Ursachenzusammenhang zwischen langjähriger Querschnittlähmung und malignen Harnblasentumoren View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-03

AUTHORS

Ralf Böthig, Wolfgang Schöps, Michael Zellner, Kai Fiebag, Birgitt Kowald, Sven Hirschfeld, Roland Thietje, Ines Kurze, Holger Böhme, Albert Kaufmann, Olaf Jungmann, Jürgen Zumbé, Daniel Porres, Marcus Nehiba, Thura Kadhum, Klaus Golka, Martin Forchert

ABSTRACT

Zur Zusammenhangsbeurteilung traumatisch bedingter Querschnittlähmungen und Jahre später auftretender Harnblasenkarzinome gibt es keine aussagefähige Literatur. Ziel dieser Arbeit ist der Vorschlag für eine Konvention, die auf der Grundlage des aktuellen medizinisch-wissenschaftlichen Kenntnisstandes den Gutachtern, der gesetzlichen Unfallversicherung und den Sozialgerichten Anhaltspunkte zur Beurteilung der Zusammenhangsfrage liefert. Die Grundlage der vorgeschlagenen Konvention bildet eine Studie des BG Klinikums Hamburg, die von April 1998 bis März 2017 durchgeführt wurde: 32 der 6432 stationär oder ambulant behandelten querschnittgelähmten Patienten waren an einem Harnblasenkarzinom erkrankt. Zudem wurde die zu dieser Thematik bislang publizierte Literatur einbezogen. Harnblasenkarzinome treten bei querschnittgelähmten Patienten im Vergleich zur Allgemeinbevölkerung in wesentlich jüngeren Jahren auf, sie weisen bei Erstdiagnose deutlich häufiger einen muskelinvasiven Tumor und ein höheres Grading auf, und der Anteil der Plattenepithelkarzinome ist stark erhöht. Entsprechend ist die Überlebenszeit erschreckend schlecht. Für die Begutachtung wurde eine Matrix erstellt, die Einflussfaktoren erfasst, die für oder gegen eine Anerkennung eines Zusammenhanges zwischen Querschnittlähmung und Harnblasenkarzinom sprechen, und diese Faktoren wurden nach ihrer Bedeutung gewichtet. Harnblasentumoren bei Querschnittpatienten unterscheiden sich offenbar erheblich von denen der Nicht-Gelähmten. Diese Unterschiede verkürzen drastisch die Überlebenszeiten. Diese Beobachtungen werden durch eine Studie bei Patienten mit Spina bifida bestätigt. Sie deuten auf bislang histopathologisch nicht fassbare Differenzen hin. More... »

PAGES

61-73

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10039-019-0412-4

DOI

http://dx.doi.org/10.1007/s10039-019-0412-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1112095060


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