1
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Brehm TT, Matthews H, Hennigs A. [Emergencies in infectious diseases]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01147-7. [PMID: 38652143 DOI: 10.1007/s00063-024-01147-7] [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] [Accepted: 01/03/2024] [Indexed: 04/25/2024]
Abstract
This article aims to provide an overview of common and high-impact medical emergencies that require prompt and effective infectious diseases management. In the described clinical scenarios of malaria, sepsis, necrotizing fasciitis, and meningitis the authors have emphasized the crucial importance of rapid and accurate diagnosis, as well as appropriate treatment from the perspective of infectious diseases. All of these emergencies demand a high degree of clinical suspicion for accurate diagnosis. Some of them also necessitate the involvement of other medical disciplines, such as neurology in the case of meningitis or surgery for necrotizing fasciitis. Additionally, implementing the right empiric antibiotic regimen or, in the case of malaria, antiparasitic treatment is crucial for improving patient outcomes. As patients with these diagnoses may present at any outpatient department, and efficient and quick management is essential, a deep understanding of diagnostic algorithms and potential pitfalls is of the utmost importance.
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Affiliation(s)
- Thomas Theo Brehm
- I. Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Deutschland
| | - Hanna Matthews
- Ambulanzzentrum für Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Annette Hennigs
- I. Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Deutschland.
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2
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Meyer-Schwickerath C, Weber C, Hornuss D, Rieg S, Hitzenbichler F, Hagel S, Ankert J, Hennigs A, Glossmann J, Jung N. Complexity of patients with or without infectious disease consultation in tertiary-care hospitals in Germany. Infection 2024; 52:577-582. [PMID: 38277092 PMCID: PMC10955003 DOI: 10.1007/s15010-023-02166-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE Patients seen by infectious disease (ID) specialists are more complex compared to patients treated by other subspecialities according to Tonelli et al. (2018). However, larger studies on the complexity of patients related to the involvement of ID consultation services are missing. METHODS Data of patients being treated in 2015 and 2019 in four different German university hospitals was retrospectively collected. Data were collected from the hospitals' software system and included whether the patients received an ID consultation as well as patient clinical complexity level (PCCL), case mix index (CMI) and length of stay (LOS) as a measurement for the patients' complexity. Furthermore, a comparison of patients with distinct infectious diseases treated with or without an ID consultation was initiated. RESULTS In total, 215.915 patients were included in the study, 3% (n = 6311) of those were seen by an ID consultant. Patients receiving ID consultations had a significantly (p < 0.05) higher PCCL (median 4 vs. 0), CMI (median 3,8 vs. 1,1) and deviation of the expected mean LOS (median 7 days vs. 0 days) than patients in the control group. No differences among hospitals or between years were observed. Comparing patients with distinct infectious diseases treated with or without an ID consultation, the differences were confirmed throughout the groups. CONCLUSION Patients receiving ID consultations are highly complex, frequently need further treatment after discharge and have a high economic impact. Thus, ID specialists should be clinically trained in a broad spectrum of diseases and treating these complex patients should be sufficiently remunerated.
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Affiliation(s)
- C Meyer-Schwickerath
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - C Weber
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - D Hornuss
- Faculty of Medicine, Department of Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg, Germany
| | - S Rieg
- Faculty of Medicine, Department of Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg, Germany
| | - F Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital of Regensburg, Regensburg, Germany
| | - S Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - J Ankert
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - A Hennigs
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Glossmann
- Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University of Cologne, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany.
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3
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Brehm TT, Matthews H, Hennigs A. [Emergencies in infectious diseases]. Inn Med (Heidelb) 2024; 65:248-258. [PMID: 38315189 DOI: 10.1007/s00108-024-01662-x] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
This article aims to provide an overview of common and high-impact medical emergencies that require prompt and effective infectious diseases management. In the described clinical scenarios of malaria, sepsis, necrotizing fasciitis, and meningitis the authors have emphasized the crucial importance of rapid and accurate diagnosis, as well as appropriate treatment from the perspective of infectious diseases. All of these emergencies demand a high degree of clinical suspicion for accurate diagnosis. Some of them also necessitate the involvement of other medical disciplines, such as neurology in the case of meningitis or surgery for necrotizing fasciitis. Additionally, implementing the right empiric antibiotic regimen or, in the case of malaria, antiparasitic treatment is crucial for improving patient outcomes. As patients with these diagnoses may present at any outpatient department, and efficient and quick management is essential, a deep understanding of diagnostic algorithms and potential pitfalls is of the utmost importance.
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Affiliation(s)
- Thomas Theo Brehm
- I. Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Deutschland
| | - Hanna Matthews
- Ambulanzzentrum für Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Annette Hennigs
- I. Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Deutschland.
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Koch T, Hennigs A, Schmiedel S. Endocarditis guidelines: call for an interdisciplinary approach. Lancet Infect Dis 2024; 24:e75. [PMID: 38134950 DOI: 10.1016/s1473-3099(23)00748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Till Koch
- Division of Infectious Diseases, First Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; Antibiotic Stewardship Team, Pharmacy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Annette Hennigs
- Division of Infectious Diseases, First Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
| | - Stefan Schmiedel
- Division of Infectious Diseases, First Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; Infectious Diseases Clinic, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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5
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Bahrs C, Rieg S, Hennigs A, Hitzenbichler F, Brehm TT, Rose N, Jacobi RJ, Heine V, Hornuss D, Huppertz G, Hagel S, Hanses F, Hornuss D, Hennigs A, Brehm TT, Rolling T, Jung N, Hagel S, Bahrs C, Kaasch A, Hanses F, Hitzenbichler F. Short-course versus long-course antibiotic treatment for uncomplicated vancomycin-resistant enterococcal bacteraemia: a retrospective multicentre cohort study. Clin Microbiol Infect 2023; 29:200-207. [PMID: 36087919 DOI: 10.1016/j.cmi.2022.08.023] [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: 05/26/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The optimal treatment duration for vancomycin-resistant enterococcal (VRE) bacteraemia is still a matter of debate. The aim of the present study was to compare short-course (≤9 days) and long-course (≥10 days) antibiotic treatments in hospitalized adult patients with uncomplicated VRE bacteraemia. METHODS This retrospective study was conducted in four university hospitals in Germany. Adult patients with a positive blood culture for a VRE were screened from 1 January 2016 to 31 December 2018. Only patients who received a VRE-active antibiotic for at least 48 hours were included. The exclusion criteria were a survival of <10 days and a deep-seated source of infection requiring prolonged treatment. To compare the outcome of short-course therapy with that of long-course therapy, 30-day and 90-day overall mortality, relapse within 90 days, duration of hospitalization, and potential antibiotic-related adverse events were analysed by inverse probability of treatment weighting using the propensity score and by additional covariate adjustment. RESULTS Of the 363 patients screened, 219 (60.3%) patients were included in the final analysis. Among them, 48 (21.9%) patients had underlying haematological diseases. Seventy-eight (35.6%) patients received short-course treatment (median, 7 days; interquartile range, 5-8 days) and 141 (64.4%) patients received long-course treatment (median, 15 days; interquartile range, 12-23.5 days). Thirty-day mortality was similar in both groups (19.2% vs. 22.0%; adjusted OR, 1.15; p 0.773). Duration of hospitalization (in total and after onset of bacteraemia) was significantly shorter (p < 0.05) in the short-course treatment group, whereas other secondary outcome parameters did not differ between both groups. DISCUSSION Our study suggests that short-course treatment might not be associated with a worse outcome in patients with uncomplicated VRE bacteraemia.
