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Biomedical subjects

K G Hering

Publications and source records attributed to K G Hering.

At least 19 recordsLinked to original sources
PubMed2006

Asbestos Surveillance Program Aachen (ASPA): initial results from baseline screening for lung cancer in asbestos-exposed high-risk individuals using low-dose multidetector-row CT.

The purpose of this study was to assess the prevalence of lung cancer in a high-risk asbestos-exposed cohort using low-dose MDCT. Of a population of 5,389 former power-plant workers, 316 were characterized as individuals at highest risk for lung cancer according to a lung-cancer risk model including age, asbestos exposure and smoking habits. Of these 316, 187 (mean age: 66.6 years) individuals were included in a prospective trial. Mean asbestos exposure time was 29.65 years and 89% were smokers. Screening was performed on a 16-slice MDCT (Siemens) with low-dose technique (10/20 mAs(eff.); 1 mm/0.5 mm increment). In addition to soft copy PACS reading analysis on a workstation with a dedicated lung analysis software (LungCARE; Siemens) was performed. One strongly suspicious mass and eight cases of histologically proven lung cancer were found plus 491 additional pulmonary nodules (average volume: 40.72 ml, average diameter 4.62 mm). Asbestos-related changes (pleural plaques, fibrosis) were visible in 80 individuals. Lung cancer screening in this high-risk cohort showed a prevalence of lung cancer of 4.28% (8/187) at baseline screening with an additional large number of indeterminate pulmonary nodules. Low-dose MDCT proved to be feasible in this highly selected population.

Aged↗
PubMed2006

Selection of reference films based on reliability assessment of a classification of high-resolution computed tomography for pneumoconioses.

OBJECTIVE: Worldwide demand has increased for the development of a computed tomography (CT) classification system that supplements the ILO classification of radiographs for pneumoconioses. The authors aimed to show preliminary reliability test results for selected referent films for the CT classification system developed through an international effort by researchers from seven countries. METHODS: Reading trials by eight physicians who have considerable experience in pneumoconioses using a total of 114 lung zones consisting of 6 lung zones of 19 CT films of dust-exposed workers were performed to assess reliability of the classification system by weighted kappa. The results were also utilized for selecting reference films. RESULTS: A good agreement was observed for both first and second reading trials for rounded opacities (weighted kappa=0.76, 0.74, first and second trial results, respectively), irregular opacities (0.60, 0.48), emphysema (0.56, 0.70) and honeycombing (0.72, 0.79). Ground glass opacities, on the other hand, showed moderate agreement (0.43, 0.38). Intra-reader agreements among eight readers were shown in the same table as the mean and standard deviation of weighted kappa statistics. The inter-reader agreement for pleural thickening was not as good as for parenchymal lesions. DISCUSSION: The CT classification development may pioneer noble and sensitive medical screening for dust-exposed workers in selected settings. This system may be applied to radiographic borderline cases of profusion 0/1 and 1/0 by the ILO classification, in a setting that assures the occupational safety and health of workers exposed to some newly developed chemical compounds.

Classification↗
PubMed2004

[Standardized CT/HRCT-classification of the German Federal Republic for work and environmental related thoracic diseases].

High resolution computed tomography (HRCT) plays an indispensable role in the diagnosis of pneumoconiosis and other lung damage arising from inhalation. Till now, however, there has been no agreed standardized convention for the use of the technique, or for documenting results uniformly. A task-group on Diagnostic Radiology in Occupational and Environmental Diseases of the German Radiological Society has produced a coding sheet based on experience gained in production of consultants' clinical reports, experts' examinations of patients seeking compensation for occupational lung disease, and physicians' professional development courses. The coding sheet has been used in a national multicenter study. It has been further developed and tested by an international working group comprising experts from Belgium (P.A. Gevenois), Germany (K.G. Hering, T. Kraus, S. Tuengerthal), Finland (L. Kivisaari, T. Vehmas), France (M. Letourneux), Great Britain (M.D. Crane), Japan (H. Arikawa, Y. Kusaka, N. Suganuma), and the USA (J. Parker). The intention is to standardize documentation of computertomographic findings in occupationally and environmentally related lung and pleural changes, and to facilitate international comparisons of results. Such comparisons were found to be achievable reproducibly with the help of CT/HRCT reference films. The classification scheme is purely descriptive (rather than diagnostic), so that all aspects of occupationally and environmentally related parenchymal and pleural abnormalities may be recorded. Although some of the descriptive terms used are associated with pneumoconiosis (e.g., rounded opacities in silicosis, or, in asbestosis, interlobular septal and intralobular non-septal lines, as well as honeycombing) many overlapping patterns that need to be considered for differential diagnosis are also included in the scheme.

