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Schuler A, Huser J, Schmid S, Schär S, Scherz A, Gautschi O, Mauti L, von Briel T, Waibel C, Wannesson L, Pankovics J, Mark MT, Rothschild SI, Addeo A, Janthur WD, Siano M, Boos L, Britschgi C, Früh M. Patterns of progression on first line osimertinib in patients with EGFR mutation-positive advanced non-small cell lung cancer (NSCLC): A Swiss cohort study. Lung Cancer 2024; 187:107427. [PMID: 38043395 DOI: 10.1016/j.lungcan.2023.107427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
AIM Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved for patients with EGFR mutated non-small cell lung cancer as first-line treatment. However, treatment resistance inevitably emerges and may present as oligo-progressive disease (OPD) or systemic progressive disease (SPD). The incidence of OPD on first-line osimertinib is unknown. METHODS We retrospectively analyzed patients who received first-line osimertinib at 13 Swiss centers. The rate of OPD (PD in ≤ 5 lesions) and treatment outcomes were analyzed. RESULTS The median age of the 148 patients was 68.2 years (range. 38.0-93.3). There were 62 % females, 83 % with a PS ≤ 1, 59 % never smokers, 57 % of patients with an EGFR exon 19 deletion and 37 % with EGFR p.L858R exon 21. 77 % experienced OPD. Median overall survival (OS) was 51.6 months (95 % CI, 38.4-65.0). Median progression-free survival (PFS) was 19.2 (95 % CI, 14.3-23.5) and 8.7 (95 % CI, 2.8-15.6) months for patients with common and uncommon EGFR mutations. Patients with OPD compared to SPD had a significantly longer time to treatment failure and longer OS of (22.9 vs. 10.8 months, p < 0.001 and 51.6 vs. 26.4 months, p = 0.004, respectively). The most common organ sites of PD were lung (62 %), brain (30 %), lymph nodes (30 %), bone (27 %) and pleura (27 %). Twenty-six patients (45 %) with OPD received local ablative treatment (LAT). The OS of OPD patients with LAT was 60.0 (95 % CI, 51.6-NA) vs. 51.4 (95 % CI 38.4-65.3) months (p = 0.43) without LAT. CONCLUSION The rate of OPD of patients receiving first line osimertinib was 77 %. Patients with OPD had a significantly better OS compared to patients with SPD (51.6 vs. 26.4 months). Patients with OPD receiving LAT had the longest median OS (60.0 months).
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Affiliation(s)
- A Schuler
- Cantonal Hospital St. Gallen, Department of Medical Oncology and Haematology, Switzerland.
| | - J Huser
- Cantonal Hospital St. Gallen, Department of Medical Oncology and Haematology, Switzerland
| | - S Schmid
- Cantonal Hospital St. Gallen, Department of Medical Oncology and Haematology, Switzerland; Inselspital, University Hospital Bern, Department of Medical Oncology, Switzerland
| | - S Schär
- Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung (SAKK) , Switzerland
| | - A Scherz
- Inselspital, University Hospital Bern, Department of Medical Oncology, Switzerland
| | - O Gautschi
- Cantonal Hospital Luzern, Department of Medical Oncology, Switzerland
| | - L Mauti
- Cantonal Hospital Winterthur, Department of Medical Oncology and Haematology, Switzerland
| | | | - C Waibel
- Cantonal Hospital Baden, Department of Medical Oncology and Haematology, Switzerland
| | - L Wannesson
- Istituto Oncologico d. Svizzera Italiana, Switzerland
| | - J Pankovics
- Istituto Oncologico d. Svizzera Italiana, Switzerland
| | - M T Mark
- Cantonal Hospital Graubünden, Department of Medical Oncology and Haematology, Switzerland
| | - S I Rothschild
- University Hospital Basel, Department of Medical Oncology, Switzerland
| | - A Addeo
- University Hospital Geneva, Department of Medical Oncology, Switzerland
| | - W D Janthur
- Cantonal Hospital Aarau, Department of Medical Oncology, Switzerland
| | - M Siano
- Seeland Cancer Center, Bern-Biel, Switzerland
| | - L Boos
- Comprehensive Cancer Center Zurich, Department of Medical Oncology and Haematology, Switzerland
| | - C Britschgi
- Comprehensive Cancer Center Zurich, Department of Medical Oncology and Haematology, Switzerland
| | - M Früh
- Cantonal Hospital St. Gallen, Department of Medical Oncology and Haematology, Switzerland; Inselspital, University Hospital Bern, Department of Medical Oncology, Switzerland
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Schuler A, Wedel A, Kelsey SW, Wang X, Quiballo K, Beatrice Floresca Y, Phillips G, Beach LB. Suicidality by Sexual Identity and Correlates Among American Indian and Alaska Native High School Students. J Adolesc Health 2023; 73:1030-1037. [PMID: 37737757 PMCID: PMC10840863 DOI: 10.1016/j.jadohealth.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE This study aims to determine the prevalence of suicidality among American Indian and Alaskan Native (AI/AN) adolescents. Additionally, we measured suicidality, stratified by sex, and its association with sexual identity, sexual violence, and binge drinking. METHODS We pooled data from the Youth Risk Behavior Survey from 2005 to 2019 to analyze the prevalence of sexual minorities, forced sex, and binge drinking, and their association with suicidality using basic descriptive statistics followed by adjusted odds ratios stratified by sex among AI/AN youth. RESULTS 19% of AI/AN participants reported having suicidal thoughts and 14% reported having a previous suicide attempt. More than 17% of AI/AN participants identified as sexual minority youth (SMY). Compared to AI/AN heterosexual youth, AI/AN bisexual youth had significantly higher odds of reporting suicidal thoughts (aOR = 16.01), planning (aOR = 12.4), and previous attempts (aOR = 7.73). This pattern was also significantly demonstrated for AI/AN gay/lesbian youth. 43% of all AI/AN participants reported being forced into sexual intercourse. The presence of binge drinking was associated with higher odds of suicidal thoughts for both females and males compared to those who did not binge drink. DISCUSSION At the intersection of multiple marginalization, AI/AN SMY have a high mental health burden, demonstrating the need for culturally informed, community-led, and targeted mental health support focused on SMY AI/AN. Though this study fails to capture the heterogeneity within the AI/AN community, as nuances exist at the tribal level, these results demonstrate work needs to be done to support the health burden that AI/AN youth carry.
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Affiliation(s)
- Adrienne Schuler
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anneliese Wedel
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Scar Winter Kelsey
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xinzi Wang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kay Quiballo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ysabel Beatrice Floresca
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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3
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Schuler A, Huser J, Schaer S, Schmid S, Scherz A, Gautschi O, Mauti L, Von Briel T, Waibel C, Wannesson De Nicola L, Pankovics J, Mark M, Rothschild S, Addeo A, Janthur WD, Siano M, Britschgi C, Frueh M. 365P Patterns of progression on first-line osimertinib in patients with EGFR mutation-positive advanced non-small cell lung cancer (NSCLC): A Swiss cohort study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Hughes LM, Schuler A, Sharmuk M, Schauer JM, Pavone ME, Bernardi LA. Early β-hCG levels predict live birth after single embryo transfer. J Assist Reprod Genet 2022; 39:2355-2364. [PMID: 36074224 PMCID: PMC9596620 DOI: 10.1007/s10815-022-02606-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE Specific serum beta human chorionic gonadotropin (β-hCG) parameters that can predict live birth after an embryo transfer have yet to be defined. METHODS We performed a retrospective cohort study of 1,028 patients with a detectable β-hCG who underwent a single embryo transfer between 2002 and 2019 at a large academic center. Two β-hCG parameters were examined in relation to live birth: 1) "doubling" defined as β-hCG doubling over 48 h and 2) "reaching 100" defined as a β-hCG ≥ 100 mIU/mL by 15 days after oocyte retrieval (AOR). RESULTS One thousand three hundred forty cycles involving a single embryo were analyzed. Two thirds were frozen embryos and 86% were blastocyst transfers. Preimplantation genetic testing was performed in almost 30% of cycles. When β-hCG levels "doubled," a live birth occurred in 80.7% of cycles and when β-hCG levels "reached 100" by 15 days AOR, live birth occurred in 81.6% of cycles. When β-hCG levels both doubled and reached 100 by 15 days, AOR 85.4% cycles resulted in live birth. A multiple logistic regression model to control for patient and cycle level factors revealed a live birth odds ratio (OR) of 8.0 (95% CI 5.7-11.1) when β-hCG "doubled" and an OR of 21.2 (95% CI 14.3-31.5) when β-hCG "reached 100." When both these latter parameters were met, the OR was 12.5 (95% CI 8.9-17.8). CONCLUSION β-hCG parameters of "doubling" and "reaching 100" by 15 days AOR are robust predictors of live birth and can aid in patient counseling regarding pregnancy outcomes soon after single embryo transfer.
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Affiliation(s)
- Lydia M Hughes
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA.
- Biostatistics Collaboration Center, Northwestern University, Chicago, IL, USA.
