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Schwesinger G, Witte B, Blechschmidt N, Riebe H, Zentgraf K. MRE Netzwerk Ilm-Kreis: Ergebnisse und Auswertung einer MRE-Surveillance vom 01.07.2013 – 31.12.2013. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1371663] [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: 10/19/2022]
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Abstract
The autopsy rate in Germany has drastically diminished in the last decades and is below 10% nowadays. Possible reasons for this development are discussed. Pressure of cost is a quoted cause, although it is not so high. There is a large discrepancy between the clinically supposed cause of death and the by autopsy confirmed diagnosis (40-60%). This especially applies to mycoses. Every year in Germany 1200 crimes of causing death and 11.000 non-natural deaths are not found because of missing autopsy. Another important aspect for a sufficient number of autopsies is their value for the quality assurance in diagnosis and therapy and also in education and further training of physicians and students.
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Affiliation(s)
- G Schwesinger
- Ernst-Moritz-Arndt-Universität Greifswald, Medizinische Fakultät, Greifswald, Deutschland
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Busemann C, Krüger W, Schwesinger G, Kallinich B, Schröder G, Abel P, Kiefer T, Neumann T, Dölken G. Myocardial and aortal involvement in a case of disseminated infection with Fusarium solani after allogeneic stem cell transplantation: report of a case. Mycoses 2009; 52:372-6. [PMID: 19207852 DOI: 10.1111/j.1439-0507.2008.01623.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We describe a 57-year-old woman suffering from acute erythroblastic leukaemia. After the first course of high-dose Ara-C containing consolidation therapy, the patient developed multiple skin lesions on the left foot. A skin biopsy revealed a Fusarium infection. The lesions regressed under therapy with caspofungin and voriconazole. Leukaemia relapsed after 1 year and an allogeneic stem cell transplantation was performed for consolidation of leukaemia in second remission. Again, the patient developed macular skin lesions located on the trunk and the extremities with central pallor. Clinical examination showed fever, tachyarrhythmia and a systolic murmur. Fusarium spp. was cultured from blood samples. An antimycotic therapy with amphotericin B, voriconazole and posaconazole failed completely. The patient died in a septic shock with consecutive multiple organ failure. The autopsy (SN 1/06, Institute of Pathology, University of Greifswald) revealed a disseminated infiltration with Fusarium solani including myocardial, endocardial and aortal infection. The involvement of the cardiovascular system is uncommon in fusariosis and has not been described so far. This case confirms other reports describing the high mortality of fusariosis after allogeneic stem cell transplantation. A rapid diagnosis and antimycotics with higher activity against Fusarium spp. are necessary for successful therapy of this severe mould infection in the immunocompromised host.
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Affiliation(s)
- Christoph Busemann
- Department of Hematology and Oncology, University Medical Center, Ernst-Moritz-Arndt-University, Greifswald, Germany
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Schwesinger G, Eckel L, Wollert HG. [Pulmonary embolism caused by aspergillosis (so-called fungal embolism)]. Mycoses 2008; 51 Suppl 3:44-7. [PMID: 18782245 DOI: 10.1111/j.1439-0507.2008.01587.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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 71-year-old man developed a cardiac tumour in the right ventricle and a pulmonary embolism caused by aspergillosis after implantation of a pacemaker because of arrhythmia. Repeated revisions during pocket infections. Emergency operation and tricuspid valve replacement with a Carpentier Edwards xenograft. The pacing electrodes and the endocardium were infected by Aspergillus in form of an aspergilloma. This case is an example of the rare condition of a pulmonary embolism with pure fungal material.
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Affiliation(s)
- G Schwesinger
- Universitätsklinikum Greifswald der Ernst-Moritz-Arndt-Universität Greifswald AöR, Institut für Pathologie.
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Rösing D, Zimmermann U, Woenckhaus C, Schwesinger G, Klebingat KJ. Das kavernöse Hämangiom der Nebenniere. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1065269] [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: 10/21/2022]
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Poetsch M, Schuart BJ, Schwesinger G, Kleist B, Protzel C. Screening of microsatellite markers in penile cancer reveals differences between metastatic and nonmetastatic carcinomas. Mod Pathol 2007; 20:1069-77. [PMID: 17690710 DOI: 10.1038/modpathol.3800931] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Penile cancer, observed only rarely in the western world, represents a carcinoma that may be cured by resection of primary lesion and in case of lymph node metastasis by early lymph node dissection. This early inguinal lymphadenectomy bares a significant better survival even in cases of nonpalpable lymph nodes, but carries also a high risk of overtreatment, especially in lower tumor stages. Due to the low incidence, only few data are available on the molecular genetic background of this tumor, especially concerning tumor progression and metastasis. Therefore, we studied 62 microsatellite markers in 28 penile carcinomas searching for markers predicting progression or outcome. LOH in more than 25% of primary tumors was found on six different chromosomes, including 2q, 6p, 8q, 9p, 12q and 17p13. Statistically significant correlations could be established in D6S260 to clinical outcome and in markers from chromosomes 6, 9 and 12 to tumor stage and metastasis. These regions are worthy for further analysis concerning tumor suppressor genes and metastasis suppressor genes.
