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  • 1
    Electronic Resource
    Electronic Resource
    Prenatal diagnosis and obstetric outcomes in triplet pregnancies in relation to chorionicity (2005)
    Oxford, UK and Malden, USA : Blackwell Science Ltd
    BJOG 112 (2005), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective  This study describes the frequency, pregnancy complications and outcomes of non-trichorionic triplet pregnancies.Design  A retrospective observational study.Setting  Two tertiary level referral centres of Obstetrics and Prenatal Medicine, Germany.Population  All women booked to receive targeted ultrasound screening between January 1998 and June 2003. The mixed low and high risk population included 36,430 women with ultrasound examinations between 11 and 24 weeks of gestation. Of those with available outcome, 176 were triplet pregnancies with three viable fetuses.Methods  Analysis of ultrasound data and perinatal outcome in triplet gestations who had first and second trimester targeted ultrasound examination. Pregnancies with monochorionic or dichorionic placentation were identified and pregnancy outcome was compared to trichorionic triplets.Main outcome measures  Intrauterine fetal death, fetal growth restriction (FGR), mean discordance and survival rate in non-trichorionic versus trichorionic triplets.Results  Triplets were trichorionic in 81.8% and had a monochorionic or dichorionic placentation in the remaining 18.2%. The rate of monochorionicity and dichorionicity was significantly higher after spontaneous conception than after assisted reproductive technologies (44.8%vs 12.9%, P 〈 0.001). In non-reduced monochorionic and dichorionic triplets compared with non-reduced trichorionic triplets, there was a higher rate of intrauterine fetal death (8.8%vs 1.5%, P 〈 0.01), FGR (33.3%vs 25.5%), mean discordance (20.5%vs 12.7%, P 〈 0.01), discordance 〉30% (26.3%vs 2.9%, P 〈 0.01) and delivery 〈32 weeks of gestations (47.4%vs 32.2%). There was a lower survival rate in non-trichorionic triplets (84.2%) than in trichorionic ones (91.7%).Conclusion  Triplet pregnancies with a monochorionic or dichorionic placentation are at significantly higher risk of adverse pregnancy outcome compared with trichorionic pregnancies. First trimester evaluation of chorionicity is strongly emphasised.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2005.00627.x
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  • 2
    Electronic Resource
    Electronic Resource
    Influence of circulating c-erbB-2 serum protein on response to adjuvant chemotherapy in node-positive breast cancer patients (1997)
    Springer
    Breast cancer research and treatment 43 (1997), S. 87-95 
    Details
    ISSN: 1573-7217
    Keywords: breast cancer ; c-erbB-2 ; chemotherapy ; oncogene ; prognosis ; survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This retrospective case control study investigated the therametricvalue of the circulating c-erbB-2 gene product (Her-2,NEU) as (1) an eligibility criterion for highdoses of chemotherapy and (2) response to standardadjuvant chemotherapy in node-positive breast cancer patients. Preoperativec-erbB-2 levels were measured in 211 locally advanced(〉 3 nodes positive), pre- and perimenopausal breastcancer patients to determine if circulating levels ofthe gene product can assist in the determinationof appropriate therapeutic options.152 of 211 breast cancer patients received post-operativelya combination chemotherapy including the anthracycline analog mitoxantrone,while 59 patients were treated with conventional CMFtherapy. Using 120 fmol/ml as a cut-off level,elevated c-erbB-2 values were found in 26 (12.3%)patients with locally advanced breast cancer. In univariateanalysis significant survival differences were detected when c-erbB-2‘positive’ patients were compared with c-erbB-2 ‘negative’ patients.However, no significant survival differences were detected, whenc-erbB-2 ‘positive’ patients were compared according to regimenof adjuvant treatment.In multivariate analysis c-erbB-2 was an independent prognosticfactor for predicting disease-free survival, but not foroverall survival. High levels of c-erbB-2 were associatedwith low estrogen and progesterone receptor concentrations ofthe tumor cytosol. There was no correlation betweenelevated c-erbB-2 values and age, tumor size ordegree of nodal involvement. c-erbB-2 was a betterpredictor of risk of recurrence than extent ofnodal involvement or hormone receptor status.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1005700812422
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  • 3
    Electronic Resource
    Electronic Resource
    Mutations of p53 Tumor Suppressor Gene, Apoptosis, and Proliferation in Intrahepatic Cholangiocellular Carcinoma of the Liver (2000)
    Springer
    Digestive diseases and sciences 45 (2000), S. 317-324 
    Details
    ISSN: 1573-2568
    Keywords: cholangiocellular carcinoma ; p53 ; proliferation markers ; apoptosis ; histopathological parameters ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was performed to examine the correlation between mutations of the p53 tumor suppressor gene, the occurrence of apoptosis, and proliferation in cholangiocellular carcinoma of the liver. The results obtained were compared with pathohistological stage (according to UICC) and grade and with disease related survival rate. In 41 curatively (R0−) resected intrahepatic cholangiocellular carcinomas, the status of the p53 gene was determined by direct sequencing of exons 4–9 and immunohistochemically. Apoptosis was assessed using the in situ end labeling (ISEL) technique in combination with morphological criteria. Proliferation was analyzed by immunohistochemistry of MIB-1 (Ki-67), Proliferating cell nuclear antigen (PCNA), and silver-stained nucleolar organizer regions (AgNOR). The results obtained were compared with pathohistological stage (according to UICC), grade, several other histopathological factors, and survival rate. Mutations of p53 were detected in 15/41 carcinomas examined (37%). The most common change was a G→C and C→T transition, changing the hot spot amino acid determined by exons 4–8. Of these 15 tumors, 14 were also p53-positive by immunohistochemistry. In each carcinoma examined, we could demonstrate MIB-1, PCNA, and AgNOR dots and also apoptotic cells in variable proportions. The proliferation markers showed a significant correlation among themselves. In univariate survival analysis, the extent of the primary tumor, lymph node status, grade, and p53 were significant factors influencing patient survival. Performing multivariate Cox regression survival analysis, however, only the extent of primary tumor and lymph node status had an independent prognostic impact. Apoptosis was not related to patient prognosis or to other parameters examined. In conclusion, these results indicated that p53 could serve as an additional prognostic parameter that could provide auxiliary information for patient outcome. However, tumor stage and lymph node involvement were the strongest prognostic factors. We failed to establish apoptosis or other pathological parameters as factors predicting the prognosis of patients with cholangiocellular carcinoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1005412626515
