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Hellinger A, Hörscher D, Biber FC, Haasenritter J, Jost K, Kreuzer T, Müller HH, Wächtershäuser EM, Weber J, Weise C, Opitz E. [Safety of patient care on an interprofessional training ward in visceral surgery]. Chirurgie (Heidelb) 2024; 95:299-306. [PMID: 38319344 DOI: 10.1007/s00104-024-02034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Interprofessional training wards (ITW) are increasingly being integrated into teaching and training concepts in visceral surgery clinics. OBJECTIVE How safe is patient care on an ITW in visceral surgery? MATERIAL AND METHODS Data collection took place from November 2021 to December 2022. In this nonrandomized prospective evaluation study the frequency and severity of adverse events (AE) in 3 groups of 100 patients each in a tertiary referral center hospital for visceral surgery were investigated. The groups consisted of patients on the ITW and on the conventional ward before and after implementation of the ITW. The Global Trigger Tool (GTT) was used to search for AE. Simultaneously, a survey of the treatment was conducted according to the Picker method to measure patient reported outcome. RESULTS Baseline characteristics and clinical outcome parameters of the patients in the three groups were comparable. The GTT analysis found 74 nonpreventable and 5 preventable AE in 63 (21%) of the patients and 12 AE occurred before the hospital stay. During the hospital stay 50 AE occurred in the operating theater and 17 on the conventional ward. None of the five preventable AE (in 1.7% of the patients) was caused by the treatment on the ITW. Patients rated the safety on the ITW better than in 90% of the hospitals included in the Picker benchmark cohort and as good as on the normal ward. CONCLUSION The GTT-based data as well as from the patients' point of view show that patient care on a carefully implemented ITW in visceral surgery is safe.
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Affiliation(s)
- A Hellinger
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland.
| | - D Hörscher
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - F C Biber
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - J Haasenritter
- Institut für Allgemeinmedizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - K Jost
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - T Kreuzer
- Studiendekanat des Fachbereichs Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - H-H Müller
- Institut für Medizinische Bioinformatik und Biostatistik, Philipps-Universität Marburg, Marburg, Deutschland
| | - E M Wächtershäuser
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - J Weber
- Apotheke, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Fulda, Deutschland
| | - C Weise
- Medizinische Klinik III - Nephrologie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Fulda, Deutschland
| | - E Opitz
- Studiendekanat des Fachbereichs Medizin, Philipps-Universität Marburg, Marburg, Deutschland
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Paul C, Krug P, Müller HH, Wachtlin J, Mennel S, Müller S, Schmitz-Valckenberg S, Bertelmann T, Schumann RG. Comparison of the horizontal diameter to a modeled area of traction in eyes with vitreomacular traction: is the diameter close enough to the truth? Graefes Arch Clin Exp Ophthalmol 2018; 256:1817-1822. [PMID: 29955972 DOI: 10.1007/s00417-018-4055-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/21/2017] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In daily practice, vitreomacular traction (VMT) is described by the horizontal diameter of its attachment site implying a regular round shape of VMT. We investigated the deviation from this circular area of vitreous traction in patients with VMT. METHODS A retrospective analysis of optical coherence tomography (OCT) scans was performed. The area of vitreomacular attachment was determined using six radial OCT scans (Ameasured). The assumed circular area of traction was calculated based on measuring the maximal horizontal diameter for comparison (Acircular). RESULTS Thirty-seven eyes of 37 patients with pure VMT were included. Patients' mean age was 72.8 ± 8.2 years. Mean horizontal VMT diameter was 400.8 ± 230.5 μm (median 361 μm; range 44-991 μm). While there was no difference between mean areas of traction for Acircular and Ameasured (P = 0.93), the individual difference (|Acircular - Ameasured|) was 0.042 (± 0.044) mm2 in mean or relative 73.0% (± 135.8%). A difference of ≥ 30% of Ameasured to Acircular was found in 16 eyes (43.2%) and ≥ 100% in 7 eyes (18.9%), respectively. CONCLUSION Vitreous attachment sites possess an irregular non-circular shape in a significant number of eyes with VMT. Consequently, the area of traction appears inaccurately described by its horizontal VMT diameter alone. As the area of traction is important for therapeutic recommendation, our results emphasize the need for a more precise description of the area of traction in eyes with VMT.
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Affiliation(s)
- Christoph Paul
- Department of Ophthalmology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - P Krug
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - H H Müller
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - J Wachtlin
- Department of Ophthalmology, Sankt Gertrauden-Krankenhaus, Berlin, Germany.,The Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - S Mennel
- Department of Ophthalmology, Feldkirch State Hospital, Feldkirch, Austria
| | - S Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - T Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany.,ARTEMIS Eye Clinic, Dillenburg, Germany
| | - R G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
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Vassiliou T, Müller HH, Limberg S, De Andres J, Steinfeldt T, Wiesmann T. Risk evaluation for needle-nerve contact related to electrical nerve stimulation in a porcine model. Acta Anaesthesiol Scand 2016; 60:400-6. [PMID: 26666693 DOI: 10.1111/aas.12664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/06/2015] [Accepted: 10/19/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND For performing peripheral nerve blocks, the risk for needle-nerve contact (NNC) as an adverse event for low and high current thresholds has not yet been clearly defined when nerve stimulator guided techniques were applied. This experimental study aimed to investigate the risk of NNCs when applying stimulation currents between 0.1 and 2 mA (in increments of 0.1 mA). METHODS Brachial plexus nerves were exposed surgically in five anesthetized pigs. An insulated needle connected to a nerve stimulator was placed at 10 mm distance to the targeted nerves. Current intensity was adjusted according to randomization (0.1-2.0 mA, increments of 0.1 mA). The needle tip was advanced toward the nerve until a motor response was elicited. The frequencies of NNCs for each of the adjusted current intensities were noted. Risks of NNCs were calculated according to the analysis of 95% confidence intervals (95% CI). RESULTS We executed 2000 needle placements with stimulation currents ranging from 0.1 to 2.0 mA. The risks for NNC at low current intensities were 0.85 (95% CI, 0.77-0.91) for 0.3 mA and 0.5 (95% CI, 0.4-0.6) for 0.5 mA, respectively. For high current intensities, risks of 0.13 (95% CI, 0.07-0.21) for 0.9 mA and 0.01 (95% CI, 0-0.05) for 1.1 mA were calculated. CONCLUSIONS In this experimental animal study, a relevant reduction in the risk of NNCs could be observed when high current intensities (0.9-1.1 mA) were applied compared to low current intensities (0.3-0.5 mA).
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Affiliation(s)
- T Vassiliou
- Department of Anaesthesiology and Critical Care, University Hospital Gießen-Marburg, Philipps-University Marburg, Marburg, Germany
| | - H-H Müller
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - S Limberg
- Department of Anaesthesiology and Critical Care, University Hospital Gießen-Marburg, Philipps-University Marburg, Marburg, Germany
| | - J De Andres
- Department of Anaesthesiology and Critical Care, University General Hospital Valencia, Valencia, Spain
| | - T Steinfeldt
- Department of Anaesthesiology and Critical Care, University Hospital Gießen-Marburg, Philipps-University Marburg, Marburg, Germany
| | - T Wiesmann
- Department of Anaesthesiology and Critical Care, University Hospital Gießen-Marburg, Philipps-University Marburg, Marburg, Germany
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Fensterer H, Schade-Brittinger C, Müller HH, Tebbe S, Fass J, Lindig U, Settmacher U, Schmidt WE, Märten A, Ebert MP, Kornmann M, Hofheinz R, Endlicher E, Brendel C, Barth PJ, Bartsch DK, Michl P, Gress TM. Multicenter phase II trial to investigate safety and efficacy of gemcitabine combined with cetuximab as adjuvant therapy in pancreatic cancer (ATIP). Ann Oncol 2013; 24:2576-2581. [PMID: 23897705 DOI: 10.1093/annonc/mdt270] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate whether addition of cetuximab to standard adjuvant chemotherapy with gemcitabine improves outcome in pancreatic cancer, specifically whether the rate of disease-free survival (DFS) at 18 months (primary end point) exceeds the previously reported 35% of gemcitabine alone. PATIENTS AND METHODS Prospective, open-label, multicenter, nonrandomized phase II study in 76 patients with R0- or R1-resected ductal adenocarcinoma of the pancreas included between October 2006 and November 2008. Gemcitabine and cetuximab were administered for 24 weeks. Secondary end points included overall survival (OS) and toxic effect. RESULTS Seventy-three patients received cetuximab. Median DFS was 10.0 [95% confidence interval (CI) 8.9-13.6] months and the DFS rate at month 18 of 27.1% (16.7%-37.6%) was inferior to 35%. Median OS was 22.4 (18.2-27.9) months. Subgroup analyses revealed a nonsignificant increase in DFS for patients with versus without skin toxic effect ≥ grade 2 (median 14.7 versus 8.3 months, P = 0.073) and wild-type versus mutated K-Ras (median 11.5 versus 9.3 months, P = 0.57). Grade 3/4 toxic effects included neutropenia (11.0%), thrombopenia (7%), skin toxic effect (7%) and allergic reactions (7%). CONCLUSION Addition of cetuximab to adjuvant gemcitabine does not seem to improve DFS or OS of unstratified pancreatic cancer patients. Trends for improved DFS in patients with wild-type K-Ras and skin toxic effect remain to be confirmed.