| | - Adrienne Schuler
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA
| | - Maxwell Sharmuk
- Department of Obstetrics and Gynecology, Northwestern University, 250 E Superior St, Suite 5-2177, Chicago, IL, 60611, USA
| | - Jacob Michael Schauer
- Department of Obstetrics and Gynecology, Northwestern University, 250 E Superior St, Suite 5-2177, Chicago, IL, 60611, USA
| | - Mary Ellen Pavone
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA
| | - Lia A Bernardi
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA
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Bitzer M, Voesch S, Albert J, Bartenstein P, Bechstein W, Blödt S, Brunner T, Dombrowski F, Evert M, Follmann M, La Fougère C, Freudenberger P, Geier A, Gkika E, Götz M, Hammes E, Helmberger T, Hoffmann RT, Hofmann WP, Huppert P, Kautz A, Knötgen G, Körber J, Krug D, Lammert F, Lang H, Langer T, Lenz P, Mahnken A, Meining A, Micke O, Nadalin S, Nguyen HP, Ockenga J, Oldhafer K, Paprottka P, Paradies K, Pereira P, Persigehl T, Plauth M, Plentz R, Pohl J, Riemer J, Reimer P, Ringwald J, Ritterbusch U, Roeb E, Schellhaas B, Schirmacher P, Schmid I, Schuler A, von Schweinitz D, Seehofer D, Sinn M, Stein A, Stengel A, Steubesand N, Stoll C, Tannapfel A, Taubert A, Trojan J, van Thiel I, Tholen R, Vogel A, Vogl T, Vorwerk H, Wacker F, Waidmann O, Wedemeyer H, Wege H, Wildner D, Wittekind C, Wörns MA, Galle P, Malek N. S3-Leitlinie: Diagnostik und Therapie biliärer Karzinome. Z Gastroenterol 2022; 60:219-238. [PMID: 35148562 DOI: 10.1055/a-1589-7638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Bitzer
- Medizinische Klinik I, Universitätsklinikum Tübingen
| | - S Voesch
- Medizinische Klinik I, Universitätsklinikum Tübingen
| | - J Albert
- Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus, Stuttgart
| | - P Bartenstein
- Klinik und Poliklinik für Nuklearmedizin, LMU Klinikum, München
| | - W Bechstein
- Klinik für Allgemein-, Viszeral-, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt
| | - S Blödt
- AWMF-Geschäftsstelle, Berlin
| | - T Brunner
- Klinik für Strahlentherapie, Universitätsklinikum Magdeburg
| | - F Dombrowski
- Institut für Pathologie, Universitätsmedizin Greifswald
| | - M Evert
- Institut für Pathologie, Regensburg
| | - M Follmann
- Office des Leitlinienprogrammes Onkologie, c/o Deutsche Krebsgesellschaft e.V., Berlin
| | - C La Fougère
- Nuklearmedizin und Klinische Molekulare Bildgebung, Tübingen
| | | | - A Geier
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg
| | - E Gkika
- Klinik für Strahlenheilkunde, Department für Radiologische Diagnostik und Therapie, Universitätsklinikum Freiburg
| | | | - E Hammes
- Lebertransplantierte Deutschland e. V., Ansbach
| | - T Helmberger
- Institut für Radiologie, Neuroradiologie und minimal-invasive Therapie, München Klinik Bogenhausen, München
| | - R T Hoffmann
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Dresden
| | - W P Hofmann
- Gastroenterologie am Bayerischen Platz, medizinisches Versorgungszentrum, Berlin
| | - P Huppert
- Radiologisches Zentrum, Max Grundig Klinik, Bühl
| | - A Kautz
- Deutsche Leberhilfe e.V., Köln
| | - G Knötgen
- Konferenz onkologischer Kranken- und Kinderkrankenpflege, Hamburg
| | - J Körber
- Klinik Nahetal, Fachklinik für onkologische Rehabilitation und Anschlussrehabilitation, Bad Kreuznach
| | - D Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel
| | | | - H Lang
- Klinik für Allgemein-, Viszeral und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - T Langer
- Office des Leitlinienprogrammes Onkologie, c/o Deutsche Krebsgesellschaft e.V., Berlin
| | - P Lenz
- Universitätsklinikum Münster, Zentrale Einrichtung Palliativmedizin, Münster
| | - A Mahnken
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Gießen und Marburg GmbH, Marburg
| | - A Meining
- Medizinische Klinik und Poliklinik II des Universitätsklinikums Würzburg
| | - O Micke
- Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital Bielefeld
| | - S Nadalin
- Universitätsklinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen
| | | | - J Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen
| | - K Oldhafer
- Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Semmelweis Universität, Asklepios Campus Hamburg
| | - P Paprottka
- Abteilung für interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München
| | - K Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpflege, Hamburg
| | - P Pereira
- Abteilung für interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München
| | - T Persigehl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln
| | | | - R Plentz
- Klinikum Bremen-Nord, Innere Medizin, Bremen
| | - J Pohl
- Interventionelles Endoskopiezentrum und Schwerpunkt Gastrointestinale Onkologie, Asklepios Klinik Altona, Hamburg
| | - J Riemer
- Lebertransplantierte Deutschland e. V., Bretzfeld
| | - P Reimer
- Institut für diagnostische und interventionelle Radiologie, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe
| | - J Ringwald
- Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen
| | | | - E Roeb
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH, Gießen
| | - B Schellhaas
- Medizinische Klinik I, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - P Schirmacher
- Pathologisches Institut, Universitätsklinikum Heidelberg
| | - I Schmid
- Zentrum Pädiatrische Hämatologie und Onkologie, Dr. von Haunersches Kinderspital, Klinikum der Universität München
| | - A Schuler
- Medizinische Klinik, Alb Fils Kliniken GmbH, Göppingen
| | | | - D Seehofer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig
| | - M Sinn
- Medizinische Klinik II, Universitätsklinikum Hamburg-Eppendorf
| | - A Stein
- Hämatologisch-Onkologischen Praxis Eppendorf, Hamburg
| | - A Stengel
- Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen
| | | | - C Stoll
- Klinik Herzoghöhe Bayreuth, Bayreuth
| | - A Tannapfel
- Institut für Pathologie der Ruhr-Universität Bochum am Berufsgenossenschaftlichen Universitätsklinikum Bergmannsheil, Bochum
| | - A Taubert
- Kliniksozialdienst, Universitätsklinikum Heidelberg, Bochum
| | - J Trojan
- Medizinische Klinik I, Universitätsklinikum Frankfurt, Frankfurt am Main
| | | | - R Tholen
- Deutscher Verband für Physiotherapie e. V., Köln
| | - A Vogel
- Klinik für Gastroenterologie, Hepatologie, Endokrinologie der Medizinischen Hochschule Hannover, Hannover
| | - T Vogl
- Universitätsklinikum Frankfurt, Institut für Diagnostische und Interventionelle Radiologie, Frankfurt
| | - H Vorwerk
- Klinik für Strahlentherapie, Universitätsklinikum Gießen und Marburg GmbH, Marburg
| | - F Wacker
- Institut für Diagnostische und Interventionelle Radiologie der Medizinischen Hochschule Hannover, Hannover
| | - O Waidmann
- Medizinische Klinik I, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - H Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie Medizinische Hochschule Hannover, Hannover
| | - H Wege
- Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - D Wildner
- Innere Medizin, Krankenhäuser Nürnberger Land GmbH, Lauf an der Pegnitz
| | - C Wittekind
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig
| | - M A Wörns
- Medizinische Klinik und Poliklinik, Universitätsklinikum Mainz, Mainz
| | - P Galle
- Medizinische Klinik und Poliklinik, Universitätsklinikum Mainz, Mainz
| | - N Malek
- Medizinische Klinik I, Universitätsklinikum Tübingen, Tübingen
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6
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Bitzer M, Voesch S, Albert J, Bartenstein P, Bechstein W, Blödt S, Brunner T, Dombrowski F, Evert M, Follmann M, La Fougère C, Freudenberger P, Geier A, Gkika E, Götz M, Hammes E, Helmberger T, Hoffmann RT, Hofmann WP, Huppert P, Kautz A, Knötgen G, Körber J, Krug D, Lammert F, Lang H, Langer T, Lenz P, Mahnken A, Meining A, Micke O, Nadalin S, Nguyen HP, Ockenga J, Oldhafer K, Paprottka P, Paradies K, Pereira P, Persigehl T, Plauth M, Plentz R, Pohl J, Riemer J, Reimer P, Ringwald J, Ritterbusch U, Roeb E, Schellhaas B, Schirmacher P, Schmid I, Schuler A, von Schweinitz D, Seehofer D, Sinn M, Stein A, Stengel A, Steubesand N, Stoll C, Tannapfel A, Taubert A, Trojan J, van Thiel I, Tholen R, Vogel A, Vogl T, Vorwerk H, Wacker F, Waidmann O, Wedemeyer H, Wege H, Wildner D, Wittekind C, Wörns MA, Galle P, Malek N. S3-Leitlinie – Diagnostik und Therapie biliärer Karzinome. Z Gastroenterol 2022; 60:e186-e227. [PMID: 35148560 DOI: 10.1055/a-1589-7854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M Bitzer
- Medizinische Klinik I, Universitätsklinikum Tübingen
| | - S Voesch
- Medizinische Klinik I, Universitätsklinikum Tübingen
| | - J Albert
- Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus, Stuttgart
| | - P Bartenstein
- Klinik und Poliklinik für Nuklearmedizin, LMU Klinikum, München
| | - W Bechstein
- Klinik für Allgemein-, Viszeral-, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt
| | - S Blödt
- AWMF-Geschäftsstelle, Berlin
| | - T Brunner
- Klinik für Strahlentherapie, Universitätsklinikum Magdeburg
| | - F Dombrowski
- Institut für Pathologie, Universitätsmedizin Greifswald
| | - M Evert
- Institut für Pathologie, Regensburg
| | - M Follmann
- Office des Leitlinienprogrammes Onkologie, c/o Deutsche Krebsgesellschaft e.V., Berlin
| | - C La Fougère
- Nuklearmedizin und Klinische Molekulare Bildgebung, Tübingen
| | | | - A Geier
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg
| | - E Gkika
- Klinik für Strahlenheilkunde, Department für Radiologische Diagnostik und Therapie, Universitätsklinikum Freiburg
| | | | - E Hammes
- Lebertransplantierte Deutschland e. V., Ansbach
| | - T Helmberger
- Institut für Radiologie, Neuroradiologie und minimal-invasive Therapie, München Klinik Bogenhausen, München
| | - R T Hoffmann
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Dresden
| | - W P Hofmann
- Gastroenterologie am Bayerischen Platz, medizinisches Versorgungszentrum, Berlin
| | - P Huppert
- Radiologisches Zentrum, Max Grundig Klinik, Bühl
| | - A Kautz
- Deutsche Leberhilfe e.V., Köln
| | - G Knötgen
- Konferenz onkologischer Kranken- und Kinderkrankenpflege, Hamburg
| | - J Körber
- Klinik Nahetal, Fachklinik für onkologische Rehabilitation und Anschlussrehabilitation, Bad Kreuznach
| | - D Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel
| | | | - H Lang
- Klinik für Allgemein-, Viszeral und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - T Langer
- Office des Leitlinienprogrammes Onkologie, c/o Deutsche Krebsgesellschaft e.V., Berlin
| | - P Lenz
- Universitätsklinikum Münster, Zentrale Einrichtung Palliativmedizin, Münster
| | - A Mahnken
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Gießen und Marburg GmbH, Marburg
| | - A Meining
- Medizinische Klinik und Poliklinik II des Universitätsklinikums Würzburg
| | - O Micke
- Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital Bielefeld
| | - S Nadalin
- Universitätsklinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen
| | | | - J Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen
| | - K Oldhafer
- Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Semmelweis Universität, Asklepios Campus Hamburg
| | - P Paprottka
- Abteilung für interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München
| | - K Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpflege, Hamburg
| | - P Pereira
- Abteilung für interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München
| | - T Persigehl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln
| | | | - R Plentz
- Klinikum Bremen-Nord, Innere Medizin, Bremen
| | - J Pohl
- Interventionelles Endoskopiezentrum und Schwerpunkt Gastrointestinale Onkologie, Asklepios Klinik Altona, Hamburg
| | - J Riemer
- Lebertransplantierte Deutschland e. V., Bretzfeld
| | - P Reimer
- Institut für diagnostische und interventionelle Radiologie, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe
| | - J Ringwald
- Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen
| | | | - E Roeb
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH, Gießen
| | - B Schellhaas
- Medizinische Klinik I, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - P Schirmacher
- Pathologisches Institut, Universitätsklinikum Heidelberg
| | - I Schmid
- Zentrum Pädiatrische Hämatologie und Onkologie, Dr. von Haunersches Kinderspital, Klinikum der Universität München
| | - A Schuler
- Medizinische Klinik, Alb Fils Kliniken GmbH, Göppingen
| | | | - D Seehofer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig
| | - M Sinn
- Medizinische Klinik II, Universitätsklinikum Hamburg-Eppendorf
| | - A Stein
- Hämatologisch-Onkologischen Praxis Eppendorf, Hamburg
| | - A Stengel
- Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen
| | | | - C Stoll
- Klinik Herzoghöhe Bayreuth, Bayreuth
| | - A Tannapfel
- Institut für Pathologie der Ruhr-Universität Bochum am Berufsgenossenschaftlichen Universitätsklinikum Bergmannsheil, Bochum
| | - A Taubert
- Kliniksozialdienst, Universitätsklinikum Heidelberg, Bochum
| | - J Trojan
- Medizinische Klinik I, Universitätsklinikum Frankfurt, Frankfurt am Main
| | | | - R Tholen
- Deutscher Verband für Physiotherapie e. V., Köln
| | - A Vogel
- Klinik für Gastroenterologie, Hepatologie, Endokrinologie der Medizinischen Hochschule Hannover, Hannover
| | - T Vogl
- Universitätsklinikum Frankfurt, Institut für Diagnostische und Interventionelle Radiologie, Frankfurt
| | - H Vorwerk
- Klinik für Strahlentherapie, Universitätsklinikum Gießen und Marburg GmbH, Marburg
| | - F Wacker
- Institut für Diagnostische und Interventionelle Radiologie der Medizinischen Hochschule Hannover, Hannover
| | - O Waidmann
- Medizinische Klinik I, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - H Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie Medizinische Hochschule Hannover, Hannover
| | - H Wege
- Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - D Wildner
- Innere Medizin, Krankenhäuser Nürnberger Land GmbH, Lauf an der Pegnitz
| | - C Wittekind
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig
| | - M A Wörns
- Medizinische Klinik und Poliklinik, Universitätsklinikum Mainz, Mainz
| | - P Galle
- Medizinische Klinik und Poliklinik, Universitätsklinikum Mainz, Mainz
| | - N Malek
- Medizinische Klinik I, Universitätsklinikum Tübingen, Tübingen
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7
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Omoumi P, Schuler A, Babel H, Stoffel C, Jolles BM, Favre J. Proximal tibial osteophyte volumes are correlated spatially and with knee alignment: a quantitative analysis suggesting the influence of biochemical and mechanical factors in the development of osteophytes. Osteoarthritis Cartilage 2021; 29:1691-1700. [PMID: 34571138 DOI: 10.1016/j.joca.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/16/2021] [Accepted: 09/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the differences and correlations in osteophyte volumes between and within proximal tibial compartments, and to assess the correlations between osteophyte volumes and the femorotibial angle. DESIGN CT scans of 73 knees with predominantly medial femorotibial osteoarthritis (21 K/L2, 28 K/L3, 24 K/L4) were retrospectively analyzed using a new, reproducible method measuring total and subregional osteophyte volumes in the medial and lateral compartments. Non-parametric statistics was used for comparison and correlation analyses. RESULTS Total osteophyte volumes were larger in the medial than in the lateral compartment for all severity groups (p < 0.05). Additionally, statistically significant differences were observed among subregions of the lateral compartment in K/L3 and K/L4 knees. Statistically significant positive correlations were found between the medial and lateral total osteophyte volumes in K/L3 and K/L4 knees (ρ ≥ 0.44, p = 0.03), and among most subregional osteophyte volumes within each compartment in K/L3 knees. Markedly fewer statistically significant correlations were present in K/L2 and K/L4 knees. In K/L3 knees, the femorotibial angle was statistically significantly positively correlated with the total osteophyte volume in the medial compartment (ρ = 0.50, p = 0.01), with osteophyte volumes in most medial subregions, and with the osteophyte volume in the lateral posterior subregion (ρ = 0.40, p = 0.05). CONCLUSIONS Quantitative assessment of osteophytes may bring insight on factors influencing their development. Positive correlations of osteophyte volumes found between and within compartments suggest the influence of biochemical mediators acting on the entire joint, while positive correlations between the femorotibial angle and osteophyte volumes suggest a role of mechanical factors. These hypotheses are to be further confirmed.
