University Hospital Hamburg-Eppendorf Research Articles

Getting the Drift - Methyl Bromide Application and Adverse Birth Outcomes in an Agricultural Area

Although occupational exposures to the pesticide methyl bromide are associated with numerous health problems,1 little is known about the potential effects to the general population of chronic low-level exposure. However, agricultural drift has been associated with prostate cancer in one study of adult males,2 and a handful of animal studies have suggested potential developmental toxicity, including reduced birth weight.3 A new study in EHP based on modeled methyl bromide exposure in a human population now reports associations consistent with experimental findings.4 Some uses of methyl bromide were phased out in 2005 under the Montreal Protocol on Substances that Deplete the Ozone Layer.5 However, the protocol permits several continued agricultural applications, or “critical uses,” due to a lack of technically and economically viable alternatives.6 One reason methyl bromide is so difficult to replace is that none of the alternatives have such broad activity at a cost growers can afford. There has been some research on combining other compounds, but so far there aren’t any cost-effective options that work as well.7 More than 1.75 million kg of the pesticide was applied in California in 2010.8 “Before we even started our research, we looked to see what was already known about this chemical, which is such an important pesticide in California agriculture,” says Kim Harley, study coauthor and associate director for health effects research at the Center for Environmental Research and Children’s Health, University of California, Berkeley. “There was very limited evidence for reproductive and developmental toxicity; there was almost nothing.” To learn more, Harley and her colleagues drew on data collected through the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) Study. This longitudinal cohort study began in 1999–2000 with the enrollment of 601 pregnant women living in the Salinas Valley, an agricultural area in Northern California, and was designed to assess children’s exposure to pesticides and other chemicals and potential related effects. The researchers paired CHAMACOS Study data for a subset of 442 women with information from California’s Pesticide Use Reporting system, which logs detailed information about the timing, location, and amount of pesticide applications. Interviews with the women at baseline and during the course of their pregnancies provided demographic and health information. The Global Positioning System coordinates of their homes were meshed with data from the Pesticide Use Reporting system to reveal methyl bromide amounts applied within 1, 3, 5, and 8 km of each residence. Medical records included pregnancy duration and newborns’ length, weight, and head circumference. A strawberry field outside Salinas, California. Strawberries are one of several crops for which methyl bromide may still be used. The primary analysis focused on methyl bromide use within 5 km of a residence during each trimester of pregnancy. During the second trimester—a critical period of fetal growth—there were estimated decreases in average birth weight, length, and head circumference of 21.4 g, 0.16 cm, and 0.08 cm, respectively, for each 10-fold increase in methyl bromide use within 5 km. Clinically, the estimated changes would be considered insignificant; however, the association suggests a downward shift in the overall distribution of growth variables with exposure during the second trimester. More highly exposed women had babies estimated to average 113.1 g (about 4 oz) lighter than those of unexposed mothers. By comparison, Harley says, smokers have babies that are about 150–250 g lighter than nonsmokers, “so this is not a trivial difference in birth weight that we’re seeing in the high-exposed groups versus the unexposed group.” “The data are interesting,” says Lygia Budnik, a professor in the Division of Occupational Toxicology and Immunology, Institute for Occupational and Maritime Medicine, University Hospital Hamburg-Eppendorf, Germany. “The critical-use exemption aspect is very important.” Budnik emphasizes that in addition to use in agriculture, other uses of methyl bromide are still permitted, such as fumigation of freight containers. “We believe that more people are or were exposed than has been [reported], and many people might not be aware of the exposure and the resulting health problems,” she says. The study’s strengths included detailed information about the women and their babies and about methyl bromide use near their homes. However, effects of other pesticides, especially chloropicrin, which is often combined with methyl bromide, could not be ruled out. Additionally, individuals’ actual exposure could not be assessed. “That’s what’s really hard about methyl bromide—we don’t have a biomarker,” says Harley. Residential proximity to application sites provides a good estimate of exposure, but it only applies to exposure at home; exposure levels away from home are unknown. Budnik and her colleagues are currently working on a potential biomarker based on increased blood levels of mitochondrial DNA in individuals exposed to methyl bromide and other fumigants.9

