Socie G.,Service dHematologie Greffe de Moelle |
Socie G.,Paris West University Nanterre La Défense |
Schmoor C.,Clinical Trials Center Universitatsklinikum Freiburg |
Bethge W.A.,University Hospital of Tuebingen |
And 19 more authors.
Blood | Year: 2011
Previous randomized graft-versus-host disease (GVHD)-prophylaxis trials have failed to demonstrate reduced incidence and severity of chronic GVHD (cGVHD). Here we reanalyzed and updated a randomized phase 3 trial comparing standard GVHD prophylaxis with or without pretransplantation ATG-Fresenius (ATG-F) in 201 adult patients receiving myeloablative conditioning before transplantation from unrelated donors. The cumulative incidence of extensive cGVHD after 3 years was 12.2% in the ATG-F group versus 45.0% in the control group (P < . 0001). The 3-year cumulative incidence of relapse and of nonrelapse mortality was 32.6% and 19.4% in the ATG-F group and 28.2% and 33.5% in the control group (hazard ratio [HR] = 1.21, P = . 47, and HR = 0.68, P = . 18), respectively. This nonsignificant reduction in nonrelapse mortality without increased relapse risk led to an overall survival rate after 3 years of 55.2% in the ATG-F group and 43.3% in the control group (HR = 0.84, P = . 39, nonsignificant). The HR for receiving immunosuppressive therapy (IST) was 0.31 after ATG-F (P < . 0001), and the 3-year probability of survival free of IST was 52.9% and 16.9% in the ATG-F versus control, respectively. The addition of ATG-F to standard cyclosporine, methotrexate GVHD prophylaxis lowers the incidence and severity of cGVHD, and the risk of receiving IST without raising the relapse rate. ATG-F prophylaxis reduces cGVHD morbidity. © 2011 by The American Society of Hematology.
Kastrup J.,Copenhagen University |
Jorgensen E.,Copenhagen University |
Fuchs S.,Rabin Medical Center |
Nikol S.,Universitatsklinik Munster |
And 4 more authors.
EuroIntervention | Year: 2011
Aims: Genes encoding vascular endothelial growth factor (VEGF) can potentially augment myocardial perfusion in patients with coronary artery disease (CAD). We conducted a randomised, double-blind, placebo-controlled gene therapy study with the adenovirus carrying VEGF121 (BIOBYPASS [Ad GVVEGF121.10NH]). Methods and results: Seventeen patients with severe CAD were 2:1 randomised to BIOBYPASS (n=12; 61 years) or placebo (n=5; 64) as 12 intra-myocardial injections into the ischaemic area using the NOGA XP® system. The study was terminated prematurely due to a company product portfolio decision. Mean change in total exercise duration from baseline to 12, 26 and 52 weeks was 20.2, 21.4 and 16.4 sec in BIOBYPASS treated and 46.2, 31.4 and 12.4 sec in placebo (NS). Change from baseline to at least 1 mm ST depression during exercise at 12, 26 and 52 weeks did not differ between BIOBYPASS and placebo. Change in stress-induced ischaemia score was similar in the BIOBYPASS (3.4%) and placebo (2.0%) groups. An improvement in symptoms was seen in patients treated with BIOBYPASS, but no difference between the groups. Conclusions: Direct intramyocardial injection of BIOBYPASS (AdGVVEGF121.10NH) was safe but did not improve exercise capacity, time to ischaemic threshold or myocardial perfusion compared to sham injection in patients with refractory myocardial ischaemia. © Europa Edition 2011. All rights reserved.
PubMed | Ruhr University Bochum and Universitatsklinik Munster
Type: | Journal: Der Internist | Year: 2017
Approximately half of neurological and geriatric inpatients suffer from oropharyngeal dysphagia. This often leads to pneumonia, malnutrition and dehydration; however, the underlying dysphagia is frequently not diagnosed and treated. This is particularly the case for patients with so-called silent aspiration. Knowledge on the physiology of swallowing, including the central nervous system control of swallowing and the therapeutic options have achieved considerable progress in recent years. In particular, the increasing implementation of flexible endoscopic evaluation of swallowing (FEES) has significantly contributed to this knowledge. It provides the ability to identify the individual pattern of oropharyngeal dysphagia leading to a suitable selection of therapeutic and compensatory strategies for individual patients. The various therapeutic options range from modification of the consistency of the diet, over diverse logopedic strategies and stimulation techniques up to interventional procedures.
