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Abstract
CONTEXT Treatment of obesity requires long-term therapy, which can be hampered by difficulties in achieving patient compliance. The effectiveness of sibutramine hydrochloride in treating obesity has been shown in randomized controlled trials. OBJECTIVE To compare the effectiveness of 2 distinct sibutramine regimens with each other and with placebo for weight reduction among obese persons. DESIGN Randomized, double-blind, parallel-group placebo-controlled trial from April 1997 to September 1998. SETTING One hundred eight private practices and 3 outpatient departments of university hospitals in Germany. PATIENTS A total of 1102 obese adults (body mass index, 30-40 kg/m(2)) entered the 4-week open-label run-in period with 15 mg/d of sibutramine, 1001 of whom had weight loss of at least 2% or 2 kg were randomized into the 44-week randomized treatment period. INTERVENTIONS Patients were randomly assigned to receive 15 mg/d of sibutramine continuously throughout weeks 1-48 (n = 405); 15 mg/d of sibutramine intermittently during weeks 1-12, 19-30, and 37-48, with placebo during all other weeks (n = 395); or placebo for weeks 5-48 (n = 201). MAIN OUTCOME MEASURE Weight loss during the randomized treatment period, compared among all 3 groups. RESULTS Mean weight loss in the intention-to-treat population during the 44-week randomized treatment period was 3.8 kg (4.0%) in patients receiving continuous therapy (95% confidence interval [CI], - 4.42 to - 3.20 kg) and was 3.3 kg (3.5%) in patients receiving intermittent therapy (95% CI, - 3.96 to - 2.66 kg), vs a mean weight gain of 0.2 kg (0.2%) (95% CI, - 0.60 to 0.94 kg) in patients receiving placebo. Therapeutic equivalence of the 2 active treatments could be shown. Although there was a greater weight loss in the continuous than in the intermittent group, this difference was nonsignificant (P =.28) and the 95% CIs were within the predefined range of therapeutic equivalence-0 +/-1.5 kg (-1.37 to 0.28 for the intent-to-treat population). Overall weight loss during the 48-week period was 7.9 kg and 7.8 kg in the continuous and intermittent groups, respectively, but was 3.8 kg in the sibutramine run-in placebo group. Waist circumference reduction, triglyceride levels, and high-density lipoprotein cholesterol concentrations were also positively influenced by sibutramine treatment. Systolic and diastolic blood pressures were stable across all 3 groups. Overall, adverse events occurred at similar frequencies across all treatment groups, but the proportion was lowest in the group receiving intermittent therapy. CONCLUSIONS Sibutramine, administered for 48 weeks to a typically obese population, results in clinically relevant weight loss compared with placebo. Regarding effectiveness, continuous and intermittent sibutramine therapies are equivalent and the safety profiles for both treatments are comparable.
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Ritchie DS, Wirth A, Grigg AP. Successful transplant outcome in a morbidly obese patient with acute myeloblastic leukemia. Leuk Lymphoma 2001; 42:1111-4. [PMID: 11697629 DOI: 10.3109/10428190109097732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a case of matched unrelated bone marrow transplant (BMT) in a morbidly obese patient with acute myeloblastic leukaemia. The challenges presented in the management of this case included the calculation of chemotherapy and radiotherapy doses and the acute presentation of obstructive sleep apnea. Despite these difficulties, an ultimately successful outcome was obtained, indicating that although associated with increased risk of peri-transplant morbidity, obesity need not represent a contraindication to BMT.
