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Chiru ED, Grasic Kuhar C, Oseledchyk A, Schötzau A, Gonzalez MJ, Kurzeder C, Vetter M. Clinical application of the 21-gene oncotype recurrence score in an older cohort: A single center experience. Transl Oncol 2023; 36:101724. [PMID: 37480708 PMCID: PMC10375846 DOI: 10.1016/j.tranon.2023.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND In early luminal breast cancer, the Oncotype DX® Recurrence Score (RS) prognostic and predictive value with regards to chemotherapy (CHT) application benefit has been broadly validated. In older patients its value has not been deeply addressed. This study aimed to evaluate the benefits of RS testing and to look at differences in treatment allocation for these patients when compared with younger ones. METHODS We included data from consecutive patients with early luminal HER2-negative breast cancer, treated between 2010 and 2022 at the University Hospital Basel and Cantonal Hospital Baselland, Switzerland. The older cohort included 63 (19%) patients aged ≥70, and the younger cohort 263 (81%) patients aged <70. RESULTS Older breast cancer patients had more co-morbidities (N = 36, 57% vs. N = 92, 35%, p = 0.002) and a higher clinical risk status (N = 49, 78% vs. N = 155, 59%; p = 0.01) when compared to younger patients. Histopathologic characteristics were significantly different between the two cohorts. Although older patients had a higher clinical risk status (78% vs. 59%) (p = 0.01), most of them (74%) received no CHT. Specifically, adjuvant CHT was administered less frequently in older than in younger patients (13% vs. 22%; p = 0.01). Moreover, older patients were less likely to complete CHT (>4 cycles: 78% vs. 97%). CONCLUSION Breast cancer patients aged ≥70 have higher clinical risk status, more co-morbidities, higher clinical stage (driven by larger tumor size), and more often RS ≥26. However, they receive fewer adjuvant RT and CHT than those aged <70. RS maintains its independent prognostic value in older patients. However, assessing the predictive value of additional CHT benefit remains challenging due to significant differences in CHT administration. Although therapy decision-making in older patients with breast cancer still follows RS-based guidelines, clinical practice indicates an individualized treatment approach.
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Affiliation(s)
- E D Chiru
- Medical Oncology, Basel University Hospital, Basel, Switzerland; Center of Oncology and Hematology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - C Grasic Kuhar
- Medical Oncology Department, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - A Oseledchyk
- Medical Oncology, Basel University Hospital, Basel, Switzerland
| | - A Schötzau
- Department of Gynecologic Oncology, Basel University Hospital, Basel, Switzerland
| | - M J Gonzalez
- Adullam Hospital and care centers, Basel, Switzerland
| | - C Kurzeder
- Breast Center, Basel University Hospital, Basel, Switzerland; Department of Gynecologic Oncology, Basel University Hospital, Basel, Switzerland
| | - M Vetter
- Medical Oncology, Basel University Hospital, Basel, Switzerland; Center of Oncology and Hematology, Cantonal Hospital Baselland, Liestal, Switzerland; Breast Center, Basel University Hospital, Basel, Switzerland.
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Edenhofer H, Hösli I, Zemp E, Schötzau A. Influencing factors of early breastfeeding status – a retrospective analysis of 4200 mother-and-child-pairs of the University Hospital Basel, Switzerland, between 2014 – 2015. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- H Edenhofer
- Frauenklinik, Universitätsspital Basel, Basel, Schweiz
| | - I Hösli
- Frauenklinik, Universitätsspital Basel, Basel, Schweiz
| | - E Zemp
- Swiss Tropical and Public Health Institute, Basel, Schweiz
| | - A Schötzau
- Frauenklinik, Universitätsspital Basel, Basel, Schweiz
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3
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Jacob F, Alam S, Liang CY, Kohler R, Nonantz M, Everest-Dass A, Huang YL, Fedier A, Schötzau A, Nunez Lopez M, Packer N, Lengerke C, Heinzelmann-Schwarz V. A4GALT-related glycosphingolipids play a pivotal role in the reversible transition of mesenchymal and epithelial ovarian cancer cells and hence are important regulators of metastasis. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- F Jacob
- University Hospital Basel, Department of Biomedicine, Glyco-Oncology, Ovarian Cancer Research, Basel, Schweiz
| | - S Alam
- University Hospital Basel, Department of Biomedicine, Glyco-Oncology, Ovarian Cancer Research, Basel, Schweiz
| | - CY Liang
- University Hospital Basel, Department of Biomedicine, Ovarian Cancer Research, Basel, Schweiz
| | - R Kohler
- University Hospital Basel, Department of Biomedicine, Ovarian Cancer Research, Basel, Schweiz
| | - M Nonantz
- University Hospital Basel, Department of Biomedicine, Stem Cell and Hematopoiesis, Basel, Schweiz
| | - A Everest-Dass
- Griffith University, Institute for Glycomics, Gold Coast, Australien
| | - YL Huang
- University Hospital Basel, Department of Biomedicine, Ovarian Cancer Research, Basel, Schweiz
| | - A Fedier
- University Hospital Basel, Department of Biomedicine, Ovarian Cancer Research, Basel, Schweiz
| | - A Schötzau
- University Hospital Basel, Department of Biomedicine, Ovarian Cancer Research, Basel, Schweiz
| | - M Nunez Lopez
- University Hospital Basel, Department of Biomedicine, Ovarian Cancer Research, Basel, Schweiz
| | - N Packer
- Macquarie University, Department of Chemistry and Biomolecular Sciences, North Ride, Australien
| | - C Lengerke
- University Hospital Basel, Department of Biomedicine, Stem Cell and Hematopoiesis, Basel, Schweiz