Stallmeyer B.,Universitatsklinik Munster |
Koopmann M.,Universitatsklinik Munster |
Schulze-Bahr E.,Universitatsklinik Munster
Genetic Testing and Molecular Biomarkers | Year: 2012
The lamin A/C proteins are major structural and functional components of the nuclear lamina. Mutations identified in LMNA encoding lamin A/C belong to the most frequently described causes for inherited forms of dilated cardiomyopathy (DCM). To elucidate the clinical characteristics of LMNA mutation carriers we performed genetic analysis of LMNA in 20 unrelated patients with DCM and cardiac conduction disease. In six small nuclear families heterozygous mutations in LMNA were identified. Two missense mutations led to the substitution of highly conserved amino acid residues within the rod domain of lamin A/C and four not-yet-described nonsense mutations cause the formation of predicted truncated lamin A/C missing parts of the tail domain. DCM was the most prominent clinical characteristic of the affected family members with a high degree of involvement of conduction system defects and less often accompanied by muscular dystrophy. The cardiac phenotype of the affected family members was severe and progressive with age, indicating the necessity for a genetic testing for LMNA mutations in patients with familial DCM and early onset of conduction disorders. © Copyright 2012, Mary Ann Liebert, Inc.
Marian T.,Universitatsklinik Munster |
Dziewas R.,Universitatsklinik Munster
Aktuelle Ernahrungsmedizin | Year: 2016
The act of swallowing is coordinated through a complex interface of different brain regions both at the level of the brainstem as well as the cerebrum. Accordingly strokes of different localizations can cause swallowing disorders. Evident results show that up to 80 % of these patients portray a reduction of ability to swallow. A chronic dysfunction is found in approximately 10-25 % of these patients. In addition to impaired food intake with the possible consequences of dehydration and malnutrition, those patients are particularly at risk of aspiration pneumonia and a significantly higher mortality rate. An early clinical examination with the support of modern dysphagia diagnostic, supplemented by a standardized dysphagia management, is therefore of crucial importance. In addition to aspiration screening and clinical swallowing examination, the use of apparatus methods like Fibreoptic Endoscopic Evaluation of Swallowing (FEES) plays an important role. These methods allow the therapeutic multi-professional team to analyze the pathogenic mechanism of swallowing disorder, it even enables the detection of small distinct aspirations and to develop an individualized treatment plan for each patient. In addition to established methods, such as diet modification and speech therapy, the use of various non-invasive neurostimulation is currently intensively investigated. © Georg Thieme Verlag KG.
Herbort M.,Universitatsklinik Munster |
Fink C.,Institute For Sportmedizin
Arthroskopie | Year: 2015
Background: The anterior cruciate ligament (ACL) greatly influences joint kinematics. In particular, the complex structure of the ACL enables functional stabilization of the knee joint.Biomechanics of the intact ACL: The main task of the anterior cruciate ligament is to stabilize against anterior tibial translation (ATT) as well as the preservation of rotational stability. These two stabilization tasks can be examined using the Lachman and the pivot–shift tests. While stabilization of the knee joint against ATT can be assigned to the anteromedial fibers of the ACL in flexion, the posterolateral fibers are responsible for rotation stabilization in near extension.Kinematics after ACL insufficiency: Following rupture of the anterior cruciate ligament, there is mainly a combination of anterior instability with increased anterior tibial translation and rotation instability. The degree of instability after partial ACL ruptures depends on the extent of the affected fibers. Existing ACL insufficiency has far-reaching effects on knee joint kinematics. In addition to increased load on the medial and lateral collateral ligaments and the posterior horn of the meniscus, increased translational and rotational instability leads to a shift of the main stress points in the knee joint and, thus, to an overload of certain areas of the cartilage.Kinematics of ACL reconstruction: The recovery of the kinematics of the knee joint by ACL reconstruction depends of the anatomical reconstruction of the complex ACL fiber structure and ACL insertion. Increased consideration of the anteromedial and posterolateral bundle portions of the ACL leads to improved stability of the knee joint. © 2015, Springer-Verlag Berlin Heidelberg.