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Seymour JF, Solomon B, Wolf MM, Janusczewicz EH, Wirth A, Prince HM. Primary large-cell non-Hodgkin's lymphoma of the testis: a retrospective analysis of patterns of failure and prognostic factors. CLINICAL LYMPHOMA 2001; 2:109-15. [PMID: 11707851 DOI: 10.3816/clm.2001.n.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have analyzed 25 patients with primary testicular large-cell non-Hodgkin's lymphoma managed at our institution from 1972-1998. The median age was 69 years, with bilateral testicular involvement in 16%. The disease stage was I in 56%, II in 32%, and IV in 12%. Twenty-four patients received further therapy after orchiectomy, including chemotherapy in 18 and radiation therapy in 11 (encompassing regional nodes in 8 and the contralateral testis in 6), with 5 patients receiving both modalities. The complete remission rate was 88%, but a continuous pattern of recurrence is evident up to 10 years, when only 23% of patients are predicted to be in ongoing remission. The dominant sites of first failure were extranodal (91%), with prominent involvement of the contralateral testis and cerebral parenchyma. The 10-year overall survival rate is 32%, and the median overall survival is 4.4 years. Within the entire cohort, adverse prognostic factors for treatment failure were serum albumin < or = to 3.5 g/dL (P = 0.02), advanced age, advanced stage, and lack of anthracycline-containing chemotherapy (each P < or = to 0.3). Among patients with locoregional disease, albumin < or = to 3.5 g/dL (P = 0.08), no anthracycline-containing chemotherapy (P = 0.15), and fewer than 6 cycles of chemotherapy (P = 0.03) remained predictive. Based on this analysis, we are prospectively evaluating a treatment program for patients with testicular non-Hodgkin's large-cell lymphoma comprising (1) 6 cycles of anthracycline-based chemotherapy, (2) prophylactic radiation therapy to the contralateral testis, and (3) central nervous system prophylaxis with both intrathecal chemotherapy and systemic high-dose methotrexate.
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Mac Manus MP, Hicks RJ, Ball DL, Kalff V, Matthews JP, Salminen E, Khaw P, Wirth A, Rischin D, McKenzie A. F-18 fluorodeoxyglucose positron emission tomography staging in radical radiotherapy candidates with nonsmall cell lung carcinoma: powerful correlation with survival and high impact on treatment. Cancer 2001; 92:886-95. [PMID: 11550162 DOI: 10.1002/1097-0142(20010815)92:4<886::aid-cncr1397>3.0.co;2-v] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Successful treatment of nonsmall cell lung carcinoma (NSCLC) with radical radiotherapy (RT) requires accurate delineation of tumor extent. Conventional computed tomography-based noninvasive staging often estimates intrathoracic thoracic tumor extent incorrectly and fails to detect distant metastasis. High sensitivity and specificity are reported for F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) staging in potentially resectable NSCLC. The authors investigated FDG-PET staging in radical RT candidates with unresectable NSCLC. METHODS The authors prospectively studied 153 consecutive patients with unresectable NSCLC who were candidates for radical RT after conventional staging and had PET scans. Patients were allocated both "before PET" and "after PET" stages. Subsequent management was recorded. Survival analysis was used to compare validity of pre-PET and post-PET staging. RESULTS After PET, 107 patients (70%) actually received radical therapies (radical RT with or without concurrent chemotherapy, n = 102; radical surgery, n = 5); 46 patients (30%) received palliative treatment because of PET-detected distant metastasis (n = 28; 18%) or extensive locoregional disease (n = 18; 12%). Palliative therapies were RT (n = 33), chemotherapy (n = 12), or supportive care (n = 1). All five surgically treated patients underwent potentially curative resections after downstaging by PET. For radically treated patients, post-PET stage (P = 0.0041) but not pre-PET stage (P = 0.19) was strongly associated with survival. Radically treated patients survived longer than those treated palliatively (P = 0.02; 1-year survival, 69% and 44%, respectively; 2-year survival, 44% radical; no palliative patients had 2-yr follow-up). CONCLUSIONS Positron emission tomography-assisted staging detected unsuspected metastasis in 20%, strongly influenced choice of treatment strategy, frequently impacted RT planning, and was a powerful predictor of survival. Potential impact of FDG-PET is even greater in radical RT candidates with NSCLC than in surgical candidates.
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Christie DR, Wirth A. The Australasian Radiation Oncology Lymphoma Group: an evolving role. AUSTRALASIAN RADIOLOGY 2001; 45:265-7. [PMID: 11531746 DOI: 10.1046/j.1440-1673.2001.00918.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gandjour A, Westenhöfer J, Wirth A, Fuchs C, Lauterbach KW. Development process of an evidence-based guideline for the treatment of obesity. Int J Qual Health Care 2001; 13:325-32. [PMID: 11560352 DOI: 10.1093/intqhc/13.4.325] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To present the development process, summarize the content and discuss the implications of the German evidence-based guideline for the treatment of obesity. DESIGN The target audience and the development process were defined by a multidisciplinary team of experts. A systematic search of the literature was performed to identify relevant clinical articles. The validity of published studies was systematically evaluated. After developing the draft, an external peer review process was initiated. RESULTS Three versions of the guideline were published; an expert version, a short version tailored to primary care physicians and a patient version supporting patient participation in the decision-making process. Total development, printing and distribution costs xvere estimated to be 300,000 Euro. CONCLUSIONS The guideline raises the awareness of obesity and related comorbidities in Germany and may improve the quality of care for obese patients. The development process could serve as an efficient model for other guideline developers.
