Biomedical subjects

Stefan Paepke

Publications and source records attributed to Stefan Paepke.

12 recordsLinked to original sources

PubMed2006

The impact of breast cancer awareness and socioeconomic status on willingness to receive breast cancer prevention drugs.

PURPOSE: To find associations between knowledge about risk factors for breast cancer and the socioeconomic status of healthy women, as well as their attitude toward taking chemopreventive drugs. PATIENTS AND METHODS: Between April and September 1999, 7135 healthy women completed questionnaires providing information about their willingness to take chemopreventive drugs. Items in the questionnaire included the sources of the information they had, their estimates of the population and personal lifetime risk, and risk factors for breast cancer. RESULTS: A total of 6597 questionnaires were evaluable. The responders' median age was 44. Fifty-five percent of the women were willing to consider receiving chemopreventive drugs to lower their risk for breast cancer. Participants who estimated the population risk as being very high were more disposed to receive chemoprevention (65.3%), as were women who estimated their own breast cancer risk as being high (74.1%). A family history of breast cancer only had a low impact on willingness to receive chemoprevention. Women with a family history of breast cancer were willing to take chemopreventive agents in 57.2% of cases. The multivariate analysis showed that knowing about risk factors and having a lower educational level were factors positively correlated with willingness to consider chemoprevention. CONCLUSION: These findings emphasize the role of estimations of the risk of breast cancer for patients considering whether to accept chemoprevention treatment. To date, only a few modern models of risk estimation have been evaluated in relation to chemoprevention. There is a need for better integration of professional risk estimations into clinical practice.

Adult↗

PubMed2006

Critical appraisal of primary systemic endocrine therapy in receptor-positive postmenopausal breast cancer: an update.

Even in elderly patients, greater consideration is now being given to tumor volume reduction in locally advanced breast cancer, with increased subsequent breast-conserving surgery. Neoadjuvant endocrine therapy offers the possibility of testing therapeutic efficacy in vivo, which is of great importance for optimal adjuvant treatment. Resulting therapy modifications can be expected to increase disease-free as well as overall survival. Recent results indicate that remission rates with primary chemotherapy are significantly lower in receptor-positive than in receptor-negative breast cancer and that efficacy parameters in receptor-positive tumors tend to favor primary endocrine therapy, highlighting the increased importance of this type of treatment. Aromatase inhibitors are superior to tamoxifen in terms of clinical response as well as breast conservation rate. Results from a small number of studies suggest that prolonged preoperative aromatase inhibitor therapy for up to 12 months can increase the rate of clinical and pathological complete remissions. In conclusion, primary endocrine therapy is a valid therapeutic option for postmenopausal patients with locally advanced hormone receptor-positive breast cancer and significant comorbidity, increased risk of complications with regard to anesthesia and surgery, desire for breast-conserving surgery and/or reduced suitability for chemotherapy, as well as in very old patients.

Aromatase Inhibitors↗

PubMed2006

G-CSF in the prevention of febrile neutropenia in chemotherapy in breast cancer patients.

The most common chemotherapeutic agents in the treatment of breast cancer are anthracyclines and taxanes. The major dose-limiting toxicities associated with these agents are myelosuppression and associated febrile neutropenia (FN). FN can significantly impact the ability to deliver full-dose chemotherapy on schedule and as a result may increase the risk of disease recurrence and eventual disease-related mortality. The use of granulocyte colony stimulating factors (G-CSFs) significantly improves the management of FN, both in a therapeutic and in a prophylactic approach. Nevertheless, the high cost of these agents limits their widespread prophylactic use. Therefore, the identification of patients who are at a higher risk of developing FN and who will benefit from the prophylactic use of G-CSFs has become the subject of several clinical and cost-effectiveness studies. Recently, new data have been accumulated concerning the risk of FN in different chemotherapy regimens, and different risk models have been developed to assess the neutropenic risk with all its complications. This article reviews and summarizes cutting-edge, disease-specific data as well as national and international guidelines regarding the use of G-CSFs to prevent chemotherapy-induced FN, with focus on the treatment of breast cancer.

Antineoplastic Agents↗

PubMed2005

Physician-based active cost management of oncological therapies reducing pharmaceutical costs by 83.4% in two years without leaving standard of care.

