275 results on '"Wirth A"'
Search Results
2. Substaging of pT1 Urothelial Bladder Carcinoma Predicts Tumor Progression and Overall Survival
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Grobet-Jeandin, Elisabeth, primary, Wirth, Gregory Johannes, additional, Benamran, Daniel, additional, Dupont, Amandine, additional, Tille, Jean-Christophe, additional, and Iselin, Christophe Emmanuel, additional
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- 2021
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3. The Clinical Complexity of Penile Cancer: Current Clinical-Epidemiological Data from the Database of the Free State of Saxony/Germany.
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Boehm, Wolf-Diether U., Piontek, Daniela, Latarius, Stefanie, Schoffer, Olaf, Borkowetz, Angelika, Klug, Stefanie J., and Wirth, Manfred P.
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PENILE cancer ,PENILE transplantation ,SURGICAL margin ,LYMPHADENECTOMY ,ADJUVANT chemotherapy - Abstract
Objectives: The aim of this study was to assess penile cancer incidence, clinical characteristics, treatment options, transparency of clinical quality, and relative survival based on data from the clinical cancer registry. Subjects and Methods: A total of 898 patients with tumours of the penis were diagnosed and analysed in the period from 2000 to 2018; they were documented in the 4 regional clinical cancer registries and summarized in the Command Office of these 4 registries. Results: The standardized incidence rate increased from 0.86 in 2000 to 2.67 in 2018. Most tumours were located at the glans (42.9%) followed by the prepuce (19.5%) and corpus penis (6.9%); they were classified into pT1a/pT1b (20.0%/7.0%), pT2 (23.5%), pT3 (12.4%), and pT4 (0.8%). In only 32.0% of all documented cases, a stage-related lymphadenectomy (LND) was carried out. Negative surgical margins were found in only 70% and the Rx status in 15.1%. Primary metastasis was detected in pN1 (5.1%), pN2 (3.9%), pN3 (3.1%), and M1 status in 3.0%, respectively. The predominant therapy was surgery in 78.3%. The proportion of penile partial resections was significantly (p = 0.0045) regredient over the control period. Adjuvant chemotherapy was performed in 4.7%, adjuvant external-beam radiotherapy in 3.0%. The 5-year relative overall survival rate was 74.7% and ranged from 108.0% (stage 0) to 17.1% (stage IV). A total of 29 hospitals performed tumour operations. Conclusions: The multitude of clinical and epidemiological variables available in clinical cancer registries allows a safe assessment of tumour dynamics themselves, as well as good quality of transparency and broadly acceptable guideline adherence. Deviations from the accepted level of evidence were found in the grading definition, in the high quota of positive surgical margins, in the defensive indication position to the glans resurfacing/reconstruction and diagnostical LND. Based on these relevant findings in the database combined with the low frequency of the tumour in area/clinics/year, we recommended establishing SCCP reference clinics. This work is the first time that European standardized rate-based cancer registry data on penile cancer from Germany has been communicated. [ABSTRACT FROM AUTHOR]
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- 2022
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4. Anti-Biofilm Effect of Octenidine and Polyhexanide on Uropathogenic Biofilm-Producing Bacteria
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Florian M.E. Wagenlehner, Larry Purcell, Maria Loose, Manfred P. Wirth, and Kurt G. Naber
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Pyridines ,Urology ,030232 urology & nephrology ,Polyhexanide ,Biguanides ,Microbial Sensitivity Tests ,Urinary Catheters ,medicine.disease_cause ,Microbiology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Escherichia coli ,Proteus mirabilis ,Original Paper ,biology ,Pseudomonas aeruginosa ,business.industry ,Biofilm ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,Triclosan ,ddc ,chemistry ,030220 oncology & carcinogenesis ,Sodium hypochlorite ,Biofilms ,Urinary Tract Infections ,Anti-Infective Agents, Local ,Imines ,business ,Antibacterial activity ,Bacteria ,Disinfectants - Abstract
Background: A catheter allowing a release of antibacterial substances such as antiseptics into the bladder could be a new way of preventing biofilm formation and subsequent catheter-associated urinary tract infections. Methods: Minimal inhibitory and bactericidal concentration (MIC/MBC) determinations in cation-adjusted Mueller-Hinton broth and artificial urine were performed for 4 antiseptics against 3 uropathogenic biofilm producers, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis. Furthermore, effects of octenidine and polyhexanide against catheter biofilm formation were determined by quantification of biofilm-producing bacteria. Results: Sodium hypochlorite showed MIC/MBC values between 200 and 800 mg/L for all strains tested. Triclosan was efficient against E. coli and P. mirabilis (MIC ≤2.98 mg/L) but ineffective against P. aeruginosa. Octenidine and polyhexanide showed antibacterial activity against all 3 species tested (MIC 1.95–7.8 and 3.9–31.25 mg/L). Both octenidine and polyhexanide were able to prevent biofilm formation on catheter segments in a concentration dependent manner. Furthermore, adding 250 mg/L of each biocide disrupted biofilms formed by E. coli and P. mirabilis, whereas even 500 mg/L was not sufficient to completely destroy P. aeruginosa biofilms. Conclusion: Octenidine- and polyhexanide-containing antiseptics showed a broad effect against typical uropathogenic biofilm producers even in high dilutions. This study provides a basis for further investigation of the potential of octenidine and polyhexanide as prophylaxis or treatment of catheter biofilms.
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- 2020
5. Anti-Biofilm Effect of Octenidine and Polyhexanide on Uropathogenic Biofilm-Producing Bacteria
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Loose, Maria, primary, Naber, Kurt G., additional, Purcell, Larry, additional, Wirth, Manfred P., additional, and Wagenlehner, Florian M.E., additional
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- 2021
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6. Substaging of pT1 Urothelial Bladder Carcinoma Predicts Tumor Progression and Overall Survival.
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Grobet-Jeandin, Elisabeth, Wirth, Gregory Johannes, Benamran, Daniel, Dupont, Amandine, Tille, Jean-Christophe, and Iselin, Christophe Emmanuel
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BLADDER cancer , *OVERALL survival , *TRANSITIONAL cell carcinoma , *CANCER invasiveness , *SURVIVAL analysis (Biometry) , *LOG-rank test - Abstract
Introduction: Limitations in tumor staging and the heterogeneous natural evolution of pT1 urothelial bladder carcinoma (UBC) make the choice of treatment challenging. We evaluated if histopathological substaging (pT1a, pT1b, and pT1c) helps predict disease recurrence, progression, and overall survival following transurethral resection of the bladder (TURB). Methods: We included 239 consecutive patients diagnosed with pT1 UBC at TURB in a single institution since 2001. Each sample was interpreted by our specialized uropathologists trained to subclassify pT1 stage. Three groups were distinguished according to the degree of invasion: T1a (up to the muscularis mucosae [MM]), T1b (into the MM), and T1c (beyond the MM). Results: T1 substaging was possible in 217/239 (90%) patients. pT1a, b, and c occurred in 124 (57), 59 (27), and 34 (16%), respectively. The median follow-up was 3.1 years, with a cumulative recurrence rate of 52%, progression rate of 20%, and survival rate of 54%. Recurrence was not significantly associated with tumor substage (p = 0.61). However, the Kaplan-Meier survival analysis showed a significantly higher progression rate among T1b (31) and T1c (26%) tumors than T1a (13%) (log-rank test: p = 0.001) stages. In a multivariable model including gender, age, ASA score, smoking, tumor grade, and presence of carcinoma in situ, T1 substage was the single variable significantly associated with progression-free survival (HR 1.7, p = 0.005). Nineteen patients (9%) needed radical cystectomy; among them, 12/19 (63%) had an invasive tumor. Overall survival was significantly associated with tumor substaging (p = 0.001). Conclusion: Histopathological substaging of pT1 UBC is significantly associated with tumor progression and overall survival and therefore appears to be a useful prognostic tool to counsel patients about treatment options. [ABSTRACT FROM AUTHOR]
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- 2022
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7. Validation of a Questionnaire-Suitable Comorbidity Index in Patients Undergoing Radical Cystectomy
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Froehner, Michael, primary, Koch, Rainer, additional, Heberling, Ulrike, additional, Borkowetz, Angelika, additional, Hübler, Matthias, additional, Novotny, Vladimir, additional, Wirth, Manfred P., additional, and Thomas, Christian, additional
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- 2020
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8. Evaluation of Prostate Imaging Reporting and Data System Classification in the Prediction of Tumor Aggressiveness in Targeted Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy
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Roman Herout, Gustavo Baretton, Theresa Renner, Angelika Borkowetz, Ivan Platzek, Michael Laniado, Marieta Toma, Manfred P. Wirth, Stefan Zastrow, Martin Baunacke, and Michael Froehner
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Image-Guided Biopsy ,Male ,Magnetic resonance imaging/ultrasound-fusion biopsy, Multiparametric MRI, Prostate Imaging Reporting and Data System, Prediction, Prostate cancer, Systematic biopsy ,medicine.medical_specialty ,Magnetresonanz-Bildgebung/Ultraschall-Fusionsbiopsie, Multiparametrisches MRI, Berichts- und Datensystem für Prostata-Bildgebung, Vorhersage, Prostatakrebs, Systematische Biopsie ,Urology ,030232 urology & nephrology ,urologic and male genital diseases ,Lesion ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Predictive Value of Tests ,Prostate ,Image Interpretation, Computer-Assisted ,Humans ,Medicine ,ddc:610 ,Ultrasonography, Interventional ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Prostatic Neoplasms ,Reproducibility of Results ,Multiparametric MRI ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,ROC Curve ,Area Under Curve ,030220 oncology & carcinogenesis ,Predictive value of tests ,Radiology ,Neoplasm Grading ,medicine.symptom ,business - Abstract
Objectives: The study aimed to evaluate the prediction of Prostate Imaging Reporting and Data System (PI-RADS) with respect to the prostate cancer (PCa) detection rate and tumor aggressiveness in magnetic resonance imaging (MRI)/ultrasound-fusion-biopsy (fusPbx) and in systematic biopsy (sysPbx). Materials and Methods: Six hundred and twenty five patients undergoing multiparametric MRI were investigated. MRI findings were classified using PI-RADS v1 or v2. All patients underwent fusPbx combined with sysPbx (comPbx). The lesion with the highest PI-RADS was defined as maximum PI-RADS (maxPI-RADS). Gleason Score ≥7 (3 + 4) was defined as significant PCa. Results: The overall PCa detection rate was 51% (n = 321; 39% significant PCa). The detection rate was 43% in fusPbx (n = 267; 34% significant PCa) and 36% in sysPbx (n = 223; 27% significant PCa). Nine percentage of significant PCa were detected by sysPbx alone. A total of 1,162 lesions were investigated. The detection rate of significant PCa in lesions with PI-RADS 2, 3, 4, and 5 were 9% (18/206), 12% (56/450), 27% (98/358), and 61% (90/148) respectively. maxPI-RADS ≥4 was the strongest predictor for the detection of significant PCa in comPbx (OR 2.77; 95% CI 1.81-4.24; p < 0.005). Conclusions: maxPI-RADS is the strongest predictor for the detection of significant PCa in comPbx. Due to a high detection rate of additional significant PCa in sysPbx, fusPbx should still be combined with sysPbx.
