Browsing by Author "Von Groote-Bidlingmaier, Florian"
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- ItemAdenocarcinoma the most common cell type in patients presenting with primary lung cancer in the Western Cape(Health and Medical Publishing Group (HMPG), 2011-05) Koegelenberg, Coenraad F. N.; Aubeelack, Kushroo; Nanguzgambo, Aldoph B.; Irusen, Elvis M.; Mowlana, Abdurasiet; Von Groote-Bidlingmaier, Florian; Bolliger, Chris T.Lung cancer is the most common cause of cancer-related mortality worldwide for men and women, causing approximately 1.2 million deaths per year. The absolute and relative frequencies of lung cancer have risen dramatically and in South Africa account for 17% of all cancer deaths. We found that adenocarcinoma is now the most common histological subtype of primary lung cancer diagnosed in the Western Cape and that almost 90% of all patients with non-small cell lung cancer have advanced local or metastatic disease at the time of diagnosis.
- ItemEndoscopic lung volume reduction in severe emphysema(Health & Medical Publishing Group, 2015) Koegelenberg, Coenraad Frederik N.; Theron, Johan; Bruwer, J. W.; Allwood, Brian W.; Vorster, Morne J.; Von Groote-Bidlingmaier, Florian; Dheda, KeertanENGLISH ABSTRACT: Therapeutic options in severe emphysema are limited. Endoscopic lung volume reduction (ELVR) refers to bronchoscopically inducing volume loss to improve pulmonary mechanics and compliance, thereby reducing the work of breathing. Globally, this technique is increasingly used as treatment for advanced emphysema with the aim of obtaining similar functional advantages to surgical lung volume reduction, while reducing risks and costs. There is a growing body of evidence that certain well-defined subgroups of patients with advanced emphysema benefit from ELVR, provided that a systematic approach is followed and selection criteria are met. In addition to endobronchial valves, ELVR using endobronchial coils is now available in South Africa. The high cost of these interventions underscores the need for careful patient selection to best identify those likely to benefit from such procedures.
- ItemIntegrated positron emission tomography/computed tomography for evaluation of mediastinal lymph node staging of non-small-cell lung cancer in a tuberculosis-endemic area : a 5-year prospective observational study(Health & Medical Publishing Group, 2015) Shaw, Jane A.; Irusen, Elvis M.; Von Groote-Bidlingmaier, Florian; Warwick, James M.; Jeremic, Branislav; Du Toit, Rudolf; Koegelenberg, Coenraad F. N.Background. Integrated positron emission tomography/computed tomography (PET-CT) is a well-validated modality for assessing mediastinal lymph node metastasis in non-small-cell lung cancer (NSCLC), which determines management and predicts survival. Tuberculosis (TB) is known to lead to false-positive PET-CT findings. Objectives. To assess the diagnostic accuracy of PET-CT in identifying mediastinal lymph node involvement of NSCLC in a high TB-endemic area. Methods. Patients who underwent both PET-CT and lymph node tissue sampling for the investigation of suspected NSCLC were prospectively included in this observational study. Results were analysed per patient and per lymph node stage. A post-hoc analysis was performed to test the validity of a maximum standardised uptake value (SUVmax) cut-off for lymph node positivity. Results. PET-CT had a sensitivity of 92.6%, specificity of 48.6%, positive predictive value of 56.8% and negative predictive value (NPV) of 90.0% in the per-patient analysis. Diagnostic accuracy was 67.2%. Similar values were obtained in the per-lymph node stage analysis. TB was responsible for 21.1% of false-positive results. A SUVmax cut-off of 4.5 yielded an improvement in diagnostic accuracy from 64.0% to 84.7% compared with a cut-off of 2.5, but at the cost of decreasing the NPV from 90.6% to 83.5%. Conclusion. In a high TB-endemic area, PET-CT remains a valuable method for excluding mediastinal lymph node involvement in NSCLC. Patients with a negative PET-CT may proceed to definitive management without further invasive procedures. However, PET-CT-positive lymph nodes require pathological confirmation, and the possibility of TB must be considered.
- ItemAn optimized background regimen design to evaluate the contribution of levofloxacin to multidrug-resistant tuberculosis treatment regimens : study protocol for a randomized controlled trial(BioMed Central, 2017-11-25) Bouton, Tara C.; Phillips, Patrick P. J.; Mitnick, Carole D.; Peloquin, Charles A.; Eisenach, Kathleen; Patientia, Ramonde F.; Lecca, Leonid; Gotuzzo, Eduardo; Gandhi, Neel R.; Butler, Donna; Diacon, Andreas H.; Martel, Bruno; Santillan, Juan; Hunt, Kathleen R.; Vargas, Dante; Von Groote-Bidlingmaier, Florian; Seas, Carlos; Dianis, Nancy; Moreno-Martinez, Antonio; Horsburgh, C. R.Background: Current guidelines for treatment of multidrug-resistant tuberculosis (MDR-TB) are largely based on expert opinion and observational data. Fluoroquinolones remain an essential part of MDR-TB treatment, but the optimal dose of fluoroquinolones as part of the regimen has not been defined. Methods/design: We designed a randomized, blinded, phase II trial in MDR-TB patients comparing across levofloxacin doses of 11, 14, 17 and 20 mg/kg/day, all within an optimized background regimen. We assess pharmacokinetics, efficacy, safety and tolerability of regimens containing each of these doses. The primary efficacy outcome is time to culture conversion over the first 6 months of treatment. The study aims to determine the area under the curve (AUC) of the levofloxacin serum concentration in the 24 hours after dosing divided by the minimal inhibitory concentration of the patient’s Mycobacterium tuberculosis isolate that inhibits > 90% of organisms (AUC/MIC) that maximizes efficacy and the AUC that maximizes safety and tolerability in the context of an MDR-TB treatment regimen. Discussion: Fluoroquinolones are an integral part of recommended MDR-TB regimens. Little is known about how to optimize dosing for efficacy while maintaining acceptable toxicity. This study will provide evidence to support revised dosing guidelines for the use of levofloxacin as part of combination regimens for treatment of MDR-TB. The novel methodology can be adapted to elucidate the effect of other single agents in multidrug antibiotic treatment regimens.