[Contrast agents in transabdominal ultrasonography: state of the art and perspectives].
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Abdomen↗
Biomedical subjects
A Stang
Publications and source records attributed to A Stang.
[Minimally-invasive regional treatment of a symptomatic ischial metastasis using radiofrequency ablation and osteoplasty].
HISTORY AND ADMISSION FINDINGS: A 46-year-old woman presented with worsening, morphine-resistant pain during the previous 8 weeks in the right ischium which rendered her immobile. The patient refused further surgery, radiotherapy or chemotherapy, as she had been treated for ovarian cancer and recurring rectal carcinoma with peritoneal carcinomatosis for the last three years almost without interruption and experienced several complications. The pelvic region had radiotherapy up to 70,4 Gy. INVESTIGATION: Scintigraphy of the bone showed enhancement in the right ischium. Conventional radiography demonstrated an irregular lesion with destruction of the corticalis 3 x 4 cm in size. Computed tomography revealed numerous microfractures and pseudo-arthritic changes. Needle biopsy confirmed a bone metastasis from the rectal carcinoma. Examination of radiation fields showed a high risk for radiation damage using conventional fractionation. TREATMENT AND COURSE: After achieving an interdisciplinary consensus the metastatic lesion of the patient under analgesia and sedation was thermo-ablated by using radiofrequency percutaneously under ct-control and filled with bone cement. 8 days later the patient was released from hospital pain-free and mobile. Her Karnofsky index rose from 30 % to 90 %. Morphine could be reduced to zero. No complications occurred. 9 month later, though newly appearing lung metastasis, the lesion of the ischium was still asymptomatic and stable and conventional radiography did not indicate local tumor progress or dislocated bone cement. The patient now agreed to further chemotherapy. CONCLUSION: Palliative minimally invasive radiofrequency ablation with concurrent osteoplasty can be effective in individual cases giving a better quality of life and mobility. Benefits and risks should be carefully evaluated in studies examining quality of life, especially in patients without the options of surgical and radiotherapy.
Biopsy, Needle↗
Baseline recruitment and analyses of nonresponse of the Heinz Nixdorf Recall Study: identifiability of phone numbers as the major determinant of response.
The Heinz Nixdorf Recall Study is an ongoing population-based prospective cardiovascular cohort study of the Ruhr area in Germany. This paper focuses on the recruitment strategy and its response results including a comparison of participants of the baseline examination with nonparticipants. Random samples of the general population were drawn from residents' registration offices including men and women aged 45-74 years. We used a multimode contact approach including an invitational letter, a maximum of two reminder letters and phone calls for the recruitment of study subjects. Nonparticipants were asked to fill in a short questionnaire. We calculated proportions of response, contact, cooperation and recruitment efficacy to characterize the participation. Overall, 4487 eligible subjects participated in our study. Although the elderly (65-75 years) had the highest contact proportion, the cooperation proportion was the lowest among both men and women. The recruitment efficacy proportion was highest among subjects aged 55-64 years. The identifiability of the phone number of study subjects was an important determinant of response. The recruitment efficacy proportion among subjects without an identified phone number was 11.4% as compared to 65.3% among subjects with an identified phone number. The majority of subjects agreed to participate after one invitational letter only (52.6%). A second reminding letter contributed only very few participants to the study. Nonparticipants were more often current smokers than participants and less often belonged to the highest social class. Living in a regular relationship with a partner was more often reported among participants than nonparticipants.
Age Factors↗
Population-based incidence rates of malignant melanoma of the vulva in Germany.
OBJECTIVES: Only few population-based incidence analyses of vulvar melanoma including the United States and Sweden are currently available. We studied the incidence of vulvar melanoma in a large population-based cancer registry of East Germany and compared our findings with the United States and Sweden. METHODS: We extracted vulvar melanoma registered between 1976 and 1989 in the former National Cancer Registry of the German Democratic Republic (GDR) and of three new East German cancer registries of the federal states of Sachsen, Brandenburg, and Mecklenburg-Vorpommern of the period 1998 to 2002. We calculated age-specific and age-standardized incidence rates using the World Standard Population. RESULTS: One hundred two cases (1976-1989, former GDR) and twenty-five cases of vulvar melanoma (1998-2002, three new federal states) were registered. The age-standardized incidence rate (World Standard Population) remained constant over the period from 1976 to 1989 and ranged between 0.26 and 0.52 cases per million. From 1998 to 2002, the incidence rate was 0.48 per million. The ratio of registered vulvar melanoma to skin melanoma was 1:71, and the ratio of vaginal melanoma to skin melanoma was 1:314. Age at diagnosis during the period 1976 to 1989 was lower among women with vulvar melanoma (median age 70 years) compared to women with vulvar tumors other than melanoma (median age 73 years). CONCLUSIONS: The risk of vulvar melanoma was considerably lower in East Germany than in the United States and Sweden. Due to the rarity of vulvar melanoma, population-based cancer registries are hampered to study this tumor in detail.
