@article{AlfredsonWaldenRobertsetal.2023, author = {Alfredson, H{\aa}kan and Wald{\´e}n, Markus and Roberts, David and Spang, Christoph}, title = {Combined midportion Achilles and plantaris tendinopathy: a 1-year follow-up study after ultrasound and color-Doppler-guided WALANT surgery in a private setting in southern Sweden}, series = {Medicina}, volume = {59}, journal = {Medicina}, number = {3}, issn = {1648-9144}, doi = {10.3390/medicina59030438}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-303966}, year = {2023}, abstract = {Background and Objectives: Chronic painful midportion Achilles combined with plantaris tendinopathy can be a troublesome condition to treat. The objective was to prospectively follow patients subjected to ultrasound (US)- and color doppler (CD)-guided wide awake, local anesthetic, no-tourniquet (WALANT) surgery in a private setting. Material and Methods: Twenty-six Swedish patients (17 men and 9 women, mean age 50 years (range 29-62)) and eight international male patients (mean age of 38 years (range 25-71)) with combined midportion Achilles and plantaris tendinopathy in 45 tendons altogether were included. All patients had had >6 months of pain and had tried non-surgical treatment with eccentric training, without effect. US + CD-guided surgical scraping of the ventral Achilles tendon and plantaris removal under local anesthesia was performed on all patients. A 4-6-week rehabilitation protocol with an immediate full-weight-bearing tendon loading regime was used. The VISA-A score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation. Results: At the 1-year follow-up, 32/34 patients (43 tendons) were satisfied with the treatment result and had returned to their pre-injury Achilles tendon loading activity. There were two dropouts (two tendons). For the Swedish patients, the mean VISA-A score increased from 34 (0-64) before surgery to 93 (61-100) after surgery (p < 0.001). There were two complications, one wound rupture and one superficial skin infection. Conclusions: For patients suffering from painful midportion Achilles tendinopathy and plantaris tendinopathy, US + CD-guided surgical Achilles tendon scraping and plantaris tendon removal showed a high satisfaction rate and good functional results 1 year after surgery.}, language = {en} } @phdthesis{Fleischmann2023, author = {Fleischmann, Lorena}, title = {Talent Development in Academic Domains: A Follow-Up of Former Junior Students at Julius-Maximilians-Universit{\"a}t W{\"u}rzburg}, doi = {10.25972/OPUS-30281}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-302814}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {The field of giftedness and gifted education has long been characterized by internal fragmentation and inconsistent definitions of core concepts (e.g., Ambrose et al., 2010; Coleman, 2006; McBee et al., 2012). It was only in recent years that increased efforts have been made to organize available research findings and thereby bring back greater uniformity to the field of giftedness and gifted education. For example, Preckel et al.'s (2020) Talent Development in Achievement Domains (TAD) framework integrates theoretical perspectives and empirical knowledge from different parts of the field. It is general in concept and can be applied to a wide range of achievement domains. By specifically focusing on measurable psychological constructs as well as their relevance at different stages of the talent development process, Preckel et al.'s (2020) TAD framework is well suited as a starting point for generating more domain-specific talent development models. The present thesis represents one of the first attempts to empirically test the validity of Preckel et al.'s (2020) TAD framework in academic domains using longitudinal data. The longitudinal data came from a sample of former junior students at Julius-Maximilians-Universit{\"a}t (JMU) W{\"u}rzburg who showed high academic achievement potential. There were two related research issues: Research Issue 1 first aimed to document in detail how the educational trajectories of former junior students unfold in the years following their Abitur. To this end, a follow-up was conducted among 208 young adults who had participated in the junior study program at JMU W{\"u}rzburg between the winter semester of 2004/2005 and the summer semester of 2011. The design of the follow-up questionnaire was based on a series of research questions that had emerged from the relevant literature on junior study programs in Germany. The follow-up ran from October 2019 to February 2020. The data were analyzed descriptively and documented as a detailed report. The results of Research Issue 1 revealed that the former junior students continued to be academically (and later professionally) successful long after their school years. For example, at the time of the follow-up, almost all former junior students had earned a bachelor's and a master's degree, most often with notable academic successes (e.g., scholarships, awards/prizes). In addition, more than half of those who responded had begun or already completed a doctoral degree, also recording special academic accomplishments (e.g., scientific publications, scholarships). A significant proportion of the former junior students had already entered the workforce at the time of their response. A look at their current professional situation revealed an above-average expression of success indicators (e.g., income, professional status). The clear majority of the former junior students reported that, even in retrospect, they would choose to take part in the junior study program at JMU W{\"u}rzburg again. Research Issue 2 aimed to determine the extent to which the structure of Preckel et al.'s (2020) TAD framework could be empirically validated in academic domains. The educational trajectories of 84 former junior students at JMU W{\"u}rzburg who had chosen a subject from the same subject field in their regular studies as in their junior studies served as the data basis. The educational trajectories were compiled from the former junior students' follow-up data and from their data on the selection process for the junior study program at JMU W{\"u}rzburg. Combining the structural assumptions of Preckel et al.'s (2020) TAD framework with relevant insights from individual academic disciplines made it possible to derive hypotheses regarding potential predictors and indicators of the talent development stages aptitude, competence, and expertise