Medizinische Hochschule Research Articles

Ki67, E-cadherin, and p53 as prognostic indicators of long-term outcome after liver transplantation for metastatic neuroendocrine tumors.

Patients suffering from hepatic metastases of neuroendocrine tumors (NET) are potential candidates for orthotopic liver transplantation. Because recurrence rates are high and outcome is variable, prognostic indicators are required. The aim of our study was to identify predictors of long-term survival with a focus on the impact of tumor biology. We retrospectively analyzed 19 patients who received an orthotopic liver graft for metastatic NET at the Medizinische Hochschule Hannover. Expression of Ki67, E-cadherin, and p53 was studied immunohistochemically in metastases of neuroendocrine tumors of the explanted livers. Patients were followed up to 146 months after liver transplantation. Six patients died during follow-up. The resulting 1-, 5-, and 10-year survival rates are 89%, 80%, and 50%, respectively. All deaths during long-term follow-up were tumor-associated. Recurrence was diagnosed in 12 patients between 2 weeks and 48 months after liver transplantation. Three patients are without tumor recurrence more than 8 years after liver transplantation. Survival in the 5 patients with low Ki67 and regular E-cadherin staining was significantly better than in the 12 patients with high Ki67 or aberrant E-cadherin expression (7-year survival 100% vs. 0%, respectively, log rank P=0.007). p53 expression did not significantly improve prognostic accuracy. We conclude that analysis of Ki67 and E-cadherin expression may improve the identification of patients with a favorable prognosis after liver transplantation for metastatic neuroendocrine tumors.

New ultrasound simulation system: a method for training and improved quality management in ultrasound examination

Although ultrasound examination became almost indispensable in prenatal diagnosis as well as in gynecological examination, there are still a lot of deficits in the quality management of medical education. We present a "ultrasound simulation system", that makes it possible to simulate a complete ultrasound examination. The system is able to simulate all imaginable kinds of ultrasound examination. At the Department of Gynecology and Obstetrics of the "Medizinische Hochschule Hannover" 115 banks of normal and 29 banks of pathologic volumes were scanned and stored into our newly developed "ultrasound simulation system". 7 physicians had to examine 10 "virtual" cases each; we evaluated the incidence of positive and negative results. Furthermore, the physicians had to evaluate the quality of visualization with a score. 12 of 14 malformations were identified as "fetal anomalies", whereas 2 fetal anomalies could not be identified correctly. All 56 healthy fetuses could be identified to be normal. The quality of visualization was regarded to be good in 62 cases, sufficient in 6 cases and poor in 2 cases. The "ultrasound simulation system" enables users to test and improve their levels of skill to detect pathologic findings in gynecological and obstetrical examinations. At the same time the system gives the instructor the possibility to test the quality of medical examinations. The integration of ultrasound training with an ultrasound simulation system into medical education should be discussed to improve the general level of skill in gynecological ultrasound.

This month in J Lab Clin Med: Issue highlights for August 2001

This month in J Lab Clin Med: Issue highlights for August 2001

Erectile dysfunction in relation to traumatic pelvic injuries or pelvic fractures