Age Factors↗
[Smoking as potential confounder in german epidemiological studies: standardization of assessment, quantification, and analysis].
Tobacco smoking is one of the most frequently examined risk factors in epidemiological studies due to the high frequency of smoking in the population and its high risk potential. This paper discusses the issue of standardization of the assessment of tobacco exposure in German epidemiological studies based on a suggestion of the working group "Epidemiological methods" of the German Society of Epidemiology (DGEpi), the German Society of Social Medicine and Prevention (DGSMP), and German Society of Medical Informatics, Biometry and Epidemiology (GMDS) together with the working group "Epidemiology in the workplace" of the DGEpi and the German Society of Occupational and Environmental Medicine (DGAUM). The main element is a short questionnaire for German adults for the assessment of tobacco smoking in epidemiological studies where smoking is a potential confounder. In addition, information on the consideration of intermittent periods of non-smoking, a very short questionnaire for medical examinations in the workplace or non-responder interviews as well as the quantification and statistical modelling of smoking are presented. A brief discussion of scientific problems and questionnaires related to the exposure to environmental tobacco smoke is given.
Bias↗
[Mucocele of the appendix. Incidental sonographic discovery and laparoscopic resection].
HISTORY AND ADMISSION FINDINGS: A 76-year-old currently asymptomatic man was admitted for routine sonography of the abdomen. 15 years he had had intermittently symptomatic cholecystolithiasis. 25 years before a colon contrast showed a normal coecum but no filling of the appendix. SUBSEQUENT INVESTIGATION: Sonographic examination showed the known cholecystolithisasis but additionally revealed as an incidental finding a tubular-cystic structure with a thin, echogenic wall and a hypoechogenic lumen. The lesion was located in the right upper quadrant, not compressible and arising from the coecum. Computed tomography confirmed a mucocele of the appendix without ascites and no inflammatory changes, peritoneal thickening or nodules. TREATMENT AND COURSE: Laparoscopic resection of the unruptured appendiceal mucocele together with cholestectomy was performed. On gross examination, the resected mucocele proved to be macroscopally an intact mass with a thin wall and full of white gelatinous material measuring 3 cm in diameter and 8 cm long. The histologic diagnosis was mucinous cystadenoma. The patient was discharged on the second postoperative day and recovered uneventfully. Because of the clear association of appendiceal cystadenoma with colorectal tumor a colonoscopy was performed which showed a normal colon. CONCLUSION: The differential diagnosis of a cystic mass in the right lower quadrant without previous appendectomy should include an appendiceal mucocele. If preoperatively there are no signs of malignancy, laparoscopic resection can be performed. In patients with histologic diagnosis of appendiceal cystadenoma: the colon should be examined to exclude synchronous colon tumors.
Aged↗
Prognostic value of electron-beam computed tomography-derived coronary calcium scores compared with clinical parameters in patients evaluated for coronary artery disease. Prognostic value of EBCT in symptomatic patients.
