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  • 1
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    Improving Accuracy in Image-Guided Prostate Biopsy by Using Trocar-Sharpened Needles
    S. Karger AG ; 2013
    In:  Urologia Internationalis Vol. 91, No. 4 ( 2013), p. 404-409
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 91, No. 4 ( 2013), p. 404-409
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To optimize image-guided prostate biopsy by minimizing the target error with trocar-sharpened needle tips instead of beveled needles, which constantly deviate away from the bevel. 〈 b 〉 〈 i 〉 Materials and Methods: 〈 /i 〉 〈 /b 〉 We performed stereotactic biopsies on two prostate phantoms, which incorporate three randomly placed TRUS-visible lesions. Four stereotactic biopsies per lesion were taken under live-ultrasound guidance through a template: two biopsies with conventional beveled needles and two biopsies with novel trocar-sharpened needles. The procedural targeting error (PTE) between the virtually planned biopsy trajectory and the manually registered 3D needle position of every single biopsy core taken was calculated. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The absolute overall targeting error using the novel needle-tip design was 0.13 mm (SD: ± 0.15 mm) with the highest PTE in the sagittal plane (0.18 ± 0.16 mm), followed by the coronal (0.13 ± 0.17 mm) and axial (0.09 ± 0.05 mm) planes. Comparing the PTE of the novel trocar-shaped needles with conventional beveled needles, there was a statistically significant difference in the axial plane [p (overall) = 0.47, p(axial) = 0.03]. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The targeting error of stereotactic biopsies using trocar-sharpened needles is significantly lower than the targeting error of classical beveled needles. Thus, trocar-tip configurations improve the accuracy of computer-assisted biopsies and allow precise assessment of suspicious lesions in the prostate and in other organs accessible to image-guided biopsy.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000350653
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
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  • 2
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    Clinical Importance of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-Analysis
    S. Karger AG ; 2022
    In:  Urologia Internationalis Vol. 106, No. 1 ( 2022), p. 28-34
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 106, No. 1 ( 2022), p. 28-34
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Robot-assisted radical prostatectomy (RARP) including pelvic lymph node dissection (PLND) is the current state of the art in surgical therapy of localized prostate cancer with intermediate or high risk. PLND in particular is associated with morbidity inherent to this method; the rate of symptomatic lymphoceles (sLCs), for example, ranges up to 10%. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 Various intraoperative modifications have been developed with the aim of reducing the sLC rate. Based on current studies, a peritoneal interposition flap (PIF) appears to be one of the most effective methods for this purpose. Under the criteria of a systematic review, 5 retrospective studies have been identified until now, 4 of which showed a positive effect of PIF on the sLC rate. 〈 b 〉 〈 i 〉 Results and Limitations: 〈 /i 〉 〈 /b 〉 A total of 1,308 patients were included in the aggregated analysis of these 5 studies. The amount of sLCs was 1.3% (8/604) and 5.7% (40/704) in the PIF and standard groups, respectively ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). The resulting odds ratio (OR) was 0.23 (95% confidence interval [CI]: 0.05–0.99), taking in­to account a noteworthy heterogeneity of the 5 studies ( 〈 i 〉 Q 〈 /i 〉 = 9.47, 〈 i 〉 p 〈 /i 〉 = 0.05; 〈 i 〉 I 〈 /i 〉 〈 sup 〉 2 〈 /sup 〉 = 58%). In addition, a prospective randomized and blinded study (Pianoforte trial) with corresponding sLC rates of 8.3% (9/108) versus 9.7% (12/124) ( 〈 i 〉 p 〈 /i 〉 = 0.820) exists. In this study, the OR was 0.85 (95% CI: 0.34–2.10, 〈 i 〉 p 〈 /i 〉 = 0.722). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Despite positive results from retrospective studies with indirect evidence, the role of the PIF in the reduction of sLC in RARP could not be conclusively assessed yet. The results of the first prospective randomized study do not show a positive effect of PIF, declaring a research gap for further studies with direct evidence.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000512960