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Dowling AJ, Prince HM, Wirth A, Wolf M, Januszewicz EH, Juneja S, Seymour JF, Gates P, Smith JG. High-dose therapy and autologous transplantation for lymphoma: The Peter MacCallum Cancer Institute experience. Intern Med J 2001; 31:279-89. [PMID: 11512599 DOI: 10.1046/j.1445-5994.2001.00066.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND High-dose therapy (HDT) with autologous bone marrow or blood cell transplantation for the treatment of lymphoma commenced at Peter MacCallum Cancer Institute in 1986. AIM To examine the patient characteristics and outcomes of patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) treated with HDT and autologous transplantation at our Institute in the first 10 years of the service (1986-95). METHODS A retrospective analysis was performed examining patient characteristics, prior chemotherapy regimens, pretransplant disease status, HDT regimen, source of stem cells, time for haematopoietic recovery, complications of transplantation, response rates, overall survival (OS) and progression-free survival (PFS). RESULTS Sixty-seven patients with NHL were treated with an estimated 5-year OS rate of 44% (95% confidence interval (CI) 32-56%) and PFS rate of 34% (95% CI 21-44%). Factors independently predictive of an unfavourable PFS on multivariate analyses were presence of constitutional symptoms at transplant (P < 0.002) and chemotherapy-resistant disease at transplant (P = 0.02). Twenty-three patients with HD were treated with a 5-year predicted OS rate of 74% (95% CI 56-92%) and PFS rate of 57% (95% CI 36-77%). There was no difference in PFS for HD patients who relapsed either within 12 months of completion of front-line therapy or after this time (P= 0.5). The transplant-related mortality for the entire cohort was 17%, with a progressive decrease over time. CONCLUSION HDT with autologous transplantation achieves durable PFS and OS in patients with lymphoma. Improved patient selection, therapy modifications according to prognostic factors and ongoing improvements in supportive care should improve outcomes further.
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MacManus MP, Hicks RJ, Matthews JP, Hogg A, McKenzie AF, Wirth A, Ware RE, Ball DL. High rate of detection of unsuspected distant metastases by pet in apparent stage III non-small-cell lung cancer: implications for radical radiation therapy. Int J Radiat Oncol Biol Phys 2001; 50:287-93. [PMID: 11380213 DOI: 10.1016/s0360-3016(01)01477-8] [Citation(s) in RCA: 247] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Most radical radiotherapy (RT) candidates with non-small-cell lung cancer (NSCLC) have Stage III disease and ultimately die with distant metastases. We tested the hypothesis that positron emission tomography (PET) using 18-F fluorodeoxyglucose (FDG) would detect more unsuspected metastases in apparent Stage III disease than in Stages I-II. METHODS AND MATERIALS Staging FDG-PET was performed for 167 NSCLC patients, with Stage I-III by conventional workup, who were candidates for curative therapy with surgery (n = 8), radical chemo/RT or RT (n = 156), or preoperative chemo/RT (n = 3). Each patient was allocated a conventional "pre-PET stage" and a "post-PET stage" that relied on PET when discordance with conventional staging occurred. RESULTS Stage distribution pre-PET was n = 39 (Stage I), n = 28 (Stage II), and n = 100 (Stage III). In 32 patients (19%), PET detected distant metastasis, most commonly abdominal with 17 cases (adrenal, n = 7; liver, n = 4; other, n = 6). Other sites included lung (n = 10) and bone (n = 6). PET-detected metastasis increased with increasing pre-PET stage from I (7.5%) through II (18%) to III (24%, p = 0.016), and, in particular, was significantly higher in Stage III (p = 0.039). Biopsy confirmation was not routine, but progression occurred at PET-detected metastatic sites or other metastatic sites in all but 3 of the 32 patients by last review. CONCLUSION PET staging is recommended for radical RT candidates with NSCLC. The highest yield of unexpected distant metastases is observed in Stage III.