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Affiliation(s)
- Christina Bahrs
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany; Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Annette Hennigs
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Thomas T Brehm
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Norman Rose
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Rebecca J Jacobi
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Valerie Heine
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Daniel Hornuss
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Gunnar Huppertz
- Center for Clinical Studies, University Medical Center, Regensburg, Germany
| | - Stefan Hagel
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Frank Hanses
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Emergency Department, University Hospital Regensburg, Regensburg, Germany
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Brehm TT, Hennigs A. [Seasonal Influenza - Update on Epidemiology, Prevention and Therapy]. Dtsch Med Wochenschr 2022; 147:1456-1464. [PMID: 36318908 DOI: 10.1055/a-1838-9223] [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: 06/16/2023]
Abstract
Infection control measures and travel restrictions implemented during the COVID-19 pandemic have limited the transmission of seasonal influenza viruses as well. It must be assumed that after these public health measures have largely been lifted, influenza activity will sharply increase in the coming influenza season. Anticipating the potentially high number of cases, the co-circulation of influenza viruses and SARS-CoV-2, efforts to increase vaccination rates against both infectious diseases must be given more attention.
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Affiliation(s)
- Thomas Theo Brehm
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf
| | - Annette Hennigs
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf
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Hennigs JK, Huwe M, Hennigs A, Oqueka T, Simon M, Harbaum L, Körbelin J, Schmiedel S, Schulze Zur Wiesch J, Addo MM, Kluge S, Klose H. Respiratory muscle dysfunction in long-COVID patients. Infection 2022; 50:1391-1397. [PMID: 35570238 PMCID: PMC9108020 DOI: 10.1007/s15010-022-01840-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/23/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose
Symptoms often persistent for more than 4 weeks after COVID-19—now commonly referred to as ‘Long COVID’. Independent of initial disease severity or pathological pulmonary functions tests, fatigue, exertional intolerance and dyspnea are among the most common COVID-19 sequelae. We hypothesized that respiratory muscle dysfunction might be prevalent in persistently symptomatic patients after COVID-19 with self-reported exercise intolerance.
Methods
In a small cross-sectional pilot study (n = 67) of mild-to-moderate (nonhospitalized) and moderate-to-critical convalescent (formerly hospitalized) patients presenting to our outpatient clinic approx. 5 months after acute infection, we measured neuroventilatory activity P0.1, inspiratory muscle strength (PImax) and total respiratory muscle strain (P0.1/PImax) in addition to standard pulmonary functions tests, capillary blood gas analysis, 6 min walking tests and functional questionnaires.
Results
Pathological P0.1/PImax was found in 88% of symptomatic patients. Mean PImax was reduced in hospitalized patients, but reduced PImax was also found in 65% of nonhospitalized patients. Mean P0.1 was pathologically increased in both groups. Increased P0.1 was associated with exercise-induced deoxygenation, impaired exercise tolerance, decreased activity and productivity and worse Post-COVID-19 functional status scale. Pathological changes in P0.1, PImax or P0.1/PImax were not associated with pre-existing conditions.
Conclusions
Our findings point towards respiratory muscle dysfunction as a novel aspect of COVID-19 sequelae. Thus, we strongly advocate for systematic respiratory muscle testing during the diagnostic workup of persistently symptomatic, convalescent COVID-19 patients.
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Affiliation(s)
- Jan K Hennigs
- Division of Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Marie Huwe
- Division of Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Annette Hennigs
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Tim Oqueka
- Division of Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marcel Simon
- Division of Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lars Harbaum
- Division of Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jakob Körbelin
- Division of Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stefan Schmiedel
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Marylyn M Addo
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
- Department of Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, 20359, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, 20359, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Hans Klose
- Division of Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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8
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Woo MS, Haag F, Nierhaus A, Jarczak D, Roedl K, Mayer C, Brehm TT, van der Meirschen M, Hennigs A, Christopeit M, Fiedler W, Karagiannis P, Burdelski C, Schultze A, Huber S, Addo MM, Schmiedel S, Friese MA, Kluge S, Schulze zur Wiesch J. Multi-dimensional and longitudinal systems profiling reveals predictive pattern of severe COVID-19. iScience 2021; 24:102752. [PMID: 34179733 PMCID: PMC8213514 DOI: 10.1016/j.isci.2021.102752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/19/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is a respiratory tract infection that can affect multiple organ systems. Predicting the severity and clinical outcome of individual patients is a major unmet clinical need that remains challenging due to intra- and inter-patient variability. Here, we longitudinally profiled and integrated more than 150 clinical, laboratory, and immunological parameters of 173 patients with mild to fatal COVID-19. Using systems biology, we detected progressive dysregulation of multiple parameters indicative of organ damage that correlated with disease severity, particularly affecting kidneys, hepatobiliary system, and immune landscape. By performing unsupervised clustering and trajectory analysis, we identified T and B cell depletion as early indicators of a complicated disease course. In addition, markers of hepatobiliary damage emerged as robust predictor of lethal outcome in critically ill patients. This allowed us to propose a novel clinical COVID-19 SeveriTy (COST) score that distinguishes complicated disease trajectories and predicts lethal outcome in critically ill patients.