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
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  • 3
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    The Role of YKL-40 in Predicting Resistance to Docetaxel Chemotherapy in Prostate Cancer
    S. Karger AG ; 2018
    In:  Urologia Internationalis Vol. 101, No. 1 ( 2018), p. 65-73
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 101, No. 1 ( 2018), p. 65-73
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 High baseline YKL-40 serum levels are associated with drug resistance in several solid tumours. However, their role in predicting docetaxel (DOC) resistance in prostate cancer (PCa) is unknown. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Pre-treatment serum levels of YKL-40 and prostate-specific antigen (PSA) were analyzed in 109 castration-resistant prostate cancer patients who underwent DOC-therapy. Responsive patients were retreated by repeated series of DOC. Results were compared with the clinical parameters as well as overall (OS) and disease-specific survival (DSS). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 YKL-40 but not PSA serum levels were significantly higher in patients with baseline resistance to DOC ( 〈 i 〉 p 〈 /i 〉 = 0.035). Higher YKL-40 and PSA levels were detected in patients with bone metastasis ( 〈 i 〉 p 〈 /i 〉 = 0.032; 〈 i 〉 p 〈 /i 〉 = 0.010) and in those who were not pre-treated with radical prostatectomy ( 〈 i 〉 p 〈 /i 〉 = 0.011, 〈 i 〉 p 〈 /i 〉 = 0.008). High YKL-40 levels were associated with shorter OS ( 〈 i 〉 p 〈 /i 〉 = 0.037) and DSS ( 〈 i 〉 p 〈 /i 〉 = 0.017) in patients who received DOC in the first-line setting. In multivariable analysis, ECOG performance status ( 〈 i 〉 p 〈 /i 〉 = 0.009), presence of any metastases ( 〈 i 〉 p 〈 /i 〉 = 0.016) and high PSA levels ( 〈 i 〉 p 〈 /i 〉 = 0.005) remained independent predictors for DSS. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 YKL-40 may help to identify patients with baseline resistance to DOC and therefore may help to optimize treatment decisions. In accordance, high pre-treatment YKL-40 serum levels were associated with shorter OS and DSS in patients who received DOC as first-line therapy.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000489891
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
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  • 4
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    Diagnostic Accuracy of Transperineal MRI Fusion Biopsy in Comparison to Transrectal Biopsy with Regard to Incidental Histopathological Findings in Transurethral Resection of the Prostate
    S. Karger AG ; 2017
    In:  Urologia Internationalis Vol. 99, No. 2 ( 2017), p. 162-167
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 99, No. 2 ( 2017), p. 162-167
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To investigate the diagnostic accuracy of transperineal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy vs. transrectal prostate biopsy in transurethral resection (TUR) specimen of men undergoing TUR of the prostate (TURP) for symptomatic bladder outlet obstruction. 〈 b 〉 〈 i 〉 Material and Methods: 〈 /i 〉 〈 /b 〉 From a database of 3,509 men receiving prostate biopsy, all those undergoing TURP and negative prostate biopsy ( 〈 i 〉 n 〈 /i 〉 = 95; 45 transrectal, 50 transperineal fusion) were analysed. TURP specimens were compared with regard to incidental prostate cancer. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Pre- and peri-interventional parameters in transrectal vs. fusion biopsy groups for age (65.2 ± 7.8 vs. 65.5 ± 7.3 years; 〈 i 〉 p 〈 /i 〉 = 0.84), prostate specific antigen (10.7 ± 8.5 vs. 10.9 ± 8.7 ng/mL; 〈 i 〉 p 〈 /i 〉 = 0.93), preoperative prostate volume (72.5 ± 26.1 vs. 71.8 ± 28.1 mL; 〈 i 〉 p 〈 /i 〉 = 0.91) and resected weight (43.7 ± 21.9 vs. 41.4 ± 20.7 g; 〈 i 〉 p 〈 /i 〉 = 0.61) showed no significant differences. Analysing the TURP specimen, 5 incidental T1a prostate cancers were found (3 Gleason 3 + 3 = 6; 2 Gleason 3 + 4 = 7, all in the transrectal biopsy group). Although, more biopsy cores were obtained in the MRI/TRUS fusion biopsy group (26 cores [interquartile range, IQR 24-28] vs. 14 cores [IQR 12-24] , 〈 i 〉 p 〈 /i 〉 〈 0.01), there was no statistical impact of the obtained number of cores ( 〈 i 〉 p 〈 /i 〉 = 0.9) on diagnostic accuracy. Statistical analyses revealed significantly better diagnostic accuracy favoring image-guided fusion biopsy ( 〈 i 〉 p 〈 /i 〉 = 0.02). