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Biomedical subjects

D Hölzel

Publications and source records attributed to D Hölzel.

At least 19 recordsLinked to original sources
PubMed2002

Primary breast cancer therapy in six regions of Germany.

Studies from six regions of Germany (Aachen (W1), Dresden (E1), Jena (E2), Marburg (W2), Munich (W3), and Stuttgart (C1)) have been compared to verify and assess the quality of healthcare using breast cancer as an example. All of the data collection was carried out in comprehensive cancer centres and is population-based, with the exception of C1. Classic prognostic factors and the initial treatment of 8661 women with breast cancer, diagnosed between 1996 and 1998, were examined. Primary therapy, breast conserving therapy (BCT), and the use of subsequent local radiation and/or systemic therapy (chemotherapy or hormonal therapy) were analysed. BCT was performed on 39.3-57.7% of patients. By pT-category, the proportion of BCT in the six regions were as follows: for pTis between 37.8 and 64.3%, for pT1 between 51.7 and 71.5%, for pT2 between 25.9 and 51.1%, for pT3 between 0 and 13.1% and for pT4 between 0 and 15.2%. Multivariate analyses, adjusted for age and biological factors, showed a significant influence of the treating hospital on the mastectomy rate. The use of radiotherapy after BCT (80%) was quite homogeneous in the six regions. The application of radiotherapy after mastectomy, however, varied between 10.4 and 32.2%. In all regions, for premenopausal patients, the use of adjuvant systemic therapy almost reflected the St. Gallen-Consensus recommendations. In contrast, post-menopausal women with positive lymph nodes were not always treated according to these standards. In all regions, age had an influence on the administration of treatment: elderly breast cancer patients received less BCT, less radiotherapy and less adjuvant therapy than recommended in the St. Gallen-Consensus. Feedback of the results was made available to each hospital, providing a comparative summary of patient care that could be used by the participating hospitals for self-assessment and quality-control.

Age Distribution↗
PubMed2001

Myc/Max/Mad regulate the frequency but not the duration of productive cell cycles.

Upregulation of the proto-oncoprotein Myc, a basic, helix-loop-helix, leucin zipper domain transcription factor has profound consequences on cell proliferation, cell growth and apoptosis. Cell cultures of somatic c-myc-/- rat fibroblasts show extremely prolonged doubling times of 52 h. Using time-lapse microscopy, we show here that individual c-myc-/- cells proceeded within approximately 24 h through the cell cycle as fast as c-myc+/+ cells. However, c-myc-/- cells were highly sensitive to contact inhibition and readily arrested in the cell cycle already at low density. Activation of conditional MycER overcame cell cycle arrest in c-myc-/- cells and led to continuous proliferation at the expense of increased apoptosis at high cell density. Conditional expression of Mad1, a Myc antagonist, represses proliferation of different cell types including U2OS cells. In analogy to the effect of Myc, this occurs mainly by reducing the probability of cells remaining in the cycle. Our data demonstrate that the Myc/Max/Mad network does not regulate the duration of the cell cycle, but the decision of cells to enter or exit the cell cycle.

Animals↗
PubMed2001

[A model for primary and secondary metastasis in breast cancer and the clinical consequences].

