1
|
Rahn AC, Peper J, Köpke S, Antony G, Liethmann K, Vettorazzi E, Heesen C. Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) - A cluster- randomised controlled trial and mixed methods process evaluation. Patient Educ Couns 2024; 125:108293. [PMID: 38728999 DOI: 10.1016/j.pec.2024.108293] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To evaluate a nurse-led decision coaching programme aiming to redistribute health professionals' tasks to support immunotherapy decision-making in people with multiple sclerosis (MS). METHODS Cluster-randomised controlled trial with an accompanying mixed methods process evaluation (2014 - 2018). We planned to recruit 300 people with clinically isolated syndrome or relapsing-remitting MS facing immunotherapy decisions in 15 clusters across Germany. Participants in the intervention clusters received up to three decision coaching sessions by a trained nurse and access to an evidence-based online information platform. In the control clusters, participants also had access to the information platform. The primary outcome was informed choice after six months, defined as good risk knowledge and congruent attitude and uptake. RESULTS Twelve nurses from eight clusters participated in the decision coaching training. Due to insufficient recruitment, the randomised controlled trial was terminated prematurely with 125 participants (n = 42 intervention clusters, n = 83 control clusters). We found a non-significant difference between groups for informed choice favouring decision coaching: odds ratio 1.64 (95% CI 0.49-5.53). CONCLUSIONS Results indicate that decision coaching might facilitate informed decision-making in MS compared to providing patient information alone. PRACTICE IMPLICATIONS Barriers have to be overcome to achieve structural change and successful implementation.
Collapse
Affiliation(s)
- A C Rahn
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - J Peper
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - S Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - G Antony
- Central Information Office Marburg, Fronhausen-Bellnhausen, Germany
| | - K Liethmann
- University Hospital Schleswig-Holstein, Campus Kiel, Department of Radiation Oncology, Kiel, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Center for integrative Psychiatry ZiP gGmbH, Psychooncology, Kiel, Germany
| | - E Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Benjafield A, Woehrle H, Vettorazzi E, Wegscheider K, Simonds A, Cowie M. New treatments for central sleep apnoea in heart failure: sample size required to detect a safety signal. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.699] [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: 11/29/2022]
|
3
|
Fabritz L, Connolly DL, Czarnecki E, Dudek D, Guasch E, Haase D, Huebner T, Zlahoda-Huzior A, Jolly K, Kirchhof P, Obergassel J, Schotten U, Vettorazzi E, Winkelmann SJ, Zapf A, Schnabel RB. Smartphone and wearable detected atrial arrhythmias in Older Adults: Results of a fully digital European Case finding study. Eur Heart J Digit Health 2022; 3:610-625. [PMID: 36710894 PMCID: PMC9779806 DOI: 10.1093/ehjdh/ztac067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/24/2022] [Indexed: 11/23/2022]
Abstract
Aims Simplified detection of atrial arrhythmias via consumer-electronics would enable earlier therapy in at-risk populations. Whether this is feasible and effective in older populations is not known. Methods and results The fully remote, investigator-initiated Smartphone and wearable detected atrial arrhythmia in Older Adults Case finding study (Smart in OAC-AFNET 9) digitally enrolled participants ≥65 years without known atrial fibrillation, not receiving oral anticoagulation in Germany, Poland, and Spain for 8 weeks. Participants were invited by media communications and direct contacts. Study procedures adhered to European data protection. Consenting participants received a wristband with a photoplethysmography sensor to be coupled to their smartphone. The primary outcome was the detection of atrial arrhythmias lasting 6 min or longer in the first 4 weeks of monitoring. Eight hundred and eighty-two older persons (age 71 ± 5 years, range 65-90, 500 (57%) women, 414 (47%) hypertension, and 97 (11%) diabetes) recorded signals. Most participants (72%) responded to adverts or word of mouth, leaflets (11%) or general practitioners (9%). Participation was completely remote in 469/882 persons (53%). During the first 4 weeks, participants transmitted PPG signals for 533/696 h (77% of the maximum possible time). Atrial arrhythmias were detected in 44 participants (5%) within 28 days, and in 53 (6%) within 8 weeks. Detection was highest in the first monitoring week [incidence rates: 1st week: 3.4% (95% confidence interval 2.4-4.9); 2nd-4th week: 0.55% (0.33-0.93)]. Conclusion Remote, digitally supported consumer-electronics-based screening is feasible in older European adults and identifies atrial arrhythmias in 5% of participants within 4 weeks of monitoring (NCT04579159).
Collapse
Affiliation(s)
- L Fabritz
- Corresponding author. Tel. +4940741057980,
| | - D L Connolly
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston Wolfson Drive, B15 2TT Birmingham, UK,Department of Cardiology and R&D, Birmingham City Hospital, Sandwell and West Birmingham Trust, Dudley Road, B18 7QH Birmingham, UK
| | - E Czarnecki
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - D Dudek
- Jagiellonian University Medical College, Center for Digital Medicine and Robotics, Ul. Kopernika 7E, 33-332 Kraków, Poland,Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola RA, Italy
| | - E Guasch
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Carrer de Villaroel, 170, 08036 Barcelona, CA, Spain, Spain,IDIBAPS, Rosselló 149-153, 08036 Barcelona, CA, Spain,CIBERCV, Monforte de Lemos 3-5, Pabellon 11, Planta 0, 28029 Madrid, Spain
| | - D Haase
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - T Huebner
- Preventicus GmbH, Ernst-Abbe-Straße 15, 07743 Jena, Germany
| | - A Zlahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, Al. Mickiewicza 30, 30-059 Kraków, Poland
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT Birmingham, UK
| | - P Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston Wolfson Drive, B15 2TT Birmingham, UK,Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - J Obergassel
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany
| | - U Schotten
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany,Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center +, Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - E Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Christoph-Probst-Weg 1, 20246 Hamburg, Germany
| | - S J Winkelmann
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany
| | - A Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Christoph-Probst-Weg 1, 20246 Hamburg, Germany
| | - R B Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany,Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | | |
Collapse
|
4
|
Petersen J, Meißner V, Wosgien K, Vettorazzi E, Blankenberg S, Conradi L, Girdauskas E, Reichenspurner H. Physical and Mental Recovery in Patients with Severe Aortic Valve Stenosis at Low-to-Intermediate Risk: SAVR versus TAVR. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742923] [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: 10/19/2022]
Affiliation(s)
| | - V. Meißner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland
| | - K. Wosgien
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland
| | - E. Vettorazzi
- Department of Medical Biometry and Epidemiology, Hamburg, Deutschland
| | | | | | - E. Girdauskas
- Department of Cardiac and Thoracic Surgery, University Hospital Augsburg, Augsburg, Deutschland
| | - H. Reichenspurner
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| |
Collapse
|
5
|
Jaeger A, Prieske K, Mathey S, Fischer I, Vettorazzi E, Kuerti S, Reuter S, Dieckmann J, Schmalfeldt B, Woelber L. Pelvic lymphadenectomy in vulvar cancer and its impact on prognosis and outcome. Arch Gynecol Obstet 2021; 305:233-240. [PMID: 34387725 PMCID: PMC8782795 DOI: 10.1007/s00404-021-06156-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general. PATIENTS AND METHODS N = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018. In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement. RESULTS The majority had T1b/T2 tumors (n = 15, 78.9%) with a median diameter of 40 mm (11-110 mm). 17/21 patients showed positive inguinal nodes. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients with positive groin nodes also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1-8)). These 6 patients were highly node positive with median 4.5 (2-9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed. Five recurrences were observed after a median follow-up of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group. Patients with pelvic metastasis at first diagnosis had a median progression-free survival of only 9.9 months and overall-survival of 31.1 months. CONCLUSION A relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.