OBJECTIVE: The electron-beam computed tomography-(EBCT-)derived calcium score provides a measure of coronary atherosclerotic plaque disease which may allow for more precise risk stratification in symptomatic patients. However, it remains unclear if EBCT can add prognostic information compared with the clinical information derived from risk factor assessment, exercise stress testing, and coronary angiography. METHODS AND RESULTS: A cohort of 300 consecutive patients with recent (<3 months) onset of symptoms was retrospectively identified who were examined for possible coronary artery disease (CAD) and who all underwent EBCT. Successful follow-up after 3.5 years was obtained in 255 (85%) patients whose mean age at baseline was 58+/-11 years (n = 181 (71%), males). Four clinical categories with increasing evidence of CAD were constructed on the basis of risk factor assessment, exercise stress testing, coronary angiographic anatomy, and coronary revascularization at baseline. During follow-up, major adverse cardiac events (MACE: myocardial infarction, cardiac death, revascularization) were observed in 40 (16%) patients, including myocardial infarction and cardiac death in 5 patients. The 4 clinical categories were highly predictive of MACE, with a relative risk estimate of 28.3 (95% CI, 6.7-119.1) in the upper vs. the reference category. In univariate analysis, the relative risk estimate of MACE associated with a calcium score > or =100 was 12.0 (95% CI, 4.7-30.6). After adjustment for the clinical categories and for age, this estimate decreased in multivariate analysis, but remained predictive at 4.4 (95% CI, 1.5-12.6). CONCLUSION: In patients with first-time evaluation of possible CAD, EBCT-derived coronary calcium is suggested to provide for independent and additional information compared with the clinically available information.
Adult↗
Declining mortality rates for nonmelanoma skin cancers in West Germany, 1968-99.
BACKGROUND: Mortality analyses based on routine death certification provide a rough guide to the magnitude of nonmelanoma skin cancer (NMSC) mortality. OBJECTIVES: To examine time trends in NMSC mortality over a 32-year period for the territory of West Germany which included a population of about 66 million people. METHODS: We analysed the NMSC skin cancer mortality data (1968-99) from the former West Germany including West Berlin. We calculated the age-specific and age-standardized mortality rates (World Standard Population) and used a Poisson regression to estimate the underlying age, cohort and period effects. RESULTS: The age-standardized mortality rate decreased from 0.56 per 100,000 in 1968 to 0.24 per 100,000 in 1999 among men and from 0.42 per 100,000 in 1968 to 0.11 per 100,000 in 1999 among women. The estimated annual percentage decrease of the age-standardized NMSC skin cancer mortality rate was -2.3%[95% confidence interval (CI) -2.6 to -1.9] among men and -3.5% (95% CI -4.0 to -3.1) among women during the period 1968-99. This decline is mainly due to a rate decrease in people aged 80 years or more. The change in NMSC skin cancer mortality rates was best explained by age, cohort and period effects. CONCLUSIONS: The NMSC mortality in West Germany showed a continuous decrease from 1968 to 1999. The favourable mortality decline by birth cohort in the most recent birth cohort is an indicator of a likely decline in mortality in the future.
Adult↗
[Should sex specific differences in venous diseases be explained by pregnancies and hormone intake?].
AIM OF THE STUDY: Diseases of the venous system are among the most frequently occurring diseases in the German population. However, the last comprehensive population-based German data were obtained in 1979. Since then, diagnostic methods have improved substantially. Here, we examine the prevalence of venous diseases in women and their association with pregnancies and intake of hormones. METHODS: We conducted a population-based cross-sectional study in Bonn and rural environments (Recruitment period: 11/2000 - 11/2001; response: 59 %; 3072 study participants (1350 men, 1722 women), 18 to 79 years of age; investigation: standardised medical history, physical examination, duplex sonography, photography and CEAP-classification of veins of the legs). The following definitions were used: 1) Varicosis: clinical classification C2-C6 (primary varicosis only, excluding those showing spider-bursts exclusively); 2) Chronic venous insufficiency (CVI): C3-C6. For women, the risk factors examined were the number of pregnancies (P) and intake of hormones. Odds ratios (OR) and 95 % confidence intervals (95 %-CI) were calculated by multiple logistic regression (adjusted for age, region of residence and socioeconomic status). In addition, never pregnant women and men were compared regarding the two outcome variables. RESULTS: 713 participants (23 %) had varicosis and 522 (17 %) CVI. The OR for women (reference group: men) was OR = 1.4, 95 %-CI: 1.25 - 1.79 (varicosis) and OR = 1.2, 95 %-CI: 0.93 - 1.42 (CVI). There was a positive dose-response relationship between the number of pregnancies and varicosis: 1 P: OR = 1.3 (95 %-CI: 0.89 - 1.96), 2 P: OR = 1.4 (95 %-CI: 1.00 - 2.07), 3 P: OR = 1.6 (95 %-CI: 1.05 - 2.41), 4 P: OR = 1.9 (95 %-CI: 1.18 - 3.20), > or = 5 P: OR = 2.2 (95 %-CI: 1.28 - 3.74) and this trend was similar for CVI. Never-pregnant women (n = 518) and men had a similar prevalence. We did not see a consistent effect of intake of hormones in varicosis (OR = 0.9 [95 %-CI: 0.68 - 1.22]), but a negative association with CVI (OR = 0.6 [95 %-CI: 0.47 - 0.89]). CONCLUSIONS: Our results confirm the known association between diseases of the venous system and pregnancies, which seem to explain a big share of the sex-specific differences in the prevalence of these diseases.
