32 results on '"Jörg Pelz"'
Search Results
2. Peritoneum
- Author
-
Jörg Pelz
- Published
- 2021
3. Scoring Systems for CRS and HIPEC
- Author
-
Jörg Pelz and Pankaj Kumar Garg
- Subjects
Peritoneal malignancy ,medicine.medical_specialty ,Scoring system ,Quality of life ,business.industry ,medicine ,Patient evaluation ,Perioperative ,Peritoneal diseases ,Intensive care medicine ,business - Abstract
Effective patient selection is key in minimizing perioperative morbidity and mortality scores to evaluate the extent of peritoneal disease and help identify patients most likely to benefit from CRS and HIPEC. Although prolonged survival is often the focus of treatment, this must be balanced against impaired quality of life. In this chapter we summarize the most frequently used scoring systems for patients with peritoneal malignancy.
- Published
- 2021
4. Stadiengerechte Therapie der akuten Divertikulitis anhand der neuen Klassifikation der Divertikelkrankheit
- Author
-
Stefanie Alexandra Lang, Jörg Pelz, Eyleen Wagner, Joachim Reibetanz, Johan Friso Lock, Christoph-Thomas Germer, and Patrick Schneider
- Subjects
Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Acute diverticulitis ,business.industry ,Diverticular disease ,medicine ,030211 gastroenterology & hepatology ,Surgery ,030230 surgery ,business - Abstract
Zusammenfassung Hintergrund In den vergangenen Jahren gab es einen deutlichen Wandel in den Therapieempfehlungen der akuten Divertikulitis. Die stadiengerechte Therapie orientiert sich an der neuen Klassifikation der Divertikelkrankheit aus der aktuellen Leitlinie. Patienten und Methode Erfasst wurden alle Patienten, die in den Jahren 2010 bis 2014 wegen einer akuten Divertikulitis im Universitätsklinikum Würzburg behandelt wurden. Einschlusskriterium für die Auswertung war das Vorhandensein einer Computertomografie zur Stadieneinteilung. Ergebnisse Gut die Hälfte der untersuchten Patienten (n = 135, 52,9%) hatte bei Aufnahme eine akute unkomplizierte Divertikulitis, 112 (43,2%) wiesen eine gedeckte Perforation (Mikroabszess n = 63, 24,3%; bzw. Makroabszess n = 49, 18,9%), 12 Patienten (4,6%) eine freie Perforation auf. Bei insgesamt 150 (57,9%) Patienten war es der 1. Schub einer Divertikulitis, eine gedeckte (66,1%) oder eine freie Perforation (75,0%) trat dabei überdurchschnittlich häufig als Erstmanifestation auf. Knapp zwei Drittel (66,4%, n = 168) der Patienten wurden im Verlauf sigmareseziert. Diskussion und Schlussfolgerung Trotz des Trends hin zu einer konservativen Therapie der akuten Divertikulitis bleibt die (elektive) Sigmaresektion nach wie vor ein zentraler Bestandteil in der Therapie über alle Stadien hinweg. Die Indikationsstellung ist jedoch heutzutage deutlich differenzierter und erfordert neben der individuellen Klassifikation der Entzündungssituation auch Kenntnisse über die individuelle krankheitsspezifische Prognose in Bezug auf Rezidivwahrscheinlichkeit und Lebensqualität.
- Published
- 2018
5. Registries on peritoneal surface malignancies throughout the world, their use and their options
- Author
-
Ingvar Syk, Ignace H J T de Hingh, François Noël Gilly, Paul H. Sugarbaker, Kurt Van der Speeten, Roman Yarema, Sarah T O'Dwyer, Jurgen Mulsow, Beate Rau, Y. Yonemura, Lene Hjerrild Iversen, Faheez Mohamed, Santiago González-Moreno, Rami Younan, Olivier Glehen, Victor J. Verwaal, Heikki Takala, Kusamura Shigeki, Jörg Pelz, and Faek R. Jamali
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,Palliative care ,Peritoneal surface ,Physiology ,Peritoneal Surface Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Journal Article ,medicine ,Humans ,Registries ,Peritoneal Neoplasms ,business.industry ,Intraperitoneal chemotherapy ,medicine.disease ,Surgery ,Patient recruitment ,General purpose ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Medical emergency ,business ,Cytoreductive surgery - Abstract
The treatment of peritoneal surface malignancies ranges from palliative care to full cytoreductive surgery (CRS) and Heated Intraperitoneal Chemotherapy HIPEC. Ongoing monitoring of patient recruitment and volume is usually carried out through dedicated registries. With multiple registries available worldwide, we sought to investigate the nature, extent and value of existing worldwide CRS and HIPEC registries.METHODS: A questionnaire was sent out to all known major treatment centres. The questionnaire covers: general purpose of the registry; inclusion criteria in the registry; the date the registry was first established; volume of patients in the registry and description of the data fields in the registries. Finally, the population size of the catchment area of the registry was collected.RESULTS: 27 questionnaires where returned. National databases are established in northwest European countries. There are five international general databases. Most database collect data on patients who have undergone an attempt to CRS and HIPEC. Two registries collect data on all patients with peritoneal carcinomatosis regardless the treatment. Most registries are primarily used for tracking outcomes and complications. When correlating the number of cases of CRS and HIPEC that are performed to the catchment area of the various registry, a large variation in the number of performed procedures related to the overall population was noted, ranging from 1.3 to 57 patients/million year with an average of 15 patients/1 million year.CONCLUSION: CRS and HIPEC is a well-established treatment for peritoneal surface malignancies worldwide. However, the coverage as well as the registration of treatment procedures differs widely. The most striking difference is the proportion of HIPEC procedures per capita which ranges from 1.3 to 57 patients per million. This suggests either a difference in patient selection, lack of access to HIPEC centres or lack of appropriate data collection.
