Showing papers by "Markus M. Heiss published in 2006"

One year ago not business as usual: Wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia

Abstract: Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients. This study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities). Multiple large flap lacerations (2 × 3 to 60 × 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response. Individuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory.

Efficacy of intraperitoneal treatment with the trifunctional antibody catumaxomab in patients with GI-tract cancer and peritoneal carcinomatosis: A matched-pair analysis

Abstract: 2544 Background: Peritoneal carcinomatosis (PC) due to GI-tract cancer is an advanced tumor stage with poor survival. At present, no standard therapy has been recommended, as chemotherapy and surge...

The 2004 tsunami disaster: injury pattern and microbiological aspects

Abstract: On 26 December 2004, a giant earthquake shocked south-east Asia triggering deadly flood waves (tsunami) across the Indian Ocean. More than 300,000 people have been reported dead and millions left destitute. Shortly thereafter, the German government organized airborne home transfer of the most severely injured tourists using 'MedEvac' aircraft (Medical Evacuation). Upon arrival, patients were distributed to various medical centers. One cohort was admitted to the Cologne-Merheim Medical Center (Germany) for further surgical and ICU treatment.

Intraperitoneale Immuntherapie der Peritonealkarzinose gastrointestinaler Karzinome mit dem trifunktionalen Antikörper Catumaxomab (anti-EpCAM x anti-CD3): Eine Phase I/II Studie Intraperitoneal Immunotherapy of peritoneal carcinomatosis of GI-tract cancer with the trifunctional antibody Catumaxomab (anti-EpCAM x anti-CD3): A phase I/II study

Abstract: Peritoneal carcinomatosis (PC) from GI-tract cancer is associated with prognosis of 3–6 months. Since chemotherapy and surgical procedures showed only limited efficacy, there is no standard therapy recommended. The trifunctional antibody (trAb) catumaxomab (anti-EpCAM x anti-CD3) represents a new class of intact antibodies, which are able to re-direct T-lymphocytes to tumor cells and to induce active anti tumor immunity by activating FcgRI/III + APC/DC by their intact Fc region. In a phase I trial, intraperitoneal application of catumaxomab was investigated in patients with PC due to GI-tract cancer. 22 patients (mean age 55 years; 8 gastric-ca, 10 colon-ca, 3 pancreatic-ca, 1 CUP) were included after diagnosis of EpCAM+ PC. Treatment consisted of 4 escalating doses of catumaxomab within 10 days by i. p. application. MTD was defined separately for the 1st, 2nd, 3rd and 4th infusion according to a dynamic escalation schedule. Anti-tumor efficacy was evaluated by immunohistochemical EpCAM analysis of peritoneal lavages before and after treatment. Patients were free to get any further chemo- or radiotherapy after trAb treatment and followed up every 6 weeks. I. p. application of catumaxomab was well tolerated. MTD was defined at 10–20–50–200 µg for the 1st, 2nd, 3rd and 4th i. p. infusion. Most frequent adverse events > CTC grade 2 were nausea/vomiting (19), abdominal pain (16), fever (10), exanthema (6), elevation of liver enzymes (6) and cholangitis (3), which could all be successfully treated by conventional medication. Analysis of the peritoneal lavages showed a significant decrease/complete destruction of tumor cells after trAb treatment (p = 0.04). Follow-up showed a median survival of 9.0 months (mean 8.6) after treatment and 12.0 months (mean 12.2) after first diagnosis of peritoneal carcinomatosis. I. p. application of the trifunctional antibody catumaxomab is safe and technically feasible and may represent a new concept for treatment of PC due to gastrointestinal malignancies.