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Hellenkamp K.,University of Gottingen | Darius H.,Angiology and Intensive Care Medicine | Giannitsis E.,University of Heidelberg | Erbel R.,University of Duisburg - Essen | And 9 more authors.
International Journal of Cardiology | Year: 2015

Background While dyspnea is a common symptom in patients admitted to Chest Pain Units (CPUs) little is known about the impact of dyspnea on their outcome. The purpose of this study was to evaluate the impact of dyspnea on the short-term outcome of CPU patients. Methods We analyzed data from a total of 9169 patients admitted to one of the 38 participating CPUs in this registry between December 2008 and January 2013. Only patients who underwent coronary angiography for suspected ACS were included. 2601 patients (28.4%) presented with dyspnea. Results Patients with dyspnea at admission were older and frequently had a wide range of comorbidities compared to patients without dyspnea. Heart failure symptoms in particular were more common in patients with dyspnea (21.0% vs. 5.3%, p < 0.05) at admission. Importantly, in patients presenting with dyspnea the 3 month mortality was fourfold higher compared to patients without dyspnea (8.6% vs. 2.1%, p < 0.05, OR death: 4.40 95% CI 3.14-6.03). Interestingly, the mortality estimated from the GRACE risk score was below the actual mortality assessed after the 3 month follow-up. After adjustment for the GRACE risk score or for heart failure, dyspnea remained highly predictive of death and myocardial infarction within 3 months (OR death adjusted for heart failure: 2.99 95% CI 1.99-4.47 and OR death adjusted for GRACE risk score: 3.37 95% CI 2.27-4.99). Conclusion Dyspnea is a common symptom in CPU patients. Our data show that dyspnea is associated with a fourfold higher 3 month mortality which is underestimated by the established ACS risk scores. To improve their predictive value we therefore propose to add dyspnea as an item to common risk scores. © 2014 Elsevier Ireland Ltd. All rights reserved.

Lopez C.L.,University of Marburg | Falconi M.,University of Verona | Waldmann J.,University of Marburg | Boninsegna L.,University of Verona | And 6 more authors.
Annals of Surgery | Year: 2013

OBJECTIVE: To evaluate the outcome of pancreaticoduodenectomy (PD) versus non-PD resections for the treatment of gastrinoma in multiple endocrine neoplasia type 1. BACKGROUND: Gastrinoma in MEN1 is considered a rarely curable disease and its management is highly controversial both for timing and extent of surgery. METHODS: Clinical characteristics, complications and outcomes of 27 prospectively collected MEN1 patients with biochemically proven gastrinoma, who underwent surgery, were analyzed with special regard to the gastrinoma type and the initial operative procedure. RESULTS: Twenty-two (81%) patients with gastrinoma in MEN1 had duodenal gastrinomas and 5 patients (19%) had pancreatic gastrinomas. At the time of diagnosis, 21 (77%) gastrinomas were malignant (18 duodenal, 3 pancreatic), but distant metastases were only present in 4 (15%) patients. Patients with pancreatic gastrinomas underwent either distal pancreatic resections or gastrinoma enucleation with lymphadenectomy, 2 patients also had synchronous resections of liver metastases. One of these patients was biochemically cured after a median of 136 (77-312) months. Thirteen patients with duodenal gastrinomas underwent PD resections (group 1, partial PD [n = 11], total PD [n = 2]), whereas 9 patients had no-PD resections (group 2) as initial operative procedure. Perioperative morbidity and mortality, including postoperative diabetes, differed not significantly between groups (P > 0.5). All patients of group 1 and 5 of 9 (55%) patients of group 2 had a negative secretin test at hospital discharge. However, after a median follow-up of 136 (3-276) months, 12 (92%) patients of group 1 were still normogastrinemic compared to only 3 of 9 (33%) patients of group 2 (P = 0.023). Three (33%) patients of group 2 had to undergo up to 3 reoperations for recurrent or metastatic disease compared to none of group 1. CONCLUSIONS: Duodenal gastrinoma in MEN1 should be considered a surgically curable disease. PD seems to be the adequate approach to this disease, providing a high cure rate and acceptable morbidity compared to non-PD resections. Copyright © 2013 by Lippincott Williams & Wilkins.

