Medication review of community-dwelling seniors using intensified home-care service.

UNLABELLED: Investigations on medication burden, falling, and inappropriate dosing in renal impairment have been obtained in patients living in nursing homes. Data from home-dwelling patients in intensified ambulatory care, especially from Germany are scant. MATERIAL AND METHOD: We evaluated patients daily visited by an ambulatory care service (Cohort 1, n = 102, median age 80 y) or had care given by relatives only (cohort 2, n = 101, median age 76 y) at baseline (V1), 6 (V2) and 12 months (V3). RESULTS: At V1 patients in Cohort 1 had 5 (median, range 3 - 15) and at V3 6 (3 - 17) medications. No differences could be observed between cohorts regarding number and pattern of medications. At V1, 30/102 patients of Cohort 1 had creatinine measured within the last 6 months, 13/30 patients had an eGFR < 50 ml/min. 6/34 medications which need dose-adjustment were unadjusted. Low surveillance of renal function and unadjusted dosing were also observed at other visits and also in Cohort 2. Within 1 year, 29/75 mobile patients in cohort 1 had a fall, 18/29 patients had a benzodiazepine prescribed regularly, whereas a benzodiazepine was prescribed in 6/46 patients which did not fall (chi2 p = 0.004). In Cohort 2, the number of falling patients was lower (19/84 mobile patients, p = 0.028). 11/19 patients had a benzodiazepine prescribed, in contrast to 5/65 patients which did not fall (chi2 p = 0.001). CONCLUSIONS: It needs to be elucidated whether a care service can contribute to medication safety in patients e.g. by reviewing medication charts and organizing for controls of ancillary laboratory values.

Combined androgen deprivation therapy in recurrent androgen-receptor-positive salivary duct carcinoma - a case report and review of the literature.

Salivary duct carcinoma (SDC) is a rare and highly aggressive neoplasm of the salivary glands associated with high rates of local and distant recurrence and poor overall survival. We present a patient with SDC, who relapsed despite extensive multimodal therapy including surgery, postoperative radiochemotherapy, and heavy ion therapy. In the recurrent setting, immunohistochemical analysis confirmed androgen receptor positivity, prompting initiation of combined androgen deprivation therapy (ADT), which resulted in a fast and durable remission of the local tumor now lasting for 26 months. Analyzing the histopathologic specimens of all SDC patients treated at our department since 2009, we found significant AR expression in all patients. This is in line with other reports found in current literature and indicates AR positivity as a consistent feature of SDC, supporting ADT as a viable therapeutic option for SDC.

On the use of multi-dimensional scaling and electromagnetic tracking in high dose rate brachytherapy.

High dose rate brachytherapy affords a frequent reassurance of the precise dwell positions of the radiation source. The current investigation proposes a multi-dimensional scaling transformation of both data sets to estimate dwell positions without any external reference. Furthermore, the related distributions of dwell positions are characterized by uni-or bi-modal heavy-tailed distributions. The latter are well represented by α-stable distributions. The newly proposed data analysis provides dwell position deviations with high accuracy, and, furthermore, offers a convenient visualization of the actual shapes of the catheters which guide the radiation source during the treatment.

Recurrence rate and shift in histopathological differentiation of oral squamous cell carcinoma ­ A long-term retrospective study over a period of 13.5 years.

OBJECTIVE: Little information is available as to whether recurrences of oral squamous cell carcinoma (OSCC) show different histopathological grades than the primary tumor and whether postoperative radiotherapy (PORT) influences the grade of differentiation in the case of recurrence. The objective of this study was the evaluation of recurrence rates and change in differentiation. MATERIAL AND METHODS: This retrospective, single-institution cohort study included surgically treated OSCC patients over a 13-year period (2000-2013). The relationship among tumor size, lymph node metastases, and recurrence rate of OSCC was investigated. Primary tumor differentiation was compared with differentiation of recurrence. RESULTS: A total of 429 patients (277 men and 152 women) were included in this study. Of these, 124 (28.9%) received PORT. The incidence of primary cervical metastases increased significantly with tumor size (p < 0.001). Recurrence developed in 82 patients (19.1%). Stage T1/T2 showed a significantly lower recurrence rate than stage T3/T4 (16.3% vs. 30.2%) (p < 0.01). A total of 23 (30.7%) patients with recurrence showed a change in differentiation. CONCLUSION: Increasing primary tumor size correlates with incidence of cervical metastases and recurrence rate. Initial cervical metastases show no effect on recurrence rates. Differentiation of primary tumor does not correlate with the recurrence rate. The majority of recurrences show consistent histopathological grading.

Sensitivity and specificity of cone beam computed tomography in thin bony structures in maxillofacial surgery ­ A clinical trial.