BACKGROUND: An adjuvant locoregional radiotherapy after radical surgery results in a survival advantage for breast cancer patients. The advantage starts with a delay and reaches about 10% 15 years after diagnosis. What could explain such a delayed efficacy? METHODS: A population-based cohort from 1996 to 1998 and the Munich Cancer Registry with courses of breast cancer disease since 1977 are the empirical basis. The analysis concerns survival rates and survival times in respect to metastases, local and lymph node recurrencies. A metastatic model is derived from the data. RESULTS: A cohort of 9,347 patients with a mean follow-up of 6.5 years and 2,587 courses with metastases and/or local recurrencies were registered. The overall survival after 15 years was for pT1 57.6%, pT2 37.9%, pT3 24.4% and for pT4 10.5%. Five years after metastasization 20.1 to 12.4% survived, 10 years 6% independent on pT. Ten years after local recurrencies the survival was dependent on pT of the primary tumor: pT1 36.3%, pT2 21.0%, pT3 13.1% und pT4 4.6%. A local recurrency is a prognostic factor for metastasization of the primary tumor, but local recurrencies can also cause metastases. The mean survival time after metastasization of the primary pT1 tumor is estimated about 61 months, after metastasization by local recurrencies about 99 months with a mean time to local recurrencies of 38 months. Further results of the metastatic model are: the development of metastasization is homogeneous and independent on pT-category, the metastatic initiation starts up to 5 years before diagnosis, metastatic-free survival time and progression survival time are independent and an impact of lymph node recurrencies on survival could not be detected. CONCLUSIONS: The reduction of local recurrencies by high-quality primary therapy with radiotherapy and also the early detection of local recurrencies may reduce secondary metastasization and therefore improve survival. The metastasization model also explains the limitation of the therapeutical strategies and the almost mandatory chance of early detection programs of breast cancer.

Aged↗
PubMed2001

The surgical discharge summary: a lack of substantial clinical information may affect the postop treatment of rectal cancer patients.

BACKGROUND AND AIMS: The discharge summary is crucial for patient aftercare as it is the main document for communicating information on patient data between the hospital and the primary care practitioner. The aim of this study was to assess the completeness of hospital discharge summaries and to determine whether the inclusion or omission of specific items of clinical information may affect further patient care. PATIENTS/METHODS: A population based cohort study including patients with rectal cancer from April 1996 through March 1998 in the Munich region. Five hundred and thirty-seven discharge summaries were evaluated for completeness of clinical- and tumor-related information. In addition, the association between recommendation for (discharge summary) and initiation of adjuvant therapy after discharge was evaluated. RESULTS: Information about T and N category was given in 98%, about metastasis in 90%, and about residual tumor in 73% of all discharge summaries. Follow-up was recommended in only 68% of the summaries. No adjuvant therapy was administered to 5/5 patients with N+, T1/2 tumors nor to 14/17 patients with N+, T3/4 tumors if correspondent recommendations were missing. CONCLUSION: Lack of crucial information in surgical discharge summaries is not only surprisingly common, but may also negatively affect patient aftercare.

Cohort Studies↗
PubMed2001

Cancer prevention and the contribution of cancer registries.

"Because they know what they do" should be the contribution of cancer registration to prevention. The public should be informed about the successes and failures of prevention. In addition, each doctor and each hospital should know the long-term results for its patients despite the complex interdisciplinary health care provision. At the same time, the regional results should be available and contrasted with clinical studies and international standards. An important criterion is also the quality of life of the patients, whose cooperation is more than overdue. According to the possibilities of prevention, six important levels can be differentiated. On each level the outcome should be evaluated on the basis of slightly differing criteria. Primary prevention has the largest incidence-, and thus, mortality-reduction potential, essentially caused by the giving up of smoking. However, the primary prevention of the tumor depends upon what kind of tumor it is, as primary prevention is possible to different extents. Often, secondary prevention is the earliest intervention possible, that is, the early detection of cancer in prognostically favorable stages. However, early detection only offers a chance of cure, albeit a smaller one, for some kinds of tumor. The third prevention level comprises primary care according to the state-of-the-art standards, followed by posttreatment care (disease-free phase) even when the disease is running a fatal course (palliative phase). In the terminal phase, adequate tumor-pain therapy and symptom-oriented measures stand for the sixth prevention level. Even the quality of life of the dying can be optimized. At the beginning of treatment at the latest, the quality of life should also be added to the outcome criteria. In this paper, the individual levels of prevention and possible evaluation criteria for successful prevention, which a modern cancer registration should submit, are discussed and examples given. If the evaluation of the quality of treatment and its significance for health care provision becomes the central tasks of the cancer registers, they will need to be transformed into service centers for hospitals, doctors, and patients.

