University Clinic Aachen

Aachen, Germany

University Clinic Aachen

Aachen, Germany
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Fearon K.,Royal Infirmary | Strasser F.,Cantonal Hospital | Anker S.D.,Applied Cachexia Research | Anker S.D.,Center for Clinical and Basic Research | And 16 more authors.
The Lancet Oncology | Year: 2011

To develop a framework for the definition and classification of cancer cachexia a panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. Cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (body-mass index [BMI] <20 kg/m2) or skeletal muscle mass (sarcopenia). An agreement was made that the cachexia syndrome can develop progressively through various stages-precachexia to cachexia to refractory cachexia. Severity can be classified according to degree of depletion of energy stores and body protein (BMI) in combination with degree of ongoing weight loss. Assessment for classification and clinical management should include the following domains: anorexia or reduced food intake, catabolic drive, muscle mass and strength, functional and psychosocial impairment. Consensus exists on a framework for the definition and classification of cancer cachexia. After validation, this should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management. © 2011 Elsevier Ltd.

Flachskampf F.A.,Uppsala University | Wouters P.F.,Ghent University | Edvardsen T.,University of Oslo | Evangelista A.,University of Barcelona | And 5 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2014

With this document, we update the recommendations for transoesophageal echocardiography (TOE) of the European Association of Cardiovascular Imaging. The document focusses on the areas of interventional TOE, in particular transcatheter aortic, mitral, and left atrial appendage interventions, as well as on the role of TOE in infective endocarditis, adult congenital heart disease, and aortic disease. © The Author 2014.

Bellmunt J.,University of the Sea | Bolla M.,C.H.U. Grenoble | Joniau S.,University Hospital | Mason M.,Velindre Hospital | And 5 more authors.
European Urology | Year: 2011

Objectives: Our aim is to present a summary of the 2010 version of the European Association of Urology (EAU) guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC). Methods: The working panel performed a literature review of the new data emerging from 2007 to 2010. The guidelines were updated, and the levels of evidence (LEs) and/or grades of recommendation (GR) were added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. Results: Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care in metastatic prostate cancer (PCa). Although LHRH antagonists decrease testosterone without any testosterone surge, their clinical benefit remains to be determined. Complete androgen blockade has a small survival benefit of about 5%. Intermittent androgen deprivation (IAD) results in equivalent oncologic efficacy when compared with continuous androgen-deprivation therapy (ADT) in well-selected populations. In locally advanced and metastatic PCa, early ADT does not result in a significant survival advantage when compared with delayed ADT. Relapse after local therapy is defined by prostate-specific antigen (PSA) values >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir after radiation therapy (RT). Therapy for PSA relapse after RP includes salvage RT at PSA levels <0.5 ng/ml and salvage RP or cryosurgical ablation of the prostate in radiation failures. Endorectal magnetic resonance imaging and 11C-choline positron emission tomography/computed tomography (CT) are of limited importance if the PSA is <2.5 ng/ml; bone scans and CT can be omitted unless PSA is >20 ng/ml. Follow-up after ADT should include screening for the metabolic syndrome and an analysis of PSA and testosterone levels. Treatment of castration-resistant prostate cancer (CRPC) includes second-line hormonal therapy, novel agents, and chemotherapy with docetaxel at 75 mg/m2 every 3 wk. Cabazitaxel as a second-line therapy for relapse after docetaxel might become a future option. Zoledronic acid and denusomab can be used in men with CRPC and osseous metastases to prevent skeletal-related complications. Conclusion: The knowledge in the field of advanced, metastatic, and CRPC is rapidly changing. These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice. A full version is available at the EAU office or online at © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Herschorn S.,University of Toronto | Bruschini H.,University of Sao Paulo | Comiter C.,Stanford University | Grise P.,Service dUrologie | And 3 more authors.
Neurourology and Urodynamics | Year: 2010

Aims: The committee was charged with the responsibility of reviewing and evaluating all published data relating to surgical treatment of male urinary incontinence since the previous consultation in 2004. Methods: Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The articles were evaluated using Levels of Evidences adapted by the ICUD from the Oxford Centre for Evidence Based Medicine. The Recommendations for Care were based on the level of evidence and discussed among the committee members to reach consensus. The incontinence problems were classified according to their etiology, that is, either primarily sphincter or bladder related. Results: Specialist evaluation of the patient is primarily a clinical approach with history, frequency-volume chart, physical examination, and postvoid residual urine. Other investigations such as radiographic imaging of the lower urinary tract, cystoscopy, and urodynamic studies can provide important information for the clinician. For stress incontinence of various etiologies the artificial urinary sphincter (AUS) has the longest record of satisfactory results. Consideration must be given to the need for revisions for mechanical breakdown, erosion/infection, and recurrent incontinence, as well as cost. Sling procedures are increasingly being reported to have good outcomes for mild to moderate incontinence. Injectable agents have not shown durable results but newer technologies such as volume-adjustable balloons have shown favorable early results. Incontinence following cystectomy with neobladder and pelvic trauma has been treated most commonly with the AUS. Conclusions: Although the literature is replete with well-done cohort studies, there is a need for prospective randomized clinical trials. Recommendations for trials include standardized workup and outcome measures and complete reporting of adverse events and long-term results. Further research is also needed to elucidate the mechanism of post-prostatectomy incontinence. © 2009 Wiley-Liss, Inc.