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Affiliation(s)
- P Omoumi
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland; Cliniques Universitaires St Luc - UC Louvain, Department of Radiology, Brussels, Belgium.
| | - A Schuler
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland
| | - H Babel
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland
| | - C Stoffel
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland
| | - B M Jolles
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland
| | - J Favre
- Ecole Polytechnique Fédérale Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland
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8
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Hughes L, Schuler A, Schauer JM, Pavone ME, Bernardi LA. THE EARLIER THE BETTER: INITIAL SERUM HCG LEVELS PREDICT LIVE BIRTH AFTER SINGLE EMBRYO TRANSFER. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Ebner R, Pfleger E, Jeglitsch F, Leban K, Goldschmied G, Schuler A. Möglichkeiten der Oberflächenbehandlung metallischer Werkstoffe mit Elektronenstrahlen am Beispiel hochlegierter Stähle / Possibilities for the Surface Treatment of Metals Using Electron Beams on High Alloy Steels. ACTA ACUST UNITED AC 2021. [DOI: 10.1515/pm-1988-251002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Tik M, Woletz M, Princic M, Schuler A, Geissberger N, Hummer A, Windischberger C. Individualizing Brainstimulation through concurrent TMS/fMRI. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Wendling T, Jung K, Callahan A, Schuler A, Shah NH, Gallego B. Comparing methods for estimation of heterogeneous treatment effects using observational data from health care databases. Stat Med 2018; 37:3309-3324. [DOI: 10.1002/sim.7820] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/21/2018] [Accepted: 04/19/2018] [Indexed: 11/07/2022]
Affiliation(s)
- T. Wendling
- Centre for Health Informatics, Australian Institute of Health Innovation; Macquarie University; Sydney Australia
| | - K. Jung
- Stanford Center for Biomedical Informatics Research; Stanford University; Stanford USA
| | - A. Callahan
- Stanford Center for Biomedical Informatics Research; Stanford University; Stanford USA
| | - A. Schuler
- Stanford Center for Biomedical Informatics Research; Stanford University; Stanford USA
| | - N. H. Shah
- Stanford Center for Biomedical Informatics Research; Stanford University; Stanford USA
| | - B. Gallego
- Centre for Health Informatics, Australian Institute of Health Innovation; Macquarie University; Sydney Australia
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12
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Mertes B, Gödde S, Kuptschitsch S, Miokovic B, Mut E, Renczes J, Schäfer J, Schrödter J, Schuler A, Utermann U, Voigtländer T, Voß H, Piorkowski M. Reduktion von Majoramputationen um über 50% in einem Krankenhaus der Regel- und Notfallversorgung durch multidisziplinäres Behandlungskonzept. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B Mertes
- Cardioangiologisches Centrum Bethanien, Diabetologie, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Diabetologie, Frankfurt am Main, Germany
| | - S Gödde
- Cardioangiologisches Centrum Bethanien, Diabetologie, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Diabetologie, Frankfurt am Main, Germany
| | - S Kuptschitsch
- Agaplesion Bethanien Krankenhaus, Krankenhausdirektion, Frankfurt am Main, Germany
| | - B Miokovic
- Cardioangiologisches Centrum Bethanien, Gefäßchirurgie, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Gefäßchirurgie, Frankfurt am Main, Germany
| | - E Mut
- Agaplesion Frankfurter Diakonie Kliniken gGmbH, Medizin Controlling, Frankfurt am Main, Germany
| | - J Renczes
- Cardioangiologisches Centrum Bethanien, Angiologie, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Angiologie, Frankfurt am Main, Germany
| | - J Schäfer
- Agaplesion Bethanien Krankenhaus, Krankenhausdirektion, Frankfurt am Main, Germany
- Universität Pécs, Medizinische Fakultät, Pécs, Hungary
| | - J Schrödter
- Cardioangiologisches Centrum Bethanien, Gefäßchirurgie, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Gefäßchirurgie, Frankfurt am Main, Germany
| | - A Schuler
- Chirurgisches Zentrum am Bethanien, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Allgemeinchirurgie, Frankfurt am Main, Germany
| | - U Utermann
- Cardioangiologisches Centrum Bethanien, Diabetologie, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Diabetologie, Frankfurt am Main, Germany
| | - T Voigtländer
- Agaplesion Bethanien Krankenhaus, Krankenhausdirektion, Frankfurt am Main, Germany
| | - H Voß
- Chirurgisches Zentrum am Bethanien, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Allgemeinchirurgie, Frankfurt am Main, Germany
| | - M Piorkowski
- Cardioangiologisches Centrum Bethanien, Angiologie, Frankfurt am Main, Germany
- Agaplesion Bethanien Krankenhaus, Angiologie, Frankfurt am Main, Germany
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Leiherer A, Muendlein A, Saely C, Ebner J, Brandtner E, Schuler A, Schwerzler P, Mader A, Fraunberger P, Drexel H. P6222Serum uromodulin predicts mortality independently from the presence of type 2 diabetes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Zanolin D, Rein P, Saely C, Vonbank A, Lins C, Leiherer A, Schuler A, Schwerzler P, Mader A, Muendlein A, Drexel H. P5344Pro-B-type natriuretic peptide strongly predicts cardiovascular mortality in coronary artery disease patients with type 2 diabetes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Saely C, Vonbank A, Lins C, Zanolin D, Leiherer A, Schuler A, Schwerzler P, Mader A, Rein P, Muendlein A, Drexel H. P1545Type 2 diabetes, chronic kidney disease, and mortality in patients with established cardiovascular disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Leiherer A, Muendlein A, Saely C, Brandtner E, Geiger K, Schuler A, Schwerzler P, Mader A, Fraunberger P, Drexel H. P5347Serum uromodulin predicts a decline in kidney function independently from the presence of type 2 diabetes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Leiherer A, Muendlein A, Saely C, Ebner J, Brandtner E, Schuler A, Schwerzler P, Mader A, Fraunberger P, Drexel H. P6220The creatinine to uromodulin ratio in serum predicts major cardiovascular events independently from the presence of type 2 diabetes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Lofters AK, Schuler A, Slater M, Baxter NN, Persaud N, Pinto AD, Kucharski E, Davie S, Nisenbaum R, Kiran T. Using self-reported data on the social determinants of health in primary care to identify cancer screening disparities: opportunities and challenges. BMC Fam Pract 2017; 18:31. [PMID: 28241787 PMCID: PMC5330155 DOI: 10.1186/s12875-017-0599-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/09/2017] [Indexed: 12/13/2022]
Abstract
Background Data on the social determinants of health can help primary care practices target improvement efforts, yet relevant data are rarely available. Our family practice located in Toronto, Ontario routinely collects patient-level sociodemographic data via a pilot-tested survey developed by a multi-organizational steering committee. We sought to use these data to assess the relationship between the social determinants and colorectal, cervical and breast cancer screening, and to describe the opportunities and challenges of using data on social determinants from a self-administered patient survey. Methods Patients of the family practice eligible for at least one of the three cancer screening types, based on age and screening guidelines as of June 30, 2015 and who had answered at least one question on a socio-demographic survey were included in the study. We linked self-reported data from the sociodemographic survey conducted in the waiting room with patients’ electronic medical record data and cancer screening records. We created an individual-level income variable (low-income cut-off) that defined a poverty threshold and took household size into account. The sociodemographic characteristics of patients who were overdue for screening were compared to those who were up-to-date for screening for each cancer type using chi-squared tests. Results We analysed data for 5766 patients for whom we had survey data. Survey participants had significantly higher screening rates (72.9, 78.7, 74.4% for colorectal, cervical and breast cancer screening respectively) than the 13, 036 patients for whom we did not have survey data (59.2, 65.3, 58.9% respectively). Foreign-born patients were significantly more likely to be up-to-date on colorectal screening than their Canadian-born peers but showed no significant differences in breast or cervical cancer screening. We found a significant association between the low-income cut-off variable and cancer screening; neighbourhood income quintile was not significantly associated with cancer screening. Housing status was also significantly associated with colorectal, cervical and breast cancer screening. There was a large amount of missing data for the low-income cut-off variable, approximately 25% across the three cohorts. Conclusion While we were able to show that neighbourhood income might under-estimate income-related disparities in screening, individual-level income was also the most challenging variable to collect. Future work in this area should target the income disparity in cancer screening and simultaneously explore how best to collect measures of poverty. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0599-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada. .,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada. .,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - A Schuler
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - M Slater
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - N N Baxter
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - N Persaud
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - A D Pinto
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - E Kucharski
- Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - S Davie
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - R Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - T Kiran
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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19
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Schuler A, Greif M, Seitsonen AP, Mette G, Castiglioni L, Osterwalder J, Hengsberger M. Sensitivity of photoelectron diffraction to conformational changes of adsorbed molecules: Tetra-tert-butyl-azobenzene/Au(111). Struct Dyn 2017; 4:015101. [PMID: 28217715 PMCID: PMC5291794 DOI: 10.1063/1.4975594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
Electron diffraction is a standard tool to investigate the atomic structure of surfaces, interfaces, and adsorbate systems. In particular, photoelectron diffraction is a promising candidate for real-time studies of structural dynamics combining the ultimate time resolution of optical pulses and the high scattering cross-sections for electrons. In view of future time-resolved experiments from molecular layers, we studied the sensitivity of photoelectron diffraction to conformational changes of only a small fraction of molecules in a monolayer adsorbed on a metallic substrate. 3,3',5,5'-tetra-tert-butyl-azobenzene served as test case. This molecule can be switched between two isomers, trans and cis, by absorption of ultraviolet light. X-ray photoelectron diffraction patterns were recorded from tetra-tert-butyl-azobenzene/Au(111) in thermal equilibrium at room temperature and compared to patterns taken in the photostationary state obtained by exposing the surface to radiation from a high-intensity helium discharge lamp. Difference patterns were simulated by means of multiple-scattering calculations, which allowed us to determine the fraction of molecules that underwent isomerization.
