R Busch

Deutsches Herzzentrum München, München, Bavaria, Germany

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Publications (143)477.57 Total impact

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    ABSTRACT: Einleitung: Grundlage für den Vergleich von Behandlungsresultaten ist die Anwendung einer international einheitlichen Klassifikation. 1997 wurde die etablierte TNM-Klassifikation der UICC erneuert. Methoden: Von 1983–1997 wurden an unserer Klinik 159 Patienten mit einem duktalen Pankreascarcinom reseziert. Die Daten dieser Patienten wurden standardisiert prospektiv nach einem Protokoll erfaßt. Die Fälle wurden entsprechend der UICC-Klassifikation von 1997 neu klassifiziert und mit der Klassifikation von 1992 verglichen. Ergebnisse: In der UICC-Klassifikation 1997 wurde für das duktale Pankreascarcinom die pT-Kategorie (neu pT4) und die pN-Kategorie (neu pN1 a/b) sowie die Stadieneinteilung neu definiert. Entsprechend der klinischen Realität finden sich jetzt geringere Fallzahlen in den prognostisch günstigeren Kategorien (pT1/2; n = 5) und im Stadium I (n = 4). Das Stadium II (1992) mit geringer Fallzahl (n = 5) und mangelnder Prognoserelevanz wurde durch ein Stadium II mit ausgewogener Fallzahl (n = 51) und angemessener Prognose ersetzt, das sich zum Stadium III (n = 74) abgrenzt. Schlußfolgerung: Somit führt die Neuklassifikation zu homogenerer Stadienverteilung und erlaubt eine mit anderen gastrointestinalen Tumoren vergleichbare individuelle Prognoseabschätzung. Introduction: To compare treatment results an international established classification is necessary. In 1997 the TNM classification of 1992 was modified. Methods: Between 1983 and 1997, 159 patients with a ductal carcinoma of the pancreas underwent resection. All data of the resected specimens were documented in standardized manner prospectively in a protocol that offered ready transfer of the collected data to a new classification. The TNM categories and stage groupings were transferred to the new UICC classification of 1997 and analyzed in comparison to the classification of 1992. Results: The inclusion of a pT4 category equivalent to the other GI tumors made a new stage grouping necessary. Also division into pN1 a and pN1 b was established. According to the clinical experience only few tumors in early stages (pT1/2 and stage I) were observed in the new classification. There was a significant improval in the patient's distribution to the new stage grouping because of the homogeneous groups. In comparison to the 1992 classification the new stage II shows a relevant prognostic value and a significant difference to stage III. Conclusion: We conclude that the new UICC classification relates to prognosis better than the old classification.
    Der Chirurg 04/2012; 71(2):189-195. · 0.52 Impact Factor
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    ABSTRACT: To evaluate the SUV calculation and integration of the gated (4D) PET in the iPlan 4.0 treatment planning software (BrainLAB). Phantom and patient data for different tracers were used. Two comparisons were performed for each patient: for the delineated VOI, the maximum value of SUV in iPlan was compared with the results from TrueD software. For 10 patients lesion volumes were defined in both systems for a given SUV threshold and differences were calculated. For four patients examined with respiratory gated PET, SUV(max) and volume analysis was performed in each phase of the breathing cycle in the gated and the ungated PET. Maximum differences of 6% and 10% were found for phantom and patient measurements of SUV(max). For patient data, maximal differences in delineated volume of 10% for ungated and up to 27% for gated PET were found in both systems. This study suggests that for the safe implementation of PET data and delineation algorithms in the radiotherapy planning system, one has to be aware of the differences in SUVs and volumes found in the two systems.
