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Cueva K, Cueva M, Revels L, Hensel M, Dignan M. Culturally Relevant Online Cancer Education Supports Tribal Primary Care Providers to Reduce Their Cancer Risk and Share Information About Cancer. Health Promot Pract 2021; 23:631-639. [PMID: 34416831 DOI: 10.1177/15248399211027827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Culturally relevant education is an opportunity to reduce health disparities, and online learning is an emerging avenue for health promotion. In 2014-2019, a team based at the Alaska Native Tribal Health Consortium developed, implemented, and evaluated culturally relevant online cancer education modules with, and for, Alaska's tribal primary care providers. The project was guided by Indigenous Ways of Knowing and the principles of community-based participatory action research and was evaluated in alignment with empowerment theory. About 265 unique learners completed 1,898 end-of-module evaluation surveys between March 2015 and August 2019, and 13 people completed a follow-up survey up to 28 months post module completion. KEY FINDINGS Learners described the modules as culturally respectful and informative and reported feeling more knowledgeable and comfortable talking about cancer as a result of the modules. About 98% of the learners planned to reduce their cancer risk because of the modules, and all follow-up survey respondents had reduced their risk, including by quitting smoking, getting screened for cancer, eating healthier, and exercising more. About 98% of the learners planned to share information with their patients, families, friends, and community members because of the modules, with all follow-up survey respondents indicating that they had shared information about cancer from the modules. IMPLICATIONS FOR PRACTICE AND FURTHER RESEARCH Culturally relevant online modules have the capacity for positive behavioral change and relatively high correlations between intent and behavior change. Future research could determine which aspects of the modules catalyzed reduced cancer risk and increased dissemination of cancer information.
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Affiliation(s)
- Katie Cueva
- University of Alaska Anchorage, Anchorage, AK, USA
| | - Melany Cueva
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Laura Revels
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
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Abstract
Culturally relevant health promotion is an opportunity to reduce health inequities in the cancer burden, and online learning is an emerging avenue for health promotion. To address a desire for synchronous online cancer education, a project team offered ten 1-hr cancer education webinars for Alaska's rural tribal health workers. The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. The evaluation of this community-based intervention included end-of-webinar surveys. Between February and April 2018, 41 surveys were completed by 11 unique participants. All participants reported that, as a result of the webinars, they planned both to change their own behavior to reduce cancer risk, and to talk with their patients more often about cancer prevention strategies such as screenings, physical activity, tobacco cessation, and eating healthy. While the webinars addressed desires for synchronous actions to support cancer learning, and led to intentions to positive change behaviors, the ten webinars engaged far fewer unique learners than the team's asynchronous cancer education modules. This experience may inform other cancer educators' efforts to develop, implement, and evaluate online learning opportunities. Despite the small numbers, these webinars resulted in increased learners' intent to reduce cancer risk behaviors, share cancer information, and improved learners' capacity to talk about cancer in their communities.
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Affiliation(s)
- Katie Cueva
- Institute of Social and Economic Research, University of Alaska Anchorage, 3211 Providence Dr., Anchorage, AK, 99508, USA.
| | - Melany Cueva
- Community Health Aide Program, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Laura Revels
- Clinical & Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Michelle Hensel
- Community Health Aide Program, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Mark Dignan
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
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Hensel M, Meason-Smith C, Plumlee QD, Myers AN, Coleman MC, Lawhon S, Rodrigues Hoffmann A, Rech RR. Retrospective Analysis of Aetiological Agents Associated with Pulmonary Mycosis Secondary to Enteric Salmonellosis in Six Horses by Panfungal Polymerase Chain Reaction. J Comp Pathol 2019; 174:1-7. [PMID: 31955794 DOI: 10.1016/j.jcpa.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 12/15/2022]
Abstract
Pulmonary mycosis secondary to enterocolitis is an uncommon diagnosis in equine medicine, but is thought to result from mucosal compromise and translocation of enteric fungi. The aetiological agent associated with translocation is often identified based on fungal culture or hyphal features in histological sections. In order to understand better the aetiological agents involved, six horses diagnosed with Salmonella enteritis and concurrent pulmonary mycosis were identified retrospectively through a database search of veterinary teaching hospital records. Samples from these cases were subjected to polymerase chain reaction and sequencing of the internal transcribed spacer 2 (ITS-2) located between the 5.8S and 28S rRNA genes to identify the aetiological agent involved. Sequencing identified Aspergillus fumigatus, Aspergillus flavus, Fusarium spp., Cladosporium spp. and Curvularia spp. A single case had a dual infection with Fusarium spp. and A. fumigatus.
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Affiliation(s)
- M Hensel
- Texas A&M University, College Station, Texas, USA
| | | | - Q D Plumlee
- Texas A&M University, College Station, Texas, USA
| | - A N Myers
- Texas A&M University, College Station, Texas, USA
| | - M C Coleman
- Texas A&M University, College Station, Texas, USA
| | - S Lawhon
- Texas A&M University, College Station, Texas, USA
| | | | - R R Rech
- Texas A&M University, College Station, Texas, USA.
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Hensel M, Hoffmann AR, Gonzales M, Owston MA, Dick EJ. Phylogenetic analysis of Histoplasma capsulatum var duboisii in baboons from archived formalin-fixed, paraffin embedded tissues. Med Mycol 2019; 57:256-259. [PMID: 29471422 DOI: 10.1093/mmy/myy003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/05/2018] [Indexed: 01/25/2023] Open
Abstract
Histoplasma capsulatum var. duboisii (Hcd) infections have been well documented to cause chronic granulomatous disease, mainly involving the skin of baboons and humans in African countries primarily. This retrospective study classified the subspecies of Histoplasma and developed a phylogenetic tree utilizing DNA sequences extracted from formalin-fixed, paraffin embedded (FFPE) tissues from 9 baboons from a research colony in Texas histologically diagnosed with Hcd. Based on sequence analysis of ITS-2, Tub-1, and ARF, Hcd isolated from the archived samples closely aligns with the African clade and has 88% sequence homology with a sample isolated from an individual in Senegal.
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Affiliation(s)
- M Hensel
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
| | - A Rodrigues Hoffmann
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
| | - M Gonzales
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - M A Owston
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - E J Dick
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
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Cueva K, Cueva M, Revels L, Hensel M, Dignan M. Online Health Promotion to Reduce Cancer Risk: Lessons From Learning With Alaska’s Tribal Primary Care Providers. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.40100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Alaska's tribal primary care providers in rural Alaska - community health aides and practitioners (CHA/Ps) - requested online education about cancer for themselves and their communities. Aim: A research team at the Alaska Native Tribal Health Consortium engaged in community-based participatory action research to develop culturally respectful online cancer education to support CHA/Ps to increase their knowledge, reduce their own cancer risk, and share cancer information. Methods: This project created ten online learning modules, a semester-long online course that combined the modules with synchronous conversations, and a supplemental webinar series. All modules were community-based and collaboratively developed with input from a community advisory group of CHA/Ps, content experts, and interested partners. Learners completed an evaluation survey at the end of each module and webinar. Course participants completed a precourse assessment, and evaluations at the end of each module, at the end of the course, two-months postcourse, and six-months postcourse. Results: While evaluation is ongoing, as of March 2018, 194 unique individuals, including 27 course participants, had completed 1,288 module evaluation surveys. Learners reported an increase in cancer knowledge, and intentions to reduce their personal cancer risk and share cancer information as a result of the online learning. On 98% of completed surveys, learners shared that they planned to change their interactions with patients as a result of the learning, including talking more about cancer screening, cutting down/quitting tobacco, being more physically active, and eating healthy. A total of 88% of unique learners planned to reduce their personal cancer risk as a result of the learning, including by quitting tobacco, having recommended cancer screenings, exercising, and eating healthier. Comparison of pre and postcourse survey responses showed CHA/Ps’ had changed to eat more fruits and vegetables and exercise more, as well as felt more knowledgeable about cancer, and more comfortable both with finding medically-accurate cancer information online and talking to their patients, families, and communities about cancer. Conclusion: This culturally respectful education strategy may be adaptable to other populations to support primary care providers and their communities to reduce cancer risk. This intervention may be of particular interest to health care providers, public health professionals, and those interested in health systems in rural and remote regions and in areas with limited medical infrastructure.
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Affiliation(s)
- K. Cueva
- Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, AK
| | - M. Cueva
- Alaska Native Tribal Health Consortium, Anchorage, AK
| | - L. Revels
- Alaska Native Tribal Health Consortium, Anchorage, AK
| | - M. Hensel
- Alaska Native Tribal Health Consortium, Anchorage, AK
| | - M. Dignan
- University of Kentucky, Lexington, KY
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Hensel M, Güldenpfennig T, Schmidt A, Krumm M, Kerner T, Kox WJ. Digital palpation of the pilot balloon vs. continuous manometry for controlling the intracuff pressure in laryngeal mask airways. Anaesthesia 2016; 71:1169-76. [PMID: 27501056 DOI: 10.1111/anae.13566] [Citation(s) in RCA: 4] [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] [Accepted: 05/18/2016] [Indexed: 11/29/2022]
Abstract
This study compared two methods of controlling the intracuff pressure in laryngeal mask airways. One hundred and eighty patients were randomly assigned into two groups. In the first group (n = 90), after training, the intracuff pressure was controlled using digital palpation of the pilot balloon. In the second group (n = 90), continuous manometry was used to control the intracuff pressure. An upper pressure limit of 60 cmH2 O was set. The median (IQR [range]) intracuff pressure in the palpation group was 130 (125-130 [120-130]) cmH2 O compared with 29 (20-39 [5-60]) cmH2 O in the manometry group (p < 0.001). In the palpation group, 37% of patients experienced pharyngolaryngeal complications vs. 12% in the manometry group (p < 0.001). We conclude that the digital palpation technique is not a suitable alternative to manometry in controlling the intracuff pressure in laryngeal mask airways.