BJU InternationalVolume 87, Issue 5 p. 441-448 Erectile dysfunction in relation to traumatic pelvic injuries or pelvic fractures S. Machtens, S. Machtens Departments of Urology and Trauma Surgery, Medizinische Hochschule, Hannover, GermanySearch for more papers by this authorA. Gänsslen, A. Gänsslen Departments of Urology and Trauma Surgery, Medizinische Hochschule, Hannover, GermanySearch for more papers by this authorT. Pohlemann, T. Pohlemann Departments of Urology and Trauma Surgery, Medizinische Hochschule, Hannover, GermanySearch for more papers by this authorC.G. Stief, C.G. Stief Departments of Urology and Trauma Surgery, Medizinische Hochschule, Hannover, GermanySearch for more papers by this author S. Machtens, S. Machtens Departments of Urology and Trauma Surgery, Medizinische Hochschule, Hannover, GermanySearch for more papers by this authorA. Gänsslen, A. Gänsslen Departments of Urology and Trauma Surgery, Medizinische Hochschule, Hannover, GermanySearch for more papers by this authorT. Pohlemann, T. Pohlemann Departments of Urology and Trauma Surgery, Medizinische Hochschule, Hannover, GermanySearch for more papers by this authorC.G. Stief, C.G. Stief Departments of Urology and Trauma Surgery, Medizinische Hochschule, Hannover, GermanySearch for more papers by this author First published: 20 December 2001 https://doi.org/10.1046/j.1464-410x.2001.02147.xCitations: 33 Prof. Dr C. Stief, Department of Urology, MHH, D−30623 Hannover, Germany. e-mail: stief.christian@mh-hannover.de Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume87, Issue5March 2001Pages 441-448 RelatedInformation

Post-genomic Pseudomonas

A report on the Pseudomonas 2001 Meeting, Brussels, Belgium, 17-21 September 2001.

Lawrence E. Scheving, Ph.D.: Chronobiology pioneer, “Full Bird” colonel, and native son

Lawrence E. Scheving, Ph.D.: Chronobiology pioneer, “Full Bird” colonel, and native son

Complications in pediatric cochlear implant surgery.

In a retrospective analysis we evaluated the intra and postoperative complications in children who underwent cochlear implantation between 1984 and 1993 at the Medizinische Hochschule Hannover. The data and records of 366 children were collected and analyzed. Relevant parameters were major complications such as significant infection, intraoperative bleeding, facial nerve injury, implant loss and device failure, as well as lesser complications, including delayed wound healing, chronic pain and vertigo. Late complications such as cholesteatoma or electrode dislocations were also registered. Cases of acute otitis media were managed with conservative treatment. Data presented indicate that cochlear implant surgery in children is a reliable and safe procedure with a low percentage of severe complications. Problems related to ear surgery can occur and should be manageable with standard procedures. Careful operative techniques and sufficient personal experience can help avoid severe post-operative problems.

Report from the Department of Epidemiology, Social Medicine, and Health System Research, Medizinische Hochschule Hannover, Germany.

The Department of Epidemiology and Social Medicine at the Medizinische Hochschule Hannover is one of the leading university-based public health departments in Germany. It is divided into units for health system analysis, epidemiology, prevention, and health economics. The department offers a postgraduate master's degree program in public health. The staff number is approximately 25, two-thirds of whom are researchers. The German Federal Ministries of Health and of Education, Science, Research, and Technology are the major providers of research grants. The department is the managerial focus of the North German Center for Public Health Research. Internationally, the department is an active member of the International Society of Technology Assessment in Health Care (ISTAHC), the European Healthcare Management Association (EHMA), and the International Society for Quality Assurance (ISQua). The department has been involved in several European-wide studies and collaborates with the World Health Organization (WHO).

Long-Term Results Following Dorsal Penile Vein Ligation in 126 Patients With Veno-Occlusive Dysfunction

No AccessJournal of UrologyUrological Survey: Abstracts: Sexual Function and Dysfunction1 Aug 1998Long-Term Results Following Dorsal Penile Vein Ligation in 126 Patients With Veno-Occlusive Dysfunction D. Schultheiss, M.C. Truss, A.J. Becker, C.G. Stief, and U. Jonas D. SchultheissD. Schultheiss More articles by this author , M.C. TrussM.C. Truss More articles by this author , A.J. BeckerA.J. Becker More articles by this author , C.G. StiefC.G. Stief More articles by this author , and U. JonasU. Jonas More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62986-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Long-Term Results Following Dorsal Penile Vein Ligation in 126 Patients With Veno-Occlusive Dysfunction." The Journal of Urology, 160(2), p. 626 Department of Urology, Medizinische Hochschule Hannover, Hannover, Germany© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 160Issue 2August 1998Page: 626 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information D. Schultheiss More articles by this author M.C. Truss More articles by this author A.J. Becker More articles by this author C.G. Stief More articles by this author U. Jonas More articles by this author Expand All Advertisement PDF DownloadLoading ...

