Biomedical subjects

Marcus Schmidt

Publications and source records attributed to Marcus Schmidt.

8 recordsLinked to original sources

PubMed2006

MED-EL Cochlear implants: state of the art and a glimpse into the future.

Cochlear implantation is an accepted treatment method for adults and children with severe to profound hearing loss. Confidence in technology has led to changes in individuals who can receive a cochlear implant and changes in expected benefit with a cochlear implant. This article describes the research and development activities at MED-EL, which make possible the implementation of new speech-coding strategies as well as the application of acoustic and electric stimulation via a combined speech processor in MED-EL devices. Research on benefits from bilateral cochlear implantation and electric-acoustic stimulation are also reviewed. Finally, the potential of drug delivery systems is considered as a way to improve cochlear implant outcomes, and results from preliminary evaluations of a hybrid cochlear implant system with drug delivery capabilities are reported.

Acoustic Stimulation↗

PubMed2005

Combined electric and acoustic stimulation of the auditory system: results of a clinical study.

Combined electric and acoustic stimulation (EAS) of the auditory system is a new therapy for patients with severe to profound high- and mid-frequency hearing loss but remaining low-frequency hearing. In a prospective study, 13 patients with low-frequency hearing of better than 60 dB below 1 kHz were implanted with a MED-EL COMBI 40+ cochlear implant. Pure tone thresholds as well as monosyllabic word scores and Hochmair-Schulz-Moser sentences in quiet and in noise were measured with hearing aids, cochlear implant alone and in the combined stimulation mode (EAS) in the same ear. Hearing could be partially preserved in 11 out of the 13 patients. All patients scored significantly higher with cochlear implant alone than with hearing aids. Seven patients scored higher in the EAS mode than with cochlear implant alone for sentences in noise, 4 remained unchanged, and 2 could not use EAS. Synergistic effects of EAS were most prominent for hearing in noise with increases of up to 72% as compared to cochlear implant alone.

Acoustic Stimulation↗

PubMed2005

Long-term prognostic significance of HER-2/neu in untreated node-negative breast cancer depends on the method of testing.

INTRODUCTION: The prognostic significance of HER-2/neu in breast cancer is a matter of controversy. We have performed a study in 101 node-negative breast cancer patients with long-term follow-up not treated in the adjuvant setting, and analysed the prognostic significance of immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH), both separately and in combination, in comparison with traditional prognostic factors. METHODS: Overexpression was classified semiquantitatively according to a score (0 to 3+) (HER-2_SCO). FISH was used to analyse HER2/neu amplification (HER-2_AMP). Patients classified 2+ by IHC were examined with FISH for amplification (HER-2_ALG). Patients with 3+ overexpression as well as amplification of HER-2/neu were positive for the combined variable HER2_COM. These variables were compared with tumour size, histological grade and hormone receptor status. RESULTS: HER-2_SCO was 3+ in 20% of all tumours. HER-2_ALG was positive in 22% and amplification (HER-2_AMP) was found in 17% of all tumours. Eleven percent of the tumours showed simultaneous 3+ overexpression and amplification. Only histological grade (relative risk [RR] 3.22, 95% confidence interval [CI] 1.73-5.99, P = 0.0002) and HER-2_AMP (RR 2.47, 95% CI 1.12-5.48, P = 0.026) were significant for disease-free survival in multivariate analysis. For overall survival, both histological grade (RR 3.89, 95% CI 1.77-8.55, P = 0.0007) and HER-2_AMP (RR 3.08, 95% CI 1.24-7.66, P = 0.016) retained their independent significance. CONCLUSION: The prognostic significance of HER-2/neu in node-negative breast cancer depends on the method of testing: only the amplification of HER-2/neu is an independent prognostic factor for the long-term prognosis of untreated node-negative breast cancer.

Adult↗

PubMed2004

The impact of treatment for genital cancer on quality of life and body image--results of a prospective longitudinal 10-year study.

OBJECTIVE: To evaluate the impact of treatment for genital cancer on quality of life and body image to determine patients' therapy-related needs for quality improvement of medical care before and after surgery. METHODS: We started to evaluate women with cervical cancer planned for pelvic exenteration in 1993 and integrated women planned for a Wertheim-Meigs surgery in 1995 before surgery, 4 and 12 months after surgery. Thanks to funding since 1999, more than 400 patients with a diagnosis of genital (n = 185) or breast (n = 217) cancer participated in this prospective study until July 2003. In this paper, we will focus on n = 129 women with cervical cancer. The assessment protocol included objective questionnaires for quality of life and body image (CARES; EORTC; Body image by Strauss and Appelt). The evaluation of quality of life incorporated five dimensions: physical and psychosocial health, marital and sexual status, and medical interaction. RESULTS: Before surgery, women with a Wertheim's procedure indicated significantly less problems concerning the quality of life global score (P = 0.002) and several subscales compared to women with a pelvic exenteration. After surgery, both groups indicated their sexual problems to be the greatest restriction in terms of quality of life, especially in women with non-reconstructive surgery as well as in women with adjuvant radio and/or chemotherapy. Concerning body image, attractiveness or self-confidence was significantly reduced postoperatively compared to the preoperative status for both groups (P = 0.000), and also worsened with the extent of treatment. Worries about the patient's family persisted over time and represented the most important item about all questions concerning quality of life as well as the fear of recurrence. CONCLUSION: This on-going study demonstrates the interferences between the treatment modality and the patient's quality of life, especially about sexuality and body image. Our results suggest not only to provide reconstructive surgery if possible, but also to integrate psychosocial information aspects on future quality of life outcome before surgery as well as to offer psychosocial support related to the extent of treatment modality after surgery.