We report about the 2-year results of a physician-based active cost management model for oncological therapies in a German OB/GYN university clinic. Over 2 years more than 4,000 oncological cycles were prospectively and individually analyzed regarding costs and reimbursement mode. Main aim was reducing costs without lowering cycle number and standard of care. Within two years pharmaceutical costs were reduced by 83.4% or 785,976-EUR. All causes for a previous financial loss were identified and eliminated. Debts were paid back and employment of new staff and investments were possible. With this first active cost management model by and for physicians, oncological therapies can be performed cost covering even in a university clinic. Although developed for optimization of cost coverage of oncological therapies in Germany, this model is universally transferable.

Antineoplastic Agents↗

PubMed2005

Primary systemic chemotherapy with sequential, dose-dense epirubicin and docetaxel for inoperable, locally advanced inflammatory breast cancer: a phase II study.

Sequential, dose-dense epirubicin plus docetaxel was evaluated as primary systemic therapy for women with inoperable, locally advanced breast cancer (LABC) or inflammatory breast cancer (IBC). Patients (LABC n=27; IBC n=7) received 3 cycles of epirubicin 120 mg/m2 every 2 weeks followed by 3 cycles of docetaxel 100 mg/m2 every 2 weeks, with granulocyte colony-stimulating factor. Grade 3-4 toxicities were observed in 21 of 195 cycles (10.8%). Grade 3 anemia and leukopenia each occurred in 1% of cycles. Following chemotherapy, all patients underwent surgery. Eight patients (23.5%) had a clinical complete response and 15 (44.1%) had a partial response. In patients with IBC, median skin thickness decreased from 5.85 mm (range: 3.1-6.2 mm) to 4 mm (range: 2.7-5.1 mm) (p<0.005). Sequential, dose-dense epirubicin plus docetaxel achieved a high response rate among patients with LABC or IBC with only moderate toxicity.

Adult↗

PubMed2005

Effect of pregnancy on long-term kidney function in renal transplant recipients treated with cyclosporine and with azathioprine.

In order to investigate the effect of different immunosuppressive regimens and the time interval between transplantation and pregnancy on long-term outcome, we performed a case-control study in pregnant renal allograft recipients. Eighty-one pregnancies of kidney transplanted recipients were identified [cyclosporine (CYA): n = 40; azathioprine (AZA): n = 41]. Controls were matched with respect to important prognostic factors. Posttransplant follow-up was 91.3 +/- 5 months. Graft and patient survival were similar in both groups and there was no apparent effect of immunosuppression. A total of 28 recipients (33%) delivered within 2 years and 6 (8%) subjects within 1 year after transplantation, but these short transplantation-to-pregnancy intervals had no apparent adverse effect on long-term outcome. In contrast to AZA-treated patients, CYA-treated patients experienced an increase in serum creatinine postpartum (1.15 +/- 0.2 mg/dL vs. 1.61 +/- 0.1 mg/dL; p < 0.05). Whole blood CYA levels decreased transiently during pregnancy from 115.9 +/- 8 ng/mL to 80.7 +/- 7 ng/mL leading to a gradual increase in drug dose from 240 +/- 14 mg/day to 324 +/- 21 mg/day (p < 0.05). Following delivery, there was an increase in CYA concentrations to 173 +/- 5.4 ng/mL, requiring rapid dose tapering to baseline of 246 +/- 15 mg/day. Pregnancies in renal recipients do not affect long-term patient and graft survival, independent of the immunosuppression. No detrimental effect of short transplantation-to-pregnancy intervals on long-term graft function was detected.

Adult↗

PubMed2005

Demographic and psychosocial factors associated with risk perception for breast cancer.