in academic domains. Structural equation models were used for data analysis. The results of Research Issue 2 suggested that the talent development stages aptitude, competence, and expertise, while being predictive of each other in their chronological order, could be satisfactorily modeled using framework-compliant indicators in academic domains. In comparison, the talent development stage transformational achievement could not (yet) be modeled based on the longitudinal data. Among the hypothesized predictors, former junior students' investigative interests and their metacognitive abilities reliably determined the talent development stages competence and expertise, whereas the remaining predictors did not make significant contributions. Taken together, the results of the present thesis suggest that the validity of Preckel et al.'s (2020) TAD framework can only be partially confirmed in academic domains. Unlike the postulated indicators, the predictors in Preckel et al.'s (2020) TAD framework do not seem to be easily generalizable to academic domains but to be highly specific with regard to the talent domain under consideration. Therefore, a natural progression of the present thesis would be to examine the structure of Preckel et al.'s (2020) TAD framework at the subordinate level of subject fields or even at the level of individual academic disciplines, for example.}, subject = {Hochbegabung}, language = {en} } @phdthesis{Herold2021, author = {Herold, Johannes Helmut}, title = {Nachsorge bei gastralen MALT-Lymphomen nach alleiniger Helicobacter pylori-Eradikation unter besonderer Ber{\"u}cksichtigung der Patientencompliance}, doi = {10.25972/OPUS-24984}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-249846}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Hintergrund: Der EGILS (European Gastro-Intestinal Lymphoma Study) Consensus Report von 2011 enth{\"a}lt als zentralen Therapiebaustein die H.p.-Eradikationsbehandlung mit nachfolgendem „Watch-and-Wait" bzw. die Nachsorge nach Vollremission. Voraussetzung f{\"u}r eine strukturierte Nachsorge ist eine gute Patientencompliance. Eine Studie {\"u}ber Dauer und praktische Umsetzbarkeit der Nachsorge, insbesondere nach Vollremission, gibt es bisher nicht. Ziel: Ziel dieser retrospektiven Arbeit war es zu {\"u}berpr{\"u}fen, ob die von der EGILS empfohlenen Nachsorgeintervalle von den Patienten nach einer alleinigen H.p.-Eradikation eingehalten werden. Ferner sollte auf dieser Grundlage und unter Ber{\"u}cksichtigung des Therapieerfolgs eine Empfehlung f{\"u}r optimale Nachsorgeintervalle nach klinischer Vollremission erarbeitet werden. Methode: 106 Patienten (50 weiblich; 56 m{\"a}nnlich); Alter 59 (33 - 85) Jahre mit beliebigem H.p.Status, histologisch gesichertem gastralem MALT-Lymphom und alleiniger H.p.-Eradikationsbehandlung wurden eingeschlossen. Grundlage zur Beurteilung war, bis zur Vollremission, das Nachsorgeschema gem{\"a}ß EGILS (alle 4-6 Monate); danach erfolgte die Nachsorge alle 6 bis 12 Monate. Die Compliance wurde bei jedem Patienten als das Verh{\"a}ltnis aus erf{\"u}llter Nachsorgepflicht zu individueller Gesamtdauer der Nachsorge berechnet und {\"u}ber alle Patienten gemittelt. Ergebnisse: Die meisten Patienten erreichen nach alleiniger H.p.-Eradikation unabh{\"a}ngig vom H.p.-Status eine Vollremission (ca. 71\%). Die Nachsorgen wurden {\"u}ber den gesamten Beobachtungszeitraum zu ca. 55\% eingehalten. Patienten mit Interesse an einer Nachsorge nehmen diese {\"u}ber Jahre hinweg sehr zuverl{\"a}ssig war. In dieser Patientengruppe liegt die Compliance bei ca. 95\%. Schlussfolgerung: Die exzellente Prognose gastraler MALT-Lymphome, unabh{\"a}ngig vom H.p.-Status, und die hohe Bereitschaft der Patienten f{\"u}r Nachsorgeuntersuchungen auch nach Vollremission erh{\"o}ht die Attraktivit{\"a}t einer „Watch-and-Wait"-Strategie. Nach klinischer Vollremission sind j{\"a}hrliche endoskopische Nachsorgeuntersuchungen praktisch umsetzbar.}, subject = {Lymphom}, language = {de} } @article{GeigerHirtlerGottfriedetal.2017, author = {Geiger, Julia and Hirtler, Daniel and Gottfried, Kristina and Rahman, Ozair and Bollache, Emilie and Barker, Alex J. and Markl, Michael and Stiller, Brigitte}, title = {Longitudinal Evaluation of Aortic Hemodynamics in Marfan Syndrome: New Insights from a 4D Flow Cardiovascular Magnetic Resonance Multi-Year Follow-Up Study}, series = {Journal of Cardiovascular Magnetic Resonance}, volume = {19}, journal = {Journal of Cardiovascular Magnetic Resonance}, number = {33}, doi = {10.1186/s12968-017-0347-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-171119}, year = {2017}, abstract = {Background The aim of this 4D flow cardiovascular magnetic resonance (CMR) follow-up study was to investigate longitudinal changes in aortic hemodynamics in adolescent patients with Marfan syndrome (MFS). Methods 4D flow CMR for the assessment of in-vivo 3D blood flow with full coverage of the thoracic aorta was performed twice (baseline scan t1/follow-up scan t2) in 19 adolescent MFS patients (age at t1: 12.7 ± 3.6 years, t2: 16.2 ± 4.3 years) with a mean follow-up duration of 3.5 ± 1.2 years. Ten healthy volunteers (24 ± 3.8 years) served as a control group. Data analysis included aortic blood flow visualization by color-coded 3D pathlines, and grading of flow patterns (helices/vortices) on a 3-point scale (none, moderate, severe; blinded reading, 2 observers). Regional aortic peak systolic velocities and systolic 3D wall shear stress (WSS) along the entire aortic wall were quantified. Z-Scores of the aortic root and proximal descending aorta (DAo) were assessed. Results Regional systolic WSS was stable over the follow-up duration, except for a significant decrease in the proximal inner DAo segment (p = 0.02) between t1 and t2. MFS patients revealed significant lower mean systolic WSS in the proximal inner DAo compared with volunteers (0.78 ± 0.15 N/m\(^{2}\)) at baseline t1 (0.60 ± 0.18 N/m\(^{2}\); p = 0.01) and follow-up t2 (0.55 ± 0.16 N/m\(^{2}\); p = 0.001). There were significant relationships (p < 0.01) between the segmental WSS in the proximal inner DAo, DAo Z-scores (r = -0.64) and helix/vortex pattern grading (r = -0.55) at both t1 and t2. The interobserver agreement for secondary flow patterns assessment was excellent (Cohen's k = 0.71). Conclusions MFS patients have lower segmental WSS in the inner proximal DAo segment which correlates with increased localized aberrant vortex/helix flow patterns and an enlarged diameter at one of the most critical sites for aortic dissection. General aortic hemodynamics are stable but these subtle localized DAo changes are already present at young age and tend to be more pronounced in the course of time.