- Published
- 2017
6. Peritoneal metastasis in gastric cancer: results from the German database
- Author
-
Visceral Surgery, Alfred Königsrainer, Ingmar Königsrainer, Michael Hünerbein, Hans-Jürgen Schlitt, Beate Rau, Andreas Brandl, Rüdiger Hörbelt, Pompiliu Piso, Stefan Beckert, Marc Roitman, Faik Uzunoglu, Udo Sulkowski, Cedric Demtröder, Silke Schüle, Peter Busch, Michael A. Ströhlein, Jürgen Tepel, and Jörg Pelz
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Peritoneal metastasis ,Databases, Factual ,Antineoplastic Agents ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Surgical oncology ,Stomach Neoplasms ,Germany ,medicine ,Humans ,Survival rate ,Peritoneal Neoplasms ,business.industry ,Gastroenterology ,Cancer ,General Medicine ,Cytoreduction Surgical Procedures ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Oncology ,030220 oncology & carcinogenesis ,Conventional PCI ,030211 gastroenterology & hepatology ,Hyperthermic intraperitoneal chemotherapy ,Female ,business ,Cytoreductive surgery ,Abdominal surgery - Abstract
Patients with peritoneal metastases of gastric cancer have a poor prognosis with a median survival of 7 months. A benefit of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) could be shown in several selected patient cohorts but remains controversial. The aim of this study was, to reflect the results of a national German HIPEC registry initiated by the German Society of General and Visceral Surgery (DGAV). The DGAV HIPEC registry StuDoQ|Peritoneum documents patients with peritoneal malignancy contributed from 52 hospitals. All consecutive documented patients from 2011 until 2016 (n = 3078) were treated with CRS and HIPEC and were analysed. A total of 315 (10%) suffered from gastric cancer and were analysed. A complete data set of 235 patients was available for this study, including 113 male (48.1%) and 122 female (51.9%) patients with a median age of 53.4 years (SD ± 11.9). The median PCI was 8.0 (range 1–30). A complete cytoreduction was achieved in 121 patients (71.6%). Postoperative complications (Clavien–Dindo grades 3–4) occurred in 40 patients (17%). The median overall survival (OS) time was 13 months. The 5-year survival rate was 6%. According to the PCI from 0–6 (n = 74); 7–15 (n = 70) and 16–39 (n = 24) the median OS differs significantly (18 months vs. 12 months vs. 5 months; p = 0.002). CRS and HIPEC in selected patients with gastric cancer and peritoneal spread can improve survival when they are treated in centers. An accurate staging and patient selection are of major importance to achieve long-term survival.
- Published
- 2018
7. [Classification of Acute Diverticulitis for Stage-directed Therapy]
- Author
-
Johan Friso, Lock, Patrick, Schneider, Stefanie Alexandra, Lang, Eyleen, Wagner, Jörg, Pelz, Joachim, Reibetanz, and Christoph Thomas, Germer
- Subjects
Cohort Studies ,Male ,Germany ,Acute Disease ,Humans ,Female ,Middle Aged ,Severity of Illness Index ,Diverticulitis - Abstract
In recent years, there has been a significant change in the treatment recommendations for acute diverticulitis. In order to provide the right treatment to the individual patient, it is therefore important to classify the stage of the disease accurately, after taking various aspects into consideration.Patients treated for acute diverticulitis in Würzburg University Hospital during 2010 to 2014 were included. Inclusion criteria were the presence of a computer tomography for disease classification.More than half of the patients examined (n = 135, 52.9%) had acute uncomplicated diverticulitis on admission; 112 (43.2%) had a covered perforation (small paracolic abscess n = 63, 24,3%; large abscess n = 49, 18,9%) and 12 (4.6%) a free perforation. In a total of 150 (57.9%) patients, this was the first episode of diverticulitis, with a covered (66.1%) or a free perforation (75.0%) occurring at a higher than average rate as the first manifestation. Nearly two-thirds (66.4%, n = 168) of patients underwent sigmoid resection during follow-up.Despite current trends towards more conservative therapy of acute diverticulitis, sigmoid resection remains a corner stone of successful therapy throughout all types of acute diverticulitis. The indication of sigmoid resection nowadays requires profound knowledge of the individual prognosis for recurrent diverticulitis and quality of life.In den vergangenen Jahren gab es einen deutlichen Wandel in den Therapieempfehlungen der akuten Divertikulitis. Die stadiengerechte Therapie orientiert sich an der neuen Klassifikation der Divertikelkrankheit aus der aktuellen Leitlinie.Erfasst wurden alle Patienten, die in den Jahren 2010 bis 2014 wegen einer akuten Divertikulitis im Universitätsklinikum Würzburg behandelt wurden. Einschlusskriterium für die Auswertung war das Vorhandensein einer Computertomografie zur Stadieneinteilung.Gut die Hälfte der untersuchten Patienten (n = 135, 52,9%) hatte bei Aufnahme eine akute unkomplizierte Divertikulitis, 112 (43,2%) wiesen eine gedeckte Perforation (Mikroabszess n = 63, 24,3%; bzw. Makroabszess n = 49, 18,9%), 12 Patienten (4,6%) eine freie Perforation auf. Bei insgesamt 150 (57,9%) Patienten war es der 1. Schub einer Divertikulitis, eine gedeckte (66,1%) oder eine freie Perforation (75,0%) trat dabei überdurchschnittlich häufig als Erstmanifestation auf. Knapp zwei Drittel (66,4%, n = 168) der Patienten wurden im Verlauf sigmareseziert.Trotz des Trends hin zu einer konservativen Therapie der akuten Divertikulitis bleibt die (elektive) Sigmaresektion nach wie vor ein zentraler Bestandteil in der Therapie über alle Stadien hinweg. Die Indikationsstellung ist jedoch heutzutage deutlich differenzierter und erfordert neben der individuellen Klassifikation der Entzündungssituation auch Kenntnisse über die individuelle krankheitsspezifische Prognose in Bezug auf Rezidivwahrscheinlichkeit und Lebensqualität.
- Published
- 2018
8. Morbidity and Mortality Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Data from the DGAV StuDoQ Registry with 2149 Consecutive Patients
- Author
-
Sebastian D. Nedelcut, Rüdiger Hörbelt, Pompiliu Piso, Michael A. Ströhlein, Beate Rau, Alfred Königsrainer, Gabriel Glockzin, and Jörg Pelz
- Subjects
Male ,medicine.medical_specialty ,Colectomies ,medicine.medical_treatment ,Anastomosis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Hospital Mortality ,Registries ,Survival rate ,Peritoneal Neoplasms ,Aged ,Retrospective Studies ,Chemotherapy ,business.industry ,Retrospective cohort study ,Odds ratio ,Cytoreduction Surgical Procedures ,Hyperthermia, Induced ,Prognosis ,Combined Modality Therapy ,Confidence interval ,Surgery ,Survival Rate ,Oncology ,030220 oncology & carcinogenesis ,Chemotherapy, Cancer, Regional Perfusion ,030211 gastroenterology & hepatology ,Hyperthermic intraperitoneal chemotherapy ,Female ,Morbidity ,business ,Follow-Up Studies - Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are performed for well-selected patients with peritoneal surface malignancies. This combined treatment is potentially associated with an increased rate of complications. The aim of this paper was to analyze the morbidity and mortality of CRS and HIPEC in the German national registry. We present a retrospective analysis of 2149 consecutive patients from 52 hospitals. The data were prospectively documented in the DGAV StuDoQ Registry between February 2011 and December 2016. Almost two-thirds of all patients had a colorectal malignancy; therefore, the most frequently performed resections were colectomies (54%) and rectal resections (30%). Only 36.2% of all patients had no anastomosis, and fewer than 20% of all patients were older than 70 years of age (16.4%). Enteric fistula and anastomotic leaks occurred in 10.5% of all cases. The reoperation rate was 14.6% (95% confidence interval [CI] 11.51–18.1). Major grade 3 and 4 complications (Clavien–Dindo classification) occurred in 19.3% of all patients, half of which were due to surgical complications. The overall 30-day postoperative hospital mortality was 2.3% (95% CI 1.02–3.85). Multivariate analysis showed an increased risk for morbidity associated with pancreatic resections (odds ratio [OR] 2.4), rectal resection (OR 1.5), or at least one anastomosis (OR 1.35), and mortality with reoperation (OR 8.7) or age > 70 years (OR 3.35). CRS and HIPEC are associated with acceptable morbidity and low mortality. These results show that CRS and HIPEC can be safely performed nationwide when close mentoring by experienced centers is provided.