Aftercare↗
PubMed2001

Prognostic index for cutaneous melanoma: an analysis after follow-up of 2715 patients.

In 2715 of 4524 patients with cutaneous melanoma treated surgically between 1968 and 1992 prognostic parameters were analysed for their value in predicting the occurrence of first progression. All of the 2715 patients developed only one invasive cutaneous melanoma during the follow-up period. Data concerning tumour thickness and mitotic index (maximum number of mitoses per square millimetre) of the cutaneous melanomas were determined. Between the characteristics age, tumour thickness, mitotic index, prognostic index (PI), sex, site of tumour, melanoma subtype and Clark level, the value of the mitotic index, as a prognostic parameter independent of tumour thickness, and the combination of mitotic index and tumour thickness were evaluated. The development of the first metastases was documented during a mean follow-up of 7.5 years. The majority of first recurrences occurred at regional lymph nodes and attempts have been made to identify those patients at risk of developing metastatic disease. The most effective parameters proved to be tumour thickness and mitotic index. For both parameters an independent prognostic influence was shown. The prognostic index, defined as the product of tumour thickness and number of mitoses per square millimetre, was re-evaluated and confirmed. A new modified prognostic index, defined as the product of square tumour thickness and mitotic index, proved to be even more useful for defining a subgroup of patients who are at risk of developing metastases and, therefore, might benefit from adjuvant therapy.

Adult↗
PubMed2001

[Risk and prognosis of corpus carcinomas after tamoxifen treatment of breast carcinoma].

BACKGROUND: Dysphagia after radiotherapy of thoracic tumors may be caused by recurrences or by radiation damage to the esophagus. CASE REPORT: A 75-year-old patient presented with a complete obstruction of the esophagus 5 months after CHARTWEL radiotherapy for a non-small cell lung cancer. During the last week of radiotherapy mild dysphagia (Grade 1 EORTC/RTOG, Grade 2 MRC-CHART-Score) occurred that persisted over the following months. X-ray and endoscopic investigations revealed an easily removable food bolus without evidence of esophageal stricture or ulceration. CONCLUSION: The case report describes a mild but prolonged early radiation reaction of the esophagus. In comparison with conventional fractionation the incidence of dysphagia is higher after accelerated fractionation schedules. The pathophysiologic mechanisms underlying persistent dysphagia are currently unknown. Beside of recurrences, radiation effects to the esophagus should be considered if dysphagia after irradiation of thoracic tumors occurs, because, as in this case, therapy may rapidly improve the symptoms.

Breast Neoplasms↗
PubMed2000

[Early detection of breast cancer in Germany. Time to deal with the problem].

In Germany there is still an urgent need for action in regard to screening for breast cancer. The announcement of research projects for mammography screening proves this. The following reports the results of the Munich field study. In 2 years, 2489 breast cancer cases were registered (status 6/98). Screening data were available for 1319 patients. The reduction in mortality, found in randomized studies, due to mammography in women over 50 years old was confirmed. A relative reduction of 44.8% in 10-year mortality could be estimated through mammography and 25.1% through palpation, in comparison with "doing nothing." We could also estimate the participation of screening and the used methods in the Munich region. If the mammographies carried out today were used at 2-year intervals for women aged between 50 and 70 years, then the mammography screening could be performed with no additional costs for 70% of the women. The known facts regarding the population-based mortality and regarding the acceptance of the palpation screening and frequency of mammography are additional aspects for inclusion in the discussion of what research projects in Germany are and what they should fulfill.

Breast Neoplasms↗
PubMed2000

[Population-related findings and treatment results and clinic variations in the Munich field study of rectal carcinoma].

