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Kaufmann M, Orth V, Dorwarth TJ, Benrath J, Gerber B, Ghezel-Ahmadi D, Reißfelder C, Herrle F. Correction to: Two-stage laparoscopic transversus abdominis plane block as an equivalent alternative to thoracic epidural anaesthesia in bowel resection-an explorative cohort study. Int J Colorectal Dis 2024; 39:22. [PMID: 38285229 PMCID: PMC10824810 DOI: 10.1007/s00384-024-04597-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- M Kaufmann
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - V Orth
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - T-J Dorwarth
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - J Benrath
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - B Gerber
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - D Ghezel-Ahmadi
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - C Reißfelder
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - F Herrle
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
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Kaufmann M, Orth V, Dorwarth TJ, Benrath J, Gerber B, Ghezel-Ahmadi D, Reißfelder C, Herrle F. Two-stage laparoscopic transversus abdominis plane block as an equivalent alternative to thoracic epidural anaesthesia in bowel resection-an explorative cohort study. Int J Colorectal Dis 2024; 39:18. [PMID: 38206380 PMCID: PMC10784341 DOI: 10.1007/s00384-023-04592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE We evaluated the effect of the two-stage laparoscopic transversus abdominis plane block (TS-L-TAPB) in comparison to thoracic epidural anaesthesia (TEA) and a one-stage L-TAPB (OS-L-TAPB) in patients who underwent elective laparoscopic bowel resection. METHODS We compared a TS-L-TAPB (266 mg bupivacaine), which was performed bilaterally at the beginning and end of surgery, with two retrospective cohorts. These were patients who had undergone a TEA (ropivacaine/sufentanil) or an OS-L-TAPB (200 mg ropivacaine) at the beginning of surgery. Oral and i.v. opiate requirements were documented over the first 3 postoperative days (POD). RESULTS Patients were divided into three groups TEA (n = 23), OS-L-TAPB (n = 75), and TS-L-TAPB (n = 49). By the evening of the third POD, patients with a TEA had a higher cumulative opiate requirement with a median of 45.625 mg [0; 202.5] than patients in the OS-L-TAPB group at 10 mg [0; 245.625] and the TS-L-TAPB group at 5.625 mg [0; 215.625] (p = 0.1438). One hour after arrival in the recovery room, significantly more patients in the TEA group (100%) did not need oral and i.v. opioids than in the TS-L-TAPB (78%) and OS-L-TAPB groups (68%) (p = 0.0067).This was without clinical relevance however as the median in all groups was 0 mg. On the third POD, patients in the TEA group had a significantly higher median oral and i.v. opioid dose at 40 mg [0; 80] than the TS-L-TAPB and OS-L-TAPB groups, both at 0 mg [0; 80] (p = 0.0009). CONCLUSION The TS-L-TAP showed statistically significant and clinically meaningful benefits over TEA and OS-L-TAP in reducing postoperative opiate requirements.
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Affiliation(s)
- M Kaufmann
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - V Orth
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - T-J Dorwarth
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - J Benrath
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - B Gerber
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - D Ghezel-Ahmadi
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - C Reißfelder
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - F Herrle
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
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Ghanad E, Machado J, Santos M, Goncalves M, Reißfelder C, Herrle F, Greten J. Pain therapy within the ERAS concept – Creating objectivity in studies on personalized checkpoint acupuncture. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.104] [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: 10/14/2022]
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Staff S, Yang C, Ghanad E, Greten J, Otto M, Weiß C, Reißfelder C, Herrle F. The effect of checkpoint acupuncture on postoperative pain after abdominal surgery: A controlled pilot study in an ERAS®-setting. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.044] [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: 10/14/2022]
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Kerber K, Seyfried S, Hetjens S, Reißfelder C, Herrle F. Is there a superior anastomosis technique in right hemicolectomy? Clinical outcome analysis and survey of long-term quality of life and functional outcome of intracorporeal versus extracorporeal anastomosis techniques in laparoscopic and open surgery. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.076] [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: 10/14/2022]
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Staff S, Yang C, Ghanad E, Greten J, Reißfelder C, Herrle F. The effect of manual acupuncture on postoperative pain and recovery from abdominal surgery: A systematic review. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.083] [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: 10/14/2022]
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Kaufmann M, Dorwarth TJ, Hartwig V, Benrath J, Reißfelder C, Herrle F. Implementation of the repeated, laparoscopic-vision-controlled "transversus-abdominis-plane" block (L-TAP) using bupivacaine in laparoscopic bowel resections – A prospective observational study. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lindner S, von Rudno K, Gawlitza J, Hardt J, Sandra-Petrescu F, Seyfried S, Kienle P, Reissfelder C, Bogner A, Herrle F. Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal. Int J Colorectal Dis 2021; 36:413-417. [PMID: 33048240 PMCID: PMC7801265 DOI: 10.1007/s00384-020-03766-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE This study investigates whether contrast enema (CE) and flexible endoscopy (FE) should be performed routinely after low anterior resection (LAR) before ileostomy reversal. Additionally, the impact of previous anastomotic leakage (AL) on diagnostic test accuracy (DTA) was assessed. METHODS This is a retrospective analysis of prospectively collected tertiary care data of two centers. Consecutive rectal cancer patients undergoing LAR with loop ileostomy formation were included. Before ileostomy reversal, all patients were assessed by CE and FE. DTA of FE and CE for asymptomatic AL in patients who had previously suffered from clinically relevant AL (group 1) compared with those without apparent AL after LAR (group 0) were assessed separately. RESULTS Two hundred ninety-three patients were included in the analysis, 86 in group 1 and 207 in group 0. Overall sensitivity for detection of asymptomatic AL was 76% (FE) and 60% (CE). Specificity was 100% for both tests. DTA of FE was equal or superior to CE in all subgroups. Prevalence of asymptomatic AL at the time of testing was 1.4% in group 0 and 25.6% in group 1. CONCLUSION Flexible endoscopy is the more accurate diagnostic test for the detection of asymptomatic anastomotic leaks prior to ileostomy reversal. Contrast enema showed no gain of information. In the group without complications after the initial rectal resection, 104 must be tested to find one leak prior to reversal. In those patients, routine diagnostic testing additional to digital rectal examination may be questioned.