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Affiliation(s)
- A Schuler
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - M Greif
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - A P Seitsonen
- Département de Chimie, Ecole Normale Surpérieure , 24, Rue Lhomond, 75005 Paris, France
| | | | - L Castiglioni
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - J Osterwalder
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - M Hengsberger
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
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20
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Friedrich-Rust M, Vorlaender C, Dietrich CF, Kratzer W, Blank W, Schuler A, Broja N, Cui XW, Herrmann E, Bojunga J. Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study. Ultraschall Med 2016; 37:262-270. [PMID: 27070127 DOI: 10.1055/s-0042-104647] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Many patients with thyroid nodules are presently referred to surgery for not only therapeutic but also diagnostic purposes. The aim of noninvasive diagnostic methods is to optimize the selection of patients for surgery. Strain elastography (SE) enables the ultrasound-based determination of tissue elasticity. The aim of the present study was to evaluate the value of SE for the differentiation of thyroid nodules in a prospective multicenter study. MATERIALS AND METHODS The study was registered at clinicaltrials.gov and was approved by the local ethics committees of all participating centers. All patients received an ultrasound (US) of the thyroid gland including color Doppler US. In addition, all nodules were evaluated by SE (Hitachi Medical Systems) using qualitative image interpretation of color distribution (SE-ES), strain value and strain ratio. RESULTS Overall, 602 patients with 657 thyroid nodules (567 benign, 90 malignant) from 7 centers were included in the final analysis. The sensitivity, specificity, NPV, PPV, +LR were 21 %, 73 %, 86 %, 11 %, 0.8, respectively, for color Doppler US; 69 %, 75 %, 94 %, 30 %, 2.9, respectively, for SE-ES; 56 %, 81 %, 92 %, 32 %, 2.9, respectively, for SE-strain value; and 58 %, 78 %, 92 %, 30 %, 2.6, respectively, for SE-strain ratio. The diagnostic accuracy was 71 % for both strain value and strain ratio of nodules. CONCLUSION SE as an additional ultrasound tool improves the value of ultrasound for the work-up of thyroid nodules. It might reduce diagnostic surgery of thyroid nodules in the future.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Fine-Needle
- Diagnosis, Differential
- Elasticity Imaging Techniques/methods
- Female
- Germany
- Goiter, Nodular/diagnostic imaging
- Goiter, Nodular/pathology
- Goiter, Nodular/surgery
- Humans
- Image Interpretation, Computer-Assisted
- Male
- Middle Aged
- Prospective Studies
- Sensitivity and Specificity
- Societies, Medical
- Thyroid Gland/diagnostic imaging
- Thyroid Gland/pathology
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Nodule/diagnostic imaging
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Ultrasonography, Doppler, Color
- Young Adult
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Affiliation(s)
- M Friedrich-Rust
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
| | - C Vorlaender
- Department of General Surgery, Buergerhospital Frankfurt, Germany
| | - C F Dietrich
- Innere Medizin 2, Caritas Hospital, Bad Mergentheim, Germany
| | - W Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | - W Blank
- Medizinische Klinik 1, Hospital am Steinenberg, Reutlingen, Germany
| | - A Schuler
- Department of Internal Medicine, Helfenstein Hospital, Geislingen, Germany
| | - N Broja
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
| | - X W Cui
- Innere Medizin 2, Caritas Hospital, Bad Mergentheim, Germany
| | - E Herrmann
- Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J.W. Goethe-University, Frankfurt, Germany
| | - J Bojunga
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
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Ignee A, Boerner N, Bruening A, Dirks K, von Herbay A, Jenssen C, Kubale R, Sattler H, Schuler A, Weiss H, Schuessler G, Dietrich CF. Duplex sonography of the mesenteric vessels--a critical evaluation of inter-observer variability. Z Gastroenterol 2016; 54:304-11. [PMID: 27056458 DOI: 10.1055/s-0041-107544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The number of publications concerning mesenteric Doppler sonography (mesDS) is immense and does not correlate with the frequency of its use in clinical practice. This is astonishing since it provides real time blood flow (perfusion) information without side effects. Despite uncontrollable parameters like the technical limitations in some situations the optimization of (possibly) controllable parameters like standardization, production of normal values and reduction of the investigator variability by evaluating stable parameters could change the situation. PATIENTS AND METHODS 10 investigators experienced in abdominal sonography ("DEGUM-Seminarleiter") performed mesenteric Doppler sonography in 5 healthy subjects with 5 different machines. RESULTS The portal vein at the confluence and the common hepatic artery provide a significant portion of investigations with intromission angles of more than 60°. Values of diameter, resistance index and pulsatility index of the celiac trunc could be obtained with inter-observer variability values below 25 %. The proper and the common hepatic artery show no differences in inter-observer variability values, whereas the intrahepatic measure point of the portal vein showed a higher reproducibility. DISCUSSION We define frame conditions for future mesenteric Doppler studies: the portal vein should be investigated at the intrahepatic measure point. Pathophysiological studies should refrain from velocity parameters except in the case of larger vessels running in a straight course towards the probe.
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Affiliation(s)
- A Ignee
- Caritas-Krankenhaus Bad Mergentheim, Medizinische Klinik 2, Bad Mergentheim, Germany
| | - N Boerner
- Gastroenterologische Gemeinschaftspraxis, Mainz, Germany
| | - A Bruening
- Facharztpraxis für Innere Medizin, Bad Malente/Gremsmühlen, Germany
| | - K Dirks
- Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - A von Herbay
- St. Marien-Hospital Hamm, Klinik für Innere Medizin/Gastroenterologie, Hamm, Germany
| | - C Jenssen
- Krankenhaus Märkisch-Oderland, Strausberg, Germany
| | - R Kubale
- Gemeinschaftspraxis für Radiologie und Nuklearmedizin, Pirmasens, Germany
| | - H Sattler
- Praxis Dr. med. Sattler, Bad Dürkheim, Germany
| | - A Schuler
- Helfenstein Klinik, Geislingen/Steige, Germany
| | | | - G Schuessler
- Caritas-Krankenhaus Bad Mergentheim, Medizinische Klinik 2, Bad Mergentheim, Germany
| | - C F Dietrich
- Caritas-Krankenhaus Bad Mergentheim, Medizinische Klinik 2, Bad Mergentheim, Germany
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Bainbridge C, Schuler A, Vidal-Gadea AG. Method for the assessment of neuromuscular integrity and burrowing choice in vermiform animals. J Neurosci Methods 2016; 264:40-46. [PMID: 26947253 DOI: 10.1016/j.jneumeth.2016.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/26/2016] [Accepted: 02/29/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The study of locomotion in vermiform animals has largely been restricted to animals crawling on agar surfaces. While this has been fruitful in the study of neuronal basis of disease and behavior, the reduced physical challenge posed by these environments has prevented these organisms from being equally successful in the study of neuromuscular diseases. Our burrowing assay allowed us to study the effects of muscular exertion on locomotion and muscle degeneration during disease (Beron et al., 2015), as well as the natural burrowing preference of diverse Caenorhabditis elegans strains (Vidal-Gadea et al., 2015). NEW METHOD We describe a simple, rapid, and affordable set of assays to study the burrowing behavior of nematodes and other vermiform organisms which permits the titration of muscular exertion in test animals. RESULTS We show that our burrowing assay design is versatile and can be adapted for use in widely different experimental paradigms. COMPARISON WITH EXISTING METHOD(S) Previous assays for the study of neuromuscular integrity in nematodes relied on movement through facile and homogeneous environments. The ability of modulating substrate density allows our burrowing assay to be used to separate animal populations where muscular fitness or health are not visible differentiable by standard techniques. CONCLUSION The simplicity, versatility, and potential for greatly facilitating the study of previously challenging neuromuscular disorders makes this assay a valuable addition that overcomes many of the limitations inherent to traditional behavioral tests of vermiform locomotion.
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Affiliation(s)
- C Bainbridge
- School of Biological Sciences, Illinois State University, 339 Science Laboratory Building, Normal, IL 61790-4120, USA
| | - A Schuler
- School of Biological Sciences, Illinois State University, 339 Science Laboratory Building, Normal, IL 61790-4120, USA
| | - A G Vidal-Gadea
- School of Biological Sciences, Illinois State University, 339 Science Laboratory Building, Normal, IL 61790-4120, USA.
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Bernatik T, Schuler A, Kunze G, Mauch M, Dietrich CF, Dirks K, Pachmann C, Börner N, Fellermann K, Menzel J, Strobel D. Benefit of Contrast-Enhanced Ultrasound (CEUS) in the Follow-Up Care of Patients with Colon Cancer: A Prospective Multicenter Study. Ultraschall Med 2015; 36:590-593. [PMID: 26544634 DOI: 10.1055/s-0041-107833] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE According to the German guidelines on colorectal cancer, unenhanced ultrasound is recommended for follow-up. On the other hand, ultrasound and radiology societies specify the use of contrast-enhanced ultrasound for ruling out liver metastases. Studies focusing on the follow-up of cancer patients are lacking. The goal of this multicenter study initiated by the German Ultrasound Society (DEGUM) was to determine the potential benefit of contrast-enhanced ultrasound in the follow-up of patients with colon cancer. MATERIALS AND METHODS Follow-up patients with colon cancer (UICC > IIa) were investigated. As scheduled according to the German guidelines, unenhanced ultrasound was performed followed by contrast-enhanced ultrasound. All liver lesions were recorded. In case of additional metastases detected on contrast-enhanced ultrasound, contrast-enhanced CT, MRI or biopsy was performed to confirm additional liver metastases. RESULTS A total of 45 liver metastases were detected in 26/290 patients (= 9 %) using unenhanced ultrasound. A further 28 metastases were detected on contrast-enhanced ultrasound in these 26 patients. In 18 patients showing no liver metastases, 40 additional metastases were detected on unenhanced ultrasound. This means that 44 patients with a total of 113 liver metastases were detected on contrast-enhanced ultrasound (p = 0.0006). CONCLUSION Contrast-enhanced ultrasound should be recommended in the follow-up of patients with colon cancer in addition to unenhanced ultrasound - the up-to-date standard.
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Affiliation(s)
- T Bernatik
- Dept. of Internal Medicine, Kreisklinik Ebersberg, Germany
| | - A Schuler
- Dept. of Internal Medicine, Helfenstein Klinik, Geislingen, Germany
| | - G Kunze
- Dept. of Internal Medicine, KH Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - M Mauch
- Dept. of Internal Medicine, Kreisklinik Sigmaringen, Germany
| | - C F Dietrich
- Dept. of Internal Medicine2, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - K Dirks
- Dept. of Internal Medicine, Rems-Murr-Klinik, Winnenden, Germany
| | - C Pachmann
- Dept. of Internal Medicine, Israelisches Krankenhaus, Hamburg, Germany
| | - N Börner
- MED Facharztzentrum, Gastroenterologische Praxis, Mainz, Germany
| | - K Fellermann
- Dept. of Internal Medicine1, university, Lübeck, Germany
| | - J Menzel
- Dept. of Internal Medicine2, Klinikum Ingolstadt, Germany
| | - D Strobel
- Dept. of Medicine 1, University of Erlangen, Germany
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Fröhlich E, Jenssen C, Schuler A, Dietrich CF. [Contrast-enhanced ultrasound for characterisation of focal liver lesions, practical advice]. Z Gastroenterol 2015; 53:1099-107. [PMID: 26367027 DOI: 10.1055/s-0035-1553491] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review article reports on evidence-based and clinical aspects of contrast-enhanced ultrasound of liver masses. The advanced possibilities of contrast-enhanced ultrasound to detect and characterise liver tumors are described as well as limitations and pitfalls of the method. The choice of the ultrasound device and contrast agents as well as the qualifications of the examiners according to guidelines are discussed.
