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Biomedical subjects

T Wagner

Publications and source records attributed to T Wagner.

At least 37 records · Page 2Linked to original sources
PubMed2004

Second-line treatment of advanced colorectal cancer with a weekly simultaneous 24-hour infusion of 5-fluorouracil and sodium-folinate: a multicentre phase II trial.

BACKGROUND: A weekly continuous 24-h infusion therapy with 5-fluorouracil (5-FU) preceded by a 2-h infusion of calcium folinate (CA-FA) was shown to be an effective first- and secondline treatment in advanced metastatic colorectal cancer. Substitution of CA-FA by the new formulation sodium folinate (S-FA) allows the simultaneous i.v. administration of folinic acid with 5-FU in one pump. PATIENTS AND METHODS: From 1999 to 2001, 42 patients with metastatic colorectal cancer after pre-treatment with a 5-FU bolus regimen were recruited in 5 centres to receive weekly 24-h infusions of 5-FU (2,600 mg/m2) and S-FA (500 mg/m2) dissolved in one pump for 6 weeks as second-line treatment. The treatment cycle was repeated after a 2-week rest period. RESULTS: 106 6-week cycles (median 2, range 1-6 per patient) were administered during the study. The median followup was 22 months. Out of 42 patients, 1 (2%) achieved complete remission, 3 (7%) partial remission, and 31 (74%) no change. Median time to tumour progression was 5.7 months (95% CI: 4.1-6.5). The median survival was reached at 14.7 months (95% CI: 11.0-22.0). Among major toxicities, NCI-CTC grade III/IV diarrhoea occurred in 8/42 (19%), grade III hand-foot-syndrome in 5/42 (12%) and grade III/IV stomatitis in 3/42 (7%) patients. CONCLUSION: Similar to conventional 24-h 5-FU + CA-FA treatment, the combination with S-FA in second-line therapy induced 9% objective responses and stopped tumour progression in 74%. The simultaneous administration of both, S-FA and 5-FU over 24 h dissolved in one pump is convenient, safe and effective as second-line treatment for patients with colorectal cancer.

Adult↗
PubMed2004

Detection of aquatic colloids in drinking water during its distribution via a water pipeline network.

Laser-induced Breakdown Detection (LIBD) is a highly sensitive method for the direct detection of nano-particles (colloids). During the detection process plasmas are generated on single particles by a focused laser beam, the resulting plasma light emissions are detected optically. The method is based on the difference in breakdown thresholds of liquid and solid matter, it is lower for solid material. The laser pulse energy is adjusted precisely so that in the pure liquid no breakdown events occur, and only in the presence of colloids is the breakdown threshold in the focal volume exceeded. The spatial distribution of several thousand recorded plasma flashes within the focal volume reveals the mean particle diameter. The evaluation of the number of breakdown events per number of laser pulses results in a breakdown probability, together with the particle size the concentration is calculated using specially-designed computer software. Compared to conventional laser light scattering methods the LIBD is approximately 6 orders of magnitude more sensitive for particles smaller than ca. 0.05 pm. Together with laser light obscuration the LIBD technique has been used successfully for the quantification of aquatic nano-particles during drinking water processing and its distribution via a pipeline network of nearly 1,700 km total length. In addition, the particulate content of several brands of mineral water has been investigated.

Colloids↗
PubMed2003

[Diffuse pulmonary ossifications with mortal consequences. A case report].

Dendriform pulmonary ossification (DPO) represents a relatively frequent form of diffuse pulmonary and mostly clinically inapparent bone formation of unknown etiology. An association with other pulmonary diseases, particularly pulmonary interstitial fibrosis, has been suggested. Here we report a female patient with a 15-year history of DPO whereby at the age of 48 an X-ray of the thorax first revealed findings suggestive of pulmonary fibrosis. For 9 years the patient suffered from chronic progressive ventilation disorder and after a further 3 years open lung biopsy revealed DPO in conjunction with interstitial fibrosis. After a history of progressive respiratory failure the patient suddenly died of cardiac arrhythmia along with deteriorated cor pulmonale at the age of 71. Autopsy revealed an almost complete ossification of the lungs with an increasing gradient from apex to base. In contrast to previous reports, the DPO of our patient was life-limiting.