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Affiliation(s)
- Marcel S. Woo
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Friedrich Haag
- Department of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christina Mayer
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Thomas T. Brehm
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
- German Center for Infection Research (DZIF), University Medical Center Hamburg-Eppendorf, Lübeck - Borstel - Riems, Hamburg, Germany
| | - Marc van der Meirschen
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Annette Hennigs
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Panagiotis Karagiannis
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christoph Burdelski
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Alexander Schultze
- Department of Emergency Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Samuel Huber
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Marylyn M. Addo
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
- German Center for Infection Research (DZIF), University Medical Center Hamburg-Eppendorf, Lübeck - Borstel - Riems, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
- German Center for Infection Research (DZIF), University Medical Center Hamburg-Eppendorf, Lübeck - Borstel - Riems, Hamburg, Germany
| | - Manuel A. Friese
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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9
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Brehm TT, van der Meirschen M, Hennigs A, Roedl K, Jarczak D, Wichmann D, Frings D, Nierhaus A, Oqueka T, Fiedler W, Christopeit M, Kraef C, Schultze A, Lütgehetmann M, Addo MM, Schmiedel S, Kluge S, Schulze Zur Wiesch J. Comparison of clinical characteristics and disease outcome of COVID-19 and seasonal influenza. Sci Rep 2021; 11:5803. [PMID: 33707550 PMCID: PMC7970952 DOI: 10.1038/s41598-021-85081-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
While several studies have described the clinical course of patients with coronavirus disease 2019 (COVID-19), direct comparisons with patients with seasonal influenza are scarce. We compared 166 patients with COVID-19 diagnosed between February 27 and June 14, 2020, and 255 patients with seasonal influenza diagnosed during the 2017-18 season at the same hospital to describe common features and differences in clinical characteristics and course of disease. Patients with COVID-19 were younger (median age [IQR], 59 [45-71] vs 66 [52-77]; P < 0001) and had fewer comorbidities at baseline with a lower mean overall age-adjusted Charlson Comorbidity Index (mean [SD], 3.0 [2.6] vs 4.0 [2.7]; P < 0.001) than patients with seasonal influenza. COVID-19 patients had a longer duration of hospitalization (mean [SD], 25.9 days [26.6 days] vs 17.2 days [21.0 days]; P = 0.002), a more frequent need for oxygen therapy (101 [60.8%] vs 103 [40.4%]; P < 0.001) and invasive ventilation (52 [31.3%] vs 32 [12.5%]; P < 0.001) and were more frequently admitted to the intensive care unit (70 [42.2%] vs 51 [20.0%]; P < 0.001) than seasonal influenza patients. Among immunocompromised patients, those in the COVID-19 group had a higher hospital mortality compared to those in the seasonal influenza group (13 [33.3%] vs 8 [11.6%], P = 0.01). In conclusion, we show that COVID-19 patients were younger and had fewer baseline comorbidities than seasonal influenza patients but were at increased risk for severe illness. The high mortality observed in immunocompromised COVID-19 patients emphasizes the importance of protecting these patient groups from SARS-CoV-2 infection.
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Affiliation(s)
- Thomas Theo Brehm
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
| | - Marc van der Meirschen
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Annette Hennigs
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Frings
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tim Oqueka
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Kraef
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Schultze
- Department of Emergency Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
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10
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Brehm TT, van der Meirschen M, Hennigs A, Roedl K, Jarczak D, Wichmann D, Frings D, Nierhaus A, Oqueka T, Fiedler W, Christopeit M, Kraef C, Schultze A, Lütgehetmann M, Addo MM, Schmiedel S, Kluge S, Schulze Zur Wiesch J. Comparison of clinical characteristics and disease outcome of COVID-19 and seasonal influenza. Sci Rep 2021. [PMID: 33707550 DOI: 10.1038/s41598‐021‐85081‐0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
While several studies have described the clinical course of patients with coronavirus disease 2019 (COVID-19), direct comparisons with patients with seasonal influenza are scarce. We compared 166 patients with COVID-19 diagnosed between February 27 and June 14, 2020, and 255 patients with seasonal influenza diagnosed during the 2017-18 season at the same hospital to describe common features and differences in clinical characteristics and course of disease. Patients with COVID-19 were younger (median age [IQR], 59 [45-71] vs 66 [52-77]; P < 0001) and had fewer comorbidities at baseline with a lower mean overall age-adjusted Charlson Comorbidity Index (mean [SD], 3.0 [2.6] vs 4.0 [2.7]; P < 0.001) than patients with seasonal influenza. COVID-19 patients had a longer duration of hospitalization (mean [SD], 25.9 days [26.6 days] vs 17.2 days [21.0 days]; P = 0.002), a more frequent need for oxygen therapy (101 [60.8%] vs 103 [40.4%]; P < 0.001) and invasive ventilation (52 [31.3%] vs 32 [12.5%]; P < 0.001) and were more frequently admitted to the intensive care unit (70 [42.2%] vs 51 [20.0%]; P < 0.001) than seasonal influenza patients. Among immunocompromised patients, those in the COVID-19 group had a higher hospital mortality compared to those in the seasonal influenza group (13 [33.3%] vs 8 [11.6%], P = 0.01). In conclusion, we show that COVID-19 patients were younger and had fewer baseline comorbidities than seasonal influenza patients but were at increased risk for severe illness. The high mortality observed in immunocompromised COVID-19 patients emphasizes the importance of protecting these patient groups from SARS-CoV-2 infection.