    Radiotherapy and Oncology 02/2011; 98(3):323-9. · 4.52 Impact Factor
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    ABSTRACT: Dysfunction of valved conduits in the right ventricular outflow tract (RVOT) limits durability and enforces repeated surgical interventions. We report on our combined two-centre experience with percutaneous pulmonary valve implantation (PPVI). One hundred and two patients with RVOT dysfunction [median weight: 63 kg (54.2-75.9 kg), median age: 21.5 years (16.2-30.1 years), diagnoses: TOF/PA 61, TAC 14, TGA 9, other 10, AoS post-Ross-OP 8] were scheduled for PPVI since December 2006. Percutaneous pulmonary valve implantation was performed in all patients. Pre-stenting of the RVOT was done in 97 patients (95%). The median peak systolic RVOT gradient decreased from 37 mmHg (29-46 mmHg) to 14 mmHg (9-17 mmHg, P < 0.001) and the ratio RV pressure/AoP decreased from 62% (53-76%) to 36% (30-42%, P < 0.0001). The median end-diastolic RV-volume index (MRI) decreased from 106 mL/m(2) (93-133 mL/m(2)) to 90 mL/m(2) (71-108 mL/m(2), P = 0.001). Pulmonary regurgitation was significantly reduced in all patients. One patient died due to compression of the left coronary artery. The incidence of stent fractures was 5 of 102 (5%). During follow-up [median: 352 days (99-390 days)] one percutaneous valve had to be removed surgically 6 months after implantation due to bacterial endocarditis. In 8 of 102 patients, a repeated dilatation of the valve was done due to a significant residual systolic pressure gradient, which resulted in a valve-in-valve procedure in four. This study shows that PPVI is feasible and it improves the haemodynamics in a selected patient collective. Apart from one coronary compression, the rate of complications at short-term follow-up was low. Percutaneous pulmonary valve implantation can be performed by experienced interventionalists with similar results as originally published. The intervention is technically challenging and longer clinical follow-up is needed.
    European Heart Journal 01/2011; 32(10):1260-5. · 14.10 Impact Factor
  • European Journal of Cancer - EUR J CANCER. 01/2011; 47.
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    ABSTRACT: Targeted molecular therapies against the epidermal growth factor receptor (EGFR) are novel, promising and potentially radiosensitising therapeutic approaches in the treatment of glioblastoma, a highly malignant and treatment-refractory brain tumour. Despite a solid rational basis, specific EGFR inhibition has rendered only disappointing clinical results to date. We therefore evaluated the efficacy of additional inhibition of human epidermal growth factor receptor 2 (HER2), the 'non-autonomous amplifier' of EGFR signalling. Glioblastoma cells (LN-18, LN-229) with different co-expression levels of EGFR and HER2 were treated with specific EGFR and bispecific EGFR/HER2 tyrosine kinase inhibitors (TKIs) (AG1478, AEE788) and experimental radiotherapy, followed by assessment of growth inhibition. Activity of the major downstream signalling pathways Akt and MAPK was determined by immunoblotting. EGFR-overexpressing LN-18 cells (EGFR++++/HER2+) showed resistance and HER2-overexpressing LN-229 cells (EGFR+/HER2++) showed sensitivity to EGFR-specific inhibition. Interestingly, resistance of LN-18 to EGFR inhibition was overcome by AEE788 treatment, supposedly due to its additional HER2 inhibition. Application of AEE788 resulted in blockage of EGF-dependent EGFR/HER2-heterodimer activation in LN-18 cells, disclosing a possible mediating mechanism for overcoming EGFR-resistance. TKI treatment resulted in significant blockage of both Akt and MAPK signalling pathways, but an incomplete inhibition of PI3K/Akt paralleled the resistance of cells to TKI-induced growth inhibition. Furthermore, the bispecific EGFR/HER2 inhibitor AEE788 showed a radio-sensitising effect in EGFR-overexpressing cells. Taken together, we conclude that inhibition of HER2 in EGFR-overexpressing tumours may harbour the potential to overcome resistance to EGFR-targeted therapy and exert radio-sensitising properties. We suggest that responsiveness to EGFR targeted therapy is mediated through impairment of EGFR/ HER2 heterodimer signalling, and thus depends on the ratio of EGFR to HER2 rather than on the amount of individual receptors.
    International Journal of Molecular Medicine 11/2010; 26(5):713-21. · 1.96 Impact Factor
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    ABSTRACT: To prospectively assess the intestinal symptoms and fecal continence in patients who had undergone conformal radiotherapy (CRT) for prostate cancer. A total of 78 men who had undergone definitive CRT for prostate cancer were evaluated. The patients were assessed before, during (treatment Weeks 4 and 6), and 2, 12, and 24 months after CRT completion. The intestinal symptoms and fecal continence were evaluated with comprehensive standardized questionnaires. The intestinal symptoms were mostly intermittent, with only a small minority of patients affected daily. Defecation pain, fecal urge, and rectal mucous discharge increased significantly during therapy. Defecation pain and rectal mucous discharge had returned to baseline levels within 8 weeks and 1 year after CRT, respectively. However, fecal urge remained significantly elevated for ≤1 year and then returned toward the pretreatment values. The prevalence of rectal bleeding was significantly elevated 2 years after CRT. Fecal continence deteriorated during CRT and remained impaired at 1 year after treatment. Incontinence was mostly minor, occurring less than once per week and predominantly affecting incontinence for gas. Intestinal symptoms and fecal incontinence increased during prostate CRT. Except for rectal bleeding, the intestinal symptoms, including fecal incontinence, returned to baseline levels within 1-2 years after CRT. Thus, the rate of long-term late radiation-related intestinal toxicity was low.