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Affiliation(s)
- E Fröhlich
- Medizinische Klinik, Karl-Olga-Krankenhaus, Stuttgart, Germany
| | - C Jenssen
- Medizinische Klinik, Krankenhaus Märkisch Oderland GmbH, Wriezen, Germany
| | - A Schuler
- Medizinische Klinik, Helfenstein Klinik, Geislingen, Germany
| | - C F Dietrich
- Medizinische Klinik, Caritas-Krankenhaus Bad Mergentheim, Germany
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Mauch M, Blank W, Kunze G, Dirks K, Schuler A, Klinggräff von G, Seitz K. Importance of Abdominal Ultrasound in 17 Patients with Histologically Confirmed Autoimmune Pancreatitis (AIP). Ultraschall Med 2015; 36:248-254. [PMID: 25377446 DOI: 10.1055/s-0034-1385385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Autoimmune pancreatitis (AIP) is an independent, underdiagnosed, rare form of chronic pancreatitis. The goal of this study is to document ultrasound findings in histologically confirmed AIP in order to determine the diagnostic value of ultrasound. MATERIALS AND METHODS 6 of 74 DEGUM instructors for internal medicine (level 3 and 2) provided anonymized clinical and sonographic data from 17 patients with histologically confirmed AIP. RESULTS 9/17 patients had diffuse AIP, 8/17 had focal AIP, 14/17 suffered from upper abdominal pain, 9/17 had jaundice, and 3/9 had an elevated IgG4 level. Ultrasound showed diffuse hypoechoic organ enlargement in 9/17 cases and a hypoechoic tumor with an unclear border in 8/17 cases. AIP was verified by ultrasound-guided percutaneous core biopsy in 14 cases, by biopsy of the bile duct in 1 case, and by surgical biopsy in 2 cases. Involvement of the hepatobiliary system was present in 7/17 patients and autoimmune cholangitis was verified in 5 cases. All patients experienced remission after immunosuppressive treatment. The pancreatic duct had a normal width in 11 cases, was dilated in 5 cases, and was stenosed over a long stretch in 3 cases. Contrast-enhanced ultrasound did not show uniform signal increase but also no significantly reduced or absent perfusion. CONCLUSION Ultrasound can be diagnostically useful if the clinical manifestations of AIP are known. While the diffuse form allows an ad-hoc suspected diagnosis, the focal form can only be suspected in the case of additional extrapancreatic involvement. Contrast-enhanced ultrasound (CEUS) contributes greatly to the differentiation from ductal adenocarcinoma in the case of focal AIP.
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Affiliation(s)
- M Mauch
- Medizinische Klinik, Ultraschall, Kreiskrankenhaus Sigmaringen, Germany
| | - W Blank
- Medizinische Klinik I, Klinikum am Steinenberg, Reutlingen, Germany
| | - G Kunze
- Innere Medizin I, Schwarzwald-Baar Klinikum, Villingen, Germany
| | - K Dirks
- Klinikum Bad Cannstatt, Stuttgart, Germany
| | - A Schuler
- Medizinische Klinik, Helfenstein Klinik, Geislingen, Germany
| | - G Klinggräff von
- Röntgen Abteilung, Allgemeines Krankenhaus Harburg, Hamburg, Germany
| | - K Seitz
- Medizinische Klinik, Ultraschall, Kreiskrankenhaus Sigmaringen, Germany
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26
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Scheuing N, Stingl J, Dapp A, Denkinger MD, Fasching P, Jehle PM, Merger S, Mühldorfer S, Pieper U, Schuler A, Zeyfang A, Holl RW. Glukozentrische Diabetestherapie bei geriatrischen Patienten mit Demenz sinnvoll? Multizentrische DPV-Daten von insgesamt 215.932 Typ-2-Diabetespatienten zeigen signifikant erhöhte Hypoglykämierate bei 6.771 Patienten mit komorbider Demenz. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Strobel D, Bernatik T, Blank W, Will U, Reichel A, Wüstner M, Keim V, Schacherer D, Barreiros AP, Kunze G, Nürnberg D, Ignee A, Burmester E, Bunk AA, Friedrich-Rust M, Froehlich E, Schuler A, Jenssen C, Bohle W, Mauch M, Dirks K, Kaemmer J, Pachmann C, Stock J, Hocke M, Kendel A, Schmidt C, Jakobeit C, Kinkel H, Heinz W, Hübner G, Pichler M, Müller T. Incidence of bleeding in 8172 percutaneous ultrasound-guided intraabdominal diagnostic and therapeutic interventions - results of the prospective multicenter DEGUM interventional ultrasound study (PIUS study). Ultraschall Med 2015; 36:122-131. [PMID: 25876060 DOI: 10.1055/s-0034-1399282] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To analyse the incidence of bleeding after percutaneous ultrasound guided diagnostic and therapeutic intraabdominal interventions in a prospective multicentre study (DEGUM percutaneous interventional ultrasound study). MATERIALS AND METHODS Within a time period of 2 years diagnostic and therapeutic intraabdominal interventions (with the exclusion of ascites paracentesis) performed percutaneously under continuous ultrasound (US) guidance were prospectively assessed using a pseudonymized standardized web site entry form. Number and type of intervention, operator experience, patient characteristics, medication, lab data as well as technical aspects of the procedure and bleeding complications were analysed according to the interventional radiology standards. RESULTS 8172 US-guided intraabdominal interventions (liver n = 5903; pancreas n = 501, kidney n = 434, lymph node = 272, biliary system n = 153, spleen n = 63, other abdominal organs and extra-organic targets n = 999) were analysed in 30 hospitals. The majority were diagnostic biopsies including 1780 liver parenchyma, 3400 focal liver lesions and 404 pancreatic lesions. 7525 interventions (92.1 %) were performed in hospitalized patients (mean age 62.6 years). Most operators were highly experienced in US-guided interventions (> 500 interventions prior to the study n = 5729; 70.1 %). Sedation was administered in 1131 patients (13.8 %). Needle diameter was ≥ 1 mm in 7162 punctures (87.9 %) with main focus on core needle biopsies (18 G, n = 4185). Clinically relevant bleeding complications with need of transfusion (0.4 %), surgical bleeding control (0.1 %) and radiological coiling (0.05 %) were very rare. Bleeding complications with fatal outcome occurred in four patients (0.05 %). The frequency of major bleeding complications was significantly higher in patients with an INR > 1.5 (p < 0.001) and patients taking a medication potentially interfering with platelet function or plasmatic coagulation (p < 0.0333). CONCLUSION This prospective multicentre study confirms the broad spectrum of percutaneous US-guided intraabdominal interventions. However diagnostic liver biopsies dominate with the use of core needle biopsies (18 G). Percutaneous US-guided interventions performed by experienced sonographers are associated with a low bleeding risk. Major bleeding complications are very rare. A pre-interventional INR < 1.5 and individual medication risk assessment are recommended.
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Affiliation(s)
- D Strobel
- Internal Medicine 1, University Hospital Erlangen, Germany
| | - T Bernatik
- Department of Internal Medicine, District Hospital Ebersberg, Germany
| | - W Blank
- Department of Internal Medicine 1, Municipal Hospital Steinenberg, Reutlingen, Germany
| | - U Will
- Department of Gastroenterology, Municipal Hospital (Waldklinikum Gera gGmbH), Gera, Germany
| | - A Reichel
- Department of Gastroenterology, Municipal Hospital (Waldklinikum Gera gGmbH), Gera, Germany
| | - M Wüstner
- Central Interdisciplinary Ultrasound, Municipal Hospital Trier (Barmherzige Brüder), Trier, Germany
| | - V Keim
- Department of Gastroenterology, Central Ultrasound Unit, University Hospital Leipzig, Germany
| | - D Schacherer
- Department of Internal Medicine 1, University Hospital Regensburg, Germany
| | - A P Barreiros
- Department of Internal Medicine 1, University Hospital Mainz, Germany
| | - G Kunze
- Department of Internal Medicine 1, Municipal Hospital (Schwarzwald-Baar), Villingen-Schwenningen, Germany
| | - D Nürnberg
- Department of Internal Medicine B, Gastroenterology, District Hospital (Ruppiner Kliniken), Neuruppin, Germany
| | - A Ignee
- Department of Internal Medicine 2, Municipal Hospital (Caritas), Bad Mergentheim, Germany
| | - E Burmester
- Department of Internal Medicine/Gastroenterology, Municipal Hospital (Sana Kliniken Lübeck GmbH), Lübeck, Germany
| | - A A Bunk
- Surgery, University Hospital Dresden, Germany
| | - M Friedrich-Rust
- Department of Internal Medicine 1, University Hospital Frankfurt, Germany
| | - E Froehlich
- Department of Internal Medicine 1, Municipal Hospital (Karl-Olga-Krankenhaus), Stuttgart, Germany
| | - A Schuler
- Department of Internal Medicine, District Hospital Helfenstein, Geislingen, Germany
| | - C Jenssen
- Department of Internal Medicine, District Hospital (Krankenhaus Märkisch Oderland GmbH), Wriezen, Germany
| | - W Bohle
- Department of Medicine and Gastroenterology, Municipal Hospital (Katharinen), Stuttgart, Germany
| | - M Mauch
- Innere Medicine, District Hospital (SRH Kliniken Sigmaringen), Sigmaringen, Germany
| | - K Dirks
- Department of Interal Medicine and Gastroenterology, District Hospital Rems-Murr, Winnenden, Germany
| | - J Kaemmer
- Depatment of Internal Medicine, Hospital St Hedwig, Berlin, Germany
| | - C Pachmann
- Department of Internal Medicine, Israeli Hospital, Hamburg, Germany
| | - J Stock
- Gastroenterology, Hospital Vivantes Humboldt, Berlin, Germany
| | - M Hocke
- Department of Medicine 2 and Gastroenterology, District Hospital Helios Meiningen, Germany
| | - A Kendel
- Department of Internal Medicine, District Hospital Gummersbach, Germany
| | - C Schmidt
- Department of Internal Medicine, Hospital Albertinen, Hamburg, Germany
| | - C Jakobeit
- Gastroenterology, St. Josefs Hospital (Helios), Bochum, Germany
| | - H Kinkel
- Department of Internal Medicine 2, Municipal Hosital Düren, Germany
| | - W Heinz
- Department of Internal Medicine, Hospital Leonberg, Germany
| | - G Hübner
- Department of Internal Medicine, District Hospital Köthen, Germany
| | - M Pichler
- Campus Innenstadt Gastroenterology, University Hospital Munich, Germany
| | - T Müller
- Department of Internal Medicine 1, Municipal Hospital Steinenberg, Reutlingen, Germany
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Schuler A, Seitz K. [Trends in ultrasound of gastroenterology - 36. Dreiländertreffen 2013 in retrospect]. Ultraschall Med 2014; 35:475-476. [PMID: 25317553 DOI: 10.1055/s-0034-1385172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A Schuler
- Alb Fils Kliniken, Zentrum für Innere Medizin, Geislingen an der Steige
| | - K Seitz
- Kliniken Landkreis Sigmaringen
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Prager G, Schuler A, Pausz C, Bianconi D, Lenz H, Ay C, Pabinger I, Zielinski C. Integrin Beta-3 Genetic Variants Predict the Risk of Thrombo-Embolic Events in Patients with Colorectal Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Greten TF, Malek NP, Schmidt S, Arends J, Bartenstein P, Bechstein W, Bernatik T, Bitzer M, Chavan A, Dollinger M, Domagk D, Drognitz O, Düx M, Farkas S, Folprecht G, Galle P, Geißler M, Gerken G, Habermehl D, Helmberger T, Herfarth K, Hoffmann RT, Holtmann M, Huppert P, Jakobs T, Keller M, Klempnauer J, Kolligs F, Körber J, Lang H, Lehner F, Lordick F, Lubienski A, Manns MP, Mahnken A, Möhler M, Mönch C, Neuhaus P, Niederau C, Ocker M, Otto G, Pereira P, Pott G, Riemer J, Ringe K, Ritterbusch U, Rummeny E, Schirmacher P, Schlitt HJ, Schlottmann K, Schmitz V, Schuler A, Schulze-Bergkamen H, von Schweinitz D, Seehofer D, Sitter H, Straßburg CP, Stroszczynski C, Strobel D, Tannapfel A, Trojan J, van Thiel I, Vogel A, Wacker F, Wedemeyer H, Wege H, Weinmann A, Wittekind C, Wörmann B, Zech CJ. [Diagnosis of and therapy for hepatocellular carcinoma]. Z Gastroenterol 2013; 51:1269-326. [PMID: 24243572 PMCID: PMC6318804 DOI: 10.1055/s-0033-1355841] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The interdisciplinary guidelines at the S3 level on the diagnosis of and therapy for hepatocellular carcinoma (HCC) constitute an evidence- and consensus-based instrument that is aimed at improving the diagnosis of and therapy for HCC since these are very challenging tasks. The purpose of the guidelines is to offer the patient (with suspected or confirmed HCC) adequate, scientifically based and up-to-date procedures in diagnosis, therapy and rehabilitation. This holds not only for locally limited or focally advanced disease but also for the existence of recurrences or distant metastases. Besides making a contribution to an appropriate health-care service, the guidelines should also provide the foundation for an individually adapted, high-quality therapy. The explanatory background texts should also enable non-specialist but responsible colleagues to give sound advice to their patients concerning specialist procedures, side effects and results. In the medium and long-term this should reduce the morbidity and mortality of patients with HCC and improve their quality of life.
