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Biomedical subjects

D Messerer

Publications and source records attributed to D Messerer.

28 records · Page 2Linked to original sources
PubMed1988

Randomized study on the treatment of chronic myeloid leukemia (CML) in chronic phase with busulfan versus hydroxyurea versus interferon-alpha.

For palliative therapy during the chronic phase of CML busulfan has proved to be the drug of choice. During the past years hydroxyurea and also interferon-alpha have gained increasing significance since they might prolong the duration of the chronic phase. In a multicenter study it is being determined, whether the use of hydroxyurea or of interferon-alpha instead of busulfan prolongs the duration of the chronic phase of Philadelphia positive CML. Additional goals are the examination of whether the types of disease evolution and the terminal phases differ between the treatment groups, and the prospective recognition of prognostic criteria for the duration of the chronic phase of CML. By December 31, 1987, 326 CML-patients had been randomized, 150 for busulfan, 150 for hydroxyurea and 26 for interferon-alpha. The average age is 50 years. 59 patients reached the end of the chronic phase, 55 died. The mean observation time of all patients is 1.34 years. At present no significant difference in survival is recognizable between the busulfan and hydroxyurea groups. Fewer adverse effects have been observed in the hydroxyurea group. Philadelphia chromosome negative patients show a higher average age and tend to have lower white blood cell and platelet counts. The number of patients having received interferon-alpha is still too small to allow evaluation. This report intends to document organization and progress of this study which to our knowledge is, at present, the largest ongoing prospective multicenter study on the therapy of CML.

Busulfan↗
PubMed1988

Comparative morphometric study on the depth of invasion in vulvar carcinoma.

Various studies assess the significance of depth of invasion as an important prognostic factor in squamous cell carcinoma of the vulva. However, methodologic problems exist with regard to the measurement points. While the deepest point of invasion can be measured accurately, the upper reference point is arbitrarily chosen. The goal of the present study was to identify the method of measurement and the threshold value, allowing the clearest prognostic differentiation between groups of patients with vulvar carcinoma. The study involved 124 patients treated between 1971 and 1980, who had received identical treatment (simple vulvectomy followed by local and inguinal irradiation) and identical histopathologic workup (large-scale sections). Beginning with the deepest point of tumor invasion, comparative measurement was carried out with three different points of reference: to the basement of the most superficial dermal papilla (method A), to the surface of the tumor (method B), and to the basement membrane of the deepest rete ridge (method C). The data were used to determine differences in specified end points. The results and conclusions are as follows: (1) The morphometrically determined degree of tumor invasion had prognostic significance. (2) Measurement of tumor thickness (method B) prognostically differentiates patient groups better than measurement of invasion from the most superficially lying epithelial papilla (method A), if classified into tumors up to and over 0.5 cm. (3) Patients with superficial invasive vulvar carcinomas up to 0.5 cm can be further prognostically differentiated into two groups, when measuring depth of invasion from the deepest rete ridge (method C), and classifying into tumors up to and over 0.3 cm.

Adult↗
PubMed1988

[Chemotherapy of chronic myelocytic leukemia. Status of the German Multicenter Study on busulfan versus hydroxyurea versus alpha interferon, October 1897].

For palliative therapy during the chronic phase of CML busulfan has proved to be the drug of choice. During the past years hydroxyurea and also interferon-alpha have gained increasing significance since they might prolong the duration of the chronic phase. In a multicenter study it is being determined, whether the use of hydroxyurea or of interferon-alpha instead of busulfan prolongs the duration of the chronic phase of Philadelphia-positive CML. Additional goals are the examination, whether the types of disease evolution and the terminal phases differ between the treatment groups, and the prospective recognition of prognostic criteria for the duration of the chronic phase of CML. By November 26, 1987, 321 CML-patients had been randomized, 147 for busulfan, 149 for hydroxyurea and 25 for interferon-alpha. The average age is about 50 years. 59 patients reached the end of the chronic phase, 55 died. The mean observation time of all patients is 1.34 years. At present no significant difference in survival is recognizable between the busulfan and hydroxyurea groups. Fewer adverse effects have been observed in the hydroxyurea group. Philadelphia chromosome-negative patients show a higher average age and tend to have lower white blood cell and platelet counts. The number of patients having received interferon-alpha is still too small to allow evaluation. This report intends to document organization and progress of this study which to our knowledge is, at present, the largest ongoing prospective multicenter study on the therapy of CML.

Busulfan↗
PubMed1987

[Advantages and problems of multicenter therapy studies exemplified by a study of the treatment of metastasizing renal cell carcinoma with recombinant interferon-alpha-2c].

The advantages of multicenter trials are numerous: quicker recruitment of the necessary number of patients, clearer results which are more convincing and whose acceptance is higher, as the patient sample of multicenter trials is supposed to be representative. However, multicenter trials require strong efforts for quality assurance concerning admission, treatment and follow-up, thus a highly developed coordinating center is needed. Data on recruitment and protocol compliance, i.e. deviations from the study protocol, are presented for the study of the treatment of metastatic renal cell carcinoma and discussed with respect to their impact on the results of the study. 102 patients were randomized either for IFN alpha-2C or IFN alpha-2C plus medroxyprogesteroneacetate. 16% of the patients violated inclusion criteria and essential data were missing in 16% of the patients. Overall treatment results (remission rate of 5.6%, median survival time of 7 months) and the data on adverse events have been biased by lack of protocol compliance. However, the results concerning the lack of differences between treatments remain valid.

Carcinoma, Renal Cell↗
PubMed1985

[So-called preventive ovarectomy].

Carcinoma of the ovaries can be prevented by performing the operation known as prophylactic oophorectomy, i.e. the simultaneous removal of macroscopically non-pathological ovaries in laparotomy because of a benign disease (for example, in uterus myomatosus). Hence, this operation is advocated on the basis of numerous clinical studies, using in most cases derived epidemiological arguments. However, model calculations with population-based data from the Federal Republic of Germany show that, firstly, the so-called prophylactic oophorectomy cannot be justified by means of epidemiological arguments, and, secondly, that no epidemiological effect can be expected to materialise from prophylactic oophorectomy, since unrealistically high prevalences of oophorectomy or hysterectomy must be assumed as essential prerequisites of such an effect. These considerations result in the following assessment: In women who are still menstruating or who are in their menopausal stage, prophylactic oophorectomy cannot be regarded as a generally recommended procedure. This operation is of individual significance, but by no means of epidemiological importance, even in post-menopausal women.

Adolescent↗
PubMed1985

[Postoperative complications following gynecologic operations in elderly females with benign and malignant changes of the genitals].

The retrospective study reported here, which covered 2116 patients operated on, indicates that postoperative complications are more likely to occur in women aged over 60 than in younger patients. There is also a connection between the patient's age and previous internal disease, the surgical approach, and the severity of the change requiring surgery. The connection between age and postoperative complications is principally explained by previous internal disease. Patients with malignant tumors are at greater risk than women with benign genital changes. Carcinoma cases apart, these patients are older and have suffered more from previous internal disease. While postoperative morbidity and mortality rates are higher among older patients, the percentage of complications occurring is so low that age does not represent a contraindication to gynecological surgery.

Adolescent↗