    International journal of radiation oncology, biology, physics 10/2010; 79(5):1373-80. · 4.59 Impact Factor
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    ABSTRACT: A comparative analysis of the three most advanced intensity-modulated radiotherapy (IMRT) techniques currently commercially available was performed. Treatment plans made in rotational techniques (helical tomotherapy [HT] and RapidArc) were compared with sliding-window IMRT (dIMRT) on a conventional linear accelerator using different leaf thicknesses (2.5 mm, 5 mm, and 10 mm). The influence of the different planning techniques on the coverage of planning volume and sparing of organs at risk (OARs) was investigated. Nine patients with localized prostate and nine patients with head and neck cancer were chosen for this study. Treatment planning was performed in Eclipse (Varian) and in Tomotherapy planning software. Treatment plans were compared according to target volume coverage and sparing OARs, as well as by conformity and homogeneity index. For both investigated tumor sites, the dosimetric effects of leaf widths between 2.5 mm, 5 mm and 10 mm were shown to be small in regard to target coverage. Tomotherapy plans had better target coverage (higher minimum dose). For prostate cancer, better sparing of bladder and rectum was achieved with RapidArc and dIMRT plans. For head and neck cancer, best sparing of parotid glands was achieved in HT plans. There was no significant difference (p > 0.05) in sparing of OARs between the dIMRT plans with different leaf widths neither for prostate cancer nor for head and neck cancer. For prostate and head and neck cases, all investigated IMRT techniques provide highly conformal treatment plans in terms of both target coverage and critical structure sparing.
    Strahlentherapie und Onkologie 09/2010; 186(9):502-10. · 4.16 Impact Factor
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    ABSTRACT: Pulmonary atresia with intact ventricular septum (PA-IVS) is a complex congenital heart defect with a large variety of right heart-sided morphologies. We undertook a retrospective review of 86 patients with PA-IVS with a special emphasis on the angiographic findings. The aim of the study was to determine predictors for biventricular repair. Initial surgical procedures depended on the right ventricular morphology, the tricuspid valve size and coronary anomalies. Fifty-five patients (64%) underwent decompression of the right ventricle (RV) as an initial procedure; 16 of them required an additional systemic-to-pulmonary artery shunt. Twenty-six patients (30%) had only a systemic-to-pulmonary artery shunt as their initial procedure. Five patients underwent interventional procedures performed by pediatric cardiologists. Biventricular repair was possible in 56 patients (65%). Univentricular palliation was achieved in 16 patients. Fourteen patients had only palliation with a systemic-to-pulmonary artery shunt. Mean tricuspid valve size was significantly bigger in patients with biventricular repair (z-score -3.6 +/- 2.6) than in patients who did not undergo biventricular repair (-5.2 +/- 1.7, P = 0.003). Predictors for biventricular repair were right ventricular decompression with or without systemic-to-pulmonary artery shunt ( P < 0.001), tripartite right ventricle ( P < 0.001) and the absence of coronary fistulae ( P < 0.001). Long-term survival was 80% +/- 13% at 25 years for patients undergoing biventricular repair. Decompression of the RV as an initial surgical procedure improves the possibility of achieving biventricular repair with good long-term results. However, morphological factors such as right ventricular size and the absence of coronary fistulae are significant predictors for biventricular repair.
