ORCID Profile
0000-0002-1574-6572
Current Organisation
Peter MacCallum Cancer Centre
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Publisher: Springer Science and Business Media LLC
Date: 09-11-2020
DOI: 10.1186/S12893-020-00892-8
Abstract: Vision is an essential element of laparoscopic surgery that defines the outcome of an operation in regards to time, mistakes and precision. A 3-dimensional (3D) perspective may improve vision during an operation. Therefore, this study was designed to compare 3D versus 2-dimensional (2D) perspectives using a pelvitrainer model. Fifty candidates were ided into 3 categories based on different experience levels. The candidates were randomised into two groups, with each group performing the same 4 standardised tasks. Group A approached the tasks first with 3D high definition and in a second turn with 2D high definition. Group B carried out the tasks with the systems in reverse order. Task completion time and the number of mistakes made for each task were recorded. After completing the tasks, participants answered questions concerning the two systems. Group A was, on average, 20% faster at all four tasks and made approximately 18% fewer mistakes in two of the tasks in comparison to group B. The experts significantly benefited from the 3D system in terms of accuracy compared to non-experts and students. The students demonstrated a significantly greater benefit from the 3D system when performing non-linear, continuous movements. Loss of concentration occurred at the same rate for subjects using the 2D and 3D systems. Nausea and dizziness were reported only when working with the 3D system. 91% found the 3D system advantageous for accomplishing the tasks. Irrespective of experience level, 3D laparoscopy shows advantages in saving time, increasing accuracy and reducing mistakes. These benefits were also accompanied by subjective advantages that were noted by the participants. However, the more complex the task, the less significant the benefit of the 3D system and some people feel handicapped by the eyewear.
Publisher: Springer Science and Business Media LLC
Date: 06-05-2022
DOI: 10.1186/S12885-022-09555-8
Abstract: A high percentage of epithelial ovarian cancers (EOC) express the estrogen receptor (ER), which is an ideal target for endocrine therapy. Letrozole is a proven, potent aromatase inhibitor, extensively tested and used in the treatment of ER positive breast cancer. In addition, it seems a potent drug for patients with heavily pre-treated OC as demonstrated in several distinctive settings. However, it has never been evaluated prospectively in a maintenance setting for ovarian cancer after standard of care. The here proposed trial aims to define a population of EOC patients, who would benefit from the effectiveness of the generic agent letrozole, with little expected toxicity and thus beneficial impact on overall quality of life (QoL). In this international multicenter randomized, placebo-controlled phase III trial at clinical centers in Switzerland, Germany and Austria, we plan to include 540 patients with primary, newly diagnosed FIGO Stage II to IV and histologically confirmed low- or high-grade serous or endometrioid epithelial ovarian/fallopian tube eritoneal cancer. Patients are randomized in a 1:1 ratio into two groups: receiving blinded study treatment (letrozole or placebo tablets). When assuming a HR of 0.7, a median PFS of 18 months in the control arm and a median PFS of 25.7 months in the treatment arm, a two-sided alpha level of 5%, 3.5 years recruitment and 1.5 years observation time, we expect 330 events to have occurred within these 5 years in the total cohort yielding a power of 90%. Follow-up data for the whole cohort will be collected for up to 10 years and for the low-grade cancer for up to 12 years. The here proposed randomized phase III trial aims to identify patients with EOC in the maintenance setting, who benefit from the effectiveness of the letrozole, by proving its efficacy whilst maintaining a high standard of QoL due to the limited toxicity expected in comparison to the current alternative drugs on the market for this treatment phase. This trial is registered at clinicaltrials.gov under the identifier NCT04111978 . Registered 02 October 2019.