}, language = {en} } @article{WernerSchmidMueggeetal.2015, author = {Werner, R.A. and Schmid, J.S. and Muegge, D.O. and L{\"u}ckerath, K. and Higuchi, T. and H{\"a}nscheid, H. and Grelle, I. and Reiners, C. and Herrmann, K. and Buck, A.K. and Lapa, C.}, title = {Prognostic value of serum tumor markers in medullary thyroid cancer patients undergoing vandetanib treatment}, series = {Medicine}, volume = {94}, journal = {Medicine}, number = {45}, doi = {10.1097/MD.0000000000002016}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-145154}, pages = {e2016}, year = {2015}, abstract = {Tyrosine kinase inhibitors (TKIs) such as vandetanib have shown clinical effectiveness in advanced medullary thyroid cancer (MTC). During TKI treatment, fluctuations in the tumor markers carcinoembryonic antigen (CEA) and calcitonin (CTN) are frequently observed. Their role for treatment monitoring and the decision-making process has not been fully elucidated yet. Twenty-one patients (male, 16, female, 5; mean age, 49±13 years) with progressive MTC receiving vandetanib (300mg orally per day) were considered. Tumor restaging was performed every 3 months including contrast-enhanced computed tomography (CT). Response was assessed according to recent criteria (Response Evaluation Criteria in Solid Tumors, RECIST 1.1). Additionally, CEA and CTN were measured at the day of CT imaging and alterations observed in tumor markers were compared to respective imaging findings (partial response, PR; stable disease, SD; progressive disease, PD). During long-term follow-up (510±350 days [range, 97-1140 days]), CTN and CEA levels initially dropped in 71.4\% and 61.9\% of the patients followed by fluctuations in serum marker levels. A rise in CTN ≥39.5\% between 2 subsequent measurements (defined by ROC analysis) had a sensitivity of 70.6\% and a specificity of 83.2\% in predicting PD with an accuracy of 82.0\% (area under the curve (AUC), 0.76). Oscillations in CEA levels were not predictive for PD. Whereas tumor marker fluctuations in MTC patients undergoing TKI treatment are a frequent phenomenon, a significant rise in CTN ≥40\% turns out to as an early indicator of tumor progression.}, language = {en} } @article{vandeKerkhofvanderHeijdenSchneideretal.2012, author = {van de Kerkhof, Noortje W. A. and van der Heijden, Frank M. M. A. and Schneider, Marc K. F. and Pfuhlmann, Bruno and St{\"o}ber, Gerald and Egger, Jos I. M. and Verhoeven, Willem M. A.}, title = {Cycloid psychoses: Leonhard's descriptions revisited}, series = {European Journal of Psychiatry}, volume = {26}, journal = {European Journal of Psychiatry}, number = {4}, doi = {10.4321/S0213-61632012000400006}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-134779}, pages = {266-278}, year = {2012}, abstract = {Background and Objectives: Cycloid psychoses are characterized by polymorphic symptomatology with intraphasic bipolarity, a remitting and recurrent course and favourable prognosis. Perris and Brocicington (P\&B) described the first set of operational criteria that were partly incorporated in ICD-10. The present study investigates psychopathological profiles according to the P\&B criteria and the original descriptions by Leonhard, both against the background of the criteria from the prevailing international classification systems. Methods: Eighty patients with psychotic disorders were recruited and assessed with various psychometric instruments at baseline and after six weeks of antipsychotic treatment in order to investigate the presence of cycloid psychoses according to Leonhard (LCP) and the effect of treatment with antipsychotics. The overlap between LCP and DSM-IV Brief Psychotic Disorder (BPD), ICD Acute Polymorphic Psychotic Disorder (APP) and P\&B criteria was calculated. Results: Using P\&B criteria and a symptom checklist adapted from the original descriptions by Leonhard, 14 and 12 cases of cycloid psychosis were identified respectively reflecting a prevalence of 15-18\%. Small though significant concordance rates were found between LCP and both DSM-BPD and ICD-APP. Concordance between LCP and P\&B criteria was also significant, but modest. Conclusions: This study demonstrates that LCP can be identified in a substantial number of patients with psychotic disorders. Cycloid psychoses are not adequately covered in current classification systems and criteria. Since they are demonstrated to have a specific psychopathological profile, relapsing course and favourable prognosis, it is advocated to include these psychoses in daily differential diagnostic procedures.}, language = {en} } @article{GybergDeBacquerDeBackeretal.2015, author = {Gyberg, Viveca and De Bacquer, Dirk and De Backer, Guy and Jennings, Catriona and Kotseva, Kornelia and Mellbin, Linda and Schnell, Oliver and Tuomilehto, Jaakko and Wood, David and Ryden, Lars and Amouyel, Philippe and Bruthans, Jan and Conde, Almudena Castro and Cifkova, Renata and Deckers, Jaap W. and De Sutter, Johan and Dilic, Mirza and Dolzhenko, Maryna and Erglis, Andrejs and Fras, Zlatko and Gaita, Dan and Gotcheva, Nina and Goudevenos, John and Heuschmann, Peter and Laucevicius, Aleksandras and Lehto, Seppo and Lovic, Dragan and Milicic, Davor and Moore, David and Nicolaides, Evagoras and Oganov, Raphae and Pajak, Andrzej and Pogosova, Nana and Reiner, Zeljko and Stagmo, Martin and St{\"o}rk, Stefan and Tokg{\"o}zoglu, Lale and Vulic, Dusko}, title = {Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology}, series = {Cardiovascular Diabetology}, volume = {14}, journal = {Cardiovascular Diabetology}, number = {133}, doi = {10.1186/s12933-015-0296-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-141358}, year = {2015}, abstract = {Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results: A total of 2846 (46 \%) patients had no diabetes, 1158 (19 \%) newly diagnosed diabetes and 2183 (35 \%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 \%, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54 \% and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28 \%. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0 \% (53 mmol/mol) in 95 and 53 \% and 11 \% of those with previously known diabetes had an HbA1c >9.0 \% (>75 mmol/mol). Of the patients with diabetes 69 \% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (approximate to 40 \%) and only 27 \% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.