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Affiliation(s)
| | | | - H-H Müller
- Department of Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich
| | | | - J Fass
- Department of Surgery, Clinical Centre Kassel, Kassel
| | | | | | - W E Schmidt
- Medical Department I, Ruhr-University Bochum, Bochum
| | - A Märten
- Department of Surgery, National Centre for Tumour Disease, University of Heidelberg, Heidelberg
| | | | - M Kornmann
- Department of Surgery, University of Ulm, Ulm
| | - R Hofheinz
- Day Treatment Centre at the Interdisciplinary Tumour Centre, University Hospital Mannheim, Mannheim
| | - E Endlicher
- Department of Gastroenterology, University Clinic Regensburg, Regensburg
| | - C Brendel
- Department of Hematology, Philipps-University of Marburg, Marburg
| | - P J Barth
- Institute of Pathology, University of Marburg, University Hospital Münster, Germany
| | | | - P Michl
- Department of Gastroenterology
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Beuschlein F, Obracay J, Saeger W, Reincke M, Libe R, Lolli P, Terzolo M, Allolio B, Müller HH, Fassnacht M. Prognostic value of histological markers in localized adrenocortical carcinoma after complete resection. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kuhnle GE, Hornuss C, Lenk M, Salam AP, Wiepcke D, Edelmann-Gahr V, Flake G, Daunderer M, Oberhauser M, Müller HH, Feuerecker M. Impact of propofol on mid-latency auditory-evoked potentials in children. Br J Anaesth 2013; 110:1001-9. [PMID: 23399557 DOI: 10.1093/bja/aet002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Propofol is increasingly used in paediatric anaesthesia, but can be challenging to titrate accurately in this group. Mid-latency auditory-evoked potentials (MLAEPs) can be used to help titrate propofol. However, the effects of propofol on MLAEP in children are unclear. Therefore, we investigated the relationship between propofol and MLAEP in children undergoing anaesthesia. METHODS Fourteen healthy children aged 4-16 yr received anaesthesia for elective surgery. Before surgery, propofol was administered in three concentrations (3, 6, 9 µg ml(-1)) through a target-controlled infusion pump using Kataria and colleagues' model. MLAEPs were recorded 5 min after having reached each target propofol concentration at each respective concentration. Additionally, venous propofol blood concentrations were assayed at each measuring time point. RESULTS Propofol increased all four MLAEP peak latencies (peaks Na, Pa, Nb, P1) in a dose-dependent manner. In addition, the differences in amplitudes were significantly smaller with increasing propofol target concentrations. The measured propofol plasma concentrations correlated positively with the latencies of the peaks Na, Pa, and Nb. CONCLUSIONS Propofol affects MLAEP latencies and amplitudes in children in a dose-dependent manner. MLAEP measurement might therefore be a useful tool for monitoring depth of propofol anaesthesia in children.
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Affiliation(s)
- G E Kuhnle
- Clinic of Anaesthesiology, SRH Wald-Klinikum Gera GmbH, Straße des Friedens 122, 07548 Gera, Germany
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Koinzer S, Müller HH, Ptaszynski L, Schlott K, Birngruber R, Brinkmann R, Roider J, Hüttmann G. Detektion molekularer Gewebeveränderungen durch Vergleich von high-speed Fourier-Domain- und phasenkontrastsensitiver optischer Kohärenztomografie (OCT). ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1329774] [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: 10/27/2022]
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Ziller V, Kyvernitakis I, Storch A, Müller HH, Albert U, Wagner U, Hadji P. Einfluss eines schriftlichen oder mündlichen Patientienteninformationsprogrammes auf die Compliance mit einem Aromatasehemmer in der adjuvanten Therapie des Mammakarzinoms im Vergleich zur Standardaufklärung – Ergebnisse der COMPAS-Studie. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Feuerecker M, Lenk M, Flake G, Edelmann-Gahr V, Wiepcke D, Hornuss C, Daunderer M, Müller HH, Kuhnle GE. Effects of increasing sevoflurane MAC levels on mid-latency auditory evoked potentials in infants, schoolchildren, and the elderly. Br J Anaesth 2011; 107:726-34. [PMID: 21862495 DOI: 10.1093/bja/aer226] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Detection of mid-latency auditory evoked potentials (MLAEPs) is a technology to monitor central nervous structures. As seen in adults and children, general anaesthesia influences the MLAEP latencies. MLAEP detection seems to be a promising tool to assess different levels of anaesthesia depth in adults and children. METHODS MLAEPs were recorded in 10 infants (2 months-3 yr), 12 schoolchildren (6-14 yr), and 10 elderly (75-89 yr) under general anaesthesia with increasing concentrations of sevoflurane at steady state. In addition, MLAEPs were detected before and after the application of sufentanil. RESULTS At all different ages, MLAEP latencies increased significantly with higher volume percentages of sevoflurane. These results were also detectable when MAC values of sevoflurane were compared with MLAEP peaks. An age-dependent effect could be displayed as elderly people need lower absolute sevoflurane concentrations to achieve the same MLAEP peak increase. Overall, the application of sufentanil under steady-state sevoflurane application at 1 MAC did not importantly affect the MLAEP latencies. CONCLUSIONS MLAEP latencies increase at the influence of sevoflurane in a dose-dependent manner and in relation to age. These results imply that MLAEP detection is a reasonable tool for monitoring hypnotic effects at all ages. Further studies are required to standardize MLAEP alterations related to effects of medication used for general anaesthesia at all different ages.
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Affiliation(s)
- M Feuerecker
- Department of Anaesthesiology, Klinikum Grosshadern, University of Munich, Munich, Germany.
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Steinfeldt T, Graf J, Vassiliou T, Nimphius W, Sturm K, Kill C, Wiesmann T, Wulf H, Müller HH. Systematic evaluation of the highest current threshold for regional anaesthesia in a porcine model. Acta Anaesthesiol Scand 2010; 54:770-6. [PMID: 20397982 DOI: 10.1111/j.1399-6576.2010.02235.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to determine systematically the highest minimal stimulation current threshold for regional anaesthesia in pigs. METHODS In an established pig model for regional anaesthesia, needle placements applying electric nerve stimulation were performed. The primary outcome was the frequency of close needle to nerve placements as assessed by resin injects and subsequent anatomical evaluation. Following a statistical model (continual reassessment method), the applied output currents were selected to limit the necessary number of punctures, while providing guidance towards the highest output current range. RESULTS Altogether 186 punctures were performed in 11 pigs. Within the range of 0.3-1.4 mA, no distant needle to nerve placement was found. In the range of 1.5-4.1 mA, 43 distant needle to nerve placements occurred. The range of 1.2-1.4 mA was the highest interval that resulted in a close needle to nerve placement rate of > or =95%. CONCLUSIONS In the range of 0.3-1.4 mA, all resin deposition was found to be adjacent to nerve epineurium. The application of minimal current intensities up to 1.4 mA does not obviously lead to a reduction of epineural injectate contacts in pigs. These findings suggest that stimulation current thresholds up to 1.4 mA result in equivalent needle tip localisation in pigs.
