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Biomedical subjects

Meinolf Karthaus

Publications and source records attributed to Meinolf Karthaus.

At least 19 recordsLinked to original sources
PubMed2006

[Malnutrition due to malignant bowel obstruction].

A reduced nutritional state in cancer patients is associated with an unfavourable prognosis, can increase morbidity or be the primary cause of death in patients with progressed disease. Furthermore malnutrition can be the cause of additional hospitalisation. For the diagnosis of malnutrition there are simple assessments, e. g. the Nutritional Assessment SGA (Subjective Global Assessment; Detsky et al) available. If malnutrition is diagnosed, a specific nutritional therapy should be initiated after obtaining informed consent. Whenever possible, the enteral route should be preferred. In case of malignant intestinal obstruction this is often not possible, which leaves parenteral nutrition as the only choice. Currently available data indicate that especially patients, whose estimated life expectancy is three months or more and whose Karnofsky-Index is above 50 or whose Performance Status is above 2, profit from total parenteral nutrition. We report on a patient with advanced GI-cancer and bowel obstruction who developed malnutrition. Nutrition of advanced cancer patients and their limitations are discussed in a case report on a patient with advanced GI-cancer.

Bile Duct Neoplasms↗
PubMed2006

Second-line treatment in invasive mould infections.

A prevalence of up to 30% of invasive fungal infections (IFI) has been reported from autopsy studies in patients treated for haematological malignancies. Despite substantial advances in the last decade, IFI are still associated with a mortality of up to more than 70%, in particular for those patients suffering from invasive aspergillosis. Some progress has been made in diagnostics with the advent of new non-culture based tools and the improvement of imaging techniques. However, the response rates are about 40-60% in the first-line treatment of IFI. Salvage therapy will be necessary for those being intolerant or refractory towards the respective first-line antifungal. Following a long period of stagnation, there has been a considerable progress during the last five years in the treatment of refractory IFI. This review highlights the new treatment options for the salvage setting in the context of the state-of-the-art management of IFI in cancer patients.

Antifungal Agents↗
PubMed2004

Recent developments in the management of invasive fungal infections in patients with hematological malignancies.

Despite recent advances in the last decade, invasive fungal infections are still associated with a high morbidity and mortality. Invasive fungal infections constitute severe infectious complications in patients with hematological malignancies receiving myelosuppressive chemotherapy or sustained immunosuppression after allogeneic transplant regimens. Following a long period of stagnation, considerable progress has been made during the last 5 years in non-culture-based diagnostics and in the treatment of invasive fungal infections. This review highlights recent developments in the epidemiology, diagnosis, and treatment in the context of state-of-the-art management of invasive fungal infections in cancer patients.

Disease Management↗
PubMed2004

Once-daily oral levofloxacin monotherapy versus piperacillin/tazobactam three times a day: a randomized controlled multicenter trial in patients with febrile neutropenia.

A prospective, randomized, controlled multicenter trial was performed to evaluate the efficacy and safety of once-daily oral monotherapy with 500 mg levofloxacin in comparison with 4.5 g piperacillin/tazobactam 3 times a day in patients with low-risk febrile neutropenia. Low risk was defined by oral temperature > or = 38.5 degrees C on one occasion or > or = 38.0 degrees C twice within 24 hours and granulocytopenia < or = 500/microL for less than 10 days. The primary end point was defined as defervescence after 72 hours followed by at least 7 afebrile days. Secondary end points were overall response, time to defervescence, survival on day 30, and toxicity. Thirty-four episodes were included. Fever of unknown origin accounted for 26 (76.5%) of the episodes, microbiologically defined infection for 5 (14.7%) of the episodes, and clinically defined infection for 3 (8.8%) of the episodes. On an intent-to-treat basis, all episodes were evaluable for the primary end point. Levofloxacin and piperacillin/tazobactam were successful after 72 hours of treatment in 76.5% and 88.3% of the episodes. Overall response was achieved in 94.1% and 100% of the episodes, respectively. One inpatient in the oral treatment group died of septic shock without identification of a causative pathogen. A larger phase III trial is warranted to further evaluate the lack of inferiority of the oral monotherapy regimen versus standard intravenous therapy.

Administration, Oral↗
PubMed2004

[Eating and drinking at the end of life. Nutritional support for cancer patients in palliative care].