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  • 4
    Electronic Resource
    Electronic Resource
    Expression of nm23-H1 predicts lymph node involvement in colorectal carcinoma (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 651-654 
    Details
    ISSN: 1530-0358
    Keywords: nm23-H1 ; Colorectal carcinoma ; Staging ; Lymph node metastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Reduced expression of the metastasis suppressor gene nm23-H1 has previously been correlated with high tumor metastatic potential and fatal clinical outcome in some tumors (e.g.,breast). For colorectal carcinomas, the findings are equivocal. METHODS: We have used a monoclonal antibody against nm23-H1 to investigate the expression in colorectal carcinomas at the time of primary curative surgery (RO resection) to assess if there was any relation between nm23-H1 expression and stage or histologic grade at the time of primary tumor removal. RESULTS: Of 100 colorectal carcinomas studied (Stages I, II, and III according UICC, all resected curatively), nm23-H1 immunoreactivity was weak in 41 (41 percent), moderate in 24 (24 percent), and strong in 35 (35 percent) cases. The grade of positivity against nm23-H1 was significantly lower in advanced stages of the disease (Stages II or III) (P 〈 0.001, chi-squared=52.8). In tumors with low or weak immunoreactivity against nm23-H1, frequency of lymph node metastases was significantly higher compared with those with moderate or strong staining (P 〈 0.001; chi-squared=50.58). Therefore, with a sensitivity of 93 percent and a specificity of 58 percent, low nm23-H1 immunoreactivity of the primary tumor, assessed at the time of surgery, is an indicator of the presence of lymph node metastases. CONCLUSIONS: Immunohisto-chemical evaluation of nm23-H1 in the primary tumor or in a biopsy is a useful predictor of stage of disease and presence of lymph node metastases in colorectal carcinomas and may have clinical significance,e.g.,in predicting optimal therapeutic regimes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02054128
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  • 5
    Electronic Resource
    Electronic Resource
    Strahlentherapie von gutartigen Erkrankungen: eine Bestandsaufnahme für Deutschland (1999)
    Springer
    Strahlentherapie und Onkologie 175 (1999), S. 541-547 
    Details
    ISSN: 1439-099X
    Keywords: Schlüsselwörter: Radiotherapie von nichtmalignen/gutartigen Erkrankungen ; “Patterns of Care”-Studie ; Qualitätssicherung ; Radiotherapiekonzepte ; Key Words: Radiotherapy of non-malignant/benign disease ; Patterns of care study ; Quality assurance ; Treatment concepts
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Background: Radiation therapy of benign diseases is controversially discussed and rarely applied in Anglo-American countries, while in other parts of the world, especially Central and East Europe, it is commonly practised for several benign disorders. Similar to the European Society of Therapeutic Radiology and Oncology survey, a patterns of care study was performed in Germany. Method: A questionnaire was mailed in 3 years (1994, 1995, 1996) to all radiation facilities in Germany, which assessed equipment, indications, number of patients and treatment concepts. A total of 134 (88%) institutions returned all requested data: 22 in East and 112 in West Germany; 30 in university and 104 in community/private hospitals. The average data of each institution and of all institutions were analyzed for frequencies and ratios between different regions and institutions. Resultls: A mean of 2 (range 1 to 7) megavoltage (Linac/Cobalt 60) and 1,4 (range 0 to 4) orthovoltage units were available per institions; 32 (24%) institutions had no orthovoltage equipment. A mean of 20,082 patients were treated per year; 456 (2%) for inflammatory diseases (221 hidradentitis, 78 nail bed infection, 23 parotitis, 134 not specified), 12,600 (63%) for degenerative diseases (2,711 peritendinitis humeroscapularis, 1,555 epicondylitis humeri, 1,382 heel spur, 2,434 degenerative osteoarthritis, 4,518 not specified), 927 (5%) for hypertrophic diseases (146 Dupuytren's contracture, 382 keloids, 155 Peyronie's disease, 244 not specified), 1,210 (6%) for functional disorders (853 Graves' orbitopathy, 357 not specified), and 4,889 (24%) for other disorders (e.g. 3,680 heterotropic ossification prophylaxis). In univariate analysis, there were significant geographical (West vs. East Germany) differences in the use of radiotherapy for inflammatory and degenerative disorders and institutional differences (university vs community/private hospitals) in the use of radiotherapy for hypertrophic and functional disorders (p〈0.05). The prescribed dose concepts were mostly in the low dose range (〈10 Gy), but varied widely and inconsistently within geographic regions and institution types. Conclusion: Radiotherapy is a well accepted and frequently practised treatment for several benign diseases in Germany, however, there are significant geographical and institutional differences. As the number of orthovoltage units decreases, an increasing patient load is in demand of more megavoltage units, which may compromise the cost-effectiveness of this treatment. Only 4% of all clinical institutions are involved in controlled clinical trials. To maintain a high level of radiotherapy service to other disciplines, radiotherapy treatment guidelines, quality control and continuing medical education are required.