Wierts R.,Maastricht University | de Pont C.D.J.M.,Maastricht University | Brans B.,Maastricht University | Mottaghy F.M.,Maastricht University | And 2 more authors.
Methods | Year: 2011

Advanced personalized dosimetry for molecular nuclear therapy has been shown to be feasible in clinical practice. At the same time instrumentation and dosimetric software are still evolving at a high pace. Procedures developed so far differ in approach and sophistication, and standard operating procedures necessary for accurate patient specific dosimetry do not yet exist. For this reason we restricted ourselves to reviewing the literature and highlighting relevant developments. © 2011 Elsevier Inc.

Schwantes U.,Dr. R. Pfleger GmbH | Grosse J.,University Clinic Aachen | Wiedemann A.,Witten/Herdecke University
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2015

Introduction and hypothesis: Unsatisfactory treatment outcome sometimes is described as frequently occurring in patients treated with first-line therapy for overactive bladder (OAB). The present article reviews the different circumstances which may result in failure to respond to lifestyle interventions, behavioral therapy, and/or antimuscarinic treatment. Methods: An extensive literature search was conducted to identify relevant articles on pathophysiological, clinical, and pharmacological aspects of refractory OAB. Results: Missing definition, unrealistic individual expectation of treatment outcomes, lack of communication between physician and patient as well as pathophysiological and pharmacological processes were identified as relevant for failure to respond to first-line OAB treatment. Increase of patient’s motivation to adhere to the prescribed treatment, critical examination of the patient in regard to the initial diagnosis, and individual adjustment of antimuscarinic therapy may be appropriate tools to improve treatment outcome in OAB patients. Conclusions: Overall, the incidence of refractory OAB seems to be overestimated. There are several approaches to improve therapy results. © 2015, The Author(s).

Schumann C.,University of Ulm | Hetzel M.,Red Cross | Babiak A.J.,Red Cross | Hetzel J.,University of Tübingen | And 5 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2010

Objective: In addition to use of a laser, argon plasma coagulation, electrocautery, or coring with a rigid bronchoscope, tumor debulking with a flexible cryoprobe is used for therapeutic bronchoscopy with an immediate effect for endobronchial pathologies. We performed this analysis to determine the usefulness, efficacy, and safety of the flexible cryorecanalization in a large population under routine conditions. Methods: We identified 225 bronchoscopic interventions that were done as cryorecanalization with a flexible cryoprobe. All patients had symptomatic airway stenosis. We determined the endoscopic success rate and safety (bleeding and perforation) of the procedure. Results: Successful cryorecanalization was achieved in 205 (91.1%) of 225 patients. The flexible cryoprobe was used with all patients, in most patients in combination with flexible bronchoscopy and only in a minority (n = 31, 13.8%) in combination with a rigid bronchoscope. Additional interventional techniques used were endobronchial stents (n = 11, 4.9%) and argon plasma coagulation (n = 37, 16.4%). Mild bleeding (if ice-cold NaCl or epinephrine solution was necessary) occurred in 9 (4.0%) patients, moderate bleeding (if argon plasma coagulation or a bronchus blocker was required) occurred in 18 (8.0%) patients, and severe bleeding (events with hemodynamic instability) never occurred. Conclusions: Cryorecanalization with the flexible cryoprobe for treatment of symptomatic endobronchial tumor stenosis is a safe technique with a high success rate and immediate treatment effect. © 2010 The American Association for Thoracic Surgery.

Bilalic M.,University of Tübingen | Turella L.,University of Ferrara | Campitelli G.,Edith Cowan University | Erb M.,University of Tübingen | Grodd W.,University Clinic Aachen
Human Brain Mapping | Year: 2012

Recognition of objects and their relations is necessary for orienting in real life. We examined cognitive processes related to recognition of objects, their relations, and the patterns they form by using the game of chess. Chess enables us to compare experts with novices and thus gain insight in the nature of development of recognition skills. Eye movement recordings showed that experts were generally faster than novices on a task that required enumeration of relations between chess objects because their extensive knowledge enabled them to immediately focus on the objects of interest. The advantage was less pronounced on random positions where the location of chess objects, and thus typical relations between them, was randomized. Neuroimaging data related experts' superior performance to the areas along the dorsal stream-bilateral posterior temporal areas and left inferior parietal lobe were related to recognition of object and their functions. The bilateral collateral sulci, together with bilateral retrosplenial cortex, were also more sensitive to normal than random positions among experts indicating their involvement in pattern recognition. The pattern of activations suggests experts engage the same regions as novices, but also that they employ novel additional regions. Expert processing, as the final stage of development, is qualitatively different than novice processing, which can be viewed as the starting stage. Since we are all experts in real life and dealing with meaningful stimuli in typical contexts, our results underline the importance of expert-like cognitive processing on generalization of laboratory results to everyday life. © 2011 Wiley Periodicals, Inc.