Lipid Evaluation in HIV-1-Positive Patients Treated with Protease Inhibitors

There is accumulating evidence that human immunodeficiency virus type 1 (HIV-1) protease inhibitors (PIs) can induce hyperlipidaemia. To evaluate the frequency and type of hyperlipidaemia in PI-treated patients, 98 outpatients were prospectively analysed for their lipoprotein characteristics at the Medizinische Hochschule in Hannover, Germany. Fifty-seven percent of the patients studied presented with hyperlipidaemia. Both hypertrigylceridaemia (type IV and V hyperlipoproteinaemia, 33%) and hypercholesterolaemia (type IIa hyperlipoproteinaemia, 6%) were detectable. The remaining 18% had a type IIb hyperlipoproteinaemia. Increased lipid levels were highly statistically significant compared to a control group of PI-naive HIV-1-infected patients [low-density lipoprotein (LDL) 146 mg/dl (range, 53-274 mg/dl) versus 105 mg/dl (range, 22-188 mg/dl; P=0.0006); very-low-density lipoprotein (VLDL) 35.5 mg/dl (5-253 mg/dl) versus 18 mg/dl (range, 3-94 mg/dl; P=0.0002)]. All PIs used (saquinavir, indinavir, nelfinavir and ritonavir) were associated with this variable form of hyperlipidaemia according to the Fredrickson classification. There was no significant correlation of any determined lipid value with the duration of treatment. A higher frequency of the apolipoprotein E2 allele and E4 allele was observed in the hyperlipidaemic subjects. Patients with excessive hypertriglyceridaemia showed a reduced lipoprotein lipase activity. Lipodystrophy was observed especially in hyperlipidaemic patients and to a lesser extent in normolipidaemic subjects. The frequency of hyperlipidaemic risk factors was surprisingly high in the group studied, which in turn may explain the proposed increased risk of atherogenesis in HIV-1 PI-treated patients. Therefore, PI-treated subjects should also be evaluated for their lipoprotein pattern, which may require antihyperlipidaemic interventions.

Independent observation of SRY mutation I90M in a patient with complete gonadal dysgenesis

Human MutationVolume 11, Issue 1 p. 90-91 Letter to the Editor Independent observation of SRY mutation I90M in a patient with complete gonadal dysgenesis Thilo Dörk, Corresponding Author Thilo Dörk doerk.thilo@mh-hannover.de Institute of Human Genetics, Center for Pediatrics and Human Genetics, Medical School Hannover, D-30623 Hannover, GermanyInstitut für Humangenetik, OE 6300, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, D-30623 Hannover, GermanySearch for more papers by this authorManfred Stuhrmann, Manfred Stuhrmann Institute of Human Genetics, Center for Pediatrics and Human Genetics, Medical School Hannover, D-30623 Hannover, GermanySearch for more papers by this authorKonstantin Miller, Konstantin Miller Institute of Human Genetics, Center for Pediatrics and Human Genetics, Medical School Hannover, D-30623 Hannover, GermanySearch for more papers by this authorJörg Schmidtke, Jörg Schmidtke Institute of Human Genetics, Center for Pediatrics and Human Genetics, Medical School Hannover, D-30623 Hannover, GermanySearch for more papers by this author Thilo Dörk, Corresponding Author Thilo Dörk doerk.thilo@mh-hannover.de Institute of Human Genetics, Center for Pediatrics and Human Genetics, Medical School Hannover, D-30623 Hannover, GermanyInstitut für Humangenetik, OE 6300, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, D-30623 Hannover, GermanySearch for more papers by this authorManfred Stuhrmann, Manfred Stuhrmann Institute of Human Genetics, Center for Pediatrics and Human Genetics, Medical School Hannover, D-30623 Hannover, GermanySearch for more papers by this authorKonstantin Miller, Konstantin Miller Institute of Human Genetics, Center for Pediatrics and Human Genetics, Medical School Hannover, D-30623 Hannover, GermanySearch for more papers by this authorJörg Schmidtke, Jörg Schmidtke Institute of Human Genetics, Center for Pediatrics and Human Genetics, Medical School Hannover, D-30623 Hannover, GermanySearch for more papers by this author First published: 07 January 1999 https://doi.org/10.1002/(SICI)1098-1004(1998)11:1<90::AID-HUMU14>3.0.CO;2-UCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume11, Issue11998Pages 90-91 RelatedInformation