Profile of bosutinib and its clinical potential in the treatment of chronic myeloid leukemia

Bosutinib (SKI-606) is an orally available, once-daily, dual Src and Abl kinase inhibitor with promising clinical potential in first-, second-, and third-line treatment of chronic myeloid leukemia (CML). Bosutinib effectively inhibits wild-type BCR-ABL and most imatinib-resistant BCR-ABL mutations except for V299L and T315I. Low hematologic toxicity is a remarkable characteristic of this novel second-generation tyrosine kinase inhibitor, and this has been ascribed to its minimal activity against the platelet-derived growth factor receptor and KIT. Low-grade, typically self-limiting diarrhea, which usually appears within the first few weeks after treatment initiation, represents the predominant toxicity of bosutinib. Other treatment-associated adverse events are mostly mild to moderate. Bosutinib has been approved by the US Food and Drug Administration for the treatment of chronic, accelerated, or blast phase Philadelphia chromosome-positive CML in adult patients with resistance or intolerance to prior therapy. This review summarizes the main properties of bosutinib and the currently available data on its clinical potential in the treatment of CML.

Pelvic and acetabular fractures.

The focus of this issue is the treatment of pelvic and acetabular fractures. The spectrum of these injuries varies, ranging from simple non-displaced fractures to highly unstable complex injuries that can be extremely challenging in terms of clinical management, surgical intervention and prevention of residual functional disability. Moreover, there has been an increase in pelvic injuries in Europe, which can be attributed to the changing age structure of the European population, with an increase of middle-aged and advancedage people. Growing age also impacts the origin and causes of those fractures; whereas previously young people suffered injury of the pelvis or acetabulum due to high-energy trauma, we see an increasing number of patients with insufficiency fractures of the sacrum or acetabular fractures after a trivial trauma. On the other hand, the progress in the treatment of pelvic fractures over the last two decades has undoubtedly led to a substantial improvement in the outcome of those patients. The following papers focus on specific aspects in the diagnosis and management of pelvic fractures. Keel et al. [1] provide an overview of some important developments in pelvic surgery. Rommens et al. [2] discuss specific aspects that arise in fractures of the pelvis in the older patient. In addition to this work, the article by Rickman et al. [3] deals with the management of complex acetabular fractures in the elderly. Lehmann et al. [4] give an overview of the handling of spinopelvic dissociations. These authors would like to take the opportunity to dedicate this issue to the 60th anniversary of Professor Johannes M. Rueger. Johannes M. Rueger was born on 28 September 1952 in Frankfurt/Main, Germany. He studied in Tubingen, Mainz and Berlin, and graduated in 1978. After a phase of orientation in which he received training in anaesthesia and urology, Professor Rueger passed, in 1979, the United States Medical Licensing Examination and started his residency in the Department of Surgery, University of Louisville, KY, USA. In 1981, he moved to the University Hospital of Frankfurt, where he received further training in the Department of Trauma, Hand and Reconstructive Surgery (Director Professor A. Pannicke). In 1990, he completed his habilitation on bone substitute materials. For this work, he was awarded several times. In 1991, he was appointed to Senior Consultant in Frankfurt. Clinically, pelvic and acetabular surgery was his particular passion early on. In 1992, he worked as a visiting physician at the University of California under Professor J. Matta. In 1998, he was appointed to the Chair of the Department of Traumatology at the University Hospital Hamburg-Eppendorf. He was the successor to Professor Jungbluth, who led the department as one of the first German Professors for trauma surgery in Germany. Under the direction of Professor Rueger, the clinic expanded constantly, especially with a focus on the treatment of pelvic injuries. He is, for many years, faculty member of the Matta Pelvic Courses in Los Angeles, CA, USA, as well as pelvic Letournel Institute Courses in Paris, France, and introduced his own European Pelvic Course in Hamburg, Germany. His passion for pelvic surgery is still ongoing. We wish Professor Rueger on his 60th Birthday optimal health and as much creative energy to Dedicated to Professor Johannes M. Rueger’s 60th Birthday.

