Maschmeyer G.,Klinikum Ernst von Bergmann |
Heinz W.J.,Universitatsklinikum Wurzburg |
Hertenstein B.,Klinikum Bremen Mitte |
Horst H.-A.,University of Kiel |
And 4 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2013
Empirical antifungal therapy is widely used in high-risk neutropenic hematology patients with fever persisting for more than 4 days. This clinical trial assessed whether immediate empirical therapy with voriconazole could lower the rates of invasive fungal infections (IFIs) compared with this approach. In a double-blind, placebo-controlled, multicenter study, patients with acute leukemia undergoing chemotherapy or allogeneic hematopoietic stem cell transplantation (HSCT) recipients were randomized to broad-spectrum antibacterial therapy plus voriconazole (immediate) or placebo (deferred) after the onset of neutropenic fever. If fever persisted for 96 h, patients were switched to open-label intravenous voriconazole; oral treatment was permitted after 96 h. The primary endpoint was the rate of proven/probable IFIs between Days 2 and 28 after fever onset in the modified intent-to-treat (mITT) complete-case population. One hundred and forty-seven patients were randomized to immediate (n = 81) or deferred (n = 66) voriconazole. In the mITT population, six patients in the immediate group and nine in the deferred group developed proven/probable IFI between Days 2 and 28 (p = 0.258). The safety profiles were similar in both groups. While immediate empirical therapy with voriconazole appears to be safe in febrile neutropenic high-risk patients, it was not associated with a significant reduction in IFIs compared with therapy deferred for 96 h after fever onset. © 2012 Springer-Verlag Berlin Heidelberg.
Johnson R.W.,9 Ridgeway Road |
Bouhassira D.,French Institute of Health and Medical Research |
Kassianos G.,61 Plough Lane |
Leplege A.,University Paris Diderot |
And 2 more authors.
BMC Medicine | Year: 2010
Background: The potentially serious nature of herpes zoster (HZ) and the long-term complication post-herpetic neuralgia (PHN) are often underestimated. One in four people will contract herpes zoster in their lifetime, with this risk rising markedly after the age of 50 years, and affecting one in two in elderly individuals. Pain is the predominant symptom in all phases of HZ disease, being reported by up to 90% of patients. In the acute phase, pain is usually moderate or severe, with patients ranking HZ pain as more intense than post-surgical or labour pains. Up to 20% of patients with HZ develop PHN, which is moderate-to-severe chronic pain persisting for months or years after the acute phase. We review the available data on the effect of HZ and PHN on patients' quality-of-life.Discussion: Findings show that HZ, and particularly PHN, have a major impact on patients' lives across all four health domains - physical, psychological, functional and social. There is a clear correlation between increasing severity of pain and greater interference with daily activities. Non-pain complications such as HZ ophthalmicus can increase the risk of permanent physical impairment. Some elderly individuals may experience a permanent loss of independence after an acute episode of HZ. Current challenges in the management of HZ and PHN are highlighted, including the difficulty in administering antiviral agents before pain becomes established and the limited efficacy of pain treatments in many patients. We discuss the clinical rationale for the HZ vaccine and evidence demonstrating that the vaccine reduces the burden of the disease. The Shingles Prevention Study, conducted among >38,000 people aged ≥60 years old, showed that the HZ vaccine significantly reduces the burden of illness and the incidence of both HZ and PHN. In the entire study population, zoster vaccination reduced the severity of interference of HZ and PHN with activities of daily living by two-thirds, as measured by two questionnaires specific to HZ.Summary: A vaccination scheme may positively impact the incidence and course of HZ disease, thereby improving patients' quality-of-life. © 2010 Johnson et al; licensee BioMed Central Ltd.
Teltzrow T.,Klinikum Ernst von Bergmann |
Arens A.,Kaiserswerther Diakonie Krankenhaus |
Schwipper V.,Fachklinik Hornheide
Facial Plastic Surgery | Year: 2011
Complex nasal defects in the distal regions of the nose are cosmetically difficult to repair. In 70 patients over a period of 10 years, defects of the nasal ala and the soft triangle, nasal tip, columella, and columellar-lobular junction were reconstructed with modified auricular composite grafts. A randomized group of 40 of these patients was assessed after a mean of 55.5 months to evaluate the method's functional and cosmetic long-term results. The majority of the patients (60%, n=48) had been treated primarily for basal cell carcinoma. Of all defects, 57% (n=46) measured 2 to 3 cm in width and 43% (n=34) 1 to 2 cm. Seventy-five percent (n=60) of all defects were composite lesions involving skin, cartilage, and vestibular mucosa, in contrast to 25% (n=20) involving skin and cartilage with intact vestibular skin. Two crucial technical modifications seemed to have improved survival for larger grafts: first, the use of hinge flaps from the margins of the defect to obtain a well-vascularized recipient bed and optimization of the raw contact surface; second, postoperative gentle scarification of the graft in combination with a constantly applied heparin solution decongests venous stasis normally seen in such grafts. This maneuver establishes a stable and early blood supply enhancing graft take. With this type of treatment, 67 (84%) grafts healed well without further complications, whereas 13 (16%) grafts developed complications, resulting in partial (n=9) and total (n=4) necrosis of the transplant. Six of these patients underwent a secondary reconstruction using another auricular composite graft. Long-term results of this method have turned out to be very satisfying in terms of functional and cosmetic outcome and patient acceptance. Copyright © 2011 by Thieme Medical Publishers, Inc.
