Biomedical subjects

Andreas Steiner

Publications and source records attributed to Andreas Steiner.

9 recordsLinked to original sources

PubMed2005

Prospective, randomized, multicenter, double-blind placebo-controlled trial comparing adjuvant interferon alfa and isotretinoin with interferon alfa alone in stage IIA and IIB melanoma: European Cooperative Adjuvant Melanoma Treatment Study Group.

PURPOSE: The combination of interferon alfa (IFNalpha) and isotretinoin has shown a direct antiproliferative effect on human melanoma cell lines, but it remained unclear whether this combination is more effective than IFNalpha alone in patients with metastatic melanoma. We evaluated safety and efficacy of IFNalpha and isotretinoin compared with IFNalpha alone as adjuvant treatment in patients with primary malignant melanoma stage IIA and IIB. PATIENTS AND METHODS: In a prospective, randomized, double-blind, placebo-controlled trial, 407 melanoma patients in stage IIA (301 patients) and IIB (106 patients) were randomly assigned to either IFNalpha and isotretinoin (isotretinoin group; 206 patients) or IFNalpha and placebo (placebo group; 201 patients) after excision of the primary tumor. IFNalpha was administered three times a week at a dose of 3 million units subcutaneously for 24 months. Isotretinoin at a dose of 20 mg for patients < or = 73 kg, 30 mg for patients greater than 73 kg, or placebo daily for 24 months. RESULTS: A scheduled interim analysis revealed no significant differences in survival rates, with the isotretinoin group and the placebo group showing 5-year disease-free survival rates of 55% (95% CI, 46% to 65%) and 67% (95% CI, 59% to 75%), respectively, and overall 5-year survival rates of 76% (95% CI, 67% to 84%) and 81% (95% CI, 74% to 88%), respectively. The trial was stopped for futility. CONCLUSION: The addition of isotretinoin to an adjuvant treatment of low-dose IFNalpha in patients with stage IIA and IIB melanoma had no significant effect on disease-free or overall survival and is therefore not recommended.

Adolescent↗

PubMed2005

[Cancer and deep vein thrombosis].

Patients with cancer have a high risk of recurrent thromboembolism and bleeding complications during anticoagulant therapy. Clinical trials in patients with deep vein thrombosis have shown that patients can be treated safely at home with "low molecular weight heparin". A recent study has shown that in patients with cancer and acute venous thromboembolism, therapy with low molecular weight heparin is more effective than oral anticoagulation in reducing the risk of recurrent thromboembolism without increasing the risk of bleeding.

Administration, Oral↗

PubMed2005

S-classification of sentinel lymph node biopsy predicts the results of complete regional lymph node dissection.

The purpose of this study was to identify melanoma patients with positive sentinel lymph nodes (SLNs) at increased risk for further metastases in this specific lymph node basin. A series of consecutive patients with primary malignant melanoma stage I and II were evaluated retrospectively. The results of SLN biopsy in 26 patients with positive SLNs were compared with those of complete regional lymph node dissection (RLND) using the recently published S-classification of SLNs. The results of S-classification of SLNs were correlated with the outcome of complete RLND. There was a significant correlation between the S stage of positive SLNs and the results of complete RLND (P=0.02). Only patients with SIII stage (n=4) SLNs were found to have further metastases in the residual lymph node basin. The present study indicates that patients with SI stage and SII stage SLNs rarely have further metastases in the specific lymph node basin.

Adult↗

PubMed2004

Positron emission tomography is not useful in detecting metastasis in the sentinel lymph node in patients with primary malignant melanoma stage I and II.

The most powerful predictor for recurrence and survival in patients with primary malignant melanoma is the presence or absence of lymph node metastases. In the present study, 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) findings were compared with histopathological results of sentinel lymph node biopsy (SNB). The purpose was to determine the value of FDG-PET in predicting regional lymph node involvement in patients with primary malignant melanoma stage I and II. Forty-eight consecutive patients with primary cutaneous melanoma stage I (Breslow thickness > 1 mm) and II underwent FDG-PET scans, preoperative lymphoscintigraphy, and SNB. The FDG-PET and SNB results were interpreted independently of each other and then compared. Of the 48 patients included in the study, eight (16.7%) had a positive SNB. PET was positive in only one patient with a positive SNB, yielding a sensitivity of 13%. All other positive sentinel nodes could not be detected by metabolic FDG-PET imaging. Our study revealed that FDG-PET is obviously not an adequate screening test for subclinical and sonographically inconspicuous lymph node metastases in patients with malignant melanoma stage I and II. The low sensitivity is probably due to the small size of metastatic deposits in sentinel nodes. Therefore, SNB remains the technique of choice for evaluating the histological status of lymph node basins in patients with early-stage cutaneous melanoma.

Adult↗

PubMed2003

[Development of squamous epithelial carcinoma on the lower leg in long-term verrucous lichen planus].