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Grossi M, Millward M, Fisher R, Porceddu S, Mac Manus M, Ryan G, Wirth A, Ball D. Combined modality treatment using concurrent radiotherapy and pharmacologically-guided carboplatin for inoperable and incompletely resected non-small cell lung cancer. Lung Cancer 2001; 31:73-82. [PMID: 11162869 DOI: 10.1016/s0169-5002(00)00164-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In our previous randomised trial, radiotherapy (RT) was given concurrently with carboplatin 350 mg/m(2). We wanted to show that the safety and efficacy of the drug could be improved by pharmacologically-guided dosing based on renal function. PATIENTS AND METHODS Patients were eligible if they had unresectable or incompletely resected NSCLC, good performance status (ECOG 0-2), weight loss < 10%, no distant metastases and adequate haematology and biochemistry. Radiotherapy was given to the primary site and regional lymph nodes to a total dose of 60 Gy in 30 fractions over 6 weeks. Two cycles of carboplatin were given in divided doses of 1-h infusions daily for 5 days before RT weeks 1 and 6. A total plasma AUC of 7 mg/ml per minute per cycle was targeted. The total dose was calculated by using Calvert or Chatelut formulae. RESULTS Forty-nine patients were treated. Patient characteristics included: 78% male; mean age 66 (range: 38--78); 80% stage 3A or 3B; incomplete resection in six patients. The median dose of carboplatin administered per cycle was 850 mg (range 435--1650); 89% of patients received a higher carboplatin dose compared with BSA-calculated dose (mean increase 41%). Forty-two patients (86%) completed treatment as planned. Myelosuppression > or = grade 3 occurred in 14 patients (29%) (one patient died of pneumonia while neutropenic); two patients developed > or = grade 3 acute oesophagitis and two patients had > or = grade 3 acute pulmonary toxicity. Late pulmonary toxicity > or = grade 3 occurred in two patients. The mean potential follow-up time was 2.7 years. The estimated proportion of patients alive and free of local or distant progression at 1 year was 42% and the median survival duration was 16 months (95% CI: 11--21 months). CONCLUSIONS Radical chest irradiation can be combined with two cycles of pharmacologically-guided full-dose carboplatin, however because our study demonstrated significant haematologic toxicity, we recommend carboplatin dosing according to renal function at less than full dose (i.e. AUC 6 mg/ml per minute per cycle).
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Wirth A. [Hypertension in obesity. Weight reduction, then blood pressure returns to normal!. Interview by Eckhard Böttcher-Bühler]. MMW Fortschr Med 2000; 142:47-8. [PMID: 11107824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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136
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Ball D, Bowden P, Fisher R, Andrews J, Duchesne G, Mac Manus M, Millward M, Wirth A, McKenzie A. Interclinician variation in lung tumour volume determination using a 3-D treatment planning system. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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137
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Ball D, Millward M, Smith J, Mac Manus M, Wirth A, Ryan G, Toner G, Rischin D. Dose escalation study of concurrent carboplatin and fluorouracil with radical radiotherapy [RT] in non-small cell lung cancer. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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138
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Hewstone M, Hassebrauck M, Wirth A, Waenke M. Pattern of disconfirming information and processing instructions as determinants of stereotype change. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2000; 39 ( Pt 3):399-411. [PMID: 11041010 DOI: 10.1348/014466600164561] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This experiment examined the effects of pattern of disconfirming information (concentrated vs. dispersed) and processing instructions (focus on similarities vs. differences vs. control) on stereotype change. If subtyping and perceived typicality are central to the stereotype change process, then processing instructions designed to affect these processes should affect stereotyping. There was lower stereotyping when perceivers focused on similarities between group members, and after exposure to a dispersed pattern of disconfirming information. Only the main effect of pattern was mediated by the perceived typicality of disconfirmers, but not by an index of subtyping based on clustering of information from disconfirmers in recall. Results support a model of stereotype change in terms of the impact of disconfirming group members who are also seen as typical of the group; subtyping of extreme disconfirmers may work in parallel, or later, and contribute to the long-term maintenance of a stereotype.
