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151.
Evaluation of an ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients 总被引:4,自引:0,他引:4
U Mey A Glasmacher C Hahn M Gorschlüter C Ziske M Mergelsberg T Sauerbruch I G H Schmidt-Wolf 《Supportive care in cancer》2003,11(3):148-155
Ultrasound guidance for percutaneous puncture of the internal jugular vein provides many advantages over the classic landmark-guided technique, particularly in complicated cases (e.g. thrombocytopenia, obesity, dyspnea). The present prospective investigation involved analysis of 493 punctures and provides patient- and operator-dependent variables with respect to the impact on puncture success and the complication rate. These 493 punctures of the internal jugular vein were performed using identical puncturing equipment and a standardized two-operator catheterization technique and were prospectively recorded on the hematology-oncology ward of a university hospital. Alongside success rates, the frequency and nature of complications, patient-inherent risk variables (obesity, thrombocytopenia, patient cooperation, vein diameter, etc.) and the individual experience of the physician performing the puncture and ultrasound were analyzed with respect to possible impact on success and complication rate. Internal jugular vein cannulation was successful in 94.5% of all patients. Catheter placement was successful at the first attempt in 87.6% of cases. Arterial fail punctures occurred in 1.4% of the patients and local hematoma in a further 4.3%. Among the patient-dependent variables, only poor patient compliance and a maximum vein diameter smaller than 7 mm showed a negative influence on the success rate. The experience of the physician carrying out the puncture influenced neither the success rate nor the complication rate. In contrast, both failure and complication rates were significantly lower when the physician guiding the sonographic probe was familiar with the method. Ultrasound-guided cannulation of the internal jugular vein provides safe central venous access with high success rates and low complication rates. Difficulties due to patient-inherent risk factors (e.g. thrombocytopenia, obesity, dyspnea) can be managed well using ultrasonographic guidance. The success rate achieved and the frequency of complications are decisively influenced not by the experience of the physician performing the puncture, but by the experience of the physician acting as sonographer. 相似文献
152.
Franziska Geiser Corinna Hahn Rupert Conrad Reinhard Liedtke Tilman Sauerbruch Ingo Schmidt-Wolf Axel Glasmacher 《Supportive care in cancer》2007,15(3):273-278
Introduction and background Epoetin alfa is known to produce a hematological response in anemic cancer patients. A concomitant reduction in fatigue as
well as an improvement of depression and anxiety and of quality of life has been reported. However, these effects are discussed
controversially. Psychological variables may have a moderating effect on fatigue reduction.
Materials and methods Fifty-four anemic cancer outpatients were treated with epoetin alfa over 26 weeks with an initial dose of 3×10,000 IU/week
and further individually adapted dosage. Hemoglobin level, fatigue, depression, anxiety, and health-related quality of life
were measured every 4 weeks.
Results The hematological response rate was 50%, with 1/3 occurring after more than 8 weeks of treatment. Fatigue, depression, and
quality of life improved significantly. Reduction in fatigue was associated with response, but the correlations between fatigue
and hemoglobin were weak. Less depression and higher quality of life before treatment correlated with a better fatigue reduction
when controlling for hemoglobin increase and initial fatigue level.
Conclusion Psychological variables influence the reduction of fatigue during therapy with epoetin alfa in anemic cancer patients and
should therefore be assessed at the beginning of treatment. 相似文献
153.
