Suhl, Germany
Suhl, Germany

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Bloos F.,Jena University Hospital | Bloos F.,Jena University Hospital Jena | Thomas-Ruddel D.,Jena University Hospital | Thomas-Ruddel D.,Jena University Hospital Jena | And 62 more authors.
Critical Care | Year: 2014

Introduction: Current sepsis guidelines recommend antimicrobial treatment (AT) within one hour after onset of sepsis-related organ dysfunction (OD) and surgical source control within 12 hours. The objective of this study was to explore the association between initial infection management according to sepsis treatment recommendations and patient outcome.Methods: In a prospective observational multi-center cohort study in 44 German ICUs, we studied 1,011 patients with severe sepsis or septic shock regarding times to AT, source control, and adequacy of AT. Primary outcome was 28-day mortality.Results: Median time to AT was 2.1 (IQR 0.8 - 6.0) hours and 3 hours (-0.1 - 13.7) to surgical source control. Only 370 (36.6%) patients received AT within one hour after OD in compliance with recommendation. Among 422 patients receiving surgical or interventional source control, those who received source control later than 6 hours after onset of OD had a significantly higher 28-day mortality than patients with earlier source control (42.9% versus 26.7%, P <0.001). Time to AT was significantly longer in ICU and hospital non-survivors; no linear relationship was found between time to AT and 28-day mortality. Regardless of timing, 28-day mortality rate was lower in patients with adequate than non-adequate AT (30.3% versus 40.9%, P < 0.001).Conclusions: A delay in source control beyond 6 hours may have a major impact on patient mortality. Adequate AT is associated with improved patient outcome but compliance with guideline recommendation requires improvement. There was only indirect evidence about the impact of timing of AT on sepsis mortality. © 2014 Bloos et al.; licensee BioMed Central Ltd.


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.


Guntinas-Lichius O.,Jena University Hospital | Wendt T.G.,Jena University Hospital | Buentzel J.,Suedharzkrankenhaus Nordhausen | Esser D.,Helios Klinikum Erfurt | And 6 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2015

Purpose: The objective of this study was to examine patterns of care and survival in a population-based sample of patients with parotid cancer who were treated in Thuringia, a federal state in Germany, between 1996 and 2011. Methods: Data of 295 patients with primary parotid cancer from the Thuringian cancer registry were evaluated for patient’s characteristics, tumor stage, incidence, and trends in treatment, cancer-specific survival (CSS), and overall survival (OS). Results: Stages IV tumors and the amount of tumors in all age cohorts ≥45 years of age increased significantly during the observation period (p = 0.002; age all p < 0.05, respectively). The highest increase in crude incidence was observed for salivary duct carcinomas [relative risk per decade (RR) 5.46; 95 % confidence interval (CI) 1.14–26.14] and rare carcinoma subtypes (RR 9.99; 95 % CI 1.85–53.94). CSS at 5 years and at 10 years for all patients was 82.4 and 82.4 %, respectively. OS at 5 years and at 10 years for all patients was 60.1 and 48.2 %, respectively. CSS and OS did not improve over the time. Salivary duct carcinoma showed the lowest 5-year OS (35.6 %). Acinic cell carcinoma had the highest OS rate (85.3 %). Multivariate Cox models revealed that higher grading (G3/G4) was a more powerful independent predictor of decreased OS than TNM stage. Conclusions: CSS and OS did not improve during the study period. Incidence of parotid cancer increased significantly in elderly patients. It seems that grading is next to patient’s age the better predictor of OS than TNM stage. © 2015, Springer-Verlag Berlin Heidelberg.