Collapse
Affiliation(s)
- A Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - K Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Mathey
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - I Fischer
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Kuerti
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - S Reuter
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - J Dieckmann
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - B Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - L Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| |
Collapse
|
6
|
Salchow J, Mann J, Koch B, von Grundherr J, Jensen W, Elmers S, Straub LA, Vettorazzi E, Escherich G, Rutkowski S, Dwinger S, Bergelt C, Sokalska-Duhme M, Bielack S, Calaminus G, Baust K, Classen CF, Rössig C, Faber J, Faller H, Hilgendorf I, Gebauer J, Langer T, Metzler M, Schuster S, Niemeyer C, Puzik A, Reinhardt D, Dirksen U, Sander A, Köhler M, Habermann JK, Bokemeyer C, Stein A. Comprehensive assessments and related interventions to enhance the long-term outcomes of child, adolescent and young adult cancer survivors - presentation of the CARE for CAYA-Program study protocol and associated literature review. BMC Cancer 2020; 20:16. [PMID: 31906955 PMCID: PMC6945396 DOI: 10.1186/s12885-019-6492-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/23/2019] [Indexed: 12/21/2022] Open
Abstract
Background Improved, multimodal treatment strategies have been shown to increase cure rates in cancer patients. Those who survive cancer as a child, adolescent or young adult (CAYA), are at a higher risk for therapy-, or disease-related, late or long-term effects. The CARE for CAYA-Program has been developed to comprehensively assess any potential future problems, to offer need-based preventative interventions and thus to improve long-term outcomes in this particularly vulnerable population. Methods The trial is designed as an adaptive trial with an annual comprehensive assessment followed by needs stratified, modular interventions, currently including physical activity, nutrition and psycho-oncology, all aimed at improving the lifestyle and/or the psychosocial situation of the patients. Patients, aged 15–39 years old, with a prior cancer diagnosis, who have completed tumour therapy and are in follow-up care, and who are tumour free, will be included. At baseline (and subsequently on an annual basis) the current medical and psychosocial situation and lifestyle of the participants will be assessed using a survey compiled of various validated questionnaires (e.g. EORTC QLQ C30, NCCN distress thermometer, PHQ-4, BSA, nutrition protocol) and objective parameters (e.g. BMI, WHR, co-morbidities like hyperlipidaemia, hypertension, diabetes), followed by basic care (psychological and lifestyle consultation). Depending on their needs, CAYAs will be allocated to preventative interventions in the above-mentioned modules over a 12-month period. After 1 year, the assessment will be repeated, and further interventions may be applied as needed. During the initial trial phase, the efficacy of this approach will be compared to standard care (waiting list with intervention in the following year) in a randomized study. During this phase, 530 CAYAs will be included and 320 eligible CAYAs who are willing to participate in the interventions will be randomly allocated to an intervention. Overall, 1500 CAYAs will be included and assessed. The programme is financed by the innovation fund of the German Federal Joint Committee and will be conducted at 14 German sites. Recruitment began in January 2018. Discussion CAYAs are at high risk for long-term sequelae. Providing structured interventions to improve lifestyle and psychological situation may counteract against these risk factors. The programme serves to establish uniform regular comprehensive assessments and need-based interventions to improve long-term outcome in CAYA survivors. Trial registration Registered at the German Clinical Trial Register (ID: DRKS00012504, registration date: 19th January 2018).
Collapse
Affiliation(s)
- J Salchow
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - J Mann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Koch
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J von Grundherr
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Jensen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Elmers
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L A Straub
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Escherich
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Rutkowski
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Dwinger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bergelt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - S Bielack
- Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | | | - K Baust
- University Hospital Bonn, Bonn, Germany
| | - C F Classen
- University Hospital Rostock, Rostock, Germany
| | - C Rössig
- University Children's Hospital Münster, Münster, Germany
| | - J Faber
- Mainz University Medical Center, Mainz, Germany
| | - H Faller
- University Hospital Würzburg, Würzburg, Germany
| | | | - J Gebauer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - M Metzler
- University Hospital Erlangen, Erlangen, Germany
| | - S Schuster
- University Hospital Erlangen, Erlangen, Germany
| | - C Niemeyer
- Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Puzik
- Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Reinhardt
- University Hospital Essen, Essen, Germany.,German Cancer Consortium, Essen, Germany
| | - U Dirksen
- University Hospital Essen, Essen, Germany.,German Cancer Consortium, Essen, Germany
| | - A Sander
- Hannover Medical School, Hannover, Germany
| | - M Köhler
- Medical Faculty University Hospital Magdeburg, Magdeburg, Germany
| | | | - C Bokemeyer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stein
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
7
|
Rupp T, Butscheidt S, Vettorazzi E, Oheim R, Barvencik F, Amling M, Rolvien T. High FGF23 levels are associated with impaired trabecular bone microarchitecture in patients with osteoporosis. Osteoporos Int 2019; 30:1655-1662. [PMID: 31044263 DOI: 10.1007/s00198-019-04996-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 11/13/2018] [Accepted: 04/21/2019] [Indexed: 11/29/2022]
Abstract
UNLABELLED This cross-sectional study examined the associations between c-terminal FGF23 levels, laboratory markers of bone metabolism and bone microarchitecture in 82 patients with osteoporosis. Higher FGF23 levels were associated with impaired trabecular but not cortical bone microarchitecture, and this was confirmed after adjusting for confounding variables such as age or BMI. INTRODUCTION Fibroblast growth factor 23 (FGF23) is an endocrine hormone-regulating phosphate and vitamin D metabolism. While its mode of action is well understood in diseases such as hereditary forms of rickets or tumor-induced osteomalacia, the interpretation of FGF23 levels in patients with osteoporosis with regard to bone microarchitecture is less clear. METHODS C-terminal FGF23 levels and bone turnover markers were assessed in 82 patients with osteoporosis (i.e., DXA T-score ≤ - 2.5 at the lumbar spine or total hip). Bone microarchitecture was measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and tibia. Data were analyzed in a cross-sectional design using correlation and regression models. RESULTS We found a significant negative logarithmic correlation between FGF23 levels and trabecular but not cortical bone microarchitecture at both skeletal sites. Furthermore, using a multiple linear regression model, we confirmed FGF23 as a predictor for reduced trabecular parameters even when adjusting for confounding factors such as age, BMI, phosphate, bone-specific alkaline phosphatase, vitamin D3, and PTH. CONCLUSIONS Taken together, high FGF23 levels are associated with impaired trabecular bone microarchitecture in osteoporosis patients, and this association seems to occur after adjustment of confounding variables including phosphate and vitamin D. Future longitudinal studies are now needed to validate our findings and investigate FGF23 in relation to fracture risk.
Collapse
Affiliation(s)
- T Rupp
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | - S Butscheidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | - F Barvencik
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | - M Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | - T Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany.
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
8
|
Bohnen S, Prüßner L, Vettorazzi E, Radunski UK, Tahir E, Schneider J, Cavus E, Avanesov M, Stehning C, Adam G, Blankenberg S, Lund GK, Muellerleile K. Stress T1-mapping cardiovascular magnetic resonance imaging and inducible myocardial ischemia. Clin Res Cardiol 2019; 108:909-920. [PMID: 30701297 DOI: 10.1007/s00392-019-01421-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alterations in native myocardial T1 under vasodilation stress ("T1 reactivity") were recently proposed as a non-contrast cardiovascular magnetic resonance (CMR) method to detect myocardial ischemia. This study evaluated the performance of a segmental, truly non-contrast stress T1 mapping CMR approach to detect inducible ischemia. METHODS AND RESULTS One-hundred patients with suspected/known coronary artery disease underwent CMR at 3.0 or 1.5 T. T1 mapping was performed using the 5s(3s)3s-modified look-locker inversion-recovery (MOLLI) sequence at rest and under regadenoson stress. We defined T1 reactivity as the change in native T1 from rest to stress (1) in the 16-segment AHA model independent from perfusion images and (2) in focal regions of interest that were copied from perfusion images to T1 maps. We compared T1 reactivity between segments/regions with inducible ischemia, scar, and remote myocardium for both approaches. Segmental T1 reactivity was significantly lower in segments including inducible ischemia [- 1.15 (95% CI, - 2.16 to - 0.14)%] compared to remote segments [2.49 (95% CI, 1.87 to 3.11)%; p < 0.001]. Focal T1 reactivity was also significantly lower [- 2.65 (95% CI, - 3.84 to - 1.46)%] in regions with stress-perfusion defects compared to remote regions [4.72 (95% CI, 3.90 to 5.54)%; p < 0.001]. However, the performance of segmental T1 reactivity to depict inducible ischemia was significantly inferior compared to the focal approach (AUCs 0.68 versus 0.85; p < 0.0001). CONCLUSIONS Myocardium with inducible ischemia is characterized by the absence of significant T1 reactivity, but a clinically applicable approach for truly non-contrast stress T1 mapping remains to be determined.