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Affiliation(s)
- T Steinfeldt
- Department of Anaesthesiology and Intensive Care Therapy, Philipps-University Marburg, Marburg, Germany.
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Albert US, Seifart U, Barth J, Müller HH, Brand J, Kalder M. Ultraschallmessung der Hautschichtendicke zur Diagnostik des sekundären Lympharmödems bei Brustkrebs – Ergebnisse einer prospektiven Multicenterstudie. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089234] [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: 10/19/2022] Open
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Albert US, Stibane A, Seifert U, Barth J, Derichsweiler K, Minning H, Müller HH, Zamzow K, Thommes S, Brand J, Wagner U, Kalder M. Interimsanalyse: Hochfrequenz-Ultraschallmessung der Hautschichtendicke zur Diagnostik des sekundären Lymphödems bei Patientinnen nach Brustkrebs – eine prospektive, Multicenterstudie. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-984637] [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: 10/21/2022] Open
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Albert US, Stibane A, Seifart U, Barth J, Müller HH, Wagner U, Kalder M. Ist eine standardisierte vergleichende Ultrasschallmessung der Hautschichtendicke der Unterarme zur Diagnostik des Lymphödems bei Brustkrebspatientinnen geeignet? Interimsanalyse. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952674] [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: 10/20/2022] Open
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Dünne AA, Müller HH, Eisele DW, Kessel K, Moll R, Werner JA. Meta-analysis of the prognostic significance of perinodal spread in head and neck squamous cell carcinomas (HNSCC) patients. Eur J Cancer 2006; 42:1863-8. [PMID: 16831543 DOI: 10.1016/j.ejca.2006.01.062] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [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: 09/24/2005] [Revised: 11/22/2005] [Accepted: 01/26/2006] [Indexed: 11/26/2022]
Abstract
To assess the risk factor of capsular rupture for individual prognosis and potential therapeutic decision making, the present meta-analysis elaborated the prognostic significance of perinodal spread in a large group of patients suffering from head and neck squamous cell carcinomas (HNSCC). A review of the published literature was conducted, and fixed and random effects models were applied for estimation of the summarised odds ratio and 95% confidence intervals, including a test for homogeneity of the odds ratios. Study methodology allowed the enrollment of only nine studies of 115 published papers. Excluded studies lacked regarding primary tumour location, number and location of lymph node metastases, values on five-year survival, or adequate follow-up data. A summarised odds ratio of 2.7 leads to the conclusion that perinodal spread negatively impacts the five-year survival. The lower confidence limit of more than 2 also supports the concept that perinodal spread significantly reduces (doubled risk) the five-year-survival. These results support the conclusion that perinodal spread is a significant adverse risk factor for survival in patients with HNSCC.
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Affiliation(s)
- A A Dünne
- Department of Otolaryngology, Head and Neck Surgery, Philipps University Marburg, Deutschhausstrasse 3, 35037 Marburg, Germany.
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Lehmann MS, Müller HH, Stuhrmann HB. Protein single-crystal diffraction with 5 A synchrotron X-rays at the sulfur K-absorption edge. Acta Crystallogr D Biol Crystallogr 2005; 49:308-10. [PMID: 15299536 DOI: 10.1107/s0907444992011910] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
. Sulfur atoms, an integral part of many proteins, are possible candidates for anomalous scattering in phase determination by multiple-wavelength methods. The main difficulty encountered is that a wavelength of about 5 A is required to obtain a large anomalous signal from these atoms, leading to very large absorption effects. Initial experiments have been carried out using a synchrotron X-ray source, evacuated beam tubes, a diffractometer inside a vacuum chamber, a special sample holder and a suitable scattering geometry. The results are encouraging, showing that Bragg reflections can be measured, and that changes in their intensities around the absorption edge are observable.
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Chen X, Sure U, Haag A, Knake S, Fritsch B, Müller HH, Becker R, Hamer HM, Rosenow F. Predictive Value of Electrocorticography in Epilepsy Patients with Unilateral Mesial Temporal Sclerosis Undergoing Selective Amygdalohippocampectomy. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-831943] [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: 10/19/2022]
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Reis J, John D, Müller HH, Hamer HM, Oertel WH, Rosenow F. Effect of Amantadine on Human Motor Cortex Excitability as Measured by TMS. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832136] [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: 10/19/2022]
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Hildebrand R, Trappmann D, Georg C, Müller HH, Koller M, Klose KJ, Griss P, Kienapfel H. [What effect does the hydroxyapatite coating have in cementless knee arthroplasty?]. Orthopade 2003; 32:323-30. [PMID: 12707697 DOI: 10.1007/s00132-002-0443-5] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The goal of this study was to compare the migration of noncemented diffusion sintered titanium fibermesh-coated tibial components with (HA group) and without (non-HA group) additional hydroxyapatite coating. For this purpose digital radiostereometry (DIRSA) was used to compare the migration after 2 and 9 years for the two groups. After 2 years the mean maximum subsidence of the HA-coated components (0.24+/-0.18 mm) was about one-half of the mean maximum subsidence of the non-HA-coated group (0.55+/-0.55 mm). After 9 years the maximum subsidence of the HA-coated components was still smaller, but not as pronounced as before. The same trend was also found for the endpoint maximum total point motion (MTPM). After 2 years the mean MTPM of the HA-coated components was 0.66+/-0.38 mm and of the non-HA group 0.73+/-0.50 mm. After 9 years the mean MTPM for the HA-coated components was 0.54+/-0.15 mm and for the non-HA-coated components 0.74+/-0.20 mm. None of the HA-coated tibial components but one of the non-HA group had to be revised and exchanged due to aseptic loosening.
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Affiliation(s)
- R Hildebrand
- Klinik für Orthopädie und Rheumatologie, Philipps-Universität, Marburg.
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19
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Lorenz M, Staib-Sebler E, Gog C, Proschek D, Jauch KW, Ridwelski K, Hohenberger W, Gassel HJ, Lehmann U, Vestweber KH, Padberg W, Zamzow K, Müller HH. Prospective pilot study of neoadjuvant chemotherapy with 5-fluorouracil, folinic acid and oxaliplatin in resectable liver metastases of colorectal cancer. Analysis of 42 neoadjuvant chemotherapies. Zentralbl Chir 2003; 128:87-94. [PMID: 12632273 DOI: 10.1055/s-2003-37760] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Since there are currently no data available from a prospective trial, the primary objective of this prospective study was to investigate whether the rate of R0-liver resections without morbidity would be at least 50 % in patients with neoadjuvant chemotherapy for colorectal liver metastases. PATIENTS AND METHODS 42 patients were treated with a biweekly FOLFOX regimen. Chemotherapy consisted of a 2-hour infusion of folinic acid (FOL) 500 mg/m2, followed by a 24-hour infusion of 5- fluorouracil (F) 2000 mg/m2 daily for two days. Oxaliplatin (OX) 85 mg/m 2 was given simultaneously with FOL. Treatment allocation was randomized with either 3 or 6 cycles for the final 30 patients. A liver resection was performed 2 to 5 weeks after the final infusion. RESULTS An objective response was observed in 20 of 42 patients (response rate was 27 % higher after 6 cycles). Liver resection (R0) could be performed in 34 patients. Postoperative complications were reported in 14 patients (13 occurring within 30 days after resection) and severe complications in 5 cases (including two deaths after extended resection). Liver failure and persistent biliary fistula were the most frequently documented complications. There was no relevant difference in safety criteria between 3 and 6 applications. CONCLUSION The use of neoadjuvant chemotherapy in resectable liver metastases induced significant remissions without increasing morbidity. The rate of severe complications and cases of no R0-resection in this study was 31 % and was with that significantly lower than 50 % (95 % CI 17.6 %-47.1 %). The risk to the patient is therefore acceptable when undergoing neoadjuvant treatment in a prospective intergroup trial.