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Affiliation(s)
- S Lindner
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K von Rudno
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - J Gawlitza
- Department of Radiology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J Hardt
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F Sandra-Petrescu
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - S Seyfried
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus Mannheim, Mannheim, Germany
| | - C Reissfelder
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Bogner
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - F Herrle
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Hardt J, Herrle F, Kienle P. Reply to 'Response to a pilot single centre randomized trial: the PATRASTOM trial' and 'Assessing the efficacy of lateral rectus abdominis positioned stoma (LRAPS) formation in the PATRASTOM trial'. Colorectal Dis 2016; 18:623-4. [PMID: 27167184 DOI: 10.1111/codi.13380] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 02/08/2023]
Affiliation(s)
- J Hardt
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - F Herrle
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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Hardt J, Seyfried S, Weiß C, Post S, Kienle P, Herrle F. A pilot single-centre randomized trial assessing the safety and efficacy of lateral pararectus abdominis compared with transrectus abdominis muscle stoma placement in patients with temporary loop ileostomies: the PATRASTOM trial. Colorectal Dis 2016; 18:O81-90. [PMID: 26713666 DOI: 10.1111/codi.13251] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 08/17/2015] [Accepted: 10/21/2015] [Indexed: 12/13/2022]
Abstract
AIM Transrectal stoma placement is considered the standard technique for positioning a stoma. A prospective series using a novel method of lateral pararectal stoma placement recently revealed a remarkably low stoma herniation rate. A randomized trial was conducted to compare the lateral pararectal with the transrectal stoma position with regard to parastomal herniation, stoma-related morbidity and quality of life. METHOD Adult patients undergoing elective placement of a temporary loop ileostomy were eligible for inclusion. Patients were intra-operatively randomized to undergo either a lateral pararectal or a transrectal ileostomy. The primary end-point was the rate of parastomal herniation. Secondary end-points included other stoma-related complications and quality of life. Sample size calculation resulted in 54 patients having to be analysed to detect a difference of parastomal herniation of 30% with an 80% power and a 5% significance level. The trial was registered with the German Clinical Trials Register (registration number DRKS00003534). RESULTS Between April 2012 and April 2014, 30 patients were randomized to each group. The incidence of parastomal herniation did not differ between the lateral pararectal (5 of 27) and the transrectal group (4 of 29; P = 0.725). There was also no significant difference regarding other stoma-related complications and the EORTC quality of life scales C30 and CR29. CONCLUSION The incidence of parastomal herniation and other stoma-related complications did not differ between the groups. However, due to the limited sample size a small difference in favour of one of the two stoma placement techniques cannot be entirely ruled out.
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Affiliation(s)
- J Hardt
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - S Seyfried
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - C Weiß
- Department of Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Post
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - P Kienle
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - F Herrle
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
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Dusch N, Goranova D, Herrle F, Niedergethmann M, Kienle P. Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture. Colorectal Dis 2013; 15:1033-40. [PMID: 23634717 DOI: 10.1111/codi.12211] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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: 07/12/2012] [Accepted: 11/04/2012] [Indexed: 02/08/2023]
Abstract
AIM Surgical site infection (SSI) is a common complication following ileostomy closure with a frequency of up to 40%. This prospective randomized controlled trial was initiated to compare two surgical techniques - direct suture (DS) and purse-string suture (PSS) - used to close the wound following ileostomy closure. The primary end-point was the SSI rate. Secondary end-points were cosmetic outcome [using two validated scales: the Patient and Observer Scar Assessment Scale (POSAS) and the Body Image Questionnaire (BIQ)] and the influence of other factors on the SSI rate. METHOD Of a total of 99 patients screened, 84 were included in this study. Forty-three patients were randomized into the PSS group and 41 were randomized into the DS group. Follow up was performed within 3 days after surgery, at discharge, and 30 days and 6 months after the operation. RESULTS In the PSS group there were no cases of SSI compared with 10 (24%) cases in the DS group (P = 0.0004). There were no statistically significant differences in cosmetic outcome between the two groups. No other statistically significant factors influencing the incidence of SSI could be identified. CONCLUSION The rate of SSI is significantly lower following PSS than following DS, and both techniques have a similar cosmetic outcome. PSS closure should be considered as standard of care for wound closure after ileostomy reversal.