The objective of this study was to investigate, in a female population-based sample, specific demographic and psychosocial predictors of perception of risk for female breast cancer. The study was a cross-sectional survey of 7135 healthy women ranging from 15 to 85 years. A questionnaire assessed the perceived risk for breast cancer in 6 German centers. Specified awareness was personal knowledge in relation to breast cancer incidence, risk factors, perception, and level of concern. An awareness score was defined and related to values of several risk factors. Generally, 78.1% of women were aware of breast cancer. However, only one-third (31.2%) of women estimated the incidence of breast cancer correctly; 52% recognized age, 33.9% recognized hormonal contraceptives, and 34.1% recognized hormonal replacement therapy as factors of breast cancer risk. The most frequent specified sources of information were gynecologists (48.4%). The awareness score of women informed by gynecologists was significantly better compared to women informed by other healthcare professionals. However, a statistically significant improvement of the awareness score was reached for women with a higher educational level, information seeking by TV, radio, printed sources, medical books and healthcare flyers. Recommendations for improvement of cancer prevention programs include targeting comprehension regarding the lifetime risk of breast cancer, age as a risk factor, survival from breast cancer and hormonal factors. According to these results, there is an urgent need to separately address the perceptions of women, depending on age, social status and educational level.

Adolescent↗

PubMed2004

Body piercing affecting laparoscopy: perioperative precautions.

Piercing is an increasingly popular fashion trend mainly among adolescents. Umbilical piercing in particular can cause perioperative problems during laparoscopic procedures. We describe how to deal with this fashion trend in our institutions. First, any piercing needs to be documented during preoperative physical examination. During preoperative informed consent, patients are told that all pierced jewelry needs to be removed, preferably by the patient before the procedure. For the operation, patients may be offered the use of sterile "sleepers," which are substitutes made of plastic to avoid closure of the wound canal perioperatively. Postoperatively, most pierced jewelry can be put back into position after anesthesia has completely worn off. Only jewelry for piercings close to wounds (e. g., navel piercings) should not be reinserted until the skin is closed. Careful observation and increased hygienic effort to prevent local infection is necessary. To date, we have not seen any severe umbilical infection after laparoscopy. However, in several patients the umbilical pierced jewelry was back in the navel on the same day of surgery, sometimes immediately after waking from anesthesia. Hospital staff should know how to remove and substitute piercing jewelry as well as how to optimize hygienic care perioperatively to prevent umbilical wound infections. Time and effort for patient teaching and hygienic care are slightly increased.

Body Piercing↗

PubMedDate not supplied

Breast ductoscopy with a 0.55-mm mini-endoscope for direct visualization of intraductal lesions.

Standard radiologic examinations of breast duct lesions can give only indirect information. Mini-endoscopy with a breast ductoscope of only 0.55 mm offers direct visualization of the lesion and helps in the decision to perform or avoid exploratory breast tissue resection. We used a LaDuScope (PolyDiagnost, Pfaffenhofen, Germany) with a 0.55- or 0.95-mm outer diameter and a 75-mm working length from October 2003 through July 2004 on 11 women (average age of 48.3 years [range 36-69 years]) with suspicious nipple discharge. The optics have zero-degree direct view, 70-degree field vision, and 3000 or 6000 pixel resolution. Breast ducts and walls could be easily inspected; and irrigation of breast ducts, aspiration, and use of cytology brush were possible under visual control. We had no intraoperative or postoperative complications. The new procedure of mini-ductoscopy is feasible, safe, and helpful as an additional ambulatory diagnostic method for visual inspection of breast ducts. This instrument demonstrates the latest advances of technology and a trend toward less-invasive diagnostics for breast duct lesions.

Adult↗

PubMedDate not supplied

Development of a thinner and more flexible type of minihysteroscope with a controlled 90-degree bendable tip for vision-guided endometrium biopsy.

STUDY OBJECTIVE: Evaluation of the uterine cavity is limited with rigid 5-mm hysteroscopes because of the need for cervical dilatation, reduced movements inside the uterus, and no option for vision-guided biopsy. In cooperation with PolyDiagnost GmbH, Pfaffenhofen, Germany, a new type of flexible minihysteroscope with bendable tip was developed and evaluated. DESIGN: Prospective and parallel observational interindividual evaluation of flexible minihysteroscope and standard hysteroscope for diagnostic hysteroscopy (Canadian Task Force classification II-3). SETTING: Obstetrics and gynecology department of a university clinic. PATIENTS: Nine women, average age 65.0 years (range 46-89 years), with indications for diagnostic hysteroscopy. INTERVENTIONS: After defining requirements, a novel, thinner, and more flexible minihysteroscope, 18-cm long with a 2.67-mm outer diameter, was developed with straight zero-degree scope, 70-degree vision field, and 6000-pixel resolution. Two working channels, 1.2 mm and 0.55 mm, allow suction-irrigation and introduction of a 1.0-mm biopsy forceps or cytology brush. The tip of the instrument is 90-degree stageless bendable to both sides. Diagnostic hysteroscopy was performed with flexible minihysteroscope followed by standard rigid hysteroscopy to verify results. MEASUREMENTS AND MAIN RESULTS: From July 2003 through March 2004, both procedures were performed in nine patients with identical visual and histologic results. No complications occurred. No cervix-dilating instruments were necessary for introduction of the flexible minihysteroscope. Visualization of the entire uterine cavity is improved with the flexible scope because a bendable tip allows better peripheral vision (e.g., of the openings of the tubes). However, movement of the tip should be performed carefully due to potential risk of uterine perforation. CONCLUSION: This new flexible minihysteroscope is less invasive compared with standard rigid hysteroscopy, which supports performance of ambulatory hysteroscopy and makes increased movements and vision-guided biopsy inside the uterine cavity possible.