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Affiliation(s)
- Matthias Lorenz
- Department of General and Vascular Surgery, Johann-Wolfgang-Goethe-University Frankfurt, Frankfurt au Main.
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20
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Haake M, Schade-Brittinger C, Müller HH, Prinz H, Basler HD, Donner-Banzhoff N, Schäfer H, Molsberger A. [Acupuncture in chronic back pain. Background, development and design of the German Acupuncture Trial (gerac-cLBP)]. Z Orthop Ihre Grenzgeb 2003; 141:6-10. [PMID: 12647733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- M Haake
- Orthopädische Klinik der Universität Regensburg
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21
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Stiasny-Kolster K, Haeske H, Tergau F, Müller HH, Braune HJ, Oertel WH. Chapter 38 Cortical silent period is shortened in restless legs syndrome independently from circadian rhythm. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, Proceedings of the 2nd International Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) Symposium 2003; 56:381-9. [PMID: 14677414 DOI: 10.1016/s1567-424x(09)70241-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- K Stiasny-Kolster
- Department of Neurology, Center of Nervous Diseases, Philipps-University of Marburg, Rudolf-Bultmann-Strasse 8, D-35033 Marburg, Germany.
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22
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Haake M, König IR, Decker T, Riedel C, Buch M, Müller HH. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial. J Bone Joint Surg Am 2002; 84:1982-91. [PMID: 12429759 DOI: 10.2106/00004623-200211000-00012] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.8] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND On the basis of observational trials, numerous investigators have recommended extracorporeal shock wave therapy as an alternative treatment for chronic lateral epicondylitis of the elbow. However, there has been no evidence of its efficacy from well-designed randomized clinical trials. The objective of this study was to find out whether extracorporeal shock wave therapy in combination with local anesthesia was superior to placebo therapy in combination with local anesthesia. METHODS A randomized multicenter trial with a parallel-group design was conducted. Following administration of local anesthesia, either extracorporeal shock wave therapy with three treatments of 2000 pulses each and a positive energy flux density (ED+) of 0.07 to 0.09 mJ/mm (2) or placebo therapy was applied on an outpatient basis. Treatment allocation was blinded for patients and for observers. The primary end point was based on the rate of success, as determined with the Roles and Maudsley score and whether additional treatment was required, twelve weeks after the intervention. Crossover was possible after assessment of the primary end point. Secondary end points were the Roles and Maudsley score, subjective pain rating, and grip strength after six and twelve weeks and after twelve months. The planned number of 272 patients was included in the study. RESULTS The primary end point could be assessed for 90.8% of the patients. The success rate was 25.8% in the group treated with extracorporeal shock wave therapy and 25.4% in the placebo group, a difference of 0.4% with a 95% confidence interval of -10.5% to 11.3%. Similarly, there was no relevant difference between groups with regard to the secondary end points. Improvement was observed in two-thirds of the patients from both groups twelve months after the intervention. Few side effects were reported. CONCLUSIONS Extracorporeal shock wave therapy as applied in the present study was ineffective in the treatment of lateral epicondylitis. The previously reported success of this therapy appears to be attributable to inappropriate study designs. Different application protocols might improve clinical outcome. We recommend that extracorporeal shock wave therapy be applied only in high-quality clinical trials until it is proved to be effective.
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Affiliation(s)
- M Haake
- Klinik für Orthopädie und Rheumatologie, Philipps-Universität-Marburg, Baldingerstrasse 1, D-35033 Marburg, Germany.
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Krause W, Müller HH, Schäfer H, Weidner W. Does treatment of varicocele improve male fertility? results of the 'Deutsche Varikozelenstudie', a multicentre study of 14 collaborating centres. Andrologia 2002; 34:164-71. [PMID: 12059812 DOI: 10.1046/j.1439-0272.2002.00494.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Treatment of varicocele is suggested in infertile men if sperm parameter values are abnormal. The effectiveness of the treatment with respect to fertility remains to be clarified. A multicentre, prospective randomized study on varicocele treatment in infertile men to demonstrate the superiority of sclerotization of the varicocele in preventing persistence, was started in 1995 with the collaboration of 15 German andrological centres. The primary endpoint was the incidence of pregnancy 1 year after randomisation. The number of cases needed to achieve the goal of the study was calculated at 460. However, three years after starting the study, only 67 patients had been randomized. Different reasons contributed to the poor recruitment. There was no significant increase in pregnancy rate in the treated group, compared to the controls, the confidence interval being 20.8% to 15.7%. The authors would like to encourage further collaborative study groups to start another prospective, randomized study with the aim of avoiding the costs and risks of varicocele treatment when its success remains unclear.
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Affiliation(s)
- W Krause
- Department of Andrology, University Hospital, Philipps University, Marburg, Germany.
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24
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Böddeker IR, Müller HH, Kress R, Geller F, Ziegler A, Schäfer H. The use of sequential designs in genome scans for asthma susceptibility loci with affected sib pairs. Genet Epidemiol 2002; 21 Suppl 1:S49-54. [PMID: 11793724 DOI: 10.1002/gepi.2001.21.s1.s49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We use optimized group sequential study designs to analyze data from two genome scans (German and CSGA) for asthma susceptibility loci with affected sib pairs from Genetic Analysis Workshop (GAW) 12. Results are compared with those from a fixed sample design and the sequential probability ratio test (SPRT). The SPRT does not reach significance at any position. Using the fixed sample design, evidence for linkage is found on chromosomes 6 and 9 in the German and on chromosome 1 in the CSGA scan. The group sequential designs identify the same regions on chromosomes 1 and 6 with a reduced sample size.
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Affiliation(s)
- I R Böddeker
- Institute of Medical Biometry and Epidemiology, Center for Methodology and Health Research, Philipps-University of Marburg, Bunsenstr. 3, 35033 Marburg, Germany
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25
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Abstract
A method is presented which allows us to adapt the sample size as well as the number and time points of interim analyses to the treatment difference observed at an interim look during the course of a clinical trial with censored survival time as the endpoint. The method allows the inclusion of data inspections during the course of the trial and redesign of the trial on the basis of the observed treatment difference without affecting the type I error risk. Formulae for recalculating the required number of events and the number of further patients to be randomized as a function of the observed hazard rates and the detectable hazard ratio are given.
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Affiliation(s)
- H Schäfer
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Bunsenstrasse 3, D-35037 Marburg, Germany.
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26
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König IR, Schäfer H, Müller HH, Ziegler A. Optimized group sequential study designs for tests of genetic linkage and association in complex diseases. Am J Hum Genet 2001; 69:590-600. [PMID: 11479836 PMCID: PMC1235488 DOI: 10.1086/323250] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 05/29/2001] [Accepted: 07/09/2001] [Indexed: 11/04/2022] Open
Abstract
The study of genetic linkage or association in complex traits requires large sample sizes, as the expected effect sizes are small and extremely low significance levels need to be adopted. One possible way to reduce the numbers of phenotypings and genotypings is the use of a sequential study design. Here, average sample sizes are decreased by conducting interim analyses with the possibility to stop the investigation early if the result is significant. We applied optimized group sequential study designs to the analysis of genetic linkage (one-sided mean test) and association (two-sided transmission/disequilibrium test). For designs with two and three stages at overall significance levels of.05 and.0001 and a power of.8, we calculated necessary sample sizes, time points, and critical boundaries for interim and final analyses. Monte Carlo simulation analyses were performed to confirm the validity of the asymptotic approximation. Furthermore, we calculated average sample sizes required under the null and alternative hypotheses in the different study designs. It was shown that the application of a group sequential design led to a maximal increase in sample size of 8% under the null hypothesis, compared with the fixed-sample design. This was contrasted by savings of up to 20% in average sample sizes under the alternative hypothesis, depending on the applied design. These savings affect the amounts of genotyping and phenotyping required for a study and therefore lead to a significant decrease in cost and time.