Lichen ruber planus and squamous cell carcinoma are common diseases of the skin. Several publications have dealt with the association between these two types of dermatosis. Extensive trials have shown the potentially premalignant nature of lichen planus of the oral mucosa. However, no study conducted so far was able to show that lichen planus of the skin increases the risk for squamous cell carcinoma. We report a 65-year-old man who developed a squamous cell carcinoma in a long standing verrucous lichen planus in the lower leg.

Aged↗

PubMed2003

Proximal extent of pelvic vein thrombosis and its association with pulmonary embolism.

OBJECTIVE: Conventional methods such as duplex ultrasound scanning do not provide accurate information about proximal extension of pelvic vein thrombosis. We evaluated proximal extent of thrombus toward pelvic veins with magnetic resonance imaging in patients with suspected deep vein thrombosis (DVT) proximal to the inguinal ligament on the basis of duplex ultrasound scans. In addition, frequency of pulmonary embolism (PE) and early (4 weeks) clinical outcome were evaluated. METHODS: Two hundred twelve patients with acute symptomatic DVT proximal to the inguinal ligament, diagnosed at duplex ultrasound scanning, were enrolled in this prospective study. All patients underwent magnetic resonance imaging of the abdominal and pelvic veins, as well as lung scintigraphy to detect the presence of pulmonary embolism. RESULTS: In 24 of 212 patients (11%), thrombus was restricted to the femoral vein. The thrombus extended into iliac veins in 142 patients (67%) and into the inferior vena cava in 46 patients (22%). The frequency of PE was not associated with the most proximal extension of thrombus (P =.61). No patients died as a consequence of thromboembolic events. CONCLUSIONS: Extension of DVT into the inferior vena cava occurs relatively frequently. In our patients this finding was not associated with higher risk for PE compared with DVT of the femoral or iliac veins.

Adolescent↗

PubMed2003

Lupus anticoagulant in patients with chronic venous insufficiency.

Chronic venous insufficiency is a widespread disease that can often lead to venous leg ulcers. Recent studies report that certain clotting abnormalities, such as anticardiolipin antibodies, are associated with leg ulcers. Although lupus anticoagulant belongs to the antiphospholipid antibodies, its presence in patients with chronic venous insufficiency has not been reported previously. The purpose of our study was to determine the presence of lupus anticoagulant in chronic venous insufficiency patients at a stage with no leg ulcers, and to follow the clinical outcome. In 37 patients with chronic venous insufficiency and in 54 control patients, lupus anticoagulant was evaluated using the Viper Venom Russell's Diluted Test. Lupus anticoagulant was found significantly more often (p < 0.001) in patients with chronic venous insufficiency than in controls. After 4 years, patients with chronic venous insufficiency with lupus anticoagulant were found to develop a venous leg ulceration more frequently compared to those without (p = 0.01), suggesting that lupus anticoagulant may play an important role in the pathogenesis of chronic venous insufficiency.

Adult↗

PubMed2002

Seasonal variations of deep vein thrombosis and its influence on the location of the thrombus.

The role of season as a predisposing factor for the development of deep vein thrombosis is controversially discussed. We analysed retrospectively seasonal variations in the occurrence of deep vein thrombosis of the leg in 905 patients between 1996 and 2000. Additionally, we evaluated the relationship between the season and the location of the thrombus. Our study revealed that the frequency of deep vein thrombosis of the leg was significantly higher during the winter half than during the summer half (p < 0.001). Regarding the seasonal variation of the location of the thrombus, distal deep vein thrombosis was more frequent during the winter half while proximal deep vein thrombosis was diagnosed more often during the summer half of the year. In conclusion, we suggest that the season has an influence on the development of deep vein thrombosis in the leg as well as on the location of the thrombus.

Adult↗

PubMed2002

Extent of thrombus evaluated in patients with recurrent and first deep vein thrombosis.

OBJECTIVES: The objective of this retrospective study was to document the extent of thrombus in patients with recurrent and first deep vein thrombosis (DVT). PATIENTS AND METHODS: A total of 864 patients with DVT of the leg were enrolled in the study. They were divided into two groups: patients with recurrent DVT (n = 233) of the leg, and patients with first DVT of the leg (n = 631). In both groups the extent of the thrombus was evaluated by duplex scanning, contrast venography, or magnetic resonance imaging. Thrombus involving veins distal to the popliteal vein was classified as distal DVT, whereas involvement of the popliteal vein and proximal was classified as proximal DVT. RESULTS: We could demonstrate that involvement of proximal segments (CEAP anatomic classification 1-9) occurred significantly more often in patients with recurrent DVT than in patients with the first DVT (P <.001). The incidence of pulmonary embolism (PE) and the clinical symptoms of PE were equally distributed between patients with recurrent DVT and those with first DVT (P >.05). Only one patient died as a consequence of PE in our patient sample. CONCLUSIONS: In our experience, patients with recurrent DVT have a higher frequency of proximal DVT. Nevertheless, the incidence of PE is similar in patients with recurrent and those with first DVT.

Aged↗