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Affiliation(s)
- Micaela Poetsch
- Institute of Forensic Medicine, University of Greifswald, Greifswald, Germany.
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Riebe E, Günther K, Schulz K, Köhler G, Schimming A, Schwesinger G, Ohlinger R. Recurrent disease after breast preserving therapy (BPT) and radiation therapy for breast cancer--diagnostic yield of palpation, mammography and ultrasonography. Ultraschall Med 2007; 28:394-400. [PMID: 17610177 DOI: 10.1055/s-2007-963019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE According to the S-3 guidelines for the diagnosis and treatment of breast cancer, only palpation and mammography are mandatory follow-up examinations. Ultrasonography is only mentioned as an optional technique. Aiming to elucidate the diagnostic yield for detecting recurrent disease after breast-preserving therapy (BPT) and radiation treatment, we analysed the sensitivity of palpation, mammography, ultrasonography, and combinations of these methods. MATERIALS AND METHODS Over a period of 12 years, 27 suspicious lesions in patients status post BPT and radiation therapy were biopsied (histologic results: 16 benign lesions: 59.3 %, 11 malignant lesions: 40.7 %). Prior to biopsy, the benign or malignant character of each lesion was predicted by palpation, mammography and ultrasonography (BIRADS). Sensitivity, specifity, positive predictive value (ppv), negative predictive value (npv), and efficiency were calculated from a contingency table. RESULTS For lesions status post BPT and radiation treatment, palpation had a sensitivity of 72.7 % and was 25 % specific. For mammography, the respective values were 36.4 % and 87.5 %, and for ultrasonography 90.9 % and 68.8 %. Palpation and mammography combined were 81.8 % sensitive and had a specificity of 6.2 %. The computed sensitivity for the 3 methods applied together was 100 %. Adding ultrasonography to palpation and mammography therefore increases sensitivity by 18.2 %. CONCLUSION For diagnosing recurrent disease in patients status post BPT and radiation therapy, ultrasonography is superior to palpation and/or mammography and should become an obligatory follow-up tool. The role of mammographic follow-up appears overrated and the role of ultrasonographic assessment underrated. The S-3 guidelines will need to be changed accordingly.
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Affiliation(s)
- E Riebe
- Department of Gynecology and Obstetrics, Ernst-Moritz-Arndt University Greifswald.
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Busemann C, Kallinich B, Schwesinger G, Krüger W, Schüler F, Schmidt CA, Dölken G. Erdheim-Chester disease with hemophagocytosis. Ann Hematol 2007; 86:847-9. [PMID: 17579863 DOI: 10.1007/s00277-007-0324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 05/29/2007] [Indexed: 10/23/2022]
Affiliation(s)
- Christoph Busemann
- Department of Hematology and Oncology, University Medical Center, Ernst-Moritz-Arndt-University Greifswald, Sauerbruchstrasse, 17487, Greifswald, Germany.
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Köhler J, Krause B, Grunwald S, Thomas A, Köhler G, Schwesinger G, Schimming A, Jäger B, Paepke S, Ohlinger R. Ultrasound and mammography guided wire marking of non-palpable breast lesions: analysis of 741 cases. Ultraschall Med 2007; 28:283-90. [PMID: 17315109 DOI: 10.1055/s-2006-927238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Aim of the study were to evaluate the success of ultrasound and mammography guided wire marking of non-palpable breast lesions and the results of specimen mammography/ultrasonography, completeness of resection, and number of secondary resections (during the initial surgical session and as a separate intervention) were analysed. MATERIALS AND METHODS Between May 1994 and December 2004, 668 women with 741 non-palpable breast lesions underwent surgery at the Greifswald University Department of Gynaecology and Obstetrics. Ultrasound directed wire marking was used in 418, mammography directed marking in 284 cases. In 39 lesions, both techniques were combined. RESULTS Out of all lesions approached with ultrasound directed wire marking, 88 (21.1 %) were malignant. Among lesions marked during mammography, 52 (19.3 %) were malignant. Specimen ultrasonography indicated that 90.9 % of lesions were resected completely. Specimen mammography demonstrated complete resection in 89.1 %. On histological examination, 19.5 % of the malignant lesions marked with sonographic guiding and 36.5 % of the malignant lesions marked with mammographic guiding did not have clear margins. Secondary resections (during the first procedure) for incomplete specimens were needed in 10 patients in whom sonographic localisation had been used, and in 25 patients in whom mammographic localisation had been employed. A second surgical session for secondary resection was required in 5.5 % of lesions marked with ultrasound and in 12.3 % of lesions marked with mammography guidance. CONCLUSION Sonography directed wire localisation appears to be superior to the respective mammographic method. Ultrasound guided wire marking should be considered the preferred method for all mammographic lesions with an ultrasonographic equivalent and no micro-calcifications.