In Vitro and In Vivo Proof of Tolerance After Two-Step Haploidentical Bone Marrow and Kidney Transplantation of the Same Donor

In Vitro and In Vivo Proof of Tolerance After Two-Step Haploidentical Bone Marrow and Kidney Transplantation of the Same Donor

The importance of pelvic lymph node dissection in the elderly population: implications for interpreting the 2010 national comprehensive cancer network practice guidelines for bladder cancer treatment

From the Cancer Prognostics and Health Outcomes Unit (FA, MS, JS, ZT) and Department of Urology, University of Montreal Health Centre (OD, CJ, PP, PIK) , Montreal, Quebec, Canada, Department of Urology, Vita Salute San Raffaele University (FA), Milan, Italy, Department of Urology, Weill Medical College of Cornell University (SFS), New York, New York, and Martiniclinic, Prostate Cancer Center University Hospital Hamburg-Eppendorf (JS), Hamburg, Germany

103 Therapy-related myeloid neoplasms following treatment with radioiodine

Department for Haematology, Oncology and Clinical Immunology, University of Duesseldorf Medical Faculty, Duesseldorf, Germany; Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany; Clinic for Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Haematology and Oncology, Georg-August University, Goettingen, Germany; Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus, Dresden, Germany, and Department of Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany

A prospective time-course study on serological testing for human immunodeficiency virus, hepatitis B virus and hepatitis C virus with blood samples taken up to 48 h after death

The transmission of viral and non-viral infectious pathogens continues to be the most serious of the potential adverse effects of allogenic tissue transplantations. EU Directive 2006/17/EC stipulates that cadaveric blood specimens for serology testing in the context of post-mortem tissue donation must be taken not later than 24 h post-mortem. An expanded time slot would significantly improve the availability of tissue donations, but there are no significant data on the stability of infectious serology assays for anti-human immunodeficiency virus (HIV), anti-hepatitis C virus (HCV), hepatitis B virus (HBV) surface antigen (HBsAg) and anti-HBC core antigen (HBc) in samples collected more than 24 h post-mortem. In this prospective study, serum samples of 30 deceased persons were taken upon admission to the Institute of Forensic Medicine (University Hospital Hamburg-Eppendorf, Germany) and at 12, 24, 36 and 48 h post-mortem. All samples were measured twice, first using the Abbott AxSYM system, and then after ~9 months of storage at -70 °C using the BEP III System with Siemens and Ortho reagents. For HIV, six deceased persons with a pre-mortem HIV history were included. All samples (at committal and at 12, 24, 36, 48 h) were reactive. Indeterminate or false-negative results did not occur. For HCV, 17 deceased persons with a pre-mortem HCV history were included; 16 samples were reactive up to 48 h and one was reactive at 36 h post-mortem (48 h sample was not available). Indeterminate or false-negative results did not occur. For HBV, nine deceased persons were included: five samples were initially positive for HBsAg and remained positive up to 48 h, and eight of the samples were reactive for anti-HBc up to 48 h and one up to 36 h post-mortem (48 h sample was not available). Indeterminate or false-negative results did not occur. These data suggest that infectious serological testing may be extended for blood samples of potential tissue donors collected up to 48 h post-mortem to detect antibodies or antigens for HIV, HBV and HCV.

Triangulation: the holy grail of endoscopic surgery?