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Affiliation(s)
- M Hensel
- Department of Anaesthesiology and Intensive Care Medicine, Park-Klinik-Weissensee, Berlin, Germany.
| | - T Güldenpfennig
- Department of Anaesthesiology and Intensive Care Medicine, Park-Klinik-Weissensee, Berlin, Germany
| | - A Schmidt
- Department of Anaesthesiology and Intensive Care Medicine, Park-Klinik-Weissensee, Berlin, Germany
| | - M Krumm
- Department of Anaesthesiology and Intensive Care Medicine, Park-Klinik-Weissensee, Berlin, Germany
| | - T Kerner
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Asklepios Klinikum Harburg, Hamburg, Germany
| | - W J Kox
- Department of Anaesthesiology and Intensive Care Unit, Campus Charité Mitte, Charité-University Hospital, Berlin, Germany
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Hensel M, Schmidbauer W, Geppert D, Sehner S, Bogusch G, Kerner T. Overinflation of the cuff and pressure on the neck reduce the preventive effect of supraglottic airways on pulmonary aspiration: an experimental study in human cadavers. Br J Anaesth 2016; 116:289-94. [PMID: 26787800 DOI: 10.1093/bja/aev435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The oesophageal leak pressure is defined as the pressure which breaks the seal between the cuff of a supraglottic airway and the peri-cuff mucosa, allowing penetration of fluid into the pharynx and the oral cavity. As a consequence, a decrease in this variable increases the risk of reflux and can lead to pulmonary aspiration. The aim of this study was to analyse the effects of cuff overinflation and pressure on the neck on the oesophageal leak pressure of seven supraglottic airways. METHODS Three laryngeal masks, two laryngeal tubes, and two oesophageal-tracheal tubes were tested in an experimental setting. In five human cadavers, we simulated a sudden increase in oesophageal pressure. To measure baseline values (control), we used an intracuff pressure as recommended by the manufacturer. The first intervention included overinflation of the cuff by applying twice the amount of pressure recommended. A second intervention was defined as external pressure on the neck. RESULTS The oesophageal leak pressure was decreased for laryngeal masks (control, 28 cm H2O; overinflation, 9 cm H2O; pressure on the neck, 8 cm H2O; P<0.01) and for laryngeal tubes (control, 68 cm H2O; overinflation, 37 cm H2O; pressure on the neck, 39 cm H2O; P<0.01) and was unaffected for oesophageal-tracheal tubes (control, 126 cm H2O; overinflation/pressure on the neck, 130 cm H2O; n.s.). CONCLUSION Cuff overinflation and pressure on the neck can enhance the risk of gastro-oesophageal reflux when using supraglottic airways. Therefore, both manoeuvres should be avoided in clinical practice.
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Affiliation(s)
- M Hensel
- Department of Anaesthesiology and Intensive Care Medicine, Chefarzt der Abteilung Anästhesiologie und Intensivmedizin, Park-Klinik-Weissensee, Schönstrasse 80, Berlin 13086, Germany
| | - W Schmidbauer
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, Combat Search and Rescue Bundeswehrkrankenhaus, Berlin 10115, Germany
| | - D Geppert
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Asklepios Klinik Nord Heidberg, Hamburg 22417, Germany
| | - S Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg 20246, Germany
| | - G Bogusch
- Center for Anatomy, Charité-Universitätsmedizin, Berlin 10117, Germany
| | - T Kerner
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Asklepios Klinikum Harburg, Hamburg 21075, Germany
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Hensel M, Güldenpfennig T, Schmidt A, Krumm M. [Continuous cuff pressure measurement during laryngeal mask anesthesia : An obligatory measure to avoid postoperative complications]. Anaesthesist 2016; 65:346-52. [PMID: 27072313 DOI: 10.1007/s00101-016-0160-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/01/2016] [Accepted: 02/26/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inflation of laryngeal masks is often performed only with regard to the clinical impression and without any objective measurement of cuff pressure. As a result the use of laryngeal masks frequently leads to postoperative complications, such as sore throat, dysphonia, dysphagia and nerve palsy. In this study the influence of continuous measurement of cuff pressure on the incidence of postoperative sore throat was investigated in patients who underwent laryngeal mask anesthesia. PATIENTS/MATERIAL AND METHODS In the context of a retrospective audit all patients who underwent laryngeal mask anesthesia were asked to complete a questionnaire on anesthesia. The primary endpoint of the study was the postoperative occurrence of a sore throat. For analysis the patients were divided into two groups. In the first group the cuff pressure was controlled only by clinical means and in the second group the cuff pressure was controlled using continuous manometry. The study covered a 10-month period of observation for each group. RESULTS During the observation period laryngeal mask anesthesia was performed in 4169 patients. Of these 917 patients (manometry group n = 433 and control group n = 484) voluntarily completed the questionnaire. In the group without cuff pressure measurement 36 % of patients complained of sore throat postoperatively but only 12 % of the patients in the group with cuff pressure measurement (p < 0.001). Postoperative nausea and vomiting occurred in 16 % of the patients and 13 % complained of severe pain in the area of the operation. No differences between the two groups were found. While 97 % of patients in the group with continuous measurement of cuff pressure were satisfied with the anesthesia, this applied to only 79 % of patients in the control group (p = 0.006). CONCLUSION In terms of the results of this study and with respect to data from the literature, measurement of cuff pressure should be compulsory during laryngeal mask anesthesia.
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Affiliation(s)
- M Hensel
- Abteilung Anästhesiologie u. Intensivmedizin, Park-Klinik-Weissensee, Schönstr. 80, 13086, Berlin, Deutschland.
| | - T Güldenpfennig
- Abteilung Anästhesiologie u. Intensivmedizin, Park-Klinik-Weissensee, Schönstr. 80, 13086, Berlin, Deutschland
| | - A Schmidt
- Abteilung Anästhesiologie u. Intensivmedizin, Park-Klinik-Weissensee, Schönstr. 80, 13086, Berlin, Deutschland
| | - M Krumm
- Abteilung Anästhesiologie u. Intensivmedizin, Park-Klinik-Weissensee, Schönstr. 80, 13086, Berlin, Deutschland
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Hoffmann C, Hentrich M, Gillor D, Behrens G, Jensen B, Stoehr A, Esser S, van Lunzen J, Krznaric I, Müller M, Oette M, Hensel M, Thoden J, Fätkenheuer G, Wyen C. Hodgkin lymphoma is as common as non-Hodgkin lymphoma in HIV-positive patients with sustained viral suppression and limited immune deficiency: a prospective cohort study. HIV Med 2014; 16:261-4. [PMID: 25252101 DOI: 10.1111/hiv.12200] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The incidence of HIV-related non-Hodgkin lymphoma (NHL) but not that of Hodgkin lymphoma (HL) has been declining. The aim of the study was to compare HIV-infected patients with NHL and HL with respect to antiretroviral therapy (ART) exposure at the time of lymphoma diagnosis. METHODS HIV-infected patients with NHL and HL included in a prospective multicentre cohort study since January 2005 were compared with respect to ART exposure and viral load at the time of lymphoma diagnosis. RESULTS As of 31 December 2012, data for 329 patients with NHL and 86 patients with HL from 31 participating centres were available. Patients with HL were more likely to be on ART (73.5% vs. 39.1%, respectively; P < 0.001) and more frequently had a viral load below the detection limit (57.3% vs. 27.9%, respectively; P < 0.001) than patients with NHL. The proportion of patients with HL was 8.0% in ART-naïve patients, 34.8% in patients with current HIV RNA < 50 HIV-1 RNA copies/mL, and 50.0% in patients with both HIV RNA < 50 copies/mL for > 12 months and a CD4 cell count of > 200 cells/μL. Of note, 45.8% of all patients with NHL were not currently on ART and had a CD4 count of < 350 cells/μL. CONCLUSIONS This prospective cohort study shows that HL was as common as NHL in patients with sustained viral suppression and limited immune deficiency. In contrast to NHL, the majority of patients with HL were on effective ART, suggesting that ART provides insufficient protection from developing HL. The high proportion of untreated patients with NHL suggests missed opportunities for earlier initiation of ART.
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Affiliation(s)
- C Hoffmann
- IPM Study Center, Hamburg, Germany; University of Schleswig Holstein, Campus Kiel, Kiel, Germany
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Herth I, Dietrich S, Benner A, Hegenbart U, Rieger M, Stadtherr P, Bondong A, Tran TH, Weide R, Hensel M, Knauf W, Franz-Werner J, Welslau M, Procaccianti M, Görner M, Meissner J, Luft T, Schönland S, Witzens-Harig M, Zenz T, Ho AD, Dreger P. The impact of allogeneic stem cell transplantation on the natural course of poor-risk chronic lymphocytic leukemia as defined by the EBMT consensus criteria: a retrospective donor versus no donor comparison. Ann Oncol 2014; 25:200-6. [PMID: 24356631 DOI: 10.1093/annonc/mdt511] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In a single-center retrospective donor versus no-donor comparison, we investigated if allogeneic stem cell transplantation (alloSCT) can improve the dismal course of poor-risk chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS All patients with CLL who were referred for evaluation of alloSCT within a 7-year time frame and had a donor search indication according to the EBMT criteria or because of Richter's transformation were included. Patients for whom a matched donor could be found within 3 months (matches) were compared with patients without such a donor (controls). Primary end point was overall survival measured from the 3-month landmark after search initiation. RESULTS Of 105 patients with donor search, 97 (matches 83; controls 14) were assessable at the 3-month landmark. Matches and controls were comparable for age, gender, time from diagnosis, number of previous regimens, and remission status. Disregarding if alloSCT was actually carried out or not, survival from the 3-month landmark was significantly better in matches versus controls [hazard ratio 0.38, 95% confidence interval (CI) 0.17-0.85; P = 0.014]. The survival benefit of matches remained significant on multivariate analysis. CONCLUSION This study provides first comparative evidence that alloSCT may have the potential to improve the natural course of poor-risk CLL as defined by the EBMT criteria.
