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Pforzheim, Germany

Riphaus A.,Ruhr University Bochum | Am Weg P.,Siloah Hospital | Seifert H.,University of Oldenburg | Wehrmann T.,Deutsche Klinik fuer Diagnostik
European Journal of Gastroenterology and Hepatology | Year: 2013

BACKGROUND: Precut sphincterotomy (PCS) is a well-established alternative after repeated unsuccessful attempts of common bile duct (CBD) cannulation using standard catheters and/or guide-wire. Commonly used instruments for precutting are the needle-knife and a modified traction-type sphincterotome. In 1996, a so-called 'baby-sphincterotome' with a preshaped, small-caliber 3 Fr tip was developed, which enables cannulation and precutting in one step. OBJECTIVE: A clinical evaluation was carried out and the complication rates were determined at a tertiary referral hospital. DESIGN: Prospective clinical evaluation. INTERVENTIONS: During an 8-year period, a total of 5389 endoscopic retrograde cholangiopancreatographies were performed at our hospital. In total, 1886 patients fulfilled the inclusion criteria for this prospective study. The baby-sphincterotome was used in 345 of 1886 patients (mean age 63.4±16.4 years, 203 women) after five unsuccessful attempts of CBD cannulation using a hydrophilic guide-wire. After two more failed CBD cannulations with the baby-sphincterotome, PCS was performed using the same device. MAIN OUTCOME MEASUREMENTS: The success rates of biliary access, postendoscopic retrograde cholangiopancreatography pancreatitis, and bleeding were assessed. RESULTS: Initially, the success rate of CBD cannulation on using the baby-sphincterotome was 28% (96/345 patients). Postinterventional pancreatitis occurred in two of 96 patients (2%) and minor bleeding occurred during traction-type sphincterotomy in four of 93 patients (4%). In the remaining 249 patients precut with a baby-sphincterotome, CBD cannulation was achieved in 219 cases (88%), although with pancreatitis and severe bleeding in 4% each. In 30 of 249 patients (12%), a second or a third (n=5) intervention was necessary, with a success rate of 73% (22/30 cases) after PCS. LIMITATIONS: This was a single-centre, uncontrolled study. CONCLUSION: The newly developed baby-sphincterotome enables bile duct access in a single session in 91% of the patients when guide-wire cannulation has failed. Direct cannulation was possible in about one-quarter of the patients, whereas PCS with the new device showed a high efficacy and a low complication rate. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Rades D.,University of Lubeck | Freundt K.,University of Lubeck | Meyners T.,University of Lubeck | Bajrovic A.,University of Hamburg | And 7 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: Radiotherapy alone is the most common treatment for metastatic spinal cord compression (MSCC) from relatively radioresistant tumors such as renal cell carcinoma, colorectal cancer, and malignant melanoma. However, the results of the "standard" regimen 30 Gy/10 fractions need to be improved with respect to functional outcome. This study investigated whether a dose escalation beyond 30 Gy can improve treatment outcomes. Methods and Materials: A total of 91 patients receiving 30 Gy/10 fractions were retrospectively compared to 115 patients receiving higher doses (37.5 Gy/15 fractions, 40 Gy/20 fractions) for motor function and local control of MSCC. Ten further potential prognostic factors were evaluated: age, gender, tumor type, performance status, number of involved vertebrae, visceral or other bone metastases, interval from tumor diagnosis to radiotherapy, pretreatment ambulatory status, and time developing motor deficits before radiotherapy. Results: Motor function improved in 18% of patients after 30 Gy and in 22% after higher doses (p = 0.81). On multivariate analysis, functional outcome was associated with visceral metastases (p = 0.030), interval from tumor diagnosis to radiotherapy (p = 0.010), and time developing motor deficits (p < 0.001). The 1-year local control rates were 76% after 30 Gy and 80% after higher doses, respectively (p = 0.64). On multivariate analysis, local control was significantly associated with visceral metastases (p = 0.029) and number of involved vertebrae (p = 0.043). Conclusions: Given the limitations of a retrospective study, escalation of the radiation dose beyond 30 Gy/10 fractions did not significantly improve motor function and local control of MSCC in patients with relatively radioresistant tumors. © 2011 Elsevier Inc.