Collapse
Affiliation(s)
- Sebastian Bohnen
- General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Lennard Prüßner
- General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulf K Radunski
- General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Schneider
- General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Ersin Cavus
- General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Stehning
- Philips Research Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| |
Collapse
|
9
|
Westhofen S, Stiefel R, Vettorazzi E, Reichenspurner H, Detter C. In-hospital Outcome and Risk Predictors of Mortality after Redo Aortic Valve Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678764] [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: 10/27/2022]
Affiliation(s)
- S. Westhofen
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - R. Stiefel
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - E. Vettorazzi
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - C. Detter
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| |
Collapse
|
10
|
Ernst M, Boers AMM, Forkert ND, Berkhemer OA, Roos YB, Dippel DWJ, van der Lugt A, van Oostenbrugge RJ, van Zwam WH, Vettorazzi E, Fiehler J, Marquering HA, Majoie CBLM, Gellissen S. Impact of Ischemic Lesion Location on the mRS Score in Patients with Ischemic Stroke: A Voxel-Based Approach. AJNR Am J Neuroradiol 2018; 39:1989-1994. [PMID: 30287456 DOI: 10.3174/ajnr.a5821] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies indicated that ischemic lesion volume might be a useful surrogate marker for functional outcome in ischemic stroke but should be considered in the context of lesion location. In contrast to previous studies using the ROI approach, which has several drawbacks, the present study aimed to measure the impact of ischemic lesion location on functional outcome using a more precise voxelwise approach. MATERIALS AND METHODS Datasets of patients with acute ischemic strokes from the Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) were used. Primary outcome was functional outcome as assessed by the modified Rankin Scale 3 months after stroke. Ischemic lesion volume was determined on CT scans 3-9 days after stroke. Voxel-based lesion-symptom mapping techniques, including covariates that are known to be associated with functional outcome, were used to determine the impact of ischemic lesion location for outcome. RESULTS Of the 500 patients in the MR CLEAN trial, 216 were included for analysis. The mean age was 63 years. Lesion-symptom mapping with inclusion of covariates revealed that especially left-hemispheric lesions in the deep periventricular white matter and adjacent internal capsule showed a great influence on functional outcome. CONCLUSIONS Our study confirms that infarct location has an important impact on functional outcome of patients with stroke and should be considered in prediction models. After we adjusted for covariates, the left-hemispheric corticosubcortical fiber tracts seemed to be of higher functional importance compared with cortical lesions.
Collapse
Affiliation(s)
- M Ernst
- From the Departments of Diagnostic and Interventional Neuroradiology (M.E., J.F., S.G.)
| | - A M M Boers
- Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics (A.M.M.B., H.A.M.).,Department of Robotics and Mechatronics (A.M.M.B.), University of Twente, Enschede, the Netherlands
| | - N D Forkert
- Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
| | - O A Berkhemer
- Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.).,Departments of Neurology (O.A.B., D.W.J.D.).,Department of Radiology (O.A.B.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Y B Roos
- Neurology (Y.B.R.), Academic Medical Center, Amsterdam, the Netherlands
| | | | - A van der Lugt
- Radiology (A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - R J van Oostenbrugge
- Department of Neurology (R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute, Maastricht, the Netherlands
| | - W H van Zwam
- Department of Radiology and Cardiovascular Research Institute Maastricht (W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - E Vettorazzi
- Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- From the Departments of Diagnostic and Interventional Neuroradiology (M.E., J.F., S.G.)
| | - H A Marquering
- Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics (A.M.M.B., H.A.M.)
| | - C B L M Majoie
- Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.)
| | - S Gellissen
- From the Departments of Diagnostic and Interventional Neuroradiology (M.E., J.F., S.G.)
| | | |
Collapse
|
11
|
Stellmann JP, Young KL, Vettorazzi E, Pöttgen J, Heesen C. No relevant impact of ambient temperature on disability measurements in a large cohort of patients with multiple sclerosis. Eur J Neurol 2017; 24:851-857. [PMID: 28544407 DOI: 10.1111/ene.13301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Many patients with multiple sclerosis (MS) report a worsening of symptoms due to high ambient temperatures, but objective data about this association are rare and contradictory. The aim of this study was to investigate the influence of ambient temperature on standard clinical tests. METHODS We extracted the Symbol Digit Modality Test, Nine Hole Peg Test, Timed 25 Foot Walk (T25FW), Timed Tandem Walk, Expanded Disability Status Scale (EDSS) and quality-of-life items on cognition, fatigue and depression from our clinical database and matched them to historical temperatures. We used linear mixed-effect models to investigate the association between temperature and outcomes. RESULTS A total of 1254 patients with MS (mean age, 42.7 years; 69.9% females; 52.1% relapsing-remitting MS, mean EDSS, 3.8) had 5751 assessments between 1996 and 2012. We observed a worsening in the T25FW with higher ambient temperatures in moderately disabled patients (EDSS ≥ 4) but not in less disabled patients. However, an increase of 10°C prolonged the T25FW by just 0.4 s. Other outcomes were not associated with ambient temperatures. CONCLUSIONS Higher ambient temperature might compromise walking capabilities in patients with MS with a manifest walking impairment. However, effects are small and not detectable in mildly disabled patients. Hand function, cognition, mood and fatigue do not appear to be correlated with ambient temperature.
Collapse
Affiliation(s)
- J-P Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - K L Young
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - E Vettorazzi
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - J Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - C Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| |
Collapse
|
12
|
Czorlich P, Sauvigny T, Ricklefs F, Abboud T, Nierhaus A, Vettorazzi E, Reuter DA, Regelsberger J, Westphal M, Schmidt NO. Impact of dexamethasone in patients with aneurysmal subarachnoid haemorrhage. Eur J Neurol 2017; 24:645-651. [DOI: 10.1111/ene.13265] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- P. Czorlich
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - T. Sauvigny
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - F. Ricklefs
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - T. Abboud
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - A. Nierhaus
- Department of Intensive Care Medicine; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - E. Vettorazzi
- Department of Medical Biometry and Epidemiology; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - D. A. Reuter
- Department of Anaesthesiology; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - J. Regelsberger
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - M. Westphal
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - N. O. Schmidt
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| |
Collapse
|
13
|
Petersen J, Winter L, Vettorazzi E, Schmied W, Girdauskas E, Reichenspurner H, Schäfers H. Physical and Mental Recovery after Aortic Valve Repair. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598966] [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: 10/20/2022]
Affiliation(s)
- J. Petersen
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - L. Winter
- Saarland University Medical Center, Department of Thoracic and Cardiovascular Surgery, Homburg/Saar, Germany
| | - E. Vettorazzi
- University Heart Center Hamburg, Department of Medical Biometry and Epidemiology, Hamburg, Germany
| | - W. Schmied
- Saarland University Medical Center, Clinic for Psychosomatic Medicine, Homburg/Saar, Germany
| | - E. Girdauskas
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - H. Reichenspurner
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - H.J. Schäfers
- Saarland University Medical Center, Department of Thoracic and Cardiovascular Surgery, Homburg/Saar, Germany
| |
Collapse
|
14
|
Mosow N, Vettorazzi E, Breyer S, Ridderbusch K, Stücker R, Rupprecht M. Outcome After Combined Pelvic and Femoral Osteotomies in Patients with Legg-Calvé-Perthes Disease. J Bone Joint Surg Am 2017; 99:207-213. [PMID: 28145951 DOI: 10.2106/jbjs.16.00255] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the outcome at skeletal maturity of combined pelvic and femoral varus osteotomies in children with Legg-Calvé-Perthes (LCP) disease. METHODS From January 1998 to December 2009, 69 patients with LCP disease underwent combined osteotomies at our institution. Fifty-two children (19 girls and 33 boys) met the inclusion criteria and were enrolled in the study. The LCP disease was classified and the cases of all patients were reviewed at skeletal maturity. The mean age (and standard deviation) at the time of diagnosis was 6.9 ± 2.4 years, and the mean age at the time of surgery was 7.9 ± 2.3 years. The mean time to follow-up was 10.8 ± 3.5 years. The final follow-up radiographs were assessed according to the Stulberg classification and the sphericity deviation score. RESULTS The mean Harris hip score at the time of follow-up was 90 ± 13.2. According to the Harris hip score grading system, 37 patients (71%) had an excellent outcome; 8 patients (15%), a good result; 3 patients (6%), a fair result; and 4 patients (8%), a poor result. Seven patients (13%) were classified as having a Stulberg class-I hip; 20 (38%), a class-II hip; 15 (29%), a class-III hip; 6 (12%), a class-IV hip; and 4 (8%), a class-V hip. The mean sphericity deviation score was 24.4 ± 14.4 at skeletal maturity. There was a strong relationship between a younger age at diagnosis and better functional and radiographic outcomes. CONCLUSIONS In the absence of a randomized study design, conclusions have to be drawn with caution. Combined pelvic and femoral osteotomies in these children with LCP disease did not result in better functional or radiographic outcomes compared with the historic results of Salter osteotomy or proximal femoral osteotomy alone. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- N Mosow
- 1Department of Pediatric Orthopaedics, The Altona Children's Hospital, Hamburg, Germany 2Department of Orthopaedics (N.M., S.B., K.R., R.S., and M.R.) and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | |
Collapse
|
15
|
Buhmann C, Dogac S, Vettorazzi E, Hidding U, Gerloff C, Jürgens TP. The impact of Parkinson disease on patients' sexuality and relationship. J Neural Transm (Vienna) 2016; 124:983-996. [PMID: 27853927 DOI: 10.1007/s00702-016-1649-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 09/08/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022]
Abstract
This study aimed at examining the impact of Parkinson disease (PD) on patients' sexuality and relationship and to evaluate gender-specific differences. Using a standardized questionnaire on sexual functioning in chronic diseases (SFCE), the impact of PD diagnosis on 38 domains of sexuality before and since PD diagnosis was evaluated retrospectively in 53 consecutive patients in a relationship. Changes in self-assessed ratings on a four-point Likert scale were determined for all patients. In addition, gender-specific differences and the influence of age, depression (BDI-II), medication, disease severity and disease duration on domains of the SFCE were calculated. The importance of non-sexual relational aspects, such as talking about feelings or tenderness increased for both genders after PD diagnosis, especially in women. Sexual function, such as frequency of intercourse, sexual arousal, subjective abnormal sexual fantasies or sexual satisfaction deteriorated in both genders, especially in men. Some sexual aspects improved in women but worsened in men after PD diagnosis. This includes frequency of orgasm dysfunction, fear not to fulfill sexual expectations of the partner, avoidance of sexual acts, withdrawal from relationship, increase of thoughts about divorce, or increase of dissatisfaction with sexuality and relationship. With age, thoughts about divorce declined. With disease duration, frequency of tenderness with the partner increased. Depression unexpectedly correlated with higher frequency of intercourse. Dopaminergic dosage influenced stability of the relationship negatively. PD influences patients' sexuality negatively, independently of age, disease duration or disease severity and men show greater sexual dysfunction and impairment of their sexual relationship than women.