Barski D.,Lukas Hospital Neuss | Ezziddin S.,University of Bonn | Heikaus S.,Heinrich Heine University Dusseldorf | Neumann H.P.H.,Albert Ludwigs University of Freiburg
Central European Journal of Urology | Year: 2014

This case describes a 50-yr-old man who was admitted to the Urology Ward upon the suspicion of a left kidney tumor. As part of the pre-operative check-up, an ultrasound and computed tomography of the kidneys were conducted. The results confirmed the initial diagnosis. The postoperative diagnosis was extra-adrenal pararenal phaeochromocytoma (ePCC) with succinate dehydrogenase complex, subunit B (SDHB) gene mutation. During the follow-up, a second tumor was detected by 3,4-dihydroxy-6-F-18-fluoro-L-phenylalanine positron emission tomography/computed tomography F-DOPA-PET CT that resulted in another surgery with complete resection of the tumor. The patient and his family were counseled by a genetic laboratory and remain under surveillance.

Barski D.,Lukas Hospital Neuss
Central European Journal of Urology | Year: 2014

Introduction The prevalence of phaeochromocytoma (PCC) in patients with hypertension is 0.1-0.6% and about 10% of PCCs are detected in extra-adrenal tissue. The diagnosis and therapy of this rare disease detected as a retroperitoneal tumor mass can be difficult for clinicians. Material and methods A PubMed database was searched for the peer-reviewed articles, the listed articles until Dec 2012 were included. Following key words were used: "extra-adrenal phaeochromocytoma", "paraganglioma", "diagnosis", "therapy", "surgery", "genetic analysis", and "SDH mutation". Results Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are first choice imaging tools for PCC (sensitivity 90-100%). For the validation of the diagnosis or follow up, the functional imaging 123I-metaiodobenzylguanidine (MIBG) or Fluorine-18-L-dihydroxyphenylalanine (18F-DOPA) positron emission tomography (excellent specificity and sensitivity of 90-100% in detection of small tumors >1-2 cm) are used. Laparoscopic surgery with complete resection is a safe and a first choice approach. The conversion (about 5%) to direct open operation was needed for large lesions (>8 cm) with the suspicion of malignancy. Currently, there are no histological criteria for distinguishing benign and malignant tumors. The genetic testing (Sanger DNA sequencing) for hereditary syndromes (von Hippel-Lindau, neurofibromatosis, etc.) is used for prediction of malignancy and recurrence. All patients should get individual and risk- adapted genetic analysis and consultation, including family members. The rate of malignancy in ePCC is about 30% (PCC about 5-10%). In patients with proven SDHB germline mutations, higher malignancy rate, multiple PCCs and recurrences are likely. A stringent lifelong clinical follow-up is recommended in these cases. Patients with syndromic hereditary forms should be screened for other often associated neoplasms. Conclusions New imaging tools and genetic analysis are crucial to improve the diagnosis and prognosis of phaeochromocytoma.

Gerullis H.,Lukas Hospital Neuss | Gerullis H.,German Center for Assessment | Gerullis H.,University of Duisburg - Essen | Otto T.,Lukas Hospital Neuss | And 3 more authors.
Anti-Cancer Drugs | Year: 2012

The treatment of metastasized urothelial cancer has been evolving in recent years. In particular, in the second-line setting after the failure of platinum-containing therapy, options are few and besides vinflunine, the recently approved standard in Europe, well-designed highly selective clinical trials may be possible alternatives for patients in this palliative situation. However, targeted therapy approaches have not achieved the same results in urothelial cancer as for instance in renal cell carcinoma. Many of the new targeted drugs have been investigated as single agents in phase II clinical trials without convincing oncologic outcome. This review aims to highlight the most relevant clinical studies examining targeted agents in the second-line setting of metastasized transitional carcinoma of the urothelium.© 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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