Interventional endoscopy has recently breached the boundaries of the gastrointestinal lumen, entering into the peritoneal cavity to perform natural orifice translumenal endoscopic surgery (NOTES) [1–3]. NOTES is defined as a surgical procedure in which visualization, dissection, and organ retraction is performed with flexible endoscopic instruments through the natural orifices of the body. NOTES is theoretically scarless, and therefore, incisional hernias and associated wound infections are avoided. Other potential benefits include reduced surgical trauma resulting in less postoperative pain and adhesion formation compared with laparoscopic surgery [3]. Currently, no randomized, controlled trial has demonstrated a true advantage of NOTES compared with laparoscopic surgery and the proposed benefits remain speculative. Thus far, and largely in animal laboratories, gastroenterologist and surgeon have opened and closed the gastrointestinal wall, peered into the peritoneal cavity, and demonstrated feasibility of organ resection [4, 5]. Why is it that despite being eager to perform endoscopic intraperitoneal surgery, gastroenterologists and surgeons have only scratched the surface of this novel surgical approach, which is still nowhere near primetime? When experts try to predict how NOTES could function, they normally look at the principles of laparoscopic surgery. Laparoscopic surgery is performed with careful placement of trocars to optimize exposure and to permit triangulation. It is assumed that triangulation is necessary to create traction and countertraction and that this physical principle is what permits appropriate retraction, dissection, or suturing. Accordingly, many experts have suggested that flexible endoscopic surgery will need to emulate the same principles of triangulation to be an effective surgical approach [6, 7]. Several articles have proposed a triangulating endoscope as a key element for the success of NOTES [3, 8–11]. Consequently, NOTES research in recent years has been dominated by major efforts to develop devices and platforms that simulate triangulation and surgical tasks based on how they are performed in the laparoscopic environment. The first patent describing the concept of an endoscope with angulating end-effectors was filed by Mitsui for Olympus as early as 1974 (United States patent number 3,915,157). This patent was subsequently further refined and advanced to a prototype triangulating endoscopic platform filed for patent in 1999 (Matsui et al., United States Patent number 6,352,503). Despite these enduring efforts to build a triangulating endoscopic platform, no such device has become available for clinical use, and those among us who had the opportunity to work with triangulating prototypes have realized that triangulating end-effectors at the tip of a flexible endoscope may have inherited more problems than solutions. Using the flexible translumenal instead of a laparoscopic approach for intraperitoneal surgery does not nullify surgical principles and certain tasks, such as robust organ retraction and classic suturing, will likely require triangulation. There D. von Renteln (&) T. Rosch Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistrase. 52, 20246 Hamburg, Germany e-mail: renteln@gmx.net

Malignant gastroduodenal obstruction: Retrospective comparison of endoscopic and surgical palliative therapy

Introduction. Endoscopic stenting (ES) is a minimally invasive alternative to surgical gastroenterostomy (GE) for palliation of malignant gastroduodenal obstructions. This consecutive, retrospective analysis compares the clinical outcome of all patients undergoing ES or GE in the same period. Methods. ES was performed at the Endoscopy Department, University Hospital Mannheim or at the Interdisciplinary Endoscopy Department, University Hospital Hamburg-Eppendorf. GE was performed at the Surgical Department, University Hospital Mannheim. All palliative ES or GE on patients with malignant gastroduodenal obstruction without earlier gastric resections between January 2001 and April 2007 were evaluated. Main outcome measurements were ability of solid food intake (gastric outlet obstruction score), persistence of nausea and vomiting (gut function score), length of hospital stay, morbidity, mortality and re-interventions. Results. A total of 44 ES and 43 GE were performed. Nausea and vomiting – measured by means of the gut function score – persisted in significantly more patients in the GE group than in those who underwent stent placement (p = 0.0102). The gastric outlet obstruction score at discharge from the hospital revealed no significant difference in the ability of solid food intake between the groups. The hospital stay was significantly longer in the GE group (p = 0.0003). There was no significant difference in mortality and the rates of complications and re-interventions. Conclusion. In this study, ES is a generally equivalent – and in several points superior – alternative to GE for palliation of malignant gastroduodenal obstruction. ES seems to be the less invasive alternative for symptomatic patients. GE has good results in patients with longer survival and can be practiced within abdominal explorations.