Collapse
Affiliation(s)
- C Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - S Dogac
- Department of Psychology, Institute of Psychology, Education and Human Movement Science, University Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - U Hidding
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - C Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - T P Jürgens
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Neurology, University Medical Center Rostock, Gehlsheimer Strasse 20, 18147, Rostock, Germany
| |
Collapse
|
16
|
Köpke S, Kasper J, Flachenecker P, Meißner H, Brandt A, Hauptmann B, Bender G, Backhus I, Rahn AC, Pöttgen J, Vettorazzi E, Heesen C. Patient education programme on immunotherapy in multiple sclerosis (PEPIMS): a controlled rater-blinded study. Clin Rehabil 2016; 31:250-261. [DOI: 10.1177/0269215516639734] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the effectiveness of a multi-component evidence-based education programme on disease modifying therapies in multiple sclerosis. Design: Controlled trial with two consecutive patient cohorts and a gap of two months between cohorts. Setting: Three neurological rehabilitation centres. Subjects: Patients with multiple sclerosis within rehabilitation. Interventions: Control group (CG) participants were recruited and received standard information. Two months later, intervention group (IG) participants were recruited and received a six-hour nurse-led interactive group education programme consisting of two parts and a comprehensive information brochure. Main measures: Primary endpoint was “informed choice”, comprising of adequate risk knowledge in combination with congruency between attitude towards immunotherapy and actual immunotherapy uptake. Further outcomes comprised risk knowledge, decision autonomy, anxiety and depression, self-efficacy, and fatigue. Results: A total of 156 patients were included (IG=75, CG=81). The intervention led to significantly more participants with informed choice (IG: 47% vs. CG: 23%, P=0.004). The rate of persons with adequate risk knowledge was significantly higher in the IG two weeks after the intervention (IG: 54% vs. CG: 31%, P=0.007), but not after six months (IG: 48% vs. CG: 31%, P=0.058). No significant differences were shown for positive attitude towards disease modifying therapy (IG: 62% vs. CG: 71%, P=0.29) and for disease modifying therapy status after six months (IG: 61.5% vs CG: 68.6%, P=0.39). Also no differences were found for autonomy preferences and decisional conflict after six months. Conclusion: Delivering evidence-based information on multiple sclerosis disease modifying therapies within a rehabilitation setting led to a marked increase of informed choices.
Collapse
Affiliation(s)
- S Köpke
- Institute of Social Medicine, University of Lübeck, Lübeck, Germany
| | - J Kasper
- Department of Health and Caring Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - P Flachenecker
- Neurological Rehabilitation Center Quellenhof, Bad Wildbad, Germany
| | - H Meißner
- Neurological Rehabilitation Center Quellenhof, Bad Wildbad, Germany
| | - A Brandt
- Department of Neurology, Segeberger Kliniken, Bad Segeberg, Germany
| | - B Hauptmann
- Department of Neurology, Segeberger Kliniken, Bad Segeberg, Germany
- Department of Therapeutic Sciences, MSH Medical School Hamburg, Hamburg, Germany
| | - G Bender
- RehaCentre Hamburg, Hamburg, Germany
| | - I Backhus
- Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany
- Institute of Neuroimmunology & Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - AC Rahn
- Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany
- Institute of Neuroimmunology & Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Pöttgen
- Institute of Neuroimmunology & Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Heesen
- Institute of Neuroimmunology & Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
17
|
Nader S, Burkhardt T, Vettorazzi E, Milian M, Aberle J, Petersenn S, Flitsch J. Health-related Quality of Life in Patients After Treatment of Cushing's Disease. Exp Clin Endocrinol Diabetes 2016; 124:187-91. [PMID: 27008635 DOI: 10.1055/s-0035-1569340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients suffering from Cushing's disease are known to be restricted due to a wide range of symptoms. Despite biochemical cure, symptoms might last life-long. These include - among well-known somatic symptoms - several neuropsychiatric symptoms that cannot be as easily tested, but lead to a serious negative impact on quality of life. We aimed to evaluate what factors diminish the self-perceived quality of life the most using 3 questionnaires visualizing those impairments. Furthermore we investigated whether there would be differences in quality of life between patients still being affected by the disease and those that are already in remission. PATIENTS AND METHODS We reviewed patient charts treated between April 2008 and June 2012 for Cushing's disease and sent 3 questionnaires to the patients for evaluation. For this purpose we used the SF-36, the BDI and the Tuebingen CD-25. 54 patients complied with our request and returned the completed questionnaires. The average time after surgery was 36 months. RESULTS In all 8 dimensions of the SF-36 significant differences between the patient collective and the expected age- and gender-specific scores could be observed and thus a detectable impairment in quality of life. The BDI revealed that every other patient suffering from Cushing's disease presented depressive symptoms, partially with clinical relevance. In all 6 dimensions of the Tuebingen CD-25 there were notable restrictions in patients. Those restrictions particularly concerned bodily restrictions and cognitive performance. The self-perceived quality of life of active patients was - although not statistically significant - in almost all measured fields worse than the test results of patients in remission after TSS. CONCLUSION Former and active Cushing's disease patients suffer from a wide range of neuropsychiatric symptoms. Those symptoms might dominate the clinical picture and lead to a serious impairment in quality of life as well as extend periods of suffering and might persist even years after being found healthy. Therefore it is important to evaluate quality of life as an independent factor in every patient being affected by Cushing's disease and to include a holistic view in their therapy. Concomitant therapeutic measures should be accessible at any time for Cushing's disease patients as the normalization of pathologically increased laboratory values doesn't obligatory lead to an improvement of the patients subjectively felt well-being.
Collapse
Affiliation(s)
- S Nader
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - T Burkhardt
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Milian
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
| | - J Aberle
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany
| | - J Flitsch
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
18
|
Trillsch F, Mahner S, Vettorazzi E, Woelber L, Reuss A, Baumann K, Keyver-Paik MD, Canzler U, Wollschlaeger K, Forner D, Pfisterer J, Schroeder W, Muenstedt K, Richter B, Fotopoulou C, Schmalfeldt B, Burges A, Ewald-Riegler N, de Gregorio N, Hilpert F, Fehm T, Meier W, Hillemanns P, Hanker L, Hasenburg A, Strauss HG, Hellriegel M, Wimberger P, Kommoss S, Kommoss F, Hauptmann S, du Bois A. Surgical staging and prognosis in serous borderline ovarian tumours (BOT): a subanalysis of the AGO ROBOT study. Br J Cancer 2015; 112:660-6. [PMID: 25562434 PMCID: PMC4333495 DOI: 10.1038/bjc.2014.648] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/27/2014] [Accepted: 12/06/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure. METHODS Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS). RESULTS For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66-2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06-3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22-4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15-3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation. CONCLUSION Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed.