}, language = {en} } @article{ZhaoYuHuetal.2015, author = {Zhao, De-Wei and Yu, Mang and Hu, Kai and Wang, Wei and Yang, Lei and Wang, Ben-Jie and Gao, Xiao-Hong and Guo, Yong-Ming and Xu, Yong-Qing and Wei, Yu-Shan and Tian, Si-Miao and Yang, Fan and Wang, Nan and Huang, Shi-Bo and Xie, Hui and Wei, Xiao-Wei and Jiang, Hai-Shen and Zang, Yu-Qiang and Ai, Jun and Chen, Yuan-Liang and Lei, Guang-Hua and Li, Yu-Jin and Tian, Geng and Li, Zong-Sheng and Cao, Yong and Ma, Li}, title = {Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey}, series = {Chinese Medical Journal}, volume = {128}, journal = {Chinese Medical Journal}, number = {21}, doi = {10.4103/0366-6999.168017}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-138482}, pages = {2843-2850}, year = {2015}, abstract = {Background: Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population. Methods: A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH. Results: NONFH was diagnosed in 218 subjects (0.725\%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02\% vs. 0.51\%, \(\chi^2\) = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85\% vs. 0.61\%, \(\chi^2\) = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH. Conclusions: Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.}, language = {en} } @article{WimmerRandauDemletal.2013, author = {Wimmer, Matthias D. and Randau, Thomas M. and Deml, Moritz C. and Ascherl, Rudolf and Forst, Raimund and Gravius, Nadine and Wirtz, Dieter and Gravius, Sascha}, title = {Impaction grafting in the femur in cementless modular revision total hip arthroplasty: a descriptive outcome analysis of 243 cases with the MRP-TITAN revision implant}, series = {BMC Musculoskeletal Disorders}, volume = {14}, journal = {BMC Musculoskeletal Disorders}, number = {19}, issn = {1471-2474}, doi = {10.1186/1471-2474-14-19}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-122061}, year = {2013}, abstract = {Background: We present a descriptive and retrospective analysis of revision total hip arthroplasties (THA) using the MRP-TITAN stem (Peter Brehm, Weisendorf, GER) with distal diaphyseal fixation and metaphyseal defect augmentation. Our hypothesis was that the metaphyseal defect augmentation (Impaction Bone Grafting) improves the stem survival. Methods: We retrospectively analyzed the aggregated and anonymized data of 243 femoral stem revisions. 68 patients with 70 implants (28.8\%) received an allograft augmentation for metaphyseal defects; 165 patients with 173 implants (71.2\%) did not, and served as controls. The mean follow-up was 4.4 +/- 1.8 years (range, 2.1-9.6 years). There were no significant differences (p > 0.05) between the study and control group regarding age, body mass index (BMI), femoral defects (types I-III as described by Paprosky), and preoperative Harris Hip Score (HHS). Postoperative clinical function was evaluated using the HHS. Postoperative radiologic examination evaluated implant stability, axial implant migration, signs of implant loosening, periprosthetic radiolucencies, as well as bone regeneration and resorption. Results: There were comparable rates of intraoperative and postoperative complications in the study and control groups (p > 0.05). Clinical function, expressed as the increase in the postoperative HHS over the preoperative score, showed significantly greater improvement in the group with Impaction Bone Grafting (35.6 +/- 14.3 vs. 30.8 +/- 15.8; p <= 0.05). The study group showed better outcome especially for larger defects (types II C and III as described by Paprosky) and stem diameters >= 17 mm. The two groups did not show significant differences in the rate of aseptic loosening (1.4\% vs. 2.9\%) and the rate of revisions (8.6\% vs. 11\%). The Kaplan-Meier survival for the MRP-TITAN stem in both groups together was 93.8\% after 8.8 years. [Study group 95.7\% after 8.54 years; control group 93.1\% after 8.7 years]. Radiologic evaluation showed no significant change in axial implant migration (4.3\% vs. 9.3\%; p = 0.19) but a significant reduction in proximal stress shielding (5.7\% vs. 17.9\%; p < 0.05) in the study group. Periprosthetic radiolucencies were detected in 5.7\% of the study group and in 9.8\% of the control group (p = 0.30). Radiolucencies in the proximal zones 1 and 7 according to Gruen occurred significantly more often in the control group without allograft augmentation (p = 0.05). Conclusion: We present the largest analysis of the impaction grafting technique in combination with cementless distal diaphyseal stem fixation published so far. Our data provides initial evidence of improved bone regeneration after graft augmentation of metaphyseal bone defects. The data suggests that proximal metaphyseal graft augmentation is beneficial for large metaphyseal bone defects (Paprosky types IIC and III) and stem diameters of 17 mm and above. Due to the limitations of a retrospective and descriptive study the level of evidence remains low and prospective trials should be conducted.}, language = {en} } @article{GassenmaierPetritschKunzetal.2015, author = {Gassenmaier, Tobias and Petritsch, Bernhard and Kunz, Andreas S. and Gkaniatsas, Spyridon and Gaudron, Philipp D. and Weidemann, Frank and Nordbeck, Peter and Beer, Meinrad}, title = {Long term evolution of MRI characteristics in a case of atypical left lateral wall hypertrophic cardiomyopathy}, series = {World Journal of Cardiology}, volume = {7}, journal = {World Journal of Cardiology}, number = {6}, doi = {10.4330/wjc.v7.i6.357}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-124934}, pages = {357-360}, year = {2015}, abstract = {We are reporting a long-time magnetic resonance imaging (MRI) follow-up in a rare case of cardiac left lateral wall hypertrophy. Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder and a significant cause of sudden cardiac death. Cardiac magnetic resonance (CMR) imaging can be a valuable tool for assessment of detailed information on size, localization, and tissue characteristics of hypertrophied myocardium. However, there is still little knowledge of long-term evolution of HCM as visualized by magnetic resonance imaging. Recently, our group reported a case of left lateral wall HCM as a rare variant of the more common forms, such as septal HCM, or apical HCM. As we now retrieved an old cardiac MRI acquired in this patient more than 20 years ago, we are able to provide the thrilling experience of an ultra-long MRI follow-up presentation in this rare case of left lateral wall hypertrophy. Furthermore, this case outlines the tremendous improvements in imaging quality within the last two decades of CMR imaging.