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- 2017
9. Validation of a Questionnaire-Suitable Comorbidity Index in Patients Undergoing Radical Cystectomy
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Christian Thomas, Ulrike Heberling, Vladimir Novotny, Angelika Borkowetz, Matthias Hübler, Manfred P. Wirth, Michael Froehner, and Rainer Koch
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Male ,Multivariate statistics ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,Logistic regression ,Cystectomy ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Bladder cancer ,Proportional hazards model ,business.industry ,Area under the curve ,medicine.disease ,Prognosis ,Comorbidity ,Urinary Bladder Neoplasms ,Female ,Self Report ,business ,Comorbidity index - Abstract
Objective: To investigate the capability of a modified self-administrable comorbidity index recommended in the standard sets for neoplastic diseases published by the International Consortium for Health Outcomes Measurement (ICHOM) to predict 90-day and long-term mortality after radical cystectomy. Methods: A single-center series of 1,337 consecutive patients who underwent radical cystectomy for muscle-invasive or high-risk non-muscle-invasive urothelial or undifferentiated bladder cancer were stratified by the modified self-administrable comorbidity index and Charlson score, respectively. Multivariate logit models (for 90-day mortality) and proportional-hazards models (for overall and non-bladder cancer mortality) were used for statistical workup. Results: Considering 90-day mortality, both comorbidity indexes contributed independent information when analyzed together with age (p < 0.0001). The Charlson score performed slightly better (area under the curve [AUC] 0.74 vs. 0.72 for the ICHOM-recommended comorbidity index). Considering 5-year overall mortality in 727 patients with complete observation, the performance of both measures was similar (AUC 0.63 vs. 0.62, including age AUC 0.66 for both indexes). With 6-sided stratifications, the modified self-administrable comorbidity index separated the risk groups slightly better (p values for directly neighboring curves: 0.0068–0.1043 vs. 0.0001–0.8100). Conclusion: The ICHOM-recommended modified self-administrable comorbidity index is capable of predicting 90-day mortality and long-term non-bladder cancer mortality after radical cystectomy similarly to the commonly used Charlson score.
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- 2019
10. Socioeconomic Status-Related Parameters as Predictors of Competing (Non-Bladder Cancer) Mortality after Radical Cystectomy
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David Muallah, Ulrike Heberling, Johannes Huber, Matthias Hübler, Michael Froehner, Rainer Koch, Manfred P. Wirth, Christian Thomas, and Angelika Borkowetz
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Male ,medicine.medical_specialty ,Multivariate analysis ,Urology ,medicine.medical_treatment ,Urinary Bladder ,Comorbidity ,Cystectomy ,Risk Assessment ,Risk Factors ,Internal medicine ,medicine ,Humans ,Socioeconomic status ,Aged ,Proportional Hazards Models ,Bladder cancer ,Proportional hazards model ,business.industry ,Hazard ratio ,Neoplasms, Second Primary ,Middle Aged ,medicine.disease ,Prognosis ,Social Class ,Urinary Bladder Neoplasms ,Multivariate Analysis ,Marital status ,Female ,Urothelium ,business ,Follow-Up Studies - Abstract
Objective: To investigate the impact of socioeconomic status-related parameters on competing (non-bladder cancer) mortality after radical cystectomy. Patients and Methods: A total of 1,268 consecutive patients who underwent radical cystectomy for urothelial or undifferentiated bladder cancer at our institution between 1993 and 2016 with a mean age of 69 years (median 70 years) were studied. The mean follow-up of the censored patients was 7.2 years (median 5.7 years). Proportional hazard models for competing risk were used to identify predictors of non-bladder cancer (competing) mortality. The following parameters were included into multivariate analyses: age, American Society of Anesthesiologists physical status classification, Charlson score, gender, level of education, smoking status, marital status, local tumour stage, lymph node status, adjuvant and neoadjuvant chemotherapy. Results: Besides age and both comorbidity classifications, the socioeconomic status-related parameters gender (female versus male, hazard ratio [HR] 0.58, 95% CI 0.40–0.84, p = 0.0042), level of education (university degree or master craftsman versus others, HR 0.76, 95% CI 0.56–0.1.03, p = 0.0801), smoking status (current smoking versus others, HR 1.47, 95% CI 1.10–1.96, p = 0.0085) and marital status (married versus others, HR 0.68, 95% CI 0.50–0.92, p = 0.0133) were independent predictors of competing mortality after radical cystectomy. If considered in combination (multiplication of HRs), the prognostic impact of socioeconomic parameters superseded that of the investigated comorbidity classifications. Conclusion: Socioeconomic status-related parameters may provide important information on the long-term competing mortality risk after radical cystectomy supplementary to chronological age and comorbidity.
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- 2019
11. Long-Term Mortality in Patients with Positive Lymph Nodes at the Time of Radical Prostatectomy
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Gustavo B. Baretton, Samaneh Farahzadi, Ulrike Heberling, Lars Twelker, Manfred P. Wirth, Michael Froehner, Rainer Koch, Christian Thomas, and Angelika Borkowetz
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Male ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,Prostate cancer ,Medicine ,Humans ,In patient ,Lymph node ,Aged ,Prostatectomy ,business.industry ,Hazard ratio ,Cancer ,Prostatic Neoplasms ,medicine.disease ,Prognosis ,medicine.anatomical_structure ,Lymphatic Metastasis ,Long term mortality ,Lymph ,business ,Follow-Up Studies - Abstract
Background: The aim of this study was to determine prognostic factors and to provide long-term mortality data in patients with positive lymph nodes at the time of radical prostatectomy in a sample with long-term follow-up. Methods: A total of 527 patients with complete data sets treated in the years 1992–2014 were studied. The median follow-up was 7.2 years. The median number of removed lymph nodes was 15. Age, year of surgery, Gleason score, local tumor stage, prostate-specific antigen level, lymph node density, lymph node count and the number of positive lymph nodes were included in multivariable competing risk analyses with prostate cancer mortality as endpoint. Results: After 20 years, 28% of patients (95% CI 20–36%) died from non-prostate cancer (competing) causes, whereas 29% (95% CI 23–36%) died from prostate cancer. Only lymph node density (stratified by the median of 11.1%; hazard ratio [HR] 1.66, 95% CI 1.04–2.64, p = 0.0340) and Gleason score (8–10 vs. p < 0.0001) were independent predictors of prostate cancer mortality. Patients with a Gleason score p < 0.0001. Conclusions: Mortality in patients with positive lymph nodes was determined by tumor aggressiveness and the relative extent of spread; neither the year of surgery nor the number of removed lymph nodes was associated with outcome. Patients with a lymph node density of
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- 2019
12. Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques
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Arachk Marie De Gorski, Grégory Johann Wirth, Thomas Benoît De Perrot, Jacques Klein, Jean-Paul Vallée, Daniel Benamran, and Christophe Iselin
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Image-Guided Biopsy ,Male ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Rectum ,Cancer detection ,urologic and male genital diseases ,ddc:616.0757 ,03 medical and health sciences ,Prostate cancer ,Imaging, Three-Dimensional ,0302 clinical medicine ,Prostate ,medicine ,Humans ,Ultrasonography, Interventional ,Aged ,Retrospective Studies ,ddc:617 ,medicine.diagnostic_test ,Prostate/diagnostic imaging/pathology ,business.industry ,Ultrasound ,Prostatic Neoplasms ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Ultrasound-Guided Prostate Biopsy ,medicine.anatomical_structure ,Prostatic Neoplasms/diagnostic imaging/pathology ,030220 oncology & carcinogenesis ,Image-Guided Biopsy/methods ,Radiology ,Ultrasonography ,business - Abstract
Introduction: The study aimed to evaluate 3 different modalities of transrectal ultrasound (TRUS)-guided prostate biopsies (PBs; 2D-, 3D- and targeted 3D-TRUS with fusion to MRI - T3D). Primary end point was the detection rate of prostate cancer (PC). Secondary end point was the detection rate of insignificant PC according to the Epstein criteria. Patients and Methods: Inclusion of 284 subsequent patients who underwent 2D-, 3D- or T3D PB from 2011 to 2015. All patients having PB for initial PC detection with a serum prostate-specific antigen value ≤20 ng/ml were included. Patients with T4 and/or clinical and/or radiological metastatic disease, so as these under active surveillance were excluded. Results: Patients with T3D PB had a significantly higher detection rate of PC (58 vs. 19% for 2D and 38% for 3D biopsies; p = 0.001), with no difference in Gleason score distribution (p = 0.644), as well as detection rate of low-risk cancers (p = 0.914). Main predictive factor for positive biopsies was the technique used, with respectively a 3- and 8-fold higher detection rate in the 3D- and T3D group. For T3D-PB, there was a significant correlation between radiological cancer suspicion (Prostate Imaging Reporting and Data System Score) and cancer detection rate (p = 0.02). Conclusions: T3D PB should be preferred over 2D PB and 3D PB in patients with suspected PC as it improves the cancer detection rate.
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- 2016
13. In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014
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Manfred P. Wirth, Angelika Borkowetz, Martin Baunacke, Johannes Huber, Rainer Koch, and Christer Groeben
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Male ,Risk ,Multivariate analysis ,Blood transfusion ,Urology ,medicine.medical_treatment ,Population ,Urinary Bladder ,030232 urology & nephrology ,Urinary Diversion ,Cystectomy ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Germany ,medicine ,Humans ,Blood Transfusion ,ddc:610 ,Hospital Mortality ,education ,Radikale Zystektomie, Blasenkrebs, Bevölkerungsbezogene Analyse, Endergebnisse, Forschung im Gesundheitswesen ,Aged ,education.field_of_study ,Inpatients ,Bladder cancer ,business.industry ,Mortality rate ,Urinary diversion ,Health services research ,Length of Stay ,Middle Aged ,medicine.disease ,United States ,Hospitalization ,Treatment Outcome ,Urinary Bladder Neoplasms ,030220 oncology & carcinogenesis ,Linear Models ,Female ,business ,Radical cystectomy, Bladder cancer, Population-based analysis, Outcomes, Health services research ,Demography - Abstract
Background: Radical cystectomy (RC) still poses a significant risk for mortality and morbidity. Objectives: We compared in-hospital outcomes after RC in the United States and Germany using population-based data. Methods: We compared data from the US Nationwide Inpatient Sample to the German hospital billing database. Mortality and transfusion during hospital stay and length of stay (LOS) were evaluated. Results: In all, 17,711 (the United States) and 60,447 (Germany) cases were included. The share of robot-assisted RC increased to 20.5% in the United States vs. 2.3% in Germany (p < 0.001). In-hospital mortality was 1.9% (the United States) vs. 4.6% (Germany), transfusion rates were 34.2% (the United States) vs. 58.7% (Germany), and LOS was 10.7 (the United States) vs. 25.1 days (Germany; all p < 0.001). On multivariate analysis, higher patient age and lower annual hospital caseload were associated with increased mortality and longer LOS. Minimal-invasive surgery was associated with less blood transfusion and shorter LOS in the United States vs. hospital caseload and choice of urinary diversion in Germany. Conclusions: Healthcare systems might exert a relevant impact on outcomes of oncologic surgery. Increased in-hospital mortality rates in Germany seem to be partly explained by much longer LOS compared to those in the United States. Annual caseload seems to be influential on in-hospital outcomes raising the question of centralization of RC.
