Biomedical subjects

Ulrich Guller

Publications and source records attributed to Ulrich Guller.

40 records · Page 3Linked to original sources

PubMed2002

Tissue microarray evaluation of Melanoma antigen E (MAGE) tumor-associated antigen expression: potential indications for specific immunotherapy and prognostic relevance in squamous cell lung carcinoma.

OBJECTIVE: To evaluate MAGE tumor-associated antigen (TAA) expression in an extensive panel of normal and neoplastic tissues. SUMMARY BACKGROUND DATA: TAAs of the MAGE family represent targets of active specific immunotherapy. Limited-size studies indicate that they are expressed in normal testis and tumors of different histologies. High-throughput tissue microarray (TMA) technology and MAGE TAA-specific monoclonal antibodies now allow us to comprehensively evaluate their expression in large numbers of tissues and to address clinical correlations. METHODS: A TMA containing 3,520 samples from 197 different tissues and a non-small-cell lung cancer TMA including 301 specimens were stained using the MAGE TAA-specific monoclonal antibody 57B. For patients with squamous cell carcinoma of the lung, the dichotomous result (positive vs. negative) of MAGE TAA staining was used as a predictor variable along with other covariates in proportional hazard regression analysis of tumor-specific survival. RESULTS: MAGE TAAs are expressed with frequencies ranging between 22.7% (larynx) and 50% of cases (lung) in squamous cell carcinomas from different anatomic areas and in large cell carcinomas of the lung (37.9%). The authors provide here the first description of MAGE TAA expression in basalioma (48.1%). To investigate the clinical significance of MAGE expression in a frequently positive tumor type, a non-small-cell lung cancer, TMA was then studied. In this TMA 43.2% of tumors were 57B positive. In patients with squamous cell carcinoma, MAGE TAA positivity was significantly correlated with a shorter tumor-specific survival in the proportional hazard regression analysis model. CONCLUSIONS: These data suggest novel potential therapeutic indications in different types of cancers. In lung squamous cell carcinoma, the significant association of MAGE TAA expression with poor prognosis suggests that patients with 57B-positive tumors may benefit from early, specific immunotherapy procedures.

Adult↗

PubMedDate not supplied

Influence of provider volume on length of stay, operating room time, and discharge status for rotator cuff repair.

Length of hospital stay, operating room time, and disposition of patient on discharge are important determinants of health care resource utilization. We examined the relationship between these determinants and hospital/surgeon volume for rotator cuff repair. A total of 9,973 patients undergoing rotator cuff repair were extracted from the New York State Ambulatory Surgery Databases for the years 1997 through 2000. Surgeon volume and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate regression models were used to estimate the risk-adjusted association between provider volume and outcomes. Patients operated on by low-volume surgeons had significantly higher likelihood for an extended length of stay when compared with those operated on by high-volume surgeons (adjusted odds ratio for extended length of stay, 2.3; 95% confidence interval, 1.2-4.4). There was a linear trend for a higher proportion of routine patient discharge with increasing surgeon volume. The mean operating room times for low- and intermediate-volume surgeons were significantly higher than that for high-volume surgeons (P < .001). We conclude that high-volume providers use health care resources more efficiently.

Adult↗

PubMedDate not supplied

Total arthroplasty versus hemiarthroplasty for glenohumeral osteoarthritis: role of provider volume.

The selection between total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) for the treatment of glenohumeral osteoarthritis is largely a matter of the surgeon's preference. We evaluated practice patterns among surgeons and hospitals in using shoulder arthroplasty procedures for osteoarthritis. Patients undergoing TSA (8,743 cases) and HA (4,998 cases) for osteoarthritis were extracted from the Nationwide Inpatient Sample databases. Surgeon volume and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the risk-adjusted association between provider volume and selection of TSA. High-volume surgeons (TSA rate, 77.2%) and intermediate-volume surgeons (TSA rate, 65.2%) were significantly more likely to perform a TSA compared with low-volume surgeons (TSA rate, 60.1%) after adjustment for confounders (P < .005). Similarly, patients admitted to high-volume hospitals were significantly more likely to undergo TSA compared with those admitted to low-volume hospitals (TSA rate, 69.9% compared with 59.5%; P < .001). In addition, procedure volume of the hospital in which the surgery was performed independently influenced a surgeon's decision to choose TSA over HA. Our study showed that high-volume providers, shown to have better outcomes after shoulder arthroplasty in previous studies, use TSA more frequently for osteoarthritis. Possible explanations may include better patient outcomes with TSA and a low-volume surgeon's comfort level in performing the more technically complex TSA procedure. Definitive treatment guidelines for glenohumeral osteoarthritis are needed.

Aged↗

PubMedDate not supplied

National trends in health care utilization and racial and socioeconomic disparities in pediatric pyogenic arthritis.

PURPOSE: To determine national trends and putative racial and socioeconomic disparities in health care utilization in pediatric patients with pyogenic arthritis over a 13-year period. STUDY DESIGN: We assessed trends in length of hospital stay, hospital disposition, and inflation-adjusted charges for pediatric patients hospitalized with pyogenic arthritis based on 13 consecutive years (1988-2000) of the Nationwide Inpatient Sample. Patients with an International Classification of Diseases, Ninth Revision code of pyogenic arthritis were selected for this study. Trends in health care utilization were analyzed, stratified by age, prematurity, joint location, socioeconomic status, and race. RESULTS: The median length of stay (LOS) decreased from 10 to 5 days in 1988 and 2000, respectively (P < 0.05). Whites had a shorter mean LOS (7.8 days) than nonwhites (10.7 days; P < 0.05). For both whites and nonwhites, LOS decreased significantly (P < 0.05), but the difference between the 2 groups remained constant. For patients with a higher socioeconomic status, LOS was shorter (P'< 0.05). The percentage of patients discharged to home'health care increased from 3.8% in 1988 to 18.9% in 2000 (P'< 0.05), but the increase was much greater for whites than nonwhites (P < 0.05). Inflation adjusted total charges increased over time, from a median total charge of 10,098 dollars in 1988 to a median total charge of 11,155 dollars in 2000 (P < 0.05). CONCLUSIONS: There was a trend toward decreased health care utilization, but no decrease in charges for pediatric pyogenic arthritis from 1988 to 2000. Racial disparities still exist, with little improvement over time.

Adolescent↗