J Schäfer

Universitätsklinikum Tübingen, Tübingen, Baden-Württemberg, Germany

Are you J Schäfer?

Claim your profile

Publications (100)179.76 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To compare positron emission tomography (PET)/magnetic resonance (MR) imaging and PET/computed tomography (CT) for lesion detection and interpretation, quantification of fluorine 18 ((18)F) fluorodeoxyglucose (FDG) uptake, and accuracy of MR-based PET attenuation correction in pediatric patients with solid tumors. Materials and Methods This prospective study had local ethics committee and German Federal Institute for Drugs and Medical Devices approval. Written informed consent was obtained from all patients and legal guardians. Twenty whole-body (18)F-FDG PET/CT and (18)F-FDG PET/MR examinations were performed in 18 pediatric patients (median age, 14 years; range, 11-17 years). (18)F-FDG PET/CT and (18)F-FDG PET/MR data were acquired sequentially on the same day for all patients. PET standardized uptake values (SUVs) were quantified with volume of interest measurements in lesions and healthy tissues. MR-based PET attenuation correction was compared with CT-derived attenuation maps (µ-maps). Lesion detection was assessed with separate reading of PET/CT and PET/MR data. Estimates of radiation dose were derived from the applied doses of (18)F-FDG and CT protocol parameters. Descriptive statistical analyses were performed to report correlation coefficients and relative deviations for comparison of SUVs, rates of lesion detection, and percentage reductions in radiation dose. Results PET SUVs showed strong correlations between PET of PET/CT (PETCT) and PET of PET/MR (PETMR) (r > 0.85 for most tissues). Apart from drawbacks of MR-based PET attenuation correction in osseous structures and lungs, similar SUVs were found on PET images corrected with CT-based µ-maps (13.1% deviation of SUVs for bone marrow and <5% deviation for other tissues). Lesion detection rate with PET/MR imaging was equivalent to that with PET/CT (61 areas of focal uptake on PETMR images vs 62 areas on PETCT images). Advantages of PET/MR were observed especially in soft-tissue regions. Furthermore, PET/MR offered significant dose reduction (73%) compared with PET/CT. Conclusion Pediatric oncologic PET/MR is technically feasible, showing satisfactory performance for PET quantification with SUVs similar to those of PET/CT. Compared with PET/CT, PET/MR demonstrates equivalent lesion detection rates while offering markedly reduced radiation exposure. Thus, PET/MR is a promising modality for the clinical work-up of pediatric malignancies. © RSNA, 2014 Online supplemental material is available for this article.
    Radiology 05/2014; · 6.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The aim of this study was to investigate frequencies of typical artifacts in low-dose pediatric lung examinations using high-pitch computed tomography (HPCT) compared to MDCT, and to estimate the effective radiation dose (Eeff). Materials and Methods: Institutional review board approval for this retrospective study was obtained. 35 patients (17 boys, 18 girls; mean age 112 ± 69 months) were included and underwent MDCT and follow-up scan by HPCT or vice versa (mean follow-up time 87 days), using the same tube voltage and current. The total artifact score (0 - 8) was defined as the sum of artifacts arising from movement, breathing or pulsation of the heart or pulmonary vessels (0 - no; 1 - moderate; 2 - severe artifacts). Eeff was estimated according to the European Guidelines on Quality Criteria for Multislice Computed Tomography. The Mann-Whitney U test was used to analyze differences between the patient groups. The Spearman's rank correlation coefficient was used for correlation of ordinal variables. Results: The scan time was significantly lower for HPCT compared to MDCT (0.72 ± 0.13 s vs. 3.65 ± 0.81s; p < 0.0001). In 28 of 35 (80 %) HPCT examinations no artifacts were visible, whereas in MDCT artifacts occurred in all examinations. The frequency of pulsation artifacts and breathing artifacts was higher in MDCT compared to HPCT (100 % vs. 17 % and 31 % vs. 6 %). The total artifact score significantly correlated with the patient's age in MDCT (r = - 0.42; p = 0.01), but not in HPCT (r = - 0.32; p = 0.07). The estimated Eeff was significantly lower in HPCT than in MDCT (1.29 ± 0.31 vs. 1.47 ± 0.37 mSv; p < 0.0001). Conclusion: Our study indicates that the use of HPCT has advantages for pediatric lung imaging with a reduction of breathing and pulsation artifacts. Moreover, the estimated Eeff was lower. In addition, examinations can be performed without sedation or breath-hold without losing image quality. Key points: • Fewer artifacts in pediatric lung imaging with HPCT• Reduced Eeff in HPCT• HPCT without sedation or breath-hold without loss of image quality Citation Format: • Tsiflikas I, Thomas C, Ketelsen D et al. High-Pitch Computed Tomography of the Lung in Pediatric Patients: An Intraindividual Comparison of Image Quality and Radiation Dose to Conventional 64-MDCT. Fortschr Röntgenstr 2014; DOI: 10.1055/s-0034-1366426.