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- 2018
14. Socioeconomic Status-Related Parameters as Predictors of Competing (Non-Bladder Cancer) Mortality after Radical Cystectomy
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Froehner, Michael, primary, Muallah, David, additional, Koch, Rainer, additional, Hübler, Matthias, additional, Borkowetz, Angelika, additional, Heberling, Ulrike, additional, Huber, Johannes, additional, Wirth, Manfred P., additional, and Thomas, Christian, additional
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- 2019
- Full Text
- View/download PDF
15. Long-Term Mortality in Patients with Positive Lymph Nodes at the Time of Radical Prostatectomy
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Froehner, Michael, primary, Koch, Rainer, additional, Farahzadi, Samaneh, additional, Heberling, Ulrike, additional, Borkowetz, Angelika, additional, Twelker, Lars, additional, Baretton, Gustavo B., additional, Wirth, Manfred P., additional, and Thomas, Christian, additional
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- 2019
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16. In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014
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Groeben, Christer, primary, Koch, Rainer, additional, Baunacke, Martin, additional, Borkowetz, Angelika, additional, Wirth, Manfred P., additional, and Huber, Johannes, additional
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- 2019
- Full Text
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17. Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy
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Michael Laniado, Johannes Huber, Gustavo B. Baretton, Stefan Zastrow, Ivan Platzek, Martin Baunacke, Michael Froehner, Manfred P. Wirth, Marieta Toma, Theresa Renner, Angelika Borkowetz, Christer Groeben, and Roman Herout
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Image-Guided Biopsy ,Male ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Predictive Value of Tests ,Biopsy ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,In patient ,Watchful Waiting ,Systematic biopsy ,Fusion Biopsy ,Multiparametric Magnetic Resonance Imaging ,Ultrasonography, Interventional ,Aged ,Neoplasm Staging ,Retrospective Studies ,Prostatectomy ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Prostatic Neoplasms ,Reproducibility of Results ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,030220 oncology & carcinogenesis ,Radiology ,business - Abstract
Introduction: Targeted biopsy of tumour-suspicious lesions detected in multiparametric magnetic resonance imaging (mpMRI) plays an increasing role in the active surveillance (AS) of patients with low-risk prostate cancer (PCa). The aim of this study was to compare MRI/ultrasound-fusion biopsy (fusPbx) with systematic biopsy (sysPbx) in patients undergoing biopsy for AS. Methods: Patients undergoing mpMRI and transperineal fusPbx combined with transrectal sysPbx (comPbx) as surveillance biopsy were investigated. The detection of Gleason score upgrading and reclassification according to Prostate Cancer Research International Active Surveillance criteria were evaluated. Results: Eighty-three patients were enrolled. PCa upgrading was detected in 39% by fusPbx and in 37% by sysPbx (p = 1.0). The percentage of patients who were reclassified in fusPbx and sysPbx (p = 0.45) were 64 and 59% respectively. ComPbx detected more frequently tumour upgrading than fusPbx (71 vs. 64%, p = 0.016) and sysPbx (71 vs. 59%, p < 0.001) and more patients had to be reclassified after comPbx than after fusPbx or sysPbx alone. Conclusions: The combination of fusPbx and sysPbx outperforms both modalities alone with regard to the detection of upgrading and reclassification in patients under AS. Because a high missing rate of significant PCa still exists in both biopsy modalities, a combination of fusPbx and sysPbx should be recommended in these patients.
- Published
- 2017
18. Leiomyosarcoma of the Urinary Bladder in Adult Patients: A Systematic Review of the Literature and Meta-Analysis
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Zieschang, Helen, primary, Koch, Rainer, additional, Wirth, Manfred P., additional, and Froehner, Michael, additional
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- 2018
- Full Text
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19. Is the Post-Radical Prostatectomy Gleason Score a Valid Predictor of Mortality after Neoadjuvant Hormonal Treatment?
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Manfred P. Wirth, Gustavo Baretton, Angelika Borkowetz, Michael Froehner, Stefan Propping, Marieta Toma, Dorothea Liebeheim, and Rainer Koch
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Male ,Oncology ,medicine.medical_specialty ,Antineoplastic Agents, Hormonal ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Prostatakrebs, Radikale Prostatektomie, Prognostische Faktoren, Hormonale Behandlung, Neoadjuvant, Gleason-Score, Forschung zu Gesundheitsergebnissen ,urologic and male genital diseases ,Prostate cancer, Radical prostatectomy, Prognostic factors, Hormonal treatment, Neoadjuvant, Gleason score, Health outcomes research ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,ddc:610 ,neoplasms ,Aged ,Proportional Hazards Models ,Prostatectomy ,Gynecology ,business.industry ,Prostate ,Prostatic Neoplasms ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Neoadjuvant Therapy ,Treatment Outcome ,030220 oncology & carcinogenesis ,Neoplasm Grading ,business ,Follow-Up Studies - Abstract
Purpose: To evaluate the validity of the Gleason score after neoadjuvant hormonal treatment as predictor of disease-specific mortality after radical prostatectomy. Patients and Methods: A total of 2,880 patients with a complete data set and a mean follow-up of 10.3 years were studied; 425 of them (15%) had a history of hormonal treatment prior to surgery. The cumulative incidence of deaths from prostate cancer was determined by univariate and multivariate competing risk analysis. Cox proportional hazard models for competing risks were used to study combined effects of the variables on prostate cancer-specific mortality. Results: A higher portion of specimens with a history of neoadjuvant hormonal treatment were assigned Gleason scores of 8-10 (28 vs. 17%, p < 0.0001). The mortality curves in the Gleason score strata Conclusion: This study suggests that the prognostic value of the post-radical prostatectomy Gleason score is not meaningfully jeopardized by heterogeneous neoadjuvant hormonal treatment in a routine clinical setting.
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- 2015
20. A Phase II Study of the Central European Society of Anticancer-Drug Research (CESAR) Group: Results of an Open-Label Study of Gemcitabine plus Cisplatin with or without Concomitant or Sequential Gefitinib in Patients with Advanced or Metastatic Transitional Cell Carcinoma of the Urothelium
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Arnulf Stenzl, Rudolf Morant, Manfred P. Wirth, Kurt Miller, and Ivan Zuna
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Adult ,Male ,Oncology ,medicine.medical_specialty ,Metastatic Urothelial Carcinoma ,Cisplatin, Gefitinib, Gemcitabine, Transitional cell carcinoma, Urothelial carcinoma ,medicine.drug_class ,Urology ,medicine.medical_treatment ,Phases of clinical research ,Antineoplastic Agents ,Kaplan-Meier Estimate ,Deoxycytidine ,Drug Administration Schedule ,Tyrosine-kinase inhibitor ,Gefitinib ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,ddc:610 ,Epidermal growth factor receptor ,Neoplasm Metastasis ,Aged ,Aged, 80 and over ,Carcinoma, Transitional Cell ,Cisplatin, Gefitinib, Gemcitabin, Übergangszellkarzinom, Urothelkarzinom ,Chemotherapy ,biology ,business.industry ,Middle Aged ,medicine.disease ,Gemcitabine ,ErbB Receptors ,Treatment Outcome ,Transitional cell carcinoma ,Urinary Bladder Neoplasms ,Disease Progression ,Quinazolines ,biology.protein ,Female ,Cisplatin ,Urothelium ,business ,medicine.drug - Abstract
Introduction: This phase II trial evaluated the efficacy and safety of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, gefitinib, in combination with first-line chemotherapy in advanced urothelial cancer. Methods: Chemotherapy-naïve patients with advanced or metastatic urothelial carcinoma were randomized 1:1:1 to receive six cycles of chemotherapy (gemcitabine 1,250 mg/m2 on days 1 and 8, and cisplatin 70 mg/m2 on day 1 of every cycle) concomitantly with gefitinib 250 mg/day (arm A); or with sequential gefitinib (arm B); or alone (arm C). The primary endpoint was the time to progression (TTP). Results: A total of 105 patients received study treatment. Median TTP for arms A, B, and C were 6.1, 6.3, and 7.8 months, respectively. There were no significant differences between treatment arms for any outcomes measured. The most common adverse events were nausea and vomiting. Conclusion: Gefitinib in combination with chemotherapy did not improve efficacy in advanced urothelial cancer.
- Published
- 2015
21. Health-Related Quality of Life in 536 Long-Term Prostate Cancer Survivors after Treatment with Leuprorelin Acetate: A Combined Retrospective and Prospective Analysis
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Peter Hammerer, Ena E, and Manfred P. Wirth
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Oncology ,Male ,medicine.medical_specialty ,Time Factors ,Antineoplastic Agents, Hormonal ,Urology ,030232 urology & nephrology ,Androgen deprivation therapy ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Quality of life ,Cancer Survivors ,Leuprorelin ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Cancer ,Prostatic Neoplasms ,Testosterone (patch) ,medicine.disease ,humanities ,Prostate-specific antigen ,030220 oncology & carcinogenesis ,Quality of Life ,Observational study ,Leuprolide ,business ,medicine.drug - Abstract
Introduction: We investigated the health-related quality of life (HRQoL) of long-term prostate cancer patients who received leuprorelin acetate in microcapsules (LAM) for androgen-deprivation therapy (ADT). Methods: The observational study was carried out by 30 office-based German urologists in 536 prostate cancer (PCa) patients treated for ≥5 years with LAM and in 116 patients of an age-matched control group (CG). Data on HRQoL and health status was collected prospectively using validated questionnaires QLQ-C30, QLQ-PR25 and Karnofsky Index. Data on effectiveness (clinical response, prostate specific antigen [PSA], testosterone) and safety was collected retrospectively from patients' health records. We used descriptive statistics to analyze the data. Results: The mean treatment duration was 8.6 years (range 4.5-19.8 years). General health status (QLQ-C30) was comparable for both groups. Differences were observed regarding physical - and role functioning. ADT patients rated single items slightly worse than CG. Karnofsky-Index showed comparable high values (median of 90%). QLQ-PR25 revealed more PCa-related symptoms for ADT patients. Within 6 months, median PSA level declined >90% and median testosterone levels declined below castration level from 4.0 to 0.2 ng/mL. Clinical response (European Organisation for Research and Treatment of Cancer criteria) was observed in at least 90% of ADT patients. Conclusions: Long-term ADT with LAM is a well-accepted, tolerated, effective, and low-burden treatment option for patients with advanced, hormone-sensitive PCa.