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Wirth A, Sharma AM, Schunkert H. [Cardiomyopathy in obesity--a disease entity?]. Dtsch Med Wochenschr 2000; 125:944-9. [PMID: 10967959 DOI: 10.1055/s-2000-7047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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140
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Mac Manus M, Hicks R, Matthews J, Hogg A, McKenzie A, Wirth A, Ware R, Ball D. High rate of detection of unsuspected distant metastases by pet in apparent stage III non small cell lung cancer: Implications for radical radiation therapy. Int J Radiat Oncol Biol Phys 2000. [DOI: 10.1016/s0360-3016(00)80052-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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141
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Wirth A, Moers O, Jones PG, Blaschette A. Polysulfonylamines. CXIV.trans-Dimethyltetrakis(urea-O)tin(IV) bis[di(methanesulfonyl)amidate] acetonitrile monosolvate. Acta Crystallogr C 1999. [DOI: 10.1107/s0108270199011634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Baethmann A, Chapuis D, Wirth A. System analysis of patient management during the pre- and early clinical phase in severe head injury. ACTA NEUROCHIRURGICA. SUPPLEMENT 1999; 73:93-7. [PMID: 10494349 DOI: 10.1007/978-3-7091-6391-7_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Head injury with or without polytrauma is the most important cause of death and severe morbidity in an age bracket of up to 45 years. Two major factors are determining its outcome, the extent and nature of the primary irreversible brain injury, and the subsequently developing manifestations of secondary brain damage, which in principle can be prevented by the management procedures and therapeutical interventions. Therefore, a better outcome from severe head injury depends exclusively on a higher efficiency of the management and treatment in order to inhibit secondary brain damage. In a novel nationwide research program on "Neurotraumatology and Neuropsychological Rehabilitation" sponsored by the Federal Government, the University of Munich in collaboration with the Max-Planck-Institute of Neurobiology, Martinsried, formed a research consortium with major city hospitals in Munich, Augsburg, Ingolstadt, Murnau, Vogtareuth, and the Southern Bavaria rural area, which are caring for neurotrauma patients with severe head- or spinal cord injury. Together with the corresponding rescue- and emergency organizations, such as the Red Cross, fire brigades, etc. the consortium is carrying out a system analysis as a joint venture on the organization, logistics, management, patient referral, etc. in severe head injury. The analysis includes the assessment of outcome-relevant time intervals of providing emergency care during the preclinical phase until admission of the patient to the hospital, until termination of the diagnostic procedures after hospital admission, and of the clinical management. The present findings and results are based on these comprehensive investigations by the study group in collaboration with more than 30 hospitals, institutions, organizations, and of more than forty physicians, students, and statisticians. In total 194 patients suspected to suffer from severe head injury were prospectively documented with onset of the assessment in the preclinical rescue phase. Confirmation of severe head injury according to a priori established selection criteria was obtained in 100 patients, the remaining number of cases was excluded. The protocol by purpose did not impose study-specific requirements outside of the routine procedures, which are established for the preclinical care and early hospital management. An exception, however, was to collect arterial blood samples, if possible prior to intubation and ventilation, or administration of O2, in order to obtain early information on the acute respiratory state as a potential risk factor of the outcome. Arterial blood samples could be collected in 60 cases at the scene, in no less than 37 patients prior to intubation and ventilation. The data collected during the prehospital and early clinical phase on the temporal course of these patients provide valuable information with unmatched accuracy for evaluation of the management efficiency of the rescue system, transportation, and the clinical care. In conclusion, the prospective system analysis on the organization and management of patients with severe head injury is the first study of this type carried out in Germany. Due to the specific efforts of quasi on-line documentation of the patients' state and course of events, beginning at the scene of an accident and covering the first days at the hospital, data of high quality were obtained. The data flow during the investigation was maintained among others by regular conferences of the Study Group including the crew of documentation assistants at regular intervals. The presently reported phase-1 study was concluded in October 1997. It is followed by a phase-2 study with the attempt to collect prehospital- and early clinical management and care data in the catchment area on an epidemiological basis. (ABSTRACT TRUNCATED)