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Behrens A, Labenz J, Schuler A, Schröder W, Rünzi M, Steinmann RU, de Mas CR, Kreuzmayr A, Barth K, Bahr MJ, Burmester E, Erckenbrecht JF, Frieling T, Dumoulin FL, Pfaffenbach B, Schepp W, Schneider A, Kleber G, Meiborg M, Böhm S, Dietrich C, Dietrich CF, Gottschalk U, Ell C. [How safe is sedation in gastrointestinal endoscopy? A multicentre analysis of 388,404 endoscopies and analysis of data from prospective registries of complications managed by members of the Working Group of Leading Hospital Gastroenterologists (ALGK)]. Z Gastroenterol 2013; 51:432-6. [PMID: 23681895 DOI: 10.1055/s-0032-1325524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Gastrointestinal endoscopies are increasingly being carried out with sedation. All of the drugs used for sedation are associated with a certain risk of complications. Data currently available on sedation-associated morbidity and mortality rates are limited and in most cases have substantial methodological limitations. The aim of this study was to record severe sedation-associated complications in a large number of gastrointestinal endoscopies. METHODS Data on severe sedation-associated complications were collected on a multicentre basis from prospectively recorded registries of complications in the participating hospitals (median documentation period 27 months, range 9 - 129 months). RESULTS Data for 388,404 endoscopies from 15 departments were included in the study. Severe sedation-associated complications occurred in 57 patients (0.01 %). Forty-one percent of the complications and 50 % of all complications with a fatal outcome (10/20 patients) occurred during emergency endoscopies. In addition, it was found that 95 % of the complications and 100 % of all fatal complications affected patients in ASA class ≥ 3. CONCLUSIONS Including nearly 400,000 endoscopies, this study represents the largest prospective, multicenter record of the complications of sedation worldwide. The analysis shows that sedation is carried out safely in gastrointestinal endoscopy. The morbidity and mortality rates are much lower than previously reported in the literature in similar groups of patients. Risk factors for the occurrence of serious complications include emergency examinations and patients in ASA class ≥ 3.
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Affiliation(s)
- A Behrens
- Die Institutsangaben sind am Ende des Beitrags gelistet.
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Liebeck M, Schuler A, Votsmeier M, Drochner A, Vogel H. Infrared Spectroscopic Study of the NH3-SCR on Fe-Zeolites under Transient Conditions. Top Catal 2013. [DOI: 10.1007/s11244-013-9954-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wolf H, Gross F, Merz A, Schuler A. [Liver segment anatomy in ultrasound--examinations to define the frontier between segment II/III and literature review]. Z Gastroenterol 2013; 51:271-7. [PMID: 23487356 DOI: 10.1055/s-0032-1325353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Liver segment definition due to Couinaud is the basis for localisation of focal liver lesions in imaging, in the follow-up or for planning operations. A literature review shows variety in segment definition and the frontier between segment II and III in the left liver lobe, in the course of the portal vein level and in variations of liver veins. The aim of this study is to demonstrate liver segment anatomy in sonography compared to anatomic preparations and the literature. This leads to a proposal for a unique nomenclature and illustration. MATERIAL AND METHODS 152 liver healthy persons (77 F, 75 M, mean age 63.3 years (18 - 91 years) were examined with standardised abdominal ultrasound in longitudinal, transversal and axis planes. (Angle) measurements were taken to define the left hepatic vein (Fissura sinistra), the Ramus umbilicalis of the portal vein (Fissura umbilicalis), the portal vein level and the amount and variations of the liver veins. RESULTS The left hepatic vein was found with a mean angle of 24° (0 - 70°) left to the median axis, the Pars umbilicalis of the portal vein wasalmost strictly in the mid axis. The portal vein level was located with a mean angle of 61° (5 - 110°) right to the median with no variations of the two main branches. 27 (18 %) out of the remaining 151 patients showed variations of the liver veins: 7 × (4.6 %) a doubled mid hepatic vein, 12 × (8 %) a doubled left hepatic vein, 4 × (2.7 %) 3 left liver veins were found with a short (≤ 1 cm) common trunk, 1 × each (0.7 %) four left liver veins with a short common trunk, one trifurcation of the mid hepatic vein, one doubled right liver vein and one common trunk (2 cm) of all 3 main liver veins leading to the inferior V. cava. DISCUSSION The surgical functional liver segment definition by Couinaud is the basis for localisation of focal liver lesions. The frontier between segment II and III is mainly described as a horizontal plane in the literature. The course of the left liver vein (fissura sinistra) has a mean angle of 24° left to the median and not like the umbilical fissure, which is found almost strictly in the median plane. The left hepatic vein(s), their course and liver vein variations are well demonstrated by sonography (99.3 % in this study). Anatomic landmarks as well as variations and a unique nomenclature should be well known and considered in the localisation of focal liver lesions, their feeding vessels and liver segment anatomy.
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Affiliation(s)
- H Wolf
- Facharzt für Allgemeinmedizin, Niederstotzingen, Germany.
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Seitz K, Greis C, Schuler A, Bernatik T, Blank W, Dietrich CF, Strobel D. Frequency of tumor entities among liver tumors of unclear etiology initially detected by sonography in the noncirrhotic or cirrhotic livers of 1349 patients. Results of the DEGUM multicenter study. Ultraschall Med 2011; 32:598-603. [PMID: 22161557 DOI: 10.1055/s-0031-1281858] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Investigation of the frequency of various solid focal liver lesions (SFLL) in noncirrhotic and cirrhotic livers with focus on the frequency of metastasis in cirrhotic livers. MATERIAL AND METHODS The patient collective in the DEGUM multicenter study (n = 1349) was reevaluated and divided in subcollective A without (n = 1067) and B with cirrhosis (n = 282). 74.6 % of the various tumor entities were confirmed histologically (n = 1006). RESULTS In subcollective A there were 385 patients with metastases (36.4 %) and 65 with HCC (6.1 %), whereas the most common benign lesions were hemangioma, with 237 cases (22.4 %) and FNH, with 170 cases (16.1 %). In subcollective B there were 216 cases of HCC (76.6 %) and 12 metastases (4.3 %), as well as 42 benign lesions (14.9 %). CCC was rare in both subcollective A (3.3 %) and subcollective B (2.5 %). A positive oncological history increased the probability of a malignant SFLL in subcollective A by 1.8 times, but did not do so in subcollective B. CONCLUSION The frequency of various tumor entities is different in patients with and without cirrhosis of the liver. In noncirrhotic livers, malignant and benign SFLL are equally common. The most common forms are metastases, hemangiomas and FNH, CCC is rare. A positive history of extrahepatic malignancy increases the probability of a malignant SFLL. In cirrhosis, HCC dominates, HCC is 18 times as common as metastases. Benign SFLL and CCC are rare.
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Affiliation(s)
- K Seitz
- Department of Internal Medicine, KKH Sigmaringen.
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Strobel D, Bernatik T, Blank W, Schuler A, Greis C, Dietrich CF, Seitz K. Diagnostic accuracy of CEUS in the differential diagnosis of small (≤ 20 mm) and subcentimetric (≤ 10 mm) focal liver lesions in comparison with histology. Results of the DEGUM multicenter trial. Ultraschall Med 2011; 32:593-597. [PMID: 22161556 DOI: 10.1055/s-0031-1271114] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of small and subcentimetric liver tumors in clinical practice. MATERIALS AND METHODS 1349 patients with a hepatic tumor lacking a definite diagnosis based on B-mode ultrasound and power Doppler ultrasound were examined at 14 hospitals by CEUS using a standardized protocol (pulse/phase inversion imaging, mechanical index < 0.4). Differential diagnosis was based on the vascularity pattern and contrast enhancement pattern during the arterial, portal, and late phase according to the EFSUMB guidelines. 335 patients with focal liver lesions (FLL) ≤ 20 mm were analyzed. The tumor status established after CEUS was compared to histology (73.2 %) or in some cases to CT or MRI. RESULTS A definitive diagnosis based on the gold standard was possible in 329 FLLs, while 6 FLLs remained unclear even in the combined gold standard (histology and/or CT and/or MRI). The final diagnoses of ≤ 20 mm FLL with histological confirmation (n = 241) included 87 benign and 154 malignant entities. The overall diagnostic accuracy of CEUS in FLL ≤ 20 mm with histological confirmation was 83.8 %. CEUS correctly identified 144 /154 malignant FLLs (sensitivity 93.5 %) and 58 /87 benign FLLs (specificity 66.7 %). 24 /241 FLLs remained unclear after CEUS (9.9 %). CEUS misclassified 15 /241 FLLs (6.2 %; 12 benign and 3 malignant FLLs). The positive predictive value of CEUS for a malignant FLL was 92.3 % and the negative predictive value was 95.1 %. Out of 241 small FLLs with histological confirmation, 62 FLLs were ≤ 10 mm (diagnostic accuracy of CEUS 80.6 %) and 179 FLLs were > 10 mm and ≤ 20 mm (diagnostic accuracy of CEUS 84.9 %). CONCLUSION CEUS has a high diagnostic accuracy for the differential diagnosis of small and subcentimetric FLLs in clinical practice.
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Affiliation(s)
- D Strobel
- Dept. of Medicine 1, University of Erlangen, Germany.
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Kratzer W, Schmid A, Akinli AS, Thiel R, Mason RA, Schuler A, Haenle MM. [Gallbladder polyps: prevalence and risk factors]. Ultraschall Med 2011; 32 Suppl 1:S68-S73. [PMID: 20414857 DOI: 10.1055/s-0029-1245265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The objective of the present study was to investigate the prevalence of gallbladder polyps and possible risk factors in a random population sample of an urban population. MATERIAL AND METHODS A total of 2099 subjects (1072 women, 1027 men; aged 19 - 65 years, mean age 42.1 (SD ± 12.8 years) were prospectively examined using ultrasound, a standardized questionnaire and laboratory studies. RESULTS Gallbladder polyps were identified in 6.1 % (128 / 2099) of all subjects (women: 6.1 % [63 / 1027]); men: 6.1 % [65 / 1072]). Solitary polyps were found in 52.4 % (65 / 124), two polyps in 16.1 % (20 / 124), three polyps in 6.5 % (8 / 124), several polyps in 22.6 % (28 / 124) and multiple polyps in 2.4 % (3 / 124) of subjects. The mean polyp diameter was 4.7 mm (SD ± 2.2; range 2 - 20 mm). The polyp diameter was ≤ 7 mm in 94.5 % of subjects. The polyps were described as pedunculate in 82.3 % (102 / 124). The polyps were broad-based in 11.3 % of subjects (14 / 124; men: 18 % women: 4.8 %). The polyps were homogeneously echogenic in 100 % of cases and with irregular contours in only one male subject. Multiple logistic regression failed to demonstrate an influence on the increased occurrence of gallbladder polyps for the risk factors of male sex, age, body-mass index (BMI), alcohol, nicotine or caffeine consumption or diabetes mellitus. CONCLUSION The prevalence of gallbladder polyps reported in the present study (6.1 %) is higher than figures previously published for populations in Germany or Europe. The majority of polyps were pedunculate and solitary. A typical risk factor profile for gallbladder polyps could not be identified in the present population sample.
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Affiliation(s)
- W Kratzer
- Zentrum für Innere Medizin, Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm.