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Affiliation(s)
- I Herth
- Department Medicine V, University of Heidelberg, Heidelberg
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Hensel M, Frenzel J, Späker M, Keil E, Reinhold N. [Postoperative pain management after minimally invasive hysterectomy: thoracic epidural analgesia versus intravenous patient-controlled analgesia]. Anaesthesist 2013; 62:797-807. [PMID: 24057760 DOI: 10.1007/s00101-013-2234-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/25/2013] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND In view of the development of innovative and non-traumatic surgical techniques, postoperative pain management should be carried out depending on the invasiveness of the intervention. In the present study two analgesic strategies were compared in patients undergoing minimally invasive hysterectomy: epidural analgesia (EDA) and intravenous patient-controlled analgesia (iv-PCA). MATERIAL AND METHODS For this prospective case controlled study 60 women with benign uterine diseases undergoing vaginal hysterectomy (VH) or laparoscopically assisted vaginal hysterectomy (LAVH) were enrolled. Patients were divided for analysis into two groups (n=30 each) according to the postoperative analgesic strategy (EDA group versus iv-PCA group). A matched-pair analysis was applied (matching criteria: risk assessment, surgeon and age of patient) to minimize the differences between both groups. Patients were evaluated with respect to the extent of pain determined by a numeric rating scale (NRS 0-10 scale), analgesic consumption, rate of postoperative nausea and vomiting (PONV), mobilization from bed, oral intake of nutrition, complications, duration of stay in the recovery room as well as hospital stay and health-related quality of life (SF-36 Health Survey; collected before and 6 weeks after surgery). RESULTS Laparoscopically assisted removal of the uterus was carried out in 22 women and by vaginal hysterectomy in 38 women. No significant differences between the study groups were seen in the duration of surgery (iv-PCA 58 ± 25 min versus EDA 60 ± 26 min). Demographic data of both groups as well as intraoperative hemodynamic and respiratory parameters were comparable to a great extent. Compared to the iv-PCA group, women in the EDA group showed lower NRS values (p<0.01): recovery room admission 4.7 ± 2.5 iv-PCA vs. 0.9 ± 1.3 EDA, recovery room discharge 3.8 ± 1.8 iv-PCA vs. 1.0 ± 1.2 EDA, day of surgery at 8 p.m. 5.0 ± 2.1 iv-PCA vs. 1.8 ± 2.3 EDA and first postoperative day at 8 a.m. 3.5 ± 1.7 iv-PCA vs. 1.9 ± 2.2 EDA. In addition, less PONV (iv-PCA 9/30 vs. EDA 1/30, p<0.01), less shivering (iv-PCA 8/30 vs. EDA 2/30, p<0.05), reduced fatigue (iv-PCA 26/30 vs. EDA 9/30, p<0.05) and a lower consumption of analgesics were found. Average postoperative requirement for piritramide in the iv-PCA group was 7 mg (range 0-24 mg) on the day of surgery and 5 mg (0-39 mg) on the first postoperative day. In the EDA group no opiate medication was given postoperatively (p<0.01). Duration of stay in the recovery room was shorter in the EDA group (71 ± 32 min vs. 50 ± 13 min, p<0.05). Hospital stay was 5 days on average in both groups. There were no surgical complications or epidural catheter-related complications. Because of urinary retention catheterization of the bladder had to be made in 3 patients of the iv-PCA group and 13 patients of the EDA group (p<0.05). Furthermore, the possibility to take a shower postoperatively was restricted in the EDA group because the epidural catheter was in place and thereby hygiene concerns. Regarding the early oral nutritional intake as well as postoperative mobilization, no significant differences between groups were found. In comparison with the preoperative status, the results regarding health-related quality of life were significantly better for both groups after a follow-up of 6 weeks (p<0.01); however, this effect was especially pronounced in the EDA group (p<0.05). CONCLUSIONS To reduce the number of patients suffering from postoperative pain a procedure-specific pain management should be developed. The results of this study have shown that even in minimally invasive surgery, such as vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy there are some advantages for epidural analgesia compared to intravenous patient-controlled analgesia. In particular reduced pain intensity, lower need for analgesics and reduced occurrence of PONV can lead to excellent patient comfort, fast recovery as well as positive effects on health-related quality of life. However, there are also some disadvantages such as an increased rate of urinary retention and restriction of mobility.
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Affiliation(s)
- M Hensel
- Abteilung Anästhesiologie und Intensivmedizin, Park-Klinik-Weissensee, Schönstr. 80, 13086, Berlin, Deutschland,
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Fink AM, Böttcher S, Ritgen M, Fischer K, Pflug N, Eichhorst B, Wendtner CM, Winkler D, Bühler A, Zenz T, Staib P, Mayer J, Hensel M, Hopfinger G, Wenger M, Fingerle-Rowson G, Döhner H, Kneba M, Stilgenbauer S, Busch R, Hallek M. Prediction of poor outcome in CLL patients following first-line treatment with fludarabine, cyclophosphamide and rituximab. Leukemia 2013; 27:1949-52. [PMID: 23787395 PMCID: PMC3768112 DOI: 10.1038/leu.2013.190] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sommer C, Gold R, Stangel M, Pittrow D, Huscher D, Kirch W, Baumann U, Fasshauer M, Borte M, Reiser M, Hensel M. Behandlung von Patienten mit Multifokaler Motorischer Neuropathie (MMN) mit Immunglobulinen im prospektiven SIGNS-Register. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337233] [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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14
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Hensel M, Reinartz R, Marnitz R. [Fatal outcome of multiorgan tuberculosis with peritoneal involvement after abdominal surgery]. Med Klin Intensivmed Notfmed 2013; 108:319-22. [PMID: 23392616 DOI: 10.1007/s00063-012-0212-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/16/2012] [Accepted: 12/17/2012] [Indexed: 11/28/2022]
Abstract
Severe cases of tuberculosis can cause vital functional disturbances depending on the stage of the disease and the organ manifestation. There is a particularly high mortality rate in intensive care patients with tuberculosis. Extrapulmonary organ manifestations of this disease in particular can be associated with misdiagnosis and fatal outcome. In this article the intensive care treatment of a patient who suffered from abdominal as well as pulmonary tuberculosis is reported.
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Affiliation(s)
- M Hensel
- Abteilung Anästhesiologie und Intensivmedizin, Park-Klinik-Weissensee, Schönstr. 80, 13086, Berlin.
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15
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Hensel M, Schernikau U, Schmidt A, Arlt G. [Assessment of quality of life and gynaecological follow-up after transvaginal cholecystectomy]. Zentralbl Chir 2012. [PMID: 23208857 DOI: 10.1055/s-0032-1315122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND It has been reported recently that transvaginal cholecystectomy (TV‑ChE) has advantages over ‘classic’ laparoscopic cholecystectomy (LAP‑ChE) because of its minimal invasiveness. TV‑ChE seems to be associated with a lesser need for analgesics and faster reconvalescence of patients. However, substantial doubts about the transvaginal access and possibly associated complaints and complications of the procedure have been raised. PATIENT/MATERIAL AND METHODS: In this prospective case-control study 30 female patients undergoing transvaginal cholecystectomy (TV‑ChE group) have been compared with 30 women undergoing conventional laparoscopic cholecystectomy (LAP‑ChE group). Female patients were evaluated with special regard to health-related quality of life, outcome data such as surgical complications and gynaecological complaints and changes in sexual behaviour after surgery. Additional attention was given to the extent of postoperative pain, the analgesic consumption and the rate of postoperative nausea and vomiting (PONV). RESULTS The demographic data of both groups were comparable to a great extent. Compared to the LAP‑ChE group women of the TV‑ChE group reported less postoperative pain, less PONV and a lower analgesic consumption (p < 0.001). There were no serious complications in the LAP‑ChE group and also none in the TV‑ChE group. In comparison with the preoperative status, the results regarding health-related quality of life and feeling of well-being were significantly better for both groups after a follow-up of 12 months (p < 0.01). However, this effect was especially pronounced in the TV‑ChE group (p < 0.05). No infections of the surgical wound, wound healing problems or other complications were seen in the gynaecological follow-up examination 3 weeks after the TV‑ChE. Two women reported slight and temporary colpotomy-related complaints without any consequences for their sexual behaviour. CONCLUSIONS The transvaginal cholecystectomy is a safe and less invasive surgical technique providing for an excellent patient comfort and a fast reconvalescence. TV‑ChE has a positive longterm effect on health-related quality of life. Doubts about transvaginal approach of this surgical technique with regard to an increased risk of infection or late gynaecological complications appear to be unfounded.
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Affiliation(s)
- M Hensel
- Anästhesiologie und Intensivmedizin, Park-Klinik Weißensee, Berlin, Deutschland
| | - U Schernikau
- Allgemein- und Viszeralchirurgie, Park-Klinik Weißensee, Berlin, Deutschland
| | - A Schmidt
- Anästhesiologie und Intensivmedizin, Park-Klinik Weißensee, Berlin, Deutschland
| | - G Arlt
- Allgemein- und Viszeralchirurgie, Park-Klinik Weißensee, Berlin, Deutschland
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16
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McClanahan F, Hielscher T, Rieger M, Hensel M, Bentz M, Schmidt-Wolf I, Käbisch A, Salwender H, Dürk H, Staiger H, Mandel T, Neben K, Hillengass J, Leo E, Krämer A, Ho AD, Witzens-Harig M. Final results of a randomized trial comparing 1, 3, or 6 infusions of Rituximab plus 6 cycles CHOP provide valuable preliminary data towards a more cost-effective and safer treatment of advanced follicular lymphoma. Am J Hematol 2012; 87:E68-71. [PMID: 22847344 DOI: 10.1002/ajh.23286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/economics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/economics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor
- Cost-Benefit Analysis
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Cyclophosphamide/economics
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Doxorubicin/economics
- Humans
- Kaplan-Meier Estimate
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/economics
- Lymphoma, Follicular/genetics
- Middle Aged
- Polymerase Chain Reaction
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Prednisone/economics
- Proportional Hazards Models
- Remission Induction
- Rituximab
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/adverse effects
- Vincristine/economics
- Young Adult
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Affiliation(s)
- F McClanahan
- Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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17
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Hensel M, Brust J, Plöger C, Schuster D, Memmer ML, Franz-Werner J, Feustel HP, Karcher A, Fuxius S, Mosthaf FA, Rieger M, Ho AD, Witzens-Harig M. Excellent long-term survival of 170 patients with Waldenström's macroglobulinemia treated in private oncology practices and a university hospital. Ann Hematol 2012; 91:1923-8. [PMID: 22895554 DOI: 10.1007/s00277-012-1545-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 07/28/2012] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to compare treatment and outcome of patients with Waldenström's macroglobulinemia (WM) in four private oncology practices (PP) and a university hospital (UH) in southwest Germany. We retrospectively reviewed the charts of all patients with WM of the last two decades of four PP in Mannheim, Heidelberg, Karlsruhe, and Speyer and the Department of Hematology of the University of Heidelberg. One hundred seventy patients could be identified, 74 from PP, 96 from the UH. Median age was 63.3 years. Patients from PP were older (median 65.3 vs. 62.5 years, p = 0.01). Only 54 % of patients from PP have received treatment during the observation time, as compared to 78.1 % of the UH (p < 0.001). In PP, 35 % of treated patients have received rituximab, as compared to 62.6 % of the patients of the UH (p < 0.001). Sixty percent of treated patients of PP have received bendamustine, as compared to only 8 % of the patients of the UH (p < 0.001). Time to first treatment was significantly shorter in patients from the UH compared to PP (median 13.7 vs. 52.9 months, p = 0.05). A trend towards a better overall survival was observed for patients treated with a rituximab-containing first-line regimen. The International Prognostic Scoring System for WM had significant prognostic value. Median overall survival was 25.0 years and did not differ between PP and UH. Despite different treatment strategies between PP and UH today overall survival of patients with WM is excellent, and better than previously reported.
