Patienten mit deletärer Hirnschädigung muss derzeit hierzulande der Wunsch nach einer Organspende verwehrt werden, wenn das Vollbild des „Irreversiblen Hirnfunktionsausfalls“ (IHA) nicht eintritt. Dies schränkt die Autonomie des Patienten am Lebensende maßgeblich ein. Intensivtherapie darf und muss beendet werden, wenn der Patient ihre Fortführung ablehnt. Nach Beendigung lebenserhaltender Maßnahmen (WLST) verstirbt der Patient dann unter einer symptomlindernden Therapie im Herzkreislaufstillstand. In zahlreichen Ländern kann sich dem Versterben eines Patienten im Herzkreislaufstand unter strikt regulierten Bedingungen eine Organspende anschließen (Organspende nach kontrolliertem Herzkreislaufstillstand, cDCD): Der Herzstillstand tritt hierbei nach WLST unter intensivmedizinischem Monitoring ein. Nach einer No-touch-Zeit von 5 Minuten ist ein spontanes Wiedereinsetzen der Herzfunktion nicht mehr zu erwarten. Der Zusammenbruch der gesamten Zirkulation bedingt den kompletten Stopp der Hirndurchblutung und nachfolgend den rasch einsetzenden globalen Funktionsverlust des Gehirns. Wird – dem Patientenwunsch folgend – auf eine Wiederbelebung verzichtet, resultiert ein permanenter Verlust der Hirnfunktion. Dieser wird durch den Ausfall der Hirnstammreflexe nach Ablauf der No-touch-Phase bestätigt - und der Tod des Patienten wird festgestellt. Eine Organspende kann sich nun – wenn vom Patienten gewünscht – anschließen. Die Transplantationsergebnisse von Organen, welche nach cDCD gespendet werden, sind denen einer Organspende nach IHA ebenbürtig. cDCD respektiert und realisiert den Organspendewunsch zahlreicher Intensivpatienten. Eine absehbare Zunahme der Organspenden hat bedeutsame Auswirkungen auf die Lebensperspektiven von Patienten auf den Transplantations-Wartelisten.
Background The treatment landscape for metastatic triple-negative breast cancer (mTNBC) has evolved. However, data on implementation of novel treatment approaches in clinical routine and current real-world outcomes are limited. Patients and methods Patients with mTNBC who initiated first-line (1L) treatment between January 2018 and August 2023 were prospectively observed within the OPAL registry. Treatment patterns, median real-world overall survival (rwOS), and progression-free survival (rwPFS) were analyzed by programmed death-ligand 1 (PD-L1) status. Results Among 368 patients included in this analysis, 31.8% were PD-L1 positive, 35.9% PD-L1 negative, and 32.3% PD-L1 unknown. Median age was 62.0 years, 10.6% had an Eastern Cooperative Oncology Group performance status ≥2, and 37.8% had de novo metastatic disease. Of patients with PD-L1-positive tumors, 81.2% received 1L PD-(L)1 inhibitors ± chemotherapy. Mono-chemotherapy was the most common treatment strategy for patients with PD-L1-negative and unknown status. At database cut, 25.8% of patients died before start of second line (2L). In the total cohort, rwOS was 17.6 months [95% confidence interval (CI) 15.6-19.7 months] and rwPFS was 6.8 months (95% CI 5.9-7.6 months). For patients with PD-L1-positive tumors treated with PD-(L)1 inhibitors, rwOS was 23.2 months (95% CI 17.5-28.2 months) and rwPFS was 7.2 months (95% CI 6.5-9.1 months). In patients with PD-L1-negative tumors receiving chemotherapy, rwOS was 16.0 months (95% CI 13.9-20.7 months) and rwPFS was 6.3 months (95% CI 4.9-7.6 months). Conclusions Although new treatment options have been rapidly integrated into clinical routine, chemotherapy remains standard for most patients in 1L. Survival remains poor, with at least one-quarter dying without reaching 2L. This highlights the need for novel therapies to improve mTNBC outcomes.
Purpose Topical glycopeptide antibiotics are widely used during spinal fusion procedures to reduce the risk of surgical site infection; however, their dose-dependent effects on fusion biology remain unclear. This experimental study aimed to compare the effects of locally applied vancomycin and teicoplanin at different doses on fusion mass formation in a rat posterolateral lumbar arthrodesis model. Methods Forty-five female Wistar rats underwent unilateral L4–L5 posterolateral fusion and were randomized into five groups (n = 9 each): control (no topical antibiotic), low-dose vancomycin (14.3 mg/kg), high-dose vancomycin (71.5 mg/kg), low-dose teicoplanin (15 mg/kg), and high-dose teicoplanin (50 mg/kg). Autologous iliac crest bone graft was combined with the assigned antibiotic solution and placed onto the decorticated fusion bed. Fusion was evaluated at 8 weeks using micro-computed tomography (fusion mass volume), manual palpation (fusion score), and qualitative histological assessment (hematoxylin–eosin and Masson’s trichrome staining). Results Micro-CT fusion scores did not differ significantly among groups (p = 0.106). In contrast, fusion mass volume showed a significant intergroup difference (p = 0.018). The high-dose vancomycin group demonstrated the lowest fusion mass volume (median 7.3 mm³ [4.4–14.9]), which was significantly reduced compared with the control group (13.6 mm³ [10.3–19.7]) and both teicoplanin groups (median range 13.1–13.7 mm³; post hoc p ≤ 0.007). Manual palpation scores showed a non-significant trend toward lower values in the high-dose vancomycin group (p = 0.073). Histologically, fusion masses in the high-dose vancomycin group appeared less organized, whereas both teicoplanin groups demonstrated bone morphology comparable to controls. Conclusion In this rat posterolateral fusion model, high-dose topical vancomycin was associated with a reduction in fusion mass volume, despite similar fusion scores. In contrast, topical teicoplanin at both low and high doses did not adversely affect fusion mass formation. These findings highlight the importance of dose selection when using topical vancomycin and indicate that teicoplanin may be considered a bone-compatible alternative for local application during spinal fusion.
Vascular malformations are classified according to the predominant vessel type involved, such as arteriovenous malformations (AVMs), lymphatic malformations (LMs), or venous malformations (VMs). Venous malformations, considered simple vascular malformations, typically present as bluish discolorations or nodular lesions of the skin or mucosa. Venous malformations of the external genitalia are rare. In pediatric patients, these lesions may raise parental concerns regarding cosmetic appearance and potential implications for future sexual function. We report the case of a five-year-old boy with a venous malformation involving the glans penis, scrotum, perineal, and perianal regions. We describe the clinical evaluation, diagnostic work-up, and management considerations for this complex presentation. Based on this case and a review of current literature, we propose a practical framework for the diagnosis and treatment of genital venous malformations to guide therapeutic decision-making.