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Affiliation(s)
- I R König
- Center for Methodology and Health Research, Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, 35033 Marburg, Germany
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27
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Abstract
A general method is presented integrating the concept of adaptive interim analyses into classical group sequential testing. This allows the researcher to represent every group sequential plan as an adaptive trial design and to make design changes during the course of the trial after every interim analysis in the same way as with adaptive designs. The concept of adaptive trial designing is thereby generalized to a large variety of possible sequential plans.
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Affiliation(s)
- H H Müller
- Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Germany.
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Haake M, Sattler A, Gross MW, Schmitt J, Hildebrandt R, Müller HH. [Comparison of extracorporeal shockwave therapy (ESWT) with roentgen irradiation in supraspinatus tendon syndrome--a prospective randomized single-blind parallel group comparison]. Z Orthop Ihre Grenzgeb 2001; 139:397-402. [PMID: 11605290 DOI: 10.1055/s-2001-17981] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM Extracorporal shock wave therapy (FSWT) is applied in the case of supraspinatus tendinitis if conservative therapies have failed. So far there has been no controlled study comparing the effectiveness of ESWT with an established conservative method of therapy such as X-ray stimulation radiotherapy. METHOD Thirty patients with chronic supraspinatus tendinitis were admitted into the prospective randomised study. After randomisation, the patients were treated either three times with 2000 pulses (energy flux density ED+ 0.33 mJ/mm2) with a Storz Minilith SL1 after one week, or with X-ray stimulation radiotherapy with 6 x 0.5 Gy on the ICRU reference point (1 neutral fraction/day) with cobalt 60 gamma rays. Primary endpoint was the age-corrected constant score. RESULTS In the ESWT group the average age-corrected constant score rose from 50.1 points before ESWT to 91.5 points after 12 weeks and to 97.8 after 52 weeks. In the radiotherapy group it improved from 47.6 through 79.5 points to 87.4 points. CONCLUSION No statistically significant differences were proven between ESWT and radiotherapy. ESWT appears to be at least equivalent to radiotherapy in treating chronic supraspinatus tendinitis syndrome and can avoid a dose of radiation for patients and staff. A comprehensive randomised study is, however necessary to ensure the equivalence of ESWT.
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Affiliation(s)
- M Haake
- Orthopädische Klinik, Philipps-Universität Marburg.
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29
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Ziegler A, Böddeker I, Geller F, Müller HH, Guo X. On the total expected study cost in two-stage genome-wide search designs for linkage analysis using the mean test for affected sib pairs. Genet Epidemiol 2001; 20:397-400. [PMID: 11255247 DOI: 10.1002/gepi.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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30
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Lorenz M, Staib-Sebler E, Hochmuth K, Heinrich S, Gog C, Vetter G, Encke A, Müller HH. Surgical resection of liver metastases of colorectal carcinoma: short and long-term results. Semin Oncol 2000; 27:112-9. [PMID: 11049042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- M Lorenz
- Department of General and Vascular Surgery, Johann Walfgang Goethe-University Frankfurt, Frankfurt am Main, Germany
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Abstract
In 169 patients visiting our department complaining of sexual dysfunction, the medical history was taken using a semistructured interview. A clinical investigation and a hormone analysis were added. The age of patients, hormone values, and items of the interview were collected into a common database. The items were categorized as either dichotomous (yes/no) or ordinal. Statistical analysis was performed using regression analysis with the aim to generate hypotheses of relations. An increase of FSH levels and a decrease of testosterone levels with age occurred. None of the relations of hormone levels or diseases to symptoms of sexual dysfunction produced odds ratios (OR) statistically significant different from 1. However, the risk of having a reduced libido and reduced morning erections was lower in psychoneurological diseases, the risk of reduced arousal and libido was lower in men with diabetes mellitus, but the risk of reduced morning erections was higher in these men. The testosterone levels were not associated with the risk of having reduced penile rigidity, duration of erection, arousal and sexual libido, reduced morning erections and the ability to masturbate. Smoking was not associated with reduced arousal, libido and morning erections. However, a significant increase of testosterone levels with number of cigarettes used was observed. We conclude that sexual dysfunction in patients visiting an andrological department for diagnosis and treatment is mostly not associated to any single evaluable factor.
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Affiliation(s)
- W Krause
- Departments of Andrology and Medical Biometrics, University Hospital, Philipps University, Marburg, Germany.
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32
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Assaf C, Hummel M, Dippel E, Goerdt S, Müller HH, Anagnostopoulos I, Orfanos CE, Stein H. High detection rate of T-cell receptor beta chain rearrangements in T-cell lymphoproliferations by family specific polymerase chain reaction in combination with the GeneScan technique and DNA sequencing. Blood 2000; 96:640-6. [PMID: 10887129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
The distinction between benign polyclonal and malignant monoclonal lymphoid disorders by morphology or immunophenotyping is frequently difficult. Therefore, the demonstration of clonal B-cell or T-cell populations by detecting identically rearranged immunoglobulin (Ig) or T-cell receptor (TCR) genes is often used to solve this diagnostic problem. Whereas the detection of rearranged Ig genes is well established, TCR gamma (gamma) and beta (beta) gene rearrangements often escape detection with the currently available polymerase chain reaction (PCR) assays. To establish a sensitive, specific, and rapid method for the detection of rearranged TCR-beta genes, we developed a new PCR approach with family-specific Jbeta primers and analyzed the resulting PCR products by high-resolution GeneScan technique. The superior efficiency of this new method was demonstrated by investigating 132 DNA samples extracted from lymph node and skin biopsy specimens (mostly formalin fixed) and blood samples of 62 patients who had a variety of T-cell lymphomas and leukemias. In all but 1 of the tumor samples (98.4%) a clonal amplificate was detectable after TCR-beta PCR and the same clonal T-cell population was also found in 15 of 18 (83%) of the regional lymph nodes and in 7 of 11 (64%) of the peripheral blood samples. Direct comparison of these results with those obtained currently by the most widely applied TCR-gamma PCR revealed an approximate 20% lower detection rate in the same set of samples than with the TCR-beta PCR method. These results indicate that the new TCR-beta PCR is most suitable for a rapid and reliable detection of clonal T-cell populations. (Blood. 2000;96:640-646)
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Affiliation(s)
- C Assaf
- Institute of Pathology, Consultation and Reference Center for Lymph Node Pathology and Hematopathology and Department of Dermatology, University Medical Centre Benjamin Franklin, The Free University of Berlin, Berlin, Germany
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Grimm W, Glaveris C, Hoffmann J, Menz V, Müller HH, Hufnagel G, Maisch B. Arrhythmia risk stratification in idiopathic dilated cardiomyopathy based on echocardiography and 12-lead, signal-averaged, and 24-hour holter electrocardiography. Am Heart J 2000; 140:43-51. [PMID: 10874262 DOI: 10.1067/mhj.2000.107178] [Citation(s) in RCA: 29] [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] [Indexed: 11/22/2022]
Abstract
BACKGROUND To date, considerable controversy exists regarding noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy (IDC). Methods and Results Between 1992 and 1997, 202 patients with IDC without a history of sustained ventricular tachycardia (VT) underwent echocardiography, signal-averaged electrocardiogram (ECG), and 24-hour Holter ECG in the absence of antiarrhythmic drugs. During 32 +/- 15 months of prospective follow-up, major arrhythmic events, including sustained VT, ventricular fibrillation, or sudden death, occurred in 32 (16%) of 202 patients. After adjusting for baseline medical therapy and antiarrhythmic therapy during follow-up, multivariate Cox regression analysis identified a left ventricular (LV) end-diastolic diameter >/=70 mm and nonsustained VT on Holter as the only independent arrhythmia risk predictors. The combination of an LV end-diastolic diameter >/=70 mm and nonsustained VT was associated with a 14. 3-fold risk for future arrhythmic events (95% confidence interval 2. 3-90). To further elucidate the prognostic value of LV ejection fraction, multivariate Cox analysis was repeated with ejection fraction forced to remain in the model. In the latter model, an ejection fraction </=30% combined with nonsustained VT on Holter was found to be a significant arrhythmia risk predictor with a relative risk of 14.6 (95% confidence interval 2.2-97). CONCLUSIONS The combination of an LV end-diastolic diameter >/=70 mm and nonsustained VT on Holter, and the combination of LV ejection fraction </=30% and nonsustained VT on Holter, identify a subgroup of patients with IDC with a 14-fold risk for subsequent arrhythmic events. These findings have important implications for the design of future studies evaluating the role of prophylactic defibrillator therapy in patients with IDC.