| | - V Heinzelmann-Schwarz
- University Hospital Basel, Department of Biomedicine, Ovarian Cancer Research, Basel, Schweiz
- University Hospital Basel, Hospital for Women, Department of Gynecology and Gynecological Oncology, Basel, Schweiz
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Kohler R, Anugraham M, Nunez Lopez M, Xiao C, Schötzau A, Hettich T, Schlotterbeck G, Fedier A, Heinzelmann-Schwarz V, Jacob F. Low MGAT3 expression identifies long-term survivors with high grade serous ovarian cancer. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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5
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Mirza U, Montavon C, Schötzau A, Fink D, Hacker N, Heinzelmann-Schwarz V. Impact of the new FIGO 2013 classification on survival analysis of stage I epithelial ovarian cancer. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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6
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Schwab F, Redling K, Siebert M, Schötzau A, Schoenenberger CA, Zanetti-Dällenbach R. Ultrasound BI-RADS classification and real-time elastography Tsukuba score assessment of breast lesions: inter-and intraobserver agreement. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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7
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Mirza U, Montavon C, Schötzau A, Zanetti R, Heinzelmann-Schwarz V. Detection of microscopic peritoneal spread in gynecological cancers using diaphragmatic scrapings adds no benefit to standard staging procedures. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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8
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Jacob F, Anugraham M, Schötzau A, Everest-Dass A, Bovin N, Huflejt M, Fedier A, Hacker N, Fink D, Packer N, Heinzelmann-Schwarz V. High-grade serous ovarian and peritoneal cancers display distinct genetic and post-translational signatures – a criterion to treat them differently? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Jurga-Karwacka A, Karwacki GM, Schwab FD, Schötzau A, Zech C, Heinzelmann-Schwarz V. Chronic lower abdominal pain is commonly associated with pelvic congestion syndrome. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Nützi C, Orgül S, Schötzau A, Grieshaber M. Predictability of Morphological Changes of the Anterior Chamber Angle after Laser Iridotomy by Ultrasound Biomicroscopy. Klin Monbl Augenheilkd 2015; 232:419-26. [DOI: 10.1055/s-0035-1545793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Nützi
- Department of Ophthalmology, University Hospital of Basel, Switzerland (Chairman ad interim: Dr. sc. nat. Norbert Spirig)
| | - S. Orgül
- Department of Ophthalmology, University Hospital of Basel, Switzerland (Chairman ad interim: Dr. sc. nat. Norbert Spirig)
| | - A. Schötzau
- Department of Ophthalmology, University Hospital of Basel, Switzerland (Chairman ad interim: Dr. sc. nat. Norbert Spirig)
| | - M. Grieshaber
- Department of Ophthalmology, University Hospital of Basel, Switzerland (Chairman ad interim: Dr. sc. nat. Norbert Spirig)
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Huhn E, Hoffmann I, Schötzau A, Lapaire O. Changes of angiogenesis factors around delivery in preeclampsia and high risk patients. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1548714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Schmid SM, Pfefferkorn C, Myrick ME, Viehl CT, Obermann E, Schötzau A, Güth U. Prognosis of early-stage synchronous bilateral invasive breast cancer. Eur J Surg Oncol 2011; 37:623-8. [PMID: 21628090 DOI: 10.1016/j.ejso.2011.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/02/2011] [Accepted: 05/09/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Contradictory data exists concerning the prognosis of patients with synchronous bilateral breast cancer (SBBC). Most authors report a worse prognosis for SBBC patients compared to unilateral breast cancer (UBC) patients. There are a few studies that did not support these findings. This study gives a comprehensive picture of SBBC and tests the hypothesis that outcome of this entity is based on the tumor with the worse prognosis (reference lesion). PATIENTS & METHODS The data of two prospective Swiss breast cancer databases covering a 20-year period (1990-2009) was reviewed. Forty-six cases of SBBC were identified. In 34 patients with early-stage SBBC, the reference lesions (defined as the tumor with the more advanced stage or, in cases where both tumors had the same stage, the larger tumor) were compared in a case-control approach with 100 patients having UBC (SBBC/UBC ratio = 1/3). The controls were matched for age, time of diagnosis, tumor size, axillary node status, histological grade and estrogen-receptor status. Differences in terms of survival curves were analyzed using the log rank test; the possible correlation between matched groups was evaluated by a frailty Cox model. RESULTS There were no significant differences in disease-specific survival between SBBC and its unilateral controls (HR, 0.932; 95% CI, 0.322-1.07; p = 0.90). CONCLUSIONS The prognosis of SBBC was determined by the reference lesion; the contralateral second tumor had no additional impact on outcome.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Case-Control Studies
- Female
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Neoplasm Staging
- Neoplasms, Multiple Primary/mortality
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Prognosis
- Proportional Hazards Models
- Survival Rate
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Affiliation(s)
- S M Schmid
