended aortic disease (midaortic syndrome). The latter is usually restricted to dysplastic aortic segments of up to 15 cm. Long segment dysplasia of the entire abdominal or thoracic aorta is extremely rare. This case of a 30-year-old patient with a very long segment congenital thoracoabdominal aortic coarctation and infrarenal aortobi-iliac and cavobi-iliac aplasia represents to our knowledge the most extended congenital vascular malformation in a surviving adult patient. The developed extensive collateral pathways ensured the survival of the patient, so that the main clinical manifestation was a refractory hypertension. Because of the extent of the disease, open surgery represented the only viable option. Interestingly, after 30 years of uncontrollable hypertension, the patient's blood pressure promptly responded to surgical treatment. A concomitant infrarenal aplasia of both the aorta and cava vein is also very unusual and points to a major developmental deficit during vascular embryogenesis. Copyright © 2015 Elsevier Inc. All rights reserved.


Mamopoulos A.T.,HELIOS Klinikum Krefeld | Nowak T.,HELIOS Klinikum Krefeld | Luther B.,HELIOS Klinikum Krefeld
Journal of Vascular Surgery | Year: 2013

Retrograde ascending aortic dissections usually complicate endovascular reconstructions of Stanford B dissections. Although rare, with an incidence of 1.3% to 6.8%, they are catastrophic, with a high mortality rate of up to 42%. The exact mechanism is not known, but all indications point to a mechanical interaction between the tips of the proximal bare stent and a fragile aortic wall. Practically all reported cases involve dissections of the thoracic aorta. We report a patient with an asymptomatic retrograde ascending aortic dissection that originated at the level of a damaged suprarenal stent during capture tip retrieval during a routine endovascular aneurysm repair to treat an infrarenal aortic aneurysm. © 2013 by the Society for Vascular Surgery.


A right-sided aortic arch is a rare anomaly with an incidence of 0.1% worldwide and is usually associated with a mirror image of all supra-aortic branches or an aberrant left subclavian artery. The latter is often associated with a Kommerell diverticulum, although it can rarely be hypoplastic or atretic and lead to congenital subclavian steal. In most patients, the situation is well-tolerated. In this report, we present a case of subclavian steal syndrome with multiple cerebellar infarcts in a patient with an atypical right-sided aortic arch and an atretic aberrant left subclavian artery arising from a left-sided descending thoracic aorta. Copyright © 2014 by the Society for Vascular Surgery.

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