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Affiliation(s)
- W Grimm
- Department of Cardiology, Hospital of the Philipps-University of Marburg, Germany
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Abstract
Hereditary colorectal cancer syndromes are among the best in vivo models to study colorectal carcinogenesis and the influence of putative modifiers of the cancer risk. The present knowledge regarding the wide range of colorectal cancer (CRC) susceptibilities and the histological and molecular changes they elicit is leading to a very dynamic and integrated concept of tumorigenesis in the colon and to new views about prevention and early treatment of cancer.
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Affiliation(s)
- H H Müller
- Research Group Human Genetics of the Devision of Medical Genetics, DKBW University of Basel, UKBB, CH 4005, Basel, Switzerland.
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35
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Lorenz M, Hochmuth K, Müller HH. Hepatic arterial infusion of chemotherapy for metastatic colorectal cancer. N Engl J Med 2000; 342:1525-6; author reply 1526-7. [PMID: 10819651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Abstract
OBJECTIVE To examine the relation between cardiac autonomic tone, assessed by baroreflex sensitivity and heart rate variability, and left ventricular function, arrhythmias on Holter monitoring, and clinical variables in patients with idiopathic dilated cardiomyopathy. DESIGN A prospective observational study. PATIENTS 160 patients with idiopathic dilated cardiomyopathy and preserved sinus rhythm in the absence of antiarrhythmic drug treatment. Measures of heart rate variability obtained by digital 24 hour Holter recordings included the mean of all coupling intervals between normal beats (RRm), the standard deviation of the mean of normal RR intervals (SDNN), and the square root of the mean of the squared differences between adjacent normal RR intervals (rMSSD). Baroreflex sensitivity testing was performed using the phenylephrine method. RESULTS Mean SDNN (SEM) was 112 (46) ms, and baroreflex sensitivity was 7.5 (5.0) ms/mm Hg. SDNN showed a weak correlation with baroreflex sensitivity (r = 0.19, p < 0.05) and with left ventricular ejection fraction (r = 0.29, p < 0.05). SDNN showed no significant correlation with age (r = -0.07), the presence of non-sustained ventricular tachycardia (r = -0.13), or left ventricular end diastolic diameter (r = -0.07). In addition, baroreflex sensitivity showed no significant correlation with age (r = -0.13), non-sustained ventricular tachycardia (r = -0.08), left ventricular end diastolic diameter (r = 0.09), or ejection fraction (r = 0.14). CONCLUSIONS The weak correlation between baroreflex sensitivity and heart rate variability suggests that these two indices explore different aspects of cardiac autonomic control in patients with idiopathic dilated cardiomyopathy. The weak or absent correlation between baroreflex sensitivity, heart rate variability, and other potential non-invasive risk predictors, including left ventricular ejection fraction, left ventricular end diastolic diameter, and non-sustained ventricular tachycardia on Holter monitoring, indicate that these variables may have independent prognostic value in idiopathic dilated cardiomyopathy.
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Affiliation(s)
- J Hoffmann
- Department of Internal Medicine and Cardiology, Hospital of the Philipps- University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
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Grimm W, Hoffmann J, Menz V, Müller HH, Maisch B. Prediction of major arrhythmic events and sudden cardiac death in dilated cardiomyopathy. The Marburg Cardiomyopathy Study design and description of baseline clinical characteristics. Herz 2000; 25:189-99. [PMID: 10904838 DOI: 10.1007/s000590050006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The Marburg Cardiomyopathy Study (MACAS) is a prospective observational study designed to determine the value of the following potential non-invasive arrhythmia risk predictors in more than 200 patients with idiopathic dilated cardiomyopathy (IDC) over a 5-year follow-up period: New York Heart Association functional class, left ventricular end-diastolic diameter and ejection fraction, left bundle branch block and atrial fibrillation on ECG, QTc and JTc-dispersion on 12-lead ECG, abnormal time-domain analysis and spectral turbulence analysis of the signal-averaged ECG, ventricular arrhythmias and heart-rate variability on 24-hour Holter ECG, baroreflex sensitivity, and microvolt T wave alternans during exercise. This report describes the rationale of MACAS as well as the clinical characteristics of the first 236 patients enrolled between March 1996 and October 1999. The prognostic significance of the potential arrhythmia risk predictors in MACAS will be determined by multivariate Cox analysis at the end of 5-year follow-up. Primary endpoints are total mortality and major arrhythmic events defined as sustained ventricular tachycardia, ventricular fibrillation or sudden cardiac death. The results of MACAS will have important implications for the design of future studies evaluating the role of prophylactic defibrillator therapy in idiopathic dilated cardiomyopathy.
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Affiliation(s)
- W Grimm
- Department of Internal Medicine-Cardiology, Philipps University, Marburg, Germany
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Umstadt HE, Ellers M, Müller HH, Austermann KH. Functional reconstruction of the TM joint in cases of severely displaced fractures and fracture dislocation. J Craniomaxillofac Surg 2000; 28:97-105. [PMID: 10958422 DOI: 10.1054/jcms.2000.0123] [Citation(s) in RCA: 27] [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] [Indexed: 11/18/2022] Open
Abstract
In a clinical and axiographic study the outcome of patients with severely displaced fractures and fracture dislocations of the mandibular condyle was evaluated. Two operation methods were compared one via an intraoral approach without joint revision and another via a preauricular approach with open reduction of the joint. In the group with joint revision, resorbable material was used for osteosynthesis. Twenty-eight patients (32 joints) treated without revision of the joint and 26 patients (29 joints) with open reduction of the joint were evaluated. The mean observation time following surgery was 3 years and 10 months (range 1-7.5 years). Clinical examination utilized the Helkimo-index, while the electronic axiographical results were evaluated by using a five point scheme of joint-mobility. Concerning clinical evaluation, 20 out of 28 patients (71%) without joint revision and 23 out of 26 (89%) patients with joint revision had none or only slight dysfunction of the stomatognathic system. When focusing on arthralgia and pain in motion (part D and E of Helkimo's-index) significantly better results were achieved by open joint revision (Helkimo D: p< or =0.007; Helkimo E: p = 0.0029). No patient exhibited severe dysfunction (group D3). In axiographic evaluation optimal results (group A1) were achieved in seven joints (24%) with revision and four joints (12%) without revision. Twelve out of 29 joints with revision (41%) and six out of 32 joints without revision (19%) were classified as group A2 with a slightly shortened condylar excursion. Revision of joints with disc reduction and reconstruction of ligaments in cases of severely displaced or dislocated fractures resulted in better mobility and less pain. This was seen clinically and in the axiographic results. Looking at the long-term outcome of patients better mobility of the joint without internal derangement due to surgical repair also protects the contralateral (nonoperated) joint. When managing severe TMJ-trauma we suggest that both, bony and soft tissue structures should be reconstructed if there are any signs of internal derangement. However, the limits between bony reconstruction with or without joint revision are still not defined. Our results appear to be promising concerning mobility and absence of pain of the joints after open reduction. Further research comparing the two operative treatment regimes in a randomized controlled clinical trial will be necessary.
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Affiliation(s)
- H E Umstadt
- Department of Oral- and Maxillofacial Surgery, Philipps-Universität, Marburg, Germany.