- Department of Gynecology and Obstetrics, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
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Mozaffarieh M, Schötzau A, Josifova T, Flammer J. The effect of ranibizumab versus photodynamic therapy on DNA damage in patients with exudative macular degeneration. Mol Vis 2009; 15:1194-9. [PMID: 19536305 PMCID: PMC2697459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 06/08/2009] [Indexed: 11/01/2022] Open
Abstract
PURPOSE To compare the effect of ranibizumab treatment versus photodynamic therapy (PDT) on single-stranded DNA damage in circulating leukocytes in patients with exudative age-related macular degeneration (AMD). METHODS A comparative quantification of single-stranded DNA breaks was performed in circulating leukocytes of AMD patients before and 30 min, 45 min, 60 min, and 24 h after two different modes of therapy: a) PDT; and b) intravitreal ranibizumab injection. DNA breaks lead to smaller pieces of DNA, which in an electrical field, migrate out of the nucleus forming a tail. Damage of an individual cell was quantified as a comet tail moment. The proportion of non-zero values compared to the total number of observations was referred to as "amount of DNA damage" expressed in arbitrary units (AU). Comparisons between time points and study groups were assessed using a linear mixed-effect model. RESULTS PDT induced an increase in the amount of single-stranded DNA damage in the circulating leukocytes from 0.2 AU (before treatment) to 0.53 AU (30 min after treatment). This increase was significant (p=0.004). In contrast, after ranibizumab treatment, the DNA damage in the circulating leukocytes remained unchanged. CONCLUSIONS PDT purposely induces a local oxidative stress to damage the newly formed vessels. Our results indicate an additional systemic oxidative stress, apparent as amount of single-stranded DNA damage in the circulating leukocytes, for at least 30 min after treatment.
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14
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Rickenbacher I, Gugleta K, Zawinka C, Schötzau A, Katamay R, Flammer J, Orgül S. [Response of retinal vessel diameter to flicker-light in vasospastics compared to healthy controls]. Klin Monbl Augenheilkd 2009; 226:305-9. [PMID: 19384788 DOI: 10.1055/s-0028-1109271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vascular dysregulation is considered to be a risk factor in several ophthalmic diseases. The purpose of this study was to evaluate the reaction of retinal vessels to flicker light in otherwise healthy subjects with a vasospastic propensity. PATIENTS AND METHODS Thirty healthy Caucasians, aged between 18-35 years were recruited for this study and grouped into vasospastics, based on a history of frequent cold hands, even in summer, with concordant findings in nailfold capillary microscopy, or as controls, if such a history was absent. The reaction of the retinal vascular diameter to flicker light was observed in a distance of two to three discs diameters away from the optic nerve head with the retinal vessel analyser. Three phases of flicker light of twenty seconds followed by baseline light phases of eighty seconds were recorded. The maximal vasodilatory amplitude of each flicker phase was determined and the results averaged. RESULTS The maximal average dilatory amplitude at the arterial side reached (mean +/- SD) 2.9 +/- 1.7 % and 4.8 +/- 2.6 % of the baseline amplitude respectively in vasospastic subjects and in healthy controls (t = 2.34; p = 0.025). The reaction at the venous side was statistically comparable in both groups. CONCLUSIONS Otherwise healthy, vasospastic subject disclosed an altered reaction of the retinal vasculature to flicker light in this study.
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Affiliation(s)
- I Rickenbacher
- Universitätsspital Basel, Abteilung Ophthalmologie, Schweiz
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15
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Henrich PB, Priglinger S, Klaessen D, Kono-Kono JO, Maier M, Schötzau A, Meyer P, Josifova T, Schneider U, Flammer J, Haritoglou C. Macula-off retinal detachment--a matter of time? Klin Monbl Augenheilkd 2009; 226:289-93. [PMID: 19384785 DOI: 10.1055/s-0028-1109330] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to determine the influence of the lag time between macular detachment and surgical intervention on post-operative visual acuity gain in patients with rhegmatogenous macula-off retinal detachment. PATIENTS AND METHODS We retrospectively evaluated the medical records of 62 consecutive patients having undergone scleral buckling surgery for rhegmatogenous macula-off retinal detachment. The correlation of gender, age, refraction, number of retinal breaks, development of cataract during follow-up, pre-operative visual acuity and timing of surgical intervention with final visual acuity and post-operative visual acuity gain were determined. Mean follow-up time was 12.7 months. RESULTS A correlation with final visual acuity was found for pre-operative visual acuity and lag between the beginning of symptoms and surgical intervention. A correlation with visual acuity gain was found only for timing of surgical procedure. When divided into subgroups operated after 0, 1-3, 4-6, or 7-9 days, respectively, visual recovery was better the earlier the patients underwent surgical repair. Compared to surgery at day 0, statistical significance was found only for patients operated 4 or more days after the occurrence of symptoms. CONCLUSION The first three days seem to represent a relatively safe period during which surgery for macula-off retinal detachment may be postponed without compromising the patient's visual prognosis.