Disability Evaluation↗
PubMed2003

[Further development of the International Pneumoconiosis Classification--from ILO 1980 to ILO 2000 and to ILO 2000/German Federal Republic version].

The ILO (1980) Classification has been revised during recent years. The new version is now available as the International Classification of Radiographs of Pneumoconioses (Revised edition 2000). The Guidelines booklet is currently available only in English. Those involved felt it was important to maintain continuity with the ILO (1980) edition, in particular to retain the standard radiographs, despite their restricted quality, so as to ensure comparability with earlier national and international data sets. The standard films illustrating pleural abnormalities, and 'u'-shadows, have been modified and reconstituted. The most important changes relate to assessment of film quality, pleural abnormalities, and additional symbols. In Germany, film quality is characterised as "+", "+-", "+--" and "u" according to whether the ability to assess pneumoconiosis is judged to be unimpeachable ("+") to unusable ("u"). If a film is not classified as "+", then written comments regarding defects are required. For "diffuse" pleural thickening, the ILO (2000) edition now requires the presence also of obliteration of the costophrenic angle. This was not required in the earlier (1980) edition and, as previously, is also not stipulated in the German version. A minimum width of 3 mm (previously 0-5 mm), coded "a", is required both for plaques as well as for the margin to the lateral chest wall. Congruence is thus achieved for criteria, which, in German practice, lead to an indication of suspect occupational disease. Plaques on the diaphragm are not considered for measurement of extent; they are only coded as present or absent. If calcification is identified, then this must also be classified and measured as a localised plaque. Extent of calcification on its own, previously coded "0" to "3", is no longer specified. The following new symbols, illustrated by new diagrams, have been introduced: aa = atherosclerotic aorta; at = apical thickening; cg = calcified granuloma (or other non-pneumocononiotic nodules); me = mesothelioma (already previously differentiated from "ca" on the German record sheet); pa = plate atelectasis; pb= parenchymal bands; ra = rounded atelectasis; od = other disease. (Examples of the latter are illustrated diagrammatically by lobar pneumonia, aspergilloma, goiter and hiatal hernia.) Earlier national differences (ILO 1980/German Federal Republic) on particular issues have also been agreed among German "double-readers" ["Zweitbeurteiler"]. However, conformity between the original (ILO 2000) text and the national (German) modified text has been retained in large measure. The detailed descriptions of the standard films differ in certain respects from the German (1980) definitions. Some revision of individual descriptions of the films are proposed. Except for a few differences, agreement was reached here too. The definitive date for the change in Germany is expected to be in early 2004. The standard films are already available now through ILO offices in Geneva or Bonn (addresses in appendix.)

Germany↗
PubMed1996

Evaluation and classification of high-resolution computed tomographic findings in patients with pneumoconiosis.

The standard ILO classification for pneumoconiotic changes using conventional X-ray films has become well established. In recent years computed tomography has played an increasing role in occupational medicine and above all in the assessment of pneumoconiosis. Therefore a standardised method of classification for CT also seems necessary. A system of classification developed by occupational hygienists and radiologists allows a detailed description of parenchymal and pleural changes and the use of 28 additional symbols. Furthermore, special diagnoses relevant to occupational medicine and additional comments can be made. The classification system was tested in practice in the research project "Early diagnosis of asbestos-related diseases" (Frühdiagnostik asbestverursachter Erkrankungen). It was shown to be both practicable and easily reproducible, intra-individually and interindividually.

Asbestosis↗
PubMed1996

Epirubicin and ifosfamide in metastatic breast cancer.