Levovist enhanced colour doppler: Diagnosis of portal hypertensive gastropathy : M.J. Gebel, K. Caselitz, B. Sterath, C. Boozari, P.N. Schoefl, J.S. Meier, S. Bleck, M.P. Weber. Manns Dept. Gastroenterology and Hepatology, Medizinische Hochschule Hannover, Schering Inc., Berlin, FRG

Levovist enhanced colour doppler: Diagnosis of portal hypertensive gastropathy : M.J. Gebel, K. Caselitz, B. Sterath, C. Boozari, P.N. Schoefl, J.S. Meier, S. Bleck, M.P. Weber. Manns Dept. Gastroenterology and Hepatology, Medizinische Hochschule Hannover, Schering Inc., Berlin, FRG

Cochlear implant management of young children

Since 1988, more than 450 children have received cochlear implants at the Department of Otolaryngology of the Medizinische Hochschule Hannover. Among them are 38 children who underwent surgery before the age of two. Due to increasing experience with this technique, the mean age at implantation has decreased over time so that most children nowadays receive implants between the ages of two and five. In terms of the critical periods of both development of the auditory system and the acquisition of language, it is advantageous for even younger children to receive implants soon after detection of deafness. However, the present diagnostic tools do not allow proper estimation of residual hearing and additional handicaps. Therefore longer periods of hearing aid use and audioverbal training are mandatory before implantation. Additional objections against early implantation are biosafety problems such as head growth, the high incidence of otitis media, and the specific surgical anatomy. This paper outlines criteria for patient selection, the surgical concept, postoperative rehabilitation, and complications. Twenty-six children suffered from postmeningitic deafness and beginning obliteration of the cochlea as shown by repeated high resolution CT scans. Nine children had congenital deafness which was detected early in life and showed no improvement after proper hearing aid fitting and audioverbal training for speech development. Three children had severe inner ear malformations detected by CT scans. All children had no ABR or CAP responses in ECoG. Their developmental, language, and neuropaediatric status was examined. Thirty-five children received the Nucleus Mini 22 cochlear implant; three children received the Clarion 1.2 device. The surgery was not different from adult surgery. Special care was given to proper fixation and placement of the electrode in the drilled out mastoid to compensate for head growth. POSTOPERATIVE RESULTS: All children wear the speech processor regularly. They are able to detect everyday sounds and suprasegmental features of speech after a few months. After one year, the child begins to understand and produce speech; after two years speech understanding has been achieved and normal language development starts with small sentences. The complication rate was not higher than in other age groups of patients. Fitting and tune-up of the speech processor required a broad range of experience and a specialized team working at the children's implant center. Early implantation in children is both possible and effective in selected cases. Due to an improved early detection of deafness, it should be possible to increase the percentage of children with early cochlear implantation.

Serum leptin and weight reduction in female obesity.