- Published
- 2017
22. Treatment of Bone Metastases in Urologic Malignancies
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Tobias Hölscher, Oliver W. Hakenberg, Manfred P. Wirth, and Michael Froehner
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Male ,Oncology ,Urologic Neoplasms ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Bone Neoplasms ,Antibodies, Monoclonal, Humanized ,Radiosurgery ,Zoledronic Acid ,Knochenmetastasen, Strahlentherapie, Stereotaxie, Denosumab, Zoledronsäure, urologische Neoplasien ,Prostate cancer ,Internal medicine ,medicine ,Humans ,ddc:610 ,External beam radiotherapy ,Neoplasm Metastasis ,Carcinoma, Renal Cell ,Bladder cancer ,Bone Density Conservation Agents ,Diphosphonates ,business.industry ,Imidazoles ,Prostatic Neoplasms ,Cancer ,Bone metastases, Radiotherapy, Stereotactic, Denosumab, Zoledronic acid, Urologic neoplasms ,Neoplasms, Germ Cell and Embryonal ,medicine.disease ,Radiation therapy ,Treatment Outcome ,Denosumab ,Zoledronic acid ,Urinary Bladder Neoplasms ,Quality of Life ,Germ cell tumors ,Cisplatin ,business ,medicine.drug - Abstract
The skeletal system is the most common site of metastatic cancer spread. Bone metastases are often associated with severe morbidity, pain and functional impairment. Timely diagnosis and proper treatment may decrease morbidity, improve quality of life and in some cases even improve survival. External beam radiotherapy may effectively give pain relief in patients with painful bone metastases. In bone metastases from castration-resistant prostate cancer or urothelial bladder cancer, treatment with zoledronic acid or denosumab may reduce skeletal-related events. In contrast to castration-resistant prostate cancer, in patients with bone metastases from bladder cancer such treatment may even improve survival. On the other hand, the efficacy of these agents is questionable in patients with bone involvement from metastatic renal cell carcinoma or germ cell tumors. When bisphosphonates or denosumab are considered in such cases, the potential benefits of treatment should be critically weighed against the risk of side effects. In germ cell tumors, bone metastases may be cured by cisplatin-based chemotherapy, however, there are only limited data on the specific management of residual disease. Oligometastases may be treated by stereotactic radiotherapy or - especially in patients with renal cell carcinoma - by surgical resection and endoprosthetic replacement. Limited data are available on the management of bone involvement in germ cell tumors. Decisions on the resection or local radiotherapy of residual disease should be individualized considering the overall response and the feasibility and risks of resection.
- Published
- 2014
23. Contents Vol. 92, 2014
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Juan Francisco Hermida Gutiérrez, Ho Song Yu, Cui-Yun Tian, Jie Li, Folin Liu, Sun-Ouck Kim, Praful Ravi, C. Andreoni, Oliver W. Hakenberg, Christian Uprimny, Stefan Zastrow, Dalibor Pacik, Feng Wang, Piotr Milecki, Qiang Lv, Nobuo Tsuru, Jia Li, Taek Won Kang, Massimo Madonia, Chunxi Wang, Satz Mengensatzproduktion, Evangelos Liatsikos, Rahul Janak Sinha, Yuanhu Yuan, Giorgio Gandaglia, Zoltan Bajory, Murat Kosan, Shohei Tobu, Qian Zhang, Dong Deuk Kwon, Silke Gillessen, Jesús Moreno Sierra, V. Ortiz, Ken-ichi Mori, Xiaoning Wang, Qiang Cao, Heng-Qing An, Jinghai Hu, Zhe Tian, Nianzeng Xing, Roland Dahlem, Luis Ortega Medina, Yuting Wu, Quoc-Dien Trinh, Vincenzo Favilla, Luis A. Kluth, Yan Wang, Jun Yang, In Sang Hwang, Gengqing Wu, Wahid Tantawy, Giorgio Ivan Russo, Massimiliano Veroux, Dazhi Long, Vladimir Novotny, Ben Xu, Andreas Becker, Mohammad Mohseni, Jiro Uozumi, Richard Cathomas, Pu Li, Eu Chang Hwang, Rudolf Wolfgang Gasser, Tommaso Castelli, Rihai Xiao, Stavros Kontogiannis, Seyed Reza Hosseini, Alexander Fesenko, Maxine Sun, Hakan Ozkardes, Xiaoqing Wang, Panagiotis Kallidonis, Tufan Cicek, Hannes Steiner, Pierre I. Karakiewicz, Martin Hatzinger, Markus Graefen, Ignacio T. Castillón Vela, Krzystof Lesniewski-Kmak, Serdar Goktas, Xiaobing Ju, Abdulrahman Al-Aown, Changjun Yin, Frederico Goncalves, Yukio Homma, Florian Roghmann, Guoxi Zhang, Gabriel Kacso, Giuseppe Morgia, Ji Lu, Mitsuru Noguchi, Haruki Kume, Farshid Alizadeh, Gökçen Çoban, Iason Kyriazis, Chao Qin, Dheeraj Kumar Gupta, Immanuel von Bar, Maria Eugenia León Rueda, Hiroyuki Ihara, Joachim Noldus, Xiaoxin Meng, Hui Xu, Thorsten Schlomm, Yijun Xue, Mohit Pandey, Yu-Jie Wang, Ahmed El Ghoneimy, Xiaofeng Zou, Anh Phuong, Giuseppe Sortino, Umut Gonulalan, Gero Kramer, Michael Sohn, Qihui Chen, Ioannis Georgiopoulos, Jie Jin, Yanbo Wang, Pengfei Shao, Min Liu, Mounira Bouzid, Murat Akand, Renate Pichler, Zhihua Lu, Isabel Heidegger, Toru Sugihara, Alexander Kroiss, Druckerei Stückle, Javier Casado Varela, Manabu Matsuo, Junhui Zhang, Fengming Jiang, R.K. Krebs, Jianzhong Zhang, Georg Schäfer, Alberto Saita, Yuchuan Hou, Sebastiano Cimino, Vishwajeet Singh, Gerald Klinglmair, Manfred P. Wirth, and Jens-Uwe Stolzenburg
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Traditional medicine ,business.industry ,Urology ,Medicine ,business - Published
- 2014
24. Socioeconomic Status-Related Parameters as Predictors of Competing (Non-Bladder Cancer) Mortality after Radical Cystectomy.
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Froehner, Michael, Muallah, David, Koch, Rainer, Hübler, Matthias, Borkowetz, Angelika, Heberling, Ulrike, Huber, Johannes, Wirth, Manfred P., and Thomas, Christian
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CYSTECTOMY ,PROPORTIONAL hazards models ,AGE ,MARITAL status ,MORTALITY ,BLADDER cancer - Abstract
Objective: To investigate the impact of socioeconomic status-related parameters on competing (non-bladder cancer) mortality after radical cystectomy. Patients and Methods: A total of 1,268 consecutive patients who underwent radical cystectomy for urothelial or undifferentiated bladder cancer at our institution between 1993 and 2016 with a mean age of 69 years (median 70 years) were studied. The mean -follow-up of the censored patients was 7.2 years (median 5.7 years). Proportional hazard models for competing risk were used to identify predictors of non-bladder cancer (competing) mortality. The following parameters were included into multivariate analyses: age, American Society of Anesthesiologists physical status classification, Charlson score, gender, level of education, smoking status, marital status, local tumour stage, lymph node status, adjuvant and neoadjuvant chemotherapy. Results: Besides age and both comorbidity classifications, the socioeconomic status-related parameters gender (female versus male, hazard ratio [HR] 0.58, 95% CI 0.40–0.84, p = 0.0042), level of education (university degree or master craftsman versus others, HR 0.76, 95% CI 0.56–0.1.03, p = 0.0801), smoking status (current smoking versus others, HR 1.47, 95% CI 1.10–1.96, p = 0.0085) and marital status (married versus others, HR 0.68, 95% CI 0.50–0.92, p = 0.0133) were independent predictors of competing mortality after radical cystectomy. If considered in combination (multiplication of HRs), the prognostic impact of socioeconomic parameters superseded that of the investigated comorbidity classifications. Conclusion: Socioeconomic status-related parameters may provide important information on the long-term competing mortality risk after radical cystectomy supplementary to chronological age and comorbidity. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
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25. Evaluation of Transperineal Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Compared to Transrectal Systematic Biopsy in the Prediction of Tumour Aggressiveness in Patients with Previously Negative Biopsy
- Author
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Borkowetz, Angelika, primary, Renner, Theresa, additional, Platzek, Ivan, additional, Toma, Marieta, additional, Herout, Roman, additional, Baunacke, Martin, additional, Groeben, Christer, additional, Huber, Johannes, additional, Laniado, Michael, additional, Baretton, Gustavo, additional, Froehner, Michael, additional, Zastrow, Stefan, additional, and Wirth, Manfred P., additional
- Published
- 2018
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26. Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy
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Borkowetz, Angelika, primary, Renner, Theresa, additional, Platzek, Ivan, additional, Toma, Marieta, additional, Herout, Roman, additional, Baunacke, Martin, additional, Groeben, Christer, additional, Huber, Johannes, additional, Laniado, Michael, additional, Baretton, Gustavo B., additional, Froehner, Michael, additional, Zastrow, Stefan, additional, and Wirth, Manfred P., additional
- Published
- 2018
- Full Text
- View/download PDF
27. Gender and Mortality after Radical Cystectomy: Competing Risk Analysis
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Heberling, Ulrike, primary, Koch, Rainer, additional, Hübler, Matthias, additional, Baretton, Gustavo B., additional, Hakenberg, Oliver W., additional, Wirth, Manfred P., additional, and Froehner, Michael, additional
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- 2018
- Full Text
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28. Systematic Assessment of Complications and Outcome of Radical Cystectomy Undertaken with Curative Intent in Patients with Comorbidity and over 75 Years of Age
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Oliver W. Hakenberg, Vladimir Novotny, Rainer Koch, Manfred P. Wirth, Steffen Leike, Michael Froehner, and Stefan Zastrow
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Male ,medicine.medical_specialty ,Time Factors ,Ileus ,Urology ,medicine.medical_treatment ,Comorbidity ,Urinary Diversion ,Cystectomy ,Disease-Free Survival ,Postoperative Complications ,medicine ,Humans ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,Bladder cancer ,business.industry ,Incidence ,Mortality rate ,Retrospective cohort study ,Perioperative ,medicine.disease ,Surgery ,Treatment Outcome ,Urinary Bladder Neoplasms ,Female ,business ,Follow-Up Studies - Abstract
Objective: To evaluate the complications, survival and oncological outcome of patients ≥75 years of age after radical cystectomy for muscle-invasive bladder cancer. Patients and Methods: Between April 1993 and August 2010, 765 patients with muscle-invasive bladder cancer underwent radical cystectomy at one high-volume center. Of these, 70 patients were ≥75 years of age. All 70 patients had at least one severe systemic comorbidity with an American Society of Anesthesiologists score of 3. Primary endpoints of this retrospective study were overall and recurrence-free survival with a mean follow-up of 22 months (1-159). Perioperative parameters such as need for blood transfusions, hospital stay, mortality, short- and long-term complications were also assessed. Complications were graded according to the Clavien-Dindo classification. Results: Perioperative complications occurred in 23/70 patients (33%) with a 30-day mortality rate of 1.4%. 16/70 patients (23%) developed late complications requiring hospitalization. Within 30 days of surgery, according to the Clavien-Dindo grading, 27% had no complications, 3% grade 1, 49% grade 2, 14% grade 3, 6% grade 4 and 1.4% grade 5 complications. Within 31-90 days after surgery, 76% had grade 1 complications, 3% grade 2, 6% grade 3, 9% grade 4 and 6% grade 4 complications. The calculated 5- and 8-year overall survival rates were 30 and 25%, respectively, with a recurrence-free survival rate of 52% at 5 and 42% at 8 years. Conclusions: Radical cystectomy is an appropriate and effective treatment for comorbid elderly patients. The oncological long-term outcome is the same as in younger patients while overall survival is comparatively lower. Mortality and complication-related morbidity are comparable to those in younger patients with modern perioperative management.