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Affiliation(s)
- P B Henrich
- University of Basel, Department of Ophthalmology, Basel, Switzerland.
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Wyler S, Huang DJ, Singer G, Schötzau A, Holzgreve W, Güth U. Metastatic involvement of the urinary tract in patients with advanced ovarian carcinoma: lessons from the autopsy for an interdisciplinary treatment approach. EUR J GYNAECOL ONCOL 2009; 30:174-177. [PMID: 19480248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE OF INVESTIGATION Frequency and extent of metastases in urologic organs found at autopsy of ovarian carcinoma patients were evaluated. METHODS Autopsy reports from 170 patients who died of advanced ovarian carcinoma between 1975 and 2005 were studied. The distribution of abdominal metastatic sites with particular attention to the involvement of the urologic organs, and hydronephrosis was analyzed. RESULTS The distribution of metastatic sites was as follows: kidney (n = 6, 3.5%), urinary bladder (n = 38, 22.4%), and ureter (n = 20, 11.8%). In 36 patients, hydronephrosis was observed (21.2%); of these patients, 20 (55.6%) also had ureteral involvement. All patients with ureteral involvement had hydronephrosis. CONCLUSION Hydronephrosis in late stages of ovarian carcinoma, usually attributed to extrinsic compression of the ureter by an abdominal tumor, may also be explained by ureteral metastases. This fact must be considered in the clinical management of these patients, particularly in the restoration of luminal patency through an endoscopically placed internal ureteral stent.
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Affiliation(s)
- S Wyler
- Department of Urology, University Hospital Basel (UHB), Switzerland
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Güth U, Huang DJ, Schötzau A, Zanetti-Dällenbach R, Holzgreve W, Bitzer J, Wight E. Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer. Br J Cancer 2008; 99:428-33. [PMID: 18665168 PMCID: PMC2527804 DOI: 10.1038/sj.bjc.6604525] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Previous research evaluating the use of adjuvant endocrine therapy among postmenopausal breast cancer patients showed with 15–50% wide ranges of non-adherence rates. We evaluated this issue by analysing an unselected study group comprising of 325 postmenopausal women, diagnosed from 1997 to 2003 with hormonal receptor-positive invasive breast cancer. The different clinical situations that led to the discontinuation of adjuvant endocrine therapy were clearly defined and differentiated: non-adherence was not simply the act of stopping medication, but rather the manifestation of an intentional behaviour of the patient. Of the 287 patients who initiated endocrine therapy, 191 (66.6%) fully completed this treatment. Thirty-one patients (10.8%) showed non-adherence to therapy. Patients who had follow-up with a general practitioner, rather than in an oncologic unit, were more likely to be non-adherent (P=0.0088). Of 25 patients who changed medication due to therapy-related adverse effects, 20 (80%) patients fully completed the therapy after drug change. In adjuvant endocrine therapy, a lowering of the non-adherence rate to 10.8%, the lowest reported in the literature, is realistic when patients are cared for by a specialised oncologic unit focusing on the individual needs of the patients.
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Affiliation(s)
- U Güth
- Department of Gynaecology and Obstetrics, University Hospital Basel, Spitalstrasse 21, Basel CH-4031, Switzerland.
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Kovalska M, Grieshaber MC, Schötzau A, Katamay R, Hauenstein D, Flammer J, Orgül S. Detection of visual field progression in glaucoma. Klin Monbl Augenheilkd 2008; 225:342-5. [PMID: 18454368 DOI: 10.1055/s-2008-1027289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of this study was to compare an event analysis and a trend analysis for the detection of progression in glaucomatous visual field loss. PATIENTS AND METHODS Excluding initial fields (Octopus, Haag-Streit AG, Köniz, Switzerland), baseline was defined as the average result of the second and third examinations. Eyes with at least 6 additional fields entered the study. The event analysis used the method of the Collaborative Normal Tension Glaucoma Study, and the trend analysis was based on a point-wise linear regression analysis. RESULTS Of 251 glaucoma patients, 235 left eyes and 225 right eyes qualified for the study. Using the event analysis, 44 series suggested a progressive damage, while the point-wise regression approach disclosed only 14 progressing series. In 9 eyes, the two approaches were concordant. Among the latter, 1 - 5 additional fields were necessary in 7 series to disclose progression using the trend analysis. In one series, the event analysis showed progression 7 examinations later. CONCLUSIONS The point-wise linear regression analysis classified fewer cases as progressing than the event analysis and determined progression later.