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Affiliation(s)
- M Hensel
- Mannheimer Onkologie Praxis, Mannheim, Germany
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18
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Borte M, Baumann U, Pittrow D, Hensel M, Faßhauer M, Huscher D, Reiser M, Stangel M, Gold R, Kirch W. Anwendung von Immunglobulinen bei primären und sekundären Immundefekten und neurologischen Autoimmunerkrankungen. Dtsch Med Wochenschr 2012; 137:675-80. [DOI: 10.1055/s-0032-1304844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Borte
- Fachbereich Pädiatrische Rheumatologie, Immunologie und Infektiologie am Klinikum St. Georg gGmbH Leipzig
| | - U. Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - D. Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden
| | - M. Hensel
- Mannheimer Onkologie Praxis, Mannheim
| | - M. Faßhauer
- Fachbereich Pädiatrische Rheumatologie, Immunologie und Infektiologie am Klinikum St. Georg gGmbH Leipzig
| | - D. Huscher
- Epidemiologie, Rheumaforschungszentrum Berlin
| | - M. Reiser
- PIOH - Praxis Internistische Onkologie, Hämatologie, Köln, Germany
| | - M. Stangel
- Klinik für Neurologie, Medizinische Hochschule Hannover
| | - R. Gold
- Klinik für Neurologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - W. Kirch
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden
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19
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Viviano E, Renius M, Rückert JC, Bloch A, Meisel C, Harbeck-Seu A, Boemke W, Hensel M, Wernecke KD, Spies C. Selective Neurogenic Blockade and Perioperative Immune Reactivity in Patients Undergoing Lung Resection. J Int Med Res 2012; 40:141-56. [DOI: 10.1177/147323001204000115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE: This double-blind, prospective, randomized, controlled trial examined the effects of thoracic epidural block and intravenous clonidine and opioid treatment on the postoperative Th1/Th2 cytokine ratio after lung surgery. The primary endpoint was the interferon γ (IFN-γ; Th1 cytokine)/interleukin 4 (IL-4; Th2 cytokine) ratio. Secondary endpoints were reductions in pain and incidence of pneumonia. METHODS: Sixty patients were randomized into three groups to receive remifentanil intravenously (remifentanil group, n = 20), remifentanil and clonidine intravenously (clonidine group, n = 20), or ropivacaine epidurally (ropivacaine group, n = 20). Pain was assessed using a numerical rating scale (NRS). Cytokines were measured using a cytometric bead array. RESULTS: Patients in the ropivacaine group (thoracic epidural block) had a significantly lower IFN-γ/IL-4 ratio at the end of surgery than those in the remifentanil group and clonidine group. There were no significant between-group differences in the IFN-γ/IL-4 ratio at other time-points. There were no differences in NRS scores at any time-point. No patient developed pneumonia. CONCLUSION: Intraoperative thoracic epidural block decreased the IFN-γ/IL-4 ratio immediately after lung surgery, indicating less inflammatory stimulation during surgery.
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Affiliation(s)
- E Viviano
- Department of Anaesthesiology and Intensive Care Medicine Unit
| | - M Renius
- Department of Anaesthesiology and Intensive Care Medicine Unit
| | - J-C Rückert
- Department of General, Visceral, Vascular and Thoracic Surgery
| | - A Bloch
- Department of Anaesthesiology and Intensive Care Medicine Unit
| | - C Meisel
- Institute of Immunology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité—University Hospital Berlin, Berlin, Germany
| | - A Harbeck-Seu
- Department of Anaesthesiology and Intensive Care Medicine Unit
| | - W Boemke
- Department of Anaesthesiology and Intensive Care Medicine Unit
| | - M Hensel
- Department of Anaesthesiology and Intensive Care Medicine Unit
| | - K-D Wernecke
- Department of Medical Biometry, SOSTANA GmbH (CRO), Berlin, Germany
| | - C Spies
- Department of Anaesthesiology and Intensive Care Medicine Unit
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20
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Hallek M, Fischer K, Fingerle-Rowson G, Fink AM, Busch R, Mayer J, Hensel M, Hopfinger G, Hess G, von Grünhagen U, Bergmann M, Catalano J, Zinzani PL, Caligaris-Cappio F, Seymour JF, Berrebi A, Jäger U, Cazin B, Trneny M, Westermann A, Wendtner CM, Eichhorst BF, Staib P, Bühler A, Winkler D, Zenz T, Böttcher S, Ritgen M, Mendila M, Kneba M, Döhner H, Stilgenbauer S. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. Lancet 2010; 376:1164-74. [PMID: 20888994 DOI: 10.1016/s0140-6736(10)61381-5] [Citation(s) in RCA: 1269] [Impact Index Per Article: 90.6] [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: 01/19/2023]
Abstract
BACKGROUND On the basis of promising results that were reported in several phase 2 trials, we investigated whether the addition of the monoclonal antibody rituximab to first-line chemotherapy with fludarabine and cyclophosphamide would improve the outcome of patients with chronic lymphocytic leukaemia. METHODS Treatment-naive, physically fit patients (aged 30-81 years) with CD20-positive chronic lymphocytic leukaemia were randomly assigned in a one-to-one ratio to receive six courses of intravenous fludarabine (25 mg/m(2) per day) and cyclophosphamide (250 mg/m(2) per day) for the first 3 days of each 28-day treatment course with or without rituximab (375 mg/m(2) on day 0 of first course, and 500 mg/m(2) on day 1 of second to sixth courses) in 190 centres in 11 countries. Investigators and patients were not masked to the computer-generated treatment assignment. The primary endpoint was progression-free survival (PFS). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00281918. FINDINGS 408 patients were assigned to fludarabine, cyclophosphamide, and rituximab (chemoimmunotherapy group) and 409 to fludarabine and cyclophosphamide (chemotherapy group); all patients were analysed. At 3 years after randomisation, 65% of patients in the chemoimmunotherapy group were free of progression compared with 45% in the chemotherapy group (hazard ratio 0·56 [95% CI 0·46-0·69], p<0·0001); 87% were alive versus 83%, respectively (0·67 [0·48-0·92]; p=0·01). Chemoimmunotherapy was more frequently associated with grade 3 and 4 neutropenia (136 [34%] of 404 vs 83 [21%] of 396; p<0·0001) and leucocytopenia (97 [24%] vs 48 [12%]; p<0·0001). Other side-effects, including severe infections, were not increased. There were eight (2%) treatment-related deaths in the chemoimmunotherapy group compared with ten (3%) in the chemotherapy group. INTERPRETATION Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab improves progression-free survival and overall survival in patients with chronic lymphocytic leukaemia. Moreover, the results suggest that the choice of a specific first-line treatment changes the natural course of chronic lymphocytic leukaemia. FUNDING F Hoffmann-La Roche.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Disease Progression
- Disease-Free Survival
- Drug Administration Schedule
- Female
- Humans
- Immunologic Factors/administration & dosage
- Incidence
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukopenia/chemically induced
- Male
- Middle Aged
- Neutropenia/chemically induced
- Rituximab
- Severity of Illness Index
- Treatment Outcome
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- M Hallek
- Department I of Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany.
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21
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Hensel M, Schernikau U, Schmidt A, Arlt G. [Comparison between transvaginal and laparoscopic cholecystectomy - a retrospective case-control study]. Zentralbl Chir 2010. [PMID: 20446249 DOI: 10.1055/s-0030-1247332.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) appears to be established in specialised surgical centres. Potential advantages of these operating techniques include surgery without scars as well as faster and more comfortable recovery. However, to date there are no controlled studies evaluating the assumed advantages of NOTES compared with both minimally invasive and open surgery. PATIENT / MATERIAL AND METHODS: In this retrospective case-controlled study 47 women undergoing transvaginal cholecystectomy (TV-ChE) have been compared with 46 women undergoing conventional laparoscopic cholecystectomy (LAP-ChE). Both groups were evaluated with regard to intraoperative respiratory and oxygenation parameters, pain intensity and need for analgesics postoperatively, rate of postoperative nausea and vomiting (PONV), duration of stay in recovery room as well as hospital stay. RESULTS Demographic data of both groups were comparable to a great extent. However, in comparison with the women of TV-ChE group those of the LAP-ChE group were 5 years older on average (49 ± 15 vs. 54 ± 16 years). Even so, there were no differences in preoperative risk assessment (ASA classification) as well as intraoperative respiratory and haemodynamic parameters. Compared to the LAP-ChE group, women of TV-ChE group reported less postoperative pain (p < 0.001), less nausea or vomiting (p < 0.001) and a lower analgesic consumption in both opiates (p < 0.001) and non-opiates (p < 0.001). Furthermore, the duration of stay in recovery room was shorter in the TV-ChE group (40 minutes vs. 60 minutes, p < 0.001). Hospital stay in the TV-ChE group was 3 days on average compared to 4 days for the LAP-ChE group. The rate of general and surgical complications was lower in TV-ChE group (1 / 47) compared to the LAP-ChE group (4 / 46). In 9 women undergoing transvaginal cholecystectomy negligible vaginal bleeding was seen which stopped spontaneously in each case. CONCLUSION The transvaginal cholecystectomy is a safe and less invasive surgical technique. Compared to laparoscopic cholecystectomy, there seem to be some advantages such as better cosmetic results, lower need for analgesics, faster mobilisation, more comfortable recovery and shorter hospital stay. These effects should be confirmed in prospective controled studies.
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Affiliation(s)
- M Hensel
- Park-Klinik Weißensee, Anästhesiologie und Intensivmedizin, Berlin, Deutschland.
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22
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Hensel M, Schernikau U, Schmidt A, Arlt G. [Comparison between transvaginal and laparoscopic cholecystectomy - a retrospective case-control study]. Zentralbl Chir 2010; 137:48-54. [PMID: 20446249 DOI: 10.1055/s-0030-1247332] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) appears to be established in specialised surgical centres. Potential advantages of these operating techniques include surgery without scars as well as faster and more comfortable recovery. However, to date there are no controlled studies evaluating the assumed advantages of NOTES compared with both minimally invasive and open surgery. PATIENT / MATERIAL AND METHODS: In this retrospective case-controlled study 47 women undergoing transvaginal cholecystectomy (TV-ChE) have been compared with 46 women undergoing conventional laparoscopic cholecystectomy (LAP-ChE). Both groups were evaluated with regard to intraoperative respiratory and oxygenation parameters, pain intensity and need for analgesics postoperatively, rate of postoperative nausea and vomiting (PONV), duration of stay in recovery room as well as hospital stay. RESULTS Demographic data of both groups were comparable to a great extent. However, in comparison with the women of TV-ChE group those of the LAP-ChE group were 5 years older on average (49 ± 15 vs. 54 ± 16 years). Even so, there were no differences in preoperative risk assessment (ASA classification) as well as intraoperative respiratory and haemodynamic parameters. Compared to the LAP-ChE group, women of TV-ChE group reported less postoperative pain (p < 0.001), less nausea or vomiting (p < 0.001) and a lower analgesic consumption in both opiates (p < 0.001) and non-opiates (p < 0.001). Furthermore, the duration of stay in recovery room was shorter in the TV-ChE group (40 minutes vs. 60 minutes, p < 0.001). Hospital stay in the TV-ChE group was 3 days on average compared to 4 days for the LAP-ChE group. The rate of general and surgical complications was lower in TV-ChE group (1 / 47) compared to the LAP-ChE group (4 / 46). In 9 women undergoing transvaginal cholecystectomy negligible vaginal bleeding was seen which stopped spontaneously in each case. CONCLUSION The transvaginal cholecystectomy is a safe and less invasive surgical technique. Compared to laparoscopic cholecystectomy, there seem to be some advantages such as better cosmetic results, lower need for analgesics, faster mobilisation, more comfortable recovery and shorter hospital stay. These effects should be confirmed in prospective controled studies.
