Karger Kompass最新文献

{"title":"Sensitivität und Spezifität verschiedener prognostischer Systeme zur Lenkung der Überwachung auf Metastasen beim Aderhautmelanom","authors":"Ira Seibel","doi":"10.1159/000534139","DOIUrl":"https://doi.org/10.1159/000534139","url":null,"abstract":"Uveal melanoma (UM) metastasises in ∼50% of patients, most frequently to the liver. Surveillance imaging can provide early detection of hepatic metastases; however, guidance regarding UM patient risk stratification for surveillance is unclear. This study compared sensitivity and specificity of four current prognostic systems, when used for risk stratification for surveillance, on patients treated at the Liverpool Ocular Oncology Centre (LOOC) between 2007–2016 (n = 1047). It found that the Liverpool Uveal Melanoma Prognosticator Online III (LUMPOIII) or Liverpool Parsimonious Model (LPM) offered greater specificity at equal levels of sensitivity than the American Joint Committee on Cancer (AJCC) system or monosomy 3 alone, and suggests guidance to achieve 95% sensitivity and 51% specificity (i.e., how to detect the same number of patients with metastases, while reducing the number of negative scans). For example, 180 scans could be safely avoided over 5 years in 200 patients using the most specific approach. LUMPOIII also offered high sensitivity and improved specificity over the AJCC in the absence of genetic information, making the result relevant to centres that do not perform genetic testing, or where such testing is inappropriate or fails. This study provides valuable information for clinical guidelines for risk stratification for surveillance in UM.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"79 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136317425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uveamelanom: Neue Therapieoption zugelassen","authors":"Kai-Christian Klespe","doi":"10.1159/000534265","DOIUrl":"https://doi.org/10.1159/000534265","url":null,"abstract":"In der IMCgp100-202 Studie wurden zuvor unbehandelte HLA-A*02:01-positive Patienten mit metastasiertem Aderhautmelanom im Verhältnis 2:1 nach dem Zufallsprinzip entweder mit Tebentafusp (Tebentafusp-Gruppe) oder einer Therapie nach Wahl des Prüfarztes mit Pembrolizumab, Ipilimumab oder Dacarbazin (Kontrollgruppe) behandelt, stratifiziert nach dem Laktatdehydrogenase-Spiegel. Der primäre Endpunkt war das Gesamtüberleben.Die Gesamtüberlebensrate nach einem Jahr betrug 73% in der Tebentafusp-Gruppe und 59 %in der Kontrollgruppe (Hazard Ratio für Tod 0,51; 95% Konfidenzintervall [CI] 0,37 bis 0,71; P<0,001) in der Intention-to-Treat-Population. Das progressionsfreie Überleben war in der Tebentafusp-Gruppe ebenfalls signifikant höher als in der Kontrollgruppe (31% gegenüber 19% nach 6 Monaten; Hazard Ratio für Krankheitsprogression oder Tod, 0,73; 95% CI, 0,58 bis 0,94; P = 0,01). Die häufigsten behandlungsbedingten unerwünschten Ereignisse in der Tebentafusp-Gruppe waren zytokinvermittelte Ereignisse (aufgrund von T-Zell-Aktivierung) und hautbezogene Ereignisse (aufgrund von Glykoprotein-100-positiven Melanozyten), einschließlich Hautausschlag (83%), Pyrexie (76%) und Pruritus (69%). Die Häufigkeit und der Schweregrad dieser unerwünschten Ereignisse nahmen nach den ersten 3 oder 4 Dosen ab und führten nur in seltenen Fällen zum Abbruch der Studienbehandlung (2%). Es wurden keine behandlungsbedingten Todesfälle gemeldet.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136317753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empfehlungen für die interdisziplinäre Betreuung von Patienten mit Riesenzellarteriitis: «Giant Cell Arteritis Hospital Quality Standards» (GHOST)","authors":"Christoph Tappeiner","doi":"10.1159/000534264","DOIUrl":"https://doi.org/10.1159/000534264","url":null,"abstract":"<b>Objective:</b> GCA is the commonest primary systemic vasculitis in adults, with significant health economic costs and societal burden. There is wide variation in access to secondary care GCA services, with 34% of hospitals in England not having any formal clinical pathway. Quality standards provide levers for change to improve services. <b>Methods:</b> The multidisciplinary steering committee were asked to anonymously put forward up to five aspects of service essential for best practice. Responses were qualitatively analysed to identify common themes, subsequently condensed into domain headings, and ranked in order of importance. Quality standards and metrics for each domain were drafted, requiring a minimum 75% agreement. <b>Results:</b> 13 themes were identified from the initial suggestions. Nine quality standards with auditable metrics were developed from the top 10 themes. Patient Access, glucocorticoid use, pathways, ultrasonography, temporal artery biopsy, PET scan access, rheumatology/ophthalmology expertise, education, multidisciplinary working have all been covered in these quality standards. Access to care is a strand that has run through each of the developed standards. An audit tool was developed as part of this exercise.