Collapse
Affiliation(s)
- F Trillsch
- Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany
| | - S Mahner
- Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany
| | - E Vettorazzi
- Universitaetsklinikum Hamburg-Eppendorf, Institut fuer Medizinische Biometrie und Epidemiologie, Martinistr. 52, 20246 Hamburg, Germany
| | - L Woelber
- Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany
| | - A Reuss
- Philipps-Universitaet Marburg, Koordinierungszentrum fuer Klinische Studien, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany
| | - K Baumann
- Universitaetsklinikum Giessen u. Marburg GmbH, Klinik fuer Gynaekologie, Gyn. Endokrinologie und Onkologie, Baldingerstr., 35043 Marburg, Germany
| | - M-D Keyver-Paik
- Rheinische Friedrich-Wilhelms-Universitaet, Universitaets-Frauenklinik, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - U Canzler
- Technische Universitaet Dresden, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Fetscherstr. 74, 01307 Dresden, Germany
| | - K Wollschlaeger
- Universitaetsklinikum Magdeburg, Universitaets-Frauenklinik, Gerhart-Hauptmann-Str. 35, 39108 Magdeburg, Germany
| | - D Forner
- Sana-Klinikum Remscheid, Klinik fuer Frauenheilkunde und Geburtsmedizin, Burger Strasse 211, 42859 Remscheid, Germany
| | - J Pfisterer
- 1] Staedtisches Klinikum Solingen gGmbH, Klinik fuer Gynaekologie und Geburtshilfe, Gotenstrasse 1, 42653 Solingen, Germany [2] Zentrum fuer Gynaekologische Onkologie, Herzog-Friedrich-Str. 21, 24103 Kiel, Germany
| | - W Schroeder
- GYNAEKOLOGICUM Bremen, Schwachhauser Heerstrasse 367, 28211 Bremen, Germany
| | - K Muenstedt
- Universitaetsklinikum Giessen, Zentrum fuer Frauenheilkunde und Geburtshilfe, Klinikstrasse 33, 35352 Giessen, Germany
| | - B Richter
- Elblandkliniken Meissen-Radebeul GmbH & Co. KG, Frauenklinik, Heinrich-Zille-Str. 13, 01445 Radebeul, Germany
| | - C Fotopoulou
- Charité, Campus Virchow Klinikum, Frauenklinik, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B Schmalfeldt
- Klinikum rechts der Isar der Technischen Universitaet, Frauen- und Poliklinik, Ismaninger Str. 22, 81675 Munich, Germany
| | - A Burges
- Klinikum der Universitaet Muenchen, Campus Grosshadern, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Marchioninistr.15, 81377 Munich, Germany
| | - N Ewald-Riegler
- Dr Horst Schmidt Klinik GmbH, Klinik fuer Gynaekologie und gynaekologische Onkologie, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany
| | - N de Gregorio
- Universitaetsklinikum Ulm, Frauenklinik, Prittwitzstrasse 43, 89075 Ulm, Germany
| | - F Hilpert
- Universitaetsklinikum Schleswig-Holstein, Campus Kiel, Klinik fuer Gynaekologie und Geburtshilfe, Michaelisstrasse 16, 24105 Kiel, Germany
| | - T Fehm
- 1] Universitaetsklinikum Tuebingen, Department fuer Frauengesundheit, Calwerstrasse 7, 72076 Tuebingen, Germany [2] Universitaetsklinikum Duesseldorf, Universitaetsfrauenklinik, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - W Meier
- Evangelisches Krankenhaus, Frauenklinik, Kirchfeldstrasse 40, 40217 Duesseldorf, Germany
| | - P Hillemanns
- Medizinische Hochschule Hannover, Frauenklinik, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - L Hanker
- 1] Klinikum der J.W. Goethe-Universitaet, Zentrum fuer Frauenheilkunde und Geburtshilfe, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany [2] Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Klinik fuer Gynaekologie und Geburtshilfe, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - A Hasenburg
- Universitaetsklinikum Freiburg, Frauenklinik, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany
| | - H-G Strauss
- Universitaetsklinikum Halle (Saale), Universitaetsklinik und Poliklinik fuer Gynaekologie, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - M Hellriegel
- Georg-August-Universitaet Goettingen, Gynaekologie und Geburtshilfe, Robert-Koch-Str. 40, 37075 Goettingen, Germany
| | - P Wimberger
- 1] Technische Universitaet Dresden, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Fetscherstr. 74, 01307 Dresden, Germany [2] Universitaetsklinikum Essen, Klinik fuer Frauenheilkunde und Geburtshilfe, Essen, Germany
| | - S Kommoss
- 1] Dr Horst Schmidt Klinik GmbH, Klinik fuer Gynaekologie und gynaekologische Onkologie, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany [2] Universitaetsklinikum Tuebingen, Department fuer Frauengesundheit, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - F Kommoss
- Institut fuer Pathologie, Referenzzentrum fuer Gynaekopathologie, A2,2, 68159 Mannheim, Germany
| | - S Hauptmann
- 1] Universitaetsklinikum Halle (Saale), Universitaetsklinik und Poliklinik fuer Gynaekologie, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany [2] Institut fuer Pathologie Trier-Dueren-Duesseldorf, Roonstrasse 30, 52351 Dueren, Germany
| | - A du Bois
- Kliniken Essen-Mitte, Klinik fuer Gynaekologische Onkologie, Henricistrasse 92, 45136 Essen, Germany
| |
Collapse
|
19
|
Krause M, Lehmann A, Vettorazzi E, Amling M, Barvencik F. Radiation-free spinometry adds to the predictive power of historical height loss in clinical vertebral fracture assessment. Osteoporos Int 2014; 25:2657-62. [PMID: 25001984 DOI: 10.1007/s00198-014-2782-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 04/30/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED After introducing radiation-free spinometry as a diagnostic tool to predict prevalent vertebral fractures, its validity and comparison with established tools such as historical height loss (HHL) was missing. This study shows that radiation-free spinometry is valid and its application adds predictive power to the ability of HHL to assess presence of vertebral fractures. INTRODUCTION Recently, radiation-free spinometry was introduced to identify patients with vertebral fractures (VFs). The goals of this study were to validate previous findings and to test the predictive accuracy of radiation-free spinometry compared to the assessment of historical height loss (HHL). METHODS We analyzed 304 patients [258 (85%) females (age range, 42-90 years) and 46 males (50-84 years)], including 108 patients with VFs. We performed receiver operator characteristic and net reclassification improvement (NRI) analyses to quantify the predictive power and the added predictive ability of radiation-free spinometry and HHL for VFs. RESULTS The estimated odds ratios in the thoracic and the lumbar spine showed no significant differences compared to the previously published, except for the effect of thoracic kyphosis in region "Th12 + L4-5." Radiation-free spinometry and HHL were both moderately accurate to raise suspicion for VFs. According to the NRI, which is defined as the net sum of the predicted risk increase in individuals who have VFs and the predicted net risk decrease for those who have not, we found significant improvements in all regions of interest when HHL and radiation-free spinometry were used in combination (area under the curve (AUC) 0.729-0.788). CONCLUSION Our results based on a new data set suggest validity of the prognostic score published previously. In addition, although our findings did not confirm our initial hypothesis that radiation-free spinometry alone performs superior to the assessment of HHL to predict VFs, we showed that radiation-free spinometry still adds predictive power to the ability of HHL to discriminate patients with VFs.
Collapse
Affiliation(s)
- M Krause
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | | | | | | | | |
Collapse
|
20
|
Trillsch F, Mahner S, Woelber L, Vettorazzi E, Reuss A, Baumann K, Keyver-Paik MD, Canzler U, Wollschlaeger K, Forner D, Pfisterer J, Schroeder W, Muenstedt K, Richter B, Fotopoulou C, Schmalfeldt B, Burges A, Ewald-Riegler N, De Gregorio N, Hilpert F, Fehm T, Meier W, Hillemanns P, Hanker L, Hasenburg A, Strauß HG, Hellriegel M, Wimberger P, du Bois A. Prognostische Bedeutung von Zeitintervall und Staging-Prozeduren für Patientinnen mit primären Borderline-Tumoren des Ovars (BOT): Eine Subgruppen-Analyse der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) ROBOT-Studie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388590] [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: 10/24/2022] Open
|
21
|
Schönfeld MH, Schlotfeldt V, Forkert ND, Goebell E, Groth M, Vettorazzi E, Cho YD, Han MH, Kang HS, Fiehler J. Aneurysm Recurrence Volumetry Is More Sensitive than Visual Evaluation of Aneurysm Recurrences. Clin Neuroradiol 2014; 26:57-64. [PMID: 25159038 DOI: 10.1007/s00062-014-0330-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 07/29/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Considerable inter-observer variability in the visual assessment of aneurysm recurrences limits its use as an outcome parameter evaluating new coil generations. The purpose of this study was to compare visual assessment of aneurysm recurrences and aneurysm recurrence volumetry with an example dataset of HydroSoft coils (HSC) versus bare platinum coils (BPC). METHODS For this retrospective study, 3-dimensional time-of-flight magnetic resonance angiography datasets acquired 6 and 12 months after endovascular therapy using BPC only or mainly HSC were analyzed. Aneurysm recurrence volumes were visually rated by two observersas well as quantified by subtraction of the datasets after intensity-based rigid registration. RESULTS A total of 297 aneurysms were analyzed (BPC: 169, HSC: 128). Recurrences were detected by aneurysm recurrence volumetry in 9 of 128 (7.0 %) treated with HSC and in 24 of 169 (14.2 %) treated with BPC (odds ratio: 2.39, 95 % confidence interval: 1.05-5.48; P = 0.039). Aneurysm recurrence volumetry revealed an excellent correlation between observers (Cronbach's alpha = 0.93). In contrast, no significant difference in aneurysm recurrence was found for visual assessment (3.9 % in HSC cases and 4.7 % in BPC cases). Recurrences were observed in aneurysms smaller than the sample median in 10 of 33 (30.3 %) by aneurysm recurrence volumetry and in 1 of 13 (7.7 %) by visual assessment. CONCLUSIONS Aneurysm recurrences were detected more frequently by aneurysm recurrence volumetry when compared with visual assessment. By using aneurysm recurrence volumetry, differences between treatment groups were detected with higher sensitivity and inter-observer validity probably because of the higher detection rate of recurrences in small aneurysms.