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Affiliation(s)
- N Dusch
- Department of Surgery, University of Heidelberg, Mannheim, Germany
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Herrle F, Hasenberg T, Fini B, Jonescheit J, Shang E, Kienle P, Post S, Niedergethmann M. [Open abdomen 2009. A national survey of open abdomen treatment in Germany]. Chirurg 2012; 82:684-90. [PMID: 21249325 DOI: 10.1007/s00104-010-2042-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Open abdomen (OA) treatment has been established worldwide. This survey examines the current status of OA treatment in Germany. MATERIAL AND METHODS A national survey was conducted between October 2008 and September 2009 by questionnaires sent to 1,219 surgical departments. Data were evaluated descriptively. RESULTS The response rate was 38% overall and 69% for university departments. Open abdomen treatment is used by 94% of all respondents. Most commonly used are staged abdominal lavage (87%), a commercial abdominal dressing system (82%), planned ventral hernia (69%), and other intra-abdominal dressings (e.g. vacuum pack 15%, Bogotá bag 5%). Nearly half of the respondents (46%) indicated a modification of their strategy towards vacuum techniques during the last 5 years. CONCLUSIONS Open abdomen procedures are widely used in German surgical departments. This survey indicates a shift of treatment strategies towards vacuum techniques but even though predominant, the effectiveness and safety of these techniques must still be confirmed by prospective controlled trials. This survey helps to identify relevant clinical questions and enables focused trial networking.
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Affiliation(s)
- F Herrle
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
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Herrle F, Güller U. Reihe Evidenzbasierte Chirurgie. Z Herz- Thorax- Gefäßchir 2009. [DOI: 10.1007/s00398-009-0721-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oehler MK, Fischer DC, Orlowska-Volk M, Herrle F, Kieback DG, Rees MCP, Bicknell R. Tissue and plasma expression of the angiogenic peptide adrenomedullin in breast cancer. Br J Cancer 2004; 89:1927-33. [PMID: 14612905 PMCID: PMC2394432 DOI: 10.1038/sj.bjc.6601397] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Adrenomedullin (ADM) is an angiogenic factor that has also been shown to be a mitogen and a hypoxia survival factor for tumour cells. These properties point to ADM as a potential promoter of human malignancies, but little data are available concerning the expression of ADM in human breast cancer. In the present work, we have examined ADM peptide expression in a series of malignant breast tumours by immunohistochemistry using a newly developed anti-ADM monoclonal antibody. In addition, ADM plasma concentrations in breast cancer patients and healthy controls were determined by radioimmunoassay. Of the examined breast cancer samples, 27/33 (82%) showed a moderate to strong staining intensity. ADM-peptide expression in breast tumours was significantly correlated with axillary lymph node metastasis (P=0.030). Analysis of ADM plasma concentrations showed no significant difference between the circulating ADM levels of breast cancer patients and healthy controls. However, a significant positive correlation was found between tumour size and plasma ADM levels (r=0.641, P=0.017). Moreover, ADM levels in breast cancer patients correlated with the presence of lymph node metastasis (P=0.002). In conclusion, we have shown for the first time that ADM peptide is widely expressed in breast cancer and that the degree of expression is associated with lymph node metastasis. ADM peptide in plasma of breast cancer patients reflects the size of the primary tumour, but is unlikely to be a useful tumour marker for the detection of breast cancer. Plasma ADM might represent an independent predictor of lymph node metastasis. The clinical implications of these findings remain to be evaluated.
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Affiliation(s)
- M K Oehler
- Molecular Angiogenesis Laboratory, Cancer Research UK, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK
- Department of Obstetrics & Gynaecology, University of Freiburg, D-79106 Freiburg, Germany
| | - D C Fischer
- Department of Obstetrics & Gynaecology, University of Freiburg, D-79106 Freiburg, Germany
| | - M Orlowska-Volk
- Department of Pathology, University of Freiburg, D-79106 Freiburg, Germany
| | - F Herrle
- Department of Obstetrics & Gynaecology, University of Freiburg, D-79106 Freiburg, Germany
| | - D G Kieback
- Department of Obstetrics & Gynaecology, University of Freiburg, D-79106 Freiburg, Germany
| | - M C P Rees
- Nuffield Department of Obstetrics & Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - R Bicknell
- Molecular Angiogenesis Laboratory, Cancer Research UK, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK
- Molecular Angiogenesis Laboratory, Cancer Research UK, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK. E-mail:
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