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Affiliation(s)
- M Hensel
- Park-Klinik Weißensee, Anästhesiologie und Intensivmedizin, Berlin, Deutschland.
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23
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Viviano E, Renius M, Rückert J, Bloch A, Meisel C, Harbeck-Seu A, Boemke W, Hensel M, Wernecke K, Spies C. Selective neurogenic blockades and perioperative immune reactivity in patients undergoing lung resection. Crit Care 2010. [PMCID: PMC2933982 DOI: 10.1186/cc8711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Hensel M, Goetzenich A, Hanhoff N, Wolf E, Knechten H, Mosthaf F. Cancer incidence in HIV-positive patients in Germany: A nation-wide survey from 2000 to 2007. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22115 Background: Malignancies are an essential feature of acquired immunodeficiency syndrome and human immunodeficiency virus (HIV) infection. The purpose of this study was to gather data on the epidemiology of AIDS-defining (AD) and non-AIDS-defining (NAD) malignancies in HIV-positive patients (pts) in Germany in the past decade. Methods: Study centers (all HIV-specialty clinics and ambulatory care centers in Germany, all members of the German association of medical oncologists in private practice) were contacted annually between 2000 and 2007 and asked to respond to a structured questionnaire. The questionnaire requested information on all malignancies in HIV-positive pts, tumor stage, CDC (Center for Disease Control)-stage of the HIV infection, sex, treatment and clinical course. Results: 111 centers participated in the evaluation and provided 552 evaluable data sets from 542 pts. 89% of cases were male. The majority of pts had advanced HIV-disease (CDC stage C3), but the proportion of pts with stage C3 decreased from 58% in 2000 to 36.8% in 2007. 253 (45.8%) were AD as follows: 132 Kaposi Sarcomas, 109 aggressive B-cell lymphomas, 12 invasive cervix carcinomas. The B-cell lymphomas further included 28 Burkitt's lymphomas, 30 DLBCL, 9 Castleman diseases, 8 primary cerebral lymphomas. Among the 299 cases (54.2%) of NAD malignomas were 213 solid tumors including 71 anal carcinomas (= 33.5% of all NAD malignancies) and 85 hemoblastoses including 29 Hodgkin lymphomas (= 9.6% of all NAD malignancies). The high proportion of NAD malignancies has remained constant over all observation periods, as well as the relative incidence of most of the different subentities. Interestingly, only 1 of 8 primary cerebral lymphomas has been reported after 2001. The number of pts with Hodgkin's lymphoma has increased constantly from 2000 to 2007. Conclusions: Our observations show a high incidence of NAD malignomas over the past 8 years in Germany. Anal carcinomas and Hodgkin's lymphomas in particular were markedly more prevalent in our HIV-positive cohort compared to published reports of the general population. The incidence of primary cerebral lymphomas seems to decrease, whereas the incidence of Hodgkin's lymphoma is increasing. No significant financial relationships to disclose.
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Affiliation(s)
- M. Hensel
- Mannheimer Onkologie Praxis, Mannheim, Germany; BNHO, Köln, Germany; DAGNÄ, Aachen, Germany; HIV Schwerpunktpraxis München, München, Germany; Gemeinschaftspraxis für Hämatologie und Onkologie, Karlsruhe, Germany
| | - A. Goetzenich
- Mannheimer Onkologie Praxis, Mannheim, Germany; BNHO, Köln, Germany; DAGNÄ, Aachen, Germany; HIV Schwerpunktpraxis München, München, Germany; Gemeinschaftspraxis für Hämatologie und Onkologie, Karlsruhe, Germany
| | - N. Hanhoff
- Mannheimer Onkologie Praxis, Mannheim, Germany; BNHO, Köln, Germany; DAGNÄ, Aachen, Germany; HIV Schwerpunktpraxis München, München, Germany; Gemeinschaftspraxis für Hämatologie und Onkologie, Karlsruhe, Germany
| | - E. Wolf
- Mannheimer Onkologie Praxis, Mannheim, Germany; BNHO, Köln, Germany; DAGNÄ, Aachen, Germany; HIV Schwerpunktpraxis München, München, Germany; Gemeinschaftspraxis für Hämatologie und Onkologie, Karlsruhe, Germany
| | - H. Knechten
- Mannheimer Onkologie Praxis, Mannheim, Germany; BNHO, Köln, Germany; DAGNÄ, Aachen, Germany; HIV Schwerpunktpraxis München, München, Germany; Gemeinschaftspraxis für Hämatologie und Onkologie, Karlsruhe, Germany
| | - F. Mosthaf
- Mannheimer Onkologie Praxis, Mannheim, Germany; BNHO, Köln, Germany; DAGNÄ, Aachen, Germany; HIV Schwerpunktpraxis München, München, Germany; Gemeinschaftspraxis für Hämatologie und Onkologie, Karlsruhe, Germany
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Kornacker M, Stumm J, Pott C, Dietrich S, Süssmilch S, Hensel M, Nickelsen M, Witzens-Harig M, Kneba M, Schmitz N, Ho A, Dreger P. Characteristics of relapse after autologous stem-cell transplantation for follicular lymphoma: a long-term follow-up. Ann Oncol 2009; 20:722-8. [DOI: 10.1093/annonc/mdn691] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
In cardiac emergency events (NACA score = 3.4), a non-invasive cardiac output test involving transaortalic blood flow velocity measurement was used in the air rescue of 30 patients. An average velocity integral (Vti) of 21.9 +/- 9.9 cm was determined in the short examination time (t = 120 +/- 30 sec). Related to the middle body surface (BSA = 2.0 +/- 0.3 m (2)), the calculated cardiac index (CI) was 2.6 +/- 1.1 l/min/m (2). The CI was under 2.2 l/min/m (2) in 12 examinations (40 %). 5 patients in this group subsequently received catecholamine therapy. Thrombolysis therapy increased by 17 % in the myocardial infarction group with CI </= 2.2 l/min/m (2) by the USCOM measurement. However, the results do not justify a definitive recommendation for application of the USCOM system in air rescue service.
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Jacobi C, Haas J, Schopp L, Storch-Hagenlocher B, Hensel M, Wildemann B. Rekrutierung regulatorischer T-Zellen in den Liquor bei Meningeosis blastomatosa und carcinomatosa. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086483] [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]
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Kornacker M, Kornacker B, Schmitt C, Leo E, Ho AD, Hensel M. Commercial LightCycler-based quantitative real-time PCR compared to nested PCR for monitoring of Bcl-2/IgH rearrangement in patients with follicular lymphoma. Ann Hematol 2008; 88:43-50. [PMID: 18636259 DOI: 10.1007/s00277-008-0550-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 06/24/2008] [Indexed: 10/21/2022]
Abstract
Translocation of chromosomes 14 and 18 [t(14;18)] for detection of minimal residual disease in follicular lymphoma patients can be analyzed by nested polymerase chain reaction (PCR) or by quantitative PCR like LightCycler-based assays. We have compared both methods in blood and bone marrow samples of 28 patients enrolled in a clinical study on immunochemotherapy. In 42% of samples, the bcl2-IgH rearrangement was detectable by nested PCR, but not by LightCycler PCR. Nested PCR was able to reveal a significant drop in positive bone marrow or peripheral blood samples after therapy. In contrast, with LightCycler PCR, the detected drop in t(14;18)-positive cells did not reach statistical significance. The majority of patients showed positive results with nested PCR of peripheral blood or bone marrow without any associations to presence or absence of histological bone marrow (BM) infiltration by lymphoma cells. With LightCycler PCR, the numbers of positive cells were higher in samples from patients with BM infiltration of lymphoma cells (1.9 x 10(-2)) compared to samples from patients without involvement (4.08 x 10(-5)). A similar trend was seen in samples derived from the peripheral blood. Positivity for t(14;18) after therapy in two patients correlated with clinical relapse 6 months later. The data shown here demonstrate a lower sensitivity of LightCycler vs. nested PCR for detection of t(14;18). The usefulness of nested PCR for t(14;18) for risk stratification after primary therapy has to be validated in larger trials.
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Affiliation(s)
- M Kornacker
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
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Krieg H, Schröder T, Grosse J, Hensel M, Volk T, von Heymann C, Bauer K, Bock RW, Spies CD. [Central induction area. Reduction of non-operative time without additional costs]. Anaesthesist 2008; 56:812-9. [PMID: 17530206 DOI: 10.1007/s00101-007-1205-x] [Citation(s) in RCA: 6] [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: 10/23/2022]
Abstract
BACKGROUND Induction areas (IA) can lead to more efficient operating sessions through shortening the changeover time between patients. To date IAs have always required additional staff members, whose cost was only partly covered by improvements in productivity. The objective of this project was to demonstrate that a reduction in non-operative time through a newly introduced induction area can be achieved without a need for extra personnel. METHODS Non-operative time in 5,963 ENT, orthopedic and cardiac surgical patients from 8 operating theatres were studied for 1 year before and 1 year after the introduction of an induction area. The non-operative time was defined as the time between the end of surgical procedures in one operation and the start of surgical procedures in the next, within regular working hours. Through reallocation of anesthetic nursing and medical staff it was possible to introduce the induction area without increasing staff numbers. RESULTS Non-operative time was significantly reduced from 20 min (range 10-30 min) to 14 min (5-25 min). Subgroup analysis showed significant reductions in all specialities: from 10 min (2.5-20 min) to 5 min (0-20 min) in 1,240 cardiac surgical patients, 25 min (20-35 min) to 15 min (5-25 min) in 2,433 ENT patients and 20 min (10-30 min) to 10 min (0-20 min) in 2,290 orthopedic patients. There were no critical incidents attributable to patient handover. DISCUSSION AND CONCLUSIONS An induction area can be established and can reduce non-operative time and improve operation theatre throughput without the need for extra personnel. The efficiency of these measures will be increased when the relevant surgical organizational measures are taken to adjust to the faster anesthesiology workflow. The induction area does not lead to a higher rate of critical incidents. To what extent the induction area can be used for structured training of doctors and nurses, remains to be investigated.