INTRODUCTION: Cone-Beam Computed Tomography (CBCT) has become widely used in dentistry and maxillofacial surgery. Accuracy, sensitivity and specificity of thin bony structures below 0.5 mm have been subject of some in vitro studies. This prospective in vivo study investigates the correlation between preoperative CBCT-imaging and intraoperative clinical examination of thin bony structures. We hereby present results from daily clinical routine. METHODS: A total number of 80 sites in 64 patients has been examined to differentiate between preoperative 3D imaging and clinical measurements on cystic lesions in maxilla and mandible. Different CBCT-devices with a voxel size ranging from 0.08 mm to 0.4 mm were used. RESULTS: Overall-specificity found for detecting thin bony structures of the human jaw is 13.89%, overall sensitivity is 100%, positive predictive value (PPV) is 58.67% and negative predictive value (NPV) is 100%. DISCUSSION: Image quality is the key to make use of additional information CBCT provides and depends on spatial, temporal and contrast resolution. CBCT does not depict reliably thin bony structures of the jaw, even if high voxel resolution is used. CONCLUSION: In selected cases using high resolution protocols should be considered despite affecting the patient with higher doses of radiation.

Comparison of virtual and titanium clip marking of tumour resection margins for improved radiation planning in head and neck cancer surgery.

Communication between the surgeon and the radiation oncologist is improved with the use of virtual models of the final tumour resection, combining three-dimensional imaging and conventional clip marking with computer-aided navigation. This investigation was designed to determine the deviation of virtual marking procedures compared to conventional marking by titanium ligature clips in oral cancer with different localizations. Seventeen patients with surgically placed clips and virtual landmarks on the resection margin after complete tumour ablation were evaluated. To determine whether the virtual landmarks remain predictive of the resection margin, the deviation of the virtual points from their corresponding clips was analyzed by measuring the distance between their centres of gravity. In total, 189 clips were evaluated. Metric analyses of the deviation between the virtual points and clips showed a deviation of 2.3 ± 0.6mm for tumours with a maxilla localization, 7.2 ± 2.5mm for tumours with a mandible localization, and 12.6 ± 3.8mm for tumours with a tongue localization. A significant statistical relationship was demonstrated in the virtual point-clip deviation as a function of tumour localization. Virtual marking of maxillary tumour resection margins allows accurate definition of the former tumour bed and could lead to novel adjuvant treatment strategies.

Human immunodeficiency virus (HIV)-specific antibodies, neutralizing activity and antibody-dependent cellular cytotoxicity (ADCC) in the cerebrospinal fluid of HIV-infected patients.

We assessed the capacity of cerebrospinal fluids (CSF) and sera from human immunodeficiency virus (HIV)-seropositive patients to neutralize HIV and to mediate specific antibody-dependent lysis of HIV-infected target cells. A local HIV-specific intrathecal antibody synthesis was found in all stages of HIV infection regardless of neurological manifestations. Virus-neutralizing antibodies could not be detected in the CSF of patients with primary encephalitis or polyneuropathy. Cytotoxic antibodies mediating HIV-specific antibody-dependent cellular cytotoxicity (ADCC) were demonstrable in the CSF of most patients without evidence of central nervous system (CNS) involvement, but only in 43% of cases with HIV encephalitis. In some cases, the exclusive detection of ADCC activity in either the CSF or serum compartment suggested the presence of non-identical target antigens in the CSF and serum of the same patient. Further studies are needed to clarify the significance of these findings for the manifestation of CNS involvement in HIV infection.

Postmortem viability of the human immunodeficiency virus.

In 1989 blood samples from 2581 fatalities investigated at the Institute of Forensic Medicine in Hamburg were screened for HIV-1-antibodies. Sera from 13 corpses were confirmed positive for HIV-1 (prevalence rate approx 0.5%).-Viable HIV was found in blood cultures of 4 cadavers stored under non-refrigerated conditions up to 36 hours after death.

Rotavirus antigen detection in patients with HIV infection and diarrhea.

A wide variety of bacterial, viral, and parasitic pathogens can cause severe diarrhea in patients with advanced human immunodeficiency virus (HIV) infection. The role of enteric viruses, especially rotaviruses, in HIV-related diarrhea is still unclear. One hundred and six stool samples from 66 HIV-infected patients with otherwise unexplained diarrhea and 35 samples from 35 patients with advanced HIV infection but without diarrhea were tested for the presence of rotavirus antigen. Rotavirus was detected in 13 samples from 9 patients with diarrhea and in none of the samples from patients without diarrhea. Two patients had recurrence of rotavirus infection more than 6 months after the first episode. Rotavirus was associated with prolonged diarrhea, often accompanied by abdominal cramping. Symptoms were readily controlled with anti-diarrheal and pain-relieving measures. Illness was self-limited and did not require hospitalization. A seasonal variation, typical of infantile rotavirus infection, was not observed in this setting. While rotavirus infection has been infrequently detected in American HIV-infected patients, the prevalence in Australia and Europe appears to be considerably higher.