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Affiliation(s)
- J Köhler
- Ernst-Moritz-Arndt-University of Greifswald, Department of Gynecology and Obstetrics, Germany
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Grunwald S, Heyer H, Paepke S, Schwesinger G, Schimming A, Hahn M, Thomas A, Jacobs VR, Ohlinger R. Diagnostic value of ductoscopy in the diagnosis of nipple discharge and intraductal proliferations in comparison to standard methods. Oncol Res Treat 2007; 30:243-8. [PMID: 17460418 DOI: 10.1159/000100848] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ductoscopy is gaining increased importance in the diagnosis of nipple discharge of unclear origin and intraductal proliferation. For this reason we compared its diagnostic value and feasibility to standard diagnostic methods. MATERIAL AND METHODS Ductoscopy was compared to mammography, galactography, sonography, magnetic resonance imaging (MRI), nipple smear, fine needle aspiration cytology (FNAC), and high-speed core biopsy; feasibility, sensitivity, and specificity were investigated for each method. RESULTS 71 ductoscopies were evaluated, which were followed up by open biopsies. Here, 3 invasive and 8 ductal carcinomas in situ were found, as well as 3 atypical ductal hyperplasias, 44 papillomas/papillomatoses, and 13 benign findings. Feasibility of ductoscopy was in this series 100%. Duct sonography showed the highest sensitivity (67.3%), followed by MRI (65.2%), galactography (56.3%), ductoscopy (55.2%), and FNAC (51.9%). The highest specificity was shown by FNAC, core biopsy, and galactography (each 100.0%), followed by mammography (92.3%), nipple smear (77.8%), ductoscopy, and duct sonography (each 61.5%); the lowest specificity was displayed by MRI (25.0%). CONCLUSION The results confirm that ductoscopy can be performed within the same range of sensitivity and specificity as other techniques. In order to make conclusive statements about ductoscopy, especially in order to precisely define the indications for this method, a prospective multicenter study was initiated.
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MESH Headings
- Adult
- Aged
- Biopsy
- Breast Diseases/diagnosis
- Breast Diseases/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating
- Cell Division/physiology
- Diagnosis, Differential
- Diagnostic Imaging
- Endoscopy
- Female
- Galactorrhea/etiology
- Galactorrhea/pathology
- Humans
- Mammary Glands, Human/pathology
- Middle Aged
- Nipples/pathology
- Papilloma, Intraductal/diagnosis
- Papilloma, Intraductal/pathology
- Precancerous Conditions/diagnosis
- Precancerous Conditions/pathology
- Retrospective Studies
- Sensitivity and Specificity
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Affiliation(s)
- Susanne Grunwald
- Department of Obstetrics and Gynecology, Ernst Moritz Arndt University, Greifswald, Germany
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Grunwald S, Heyer H, Kühl A, Schwesinger G, Schimming A, Köhler G, Ohlinger R. Radial scar/complex sclerosing lesion of the breast--value of ultrasound. Ultraschall Med 2007; 28:206-11. [PMID: 16955394 DOI: 10.1055/s-2006-926787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE Although benign, radial scar/complex sclerosing adenosis is a lesion which histopathologically resembles tubular carcinoma. On physical examination, it is difficult to distinguish radial scar from a malignant tumour. Mammography cannot differentiate radial scar from malignancy. This clinical study aims to delineate the role of preoperative ultrasonography with emphasis on the question whether ultrasonography could lower the number of false-positive readings and therefore the number of open biopsies required. MATERIALS AND METHODS In this examination, we present the clinical, mammographic, ultrasonographic, and histopathological features of 6 cases of radial scars. RESULTS Although most authors describe radial scars as non-palpable, 2 of 6 lesions were indeed palpable. On mammograms, radial scars have a spiculated appearance, a feature observed in all of our cases. Numerous ultrasonographic characteristics are listed in the literature, but ultrasonography is not reported to have clear-cut advantages. CONCLUSION Although this study did not elucidate any unique ultrasonographic features to characterise these lesions, the analysis of all ultrasonographic results made us recognise a set of "nearly specific ultrasonographic features" of radial scars. Current B-mode imaging does not appear to lead to the desirable reduction of the rate of unnecessary open biopsies.