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- 2013
29. Perioperative Complications after Radical Prostatectomy: Open versus Robot-Assisted Laparoscopic Approach
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Manfred P. Wirth, Michael Froehner, Vladimir Novotny, Lars Twelker, Rainer Koch, and Steffen Leike
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Male ,medicine.medical_specialty ,Time Factors ,Lymphocele ,Urology ,medicine.medical_treatment ,Postoperative Hemorrhage ,Surgical Equipment ,symbols.namesake ,Prostate cancer ,Postoperative Complications ,medicine ,Humans ,Blood Transfusion ,Laparoscopy ,Fisher's exact test ,Aged ,Prostatectomy ,Chi-Square Distribution ,medicine.diagnostic_test ,business.industry ,Equipment Design ,Robotics ,Perioperative ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Surgery, Computer-Assisted ,symbols ,Clinical Competence ,Complication ,business ,Chi-squared distribution ,Learning Curve - Abstract
Background: The best technique of radical prostatectomy - open versus robot-assisted approach - is controversially discussed. In this study, we compared the complication rates of open and robot-assisted radical prostatectomy during the introduction and subsequent routine use of a da Vinci® robotic device while open surgery remained the standard approach. Patients and Methods: Between January 1st, 2006, and June 4th, 2012, 2,754 men underwent radical prostatectomy at our department. Among them, 317 received robot-assisted and 2,438 open surgery. According to the requirements for prostate cancer centers certified by the Deutsche Krebsgesellschaft (German Cancer Society), a prospective database recording perioperative complications was built up. The complication rates of open and robot-assisted radical prostatectomy were compared with the χ2 or Fisher exact test. The distributions of quantitative variables were compared with U tests. Results: Whereas the demographic factors favored patients selected for robot-assisted radical prostatectomy, there were no differences between open and robot-assisted surgery concerning length of stay, autologous blood transfusion rates and the incidence of perioperative complications. Conclusions: Open and robot-assisted radical prostatectomy had comparable complication rates. With better patient- and tumor-related parameters as well as decreasing transfusion rates in the robot-assisted subgroup, this observation might reflect the learning curves of the involved robotic surgeons.
- Published
- 2013
30. Impact of Adjuvant Intravesical Bacillus Calmette-Guérin Treatment on Patients with High-Grade T1 Bladder Cancer
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Stefan Zastrow, Johanna Ollig, Manfred P. Wirth, Rainer Koch, Vladimir Novotny, and Michael Froehner
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Antineoplastic Agents ,Kaplan-Meier Estimate ,Cystectomy ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Medicine ,Humans ,Cumulative incidence ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Univariate analysis ,Carcinoma, Transitional Cell ,Bladder cancer ,business.industry ,Proportional hazards model ,Hazard ratio ,Middle Aged ,medicine.disease ,Surgery ,Transitional cell carcinoma ,Administration, Intravesical ,Logistic Models ,Treatment Outcome ,Urinary Bladder Neoplasms ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Multivariate Analysis ,BCG Vaccine ,Female ,Neoplasm Grading ,business ,BCG vaccine - Abstract
Purpose: To evaluate the impact of adjuvant intravesical bacillus Calmette-Guérin (BCG) treatment in patients with high-grade transitional cell carcinoma of bladder. Patients and Methods: A total of 207 consecutive patients who underwent transurethral resection for high-grade T1 transitional cell carcinoma of bladder at our institution between January 1, 2005 and December 31, 2012. Of those patients, 77 underwent early cystectomy without BCG instillation and were excluded from the analysis. The overall survival and cancer-specific mortality were compared in 2 different therapy options groups (group of patients who received adjuvant BCG instillation vs. the group of patients who did not receive BCG therapy). Overall mortality was estimated by the Kaplan-Meier method, univariate comparisons were made with the log rank test. The cumulative incidence of deaths from bladder cancer (BC) was determined by univariate and multivariate competing risk analysis. Cox proportional hazard models for competing risks were used to study the combined effects of the variables on BC-specific mortality. Results: The 5-year overall survival in patients with BCG instillation vs. patients who did not receive BCG therapy was 74 vs. 28% (p = 0.0016). In the univariate analysis, the adjuvant intravesical BCG treatment was associated with decreased cancer-specific mortality (p = 0.0062). In the multivariable analysis, the age and the BCG instillation were independent factors of overall survival (hazard ratio 0.26, 95% CI 0.15-0.46, p < 0.0001) and cancer-specific mortality (hazard ratio 0.29, 95% CI 0.12-0.71, p = 0.0067). Conclusion: Dispensing from adjuvant intravesical BCG treatment is associated with increased overall- and disease-specific mortality in patients with T1 high-grade transitional cell carcinoma of bladder. This observation confirms that adjuvant BCG instillation is a crucial part of treatment in this patient population.
- Published
- 2015
31. Contents Vol. 84, 2010
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F. Marchese, J. Zanow, Yoshihisa Kawai, L. Macchione, Vanessa Sandim, J. Masood, Jocelyn M. Rieder, H. Wunderlich, Marc Fourmarier, Kohsuke Sasaki, Rany Shamloul, Tomoyuki Murakami, Nicolas Barry Delongchamps, Yoshiaki Yamamoto, Stephan A. Krueger, O.W. Hakenberg, Christian Schwentner, S. Fuessel, Kristina Hotakainen, I. Ioannou, Takahiko Hara, Jörg Hennenlotter, N. Kroeger, A. Di Benedetto, F. Fraggetta, Kazuhiro Nagao, Gilda Alves, Christian Saussine, Karen Stern, Klaus G. Fink, C. Magno, Charles Ballereau, Claudius Fuellhase, Pascual Chuan-Nuez, Johan Lundin, T. Briggs, José M. Martínez-Jabaloyas, Ursula Kuehs, M. Madonia, Bertrand Lukacs, Donald C. McMillan, Taku Misumi, G. Grasso, Sherif R. Aboseif, John Brusky, Hideyasu Matsuyama, Rashad Mammadov, Harald Trummer, Alexander Winter, Erkan Kismali, Salih Sanlioglu, Aurélien Descazeaud, Viet Tran, Harri Visapää, Omer Kutlu, Adnan Şimşir, I. Petersen, N. Buchholz, Roman Szlauer, Friedhelm Wawroschek, Olivier Haillot, G. Candiano, Badereddin Mohamad Al-Ali, G. Shaw, Francois Desgrandchamps, Denise A. Pereira, Shigeru Sakano, Hideaki Ito, Ahter Dilsad Sanlioglu, Jens Uphoff, Martti Ala-Opas, I. Pirozhok, Luis Arenas, T. Castelli, M.P. Wirth, Arnulf Stenzl, Kazuhiko Nakano, J. Gelister, T. Steiner, Gurhan Gunaydin, F. Aragona, G. Romano, Alexandre de la Taille, Antonio A. Ornellas, Heinz-Peter Schlemmer, Daniela Colleselli, Kazumi Suzuki, Levent A. Guner, Tahir Qayyum, A. Meye, Richard Zigeuner, Satoshi Eguchi, Marian Devonec, Ismail Turker Koksal, David Schilling, Ljiljana Paras, G. Morgia, A. Galia, Rafael Villamón-Fort, Ulrich H. Vogel, P. Pepe, Katsusuke Naito, Cag Cal, M. Gajda, Manuel Gil-Salom, Karl Pummer, Rolf-Peter Henke, A. Papatsoris, U. Settmacher, A. Galì, G. Mucciardi, Tatsuo Morita, Grégoire Robert, Olivier Dumonceau, J. Fichtner, G. Bonvissuto, Ulf-Håkan Stenman, Matthias P. Lichy, Seiji Yano, P A McArdle, and Rahmene Azzouzi
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Traditional medicine ,business.industry ,Urology ,Medicine ,business - Published
- 2010
32. Age-Related Changes of Urine Calcium Excretion after Extracorporeal Shock Wave Lithotripsy due to Artificial Renal Calcium Leakage
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Oliver W. Hakenberg, S. Oehlschläger, Michael Froehner, and Manfred P. Wirth
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Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Hypercalciuria ,chemistry.chemical_element ,Renal function ,Calcium ,Lithotripsy ,urologic and male genital diseases ,Renal calcium ,Renal stones, Lithotripsy, Renal function, Calcium ,Excretion ,Kidney Calculi ,Age related ,medicine ,Humans ,ddc:610 ,Aged ,Calcium Oxalate ,business.industry ,Nierenstein, Lithotripsie, Nierenfunktion, Kalzium ,Age Factors ,Middle Aged ,medicine.disease ,Extracorporeal shock wave lithotripsy ,female genital diseases and pregnancy complications ,Kidney Tubules ,chemistry ,Female ,business - Abstract
Introduction: Extracorporeal shock wave lithotripsy (ESWL) is the standard stone treatment. Increased excretion of tubular enzymes and hypercalciuria has been reported after ESWL. We investigated the importance of renally induced hypercalciuria after ESWL. Material and Methods: 30 calcium oxalate stoneformers (23 men, 7 women), mean age 53.3 (range 30–71) years, were evaluated prospectively. Plasma calcium and creatinine concentrations and 8-hour overnight urine were measured before ESWL and on the 1st and 2nd days after ESWL. To estimate the changes of tubular reabsorption, the calcium/creatinine clearance ratios were calculated. Results: Hypercalciuria (>5 mmol/24 h) was seen in 5/30 (16.7%) before, in 12/30 (40.0%) on day 1 and in 13/30 (43.3%) on day 2 after ESWL. The mean plasma levels of calcium were significantly decreased from 2.36 mmol/l before to 2.28 mmol/l on day 2 after ESWL (p< 0.01). The mean calcium/creatinine clearance ratio was significantly increased from 0.012 before to 0.019 after ESWL (p< 0.01). Before and on day 2 after ESWL, the calcium/creatinine clearance ratio was significantly correlated with the age of the patients (r = 0.33, p< 0.04). Conclusion: Our data show an age-related significantly increased urine calcium excretion after ESWL possibly due to decreased tubular calcium reabsorption. Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
- Published
- 2008
33. Evaluation of Prostate Imaging Reporting and Data System Classification in the Prediction of Tumor Aggressiveness in Targeted Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy