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Affiliation(s)
- M Kovalska
- University Eye Clinic, Basel, Switzerland
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Güth U, Wight E, Langer I, Schötzau A, Dieterich H, Herberich L, Holzgreve W, Singer G. Breast cancer sagittal/horizontal plane location influences axillary lymph node involvement. Eur J Surg Oncol 2006; 32:287-91. [PMID: 16466903 DOI: 10.1016/j.ejso.2005.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 12/22/2005] [Indexed: 11/28/2022] Open
Abstract
AIM To assess the influence of tumour location on axillary lymph node involvement (ALNI) and prognosis in breast cancer by evaluating the significance of the sagittal/horizontal alignment. METHODS We compared 57 patients with superficially located breast carcinomas up to 3.0 cm with patients having lesions in posterior planes of the breast. Both groups were matched according to age, time of diagnosis, tumour size, grade, hormonal receptor status and tumour site within the frontal plane. Histologic evidence of skin involvement, excluding tumours fulfilling the criteria for pT4b, was defined as inclusion criteria and reference plane for superficial tumour location. RESULTS Tumours situated in the superficial region of the breast, compared to those located in deeper planes, have an increased risk of ALNI (p=0.023), whereas no difference was observed with reference to disease-specific survival (p=0.203). CONCLUSION This study shows that ALNI is dependent on sagittal/horizontal as well as frontal tumour location. Clinicians should be aware that tumours lying posteriorly may be at increased risk of occult spread outside axillary lymph nodes.
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Affiliation(s)
- U Güth
- Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Spitalstrasse 21, CH-4031 Basel, Switzerland.
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Güth U, Singer G, Schötzau A, Langer I, Dieterich H, Rochlitz C, Herberich L, Holzgreve W, Wight E. Scope and significance of non-uniform classification practices in breast cancer with non-inflammatory skin involvement: a clinicopathologic study and an international survey. Ann Oncol 2005; 16:1618-23. [PMID: 16033873 DOI: 10.1093/annonc/mdi319] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The study evaluates the scope of non-uniform classification practices concerning breast carcinomas with non-inflammatory skin involvement. PATIENTS AND METHODS We compared the clinical course of patients with histologically proven non-inflammatory skin involvement: 119 (65.4%) with clinically obvious 'classical' skin changes (Group A) and 63 (34.6%) with no or only discreet changes (Group B). A questionnaire was circulated to pathology departments in 24 countries to assess the practice concerning the placement of skin- involved breast carcinomas in the TNM classification. RESULTS Patients in Group B showed a significantly better disease specific survival (P=0.0002). Eighty-six respondents (70.5%) of the survey preferred the 'histological view' and classified tumors with only histological proven skin involvement as T 4 b/stage IIIB. The opposing classification principle ('clinical view'), which dictates that T 4 b breast cancer is a clinical diagnosis and the classical signs must be present, was supported by 31 respondents (25.4%). CONCLUSIONS A large number of breast cancer patients with non-inflammatory skin involvement are only histologically proven and show, compared with cases exhibiting the classical clinical signs, significant differences in clinical course and prognosis. In general, both subsets were aggregated in one T category/stage (T 4 b/IIIB). This results in a considerable distortion of the reported statistical data.
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Affiliation(s)
- U Güth
- Department of Gynecology and Obstetrics, University Hospital Basel, Switzerland.
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21
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Simon R, Nocito A, Hübscher T, Bucher C, Torhorst J, Schraml P, Bubendorf L, Mihatsch MM, Moch H, Wilber K, Schötzau A, Kononen J, Sauter G. Patterns of her-2/neu amplification and overexpression in primary and metastatic breast cancer. J Natl Cancer Inst 2001; 93:1141-6. [PMID: 11481385 DOI: 10.1093/jnci/93.15.1141] [Citation(s) in RCA: 224] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Only 25% of patients with HER-2/neu-positive metastatic breast tumors respond favorably to trastuzamab (Herceptin) treatment. We hypothesized that a high failure rate of patients on trastuzamab could result if some of the metastases were HER-2 negative and these metastases ultimately determine the course of the disease. METHODS We used tissue microarrays (TMAs) containing four samples each from 196 lymph node-negative primary tumors, 196 lymph node-positive primary tumors, and three different lymph node metastases from each lymph node-positive tumor to estimate HER-2 gene amplification by fluorescence in situ hybridization (FISH) and Her-2 protein overexpression by immunohistochemistry (IHC). RESULTS FISH and IHC analyses gave the same result with respect to HER-2 status for 93.7% of the tissues contained in the TMAs. Tissue samples were, therefore, considered to be HER-2 positive if they were positive for either HER-2 DNA amplification or Her-2 protein expression and HER-2 negative if both FISH and IHC gave a negative result. The HER-2 status of lymph node-positive primary tumors was maintained in the majority of their metastases. For HER-2-positive primary tumors, 77% (95% confidence interval [CI] = 59% to 90%) had entirely HER-2-positive metastases, 6.5% (95% CI = 8% to 21%) had entirely HER-2-negative metastases, and 16.3% (95% CI = 5% to 34%) had a mixture of HER-2-positive and HER-2-negative metastases. For HER-2-negative primary tumors, 95% (95% CI = 88% to 98%) had metastases that were entirely negative for HER-2. CONCLUSIONS Our data suggest that differences in HER-2 expression between primary tumors and their lymph node metastases cannot explain the high fraction of nonresponders to trastuzamab therapy.