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Affiliation(s)
- Thomas Theo Brehm
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. .,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
| | - Marc van der Meirschen
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Annette Hennigs
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Frings
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tim Oqueka
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Kraef
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Schultze
- Department of Emergency Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.,Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
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11
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Fathi A, Hennigs A, Addo MM. [Less is more… in infectious diseases]. Internist (Berl) 2021; 62:373-378. [PMID: 33580310 DOI: 10.1007/s00108-021-00967-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increasing development of antimicrobial resistance has been identified as one of the greatest threats to public health and is caused to a relevant extent by falsely indicated antibiotic treatment. OBJECTIVE The main aim of this article is to identify areas in infectious disease diagnostics and treatment where overuse occurs and to provide recommendations on how to avoid it. MATERIAL AND METHODS The authors identified current and relevant studies on the topic of medical overuse in infectious diseases via a literature search. In particular, contributions from international "less is more" initiatives were included. The focus was on areas in which a reduction of diagnostic and therapeutic measures leads to an optimization of patient outcomes. RESULTS In many cases overuse in the context of diagnostics and treatment of infectious diseases not only leads to an unnecessary financial burden on the healthcare system and is not beneficial but can also increase the risk of development of antimicrobial resistance and have adverse consequences for patients. CONCLUSION Correct indications as well as focused selection and adequate application of antimicrobial agents is crucial to provide the best possible medical care. Diagnostic and antibiotic stewardship measures, which should be implemented in collaboration with infectious disease specialists, can help to identify and reduce areas of overuse and misuse.
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Affiliation(s)
- A Fathi
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - A Hennigs
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - M M Addo
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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12
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Hennigs A, Jochum J. [Rational antimicrobial therapy - recommendations for common infections]. Dtsch Med Wochenschr 2020; 145:1673-1682. [PMID: 33202451 DOI: 10.1055/a-1114-3946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Infectious diseases are a frequent reason for medical consultations both in the inpatient and outpatient setting. Inadequate management is associated with increased costs, morbidity and mortality. In times of rising antibiotic resistance rational therapy and antimicrobial stewardship are of utmost importance. While it is crucial to avoid excessively broad antimicrobial coverage and unnecessary therapies, serious conditions must be treated effectively. The article highlights common infections and gives recommendations for empiric and targeted antibiotic treatment. Discussed are pulmonary, abdominal, urinary tract, skin and soft tissue infections, as well as sepsis and staphylococcal bloodstream infections. The recommendations consider national and international guidelines, recent publications and current antimicrobial resistance in Germany.
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13
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Malsy J, Veletzky L, Heide J, Hennigs A, Gil-Ibanez I, Stein A, Lütgehetmann M, Rosien U, Jasper D, Peine S, Hiller J, Haag F, Schmiedel S, Huber S, Jordan S, Addo MM, Schulze Zur Wiesch J. Sustained response after remdesivir and convalescent plasma therapy in a B-cell depleted patient with protracted COVID-19. Clin Infect Dis 2020; 73:e4020-e4024. [PMID: 33103195 PMCID: PMC7665388 DOI: 10.1093/cid/ciaa1637] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
We provide detailed clinical, virological and immunological data of a B-cell depleted patient treated with obinutuzumab for follicular lymphoma with protracted COVID-19 and viremia. A sustained response was achieved after two courses of remdesivir and subsequent convalescent plasma therapy. Immunocompromised patients might require combined and prolonged antiviral treatment regimens.
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Affiliation(s)
- Jakob Malsy
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luzia Veletzky
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janna Heide
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lubeck-Borstel-Riems, Germany
| | - Annette Hennigs
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ines Gil-Ibanez
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Stein
- Hämatologisch-Onkologische Praxis Eppendorf, HOPE.,University Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lubeck-Borstel-Riems, Germany
| | - Ulrich Rosien
- Department of Medicine, Israelitisches Krankenhaus, Hamburg, Germany
| | - Dorothea Jasper
- Department of Medicine, Israelitisches Krankenhaus, Hamburg, Germany
| | - Sven Peine
- Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Jens Hiller
- Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Friedrich Haag
- Department of Clinical Immunology, University Medical Center Hamburg-Eppendorf, Germany
| | - Stefan Schmiedel
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samuel Huber
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Jordan
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lubeck-Borstel-Riems, Germany
| | - Julian Schulze Zur Wiesch
- Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lubeck-Borstel-Riems, Germany
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14
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Riedel F, Heil J, Feißt M, Moderow M, von Au A, Domschke C, Michel L, Schäfgen B, Golatta M, Hennigs A. Can the eligibility criteria of the ACOSOG Z0011 trial be extended to patients undergoing mastectomy and presenting T3-T4 tumors? An analysis of non-sentinel axillary metastases. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717160] [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: 10/23/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie und Informatik
| | | | - A von Au
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - C Domschke
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - L Michel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - B Schäfgen
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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15
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Platzer L, Orthmann N, Grozinger P, Hennigs A, Rippinger N, Wallwiener M, Rom J, Riedel F. Does music genre affect medical students’ performance in standardized laparoscopic exercises? Comparing exposure to rock, hip-hop, classic and mixed radio music at 70 decibels. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718043] [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: 10/23/2022] Open
Affiliation(s)
- L.K. Platzer
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N. Orthmann
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - P. Grozinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A. Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N. Rippinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M. Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J. Rom
- Klinikum Frankfurt-Höchst, Frauenklinik
| | - F. Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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16