    RöFo - Fortschritte auf dem Gebiet der R 04/2014; · 2.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This workshop was held a year after the initial positron emission tomography/magnetic resonance (PET/MR) workshop in Tübingen, which was recently reported in this journal. The discussions at the 2013 workshop, however, differed substantially from those of the initial workshop, attesting to the progress of combined PET/MR as an innovative imaging modality. Discussions were focused on the search for truly novel, unique clinical and research applications as well as technical issues such as reliable and accurate approaches for attenuation and scatter correction of PET emission data. The workshop provided hands-on experience with PET and MR imaging. In addition, structured and moderated open discussion sessions, including six dialogue boards and two roundtable discussions, provided input from current and future PET/MR imaging users. This summary provides a snapshot of the current achievements and challenges for PET/MR.
    Molecular imaging and biology: MIB: the official publication of the Academy of Molecular Imaging 03/2014; · 2.47 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: During recent years, minimally invasive surgery (MIS) has become the standard approach for various operations in infants and children. This also holds true for surgery in children with solid tumors. Meanwhile, more and more oncological biopsies and resections are being performed laparoscopically or thoracoscopically. Despite its increasing role in pediatric tumor surgery, the different national and international multicenter trial groups have not yet implemented MIS within guidelines and recommendations in most of the current treatment protocols. An increasing number of reports describe a potential role of MIS in the different entities of pediatric surgical oncology. Over the time, there has been a diverse development of this approach with regard to the different neoplasms. The aim of this article is to give an overview and to describe the current state of the art of MIS in pediatric solid tumors.
    Frontiers in Pediatrics 01/2014; 2:48.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surgical approach to children with complicated ureteral duplication is discussed controversially. Our aim was to determine the outcome of children with complicated renal duplication undergoing a single-stage surgical approach with laparoscopic partial nephrectomy and open bladder reconstruction. Data of patients from 2004 to 2008 were investigated retrospectively. Outcome was analyzed in terms of postoperative course, renal function, urinary tract infection and functional voiding. Thirteen patients were treated with laparoscopic partial nephrectomy and reconstruction of the lower urinary tract in a single-stage approach. Median age at operation was 15 months (2-63 m). One girl had a renal triplication. 7/13 patients presented with an ectopic ureterocele, two with an ectopic ureter, severe vesicoureteral reflux occurred in 6 patients. All patients had non-functioning renal moieties. Mean operative time was 239 min (129-309; SD 50). One re-operation was necessary 4 years after primary surgery due to a pole remnant. All patients had uneventful recoveries without evidence of recurrent UTI. Postoperative 99mTc-MAG3 scans showed no significant reduction of partial renal function (p = 0.4), and no signs of obstruction (p = 0.188). During a median follow-up of 60 months (49-86), dysfunctional voiding occurred in one patient. In children with complicated ureteral duplication a definitive single-stage procedure is feasible and shows excellent functional results.