Anorexia, malnutrition followed by cachexia is observed in up to 80% of cancer patients with advanced stages of their disease, particularly in head and neck cancer, gastro-intestinal cancer and lung cancer. Malnutrition is associated with an unfavourable prognosis and has been demonstrated to be associated with an increased morbidity and an increased readmission rate. Cachexia itself can be the primary cause of death in cancer patients. Early intervention and nutritional support may be helpful in preventing anorexia and further weight loss. Successful approaches in treating anorexia have been undertaken with corticosteroids and gestagenes.

Aged↗
PubMed2004

[Current development in the diagnostics and therapy of systemic fungal infections in cancer patients].

Invasive fungal infections are associated with a high morbidity and mortality. They are of growing concern and a severe infectious complication in cancer patients treated with intensive chemotherapy. Within the last five years substantial progress has been demonstrated for non-culture based diagnostics and treatment of invasive fungal infections. Recent developments in the epidemiology, diagnostics and treatment of fungal infections are reviewed and discussed in the context of the current state of art for the management of invasive fungal infections in cancer patients.

Adult↗
PubMed2004

[Opportunistic infections after treatment with monoclonal antibodies].

During recent years the therapeutic indications of monoclonal antibodies are on the increase. Most monoclonal antibodies are immunosuppressants. Thus, therapeutic successes are accompanied by an increase of serious infections. Closest cooperation between the haematologist/oncologist and the infectious diseases specialist is a prerequisite for the successful outcome of treatment of the individual patient. Rituximab and alemtuzumab especially pave the way for a variety of opportunistic infections. Prophylactic drugs directed against bacterial infections and invasive fungal infections have not been proven to be useful. Although the efficacy of prophylactic cotrimoxazole against Pneumocystis carinii pneumonia has not been thoroughly examined in this setting, it is usually given at a dose of two double-strength tablets every other day. Whether reactivation of herpes simplex and varizella zoster can be influenced prophylactically has not been studied in randomised trials. In case of fever and detection of cytomegalovirus reactivation preemptive therapy should be given.

Alemtuzumab↗
PubMed2004

[Vaccination of the immunocompromised host].

Vaccinations are safe and effective in immunocompromised patients. Apparently most vaccines in this patient population are underutilized. General vaccination recommendations are expressed for influenza, diphtheria and tetanus. Pneumococcal, meningococcal und Haemophilus influenzae B immunizations are specially indicated for patients with or developing B-cell-deficiency. Live attenuated vaccines are usually contraindicated. The efficacy of the immunization and its indication can be additionally measured by antibody response, which is usually decreased compared to healthy subjects. Immunocompromised hosts with cancer will benefit from consistent immunization practices. Further clinical trials are urgently warranted.

Evidence-Based Medicine↗
PubMed2003

Prophylaxis of invasive fungal infections in patients with hematological malignancies and solid tumors--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

Morbidity and mortality in patients with malignancies, especially leukemia and lymphoma, are increased by invasive fungal infections. Since diagnosis of invasive fungal infection is often delayed, antifungal prophylaxis is an attractive approach for patients expecting prolonged neutropenia. Antifungal prophylaxis has obviously attracted much interest resulting in dozens of clinical trials since the late 1970s. The non-absorbable polyenes are probably ineffective in preventing invasive fungal infections, but may reduce superficial mycoses. Intravenous amphotericin B and the newer azoles were used in clinical trials, but their role in antifungal prophylaxis is still not well defined. Allogeneic stem cell transplant recipients are at particularly high risk for invasive fungal infections. Other well described risk factors are neutropenia >10 days, corticosteroid therapy, sustained immunosuppression, graft versus host disease, and concomitant viral infections. The enormous study efforts are contrasted by a scarcity of risk stratified evidence based recommendations for clinical decision making. The objective of this review accumulating information on about 10.000 patients is to assess evidence based criteria primarily regarding the efficacy of antifungal prophylaxis in neutropenic cancer patients.

Hematologic Neoplasms↗
PubMed2003

Diagnosis and treatment of documented infections in neutropenic patients--recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

Approximately 85% of patients with acute leukemia undergoing intensive antileukemic treatment develop infections and/or fever during neutropenic phases; in about 50% of these patients clinical, microbiological or clinical and microbiological evidence of infections can be obtained. The response rate is significantly lower in documented infections than in fever of unknown origin (FUO). Evidence-based recommendations for diagnosis and treatment procedures are presented, reflecting study results and expert opinions.

