Evangelisches Krankenhaus Bethesda Mönchengladbach

Septal perforations can severely diminish quality of life. Where surgical closure is impossible, due to size, location or contraindications, septum obturators offer an alternative. Defect anatomy can be assessed two ways: analog via silicone impression, or digitally using preoperative CT scans. This study compares these two methods.Retrospective analysis of 500 patients with symptomatic septal perforations was carried out, including defect size and location, type of closure and closure rate in surgical closures. 19 patients qualified for comparison of defect size and shape determined by conventional impression with CT-based data. For high precision comparison, silicone impressions were converted into plaster models, then digitally scanned, and CT data was converted into 3D models.The analysis of the NSD in the 19 patients and the comparison of the results from analog silicone impressions and preoperative CT scans revealed deviations of less than 10% in 8 out of 19 cases and less than 20% in 13 out of 19 cases. The deviations tended to be smaller in cases of larger defects. Larger deviations were observed when there were longer time intervals between the impression and the CT scan.Measurements of NSD based on CT data yield similar results to those obtained from silicone impressions, particularly when the CT scans are performed in close temporal proximity and in cases of larger defects. Further clinical studies should investigate whether iSOs created from CT data result in comparable clinical patient acceptance.

Endocrine-based combination therapy with an inhibitor of the cyclin-dependent kinases 4 and 6 (CDK4/6 inhibitors) is currently the first-line therapy of choice for patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2−), locally advanced or metastatic breast cancer (mBC). The efficacy and safety of the treatment with palbociclib, the first CDK4/6 inhibitor approved for this indication, have been confirmed in large randomized controlled clinical trials (RCTs) with strictly defined patient cohorts. Since then, many relevant questions about CDK4/6 inhibition with palbociclib for mBC have been investigated in RCTs and real-world studies. Based on this evidence, palbociclib is widely used in clinical practice since many years because of its efficacy and good tolerability.The aim of this review is to summarize findings from RCTs and RWE considering clinically relevant aspects such as safety, tolerability, quality of life and efficacy with a focus on specific questions and patient characteristics. A critical discussion and review of the overall evidence for endocrine-based therapy with the CDK4/6 inhibitor palbociclib can contribute to support therapy decisions in daily clinical practice.

Introduction Endometriosis significantly reduces patients' quality of life and is additionally a burden on healthcare and social security systems. There are currently no quality indicators for the treatment of endometriosis. The care of patients with endometriosis must be considered inadequate. QS ENDO aims to record the quality of care available in the DACH region and to introduce quality indicators for the diagnosis and treatment of endometriosis as part of providing quality assurance in endometriosis care. The first phase, QS ENDO Real, recorded the reality of current care using a questionnaire. The second phase, QS ENDO Pilot, investigated the treatment of 435 patients who underwent surgical treatment within a defined one month period in certified endometriosis centers. Material and Methods An online tool was used to gather information about 9 points which covered both prior patient history and the process of clinical diagnosis. Surgery reports were reviewed to obtain information about the surgical approach, the investigated sites, findings of any histological examinations, the use of classification systems, and information about resection status. Results 85.3% of patients were asked all 4 questions about their prior medical history. All 5 diagnostic steps were carried out in 34.5% of patients. The 3 areas needed to describe potential sites of disease were recorded in 67.1% of patients. Samples for histological examination were taken in 84.1% of patients. The endometriosis stage was classified in 94.7% of surgeries. A combination of the rASRM and the ENZIAN classifications, which is needed for complex cases, was used in 46.1% of patients. Complete resection was achieved in 81.6% of surgical procedures. Conclusion For the first time, the quality of care in certified endometriosis centers has been recorded using QS ENDO Pilot. Despite the high certification standards, a substantial number of required indicators were omitted.

Background: In head and neck surgery, reconstruction using microvascular grafts is a successful method for functional and aesthetic restoration. Due to technological advances and medical care, the number of patients with comorbidities and diseases requiring free tissue transfer has increased. To provide adequate treatment to these patients, preoperative identification of potential risk factors is essential. Methods: In this retrospective study, we investigated the impact of renal insufficiency on reconstruction in 251 microvascular grafts. Perioperative complications, failure rate, and outcomes serve as the basis for this evaluation. Results: Comparing pre- and postoperative values, there was a significant decrease in potassium and creatinine levels and a significant increase in GFR. The electrolyte changes in relation to the complication rate showed that complications were more likely to occur as potassium levels increased. As sodium levels increase, the complication rate decreases. Conclusion: A preoperative value indicative of impaired renal function, such as creatinine levels, GFR, or electrolytes, did not prove to be an individual risk factor for the occurrence of graft failure in this patient population. Nevertheless, increased renal parameters are associated with increased incidence of serious complications. Therefore, these should be considered in the indication and preoperative planning.

Macrophages and biomaterial-induced multinucleated giant cells (BMGCs) are central elements in the tissue reaction cascade towards bone substitute materials (BSM). The enzymatic detection of the lytic enzyme tartrate-resistant acid phosphatase (TRAP) has manifoldly been used to examine the so-called "bioactivity" of BSM. The present study aimed to compare the detection validity and expression pattern of the TRAP enzyme using enzymatic and immunohistochemical detection methods in the context of biocompatibility analyses of BSM. Biopsies from 8 patients were analyzed after sinus augmentation with a xenogeneic bone substitute. Analysis of both macrophage and BMGC polarization were performed by histochemical TRAP detection and immunohistochemical detection of TRAP5a. Histomorphometrical analysis was used for comparison of the TRAP detection of BMGCs. The enzymatic TRAP detection method revealed that in 7 out of 8 biopsies only single cells were TRAP-positive, whereas most of the cells and especially the BMGCs were TRAP-negative. The immunohistochemical detection of TRAP5a showed moderate numbers of stained mononuclear cells, while the majority of the BMGCs showed signs of TRAP5a-expression. The enzymatic TRAP detection was comparable to the results obtained via immunohistochemistry only in one case. The histomorphometrical analysis showed that significantly more mononuclear and multinucleated TRAP-positive cells were found using immunohistochemical TRAP5a-staining compared to the enzymatic TRAP detection method. Also, significantly more TRAP-negative BMGCs were found using the enzymatic TRAP detection. The immunohistochemical detection of TRAP is more accurate for examination of the bioactivity and cellular degradability of BSM.

Zielsetzung Die Therapie von Patient/Innen mit Mammakarzinom wird immer subgruppenspezifischer. Das Wissen zur optimalen Therapieindikation, -Sequenz und Medikation steigt und somit wird die optimale Versorgung der Patienten für den Therapeuten komplexer. Dieser Herausforderung begegneten wir mit der Gründung des Studiennetzwerkes Rhein-Ruhr mit dem Ziel, die Studieneinschlüsse in den teilnehmenden Zentren zu verbessern, neue Medikamente im Rahmen von Studien einem größeren Patientenkollektiv anbieten zu können, sowie den edukativen Austausch zu verbessern. Die Ergebnisse dieser Kooperation sollen dargestellt werden.