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Abstract
Holter monitoring was performed in 202 patients with idiopathic dilated cardiomyopathy, which revealed accelerated idioventricular rhythm in 16 patients (8%) and nonsustained ventricular tachycardia in 70 patients (35%). During 32 +/- 15-month prospective follow-up, no significant difference was observed for major arrhythmic events and transplant-free survival between patients with and without accelerated idioventricular rhythm, whereas patients with nonsustained ventricular tachycardia had a significantly higher incidence of major arrhythmic events and a lower transplant-free survival rate.
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Affiliation(s)
- W Grimm
- Department of Cardiology, Hospital of the Philipps-University of Marburg, Germany
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Lorenz M, Heinrich S, Staib-Sebler E, Gog C, Vetter G, Petrowsky H, Müller HH. Relevance of locoregional chemotherapy in patients with liver metastases from colorectal primaries. Swiss Surg 2000; 6:11-22. [PMID: 10709432 DOI: 10.1024/1023-9332.6.1.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Progression of colorectal cancer can occur primarily isolated in the liver. But, only the minority of the affected patients is eligible for surgery. Initially, systemic chemotherapy was ineffective in the treatment of unresectable hepatic metastases. For this reason, intraarterial chemotherapy was introduced as treatment alternative to the systemic chemotherapy. Long-term intraarterial chemotherapy regimens with FUDR in patients with colorectal liver metastases, using implantable pumps and ports, resulted in improved response rates, which was confirmed by several randomized trials. However, an improvement in median survival has not yet been demonstrated after regional chemotherapy of hepatic metastases. Since the intraarterial therapy with floxuridine (FUDR) had been reported to result in a high rate of local toxicity, 5-fluorouracil (5-FU) was introduced into regional chemotherapy of the liver. A randomized trial demonstrated superiority of intraarterial 5-FU versus intraarterial FUDR therapy. Despite these reports about high response rates, the benefit of intraarterial chemotherapy remains questionable, because it has not yet resulted in a prolongation of median survival. For this reason, long-term regional chemotherapy cannot be considered as standard treatment and should therefore not be conducted outside controlled clinical trials. Further evaluations on this technique should only be performed in experienced centers.
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Affiliation(s)
- M Lorenz
- Department of General and Vascular Surgery, University Hospital of Frankfurt, Germany.
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Abstract
The performance of a diagnostic test is characterised by its specificity and sensitivity. For a quantitative diagnostic test these criteria depend on the selected cut-off point. The receiver operating characteristic (ROC) curve of a quantitative diagnostic test is generated by plotting sensitivity against specificity as the cut-off point runs through the whole range of possible test values. In practice, the ROC curve is estimated from clinical data. One important goal is to select an optimal cut-off point. For this purpose the sample variability has to be taken into account. Recently, Campbell has introduced nonparametric asymptotic simultaneous confidence bands that are valid for the whole ROC curve. In this paper a nonparametric asymptotic approach for the construction of regional confidence bands for ROC curves is proposed. It can be applied for any specificity interval of interest. Our approach is based on the asymptotic theory of empirical and quantile processes. To investigate the small sample properties of the different approaches, a Monte Carlo study was conducted using normal and log-normal data. A method for sample size calculation is presented. Finally, the approaches are applied to a tumour marker in the diagnosis of bone marrow metastases.
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Affiliation(s)
- K Jensen
- Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Bunsenstrasse 3, 35037 Marburg, Germany.
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Konrad L, Müller HH, Lenz C, Laubinger H, Aumüller G, Lichius JJ. Antiproliferative effect on human prostate cancer cells by a stinging nettle root (Urtica dioica) extract. Planta Med 2000; 66:44-47. [PMID: 10705733 DOI: 10.1055/s-2000-11117] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In the present study the activity of a 20% methanolic extract of stinging nettle roots (Urtica dioica L., Urticaceae) on the proliferative activity of human prostatic epithelial (LNCaP) and stromal (hPCPs) cells was evaluated using a colorimetric assay. A concentration-dependent and significant (p < 0.05) antiproliferative effect of the extract was observed only on LNCaP cells during 7 days, whereas stromal cell growth remained unaltered. The inhibition was time-dependent with the maximum of growth reduction (30%) at a concentration of 1.0E-6 mg/ml on day 5 compared to the untreated control. On day 4 and 6, the reduction in proliferation of LNCaP cells showed the minimal effective dose at 1.0E-9 mg/ml. No cytotoxic effect of ME-20 on cell proliferation was observed. The antiproliferative effect of ME-20 of stinging nettle roots observed both in an in vivo model and in an in vitro system clearly indicates a biologically relevant effect of compounds present in the extract.
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Affiliation(s)
- L Konrad
- Department of Anatomy and Cell Biology, Philipps-Universität Marburg, Germany.
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Lorenz M, Müller HH. Randomized, multicenter trial of fluorouracil plus leucovorin administered either via hepatic arterial or intravenous infusion versus fluorodeoxyuridine administered via hepatic arterial infusion in patients with nonresectable liver metastases from colorectal carcinoma. J Clin Oncol 2000; 18:243-54. [PMID: 10637236 DOI: 10.1200/jco.2000.18.2.243] [Citation(s) in RCA: 253] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the efficacy and tolerability of three treatments for patients with documented adenocarcinoma of the colon and/or rectum who have undergone complete resection of primary tumor and have nonresectable liver metastases that do not exceed 75% of the liver volume. PATIENTS AND METHODS A total of 168 patients at 25 treatment centers were enrolled onto this prospective, multicenter, randomized study. The three treatment arms were as follows: (1) fluorouracil (5-FU)/leucovorin (LV) administered via hepatic arterial infusion (HAI), (2) 5-FU/LV administered via intravenous (IV) infusion, and (3) fluorodeoxyuridine (FUDR) administered via HAI. RESULTS Median times to disease progression for the three treatment arms were as follows: 9.2 months for patients treated with HAI 5-FU/LV, 6.6 months for IV 5-FU/LV, and 5.9 months for HAI FUDR. Median survival times for patients treated with HAI 5-FU/LV, IV 5-FU/LV, and HAI FUDR were 18.7 months, 17.6 months, and 12.7 months, respectively. There was a nearly two-fold increase in time to progression in addition to a survival benefit among patients with an intrahepatic tumor burden of less than 25% who were treated with HAI 5-FU/LV. The most common adverse events were stomatitis, nausea and vomiting, skin irritation, diarrhea, and elevated serum levels of liver enzymes. Some patients exhibited severe reactions, including biliary sclerosis and chemical hepatitis. CONCLUSION Although the use of HAI 5-FU/LV as a means of treating liver metastases after resection of colorectal carcinoma warrants further investigation, it cannot be recommended as a routine therapeutic measure at this time.
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Affiliation(s)
- M Lorenz
- Department of General and Vascular Surgery, Johann Wolfgang Goethe-Universit]at, Frankfurt am Main, Germany.
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Lichius JJ, Lenz C, Lindemann P, Müller HH, Aumüller G, Konrad L. Antiproliferative effect of a polysaccharide fraction of a 20% methanolic extract of stinging nettle roots upon epithelial cells of the human prostate (LNCaP). Pharmazie 1999; 54:768-71. [PMID: 10563375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
In Germany, plant extracts are often used in the treatment of early stages of benign prostate hyperplasia (BPH). The effects of different concentrations of the polysaccharide fraction of the 20% methanolic extract of stinging nettle roots (POLY-M) on the cellular proliferation of lymph node carcinoma of the prostate (LNCaP) cells were determined by measurement of the genomic DNA content of the samples. All concentrations of POLY-M showed an inhibitory effect on the growth of the LNCaP cells during 7 days except the two lowest concentrations. The reduced proliferation of POLY-M treated LNCaP cells was significantly (p < 0.05) different from the untreated control. The inhibition was time- and concentration-dependent with the maximum suppression (50%) on day 6 and at concentrations of 1.0E-9 and 1.0E-11 mg/ml. No cytotoxic effect of POLY-M on cell proliferation was observed. The in vitro results show for the first time an antiproliferative effect of Urtica compounds on human prostatic epithelium and confirm our previous in vivo findings.
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Affiliation(s)
- J J Lichius
- Department of Pharmaceutical Biology, Philipps University, Marburg, Germany.
