Im Rahmen einer Phase II-Studie wurde der Stellenwert einer definitiven simultanen Radiochemotherapie mit Cisplatin/Etoposid mit anschließender Erhaltungschemotherapie mit Gemcitabine und Cis- bzw. Carboplatin bei primär nicht operablem nicht-kleinzelligen Bronchialkarzinom geprüft. Zwischen 01/02 und 10/04 wurden 30 Patienten mit inoperablem nicht-kleinzelligen Bronchialkarzinom (bis Stadium IIIb) behandelt. Alle Patienten wurden 3-D-konformal bis zu einer Dosis von 45,0 Gy standardfraktioniert bestrahlt. Simultan wurden an den Tagen 1–5 und 29–33 zwei Chemotherapiezyklen mit Cisplatin (20mg/m2 KOF) und Etoposid (90mg/m2 KOF) verabreicht. Danach erfolgte eine hyperfraktionierte, akzelerierte Bestrahlung bis zur Enddosis von 66,6 Gy. Nach Abschluss der RCT wurden 4 Zyklen Erhaltungschemotherapie mit Gemcitabine (900mg/m22 KOF, d1+8) und Cisplatin (70mg/m2 KOF, d2) bzw. Carboplatin nach AUC 5, d1 verabreicht. Die Zwischenauswertung nach 30 Patienten zeigte folgende Ergebnisse: Die Ansprechrate nach Abschluss der Therapie betrug 90% (7% CR, 83% PR). Die Gesamtüberlebensrate lag nach 24 Monaten bei 63%, progressionsfrei nach 24 Monaten waren 59%. Hämatotoxische Nebenwirkungen traten in Form von Leukopenie Grad3/4 mit 32%, sowie Thrombopenie Grad3 mit 9,6% auf. Nichthämatologische Toxizität, wie Grad2 Ösophagitiden traten bei 4 Patienten auf, Pneumonitis Grad3 bei 1 Patienten, Grad2 bei 2 Patienten. Keine therapiebedingte Todesfälle. Die Rekrutierung wird noch fortgeführt. Vorgestellt werden die endgültigen Daten nach Abschluss der Rekrutierung. Sollten sich die bisherigen Ergebnisse bestätigen, so kann die definitive simultane Radio-Chemotherapie mit Cisplatin/Etoposid und Erhaltungschemotherapie mit Gemcitabine und Platin als tolerabel und effektiv angesehen werden.
Introduction: Catheter ablation is an established therapy for the treatment of symptomatic atrial fibrillation (AF). Current guidelines recommend catheter ablation for drug-refractory paroxysmal AF (PAF) in adults, and as first-line therapy in selected patients. However, long-term data on the efficacy and safety of catheter ablation for PAF in young adults is very limited. Methods: From 2005 to 2014, 52 consecutive young adults (32 men, 20 women) with symptomatic PAF underwent pulmonary vein isolation (PVI). The procedure end point was complete PVI (entrance block) verified by circular catheters placed within the PVs. Follow-up was based on regular outpatient clinic visits including 24h Holter-ECGs and telephone interviews at last follow-up. Recurrence was defined as any symptomatic and/or documented atrial tachyarrhythmia episode [30 s following a 3-month blanking period]. Results: Mean patient age at the time of the index procedure was 30 ± 4 years (range 19-35). Complete PVI by either radiofrequency current guided by 3-dimensional mapping (n = 50) or cryoballoon (n = 2) was achieved in 51/52 patients (98%). Six patients were lost to follow-up. During a mean follow-up period of 4.9 years (range 1.0-9.7 years) stable sinus rhythm was achieved in 65% after a single procedure, and in 83% after multiple procedures (mean 1.5; range 1-3). Success rate at last follow-up off anti-arrhythmic drugs was 74%. Eight patients (17%; 3 with stable sinus rhythm) were taking antiarrhythmic drugs (AAD; only class I) at last follow-up compared to 26 patients (57%, p < 0.01) before the index procedure. A second procedure was performed in 19, and a third procedure in 2 patients. PV reconduction was observed in 16 patients (84%) during the second, and in 1 patient (50%) during the third procedure. EHRA score significantly improved at last follow-up (mean 3.2 to 1.2, p < 0.001). Major periprocedural complications occurred in 3 patients (tamponade in 1, PV stenosis in 2). No patient progressed towards persistent AF. Conclusions: In the majority of very young adults ≤35 years of age, catheter ablation for PAF is effective during long-term follow-up and associated with a low complication rate. These findings support the concept of PVI in very young adults with symptomatic PAF.