- Published
- 2018
9. Perioperative Systemic Chemotherapy, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy in Patients With Colorectal Peritoneal Metastasis: Results of the Prospective Multicenter Phase 2 COMBATAC Trial
- Author
-
Gabriel Glockzin, Hans J. Schlitt, Dirk Arnold, Florian Zeman, Roland S. Croner, Michael A. Ströhlein, Michael Koller, Beate Rau, Jörg Pelz, Pompiliu Piso, and Alfred Königsrainer
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,Population ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Clinical endpoint ,Humans ,education ,Peritoneal Neoplasms ,Aged ,Retrospective Studies ,education.field_of_study ,Cetuximab ,business.industry ,Gastroenterology ,Common Terminology Criteria for Adverse Events ,Perioperative ,Cytoreduction Surgical Procedures ,Hyperthermia, Induced ,Middle Aged ,medicine.disease ,Prognosis ,Combined Modality Therapy ,Survival Rate ,Regimen ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Hyperthermic intraperitoneal chemotherapy ,Female ,business ,Colorectal Neoplasms ,medicine.drug ,Follow-Up Studies - Abstract
Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as parts of an interdisciplinary treatment concept including systemic chemotherapy can improve survival of selected patients with peritoneal metastatic colorectal cancer (pmCRC). Nevertheless, the sequence of the therapeutic options is still a matter of debate. Thus, the COMBATAC (COMBined Anticancer Treatment of Advanced Colorectal cancer) trial was conducted to evaluate a combined treatment regimen consisting of preoperative systemic polychemotherapy + cetuximab followed by CRS + HIPEC and postoperative systemic polychemotherapy + cetuximab. Patients and Methods The COMBATAC trial is a prospective, multicenter, open-label, single-arm, single-stage phase 2 trial. Twenty-six patients with synchronous or metachronous colorectal or appendiceal peritoneal carcinomatosis were included. Enrollment was terminated prematurely by the sponsor because of slow recruitment. Progression-free survival as primary end point and overall survival were estimated by the Kaplan-Meier method. Also evaluated were morbidity according to Common Terminology Criteria for Adverse Events v4.0 and feasibility of the combined treatment concept. Results Median progression-free survival for the intention-to-treat population (n = 25) was 14.9 months. Median overall survival was not reached during the study duration. Ninety-two adverse events were documented in 16 patients, including 14 serious adverse events in 9 patients. The overall morbidity rate was 64%, and the grade 3/4 morbidity rate was 44%. Of all grade 3/4 morbidity events, 36.4% were related to systemic chemotherapy and 22.7% to surgery, whereas 40.9% were not directly related. There was no treatment-related mortality. Conclusion The results of the COMBATAC trial show that the multimodal treatment concept consisting of perioperative systemic chemotherapy and CRS + HIPEC is safe and feasible. Progression-free survival in selected patients with colorectal or appendiceal peritoneal metastasis might be improved.
- Published
- 2018
10. Fertilitätserhalt bei onkologischen Erkrankungen. Leitlinie der DGGG, DGU, DGRM (S2k-Level, AWMF-Registernummer 015/082, September 2017) - Empfehlungen und Statements bei Mädchen und Frauen
- Author
-
Tanja Fehm, Stefan Schlatt, Maren Goeckenjan, Julia Meißner, Ariane Germeyer, Thorsten Diemer, Frank-Michael Köhn, Oliver Micke, Ute Hehr, Beate Hornemann, Frank Nawroth, Anja Borgmann-Staudt, Wilfried Hoffmann, Michael P. Lux, Nicole Reisch, Ludwig Wildt, Dagmar Guth, Laura Lotz, Najib Nassar, Ramona Beck, Franc Hetzer, Patricia G. Oppelt, Annekathrin Sender, Matthias Korell, Verena Nordhoff, Christian Denzer, Friederike Siedentopf, Michael von Wolff, Dorothea Riesenbeck, H. Kentenich, Wolfgang Cremer, Jens Hirchenhain, Jana Liebenthron, Petra Thorn, Sigurd Lax, Andreas N. Schüring, Sabine Kliesch, Ludwig Kiesel, R Schwab, Pirus Ghadjar, Andreas Jantke, Matthias W. Beckmann, Almut Dorn, Berthold P. Hauffa, Karolin Behringer, Steffen Wagner, Jörg Pelz, Ralf Dittrich, Pauline Wimberger, Tewes Wischmann, Rüdiger Gaase, Falk Ochsendorf, Magdalena Balcerek, DM Baston-Büst, Beate Rau, Kristina Geue, and Martin Götte
- Subjects
medicine.medical_specialty ,fertility preservation ,Fertilitätserhalt ,Medizin ,Reproductive medicine ,onkologische Erkrankungen ,610 Medicine & health ,Reproductive age ,Commission ,Guideline/Leitlinie ,Malignant disease ,German ,03 medical and health sciences ,0302 clinical medicine ,Maternity and Midwifery ,Medicine ,GebFra Science ,Fertility preservation ,Leitlinie ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Guideline ,language.human_language ,oncologic diseases ,030220 oncology & carcinogenesis ,Family medicine ,language ,Professional association ,business ,guideline - Abstract
Aim The aim of this official guideline published by the German Society of Gynecology and Obstetrics (DGGG) and coordinated with the German Society of Urology (DGU) and the German Society of Reproductive Medicine (DGRM) is to provide consensus-based recommendations, obtained by evaluating the relevant literature, on counseling and fertility preservation for prepubertal girls and boys as well as patients of reproductive age. Statements and recommendations for girls and women are presented below. Statements or recommendations for boys and men are not the focus of this guideline. Methods This S2k guideline was developed at the suggestion of the guideline commission of the DGGG, DGU and DGRM and represents the structured consensus of representative members from various professional associations (n = 40). Recommendations The guideline provides recommendations on counseling and fertility preservation for women and girls which take account of the patient's personal circumstances, the planned oncologic therapy and the individual risk profile as well as the preferred approach for selected tumor entities. Ziel Das Ziel dieser offiziellen Leitlinie, die von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) publiziert und zusammen mit der Deutschen Gesellschaft für Urologie (DGU) sowie Deutschen Gesellschaft für Reproduktionsmedizin (DGRM) koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur konsensbasierte Handlungsempfehlungen für die Beratung und den Einsatz von fertilitätserhaltenden Maßnahmen bei präpubertären Mädchen und Jungen sowie für Patienten/-innen im reproduktiven Alter zu geben. Im Folgendem werden die Statements und Empfehlungen für Mädchen und Frauen dargestellt. Die Statements und Empfehlungen für Jungen und Männer sind nicht Inhalt dieser Publikation. Methoden Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Fachgesellschaften (n = 40) im Auftrag der Leitlinienkommission der DGGG, DGU und DGRM entwickelt. Empfehlungen Es werden Empfehlungen zur Beratung und dem Einsatz von fertilitätserhaltenden Maßnahmen bei Patientinnen unter Berücksichtigung der Lebensumstände, der geplanten onkologischen Therapie und des individuellen Risikoprofils dargestellt sowie über das Vorgehen bei ausgewählten Tumorentitäten.