Leptin, an adipocyte-derived hormone, induces a decrease in food intake and increases energy expenditure via hypothalamic interactions. In animal models obesity can be caused by leptin deficiency or by a dysfunction of the hypothalamic leptin receptor. Using a radioimmunoassay for the determination of leptin in human serum, we measured serum leptin levels in 227 otherwise healthy normal weight (N = 78; body mass index = 16.1-27.7 kg/m2) or obese women (N = 149; body mass index = 27.8-56.7 kg/m2). Fifty-three subjects were followed over a period of 12 weeks under weight reduction (800 kcal/day) and a subgroup of 33 for another 13 weeks after termination of the diet. Body mass index and serum leptin concentrations were measured longitudinally and compared to female controls not under diet. Under baseline conditions, log serum leptin levels were positively related to body mass index with a best fit using a non-linear regression (p < 0.001), indicating an attenuated increase in serum leptin levels with high body mass index. No subgroup with low serum leptin levels could be identified. Weight reduction induced a rapid decrease in serum leptin levels within the first 3 weeks to levels significantly lower than in body mass index-matched controls under normal diet (p < 0.001). This pattern was consistent after 6 and 12 weeks. Serum leptin levels increased again after the end of the diet but remained significantly lower than in the controls despite unrestricted calorie intake over 7 weeks. The rapid and persistent decrease in serum leptin to lower levels than expected from matched controls may explain the pertinent difficulties of obese subjects to cope with weight reduction.

Ionomer cement in cochlear implant surgery--applications and long-term outcome

Over the last ten years about 850 cochlear implant operations were performed at the ENT department of Hannover Medizinische Hochschule. In most cases, intracochlear nucleus implants were used. For about two years the intracochlear Clarion device has also been used in 150 adults and children. For several years we have used ionomeric cement (lonocap, supplied by lonos, Seefeld/Germany) to fix the electrode array in the region of the posterior wall and the facial recess. Previously, the implant package was fixed by ionomeric cement. To evaluate the outcome of cement application, we conducted a prospective study of our implant patients during the period from 1991 to 1993. During regular reexamination over a period of two years postoperatively in 244 patients (122 male and 122 female patients, average age 17.6 years), we did not observe any complication related to the cement. Nearly all revision cases (n = 8) showed a stable contact between electrode array, bone, and cement. With increasing experience, we reduced the cement application and fixed the package with vicryl sutures in a precisely drilled bony bed. Contact of the cement with neural and cerebral structures should be avoided. In our experience ionomeric cement is a helpful tool in cochlear implant surgery with long-term stability and no rejection reactions.

Mycobacterium genavense and Mycobacterium avium mixed infection in an AIDS patient

Several mixed nontuberculous mycobacterial infections have been reported in AIDS patients (l-5), and their prevalence is probably underestimated owing to the lack of differentiation of morphologically similar colonies in mixed cultures. Mixed infections are most difficult to detect when the coinfecting species, like Mycobacterium genavense, fails to grow on conventional solid media; according to Kirschner et al. (6), only the use of sequencing of PCRamplified nucleic acids can detect such mixed infections. We report, however, a case in which Mycobacterium avium and M. genavense were isolated from distinct blood samples, drawn at different times of the same day, using BACTEC 13A medium (Becton Dickinson, USA). While the isolation of M. avium was achieved in 2 wk, the recovery of M. genavense required nearly 3 mo, with the growth index starting to rise at the end of the eight week and with a further 25 d elapsing before microscopic detection. The M. avium isolate was identified by hybridization to commercial DNA probes (AccuProbe, USA), while the M. genavense was identified by E. Bottger (Medizinische Hochschule, Hannover, Germany) by means of 16S rRNA sequencing. The AIDS patient, a severely immunocompromised (20 CD4+ cells/ml) 27 yr-old homosexual man. presented with high fever, diffuse abdominal pain hepatosplenomegaly, and confusion; the case closely resembled those of two previously described patients with disseminated M. genavense infection. and the empirical therapy was based on the susceptibility patterns of those M. genavense strains (7). The regimen. a combination of amikacin. clofazimine and rifampin, produced, as in a previous case of M. genavense infection (7), a rapid improvement with cessation of fever and recovery of normal mental status. Such a prompt response to the antimicrobial therapy is very unusual in disseminated M. avium infections and suggests that M. genavense was responsible for the patients symptomatology, as in the only other published report (6). Also our M. avium isolate later was found to be resistant in vitro to clofazimine and rifampin, and only moderately susceptible to amikacin. The impact of infections due to M. genavense in HIV-infected patients is surely greater than the paucity of reported cases seem to suggest. The failure of M. genavense to grow on conventional solid media makes it undetectable in most clinical laboratories, even those using the BACTEC radiometric system, if a sufficient period of incubation is not allowed. In the case of mixed infection (most frequently with M. avium), M. genavense is missed because it is overgrown by the other species. In our case it was a matter of chance that the M. avium bacteremia was not continuous, and only the practice of performing repeated blood cultures and our previous experience with M. genavense infections allowed us to initiate a prompt and effective therapy and to isolate what appeared to be the organism mainly responsible for the clinical condition. Every effort should be made to diagnose disseminated infections by M . genavense in AIDS patients, because prompt and appropriate therapy can rapidly improve the otherwise severe and lifethreatening symptomatology caused by this organism.

