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Augsburg, Germany

Klingenstein A.,Ludwig Maximilians University of Munich | Haug A.R.,Ludwig Maximilians University of Munich | Zech C.J.,Ludwig Maximilians University of Munich | Schaller U.C.,Klinikum Augsburg
CardioVascular and Interventional Radiology | Year: 2013

Purpose: To retrospectively evaluate the overall survival, safety, and efficacy of metastatic uveal melanoma patients after radioembolization as salvage therapy. Materials and Methods: Thirteen patients were treated with radioembolization of branches of the hepatic artery with resin-based yttrium-90 (90Y)-labelled microspheres. Twelve patients underwent a single application, and 1 patient underwent 4 interventions. Dosages from 644 to 2,450 MBq (mean activity 1,780) were applied. Treatment response was evaluated by way of liver magnetic resonance imaging and computed tomography (CT) as well as whole-body fluorodeoxyglucose positron emission tomography (PET)/CT with evaluation of percentage changes in SUVmax before and at 2-3 months after therapy. Kaplan-Meier analysis was calculated to determine overall survival. Results: Partial remission (PR) was observed in 8 (62 %), stable disease (SD) in 2 (15 %), and progressive disease (PD) in 3 (23 %) patients under terms of standard criteria and PR in 3 (23 %), SD in 3 (23 %), and PD in 7 (54 %) patients according to PET criteria. Neither RECIST nor PET criteria showed a significant difference in predicting overall survival (P = 0.12 and 0.11, respectively). Median survival time after radioembolization was 7 months. No acute toxicity with in-hospital morbidity was observed. One patient developed hepatomegaly, and 1 patient developed gastric ulceration. Throughout follow-up, progression of extrahepatic metastases was observed. Conclusion: Radioembolization may be a promising therapy in uveal melanoma patients with predominant hepatic metastases. At first follow-up, we observed PR or SD in 77 % patients under terms of standard criteria with an acceptable toxicity profile. © 2012 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

Messmann H.,Klinikum Augsburg
Recent Results in Cancer Research | Year: 2014

Endoscopic treatment of malignant lesions in the gastrointestinal tract can be treated curatively if the risk for lymph node metastasis is lower than 1%. In the lower gi-tract (colon and rectum) the low risk criteria for this situaiton are well-defined (G1/G2, LO, invasion depth ≤1000μm). However, en-bloc R0-resection is also mandatory. Benign lesions such as lateral spreading tumors (granular-type) can be also treated with piecemeal EMR, however, recurrence rate is up to 30%. All other cases, regardless of size, such as non-granular type lesions or mixed type lesions should be treated with endoscopic submucosal dissection. The definitive histopathology of the resected specimen allows further decision (e.g., surgery if invasion depth of tumor is >1000μm). © 2014 Springer International Publishing Switzerland.

Behme D.,University of Gottingen | Berlis A.,Klinikum Augsburg | Weber W.,Ruhr University Bochum
American Journal of Neuroradiology | Year: 2015

BACKGROUND AND PURPOSE: The safety and efficacy of the Woven EndoBridge (WEB) device for the treatment of cerebral aneurysms have been investigated in several studies. Most of these studies focused on specific aneurysms or a certain WEB device. Our objective was to report the experience of 2 German centers with the WEB device, including technical feasibility, safety, and short-term angiographic outcome. MATERIALS AND METHODS: We performed a retrospective study of all ruptured and unruptured aneurysms that were treated with a WEB device (WEB Double-Layer, Single-Layer, and Single-Layer Sphere) between April 2012 and August 2014. Primary outcome measures included the feasibility of the implantation and the angiographic outcome at 3-month follow-up. Secondary outcome measures included the clinical outcome at discharge and procedural complications. RESULTS: Fifty-five aneurysms in 52 patients, including 14 ruptured aneurysms, underwent treatment with the WEB device. The median age of patients was 55 years (range, 30 -75 years); 19/55 (37%) were men. The device could be deployed in all patients and was implanted in 51/55 (93%) cases. Procedural complications occurred in 6/51 (12%), comprising 2 thromboembolic events, 2 thrombus formations, 1 high-grade posterior cerebral artery stenosis, and 1 aneurysm rupture. None of these had clinical sequelae. Angiographic follow-up at 3 months was available for 44/51 (86%) aneurysms. A favorable angiographic result at 3 months was achieved in 29/44 (66%) cases, whereas the percentage of good anatomic results increased from 40% in 2012 to 75% in 2014. CONCLUSIONS: The WEB device proved to be safe. Acceptable occlusion rates can be achieved but seem to require wide experience with the device.

Bayas A.,Klinikum Augsburg | Maurer M.,Caritas Krankenhaus Bad Mergentheim
Patient Preference and Adherence | Year: 2015

Multiple sclerosis (MS), a chronic demyelinating neuroinflammatory disease of the central nervous system, is the most common neurological disorder leading to disability in young adulthood. In the last 2 decades, numerous treatments for relapsing–remitting MS have been approved with eleven treatment options available worldwide. One of the determinants in treatment selection is disease activity in the individual patient. However, patient preferences play an increasingly major role in treatment decision making. With teriflunomide, a reversible inhibitor of the enzyme dihydroorotate dehydrogenase, a new oral therapeutic option, given once daily, has been approved within the last 2 years by the regulatory agencies. The current review focuses on characteristics of the drug relevant for patients’ preferences in the treatment decision process in the light of the available medications. Perceiving and considering patients’ preferences will have an effect on treatment adherence, which is known to be often low in MS patients. Teriflunomide-related adherence issues will also be discussed regarding mode of application, dosing, and potential side effects. © 2015 Bayas and Mäurer.

Naumann M.,Klinikum Augsburg | Boo L.M.,DuPont Company | Ackerman A.H.,DuPont Company | Gallagher C.J.,DuPont Company
Journal of Neural Transmission | Year: 2013

Botulinum neurotoxins are formulated biologic pharmaceuticals used therapeutically to treat a wide variety of chronic conditions, with varying governmental approvals by country. Some of these disorders include cervical dystonia, post-stroke spasticity, blepharospasm, migraine, and hyperhidrosis. Botulinum neurotoxins also have varying governmental approvals for cosmetic applications. As botulinum neurotoxin therapy is often continued over many years, some patients may develop detectable antibodies that may or may not affect their biological activity. Although botulinum neurotoxins are considered "lower risk" biologics since antibodies that may develop are not likely to cross react with endogenous proteins, it is possible that patients may lose their therapeutic response. Various factors impact the immunogenicity of botulinum neurotoxins, including product-related factors such as the manufacturing process, the antigenic protein load, and the presence of accessory proteins, as well as treatment-related factors such as the overall toxin dose, booster injections, and prior vaccination or exposure. Detection of antibodies by laboratory tests does not necessarily predict the clinical success or failure of treatment. Overall, botulinum neurotoxin type A products exhibit low clinically detectable levels of antibodies when compared with other approved biologic products. This review provides an overview of all current botulinum neurotoxin products available commercially, with respect to the development of neutralizing antibodies and clinical response. © 2012 The Author(s).

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