- Published
- 2018
- Full Text
- View/download PDF
11. Impact of adjuvant chemotherapy after neoadjuvant radio- or radiochemotherapy for patients with locally advanced rectal cancer
- Author
-
Sven Lichthardt, Alexander Kerscher, Volker Kunzmann, Johannes Baur, Lisa Zenorini, Johanna Wagner, Jörg Pelz, Niels Matthes, C. Kastner, Armin Wiegering, and Christoph-Thomas Germer
- Subjects
Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Subgroup analysis ,Adenocarcinoma ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Adjuvant therapy ,Humans ,Prospective Studies ,Neoadjuvant therapy ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,business.industry ,Rectal Neoplasms ,General Medicine ,Chemoradiotherapy ,Middle Aged ,medicine.disease ,Prognosis ,Neoadjuvant Therapy ,Survival Rate ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Cohort ,030211 gastroenterology & hepatology ,Female ,business ,Adjuvant ,Follow-Up Studies - Abstract
Due to its primarily extraperitoneal location, potential affection of the anorectal continence and different metastatic behavior the rectal carcinoma (RC) is classified and treated as an independent disease. Over the past few decades various trials have led to improved multimodal therapies (including radiation, chemotherapy and surgery) for locally advanced rectal cancer and significant changes in the management of this disease whereas the benefit of adjuvant chemotherapy remains unclear. Based on a prospective tumor register of the University Hospital of Wuerzburg data of 263 patients having undergone neoadjuvant therapy and surgical resection for locally advanced rectal cancer were retrieved from the Wuerzburg International database (WID) between October 1992 and September 2013 analyzing the overall survival according to the application of an adjuvant therapy. The cohort consisted of 263 patients with a median age of 65 years (27–89 years), mostly male gender (n = 191; 72.6%) and an ASA performance score of II or III. 143 patients (54.3%) received an adjuvant therapy. Those patients have been significant younger (median 10 years; p
- Published
- 2017
12. Chemotherapy in peritoneal carcinomatosis of gastrointestinal origin
- Author
-
Jörg Pelz and Jesus Esquivel
- Subjects
medicine.medical_specialty ,Chemotherapy ,business.industry ,Internal medicine ,medicine.medical_treatment ,Medicine ,business ,Gastroenterology ,Peritoneal carcinomatosis - Published
- 2014
13. Peritoneal Carcinomatosis: Registry and Centers in Germany
- Author
-
Jörg Pelz
- Subjects
medicine.medical_specialty ,business.industry ,Gastroenterology ,medicine ,Surgery ,Cytoreductive surgery ,Intensive care medicine ,business ,Objective quality ,Peritoneal carcinomatosis - Abstract
Background: At present, there are only few objective quality criteria for the treatment of peritoneal carcinomatosis using cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (HIPEC). Method and Results: However, because this therapy is associated with significant morbidity and mortality, such quality criteria are quite important. Accreditation of peritoneal carcinomatosis centers by the German Society for General and Visceral Surgery was a first step towards establishing these clinics. Conclusion: One key requirement for accreditation is membership in the German Peritoneal Carcinomatosis Registry. This prospective database provides a collation and evaluation of the epidemiological and therapeutic factors relating to this disease.
- Published
- 2013
14. Gesundheitsökonomie und das deutsche Gesundheitswesen : Ein praxisorientiertes Lehrbuch für Studium und Beruf
- Author
-
Martin H. Wernitz, Jörg Pelz, Martin H. Wernitz, and Jörg Pelz
- Subjects
- Medical care--Germany--Cost effectiveness, Medical care--Germany
- Abstract
Das Werk bietet einen praxisnahen und allgemeinverständlichen Einstieg in die Gesundheitsökonomie. Es gibt einen umfassenden Überblick über das Fach sowie die komplexen Strukturen des deutschen Gesundheitswesens; alltagsnahe Beispiele und eine klare didaktische Struktur erleichtern das Verständnis sowie den Transfer von der Theorie in die Praxis. Fragen zur Lernkontrolle runden die einzelnen Kapitel ab.
- Published
- 2015
15. Peritoneal Carcinomatosis: Cytoreductive Surgery and HIPEC–-Overview and Basics
- Author
-
Michael A. Ströhlein, Olivier Glehen, Pompiliu Piso, Yutaka Yonemura, Alfred Königsrainer, Jörg Pelz, David L. Morris, Marcello Derraco, David L. Bartlett, Santiago González-Moreno, Edward A. Levine, Björn L.D.M. Brücher, Alfredo Garofalo, Aviram Nissan, Vic J. Verwaal, and Jesus Esquivel
- Subjects
Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,Antineoplastic Agents ,Disease ,Intensive care ,Anesthesiology ,medicine ,Humans ,Combined Modality Therapy ,Laparoscopy ,Peritoneal Neoplasms ,medicine.diagnostic_test ,business.industry ,Cancer ,Hyperthermia, Induced ,General Medicine ,Prognosis ,medicine.disease ,Surgery ,Oncology ,Hyperthermic intraperitoneal chemotherapy ,Peritoneum ,business ,Injections, Intraperitoneal - Abstract
Tumor involvement of the peritoneum-peritoneal carcinomatosis-is a heterogeneous form of cancer that had been generally regarded as a sign of systemic tumor disease and as a terminal condition. The multimodal treatment approach for patients with peritoneal carcinomatosis, which had been conceived and developed, consists of what is known as cytoreductive surgery, followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Depending on the tumor mass as assessed intraoperatively and the histopathological differentiation, patients who undergo cytoreductive surgery and HIPEC have a significant survival benefit. Mean increases in the survival period ranging from six months to up to four years have now been reported. In view of the substantial logistic effort and the extent of the surgery involved, this treatment approach represents a major challenge both for patients and for surgical oncologists, as well as for the members of the overall interdisciplinary structure required, which includes oncology, anesthesiology and intensive care, psycho-oncology, and patient management. The surgical procedures alone may take 8-14 hr. The present paper provides an overview of the basis for the approach and the use of specialized classifications and quantitative prognostic indicators.