Annual Surgical Caseload and Open Radical Prostatectomy Outcomes: Improving Temporal Trends

Radical prostatectomy is the standard of care for localized prostate cancer. Numerous previous reports show the relationship between surgical experience and various outcomes. We examined the effect of surgical experience on complications and transfusion rates, and determined individual surgeon annual caseload trends in a contemporary radical prostatectomy cohort. We analyzed annual caseload temporal trends in 34,803 patients who underwent surgery between 1999 and 2008 in Florida. Logistic regression models controlled for clustering among surgeons addressed the relationship of surgical experience, defined as the number of radical prostatectomies done since January 1, 1999 until each radical prostatectomy, with complications and transfusions. During the study period the proportion of surgeons in the high annual caseload tertile (24 radical prostatectomies or greater yearly) and the proportion of patients treated by those surgeons increased from 5% to 10% and from 20% to 55%, respectively. Conversely complication and transfusion rates decreased from 14.3% to 9.2% and 12.6% to 6.9%, respectively. Radical prostatectomies done by surgeons in the high surgical experience tertile (86 or greater radical prostatectomies) decreased the risk of any complication by 33% and of any transfusion by 30% vs those in patients operated on by surgeons in the low surgical experience tertile (27 or fewer radical prostatectomies). The proportion of surgeons in the high annual caseload tertile and the proportion of patients treated by these surgeons steadily increased during the last decade. Complication and transfusion rates decreased with time. The implications of these encouraging findings may result in improved outcomes in patients with surgically managed prostate cancer.

Incorporation of a comprehensive geriatric assessment (CGA) into a randomized phase III trial for metastatic breast cancer (MBC): The PELICAN study.

1070 Background: PELICAN is a randomized phase III trial evaluating efficacy and safety of pegylated liposomal doxorubicin (PLD) vs. capecitabine (CAP) as first-line therapy in patients (pts) with MBC. CGA results and correlation to time to progression (TTP), overall survival (OS), and time to treatment failure (TTF) were evaluated. Methods: CGA comprised data on activities of daily living (ADL), instrumental sctivities of daily living (IADL), Karnofsky performance status (KPS), comorbidity (CIRS-G), and the number of comedications. According to CGA, pts were classified into 3 groups. Single and combined CGA items were analyzed for association with treatment burden and efficacy outcome (TTP, OS, TTF) using Fisher's exact test, Wilcoxon test, and logistic regression. Results: Data from 210 pts (105 PLD, 105 CAP) with a median age of 62 y (22-85) were analyzed. 123 pts (59%) were <65 y and 87 pts (41%) ≥65 y. CGA scores were available from 152 pts. According to CGA, 113 pts were considered fit (group 1, 74%), 15 compromised (group 2, 10%), and 24 frail (group 3, 16%). Pts with a good KPS (≥ 90%) (n=46) had a significantly longer TTP vs. pts with a worse KPS (n=44) (median KPS 100%: 8.7 mo; 90%: 8.6 mo; ≤ 90%: 3.8 mo; p=0.0027). CGA, ADL, and IADL scores, and CIRS-G did not have a significant impact on TTP. In terms of OS, a high KPS (≥ 90%) significantly increased OS (median 100%: 27.5 mo; 90%: 32.1; <90%: 18.4 mo; p=0.0034). IADL score 8 and CIRS-G 0-3 also correlated with longer OS vs. IADL score <8 (24.1 vs. 17.8 mo, p=0.0061) and CIRS-G >3 (median 0-1: 30.0 mo; 2-3: 32.1 mo; >3: 17.8 mo; p<0.0001). A high KPS increased TTF significantly (median 100%: 5.8.mo; 90%: 4.6 mo, ≤ 90%: 3.0 mo; p=0.0076). Pts with IADL score <8 had a longer TTP (13.7 vs 2.6 mo, p=0.0272), OS (22.7 vs. 4.0 mo, p=0.0031) and TTF (4.6 vs. 2.5 mo, p=0.0043) in the PLD vs. CAP arm. Conclusions: KPS was the most striking predictive factor in this analysis with respect to correlation to TTF and OS. Pts with IADL score <8 treated with PLD had better outcome than pts in CAP arm. Incorporation of CGA into a phase III trial is feasible and yields valuable information for deciding best therapy for MBC patients. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Essex Pharma Essex Pharma, Schering-Plough Essex Pharma, Schering-Plough Schering-Plough, University Hospital Hamburg-Eppendorf Schering-Plough

