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Berlin, Germany

Knoll N.,Charite - Medical University of Berlin | Burkert S.,Charite - Medical University of Berlin | Scholz U.,University of Bern | Roigas J.,Vivantes Klinikum Am Urban | Gralla O.,Urologie am Ring
Anxiety, Stress and Coping | Year: 2012

The dual-effects model of social control states that receiving social control leads to better health behavior, but also enhances distress in the control recipient. Associated findings, however, are inconsistent. In this study we investigated the role of relationship satisfaction as a moderator of associations of received spousal control with health behavior and affect. In a study with five waves of assessment spanning two weeks to one year following radical prostatectomy (RP), N=109 married or cohabiting prostate-cancer patients repeatedly reported on their pelvic-floor exercise (PFE) to control postsurgery urinary incontinence and affect as primary outcomes, on received PFE-specific spousal control, relationship satisfaction, and covariates. Findings from two-level hierarchical linear models with repeated assessments nested in individuals suggested significant interactions of received spousal control with relationship satisfaction predicting patients' concurrent PFE and positive affect. Patients who were happy with their relationships seemed to benefit from spousal control regarding regular PFE postsurgery while patients less satisfied with their relationships did not. In addition, the latter reported lower levels of positive affect when receiving much spousal control. Results indicate the utility of the inclusion of relationship satisfaction as a moderator of the dual-effects model of social control. © 2012 Copyright Taylor and Francis Group, LLC.

Schmidt M.,Klinikum Munich Bogenhausen | Dorwarth U.,Klinikum Munich Bogenhausen | Andresen D.,Vivantes Klinikum Am Urban | Brachmann J.,Klinikum Coburg | And 7 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2014

German Ablation Registry-Different Energy Sources in AF Ablation Background Catheter ablation is used extensively with curative intention in atrial fibrillation. Radiofrequency ablation has long been a standard of care, while cryoballoon technology has emerged as a feasible approach with promising results. Prospective multicenter registry data referring to both ablation technologies in AF ablation therapy are lacking. Methods Between January 2007 and August 2011, a total of 3,775 consecutive patients with symptomatic paroxysmal AF who underwent PV ablation in their respective centers were enrolled. The cohort was divided into 2 groups according to the ablation energy source used: cryoballoon ablation (group 1, n = 905 [24.0%], median age 63 years, 64.3% men) and RF ablation (group 2, n = 2870 [76.0%], median age 63 years, 62.7% men). Comorbidities and baseline clinical characteristics were similar in both groups. Results Acute success rate was similar in both groups (97.5% in cryo vs 97.6% in RF; P = 0.81). Procedure times were similar, ablation and fluoroscopy times were higher in cryoballoon when compared to RF ablation. Overall complication rate was similar in cryo- (4.6%) and RF-ablation (4.6%; P = 1.0). Phrenic nerve palsy was more often in cryo versus RF ablation (2.1% in cryo vs 0.0% in RF; P < 0.001). Other complications were more common in RF compared to cryoablation (4.6% in RF vs 2.7% in cryo; P < 0.05). Conclusion RF ablation is the most widespread ablation method in Germany, but use of cryoballoon increased significantly. Procedure times were similar, but ablation and fluoroscopy times were longer in cryoballoon ablation. No significant differences were found in terms of acute success and overall complication rate. © 2014 Wiley Periodicals, Inc.

Powles T.,St. Bartholomews Hospital | Bascoul-Mollevi C.,Biostatistics Unit | Kramar A.,Center Oscar Lambret | Lorch A.,University of Marburg | Beyer J.,Vivantes Klinikum Am Urban
Journal of Cancer Research and Clinical Oncology | Year: 2013

Purpose: To evaluate the impact of age and LDH levels in patients with relapsed seminoma. Methods: Data on the 204 seminoma from the International Prognostic Factor Study Group (IPFSG) were analyzed. All patients experienced unequivocal relapse/progression after at least three cisplatin-based chemotherapy cycles. Age and LDH at relapse were assessed in addition to previously identified prognostic factors for all germ cell tumor patients from the database (J Clin Oncol 28:4906, 2010). Results: The impact of the IPFSG score remained highly significant in multivariate analysis. In addition, LDH ≥1.5 times the upper limit of normal (ULN) was significant in univariate (HR 1.96; CI 1.06-3.61) and multivariate analysis (HR 1.90; CI 1.00-3.62). Age, however, was not significant. Therefore, LDH was incorporated into a modified new IPFSG seminoma score by moving patients to the next unfavorable group for patients with LDH values ≥1.5 × ULN. Three prognostic groups were thus generated, which better subdivided seminoma patients than the original IPFSG score. Progression-free survival at 2 years: "very low risk" (n = 23) 85.7 % (95 % CI 62-95), "low risk" (n = 44) 62.7 % (95 % CI 46-75) and "intermediate risk" (n = 36) 35.1 % (95 % CI 20-51). Overall survival at 3 years: "very low risk" 88.8 % (95 % CI 62-97), "low risk" 71.3 % (95 % CI 55-83) and "intermediate risk" 51.3 % (95 % CI 33-67). Conclusion: The addition of LDH, but not age, improves the impact of the IPFSG prognostic score in seminoma patients relapsing or progressing after cisplatin-based chemotherapy. © 2013 Springer-Verlag Berlin Heidelberg.