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Lorenz M, Müller HH, Staib-Sebler E, Vetter G, Gog C, Petrowsky H, Köhne CH. Relevance of neoadjuvant and adjuvant treatment for patients with resectable liver metastases of colorectal carcinoma. Langenbecks Arch Surg 1999; 384:328-38. [PMID: 10473852 DOI: 10.1007/s004230050210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Excellent results after resection of colorectal liver metastases are associated with a high rate of recurrence. Influenced by positive results of palliative and adjuvant treatment in advanced cancer, various chemotherapy regimens were evaluated to improve long-term results. METHODS The databases Medline and Cancerlit (1982-1998) gave information about 675 patients who were treated either by means of systemic, intra-arterial, intraportal or intraperitoneal administration before or after liver resection. RESULTS In general, the feasibility of an adjuvant treatment was tested. Proof has been furnished for the practicability of systemic and arterial therapy and for immunotherapy after liver resection whereas, for peritoneal and portal treatment, further studies are necessary. In a few non-randomised trials, it has been possible to discern a trend towards an improvement due to adjuvant postoperative therapy using historical or matched-pair control groups. Until now, only one of five randomised studies has been published. Six months of postoperative adjuvant intra-arterial treatment using 5-fluorouracil (1000 mg/m(2) for 5 days every 28 days) and folinic acid (200 mg/m(2) for 5 days every 28 days) was compared with observation only. Neither in the intention-to-treat nor in the as-treated analysis was median survival time (34.5 months versus 40. 8 months and 39.7 months versus 44.8 months, respectively) significantly increased. As neoadjuvant treatment was successful in primary non-resectable patients, this approach is now being tested in resectable patients. CONCLUSION Despite several theoretical reasons for post- or preoperative treatment in resectable patients, every approach should be tested using of controlled studies.
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Affiliation(s)
- M Lorenz
- Department of General and Vascular Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
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Müller HH, Schäfer H. Optimization of testing times and critical values in sequential equivalence testing. Stat Med 1999; 18:1769-88; discussion 1789. [PMID: 10407247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
In long-term clinical trials, interim analyses are planned to reduce the number of patients needed. To meet this issue in a practical way, group sequential designs are used. Most of these trials are conducted with the objective of demonstrating differences in efficacy of treatments, for example, to show superiority of a new drug or experimental treatment to a control. However, an increasing number of trials are designed to establish equivalence in efficacy or bioequivalence. This paper deals with group sequential test procedures in two-sided equivalence trials. Optimized designs with respect to sample size behaviour are constructed. Tables containing optimal testing times and corresponding optimal critical values or values to construct an underlying alpha-spending function, respectively, are provided. An example illustrates their use when planning interim analyses in equivalence trials.
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Affiliation(s)
- H H Müller
- Institute of Medical Biometry, Philipps-University of Marburg, Bunsenstrasse 3, D-35037 Marburg, Germany
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Umstadt HE, Völlinger J, Müller HH, Austermann KH. [Implants in avascular iliac crest bone transplants. Prospective study of 176 implants]. Mund Kiefer Gesichtschir 1999; 3 Suppl 1:S93-8. [PMID: 10414093 DOI: 10.1007/pl00014528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Total and subtotal defects of the upper and lower alveolar ridge require bone grafts to make masticatory rehabilitation possible using alloplastic dental implants. The aim of this study was to establish the survival rate of dental implants inserted in avascular iliac bone grafts. Furthermore, we aimed to discover whether the prognosis of implants can be influenced by choosing one-stage or a two-stage procedure. In a prospective study, jaw defects in 40 patients were treated with avascular mono- or bicortical bone transplants taken from the right iliac wing. A total of 134 of 176 dental implants were inserted into an onlay osteoplasty. In 19 cases, 95 implants could have been inserted in a one-stage procedure, while in the other 13 cases 39 implants have been inserted in a two-stage procedure. One-stage insertion of implants was done in cases of definite primary stability only; otherwise, the two-stage method was preferred. After treatment, all patients were examined at least once every year. Both the rate of loss of implants and the time-dependent crestal bone loss were recorded. Of the 134 implants, 88% (i.e., 118 implants) were still in situ 6.8 years after abutment connection, and after 8.5 years 78% (i.e., 104 implants) were in situ. The interval of confidence was 95%. Projected over 8 years, 83 implants inserted in a one-stage procedure (i.e., 87%) were still functioning, while differently only 26 of the implants inserted in a two-stage procedure (i.e., 66%) were still functioning. The probability that implants stay in situ for a particular time corresponds to the results of former studies. The results of other studies with regard to one-stage or two-stage procedures could not be confirmed. The probability of total retention time for implants inserted in a two-stage procedure is lower than for those inserted in a one-stage procedure. The unfavorable starting point with the lack of primary stability of the implants in local bone within the two-stage procedure might be a reason for this.
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Affiliation(s)
- H E Umstadt
- Klinik für MKG-Chirurgie, Philipps-Universität Marburg
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Staib-Sebler E, Müller HH, Mattes P, Junginger T, Saeger HD, Lorenz M. [Multicenter phase II study of the Liver Metastases Study Group of weekly intra-arterial 24-hour high dose therapy with 5-FU and folinic acid (FA) in liver metastases of colorectal tumors]. Langenbecks Arch Chir Suppl Kongressbd 1999; 115:1441-4. [PMID: 9931906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This prospective multicenter trial was performed to determine the response rate, toxicity and applicability of continuous 24 h hepatic arterial infusion of high-dose 5-FU and folinic acid. An improved response rate (60.5% in non-pretreated patients) was however associated with many systemic side-effects (340/509), mainly nausea and diarrhea. Therefore this treatment should be applied only in selected patients in specialized centers.
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Affiliation(s)
- E Staib-Sebler
- Klinik für Allgemein- und Gefässchirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
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Gassel HJ, Müller HH, Mattes P, Stieger R, Schramm H, Lorenz M. [Intra-arterial (5-FU/FA and FUDR) versus systemic chemotherapy (5-FU/FA) of non-resectable colorectal liver metastases]. Langenbecks Arch Chir Suppl Kongressbd 1999; 115:1458-60. [PMID: 9931911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The relative efficacy of HAI FUDR, HAI 5-FU/FA, and i.v. 5-FU/FA chemotherapy for the treatment of unresectable colorectal liver metastases was compared in a prospective randomized clinical trial. The response rate after HAI treatment was significantly higher as compared to i.v. treatment with no statistical benefit regarding survival and time to progression. HAI FUDR treatment was inferior as compared to HAI or i.v. 5-FU/FA. i.v. 5-FU/FA-therapy is therefore the method of choice outside clinical trials.
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Affiliation(s)
- H J Gassel
- Chirurgische Universitätsklinik, Universität Würzburg
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Abstract
In numerous tumors, metastasis can be limited to the liver. In non-resectable patients, regional treatment modalities, especially arterial cytostatic infusion, are favored in contrast to systemic chemotherapy, whereas intraportal or intraperitoneal application is not successful. Improved results with high response rates have been reported after development of intra-arterial (i.a.) long-term regimens with FUdR in patients with colorectal liver metastases using implantable pumps and ports. However, a survival benefit could only be demonstrated in comparison with a control group only treated symptomatically. Because of several reports on major local toxicity of i.a. FUdR treatment (i.e. chemical hepatitis and biliary sclerosis) several other effective i.a. 5-FU regimens have been developed. A randomized study has demonstrated superiority of i.a. 5-FU versus i.a. FUdR. In comparison with systemic treatment, superiority has only been demonstrated in patients with an intrahepatic tumor burden of < 25%. Publications about regional treatment of patients with breast, gastric cancer or carcinoid liver metastases are rare. Despite the high response rates reported, the benefit of arterial chemotherapy remains questionable. Overall, local long-term chemotherapy cannot be recommended outside of studies as a primary treatment. However, extensive experience and new drugs support the idea of conducting further regional studies.
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Affiliation(s)
- M Lorenz
- Klinik für Allgemein- und Gefässchirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt a. M.
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