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Ricke J.,Universitatsklinikum Magdeburg | Wust P.,Charite - Medical University of Berlin
Seminars in Radiation Oncology | Year: 2011

Limitations of thermal liver cancer ablation have led to the development of percutaneous, catheter-based brachytherapy for the treatment of liver malignancies. Computed tomography (CT)-guided brachytherapy has been used to treat primary and metastatic liver cancers, including very large tumors >10 cm. Cooling effects by adjacent blood vessels are not a concern in brachytherapy, and the method may be used safely in tumors unsuitable for thermal ablation that are close to the liver hilum due to the relatively high radiation tolerance of bile duct. CT scanning is used for dosimetry planning after catheter implantation and also to guide the catheter placement itself. Major complications, including postinterventional bleeding, are rare despite frequent application of this technique in a salvage situation. Patients with liver cirrhosis have an increased risk for complications. Prospective trials of CT-guided brachytherapy have been performed with promising survival rates for liver metastases and hepatocellular carcinoma, respectively. In this article, the radiobiological and technical properties of CT-guided brachytherapy, appropriate patients for treatment, and prospective trials that have been published to date are reviewed. © 2011 Elsevier Inc.


Geginat G.,Universitatsklinikum Magdeburg | Kaiser D.,University of Mannheim | Schrempf S.,R Biopharm AG
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2012

The analytical accuracy of the RIDASCREEN Norovirus 3rd Generation ELISA assay and the rapid immunochromatographic RIDAQUICK Norovirus assay were determined in comparison to PCR. In a prospective study 410 consecutive samples were collected from inpatients of a tertiary care hospital in Germany. All samples were tested with the two antigen detection assays, as well as with three different real-time reverse transcription PCR methods as the reference standard. A sample was considered true-positive if at least 2 out of 3 PCR methods yielded a positive signal (137 positive samples, >99% genogroup II). Compared with the PCR-based reference the overall diagnostic sensitivities of the ELISA and the immunochromatographic assay were 77% and 69% and the diagnostic specificities were 96% and 97% respectively. Both assays allow the rapid and economic screening of large numbers of samples and thus are useful diagnostic tools for the detection of suspected norovirus infections. © 2011 Springer-Verlag.


Oettle H.,Charite - Medical University of Berlin | Neuhaus P.,Charite - Medical University of Berlin | Hochhaus A.,Universitatsklinikum Jena | Hartmann J.T.,University of Kiel | And 9 more authors.
JAMA - Journal of the American Medical Association | Year: 2013

IMPORTANCE: The prognosis for patients with pancreatic cancer is poor, even after resection with curative intent. Gemcitabine-based chemotherapy is standard treatment for advanced pancreatic cancer, but its effect on survival in the adjuvant setting has not been demonstrated. OBJECTIVE: To analyze whether previously reported improvement in disease-free survival with adjuvant gemcitabine therapy translates into improved overall survival. DESIGN, SETTING, AND PATIENTS: CONKO-001 (Charité Onkologie 001), a multicenter, open-label, phase 3 randomized trial to evaluate the efficacy and toxicity of gemcitabine in patients with pancreatic cancer after complete tumor resection. Patients with macroscopically completely removed pancreatic cancer entered the study between July 1998 and December 2004 in 88 hospitals in Germany and Austria. Follow-up ended in September 2012. INTERVENTIONS: After stratification for tumor stage, nodal status, and resection status, patients were randomly assigned to either adjuvant gemcitabine treatment (1g/m2 d 1, 8, 15, q 4 weeks) for 6 months or to observation alone. MAIN OUTCOMES AND MEASURES: The primary end point was disease-free survival. Secondary end points included treatment safety and overall survival, with overall survival defined as the time from date of randomization to death. Patients lost to follow-up were censored on the date of their last follow-up. RESULTS: A total of 368 patients were randomized, and 354 were eligible for intention-to-treat-analysis. By September 2012, 308 patients (87.0%[95% CI, 83.1%-90.1%]) had relapsed and 316 patients (89.3% [95% CI, 85.6%-92.1%]) had died. The median follow-up time was 136 months. The median disease-free survival was 13.4 (95% CI, 11.6-15.3) months in the treatment group compared with 6.7 (95% CI, 6.0-7.5) months in the observation group (hazard ratio, 0.55 [95% CI, 0.44-0.69]; P < .001). Patients randomized to adjuvant gemcitabine treatment had prolonged overall survival compared with those randomized to observation alone (hazard ratio, 0.76 [95%CI, 0.61-0.95]; P = .01), with 5-year overall survival of 20.7% (95% CI, 14.7%-26.6%) vs 10.4% (95% CI, 5.9%-15.0%), respectively, and 10-year overall survival of 12.2% (95% CI, 7.3%-17.2%) vs 7.7% (95% CI, 3.6%-11.8%). CONCLUSIONS AND RELEVANCE: Among patients with macroscopic complete removal of pancreatic cancer, the use of adjuvant gemcitabine for 6 months compared with observation alone resulted in increased overall survival as well as disease-free survival. These findings provide strong support for the use of gemcitabine in this setting. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN34802808.