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Bernatik T, Seitz K, Blank W, Schuler A, Dietrich CF, Strobel D. Unclear focal liver lesions in contrast-enhanced ultrasonography--lessons to be learned from the DEGUM multicenter study for the characterization of liver tumors. Ultraschall Med 2010; 31:577-581. [PMID: 20740399 DOI: 10.1055/s-0029-1245649] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To discuss the difficulties of contrast-enhanced ultrasound (CEUS) in a large multi-center trial. MATERIALS AND METHODS CEUS was performed on 1349 liver lesions with an unclear diagnosis after native ultrasound using a standardized protocol (phase inversion; low MI < 0.4; Sonovue Bolus 1.2 - 4.8 ml). The early arterial, arterial, portal venous and late phase > 2 min. were documented. The diagnosis based on CEUS results was compared to the final diagnosis (histology: n = 1006; MRI: n = 269; CT: n = 269 - multiple examinations possible). RESULTS Of the 1349 enclosed liver lesions, 20 could not be definitively diagnosed even using all diagnostic steps including histology (the others were proven to be benign n = 573 or malignant n = 756). Of the 1349 unclear liver lesions, 1257 could be differentiated with an accuracy of 90.3% using CEUS. The sensitivity, specificity, and positive and negative predictive value for malignant liver lesions was 95.8%, 83.1%, 88.2% and 93.7% respectively. 92 liver lesions (6.8%) could not be definitively diagnosed using CEUS. Most of them were benign (n = 67) on final diagnosis. The CEUS diagnosis was wrong for 39 lesions. However, only 8 lesions classified as benign by CEUS turned out to be malignant. In 3 cases HCC proven by histology was incorrectly diagnosed by CEUS as adenoma and 2 lesions incorrectly diagnosed by CEUS as FNH turned out to be an HCC and a metastasis. Two lesions diagnosed by CEUS as hemangiomas turned out to be an HCC and a metastasis. One lesion classified as benign by CEUS was ultimately diagnosed as a lymphoma. CONCLUSION Even in this multi-center trial, CEUS proved to be an excellent method for clarifying liver lesions remaining unclear after native ultrasound. The CEUS diagnosis of benign was only incorrect in a few cases.
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Affiliation(s)
- T Bernatik
- Department of Medicine 1, Universitiy Erlangen-Nuremberg, Germany.
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Seitz K, Bernatik T, Strobel D, Blank W, Friedrich-Rust M, Strunk H, Greis C, Kratzer W, Schuler A. Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM Multicenter Trial): CEUS vs. MRI--a prospective comparison in 269 patients. Ultraschall Med 2010; 31:492-499. [PMID: 20652854 DOI: 10.1055/s-0029-1245591] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The aim of this prospective multicenter study was to assess the diagnostic role of CEUS in the diagnosis of newly discovered focal liver lesions in clinical practice. One important aspect is the comparison of CEUS with magnetic resonance imaging (MRI). MATERIALS AND METHODS From 05 / 2004 to 12 / 2006, standardized CEUS was performed prospectively on 1349 patients with focal liver lesions that had been newly detected by fundamental ultrasound in order to determine tumor differentiation and tumor entity. 269 patients had a standardized MRI after CEUS. In typical liver hemangioma and focal nodular hyperplasia (FNH), the definitive diagnosis was based on the MRI as the "diagnostic gold standard" and on clinical evidence and additional follow-up (subgroup A) or on histology (subgroup B). 262 patients met the diagnostic standard that had been set. RESULTS In the subcollective (n = 262), the tumor differentiation (malignant or benign) of CEUS and MRI was concordant in 225 cases (85.9%), and the assessment of tumor entity in 204 cases (77.9%). In subgroup A (n = 180), concordant results for tumor differentiation were obtained in 169 (93.2%) and for tumor entity in 160 (88.9%) cases. Liver hemangiomas (n = 122) and FNH (n = 43) were most frequent. Subgroup B (n = 82) comprised mainly malignant liver lesions (n = 55), with only a few of hemangiomas (n = 8) or FNH (n = 5). Tumor differentiation was concordant in 56 (68.3%) and tumor entity in 44 cases (53.7%). There were no statistically proven differences between CEUS and MRI. CONCLUSION CEUS and MRI are of equal value for the differentiation and specification of newly discovered liver tumors in clinical practice. CEUS and MRI are extremely reliable for the differentiation of benign and malignant lesions, the diagnosis of liver hemangiomas and FNH. The characterization of metastases and HCC is also very reliable.
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Affiliation(s)
- K Seitz
- Department of Internal Medicine, District Hospital Sigmaringen, Sigmaringen, Germany.
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Schuler A, Reuss J, Delorme S, Hagendorff A, Giesel F. [Costs of clinical ultrasound examinations - an economical cost calculation and analysis]. Ultraschall Med 2010; 31:379-386. [PMID: 20183779 DOI: 10.1055/s-0029-1245283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The aim of the study was to calculate the costs for clinical ultrasound examinations in Germany under defined economical aspects in a multicenter setting. MATERIALS AND METHODS There are fixed and variable costs for all common ultrasound examinations calculated under distinct scenarios for utilization and equipment quality (ultrasound systems classification concerning to DEGUM, German Ultrasound Society). RESULTS Over 5 years (on average 2007 - 2011) depending on utilization and quality, the basic sonography costs were 131.30 - 171.39 Euros for contrast-enhanced ultrasound (CEUS) and 57.06 - 77.10 Euros for ultrasound guided biopsy per examination. The costs were calculated at 54.84 - 74.88 Euros for endosonography of the lower GI tract, at 79.20 - 109.27 Euros for the upper GI tract without biopsy and at 226.18 - 367.97 Euros with biopsy depending on the needle used. The costs were 34.58 - 47.01 Euros for basic transthoracic echocardiography, 100.04 - 112.20 Euros for CEUS, and 106.15 - 134.29 Euros for the transesophageal approach. CONCLUSION Cost calculation under defined economical aspects leads to cost transparency for clinical ultrasound examinations. Echocardiography costs were calculated like this for the first time in Germany. Calculation based on fixed and variable cost aspects as well as using distinct scenarios enables prospective planning of resources and investment. The analysis points out deficits in the reimbursement of ultrasound examinations in Germany.
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Affiliation(s)
- A Schuler
- Medizinische Klinik, Helfenstein Klinik, Geislingen.
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Borchert D, Schuler A, Muche R, Haenle MM, Akinli AS, Arnold F, Kratzer W, Pauls S. Comparison of panorama ultrasonography, conventional B-mode ultrasonography, and computed tomography for measuring liver size. Ultraschall Med 2010; 31:31-36. [PMID: 19266425 DOI: 10.1055/s-2008-1109309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE The objective of the present study is to compare the utility of extended field-of-view ultrasonography and conventional B-mode ultrasonography for determining liver size. MATERIALS AND METHODS The liver size in the medioclavicular line (MCL) was determined in 104 inpatients (females: n = 47; males: n = 57) using both ultrasound methods (Philips HDI 5000). The liver size measured in computed tomography (CT; MX 8000 IDT, Philips) served as the gold standard. The body mass index (BMI), ultrasound scanning conditions, and hepatomegaly identified by CT were evaluated as possible factors affecting the measurement accuracy of the sonographic methods. RESULTS The standard deviation of the differences between the measured pairs of values shows less dispersion in B-mode ultrasonography (18.7 mm) than panorama ultrasonography (20.8 mm). The mean value of differences between the measured pairs (bias) in the ultrasonographic methods compared to CT is considerably higher in panorama sonography (15.3 mm; SD = 20.8) than in B-mode ultrasonography (0.27 mm; SD = 18.7). A paired t-test of the mean values shows a significant difference between the ultrasonographic methods (p < 0.0001). In diagnosing or excluding hepatomegaly, B-mode sonography is consistent with CT findings in 84 (80.8 %) of 104 patients and panorama ultrasonography is consistent with CT findings in 77 (74.0 %) of 104 patients. Ultrasonographic methods show moderate agreement with each other (Kappa = 0.4265). Higher BMI and limited scanning conditions lead to an increase in the mean difference of measured pairs of values (bias) as well as to an increase in standard deviation of the differences (dispersion). CONCLUSION The determination of liver size in the medioclavicular line using panorama ultrasonography often leads to the false-positive diagnosis of hepatomegaly. Therefore, the method should not be recommended for routine diagnostic scans. In cases of significant hepatomegaly, however, panorama ultrasonography offers superior visualization compared to conventional B-mode ultrasonography.
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Affiliation(s)
- D Borchert
- Zentrum für Innere Medizin, Klinik für Innere Medizin I, Universitätsklinikum Ulm
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Kratzer W, Akinli AS, Bommer M, Arnold F, Eggink S, Imhof A, Mason RA, Klaus J, Schuler A, Boehm BO, Haenle MM. Prevalence and risk factors of focal sparing in hepatic steatosis. Ultraschall Med 2010; 31:37-42. [PMID: 20157869 DOI: 10.1055/s-0028-1109894] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The prevalence, localization and potential risk factors for focal sparing were prospectively assessed in subjects with sonographically detectable hepatic steatosis as part of a population-based cross-sectional study. MATERIALS AND METHODS A total of 1,624 persons (n = 906 women; n = 718 men) were evaluated using ultrasonography, laboratory testing and a standardized questionnaire. The following were excluded from the analysis: subjects with reported alcohol consumption > 40 g/day (males) or > 20 g/day (females), those with known chronic hepatitis B or C infection, elevated serum transaminases (AST: m > 44 U/l, f > 33 U/l; ALT: m > 45 U/l, f > 35 U/l) and prior right nephrectomy. RESULTS The prevalence of focal sparing in patients with hepatic steatosis (grade I) was 25.6 % for men and 13.0 % for women. In patients with grade II/III disease, the prevalence was 70.9 % for men and 77.6 % for women. The most common site of focal sparing was in segment IV. The average diameter was 22.3 mm (range 7 - 84 mm). No correlation was found for postulated risk "age" (p = 0.09) or "status post cholecystectomy" (p = 0.09). Male sex (p = 0.02) and metabolic syndrome (odds ratio, 2.1; 95 % confidence interval, 1.1 - 4.1; p = 0.02) were confirmed as risk factors. CONCLUSION Sonographic evidence of focal sparing in subjects with hepatic steatosis is associated with an increased risk for metabolic syndrome and may be an easily obtained diagnostic criterion in routine clinical settings.
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Affiliation(s)
- W Kratzer
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Zentrum für Innere Medizin, Ulm, Germany.
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Strobel D, Seitz K, Blank W, Schuler A, Dietrich CF, von Herbay A, Friedrich-Rust M, Bernatik T. Tumor-specific vascularization pattern of liver metastasis, hepatocellular carcinoma, hemangioma and focal nodular hyperplasia in the differential diagnosis of 1,349 liver lesions in contrast-enhanced ultrasound (CEUS). Ultraschall Med 2009; 30:376-382. [PMID: 19688669 DOI: 10.1055/s-0028-1109672] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM To evaluate the incidence and diagnostic accuracy of tumor-specific vascularization pattern in contrast-enhanced ultrasound (CEUS) in the differential diagnosis of liver tumors in clinical practice. MATERIALS AND METHODS From May 2004 to December 2006 1349 patients (male 677, female 672) with a hepatic tumor lacking a definite diagnosis based on B-mode ultrasound and power Doppler ultrasound were examined at 14 hospitals by CEUS using a standardized protocol (pulse/phase inversion imaging, mechanical index < 0.4). Vascularity pattern and contrast enhancement pattern were analyzed in focal lesions during the arterial, portal, and late phase. The tumor-specific diagnosis established after CEUS was compared to histology (> 75 % cases) or in some cases to CT or MRI. RESULTS The final diagnosis of 573 benign hepatic tumors included hemangiomas (n = 242) and focal nodular hyperplasia (n = 170), other benign lesions (n = 161). Tumor-specific vascularization pattern such as a wheel-spoke pattern and arterial hyperenhancement followed by isoenhancement in the late phase in FNH or a nodular peripheral enhancement and partial or complete fill-in pattern in hemangiomas could be assessed in the majority, but not all lesions. The diagnostic accuracy of CEUS was 83.1 % for all benign lesions and 82.2 % for hemangioma and 87.1 % for FNH. The final diagnosis of 755 malignant hepatic tumors included metastases n = 383, hepatocellular carcinoma n = 279 and other malignant lesions n = 93. Late phase hypoenhancement was seen in almost all liver metastases (94.7 %) The diagnostic accuracy of CEUS was 95.8 % for all malignant lesions and 91.4 % for liver metastases and 84.9 % for hepatocellular carcinomas. CONCLUSION Tumor-specific vascularization pattern in CEUS have a high diagnostic impact on the overall high diagnostic accuracy of CEUS for the differential diagnosis of hepatic tumors in clinical practice.