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Our findings showed that a combination of MRI-targeted and systematic transperineal prostate biopsy improves patient safety. This is associated with a combination of transperineal biopsy technique and pre-interventional MRI.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000456078
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
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  • 5
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    Urachal Cancer in Germany and the USA: An RKI/SEER Population-Based Comparison Study
    S. Karger AG ; 2020
    In:  Urologia Internationalis Vol. 104, No. 9-10 ( 2020), p. 803-809
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 104, No. 9-10 ( 2020), p. 803-809
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Urachal cancer (UrC) is a rare but aggressive cancer. Due to its low incidence, structured epidemiological data have only rarely been reported. To date, no valid data on UrC are available for the German population. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Data on incidence and relative 5-year survival of urachal lesions (ICD-10: C67.7) were collected from all population-based cancer registries in Germany, provided by the Robert Koch-Institut (RKI). Data were anonymized and included age, sex, and general histology (ICD-O-3). For comparison, a similar inquiry of the “Surveillance, Epidemiology, and End Results program” (SEER-18) database for the USA was conducted. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 From 2011 to 2015, a total of 154 and 152 cases of UrC were reported for Germany (RKI) and the USA (SEER-18 area), respectively. Age-standardized incidence was 0.32/1,000,000 age-standardized cases/year in both cohorts, and elderly persons were more often affected. The major histological type was adenocarcinoma (64.9 and 81.6%). Relative 5-year survival was 54.8% (CI: 45.0–64.6) in Germany (RKI) and 64.4% (54.1–72.1) in the USA (SEER-18 cohort). 〈 b 〉 〈 i 〉 Discusssion/Conclusion: 〈 /i 〉 〈 /b 〉 The collected data demonstrate low incidence rates and similar epidemiological and clinicopathological characteristics of UrC for both registries. This is the first report of structured epidemiological data for UrC for the German population.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000509481
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
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  • 6
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    Initial Experience with Temsirolimus in 2nd-, 3rd- and 4th-Line Therapy for Metastatic Renal Cell Cancer: Good Clinical Response
    S. Karger AG ; 2011
    In:  Urologia Internationalis Vol. 86, No. 3 ( 2011), p. 256-260
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 86, No. 3 ( 2011), p. 256-260
    Abstract: 〈 i 〉 Purpose: 〈 /i 〉 To report our experience with temsirolimus in 2nd-, 3rd- and 4th-line therapy for patients with metastatic renal cell carcinoma (mRCC). 〈 i 〉 Patients and Methods: 〈 /i 〉 In our prospectively maintained tumor registry, we identified 6 mRCC patients with temsirolimus in 〉 1st-line systemic therapy. Patients were followed by weekly clinical and laboratory examination during admission of temsirolimus. Re-staging with chest CT and abdominal MRI was performed every 3 months. 〈 i 〉 Results: 〈 /i 〉 We observed excellent response rates. Progression-free survival (PFS) ranged from 6 to 40 months with a median of 15 months. Treatment was generally well tolerated. However, pneumonitis was observed in 4 of 6 patients. Drug-related pneumonitis led to severe dyspnea, with the result that treatment with temsirolimus had to be interrupted for a short period of time in 2 patients and discontinued in 1 patient. 〈 i 〉 Conclusions: 〈 /i 〉 Temsirolimus proved to be a very good treatment option in 2nd- to 4th-line therapy with excellent response rates and manageable side effects. The incidence of pneumonitis must not be underestimated.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000322545