BACKGROUND: Different approaches for an effective quality management are funded by the Ministry of health to verify, and if necessary to optimize, the quality of health care using the tracer diagnosis breast, rectal and lung cancer in 8 regions in Germany. The aim of the study is to develop a model for description and support of high quality health care for cancer patients. The conception, initial findings and inter-hospital variations are shown for some aspects of the primary therapy of rectal cancer in the region of Munich (population 2.3 million). PATIENTS AND METHODS: The field study is a population based cohort study. The recruitment phase started in April 1996 and finished March 1998. Established documentation sheets of the tumor registry along with original reports (reports of the doctors, pathologists etc.) are used for documentation. RESULTS: 26 surgical departments, 12 pathology departments, 9 radiotherapy departments and about 300 general practitioners have documented for this study. So far a sample of 809 have been analyzed. After an almost complete documentation the crude incidence will be about 23/100.000. 57% of all patients were men and 43% were women. 765 patients have been operated, 44 not. PT-categories (for the operated patients) are distributed as follows: pTis and pT1 10.7%, pT2 25%, pT3 54.5%, pT4 9.8%. Distribution of tumor localization: < 4 cm 6.7%, 4 bis < 8 cm 36.2%, 8 bis < 12 cm 30.8%, > or = 12 cm 26.3%. Local excision was performed in 4%, sphincter conserving therapy (SCT) in 71.5% (protective stoma: 23.7%), not sphincter conserving therapy (nSCT) in 18.4% and a palliative operation in 6%. The large surgical departments (> 25 patients per year) treated 53.8% of all patients. The proportion of older patients is significant higher in the smaller departments (< 10 patients per year). There are no differences in pTNM-distribution. No variations exist in the operation method between the department groups. More or less varying inter-hospital differences exist between the individual departments for all epidemiological and therapeutical parameters. CONCLUSIONS: Variations of medical care exist more between the individual hospitals than between department groups, divided by workload. To support the quality of health care a feedback of the results has to be available for each physician and each department.

Female↗
PubMed2000

Late metastases of cutaneous melanoma: an analysis of 31 patients.

Analysis of data of 6298 patients with cutaneous melanoma seen at the Department of Dermatology and Allergology at the Ludwig-Maximilians University of Munich between 1977 and 1998 identified 31 patients who first experienced metastatic disease 10 or more years after surgical treatment of the primary melanoma. The mean tumor thickness in patients with late progression of disease was 1.4 mm. There was no sex predominance. Of 31 patients, 15 (48. 3%) were female and included both premenopausal and postmenopausal women at the time of initial diagnosis without any predominance. Sixteen of the 31 patients (51.6%) with late onset of progression had primary tumors located on the trunk. The prognosis after relapse was related to the site of recurrence; survival after local or regional node recurrence was often prolonged, whereas survival after distant metastases usually was limited. Survival after late recurrence did not correlate with disease-free survival. A high-risk group for late recurrence could not be identified. The data emphasize the value of continued clinical follow-up and self-examination for early detection of regional recurrences. We advocate a lifelong follow-up, also to identify other melanocytic lesions at risk (eg, dysplastic nevi, secondary or multiple melanomas).

Adult↗
PubMed1999

Second malignancies after Hodgkin's disease: the Munich experience.