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Affiliation(s)
- S Grunwald
- Ernst-Moritz-Arndt University Greifswald, Department of Gynecology and Obstetrics.
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Bernhardt H, Knoke M, Schwesinger G, Bufier J, Czaika V, Ludwig K, Bernhardt J. P1957 Growth inhibition of biofilm-associated Candida albicans by voriconazole in long-term continuousfiow cultures. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bachmaier N, Möller S, Wegner U, Mentel R, Schwesinger G, Haas JP, Fusch C, Stenger RD. Fetaler Hydrops durch Enteroviren – die weniger bekannte Ursache? Zwei Fallberichte. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-946260] [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: 10/19/2022]
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Bobermien K, Arndt D, Heyer H, Schulz K, Grunwald S, Schwesinger G, Köhler G, Ohlinger R. Granularzelltumor der weiblichen Brust. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-924600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bobermien K, Schulz K, Heyer H, Grunwald S, Schwesinger G, Arndt D. Struma ovarii. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952773] [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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Arndt D, Bobermien K, Heyer H, Schwesinger G, Köhler G. Immunhistochemische Bestimmung der COX-2- Expression in peritonealen Endometriosebiopsien–Ein neuer Therapieansatz? Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952212] [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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Arndt D, Bobermien K, Heyer H, Hinken B, Schwesinger G, Köhler G. Die kombinierte Endometriosetherapie–Langzeitergebnisse in Abhängigkeit vom Aktivitätszustand der Endometriose. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952708] [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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Grunwald S, Bobermien K, Schulz K, Schimming A, Heyer H, Frese H, Schwesinger G, Köhler G, Ohlinger R. Intraduktale Milchgangspapillome–eine diagnostische Herausforderung. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952844] [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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Hinken B, Bartz K, Arndt D, Grabow D, Grabow D, Schwesinger G. Nikotinabusus in der Schwangerschaft als Ursache für schwere Wachstumsretardierung ohne Gestoseproblematik. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952453] [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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Arndt D, Heyer H, Bobermien K, Riebe E, Schwesinger G, Köhler G. Intraoperativer Befund eines Angioleiomyom imponiert als endometriales Stromasarkom. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952342] [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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Hinken B, Bartz K, Grabow D, Lehmann AC, Schwesinger G. Schwere Präeklampsie mit fetaler Zentralisation in der 24. SSW- geburtshilfliches Managment und fetal outcome. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952452] [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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Schulz K, Grunwald S, Schwesinger G, Frese H, Bobermien K, Heyer H, Ohlinger R. Intramammäre Leukoseinfiltrate bei akuter meyloischer Leukämie (AML) – sonographische und pathologische Differenzierungsschwierigkeiten. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952847] [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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Ohlinger R, Heyer H, Thomas A, Paepke S, Warm H, Klug U, Frese H, Schulz K, Schimming A, Schwesinger G, Köhler G, Wodny M, Kohlmann T, Grunwald S. Non-palpable breast lesions in asymptomatic women: diagnostic value of initial ultrasonography and comparison with mammography. Anticancer Res 2006; 26:3943-55. [PMID: 17094426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM This prospective double-blind study was designed to assess (i) if primary breast screening by ultrasonography is capable of detecting breast cancer independent of tissue density and (ii) if the rate of unnecessary biopsies remains acceptable when diagnostics are based on ultrasonography. PATIENTS AND METHODS Bilateral breast ultrasonography was performed in 448 asymptomatic women as the initial diagnostic method. Sonograms were interpreted using a set of standardized diagnostic criteria. Subsequently, mammograms were obtained. The radiologists reading the mammograms were blinded to the sonographic results. RESULTS Overall, 3 non-palpable breast cancers were detected by ultrasound and mammography. All 3 ultrasonographically detected breast cancers were smaller than 1 cm (0.7, 0.7, 0.6 cm). All 3 carcinomas were correctly detected by both methods. For ultrasonography, the false positive rate was 1.1% (n=5) and for mammography 0.6% (n=3). When both methods were combined, the rate of unnecessary open biopsies was 1.6% (n=7). The ratio of benign to malignant lesions was 3.7/1. CONCLUSION Without prior mammography, primary high-resolution breast ultrasonography is capable of detecting non-palpable breast carcinomas in asymptomatic women at an early stage. The rate of unnecessary open biopsies is low and the ratio of benign to malignant biopsies acceptable.