Notzon S.,Universitatsklinik Munster
Nervenarzt | Year: 2015
Background: In medical ethics there is broad agreement that patients should be empowered to make autonomous decisions about their health and that objective, detailed information promotes these decisions. According to German law patients have a right of access to their own medical records. Objectives: Which advantages and disadvantages does the access to records have for doctors and patients in psychiatry? Which requirements should be met to make access reasonable for patients? Material and methods: This article presents an analysis of the legal situation and the state of research, evaluation of empirical studies, discussion of features of psychiatry, its language and patients as well as their influence on access to medical records. Results: Psychiatrists are sometimes concerned about patient access to medical records and some psychiatric patients feel upset or uncomfortable after having inspected their records. The misunderstanding and stigmatization of psychiatric terms, the vulnerability of psychiatric patients and the nature of psychiatric disorders, the description of which affects fundamental aspects of personality, all play a role in this. In addition, in having access to their records patients use a source of information that was originally written for other addressees. Information content and language are not adapted to their needs. Possible solutions could involve improvements in patient education and (stylistic) changes in writing records. © 2015, Springer-Verlag Berlin Heidelberg.
Englbrecht J.S.,Universitatsklinik Munster |
Pogatzki-Zahn E.M.,Universitatsklinik Munster
Schmerz | Year: 2014
Abdominal and thoracic surgical procedures can result in significant acute postoperative pain. Present evidence shows that postoperative pain management remains inadequate especially after "minor" surgical procedures. Various therapeutic options including regional anesthesia techniques and systemic pharmacotherapy are available for effective treatment of postoperative pain. This work summarizes the pathophysiological background of postoperative pain after abdominal and thoracic surgery and discusses the indication, effectiveness, risks, and benefits of the different therapeutic options. Special focus is given to the controversial debate about the indication for epidural analgesia, as well as various alternative therapeutic options, including transversus abdominis plane (TAP) block, paravertebral block (PVB), wound infiltration with local anesthetics, and intravenous lidocaine. In additional, indications and contraindications of nonopioid analgesics after abdominal and thoracic surgery are discussed and recommendations based on scientific evidence and individual risk and benefit analysis are made. All therapeutic options discussed are eligible for clinical use and may contribute to improve postoperative pain outcome after abdominal and thoracic surgical procedures. © 2014 Springer-Verlag.
Meyer V.,Universitatsklinik Munster |
Kerk N.,Universitatsklinik Munster |
Meyer S.,Universitatsklinik Munster |
Goerge T.,Universitatsklinik Munster
JDDG - Journal of the German Society of Dermatology | Year: 2011
A leg ulcer is a symptom and the treating physician needs to find out its origin by differential diagnostic approaches and procedures. The correct diagnosis leads to a specific therapy that ideally accelerates the healing of the ulceration. Identifying the pathogenesis of a leg ulcer is the first and main step towards healing. Although vascular diseases are the major causes of leg ulcers, one needs to consider, in addition to venous and arterial disorders, autoimmune, infectious, metabolic and neoplastic causes. The simple truth that one can only make a diagnosis that was considered holds particularly true in leg ulcers. The differential diagnostic considerations presented here appear in the daily routine of a dermatologist and the article provides help in diagnostic approaches and therapeutic decisions. © Blackwell Verlag GmbH, Berlin.
Tunnerhoff H.-G.,Praxis fur Hand und Fuchirurgie |
Langer M.,Universitatsklinik Munster
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2014
Accurately performed anatomic and biomechanical studies as well as clinical experience during the last years have widened our knowledge about function and pathology of the distal radioulnar joint (DRUJ) making a differentiated treatment possible. In cases of trauma a rupture of the ulnar part of the triangular fibrocartilaginous complex (TFCC) frequently occurs. An overview is given on the development of different arthroscopic techniques for repair and the state of the art is presented. The ulnar part of the TFCC is constituted of the superficial part which is less important for stability and the deep part which is anchored to the fovea of the ulnar head. This deep part is the most important stabiliser of the DRUJ. Each of these parts may rupture separately or both of them may rupture at the same time. Keystones for diagnosis are clinical examination and arthroscopy. On clinical examination instability of the DRUJ is to be evaluated by comparing it to the contralateral side. Furthermore, the degree of instability should be estimated. Extraarticular associated lesions must also be assessed clinically. On arthroscopy the TFCC may be evaluated from the radiocarpal joint as well as from its undersurface, from the DRUJ. In cases of avulsion from the fovea, an anatomic reconstruction with reinsertion of the deep part to the bone is indicated and may be performed successfully according to the published studies and our own experience. If a severe instability is found on clinical examination it is to be supposed that more stabilising structures - then only the radioulnar ligaments - are affected and reinsertion of the deep fibres to the fovea may not be sufficient. © 2014 Georg Thieme Verlag KG Stuttgart.