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Riedel M, Hennigs A, Dobberkau AM, Deutsch T, Rippinger N, Wallwiener M, Finkenzeller C, Golatta M, Heil J, Riedel F. Evaluation genderspezifischer Faktoren und Assoziationen für die Wahl zur Facharztweiterbildung in der Gynäkologie und Geburtshilfe – Ergebnisse einer Befragung unter Medizinstudierenden im klinischen Studienabschnitt. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718105] [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: 10/23/2022] Open
Affiliation(s)
- M Riedel
- Klinikum rechts der Isar der Technischen Universität München, Frauenklinik
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A.-M Dobberkau
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - T Deutsch
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N Rippinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - C Finkenzeller
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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17
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Riedel F, Hoffmann AS, Moderow M, Heublein S, Deutsch T, Golatta M, Wallwiener M, Schneeweiss A, Heil J, Hennigs A. Wie hat sich die Anwendung von adjuvanter zu neoadjuvanter Chemotherapie beim frühen Mammakarzinom verändert? – Daten von 104 deutschen Brustzentren 2008-2017. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717872] [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: 10/23/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - AS Hoffmann
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | | | - S Heublein
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - T Deutsch
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Schneeweiss
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
- Nationales Centrum für Tumorerkrankungen
- Deutsches Krebsforschungszentrum
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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18
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Schäfgen B, Riedel F, Sinn P, Feisst M, Hennigs A, Hug S, Binning A, Sohn C, Golatta M, Gläser A, Heil J. Diagnostic accuracy and clinical utility of axillary ultrasound in the evaluation of axillary lymph node status in early breast cancer patients. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717874] [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: 10/23/2022] Open
Affiliation(s)
| | | | | | - M Feisst
- Institute of Medical Biometry and Informatics
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19
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Stefanovic S, TM D, Riethdorf S, Fischer C, Hartkopf A, Sinn P, Feisst M, Pantel K, Hennigs A, Golatta M, Sütterlin M, Schneeweiss A, Wallwiener M. Receptor discordance between primary tumor and metastasis influences CTC-status. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718185] [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: 10/23/2022] Open
Affiliation(s)
- S Stefanovic
- Universitätsfrauenklinik, Universitätsklinikum Mannheim, Universität Heidelberg
| | - Deutsch TM
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - S Riethdorf
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - C Fischer
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - A Hartkopf
- Universitätsfrauenklinik, Universitätsklinikum Tübingen
| | - P Sinn
- Institut für Pathologie, Universitätsklinikum Heidelberg
| | - M Feisst
- Institut für Medizinische Biometrie und Informatik, Universitätsklinikum Heidelberg
| | - K Pantel
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - A Hennigs
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - M Golatta
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - M Sütterlin
- Universitätsfrauenklinik, Universitätsklinikum Mannheim, Universität Heidelberg
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen (NCT)
- Deutsches Krebsforschungszentrum (DKFZ)
| | - M Wallwiener
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
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20
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Heinemann M, Omansen TF, Hennigs A, Völker K, Menz A, Addo MM, Schmiedel S. Relapsing cutaneous leishmaniasis in a patient requiring TNF-α-inhibitor Infliximab for Takayasu-arteritis: Case report and review of the literature. Travel Med Infect Dis 2020; 37:101700. [PMID: 32339673 DOI: 10.1016/j.tmaid.2020.101700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/16/2019] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Abstract
Leishmaniasis is a protozoan parasitic infection that can manifest as visceral or cutaneous disease. Immunosuppression, mainly through TNF-α) inhibition, is a risk factor for complicated leishmaniasis that is becoming increasingly known. Here, we present a case of cutaneous leishmaniasis (CL) in a patient who suffers from advanced Takayasu-Arteritis, requiring TNF-α inhibition with infliximab. The primary CL lesions in this 47-year-old, female patient were caused by Leishmaniapanamensis and occurred after a touristic trip to Panama on her right foot. The lesions first resolved under treatment with liposomal amphotericin B. However, ten months later, the patient returned with relapsing lesions requiring further treatment. We discuss the challenges and risks of leishmaniasis in patients with TNF-α inhibition and the rare phenomenon of relapsing CL and the management hereof. We review published cases of CL associated with TNF-α inhibition. A growing body of evidence now suggests that especially CL (and visceral leishmaniasis (VL)) can be associated with TNF-α inhibition. The host response to leishmaniasis is of the Th1-type and TNF-α and interferon-gamma expression are crucial for disease control. Inversely, TNF-α inhibition can lead to complicated and relapsing progression of leishmanial infection. Therefore, we propose that CL and VL should be considered in at-risk patients receiving immunosuppressants.
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Affiliation(s)
- Melina Heinemann
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till F Omansen
- Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Annette Hennigs
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Völker
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany
| | - Anne Menz
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Riedel F, Heil J, Golatta M, Schaefgen B, Hug S, Schott S, Rom J, Schuetz F, Sohn C, Hennigs A. Changes of breast and axillary surgery patterns in patients with primary breast cancer during the past decade. Arch Gynecol Obstet 2018; 299:1043-1053. [PMID: 30478667 DOI: 10.1007/s00404-018-4982-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Breast-conserving therapy (BCT) is the standard procedure for most patients with primary breast cancer (BC). By contrast, axillary management is still under transition to find the right balance between avoiding of morbidity, maintaining oncological safety, and performing a staging procedure. The rising rate of primary systemic therapy creates further challenges for surgical management. METHODS Patients with primary, non-metastatic BC treated between 01.01.2003 and 31.12.2016 under guideline-adherent conditions were included in this study. For this prospectively followed cohort, breast and axillary surgery patterns are presented in a time-trend analysis as annual rate data (%) for several subgroups. RESULTS Overall, 6700 patients were included in the analysis. While BCT rates remained high (mean 2003-2016: 70.4%), the proportion of axillary lymph node dissection has declined considerably from 80.1% in 2003 to 16.0% in 2016, while the proportion for sentinel lymph node biopsy (SLND) has increased correspondingly from 10.3 to 76.4%. Among patients with cT1-2, cN0 breast cancer receiving BCT with positive SLND, the rate of axillary completion has decreased from 100% in 2008 to 24.4% in 2016. CONCLUSIONS In the past decade, SLNB has been established as the standard procedure for axillary staging of clinically node-negative patients. Surgical morbidity has been further reduced by the rapid implementation of new evidence from the ACOSOG Z0011 trial into clinical routine. The results reflect the transition towards more individually tailored, less invasive treatment for selected patient subgroups, especially in regards to axillary lymph node management.