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Affiliation(s)
- R Ohlinger
- Department of Gynecology and Obstetrics, Ernst-Moritz-Arndt-University, Greifswald, Germany.
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Bachmaier N, Möller S, Wegner U, Mentel R, Schwesinger G, Haas JP, Fusch C, Stenger RD. Fetaler Hydrops durch Enteroviren – die weniger bekannte Ursache? Zwei Fallberichte. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-943345] [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: 10/19/2022]
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Ohlinger R, Frese H, Paepke S, Heyer H, Köhler G, Schwesinger G, Grunwald S. Ultrasonographic Compared to Histologic Sizing of Benign and Malignant Breast Lesions. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-924035] [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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Heyer H, Ohlinger R, Schimming A, Schwesinger G, Grunwald S. Parenchymal leiomyoma of the breast--clinical, sonographic, mammographic and histological features. Ultraschall Med 2006; 27:55-8. [PMID: 16470480 DOI: 10.1055/s-2005-858066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Intraparenchymal leiomyomas of the breast are quite rare. Areolar lesions are distinguished from intraparenchymal leiomyomas, which are less frequent. Clinically, leiomyomas appear as nodules; mammographically, they show up as round lesions. Reports on sonographic criteria are rare, and the criteria are nonspecific. Based on our case of an intraparenchymal leiomyoma, we describe additional sonographic features. The clinical, mammographic and sonographic characteristics of an intraparenchymal leiomyoma of the breast were evaluated. After surgery, the diagnosis was confirmed histologically. RESULTS The clinical presentation of our patient with deep-seated leiomyoma of the breast included skin dimpling and a reduction in tissue mobility, differing from more commonly reported characteristics. Mammographically, the lesion was dense and only partly demarcated clearly, corresponding to other reports. On breast ultrasonography, the leiomyoma appeared as a hypodense, well demarcated, inhomogeneous lesion with posterior acoustic shadowing. A central tumour vessel was visible on Doppler imaging, and Cooper's ligaments were discontinuous. Acoustic shadowing, the hypodense character, hyperechoic border and the central tumour vessel are therefore additional ultrasonographic characteristics of an intraparenchymal leiomyoma of the breast. This type of lesion is usually described as isodense to hyperdense and homogeneous, possibly containing semicystic components. Previous reports have only described posterior acoustic enhancement, but not acoustic shadowing. CONCLUSION On breast ultrasonography, an intraparenchymal leiomyoma of the breast can present with posterior acoustic shadowing, hypodense echogenicity, a hyperechoic border and a central tumour vessel. Neither imaging studies nor palpation allow distinction between benign and malignant lesions.
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Affiliation(s)
- H Heyer
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ernst-Moritz-Arndt-Universität, Wollweberstrasse 1-3, 17489 Greifswald.
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Arndt D, Bobermien K, Heyer H, Schwesinger G, Straube W. Langzeitergebnisse nach kombinierter Endometriosetherapie in Abhängigkeit vom Proliferationszustand der Endometriose. Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-920833] [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: 10/19/2022] Open
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29
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Kytö V, Saukko P, Lignitz E, Schwesinger G, Henn V, Saraste A, Voipio-Pulkki LM. Diagnosis and presentation of fatal myocarditis. Hum Pathol 2005; 36:1003-7. [PMID: 16153464 DOI: 10.1016/j.humpath.2005.07.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 07/10/2005] [Indexed: 11/29/2022]
Abstract
The clinical presentation of myocarditis is highly variable, and histopathology is thus considered to be the cornerstone of diagnosis. We studied how accurately myocarditis was diagnosed in a series of routine autopsies and how fatal myocarditis presents clinically. All death certificates with myocarditis recorded as the underlying cause of death in Finland in 1970 to 1998 were collected retrospectively (N = 639). All cases with cardiac autopsy samples and clinical data available (n = 142; median age, 51 years) were included in this study. The cardiac samples were reexamined for the presence of myocarditis by 3 experienced independent pathologists using the Dallas criteria. The clinical data were evaluated for the presenting signs and symptoms of myocarditis. Histopathologic reanalysis showed that only 32% of the 142 subjects met the Dallas criteria for myocarditis (75% of pediatric and 28% of adult patients, P = .001). Clinicians had suspected myocarditis in only one third of the hospitalized Dallas-positive patients. Dallas-positive patients presented more often with features of myocardial infarction (26% versus 9%, P = .026) or heart failure (35% versus 10%, P = .001) than Dallas-negative subjects. The signs and symptoms of infectious disease were also more common in Dallas-positive patients (61% versus 23%, P < .001). In contrast, Dallas-negative subjects died suddenly or were found dead more frequently (68% versus 39%, P = .004). The most evident cause of death in the Dallas-negative subjects was ischemic heart disease (n = 78, 55% of all cases). Our study provides evidence that myocarditis is overdiagnosed on routine autopsies, particularly in patients who have died suddenly or are found dead. Fatal myocarditis appears to present equally often as heart failure, sudden death, or mimicking myocardial infarction.
