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Biomedical subjects

M Karthaus

Publications and source records attributed to M Karthaus.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Antifungal prophylaxis in neutropenic patients].

During the last two decades the incidence of systemic fungal infections has been rising steadily. The prognosis of infected patients is often poor and the therapeutic strategies are limited. The prophylaxis of systemic fungal infections thus appears worthwhile. The substances available comprise the azoles fluconazole and itraconazole and the polyenes amphotericin B and nystatin. If candida infections are to be targeted fluconazole can be used. The adequate dose is 400 mg daily. Compliance usually is satisfactory and toxicity-related adverse events are rare. Itraconazole covers a broader spectrum which encompasses all relevant fungi. Capsules and oral solution of itraconazole do not achieve reliably the therapeutic serum level of about 500 ng/ml. An intravenous formulation of itraconazole has recently been approved in the United States, but there is a scarcity of data with regard to its prophylactic use. Concomitant vinca alkaloid medication may result in life-threatening toxicities. High-dose intravenous amphotericin B has been proven effective for prophylaxis. Due its toxicity profile prophylactic amphotericin B should be used only for selected cases and in clinical studies. Nystatin can be used topically whenever topical amphotericin B is not well tolerated. All currently available prophylactic antimycotics bear the risk of either unsatisfactory effectiveness or severe toxicity.

Antifungal Agents↗
PubMed2001

[Therapy of invasive organ mycoses in patients with systemic hematologic diseases].

Fungal infections have increased substantially in patients with acute leukemia as well as in patients receiving allogeneic stem cell transplantations. Most frequently Aspergillus ssp. and Candida ssp. are observed. Despite the recent introduction of new azoles and lipid-based formulations of amphotericin B, there are few randomized, controlled studies on the use of antifungal drugs in patients with proven invasive fungal infections. Conventional Amphotericin B is considered gold standard for the treatment of invasive fungal infections, however is limited by nephrotoxicity and infusion related adverse events. Treatment with azoles, e.g. fluconazole, itraconazole or voriconazole is generally well-tolerated. Fluconazole, however, has no activity against Aspergillus ssp. An additional serious problem is an emerging resistance of non-albicans species to fluconazole. Lipid-formulations of amphotericin B seem to be attractive alternative, but considerably higher medical costs limit broader application of lipid formulations of amphotericin B. The current strategies for the treatment of documented fungal infections as well as the role of new antifungal agents are discussed in this review.

Antifungal Agents↗
PubMed2001

[Exhaustion and fatigue--a neglected problem in hematologic oncology].

Exhaustion and tiredness are frequent symptoms in cancer patients. They are caused by the tumour itself and by application of chemotherapy, surgery, radiation or cytokine treatment. Exhaustion and tiredness are not a consequence of lacking sleep or exaggerated physical or mental labour, but are due to several other factors: Anemia, tumour cachexia, toxicity of chemo- and radiation treatment probably are the most decisive factors for the development of exhaustion and tiredness. As both were taken as inevitable side-effects of cancer and cancer treatment in the past, only little attention has been paid to exhaustion and tiredness and limited research has been done. Among several validated questionnaires measuring quality of life in tumour patients the FACT-An (Functional Assessment of Cancer Treatment--Anemia) and EORTC QLQ-C30 questionnaire are the most well-known for identifying exhaustion and tiredness. Nevertheless, until today there is no mere exhaustion scale exclusively dealing with the problem of exhaustion and tiredness. According to the 10th revision of the International Classification of Diseases (ICD) exhaustion and tiredness are subsumed under the diagnosis of tumour fatigue. In contrast to tumour fatigue, which comprises physical, mental and emotional dimensions, exhaustion and tiredness primarily refer to physical symptoms: Lacking resilience for activities of daily life, day sleepiness and nocturnal insomnia as well as restricted power of concentration are the mainstays of exhaustion and tiredness. However, regarding lacking interests, diminished energy and reduced mental capacity, exhaustion and fatigue partly overlap. From a therapeutic point of view behavioural interventions and drug therapy have successfully been tried. Beside physical exercise and psychostimulants application of Erythropoietin represents an innovative treatment of exhaustion and tiredness.

Clinical Trials as Topic↗
PubMed2001

[Thromboembolism complications in tumor diseases: pathophysiology, risk factors and preventive approaches].