Marie-Luise Hütter-Kr?nke Axel Benner Konstanze D?hner Jürgen Krauter Daniela Weber Margit Moessner Claus-Henning K?hne Heinz A. Horst Ingo G.H. Schmidt-Wolf Mathias Rummel Katharina G?tze Elisabeth Koller Andreas L. Petzer Hans Salwender Walter Fiedler Heinz Kirchen Detlef Haase Stephan Kremers Matthias Theobald Axel C. Matzdorff Arnold Ganser Hartmut D?hner Richard F. Schlenk 《Haematologica》2016,101(7):839-845
Outcome of patients with primary refractory acute myeloid leukemia remains unsatisfactory. We conducted a prospective phase II clinical trial with gemtuzumab ozogamicin (3 mg/m2 intravenously on day 1), all-trans retinoic acid (45 mg/m2 orally on days 4–6 and 15 mg/m2 orally on days 7–28), high-dose cytarabine (3 g/m2/12 h intravenously on days 1–3) and mitoxantrone (12 mg/m2 intravenously on days 2–3) in 93 patients aged 18–60 years refractory to one cycle of induction therapy. Primary end point of the study was response to therapy; secondary end points included evaluation of toxicities, in particular, rate of sinusoidal obstruction syndrome after allogeneic hematopoietic cell transplantation. Complete remission or complete remission with incomplete blood count recovery was achieved in 47 (51%) and partial remission in 10 (11%) patients resulting in an overall response rate of 61.5%; 33 (35.5%) patients had refractory disease and 3 patients (3%) died. Allogeneic hematopoietic cell transplantation was performed in 71 (76%) patients; 6 of the 71 (8.5%) patients developed moderate or severe sinusoidal obstruction syndrome after transplantation. Four-year overall survival rate was 32% (95% confidence interval 24%-43%). Patients responding to salvage therapy and undergoing allogeneic hematopoietic cell transplantation (n=51) had a 4-year survival rate of 49% (95% confidence intervaI 37%-64%). Patients with fms-like tyrosine kinase internal tandem duplication positive acute myeloid leukemia had a poor outcome despite transplantation. In conclusion, the described regimen is an effective and tolerable salvage therapy for patients who are primary refractory to one cycle of conventional intensive induction therapy. (clinicaltrials.gov identifier: 00143975) 相似文献
154.
M Gorschlüter A Glasmacher C Hahn F Schakowski C Ziske E Molitor G Marklein T Sauerbruch I G Schmidt-Wolf 《Clinical infectious diseases》2001,33(6):786-791
Clostridium difficile is the most important cause of nosocomial infectious diarrhea. The importance of C. difficile-associated diarrhea (CDAD) has been poorly investigated in patients with neutropenia who have hematologic malignancies. A retrospective chart review of all patients treated in the leukemia ward of a university medical center during 1991-2000 determined that 875 courses of myelosuppressive chemotherapy were administered. CDAD occurred in 7.0% of all cycles. In 8.2% of the patients, severe enterocolitis developed. Two patients died while they had diarrhea. However, in no patient was C. difficile infection clinically considered to be the primary cause of death. The response rate to oral metronidazole was 90.9%. These data indicate that C. difficile infection is not rare and should be suspected whenever a hospitalized patient with neutropenia develops diarrhea. Oral metronidazole can be recommended as initial drug of choice for treatment of patients with neutropenia who have hematologic malignancies and CDAD. 相似文献
155.
Population-based registration of unselected colorectal cancer patients: five-year survival in the region of Bonn/Rhine-Sieg, Germany 总被引:1,自引:0,他引:1
Lamberti C Di Blasi K Archut D Fimmers R Mathiak M Bollmann M Vogel J Kindermann D Mezger J Schmidt-Wolf IG Sauerbruch T 《Zeitschrift für Gastroenterologie》2005,43(2):149-154
INTRODUCTION: Epidemiological data of colorectal cancer are sparse and often incomplete. Therefore, we initiated a population-based examination of five-year survival of colorectal cancer patients. METHODS: For complete registration, diagnosis and tumour stage of all patients in the region of Bonn/Rhine-Sieg were assessed independently according to reports of medical practitioners and pathologists. Each patient was followed by a standardised questionnaire during a period of five years. RESULTS: Between June and November, 1994 348 patients were registered. Median age at diagnosis was 69 years for males (n = 160) and 72 years for females (n = 188). According to the UICC classification 18, 26, 23 and 26 % had stage I-IV tumours, respectively; the tumour stage remained unclear in 7 %. Adjuvant (radio)-chemotherapy was indicated in 89 patients, but only 49 % of these were treated. Five-year overall survival (OS) and relative overall survival were 41 and 54 %, respectively. Although disease-free survival (DFS) was significantly better for early stage colorectal cancer, OS did not differ significantly between stage I and stage III tumours. Young patients diagnosed before the age of 50 had a significantly lower DFS. These data were comparable with other European countries but were lower than data reported in the USA. DISCUSSION: The high rate of patients with stage IV colorectal cancer and the low proportion of patients receiving adjuvant (radio)-chemotherapy according to international or national consensus recommendations were disappointing. Although data were comparable with other European countries more efforts are necessary to establish effective screening programs for asymptomatic patients and to increase the willingness for standardised adjuvant treatment. 相似文献
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