    Pediatric Surgery International 09/2013; · 1.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Moderate persistent elevation of the γ-glutamyltransferase (γGT) level is a frequent finding during long-term follow-up of patients with total cavopulmonary connection (TCPC) for palliation of functionally univentricular hearts. Serial intraindividual data revealed a significant increase in the γGT level within a minimum 4-year interval in more than 80 % of cases. The level of γGT elevation showed a significant correlation to hemodynamic parameters such as systemic ventricular end diastolic pressure and mean pulmonary artery pressure, but did not strongly correlate with duration of follow-up or other liver function parameters, which were less frequent and less impressively deranged. None of the patients had signs of synthetic dysfunction. With increasing postoperative follow-up, abnormalities of sonographic hepatic texture including increased echogenicity, inhomogeneity, or liver surface nodularity were found. All 17 patients with liver surface nodularity had a follow-up period of over 10 years. Structural abnormalities did not correlate with biochemical or hemodynamic parameters. Doppler evaluation revealed inspiratory dependence of hepatic vein flow in more than 90 % as a relevant finding after TCPC; a decrease in portal vein flow velocity was observed in many patients. Since long-term survivors after Fontan procedure are at an increased risk of cardiac hepatopathy and cirrhosis, detailed routine investigation and monitoring of hepatic morphology are needed.
    Herz 05/2013; · 0.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe a 99-day old girl with inspissated bile syndrome (IBS) unresponsive to treatment with oral ursodeoxycholic acid. We performed a pure laparoscopic 2-stage procedure, consisting of cholecystostomy and insertion of an indwelling balloon catheter for local ursodeoxycholic acid flushing for 13 consecutive days. Subsequently, the cholecystostomy was removed, preserving the gallbladder using the same laparoscopical approach when bilirubin values returned to normal and bile duct obstruction was no longer detectable radiologically. This is the first report of an exclusively laparoscopic management of IBS.
    Journal of Pediatric Surgery 12/2012; 47(12):e47-e50. · 1.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: It would be beneficial to establish pulmonary MRI as a complementary approach to CT for direct visualization of mosaic perfusion, bullae, and emphysema in patients with cystic fibrosis. Objectives: The purpose of this study was to compare both modalities, CT and MRI, using the Helbich-Bhalla score with a special focus on reliable detection of a mosaic pattern. Methods: Out of 51 patients examined by MRI on a 1.5-Tesla system during a period of 2 years, 19 patients were scheduled for additional low-dose CT in a clinical context. The MRI protocol comprised a gradient echo (GRE) sequence with a very short echo time (TE = 0.8 ms) in inspiration and expiration, a 3-D GRE sequence in breath hold, and a fast spin echo sequence with respiration and ECG triggering. MDCT was carried out in inspiration and adapted to body weight using 100 or 120 kV, 30-60 mA, 1- and 3-mm slice thicknesses, as well as low and high kernels. Additionally incremental slices in 3 positions were recorded in expiration for distinct detection of air trapping. CT and MRI analyses were performed by two radiologic readers in consensus unaware of the clinical parameters. The Helbich-Bhalla score of both examinations was correlated. Mean difference and accordance were assessed in each category. Results: There was a strong correlation between CT and MRI (R = 0.87, p < 0.01). The mean Helbich-Bhalla score for CT was 12.2 (range 1-18) and for MRI it was 11.7 (range 2-19). The mean difference was 0.5 points. Besides this strong correlation for findings (bronchiectasis, mucus plugging, peribronchial thickening, and consolidation) with a prolonged T2 TE in MRI, we could also state a qualitative agreement of 95-100% in the categories with short T2 and low signal intensity in MRI as emphysema, bullae, and mosaic perfusion. Conclusions: These results suggest that in our patient group none of the relevant findings were missed by MR imaging and reading.
    Respiration 11/2012; · 2.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Extrahepatic portal vein (PV) obstruction (EHPVO) is a rare disorder in early childhood with unknown incidence and mostly unknown etiology. In children with EHPVO, the hepatopedal flow of the mesenteric venous blood is hindered by an obstruction of the PV resulting in prehepatic portal hypertension. The curative treatment with a meso-Rex shunt connects the superior mesenteric vein to the left PV by a venous autograft. Despite good primary patency, reocclusion of a meso-Rex bypass and its treatment can be challenging. We present 2 patients with EHPVO with subtotal functional occlusion of a meso-Rex shunt treated by percutaneous interventions with short- and mid-term follow-up.