}, language = {en} } @article{HeldHesseGoettetal.2014, author = {Held, Matthias and Hesse, Alexander and G{\"o}tt, Franziska and Holl, Regina and H{\"u}bner, Gudrun and Kolb, Philipp and Langen, Heinz Jakob and Romen, Tobias and Walter, Franziska and Sch{\"a}fers, Hans Joachim and Wilkens, Heinrike and Jany, Berthold}, title = {A symptom-related monitoring program following pulmonary embolism for the early detection of CTEPH: a prospective observational registry study}, series = {BMC Pulmonary Medicine}, volume = {14}, journal = {BMC Pulmonary Medicine}, doi = {10.1186/1471-2466-14-141}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119281}, pages = {141}, year = {2014}, abstract = {Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication following an acute pulmonary embolism (PE). It is frequently diagnosed at advanced stages which is concerning as delayed treatment has important implications for favourable clinical outcome. Performing a follow-up examination of patients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures would be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic patients may be a practical approach for detecting relevant CTEPH. This study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of symptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the role of cardiopulmonary exercise testing (CPET) as a diagnostic tool. Methods In a prospective cohort study all consecutive patients with newly diagnosed PE (n=170, 76 males, 94 females within 26 months) were recruited according to the inclusion and exclusion criteria. Patients were contacted via telephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130 patients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET and complete work-up for CTEPH. Results 37.7\%, 25.5\% and 29.3\% of the patients reported symptoms after three, six, and twelve months respectively. Subsequent clinical evaluation of these symptomatic patients saw 20.4\%, 11.5\% and 18.8\% of patients at the respective three, six and twelve months time points having an echocardiography suggesting pulmonary hypertension (PH). CTEPH with pathological imaging and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg at rest was confirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced increase of PAP without increasing pulmonary artery occlusion pressure (PAOP). Two subjects with pulmonary hypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion defects without echocardiographic signs of PH but a suspicious CPET. Conclusion A follow-up program based on telephone monitoring of symptoms and further structured evaluation of symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.}, language = {en} } @article{WirtzGraviusAscherletal.2014, author = {Wirtz, Dieter C. and Gravius, Sascha and Ascherl, Rudolf and Thorweihe, Miguel and Forst, Raimund and Noeth, Ulrich and Maus, Uwe M. and Wimmer, Matthias D. and Zeiler, Guenther and Deml, Moritz C.}, title = {Uncemented femoral revision arthroplasty using a modular tapered, fluted titanium stem 5-to 16-year results of 163 cases}, series = {Acta Orthopaedica}, volume = {85}, journal = {Acta Orthopaedica}, number = {6}, issn = {1745-3674}, doi = {10.3109/17453674.2014.958809}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-114555}, pages = {562 - 569}, year = {2014}, abstract = {Background and purpose - Due to the relative lack of reports on the medium- to long-term clinical and radiographic results of modular femoral cementless revision, we conducted this study to evaluate the medium- to long-term results of uncemented femoral stem revisions using the modular MRP-TITAN stem with distal diaphyseal fixation in a consecutive patient series. Patients and methods - We retrospectively analyzed 163 femoral stem revisions performed between 1993 and 2001 with a mean follow-up of 10 (5-16) years. Clinical assessment included the Harris hip score (HHS) with reference to comorbidities and femoral defect sizes classified by Charnley and Paprosky. Intraoperative and postoperative complications were analyzed and the failure rate of the MRP stem for any reason was examined. Results - Mean HHS improved up to the last follow-up (37 (SD 24) vs. 79 (SD 19); p < 0.001). 99 cases (61\%) had extensive bone defects (Paprosky IIB-III). Radiographic evaluation showed stable stem anchorage in 151 cases (93\%) at the last follow-up. 10 implants (6\%) failed for various reasons. Neither a breakage of a stem nor loosening of the morse taper junction was recorded. Kaplan-Meier survival analysis revealed a 10-year survival probability of 97\% (95\% CI: 95-100). Interpretation - This is one of the largest medium- to longterm analyses of cementless modular revision stems with distal diaphyseal anchorage. The modular MRP-TITAN was reliable, with a Kaplan-Meier survival probability of 97\% at 10 years.}, language = {en} } @inproceedings{FetzerWeizmanReber2012, author = {Fetzer, Anita and Weizman, Elda and Reber, Elisabeth}, title = {Follow-ups across discourse domains: A cross-cultural exploration of their forms and functions}, organization = {Lehrstuhl englische Sprachwissenschaft}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-71656}, year = {2012}, abstract = {The edited volume documents the proceedings of the ESF workshop "Follow-ups across discourse domains: a cross-cultural exploration of their forms and functions". It examines the forms and functions of the dialogue act of a follow-up, viz. accepting or challenging a prior communicative act, in political discourse across spoken and written dialogic genres. Specifically, it considers (1) the discourse domains of political interviews, editorials, op-eds and discussion forums, (2) their sequential organization as regards the status of initial (or 1st order) follow-up, a follow-up of a prior follow-up (2nd order follow-up), or nth-order follow-up, and (3) their discursive realization as regards degrees of indirectness and responsiveness which are conceptualized as a continuum along the lines of degrees of explicitness and degrees of responsiveness. The chapters come from the fields of linguistics, discourse analysis, socio-pragmatics, communication, political science and psychology, examining the heterogeneous field of political discourse and its manifestation in diverse discourse genres with respect to evasiveness, indirectness and redundancy in mediated political discourse, professional discourse, discourse identity and doing politics, to name but the most prominent questions.