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Affiliation(s)
- D Strobel
- Internal medicine I, University of Erlangen, Ulmenweg 18, 91058 Erlangen.
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Seitz K, Strobel D, Bernatik T, Blank W, Friedrich-Rust M, Herbay AV, Dietrich CF, Strunk H, Kratzer W, Schuler A. Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions - prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). Parts of this manuscript were presented at the Ultrasound Dreiländertreffen 2008, Davos. Ultraschall Med 2009; 30:383-389. [PMID: 19688670 DOI: 10.1055/s-0028-1109673] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The aim of our study was to evaluate the diagnostic value of Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions in a prospective multi-center study in clinical practice. For this purpose CEUS was compared with the spiral-CT (SCT), the standard radiological method. MATERIAL AND METHODS 1349 patients with unclear liver lesions after fundamental ultrasound diagnostics including color doppler analysis were examined with standardized CEUS (pulse inversion method, mechanical index < 0.4) from May 2004 to December 2006 in 14 hospitals in a prospective study. The enhancement of contrast medium in the liver tumors was analyzed according to known tumor-specific vascular patterns, using standardized documentation and analysis methods for the differentiation of tumor differentiation (malign or benign) and tumor specification (entity). A subcollective of 267 patients was additionally examined by standardized SCT method. Final diagnosis was based on histology, SCT or MRI in typical findings of liver hemangioma and FNH and on proved clinical data and additional follow up. RESULTS The subcollective of 267 patients was divided in two subgroups. In 109 of these patients (subgroup A) there was no histological verification, diagnoses based on clear SCT-findings in 79 cases of hemangioma or FNH, as well as in 20 cases with a clear clinical diagnosis. 6 cases (5.5 %) remained unclear. In this subgroup the assessment of tumor differentiation was concordant with CEUS in 90 cases, discordant in 19 cases and the assessment of tumor specification was concordant in 82 and and discordant in 27 cases. In 158 patients (subgroup B) a histological finding was also present, only in 4 cases no definitive tumor diagnosis was achieved. In this subgroup assessment of tumor differentiation with CEUS and SCT was concordant in 124 cases and discordant in 30 cases (CEUS/SCT: sensitivity 94.0 / 90.7 %, specificity 83.0 / 81.5 %, PPV 91.6 / 91.5 %, NPV 87.5 / 80.0 %, accuracy 90.3 / 87.8 %). Tumor specification matched in 103cases and were different in 51 cases (CEUS/SCT: sensitivity 95.3 / 90.6 %, specificity 83.7 / 81.6 %, PPV 92.7 / 91.4 %, NPV 89.1 / 80.0 %, accuracy 91.6 / 87.7 %). A statistically significant difference could not be established. The analysis of particular tumor specification showed a statistically non significant slight advantage in tumor differentiation for CEUS in the case of hemangioma, FNH, HCC and metastases. CONCLUSION In a multi-center approach under routine clinical conditions, this prospective study demonstrates CEUS to be of equal rank to the CT-scan in regard to the assessment of tumor differentiation and specification. No statistically significant differences could be established. CEUS should be employed before computed tomography is performed for the differentiation of liver tumors, because radiation exposure and invasive biopsies can be avoided in veritable numbers of cases, when precise clinical evaluation of the findings is implemented.
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Affiliation(s)
- K Seitz
- Medizinische Klinik, Kreiskrankenhaus, Hohenzollernstr. 40, 72488 Sigmaringen.
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Strobel D, Seitz K, Blank W, Schuler A, Dietrich C, von Herbay A, Friedrich-Rust M, Kunze G, Becker D, Will U, Kratzer W, Albert FW, Pachmann C, Dirks K, Strunk H, Greis C, Bernatik T. Contrast-enhanced ultrasound for the characterization of focal liver lesions--diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall Med 2008; 29:499-505. [PMID: 19241506 DOI: 10.1055/s-2008-1027806] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To evaluate the diagnostic benefit of contrast-enhanced ultrasound for the differential diagnosis of liver tumors in clinical practice. MATERIALS AND METHODS From May 2004 to December 2006 1349 patients (male 677, female 672) with a hepatic tumor lacking a definite diagnosis based on B-mode ultrasound and power Doppler ultrasound were examined at 14 hospitals by contrast-enhanced ultrasound using a standardized protocol (pulse/phase inversion imaging, mechanical index < 0.4). The Tumor status was assessed based on the vascularity pattern and contrast enhancement seen in focal lesions during the arterial, portal, and late phase. The diagnosis established after contrast-enhanced ultrasound was compared to histology (> 75% cases) or in some cases to CT or MRI. RESULTS The final diagnosis of hepatic tumors included 573 benign hepatic tumors (hemangiomas n = 242, focal nodular hyperplasia n = 170, hepatocellular adenoma n = 19, other benign lesions n = 142) and 755 malignant hepatic tumors (metastases n = 383, hepatocellular carcinoma n = 279, other malignant lesions n= 93). The overall diagnostic accuracy of contrast-enhanced ultrasound in comparison to the correct final diagnosis based on the combined gold standard was 90.3%. Contrast-enhanced ultrasound was able to correctly assess 723/755 malignant lesions (sensitivity 95.8%) and 476/573 benign lesions (specificity 83.1%). The positive predictive value of contrast-enhanced ultrasound for the diagnosis of a malignant tumor was 95.4% and the negative predictive value of contrast-enhanced ultrasound was 95.7%. CONCLUSION Contrast-enhanced ultrasound clearly improves the differential diagnosis of hepatic tumors and is very helpful in clinical practice when B-scan or power Doppler morphological criteria are missing.
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Affiliation(s)
- D Strobel
- Internal medicine I, University of Erlangen, Erlangen.
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Malmberg S, Votsmeier M, Gieshoff J, Söger N, Mußmann L, Schuler A, Drochner A. Dynamic phenomena of SCR-catalysts containing Fe-exchanged zeolites – experiments and computer simulations. Top Catal 2007. [DOI: 10.1007/s11244-007-0146-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schuler A, Drochner A, Vogel H, Malmberg S, Votsmeier M, Gieshoff J, Söger N, Mußmann L. Transiente Effekte der NH3-SCR an Fe-Zeolithen – Experimente und Computersimulation. CHEM-ING-TECH 2006. [DOI: 10.1002/cite.200650124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zeimet AG, Müller-Holzner E, Schuler A, Hartung G, Berger J, Hermann M, Widschwendter M, Bergelson JM, Marth C. Determination of molecules regulating gene delivery using adenoviral vectors in ovarian carcinomas. Gene Ther 2002; 9:1093-100. [PMID: 12140737 DOI: 10.1038/sj.gt.3301775] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2002] [Accepted: 03/23/2002] [Indexed: 12/17/2022]
Abstract
Gene therapeutic approaches currently favor adenoviral vectors over alternatively available vector systems. Ovarian cancer represents an attractive model for an intraperitoneal adenovirus-based gene therapy, which is now under intensive clinical investigation. Adenovirus-mediated gene transfer depends on adequate virus uptake and thus on the presence of sufficient amounts of high-affinity coxsackie-adenovirus receptor (CAR) and alphavbeta3- and alphavbeta5 integrins on target cells. This fact has been ignored in most ongoing clinical trials. This investigation, therefore, determined expression of CAR by immunohistochemistry in 37 ovarian carcinomas and compared it with that of alphavbeta3 and alphavbeta5 integrins. In all samples, except one undifferentiated carcinoma, CAR was immunohistochemically demonstrable. Grade 1 tumors exhibited stronger CAR immunostaining as compared with higher-grade cancers (P < 0.03). Integrins alphavbeta3 and alphavbeta5 were detectable in 62% and 65% of carcinomas, respectively, and staining for both classes correlated positively (P < 0.005). Cancers classified as undifferentiated completely lacked alphavbeta3 expression. Furthermore, in undifferentiated and grade 3 carcinomas the three molecules studied exhibited marked distributional heterogeneity with regard to focal positivity and negativity within the same tumor. Either the absence of CAR, alphavbeta3 and alphavbeta5 or the pronounced heterogeneity in their expression might seriously compromise the efficiency of adenovirus-based gene therapy in ovarian cancer.
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Affiliation(s)
- A G Zeimet
- Department of Obstetrics and Gynecology, Innsbruck University Hospital, Austria
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48
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Abstract
The purpose of the present study was to examine the effects of participation in an integrated play group on the joint attention, symbolic play and language behavior of two young boys with autism. Two 6-year-old twin brothers participated in this study, along with three typically developing girls, ages 5, 9 and 11. A multiple baseline design was used with three phases: no intervention, intervention with adult coaching, and intervention without adult coaching. After being trained, the three typically developing children implemented the integrated play group techniques in 30 minute weekly play group sessions for over 16 weeks. Results indicate that participation in the integrated play group produced dramatic increases in shared attention to objects, symbolic play acts, and verbal utterances on the part of the participants with autism. These increases were maintained when adult support was withdrawn. Implications of these findings for inclusion of children with autism are discussed.
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Affiliation(s)
- C Zercher
- San Francisco State University, CA, USA.
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Nobilis A, Kocsis I, Tóth-Heyn P, Treszl A, Schuler A, Tulassay T, Vásárhelyi B. Variance of ACE and AT1 receptor gene does not influence the risk of neonatal acute renal failure. Pediatr Nephrol 2001; 16:1063-6. [PMID: 11793101 DOI: 10.1007/s004670100028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2001] [Accepted: 08/10/2001] [Indexed: 10/27/2022]
Abstract
High neonatal activity of the renin-angiotensin system (RAS) is crucial for the maintenance of glomerular filtration of the newborn. The aim of the present study was to investigate whether genetic polymorphisms leading to lower angiotensin converting enzyme activity (ACE) or impaired functionality of angiotensin II (AII) type 1 receptor (AT1R) might predispose very low birth weight newborns (VLBWs) to the development of acute renal failure (ARF). The medical records of 110 VLBW infants were analyzed. ARF developed in 42 of them during the first postnatal week, while 68 neonates exhibited normal renal function. The ACE I/D polymorphism and the A1166C variants of AT1R were determined from dried blood samples. The frequency of the ACE I allele did not differ in ARF and non-ARF groups (0.307 and 0.284); the frequency of the AT1R C1166 variant was also the same in ARF and non-ARF groups (0.250 and 0.227). Although low activity of RAS has been implicated in the development of neonatal ARF and data indicated that the functionality of RAS is influenced by the I/D variants of the ACE gene and the A1166C variant of the AT1R gene, we could not demonstrate any effect of these polymorphisms on the development of ARF in VLBW infants.
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Affiliation(s)
- A Nobilis
- Second Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Treszl A, Kocsis I, Szathmári M, Schuler A, Tulassay T, Vásárhelyi B. Genetic variants of the tumour necrosis factor-alpha promoter gene do not influence the development of necrotizing enterocolitis. Acta Paediatr 2001; 90:1182-5. [PMID: 11697432 DOI: 10.1080/080352501317061611] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
UNLABELLED Previous studies indicated that elevated tumour necrosis factor-alpha (TNF-alpha) levels may play a role in the development of necrotizing enterocolitis (NEC). The A(-308) and A(-238) variants of the promoter region of the TNF-alpha gene are reportedly associated with altered TNF-alpha production. The aim of our study was to determine the impact of these gene polymorphisms on the development and course of NEC in very-low-birthweight (VLBW) infants. Dried blood samples from 46 VLBW neonates with NEC were analysed using the method of restriction fragment length polymorphism. Samples from 90 VLBW neonates without NEC were used as controls. The prevalence of alleles with guanine-adenine transition in the -308 and -238 positions was the same in NEC and control subjects (12% vs 10% and 3% vs 4%, respectively). CONCLUSION The investigated genetic variants of the TNF-alpha gene promoter region have no influence on the risk and course of NEC in VLBW infants.
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Affiliation(s)
- A Treszl
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
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