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Affiliation(s)
- F Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - B Schaefgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Hug
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Schott
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Rom
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Riedel F, Heil J, Mahdi R, Nitz U, Moderow M, Golatta M, Schäfgen B, Sohn C, Schütz F, Schneeweiss A, Hennigs A. Chemotherapie-Anwendung beim frühen Mammakarzinom in Deutschland – aktuelle Daten aus 179 Brustkrebszentren (2008 – 2015). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671630] [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 Riedel
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - J Heil
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - R Mahdi
- Europäisches Brustzentrum Dr. Mahdi Rezai, Luisenkrankenhaus, Düsseldorf, Deutschland
| | - U Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum Niederrhein, Mönchengladbach, Deutschland
| | - M Moderow
- Westdeutsches Brust-Centrum GmbH, Düsseldorf, Deutschland
| | - M Golatta
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - B Schäfgen
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - C Sohn
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - F Schütz
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - A Schneeweiss
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
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Köpke M, Feißt M, Rezai M, Nitz U, Moderow M, Riedel F, Golatta M, Sohn C, Schneeweiss A, Heil J, Hennigs A. Veränderung des axillären Managements bei Brustkrebspatientinnen mit 1 – 2 tumorbefallenen Sentinel-Lymphknoten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671221] [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)
- M Köpke
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Feißt
- Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - M Rezai
- Europäisches Brustzentrum Dr. Mahdi Rezai, Luisenkrankenhaus, Düsseldorf, Deutschland
| | - U Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum Niederrhein, Mönchengladbach, Deutschland
| | - M Moderow
- Westdeutsches Brust-Centrum GmbH, Düsseldorf, Deutschland
| | - F Riedel
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Golatta
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Sohn
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - J Heil
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
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Funk A, Schäfgen B, Heil J, Harcos A, Gomez C, Stieber A, Junkermann H, Hennigs A, Rauch G, Sinn HP, Riedel F, Hug S, Meier A, Schott S, Rom J, Schütz F, Sohn C, Golatta M. Evaluation des Nutzens von intraoperativer Präparateradiografie zur Randbeurteilung bei brusterhaltender Therapie maligner Brusttumore. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671333] [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)
- A Funk
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - B Schäfgen
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - J Heil
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Harcos
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Gomez
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Stieber
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - H Junkermann
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - G Rauch
- Institut für Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - HP Sinn
- Institut für Pathologie und Neuropathologie, Heidelberg, Deutschland
| | - F Riedel
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - S Hug
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Meier
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - S Schott
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - J Rom
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - F Schütz
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Sohn
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Golatta
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
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Riedel F, Schneeweiss A, Sinn HP, Marmé F, Golatta M, Wallwiener M, Schütz F, Sohn C, Heil J, Hennigs A. Veränderungen in der Anwendung und beim Outcome von Chemotherapie beim frühen Mammakarzinom in der letzten Dekade. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606152] [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: 10/18/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - A Schneeweiss
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
- Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg
| | - HP Sinn
- Universitätsklinikum Heidelberg, Pathologisches Institut, Heidelberg
| | - F Marmé
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - M Golatta
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - F Schütz
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - C Sohn
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - J Heil
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - A Hennigs
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
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Hennigs A, Riedel F, Marmé F, Sinn P, Lindel K, Gondos A, Smetanay K, Golatta M, Sohn C, Schuetz F, Heil J, Schneeweiss A. Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade. Breast Cancer Res Treat 2016; 160:491-499. [PMID: 27744486 PMCID: PMC5090013 DOI: 10.1007/s10549-016-4016-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/08/2016] [Indexed: 11/23/2022]
Abstract
Background During the last decade, neoadjuvant chemotherapy (NACT) of early breast cancer (EBC) evolved from a therapy intended to enable operability to a standard treatment option aiming for increasing cure rates equivalent to adjuvant chemotherapy (ACT). In parallel, improvements in the quality control of breast cancer care have been established in specialized breast care units. Patients and methods This study analyzed chemotherapy usage in patients with EBC treated at the Heidelberg University Breast Unit between January 2003 and December 2014. Results Overall, 5703 patients were included in the analysis of whom 2222 (39 %) received chemotherapy, 817 (37 %) as NACT, and 1405 (63 %) as ACT. The chemotherapy usage declined from 48 % in 2003 to 34 % in 2014 of the cohort. Further, the proportion of NACT raised from 42 to 65 % irrespective of tumor subtype. In addition, frequency of pathologic complete response (pCR) defined as no tumor residues in breast and axilla (ypT0 ypN0) at surgery following NACT increased from 12 % in 2003 to 35 % in 2014. The greatest effect was observed in HER2+ breast cancer with an increase in patients achieving pCR from 24 to 68 %. Conclusions The results mirror the refined indication for chemotherapy in EBC and its preferred usage as NACT in Germany. The increase in pCR rate over time suggests improvement in outcome accomplished by a multidisciplinary decision-making process and stringent measures for quality control. Electronic supplementary material The online version of this article (doi:10.1007/s10549-016-4016-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Marmé
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany
| | - P Sinn
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - K Lindel
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - A Gondos
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Smetanay
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - J Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - A Schneeweiss
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany.
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Heil J, Schaefgen B, Sinn P, Richter H, Harcos A, Gomez C, Stieber A, Hennigs A, Rauch G, Schneeweiss A, Schuetz F, Sohn C, Golatta M. Kann eine pathologische Komplettremission nach neoadjuvanter Chemotherapie bei Brustkrebspatientinnen mithilfe einer minimal invasiven Biopsie diagnostiziert werden? Ergebnisse einer prospektiven Pilotstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592805] [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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Hennigs A, Riedel F, Gondos A, Sinn HP, Marmé F, Golatta M, Rom J, Schütz F, Sohn C, Heil J, Schneeweiss A. Ergebnisqualität von Brustkrebs-Subtypen in der klinischen Routine – eine große, prospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593144] [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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Riedel F, Fremd C, Tabatabai P, Smetanay K, Doster A, Golatta M, Heil J, Schütz F, Sohn C, Hennigs A. Examensvorbereitungskurs für die Zweite Ärztliche Prüfung im Fach Gynäkologie und Geburtshilfe – Ein Proof-of-Concept an der Universitätsfrauenklinik Heidelberg. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593051] [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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Michel L, Sommer L, González Silos R, Lorenzo Bermejo J, Hennigs A, Golatta M, Heil J, Schneeweiss A, Sohn C, Marmé F. Evaluation des MD Anderson Prognostic Index (MDAPI) zur lokoregionären Risikostratifikation in der neoadjuvanten Therapiesituation. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592811] [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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Hennigs A, Heil J, Gondos A, Riedel F, Marme F, Sinn HP, Schirmacher P, Kauczor HU, Debus J, Golatta M, Schtz F, Sohn C, Schneeweiss A. Abstract P1-07-12: Prognosis of clinico-pathological breast cancer subtypes in routine clinical care. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-07-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background / Aim: To analyze oncological outcome of breast cancer (BC) subtypes in routine clinical care in specialized breast care units (BCU).