Aged↗
PubMed2003

[Angularly stable radius plate: progress in treatment of problematic distal radius fracture?].

Fractures of the distal radius represent one of the most common fractures and have high socioeconomic relevance. Using the volar approach to avoid the soft tissue problems associated with dorsal plating, we treated a consecutive series of 49 displaced intra-articular distal radius fractures with a new fixed-angle internal fixation device. According to the AO classification, there were 21 C1, 19 C2, and nine C3 fractures. A retrospective study was carried out to obtain the functional results after open reduction and plate osteosynthesis. Loss of correction between postoperative and follow-up radiography was 1 degrees in volar tilt and radial inclination. The radial shortening was 1 mm. Wrist motion at final follow-up examination had recovered to an average of 80% of that at the normal, contralateral site. Overall outcome according to the Gartland and Werley scales showed 35% excellent, 50% good, and 15% fair results. Using the Martini score, we obtained 85% excellent and good results. The DASH score represented high subjective satisfaction.

Adult↗
PubMed2003

[Pain specialist in the assessment process].

Pain specialists are often involved in assessing social medical aspects of chronic pain patients. A standardized examination in the assessment process is not published. Data and statements on the assessment process between 1993 and 1997 were recorded from 15 experts by questionnaire. Statements to 568 reports were made. The majority of performance impairments were caused by back pain (35.9%) and headache (19.3%). All examiners integrated a psychological assessment. Although the assessment processes were very different, all examiners fulfilled the minimal criteria of the presented process for assessment of chronic pain patients. Verifying the symptoms as well as capturing some aspects of aggravation proved to be problematic. The present assessment practice is discussed with regard to the unequal procedure. On basis of the received data and the own experience in examination the process of structured assessment of chronic pain patients is presented under medical and psychological aspects. It contains a recommendation of a standardized process with minimal criteria and an optional supplement of the standardized process with problematical patients (e.g.demonstration, aggravation, simulation). Minimal demands on a qualified assessment of chronic pain patients should contain the study of the history, the German Pain-Questionnaire, the analysis of all the painful complaints with weighting their importance, the examination and the basic registration of sensational, emotional, cognitive, behavioral and social aspects of the chronic pain syndrome. An appended glossary of the most usable psychological tests with comments on their validation criteria aims to provide a more standard multimodal assessment of chronic pain patients complaints and functionability.

Humans↗
PubMed2003

Effect of acupuncture on the neutrophil respiratory burst: a placebo-controlled single-blinded study.

OBJECTIVES: Little is known about the influence of acupuncture treatment on the phagocytic immune system. This trial was performed to examine whether multiple acupuncture treatment affects the respiratory burst (RB) of neutrophils, a recognised measure of their cytotoxicity. DESIGN: Placebo-controlled single-blinded study. INTERVENTIONS: Eleven volunteers were treated bilaterally with standard needles (real) at acupoint LI11, 11 volunteers with placebo needles (placebo) at the same point. Treatments were performed for 30 min each twice a week for 4 weeks, eight times in all. The standard needles were manipulated until needle sensation (DEQI) developed. Before the treatment course (baseline), 48 h after the fourth (follow-up 1) and 48 h after the last treatment (follow-up 2) blood samples were drawn. MAIN OUTCOME MEASURES: RB and plasma beta-endorphin at each time point. RESULTS: In the real group there was a highly significant increase in the RB at follow-ups 1 (P=0.004) and 2 (P=0.007). Beta-endorphin levels decreased, but not significantly. In the placebo group there was a significant increase in the RB at follow-up 2 (P=0.048). In addition, at follow-up 2 a significant drop in beta-endorphin levels was observed (P=0.015). CONCLUSIONS: The RB of neutrophils is significantly activated by a course of several acupuncture treatments. In addition, psychological effects and a placebo that was not totally inert may contribute to the findings in the placebo group which may be mediated by the opiate endorphin system.

Acupuncture Therapy↗
PubMed2003

[Value of 14-gauge ultrasound-guided large-core needle biopsy of breast lesions: own results in comparison with the literature].