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Affiliation(s)
- H Krieg
- Klinik für Anästhesiologie und operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin
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Pfreundschuh MG, Hensel M, Cavallin-Stahl E, Vasova I, Kvaloey S, Gill D, Walewski J, Zinzani P, Pettengell R, Kuhnt E. Prognostic significance of maximal tumor size (MTS) in young patients with good-prognosis diffuse large B-cell lymphoma (DLBCL) treated with CHOP-like chemotherapy with and without rituximab: Analysis of the MabThera International Trial Group (MInT) study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8053 Purpose: To determine the impact of MTS in young (18 to 60 years) patients with DLBCL and aaIPI=0,1. Patients and Methods: Outcome of patients treated with CHOP-like chemotherapy with (R-CHEMO) or without rituximab (CHEMO) was analyzed according to MTS. Results: A Martingale residual analysis revealed a linear negative prognostic impact of MTS on event-free (EFS) and overall (OS) survival. The hazard ratios for MTS per centimeter increase were significant for EFS (1.07; 95%-CI: 1.04–1.11; p<0.001) and OS (1.11; 95%-CI: 1.06–1.16; p<0.001). CHEMO 3-year EFS rates ranged between 78% for MTS <5cm and 41% for MTS >10cm. R-CHEMO 3-year EFS ranged from 83% (MTS <5cm) to 73% (MTS >=10cm). CHEMO 3-year OS rates decreased from 93% (MTS <5cm) to 74% (MTS >=10cm). R-CHEMO 3-year OS decreased from 98% (MTS <5cm) to 85% (MTS >=10cm). With CHEMO, any cut-off point between 5 and 10 cm separated a thus defined “non-bulky” from a “bulky” population with a 3-year EFS difference >20% (p<0.0001) and OS difference >12% (p<0.003), while with R-CHEMO only cut-off points >=10cm separated two populations with a significant EFS difference (9.1%; p=0.047), and cut-off points >=6cm discriminated two populations with a significant OS difference (7.6%-11.3%; p=0.037–0.0009). Conclusion: Due to the linear prognostic impact of MTS on outcome, cut-off points for “bulky” disease can be set rather arbitrarily between 5 and 10cm depending on clinical considerations. Rituximab reduces, but does not eliminate the negative prognostic impact of MTS in young patients with good-prognosis DLBCL. [Table: see text]
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Affiliation(s)
- M. G. Pfreundschuh
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - M. Hensel
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - E. Cavallin-Stahl
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - I. Vasova
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - S. Kvaloey
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - D. Gill
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - J. Walewski
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - P. Zinzani
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - R. Pettengell
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - E. Kuhnt
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
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von Heymann C, Grebe D, Schwenk W, Sander M, Hensel M, Müller JM, Spies C. [The influence of intraoperative fluid therapy on the postoperative outcome in "fast track" colon surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2006; 41:E1-7. [PMID: 16804784 DOI: 10.1055/s-2006-944529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the association between the intraoperative and postoperative application of different quantities of fluids and the incidence of postoperative complications after "fast-track"-colonic surgery. METHODS We performed a retrospective analysis of 136 patients undergoing elective "fast-track" colonic surgery (sigma resection and right hemicolectomy). Data collection in regard of fluid administration during surgery and in the post anaesthesia care unit (PACU) was based on anaesthesia charts and a prospectively generated surgery database. Classification into three volume groups (up to 3500 ml = group 1, 3500 - 5500 ml = group 2, more than 5500 ml = group 3). Basic patient characteristics, pre-existing conditions, type and duration of surgery and anastomoses were documented. We analysed the incidence of postoperative complications such as wound infections, anastomotic leak, bleeding, bowel obstruction, cardiovascular failure, hypertension, pulmonary failure, pneumonia, renal failure, urinary tract infection, neurological and psychiatric complications in the different volume groups. RESULTS 115 patients were infused with up to 3500 mLs of fluids, 19 patients received more than 3500 mLs, two patients were infused with 6000 ml and 7500 mLs, respectively. This was in median 36 ml/kg in the restrictive and 53 ml/kg in the higher volume groups (group 2 and 3 together), respectively. The duration of surgery and anaesthesia was significantly different between both fluid groups (p = 0,023). In a logistic regression model only intraoperative blood loss was independently associated with the volume of infused fluid (OR 0,393, 95 % CI 1.028 - 2.306, p < 0.01). The rate of postoperative complications was not different between groups (p = 0,228). CONCLUSION The incidence of postoperative complications was not different between patients who were infused 36 ml/kg or 53 ml/kg of fluids during surgery and post anaesthesia care unit stay.
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Affiliation(s)
- C von Heymann
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin.
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Witzens-Harig M, Hensel M, Schmier JW, Neben K, Benner A, Dreger P, Schmidt-Wolf IG, Krämer A, Ho AD. Rituximab maintenenance therapy in CD20+ B-cell non-Hodgkin lymphoma - Interim results of a multicenter prospective randomised phase II study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17524] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17524 Background: Clinical and pharmacokinetic data suggest that the effect of rituximab could be improved by prolonged exposure to the drug. Methods: To test for this hypothesis we performed a prospective randomized trial of rituximab maintenance therapy in patients with CD20+ B-cell Non-Hodgkins-Lymphoma. After completion of standard treatment patients were randomized to either observation or maintenance therapy with rituximab (375 mg/m2) every 3 months for 2 years. Patients after first line therapy as well as relapse patients were included in the study. Patients with aggressive lymphoma were enrolled if they had achieved a complete response (CR) after initial treatment. Patients with aggressive lymphoma with residual tumor mass were examined with positrone emission tomography (PET) and qualified for randomization if PET showed no signs of tumor activity. Patients with indolent lymphoma qualified for the study if at least a partial response (PR) was achieved. Results: So far 124 patients (pts) with CD20+ B-cell Non-Hodgkins-Lymphoma were enrolled in this trial. Histological subtypes included diffuse large cell lymphoma (55 pts), follicular lymphoma (24 pts), mantle cell lymphoma (16 pts), primary mediastinal lymphoma (12 pts), marginal zone lymphoma (8 pt), Burkitt’s lymphoma (3 pt), immunocytoma (2 pt), primary intestinal lymphoma (1 pt), hairy cell leukemia (1 pt), chronic lymphocytic leukemia (1 pt) and unclassified B-cell lymphoma (1 pt). No severe adverse events were observed during rituximab maintenance therapy. Results from an interim analysis including event free survival and overall survival for the observation group and for the maintenance therapy group will be presented. Conclusions: We conclude that rituximab maintenance therapy is feasable, effective, safe and well tolerated in patients with CD20+ B-cell Non-Hodgkins-Lymphoma. No significant financial relationships to disclose.
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Affiliation(s)
- M. Witzens-Harig
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
| | - M. Hensel
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
| | - J. W. Schmier
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
| | - K. Neben
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
| | - A. Benner
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
| | - P. Dreger
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
| | - I. G. Schmidt-Wolf
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
| | - A. Krämer
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
| | - A. D. Ho
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany; University of Bonn, Bonn, Germany
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Schlenk RF, Fröhling S, Hartmann F, Fischer JT, Glasmacher A, Del Valle F, Götze K, Nerl C, Schoch R, Pralle H, Mergenthaler HG, Hensel M, Koller E, Kirchen H, Matzdorff A, Salwender H, Biedermann HG, Kremers S, Haase D, Benner A, Döhner K, Döhner H. Intensive consolidation versus oral maintenance therapy in patients 61 years or older with acute myeloid leukemia in first remission: results of second randomization of the AML HD98-B treatment Trial. Leukemia 2006; 20:748-50. [PMID: 16437135 DOI: 10.1038/sj.leu.2404122] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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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Hensel M, Schwenk W, Bloch A, Raue W, Stracke S, Volk T, von Heymann C, Müller JM, Kox WJ, Spies C. Die Aufgabe der Anästhesiologie bei der Umsetzung operativer „Fast track-Konzepte“. Anaesthesist 2006; 55:80-92. [PMID: 16175343 DOI: 10.1007/s00101-005-0923-1] [Citation(s) in RCA: 19] [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: 12/18/2022]
Abstract
In the present study the "fast-track rehabilitation" protocol of the Charité university hospital for patients undergoing elective colonic resection is described. The underlying principles, clinical pathways and outcome data from 208 patients are shown. Particularly anesthesiological aspects of this multimodal approach, such as modified preoperative and postoperative fluid management, changed guidelines for preoperative fasting, effective analgetic therapy using epidural analgesia and avoiding high systemic doses of opioids, use of short-acting anesthetic agents, and maintenance of normothermia as well as normovolemia are presented and discussed. In comparison to outcome data before "fast-track rehabilitation" was established, the duration of postoperative hospital stay has been reduced from 12 to 5 days, the number of general complications (pneumonia, duodenal ulcer bleeding, urinary tract infection, cerebral, cardiac and renal dysfunction) decreased from 20% to 7%, whereas surgical complications remained constant at 17% (8% wound infections, 3% anastomotic insufficiency).
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Affiliation(s)
- M Hensel
- Klinik für Anästhesiologie und operative Intensivmedizin, Campus Charité Mitte, Universitätsmedizin, Berlin.
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Maurer B, Hensel M, Max R, Fiehn C, Ho AD, Lorenz HM. Autologous haematopoietic stem cell transplantation for Behcet's disease with pulmonary involvement: analysis after 5 years of follow up. Ann Rheum Dis 2006; 65:127-9. [PMID: 15919675 PMCID: PMC1797970 DOI: 10.1136/ard.2005.035410] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2005] [Indexed: 12/29/2022]
Abstract
BACKGROUND Myeloablative chemotherapy and autologous haematopoietic stem cell transplantation (HSCT) may provide a therapeutic option in severe Behçet's disease (BD) with pulmonary involvement. CASE REPORTS Two patients with BD with pulmonary involvement refractory to conventional immunosuppressive treatment underwent HSCT 1999. Stem cells were mobilised with cyclophosphamide (2 and 4 g/m(2)) and subsequently enriched ex vivo for CD34+ cells. The conditioning regimen used was melphalan (200 mg/m(2)). Outcome was measured by improvement of clinical features, function of affected organs, serological markers, need for immunosuppressive chemotherapy after transplant, and relapse. In both cases HSCT was successful, with good response and without serious complications. After 5 years of follow up one patient is in complete remission without immunosuppressive drugs and one has partial remission, needing low dose corticosteroids (8 mg/day). CONCLUSION In these two patients myeloablative chemotherapy, followed by HSCT could be performed safely with marked improvement. In comparison with other observational studies the duration of more than 5 years of remission is remarkable, and its full duration is still unknown.
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Affiliation(s)
- B Maurer
- Department of Internal Medicine, Unit V (Haematology, Oncology and Rheumatology), University of Heidelberg, Germany
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Wolter S, Friedel C, Böhler K, Hartmann U, Kox WJ, Hensel M. Presence of 14Hz spindle oscillations in the human EEG during deep anesthesia. Clin Neurophysiol 2005; 117:157-68. [PMID: 16326139 DOI: 10.1016/j.clinph.2005.08.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Revised: 08/25/2005] [Accepted: 08/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To report on presence of human EEG spindle oscillations on the cortical level within flat periods of the burst-suppression pattern during propofol-induced anesthesia; to search for corresponding oscillations and possible functional connections. METHODS Artefact-free epochs of spindle activation were selected from the electroencephalograms of opiate-dependent patients undergoing rapid opiate detoxification. Power spectral analysis and source localization using low-resolution-brain-electromagnetic-tomography (LORETA(Key)) were performed. RESULTS Sinusoidal rhythms with waxing and waning amplitudes appeared after propofol-induced narcosis but no direct correlations could be determined between individual dosage and characteristic spindle attributes. The power maximum stood midline over the cortical areas, especially around C(z). We calculated a peak frequency of 14(+/-1.2) Hz. Motor fields, particularly in the frontal, parietal, and various cingulate areas, were found to be the primary sources of spindle oscillations in the cortex. CONCLUSIONS The frequent occurrence of these localized spindle sources demonstrates the preference for motor fields. Spindle oscillations observed during propofol-induced narcosis were similar in frequency and shape to those observed in natural sleep. SIGNIFICANCE The results lend support to models that postulate a close link between the motor system and the organization of behavior. In addition, spindle rhythms under propofol bore some resemblance to spindle types which occur during sleep.