Collapse
Affiliation(s)
- M H Schönfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - V Schlotfeldt
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - N D Forkert
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - E Goebell
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - M Groth
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y D Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - M H Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - H-S Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - J Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| |
Collapse
|
22
|
Stellmann JP, Vettorazzi E, Poettgen J, Heesen C. A 3meter Timed Tandem Walk is an early marker of motor and cerebellar impairment in fully ambulatory MS patients. J Neurol Sci 2014; 346:99-106. [PMID: 25156343 DOI: 10.1016/j.jns.2014.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mobility assessment in Multiple Sclerosis (MS) is crucial for trials and individual patient counseling. Up to now, standard tests as the Timed 25-Foot Walk (T25FW) are restricted by floor effects in mildly disabled patients. The 3-meter Timed Tandem Walk (TTW) as a possibly more sensitive measure has not been investigated yet. OBJECTIVE To investigate sensitivity and specificity of the TTW and T25FW to detect mild clinical impairment in a large cohort of MS patients. METHODS We extracted T25FW, TTW and EDSS from our UMC patient database (2009-2012). After randomization into an explorative (n = 497) and validation (n = 228) cohort, we calculated change rates and performed ROC analyses of gait tests and EDSS including Functional System Scores. RESULTS Between disability stages of EDSS 0-2.5 and EDSS 3.0-4.0, the mean TTW difference was 4s (T25FW = 0.9s). The accuracy to separate between EDSS groups was moderate but identical for both tests (ROC-AUC T25FW = 0.79, TTW = 0.80, p = 0.4). TTW had a higher sensitivity and specificity to differentiate between asymptomatic and symptomatic patients concerning FS motor/cerebellar scores (ROC-AUC T25FW = 0.71, TTW = 0.75, p < 0.05). All hypotheses could be validated in the second cohort. CONCLUSION A 3-m Timed Tandem Walk is a standardized test that is easy to implement to detect impairment of the motor or cerebellar system in fully ambulatory MS patients. Based on the complex-task character, TTW is a potential new outcome measure for MS mobility in mildly disabled patients and can act as easily accessible and significant additional information in patient counseling.
Collapse
Affiliation(s)
- J P Stellmann
- Institute for Neuroimmunology and Clinical MS Research (inims) and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Poettgen
- Institute for Neuroimmunology and Clinical MS Research (inims) and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Heesen
- Institute for Neuroimmunology and Clinical MS Research (inims) and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
23
|
Andresen-Streichert H, Jensen P, Kietzerow J, Schrot M, Wilke N, Vettorazzi E, Mueller A, Iwersen-Bergmann S. Endogenous gamma-hydroxybutyric acid (GHB) concentrations in post-mortem specimens and further recommendation for interpretative cut-offs. Int J Legal Med 2014; 129:57-68. [DOI: 10.1007/s00414-014-1051-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
|
24
|
Trillsch F, Mahner S, Woelber L, Vettorazzi E, Reuss A, Ewald-Riegler N, de Gregorio N, Fotopoulou C, Schmalfeldt B, Burges A, Hilpert F, Fehm T, Meier W, Hillemanns P, Hanker L, Hasenburg A, Strauss HG, Hellriegel M, Wimberger P, Baumann K, Keyver-Paik MD, Canzler U, Wollschlaeger K, Forner D, Pfisterer J, Schroeder W, Muenstedt K, Richter B, Kommoss F, Hauptmann S, du Bois A. Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome: results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study. Ann Oncol 2014; 25:1320-1327. [PMID: 24618151 DOI: 10.1093/annonc/mdu119] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [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] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Approximately one-third of all borderline ovarian tumours (BOT) are diagnosed in patients with child-bearing potential. Detailed information regarding their specific characteristics and prognostic factors is limited. METHODS Clinical parameters of BOT patients treated between 1998 and 2008 in 24 German centres were retrospectively investigated. Central pathology review and prospective follow-up were carried out. Patients <40 versus ≥40 years were analysed separately and then compared regarding clinico-pathological variables and prognosis. RESULTS A total of 950 BOT patients with a median age of 49.1 (14.1-91.5) years were analysed [280 patients <40 years (29.5%), 670 patients ≥40 years (70.5%)]. Fertility-preserving surgery was carried out in 53.2% (149 of 280) of patients <40 years with preservation of the primarily affected ovary in 32 of these 149 cases (21.5%). Recurrence was significantly more frequent in patients <40 years (19.0% versus 10.1% 5-year recurrence rate, P < 0.001), usually in ovarian tissue, whereas disease-specific overall survival did not differ between the subgroups. In case of recurrent disease, malignant transformation was less frequent in younger than in older patients (12.0% versus 66.7%, P < 0.001), mostly presenting as invasive peritoneal carcinomatosis. Multivariate analysis for patients <40 years identified advanced International Federation of Gynecology and Obstetrics (FIGO) stage and fertility-sparing approach as independent prognostic factors negatively affecting progression-free survival (PFS) while, for patients ≥40 years, higher FIGO stage and incomplete staging was associated with impaired PFS. CONCLUSIONS Despite favourable survival, young BOT patients with child-bearing potential are at higher risk for disease recurrence. However, relapses usually remain BOT in the preserved ovaries as opposed to older patients being at higher risk for malignant transformation in peritoneal or distant localisation. Therefore, fertility-sparing approach can be justified for younger patients after thorough consultation.
Collapse
Affiliation(s)
- F Trillsch
- Department of Gynaecology and Gynaecologic Oncology
| | - S Mahner
- Department of Gynaecology and Gynaecologic Oncology.