Objective: All antimycotic therapies for chronic recurrent vulvovaginal candidosis (CRVS) are unsatisfactory as long as there is no immunotherapy. Methods: Three groups of 30 non-pregnant women aged between 18 and 67 years (6 post-menopausal, but with hormone replacement therapy) with CRVC were investigated in 2002 and 2003 by vaginal smear, yeast culture with species determination, the measurement of interleukin (IL) 10, 12, 13 and 16, vaginal and peripheral secretory IgA (sIgA), peripheral T-leucocyte subpopulations, IgM, IgA and IgG prior to treatment, and 612 weeks and 12 months after treatment. All patients answered validated questionnaires about their health (SF-36) and quality-of-life (PLC) and 20 own non-validated questions about their candidosis, sexuality and quality-of-life. Lactobacillus vaccination consisting of 710 9 inactivated lactobacilli of 8 species (Gynatren, Strathmann, Hamburg, Germany) was administered 3 times by intramuscular injection every 2 weeks (group 1). Group 2 had heliotherapy performed according to skin type with suberythematous doses of ultraviolet A and B rays administered 3times per week for 6 weeks (Tancan 8000, Dr.Kern, Driedorf, Germany). Ciclopyroxolamine (100mg) vaginal tablets (Taurus Pharma, Frankfurt, Germany) were given once a day for 6 days to patients in group 3. Results: Clinical signs of CRVC decreased significantly from a mean of 6.3 to 1.5/year in all groups, but vaginal yeast cultures did not. Quality-of-life and health status scores were significantly better after treatment in groups 1 and 2 with a slightly higher improvement in group 1. Peripheral Tlymphocytes were unsignificantly activated inall groups. Vaginal IL-13 as a mediator of allergy decreased significantly in groups 1 and 2 and this decrease correlated with clinical success. Anti-inflammatory IL-10 decreased in all groups but this decrease was not significant. Many patients suffered from symptoms but had negative yeast cultures. Conclusion: Immunomodulation with the injection of a lactobacillus vaccine or heliotherapy and intensive personal care can help to improve the quality-of-life of patients with CRVC. © Georg Thieme Verlag KG Stuttgart New York.

Lorch A.,Universitatsklinikum Giessen | Rick O.,Klinik Reinhardshohe | Wundisch T.,Universitatsklinikum Giessen | Hartmann J.-T.,University Hospital of Tuebingen | And 2 more authors.
Journal of Urology | Year: 2010

Purpose: We assessed the activity of high dose chemotherapy in patients with unresectable late relapse germ cell tumors. Materials and Methods: A total of 35 patients with late relapse were included in a group of 216 treated with high dose chemotherapy as first or subsequent salvage treatment in a prospective, randomized, multicenter phase III trial comparing single vs sequential high dose chemotherapy. Late relapse was defined as unequivocal evidence of relapse more than 2 years after completion of cisplatin based chemotherapy. All patients were considered to have unresectable, progressive, late relapse germ cell tumors. Responders were scheduled for surgical resection of all residual lesions when technically feasible. Results: We identified 4 late relapse groups, including late relapse in 20 of 35 patients (57%) after first line treatment (group 1), in 4 (11%) after first salvage treatment (group 2), in 4 (11%) after initial and after first salvage treatment (group 3), and in 7 (20%) after first line treatment and salvage treatment with rapid progression thereafter who were randomized to a high dose chemotherapy trial (group 4). Median time to late relapse was 4.7 years (range 2.1 to 18.3) in all groups. Resection of all residual lesions could be done in 15 of 35 patients (43%). At a median followup of 5.6 years (range 1.9 to 8.5) 5 of 35 patients (14%) had no progression, resulting in 15% projected progression-free survival. Conclusions: Management for unresectable late relapse germ cell tumors remains controversial. High dose chemotherapy followed by resection of all residual lesions can result in long-term remission in individuals. © 2010 American Urological Association Education and Research, Inc.

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