PubMed | Suedharzkrankenhaus Nordhausen, University Tumor Center, SRH Wald Klinikum Gera, Helios Klinikum Erfurt and 2 more.
Type: Journal Article | Journal: Cancer medicine | Year: 2016

To examine the impact of comorbidity on overall survival (OS) in a population-based study of patients with head and neck cancer who were treated between 2009 and 2011. Data of 1094 patients with primary head and neck carcinomas without distant metastasis from the Thuringian cancer registries were evaluated concerning the influence of patients characteristics and comorbidity on OS. Data on comorbidity prior to head and neck cancer diagnosis was adapted to the Charlson Comorbidity (CCI), age-adjusted CCI (ACCI), head and neck CCI (HNCCI), simplified comorbidity score (SCS), and to the Adult Comorbidity Evaluation-27 (ACE-27). Most patients were male (80%; median age: 60years; 50% stage IV tumors). Smoking, alcohol abuse, and anemia were registered for 38%, 33%, and 23% of the patients, respectively. Predominant therapy was surgery + radiochemotherapy (30%), surgery (29%), and surgery+radiotherapy (21%). Mean CCI, ACCI, HNCCI, SCS and ACE-27 were 1.01.5, 2.62.1, 0.60.8, 4.44.2, and 0.90.9, respectively. Median follow-up was 25.7months. Multivariable analyses showed that higher age, higher UICC stage, no therapy, including surgery or radiotherapy, alcohol abuse, and anemia, higher comorbidity were independent risk factors for worse OS (all P<0.05). According to the discriminatory power analysis none of the five comorbidity scores was superior to the other scores to prognosticate OS. This population-based study showed that comorbidity is frequent in German patients with head and neck cancer and is an important risk factor for poor OS. Comorbidity should be routinely assessed and taken into account in prospective clinical trials.


PubMed | Suedharzkrankenhaus Nordhausen, University Tumor Center, SRH Wald Klinikum Gera, Helios Klinikum Erfurt and 2 more.
Type: Journal Article | Journal: Oral oncology | Year: 2014

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.Data of 6291 patients with primary HNC from the Thuringian cancer registry were used to evaluate for patients characteristics, tumor stage, incidence, and trends in treatment and overall survival (OS).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 60years, therapy without surgery, and TNM stage were independent significant negative risk factors for OS (all p<0.0001).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.


Guntinas-Lichius O.,Friedrich - Schiller University of Jena | Wendt T.,Friedrich - Schiller University of Jena | Buentzel J.,Suedharzkrankenhaus Nordhausen | Esser D.,Helios Klinikum Erfurt | And 4 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2010

Objective: To describe epidemiology and prognosis of head and neck cancer in Germany. Methods: We analyzed the Thuringian cancer registry database from 1996 to 2005. 3,821 cases with primary head and neck cancer were evaluated for patient's characteristics, tumor stage, incidence, treatment, and trends in overall survival. Results: During the period 1996-2005, the incidence of oropharynx, hypopharynx, larynx, and salivary gland cancer increased significantly for males, and of oral cavity and hypopharynx cancer for females. There was a significant trend using more multimodal therapy combining surgery, radiotherapy, and chemotherapy, and to use less radiotherapy as a single modality. The median follow-up time of patients alive was 42 months. The 5-year overall survival rate (OS) for all patients was 47.8%. The site-specific 5-year OS for lip, oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, salivary gland, and nose/paranasal sinus cancer was 75.7, 42.6, 43.5, 45.9, 27.2, 57.3, 61.0, and 34.9%, respectively. The multivariate analysis showed that male gender, age ≥60 years, therapy without surgery, higher T classification, N classification, and M classification were independent significant negative risk factors for OS (p < 0.0001). Cancer of the oral cavity and of the hypopharynx had a significant lower OS than lip cancer (p = 0.012 and p = 0.044, respectively). Comparing the periods 1996-2000 with the period 2001-2005, there was no significant improvement of OS for any subsite. Conclusions: Many subsites of head and neck cancer have changing incidence. Although treatment strategies have changed, outcome has not improved significantly from 1995 to 2006. © 2009 Springer-Verlag.