Publisher: Research Square Platform LLC
Date: 10-07-2023
Publisher: Springer Science and Business Media LLC
Date: 02-2019
DOI: 10.1007/S00276-019-02190-2
Abstract: Structural arrangements of the bony microstructure of a joint through adaptational processes are thought to be determined by the biomechanical demands and its changes. Pursuing this theory of "form follows the biomechanical function", the load distribution of the glenoid cavity, as it is mirrored in its mineralization pattern, should link not only to its thickness distribution, but also will have an impact onto the trabecular network below. To prove and confirm this hypothesis, we analysed the mineral distribution in correlation to the subchondral bone plates thickness and the distribution of architectural parameters of the trabecular network below. Our findings clearly state an inhomogeneous but regular and reproducible mineral distribution pattern in respect to the biomechanical demands and a thickness of the subchondral bone plate which shows a significant correlation (78-93%). As for the trabecular network below, the distribution of the analysed parameters also revealed an inhomogeneous distribution with a regular pattern in correlation to the biomechanical impact. We found distinctive maxima of material distribution and stability (bone volume 79%, plate-like architecture 77%) situated below areas of high long-term load intake. With increasing depth, the trabecular network administers the expression of each structural parameter following the fact that the strain energy gets more and more evenly distributed and changes from a high degree of differentiation just beneath the SBP to a more equal distribution within the deeper areas. After all, the biomechanical situation of a joint directly influences the bony formation of the subchondral bone plate and the trabecular network below.
Publisher: Springer Science and Business Media LLC
Date: 09-04-2021
DOI: 10.1186/S12884-021-03753-1
Abstract: Pseudoaneurysm of the uterine artery (UPA) is a rare cause of potentially life-threatening hemorrhage during pregnancy and puerperium. It is an uncommon condition that mainly occurs after traumatic injury to a vessel following pelvic surgical intervention, but also has been reported based on underlying endometriosis. There is an increased risk of developing UPA during pregnancy. Diagnosis includes clinical symptoms, with severe abdominal pain and is confirmed by sonographic or magnetic resonance imaging (MRI). Due to its potential risk of rupture, with a subsequent hypovolemic maternal shock and high fetal mortality, an interdisciplinary treatment should be considered expeditiously. We present the case of a 34-year old pregnant symptomatic patient, where a large UPA was detected at 26 weeks, based on deep infiltrating endometriosis (DIE). The UPA was successfully treated by selective arterial embolization. After embolization, the pain decreased but the woman still required intravenous analgesics during follow-up. At 37 weeks she developed a sepsis from the intravenous catheter which led to a cesarean section and delivery of a healthy boy. She was discharged 10 days postpartum. UPA should be considered in pregnant women with severe abdominal and pelvic pain, once other obstetrical factors have been excluded. DIE might be the underlying diagnosis. It is a rare but potentially life-threatening condition for mother and fetus.
Publisher: Georg Thieme Verlag
Date: 10-2022
Publisher: Springer Science and Business Media LLC
Date: 24-05-2014
Publisher: Springer Science and Business Media LLC
Date: 09-02-2023
DOI: 10.1186/S12957-023-02918-W
Abstract: Contralateral axillary lymph node metastasis (CALNM) in breast cancer (BC) is considered a distant metastasis, marking stage 4cancer. Therefore, it is generally treated as an incurable disease. However, in clinical practice, staging and treatment remain controversial due to a paucity of data, and the St. Gallen 2021 consensus panel recommended a curative approach in patients with oligometastatic disease. Aberrant lymph node (LN) drainage following previous surgery or radiotherapy is common. Therefore, CALNM may be considered a regional event rather than systemic disease, and a re-sentinel procedure aided by lymphoscintigraphy permits adequate regional staging. Here, we report a 37-year-old patient with Lynch syndrome who presented with CALNM in an ipsilateral relapse of a moderately differentiated invasive ductal BC ( ER 90%, PR 30%, HER2 negative, Ki-67 25%, microsatellite stable), 3 years after the initial diagnosis. Lymphoscintigraphy detected a positive sentinel LN in the contralateral axilla despite no sign of LN involvement or distant metastases on FDG PET/CT or MRI. The patient underwent bilateral mastectomy with sentinel node dissection, surgical reconstruction with histological confirmation of the CALNM, left axillary dissection, adjuvant chemotherapy, and anti-hormone therapy. In addition to her regular BC follow-up visits, the patient will undergo annual colonoscopy, gastroscopy, abdominal, and vaginal ultrasound screening. In January 2023, the patient was free of progression for 23 months after initiation of treatment for recurrent BC and CALNM. This case highlights the value of delayed lymphoscintigraphy and the contribution of sentinel procedure for local control in the setting of recurrent BC. Aberrant lymph node drainage following previous surgery may be the underlying cause of CALNM. We propose that CALNM without evidence of systemic metastasis should be considered a regional event in recurrent BC, and thus, a curative approach can be pursued. The next AJCC BC staging should clarify the role of CALNM in recurrent BC to allow for the development of specific treatment guidelines.