    The Thoracic and Cardiovascular Surgeon 09/2010; 58(6):339-44. · 0.93 Impact Factor
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    ABSTRACT: To prospectively assess quality of life (QoL) in patients receiving conformal radiation therapy (CRT) for prostate cancer. 78 men with definitive CRT for prostate cancer were entered into the study. Patients were assessed before CRT, at 40 and 60 Gy, and 2, 12 and 24 months after the end of treatment. QoL was assessed using the EORTC Quality of Life Questionnaire C30 and the prostate module PR25. Changes in mean QoL scores with time of >or= 10 points were considered clinically relevant. Global QoL did not change statistically significant during CRT and was slightly above baseline levels during follow-up. CRT had a statistically significant negative short-term impact on role functioning, fatigue, and PR25 urinary symptoms. The scores recovered within 2 months to 1 year after CRT. Emotional functioning and social functioning scores slightly increased during and after CRT. Role functioning decreased by > 10 points at 60 Gy and urinary symptoms decreased by > 10 points at 40 and 60 Gy. All other differences were < 10 points. A high number of concomitant diseases and having no children were negative pretreatment predictors for long-term global QoL. Definitive CRT for prostate cancer does not compromise global QoL during therapy and up to 2 years after treatment. It has a limited negative effect on role functioning, urinary symptoms and, to a lesser extent, on fatigue with restitution within 2 months to 1 year after treatment.
    Strahlentherapie und Onkologie 01/2010; 186(1):46-52. · 4.16 Impact Factor
  • Strahlentherapie Und Onkologie - STRAHLENTHER ONKOL. 01/2010; 186(1):46-52.
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    ABSTRACT: Recent evidence suggests a close association between extracellular E-cadherin mutation in diffuse-type gastric carcinoma and the acquisition of a migratory phenotype of tumour cells. To characterize the cellular machinery that mediates the gain of motility of tumour cells with mutant E-cadherin, we turned to the small Rho GTPases Rac1 and Rho because they have been implicated in pathological processes including tumour cell migration and invasion. In the present study, we analyse the activity of Rac1 and Rho in relation to E-cadherin harbouring an in-frame deletion of exon 8 and prove for the first time that the mutation reduces the ability of E-cadherin to activate Rac1 and to inhibit Rho. We provide evidence that the lack of Rac1 activation observed in response to mutant E-cadherin influences the downstream signalling of Rac1, as is shown by the decrease in the binding of the Rac1 effector protein IQGAP1 to Rac1-GTP. Moreover, reduced membranous localization of p120-catenin in mutant E-cadherin expressing cells provides an explanation for the lack of negative regulation of Rho by mutant E-cadherin. Further, we show by time-lapse laser scanning microscopy and invasion assay that the enhanced motility and invasion associated with mutant E-cadherin is sensitive to the inhibition of Rac1 and Rho. Together, these findings present evidence that the mutation of E-cadherin influences Rac1 and Rho activation in opposite directions and that Rac1 and Rho are involved in the establishment of the migratory and invasive phenotype of tumour cells that have an E-cadherin mutation.
    Human Molecular Genetics 08/2009; 18(19):3632-44. · 7.69 Impact Factor
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    ABSTRACT: The best method to measure right (RV) and left (LV) ventricle volumes of patients with corrected tetralogy of Fallot is considered cardiac magnetic resonance (CMR). However, to date, no standard protocol to measure RV volumes by CMR exists. RV volumes can be measured from a stack of short-axis slices or a stack of axial slices through the patient's chest. Therefore, the aim of this study was to determine whether short-axis or axial slices are more reliable for routine measurement of RV and LV volumes in patients with corrected tetralogy of Fallot. We studied consecutive patients with corrected tetralogy of Fallot (n = 46) undergoing routine CMR. The end-diastolic and end-systolic RV and LV volumes were measured by 2 investigators unaware of the results of the other measurements using short-axis and axial slices, and the inter- and intraobserver variances were compared. The design of the study was based on the Standards for Reporting of Diagnostic Accuracy. Interobserver variance was significantly smaller using axial slices than using short-axis slices for the RV end-systolic volumes (127.9%(2) vs 315.1%(2); p = 0.003), LV end-diastolic volumes (11.4%(2) vs 36.1%(2); p <0.001), and LV end-systolic volumes (31.9%(2) vs 176.1%(2); p <0.001). Intraobserver variance was significantly smaller using axial slices than using short-axis slices for the RV end-diastolic volumes (26.7%(2) vs 51.1%(2); p = 0.032), LV end-diastolic volumes (11.0%(2) vs 23.5%(2); p = 0.012), and LV end-systolic volumes (34.3%(2) vs 86.1%(2); p = 0.003). In conclusion, axial slices are more reproducible than short-axis slices for measuring ventricular volumes of patients with corrected tetralogy of Fallot by CMR.