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Borkowetz, Angelika, primary, Platzek, Ivan, additional, Toma, Marieta, additional, Renner, Theresa, additional, Herout, Roman, additional, Baunacke, Martin, additional, Laniado, Michael, additional, Baretton, Gustavo B., additional, Froehner, Michael, additional, Zastrow, Stefan, additional, and Wirth, Manfred P., additional
- Published
- 2017
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34. Pharmacological Modulation of Mucosa-Related Impairment of β-Adrenoceptor-Mediated Relaxation in Human Detrusor
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Manfred P. Wirth, Melanie Roedel, Stefan Propping, and Ursula Ravens
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Male ,medicine.medical_specialty ,Contraction (grammar) ,Urology ,Muscle Relaxation ,Urinary Bladder ,In Vitro Techniques ,chemistry.chemical_compound ,Norepinephrine ,Internal medicine ,Renin–angiotensin system ,Receptors, Adrenergic, beta ,medicine ,Humans ,PPADS ,Urothelium ,Aged ,Mucous Membrane ,biology ,business.industry ,Antagonist ,Muscle, Smooth ,Nitric oxide synthase ,Candesartan ,Endocrinology ,chemistry ,biology.protein ,Female ,Cyclooxygenase ,business ,medicine.drug ,Signal Transduction - Abstract
Objectives: The mucosa of human detrusor strips impairs catecholamine-induced relaxation. In order to elucidate which signal transduction pathways are involved in this cross talk between the mucosa and detrusor, we have studied the effects of several pharmacological agonists and antagonists on noradrenaline-mediated relaxation in intact and mucosa-denuded detrusor strips. Patients and Methods: Strips of detrusor tissue were obtained from patients who had undergone cystectomy for bladder cancer and were set up for force measurement. KCl- or carbachol-precontracted strips were relaxed with increasing concentrations of noradrenaline in the absence and in the presence of nitric oxide synthase inhibitor, L-NAME; P2X-receptor antagonist, PPADS; ETA-receptor antagonist, BQ-123; ETB-receptor antagonist, BQ-788; cyclooxygenase inhibitor, diclofenac; AT1-receptor antagonist, candesartan; and NK1-receptor antagonist, L-703,606. Results: In intact strips, KCl-stimulated force was enhanced by all blockers; carbachol-stimulated force increased with L-703,606. In denuded strips, only L-NAME augmented the KCl-stimulated contraction. Noradrenaline relaxed the precontracted detrusor strips to a significantly larger extent and at lower concentrations in denuded than in intact strips. L-NAME, PPADS and BQ-123/BQ-788 had little effect on noradrenaline-induced relaxation, whereas diclofenac, candesartan and L-703,606 sensitized intact carbachol-stimulated detrusor strips to noradrenaline-induced relaxation. Conclusion: Inhibition of the noradrenaline-induced relaxation of precontracted human detrusor strips by the mucosa is attenuated by diclofenac, candesartan and L-703,606 suggesting the involvement of prostanoids, angiotensin and neurokinin pathways. Further experiments are required to unravel the exact mechanisms.
- Published
- 2015
35. Comparison of the Clinical Value of Complexed PSA and Total PSA in the Discrimination between Benign Prostatic Hyperplasia and Prostate Cancer
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Rainer Koch, Uta Schmidt, Oliver W. Hakenberg, Michael Froehner, Axel Meye, and Manfred P. Wirth
- Subjects
Male ,Oncology ,PCA3 ,medicine.medical_specialty ,Urology ,Prostatic Hyperplasia ,urologic and male genital diseases ,Diagnosis, Differential ,Prostate cancer ,Internal medicine ,medicine ,Humans ,ddc:610 ,urogenital system ,business.industry ,Prostate-specific antigen, Benign prostate hyperplasia, Prostate cancer, ROC analysis ,Prostatic Neoplasms ,Prostate-Specific Antigen ,Hyperplasia ,medicine.disease ,prostataspezifisches Antigen, Benigne Prostatahyperplasie, Prostatakrebs, ROC-Analyse ,Prostate-specific antigen ,Clinical value ,business ,Total psa - Abstract
Background: To compare the clinical value of the measurement of complex and total PSA in the discrimination between benign prostatic hyperplasia (BPH) and prostate cancer. Methods: In serum samples collected from 166 men with histopathologically proven clinically localized prostate cancer and of 97 men with BPH, total prostate-specific antigen (PSA), complexed PSA and the free to total PSA ratio were determined. The statistical analysis was done by the comparison of the receiver operator characteristic (ROC) curves. Results: The areas under the ROC curves were 0.776 for total PSA, 0.799 for complexed PSA (total PSA vs. cPSA: p < 0.0001) and 0.812 for the free to total PSA ratio. With a cut-off of 3.0 ng/ml for complexed PSA, the sensitivity was 90%, the specificity 58%, the positive and the negative predictive values 79 and 78%, respectively. With a cut-off of 4.0 ng/ml for total PSA, the sensitivity was 87%, the specificity 59%, the positive and the negative predictive values were 78 and 72%, respectively. Conclusions: There was a statistically significant advantage for complexed PSA compared to total PSA in the discrimination between BPH and prostate cancer. The difference was, however, small and its clinical relevance is questionable. Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
- Published
- 2006
36. Treatment of Locally Advanced Prostate Cancer – The Case for Radical Prostatectomy
- Author
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Oliver W. Hakenberg, Michael Fröhner, and Manfred P. Wirth
- Subjects
Male ,Prostatectomy ,Oncology ,medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,Locally advanced ,Prostatic Neoplasms ,Prostate carcinoma ,medicine.disease ,Prostate cancer ,Treatment Outcome ,Prostate Cancer, Radical Prostatectomy, watchful waiting, survival rate, comorbidity, hormonal treatment ,Prostatakrebs, radikale Prostatektomie, Abwarten, Komorbidität, Hormonbehandlung ,Internal medicine ,Humans ,Medicine ,ddc:610 ,Stage (cooking) ,business ,Neoplasm Staging - Abstract
The treatment of clinically locally advanced prostate carcinoma (stage cT3) remains controversial. One of the main reasons for this controversy results from the substantial staging error attached to the clinical diagnosis cT3 with overstaged T2 tumors and understaged node-positive cases. Treatment options in this situation include radical prostatectomy, external beam radiotherapy, immediate or delayed androgen deprivation treatment and the so-called ‘watchful waiting’. Acceptable and often surprisingly good tumor-specific survival rates have been reported for radical prostatectomy in pT3 series – based on good clinical case selection – approaching those of pT2 series. In lymph node-positive pT3 cases, adjuvant hormone deprivation seems to prolong survival which it does not in lymph node-negative pT3 disease. A benefit of adjuvant external beam radiotherapy after radical prostatectomy for pT3 cases in prolonging overall survival has not been shown, despite the fact that it can prevent or delay biochemical and local recurrence. External beam radiotherapy as the only treatment for cT3 disease results in unfavorable tumor-specific survival rates, which can be significantly improved with adjuvant hormonal treatment with LHRH agonists. If, in case of advanced age and/or significant comorbidity, primary hormonal treatment is chosen, early hormonal deprivation therapy seems to offer marginal benefits in survival compared to delayed treatment. Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
- Published
- 2006
37. Leiomyosarcoma of the Urinary Bladder in Adult Patients: A Systematic Review of the Literature and Meta-Analysis.
- Author
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Zieschang, Helen, Koch, Rainer, Wirth, Manfred P., and Froehner, Michael
- Subjects
LEIOMYOSARCOMA ,BLADDER tumors ,SYSTEMATIC reviews ,META-analysis ,URINARY organ cancer - Abstract
Purpose: Leiomyosarcoma of the urinary bladder is exceedingly rare. Most clinicians come across only a few cases during their career, and information regarding treatment and outcome is scattered in the scientific literature. Interested clinicians and patients have to undertake troublesome search for treatment and outcome information. Material and methods: We performed a systematic review of the literature using the PubMed and Web of Science databases and included all identified cases published in English language between 1970 and June 2018 into a meta-analysis. Prior to the literature search, key questions were formulated and with the data obtained, answers to these questions should be derived. Results: We analyzed clinical data of 210 cases of urinary bladder leiomyosarcoma revealed by this review and seen in our institution. The mean age of patients was 52 years. The majority (75%) of the tumors was classified as high-grade sarcomas. We found no report of a prior radiation therapy to the pelvic organs, but some authors suggested an association between cyclophosphamide treatment and the development of bladder leiomyosarcoma, especially in patients with retinoblastoma. For the whole sample, we determined 5- and 10-year cancer-specific cumulative mortality rates of 38 and 50%. Patients with high-grade sarcomas had a trend toward a higher mortality compared with low-grade tumors (p = 0.0280). The most promising treatment option seems to be surgery (radical or partial cystectomy) with negative resection margins, possibly supplemented by chemotherapy or radiation. Conclusion: About half of patients with bladder leiomyosarcoma survived on the long run. Low-grade tumors may have a better outcome with, nevertheless, countable long-term mortality. For better assessment of that rare bladder tumor, its best treatment options, and the influence of neoadjuvant or adjuvant therapies on the outcome of patients, a larger series with long-term survival data is required. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
38. Evaluation of Transperineal Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Compared to Transrectal Systematic Biopsy in the Prediction of Tumour Aggressiveness in Patients with Previously Negative Biopsy.