Adolescent↗
[The problem of response in epidemiological studies in Germany (part I)].
To achieve high response rates in German epidemiological studies is growing more difficult. Low response in epidemiological studies may decrease the acceptance of the results. Response, however, is not identical with the quality of a study. In the first part of this paper various definitions of response (contact, cooperation, response, recruitment proportions) are introduced and discussed in the context of different study designs with reference to practical examples. A population-based survey such as the Study of Health in Pomerania (SHIP) investigates the distribution of risk factors and health-related endpoints. Surveys should yield representative results which can be generalised to apply to the entire population (external validity). This study design usually requires large participitation proportions. In a prospective cohort study such as the European Investigation into Cancer and Nutrition (EPIC) the emphasis is on internal validity. A stable study population willing to participate in regular follow-ups is a primary recruitment goal. If the response in a case-control study such as the Northern Germany Leukaemia and Lymphoma Study (NLL) is low, the priority is to achieve approximately equal response proportions for cases and controls. Simultaneous public relation and media activities can improve participitation in a study. Multidimensional strategies combining public communications, cooperation with local and regional officials and frequent press and media coverage are emphasised. The second part of this paper will discuss methods to quantify the effects of the response proportions on the validity of the study results.
Adult↗
Ultrasound-guided radiofrequency ablation: a new treatment option after failure to stop severe acute upper gastrointestinal tumor bleeding using endoscopic techniques.
Endoscopy is well established as the primary approach in cases of severe acute upper gastrointestinal bleeding. Although endoscopic techniques can achieve hemostasis in up to 95% of instances, not all sources of bleeding seen at endoscopy can be managed endoscopically. Massive and diffuse bleeding from locally advanced gastric adenocarcinoma is not usually self-limit-ing and is often refractory to endoscopic treatment. If surgery or endovascular tumor embolization are not possible after failure of endoscopic hemostasis, the situation may become life-threaten-ing. We present a new option for the treatment of patients in this rare but potentially fatal situation, which involves radiofrequency ablation using a needle electrode placed percutaneously un-der ultrasound guidance.
Adenocarcinoma↗
[Recent new information on epidemiology of headache].
We reviewed the epidemiology of headache disorders for the most frequent primary headache-syndromes: migraine, tension-type headache and trigemino-autonomic headache syndromes. In the last years scientific data about headache disorders have increased. New studies investigated not only the prevalence of headaches, but also economic costs of this disorder. Epidemiologic headache research also investigates the quality of life.
Autonomic Nervous System Diseases↗
Nonmelanoma skin cancer in the Federal State of Saarland, Germany, 1995-1999.
We analysed incidence data of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin from the Cancer Registry Saarland, Germany. During 1995-1999, the age-standardised incidence rates (world standard population) of BCC and SCC were 43.7 and 11.2 per 100000 among men and 31.7 and 4.4 per 100000 among women.
Adult↗
Viral infection, atopy and mycosis fungoides: a European multicentre case-control study.
Mycosis fungoides (MF) is a rare disease with an unknown aetiology, although it has been suggested that infections may play a role. The present study investigates whether infections, atopic disorders and some other diseases are risk indicators for MF. A European multicentre case-control study involving seven rare cancers, including MF, was conducted from 1995 to 1998. Patients between 35 and 69 years of age diagnosed with MF (n = 140) were recruited, and the diagnoses were verified by a reference pathologist, who classified 83 cases as definitive and 35 cases as possible; 22 cases were not accepted. Of the 118 accepted cases, 104 patients were interviewed (including 76 definitive cases and 28 possible cases). These 76 definitive cases were used for this study. A common set of controls to serve all case groups were interviewed, representing a total of 4574 controls. The latter included 1008 colon cancer patients and 3566 subjects selected from population registers. Information on infections, skin pathology and clinical history 5 years before the diagnosis of MF was used to estimate odds ratios (ORs) derived from logistic regression-modelling, which included gender, age and country. The highest ORs for MF were found in patients who reported a history of psoriasis 5 years before MF was diagnosed (OR 7.2, 95% CI: 3.6-14.5). Urticaria had an OR of 1.4 (95% CI: 0.6-3.6). Infections and atopic diseases were not closely associated with MF. Some diseases correlated to MF. Whether this has a causal background or reflects early diagnostic uncertainty is not known.