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Affiliation(s)
- Ville Kytö
- Department of Anatomy, Institute of Biomedicine, University of Turku, 20520 Turku, Finland.
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30
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Ohlinger R, Frese H, Schwesinger G, Schimming A, Köhler G. Papillary intracystic carcinoma of the female breast--role of ultrasonography. Ultraschall Med 2005; 26:325-8. [PMID: 16123928 DOI: 10.1055/s-2004-813427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We report on a 76-year-old patient with papillary intracystic breast carcinoma. Papillary intracystic carcinomas represent a rare entity. Among all malignant breast tumors, this lesion has an incidence of 0.5-2%. Palpation is not sufficient to distinguish benign from malignant findings. The same applies to mammography, unless the tumor infiltrates the cyst wall. The method of pneumocystography has become obsolete. Sonography is the preferred diagnostic modality to distinguish cystic from solid lesions and to differentiate simple cysts from cysts with intracystic growth. In this respect, Doppler and power Doppler sonography can be instrumental. It is feasible to obtain preoperative ultrasound guided FNAC or core biopsies of the cystic and solid components for cytological or histological verification. Complete excision of the cyst which should include the intracystic growth is considered the treatment of choice.
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Affiliation(s)
- R Ohlinger
- Ernst-Moritz-Arndt-University, Department Gynecology and Obstetrics.
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31
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Scholz D, Schwesinger G, Grabow D, Kallwellis G, Fusch C. Die fatale Assoziation intrakranieller AV-Malformationen mit Aortenisthmusstenose. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-871478] [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: 10/19/2022]
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32
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Preuss J, Woenckhaus C, Schwesinger G, Madea B. Non-diagnosed pheochromocytoma as a cause of sudden death in a 49-year-old man: a case report with medico-legal implications. Forensic Sci Int 2005; 156:223-8. [PMID: 15982839 DOI: 10.1016/j.forsciint.2005.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 05/16/2005] [Accepted: 05/16/2005] [Indexed: 10/25/2022]
Abstract
Pheochromocytomas are known to be rare causes of sudden death. A 49-year-old man with a medical history of arterial hypertension and diabetes mellitus complained about nausea and malaise in the morning. During the day his condition deteriorated. He went to the emergency department, where he was given intravenous drugs against nausea and was sent home. On the way back, his condition deteriorated dramatically so that his wife drove back to the emergency room, where he collapsed and sustained cardiac arrest; resuscitation efforts were unsuccessful. Autopsy revealed a large tumour of the left adrenal gland. The strong suspicion of pheochromocytoma was confirmed by histology, immunohistochemistry and biochemical investigations. An acute hypertensive crisis, caused by the hitherto unknown pheochromocytoma was ascertained as the cause of death. The morphological findings are presented, the difficulty to diagnose pheochromocytoma and the medico-legal implications are discussed.
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Affiliation(s)
- J Preuss
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
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33
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Abstract
We analysed the autopsy records of the Greifswald University Institute of Pathology (located in Eastern Germany) in respect of findings of candidosis and aspergillosis from 1994 to 2003. We also present eight immature aborted fetuses and premature infants with a mycosis. In a total of 2027 autopsies we found 164 cases of invasive candidosis and aspergillosis (8.1%) including a combination of both on four occasions. Other authors cited between 0.7 and 7.3%. In these 10 years in our material mycoses and in particular candidosis increased in spite of slightly decreased numbers of autopsies. The differences comparing the 5-years periods (1994-98 and 1999-2003) are highly significant for both mycoses and candidosis. They are not significant for aspergillosis. A similar relationship was observed in the distribution of mycotic organs and causative origin for candidosis alone. In the last 5 years the gastrointestinal and respiratory tracts, including the peritoneum, were more frequently infected by Candida. Non-haematological neoplasia and pneumonia as basic diseases more often appeared in cases of candidosis. All eight immature aborted fetuses and premature infants suffered from candidosis. The survey confirms the importance of autopsy as a tool for education and quality control in medical diagnostic and therapeutic activity in the field of mycoses, too.