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MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/secondary
- DNA, Neoplasm/analysis
- Female
- Gene Amplification
- Gene Expression Regulation, Neoplastic
- Genes, erbB-2/genetics
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphatic Metastasis
- Oligonucleotide Array Sequence Analysis/methods
- Trastuzumab
- Up-Regulation
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Affiliation(s)
- R Simon
- Institute of Pathology, University of Basel, Switzerland
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22
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Abstract
PURPOSE Many physiological parameters, including blood pressure, show circadian variations. Diurnal fluctuations of the optic nerve head (ONH) circulation have not yet been studied. The purpose of the present study was to determine the pattern of ONH blood flow variations over a 24-hour period in healthy subjects. METHODS The subject group comprised 15 healthy volunteers (6 women, 9 men) aged 22 to 43 years (mean +/- SEM: 28.2 +/- 1.3 years). Blood flow in the ONH was measured by laser Doppler flowmetry (LDF) over a 24-hour period at 08:00, 12:00, 16:00, 20:00, 24:00 hours, and at 08:00 hours the following morning. RESULTS ONH perfusion varied significantly over time. The mean LDF-flow during daytime ranged from 8.2 to 8.9 arbitrary units (AU) and fell at midnight to 7.1 AU (P =.0015). The mean LDF-volume during daytime was 0.23 to 0.24 AU and decreased at midnight to 0.20 AU (P =.04). The mean LDF-velocity ranged from 0.39 to 0.41 kHz with no significant differences at any time point. CONCLUSIONS Our study in normal subjects reveals small mean changes of ONH perfusion during daytime and a significant reduction at night. The physiological and clinical relevance of the nocturnal dip in the ONH perfusion needs to be determined in future studies.
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Affiliation(s)
- R Osusky
- University Eye Hospital, Basel, Switzerland
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23
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Abstract
OBJECTIVE To evaluate normal choroidal blood flow and its relationship with various factors such as age, systemic blood pressure, and intraocular pressure (IOP). METHODS A total of 70 healthy subjects were recruited. Choroidal blood flow was assessed using a method based on laser Doppler flowmetry (LDF) technique. The LDF parameters of velocity, volume, and flux were obtained. The influence of age, mean systemic blood pressure, IOP, smoking, and sex on choroidal hemodynamic parameters was assessed in a multiple linear regression model. The correlations between interocular difference in IOP and interocular differences in the LDF parameters were assessed by means of the Pearson linear correlation factor. RESULTS Velocity decreased significantly (P = .03) with advancing age of the subjects and volume increased significantly (P = .02) with increasing IOP. Mean blood pressure, smoking, and sex had no influence on the choroidal LDF parameters. Interocular difference in IOP correlated significantly with interocular difference in volume (R = 0.34, P<.005). CONCLUSION Choroidal blood flow velocity decreased with increasing age of the subjects, while the volume of moving erythrocytes decreased with lower IOP.
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24
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Haefliger IO, Lietz A, Griesser SM, Ulrich A, Schötzau A, Hendrickson P, Flammer J. Modulation of Heidelberg Retinal Flowmeter parameter flow at the papilla of healthy subjects: effect of carbogen, oxygen, high intraocular pressure, and beta-blockers. Surv Ophthalmol 1999; 43 Suppl 1:S59-65. [PMID: 10416748 DOI: 10.1016/s0039-6257(99)00025-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Heidelberg Retina Flowmeter (HRF) is intended to assess ocular blood flow by scanning laser doppler flowmetry. In the retina and possibly in the optic nerve head, carbogen increases blood flow, whereas pure oxygen or high intraocular pressure (IOP) decrease it. This study addresses whether at the papilla of healthy volunteers, the HRF parameter flow, is modulated by breathing 5% carbogen (5% carbon dioxide + 95% oxygen) for 7 minutes, breathing 100% oxygen for 7 minutes, increasing IOP to 50 mm Hg with a suction cup, or decreasing IOP with a single topical ocular instillation of the beta-blockers 0.5% betaxolol (betoptic) or 0.5% timolol (timoptic). At the papilla (20 degrees x 5 degrees, 256 X 64 pixels), values of HRF parameter, flow (50 X 50) pixels, increased after carbogen (N = 5, P < 0.05), but decreased after oxygen (N = 5, P < 0.05) or IOP increase (N = 5, P < 0.01). Although IOP values were significantly reduced by betaxolol (N = 9, P < 0.05) and timolol (N = 9, P < 0.01), HRF values were only significantly decreased (N = 9, P < 0.05) after timolol. In conclusion, at the papilla of healthy volunteers, a positive correlation exists between changes in values of the HRF-parameter, flow, and stimuli considered to modulate retinal and ONH blood flow. Furthermore, although of unkown clinical relevance, it appears that in contrast to betaxolol, values of the HRF parameter, flow, at the papilla of healthy volunteers are significantly decreased after a single instillation of timolol.