    The American journal of cardiology 06/2009; 103(12):1764-9. · 3.58 Impact Factor
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    ABSTRACT: The selective inhibition of tyrosine kinases is a promising strategy in the treatment of several human malignancies. This study aimed to clarify expression patterns of therapeutically addressable receptor tyrosine kinases in colorectal cancer. In this study, we used tissue arrays to analyze 263 specimen of colorectal carcinoma for the expression of the tyrosine kinases c-kit (CD117), epidermal growth factor receptor (EGF-R), and platelet-derived growth factor receptor (PDGF-R). Staining patterns were then correlated with tumor stage and survival. Five tumors (1.9%) showed a strong expression of c-kit (CD117), while in 40 samples (15.2%), a weak/intermediate expression was observed. Positive staining did not correlate with histopathological parameters although a trend toward a better survival of c-kit-positive patients was observed. No positivity for PDGF-R was observed in 263 samples of colorectal carcinomas. Positive EGF-R expression was identified in 39 cases (15.2%), whereas 218 samples (84.8%) stained negative. Our study confirms that expression of the tyrosine kinases c-kit and PDGF-R are rare in colorectal carcinomas and do not correlate with tumor stage.
    Langenbeck s Archives of Surgery 04/2009; 395(4):373-9. · 1.89 Impact Factor
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    ABSTRACT: To compare survival, freedom from reoperation, and functional status between atrial switch and arterial switch operations for transposition of the great arteries. Data from 88, 329, and 512 patients who underwent Mustard, Senning, and arterial switch operations between 1974 and 2006 were analyzed. In-hospital mortalities were 8.0% for Mustard, 4.6% for Senning, and 6.4% for arterial switch. Presence of ventricular septal defect (hazard ratio 3.3, P < .001) was the only risk factor for in-hospital mortality in multivariate analysis. Follow-up for Mustard was 22.6 +/- 8.1 years, for Senning was 18.2 +/- 5.7 years, and for arterial switch was 9.5 +/- 5.7 years. Highest survival at 20 years was after arterial switch (96.6% +/- 1.3%), followed by Senning (92.6% +/- 1.5%) and Mustard (82.4% +/- 4.3%). Transposition with ventricular septal defect (hazard ratio 3.1, P < .001), transposition with ventricular septal defect and left ventricular outflow tract obstruction (hazard ratio 3.0, P = .029), and Mustard operation (hazard ratio 2.1, P = .011) emerged as risk factors for late death, with arterial switch a protective factor (hazard ratio 0.3, P = .010). Highest freedom from reoperation at 20 years was after Senning (88.7% +/- 1.9%), followed by arterial switch (75.0% +/- 6.4%) and Mustard (70.6% +/- 5.4%). Presence of complex transposition (hazard ratio 2.1, P < .001), previous palliative operation (hazard ratio 1.8, P = .016), surgery between 1985 and 1995 (hazard ratio 2.6, P = .002), surgery after 1995 (hazard ratio 3.5, P < .001), and Mustard operation (hazard ratio 3.3, P < .001) emerged as risk factors for reoperation. Change from atrial to arterial switch led to improved long-term survival after hospital discharge but not to lower incidence of reoperation. Survival and freedom from reoperation are determined by morphology.
    The Journal of thoracic and cardiovascular surgery 02/2009; 137(2):347-54. · 3.41 Impact Factor
  • Thoracic and Cardiovascular Surgeon - THORAC CARDIOVASC SURG. 01/2009; 56.
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    ABSTRACT: Cyclophosphamide, methotrexate and 5-fluorouracile (CMF)-based chemotherapy for adjuvant treatment of breast cancer reduces the risk of relapse. In this exploratory study, we tested the feasibility of identifying molecular markers of recurrence in CMF-treated patients. Using Affymetrix U133A GeneChips, RNA samples from 19 patients with primary breast cancer who had been uniformly treated with adjuvant CMF chemotherapy were analyzed. Two supervised class prediction approaches were used to identify gene markers that can best discriminate between patients who would experience relapse and patients who would remain disease-free. An additional independent validation set of 51 patients and 21 genes were analyzed by quantitative RT-PCR. Applying different algorithms to evaluate our microarray data, we identified two gene expression signatures of 21 and 12 genes containing eight overlapping genes, that predict recurrence in 19 cases with high accuracy (94%). Quantitative RT-PCR demonstrated that six genes from the combined signatures (CXCL9, ITSN2, GNAI2, H2AFX, INDO, and MGC10986) were significantly differentially expressed in the recurrence versus the non-recurrence group of the 19 cases and the independent breast cancer patient cohort (n = 51) treated with CMF. High expression levels of CXCL9, ITSN2, and GNAI2 were associated with prolonged disease-free survival (DFS) (P = 0.029, 0.018 and 0.032, respectively). When patients were stratified by combined CXCL9/ITSN2 or CXCL9/FLJ22028 tumor levels, they exhibited significantly different disease-free survival curves (P = 0.0073 and P = 0.005, respectively). Finally, the CXCL9/ITSN2 and CXCL9/FLJ22028 ratio was an independent prognostic factor (P = 0.034 and P = 0.003, respectively) for DFS by multivariate Cox analysis in the 70-patient cohort. Our data highlight the feasibility of a prognostic assay that is applicable to therapeutic decision-making for breast cancer. Whether the biomarker profile is chemotherapy-specific or whether it is a more general indicator of bad prognosis of breast cancer patients remains to be explored.