- Published
- 2012
16. Expression of Chemoresistance-Related Genes and Heat Shock Protein 72 in Hyperthermic Isolated Limb Perfusion of Malignant Melanoma: An Experimental Study
- Author
-
C. Knorr, Thomas J. Meyer, Jörg Pelz, Werner Hohenberger, and Jonas Göhl
- Subjects
Drug ,Hyperthermia ,Pathology ,medicine.medical_specialty ,Article Subject ,medicine.diagnostic_test ,business.industry ,Multidrug resistance-associated protein 2 ,media_common.quotation_subject ,Melanoma ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,lcsh:RC254-282 ,Oncology ,Western blot ,Heat shock protein ,medicine ,Cancer research ,business ,Gene ,Perfusion ,Research Article ,media_common - Abstract
Hyperthermic isolated limb perfusion (HILP) is considered an established treatment for multiple locoregional intransit metastases in malignant melanoma of the extremities. Various mechanisms such as the expression of chemoresistance genes and heat shock proteins by the tumor may be responsible for varying response rates and locoregional recurrences of the treatment. The aim of the experimental animal study was to investigate the direct impact of HILP on such mechanisms of resistance. Tissue temperature, administration of the cytostatic drug, and duration of perfusion were varied. Expression of the chemoresistance genes mdr1, mrp1, mrp2, and lrp and of heat shock protein 72 (HSP72) in the tumor tissue was analysed using RT-PCR and western blot analysis. The untreated SK-MEL-3 tumor expressed mdr1, mrp1, and lrp, but not mrp2. Neither variation of temperature, administration of the cytostatic drug, nor duration of perfusion changed the expression of this “resistance pattern”. In contrast to the cytostatic drug, hyperthermia causes a persistent induction of HSP72. Both observations could offer a potential explanation for failure of HILP in malignant melanoma.
- Published
- 2010
17. Hyperthermic intraperitoneal chemoperfusion (HIPEC) decrease wound strength of colonic anastomosis in a rat model
- Author
-
Jörg Pelz, Joerg Doerfer, Arno Dimmler, M. Decker, Werner Hohenberger, and T. Meyer
- Subjects
Male ,Hyperthermia ,medicine.medical_specialty ,Time Factors ,Colon ,Mitomycin ,medicine.medical_treatment ,Down-Regulation ,Anastomosis ,Surgical anastomosis ,Hypothermia, Induced ,Colon surgery ,Tensile Strength ,Pressure ,medicine ,Animals ,Digestive System Surgical Procedures ,Inflammation ,Wound Healing ,Chemotherapy ,Antibiotics, Antineoplastic ,business.industry ,Foreign-Body Reaction ,Anastomosis, Surgical ,Mitomycin C ,Gastroenterology ,Rats, Inbred Strains ,Hypothermia ,medicine.disease ,Rats ,Surgery ,Chemotherapy, Cancer, Regional Perfusion ,Anesthesia ,Models, Animal ,Collagen ,medicine.symptom ,Wound healing ,business - Abstract
There is controversy about the effect of the influence of hyperthermia and chemotherapeutic agents on the healing of intestinal anastomosis. The effects of hyperthermic intraperitoneal chemoperfusion (HIPEC) of wound healing after colonic anastomosis were investigated in a rat model.Thirty-six Wag/Rija rats were randomized into three groups of 12 animals each: group I: control (only colonic anastomosis was performed) (n = 12); group II: HIPEC (mitomycin C in a concentration of 20 mg/m(2) (n = 12) colonic anastomosis was performed before HIPEC; group III: HIPEC (mitomycin C in a concentration of 20 mg/m(2) (n = 12) colonic anastomosis was performed after HIPEC. Bursting pressure and bursting sites were recorded 4 and 10 days after intervention. Collagen deposits, inflammation and foreign body reactions were evaluated.Lower bursting pressure and lost of collagen were found in both HIPEC groups and compared with the control group. There was almost no difference between both HIPEC groups. They were noted overwhelmingly at the anastomosis in the HIPEC group. The degree of collagen accumulation was well-correlated with bursting pressure.These results have shown that hyperthermic intraperitoneal chemoperfusion (HIPEC) impairs wound healing in colonic anastomosis in rats.
- Published
- 2007
18. Practitioner Research Literacy Skills
- Author
-
Jörg Pelz, Harm Peters, and Wolfgang Köhler
- Subjects
Medical education ,Information literacy ,Graduate medical education ,Core competency ,Medicine (miscellaneous) ,Practitioner research ,Interpersonal communication ,Education ,law.invention ,Skills management ,law ,Venn diagram ,Psychology ,Accreditation - Abstract
The Model: For their model the authors used the six core competencies: (a) patient care, (b) medical knowledge, (c) practice based learning and improvement, (d) system based practice, (e) interpersonal and communication skills, (f) professionalism, as outlined by the Accreditation Council for Graduate Medical Education (ACGME) and some specific ‘skills sets’.2 With a Venn diagram of three sets they illustrated how the core competencies and the skills of their model are interrelated. A Venn diagram represents all possible logical relations between a finite collection of setseven a ‘metaphorical Venn diagram’ should follow this rule. The challenge to represent six core competencies with three sets is partly solved by combining competencies (a) and (b) in one set: these competencies characterize what a medical practitioner does. It fails for competencies (e) and (f) since these are no subsets of the other core competencies, but core competencies of their own. We would highly recommend to utilize a higher order Venn diagram.3
- Published
- 2013
19. Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei
- Author
-
Jörg Pelz, Marcello Deraco, Olivier Glehen, David L. Morris, Armando Sardi, I.H.J.T. de Hingh, Pompiliu Piso, François Quenet, P. Barrios, Santiago González-Moreno, A. Gómez Portilla, D. Baratti, Edward A. Levine, Tristan D. Yan, B. J. Moran, Winston Liauw, Paul H. Sugarbaker, Brian W. Loggie, S. Kusamura, F. N. Gilly, Terence Chua, Dominique Elias, K. Van der Speeten, and Wim Ceelen
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Pseudomyxoma peritonei ,Humans ,Peritoneal Neoplasms ,Retrospective Studies ,Chemotherapy ,business.industry ,Intraperitoneal chemotherapy ,Retrospective cohort study ,Odds ratio ,Combined procedure ,Cytoreduction Surgical Procedures ,Hyperthermia, Induced ,Middle Aged ,medicine.disease ,Pseudomyxoma Peritonei ,Combined Modality Therapy ,Surgery ,Learning curve ,Chemotherapy, Cancer, Regional Perfusion ,Female ,Clinical Competence ,business ,Cytoreductive surgery ,Learning Curve - Abstract
Background The learning curves for cytoreductive surgery with intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei (PMP) were explored between international centres/surgeons to identify institutional or other factors that might affect performance. Methods Data from patients with PMP treated with the combined procedure across 33 international centres between 1993 and 2012 were analysed retrospectively. A risk-adjusted sequential probability ratio test was conducted after defining the target outcome as early oncological failure (disease progression within 2 years of treatment), an acceptable risk for the target outcome (odds ratio) of 2, and type I/II error rates of 5 per cent. The risk prediction model was elaborated and patients were evaluated sequentially for each centre/surgeon. The learning curve was considered to be overcome and proficiency achieved when the odds ratio for early oncological failure became smaller than 2. Results Rates of optimal cytoreduction, severe postoperative morbidity and early oncological failure were 84·4, 25·7 and 29·0 per cent respectively. The median annual centre volume was 17 (range 6–66) peritoneal malignancies. Only eight of the 33 centres and six of 47 surgeons achieved proficiency after a median of 100 (range 78–284) and 96 (86–284) procedures respectively. The most important institutional factor affecting surgical performance was centre volume. Conclusion The learning curve is extremely long, so centralization and/or networking of centres is necessary to assure quality of services. One centre for every 10–15 million inhabitants would be ideal.