}, subject = {Pragmatik}, language = {en} } @phdthesis{Scholtka2011, author = {Scholtka, Jacqueline}, title = {Symptome und Befund der pulmonalen Sarkoidose. Eine retrospektive Verlaufsbeobachtung}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-72122}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2011}, abstract = {131 Patienten mit Sarkoidose der Medizinischen Klinik und Poliklinik I in W{\"u}rzburg wurden r{\"u}ckblickend anhand der vorliegenden Krankenakten untersucht. Hierbei wurden insbesondere Daten zu Symptomen, Laboruntersuchungen, Lungenfunktionsuntersuchungen sowie radiologischen Untersuchungen gesammelt und ausgewertet. Es wird ein allgemeiner {\"U}berblick {\"u}ber die H{\"a}ufigkeit der einzelnen Symptombereiche sowie Untersuchungsbefunde gegeben. Des weiteren wird anhand eines Bewertungsscores der Erkrankungsverlauf der Patienten abgebildet.}, subject = {Sarkoidose}, language = {de} } @phdthesis{Verburg2008, author = {Verburg, Frederik Anton}, title = {The course of differentiated thyroid carcinoma in patients in whom the initial I-131 ablative treatment was successful}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-33346}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2008}, abstract = {Objective: The objective of this study was to study recurrence in patients with differentiated thyroid carcinoma who after initial therapy consisting of total thyroidectomy and I-131 ablation, were cured defined as a negative TSH-stimulated Tg-levels and a negative I-131 whole body scan (WBS) at the first follow-up after ablation. Methods: Retrospective data for differentiated thyroid carcinoma patients from three university hospitals were pooled. Out of 1993 patients, 526 cured patients were included. All patients received at least one more TSH-stimulated WBS and Tg-measurement within 5 years after initial treatment. Results: 12 patients (2.1\%) developed a recurrence after an average interval of 35 months (range: 12-59 months) following administration I-131 ablation. Overall disease-free survival according to the method of Kaplan-Meier was 96.6\%. There was no difference in disease-free survival between high- and low-risk patients (p=0.61). Recurrence was first discovered by Tg-measurement during levothyroxin therapy in 7 patients, and by TSH-stimulated Tg-measurement in 5 patients. I-131 WBS did not contribute to the detection of recurrences. Multivariate analysis showed that age TNM-stage (p=0.015) and histology (p=0.032) were independent predictors of disease-free survival. Conclusion: Recurrence is a rare event in patients with DTC who received total thyroidectomy with subsequent I-131 ablation, and who had a negative first follow-up TSH-stimulated I-131 WBS and negative concurrent Tg. In the study population there were no recurrences after more than 5 years of follow-up.}, subject = {Schilddr{\"u}senkrebs}, language = {en} } @phdthesis{Ketz2008, author = {Ketz, Verena}, title = {Analyse der relevanten Parameter bei der Nachsorge der akuten myeloischen Leuk{\"a}mie}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-29428}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2008}, abstract = {In dieser Arbeit wurde untersucht, ob es bei der Nachsorge von Patienten in erster kompletter Remission (CR) einer akuten myeloischen Leuk{\"a}mie (AML) Parameter gibt, deren Ver{\"a}nderung ein Rezidiv ank{\"u}ndigen und ob die Struktur des Nachsorgeprogramms geeignet ist, ein Rezidiv fr{\"u}hzeitig zu erkennen. Bei 29 Patienten der 52 analysierten Patienten kam es zu einem Rezidiv. Bei 48\% dieser Patienten war der Rezidivverdacht bereits aufgrund klinischer Beschwerden wie Leistungsabfall und Dyspnoe oder durch ein pathologisches Blutbild bei der haus{\"a}rztlichen Kontrolle zu stellen. Am Rezidivtermin zeigten alle Rezidivpatienten pathologische Ver{\"a}nderungen von LDH, H{\"a}moglobin, Leuko- oder Thrombozyten. Der Rezidivverdacht wurde also nicht erst durch eine Knochenmarkpunktion gestellt. F{\"u}r viele AML Patienten in erster CR sind regelm{\"a}ßige Kontrolluntersuchungen beim Hausarzt ausreichend, eine Knochenmarkpunktion ist nicht routinem{\"a}ßig erforderlich.}, subject = {Akute Leuk{\"a}mie}, language = {de} } @phdthesis{Bentlage2008, author = {Bentlage, Patricia}, title = {Stellenwert der Nachsorge bei der Rezidiverkennung von aggressiven B-Zell-Lymphomen}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-28238}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2008}, abstract = {Der vorliegenden retrospektiven Untersuchung zum Stellenwert der strukturierten am-bulanten Nachsorge in der Rezidiverkennung von aggressiven B-NHL liegen Patientendaten der Medizinischen Klinik und Poliklinik II der Universit{\"a}t W{\"u}rzburg aus den Jahren 1991- 2003 zugrunde. Bei den eingeschlossenen 141 Patienten wurde im Zeitraum vom 01.01.1991 bis zum 31.12.2001 die Prim{\"a}rdiagnose eines aggressiven B-NHL ge-stellt und nach Erstlinientherapie mit Erreichen einer kompletten Remission die ambu-lante Nachsorge begonnen. Von den 35 ambulant diagnostizierten Rezidiven traten 46\% innerhalb des ersten Jahres nach Beendigung der Therapie auf. Innerhalb der ersten f{\"u}nf Jahre nach Therapieende waren 92\% der ambulant diagnostizierten Wiedererkrankungen aufgetreten. Auffallend ist, dass nur 51\% der Rezidive anl{\"a}sslich eines vereinbarten Termins im Rahmen des Nachsorgeschemas entdeckt wurden. Die {\"u}brigen Patienten erschienen aufgrund von Symptomen außerhalb des empfohlenen Schemas. Das Wahrnehmen von Symptomen durch den Patienten z{\"a}hlt somit zu den Bestandteilen einer erfolgreichen Nachsorge. In der vorliegenden Untersuchung wurde dies signifikant best{\"a}tigt. 72\% der Rezidivpatien-ten berichteten {\"u}ber mindestens eines der Symptome: B-Symptomatik, Lymphknoten-schwellung, Infekten, Schmerzen an Lymphknotenstationen oder Juckreiz. Bei den ge-sunden Patienten fanden sich diese Symptome nur in 20\% der F{\"a}lle. Die Patientenschu-lung sollte daher neben der Anamnese einen Schwerpunkt der Nachsorge darstellen. Bei Auftreten der oben genannten Symptome sollen sich die Patienten außerhalb der emp-fohlenen Nachsorgeintervalle vorstellen. Ebenso nahm