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Gera, Germany

Lesser T.G.,SRH Wald Klinikum Gera
Annals of Thoracic Surgery | Year: 2010

Background: Patients with T4 non-small cell lung cancers with limited involvement of mediastinal structures can undergo resection, with acceptable long-term survival. Computed tomography has not proven to be reliable in determining the operability of locally advanced lung carcinoma. This study evaluated the ability of video-assisted thoracoscopy alone and with endothoracic sonography to determine operability. Methods: Computed tomography showed a close contact of the tumor with mediastinal structures (T4) in 155 patients. Staging was expanded with video-assisted thoracoscopy, followed by thoracoscopic ultrasound. Lateral thoracotomy with hilar and mediastinal dissection was considered the gold standard in determining operability. Results: Thoracoscopic ultrasound, compared with thoracoscopy alone and computed tomography, had the highest sensitivity (94.1% vs 75.2% vs 43.6%, p < 0.001) and specificity (98.1% vs 57.4% vs 37.0%, p < 0.001) for determining operability. Computed tomography, thoracoscopy, and thoracoscopic ultrasound were falsely negative in 57 (36.8%), 25 (16.1%), and 6 (3.9%) patients and falsely positive in 34 (21.9%), 23 (14.8%), and 1 (0.6%). False-negative results for operability by thoracoscopic ultrasound were found only in tumors involving the left atrium (3.9%). Conclusions: Estimation of operability in locally advanced lung cancer can be improved with video-assisted thoracoscopy and ultrasound. More than one-third of patients classified as inoperable by computed tomography were able to undergo complete resection. © 2010 The Society of Thoracic Surgeons.

Winkler M.,University of Ulm | Skopp G.,University of Heidelberg | Alt A.,University of Ulm | Miltner E.,University of Ulm | And 6 more authors.
International Journal of Legal Medicine | Year: 2013

The importance of direct and indirect alcohol markers to evaluate alcohol consumption in clinical and forensic settings is increasingly recognized. While some markers are used to prove abstinence from ethanol, other markers are suitable for detection of alcohol misuse. Phosphatidyl ethanol (PEth) is ranked among the latter. There is only little information about the correlation between PEth and other currently used markers (ethyl glucuronide, ethyl sulfate, carbohydrate deficient transferrin, gamma-glutamyl transpeptidase, and methanol) and about their decline during detoxification. To get more information, 18 alcohol-dependent patients in withdrawal therapy were monitored for these parameters in blood and urine for up to 19 days. There was no correlation between the different markers. PEth showed a rapid decrease at the beginning of the intervention, a slow decline after the first few days, and could still be detected after 19 days of abstinence from ethanol. © 2012 Springer-Verlag Berlin Heidelberg.

Mueller A.H.,SRH Wald Klinikum Gera
Current Opinion in Otolaryngology and Head and Neck Surgery | Year: 2011

Purpose of Review: This article reviews literature on the scientific background of functional electric stimulation of the immobile larynx, the status of animal pacing trials, and first clinical attempts to establish laryngeal pacing. Recent Findings: Impaired vocal fold motion is seen following recurrent laryngeal nerve paralysis and is a result of inadequate or synkinetic reinnervation. The term vocal fold paralysis should only be used after verification using laryngeal electromyography. A variety of animal trials give clear evidence supporting the feasibility of laryngeal pacing as a new dynamic approach for the rehabilitation of patients with bilateral vocal fold motion impairment. Laryngeal pacing has become clinically applicable with minimal invasive electrode insertion and newly designed stimulation circuits. Summary: Laryngeal pacing seems to be on the right path to open up a dynamic rehabilitation of the bilaterally motion-impaired larynx. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Schiffl H.,Ludwig Maximilians University of Munich | Lang S.M.,SRH Wald Klinikum Gera
Molecular Diagnosis and Therapy | Year: 2012

