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Burgstaller S.,Klinikum Wels Grieskirchen
Memo - Magazine of European Medical Oncology | Year: 2013

Chronic myelomonocytic leukaemia (CMML) is a clonal disorder of the haematopoietic stem cell characterised by the presence of an absolute monocytosis in peripheral blood. The disease carries myelodysplastic and myeloproliferative features. This dilemma was sought to be overcome by the World Health Organization (WHO) in 2001, when CMML was classified within a new category of myelodysplastic syndromes/myeloproliferative neoplasms (MDS/MPN). The identification of molecular markers in patients with CMML has dramatically increased over the past couple of years. However, the impact on prognosis and therapeutic interventions needs to be defined. Testing of new agents in the setting of CMML proves to be difficult due to limited number of patients. This review has a focus on current diagnosis including new molecular data and treatment of CMML. © 2012 Springer-Verlag Wien.

Trieb K.,Klinikum Wels Grieskirchen | Sulzbacher I.,Vienna University Hospital | Kubista B.,Vienna University Hospital
Oncology Letters | Year: 2013

bcl-2 is a member of the bcl-2 family that inhibits apoptosis, plays a crucial role in cell viability and is expressed in various types of tumors. With respect to inconsistent results in previous studies, the aim of the present study was to generate a clear hypothesis with regards to the value of bcl-2 expression as a predictive or prognostic factor in human osteosarcoma. The expression of bcl-2 was examined immunohistochemically in 49 patients with high-grade osteosarcoma and the results were correlated with localization, histological response to chemotherapy, survival and the occurrence of metastases. In patients with osteosarcoma, 21/49 cases (43%) were positive for bcl-2 expression and the remaining cases were negative. A significantly higher expression of bcl-2 was observed in central tumors located in the pelvis (83 vs. 37% positive; P<0.05). The bcl-2 expression status revealed no statistically significant correlation with response to chemotherapy, with 57% of patients with bcl-2-positive tumors showing a good response and 43% showing a poor response. No significant difference was observed when comparing survival or occurrence in bcl-2-positive and -negative tumors. In conclusion, the results of the present study indicate that, despite higher bcl-2 expression in central osteosarcoma, the expression in high-grade osteosarcoma is not a reliable prognostic or predictive marker.

Hametner B.,AIT Austrian Institute of Technology | Hametner B.,Imperial College London | Wassertheurer S.,AIT Austrian Institute of Technology | Wassertheurer S.,Vienna University of Technology | And 4 more authors.
International Journal of Cardiology | Year: 2014

Background Analysis of the arterial pressure curve plays an increasing role in cardiovascular risk stratification. Measures of wave reflection and aortic stiffness have been identified as independent predictors of risk. Their determination is usually based on wave propagation models of the circulation. Another modeling approach relies on modified Windkessel models, where pressure curves can be divided into reservoir and excess pressure. Little is known of their prognostic value. Methods and results The aim of this study is to evaluate the predictive value of parameters gained from reservoir theory applied to aortic pressure curves in a cohort of high-risk patients. Furthermore the relation of these parameters to those from wave separation analysis is investigated. Central pressure curves from 674 patients with preserved ejection fraction, measured by radial tonometry and a validated transfer function, were analyzed. A high correlation between the amplitudes of backward traveling pressure waves and reservoir pressures was found (R = 0.97). Various parameters calculated from the reservoir and excess pressure waveforms predicted cardiovascular events in univariate Cox proportional hazards modeling. In a multivariate model including several other risk factors such as brachial blood pressure, the amplitude of reservoir pressure remained a significant predictor (HR = 1.37 per SD, p = 0.016). Conclusions Based on very different models, parameters from reservoir theory and wave separation analysis are closely related and can predict cardiovascular events to a similar extent. Although Windkessel models cannot describe all of the physiological properties of the arterial system, they can be useful to analyze its behavior and to predict cardiovascular events. © 2013 Elsevier Ireland Ltd.

Hametner B.,AIT Austrian Institute of Technology | Hametner B.,Vienna University of Technology | Wassertheurer S.,AIT Austrian Institute of Technology | Wassertheurer S.,Vienna University of Technology | And 4 more authors.
Blood Pressure Monitoring | Year: 2013

Objectives: Recently, a novel method to estimate aortic pulse wave velocity (aPWV) noninvasively from an oscillometric single brachial cuff waveform reading has been introduced. We investigated whether this new approach provides acceptable estimates of aPWV compared with intra-aortic catheter measurements. Methods: Estimated values of aPWV obtained from brachial cuff readings were compared with those obtained using an intra-aortic catheter in 120 patients (mean age 61.8±10.8 years) suspected for coronary artery disease undergoing cardiac catheterization. Differences between aPWV values obtained from the test device and those obtained from catheter measurements were estimated using Bland-Altman analysis. Results: The mean difference±SD between brachial cuff-derived values and intra-aortic values was 0.43±1.24 m/s. Comparison of aPWV measured by the two methods showed a significant linear correlation (Pearson's R=0.81, P<0.0001). The mean difference for repeated oscillometric measurements of aPWV was 0.05 m/s, with 95% confidence interval limits from-0.47 to 0.57 m/s. Conclusion: aPWV can be obtained using an oscillometric device with brachial cuffs with acceptable accuracy compared with intra-aortic readings. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins.

Trieb K.,Klinikum Wels Grieskirchen | Hofstaetter S.G.,Klinikum Wels Grieskirchen | Panotopoulos J.,University of Vienna | Wanivenhaus A.,University of Vienna
International Orthopaedics | Year: 2013

Purpose: In rheumatoid arthritis the metatarsophalangeal (MTP) joints are predominantly affected with resultant metatarsalgia and dislocation. Therapy options include many different surgical procedures with results that are not always satisfying. We present the oblique Weil metatarsal osteotomy as a treatment option for the rheumatic forefoot. Methods: A total of 216 osteotomies in 63 consecutive patients (72 feet) with a mean age at the time of surgery of 59.3 years and long-standing rheumatoid arthritis were observed prospectively for an average of 57.4 months (minimum 36 months). All patients received a Weil osteotomy of the lesser metatarsals with at least one additional procedure of the forefoot. Patients were evaluated prospectively for clinical outcome by the American Orthopaedic Foot and Ankle Society (AOFAS) lesser MTP-interphalangeal scale and subjective satisfaction. In the radiological evaluation weight-bearing X-rays were analysed for alignment, shortening and union. Results: American Orthopaedic Foot and Ankle Society score increased significantly from 21.9 ± 6.7 to 63.3 ± 9.8 (p < 0.05). The increase was significant for all subgroups regarding pain, function and alignment. All joints were dorsally dislocated preoperatively; a subluxation was present in 13.6 % at follow-up. There was a significant decrease of callositas in 82 %, a decrease in need for orthopaedic shoes in 61 %, a decrease of MTP joint stiffness in 96 % and a relief of severe pain in 97 % of all patients. No metatarsal head dislocation or necrosis, pseudoarthrosis or screw perforation was observed. Of 63 patients, 55 (88 %) subjectively reported excellent or good results. Conclusions: We conclude that the Weil procedure for lesser metatarsals is a satisfactory method for correcting the rheumatic forefoot and can be recommended as an approach for the future. © 2013 Springer-Verlag Berlin Heidelberg.

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