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Affiliation(s)
- I O Haefliger
- Laboratory of Ocular Pharmacology and Physiology, University Eye Clinic Basel, Switzerland
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25
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Gasser P, Stümpfig D, Schötzau A, Ackermann-Liebrich U, Flammer J. Body mass index in glaucoma. J Glaucoma 1999; 8:8-11. [PMID: 10084268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE To compare body mass index (BMI) of patients with open-angle glaucoma or normal-tension glaucoma with BMI in control subjects. METHODS BMI was calculated for 288 control subjects, 42 patients with open-angle glaucoma with treated intraocular pressure (IOP) higher than 21 mmHg, 87 patients with open-angle glaucoma with progression of glaucomatous damage despite IOP less than 21 mmHg, and 57 patients with normal-tension glaucoma. RESULTS There was no statistical difference in BMI between patients with glaucoma and control subjects. If anything, there was a tendency for patients with glaucoma to have a lower BMI than control subjects. CONCLUSION These data show that obesity seems not to be a risk factor for glaucoma.
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Affiliation(s)
- P Gasser
- University Eye Clinic Basel, Medical Outpatient Department, University Clinic, University Basel, Switzerland
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26
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Griesser SM, Lietz A, Orgül S, Schötzau A, Hendrickson P, Flammer J, Haefliger IO. Heidelberg retina flowmeter parameters at the papilla in healthy subjects. Eur J Ophthalmol 1999; 9:32-6. [PMID: 10230589 DOI: 10.1177/112067219900900105] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the Heidelberg Retina Flowmeter (HRF) parameters "volume", "flow", and "velocity", at the papilla in healthy subjects. METHODS HRF measurements were taken at the papilla (5 degrees x 20 degrees), superficially at level of the retina and at the bottom of the excavation. The effect of increasing frame size (1 x 1 to 50 x 50 pixels) on HRF values was assessed in ten subjects. HRF parameters were calculated (50 x 50 pixels) for 150 eyes of 150 subjects. To assess short-term reliability, measurements were repeated five times in ten subjects. RESULTS With 50 x 50 pixels the location of the frame had no influence on HRF values. Reliability was > 90%. Values were significantly higher (p < 0.001) in the superficial than in the deeper papillary layers. The correlation between HRF parameters was good (r2 > 0.85). CONCLUSIONS A low magnification (5 degrees x 20 degrees) and a 50 x 50 frame allows a global assessment of HRF parameters at the papilla with high reliability. In healthy eyes, the HRF values are influenced by the level where measurements are made at the papilla. This might be of importance in glaucoma patients with excavated papilla.
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Affiliation(s)
- S M Griesser
- Laboratory of Ocular Pharmacology and Physiology, University Eye Clinic, Basel, Switzerland
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27
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Abstract
BACKGROUND Short programs with few test locations have been proposed for glaucoma screening. Program G1x of the Octopus 1-2-3 automated perimeter is divided into four stages and permits the examination to be stopped after 16, 32, 45, or all 59 test locations. We investigated whether such short programs provide information comparable with that supplied by standard programs in glaucoma. MATERIALS AND METHODS In 99 visual fields of 81 glaucomatous and 18 glaucoma-suspect right eyes, mean defect (MD) and loss variance (LV) of the entire visual field were compared with MD and LV of the 4 stages of Program G1x. RESULTS MD of the entire visual field averaged 0.40 dB, with averages of -0.17 dB, 0.34 dB, 0.47 dB, and 1.04 dB for stages 1, 2, 3, and 4, respectively. LV of the entire visual field averaged 13.0 dB2 and was similar for all four stages. CONCLUSIONS The results show that the 16 test locations of stage 1 of Program G1x underestimate the visual-field damage present in the entire field. We recommend examination of at least 32 test locations, i.e., two stages of Program G1x. However, a prospective study is required to evaluate the sensitivity and specificity of short programs for glaucoma screening. The selection of test locations for the stages might be improved.