Acute kidney injury (AKI) represents a common disorder in hospitalized patients, and its incidence is rising at an alarming rate. Despite significant improvements in critical care and renal replacement therapies (RRT), the outcome of critically ill patients with AKI necessitating RRT remains unacceptably dismal. In current clinical practice, the diagnosis and severity classification of AKI is based on a rise in serum creatinine levels, which may occur 2-3 days after the initiating renal insult and delay potentially effective therapies that are limited to the early stage.The emergence of numerous renal tubular damage-specific biomarkers offers an opportunity to diagnose AKI at an early timepoint, to facilitate differential diagnosis of structural and functional AKI, and to predict the outcome of established AKI. The purposes of this review are to summarize and to discuss the performance of these novel AKI biomarkers in various clinical settings.The most promising AKI biomarkers include plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL), urinary interleukin (IL)-18, urinary liver-type fatty acid binding protein (L-FABP), urinary cystatin C, and urinary kidney injury molecule (KIM)-1. However, enthusiasm about their usefulness in the emergency department seems unwarranted at present. There is little doubt that urinary biomarkers of nephron damage may enable prospective diagnostic and prognostic stratification in the emergency department. However, comparison of the areas under the receiver-operating characteristic curves of these biomarkers with clinical andor routine biochemical outcome parameters reveals that none of these biomarkers has a clear advantage beyond the traditional approach in clinical decision making in patients with AKI. The performance of various biomarkers for predicting AKI in patients with sepsis or with acute-on-chronic kidney disease is poor. The inability of biomarkers to improve classification of 'unclassifiable' (structural or functional) AKI, in which accurate differential diagnosis of pre-renal versus intrinsic renal AKI has the most value, illustrates another problem. Future research is necessary to clarify whether serial measurements of a specific biomarker or the use of a panel of biomarkers may be more useful in critically ill patients at risk of AKI.Whether or not the use of AKI biomarkers revolutionizes critical care medicine by early diagnosis of severe AKI and individualizes the management of AKI patients remains to be shown. Currently, the place of biomarkers in this decision-making process is still uncertain. Indiscriminate use of various biomarkers may distract clinicians from adequate clinical evaluation, may result in worse instead of better patient outcomes, and may waste money. Future large randomized studies are necessary to demonstrate the association between biomarker levels and clinical outcomes, such as dialysis, clinical events, or death. It needs to be shown whether assignment to earlier treatment for AKI on the basis of generally accepted biomarker cut-off levels results in a reduction in mortality and an improvement in recovery of renal function. © 2012 Springer International Publishing AG. All rights reserved.

Guntinas-Lichius O.,Jena University Hospital | Wendt T.G.,Jena University Hospital | Kornetzky N.,Jena University Hospital | Buentzel J.,Suedharzkrankenhaus Nordhausen | And 6 more authors.
Oral Oncology | Year: 2014

Introduction The objective of this study was to examine patterns of care and survival in a population-based sample of patients with head neck cancer (HNC) who were treated in Thuringia, a federal state in Germany, between 1996 and 2011.Methods Data of 6291 patients with primary HNC from the Thuringian cancer registry were used to evaluate for patient's characteristics, tumor stage, incidence, and trends in treatment and overall survival (OS).Results The distribution between stages I-IV did not change significantly during the observation period. Crude incidences of HNC increased significantly between 1996 and 2011 from 13.77 to 20.39 (relative risk [RR] = 1.34; 95% confidence interval [CI] = 1.25-1.45). This increase was mainly driven by a significant increase of oropharynx cancer (from 3.29 to 5.85; RR = 1.67; 95%CI = 1.49-1.88) and cancer of the oral cavity (3.41-5.90; RR = 1.5; 95%CI = 1.33-1.69). The relative frequency of multimodal therapy increased (RR = 1.42; 95%CI = 1.3-1.55). The use of cetuximab increased (RR = 473.32; 95%CI = 51.57-4344.51). The 5-year and 10-year OS for the entire cohort was 49.1% and 34.1%, respectively. The multivariable analysis has proven that male gender, age ≥60 years, therapy without surgery, and TNM stage were independent significant negative risk factors for OS (all p < 0.0001).Conclusions OS did not improve during the study period. Incidence of oral cancer is significantly increasing. Although modern treatment strategies have been included in routine HNC care over the time, outcome has not improved significantly. © 2014 Elsevier Ltd.

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