    Journal of Pediatric Surgery 09/2012; 47(9):e23-8. · 1.38 Impact Factor
  • Clinical Research in Cardiology 05/2012; 101(10):853-5. · 3.67 Impact Factor
  • Guido Seitz, Joerg Fuchs, Juergen F Schaefer, Steven W Warmann
    [Show abstract] [Hide abstract]
    ABSTRACT: Molecular imaging is a novel field in cancer research combining various in vivo imaging modalities with molecular biology. Different techniques such as magnetic resonance tomography (MRI), positron emission tomography (PET), optical imaging methods (bioluminescence, fluorescence), or combination of these are used in basic research as well as in patients in different tumor entities. In hepatoblastoma (HB), there are only few reports on molecular imaging methods in a preclinical (optical imaging) and clinical setting (PET, PET-CT). Unimprovable treatment outcomes of patients in advanced tumor stages require novel treatment approaches. Photodynamic diagnosis (PDD) and photodynamic therapy (PDT) are novel diagnostic and therapeutic tools. Photodynamic diagnosis allows in vitro and in vivo detection of tumor cells using their fluorescending behaviour. PDT is a novel anticancer treatment approach leading to tumor cell destruction via apoptosis. In hepatoblastoma, there are only few reports on in vitro and in vivo studies using this treatment modality. First results seem to be promising and further studies will be required to further evaluate these techniques and to transfer them into clinical settings. This paper reviews different modalities of molecular imaging, photodynamic diagnosis and photodynamic therapy in childhood hepatoblastoma.
    Frontiers in bioscience (Elite edition) 01/2012; 4:487-92.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bilateral nephroblastoma involving the renal hilus represents a significant surgical challenge. Different operative strategies have been proposed for this condition. We analyzed the outcome of simultaneous bilateral partial nephrectomy for complex stage V nephroblastoma. We retrospectively analyzed patients with bilateral nephroblastoma involving the renal hilus operated on at our institution between 2002 and 2008. We assessed patient data and surgical and oncologic outcomes. We analyzed data from 5 patients with a median age of 27 months at surgery (range 13 to 58). Two children had additional pulmonary metastases. Patients were treated according to the International Society of Pediatric Oncology 2001/German Society of Pediatric Oncology and Hematology protocol. All children underwent synchronous bilateral nephron sparing surgery (longitudinal partial nephrectomy or enucleation) of the central tumors. Median operating time was 182 minutes (range 129 to 291), with vascular exclusion performed in 4 patients (7 to 25 minutes). Complications consisted of urinary leakage in 2 cases. Postoperative renal function was unimpaired in 4 patients and 1 patient had Wilms tumor/aniridia/genitourinary malformations/retardation syndrome with glomerulopathy. One patient with pulmonary metastases and blastemal histology had multiple pulmonary relapses and died due to pulmonary progressive disease. Four patients are alive without evidence of disease at a median followup of 45 months (range 44 to 73). Surgery for central stage V nephroblastoma is possible with good functional and oncologic outcomes. The single stage approach is safe, provided that operating and treating physicians have sufficient expertise with such conditions. The ultimate goal is to avoid tumor nephrectomy.
    The Journal of urology 08/2011; 186(4):1430-6. · 4.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Magnetic resonance imaging (MRI) and/or scintigraphy are commonly used for follow-up in children after treatment of acute osteomyelitis. Regularly, post-treatment imaging reveals pathological findings even if serum inflammatory parameters and clinical presentation are normal. We analyzed combined positron emission tomography and multislice computed tomography (PET/CT) for this condition. Six children received PET/CT after treatment of acute osteomyelitis. Post-treatment MRI had revealed suspicious residual and/or additional findings. All patients had physiological serum infection parameters and no clinical symptoms. Median patient age was 59.5 months (range, 48-156). No increased 18-Fluor-2-deoxy-D-glucose uptake was observed in 3 patients. In 3 patients, there was minimal activity at the site of infection, which, however, did not reach the presumed range of osteomyelitis. All children were taken off antibiotic medication. No clinical symptoms reoccurred in any of them, and repeatedly controlled serum infection parameters were all normal. Median follow-up was 33 months (range, 4-65). The PET/CT was superior to MRI in distinguishing between infection and reparative activity within the musculoskeletal system in selected children after acute osteomyelitis. The termination of antibiotic treatment for children after acute osteomyelitis seems justified when laboratory parameters as well as clinical presentation are normal, and PET/CT scan is unsuspicious.