Schreiber J.,Universitatsklinikum Magdeburg
Deutsche Medizinische Wochenschrift | Year: 2011

Adverse effects of drug therapy may induce a wide variety of bronchopulmonary disorders. The spectrum of drug induced lung and bronchial diseases include simple cough, bronchial obstruction, and obstructive bronchiolitis. Lung parenchyma may be affected by alveolitis/pneumonitis or lung fibrosis. Further damage patterns are noncardiac pulmonary oedema, diffuse alveolar damage, diffuse alveolar haemorrhage, eosinophilic lung diseases, pulmonary vascular disorders as well as pleural affections. These side effects rarely have pathognomonic features. Therefore they are relevant differential diagnoses of genuine pulmonary diseases. Diagnostics is based mainly on the verification of a compatible disease pattern, exclusion of differential diagnoses, and assessment of the temporal relationship and the consequences of drug abstention. Reexposure is rarely indicated. Strict elimination of the responsible drugs is the most important therapeutic measure. Additional drug therapy, mostly with glucocorticosteroids, may be indicated. © 2011 Georg Thieme Verlag KG Stuttgart · New York.


Grundmann R.T.,In den Gruben 144 | Meyer F.,Universitatsklinikum Magdeburg
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2013

Background: This overview comments on potential gender-specific differences in incidence, anatomic site, screening, treatment, and outcome in patients with colorectal cancer (CRC). Method: For the literature review, the Medline database (PubMed) was searched under the key words [colorectal carcinoma AND gender" and [gender differences AND colorectal cancer". Publications of the last 9 years (2005-2013) were firstly retrieved. Results: CRC is more commonly observed in men than in women, with the higher tumour risk for men being limited to the distal colon and rectum. Risk factors for the development of CRC include overweight and obesity, this relationship is more pronounced for men than for women. The extent to which gender is a prognostic factor for patient survival is controversial. A better survival of women compared to men is found especially in the younger age groups, from which can be derived a protective effect of oestrogens on the development of CRC. As for the frequency with which men and women undergo a screening of CRC, sometimes higher screening rates have been reported for men than women, however, the socio-economic status of persons invited to participate has much more influence on screening attendance than gender. An analysis of surgical procedures indicates that it is more difficult to perform the low anterior resection of the rectum in men than women, with the result that men managed by less experienced surgeons are more likely to receive abdominoperineal excision. Furthermore, the risk of anastomotic leakage is higher in men than women. Conclusion: The essential gender difference, however, is the longer life expectancy of women compared to men which has been not always clearly (risk adjusted) elaborated in the studies available so far. This difference alone can already explain at a high rate the poorer prognosis of right-sided colon cancers compared to left-sided cancers. Comparable levels of CRC risk are reached in women as compared to men at a higher age. This may influence the effectiveness of screening programmes and has not been sufficiently examined. Evidence suggests the adaptation of screening recommendations to this fact. © Georg Thieme Verlag KG Stuttgart, New York.

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