In a randomized, phase II trial, we evaluated the effectiveness of continued chemotherapy with epirubicin/ ifosfamide versus unmaintained treatment interruption in advanced metastatic breast cancer. Three hundred fifty-seven patients were enrolled and 331 were evaluable for response. Complete response was achieved in 25 patients (8%) and partial response in 121 patients (37%). Pretreatment status correlated significantly with response (complete and partial response). While 54% of unpretreated patients responded, only 42% of the patients responded who had been pretreated with adjuvant chemotherapy and 33% who had been pretreated in the metastatic stage of disease; 69 patients (21%) had disease progression. Of 11 patients pretreated in both the adjuvant and metastatic setting, only two responded. Toxicity of treatment was mild, with leukopenia being the treatment-limiting factor. Thrombocyte levels were not altered significantly by treatment. Thus, there seems to be room for dose escalation using granulocyte colony-stimulating factor. There was no considerable cardiotoxicity, central nervous system toxicity, or cystitis observed. The low rate of cardiotoxicity appeared to be related to dose fractionation of epirubicin. After randomization of patients to treatment interruption versus continuation of chemotherapy, a longer relapse-free survival was observed for patients who continued chemotherapy (mean relapse-free survival, 2+ months); however, this did not translate into prolonged survival. The cumulative scores of toxicity and quality of life parameters showed increasing superiority for treatment interruption. Therefore, a strategy of treatment until maximum response and subsequent treatment interruption seems to be superior to treatment continuation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[The importance of thoracic radiology for public health since 1896].

Without imaging procedures a variety of chest diseases cannot be diagnosed sufficiently. Examples are acute and chronic pneumonia, toxic effects on the bronchial and alveolar system, immunologic and malignant changes and cardiovascular disease involving the lung. Especially important are the types of disease that attack large sections of a population, because a path of infection may be hidden or because of short- or long-term exposure to relevant concentrations of toxic or allergic agents--not necessarily recognized as such--at work, in the general environment or associated with certain types of behaviour or illness. All this may have effects on biostatistical and socioeconomic data. Considering available epidemiologic data on morbidity and mortality, then pulmonary tuberculosis, unspecific pneumonias, drug-induced and AIDS-associated lung disease, pneumoconioses (silicosis and asbestosis) and primary and secondary chest malignancies have to be included in this category. Conventional chest radiography with high-kV technique and modern film-screen combinations continues to be the imaging modality for initial evaluation of chest disease worldwide. Low radiation exposure, low cost and overall availability are major advantages. Conventional tomography, however, has nowadays been largely replaced by CT, though a few special indications remain. High-resolution CT (HRCT) and the spiral technique bring additional benefits. Periodic radiographic mass screening of populations with certain disease prevalence still seems feasible, taking risk assessment, cost effectiveness and radiation exposure into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Germany↗
PubMed1990

[Radiologic diagnosis of pneumoconioses].

Radiology is extremely important in the diagnosis of occupational lung disease. Owing to its general availability and international comparability, the roentgenographic pa view of the chest obtained by the high-voltage technique is still the basis of the radiologic examination. Supplementary investigations are necessary for medical reasons, however, as well as for documentation of experts' certification. Valuable diagnostic information is supplied by oblique views of the thorax and by conventional X-ray tomography, though not by scintigraphic examinations or - up to now - by digital luminescence radiography. Ultrasound helps in the differentiation of free pleural fluid, organized pleural effusion, and pleural malignancy. In addition, computed tomography (CT) can be guided by ultrasound. CT has emerged as the method of choice for examination and for support of medical experts' certification of pneumoconiotic pleural disease, and high-resolution CT (HRCT) is also increasing used for examination of pneumoconiotic lung foci as well. Diagnostic accuracy in pneumoconiosis is further improved by shorter CT scanning times in combination with HRCT.

Asbestosis↗
PubMed1986

[Imaging of cecal tumors using computer tomography].

Although contrast enema of the colon and endoscopy remain the preferential diagnostic methods in tumour of the caecum, computed tomography can accurately determine the extent of extraluminar tumour growth and hence help to arrive preoperatively at the appropriate therapeutic concept. Adenocarcinomas are morphologically distinctly different, due to focal thickenings of the colon wall, from the diffuse wall thickenings associated with malignant lymphomas, or from inflammatory conglomerate tumours. Computed tomography of the caecal region is a noninvasive examination method that can speed up diagnosis especially in elderly patients with elongated colon and stool incontinence.

Adenocarcinoma↗