    Journal of Pediatric Surgery 08/2011; 46(8):1550-6. · 1.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess lung perfusion in young patients with cystic fibrosis (CF) using an arterial spin labeling (ASL) technique. Perfusion imaging was performed in 5 healthy volunteers and 33 pediatric patients (13 ± 5 years) with CF using an ASL technique. Image quality was evaluated on a five-point scale (1 = excellent). Quantitative perfusion maps were calculated based on the modified Bloch equations. Perfusion differences between volunteers and CF patients and regional differences between lobes were analyzed using Student's t test. The association of perfusion values and forced expiratory volume in 1 s (FEV1) was analyzed using univariate regression analysis. Mean lung perfusion was 698 ± 67 ml/100g/min (range: 593-777 ml/100g/min) in volunteers and 526 ± 113 ml/100g/min (range: 346-724 ml/100g/min) in CF patients. Median image quality was 2 in volunteers and 3 in CF patients. In CF patients, significantly lower perfusion was observed in the upper lobes compared to healthy volunteers. Mean perfusion values significantly correlated with FEV1 (r = 0.84, P < 0.0001). ASL perfusion imaging provides lung perfusion assessment in young CF patients. This non-invasive functional imaging technique is worth being evaluated in the clinical monitoring of CF patients.
    MAGMA Magnetic Resonance Materials in Physics Biology and Medicine 07/2011; 25(2):155-62. · 1.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To demonstrate a rare case of urological pathology, we report a combination of a single kidney and ureteral atresia. The treatment concept and outcome are outlined. Antenatal ultrasound had revealed urinary ascites which lead to caesarean section in the 34th gestational week. Persisting anuria was confirmed postnatally and peritoneal dialysis started on the second day of life. Subsequent laparotomy revealed ureteral atresia after 3 cm of patent ureter. We created an ileum conduit after discussing various other therapeutic options. A follow up of 12 months has shown steady function of the stoma with stable renal parameters. An ileal conduit represents a good option if high drainage is necessary in early childhood.
    Journal of pediatric urology 03/2011; 7(5):576-8. · 1.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate CT-guided radiofrequency (RF) ablation of osteoid osteoma using internally cooled monopolar RF electrodes for technical success, complications and clinical long-term success. Between April 1999 and July 2006, 23 patients were treated under general anesthesia with CT-guided RF ablation using an internally cooled monopolar single RF electrode (Cool-tip, Valleylab, TycoHealthcare, Boulder, USA; active tip: 10 mm). For the removal of the nidus, we used either a manual or an automated drill. The technical success was evaluated by a CT scan (MSCT, Siemens Medical Solutions, Forchheim). The clinical long-term success was investigated by questioning patients prior to discharge, and after 6, 12 and 18 months. After 18 months, patients were interviewed on an annual basis. The technical success rate was 100 %. The nidus was located in n = 19 cases at the lower extremity and in n = 4 cases at the upper extremity. Minor complications were observed for n = 2 patients. The mean hospitalization time was 1.5 d (1-2 d). The mean follow-up was 75.9 months (18-120 months) for n = 23 patients. No local recurrence was observed. One patient had intermediate pain one week after RF ablation without recurrent symptoms. CT-guided RF ablation using an internally cooled monopolar single RF electrode is an effective and safe minimally invasive method for the treatment of osteoid osteoma with excellent clinical long-term success.