Besonderheiten und Nebenwirkungen bei der Hodenbiopsie

Testicular biopsies were performed in hospital conditions on 451 patients by whom was diagnosed oligozoospermia (56,5%), azoospermia (41,9%), teratozoospermia (1,2%) and aspermia (0,4%). 95,5% of these biopsies were bilateral. Anatomic peculiarities as well as particularities and complications observed during the operations, and lastly postoperative complications were demonstrated in this contingent of patients. In order to obtain this result the clinical documents of the department of andrology of the university hospital Hamburg-Eppendorf were used. Adhesions of the tunical layers of the testis (28,3%), as well as hydroceles (35,7%), and increased vascularisation (20,9%) could be seen in the operation field. We considered as the most frequent intraoperative step a second skin cut (4,6%). In 3,0% of the cases it was not possible to obtain a testicular parenchyma. As complication during the operation the sliding of the epididymis was observed in 4,8%, and bleeding in 2,0% of the cases. The most frequent complication after operation was bleeding in the region of the skin's suture (1,2%). Patients who presented intraoperative complications bleeded most. Orchitis and epididymitis as postoperative complications were not observed. To prevent these complications the testicular biopsies should be done in hospital conditions by well experienced operation teams.

Roentgenologic stages of Perthes disease

Not only for giving the diagnosis "Perthes' disease" but also with regard to prognostic statements the knowledge of the radiological stages of Perthes' disease is essential. The present treatise demonstrates the radiological course of Perthes' disease, how it results from the evaluation of the courses of illness of 116 patients, which were treated in the period from 1965 to 1980 at the Orthopedic University Hospital Hamburg-Eppendorf because of a genuine Perthes' disease. The following schema turned out to be appropriate to the assessment: I. Initial stage, I a Early period, I b Late period. II. Florid stage, II a Sclerosing period, II b Fragmental period, II c Osteolytic period. III. Stage of regeneration. IV. Final stage.

Einfluß verschiedener Kriterien auf Verlauf und Therapieergebnis des Morbus Perthes

The present treatise gives an account of the courses of illness as well as of the results of a follow-up examination of 116 patients, which have been treated in the period from 1965 to 1980 at the Orthopedic University Hospital Hamburg-Eppendorf because of a genuine Perthes' disease. Sufficient documented courses are going back to the year 1952. In the centre of interest is the question about the influence of the method of treatment, of the patients' age at the time of giving the diagnosis as well as of the radiological stage of illness at the moment of giving the diagnosis on the course and on the therapeutic result of Perthes' disease. Clinical parameters have been subdivided in the classifications of Renckhoff (1975) as well as of Howorth and Ferguson (1934). The assessment of the radiological results took place according to the classifications of Sundt (1949) as well as of Bauer und Jünger (1977). 4 therapeutic groups, 7 stage of disease and 5 age groups have been differentiated. According to the results of this long-term study at the moment the immediate intertrochanteric varus osteotomy, independent of the radiological stage of disease and of the patient's age, is being looked upon as the best method of treatment for Perthes' disease.

Contemporary Prostate Cancer Prevalence among T1c Biopsy-Referred Men with a Prostate-Specific Antigen Level ≤ 4.0 ng per Milliliter