Publisher: BMJ Publishing Group Ltd
Date: 09-2023
Publisher: BMJ Publishing Group Ltd
Date: 09-2023
Publisher: Research Square Platform LLC
Date: 14-05-2020
DOI: 10.21203/RS.3.RS-26684/V1
Abstract: Background Vision is an essential element of laparoscopic surgery that defines the outcome of an operation in regards to time, mistakes and precision. A 3-dimensional (3D) perspective may improve vision during an operation. Therefore, this study was designed to compare 3D versus 2-dimensional (2D) perspectives using a pelvitrainer model. Methods Fifty subjects were ided into 3 categories based on different experience levels. The subjects were randomised into two groups, with each group performing the same 4 standardised tasks. Task completion time and the number of mistakes made for each task were recorded. After completing the tasks, participants answered questions concerning the two systems. Results Group A was, on average, 20% faster at all four tasks and made approximately 18% fewer mistakes in two of the tasks in comparison to group B. The experts significantly benefited from the 3D system in terms of accuracy compared to non-experts and students. The students demonstrated a significantly greater benefit from the 3D system when performing non-linear, continuous movements. Loss of concentration occurred at the same rate for subjects using the 2D and 3D systems. Nausea and dizziness were reported only when working with the 3D system. 91% found the 3D system advantageous for accomplishing the tasks. Conclusions Irrespective of experience level, 3D laparoscopy shows advantages in saving time, increasing accuracy and reducing mistakes. These benefits were also accompanied by subjective advantages that were noted by the participants. However, the more complex the task, the less significant the benefit of the 3D system.
Publisher: BMJ Publishing Group Ltd
Date: 09-2023
Publisher: Scandinavian Journal of Work, Environment and Health
Date: 11-06-2014
DOI: 10.5271/SJWEH.3440
Abstract: It is unclear to what extent assessments of work ability differ between disability claimants, their treating physicians, and multidisciplinary medical expert teams. We compared assessments of work ability for consecutive disability claimants referred to a multidisciplinary assessment center in Switzerland over a 4-year period. Assessments were made for the last job (LJ) prior to claiming a disability benefit and an alternative job (AJ) thought to suit the claimant's physical and mental abilities. Mean differences (MD) in percentage work ability between assessments from claimants, physicians, and experts were then estimated in a linear regression model. The 3562 claims made during the study period were mostly due to musculoskeletal and depressive disorders. Assessments differed little between claimants and physicians [LJ MD 1.3% (95% confidence interval [95% CI] 0.5-2.2%) AJ MD 11% (95% CI 10-12%)]. Experts on average assessed a claimant's work ability higher than either the claimant or physician, particularly in the AJ [MD between expert and claimant 57% (95% CI 56-58%) and between expert and physician 46% (95% CI 45-48%)]. Assessments of work ability differed substantially between experts in multidisciplinary medical teams and both claimants and their treating physicians. A careful evaluation of the disability assessment process is needed in an effort to reduce disagreement between expert teams and treating physicians and so improve acceptance of the process.