die k{\"o}rperliche Untersuchung einen hohen Stellenwert in der Rezidiver-kennung ein. 20 der 35 Rezidivpatienten hatten einen auff{\"a}lligen Untersuchungsbefund, davon in 15 F{\"a}llen (43\%) vergr{\"o}ßert tastbare Lymphknoten. Eine Erh{\"o}hung der Laktatdehydrogenase (LDH) trat bei 10 der 35 Rezidivpatienten (29\%) auf. Durch die Kombination aus Anamnese, k{\"o}rperlicher Untersuchung und LDH-Bestimmung wurden 34 von 35 Rezidivpatienten erkannt. Empfohlen werden kann aufgrund der analysierten Daten eine Nachsorgestruktur mit engmaschigen Kontrollen im Abstand von drei Monaten innerhalb des ersten Jahres nach Therapieende und darauf folgende halbj{\"a}hrliche Kontrollen f{\"u}r weitere vier Jahre. Die Sonographie, ein Routineverfahren der Nachsorge, zeigte sich in der vorliegenden Untersuchung als geeignetes Verfahren zur Best{\"a}tigung eines Rezidivs. Bei 28 von 30 untersuchten Rezidivpatienten wurde ein pathologischer Befund im Sinne eines Rezi-divs erhoben. Von der routinem{\"a}ßigen Bildgebung mithilfe der Schnittbildverfahren CT oder MRT profitierte nur ein Patient, welcher ausschließlich durch die Bildgebung auf-fiel. Diese Verfahren sollten nicht routinem{\"a}ßig, sondern erst bei Vorliegen auff{\"a}lliger Befunde durchgef{\"u}hrt werden. Der Nutzen der strukturierten ambulanten Nachsorge scheint aufgrund der vorliegenden Arbeit nur begrenzt geeignet Rezidive zu erkennen, da 49\% der Rezidive außerhalb der strukturierten Nachsorge diagnostiziert wurden. Sie bietet aber zugleich ein notwendi-ges Raster f{\"u}r die systematische Nachbetreuung der Patienten und sollte durch eine gr{\"u}ndliche Patientenschulung erg{\"a}nzt werden, um die Patienten fr{\"u}hzeitig auf suspekte Symptome aufmerksam zu machen. Ein weiteres Argument f{\"u}r die strukturierte Nach-sorge stellt die psychische Belastungssituation dar, in der sich die meisten Patienten nach der Therapie eines Lymphoms befinden. Die Patienten bekommen nicht nur fr{\"u}h-zeitig Gewissheit, wenn sie erneut erkranken, sondern erfahren auch Beruhigung und Best{\"a}tigung, wenn die Erkrankung nicht wieder aufgetreten ist.}, subject = {Rezidiv}, language = {de} } @phdthesis{Paul2007, author = {Paul, Dietmar Nikolai Vincent}, title = {Funktionelle und radiologische Ergebnisse nach roboterassistierter Implantation zementfreier H{\"u}fttotalendoprothesen mit dem System CASPAR}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-24060}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2007}, abstract = {In der Zeit von Juni 1999 bis M{\"a}rz 2001 wurden an der Chirurgischen Klinik Rastatt bei 40 Patienten insgesamt 43 computer- und roboterunterst{\"u}tzte zementfreie H{\"u}fttotalendoprothesen mit dem System CASPAR geplant und implantiert. Von den 43 geplanten H{\"u}ftprothesenimplantationen konnten alle 40 Patienten (100\%) mit diesem Verfahren operiert werden. 3 Patienten erhielten jeweils im Abstand von 12 Monaten eine zementfreie H{\"u}ftprothese mittels CASPAR-Fr{\"a}sung auf der Gegenseite. Einen Abbruch der Operation aufgrund technischer Probleme fand sich in keinem Fall. In einer mittelfristigen Nachuntersuchung aller Patienten wurden wichtige klinische Parameter wie Schmerzempfinden, Beweglichkeit im H{\"u}ftgelenk und Mobilit{\"a}t im t{\"a}glichen Leben erhoben. Diese Parameter wurden im Harris Hip Score und im Index nach Merle d \&\#769;Aubign{\´e} zusammengefasst. Zudem erfolgten radiologische Vergleichsaufnahmen als Kontrolle zu den unmittelbar postoperativ erstellten R{\"o}ntgenbildern. Zusammenfassend ergibt die Auswertung des Harris Hip Score eine Verteilung von 38 Patienten in der Kategorie „sehr gut" und 2 Patienten in der Kategorie „gut". In dem Index nach Merle d \&\#769;Aubign{\´e} zusammengefasst zeigten die Untersuchungen ebenfalls ausgesprochen gute Ergebnisse. Hier fanden sich 36 Patienten in der Kategorie „sehr gut". Die restlichen 4 Patienten erf{\"u}llten die Kriterien f{\"u}r ein „gut". Dieses hervorragende outcome schlug sich in der Patientenzufriedenheit nieder. Die Bewegungsausmaße der mittels roboterassistierten H{\"u}fte zeigten sehr gute Werte. In diesem Zusammenhang konnte auch in keinem Fall eine Sch{\"a}digung mit Beeintr{\"a}chtigung der pelvitrochant{\"a}ren Muskulatur festgestellt werden. Ein positives Trendelenburg- Zeichen fand sich bei keinem von uns mit CASPAR operierten Patienten. Die radiologischen Ergebnisse der robotergefr{\"a}sten zementfrei implantierten H{\"u}fttotalendoprothesen ergaben sehr gute Ergebnisse. Eine Lockerung oder Schaftsinterung konnte ebenso wenig wie eine Fehlpositionierung des Prothesenschaftes festgestellt werden. Insgesamt erbringt die Nachuntersuchung unserer mittels CASPAR-assistierten Patienten weitaus weniger Komplikationen als zum Teil in der Literatur beschrieben. Insbesondere die h{\"a}ufig erw{\"a}hnten Weichteilsch{\"a}den und Bewegungseinschr{\"a}nkungen, die durch Roboter verursacht sind, k{\"o}nnen wir nicht nachvollziehen.}, subject = {Implantation}, language = {de} } @phdthesis{Kerscher2006, author = {Kerscher, Friderike}, title = {Retrospektive Studie zum Konzept der morphologie- und funktionsgerechten Schilddr{\"u}senchirurgie der benignen Struma und der nuklearmedizinischen Nachsorge nach dem "W{\"u}rzburger Nachsorge-Schema nach Schilddr{\"u}sen-Operationen"}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-16860}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2006}, abstract = {ZIEL: Diese retrospektive Studie pr{\"u}ft die Ergebnisse und Trends verschiedener Operationstechniken in der morphologie- und funktionsgerechten Schilddr{\"u}senchirurgie der Chirurgischen Klinik der Universit{\"a}t W{\"u}rzburg. Des Weiteren wurde das „W{\"u}rzburger Nachsorge-Schema nach Schilddr{\"u}senoperationen" WNS, ein von der Universit{\"a}tsklinik f{\"u}r Nuklearmedizin der Universit{\"a}t W{\"u}rzburg empirisch entwickeltes Schema, evaluiert. PATENTEN/METHODEN: 137 Patienten wurden untersucht, die in der Chirurgischen Klinik der Universit{\"a}t W{\"u}rzburg an einer benignen Struma operiert wurden und deren Nachsorge an der Universit{\"a}tsklinik f{\"u}r Nuklearmedizin der Universit{\"a}t W{\"u}rzburg bzw. in 2 Nuklearmedizinischen Praxen stattfand. Folgende Resektionsverfahren wurden untereinander verglichen: singul{\"a}re Knotenenukleation, subtotale Resektion, Hemithyreoidektomie, atypische Resektion. Der Kalziumspiegel wurde {\"u}ber die o-Kesophthalein-Komplex-Methode bestimmt. Nach dem WNS werden Patienten 4 Wochen postoperativ erstmals sonographisch, szintigraphisch und laborchemisch untersucht, ohne davor Schilddr{\"u}senhormone/ Jodid zu substituieren. 