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
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  • 7
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    TOP: Prospective Evaluation of a Volume Based, Computer Assisted Method for Transperineal Optimized Prostate Biopsy
    S. Karger AG ; 2017
    In:  Urologia Internationalis Vol. 99, No. 2 ( 2017), p. 149-155
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 99, No. 2 ( 2017), p. 149-155
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 This study is a prospective evaluation of a volume-based, computer-assisted method for transperineal optimized prostate (TOP) biopsy. The TOP algorithm automates core planning for systematic prostate biopsies using the 3-dimensional organ contour and an alterable volume for tumors to be excluded. 〈 b 〉 〈 i 〉 Subjects and Methods: 〈 /i 〉 〈 /b 〉 MRI-transrectal ultrasound fusion biopsy with MRI-targeted biopsies (TBs) and systematic-TOP biopsies were performed on 172 men between October 2013 and March 2014. Systematic biopsies were placed according to TOP for detection of tumor volumes 〉 0.5 mL with a minimum of 80% organ coverage in prostates up to 50 mL (70% in larger organs). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Median 24 TOP cores and 3 MRI-TBs have been placed. Prostate cancer (PCa) was detected in 112 of 172 (65%) of men; TOP detected 109 (97%) and TB 62 (55%). Significant cancer (Gleason score ≥7) was detected in 75 (44%) of men and of these TOP detected 73 of 75 (97%) and TB 51 of 75 (68%). Overall, systematic-TOP sampling significantly outperformed TB for the detection of both, all PCa as well as significant PCa ( 〈 i 〉 p 〈 /i 〉 〈 0.0001, 〈 i 〉 p 〈 /i 〉 = 0.0005). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The TOP method is innovative by integrating the individual prostate volume and PCa volume detection thresholds. In the present cohort, it diagnosed more significant tumors than TB alone. However, at the same time, more low-risk tumors are detected.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000458764
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
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  • 8
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    MR-Guided Transurethral Ultrasound Ablation of Prostate Cancer: Initial Experience of Monitoring Tumor Response by Dynamic Apparent Diffusion Coefficient Measurements at 3.0 T
    S. Karger AG ; 2023
    In:  Urologia Internationalis Vol. 107, No. 7 ( 2023), p. 684-692
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 107, No. 7 ( 2023), p. 684-692
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Diffusion-weighted imaging (DWI) as part of multiparametric magnetic resonance imaging (mpMRI) is an important sequence for the detection of prostate cancer (PCa). The objective of this retrospective analysis was to evaluate changes in apparent diffusion coefficient (ADC) measurements in biopsy-proven PCa undergoing TULSA-PRO (MR-guided transurethral ultrasound ablation of the prostate) at 3.0 T after 1, 3, and 6–12 months posttreatment. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Nineteen patients underwent follow-up examinations after 1, 3, and 6–12 months including mpMRI at 3.0 T and urological-clinical examinations with quantitative analysis of ADCs. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In PCa, a significant increase of ADC values after 6–12 months was measured after TULSA-PRO treatment by 29.1% (pre-TULSA: 0.79 ± 0.16 × 10 〈 sup 〉 −3 〈 /sup 〉 mm 〈 sup 〉 2 〈 /sup 〉 /s, 6–12 months: 1.02 ± 0.35 × 10 〈 sup 〉 −3 〈 /sup 〉 mm 〈 sup 〉 2 〈 /sup 〉 /s), while the corresponding value in the reference tissue decreased by 48.5% (pre-TULSA: 1.20 ± 0.15 × 10 〈 sup 〉 −3 〈 /sup 〉 mm 〈 sup 〉 2 〈 /sup 〉 /s, 6–12 months: 0.91 ± 0.29 × 10 〈 sup 〉 −3 〈 /sup 〉 mm 〈 sup 〉 2 〈 /sup 〉 /s). The mean ADC values in the early follow-up groups at 1 and 3 months did not change significantly. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 DWI with ADC as part of mpMRI can serve as a biomarker to dynamically monitor the follow-up after TULSA after 6–12 months. For early posttreatment progression, it is not suitable due to too many confounding variables.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000529873