Publisher: Research Square Platform LLC
Date: 31-08-2023
Publisher: Wiley
Date: 06-2021
Publisher: Springer Science and Business Media LLC
Date: 26-10-2021
DOI: 10.1007/S13304-021-01195-0
Abstract: Laparoscopic surgery provides well-known benefits, but it has technological limitations. Depth perception is particularly crucial, with three-dimensional (3D) imaging being superior to two-dimensional (2D) HD imaging. However, with the introduction of 4K resolution monitors, 2D rendering is capable of providing higher-quality visuals. Therefore, this study aimed to compare 3D HD and 2D 4K imaging using a pelvitrainer model. Eight experts and 32 medical students were performing the same four standardized tasks using 2D 4K and 3D HD imaging systems. Task completion time and the number of errors made were recorded. The Wilcoxon test and mixed-effects models were used to analyze the results. Students were significantly faster in all four tasks when using the 3D HD perspective. The median difference ranged from 18 s in task 3 ( P 0.003) up to 177.5 s in task 4 ( P 0.001). With the exception of task 4, students demonstrated significantly fewer errors in all tasks involving 3D HD imaging. The experts’ results confirmed these findings, as they were also faster in all four tasks using 3D HD, which was significant for task 1 ( P 0.001) and task 4 ( P 0.006). The expert group also achieved better movement accuracy using the 3D HD system, with fewer mistakes made in all four tasks, which was significant in task 4 ( P 0.001). Participants in both groups achieved better results with the 3D HD imaging system than with the 2D 4K system. The 3D HD image system should be used when available. Trial registration: this trial is registered at research registry under the identifier researchregistry6852.
Publisher: AME Publishing Company
Date: 2020
Publisher: American Society of Clinical Oncology (ASCO)
Date: 06-2023
DOI: 10.1200/JCO.2023.41.16_SUPPL.E24120
Abstract: e24120 Background: In recent years, the understanding of endometrial cancer shifted, leading to a change in therapy strategies including targeted therapies. For a successful conduction of therapy, a patient’s expectations, preferences, and needs should be considered. The aim of this study was to define these factors. Methods: We conducted an international 80 item survey in paper-form and via the internet for endometrial cancer patients. The data recorded were demographics, tumor stage, therapy, recurrence status, comorbidities, preferences and expectations concerning therapy modalities. Results: Between 12/2021 and 12/2022, 568 endometrial cancer patients could be recruited from seven different countries – with the majority being from Germany (54.3%) and Switzerland (44.0%). Median age was 66.0 [58.0 73.0] years. While most patients (79.7%) were in follow-up care with no current anti-cancer therapy, 20.3% were still receiving treatment, of which 6.2% were due to cancer recurrence. In total, 14.6% of all patients suffered a relapse. More than two thirds were concomitantly suffering from high blood pressure (39.6%) and/or joint pain (arthrosis, arthritis) (30.5%) – a fifth (21.3%) did not have any pre-existing illnesses. On average, the patients took 2.9 (±3.0) different drugs regularly for their comorbidities. The distribution of initial tumor status was 62.5% for FIGO I, and 16.6%, 15.1% and 5.8% for FIGO II-IV, respectively. A third of the patients (34.7%) reported that their tumor was tested for molecular classification, more than half (56.9%) did not know if this had occurred. After first being diagnosed, most patients (96.6%) underwent an operation, 39.5% received radiation therapy, 27.6% chemotherapy, 7.1% hormonal treatment and 3.6% immunotherapy. More than a third (38.1%) of all patients would be interested in participating in clinical studies, less than half (43.6%) were offered this option. To receive information about their disease, 36.8% use the internet, but most (91.5%) think that the doctors’ expertise is the most important source of information. More than half (55.0%) see a need for more information material. To improve treatment, patients would like doctors to spend more time on explanations (31.2%), to better cooperate with each other (21.0%) and for the therapy not to lead to hair loss (20.6%). The maximum time of therapy, that most patients are willing to tolerate if everything goes well is 6-12 months (41.3%) followed by the time period until recurrence (34.4%). Conclusions: Women with endometrial cancer would benefit from significant improvement in the management of endometrial cancer, including the provision of information and educational materials and access to clinical trials. Clinical trial information: DRKS00025954 .
Publisher: Elsevier BV
Date: 2022
Publisher: BMJ Publishing Group Ltd
Date: 11-2021
Publisher: BMJ Publishing Group Ltd
Date: 09-2023
Start Date: 2022
End Date: 2024
Funder: Swiss National Science Foundation
View Funded ActivityStart Date: 2012
End Date: 2016
Funder: Swiss National Science Foundation
View Funded Activity