Humans↗
PubMed2003

Treatment of fungal infections in hematology and oncology--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

The Infectious Diseases Working Party of the German Society of Haematology and Oncology presents their guidelines for the treatment of fungal infections in patients with hematological and oncological malignancies. These guidelines are evidence-based, considering study results, case reports and expert opinions, using the evidence criteria of the Infectious Diseases Society of America (IDSA). The recommendations for major fungal complications in this setting are summarized here. The primary choice of therapy for chronic candidiasis should be fluconazole, reserving caspofungin or amphotericin B (AmB) for use in case of progression of the Candida infection. Patients with candidemia (except C. krusei or C. glabrata) who are in a clinically stable condition without previous azole prophylaxis should receive fluconazole, otherwise AmB or caspofungin. Voriconazole is recommended for the first-line treatment of invasive aspergillosis. The benefit of a combination of AmB and 5-flucytosine has not been demonstrated except in patients with cryptococcal meningitis. Mucormycosis is relatively rare. The drug therapy of choice consists of AmB, desoxycholate or liposomal formulation, in the highest tolerable dosage. Additional surgical intervention has been shown to achieve a lower fatality rate than with antifungal therapy alone. The role of interventional strategies, cytokines/G-CSF, and granulocyte transfusions in invasive fungal infections are further reviewed. These guidelines offer actual standards and discussions on the treatment of oropharyngeal and esophageal candidiasis, invasive candidiasis, cryptococcosis and mould infections.

Hematology↗
PubMed2003

Central venous catheter (CVC)-related infections in neutropenic patients--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

Catheter-related infections cause considerable morbidity in hospitalised patients. The incidence does not seem to be higher in neutropenic patients than in non- neutropenic patients. Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus) are the most frequently cultured pathogens, followed by Candida species. In contrast, Gram-negative bacteria play only a minor role in catheter-related infections. Positive blood cultures are the cornerstone in the diagnosis of catheter-related infections, while local signs of infection are only rarely present. However, a definite diagnosis generally requires the removal of the catheter and its microbiological examination. The role plate method with semiquantitative cultures (Maki) has been established as standard in most laboratories. Other standard procedures use quantitative techniques (Sherertz, Brun-Buisson) and are more sensitive. For therapy of catheter-related infections, antibiotics are administered according to the susceptibility of the cultured organism. Routine administration of gylcopepticed antibiotics is not indicated. Removal of the catheter has to be considered in any case of suspected catheter-related infection and is obligatory in Staphylococcus aureus and Candida infections. Tunnel or pocket infection of long-term catheters is always an indication for removal. In the future, the rate of catheter-related infections in neutropenic patients may be reduced by the use of catheters coated with antimicrobial agents.

Catheterization, Central Venous↗
PubMed2002

Evidence-based assessment of primary antifungal prophylaxis in patients with hematologic malignancies.

Invasive fungal infection is an increasing source of morbidity and mortality in patients with hematologic malignancies, particularly those with prolonged and severe neutropenia (absolute white blood cell count < 100/microL). Early diagnosis of invasive fungal infection is difficult, suggesting that antifungal prophylaxis could be the best approach for neutropenic patients undergoing intensive myelosuppressive chemotherapy. Consequently, antifungal prophylaxis has been extensively studied for more than 20 years. Nonabsorbable polyenes reduce superficial mycoses but are not effective in preventing or treating invasive fungal infections. Intravenous amphotericin B and the newer azoles were used in numerous clinical trials, but the value of antifungal prophylaxis in defined risk groups with cancer is still open to discussion. Recipients of allogeneic stem cell transplants and patients with a relapsed leukemia are high-risk patient populations. In addition, certain risk factors are well defined, for example, neutropenia more than 10 days, corticosteroid therapy, sustained immunosuppression, and graft-versus-host disease. In contrast to study efforts, evidence-based recommendations on the clinical use of antifungal prophylaxis according to risk groups are rare. The objective of this review of 50 studies accumulating more than 9000 patients is to assess evidence-based criteria with regard to the efficacy of antifungal prophylaxis in neutropenic cancer patients.

Adrenal Cortex Hormones↗