ObjectiveTo investigate the prostate cancer (PCa) prevalence and risk factors of men with prostate-specific antigen (PSA) level≤4.0ng/ml and an unsuspicious digital rectal examination (DRE) in a large biopsy referral cohort. Materials and methodsBetween 1997 and 2005, 855 men underwent initial transrectal ultrasound (TRUS)-guided prostate biopsy at the University Hospital Hamburg-Eppendorf. Patients with any previous surgical or medical treatment were excluded from analyses. Logistic regression analyses were performed to determine risk factors of PCa at biopsy and high-grade PCa defined as biopsy Gleason sum≥7. ResultsOverall PCa detection rate was 23.1%. The majority had a biopsy Gleason sum of 6 (79.5%) and 20.5% had a biopsy Gleason sum≥7. Total PSA (tPSA) and percentage of free PSA (%fPSA) were statistically significantly different in men with and without PCa (all p<0.001). In tPSA strata ≤ 0.5, 0.6–1.0, 1.1–2.0, 2.1–3.0, and 3.1–4.0ng/ml, PCa prevalence was 4.0%, 10.6%, 14.8%, 24.5%, and 32.1%, respectively. In logistic regression analyses addressing PCa and Gleason sum ≥ 7 at biopsy, %fPSA and prostate volume represented independent and most informative risk factors. ConclusionOur data demonstrate that a substantial percentage (23.1%) of men with a PSA≤4.0ng/ml and an unsuspicious DRE in a biopsy referral population harbor PCa, with 20.5% being high grade. Low %fPSA and low prostate volume represent important parameters in PCa and in high grade disease detection at biopsy, respectively.

Prätherapeutische Bestimmung des Tumorstadiums bei Patientinnen mit Zervixkarzinom - Vergleich von klinischer Untersuchung, NMR und CT

Ziel: Das Studienziel war einerseits die Beurteilung des Stellenwertes der klinischen Untersuchung, der Computertomografie (CT) und der Kernspintomografie (NMR) zur prätherapeutischen Festlegung des FIGO-Stadiums bei Patientinnen mit operablem Zervixkarzinom und andererseits des Stellenwertes von CT und NMR zum Nachweis von pelvinen und paraaortalen Lymphknotenmetastasen. Material und Methoden: Retrospektive Analyse von 190 Patientinnen, die zwischen 1. 1. 1995 und 31. 12. 2005 in der UFK Hamburg primär an einem Zervixkarzinom operiert wurden. Bei 157 Patientinnen lagen die Ergebnisse einer Narkoseuntersuchung, bei 41 Patientinnen NMR- und bei 35 Patientinnen CT-Befunde vor, die mit den postoperativen histologischen Ergebnissen korreliert wurden. Ergebnisse: Die Übereinstimmung des präoperativen FIGO-Stadiums mit dem postoperativen histologischen Ergebnis betrug für die Narkoseuntersuchung 76 %, für NMR 46 % und CT 34 %. Eine Überschätzung der Primärtumorausdehnung erfolgte mit der klinischen Untersuchung in 14 % mit CT in 37 % und NMR in 34 %. Eine Unterschätzung der Primärtumorausdehnung trat bei der klinischen Untersuchung in 10 %, bei der CT in 29 % und bei der NMR in 20 % auf. Die Sensitivität und Spezifität im Nachweis von Lymphknotenmetastasen betrug für die CT 33 und 88 % und für die NMR 30 und 90 %. Schlussfolgerung: In der Beurteilung des FIGO-Stadiums ist die klinische Untersuchung den bildgebenden Verfahren wie CT und NMR überlegen.