Patients and methods: A prospectively followed cohort of 4110 female cases with primary, non-bilateral, non-metastatic BC treated between 01.01.2003 and 31.12.2012 has been analyzed for the whole cohort and separately for the five routinely used clinico-pathological subtypes (i.e. Luminal A, Luminal B (=Her2 neg.), Luminal B (=Her2 pos.), HER-2, triple negative). The median follow-up of the cohort was 51 month. We calculated estimates for local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS) and relative overall survival (ROS).
5 year outcome results referred to 5 different endpoints (using Kaplan-Meier method) of all patients with primary, non-metastatic, non-bilateral breast cancer treated at Heidelberg Breast Care Unit between 01.01.2003 and 31.12.2012 All patients (including in-situ)Patients with invasive cancer (excluding in-situ) n=4102 (including 499 in-situ cases)n = 3603LCR [%] (95% CI)96.1 (95.6 ; 96.6)96.1 (95.7 ; 96.5)DFS [%] (95% CI)85.0 (84.2 ; 85.8)83.7 (82.8 ; 84.6)DDFS [%] (95% CI)86.9 (86.1 ; 87.7)85.7 (84.8 ; (86.6)OS [%] (95% CI)91.3 (90.5 ; 92.2)90.5 (89.6 ; 91.4)ROS [%] (95% CI)95.5 (94.3 ; 96.7)94.7 (93.4 ; 96.0)CI, confidence interval; LCR, local recurrence rate; DFS, disease-free survival; DDFS, distant disease-free survival; OS, observed overall survival; ROS, relative (age adjusted) overall survival
Outcome results referred to 5 different endpoints (using Kaplan-Meier method) according to clinico-pathological tumor subtype or in-situ tumor. Results in percent at 5 years (95% CI).invasive cancer (n = 34541) Lum A-likeLum B1-likeLum B2-likeHER2+Triple negativeCIS (n = 499)LCR [%] (95% CI)99.1 (98.7 ; 99.5)95.2 (-)**95.0 (86.3 ; 100)90.5 (-)89.6 (87.1 ; 92.1)96.2 (94.3 ; 98.1)DFS [%] (95% CI)92.2 (90.9 ; 93.5)80.1 (78.6 ; 81.6)79.0 (71.0 ; 86.0)77.0 (-)69.1 (66.4 ; 71.8)93.0 (91.3 ; 94.7)DDFS [%] (95% CI)92.9 (91.6 ; 94.2)82.2 (80.5 ; 83.9)82.8 (76.5 ; 89.1)83.3 (-)72.2 (70.7 ; 73.7)95.6 (94.4 ; 96.8)OS [%] (95% CI)95.1 (94.1 ; 96.1)88.7 (86.6 ; 90.8)92.5 (87.5 ; 97.5)85.6 (79.9 ; 91.3)78.5 (76.4 ; 80.6)96.9 (95.2 ; 98.6)ROS [%] (95% CI)100.0 (98.5 ; 100)93.4 (90.7 ; 96.1)96.0 (91.2 ; 100)88.8 (81.4 ; 96.2)80.1 (75.1 ; 85.1)100.0 (97.8 ; 100)
Results: LCR, DFS, DDFS, OS and ROS over 5 years for the whole cohort of invasive cases were 96.1%, 83.7%, 85.7%, 90.5% and 94.7%, respectively. Luminal A tumors were the most frequent (44.7%) and showed the best outcome with LCR, OS and ROS over 5 years at 99.1%, 95.1% and 100.0%, respectively; while triple negative tumors presented the poorest outcome with LCR, OS and ROS over 5 years at 89.6%, 78.5% and 80.1%, respectively.
Conclusions: This outcome analysis of a large cohort of patients with primary BC diagnosed, treated and prospectively followed on a routine basis at a specialized BCU in Germany confirmed general and detailed clinico-pathological subtype outcome data of clinical trials.
Citation Format: Hennigs A, Heil J, Gondos A, Riedel F, Marme F, Sinn H-P, Schirmacher P, Kauczor H-U, Debus J, Golatta M, Schtz F, Sohn C, Schneeweiss A. Prognosis of clinico-pathological breast cancer subtypes in routine clinical care. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-12.
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Affiliation(s)
- A Hennigs
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - J Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - A Gondos
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - F Riedel
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - F Marme
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - H-P Sinn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - P Schirmacher
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - H-U Kauczor
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - J Debus
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - F Schtz
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - C Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - A Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
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Hennigs A, Heil J. Abstract P5-02-01: Diagnosis of pathological complete response by vacuum-assisted minimal invasive biopsy after neoadjuvant chemotherapy in breast cancer - Results from a prospective pilot study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:
To explore the ability of vacuum-assisted-biopsy (VAB) to diagnose pathological complete response (pCR) or residual tumor in breast cancer patients after neoadjuvant chemotherapy (NACT).
Patients and methods: 50 patients (22 with clinical / imaging complete response 28 with clinical / imaging residual tumor) were included in this review-board approved prospective pilot study between 08/14 and 02/15. Vacuum-assisted-biopsy (VAB) was performed after NACT and before surgery. Negative predictive values (NPV) and false-negative-rates (FNR) to predict a pCR in surgical specimen (=diagnose pCR through VAB) were the main outcome measures.
Results:
The cohort (n=50) consisted of 15 (30%) triple negative (TNBC), 13 (26%) HER2 positive (HER2+) and 22 (44%) hormone receptor positive / HER2 negative (HR+/HER2-) cancers. pCR in surgical specimen was diagnosed in 23 (46%) cases of the whole cohort. The NPV of the VAB diagnosis of pCR was 94.4% (95% CI: [0.84; 1.00]). The FNR was 3.7% (95% CI: [0; 0.12]) and specificity 73.9% (95% CI: [0.54; 0.94]). Taking only those biopsies into account that pathology confirmed to be representative of the (former) tumor region, improved the outcome of VAB to a specificity of 100% while the NPV (94.4% (95% CI: [0.84; 1.00]) and the FNR (4.8% (95% CI: [0.00; 0.15]) stayed the same.
Conclusion:
Overall accuracy of VAB diagnosis of pCR questions the necessity of surgical intervention to diagnose a pCR. A confirmative, multi-center, intra-individually-controlled clinical trial including patients with clinical complete, near complete or partial response to NACT to validate the above mentioned results is warranted.