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Affiliation(s)
- K Sugimoto
- University Eye Clinic, Basel, Switzerland
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28
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Sugimoto K, Zulauf M, Schötzau A, Rentsch R. [Optimizing the distribution and test locations in statistical perimetry. Preliminary results]. Klin Monbl Augenheilkd 1997; 210:302-4. [PMID: 9324538 DOI: 10.1055/s-2008-1035058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Are short programs useful to glaucoma-screening? We investigated the concept of Program G1x with Octopus 1-2-3, which permits examination of various numbers of test locations i.e., 16, 32, 45, or all 59 test locations. PATIENTS AND METHODS Using 99 visual fields of glaucomatous or glaucoma-suspect right eyes, we compared mean defect (MD) and loss variance (LV) of the global visual field with MD and LV of the stages of G1x-program (standard strategy). RESULTS The results showed that stage 1 of Program G1x underestimated the glaucomatous visual field damage present in the entire field. CONCLUSIONS Thus, the use of only the first stage (16 test locations) of G1x is not advisable. At least 32 test locations, i.e., stages 1 and 2 of program G1x, are recommended for clinical perimetry.
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29
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Senn BC, Kaiser HJ, Schötzau A, Flammer J. Reproducibility of color Doppler imaging in orbital vessels. Ger J Ophthalmol 1996; 5:386-91. [PMID: 9479523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to evaluate the short-term reproducibility, the long-term reproducibility, and the reproducibility of the measurements made between two different examiners of blood-flow velocity in extraocular vessels using color Doppler imaging (CDI). In a group of 10 healthy volunteers, measurements of the peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) in the ophthalmic artery and the central retinal artery as well as one lateral and one medial short posterior ciliary artery were performed. The best intraindividual reproducibility, expressed as the relative error, was found for the PSV and RI measured in the ophthalmic artery (OA; PSV 5.9%, RI 3.1%) and the central retinal artery (CRA; PSV 7.7%, RI 4.7%). The PSV and RI determined in the posterior ciliary arteries were less reproducible but as much so as the EDV measured in the OA (11.8%) and CRA (19.9%). No systematic trend could be found between the first and second measurements. However, the long-term fluctuation was considerable high. Measurements of PSVs showed good concurrence between the two observers in all four vessels measured. The EDVs and RIs differed statistically significantly between the two observers. This difference was most pronounced in the posterior ciliary arteries.
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Affiliation(s)
- B C Senn
- University Eye Clinic, Basel, Switzerland
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30
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Abstract
PURPOSE To determine normal values of blood-flow velocities in extraocular vessels. METHODS In one eye each in 189 healthy adult volunteers, blood-flow velocities in the ophthalmic artery (OA), central retinal artery (CRA), central retinal vein (CRV), short lateral posterior ciliary artery (LPCA), and short medial posterior ciliary artery (MPCA) were measured by color Doppler imaging. In the arteries, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI) were calculated. In the CRV, maximal and minimal blood-flow velocities were measured. Influence of age, gender, blood pressure, and heart rate on blood-flow velocities and the resistivity index were analyzed. RESULTS Mean outcomes +/- S.D. cm/sec were as follows: in the OA, PSV was 39.2 +/- 5.3, EDV was 9.1 +/- 2.5, and RI was 0.77 +/- 0.05. In the CRA, PSV was 11.0 +/- 1.8, EDV was 3.3 +/- 0.9, and RI was 0.71 +/- 0.05. In the short LPCA, PSV was 11.2 +/- 1.7, EDV was 3.7 +/- 1.0, and RI was 0.68 +/- 0.06. In the short MPCA, PSV was 11.2 +/- 11.7, EDV was 3.6 +/- 0.9, and RI was 0.68 +/- 0.05. In the CRV, mean maximal velocity was 4.5 +/- 0.9, and mean minimal velocity was 3.3 +/- 0.7. Age, gender, systolic blood pressure, diastolic blood pressure, and heart rate had no consistent statistically significant influence on the measured and calculated variables. CONCLUSION Normal values for blood-flow velocities in the extraocular vessels serve as a basis in deciding whether a measured value of a patient is normal or abnormal.
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Affiliation(s)
- H J Kaiser
- University Eye Clinic, Basel, Switzerland
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31
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Abstract
PURPOSE Development of a clinically useful pupil perimetry on an OCTOPUS 1-2-3. MATERIALS AND METHODS Various test parameters were investigated on a moderately modified OCTOPUS 1-2-3. We evaluated the pupillary responses of 122 eyes of 122 healthy volunteers qualitatively. RESULTS Pleasing pupillary responses were obtained with the following parameters: 200 ms stimuli, Goldmann size 5 (1.5 degrees), background illumination 3 apostilb. Acoustic signals 0.5 seconds before stimulus presentation were helpful to minimize blinking artifacts. The pupillary reactions were fare stronger in central areas of the visual field than in mid-peripheral areas (i.e. 26 degrees). CONCLUSIONS Pupil perimetry can be preformed on a moderately modified OCTOPUS 1-2-3. The results reveal considerable inter- and intra-individual variability. Equal pupillary responses at all eccentricities would improve subsequent mathematical evaluation.
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