Adult↗

PubMed2004

Visualization of stimulation patterns in cochlear implants: application to event-related potentials (P300) in cochlear implant users.

Auditory P300 potentials obtained in cochlear implant users were evoked with tone bursts designed to reflect the frequency stimulation patterns of intracochlear electrodes. To visualize these stimulation patterns in MED-EL COMBI 40+ cochlear implants, we calculated color-coded plots of the charge of each stimulus pulse as a function of time and stimulation channel (stimulograms). The aim of this study was to investigate the effect of stimulation patterns on event-related potentials, such as the P300. The influence of electrode separation on the P300 response in postlingually deaf adults using a cochlear implant is demonstrated in two examples.

Adult↗

PubMed2002

Carcinoma of the neovagina: case report and review of the literature.

BACKGROUND: Carcinoma of the vagina is a rare disease, and it is even more rare in the neovagina. Nevertheless, it has been well described. The aim of this report was to analyze the reported cases and to add observations concerning a risk profile for this rare occurrence of carcinoma. CASE REPORT: The 29-year-old patient's history included congenital absence of vagina as a result of Rokitansky-Kuster syndrome. In 1987, when the patient was 17 years old, a neovagina was constructed by dissection between the bladder and the rectum, according to the Warthon method, and the apex of the neovagina was covered with Dura-mater. In 1990 the patient underwent radiation treatment with brachytherapy three times in combination with surgical treatment, because of granulation tissue in the neovagina. In 1999 several specimens of the granulation tissue were removed and histological examination showed intermediate differentiated squamous cell carcinoma. Total exenteration with pelvic and lower paraaortic lymph node dissection was performed, and the patient received a continent neobladder (Mainz Pouch I), colostoma, and sigma neovagina. Two months later in January 2000 the patient showed local recurrence and after local excision the patient received radiotherapy. The follow-up to June 2001 showed no evidence of disease. CONCLUSION: All patients with vaginoplasty should undergo regular 1-year follow-ups, including smear analysis because of the possibility of the development of carcinoma. Granulation tissue arising in a neovagina should be biopsied and no prosthesis should be used until lesions have healed completely. Patients who have undergone radiation of the neovagina carry an additional risk.

Adult↗

PubMed2002

Preoperative assessment of breast cancer: sonography versus MR imaging.

OBJECTIVE: The purposes of our study were to compare the diagnostic value of whole-breast sonography and MR imaging as adjunctive techniques to mammography and to determine whether MR imaging should be used routinely in the preoperative assessment of patients with suspected breast cancer. SUBJECTS AND METHODS: . One hundred four women (age range, 34-84 years; mean age, 60 years) with findings highly suggestive of malignancy in the breast were examined with mammography, sonography, and dynamic MR imaging before undergoing surgery. All visualized suspicious lesions were correlated histologically. The diagnostic relevance of sonographic and MR imaging findings was compared with the diagnostic value of the findings of clinical examination and mammography alone. RESULTS: . Twenty-seven tumors showed multifocal or multicentric invasive growth at pathology. Of these 27, 48% were correctly diagnosed via mammography alone; 63%, via the combination of mammography and sonography; and 81%, via MR imaging. Nine of the index tumors were invisible on mammography but were detected on sonography. Use of sonography benefited 13 patients and produced two studies with false-positive findings. Use of MR imaging benefited seven patients and produced eight studies with false-positive findings. In summary, 93% of all patients gained no advantage from MR imaging. Relevant additional findings were significantly more frequent in patients with dense breasts. CONCLUSION: Although MR imaging is most sensitive for the detection of small tumors, routine preoperative MR imaging appears to be unnecessary for most patients if a combination of mammography and whole-breast sonography is used. Additional MR imaging can be restricted to problematic cases in women with dense breast parenchyma.

Adult↗

PubMedDate not supplied

Handling of the MED-EL TEMPO+ ear-level speech processor by paediatric cochlear implant users and their parents.

MED-EL launched the first ear-level speech processor offering a high-rate CIS+ strategy, the TEMPO+, in 1999. Studies have already demonstrated improved speech perception, sound quality and ability to enjoy music with the TEMPO+ due to the new CIS+ speech-coding strategy, when compared to the body-worn processor. In this study we evaluated responses from parents of young children about ease of handling and usage of the TEMPO+, and satisfaction with the TEMPO+ and its performance. Overall, 65 custom-designed questionnaires were analysed. The results showed that MED-EL cochlear implant users felt comfortable manipulating the dials and switches, changing the battery pack, using external sources of input and using the accessories provided. These results confirm the suitability of the TEMPO+ for infants and toddlers.

Adolescent↗