Introduction: Catheter-based pulmonary vein isolation (PVI) is an established treatment option for atrial fibrillation (AF). Aim of this study was to quantify the extent of the ablation zone after wide area circumferential (WAC) PVI applying a novel high density mapping system (Rhythmia – Boston scientific). Methods: 20 consecutive pts underwent WAC-PVI for AF using the Rhythmia System in conjunction with the Orion mini-basket catheter, which was utilized to create a detailed 3-dimensional electroanatomic map of the LA and PVs during sinus rhythm, before and after the ablation procedure. Results: Mean pts age was 60 ± 4 years. 60 % had paroxysmal and 40% persistent AF. LA diameter was 45 ± 10 mm and LV ejection fraction was 55 ± 10%. PV anatomy was normal in all patients. A total of 9772 ± 3108 mapping points were taken for the initial map and 7910 ± 2344 points for the remap. Mapping time for the initial map was 19 ± 4.2 min and 10.8 ± 3.2 min for the remap. When comparing the initial voltage map with the remap after WAC – PVI, PVs and all PV antra, during remapping were isolated and displayed scar (<0.2mV), while the LA roof had scar in 10 out of 20 patients (50%), although intentionally no roof line was placed (Figure 1 showing left atrium voltage map performed before (A) and after ablation (B)). Posterior wall (PW) area during the initial map was 19,7 ± 3,5 cm2 and the ablated area at the PW during remapping was 7,8 ± 3,34 cm2 ( 40 ± 17%), although no additional lesions were intentionally placed. When the posterior wall was divided into four segments, there were no significant statistical differences regarding the location and extent of ablation zones at the PW after WAC-PVI (Table).
The telemonitoring of heart failure (HF) patients is becoming increasingly important. This study aimed to evaluate the benefit of telemonitoring in end-stage HF patients with a ventricular-assistance device (VAD). A total of 26 HF-patients (66 ± 11 years, 88% male) on VAD therapy with an implantable cardioverter-defibrillator (ICD) or a cardiac resynchronization defibrillator (CRT-D) including telemonitoring function were enrolled. The long-term follow-up data (4.10 ± 2.58 years) were assessed. All the patients (n = 26, 100%) received daily ICD/CRT-D telemonitoring. In most of the patients (73%, n = 19), the telemedical center had to take action for a mean of three times. An acute alert due to sustained ventricular arrhythmias (VAs) occurred in 12 patients (63%) with 50% of them (n = 6) requiring ICD shock delivery. Eight patients (67%) were hospitalized due to symptomatic VAs. In 11 patients (92%), immediate medication adjustments were recommended. Relevant lead issues were revealed in thirteen patients (50%), with six patients (46%) undergoing consecutive lead revisions. Most of the events (83%) were detected within 24 h. Daily telemonitoring significantly reduced the number of in-hospital device controls by 44% (p < 0.01). The telemonitoring ensured that cardiac arrhythmias and device/lead problems were identified early, allowing pre-emptive and prompt interventions. In addition, the telemonitoring significantly reduced the number of in-hospital device controls in this cohort of HF patients.
Fragestellung: Bislang gab es außer der lateralen Vaginopexie keine Alternative zur Sakropexie, wenn es um die Behandlung de Traktionszele ging. Die transobturatorielle Technik erlaubt es nun für die Blase ein Widerlager zu schaffen, ohne dass man die Scheide direkt in den Prozess einbeziehen muss. Wir stellen die Technik und erste Ergebnisse vor.
Deletions or translocations of 13q, most commonly involving band 13q14, belong to the most frequent structural chromosome abnormalities in B-cell chronic lymphocytic leukemia (B-CLL). In a combined metaphase and interphase cytogenetic study using conventional G-banding analysis and fluorescence in situ hybridization (ISH) we previously analysed the retinoblastoma susceptibility gene (RB-1) and its chromosomal locus 13q14 in 35 patients with chronic B-cell leukemias. We report here on the interphase cytogenetic analysis of 109 cases with chronic B-cell leukemias [B-CLL = 90; B-prolymphocytic leukemia (B-PLL) = 6, hairy cell leukemia (HCL) = 13]; a subset of 49 patients (B-CLL = 45; B-PLL = 4) was studied by conventional G-banding analysis. By G-banding, 5/45 (11%) patients with B-CLL had deletions or translocations affecting band 13q14; in contrast, ISH to interphase cells showed RB-1 deletion in 19/90 (21%) patients with B-CLL. No 13q14 abnormalities or RB-1 deletion were detected in patients with B-PLL and HCL. Our data confirm the high frequency of RB-1 deletions in B-CLL and further emphasize the possible pathogenetic role of this genomic region.