Adult↗
Site- and gender-specific time trend analyses of the incidence of skin melanomas in the former German Democratic Republic (GDR) including 19351 cases.
Over the past few decades, the incidence of skin melanoma has been rising in almost all developed countries. We examined trends in the incidence of skin melanoma in the former German Democratic Republic (GDR) from 1961 to 1989. Incidence rates per 100,000 person years were age-adjusted (World Standard Population). We estimated the effects of age, period, and cohort on the overall and site-specific incidence of skin melanoma. From 1961 to 1989, the incidence of melanoma increased from 1.8 to 5.0 for males and from 1.8 to 5.4 per 100,000 for females. Incidence was best explained by age, cohort and period effects. Incidence trends by anatomical site showed varying degrees of increases with the exception of melanomas of the eyelid that showed a decrease over time. Cohort effects differed by gender and anatomical site indicating that the circumstances leading to increasing site-specific incidences may have come into effect earlier for some sites than those for other sites.
Adult↗
[Cell phones and radio devices again in the news. Eye melanoma caused by telephoning? (interview by Petra Eiden)].
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Eye Neoplasms↗
Expression of Fas and Fas ligand in uveal melanoma: biological implication and prognostic value.
The interaction between Fas and Fas ligand is one possible immune escape mechanism used by tumour cells. In the present study, melanoma tissue from 103 patients who underwent enucleation for malignant uveal melanoma (iris melanomas excluded) was stained by immunohistochemistry with monoclonal antibodies specific for Fas, Fas ligand, CD3, CD8, and CD68. Histological and clinical data for these tumours were assessed. Both Fas and Fas ligand were detected in uveal melanomas. Cells of the monocyte/macrophage lineage rather than T-cells were the predominant group of tumour-infiltrating cells. The metastasis-free 5-year survival rates in the univariate analyses were considerably lower in patients with tumours that lacked Fas ligand expression (< 35% of the tumour cells), in the presence of more than 50 CD8-positive cells in 20 high-power fields and in the presence of more than 100 CD3-positive cells in 20 high-power fields. Fas and Fas ligand expression was associated with scleral infiltration. After adjustment for scleral infiltration, the predictive value of both Fas and Fas ligand expression was markedly decreased. In addition, the CD3- and CD8-positive cell count was positively associated with the histological cell type. Cox proportional hazards models showed that the presence of CD3- and CD8-positive cells was not an independent prognostic factor after adjusting for histological cell type. This preliminary observation deserves further investigation, which may shed more light on the immune escape mechanisms of this tumour and thus enable novel therapeutic strategies. The clinical relevance of this observation is limited, as more predictive parameters have been described for uveal melanoma.
Adolescent↗
Are alcohol intake and smoking associated with mycosis fungoides? A European multicentre case-control study.
The incidence of mycosis fungoides (MF) is low, and the aetiology of the disease is unknown. The aim of this study was to investigate whether wine consumption protects against the disease and whether smoking constitutes a risk factor. This paper is part of the European Rare Cancers Study that tries to determine the risk factors for seven selective rare cancers, including mycosis fungoides, involved in the development of cancer. A multicentre case-control study was conducted in six European countries. Only incident cases with confirmed histology were included in the analysis which include a total of 76 cases of MF and 2899 controls. Wine intake had no protective effect; on the contrary the consumption of more than 24 g of alcohol per day was associated with a high risk of MF (odds ratio (OR)=3.02, 95% confidence interval (CI), 1.34-6.79), after adjusting for centre, country, age, sex and education. There was a dose-dependent increase in the risk of MF with increased smoking habits, albeit the observed trend was not statistically significant. A combined exposure to high tobacco and alcohol use yielded a significantly increased risk factor for MF (P=0.0073). Alcohol intake was associated with MF.
Adult↗