Volker Kaechele

Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development.

Objectives: The objective of the present study was to investigate the prevalence of gallbladder stone disease (GD) in a collective of obese children and adolescents and to assess the role of potential influencing factors such as the degree of obesity, sex, age, and pubertal development. Methods: Four hundred ninety-three obese children and adolescents (body mass index standard deviation score [BMI-SDS] > 2.0p) aged 8 to 19 years (218 males, 275 females) were included in the study and underwent ultrasound for detection of GD. Results: Gallbladder stones were detected in 10 of 493 (2.0%; 8 girls, 2 boys) subjects studied. None of the 95 prepubertal children examined were found to suffer from GD. Patients with GD were more severely obese (BMI-SDS 3.4 ± 0.5 vs. 2.7 ± 0.4; P < 0.001) and older (16.1 ± 1.5 vs.13.9 ± 2.0 years; P < 0.008) than children and adolescents without GD. Conclusions: Compared with published data for unselected children an adolescents, the prevalence of GD (2.0%) in obese children and adolescents, previously treated with diet for obesity, is high. Obesity and female sex appear even in children and adolescents to be risk factors for the development of GD. The occurrence of prepubertal GD is rare.

Factors affecting liver size: A sonographic survey of 2080 subjects

Objective. We sought to determine the size of the liver in a nonselected population sample to establish normal and reference values and to study potential factors influencing liver size. Methods. A total of 2080 subjects (983 male and 1097 female; age range, 18–88 years) underwent prospective ultrasound examination to determine the size of the liver. Subjects also underwent physical examination and completed a short standardized interview questionnaire covering potential factors influencing liver size. Data were evaluated descriptively. The influence of multiple variables on liver size was studied by means of a covariance analysis. Results. The average measured liver diameter (midclavicular line) ± SD was 14.0 ± 1.7 cm (median, 13.9 cm; range, 9.4–21.3 cm; average in male subjects, 14.5 ± 1.6 cm; and average in female subjects, 13.5 ± 1.7 cm). Results of the multivariate analysis showed that the factors body mass index, body height, sex, age, and (in male subjects) frequent alcohol consumption exert an influence over liver size measured at the midclavicular line. Conclusions. The sonographic measurement of liver size at the midclavicular line was shown to be an easy and practical method for routine use. Only in 239 (11.5%) of 2080 subjects did the size of the liver measured at the midclavicular line exceed 16 cm. Body mass index and body height are the most important factors associated with the diameter of the liver measured at the midclavicular line.

Ultrasonographically detected gallbladder polyps: A reason for concern? A seven-year follow-up study

BackgroundThe management of coincidental detected gallbladder polyps (GP) is still nebulous. There are few published data regarding their long-term growth. Objective of the present study was to investigate the prevalence and growth of gallbladder polyps in a survey of unselected subjects from the general population of a complete rural community.MethodsA total of 2,415 subjects (1,261 women; 1,154 men) underwent ultrasound examination of the gallbladder, in November 1996 as part of a prospective study. Subjects in whom GP were detected at the initial survey underwent follow-up ultrasound examinations after 30 and 84 months.ResultsAt the initial survey gallbladder polyps were detected in 34 subjects (1.4%; females: 1.1%, range 14 to 74 years; males: 1.7%, range 19 to 63 years). Median diameter was 5 ± 2.1 mm (range 2 to10 mm) at the initial survey, 5 mm ± 2.8 mm (range 2 to 12 mm) at 30 months and 4 ± 2.3 mm (range 2 to 9 mm) at 84 months. At the time of first follow-up no change in diameter was found in 81.0% (n = 17), reduction in diameter in 4.8% (n = 1) and increase in diameter in 14.3% (n = 3). At the time of second follow-up no increase in polyp diameter was found in 76.9% (n = 10) and reduction in diameter in 7.7% (n = 1). No evidence of malignant disease of the gallbladder was found.ConclusionOver a period of seven years little change was measured in the diameter of gallbladder polyps. There was no evidence of malignant disease of the gallbladder in any subject.

HLA polymorphisms influence the development of skin rash arising from treatment with EGF receptor inhibitors

AIM Development of a skin rash under treatment with EGF receptor (EGFR) inhibitors (EGFRIs) has been linked to a favorable prognosis in some studies, suggesting a possible immunological role for EGFRIs in addition to direct antagonistic downstream effects. The present study aimed to investigate whether particular HLA polymorphisms found in cancer patients treated with EGFRIs are associated with the development of skin rash and overall survival rates. PATIENTS & METHODS HLA typing was performed on 105 cancer patients and the development of skin rash was rated during the first 4 weeks of therapy with EGFRIs. RESULTS A significantly lower incidence of skin rash was found in patients carrying the HLA-A*02:01 or HLA-A*03:01 alleles (hazard ratio: 0.277; 95% CI: 0.121-0.634; p = 0.002 and hazard ratio: 0.292; 95% CI: 0.113-0.752; p = 0.011, respectively); however, no association with worse survival was seen. CONCLUSION The chances of developing a skin rash in patients treated with EGFRIs may be lower in patients that carry the HLA-A*02:01 or HLA-A*03:01 alleles, while the antitumor efficacy of EGFRIs does not seem to be significantly impaired in these patients.

Response to Reintroduction of Cetuximab in 5 Patients with Advanced, Chemotherapy-Resistant, Colorectal Cancer without Progressive Disease following First-Line Therapy with a Cetuximab-Containing Regimen

Objective: We aimed to determine the response to cetuximab in advanced, chemotherapy-resistant, colorectal cancer following successful first-line therapy with the antibody. Methods: Five patients with metastatic colorectal cancer were treated with a cetuximab-containing regimen after failure of several conventional chemotherapies. Results: These patients had been successfully treated with cetuximab as first-line therapy, and the antibody was then discontinued without disease progression. No severe toxicities were observed upon reexposure to cetuximab. Partial response was noted in 1 patient and tumor stabilization in 2 patients. Conclusion: Reintroduction of cetuximab in combination with chemotherapy is safe and efficacious in patients with colorectal cancer whose tumors were not refractory to a prior cetuximab-containing therapy.

Beneficial Treatment Management with Trifluridine/Tipiracil in a Patient with Metastatic Colorectal Cancer and Pronounced Hematological Event History during Previous Treatments

Trifluridine/tipiracil (FTD/TPI) significantly improves overall survival in patients with metastatic colorectal cancer (mCRC). The most common treatment-related event (grade ≥3) was hematological toxicity. We here report long-term disease-stabilizing FTD/TPI treatment of an mCRC patient (KRAS wild-type, ECOG performance status 1 at baseline and at the end of FTD/TPI therapy) with multifocal synchronous metastases and a longstanding history of extensive hematological events during previous treatments. Finally, this 62-year-old male patient was treated for 10 months with FTD/TPI by consecutive alteration of treatment parameters: (i) initial daily dose reduction to 80 mg (72% of the recommended dose), (ii) 20 days dose delay, (iii) a second and later third dose reduction to 70 mg and 60 mg (about 64% and 55%, respectively, of the recommended dose), and (iv) 30 µg per day of granulocyte colony-stimulating factor administration first for 3 days, and later for 5 days, for each treatment cycle.