PURPOSE: To report the false-negative rate, sensitivity, and specificity of 14-gauge ultrasound-guided large-core needle biopsy (14-G USSB) performed on breast lesions at our institution and, furthermore, to compare and discuss our own results with those reported in the literature. MATERIALS AND METHODS: This study includes 399 lesions examined by 14-G USSB. The results of the 14-G USSB were compared with the results of the surgical biopsy or, in cases of benign histology, were followed clinically. A key word search in two medical databases was undertaken to compare our data with those reported in the literature. The search was limited to the period from January 1990 to February 2002 and only original investigations published in English and German were included in our comparison. RESULTS: At our institution, 238 (59.6 %) benign and 161 (40.4 %) malignant lesions were diagnosed by 14-G USSB. The 14-G USSB was false-negative in 5 (1.25 %) of 399 cases. It has a sensitivity of 95.7 %, and specificity 100%. The literature reports false-negative rates between 0 % and 1.26 %, sensitivities between 86% and 100%, and specificities between 99.7 % and 100 %. On the basis of 3880 results from seven selected original papers and our own study, the false-negative rate for 14-G USSB was calculated to be 0.4 % (16 of 3880). CONCLUSION: Based on our results and those reported in the literature, 14-G USSB can be considered safe and reliable in the assessment of breast lesions.

Adult↗
PubMed2002

[Focal myositis--an indication for surgery? A case report].

This case report describes focal myositis, a rare inflammatory pseudotumorous disease previously not mentioned in the surgical literature. Most often a single muscle of the upper or lower extremity is affected. Usually the diagnostic process and treatment require a long time. We present a useful diagnostic cascade and a surgical therapy, which allows the histological differentiation between malignant and inflammatory disease. Even after partial resection of the tumor, the prognosis of focal myositis is excellent.

Diagnosis, Differential↗
PubMed2002

[Malignomas following heart transplantation].

Up to 30% of patients with an organ transplantation develop precancerous lesions and malignant tumors, especially of the skin. All 241 patients who underwent heart transplantation from 1990 to 2000 were evaluated with regard to the development of neoplasias. Those alive in September 1999 were referred for a standardized dermatological exam (n=156) which detected malignancy in 28 patients being transplanted for 4.98 years on average. The skin was the organ most frequently involved (64%, n=18). 18% (n=5) of tumors were found in the urinary and genital tract, 7% (n=2) each in the respiratory and gastrointestinal tract, and 4% (n=1 ) in the breasts. The average age of patients who developed tumors was significantly higher as compared to the overall mean age (59.5+/-5 vs 49.8+/-14.7 years, p=0.00027). There was no correlation between development of malignancy and HLA matching, immunosuppressive drugs used, dosage and serum levels of immunosuppressive medication, and episodes of transplant rejection. Our study shows that the risk to develop tumors is at least doubled after heart transplantation. Due to the high incidence of skin tumors, transplant patients should undergo dermatological examinations on a regular basis.

Age Factors↗
PubMed2002

[Stereotactic needle breast biopsy: Diagnostic reliability of various biopsy systems and needle sizes].

OBJECTIVES: To compare quality of harvested tissue, false-negative rate, and complication rate of large-core needle breast biopsy (LCNBB) and directional, vacuum-assisted breast biopsy (DVABB) in non-palpable breast lesions. PATIENTS AND METHODS: From 1994 to 1999, in 580 non-palpable breast lesions a stereotactically-guided breast biopsy was performed. 14-G LCNBB was used in 168 lesions (29 %). DVABB was used in 412 lesions (71 %; 11-G DVABB: 134 lesions 32.5 %, 14-G DVABB: 278 lesions 67.5 %). Following biopsy, patients underwent either surgical excision (n = 533; 93.8 %) or mammographical follow-up (n = 36; 6.2 %). Histological results of LCNBB, DVABB, surgical breast biopsy and follow-up results were compared and scored for their tissue quality on a three-point scale (1 = disagreement between biopsy and surgery; 2 = partial agreement; 3 = complete agreement). In addition, we determined the false negative and complication rate for both systems. RESULTS: Histological examination after surgery and follow-up proved 262 (45.2 %) to be benign, 15 (2.6 %) to be high-risk lesions and 303 (52.5 %) to be malignant. In the tissue quality there was no significant difference between 14-G LCNBB (score = 2.94), 11-G DVABB (score = 2.92) and 14-G DVABB (score = 2.91) (p > 0.05). Particularly, in calcifications 11-G DVABB scored better (score = 2.92) than 14-G DVABB (score = 2.88) (p > 0.05). 14-G LCNBB had a lower false negative rate (1.8 %) than 11-G DVABB (3 %) and 14-G DVABB (3.2 %) (p > 0.05). There was no difference in the complication rate between the different needle types. CONCLUSIONS: Our results indicate that both LCNBB and DVABB are reliable and safe techniques in the diagnosis of non-palpable breast lesions. However, the use of 14-G LCNBB seems to be advantageous in masses, the use of 11-G DVABB seems to be advantageous in asymmetric densities and calcifications.