The occurrence of second malignancies (SM) is an important late event following the treatment of Hodgkin's disease (HD). We sought to determine the incidence, the risk factors, and the prognosis of SM in our population of patients with HD. A total of 1120 patients diagnosed with HD were registered at six participating institutions in Munich (calendar period 1974-1994). The mean follow-up for the development of SM was 9.1 years. A cumulative treatment score was calculated for both radio- and chemotherapy. The relative and absolute risks of SM were established. All SM were investigated for response to treatment and outcome. We observed 85 SM [eight leukemias, 22 non-Hodgkin's lymphomas (NHL), two plasma cell neoplasias, and 53 solid tumors]. Five patients developed third malignancies. The relative risk of developing a second neoplasm was compared with that within the normal population and was 3.1-fold. The risk varied according to the category of SM. Higher relative risks (20.5 and 25.9-fold), but lower absolute risks were observed for leukemias and non-Hodgkin's lymphomas. Solid tumors had lower relative risks (1.8-fold). Splenectomy increased the risk of SM (relative risk 4.4-fold versus 2.7-fold). The risk of SM did not correlate with the initial treatment (radio- or chemotherapy) and did not decrease with prolonged follow-up. The cumulative intensity of radiotherapy, chemotherapy, or the two modalities combined correlated with the risk of SM. Since some cases occurred early after diagnosis, not all second neoplasms can be considered treatment-associated. After 15 years, an actuarial risk of 11.7% was calculated for all SM, of 1.0% for leukemias, of 3.0% for NHL, and of 7.7% for solid tumors. The prognosis of SM varied between good (thyroid cancer, melanoma: median survival 5+ years), average (breast cancer, NHL), and poor (acute myeloid leukemias, lung cancers: median survival 9 months). With the exception of NHL, second cancers often occurred in topographic relation to the field of previous radiotherapy. Taken together, in our patient population, we observed all three categories of SM (solid tumors, leukemias, NHL). The risk for second leukemias is lower than in previous studies, whereas the risk of second NHL is somewhat higher. We confirm that splenectomy is a possible risk factor for SM. Even after correction for the age-specific cancer incidence, treatment intensity is associated with the development of second malignant tumors. Continued follow-up is mandatory after treatment for HD. Since the prognosis of most SM is unfavorable, early recognition and prevention are of the utmost importance.

Adolescent↗
PubMed1999

[Evaluation of guidelines in oncology].

Several activities regarding guidelines have been developed in Germany within a short time. It is desirable especially in the field of oncology that procedures are stated as proven effective, proven ineffective, and possibly effective by using procedures of evidence based medicine. However, the low impact of guidelines on the medical practice has to be taken into account. The kind of errors of known deviations should decrease the expectations. This altogether should motivate for a closer look what really happens in the daily routine. It should also reflect the hospital's and physician's outcome and might provide hints to medical standards. Improving the still insufficient documentation, which may describe quality of care, can provide important features. This has to be remembered when undertaking activities regarding guidelines.

Evaluation Studies as Topic↗
PubMed1999

[Clinical and epidemiological data of patients with malignant melanoma from the Munich Tumor Center 1977-1997].

Since 1997, data of patients with malignant melanomas have been systematically documented in the tumor registry of the Tumor Center Munich. Analysis of data of 8071 patients revealed that tumor thickness has steadily declined over the years. While in 1977 the median tumor thickness was 1.45 mm, it is now 0.75 mm. This has been followed by a significant improvement in overall survival. Males and older patients tend to have thicker melanomas than females and younger patients. There has been a relative increase of melanomas of the trunk. At diagnosis, 95% of patients had local disease. Of these patients, 18.3% developed metastastes. At least two-thirds of these patients had progression at the primary tumor site or the regional lymph nodes, both of which can be assessed by clinical or ultrasound examinations. Overall survival of patients with thin melanomas is excellent and does not differ substantially from the overall survival of the general population comparable in sex and age.

Adult↗
PubMed1999

Design elements for a computerized patient record.

Computerized medical record systems have to present user- and problem-oriented views of a patient record to health-care professionals. Presentation and manipulation of data must be easily adaptable to current and future demands of medical specialties and specific settings. During the definition, development and evaluation of a prototype of a computerized patient record system, design elements were elaborated to support physicians and other health-care professionals. Our approach shows a high degree of flexibility and adaptability to specific needs, problem orientation and connectivity to other systems, via a hospital information network. The explicit description of the contents of a patient record allows to augment the number of items that can be recorded without modifying the data structure. New views on patient data can be added to the system without interfering with the routine use of the system. Application in several medical specialties proved the feasibility of our prototype.

Medical Records Systems, Computerized↗