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"48 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136317755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Akne vulgaris: Neue Studie bestätigt Wirksamkeit und Sicherheit der Lasertherapie","authors":"Andrea Schulz","doi":"10.1159/000534625","DOIUrl":"https://doi.org/10.1159/000534625","url":null,"abstract":"<b>Background:</b> Selective photothermolysis on sebaceous glands is an effective method for treating acne vulgaris (AV); however, safety, efficacy, and discomfort hinder its utilization in clinical settings. <b>Aims:</b> The primary objective is to evaluate the safety and efficacy of a novel 1726 nm laser with contact cooling to treat AV. <b>Methods:</b> Seventeen patients aged 18 to 36 were enrolled and treated in this IRB-approved, single-center, open-label study. Patients received up to three facial laser sessions up to seven weeks apart. Follow-up visits happened ten days post-session and at the 4 and 12 weeks following the final session. The investigator assessed the severity of device-related adverse events (AEs). Investigator Global Assessment (IGA) and inflammatory lesion counts (ILC) were used as metrics to evaluate acne resolution and skin condition enhancement. Patients&amp;apos; perspectives on satisfaction and comfort using this technology were assessed using Subject Experience Questionnaires (SEQ). <b>Results:</b> Safety assessment showed mild and transient AEs. All subjects tolerated anesthetics-free treatments well, with a mean treatment discomfort score of 4.9 ± 1.5. Compared to baseline, a statistically significant reduction in ILC (p = 0.003) of 52% to 56% is achieved four to twelve weeks following treatment. Long-term follow-ups showed progressive improvement 24 months post-treatment with a 97% reduction in ILC. SEQs revealed high subject satisfaction (71%) with psychosocial improvement three months post-treatment.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134907718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NSCLC: Tumorzellen in den Luftwegen jenseits vom Tumorrand haben prognostische Bedeutung","authors":"Thomas Lesser","doi":"10.1159/000534558","DOIUrl":"https://doi.org/10.1159/000534558","url":null,"abstract":"<b>Background:</b> The current accuracy of frozen section diagnosis of tumor spread through air spaces (STAS) in non-small cell lung cancer (NSCLC) is poor. However, the accuracy and prognostic value of STAS assessment on frozen sections in small-sized NSCLC (diameter ≤2 cm) is unknown. <b>Methods:</b> Three hundred fifty-two patients with clinical stage I NSCLC (≤2 cm) were included, of which the parafin sections and frozen sections were reviewed. The accuracy of STAS diagnosis in frozen sections was assessed using parafin sections as the gold standard. The relationship between STAS on frozen sections and prognosis was assessed by the Kaplan–Meier method and log-rank tests. <b>Results:</b> STAS on frozen sections in 58 of 352 patients could not be evaluated. In the other 294 patients, 36.39% (107/294) was STAS-positive on parafin sections and 29.59% (87/294) on frozen sections. The accuracy of frozen section diagnosis of STAS was 74.14% (218/294), sensitivity was 55.14% (59/107), specifcity was 85.02% (159/187) and agreement was moderate (<i>K</i> = 0.418). In subgroup analysis, the <i>Kappa</i> values for frozen section diagnosis of STAS in the consolidation-to-tumor ratio (CTR) ≤0.5 group and CTR &amp;#x3e; 0.5 group were 0.368, 0.415, respectively. In survival analysis, STAS-positive frozen sections were associated with worse recurrence-free survival in the CTR &amp;#x3e;0.5 group (<i>P</i> &amp;#x3e; 0.5) suggests that frozen section assessment of STAS can be applied to the treatment strategy of small-sized NSCLC with CTR &amp;#x3e; 0.5.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"5 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136381431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nicht kleinzellige Lungentumoren: Frühzeitige Diagnose, vollständige Resektion und individualisierte Therapien als Schlüssel für kontinuierliche Behandlungsverbesserung","authors":"Katrin Welcker","doi":"10.1159/000534546","DOIUrl":"https://doi.org/10.1159/000534546","url":null,"abstract":"","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"51 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135367183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pleuraergüsse: Serum-Erguss-Albumin-Gradient ermöglicht die schnelle Erkennung von Transsudaten","authors":"Franz Stanzel","doi":"10.1159/000534462","DOIUrl":"https://doi.org/10.1159/000534462","url":null,"abstract":"<b>Introduction:</b> While Light’s criteria exhibit high sensitivity (98%) in detecting exudative pleural effusions, the capacity to rule out transudates is relatively limited. A previous study showed that approximately one-fifth of patients with congestive cardiac failure on diuretics also met the criteria for exudate. This study compares the diagnostic value of Light’s criteria, the serum-effusion albumin gradient (SEAG) method, and pleural effusion glucose levels for accurately categorizing pleural effusion as transudate or exudate. <b>Methodology:</b> We conducted this cross-sectional observational study in a tertiary care hospital in Ahmedabad, India. Two hundred patients with pleural effusion undergoing thoracentesis were included. Laboratory