Kirschner-Hermanns R.,University Clinic Aachen | Najjari L.,RWTH Aachen | Brehmer B.,University Clinic Aachen | Blum R.,RWTH Aachen | And 3 more authors.
BJU International | Year: 2012

Objective: • To investigate the feasibility and inter-investigator reproducibility of perineal ultrasonography in men with and without post-prostatectomy urinary incontinence (PPI). Patients and Methods: • This clinical pilot study involved 33 male patients, with a mean (range) age of 67.8 (51-76) years, who underwent radical prostatectomy (RP) ≥1 year ago. • We investigated 21 men with clinically and urodynamically proven grade ≥2 PPI and compared them with 12 men without PPI in Objective testing as well as in validated questionnaires. • We used an abdominal 3.5-5 MHz ultrasound probe, which was placed at the perineum between scrotum and anus. With the help of three-/four-dimensional (3D/4D) multislice imaging we obtained good visualization of the bladder neck, the urethra and pelvic floor muscle contraction. • The data from all 33 men was evaluated by two investigators and archived images and videos were also analysed by two independent investigators not present at the actual investigation. Result • Using perineal ultrasonography we were able to visualize hypermobility of the proximal urethra, funnelling of the bladder neck, voluntary pelvic floor contraction, urethral and paraurethral fibrosis, and suture or sling material. • Men with and without PPI differed mainly in the degree of hypermobility of the proximal urethra and opening of the bladder neck. • Inter-investigator agreement was 100% in assessing paraurethral tissue and voluntary muscle contraction and 94% in quantifying mobility of the proximal urethra. • We were able to evaluate the bladder neck opening in 85% of the men. There was 82% agreement between the initial investigators in evaluation of the bladder neck and 76% in quantifying mobility of the proximal urethra using retrospective analysis of stored images. Conclusions: • Two-dimensional and 3D/4D perineal ultrasonography provides more insight into the diagnosis of men with PPI • Perineal ultrasonography can be used further as a visual aid for biofeedback to teach correct muscle contraction of men with stress incontinence after radical prostatectomy. © 2011 The Authors.

Heidenreich A.,University Clinic Aachen
European Urology, Supplements | Year: 2010

Context: Guidelines for the management of prostate cancer are based on specific levels of clinical evidence. Objective: This review examines the clinical evidence for the use of androgen-deprivation therapy (ADT) in prostate cancer (PCa). This is placed in the context of individual patient management and how guidelines should be adapted to optimise individual patient care. Evidence acquisition: During the 2010 Annual Congress of the European Association of Urology (EAU) in Barcelona, Spain, a satellite symposium was held on the individualised management of patients with PCa. This paper is based on one of the presentations at the symposium. Data were retrieved from recent review articles, original articles, and abstracts on adjuvant ADT in PCa. Evidence synthesis: ADT is one of the main treatment options for locally advanced and metastatic PCa. The EAU Guidelines recommend a risk adapted approach to the use of ADT in patients with locally advanced disease and in those with prostate-specific antigen (PSA) relapse following radical prostatectomy. ADT provides specific benefits in patients with a PSA rise following radical prostatectomy, such as poorly differentiated PCa (Gleason score 8-10) and a very short PSA doubling time (<12 mo). The use of immediate versus deferred ADT in locally advanced disease remains controversial, while intermittent ADT can be considered for patients with both PSA rise following local treatment or metastatic disease. Individualised patient care management is required in the modern day use of ADT in men with PCa and a balance has to be reached between the risks and benefits so that appropriate patient populations can be targeted. Patients should be actively involved in such treatment-making decisions. Conclusions: ADT is still the standard of care for non-localised PCa, but treatment strategies should be adapted to individual patient profiles. Androgen-deprivation therapy is still the standard of care for non-localised prostate cancer, but individualised patient care management is required. A balance needs to be reached between the risks and benefits so that appropriate patient populations can be targeted. Specific benefits are noted in patients with a prostate-specific antigen (PSA) rise following radical prostatectomy, poorly differentiated prostate cancer (Gleason score 8-10) and very short PSA doubling time (<12 mo). © 2010 European Association of Urology.

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