| | - L Woelber
- Department of Gynaecology and Gynaecologic Oncology
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - A Reuss
- Department of Coordinating Center for Clinical Trials, Marburg
| | - N Ewald-Riegler
- Department of Gynaecology and Gynaecologic Oncology, Dr Horst Schmidt Klinik GmbH, Wiesbaden
| | - N de Gregorio
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Ulm, Ulm
| | - C Fotopoulou
- Department of Gynaecolgy, Charité, Campus Virchow Klinikum, Berlin
| | - B Schmalfeldt
- Department of Obstetrics and Gynaecolgy, Klinikum Rechts der Isar der Technischen Universität, Munich
| | - A Burges
- Department of Obstetrics and Gynaecolgy, Klinikum der Universität München, Munich
| | - F Hilpert
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Schleswig-Holstein, Kiel
| | - T Fehm
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Tübingen, Tuebingen
| | - W Meier
- Department of Gynaecolgy and Obstetrics, Evangelisches Krankenhaus, Duesseldorf
| | - P Hillemanns
- Department of Gynaecolgy and Obstetrics, Medizinische Hochschule Hannover, Hannover
| | - L Hanker
- Department of Gynaecolgy and Obstetrics, Klinikum der J.W. Goethe-Universität, Frankfurt/M; Department of Gynaecolgy and Obstetrics, Universitätsklinikum Schleswig-Holstein, Luebeck
| | - A Hasenburg
- Department of Obstetrics and Gynaecolgy, Universitätsklinikum Freiburg, Freiburg
| | - H G Strauss
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Halle/S., Halle/S
| | - M Hellriegel
- Department of Gynaecolgy and Obstetrics, Georg-August-Universität Göttingen, Goettingen
| | - P Wimberger
- Clinic of Gynaecolgy and Obstetrics, Universitätsklinikum Essen, Essen; Department of Gynaecolgy and Obstetrics, Universitätsklinikum Carl Gustav Carus, Dresden
| | - K Baumann
- Department of Gynaecolgy, Endocrinology and Oncology, Universitätsklinikum Gießen u. Marburg GmbH, Marburg
| | - M D Keyver-Paik
- Department of Obstetrics and Gynaecolgy, Rheinische Friedrich-Wilhelms-Universität, Bonn
| | - U Canzler
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Carl Gustav Carus, Dresden
| | - K Wollschlaeger
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
| | - D Forner
- Department of Gynaecolgy and Obstetrics, Sana-Klinikum Remscheid, Remscheid
| | - J Pfisterer
- Department of Gynaecolgy and Obstetrics, Städtisches Klinikum Solingen gGmbH, Solingen; Zentrum für Gynäkologische Onkologie, Kiel
| | | | - K Muenstedt
- Department of Obstetrics and Gynaecolgy, Universitätsklinikum Gießen, Gießen
| | - B Richter
- Department of Gynaecology and Obstetrics, Elblandkliniken Meißen-Radebeul GmbH & Co. KG, Radebeul
| | - F Kommoss
- Institute of Pathology, Referenzzentrum für Gynäkopathologie, Mannheim
| | - S Hauptmann
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Halle/S., Halle/S; Institute of Pathology, Trier-Dueren-Duesseldorf, Dueren
| | - A du Bois
- Department of Gynaecolgy and Gynaecolgic Oncology, Kliniken Essen-Mitte, Essen, Germany
| |
Collapse
|
25
|
Krause M, Museyko O, Breer S, Wulff B, Duckstein C, Vettorazzi E, Glueer C, Püschel K, Engelke K, Amling M. Accuracy of trabecular structure by HR-pQCT compared to gold standard μCT in the radius and tibia of patients with osteoporosis and long-term bisphosphonate therapy. Osteoporos Int 2014; 25:1595-606. [PMID: 24566588 DOI: 10.1007/s00198-014-2650-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 08/28/2013] [Accepted: 02/05/2014] [Indexed: 12/27/2022]
Abstract
UNLABELLED Despite an increasing use of high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone morphology in vivo, there are reservations about its applicability in patients with osteoporosis and antiresorptive therapy. This study shows that HR-pQCT provides acceptable in vivo accuracy for bone volume fraction (BV/TV) in patients with osteoporosis and bisphosphonate (BP) treatment. INTRODUCTION The primary aim was to analyze agreement of trabecular structure between HR-pQCT and gold standard microtomography (μCT) in patients with osteoporosis and long-term BP therapy. METHODS In the BioAsset study, we analyzed cadaver radii and tibiae of 34 postmenopausal females (81.1 ± 7.1 years) with osteoporosis (no BP n = 22, 1-5 years BP n = 5, >5 years BP n = 7). Two HR-pQCT protocols (patient-mode and μCT-mode) were compared with gold standard μCT after image registration. Undecalcified histological sections were obtained to quantify nonmineralized bone matrix. Bland-Altman plots illustrated methodological agreement. Multiple regression analysis was used to test for variables associated with method agreement. RESULTS In the radius and tibia, patient-mode HR-pQCT derived indices including bone volume fraction, trabecular number, and trabecular separation correlated well with gold standard μCT (R(2) = 0.78 - 0.88) except for trabecular thickness (R(2) = 0.11). Bland-Altman plots illustrated adequate agreement for bone volume fraction. Lower agreement of trabecular number and trabecular separation improved with decreasing structural impairment at the tibia only. Trabecular thickness was not appropriately assessed with HR-pQCT at both skeletal sites. Higher agreement for bone volume fraction was associated with increasing tissue mineral density in the tibia. CONCLUSIONS HR-pQCT provides acceptable in vivo accuracy for BV/TV in patients with osteoporosis and BP treatment. Higher TMD was associated with higher BV/TV accuracy in vivo. Overall, methodological agreement got less accurate with increasing structural impairment in the tibia.
Collapse
Affiliation(s)
- M Krause
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Buhmann C, Maintz L, Hierling J, Vettorazzi E, Moll CKE, Engel AK, Gerloff C, Hamel W, Zangemeister WH. Effect of subthalamic nucleus deep brain stimulation on driving in Parkinson disease. Neurology 2013; 82:32-40. [DOI: 10.1212/01.wnl.0000438223.17976.fb] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
27
|
Briken S, Gold SM, Patra S, Vettorazzi E, Harbs D, Tallner A, Ketels G, Schulz KH, Heesen C. Effects of exercise on fitness and cognition in progressive MS: a randomized, controlled pilot trial. Mult Scler 2013; 20:382-90. [DOI: 10.1177/1352458513507358] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Exercise may have beneficial effects on both well-being and walking ability in multiple sclerosis (MS). Exercise is shown to be neuroprotective in rodents and may also enhance cognitive function in humans. It may, therefore, be particularly useful for MS patients with pronounced neurodegeneration. Objective: To investigate the potential of standardized exercise as a therapeutic intervention for progressive MS, in a randomized-controlled pilot trial. Methods: Patients with progressive MS and moderate disability (Expanded Disability Status Scale (EDSS) of 4–6) were randomized to one of three exercise interventions (arm ergometry, rowing, bicycle ergometry) for 8–10 weeks or a waitlist control group. We analyzed the drop-out rate as a measure of feasibility. The primary endpoint of the study was aerobic fitness. Secondary endpoints were walking ability, cognitive function as measured by a neuropsychological test battery, depression and fatigue. Results: A total of 42 patients completed the trial (10.6% drop-out rate). Significant improvements were seen in aerobic fitness. In addition, exercise improved walking ability, depressive symptoms, fatigue and several domains of cognitive function. Conclusion: This study indicated that aerobic training is feasible and could be beneficial for patients with progressive MS. Larger exercise studies are needed to confirm the effect on cognition. Trial Registration: ISRCTN (trial number 76467492) http://isrctn.org
Collapse
Affiliation(s)
- S Briken
- Institute for Neuroimmunology and Clinical Multiple Sclerosis Research (inims), University Hospital Eppendorf, Hamburg, Germany
- Department of Neurology, University Hospital Eppendorf, Hamburg, Germany
| | - SM Gold
- Institute for Neuroimmunology and Clinical Multiple Sclerosis Research (inims), University Hospital Eppendorf, Hamburg, Germany
| | - S Patra
- Competence Center for Sports and Exercise Medicine (Athleticum), University Hospital Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - D Harbs
- Competence Center for Sports and Exercise Medicine (Athleticum), University Hospital Eppendorf, Hamburg, Germany
| | - A Tallner
- Institute of Sport Science, University of Erlangen-Nürnberg, Germany
| | - G Ketels
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - KH Schulz
- Competence Center for Sports and Exercise Medicine (Athleticum), University Hospital Eppendorf, Hamburg, Germany
- Institute for Medical Psychology, Hamburg, Germany
| | - C Heesen
- Institute for Neuroimmunology and Clinical Multiple Sclerosis Research (inims), University Hospital Eppendorf, Hamburg, Germany
- Department of Neurology, University Hospital Eppendorf, Hamburg, Germany
| |
Collapse
|
28
|
Krause M, Breer S, Mohrmann B, Vettorazzi E, Marshall RP, Amling M, Barvencik F. Influence of non-traumatic thoracic and lumbar vertebral fractures on sagittal spine alignment assessed by radiation-free spinometry. Osteoporos Int 2013; 24:1859-68. [PMID: 23064371 DOI: 10.1007/s00198-012-2156-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 05/10/2012] [Accepted: 09/20/2012] [Indexed: 12/01/2022]
Abstract
UNLABELLED Due to missing indications for specific diagnostics, the majority of non-symptomatic vertebral fractures are not diagnosed. This study shows the ability of radiation-free spinometry to assess sagittal spine parameters to raise suspicion for new non-traumatic thoracic and lumbar vertebral fractures and indicate specific diagnostics. INTRODUCTION The primary aim of this study was to investigate the accuracy of radiation-free spinometry to predict new non-traumatic vertebral fractures (VF) by the assessment of thoracic kyphosis (TK), lumbar lordosis (LL), and trunk inclination. METHODS Three hundred sixty-one patients (278 females and 83 males; age, 67.0 ± 8.6 years) were enrolled. In 86 women and 24 men, at least one non-traumatic VF was confirmed by radiography, MRI, and/or CT. Spinometry (video rasterstereography) was used to assess TK, LL, and trunk inclination. Receiver operating characteristic (ROC) and multivariate logistic regression analyses were performed to test the influence of age, sex, number, location, and grade of fractures on sagittal spine alignment. RESULTS TK, LL, and trunk inclination were associated with advancing age (p < 0.05). Patients with prevalent thoracic and lumbar VFs showed increased TK (p < 0.001), decreased LL (p < 0.001), and increased trunk inclination (p < 0.001) in comparison to patients without VFs. ROC analysis revealed that the combination of TK and LL presented with the best predictive accuracy to raise suspicion for new grade 2 or grade 3 VFs in the thoracic and the lumbar spine (AUC, 0.752-0.771). Odds ratio (OR) showed an increased risk for VFs with increased TK (OR, 1.05-1.11; p < 0.001) and LL (1.05-1.07; p < 0.001) in specified regions of interest. A TK <50° (sensitivity, 88-100 %; specificity, 23-25 %) and LL (78-92 %; 24-27 %) were considered as appropriate cutoffs for future screening. CONCLUSION Spinometry showed better predictive accuracy than historical height loss. Severe changes of TK and LL may help to raise suspicion of new VFs radiation-free and indicate proper diagnostics, such as radiographs, MRI, or CT.