    Breast Cancer Research and Treatment 11/2008; 118(1):45-56. · 4.47 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the use of thymidilate synthetase (TS), thymidilate phosphorylase (TP), dihydropyrimidin dehydrogenase (DPD), Her-2/neu, and cyclin D1 as predictors of therapy response, survival, and recurrence in patients with esophageal squamous cell carcinoma (ESCC) following radiochemotherapy. Twenty-six patients with histologically proven intrathoracic, locally advanced ESCC (cT3, cN0/+, cM0) underwent preoperative, combined simultaneous radiochemotherapy followed by R0-transthoracic esophagectomy. Because R0 resection is the strongest known independent prognostic factor in this tumor entity, only R0-resected patients were included in this study. Pre-therapeutically taken, formalin-fixed, and paraffin-embedded tumor biopsies were used for laser-assisted microdissection of tumor cells and RNA extraction and subjected to real-time (TaqMan) quantitative reverse transcriptase-polymerase chain reaction (Q-RT-PCR). No significant correlation between clinical or histopathological parameters and the relative gene expression of TS, TP, DPD, or Her-2/neu was observed. However, patients with relative cyclin D1 levels below the median gene expression did not reach median survival compared to the 19.9 months seen in patients with relative cyclin D1 gene expression above the median (P = 0.02). Patients with low cyclin D1 levels experienced significantly less frequent recurrence of the tumor (20% versus 63%; P = 0.006), and there was a significant difference in the recurrence-free interval (P = 0.003). Despite the small number of investigated patients, our data seem to show that high levels of cyclin D1 measured by real-time Q-RT-PCR before neoadjuvant radiochemotherapy correlate significantly with patient survival, tumor recurrence, and recurrence-free-interval. Cyclin D1 might be useful in identifying patients at high risk of poor prognosis and suffering from recurrence after neoadjuvant radiochemotherapy treatment and R0 resection. Further investigations with a larger cohort are warranted.
    International Journal of Colorectal Disease 09/2008; 24(1):69-77. · 2.24 Impact Factor
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    ABSTRACT: We report a comparative analysis of 2 sequential, prospective phase II trials on the efficacy of platinum/leucovorin/5-fluorouracil (PLF) +/- paclitaxel (T-PLF) in the neoadjuvant treatment of adenocarcinoma of the esophagus (AEG I). Inclusion criteria were histologically proven, locally advanced AEG I stage uT3/4 anyN cM0/M1a. 67 patients were treated with either PLF (n = 32) or T-PLF (n = 35). Paclitaxel (80 mg/m(2)) was added to PLF on days 1, 15, and 29. Primary endpoint was the response. Additionally, 5-year survival was analyzed. The study population was well balanced, apart from an imbalance in clinical cM1a (33.3% PLF vs. 8.6% T-PLF; p = 0.01). Histopathological response rates (23.3% PLF vs. 25.0% T-PLF) showed no significant difference. Clinical response rates were improved for T-PLF (21.9 vs. 45.7%; p = 0.04). Median overall survival for clinical and histopathological responders was significantly improved for T-PLF (p = 0.005, p = 0.01), but not for PLF (p = 0.08, p = 0.25). Median overall survival was better with T-PLF without reaching statistical significance (18.9 months PLF vs. 43.1 months T-PLF; p = 0.27). Toxicity was slightly increased by paclitaxel. No treatment-related deaths occurred. Our data failed to demonstrate statistically significant superiority of the T-PLF regimen except for clinical response. However, there was a trend towards improved survival.