- Published
- 2014
20. Unilateral terminal aphalangia in father and daughter?exogenous or genetic cause?
- Author
-
Jürgen Kunze, Jörg Pelz, and Luitgard M. Neumann
- Subjects
Pregnancy ,Pediatrics ,medicine.medical_specialty ,Daughter ,media_common.quotation_subject ,Limb reduction ,Biology ,medicine.disease ,Genetic determinism ,Recurrence risk ,Terminal (electronics) ,Agenesis ,Aphalangia ,medicine ,Genetics (clinical) ,media_common - Abstract
Published cases of familial unilateral terminal transverse defects are scarce. We report on a morphologically similar defect of the hand in a father and his daughter. The hand anomaly is similar in both, but on the opposite side. Thalidomide was taken in the sensitive period of the pregnancy by the father's mother. To our knowledge this is the second description of unilateral terminal aphalangia in successive generations. In order to evaluate the possible genetic basis we analyze epidemiological studies in respect to the recurrence risk of cases with isolated limb reduction defects. We compare reports of familial occurrence concerning the degree of relationship as well as the pattern of malformation. The latter seems to be an important aspect from an evolutionary and a developmental viewpoint. For our observation an autosomal dominant transmission is the most likely although multifactorial determination cannot be excluded.
- Published
- 1998
21. A new observation of two cases of acrofacial dysostosis type Genée-Wiedemann in a family—remarks on the mode of inheritance: Report on two sibs
- Author
-
Jörg Pelz, Luitgard M. Neumann, and Jürgen Kunze
- Subjects
Genetics ,Pediatrics ,medicine.medical_specialty ,Genetic inheritance ,business.industry ,Dysostosis ,Genee-Wiedemann syndrome ,medicine.disease ,Inheritance (object-oriented programming) ,Miller syndrome ,POSTAXIAL ACROFACIAL DYSOSTOSIS ,Medicine ,business ,Genetics (clinical) - Abstract
We report on a Yugoslavian sibpair with postaxial acrofacial dysostosis type Genee-Wiedemann with some novel signs which broaden the spectrum of this syndrome. The manifestations of the present cases are compared with those of the previously described patients. Life expectancy, change of symptoms over time, and the mode of inheritance are discussed.
- Published
- 1996
22. Dopamine D2 receptor gene (DRD2) haplotypes in Caucasians
- Author
-
Gabriele Otto, Thomas Sander, Lutz G. Schmidt, Mario Giraldo-Velasquez, Ulrich Finckh, Arndt Rolfs, Hans Rommelspacher, and Jörg Pelz
- Subjects
Genetic Markers ,Genetics ,Linkage disequilibrium ,Candidate gene ,Genotype ,TaqI ,Receptors, Dopamine D2 ,Haplotype ,General Medicine ,Biology ,Linkage Disequilibrium ,White People ,chemistry.chemical_compound ,Exon ,Gene Frequency ,Haplotypes ,chemistry ,Humans ,Restriction fragment length polymorphism ,Allele - Abstract
The human dopamine D2 receptor gene ( DRD2 ) is considered a candidate gene for neuro-psychiatric diseases. We typed three new DNA sequence variants in DRD2 intron 4, intron 6 and exon 8, in combination with the known TaqI A restriction fragment length polymorphism (RFLP) and exon 7 311 Ser/Cys in 106 unrelated psychiatrically healthy Caucasians. Based on the genotypic data we delineated 10 distinct DRD2 haplotypes and their genetic relationship. Our data provide evidence that the Taq A1 allele and the 311 Cys variant are components of different groups of haplotypes though both variants have been speculated to be associated with alcoholism or schizophrenia in recent studies. Therefore we conclude that the prior knowledge of the frequencies and genetic relationships of DRD2 haplotypes will lead to the selection of more suitable intragenic markers for future association studies.
- Published
- 1996
23. DNA stool test for colorectal cancer: hypermethylation of the secreted frizzled-related protein-1 gene
- Author
-
Dimitri Lodygin, Wei Zhang, Michael Bauer, Michael Stürzl, Werner Hohenberger, Heiko Hermeking, Klaus E. Matzel, Roland S. Croner, and Jörg Pelz
- Subjects
Adenoma ,Adult ,Male ,Colorectal cancer ,Colorectal adenoma ,Polymerase Chain Reaction ,law.invention ,Feces ,law ,Cancer screening ,medicine ,Humans ,Promoter Regions, Genetic ,Polymerase chain reaction ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,Stool test ,business.industry ,Carcinoma ,Gastroenterology ,Cancer ,Membrane Proteins ,Promoter ,General Medicine ,DNA Methylation ,Middle Aged ,medicine.disease ,Case-Control Studies ,DNA methylation ,Immunology ,Cancer research ,Feasibility Studies ,Intercellular Signaling Peptides and Proteins ,Female ,business ,Colorectal Neoplasms - Abstract
To investigate a potential mode of noninvasive screening for colorectal cancer, we evaluated the hypermethylation of the secreted frizzled-related protein-1 gene promoter in human stool DNA. In stool samples from 36 patients with colorectal neoplasia (7 adenoma, 29 colorectal cancer) and 17 healthy control subjects, isolated DNA was treated with sodium bisulfite and analyzed by methylation-specific polymerase chain reaction with primers specific for methylated or unmethylated promoter sequences of the secreted frizzled-related protein-1 gene. Hypermethylation of the secreted frizzled-related protein-1 promoter was present in the stool DNA of patients with adenoma and colorectal cancer. A sensitivity of 89 percent and specificity of 86 percent were achieved in the detection of colorectal neoplasia. The difference in hypermethylation status of the secreted frizzled-related protein-1 promoter between the patients with colorectal neoplasia and the control group was statistically highly significant (P
- Published
- 2007
24. Heilung von gastrointestinalen Anastomosen bei synchroner hyperthermer intraperitonealer Chemoperfusion (HIPEC). Anastomosennaht prä- oder postinterventionell?