Collapse
Affiliation(s)
- M Krause
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg, Germany
| | | | | | | | | | | | | |
Collapse
|
29
|
Burkhardt T, Schmidt NO, Vettorazzi E, Aberle J, Mengel M, Flitsch J. DHEA(S)--a novel marker in Cushing's disease. Acta Neurochir (Wien) 2013; 155:479-84; discussion 484. [PMID: 23314986 DOI: 10.1007/s00701-012-1596-6] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 12/13/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dehydroepiandrosterone sulfate (DHEA(S)) is a multi-functional steroid implicated in a broad range of biological effects, including obesity, diabetes, bone metabolism, neuroprotection, and anti-tumorigenesis. It has not yet undergone wider research in the context of Cushing's disease. The objective of this study was to determine if perioperative blood levels of DHEA(S) correlate with levels of ACTH and cortisol, and therefore may be useful as a new, additional marker for the early definition of cure in patients suffering from Cushing's disease. METHODS Forty-two consecutive patients undergoing transsphenoidal surgery for Cushing's disease from September 2009 to September 2010 were perioperatively monitored for ACTH, cortisol, and DHEA(S). RESULTS Pre-operative blood samples revealed ACTH levels of median 65 ng/l (range 11-1,183 ng/l, standard deviation 183.76), cortisol of median 257 μg/l (range 93-803 μg/l, standard deviation 140.88), and DHEA(S) of median 2.22 mg/l (range 0.44-7.79 mg/l, standard deviation 1.82) according to the pathology of Cushing's disease. Postoperative blood samples drawn over a 7-day time span showed a drop in median ACTH to just 14.5 % (median: 9 ng/l, range 2-44, standard deviation 12.75) of its median preoperative figure. Median cortisol levels were reduced to 6.9 % (median: 18 μg/l, range 10-190 μg/l, standard deviation 38.04) of their preoperative values and DHEA(S) levels decreased to 17 % (median: 0.38 mg/l, range 0.05-2.29, standard deviation 0.51). In persistent disease, no patient showed a drop in DHEA(S) below 38 % of its preoperative figures. CONCLUSIONS DHEA(S) shows the potential to become an additional marker in the diagnosis and follow-up of patients. However, it needs to be examined further, including whether DHEA(S) may also be a useful predictor of recovery of the HPA-axis after successful surgery.
Collapse
Affiliation(s)
- T Burkhardt
- Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany.
| | | | | | | | | | | |
Collapse
|
30
|
Hessler C, Eckert V, Vettorazzi E, Meenen N, Jürgens C, Schult M, Flamme C, Herberhold HJ, Madert J, Ekkernkamp A, Lockemann U, Püschel K, Pohlenz P. Effectiveness of Safety Vests in Pediatric Horseback Riding. Klin Padiatr 2012; 224:443-7. [DOI: 10.1055/s-0032-1327621] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C. Hessler
- Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V. Eckert
- Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E. Vettorazzi
- Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N. Meenen
- Paediatric Sport Medicine, Altona Childrens Hospital, Hamburg, Germany
| | - C. Jürgens
- Traumatology, BG-Hospital Hamburg-Boberg, Hamburg, Germany
| | - M. Schult
- Traumatology, Asklepios Hospital Hamburg Heidberg, Hamburg, Germany
| | - C. Flamme
- Traumatology, Asklepios Hospital Hamburg Harburg, Hamburg, Germany
| | - H.-J. Herberhold
- Traumatology, Asklepios Hospital Hamburg Rissen, Hamburg, Germany
| | - J. Madert
- Traumatology, Asklepios Hospital Hamburg St. Georg, Hamburg, Germany
| | - A. Ekkernkamp
- Traumatology, BG-Hospital Berlin Marzahn, Berlin, Germany
| | - U. Lockemann
- Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K. Püschel
- Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P. Pohlenz
- Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
31
|
Kutup A, Vashist YK, Groth S, Vettorazzi E, Yekebas EF, Soehendra N, Izbicki JR. Endoscopic ultrasound staging in gastric cancer: Does it help management decisions in the era of neoadjuvant treatment? Endoscopy 2012; 44:572-6. [PMID: 22528672 DOI: 10.1055/s-0032-1308950] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic ultrasonography (EUS) has been shown to be the most accurate test for locoregional staging of upper gastrointestinal tumors; however, recent studies have questioned its accuracy level in daily clinical application. The present retrospective study analyzes the accuracy of EUS in guiding interdisciplinary treatment decisions. PATIENTS AND METHODS 123 primarily operated patients (63 % men, mean age 61.4 years) were included; only cases with tumor-free resection margins and without evidence of distant metastases were selected. EUS and histopathological findings were compared. Main outcome parameter was the distinction between tumors to be primarily operated (T1 /2N0) and those to be treated by neoadjuvant or perioperative chemotherapy (T3/4, or any N + ), based on an assumed algorithm for treatment stratification. RESULTS Overall staging accuracy of EUS was 44.7 % for T and 71.5 % for N status irrespective of tumor location. Overstaging was the main problem (44.9 % for T, 42.9 % for N staging). The overall EUS classification was correct in 79.7 % (accuracy), with a sensitivity 91.9 % and specificity 51.4 %; only 19 out of 37 cases with histopathological T1/2N0 were correctly classified by EUS. Positive and negative predictive values of EUS in diagnosing advanced tumor stage for assignment to neoadjuvant therapy were 81.4 % and 73.1 %, respectively. CONCLUSIONS Whereas EUS has a high sensitivity in the diagnosis of locally advanced gastric cancer, endosonographic overstaging of T2 cancers appears to be a frequent problem. EUS stratification between local (T1 /2N0) and advanced (T3/4 or any N + ) tumors would thus result in incorrect assignment to neoadjuvant treatment in half of cases.
Collapse
Affiliation(s)
- A Kutup
- Department of General, Visceral, and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
32
|
Beckmann J, Springorum R, Vettorazzi E, Bachmeier S, Lüring C, Tingart M, Püschel K, Stark O, Grifka J, Gehrke T, Amling M, Gebauer M. Fracture prevention by femoroplasty--cement augmentation of the proximal femur. J Orthop Res 2011; 29:1753-8. [PMID: 21500251 DOI: 10.1002/jor.21410] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/24/2011] [Indexed: 02/04/2023]
Abstract
The prevention of hip fractures is a desirable goal to reduce morbidity, mortality, and socio-economic burden. We evaluated the influence on femoral strength of different clinically applicable cementing techniques as "femoroplasty." Twenty-eight human cadaveric femora were augmented by means of four clinically applicable percutaneous cementing techniques and then tested biomechanically against their native contralateral control to determine fracture strength in an established biomechanical model mimicking a fall on the greater trochanter. The energy applied until fracture could be significantly increased by two of the methods by 160% (53.1 Nm vs. 20.4 Nm, p < 0.001) and 164% (47.1 Nm vs. 17.8 Nm, p = 0.008), respectively. The peak load to failure was significantly increased by three of the methods by 23% (3818.3 N vs. 3095.7 N, p = 0.003), 35% (3698.4 N vs. 2737.5 N, p = 0.007), and 12% (3056.8 N vs. 2742.8 N, p = 0.005), respectively. The femora augmented with cemented double drill holes had a lower fracture strength than the single drilled ones. Experimental femoroplasty is a technically feasible procedure for the prophylactic reinforcement of the osteoporotic proximal femur and, hence, could be an auxiliary treatment option to protect the proximal femur against osteoporotic fractures.
Collapse
Affiliation(s)
- J Beckmann
- Department of Orthopaedics, University of Regensburg, Asklepios Klinik Bad Abbach, Regensburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Otten J, Schmitz L, Vettorazzi E, Schultze A, Marx AH, Simon R, Krauter J, Loges S, Sauter G, Bokemeyer C, Fiedler W. Expression of TGF-β receptor ALK-5 has a negative impact on outcome of patients with acute myeloid leukemia. Leukemia 2010; 25:375-9. [PMID: 21304536 DOI: 10.1038/leu.2010.273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|