    RöFo - Fortschritte auf dem Gebiet der R 01/2011; 183(4):381-7. · 2.76 Impact Factor
  • F Obermayr, P Szavay, J Schaefer, J Fuchs
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim of the study was to evaluate the outcome of augmentation cystoplasty and bladder substitution in a pediatric age group. Patient records of all children who underwent reconstructive bladder surgery between October 1999 and November 2007 were reviewed. Additionally, standardized interviews were performed to evaluate the postoperative outcome. Augmentation cystoplasty and bladder substitution were performed in 19 and 6 patients, respectively. 21 patients underwent continent catheterizable vesicostomy. Postoperative urodynamics revealed a significant increase in bladder volume (median 400 ml) as well as a significant improvement in bladder compliance (median 13.5 ml/cmH2O). 90% of the patients were reported to be socially continent. Renal function remained stable in 95% and decreased in 5% of the children. Major complications were lower urinary tract calculi (39%), stricture or insufficiency of the continent vesicostomy (28%), and intestinal obstruction (9%). No malignancies associated to bladder augmentation or substitution were detected yet. Augmentation cystoplasty and bladder substitution preserve renal function and provide urinary continence in most children with intractable lower urinary tract disease. However, the procedures remain associated with numerous complications.
    European Journal of Pediatric Surgery 11/2010; 21(2):116-9. · 0.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present the case of ureteral triplication with vesicoureteral reflux into the lowest and middle pole in a 5-year-old girl. Magnetic resonance (MR) nephrography depicted loss of function of the lowest pole, which could not be assessed through MAG3 renal scan. Morphologic analyses revealed organ structure and vascular anatomy in superior quality. A laparoscopic partial nephroureterectomy of the lower pole was performed. Intraoperative findings correlated exactly with morphologic data obtained through MR nephrography. Dynamic MR nephrography should be considered as diagnostic tool of choice for selected kidney anomalies before surgery.
    Journal of Pediatric Surgery 10/2010; 45(10):2053-7. · 1.38 Impact Factor
  • Pediatrics International 04/2010; 52(2):e79-81. · 0.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In patients with maljunction of pancreatic and common bile duct (CBD)-defined as a long common pancreaticobiliary channel (LCPC)-a resection of the CBD and a hepaticojejunostomy is recommended. To date, this operation is usually performed through an open approach. In this article, we report on our experience with minimally invasive surgery (MIS) for LCPC in children. From 2004 to 2008, 7 children underwent MIS for LCPC. Mean age at operation was 46 months. Two patients had a choledochal cyst (Todani type IV) additionally. Diagnosis was made preoperatively by magnetic resonance cholangiopancreaticography, in 5 children confirmed by endoscopic retrograde cholangio-pancreaticography. A four-trocar technique was used for the laparoscopic approach. Follow-up examinations included laboratory tests, ultrasound, and scintigraphy. A Roux-en-Y hepaticojejunostomy was performed in all patients-in 6 children completely by laparoscopy. In 1 child, the operation was converted to open after CBD diversion due to a large, vulnerable liver. In 2 children with extended choledochal cyst, additionally, a reconstruction of the separated hepatic ducts was performed. Reresection of a CBD stump was carried out by laparoscopy in another patient. A leakage of the anastomosis occurred in 1 child. The laparoscopic approach for pathology of pancreaticobiliary ducts might be a new alternative for surgical treatment in infants and children. It can also be performed in cases with choledochal cyst involving the hepatic ducts and for reresection of remnants of CBD.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2010; 20(5):485-8. · 1.07 Impact Factor

Publication Stats

553 Citations
179.76 Total Impact Points

Institutions

  • 2000–2014
    • Universitätsklinikum Tübingen
      • • Policlinic for Orthodontics
      • • Division of Diagnostic and Interventional Radiology
      • • Division of Experimental radiation oncology
      • • Department of Radiology
      Tübingen, Baden-Württemberg, Germany
  • 2001–2011
    • University of Tuebingen
      • • Institute for Neurobiology
      • • Department of Paediatric Surgery
      • • Department of General Paediatrics, Oncology/Haematology
      • • Department of Internal Medicine
      Tübingen, Baden-Württemberg, Germany