610 Medizin und Gesundheit
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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.
Hintergrund: Der EGILS (European Gastro-Intestinal Lymphoma Study) Consensus Report von 2011 enthält als zentralen Therapiebaustein die H.p.-Eradikationsbehandlung mit nachfolgendem „Watch-and-Wait“ bzw. die Nachsorge nach Vollremission. Voraussetzung für eine strukturierte Nachsorge ist eine gute Patientencompliance. Eine Studie über Dauer und praktische Umsetzbarkeit der Nachsorge, insbesondere nach Vollremission, gibt es bisher nicht.
Ziel: Ziel dieser retrospektiven Arbeit war es zu überprüfen, 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 Berücksichtigung des Therapieerfolgs eine Empfehlung für optimale Nachsorgeintervalle nach klinischer Vollremission erarbeitet werden.
Methode: 106 Patienten (50 weiblich; 56 männlich); 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 gemäß EGILS (alle 4-6 Monate); danach erfolgte die Nachsorge alle 6 bis 12 Monate. Die Compliance wurde bei jedem Patienten als das Verhältnis aus erfüllter Nachsorgepflicht zu individueller Gesamtdauer der Nachsorge berechnet und über alle Patienten gemittelt.
Ergebnisse: Die meisten Patienten erreichen nach alleiniger H.p.-Eradikation unabhängig vom H.p.-Status eine Vollremission (ca. 71%). Die Nachsorgen wurden über den gesamten Beobachtungszeitraum zu ca. 55% eingehalten. Patienten mit Interesse an einer Nachsorge nehmen diese über Jahre hinweg sehr zuverlässig war. In dieser Patientengruppe liegt die Compliance bei ca. 95%.
Schlussfolgerung: Die exzellente Prognose gastraler MALT-Lymphome, unabhängig vom H.p.-Status, und die hohe Bereitschaft der Patienten für Nachsorgeuntersuchungen auch nach Vollremission erhöht die Attraktivität einer „Watch-and-Wait“-Strategie. Nach klinischer Vollremission sind jährliche endoskopische Nachsorgeuntersuchungen praktisch umsetzbar.
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.
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.
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.
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.
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.
131 Patienten mit Sarkoidose der Medizinischen Klinik und Poliklinik I in Würzburg wurden rückblickend anhand der vorliegenden Krankenakten untersucht. Hierbei wurden insbesondere Daten zu Symptomen, Laboruntersuchungen, Lungenfunktionsuntersuchungen sowie radiologischen Untersuchungen gesammelt und ausgewertet. Es wird ein allgemeiner Überblick über die Häufigkeit der einzelnen Symptombereiche sowie Untersuchungsbefunde gegeben. Des weiteren wird anhand eines Bewertungsscores der Erkrankungsverlauf der Patienten abgebildet.
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.
In dieser Arbeit wurde untersucht, ob es bei der Nachsorge von Patienten in erster kompletter Remission (CR) einer akuten myeloischen Leukämie (AML) Parameter gibt, deren Veränderung ein Rezidiv ankündigen und ob die Struktur des Nachsorgeprogramms geeignet ist, ein Rezidiv frühzeitig 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 hausärztlichen Kontrolle zu stellen. Am Rezidivtermin zeigten alle Rezidivpatienten pathologische Veränderungen von LDH, Hämoglobin, Leuko- oder Thrombozyten. Der Rezidivverdacht wurde also nicht erst durch eine Knochenmarkpunktion gestellt. Für viele AML Patienten in erster CR sind regelmäßige Kontrolluntersuchungen beim Hausarzt ausreichend, eine Knochenmarkpunktion ist nicht routinemäßig erforderlich.