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Affiliation(s)
- S Wolter
- Department of Anesthesiology and Operative Intensive Care Medicine of the Charité (CCM)- Universitätsmedizin Berlin, Schumannstr. 20/21, 10117 Berlin, Germany.
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Hensel M, Wauer H, Bloch A, Volk T, Kox WJ, Spies C. [Implementation of modern operating room management -- experiences made at an university hospital]. Anasthesiol Intensivmed Notfallmed Schmerzther 2005; 40:393-405. [PMID: 16001318 DOI: 10.1055/s-2005-870102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Caused by structural changes in health care the general need for cost control is evident for all hospitals. As operating room is one of the most cost-intensive sectors in a hospital, optimisation of workflow processes in this area is of particular interest for health care providers. While modern operating room management is established in several clinics yet, others are less prepared for economic challenges. Therefore, the operating room statute of the Charité university hospital useful for other hospitals to develop an own concept is presented. In addition, experiences made with implementation of new management structures are described and results obtained over the last 5 years are reported. Whereas the total number of operation procedures increased by 15 %, the operating room utilization increased more markedly in terms of time and cases. Summarizing the results, central operating room management has been proved to be an effective tool to increase the efficiency of workflow processes in the operating room.
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Affiliation(s)
- M Hensel
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité Berlin.
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Witzens-Harig M, Hensel M, Schmier J, Neben K, Benner A, Krämer A, Ho AD. Rituximab maintenenance therapy in CD20+ B-cell non-Hodgkin’s-lymphoma: First interim results of a prospective randomised phase II study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Witzens-Harig
- Univ of Heidelberg, Heidelberg, Germany; German Cancer Research Ctr, Heidelberg, Germany
| | - M. Hensel
- Univ of Heidelberg, Heidelberg, Germany; German Cancer Research Ctr, Heidelberg, Germany
| | - J. Schmier
- Univ of Heidelberg, Heidelberg, Germany; German Cancer Research Ctr, Heidelberg, Germany
| | - K. Neben
- Univ of Heidelberg, Heidelberg, Germany; German Cancer Research Ctr, Heidelberg, Germany
| | - A. Benner
- Univ of Heidelberg, Heidelberg, Germany; German Cancer Research Ctr, Heidelberg, Germany
| | - A. Krämer
- Univ of Heidelberg, Heidelberg, Germany; German Cancer Research Ctr, Heidelberg, Germany
| | - A. D. Ho
- Univ of Heidelberg, Heidelberg, Germany; German Cancer Research Ctr, Heidelberg, Germany
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Nikendei C, Schilling T, Nawroth P, Hensel M, Ho AD, Schwenger V, Zeier M, Herzog W, Schellberg D, Katus HA, Dengler T, Stremmel W, Müller M, Jünger J. Integriertes Skills-Lab-Konzept für die studentische Ausbildung in der Inneren Medizin. Dtsch Med Wochenschr 2005; 130:1133-8. [PMID: 15856395 DOI: 10.1055/s-2005-866799] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE An amendment to the German medical curriculum in April 2002 will place basic practical skills at the centre of medical training. We report here on the implementation and evaluation of an obligatory, tutor-guided, and integrated skills laboratory concept in the field of internal medicine. METHODS To test the effectiveness of a skills laboratory training on OSCE performance a pilot study was carried out. The experimental group, of 77 students, participated in seven sessions of communication training, skills laboratory training, and bedside teaching, each lasting one and a half hours. The control group of 66 students had as many sessions but was only offered bedside-teaching. The evaluation of acceptance of skills' training as well as the related increase in individual competence is on-going (summer term 2004: n = 176 students). RESULTS The integrated skills laboratory concept was rated at 3.5 (SD = 1.2) on a 5-point scale and was acknowledged as practice-oriented (M = 4.2; SD = 1.0) and relevant for doctors' everyday lives (M = 3.6; SD = 1.1). Increased levels of competence according to individual self-evaluations proved to be highly significant (p<.001), and results of the pilot study showed that the experimental group had a significantly better OSCE performance than the control group (p<.001). CONCLUSION This pilot study shows that curriculum changes promoting basic clinical skills are effective and lead to an improved practical education of tomorrow's physicians. The integrated skills laboratory concept is well accepted and leads to a relevant increase in competence in the practice of internal medical. The presented skills laboratory concept in internal medicine is proving to be a viable and efficient learning tool.
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Affiliation(s)
- C Nikendei
- Abteilung für Allgemeine Klinische und Psychosomatische Medizin, Medizinische Universitätsklinik Heidelberg.
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40
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Bochtler T, Hensel M, Lorenz HM, Ho AD, Mahlknecht U. Chronic lymphocytic leukaemia and concomitant relapsing polychondritis: a report on one treatment for the combined manifestation of two diseases. Rheumatology (Oxford) 2005; 44:1199. [PMID: 15855184 DOI: 10.1093/rheumatology/keh670] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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41
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Schlenk RF, Germing U, Hartmann F, Glasmacher A, Fischer JT, del Valle y Fuentes F, Götze K, Pralle H, Nerl C, Salwender H, Grimminger W, Petzer A, Hensel M, Benner A, Zick L, Döhner K, Fröhling S, Döhner H. High-dose cytarabine and mitoxantrone in consolidation therapy for acute promyelocytic leukemia. Leukemia 2005; 19:978-83. [PMID: 15843821 DOI: 10.1038/sj.leu.2403766] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objective of our study was to evaluate high-dose cytarabine in consolidation therapy in patients with newly diagnosed acute promyelocytic leukemia (APL). Patients (age 16-60 years) received induction therapy according to the AIDA protocol (all-trans retinoic acid, idarubicin) followed by one cycle of ICE (idarubicin, cytarabine, etoposide) and two cycles of HAM (cytarabine 3 g/m(2) q12h, days 1-3; mitoxantrone 10 mg/m(2), days 2 and 3). From 1995 to 2003, 82 patients were enrolled. In total, 72 patients (88%) achieved a complete remission, and 10 patients (12%) died from early/hypoplastic death (ED/HD). A total of 71 patients received at least one cycle of HAM. Relapse-free survival (RFS) and overall survival (OS) after 46 months were 83 and 82%, respectively. White blood cell count above 10.0 x 10(9)/l at diagnosis and additional chromosomal aberrations were unfavorable prognostic markers for OS, whereas no prognostic markers for RFS were identified including FLT3 mutations. In conclusion, high-dose cytarabine in consolidation therapy for patients with newly diagnosed APL is an effective treatment approach.
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Affiliation(s)
- R F Schlenk
- Department of Internal Medicine III, University Hospital of Ulm, 89081 Ulm, Germany.
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42
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Kuhle V, Hensel M. Cellular microbiology of intracellular Salmonella enterica: functions of the type III secretion system encoded by Salmonella pathogenicity island 2. Cell Mol Life Sci 2004; 61:2812-26. [PMID: 15558211 DOI: 10.1007/s00018-004-4248-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The facultative intracellular pathogen Salmonella enterica resides in a special membrane compartment of the host cell and modifies its host to achieve intracellular survival and proliferation. The type III secretion system encoded by Salmonella pathogenicity island 2 (SPI2) has a central role in the interference of intracellular Salmonella with host cell functions. SPI2 function affects antimicrobial defense mechanisms of the host, intracellular transport processes, integrity and function of the cytoskeleton and host cell death. These modifications are mediated by translocation of a large number of effector proteins by the SPI2 system. In this review, we summarize recent work on the cellular phenotypes related to SPI2 function and contribution of SPI2 effector proteins to these manipulations. These studies reveal a complex set of pathogenic interferences between intracellular Salmonella and its host cells.
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Affiliation(s)
- V Kuhle
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, FAU Erlangen-Nürnberg, Wasserturmstr. 3-5, 91054, Erlangen, Germany
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Schneeweiss A, Diel I, Hensel M, Kaul S, Sinn HP, Unnebrink K, Rudlowski C, Lauschner I, Schuetz F, Egerer G, Haas R, Ho AD, Bastert G. Micrometastatic bone marrow cells at diagnosis have no impact on survival of primary breast cancer patients with extensive axillary lymph node involvement treated with stem cell-supported high-dose chemotherapy. Ann Oncol 2004; 15:1627-32. [PMID: 15520063 DOI: 10.1093/annonc/mdh433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To determine the impact of micrometastatic bone marrow cells (MMC) on survival in high-risk primary breast cancer (HRPBC) patients treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). PATIENTS AND METHODS Ninety-one HRPBC patients (73 patients with > or =10 involved axillary lymph nodes (ALN), 18 premenopausal women with > or =4 involved ALN) received one cycle (eight patients) or two cycles of HDCT and ASCT. Bone marrow aspiration was performed before systemic treatment to search for MMC using a cocktail of four monoclonal epithelial-specific antibodies (5D3, HEA125, BM7 and BM8). The influence of MMC and other prognostic factors on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) was analysed. RESULTS In 23 of 91 patients (25%) we detected a median of three MMC (range, 1-43) among 10(6) mononuclear cells. With a median follow-up of 62 months (range, 10-117), the detection of MMC was not associated with DFS (P=0.929), DDFS (P=0.664) or OS (P=0.642). In multivariate analysis the strongest predictor was nodal ratio for DFS (P=0.012) and expression of p53 for OS (P <0.001). CONCLUSION The detection of MMC at diagnosis has no impact on survival in HRPBC patients treated with HDCT and ASCT.
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Affiliation(s)
- A Schneeweiss
- University of Heidelberg, Department of Gynecology and Obstetrics, Heidelberg, Germany.