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Affiliation(s)
- G Schwesinger
- Institute of Pathology, University of Greifswald, D-17487 Greifswald, Germany
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34
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Krüger WH, Schüler F, Lotze C, Schwesinger G, Mentel R, Busemann C, Dölken G. Epstein-Barr virus reactivation after allogeneic stem cell transplantation without lymph node enlargement. Ann Hematol 2005; 84:477-8. [PMID: 15940514 DOI: 10.1007/s00277-005-1010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Accepted: 01/21/2005] [Indexed: 11/30/2022]
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35
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Ruppert J, Panzig B, Guertler L, Hinz P, Schwesinger G, Felix SB, Friesecke S. Two cases of severe sepsis due to Vibrio vulnificus wound infection acquired in the Baltic Sea. Eur J Clin Microbiol Infect Dis 2005; 23:912-5. [PMID: 15599654 DOI: 10.1007/s10096-004-1241-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 12/17/2022]
Abstract
Two severe cases of Vibrio vulnificus wound infection with secondary septicemia occurred during 1 week in August 2003 on the German island of Usedom in the southwestern Baltic Sea. In both cases, pre-existing wounds were inoculated by wading in contaminated sea water. One of the patients died from septic multiorgan failure. To the best of our knowledge, this is the first fatality due to a V. vulnificus infection to have occurred in Germany. Microbiological analysis revealed high concentrations of V. vulnificus in sea water along the coastline, following a period when water temperature exceeded 20 degrees C for more than 2 weeks.
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Affiliation(s)
- J Ruppert
- Department of Internal Medicine B, University of Greifswald, Germany.
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36
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Ohlinger R, Schwesinger G, Schimming A, Köhler G, Frese H. Juvenile papillomatosis (JP) of the female breast (Swiss Cheese Disease) -- role of breast ultrasonography. Ultraschall Med 2005; 26:42-45. [PMID: 15700227 DOI: 10.1055/s-2004-813122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This report summarises the imaging findings of juvenile papillomatosis (JP) in a 16-year-old woman. Sonographically, the lesion was oval, well defined, heterogeneous with multiple small, cystic spaces. Ultrasonography can be helpful in differentiating between JP and similar cystic lesions, fibroadenomas, phyllodes tumours, intracystic papillomas and carcinomas. A core needle biopsy is still needed to confirm the diagnosis. An open biopsy with excision of the lesion is mandatory, mere observation is inadequate because of insufficient knowledge about the direct relationship between JP and subsequent cancer.
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Affiliation(s)
- R Ohlinger
- Department of Gynecology and Obstetrics, Ernst Moritz Arndt University of Greifswald.
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37
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Hinken B, Grabow D, Arndt D, Kadow I, Schwesinger G. Der reversible Nullflow in der A. umbilicalis als möglicher Hinweis auf einen echten Nabelschnurknoten. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-923182] [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: 10/18/2022]
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38
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Affiliation(s)
- Ralf Ohlinger
- Department of Obstetrics and Gynecology, Ernst-Moritz-Arndt-University, Greifswald, Germany
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39
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Stenger RD, Linnemann K, Riedel J, Schwesinger G, Haas JP, Fusch C. Die spontane Magenperforation im Neugeborenenalter. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2004-829223] [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]
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40
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Abstract
We report on a 45-year-old patient who presented with a 7 cm palpable right breast mass which had been classified as a cyst by ultrasonography. Multiple aspiration cytologies revealed no evidence of malignancy. Repeat sonography in our institution showed a lesion at 1 o'clock, 1 cm deep, and 3-8 cm from the nipple. The lesion contained a solitary cystic component measuring 3.9 x 4.1 x 4.4 cm. A 3.1 x 2.6 x 2.5 cm solid, inhomogeneous mass with irregular margins was found at the lateral border of the cyst. This mass raised suspicion of an intracystic carcinoma. Histopathologic analysis of 5 high-speed biopsy tissue cores demonstrated an invasive large-cell ductal carcinoma (G2-3). Final histopathologic assessment subsequent to breast-preserving resection and axillary node dissection confirmed the initial diagnosis: keratinizing intracystic squamous cell carcinoma (G2-3, pT2, pN0 (0/15)). The search for a remote primary squamous cell carcinoma included a chest X-ray, cystoscopy, colposcopy and PAP smear, esophago-gastroscopy, ENT consultation (laryngoscopy), and did not reveal any extramammary cancer. The postoperative management consisted of a total of 6 cycles of chemotherapy (Cisplatinum 75 mg/m (2) BSA and Paclitaxel 175 mg/m (2) BSA every 21 days) and subsequent percutaneous radiotherapy. In accordance with published reports, the diagnostic and therapeutic management was analogous to that of adenocarcinoma of the breast. However, some authors recommend the same chemotherapy as used for squamous cell carcinomas of other organs. It remains difficult to make any statements regarding the adjuvant therapy and prognosis, since this type of tumor is so infrequent, especially as an intracystic lesion.