Long term outcome of hepatitis C virus infection after liver transplantation: [formula omitted]. Dept. of Gastroenterology, Dept. of Transplant-surgery and Institute of Pathology, Medizinische Hochschule Hannover, D-30623 Hannover, Germany

Long term outcome of hepatitis C virus infection after liver transplantation: [formula omitted]. Dept. of Gastroenterology, Dept. of Transplant-surgery and Institute of Pathology, Medizinische Hochschule Hannover, D-30623 Hannover, Germany

Arterial plasma amino acid patterns in patients with cirrhosis, and after liver-transplantation: [formula omitted] Dept. of Gastroenterology and Dept. of Cardiology(∗), Medizinische Hochschule Hannover, D-30623 Hannover, Germany

Arterial plasma amino acid patterns in patients with cirrhosis, and after liver-transplantation: [formula omitted] Dept. of Gastroenterology and Dept. of Cardiology(∗), Medizinische Hochschule Hannover, D-30623 Hannover, Germany

Effect of Helicobacter pylori and cytokines on interleukin 8 secretion by human gastric epithelial cells in vitro : [formula omitted], A. Paetow, U.E.H. Mai, W. Beil, S.C. Bischoff, M. Manns. Dept. of Gastroenterology and Hepatology, Medizinische Hochschule Hannover, D-30623 Hannover, Germany

Effect of Helicobacter pylori and cytokines on interleukin 8 secretion by human gastric epithelial cells in vitro : [formula omitted], A. Paetow, U.E.H. Mai, W. Beil, S.C. Bischoff, M. Manns. Dept. of Gastroenterology and Hepatology, Medizinische Hochschule Hannover, D-30623 Hannover, Germany

Parametric ultrasound: A novel diagnostic tool for the description of liver morphology: [formula omitted]1, M. Gebel 1, M.J. Bahr 1, K.H.W. Böker 1, H. Maschek 2, U.J.F. Tietge 1, A. Schwichtenberg 1, A. Schüler 1, A. Schneider 1, S. Wagner 1, C. Trautwein, M.P. Manns 1. Abt. Gastroenterologie u. Hepatologie 1, Abt. Pathologie 2, Medizinische Hochschule Hannover

Parametric ultrasound: A novel diagnostic tool for the description of liver morphology: [formula omitted]1, M. Gebel 1, M.J. Bahr 1, K.H.W. Böker 1, H. Maschek 2, U.J.F. Tietge 1, A. Schwichtenberg 1, A. Schüler 1, A. Schneider 1, S. Wagner 1, C. Trautwein, M.P. Manns 1. Abt. Gastroenterologie u. Hepatologie 1, Abt. Pathologie 2, Medizinische Hochschule Hannover