Thuss-Patience P.C.,Charité - Medical University of Berlin |
Kretzschmar A.,Klinikum St Georg GGmbH |
Dogan Y.,Charité - Medical University of Berlin |
Rothmann F.,Klinikum Ernst von Bergmann |
And 7 more authors.
British Journal of Cancer | Year: 2011
Background: No comparisons of different doses of docetaxel-capecitabine in patients with advanced gastric cancer have been performed. Methods: Patients with previously untreated metastatic/locally advanced gastro-oesophageal or gastric adenocarcinoma were enrolled in a prospective multicentre phase II trial. Two sequential cohorts received docetaxel 75 mg m2 (day 1) plus capecitabine 1000 mg m2 twice daily (days 1-14) (cohort I) or docetaxel 60 mg m2 (day 1) plus capecitabine 800 mg m2 twice daily (days 1-14) (cohort II) every 3 weeks. The primary end point was confirmed overall response rate. Results: In all, 91 patients were enrolled (cohort I, n=40; cohort II, n=51) and 87 were evaluable for efficacy (n=38, 49, respectively). Overall response rate was 50.0% in cohort I and 23.5% in cohort II (exploratory analysis, P=0.014). Median times to tumour progression and overall survival were 5.6 and 10.1 months in cohort I and 3.7 and 7.2 months in cohort II, respectively. Dose reductions for docetaxel and capecitabine were required in 50.0% and 57.5% of patients in cohort I and 11.8% and 15.7% in cohort II, respectively. Conclusion: Starting treatment with full doses and reducing promptly seems to be the more promisingly effective strategy than starting cautiously with lower doses. Docetaxel/capecitabine 75/2000 mg m 2 is a manageable, convenient outpatient combination with promising efficacy against advanced gastric cancer. © 2011 Cancer Research UK.
Kleber F.X.,Charité - Medical University of Berlin |
Schulz A.,Charité - Medical University of Berlin |
Bonaventura K.,Klinikum Ernst von Bergmann |
Fengler A.,Klinikum Ernst von Bergmann
EuroIntervention | Year: 2013
Aims: Coronary artery aneurysms (CAA) are a rare complication after percutaneous coronary intervention (PCI) and are reported with an incidence of 0.6% to 3.9%. While in recent years the use of paclitaxel drugcoated balloons (DCB) has increased, so far no CAA formation after DCB intervention has been reported. Methods and results: During the years 2010 and 2011 we used DCBs in 704 PCIs. Follow-up angiography was scheduled at four months in all patients and has so far been achieved in 380 PCIs. In three patients we found development of a CAA at the former PCI site within four months of observation. Aneurysm length varied between 8.4 mm and 13 mm and lumina increased 58% to 131%. Retrospectively all patients with CAA development showed small intimal dissection partially with tiny persisting contrast bands parallel to the lumen according to type B and type C of the NHLBI classification after PCI. Conclusions: CAA formation after DCB intervention was found in three out of 380 PCIs with DCB, consistent with an incidence of 0.8%. Thus, PCI with DCB does not cause an unexpectedly high rate of coronary artery aneurysms. © Europa Digital & Publishing 2013. All rights reserved.
Sandherr M.,Hematology and Oncology Specialized Practice |
Maschmeyer G.,Klinikum Ernst Von Bergmann
European Journal of Medical Research | Year: 2011
Invasive fungal infections, predominantly aspergillosis and candidiasis, are among the most important causes of morbidity and mortality in immunocompromised patients. Primarily, patients with acute leukemia undergoing myelosuppressive chemotherapy and allogeneic stem cell transplant recipients are affected. Up to 60% of patients with invasive aspergillosis, the most common invasive mycosis among patients with hematologic malignancies, may still die of their infection, once it has become clinically overt. The spectrum of antifungal agents for clinical use now has expanded over the past ten years and includes the novel class of the echinocandins and two newer generation triazoles with an extended spectrum of activity against a wide range of fungal pathogens. This review will address pharmacological characteristics of the two broad-spectrum antifungal azoles, voriconazole and Posaconazole, which are important for their proper use in clinical practice. © I. Holzapfel Publishers 2011.