Janssen S.,Medical Practice for Radiotherapy and Radiation Oncology | Janssen S.,University of Lubeck | Schonhofer B.,Siloah Hospital | Rades D.,University of Lubeck
Anticancer Research | Year: 2015

Aim: To evaluate the efficacy of prophylactic radiotherapy at intervention sites in patients with malignant pleural mesothelioma (MPM). Patients and Methods: From 05/2010 to 12/2014, 53 patients with histologically confirmed MPM were treated in order to prevent interventional site metastases. Irradiation was carried out with 3×7=21 Gy with 6-18 MeV electrons. Results: The mean follow-up period was 14.4 months (range=0-37 months). At the time of the analysis, 20 patients were alive. Three patients had developed a local recurrence within the irradiated site, representing a local recurrence rate of 5.7%. Toxicity was low, with transient grade I erythema found in 20.7% of patients. No grade II or higher toxicity was observed. Conclusion: Our simple and time-saving RT approach to interventional sites in patients with MPM was both effective and well-tolerated. This approach is easily integrated into general treatment concepts. Until publication of results from prospective randomized trials, prophylactic RT to intervention sites should remain standard.

Miehlke S.,Center for Digestive Diseases | Krasz S.,University Hospital | Schneider-Brachert W.,University of Regensburg | Kuhlisch E.,University Hospital | And 8 more authors.
Helicobacter | Year: 2011

Background: Triple therapy with a proton pump inhibitor, moxifloxacin, and amoxicillin has been proven effective in first-line treatment of Helicobacter pylori infection. Aim: To explore 1, the value of triple therapy with esomeprazole, moxifloxacin, and amoxicillin in second-line or rescue treatment of Caucasian patients and 2, the impact of treatment duration on eradication success. Methods: H. pylori-infected patients with at least one previous treatment failure were randomized to oral esomeprazole 20mg b.i.d., moxifloxacin 400mg o.d., and amoxicillin 1000mg b.i.d. for either 7 (EMA-7) or 14days (EMA-14). Eradication was confirmed by 13C urea breath test. Antimicrobial susceptibility testing was performed in all patients at baseline and in patients who failed treatment. Results: Eighty patients were randomized, and 60% had ≥2 previous treatment failures. Pretreatment resistance against clarithromycin and metronidazole was found in 70.5 and 61.5% of cases, respectively. The intention-to-treat eradication rate was significantly higher after EMA-14 compared with EMA-7 (95.0 vs 78.9%, p = .036). No independent risk factor for treatment failure could be identified. There were no serious adverse events. Five of the EMA-14 patients (12.5%) compared with none of the EMA-7 patients discontinued prematurely because of adverse events (p = .031). Post-treatment resistance against moxifloxacin was found in one of seven patients with isolated organisms (14.3%). Conclusion: Second-line/rescue H. pylori eradication therapy with esomeprazole, moxifloxacin, and amoxicillin is very effective and well tolerated. Fourteen days of treatment significantly increase the eradication rate but also the rate of adverse events. © 2011 Blackwell Publishing Ltd.

Madisch A.,Siloah Hospital | Miehlke S.,Facharztzentrum Eppendorf | Bartosch F.,Universitatsklinikum Dresden | Bethke B.,Pathologisches Institute | Stolte M.,Pathologisches Institute
Zeitschrift fur Gastroenterologie | Year: 2014

Abstract Background: Collagenous colitis (CC) and lymphocytic colitis (LC) are chronic disorders characterized by watery diarrhea. Aim: To evaluate prospectively the clinical features, response to treatment and outcomes in a large group of patients with CC and LC. Patients and Methods: Patients with histologically confirmed CC and LC were prospectively enrolled to complete a questionnaire on onset and duration of diarrhea, stool frequency and consistency, other gastrointestinal symptoms including weight loss, drug history, treatment success and concomitant diseases. Results: A total of 494 patients (CC, n=287, LC, n=207) were available for analysis. The mean age at diagnosis was 65 in CC and 61 years in LC with a identically female predominance (76% of patients) in both groups. Prior to diagnosis the mean duration of symptoms was 37 in CC and 23 months in LC. CC and LC patients share similar pattern of clinical symptoms. Concomitant autoimmune disorders were more common in CC patients (48.4%) than in LC patients (29.6%). Sustained clinical remission was reported by 35.5% of CC and 38,6% of LC, but more CC patients (47.7%) received medication such as corticosteroids, antibiotics, bismuth or 5-aminosalicyclic than LC patients (16.9%). 18.6% of CC patients and 17.6% of LC were regularly using NSAIDs. Conclusion: Collagenous and lymphocytic colitis are frequently diagnosed in elderly female patients. CC and LC share similar symptom pattern, but concomitant autoimmune disease were more common in CC than in LC patients. © Georg Thieme Verlag KG.

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