- Author
-
Jörg Pelz, Arno Dimmler, Werner Hohenberger, T. Meyer, J. Dörfer, and M. Decker
- Subjects
ddc: 610 ,business.industry ,Medicine ,business - Published
- 2006
25. Einfluss der hyperthermen intraperitonealen Chemoperfusion (HIPEC) auf die Heilung von gastrointestinalen Anastomosen im Rattenmodell
- Author
-
Jörg Pelz, T. Meyer, J. Dörfer, and Werner Hohenberger
- Subjects
medicine.medical_specialty ,ddc: 610 ,business.industry ,Perforation (oil well) ,Significant difference ,Mitomycin C ,Medicine ,Anastomosis ,business ,Breaking strength ,Colon anastomosis ,Surgery - Abstract
Objective: To determine if hyperthermic intraperitoneal chemoperfusion (HIPEC) of colonic anastomoses is detrimental to subsequent anastomotic healing. Methods: 24 Wag/Rija rats were randomized into four groups of six animals each: group 1: control (n = 6), group 2: HIP (n = 6), group 3: HIPEC with mitomycin C in a concentration of 30 mg/m2 (n = 6), group 4: mitomycin i.p. in a concentration of 20 mg/m2 (n = 6). In all animals colon anastomosis approximataly 3 cm proximal to the peritoneal reflection was performed. After 10 days, the anastomic breaking strength and the number of anastomic complications were observed. Results: No postoperative deaths were reported. The postoperative morbidity rate was 18,7%. No severe locoregional or systemic toxity was observed. In HIPEC treated animals bursting pressure of anastomoses was lower than in group I. No significant difference in bursting pressure were found in groups I, II and IV. In group III one animal had a covered perforation and one animal showed extensive adhesions. Conclusion: The healing of colonie anastomoses did not differ between group I, II and IV. In contrast, anastomotic complications were significantly more common in HIPEC animals.
- Published
- 2004
26. Effektivitätssteigerung der laserinduzierten Thermotherapie von Lebermetastasen — Einfluß der selektiven arteriellen und portalvenösen Okklusion und passageren Mikroembolisation
- Author
-
Jörg Pelz, D. Albrecht, J.-P. Ritz, C.-T. Germer, C. Isbert, Heinz-Johannes Buhr, and Andre Roggan
- Abstract
Die laserinduzierte Thermotherapie (LITT) ist ein Verfahren, mit dessen Hilfe maligne Tumore der Leber zerstort werden konnen [4]. Durch die Zufuhr thermischer Energie uber direkt im Tumorgewebe plazierte Laserfasern werden Koagulationsnekrosen induziert [1, 5–6]. Die sichere Behandlung von Lebertumoren mit einem solchen in-situ-Ablationsverfahren setzt die Induktion ausreichend groser thermischer Lasionen mit letaler intralasionarer Zellschadigung voraus. Fur die Ausdehnung des thermischen Lasionen stellt die lokale Durchblutung der Leber einen sigifikanten Einflusfaktor dar. In fruheren Studien konnten wir zeigen, das eine vollstandige Unterbrechung der hepatischen Perfusion zu einer signifikanten Vergroserung des Lasionsvolumens fuhrt [2,3].
- Published
- 1999
27. Signifikante Beeinflußung des hyperthermischen Effektes durch Stärkemikrospheren (Spherex®) bei der Laser-induzierten Thermotherapie im Lebermetastasenmodell der Ratte
- Author
-
C. T. Germer, H. J. Buhr, Detlef Schuppan, D. Albrecht, J.-P. Ritz, C. Isbert, and Jörg Pelz
- Abstract
In einer tierexperimentellen Studie wurde an einem Lebermetastasenmodell (Adenocarcinom) untersucht ob durch eine passagere Mikroembolisation mittels Starkemikrospheren (Spherex®) eine Elimination des „cooling effects“ moglich und eine Verbesserung des hyperthermischen Wirkungsgarades erzielbar ist. Hierzu wurden jeweils 15 Versuchstiere mittels LITTMono. EmbolisationMono oder der Kombination LITTEmbolisation behandelt. In der Gruppe LITTEmbolisation fand sich nach 24 h, 7 d und 28 d bei 1/15 Tieren vitales Tumorgewebe, in Gegensatz dazu zeigte sich in beiden anderen Gruppen bei 13/15 (LITTMono) bzw. 14/15 (EmbolisationMono) Tieren Tumorwachstum. Die Ergebnisse demonstrieren, das unter den gewahlten Versuchsbedingungen die Applikation von Starkemikrospheren zu einer signifikanten Steigerung des hyperthermischen Effektes der LITT fuhrt.
- Published
- 1998
28. Influence of the dopamine D2 receptor (DRD2) genotype on neuroadaptive effects of alcohol and the clinical outcome of alcoholism
- Author
-
P. Dufeu, S. Kuhn, Klaus-Jürgen Gräf, T Sander, M Giraldo-Velasquez, Michael Dettling, Hans Rommelspacher, Jörg Pelz, Helmut Harms, Andreas Heinz, Ulrich Finckh, A Rolfs, G Otto, and Lutz G. Schmidt
- Subjects
Agonist ,Adult ,Male ,medicine.medical_specialty ,Apomorphine ,Genotype ,medicine.drug_class ,Suicide, Attempted ,Biology ,Polymerase Chain Reaction ,Internal medicine ,Dopamine receptor D2 ,Genetics ,medicine ,Humans ,General Pharmacology, Toxicology and Pharmaceutics ,Allele ,Allele frequency ,Aged ,Human Growth Hormone ,Receptors, Dopamine D2 ,Dopaminergic ,Middle Aged ,Adaptation, Physiological ,Substance Withdrawal Syndrome ,Alcoholism ,Endocrinology ,Female ,Pharmacogenetics ,medicine.drug ,Follow-Up Studies - Abstract
The present study was performed to test the hypotheses that allelic variants at the human dopamine D2 receptor gene locus (DRD2) confer susceptibility to alcoholism or are associated with clinical subtypes of alcoholism. We investigated an A --> G substitution polymorphism in the 3'-untranslated region of exon 8 (E8) of DRD2 with allele frequencies of f(G) = 0.295 - 0.329. No significant association of the DRD2 genotype or allele frequencies with alcoholism was found in an association study including 283 alcoholics and 146 non-alcoholic controls. However, the frequent homozygous E8 A/A genotype with f(AA) = 0.47 - 0.48 was associated with increased anxiety and depression scores in alcoholics during the follow up after clinical detoxification treatment. In addition, E8 A/A was associated with increased suicide attempts and showed a tendency towards more severe withdrawal symptoms, early relapse and reduced responsiveness to the dopaminergic agonist apomorphine. Regression analysis revealed the DRD2 E8 genotype as the only significant factor determining withdrawal severity in female alcoholics. The findings suggest an influence of the DRD2 genotype on the neuropharmacological effects of chronic alcohol exposure and the clinical course of alcoholism.