Schulze K.,Klinikum Ernst Von Bergmann
Sarcoidosis Vasculitis and Diffuse Lung Diseases | Year: 2013
Idiopathic pulmonary fibrosis (IPF) is an untreatable diffuse parenchymal lung disease with a median survival of approximately three years. Pulmonary hypertension (PH) is frequently seen in patients with IPF and is commonly attributed to hypoxic vasoconstriction and capillary destruction. Pathology findings include endothelial proliferation and medial hypertrophy that exceed those expected in the setting of hypoxia. Non-invasive evaluation has limited sensitivity and specificity for the diagnosis of PH in IPF; therefore, right-heart catheterisation remains the 'gold standard' diagnostic test. PH in patients with IPF is associated with decreased exercise capacity and worse survival. Given the grave consequences of this condition, treatment of PH could improve functional outcomes and survival. However, possible treatments such as long-term supplemental oxygen and targeted vascular therapy are either unstudied or remain unproven. © Mattioli 1885
Oppert M.,Klinikum Ernst von Bergmann
Minerva Urologica e Nefrologica | Year: 2016
Acute kidney injury (AKI) is a frequent finding in patients with critical illness. In many of these patients renal replacement therapy (RRT) is needed to support organ dysfunction. Although international guidelines on the management of AKI have been developed and are widely accepted, there is still considerable controversy on the optimal timing of RRT. The clinician is in a constant dilemma that level of evidence (on timing of acute RRT) is low and the issue is of high importance. Despite this paucity of high quality prospective data, this review will give the reader an idea on how to approach the difficult question of initiating RRT. Obviously, no general recommendation can be given covering every aspect of intensive care medicine. Therefore, general thoughts are displayed, followed by a focus on specific clinical situations. The role of "novel" biomarkers in the process of deciding when to start is also discussed. Copyright © 2016 Edizioni Minerva Medica.
Maschmeyer G.,Klinikum Ernst von Bergmann |
Rolston K.V.I.,University of Texas M. D. Anderson Cancer Center
Infections in Hematology | Year: 2015
Infections are among the most frequent complications in patients with hematological malignancies and in those undergoing high-dose chemotherapy and autologous hematopoietic stem cell transplantation. A profound knowledge on the epidemiology, diagnostic approaches, treatment modalities and prophylactic strategies is essential for the clinical management of these complications in patients who are often severely immunocompromised owing to their underlying diseases and in particular, the intensive myelosuppressive chemo and immunotherapy. This textbook provides a clinically oriented, compact and up-to-date overview on infections in hematology patients and their management. The typical pathogens to be considered in different subgroups of patients are identified and further aspects of the microbiological background are explored. Clinical, imaging, and laboratory-based diagnostic techniques are discussed and therapeutic strategies appropriate to different situations are then presented, with due attention to the pitfalls, toxicities and interactions that can arise during antimicrobial treatment. Strategies to prevent infection are also outlined, encompassing antimicrobial prophylaxis, isolation procedures, hospital hygiene, protective immunization and the use of hematopoietic growth factors. © Springer-Verlag Berlin Heidelberg 2015.
Liu C.,Hannover Medical School |
Liu C.,Huazhong University of Science and Technology |
Toma I.C.,Klinikum Ernst von Bergmann |
Mastrogiacomo M.,Instituto Nazionale per la Ricerca sul Cancro |
And 3 more authors.
Archives of Orthopaedic and Trauma Surgery | Year: 2013
Injuries of the meniscus remain a burden for the development of premature cartilage degeneration and osteoarthritis. This review surveys all treatment options and focuses on the recent development of tissue engineering. Tissue engineering of the meniscus means a successful combination of cells, scaffolds and specific stimuli. Each element of the combination can be subject to variation. Studies investigating the optimum meniscus implant and previous steps in producing these implants are presented in this article. A comprehensive search of the English and German literature was performed in PubMed to retrieve appropriate manuscripts for review. Based on the literatures, autografts and allografts can delay the progress of osteoarthritis for a restricted time period, but several concerns persist. The biomechanical properties of the native meniscus are not copied entirely by the current existing autografts. Congruence, fixation, biocompatibility and potential infection will always remain as limitations for the users of allografts. Long-term results are still not available for meniscus prosthesis and even though it permits fast recovery, several aspects are questionable: bioincompatibility and a lack of cellular adhesion are likely to compromise their long-term fate. Currently, there is no ideal implant generated by means of tissue engineering. However, meniscus tissue engineering is a fast developing field, which promises to develop an implant that mimics histological and biomechanical properties of the native meniscus. At present several cell sources and scaffolds have been used successfully to grow 3-dimensional constructs. In future, optimal implants have to be developed using growth factors, modified scaffolds and stimuli that support cellular proliferation and differentiation to regenerate the native meniscus more closely. © 2012 Springer-Verlag Berlin Heidelberg.