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
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  • 9
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    Preoperative Hydronephrosis Predicts Advanced Bladder Cancer but Is Not an Independent Factor for Cancer-Specific Survival after Radical Cystectomy
    S. Karger AG ; 2011
    In:  Urologia Internationalis Vol. 86, No. 1 ( 2011), p. 25-30
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 86, No. 1 ( 2011), p. 25-30
    Abstract: 〈 i 〉 Introduction: 〈 /i 〉 Hydronephrosis and BMI are analyzed together with established factors such as TNM stage and surgical margins in a multivariate modality to investigate their status as independent prognostic factors for bladder cancer-specific survival in patients undergoing radical cystectomy. 〈 i 〉 Patients and Methods: 〈 /i 〉 We studied a prospective cohort of 328 patients who underwent radical cystectomy for bladder cancer at our institution. Statistical analyses were performed using the Kaplan-Meier method, Kendall-tau rank correlation and multivariate Cox proportional hazard model. 〈 i 〉 Results: 〈 /i 〉 Hydronephrosis was positively correlated with advanced tumor stage, positive lymph node involvement and positive surgical margins. Adjusted for all other investigated parameters, BMI and hydronephrosis did not affect cancer-specific survival. In multivariate analysis only non-organ-confined disease (HR: 1.40, 95% CI: 1.04–1.87, p = 0.024), positive lymph node stage (HR 1.71: 95% CI: 1.12–2.61, p = 0.013) and positive surgical margins (HR 3.00, 95% CI: 1.74–5.15, p 〈 0.001) were prognostic factors. 〈 i 〉 Conclusions: 〈 /i 〉 Hydronephrosis at the time of radical cystectomy is significantly correlated with the presence of more advanced bladder cancer and positive surgical margins. However, the long-established parameters pT stage, pN stage and surgical margins predominantly influence cancer-specific survival for patients undergoing radical cystectomy irrespective of hydronephrosis and BMI status.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000321008
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
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  • 10
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    Retrograde Pyelography in the Presence of Urothelial Bladder Cancer Does Not Affect the Risk of Upper Tract Urothelial Cancer: A Retrospective Analysis of a Single-Centre Cohort
    S. Karger AG ; 2022
    In:  Urologia Internationalis Vol. 106, No. 6 ( 2022), p. 638-643
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 106, No. 6 ( 2022), p. 638-643
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 Patients with bladder cancer (BC) are at risk of developing upper tract urothelial carcinoma (UTUC). Therefore, CT urography is recommended for follow-up. To avoid intravenous contrast agents, retrograde pyelography (RPG) is an alternative. However, it is still unclear whether RPG increases the incidence of UTUC. The aim of this study was to investigate the impact of RPG in the presence of BC on the risk of developing UTUC. 〈 b 〉 〈 i 〉 Patients and Methods: 〈 /i 〉 〈 /b 〉 Retrospectively analysing a total of 3,680 RPGs between 2009 and 2016, all patients with simultaneous BC (group 1) and those without synchronous BC (group 2) during RPG were compared. All patients were risk stratified according to the EORTC bladder calculator. In patients without BC during RPG, risk stratification was based on the worst prior tumour characteristics. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 145 patients with a history of BC were analysed. Of these, 112 patients underwent RPG with simultaneous BC. UTUC developed in 6 of 112 patients (5.4%) and 58.9% (66/112) had high-risk BC according to the EORTC bladder calculator. In the control group, one out of 33 (3%) patients with metachronous high-risk BC developed UTUC. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Using RPG in the presence of BC did not increase the risk of UTUC. Due to the predominant number of high-risk/high-grade tumours, individual tumour biology appears to be the primary driver for the development of UTUC.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000519898
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
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