    Onkologie 08/2008; 31(7):366-72. · 1.00 Impact Factor
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    ABSTRACT: Tricuspid valve (TV) surgery is usually performed as a concomitant reconstruction procedure in addition to the correction of other cardiac pathologies. Isolated tricuspid procedures are exceptionally rare. Prosthetic valve replacement is also seldom required. Generally, these patients face a high risk of operative mortality and long-term outcome is poor. In this study we reviewed our experience with TV surgery focusing on risk factors for operative mortality, long-term outcome and incidence of valve related complications. Retrospective analysis of 416 consecutive patients >18 years with acquired TV disease operated on between 1974 and 2003. The follow-up is 97% complete (mean 5.9+/-6.3 years). Three hundred and sixty-six patients (88%) underwent TV surgery with concomitant mitral (n=340) or aortic (n=100) valve surgery. The tricuspid valve was repaired in 310 patients (74.5%) and replaced in 106 (25.5%). A biological prosthesis was used in 68 patients (64%). Mean age at repair and replacement was 61+/-12.5 and 50+/-11.3 years, respectively (p<0.001). Overall 30-day mortality was 18.8% (78/416) and decreased from 33.3% (1974-1979) to 11.1% (2000-2003) (p< or =0.0001). Thirty-day mortality after TV repair and replacement was 13.9% (43/310) and 33% (35/106), respectively (p< or =0.001). Cox regression analysis revealed TV replacement as an independent predictor of 30-day mortality. Ten-year actuarial survival after TV repair and replacement was 47+/-3.5% and 37+/-4.8%, respectively (p=0.002). Forty-five patients (10.8%) required a TV re-operation after 7.7+/-5.1 years. Freedom from TV re-operation 10 years after TV repair and replacement was 83+/-3.6% and 79+/-6.1%, respectively (p=0.092). Patients who require tricuspid valve surgery constitute a high-risk group. Tricuspid valve repair is associated with better perioperative and long-term outcome than valve replacement. However, patients undergoing replacement showed a significant higher incidence of risk factors for operative mortality. The incidence of re-operation is low with no significant difference when the tricuspid valve has been repaired or replaced. When valve replacement is necessary we recommend the use of a biological prosthesis considering the poor long-term survival.
    European Journal of Cardio-Thoracic Surgery 08/2008; 34(2):402-9; discussion 409. · 2.67 Impact Factor
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    ABSTRACT: Patients after atrial switch operation for transposition of the great arteries have limited exercise performance. Rigid atrial baffles may cause a relative preload reduction. Previous studies have had suboptimal control groups, which ideally should consist of patients with congenitally corrected transposition of the great arteries (ccTGA) without previous heart surgery, having a systemic right ventricle, but lacking rigid atrial baffles. Therefore the aim of this study was to test the impact of atrial baffles by comparing 12 atrial switch patients with 11 ccTGA patients. Systemic right ventricular stroke volume (SV), heart rate, cardiac index, and other parameters were assessed during rest and dobutamine stress magnetic resonance imaging. The most important difference between the groups was that the atrial switch patients could not increase SV during stress, whereas ccTGA patients increased it significantly. There was no difference between groups in the rise of the cardiac index. Heart rate increased significantly more in atrial switch patients than in ccTGA patients. The results support the hypothesis that atrial baffles restrict a rise in SV under dobutamine stress in patients after atrial switch operation for transposition of the great arteries.
    Circulation Journal 08/2008; 72(7):1130-5. · 3.58 Impact Factor

Publication Stats

3k Citations
477.57 Total Impact Points

Institutions

  • 1992–2012
    • Deutsches Herzzentrum München
      • Department of Cardiovascular Surgery
      München, Bavaria, Germany
  • 1987–2010
    • Technische Universität München
      • • Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie
      • • Clinic and Polyclinic for Surgery
      • • Institut für Allgemeine Pathologie und Pathologische Anatomie
      • • Medizinische Klinik und Poliklinik III - Hämatologie/Onkologie
      München, Bavaria, Germany
  • 2008
    • Helmholtz Zentrum München
      • Institut für Pathologie
      München, Bavaria, Germany
  • 2004–2007
    • Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
      Tlalpam, The Federal District, Mexico
  • 1992–1993
    • University of Cologne
      • Institute of Pathology
      Köln, North Rhine-Westphalia, Germany