Analysis of 94 patients with advanced biliary tract cancer

15172 Background: Cholangiocarcinoma or gallbladder cancer are often diagnosed at an advanced stage with limited treatment options. Methods: Between 1994 and 2004, 94 patients (pts) (47 male, 47 female) with advanced biliary tract cancer were treated at the Department of Oncology and Hematology, University Hospital Hamburg-Eppendorf. Clinical and histopathological characteristics, response to chemotherapy, and survival were investigated in a retrospective analysis. Median age was 59 years (range 30–80) and median Karnofsky performance status was 90%. Predominant histologic type was adenocarcinoma (94.7%). Primary tumor sites were extrahepatic bile duct (29.9%), gallbladder (28.7%), intrahepatic bile duct (10.6%), ampulla of Vater (2.1%), not specified (28.7%). Predominant localizations of metastases were liver (73 pts (77.7%)), lymph nodes (49 pts (52.1%)) and the peritoneum (14 pts (14.9%)). 33 pts (35.1%) underwent surgery of the primary tumor at time of diagnosis. Results: 72 of 94 pts (76.6%) received a first-line chemotherapy, all together 10 different chemotherapy regimens were used. The median number of cycles was 2.5 (range 1 - 12). A single agent chemotherapy with gemcitabine was the most often adminstered regimen (23 pts (31.9%)), followed by carboplatin and etoposide plus whole body hyperthermia (12 pts (16.7%)) and 5- fluorouracil and folic acid (10 pts (13.9%)). The overall response rate was 8.3% (95% CI 3.1 - 17.3) (34.7% SD, 47.2% PD, 9.7% not evaluable). Second-line chemotherapy was given in 27 patients, which induced no tumor response, but a stable disease rate of 22.2%. Median time to follow- up was 44.8 months. Survival was calculated for all 94 pts since time of diagnosis. Median overall survival was 12.2 months and median progression-free survival 9.2 months. The median overall survival time for the 72 pts who were treated with chemotherapy was 14.0 months, and for the 22 pts who did not receive chemotherapy 10.7 months (p=0.2). Conclusions: Our analysis showed a poor prognosis for patients with advanced biliary tract cancer. Response rate to chemotherapy was low. Therefore, well tolerated cytotoxic agents should be used and new treatment strategies (including molecular targeted therapy) should be further investigated. No significant financial relationships to disclose.

Ernährungsberatung und diätetische Maßnahmen bei chronischer Urtikaria

Chronic urticaria is a frequent dermatological disease. Food allergy or intolerance are often suspected as the cause of urticaria symptoms. IgE-mediated food allergies are normally not relevant but pseudoallergic reactions to food additives and possibly biogenic amines may be crucial. Therefore, lots of patients presenting in an outpatient clinic kept diets that were worthless and that could lead to nutritional defiency in the long run. A structured schedule in the diagnostic procedure might be helpful and necessary in respecting the relationship to foods. This article especially focuses on additives in nutrition, clinical relevance of elimination diets and the importance of that dietary measure. Hereby, the procedure of dietary diagnostics and advice by the specialist in trophology is presented in detail on the base of national and international position papers and our own experiences of investigations, collected from our specialized outpatient clinic for chronic urticaria at the unit of allergy and environment, department of dermatology at the University Hospital Hamburg-Eppendorf. Besides, the results demonstrate that a close cooperation between allergologists and a specialist in trophology is constructive to rule out or confirm food allergy, respectively, intolerance and to avoid keeping unnecessary diets.

Complete Ectopia Cordis

Complete ectopia cordis is a very rare condition. With few exceptions, it is uniformly considered fatal. Death usually occurs within the first days of life as a result of infection, cardiac failure, or hypoxemia. We report the case of a male infant with Cantrell’s syndrome. There was complete thoracic exteriorization of the heart, with cephalic orientation of the cardiac apex (Figure 1). The cardiac surface was covered by …

The fixation strength of hydroxyapatite-coated Schanz screws and standard stainless steel Schanz screws in lower extremity lengthening

Lengthening procedures are often complicated by loosening of pins. It has been reported that coating with hydroxyapatite improves fixation and reduces the rate of pin-track infection. We compared 47 hydroxyapatite-coated Schanz screws (HA screws) in 12 monolateral fixators mounted at the University Hospital Hamburg-Eppendorf with 45 standard stainless steel screws in 9 monolateral fixators mounted at the St Josefs-Hospital Wiesbaden by measuring the insertion and extraction torque values. The average implantation period was 7 months for the hydroxyapatite-coated screws and 5.4 months for the uncoated screws. We established the quotient of the maximum extraction torque over insertion torque which shows the change in the fixation strength with respect to time, the fixation index. It eliminates the influence of the varying pin-bone contact. There was no significant difference in the rate of infection. In the Schanz screws without signs of infection the index was 1.92 for the HA screws and 0.76 for the stainless steel screws (P = 0.0002) giving evidence of the improvement of the fixation by the coating. HA coating resulted in improved fixation of Schanz screws in bone and may be useful in prolonged external fixation of the lower leg. The fixation index proved to be a simple tool for the evaluation of the fixation strength of Schanz screws.