Adult↗
PubMed2002

[Comparison of wire versus carbon localization of non-palpable breast lesions].

PURPOSE: To compare the accuracy of wire and carbon localization in stereotactically localized open breast biopsy. PATIENTS AND METHODS: From June 1995 to December 1997, a total of 725 stereotactic wire or carbon dye localizations were performed in 698 female patients. Success of localization was evaluated either by a malignant histopathological diagnosis or by mammographic follow-up. A lesion was considered to be missed if it could be still seen on follow-up mammography. RESULTS: In 703 of 725 cases, the success of localization could be evaluated with 427 (61 %) lesions localized with a wire and 276 (39 %) with carbon. Seven (1 %) out of 703 lesions were missed at open biopsy. Three lesions of these had been localized with wire and three lesions with carbon. The miss rates were 0.9 % and 1.1 %, respectively (p = 1.0). CONCLUSION: Both wire and carbon localization are reliable and accurate in the localization of non-palpable breast lesions. Concerning efficiency and costs, carbon dye seems to offer a promising compromise.

Adult↗
PubMed2002

Kell expression on myeloid progenitor cells.

Kell is one of the major human red blood cell groups and comprises 22 antigens. These antigens are produced by alleles located on chromosome 7, including sets of antithetical antigens such as Kell (K, K1) and cellano (k, K2), which differ in a single amino acid change (T193M). It consists of a 93-Kd transmembrane glycoprotein that is surface-exposed and shares sequence and structural homology with zinc endopeptidases, which are involved in regulating bioactive peptides. Anti-Kell antibodies have been shown to suppress fetal erythropoiesis. Recently published data indicate a similar effect on myeolopoiesis and megakaryopoiesis. Substantial thrombocytopenia in fetuses affected with HDN due to anti-K antibodies led to the discovery of the inhibitory effect of Kell-related antibodies on CFU-MK growth. In addition to its inhibitory effect on BFU-E growth, anti-Kell antibodies significantly reduced CFU-GM colony formation from haematologically normal individuals. Moreover, anti-cellano and anti-Kp(b) antibodies also inhibited the growth of CFU-GM from antigen positive MNC. These data indicate that Kell is not restricted to erythroid blood cells, but is expressed on a broader spectrum of haematopoietic cells than previously believed.

Autoantibodies↗
PubMed2002

New insights into the clinical pharmacokinetics of trofosfamide.

OBJECTIVE: This study focuses on the pharmacokinetics of trofosfamide (TRO) and metabolites after oral administration of TRO. METHODS: Twelve patients with solid tumors and non-Hodgkin lymphomas were treated with 450 mg TRO orally for 7 days. TRO and the stable metabolites ifosfamide (IFO), cyclophosphamide (CYC), 2- and 3-dechloroethylifosfamide (2-DCE, 3-DCE) were determined by GC and the sum of the 4-OH-metabolites was measured by HPLC. RESULTS: A fast metabolism of TRO with a half-life of about 1 h was observed. IFO was the main stable metabolite, whereas CYC was only detected in minor quantities. The peak levels and the AUC of the 4-OH-metabolites were 9.5 and 4.3 times higher than observed after an equimolar IFO dose. Only 6% of the administered dose was recovered in urine within 24 hours as stable metabolites. TRO was under limit of detection. CONCLUSIONS: Our results confirm that dechloroethylation of TRO to IFO is a major metabolic pathway. Additionally, we found considerable 4-hydroxylation not shown previously. With respect to the low levels of IFO and CYC observed, the sum of 4-OH-metabolites cannot be explained by hydroxylation of these metabolites only. Hence, we assume a direct 4-hydroxylation of TRO occurring to a high extent. Bioavailability of TRO could not be calculated directly, because TRO is only available as an oral formulation. The bioavailability of oral IFO, however, is reported to be almost 100%. Therefore, after normalization of the dose, a bioavailability of 32% for IFO after oral TRO could be calculated. Thus, in contrast to previous reports, direct 4-hydroxylation of TRO seems to be the main metabolic pathway.