Citation Format: Hennigs A, Heil J. Diagnosis of pathological complete response by vacuum-assisted minimal invasive biopsy after neoadjuvant chemotherapy in breast cancer - Results from a prospective pilot study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-02-01.
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Affiliation(s)
- A Hennigs
- Universitäts-Frauenklinik, Heidelberg, Baden-Württemberg, Germany
| | - J Heil
- Universitäts-Frauenklinik, Heidelberg, Baden-Württemberg, Germany
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Schaefgen B, Mati M, Sinn HP, Golatta M, Stieber A, Rauch G, Hennigs A, Richter H, Domschke C, Schuetz F, Sohn C, Schneeweiss A, Heil J. Can Routine Imaging After Neoadjuvant Chemotherapy in Breast Cancer Predict Pathologic Complete Response? Ann Surg Oncol 2015; 23:789-95. [PMID: 26467456 DOI: 10.1245/s10434-015-4918-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study evaluated breast imaging procedures for predicting pathologic complete response (pCR = ypT0) after neoadjuvant chemotherapy (NACT) for breast cancer to challenge surgery as a diagnostic procedure after NACT. METHODS This retrospective, exploratory, monocenter study included 150 invasive breast cancers treated by NACT. The patients received magnetic resonance imaging (MRI), mammography (MGR), and ultrasound (US). The results were classified in three response subgroups according to response evaluation criteria in solid tumors. To incorporate specific features of MRI and MGR, an additional category [clinical near complete response (near-cCR)] was defined. Residual cancer in imaging and pathology was defined as a positive result. Negative predictive values (NPVs), false-negative rates (FNRs), and false-positive rates (FPRs) of all imaging procedures were analyzed for the whole cohort and for triple-negative (TN), HER2-positive (HER2+), and HER2-negative/hormone-receptor-positive (HER2-/HR+) cancers, respectively. RESULTS In 46 cases (31%), pCR (ypT0) was achieved. Clinical complete response (cCR) and near-cCR showed nearly the same NPVs and FNRs. The NPV was highest with 61% for near-cCR in MRI and lowest with 44% for near-cCR in MGR for the whole cohort. The FNRs ranged from 4 to 25% according to different imaging methods. The MRI performance seemed to be superior, especially in TN cancers (NPV 94%; FNR 5%). The lowest FPR was 10 % in MRI, and the highest FPR was 44% in US. CONCLUSION Neither MRI nor MGR or US can diagnose a pCR (ypT0) with sufficient accuracy to replace pathologic diagnosis of the surgical excision specimen.
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Affiliation(s)
- B Schaefgen
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - M Mati
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - H P Sinn
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - A Stieber
- Department of Diagnostic and Interventional Radiology, University Breast Unit, Heidelberg, Germany
| | - G Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - H Richter
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - C Domschke
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - A Schneeweiss
- Department of Gynecology, University Breast Unit, Heidelberg, Germany.,National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology, University Breast Unit, Heidelberg, Germany.
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Hennigs A, Fuchs V, Rauch G, Golatta M, Smetanay K, Schneeweiss A, Sinn HP, Sohn C, Heil J. Einfluss von Nachresektion auf das Lokalrezidivrisiko bei Patientinnen mit Mammakarzinom nach brusterhaltender Therapie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388553] [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: 10/24/2022] Open
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Hennigs A, Biehl H, Golatta M, Rauch G, Domschke C, Schott S, Schütz F, Sohn C, Heil J. Vorhersage des ungünstigen ästhetischen Ergebnisses nach brusterhaltender Operation – Langzeitergebnisse einer prospektiven Kohortenstudie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388445] [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: 10/24/2022] Open
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Wehmeyer MH, Eißing F, Jordan S, Röder C, Hennigs A, Degen O, Hüfner A, Hertling S, Schmiedel S, Sterneck M, van Lunzen J, Lohse AW, Schulze zur Wiesch J, Lüth S. Safety and efficacy of protease inhibitor based combination therapy in a single-center "real-life" cohort of 110 patients with chronic hepatitis C genotype 1 infection. BMC Gastroenterol 2014; 14:87. [PMID: 24884400 PMCID: PMC4102246 DOI: 10.1186/1471-230x-14-87] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/28/2014] [Indexed: 12/22/2022] Open
Abstract
Background The combination of boceprevir or telaprevir with peginterferon-alfa and ribavirin for the treatment of patients infected with HCV genotype 1 has led to significantly increased rates of sustained virological response (SVR) in phase III trials. There is only limited data regarding the safety and efficacy in a “real-life” cohort. Methods We analyzed a cohort of 110 unselected HCV patients who started triple therapy from September 2011 to February 2013 by chart review with focus on the individual course of treatment, complications and outcome. We excluded 8 patients from analysis because of HIV-coinfection (N = 6) or status post liver transplant (N = 2). Importantly, 41 patients displayed F3 or F4 fibrosis, 10 patients had a history of treatment with protease/polymerase inhibitors and 15 patients were prior partial- or null-responder. Results SVR12 was achieved in 62 of the 102 patients (60.8%). A high rate of serious adverse events (N = 30) was observed in 22 patients including 2 fatalities in cirrhotic diabetes patients. Age >50 years, liver cirrhosis, bilirubin >1.1 mg/dl (P < 0.01, each), platelets <100,000/μl (P = 0.01), ASAT >100 U/l (P = 0.03) and albumin ≤35 g/l (P = 0.04) at baseline were associated with occurence of a SAE. Conclusions The frequency of SVR in a “real-life” treatment setting is slightly lower as compared to the results of the phase III trials for telaprevir or boceprevir. Importantly, we observed a high frequency of SAE in triple therapy, especially in patients with liver cirrhosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Julian Schulze zur Wiesch
- I, Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr, 52, Hamburg 20246, Germany.
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Hennigs JK, Harlandt O, Hennigs A, Braune SA, Klose H, Kluge S. 43-jähriger Patient mit perakuter schwerer respiratorischer Insuffizienz und Volumenmangelschock durch ein massives Re-Expansionsödem. Pneumologie 2012. [DOI: 10.1055/s-0032-1302575] [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: 10/28/2022]
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