- Published
- 1997
29. Computer assisted diagnosis of malformation syndromes: an evaluation of three databases (LDDB, POSSUM, and SYNDROC)
- Author
-
Jörg Pelz, Jürgen Kunze, and Volker Arendt
- Subjects
Adult ,Male ,Adolescent ,Computer science ,Multiple congenital anomaly ,computer.software_genre ,Congenital Abnormalities ,Set (abstract data type) ,Humans ,Abnormalities, Multiple ,Diagnosis, Computer-Assisted ,Medical diagnosis ,Child ,Genetics (clinical) ,Retrospective Studies ,Database ,Rank (computer programming) ,Infant, Newborn ,Infant ,Reproducibility of Results ,Bayes Theorem ,Syndrome ,Clinical diagnosis ,Child, Preschool ,Female ,computer ,Algorithms ,Information Systems - Abstract
Computer programs which can be used as an aid to diagnose multiple congenital anomaly syndromes have been used for many years, but up to now they have been evaluated very rarely. The diagnostic abilities of three of these systems [LDDB (London Dysmorphology Database), POSSUM (Pictures of Standard Syndromes and Undiagnosed Malformations), and SYNDROC] were analyzed. All three programs are based on an algorithm which defines a diagnosis by a set of phenotypic components all having the same weight (descriptive algorithm). A second algorithm is applied by SYNDROC to rank competing diagnoses in order of probability. This pseudo-Bayesian algorithm provides a coefficient of certitude (CC). For a test the clinical findings of 102 patients who had received a firm diagnosis were used. Two search strategies were tried: "novice's strategy" with all findings taken for a search and "expert's strategy" with a selected set of anomalies. Only those diagnoses that were suggested with the 1st rank, defined as the highest degree of agreement, or the highest CC were studied. The greatest resemblance between suggestions of the databases and the clinical diagnosis was obtained with the expert strategy. The highest number of matches were produced by SYNDROC (80 with expert strategy) and the lowest by POSSUM (54 with novice strategy). The overall agreement between the databases is about 40% for the 1st rank. This number reflects that different authors use different pivotal signs for the description of a syndrome. With the pseudo-Bayesian algorithm 59 cases obtained the highest CC value. Great difficulties exist with the subjective estimates for the calculation of these values; the absolute CC values seem to be meaningless. A small number of unusual cases with special combinations of anomalies provide serious problems for correct diagnosis.
- Published
- 1996
30. Laser-Induced Thermotherapy Combined With Hepatic Arterial Embolization in the Treatment of Liver Tumors in a Rat Tumor Model
- Author
-
Jörg P. Ritz, Christoph T. Germer, Gerhard A. Müller, Andre Roggan, Jörg Pelz, Heinz J. Buhr, D. Albrecht, and C. Isbert
- Subjects
Male ,Hyperthermia ,Pathology ,medicine.medical_specialty ,Laser-induced thermotherapy ,medicine.medical_treatment ,Laparotomy ,medicine ,Animals ,Embolization ,business.industry ,Arterial Embolization ,Liver Neoplasms ,Remission Induction ,Rats, Inbred Strains ,Original Articles ,Hyperthermia, Induced ,Blood flow ,medicine.disease ,Combined Modality Therapy ,Embolization, Therapeutic ,Rats ,Disease Models, Animal ,Coagulative necrosis ,Surgery ,Laser Therapy ,Nuclear medicine ,business ,Perfusion - Abstract
Laser-induced thermotherapy (LITT) or interstitial laser thermotherapy is an in situ ablation technique for the treatment of malignant tumors of the liver. 1,2 The potential of LITT is that laser light is directly transmitted through flexible bare fibers into the tumor tissue with high precision. The biologic effect of the laser light is based on the transformation of laser photon energy into heat by the absorption of tissue-specific chromophores. The aim is to induce uniform coagulation necrosis of the treatment volume. 3 Of great importance to the method’s success is the size of the induced coagulation necrosis, which must contain the whole volume of the tumor tissue. This lesion size largely depends on the temperature distribution in the target volume, which is determined partly by the blood perfusion in the target organ. 4,5 In organs with a high blood perfusion, such as the liver, a cooling effect results because of the temperature difference between the hyperthermic area and blood. 6,7 Temporary interruption of hepatic blood flow by occlusion of hepatic inflow vessels (Pringle maneuver) during LITT has been proven to increase its efficacy. 8–11 The Pringle maneuver usually requires laparotomy 10,11 or at least laparoscopy 12 and may therefore be difficult to repeat in cases of insufficient therapy. LITT, however, can be applied percutaneously without laparotomy or laparoscopy and can thus be easily repeated. 1,2 An alternative to the temporary interruption of hepatic arterial blood flow to liver tumors is the application of degradable starch microspheres (DSM), as used for chemoembolization. 13,14 The purpose of this study was to assess the effect of combined LITT and DSM on intrahepatic temperature distribution and tumor response in rats with liver tumors.
- Published
- 1999
31. Down's syndrome in infants of diabetic mothers
- Author
-
Jürgen Kunze and Jörg Pelz
- Subjects
medicine.medical_specialty ,Pediatrics ,S syndrome ,business.industry ,Obstetrics ,Confounding ,medicine.disease ,Gestational diabetes ,Age groups ,Relative risk ,Diabetes mellitus ,Pediatrics, Perinatology and Child Health ,medicine ,Risk factor ,business ,Trisomy - Abstract
Editor,—In a recent paper Narchi and Kulaylat1 analysed the prevalence (erroneously termed incidence2) of trisomy 21 in children of mothers with diabetes (7/1870) and in non-diabetic mothers (28/20 430) and found it to be significantly higher in the former. All seven cases in the diabetes group occurred in mothers with gestational diabetes. The authors concluded, that: (1) Maternal gestational diabetes is an independent risk factor for Down’s syndrome, irrespective of maternal age, as in an analysis of their data stratified by age, all five age groups showed a higher relative risk for Down’s syndrome in diabetic mothers; (2) Down’s syndrome should be added to the list of congenital anomalies known to occur more frequently in infants of diabetic mothers. Table 2 in their paper does not fully support their hypothesis. As can be seen from their data, age is a confounding factor for gestational diabetes …
- Published
- 1998
32. Natural family planning and Down syndrome—matching and confounding in a case control study
- Author
-
Jörg Pelz
- Subjects
Down syndrome ,Matching (statistics) ,Family planning ,Confounding ,Case-control study ,medicine ,Odds ratio ,medicine.disease ,Psychology ,Natural family planning ,Genetics (clinical) ,Confidence interval ,Demography - Abstract
The journal reported the findings of a case-control study conducted in 1995 by Castilla et al. to determine the association between Downs syndrome and the use of natural family planning (NFP). Researchers collected data on more than 5000 case-control pairs but provided data on only 4925 mothers of malformed infants and 4802 mothers of controls. 6.6% of the former group and 6.0% of the latter were users of NFP. There is considerable potential that sample distortion will result when using the case-control study design one particularly prone to error and bias. The author criticizes Castilla et al. for not defining the source populations exposure category not explaining why data are provided on malformed children when the study objective is trisomy 21 not stating why data are presented on less than 5000 pairs and not explaining the discrepancy between the numbers of cases and controls and how the 476 mothers of babies with Downs syndrome were matched with controls. Castilla et al. also leave it to the reader to make certain calculations provide a chi-square value after writing about 95% confidence intervals with regard to odds ratios and fail to justify a beta of 0.8. Castilla et al.s study and findings should not have been reported in the journal devoid of better analysis and more thorough explanation.
- Published
- 1996
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.