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Wirth A. [Comment of J. Fritze: Is therapy of obesity with orlistat medically necessary?]. VERSICHERUNGSMEDIZIN 1999; 51:137-8; author reply 138-9. [PMID: 10516837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Wirth A, Wolf M, Prince HM. Current trends in the management of early stage Hodgkin's disease. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1999; 29:535-44. [PMID: 10868532 DOI: 10.1111/j.1445-5994.1999.tb00755.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tennagels N, Hube-Magg C, Wirth A, Noelle V, Klein HW. Expression, purification, and characterization of the cytoplasmic domain of the human IGF-1 receptor using a baculovirus expression system. Biochem Biophys Res Commun 1999; 260:724-8. [PMID: 10403833 DOI: 10.1006/bbrc.1999.0968] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The cytoplasmatic domain of the beta-subunit of the human IGF-1 receptor (residues 929-1337) has been overexpressed in insect cells using the baculovirus expression system. Synthesis of the soluble protein (IGFK, M(r) 46 kDa) in Spodoptera frugiperda (Sf9) cells was detected 24 h after infection and maximal accumulation was achieved 40-48 h postinfection. Rapid purification to near homogeneity (>/=95% pure protein) was accomplished by sequential chromatography on Resource-Q and phenyl-Sepharose with a specific activity of 142 nmol/min/mg using poly[Glu:Tyr] as substrate. The purified IGFK showed a preference for Mn(2+) ions and a linear incorporation of (32)P from [gamma-(32)P]ATP over a 20-fold dilution of the protein and was stimulated 20-fold by the polycation poly-L-lysine. Interestingly, the kinase autophosphorylated on tyrosine and serine residues. In contrast, a kinase-negative mutant, IGFK-K1003A, did not undergo phosphorylation on tyrosine or serine residues, respectively, suggesting that IGF-1 receptor kinase is a dual specific kinase.
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Christie DR, Barton MB, Bryant G, Cheuk R, Gebski V, Hornsey J, Lonergan D, MacLeod C, Pratt G, Roos D, Shannon J, Thornton D, Wirth A. Osteolymphoma (primary bone lymphoma): an Australian review of 70 cases. Australasian Radiation Oncology Lymphoma Group (AROLG). AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1999; 29:214-9. [PMID: 10342020 DOI: 10.1111/j.1445-5994.1999.tb00686.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To examine prognostic factors, treatment outcomes and design future studies for Osteolymphoma (OL)--also known as primary bone lymphoma. METHODS Between 1979 and 1993, 70 patients with OL were treated in nine Australian centres. The effect of patient-, tumour-, and treatment-related factors on local control, distant disease-free survival and overall survival were assessed by multivariate analysis. RESULTS Most patients (94%) received radiotherapy (RT) (median dose 40 Gy) and 56% received chemotherapy. Multifocal disease was present in 20% of patients. The five year rates of overall survival and local control were 59% and 82%. Although there was a trend towards better results with the addition of chemotherapy, on multivariate analysis, there were no factors identified which appeared to impact upon overall and disease-free survival. Among the distant recurrences, there was a high proportion in bone (33%). Six patients suffered pathological fractures after treatment. CONCLUSION High rates of local control were achieved by RT, but the overall survival remains relatively poor, worse than nodal lymphoma. The natural history of the disease suggests that OL may be a distinct entity, different to nodal lymphomas, so the results of clinical trials in nodal lymphoma may not be relevant to OL. Prospective studies could define the outcome of combined modality therapy and set a benchmark for testing further proposals, as well as improving our knowledge of the clinical features of OL.
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Wirth A, Teo A, Wittwer H, MacManus M, Ryan G. Gastric irradiation for MALT lymphoma: reducing the target volume, fast! AUSTRALASIAN RADIOLOGY 1999; 43:87-90. [PMID: 10901877 DOI: 10.1046/j.1440-1673.1999.00600.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma treated with radiotherapy alone is reported here. This case highlights treatment issues related to the variability in size and position of the stomach, and the substantial reduction in the size of the irradiated volume achieved by treating the patient in a fasting state.