Adult↗
PubMed2002

[Sentinel lymph node diagnosis in prostatic carcinoma: I: Method and clinical evaluation].

AIM: Evaluation of the significance of lymphoscintigraphy and intraoperative probe measurement for the identification of the sentinel lymph node (SLN) in prostate cancer. PATIENTS AND METHOD: In 117 patients with prostate cancer scintigrams in various projections were acquired till approximately 6 hours p.i. after ultrasound guided transrectal intraprostatic injection of 99mTc-Nanocoll. On the following day the SLNs were identified in the operation theatre with a gamma probe and removed. Pelvic standard lymph node dissection followed SLNE. RESULTS: In three of 117 patients with preoperative lymphoscintigraphy no SLN was scintigraphically detectable. These three patients had antecedent transurethral resection of the prostate. In 113 of the residual 114 patients SLN could be intraoperatively localized. In the mean four SLNs per patient were removed. 28 of 117 patients had pelvic lymph node metastases. In 25 cases SLN were right-positive, in one false-negative and in one intraoperatively not detectable. In one patient we found macrometastasis of up to 4 cm diameter (one SLN was tumour positive). In 15 cases only the SLN was bearing tumour. CONCLUSION: The SLNE with preoperative lymphoscintigraphy and intraoperative gamma probe measurement is suitable for detecting lymph node metastasis in prostate cancer. SLNE is superior to the surgical techniques commonly used in pelvic lymphadenectomy.

Aged↗
PubMed2001

In vitro targeted killing of prostate tumor cells by a synthetic amoebapore helix 3 peptide modified with two gamma-linked glutamate residues at the COOH terminus.

Prostate-specific membrane antigen (PSMA) is a trans-membrane protein specifically expressed in LNCaP cells, malignant human prostate tissues, and the surrounding neovasculature. PSMA is a unique exopeptidase with reactivity toward poly-gamma-glutamated folates. It can sequentially remove the poly-gamma-glutamyl termini. To target prostate tumor cells, a novel procytolytic peptide was designed with a backbone consisting of an amoebapore H3 domain modified by two gamma-linked glutamate residues at the epsilon-amino group of the COOH-terminal lysine residue. The strategy behind the design of this prolytic peptide was to inactivate the lytic amoebapore H3 peptide by replacing its functionally important COOH-terminal positive charge with negatively charged groups, which in turn might be selectively removed by the PSMA exopeptidase. This peptide exhibited little cytolytic activity toward PSMA-negative cells, such as PC-3 cells. On the other hand, this peptide exhibited strong cytolytic activity toward PSMA-positive LNCaP cells in a concentration-dependent manner. The carboxypeptidase inhibitor 4,4'-phosphonicobis (butane-1,3-dicarboxylic acid) can inhibit this activity. Moreover, this peptide also exhibited cytolytic activity toward PSMA cDNA-transfected PC-3 cells.

Amino Acid Sequence↗
PubMed2001

[Pancreatic exocrine insufficiency in patients with diabetes mellitus. Current state of our knowledge and practical consequences].

In recent years, a number of studies have been carried out, the results of which suggest that the exocrine function of the pancreas is significantly more frequently impaired than is the case in healthy controls. In particular when a patient presents with gastrointestinal complaints of unclear origin, unexplained fluctuations in blood sugar, or loss of weight, the possibility of pancreatic exocrine insufficiencyshould be included in differential diagnostic considerations. Abnormal stools and intolerance of dietary fat can be clarified on the basis of a careful history. The diagnosis is confirmed with the aid of simple laboratory tests, for example the chemotrypsin test or the detection of elastase 1 in the stools. By way of treatment, pancreatic enzyme replacement can be applied.

Adolescent↗