- Author
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Borkowetz, Angelika, Renner, Theresa, Platzek, Ivan, Toma, Marieta, Herout, Roman, Baunacke, Martin, Groeben, Christer, Huber, Johannes, Laniado, Michael, Baretton, Gustavo, Froehner, Michael, Zastrow, Stefan, and Wirth, Manfred P.
- Subjects
MAGNETIC resonance imaging ,ULTRASONIC imaging ,PROSTATE biopsy ,ENDORECTAL ultrasonography ,PROSTATE cancer ,PROSTATECTOMY ,CANCER invasiveness ,DESMOID tumors - Abstract
Objectives: We compared the transperineal MRI/ultrasound-fusion biopsy (fusPbx) to transrectal systematic biopsy (sysPbx) in patients with previously negative biopsy and investigated the prediction of tumour aggressiveness with regard to radical prostatectomy (RP) specimen. Material and Methods: A total of 710 patients underwent multiparametric magnetic resonance imaging (mpMRI), which was evaluated in accordance with Prostate Imaging Reporting and Data System (PI-RADS). The maximum PI-RADS (maxPI-RADS) was defined as the highest PI-RADS of all lesions detected in mpMRI. In case of proven prostate cancer (PCa) and performed RP, tumour grading of the biopsy specimen was compared to that of the RP. Significant PCa (csPCa) was defined according to Epstein criteria. Results: Overall, scPCa was detected in 40% of patients. The detection rate of scPCa was 33% for fusPbx and 25% for sysPbx alone (p < 0.005). Patients with a maxPI-RADS ≥3 and a prostate specific antigen (PSA)-density ≥0.2 ng/mL
2 harboured more csPCa than those with a PSA-density < 0.2 ng/mL2 (41% [33/81] vs. 20% [48/248]; p < 0.001). Compared to the RP specimen (n = 140), the concordance of tumour grading was 48% (γ = 0.57), 36% (γ = 0.31) and 54% (γ = 0.6) in fusPbx, sysPbx and comPbx, respectively. Conclusions: The combination of fusPbx and sysPbx outperforms both biopsy modalities in patients with re-biopsy. Additionally, the PSA-density may represent a predictor for csPCa in patients with maxPI-RADS ≥3. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
39. Perspectives in Adjuvant Treatment of Prostate Cancer
- Author
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Manfred P. Wirth and Michael Froehner
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Antineoplastic Agents, Hormonal ,Bicalutamide ,medicine.drug_class ,Urology ,medicine.medical_treatment ,Antiandrogen ,Severity of Illness Index ,Prostate cancer ,Prostate ,Internal medicine ,medicine ,Humans ,Stage (cooking) ,Prostatectomy ,Clinical Trials as Topic ,business.industry ,Prostatic Neoplasms ,Prognosis ,medicine.disease ,Combined Modality Therapy ,Surgery ,Survival Rate ,Radiation therapy ,Treatment Outcome ,medicine.anatomical_structure ,Chemotherapy, Adjuvant ,Radiotherapy, Adjuvant ,business ,Adjuvant ,medicine.drug - Abstract
Public awareness and widespread screening for prostate cancer has led to an increased detection of localized and potentially curable tumor stages [1]. Whereas radical prostatectomy results in disease-specific survival rates of approximately 90% in organ-confined disease [2], the survival rates are unsatisfactory when the disease has spread outside the prostate. In a multicentric trial with 298 stage cT3 patients treated by pelvic lymphadenectomy with or without radical prostatectomy, the disease-specific 10-year survival was only 57% [3]. Similarly unfavorable results were observed after radiotherapy alone for locally advanced prostate cancer [4]. Therefore, considerable efforts have been focussed on the development of adjuvant treatment modalities to improve these results. This review will discuss the current knowledge and ongoing studies in the field of adjuvant treatment of prostate cancer.
- Published
- 2002
40. Diagnostic Value of 18F-FDG Positron Emission Tomography for Detection and Treatment Control of Malignant Germ Cell Tumors
- Author
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Bettina Beuthien-Baumann, Panagiotis Tsatalpas, Oliver W. Hakenberg, Manfred P. Wirth, Wolf G. Franke, Joachim Kropp, Andreas Manseck, Claudia Tiepolt, and Wolfgang Burchert
- Subjects
Control treatment ,Chemotherapy ,medicine.diagnostic_test ,business.industry ,Urology ,medicine.medical_treatment ,Histology ,FDG-Positron Emission Tomography ,medicine.disease ,Positron emission tomography ,Positive predicative value ,Medicine ,Germ cell tumors ,Stage (cooking) ,business ,Nuclear medicine - Abstract
Introduction: The role of positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) is currently under evaluation in urologic oncology. The aim of the present study was to investigate the use of [18F]FDG positron emission tomography ([18F]FDG-PET) in the detection and treatment control of malignant germ cell tumors compared to computed tomography (CT). Materials and Methods: Thirty-two PET studies and CT scans were carried out in 23 patients with histologically proven germ cell tumors (10 seminomas, 12 non-seminomatous germ cell tumors (NSGCT), 1 unclassified serologic recurrent disease) Lugano stage I–III. The scans were done either after initial diagnosis (n = 21) and/or within 3–45 days after chemotherapy was completed (n = 11). PET and CT were validated either by histology (n = 7) or clinical follow-up of 6–11 months after the last PET study has been performed (n = 16). Sensitivity, specificity, accuracy, positive and negative predictive values were determined for PET and CT. Differences between PET and CT for parameters of diagnostic value were evaluated by χ2 test. Results: Although not statistically significant, the sensitivity, accuracy and negative predictive value were higher for PET than for CT with respect to the detection of metastatic infradiaphragmatic and supradiaphragmatic lesions after initial diagnosis. The specificity and positive predictive value of PET and CT were comparable. After chemotherapy, PET was found to be significantly superior in specificity and accuracy compared to CT with respect to infradiaphragmatic lesions (p < 0.05). False-positive PET findings in supradiaphragmatic lesions after chemotherapy occurred in the case of inflammatory processes and resulted in a loss of specificity and accuracy compared to CT (p < 0.05). Conclusions: These preliminary results demonstrate [18F]FDG-PET to be a useful diagnostic tool for the initial staging and treatment control in patients with germ cell tumors. Possible advantages compared to CT, however, are as yet not clearly defined. The possibility of false-positive PET findings due to reactive supradiaphragmatic inflammatory processes early after chemotherapy have to be considered.
- Published
- 2002
41. Chronic Pelvic Painin Men
- Author
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Oliver W. Hakenberg and Manfred P. Wirth
- Subjects
Male ,Pelvic pain syndrome ,medicine.medical_specialty ,Feedback, Psychological ,Urology ,Prostatitis ,Pelvic Pain ,Diagnosis, Differential ,Cystitis ,medicine ,Humans ,Prostate disease ,Analgesics ,Evidence-Based Medicine ,business.industry ,Pelvic pain ,Syndrome ,Evidence-based medicine ,medicine.disease ,Surgery ,Chronic disease ,Chronic Disease ,Physical therapy ,medicine.symptom ,business - Abstract
Chronic pelvic pain is a condition which receives less attention in men than in women. It is often difficult to diagnose and more difficult to treat. The new classification of prostatis and its variants has introduced the term 'chronic pelvic pain syndrome' which underlines the difficulties in dealing with this disorder which may represent a variety of chronically painful conditions with a large functional component.
- Published
- 2002
42. β-Adrenoceptor-Mediated Relaxation of Carbachol-Pre-Contracted Mouse Detrusor
- Author
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Stefan, Propping, Manja, Newe, Kristina, Lorenz, Manfred P, Wirth, and Ursula, Ravens
- Subjects
Male ,Mice, Knockout ,Sulfonamides ,Mucous Membrane ,Muscle Relaxation ,Colforsin ,Homozygote ,Urinary Bladder ,Imidazoles ,Isoproterenol ,Muscle, Smooth ,Cholinergic Agonists ,Aminophenols ,Mice, Inbred C57BL ,Propanolamines ,Mice ,Receptors, Adrenergic, beta ,Animals ,Carbachol ,Receptors, Adrenergic, beta-2 ,Muscle Contraction - Abstract
To study the β-adrenoceptor subtypes involved in the relaxation responses to (-)-isoprenaline in carbachol-pre-contracted (CCh) mouse detrusor muscle with intact and denuded mucosa.Isolated muscle strips from the urinary bladder of male C57BL6 mice or β2-adrenoceptor knockout mice were pre-contracted with CCh, 1 µM and relaxed with increasing concentrations of the β-adrenoceptor (β-AR) agonist (-)-isoprenaline and forskolin. For estimating the β-AR subtypes involved, subtype-selective receptor blockers were used, that is, CGP 20712A (β1-ARs), ICI 118,551 (β2-ARs), and L748,337 (β3-ARs).Unlike in KCl-pre-contracted muscle, the mucosa did not affect the sensitivity of the relaxation response to (-)-isoprenaline in CCh-pre-contracted murine detrusor strips. Increasing concentrations of (-)-isoprenaline produced a biphasic concentration-relaxation response without any difference both during the presence and absence of mucosa. The relaxation fraction produced by low (-)-isoprenaline concentrations was mediated by β2-AR as evidenced by a shift of the concentration-response curve to higher concentrations with ICI 118,551, but not with CGP 20712A and L748,337, and by the absence of this fraction in β2-AR-KO mice. The relaxation response with low sensitivity to (-)-isoprenaline was not affected by any of the β-AR subtype-selective blockers and was the only response detected in detrusor strips from β2-AR-KO mice.In CCh-pre-contracted mouse detrusor, β2-ARs are responsible for the relaxation component with high sensitivity to (-)-isoprenaline as indicated by the conversion of a biphasic into a monophasic CRC with ICI 118,551 or by its absence in β2-AR KO mice. The mucosa does not impair relaxation under these conditions.
- Published
- 2014
43. Superglue in the Urethra: Surgical Treatment
- Author
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Ulrike Heberling, Michael Fröhner, Manfred P. Wirth, and S. Oehlschläger
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Urology ,urologic and male genital diseases ,Urethra ,Adhesives ,medicine ,otorhinolaryngologic diseases ,Humans ,ddc:610 ,Surgical treatment ,Foreign Bodies ,Fremdkörper, Sekundenkleber, Penis-Harnröhre, externe Urethrotomie ,business.industry ,urogenital system ,technology, industry, and agriculture ,Urethra surgery ,Male urethra ,Surgery ,medicine.anatomical_structure ,surgical procedures, operative ,External urethrotomy ,Foreign bodies, Superglue, Penile urethra, External urethrotomy ,Urologic Surgical Procedures ,business - Abstract
We describe a case of superglue application into the male urethra with successful surgical treatment of the glue particles by external urethrotomy.