parameters measured in pleural fluid analysis included pleural fluid protein, pleural fluid lactate dehydrogenase (LDH), pleural fluid albumin, and pleural fluid glucose. Serum protein, serum LDH, and serum albumin were also collected. Mean values and standard deviations (SDs) were calculated for analysis. <b>Results:</b> A significant difference was observed in the mean value of exudative and transudative effusions for each parameter (pleural fluid protein/serum fluid protein ratio, pleural fluid LDH/serum fluid LDH ratio, pleural fluid LDH, SEAG, and pleural fluid glucose) (<i>P</i> &amp;#x3c; 0.001). Light’s criteria demonstrated the highest efficacy in diagnosing exudates (accuracy = 97.50%), while SEAG demonstrated the highest efficacy in diagnosing transudates (accuracy = 97.50%).","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MPA-ILD: Eine seltene Manifestation mit schwieriger Diagnose","authors":"Fotios Drakopanagiotakis, Andreas Günther","doi":"10.1159/000534239","DOIUrl":"https://doi.org/10.1159/000534239","url":null,"abstract":"<b>Background:</b> Interstitial lung disease (ILD) is a significant complication associated with microscopic polyangiitis (MPA) that has a poor prognosis. However, the longterm clinical course, outcomes, and prognostic factors of MPA-ILD are not well defined. Hence, this study aimed to investigate the long-term clinical course, outcomes, and prognostic factors in patients with MPA-ILD. <b>Methods:</b> Clinical data of 39 patients with MPA-ILD (biopsy proven cases, <i>n</i> = 6) were retrospectively analyzed. High resolution computed tomography (HRCT) patterns were assessed based on the 2018 idiopathic pulmonary fibrosis diagnostic criteria. Acute exacerbation (AE) was defined as the worsening of dyspnea within 30 days, with new bilateral lung infiltration that is not fully explained by heart failure or fluid overload and that does not have identified extra-parenchymal causes (pneumothorax, pleural effusion, or pulmonary embolism). <b>Results:</b> The median follow-up period was 72.0 months (interquartile range: 44–117 months). The mean age of the patients was 62.7 years and 59.0% were male. Usual interstitial pneumonia (UIP) and probable usual interstitial pneumonia patterns on high resolution computed tomography were identified in 61.5 and 17.9% of the patients, respectively. During the follow-up, 51.3% of patients died, and the 5- and 10-year overall survival rates were 73.5% and 42.0%, respectively. Acute exacerbation occurred in 17.9% of the patients. The non-survivors had higher neutrophil counts in bronchoalveolar lavage (BAL) fluid and more frequent acute exacerbation than the survivors. In the multivariable Cox analysis, older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01–1.14; <i>p</i> = 0.028) and higher BAL counts (HR, 1.09; 95% CI, 1.01–1.17; <i>p</i> = 0.015) were found to be the independent prognostic factors associated with mortality in patients with MPA-ILD. <b>Conclusion:</b> During the 6 years-follow-up, about half of patients with MPA-ILD died and approximately one-fifth experienced acute exacerbation. Our results suggest that older age and higher BAL neutrophil counts mean poor prognosis in patients with MPA-ILD. © 2023 Kim, Lee, Choe and Song","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135968062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update Immunglobulin-A Vaskulitis","authors":"Sabine Adler","doi":"10.1159/000534383","DOIUrl":"https://doi.org/10.1159/000534383","url":null,"abstract":"","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135968055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nivolumab-induzierte Pneumonie bei nicht kleinzelligem Lungenkarzinom: Ein Fallbericht","authors":"Tehmina Habib, Mohammad Abu-Abaa, Diana Kolman-Taddeo","doi":"10.1159/000533781","DOIUrl":"https://doi.org/10.1159/000533781","url":null,"abstract":"Nivolumab ist ein Immuncheckpoint-Inhibitor (ICI), der sich bei der Behandlung bestimmter bösartiger Erkrankungen, einschließlich des nicht kleinzelligen Lungenkarzinoms, als wirksam erwiesen hat. In diesem Fallbericht stellen wir eine 53-jährige Patientin vor, bei der ein metastasierendes nichtkleinzelliges Lungenkarzinom dia­gnostiziert wurde. Nach Bestrahlung (sowohl extern als auch mit Brachytherapie) und Entfernung des Tumors durch bronchoskopische Kryotherapie entwickelte sie unter Nivolumab und Ipilimumab eine initiale Pneumonitis. Diese wurde erfolgreich mit einer Steroidtherapie behandelt, sodass die Monotherapie mit Nivolumab wiederaufgenommen werden konnte. Einige Monate später entwickelte die Patientin jedoch eine organisierende Pneumonie, die zum Abbruch der Immuntherapie und zum Beginn einer Kortikosteroidtherapie führte. Dieser Fall sollte Kliniker daran erinnern, dass ICI zwar eine neue und wirksame Therapie für bestimmte maligne Erkrankungen darstellen, dass aber immunologische Nebenwirkungen kräftezehrend sein und eine Fortsetzung der Immuntherapie verhindern können. Anhand dieses Falles soll hier die Literatur zu dieser seltenen Nebenwirkung der Nivolumab-induzierten Pneumonitis sowie zu den Risikofaktoren, der Diagnose und der Behandlung gesichtet werden.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}