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Biomedical subjects

W Tacke

Publications and source records attributed to W Tacke.

15 recordsLinked to original sources
PubMed2006

[Effectiveness of antiviral therapy in patients with chronic hepatitis C treated by private practice gastroenterologists].

The standard treatment for patients with chronic hepatitis C consists of pegylated interferon (PegIFN) alpha in combination with ribavirin. Information on treatment effectiveness outside clinical trials is sparse. To study community-based health care, a regional network supported by the German network of competence for hepatitis (Hep-Net) was created between gastroenterologists in private practice and a tertiary referral centre. A treatment register containing evidence-based guidelines was established and 212 consecutive patients who were treated with either PegIF Nalpha 2a/ribavirin (n = 126) or PegIFNalpha2b/ribavirin (n = 86) for 24 weeks (HCV genotype 2, 3) and 48 weeks (HCV genotype 1, 4, 5), respectively, were included and followed prospectively. Twenty-four weeks after cessation of antiviral treatment a sustained virological response was achieved in 54 % of the patients. By univariate analyses, infection with HCV genotypes 2 or 3 (p < 0.0001), younger age (p < 0.0001), normal gamma-glutamyltransferase levels before initiation of treatment (p = 0.003), and absence of language communication problems (p = 0.023) were associated with a sustained virological response. The presence of liver cirrhosis in patients with HCV genotype 1, 4, 5 infection was associated with lower sustained response rates (p = 0.025). Patients infected with HCV genotype 1 in whom the PegIFNalpha dose was reduced had higher virological relapse rates (p = 0.049). With regard to the treating physician, sustained virological response rates ranged from 26 - 67 % in patients infected with HCV genotype 1. Our study shows that virological response rates similar to those in international randomised clinical trials can be achieved by private practice gastroenterologists. The presented network allows characterization of the treatment outcome in chronic hepatitis C not only with regard to virus- and host-related factors but also on an individual physician basis.

Adult↗
PubMed1994

[Endosonographic findings in the upper gastrointestinal tract in staging of malignant nodal and extranodal lymphomas].

Endoscopic ultrasound has not yet become a routine procedure for the diagnosis and therapy planning of malignant lymphomas, and it was always restricted to patients with gastric or bowel involvement. From 1990 to 1992, 33 endoscopic ultrasound investigations have been performed in 25 patients with malignant lymphomas at the Cologne University Hospital. In addition, 21 of these patients had other (conventional) diagnostic procedures at the same time serving as reference. Endoscopic ultrasound showed lymphomas in 16/21 patients, and no evidence of lymphomas in 5/21 patients. The referencial investigations together showed lymphomas in 17/21 patients, and no evidence of lymphomas in 4/21 patients. Therefore, sensitivity was 94%. 5 of the patients in addition had involvement of the upper gastrointestinal tract's wall, proven by referencial investigations, which was diagnosed correctly in all cases. The pathological lymph nodes appeared mostly as echopoor, rather sharply demarcated and homogeneous. Their size was 7 mm to 55 mm in diameter, median 11 mm. The different histological types of lymphomas could not be distinguished by means of these criteria. Endoscopic ultrasound allows a detailed view at the mediastinal and epigastrical lymph node stations and may give important informations for the staging of malignant lymphomas.

Adult↗
PubMed1993

Comparison between endoscopic laser and different surgical treatments for palliation of advanced rectal cancer.

The results of different treatment modalities in 196 patients with rectal carcinoma were analyzed. Patients were treated by palliative endoscopic laser therapy (n = 37), palliative surgery (n = 42), and curative surgery (n = 117). Laser therapy was successful for recanalization of the stenosis with 1.3 (range, one to five) sessions. Bleeding stopped always after a single session. If necessary, treatment was repeated monthly. Good results were seen in 35/37 patients (95 percent). They received an average of four sessions during their remaining lifetime, the median of which was eight months. No morbidity and no therapy-related mortality occurred. Palliative surgery (expanded and restricted resections) showed good results in 41/42 patients (98 percent). Morbidity was 3/42 (7 percent); mortality was 1/42 (2 percent). The median survival was 14 months for local surgical treatment and 6.3 months for deep anterior rectal resection and for abdominoperineal (Dixon's) resection. No significant difference (P = 0.15) in survival times between the palliatively treated patient groups could be detected. Survival prognosis was determined by tumor stage and outcome. In the curative (outcome R0) resection patients, morbidity and mortality were each 9/117 (8 percent). The three-year survival rate was 80 percent. If curative resection is impossible, laser therapy should be considered as an alternative to palliative surgery because of less hospitalization and seemingly less side effects. The decision on the kind of palliation in patients with rectal carcinoma should be made with regard to the patient's quality of life.

Adult↗
PubMed1993

Combined treatment of large and calcified gallstones by ESWL and laparoscopic cholecystectomy.

In order to facilitate laparoscopic cholecystectomy in the presence of large gallbladder stones seven patients underwent ESWL before operation. In six cases (83%) a fragmentation to less than or equal to 1 cm could be achieved by application of 1,605 to 2,900 (mean 2,266) shock waves with the spark-gap lithotripter Philips-Dornier MFL 5000. In these cases intraoperative stone destruction or an increase of the puncture incision size could be avoided, thus proving the efficacy of this combined treatment approach. Laparoscopic inspection was performed 2 to 48 hours after ESWL. Including two additional cases operated because of unsuccessful ESWL, hematomas of the liver and adjacent organs were observed in six of nine patients (67%). This high rate of subclinical tissue lesions warrants caution if repeated ESWL sessions are scheduled at short-term intervals.

Cholecystectomy, Laparoscopic↗
PubMed1992

Senna vs. bisacodyl in addition to Golytely lavage for colonoscopy preparation--a prospective randomized trial.

Colonoscopy preparation with lavage is a clinically accepted procedure. After having shown that its results can be improved by the additional intake of Senna this randomized prospective trial was designed to evaluate the effects of different laxatives in a combined preparation regimen. The day before endoscopy either Bisacodyl or extractum Sennae was given to 120 patients. Immediately before examination all patients underwent whole gut irrigation with Golytely solution. Patient acceptance and effectiveness of the two procedures were excellent and no relevant intolerance was observed. Satisfactory cleansing results were achieved with Bisacodyl as well as with Senna (98.3 vs. 95%). There was no significant difference between the laxatives used. We conclude that both regimens are safe, generally well tolerated and effective ways of preparation for colonoscopy.

Adult↗
PubMedDate not supplied

Addition of senna improves colonoscopy preparation with lavage: a prospective randomized trial.

Attempts have been made to further improve the widely performed colonoscopy preparation with lavage. In a prospective study, 120 outpatients and inpatients scheduled for total colonoscopy were randomized to two preparatory regimens. The day before endoscopy either extractum sennae (N = 60) or a placebo solution (N = 60) was given. Just before examination all patients underwent whole gut irrigation with a polyethylene glycol electrolyte lavage solution (PEG-ELS). Adequacy of preparation, patient tolerance, and the necessary amount of PEG-ELS were assessed. Physician assessment of colon cleansing showed superiority in the group with additional laxative. The colon was free of solid debris in 66.7% of patients after PEG-ELS and in 90% after senna/PEG-ELS administration (p less than 0.01). Patient tolerance was similar in both groups with 86.7% vs. 83.3% of subjects rating the preparation as tolerable. Severe adverse events were not observed. In the senna/PEG-ELS group, significantly less (p less than 0.05) lavage fluid was needed. We conclude that the combination of senna and PEG-ELS is more effective than PEG-ELS in cleansing the colon for colonoscopy.

Adolescent↗