    Notes: Hintergrund: Der Einsatz der Strahlentherapie bei gutartigen Erkrankungen wird kontrovers diskutiert und zum Teil kaum noch praktiziert, zum Beispiel im angloamerikanischen Raum. In anderen Teilen der Welt, besonders Zentral- und Osteuropa, wird die Strahlentherapie routinemäßig eingesetzt. Analog zur European Society of Therapeutic Radiology and Oncology (ESTRO) wurde eine systematische Analyse zum Stand der Radiotherapie bei gutartigen Erkrankungen in Deutschland durchgeführt. Methodik: 1994, 1995 und 1996 wurde an alle strahlentherapeutischen Institutionen in Deutschland ein Fragebogen verschickt, mit dem technische Ausstattung, Indikationsspektrum, Patientenzahl und Therapiekonzepte bei gutartigen Erkrankungen erhoben wurden. 134 (88%) Institutionen (22 in Ost-, 112 in Westdeutschland; 30 in Universitäts-, 104 in öffentlichen/privaten Krankenhäusern) beantworteten alle Fragen. Die Häufigkeiten und Durchschnittswerte pro Institution und über alle Institutionen hinweg wurden hinsichtlich geographischer Region und Krankenhaustyp analysiert. Ergebnisse: Im Durchschnitt standen zwei (Spanne 1 bis 7) Linearbeschleuniger/Kobaltgeräte und 1,4 (Spanne 0 bis 4) Orthovoltgeräte pro Institution zur Verfügung; 32 (24%) besaßen kein Orthovoltgerät. Pro Jahr wurden im Mittel 20 082 Patienten behandelt: 456 (2%) wegen Entzündungen (221 Hidradenitis, 78 Panaritium, 23 Parotitis, 134 nicht differenziert), 12 600 (63%) wegen degenerativer Erkrankungen (2 711 Peritendinitis humeroscapularis, 1 555 Epicondylopathia humeri, 1 382 Fersensporn, 2 434 arthrotische Erkrankungen, 4 518 nicht differenziert), 927 (5%) wegen hypertrophischer Erkrankungen (146 Morbus Dupuytren, 382 Keloide, 155 Induratio penis plastica, 244 nicht differenziert), 1 210 (6%) wegen funktioneller Erkrankungen (853 endokrine Orbitopathie, 357 nicht differenziert), 4 889 (24%) wegen anderer Erkrankungen (zum Beispiel 3 680 Prophylaxe heterotoper Ossifikationen). In univariater Analyse zeigten sich signifikante geographische Unterschiede (westliche vs. östliche Bundesländer) bei entzündlichen und degenerativen Erkrankungen und institutionelle Unterschiede (Universitäts- vs. Versorgungskrankenhäuser) bei hypertrophischen und funktionellen Erkrankungen (p 〉 0,05). Die meisten Therapiekonzepte waren im Niedrigdosisbereich (〈 10 Gy) angelegt, schwankten aber im Detail unsystematisch und in weiteren Grenzen. Schlußfolgerung: Die Strahlentherapie ist eine gut akzeptierte, oft eingesetzte Therapie bei gutartigen Erkrankungen in Deutschland, doch bestehen große geographische und institutionelle Unterschiede. Der wachsende Mangel an Orthovoltgeräten erhöht das Patientenaufkommen an Hochvoltgeräten, was die Kosteneffektivität der Methode beeinträchtigen kann. Nur 4% aller Institutionen beteiligen sich an klinischen Studien. Um den hohen Standard der Therapie zu sichern, sind Therapieleitlinien, Kriterien zur Qualitätssicherung und kontinuierliche Bemühungen in der Aus- und Weiterbildung nötig.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s000660050038
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