Schummer C.,Friedrich - Schiller University of Jena | Sakr Y.,Friedrich - Schiller University of Jena | Steenbeck J.,Friedrich - Schiller University of Jena | Gugel M.,Klinik fur Anasthesiologie und Intensivtherapie | And 2 more authors.
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren | Year: 2010

Purpose: Multilumen central venous catheters (CVCs) are not commonly used for power injection. However, in critically ill patients, CVCs most of which do not have FDA approval for power injection may be the only available venous access. Materials and Methods: The pitfalls of multilumen CVCs are illustrated by a case report of a patient in whom extravasation of intravenously administered contrast medium occurred after power injection in a triple-lumen CVC using the lumen with the port furthest from the catheter tip. Results: The underlying mechanisms for the displacement of the initially correctly placed right subclavian CVC could include elevation of both arms of the obese patient or the power injection itself. The distances between port openings and catheter tips of various commercially available multilumen CVCs are assessed. We examine the possible caveats of ECG-guided CVC placement for optimal tip position, discuss technical difficulties related to power injection via CVCs, and review commonly used drugs that may cause extravasation injury. Conclusion: Knowledge of the distances between CVC port openings and the catheter tip are essential for safe intravasal administration of fluids.


Guntinas-Lichius O.,Friedrich - Schiller University of Jena | Wendt T.,Friedrich - Schiller University of Jena | Buentzel J.,Suedharzkrankenhaus Nordhausen | Esser D.,Helios Klinikum Erfurt | And 4 more authors.
Oral Oncology | Year: 2010

Head and neck in situ carcinoma is seldom diagnosed. Our knowledge about in situ cancer is limited. This study describes the epidemiology and prognosis of head and neck in situ cancer in Thuringia, Germany. We analyzed the cancer data of the Thuringian cancer registry database from 1996 to 2005. The database contained 3821 patients with primary head and neck cancer. Thirty-four patients (0.88%) had an in situ carcinoma. They were evaluated for patient's characteristics, tumor stage, incidence, treatment and trends in overall survival (OS) and recurrence-free survival (RFS). During 1996-2005, the average annual incidence of head and neck in situ carcinoma was 0.14 per 100,000 persons. Half of the cases were localized in the larynx. The patients were treated by local excision. Six patients (18%) developed a local recurrence. Only one recurrent tumor was diagnosed in early stage (rT1), but the other five tumors in advanced stage (rT3/rT4). The median time to recurrence was 27.43 months. For all 34 patients with in situ carcinoma, the 5-year OS was 84% and the 5-year RFS 60.4%. OS was better for laryngeal in situ cancer than for oral cavity or pharyngeal in situ cancer (p = 0.031). The surveillance of patients with head and neck in situ carcinoma after treatment should be performed like in patients with invasive cancer, because nearly one fifth of patients developed a recurrence, predominantly in advanced stage. © 2010 Elsevier Ltd. All rights reserved.


Pantel M.,Friedrich - Schiller University of Jena | Wittekindt C.,Justus Liebig University | Altendorf-Hofmann A.,Friedrich - Schiller University of Jena | Boeger D.,SRH Zentralklinikum Suhl | And 5 more authors.
Acta Oto-Laryngologica | Year: 2011

Conclusion. Neither elective selective neck dissection nor any conservative treatment option in pT2cN0 glottic cancer showed a significant advantage on survival. This should be the basis for future treatment standardization. Obligatory documentation of the R status and cause of death in the cancer registries will improve the data interpretation in the future. Objectives. Optimal adjuvant treatment of pT2cN0 glottic cancer is not well defined. The impact of neck dissection or radio(chemo)therapy for better outcome is unknown. Methods: In a retrospective cancer registry study we analyzed the survival of 73 patients with pT2cN0 glottic cancer in Thuringia, Germany, treated surgically between 1996 and 2005. Results: In all, 35 patients had undergone elective neck dissection, the remaining 38 patients had not. Histopathology revealed occult lymph node metastasis in three patients. Adjuvant radiotherapy was delivered to 17 patients and radiochemotherapy to 4. Overall, 52 patients received an adjuvant treatment. The 5-year recurrence-free survival rate was 60.8% and the 5-year overall survival rate was 56.5%. Multivariate but not univariate analysis revealed age >62 years (p = 0.05) and neck dissection (p = 0.033) as significant negative risk factors for tumor recurrence. Looking at overall survival, the site of primary surgery and radiotherapy were significant univariate risk factors, whereas multivariate analysis did not reveal any independent risk factor. No adjuvant treatment or combinations of adjuvant treatment resulted in better recurrence-free or overall survival (p = 0.253; p = 0.279). © 2011 Informa Healthcare.

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