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Hensel M, Krasniqi F, Villalobos M, Kornacker M, Ho AD. Pentostatin, cyclophosphamide and rituximab is an active regimen with low toxicity for previously treated patients with B-cell chronic lymphocytic leukemia and Waldenström's macroglobulinemia. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Hensel
- University of Heidelberg, Heidelberg, Germany
| | - F. Krasniqi
- University of Heidelberg, Heidelberg, Germany
| | | | | | - A. D. Ho
- University of Heidelberg, Heidelberg, Germany
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45
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Hensel M, Kox WJ. [Can alcoholic withdrawal delirium be prevented?]. Anaesthesiol Reanim 2003; 28:13-20. [PMID: 12666507] [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: 03/01/2023]
Abstract
In alcohol-dependent in-patients, an adequate drug prophylaxis should be made in order to lower the degree of a developing alcohol withdrawal syndrome (AWS) or to prevent a life-threatening delirium tremens. Pre-condition of successful therapy is a precise diagnosis. In patients, the beginning of whose abstinence is known, carefully-targeted pharmacological interventions can prevent severe imbalances of neurotransmitters. Typical time courses of destabilisation of neural balances should be considered. Since there is no single drug which is able to influence various transmitter systems, normally the use of drug combinations is necessary. In ENT-patients, traumatologic patients and patients from the department of maxillo-facial surgery, screening methods based on a simply-structured questionnaire relating to information from the patient and his surroundings and selected laboratory parameters should be used. High-risk patients who could get an AWS or delirium tremens should be treated prophylactically during their oral premedication period. Important drugs for successful prophylaxis of an AWS are benzodiazepines, clonidin, magnesium and vitamin B 1. A close-meshed control of the glucose metabolism, electrolyte and acid-base balance should be performed. Neuroleptica can be used if there is any indication for their adjuvant use. In severe cases that require deep sedation or hypnosis, propofol or gamma-hydroxy-butyric acid should be used. Perioperative infusion of alcohol as a prophylactic agent against delirium tremens is regarded as an obsolete therapeutic measure for ethical reasons and because equally good or better results can be achieved by carefully-targeted drug therapy. Due to its easy use, however, the application of alcohol has not yet completely disappeared from the therapeutic spectrum.
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Affiliation(s)
- M Hensel
- Klinik für Anästhesiologie und operative Intensivmedizin der Charité, Humboldt-Universität zu Berlin
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46
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Schlenk RF, Benner A, Hartmann F, del Valle F, Weber C, Pralle H, Fischer JT, Gunzer U, Pezzutto A, Weber W, Grimminger W, Preiss J, Hensel M, Fröhling S, Döhner K, Haas R, Döhner H. Risk-adapted postremission therapy in acute myeloid leukemia: results of the German multicenter AML HD93 treatment trial. Leukemia 2003; 17:1521-8. [PMID: 12886238 DOI: 10.1038/sj.leu.2403009] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [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: 11/08/2022]
Abstract
The objective of the AML HD93 treatment trial was to evaluate the outcome in young adults with acute myeloid leukemia (AML) after postremission therapy was stratified according to cytogenetically defined risk. The rationales for the study design were based (i) on previous favorable results with high-dose cytarabine in AML with t(8;21), inv/t(16q22) and in AML with normal karyotype, and ii) on encouraging results obtained in several phase II trials using autologous stem cell transplantation (SCT). Between July 1993 and January 1998, 223 eligible patients, 16-60 years of age with newly diagnosed AML other than French-American-British type M3/M3v, were entered into the trial. Risk groups were defined as follows: low risk: t(8;21) or inv/t(16q22); intermediate risk: normal karyotype; high risk: all other chromosomal abnormalities. Following intensive double induction therapy with idarubicin, cytarabine and etoposide, all patients in complete remission (CR) received a first consolidation therapy with high-dose cytarabine and mitoxantrone (HAM). A second consolidation therapy was stratified according to the risk group: low risk: HAM; intermediate risk: related allogeneic SCT or sequential HAM; high risk: related allogeneic or autologous SCT. Double induction therapy resulted in a high CR rate of 74.5%, and 90% of the responding patients were eligible for consolidation therapy. Survival for all 223 trial entrants was 40%, and for the 166 patients who entered CR, disease-free (DFS) and overall survival were 40 and 51% after 5 years, respectively. Within the low-, intermediate- and high-risk groups, DFS and survival after 5 years were 62.5 and 87, 40 and 49 and 17 and 26% respectively, without advantage for allogeneic transplantation in the intermediate- and high-risk groups. Postremission therapy-related mortality was 0, 7 and 14%, respectively. This study demonstrates the feasibility of cytogenetically defined risk-adapted consolidation therapy. The overall trial results are at least equivalent to those of published trials supporting the risk-adapted treatment strategy.
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Affiliation(s)
- R F Schlenk
- Department of Internal Medicine III, University of Ulm, Germany
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Schetelig J, Thiede C, Bornhauser M, Schwerdtfeger R, Kiehl M, Beyer J, Sayer HG, Kroger N, Hensel M, Scheffold C, Held TK, Hoffken K, Ho AD, Kienast J, Neubauer A, Zander AR, Fauser AA, Ehninger G, Siegert W. Evidence of a graft-versus-leukemia effect in chronic lymphocytic leukemia after reduced-intensity conditioning and allogeneic stem-cell transplantation: the Cooperative German Transplant Study Group. J Clin Oncol 2003; 21:2747-53. [PMID: 12860954 DOI: 10.1200/jco.2003.12.011] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.7] [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: 11/20/2022] Open
Abstract
PURPOSE To study whether hematopoietic stem-cell transplantation (HSCT) after reduced-intensity conditioning is effective and tolerable in patients with advanced chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS Thirty patients with advanced B-cell CLL were included into the study. After reduced-intensity conditioning with fludarabine, busulfan, and antithymocyte globulin, patients received a transplant from related (n = 15) or unrelated donors (n = 15). Minimal residual disease (MRD) was monitored with a clone-specific polymerase chain reaction. RESULTS After a median follow-up of 2 years, 23 patients are alive (to date). Neutrophil and platelet engraftment occurred after a median of 17.5 and 15 days, respectively. Acute graft-versus-host disease (GVHD) grade 2 to 4 was observed in 17 patients (56%), and chronic GVHD was observed in 21 patients (75%). Twelve patients (40%) achieved a complete remission (CR), and 16 patients (53%) achieved a partial remission. Late CR occurred up to 2 years after transplantation. MRD was monitored in eight patients with CR. All patients achieved a molecular CR. At last follow-up, six patients were in ongoing molecular CR. Causes of death were treatment-related complications in four patients and progressive disease in three patients. The probability of overall survival, progression-free survival, and nonrelapse mortality at 2 years was 72% (95% confidence interval [CI], 54% to 90%), 67% (95% CI, 49% to 85%), and 15% (95% CI, 1% to 29%), respectively. CONCLUSION Treatment-related mortality after reduced-intensity conditioning followed by allogeneic HSCT was low. The procedure induced molecular remissions in patients with advanced CLL. The observation of late remissions provided evidence of a graft-versus-leukemia effect.
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MESH Headings
- Adult
- Aged
- Busulfan/therapeutic use
- Child
- Cohort Studies
- Disease-Free Survival
- Female
- Follow-Up Studies
- Graft Rejection
- Graft Survival
- Graft vs Host Disease/prevention & control
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Probability
- Retrospective Studies
- Risk Assessment
- Severity of Illness Index
- Statistics, Nonparametric
- Survival Rate
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Treatment Outcome
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- J Schetelig
- Charité Campus Virchow Klinium, Berlin, Germany
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Schetelig J, Thiede C, Bornhäuser M, Schwerdtfeger R, Kiehl M, Beyer J, Kröger N, Hensel M, Scheffold C, Ho AD, Kienast J, Neubauer A, Zander AR, Fauser AA, Ehninger G, Siegert W. Reduced non-relapse mortality after reduced intensity conditioning in advanced chronic lymphocytic leukemia. Ann Hematol 2003; 81 Suppl 2:S47-8. [PMID: 12611075] [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: 03/01/2023]
Abstract
We studied in 30 patients with progressive or relapsing chronic lymphocytic leukemia (CLL) if hematopoietic stem cell transplantation (HSCT) after conditioning with fludarabine, busulfan and ATG is effective and if treatment related mortality can be reduced compared to myeloablative conditioning regimens. Patients had 15 matched related and 15 matched unrelated donors. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine alone or a combination with "short course" methotrexate or mycophenolate mofetil. The median follow-up is 24 months. At last follow up 11 patients were in complete and 13 in partial remission. Six patients had stable or progressive disease. Late complete remissions occurred up to one year after transplantation and the number of patients with CR is still increasing. Four patients died due to treatment related complications resulting in a probability of treatment-related mortality of 15% (CI 95%, 1% to 29%) at 2 years. The probability of overall survival and progression free survival at two years was 79% and 61%, respectively. In conclusion, HSCT after reduced conditioning may lower the treatment-related toxicity and has the capacity to induce complete remissions.
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Affiliation(s)
- J Schetelig
- Medical Hospital III, Dept. Hematology/Oncology, Charité-Campus Charité Mitte, Schumannstr. 20-21, 10117 Berlin, Germany
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Hensel M, Ho AD, Bastert G, Schneeweiss A. Prognostic markers for survival after high-dose chemotherapy with autologous stem-cell transplantation for breast cancer. Ann Oncol 2003; 14:341. [PMID: 12562667 DOI: 10.1093/annonc/mdg053] [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: 11/14/2022] Open
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50
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Egerer G, Goldschmidt H, Hensel M, Harter C, Schneeweiss A, Ehrhard I, Bastert G, Ho AD. Continuous infusion of ceftazidime for patients with breast cancer and multiple myeloma receiving high-dose chemotherapy and peripheral blood stem cell transplantation. Bone Marrow Transplant 2002; 30:427-31. [PMID: 12368954 DOI: 10.1038/sj.bmt.1703660] [Citation(s) in RCA: 10] [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] [Received: 10/10/2001] [Accepted: 05/22/2002] [Indexed: 11/08/2022]
Abstract
This prospective study was performed to examine the safety and efficacy of a continuous infusion of ceftazidime in patients who developed febrile neutropenia after high-dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplantation (PBSCT) and to determine if the underlying disease represents a risk factor for infectious complications. From September 1995 to May 2000, 55 patients with breast cancer (BC, group I, 54 females, one male) and 32 patients with multiple myeloma (MM, group II, 10 female, 22 male) were included in this study. The febrile patients received a 2 g intravenous bolus of ceftazidime, followed by a 4 g continuous infusion over 24 h using a portable infusion pump. If the fever persisted for 72 h a glycopeptide antibiotic was added. The median age was 42 years (range 22-59) in group I and 52 years (range 35-63) in group II. Thirty-five BC patients (64%) and 20 MM patients (63%) responded to the monotherapy with ceftazidime. After addition of a glycopeptide antibiotic, an additional 11 BC patients vs 10 MM patients became afebrile. The causes of fever in group I were fever of unknown origin (FUO) in 49 patients, microbiologically documented infection (MDI) in five patients, and clinically documented infection (CDI) in one patient. The causes of fever in group II were FUO in 22 patients, MDI in eight patients and CDI in two patients. Forty-one febrile episodes in BC patients (75%) and 22 episodes in the MM patients (69%) were successfully managed by out-patient treatment, resulting in a saving of an average of 20 days of inpatient care. Significantly more episodes of MDI and CDI occurred in patients with MM (P = 0.05). The results indicate that BC and MM patients with febrile neutropenia after HDCT and PBSCT can be treated as outpatients with close monitoring to ensure safety. This approach represents a better use of health care resources.
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Affiliation(s)
- G Egerer
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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