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Wirth A, Chao M, Corry J, Laidlaw C, Yuen K, Ryan G, Byram D, Davis S, Kiffer J, Quong G, Liew K. Mantle irradiation alone for clinical stage I-II Hodgkin's disease: long-term follow-up and analysis of prognostic factors in 261 patients. J Clin Oncol 1999; 17:230-40. [PMID: 10458238 DOI: 10.1200/jco.1999.17.1.230] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate mantle radiotherapy (MRT) alone as the initial therapy of patients with clinical stage (CS) I-II Hodgkin's disease (HD). PATIENTS AND METHODS We performed a retrospective study of patients treated with MRT alone for CS I-II supradiaphragmatic HD between 1969 and 1994. Prognostic factor analysis was performed for progression-free survival (PFS) and overall survival (OS). Outcome was also assessed in favorable cohorts defined in the literature. RESULTS There were 261 eligible patients. The median follow-up period for surviving patients was 8.4 years (range, 1.8 to 27.4 years). The 10-year OS rate was 73%. Multifactor analysis for OS showed that age was the only important prognostic factor. The 10-year PFS rate was 58%. On multifactor analysis for PFS, the most important prognostic factors were clinical stage, B symptoms, histology, number of sites, and tumor bulk. The 10-year PFS rate for lymphocyte-predominant disease was 81% for stage I and 78% for stage II. In favorable patient cohorts defined in the literature, the 10-year PFS rate ranged from 70% to 73% for the whole group and from 71% to 90% in patients with favorable stage I disease, but only from 48% to 57% in patients with favorable stage II disease. On competing-risks analysis, the cumulative 10-year incidence of first site of failure in the para-aortic/splenic region alone was 10.5%. Sixty percent of relapsed patients remain progression-free at 10 years after chemotherapy salvage. CONCLUSION These results support the use of MRT alone in patients with favorable CS I HD and CS I-II HD with lymphocyte-predominant histology. The remainder of patients with CS I-II HD require more intensive treatment.
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Wirth A, Prince HM, Wolf M. Treatment of intermediate-grade and high-grade non-Hodgkin's lymphoma. N Engl J Med 1998; 339:1475; author reply 1477. [PMID: 9841317 DOI: 10.1056/nejm199811123392012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wirth A, Steinmetz B. Gender differences in changes in subcutaneous and intra-abdominal fat during weight reduction: an ultrasound study. OBESITY RESEARCH 1998; 6:393-9. [PMID: 9845228 DOI: 10.1002/j.1550-8528.1998.tb00370.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In weight-reducing programs, men usually display greater improvement in metabolic risk factors than women. This gender difference may be related to enhanced weight and fat loss due to a greater energy deficit in men. To clarify the relationship between changes in metabolic profile, body fat composition, and weight loss, both sexes were studied under a regimen in which similar amounts of weight were lost. RESEARCH METHODS AND PROCEDURES A cross-sectional study using anthropometric (body mass index and waist-to-hip ratio), impedance (bioelectrical impedance analysis) and ultrasound measurement methods (thickness of subcutaneous fat layers, intra-abdominal sagittal diameter) were conducted. The metabolic risk profile was determined by measuring lipids, lipoproteins, and blood pressure. The weight loss program lasted 15 weeks: 3 weeks under controlled conditions in the hospital and 12 weeks on an ambulatory basis. Patients were instructed to follow a mixed diet. Calorie intake was restricted to 1500 kcal/day for the men and 1200 kcal/day for the women. Thirty-two subjects with obesity (16 men and 16 women), with a mean body mass index of 35 kg/m2--matched with regard to age, height, and body weight--took part in the study. RESULTS As expected, weight loss was similar for both sexes (-13.4 kg vs. -12.8 kg). Also, body fat mass changed to the same extent in absolute and relative terms. The waist-to-hip ratio was identical before and after treatment in both sexes. The men lost more visceral fat than the women. This result is based on changes in intra-abdominal diameter as well as abdominal subcutaneous fat in relation to waist circumference. Changes in abdominal diameter were paralleled by reductions in triglycerides and increases in high-density lipoprotein-cholesterol. Subcutaneous fat loss was more pronounced in women than in men. DISCUSSION Where absolute and relative reductions in body weight and body fat are similar, men mobilize more intra-abdominal fat than women, whereas women lose more subcutaneous fat. The greater reduction in intra-abdominal fat seen in men is accompanied by a more pronounced improvement in the metabolic risk profile. Therefore, greater improvement of risk factors in men is not only related to a greater negative energy balance, as shown in most studies, but is also sex-specific.
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