3 Therapiegruppen wurden festgelegt, wobei prim{\"a}r nach dem Restgewebe eingeteilt wird, dem eine entsprechende Stoffwechsellage zugeteilt ist. T3, T4 und Freies T4 wurde {\"u}ber einen RIA gemessen, die TSH-Bestimmung erfolgte mittels IRMA. Schilddr{\"u}senvolumen pr{\"a}- und postoperativ sowie Knoten wurden sonographisch ermittelt. Der Funktionszustand wurde mittels quantitativer Schilddr{\"u}senszintigraphie mit Tc-99m ermittelt. ERGEBNISSE: Die Analyse der OP-Verfahren zeigt einen klaren Trend zu radikalen Verfahren. Es wurden zu 50\% Hemithyreoidektomien gegen{\"u}ber nur 7\% Knotenenukleationen durchgef{\"u}hrt. Knotenfrei waren postoperativ mind. 84\% der Patienten. Max. 48 \% der Patienten hatten eine euthyreote Stoffwechsellage postoperativ. Zu 6\% trat direkt postoperativ eine Hypokalz{\"a}mie auf. Die Nachsorge nach dem WNS wurde nicht konsequent verfolgt. Die Kriterien zur Einteilung in die vorgesehenen 3 Therapiegruppen des WNS erlauben teilweise keine eindeutige Zuordnung. Unabh{\"a}ngig vom Nachsorgeort wurden die Patienten meist mit mehr schilddr{\"u}senspez. Medikation therapiert als im Schema vorgesehen. Die Unterteilung des Restvolumens in 3-8ml und unter 3ml zeigte keine praktische Relevanz bez{\"u}glich der postoperativen Stoffwechsellage. FAZIT: Die Chirurgische Klinik der Universit{\"a}t W{\"u}rzburg hat bei der morphologie- und funktionsgerechten Schilddr{\"u}senchirurgie einen tragf{\"a}higen Kompromiss gefunden das Risiko von Restknoten und Hypokalzi{\"a}mien klein zu halten bei m{\"o}glichst hoher Rate von postoperativ euthyreoten Patienten. In dieser Studie wurde das WNS modifiziert, wobei Patienten mit einem Restvol. unter 8ml vom Chirurgen sofort hormonsubstituiert werden. Bei gr{\"o}ßerem Restvolumen ({\"u}ber 8ml) wird die 1. nuklearmedizinische Nachsorgeuntersuche 4-6 Wochen postoperativ abgewartet. Dann wird entsprechend der sonographischen, szintigraphischen und laborchemischen Ergebnisse die Therapie nach modifiziertem Schema angepasst. Weitere Kontrollen schließen sich lebenslang an, wobei v.a. das Restvolumen und die Stoffwechsellage beobachtet werden, um {\"A}nderungen fr{\"u}hzeitig zu erkennen und rechtzeitige handeln zu k{\"o}nnen.}, language = {de} } @phdthesis{Scheuch2003, author = {Scheuch, Stephanie}, title = {Die Wertigkeit der klinischen, apparativen und laborchemischen Untersuchungen in der Nachsorge des Mammakarzinoms}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-5707}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2003}, abstract = {Im Mittelpunkt der Diskussion zur Nachsorge des Mammakarzinoms stehen das intensive Nachsorgeregime mit klinischer Untersuchung und routinem{\"a}ßigem Gebrauch von bildgebenden Suchverfahren (R{\"o}ntgenaufnahmen, Szintigraphie, Sonographie) sowie laborchemischer Untersuchungen einschließlich Tumormarker gegen{\"u}ber dem minimalen Nachsorgeregime mit klinischer Untersuchung, routinem{\"a}ßiger Mammographie und Gebrauch weiterer apparativer Verfahren nur bei symptomatischen Patienten oder klinischem Tumorverdacht. Anhand von 701 Patientinnen mit Brustkrebs und beendeter Prim{\"a}rtherapie sowie Metastasenfreiheit zu Studienbeginn wurden in der vorliegenden prospektiven Arbeit die einzelnen klinischen, bildgebenden und laborchemischen Untersuchungen in der Nachsorge hinsichtlich ihrer Effizienz bei der Entdeckung einer Reaktivierung bewertet. Allgemeine Ergebnisse waren, dass nur wenige Patientinnen von sich aus Beschwerden angaben. Schon deshalb sollte großer Wert auf die Anamnese und die klinische Untersuchung gelegt werden. Die Beschwerden waren nur f{\"u}r 1/3 der Patientinnen ein Grund, sich fr{\"u}hzeitig vorzustellen. Die Patientinnen sollten ermuntert werden, Auff{\"a}lligkeiten dem Arzt mitzuteilen und in diesem Fall nicht bis zum n{\"a}chsten vorgegebenen Nachsorgetermin warten. Ein lokoregionales bzw. kontralaterales Rezidiv wurde bei insgesamt 43 Patientinnen nachgewiesen. Zu 88\% konnte das Rezidiv durch Auff{\"a}lligkeiten in der klinischen Untersuchung vermutet und mit nachfolgenden weiterf{\"u}hrenden Untersuchungen gesichert werden. Bei 5 Patientinnen (12\% der Rezidive) wurde das Rezidiv allein durch die routinem{\"a}ßig durchgef{\"u}hrte Mammographie erkannt. Von den 48 Patientinnen mit Metastasierung wurde die Reaktivierung bei 58\% durch entsprechende Symptome der Patientinnen oder durch die klinische Untersuchung vermutet und in weiterf{\"u}hrenden Untersuchungen gesichert. Durch Untersuchungen, die aufgrund erh{\"o}hter Tumormarker, aufgrund eines Anstiegs der alkalischen Phosphatase oder anderer Enzyme bzw. aufgrund eines Lokalrezidivs zur Fernmetastasensuche veranlasst wurden, konnten 42\% der Metastasierungen gesichert werden. Bei Betrachtung der einzelnen Untersuchungen l{\"a}sst sich bez{\"u}glich ihrer Effizienz, eine Reaktivierung zu entdecken, folgendes feststellen: Von den Untersuchungen, die ohne klinische Selektion routinem{\"a}ßig oder bei Symptomen zus{\"a}tzlich durchgef{\"u}hrt wurden, zeigte die R{\"o}ntgenaufnahme des Thorax die gr{\"o}ßte Effizienz, gefolgt von den klinischen Untersuchungen der Brust/ Brustwand bzw. der Axilla und der Mammographie. Von den Laborparametern war das CA 15-3 am effizientesten. Insgesamt war die Effizienz der Laborparameter jedoch gering. Einschr{\"a}nkend ist zu sagen, dass alle Patientinnen mit Metastasierung im Thoraxbereich auch entsprechende Befunde/ Symptome hatten, die Anlass zur R{\"o}ntgenaufnahme des Thorax gaben. Von den Untersuchungen, die nur nach klinischer/ radiologischer/ laborchemischer Selektion und zum Teil in sehr seltenen F{\"a}llen durchgef{\"u}hrt wurden, waren die Punktionszytologien/ Stanzbiopsien am effizientesten, gefolgt von der Skelettszintigraphie und dem CT. Diesen folgten die Lebersonographie, die Sonographie der Mamma, R{\"o}ntgenaufnahmen des Skeletts und das Blutbild. Den Ergebnissen dieser Untersuchung zufolge scheint beim Mammakarzinom eine Nachsorge, die auf einer sorgf{\"a}ltigen Anamnese, eingehender Beurteilung des lokoregion{\"a}ren Bereichs, gr{\"u}ndlicher k{\"o}rperlicher Untersuchung und routinem{\"a}ßigem Einsatz der Mammographie beruht, gerechtfertigt. Nur bei sich daraus ergebendem klinischen Verdacht auf eine Reaktivierung erscheinen weiterf{\"u}hrende Untersuchungen indiziert, da - unselektioniert eingesetzt- ihre Effizienz gering ist.}, language = {de} }