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Affiliation(s)
- S Grunwald
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ernst-Moritz-Arndt-Universität Greifswald, Germany.
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41
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Junghans D, Schwesinger G, Lorenz G, Bernhardt H, Knoke M. Frequency of mycoses in autopsy material. Pathol Res Pract 2004. [DOI: 10.1016/s0344-0338(04)80704-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Arndt D, Straube W, Römer T, Schwesinger G. Der Proliferationsmarker mib-1– ein prädiktiver Marker für den Erfolg einer hormonellen Endometriosetherapie. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-815209] [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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43
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Knoke M, Bernhardt H, Schwesinger G. [Early description of a pulmonary aspergillosis 1847 from Greifswald]. Mycoses 2003; 46 Suppl 1:37-41. [PMID: 12955852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
In 1847 the student of medicine Theodor Sluyter (1817-1895) from Greifswald published his thesis in Berlin including the first well-documented case of human pulmonary aspergillosis. In 1856 Rudolf Virchow (1821-1902) classified the depicted fungi as an Aspergillus species. Possibly Carl Ferdinand Eichstedt (1816-1892) carried out the autopsy. He is known by the first description of a fungus as the cause of pityriasis versicolor in 1846. Further involved scientists from Greifswald were Wilhelm Baum (1799-1883), Theodor Litzmann (1815-1890) and the botanist Johann Konrad Schauer (1813-1848). Their curricula vitae are given in further details as well the curriculum of T. Sluyter.
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Affiliation(s)
- M Knoke
- Klinik und Poliklinik für Innere Medizin A, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.
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44
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Ohlinger R, Frese H, Oellig F, Schimming A, Köhler G, Schwesinger G. Lipid-Rich Carcinoma of the Female Breast - Clinical, Mammographic, Sonographic, and Histologic Diagnosis: Case Report and Literature Review. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-39608] [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: 10/27/2022] Open
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45
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Affiliation(s)
- M. Knoke
- Klinik und Poliklinik für Innere Medizin A; Greifswald Germany
| | | | - G. Schwesinger
- Institut für Pathologie der Ernst-Moritz-Arndt-Universität; Greifswald Germany
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46
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Ohlinger R, Schwesinger G, Schimming A, Köhler G. Adenoid Cystic Breast Cancer - A Case Report. Geburtshilfe Frauenheilkd 2002. [DOI: 10.1055/s-2002-36370] [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: 10/27/2022] Open
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47
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Römer T, Schwesinger G. Chance finding of a leiomyosarcoma in hysteroscopic resection of a myoma. Acta Obstet Gynecol Scand 2002. [DOI: 10.1034/j.1600-0412.2002.811114.x] [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: 11/23/2022]
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48
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Ohlinger R, Oellig F, Köhler G, Schimming A, Schwesinger G. Infiltrating Fibromatosis of the Female Breast: A Case Report and Review of Diagnosis and Management. Geburtshilfe Frauenheilkd 2002. [DOI: 10.1055/s-2002-35973] [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: 10/27/2022] Open
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49
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Römer T, Schwesinger G. Chance finding of a leiomyosarcoma in hysteroscopic resection of a myoma. Acta Obstet Gynecol Scand 2002; 81:1078-9. [PMID: 12421178] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- T Römer
- Department of Obstetrics and Gynecology of Cologne, and the Department of Pathology, Ernst Moritz Arndt University, Greifswald/Germany.
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50
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Ohlinger R, Steffen SM, Oellig F, Köhler G, Schwesinger G, Lorenz G. [Immunohistochemical research on breast cancer cell proliferation and hormonal receptor status with special emphasis on HER-2/neu expression]. Zentralbl Gynakol 2002; 124:473-7. [PMID: 12712389 DOI: 10.1055/s-2002-38918] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Breast cancer is the most frequent gynecological tumor. The HER-2/neu oncogene may play a role in the prognosis and management of patients with breast cancer. In a retrospective study on 100 patients, we correlated the expression of this oncogene with the classic clinical and pathological factors. 32 % of patients exhibited overexpression of HER-2/neu. There was no significant correlation with classic parameters. This finding could indicate that HER-2/neu expression is a new independent prognostic factor. Prospective studies correlating HER-2/neu overexpression with prognosis might provide additional data.
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Affiliation(s)
- R Ohlinger
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ernst-Moritz-Universität Greifswald
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