Aged↗

PubMedDate not supplied

Three-dimensional model for gas flow, resistance, and leakage-dependent nominal pressure maintenance of different laparoscopic insufflators.

STUDY OBJECTIVE: To compare laparoscopic insufflators with different insufflation characteristics and evaluate the effects of resistance and leakage on maintenance of nominal pressure. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Laboratory of university clinic. INTERVENTIONS: Measurement in an abdomen box model of insufflator response to different resistance and leakage combinations during steady state while attempting to maintain a nominal set pressure of 12 mm Hg. MEASUREMENTS AND MAIN RESULTS: An abdomen box model for laboratory measurements was designed with differing entrance and exit diameters simulated by hole disks of 0.5 mm to 7.6 mm. With a computer-based data-acquisition model, five insufflators (Olympus 9L and 16L, Storz 10L and 30L, HiTec 16L) were evaluated with 150 disk combinations. Average abdominal box pressures were recorded in three-dimensional (3-D) profiles showing different nominal pressure maintenance response for all insufflators regarding the resistance and leakage combination, maximum flow performance, and insufflation principle of the device. Average abdomen model box pressure can increase up to 26.57 mm Hg at 12 mm Hg nominal pressure setting (+121.4%). Insufflators with high flow rates (Storz 30L) tend to compensate leakage better but with the risk of higher intraabdominal pressure peaks. Insufflators with low-pressure principle (HiTec 16L) have limited pressure compensation but are safer for the patient. CONCLUSIONS: Nominal pressure maintenance of insufflators is mainly dependent on flow resistance and leakage rate and less on potential insufflator flow capacity. With this 3-D model, the nominal pressure maintenance of different insufflators can be described for the first time regarding these main factors.

Abdominal Cavity↗

PubMedDate not supplied

Axillary Dissection with Access Minimized (ADAM): a new technique for lymph node dissection in conservative surgery for breast cancer.

OBJECTIVE: Standard axillary lymph node dissection causes postoperative morbidity with pain, reduced arm mobility and axillary seromas. Endoscopy-supported axillary dissection using the same incision as was used for the breast tumor excision eliminates the necessity for a second axillary incision and potentially reduces operative trauma. This new technique is described and evaluated in a feasibility study. METHODS: Parallel observational study of a non-selected patient group with breast cancer (FIGO I-III) operated on with this less invasive technique from 11/2002 to 03/2003 in an oncological unit at the university level. RESULTS: 18 patients were operated on, with an average age of 74.7 (49-88) years, and a follow-up of 8.3 (5-10) months. Breast tumors could be removed in all quadrants. The single incision was 2.5-8.0 cm in length; operation time was 17-45 minutes and on the average, 14.2 (7-28) lymph nodes were removed. Only one patient was below the oncological standard of a minimum retrieval of 10 lymph nodes. There were no intra- or postoperative complications. Laparoscopic dissection was combined with sentinel lymph node biopsy, segment and quadrant resection as well as immediate breast reconstruction with latissimus dorsi flap or implant. Axillary pain and sensitivity effects were minimal. Advantages of this new technique are elimination of a second axillary incision and a remarkable increase of postoperative recovery regarding arm mobility and morbidity. CONCLUSIONS: The technique of endoscopy-supported axillary dissection with access minimized (ADAM) is feasible and safe and can be performed according to oncological standards.

Aged↗