- Published
- 2014
44. Relationship of Comorbidity, Age and Perioperative Complications in Patients Undergoing Radical Prostatectomy
- Author
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Rainer J. Litz, Michael Froehner, Manfred P. Wirth, Andreas Manseck, D. Michael Albrecht, Steffen Leike, and Oliver W. Hakenberg
- Subjects
Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Comorbidity ,Angina Pectoris ,Pulmonary Disease, Chronic Obstructive ,Prostate cancer ,Postoperative Complications ,Thromboembolism ,Diabetes Mellitus ,Prevalence ,medicine ,Humans ,In patient ,Intraoperative Complications ,Aged ,Retrospective Studies ,Prostatectomy ,business.industry ,Age Factors ,Prostatic Neoplasms ,Perioperative ,Middle Aged ,medicine.disease ,eye diseases ,Surgery ,Clinical trial ,Cardiovascular Diseases ,Hypertension ,sense organs ,business ,Complication - Abstract
Objectives: To investigate the prevalence and distribution of comorbidity and its association with perioperative complications in patients undergoing radical prostatectomy (RPE). Methods: In 431 unselected RPE patients, the American Society of Anesthesiologists Physical Status classification (ASA-PS), the New York Heart Association classification of cardiac insufficiency (NYHA), the classification of angina pectoris of the Canadian Cardiovascular Society (CCS), height, weight, the body mass index (BMI), and the number of concomitant diseases (NCD) were assessed and related to perioperative cardiovascular complications. Results: In RPE patients less than 70 years old, comorbidity rose nearly continuously with increasing age. However, after reaching an age of 70 years, the proportion of NYHA-0 patients increased (60–64 years, 86%; 65–69 years, 85%; ≧70 years, 87%). Furthermore, the severe comorbidities decreased in patients selected for RPE aged 70 or more years. There was a nonsignificant trend towards higher comorbidity in patients with perioperative cardiovascular complications. Conclusions: These data suggest that documentation of the distribution of ASA-PS, CCS, NYHA and of concomitant diseases might be helpful to characterize the general health status and the degree of selection of prostate cancer treatment populations especially in series with a high portion of patients aged 70 or more years. Concerning perioperative complications, the individual predictive value of comorbidity seems to be poor in the radical prostatectomy setting.
- Published
- 2001
45. Subject Index Vol. 84, 2010
- Author
-
G. Bonvissuto, Rahmene Azzouzi, G. Mucciardi, Tatsuo Morita, Adnan Şimşir, Friedhelm Wawroschek, Olivier Haillot, F. Marchese, Kohsuke Sasaki, Claudius Fuellhase, Pascual Chuan-Nuez, Francois Desgrandchamps, Denise A. Pereira, Olivier Dumonceau, Ursula Kuehs, Omer Kutlu, Tomoyuki Murakami, Seiji Yano, P A McArdle, Shigeru Sakano, Kristina Hotakainen, I. Ioannou, Takahiko Hara, Kazuhiro Nagao, Gilda Alves, J. Fichtner, G. Grasso, Roman Szlauer, I. Pirozhok, Luis Arenas, Marc Fourmarier, Aurélien Descazeaud, A. Papatsoris, Viet Tran, G. Shaw, Stephan A. Krueger, Martti Ala-Opas, S. Fuessel, Donald C. McMillan, Christian Schwentner, Satoshi Eguchi, F. Aragona, Antonio A. Ornellas, N. Buchholz, Klaus G. Fink, Kazumi Suzuki, J. Zanow, Ismail Turker Koksal, J. Gelister, Yoshihisa Kawai, I. Petersen, T. Castelli, Levent A. Guner, Kazuhiko Nakano, T. Steiner, Vanessa Sandim, Richard Zigeuner, Taku Misumi, L. Macchione, Marian Devonec, Johan Lundin, Gurhan Gunaydin, P. Pepe, Tahir Qayyum, A. Meye, John Brusky, Katsusuke Naito, Rany Shamloul, N. Kroeger, Rashad Mammadov, Alexandre de la Taille, A. Di Benedetto, Nicolas Barry Delongchamps, Heinz-Peter Schlemmer, Yoshiaki Yamamoto, Alexander Winter, Cag Cal, Salih Sanlioglu, M. Gajda, José M. Martínez-Jabaloyas, Daniela Colleselli, Rafael Villamón-Fort, Ulrich H. Vogel, Ahter Dilsad Sanlioglu, Jens Uphoff, Christian Saussine, M. Madonia, Charles Ballereau, Bertrand Lukacs, David Schilling, Ljiljana Paras, G. Morgia, G. Candiano, Jörg Hennenlotter, A. Galia, Arnulf Stenzl, Hideyasu Matsuyama, Erkan Kismali, F. Fraggetta, Jocelyn M. Rieder, M.P. Wirth, H. Wunderlich, Harri Visapää, O.W. Hakenberg, Karen Stern, T. Briggs, U. Settmacher, A. Galì, Grégoire Robert, G. Romano, Ulf-Håkan Stenman, Matthias P. Lichy, J. Masood, Karl Pummer, Rolf-Peter Henke, Manuel Gil-Salom, C. Magno, Sherif R. Aboseif, Harald Trummer, Badereddin Mohamad Al-Ali, and Hideaki Ito
- Subjects
Gerontology ,Index (economics) ,business.industry ,Urology ,Medicine ,Subject (documents) ,business - Published
- 2010
46. Is Systematic Sextant Biopsy Suitable for the Detection of Clinically Significant Prostate Cancer?
- Author
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Oliver W. Hakenberg, Sven Oehlschlaeger, F. Theissig, Michael Froehner, Andreas Manseck, K. Friedrich, and Manfred P. Wirth
- Subjects
Male ,medicine.medical_specialty ,Prostate biopsy ,Urology ,Prostate cancer ,Prostate ,Tumor stage ,Biopsy ,Insignificant cancer ,medicine ,Humans ,Prostate disease ,ddc:610 ,Aged ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,Prostatic Neoplasms ,Reproducibility of Results ,Middle Aged ,Sextant, Biopsie, Prostatakrebs, Stadienbestimmung, Onkologie, radikale Prostatektomie ,Systematic sextant biopsy, Prostate cancer, Tumor stage, Radical prostatectomy ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Sextant biopsy ,Radiology ,business - Abstract
Background: The optimal extent of the prostate biopsy remains controversial. There is a need to avoid detection of insignificant cancer but not to miss significant and curable tumors. In alternative treatments of prostate cancer, repeated sextant biopsies are used to estimate the response. The aim of this study was to investigate the reliability of a repeated systematic sextant biopsy as the standard biopsy technique in patients with significant tumors which are being considered for curative treatment. Methods: Systematic sextant biopsy was performed in vitro in 92 radical prostatectomy specimens. Of these patients, 81 (88.0%) had palpable lesions. Results: Of the 92 investigated patients, 70 (76.1%) had potentially curable pT2-3pN0 prostate cancers. In these patients, the cancer was detected only in 72.9% of cases by a repeated in vitro biopsy. In the pT2 tumors, there was a detection rate of only 66.7%. Conclusions: This study underlines the fact that a considerable number of significant and potentially curable tumors remain undetected by the conventional sextant biopsy. A negative sextant biopsy does not rule out significant prostate cancer. Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
- Published
- 2000
47. Locally Recurrent Malignant Fibrous Histiocytoma: A Rare and Aggressive Genitourinary Malignancy
- Author
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Oliver W. Hakenberg, Manfred P. Wirth, Andreas Manseck, Michael Froehner, and Michael Haase
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,Urological neoplasms, Sarcoma, Histiocytoma, Local recurrence, Lymph node, Radiotherapy ,Salvage therapy ,Malignancy ,Premises ,medicine ,Humans ,ddc:610 ,Lymph node ,Aged ,Histiocytoma, Benign Fibrous ,Genitourinary system ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Urologie, Neoplasie, Sarkom, Histiozytome, Lymphknoten, Strahlentherapie ,Surgery ,Radiation therapy ,medicine.anatomical_structure ,Sarcoma ,Neoplasm Recurrence, Local ,business ,Urogenital Neoplasms ,Kidney disease - Abstract
Objective: In this study, 22 cases of locally recurrent urological malignant fibrous histiocytoma were reviewed considering therapeutic options, follow-up and prognosis. Patients and Methods: In the available literature on this topic we identified 19 cases of locally recurrent genitourinary malignant fibrous histiocytoma. Three additional cases are discussed, primarily arising from the kidney, the bladder and the paratesticular region. Results: The prognosis of locally recurrent urological malignant fibrous histiocytoma was found to be extraordinarily poor. Only 2 of 22 patients have survived for longer than 3.5 years. One of them reported herein is still alive 10 years after extensive lymphatic spread accompanying the first local recurrence. In this case, late local recurrence occurred after an 8-year interval free of disease. Conclusion: Malignant fibrous histiocytoma is an unusual urological malignancy with a high rate of local recurrence. The latter is frequently accompanied by metastatic disease and unrelenting progression. Despite the poor prognosis early detection of local failure and aggressive salvage therapy might offer the chance of long-term survival in selected cases. Close and life-long follow-up is advisable for patients once treated for recurrent urological malignant fibrous histiocytoma. Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
- Published
- 1999
48. Issues in the Treatment of Penile Carcinoma
- Author
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Oliver W. Hakenberg and Manfred P. Wirth
- Subjects
medicine.medical_specialty ,Chemotherapy ,business.industry ,Urology ,medicine.medical_treatment ,MEDLINE ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Penile Carcinoma ,Penis surgery ,Penile Diseases ,medicine ,Carcinoma ,business ,Penis - Published
- 1999
49. Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques
- Author
-
Klein, Jacques, primary, de Górski, Arachk, additional, Benamran, Daniel, additional, Vallee, Jean-Paul, additional, De Perrot, Thomas, additional, Wirth, Gregory J., additional, and Iselin, Christophe E., additional
- Published
- 2016
- Full Text
- View/download PDF
50. Impact of Adjuvant Intravesical Bacillus Calmette-Guérin Treatment on Patients with High-Grade T1 Bladder Cancer
- Author
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Novotny, Vladimir, primary, Froehner, Michael, additional, Ollig, Johanna, additional, Koch, Rainer, additional, Zastrow, Stefan, additional, and Wirth, Manfred P., additional
- Published
- 2016
- Full Text
- View/download PDF
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