Thromboembolic complications are among the most common causes of death in cancer patients and result in considerable reduction in quality of life in patients affected. Besides immobilization therapeutical interventions such as surgery, chemotherapy and insertion of an indwelling central venous line have been identified as additional risk factors for thromboembolism. While postoperative prophylaxis is recommended, anticoagulation in presence of other risk factors, especially concerning cost-benefit ratio, is still a matter of debate. Evaluation of genetic risk factors for thromboembolism may add in the near future to the decision-making process to provide cancer patients with antithrombotic prophylaxis. With the introduction of low molecular weight heparin to clinical practice clinicians now face an alternative option to oral anticoagulants for long-term therapy and prophylaxis. Suggestive evidence that low molecular weight heparin reduce mortality of cancer patients independent of cardiovascular causes have stimulated intensive clinical efforts to reinvestigate anticoagulation in cancer patients.

Anticoagulants↗
PubMed2000

Myelodysplastic syndrome and acute myelogenous leukemia secondary to heart transplantation.

Myelodysplastic syndrome and acute myelogenous leukemia secondary to radiotherapy, radiation exposure, and chemotherapy is a well-documented malignant stem cell disorder. The incidence and natural course of myelodysplastic syndrome and acute myelogenous leukemia after organ transplantation remains less thoroughly investigated. In our institution, 631 heart transplantations have been performed between 1983 and 1998. We report five patients (age, 22-63 years) with myelodysplastic syndrome (MDS) (n=1) or acute myelogenous leukemia (AML) (n=4) occuring 4-8 years after transplantation. Immunosuppression consisted uniformly of a combination of prednisone, cyclosporine, and azathioprine. Successful cytogenetic analysis was performed in three patients, showing typical cytogenetic abnormalities in each case. The course of AML was uniformly fatal. One patient with MDS, refractory anemia with excess of blasts according to the FAB criteria, is alive with transfusion dependency 32 months after diagnosis. MDS and AML may occur during immunosuppression after heart transplantation. Treatment results are poor in this subgroup of patients with secondary leukemia.

Adult↗
PubMed2000

Serum and plasma parameters in clinical evaluation of neutropenic fever.

Clinicians are searching for a marker which may add to exclusion or diagnosis of relevant infection underlying neutropenic fever. The rise of such a parameter should ideally precede the date of significant microbiologic findings or justify additional intensive search for a focus of infection even in patients without pyrexia. However, the literature concerning the significance of CRP, proinflammatory cytokines and soluble adhesion molecules in the clinical evaluation of neutropenic fever is surprisingly small. In the case of procalcitonin, available data look very preliminary. Furthermore, in case of CRP, it appears that the widespread view that its determination may add substantially to the clinical evaluation of neutropenic fever is not well founded by most clinical trials listed here. Most of the studies available demonstrate several limitations such as poor design and small size of the study population. Additionally, studies were heterogeneous with respect to patients recruited (children and adults, patients with leukemia and patients with solid tumors) and compared different categories of febrile episodes. None of the investigators analyzed cost-effectiveness or impact of serial measurements of these parameters on patients' outcome. To our knowledge no single multicenter trial has been published addressing this issue. Although the group of proinflammatory cytokines and known acute-phase reactants will surely grow, more data on relevance of the available parameters in the diagnosis of neutropenic fever are needed.

Adult↗
PubMed2000

Anticoagulant prophylaxis and therapy in patients with cancer.

Due to the various reported mechanisms by which tumours may alter haemostasis directly or indirectly, a close relationship between tumour and thrombosis is convincing. As patients with cancer represent a diverse group, the establishment of general treatment guidelines concerning antithrombotic prophylaxis and therapy requires more data than are present to date. However, in cancer patients who are candidates for surgery, chemotherapy, indwelling central venous line, or prolonged immobility, primary prophylaxis is recommended. Patients with manifest thromboembolism should receive immediate treatment and a secondary prophylaxis for more than 3 months or at least as long as the cancer is active. In patients inappropriate for oral anticoagulation, the administration of LMWH is a suitable alternative. More prospective, randomized and larger studies are required to determine the optimally tailored primary prophylaxis, the best time to start and to stop treatment, to determine the best route, dosage and pharmacological antithrombotic, and to define the role of newer anticoagulants as hirudins in the anticoagulative prophylaxis and treatment of patients with cancer.

Anticoagulants↗