Biomedical subjects

R Lachmann

Publications and source records attributed to R Lachmann.

5 recordsLinked to original sources

PubMed2002

Radiochemotherapy for anal carcinoma - effectivity and late toxicity.

BACKGROUND: Radiochemotherapy of anal carcinoma is an organ-sparing approach with a high curative potential. The purpose was to evaluate the effectivity and late toxicity for patients treated with radiochemotherapy in our department. PATIENTS AND METHODS: During 1990-2000, 27 patients with anal carcinoma were treated at the Universitätsklinikum Mannheim. The median follow-up time was 23 months (max. 68 months). Before treatment, 23 patients were colostomy-free. Patients were treated according to 3 different protocols (Cummings n = 8, EORTC n = 5, RTOG n = 14). Acute toxicity was scored according to the RTOG/EORTC scale, and late toxicity according to the LENT/SOMA scale. RESULTS: 25 patients completed the therapy. One patient died due to leukopenic sepsis, and 1 patient interrupted therapy. 4 patients had a tumor relapse (2 patients immunosuppressed, 1 T4 tumor and 1 recurrence at the field-margin), one underwent abdomino- perineal resection. This resulted in a disease-free survival of about 80% and colostomy-free survival of 90% at 5 years. Total doses < 50 Gy and immunosuppression resulted in higher recurrence rates. Most patients suffered from acute toxicity grades 2 (n = 7) and 3 (n = 19) and late toxicity grades 1 (n = 7) and 2 (n = 4). CONCLUSIONS: Radiochemotherapy for anal carcinoma is an effective therapy with acceptable toxicity. Immunosuppressed patients have a higher risk for tumor recurrences and should be monitored more closely.

Adult↗

PubMed2000

Novel oral treatment of Gaucher's disease with N-butyldeoxynojirimycin (OGT 918) to decrease substrate biosynthesis.

BACKGROUND: Current treatment for Gaucher's disease involves administration of intravenous glucocerebrosidase to degrade glucocerebroside stored in lysosomes. Lowering the rate of biosynthesis of glucocerebroside should decrease accumulation of this substrate. We investigated the safety and efficacy of OGT 918 (N-butyldeoxynojirimycin), an inhibitor of glucosyltransferase, as a novel oral treatment for non-neuronopathic Gaucher's disease. METHODS: We recruited, into a 1-year open-label study, 28 adults (seven with previous splenectomies) from four national Gaucher's referral clinics, who were unable or unwilling to receive enzyme treatment. We measured liver and spleen volume by computed tomography or magnetic resonance imaging at baseline and at months 6 and 12, and biochemical and haematological variables monthly, including chitotriosidase activity (a sensitive marker of Gaucher's disease activity). Patients were started on 100 mg oral OGT 918 three times daily. FINDINGS: Baseline liver volumes were 1.1-2.7 times normal and spleen volumes 5.1-24.8 times normal. At 12 months, mean liver and spleen volumes were significantly lowered by 12% (95% CI 7.8-16.4) and 19% (14.3-23.7), respectively (each p<0.001). Haematological variables improved slightly. Mean organ volume and blood counts improved continually between 6 months and 12 months of treatment. Mean chitotriosidase concentrations fell by 16.4% over 12 months (p<.0001). Six patients withdrew because of gastrointestinal complaints (two), personal reasons (two), or severe pre-existing disease (two). The most frequent adverse effect was diarrhoea, which occurred in 79% of patients shortly after the start of treatment. INTERPRETATION: Decrease of substrate formation by OGT 918 improves key clinical features of non-neuronopathic Gaucher's disease. The strategy justifies further trials in this and other glycosphingolipid storage disorders.

1-Deoxynojirimycin↗

PubMed1998

[Value of dual-phase-helical CT in the preoperative diagnosis of pancreatic cancer--a prospective study].

PURPOSE: A prospective study was performed to evaluate the accuracy of dual phase helical CT in suspected pancreatic cancer. METHODS: Within one year 136 patients underwent helical CT with arterial and portal venous scans after bolus tracking and NaCl bolus injection. Evidence of pancreatic cancer and assessment of resectability were recorded using a standardised protocol. Suspected benign disease was verified by follow-up examination and clinical data, suspected malignant disease was correlated with biopsy or surgery. RESULTS: For the detection of tumor the overall concordance was 92%, the sensitivity 98% and the specificity 70% (6 false positive, 1 false negative). Resectability was correctly assessed in 90% with a sensitivity of 92% and a specificity of 88% (4 false positive, 4 false negative). Vascular invasion was detected correctly in 91% (veins)-94% (arteries), lymph node invasion in 67% and liver metastasis in 94%. CONCLUSION: Dual phase helical CT is a very reliable tool in the assessment of resectability in pancreatic cancer.

Biopsy↗

PubMed1998

Pancreatic cancer: value of dual-phase helical CT in assessing resectability.

PURPOSE: To evaluate the use of dual-phase helical computed tomography (CT) (with or without CT angiography) to assess resectability in patients suspected to have pancreatic cancer. MATERIALS AND METHODS: Tumor resectability was prospectively evaluated in 89 patients who later underwent surgery for suspected pancreatic cancer. Helical CT scans were obtained in the vascular phase and a phase of maximal hepatic enhancement. CT angiograms were produced with multiprojection volume reconstruction and maximum-intensity projection. CT results were correlated with surgical and histopathologic results. RESULTS: Helical CT allowed detection of pancreatic cancer in 74 of 76 cases (97%). There were six false-positive results (positive predictive value, 92%). For prediction of irresectability, helical CT had an accuracy of 91%, negative predictive value of 79%, and sensitivity of 91%. Helical CT allowed detection of liver metastases in 21 of 28 cases (75%), nodal involvement in 13 of 24 cases (54%), and vascular invasion in 35 of 40 cases (88%). CT angiography demonstrated 30 of the 35 cases of vascular invasion detected with helical CT (86%). CONCLUSION: Use of dual-phase helical CT improves prediction of resectability in patients with pancreatic cancer. CT angiography cannot show all of the findings seen on helical scans.

Adenocarcinoma↗

PubMedDate not supplied

[Selective intraarterial axillar artery thrombolysis in a neonate: angiographic and thermographic serial time course].

Arterial thrombotic vascular occlusions in the neonatal period are rare. Intraarterial thrombolytic therapy in infants and children is unchanged rarely used but can be very effective. Thrombolytic therapy in adults is well established and a summary of clinical and pharmacologic aspects exists of different thrombolytic agents. Recombinant-Tissue-Plasminogen-Activator (rTPA) is increasingly used in thrombolytic therapy in infants and children in the last years. We report thrombolysis of axillar arterial thrombosis with rTPA in a premature infant. Additional thermographic images were performed, which were very helpful in the clinical monitoring of the newborn.

Angiography, Digital Subtraction↗