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Legriel S, Lemiale V, Schenck M, Chelly J, Laurent V, Daviaud F, Srairi M, Hamdi A, Geri G, Rossignol T, Hilly-Ginoux J, Boisramé-Helms J, Louart B, Malissin I, Mongardon N, Planquette B, Thirion M, Merceron S, Canet E, Pico F, Tran-Dinh YR, Bedos JP, Azoulay E, Resche-Rigon M, Cariou A. Hypothermia for Neuroprotection in Convulsive Status Epilepticus. N Engl J Med 2016; 375:2457-2467. [PMID: 28002714 DOI: 10.1056/nejmoa1608193] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Convulsive status epilepticus often results in permanent neurologic impairment. We evaluated the effect of induced hypothermia on neurologic outcomes in patients with convulsive status epilepticus. METHODS In a multicenter trial, we randomly assigned 270 critically ill patients with convulsive status epilepticus who were receiving mechanical ventilation to hypothermia (32 to 34°C for 24 hours) in addition to standard care or to standard care alone; 268 patients were included in the analysis. The primary outcome was a good functional outcome at 90 days, defined as a Glasgow Outcome Scale (GOS) score of 5 (range, 1 to 5, with 1 representing death and 5 representing no or minimal neurologic deficit). The main secondary outcomes were mortality at 90 days, progression to electroencephalographically (EEG) confirmed status epilepticus, refractory status epilepticus on day 1, "super-refractory" status epilepticus (resistant to general anesthesia), and functional sequelae on day 90. RESULTS A GOS score of 5 occurred in 67 of 138 patients (49%) in the hypothermia group and in 56 of 130 (43%) in the control group (adjusted common odds ratio, 1.22; 95% confidence interval [CI], 0.75 to 1.99; P=0.43). The rate of progression to EEG-confirmed status epilepticus on the first day was lower in the hypothermia group than in the control group (11% vs. 22%; odds ratio, 0.40; 95% CI, 0.20 to 0.79; P=0.009), but there were no significant differences between groups in the other secondary outcomes. Adverse events were more frequent in the hypothermia group than in the control group. CONCLUSIONS In this trial, induced hypothermia added to standard care was not associated with significantly better 90-day outcomes than standard care alone in patients with convulsive status epilepticus. (Funded by the French Ministry of Health; HYBERNATUS ClinicalTrials.gov number, NCT01359332 .).
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Roquet D, Foucher JR, Froehlig P, Renard F, Pottecher J, Besancenot H, Schneider F, Schenck M, Kremer S. Resting-state networks distinguish locked-in from vegetative state patients. Neuroimage Clin 2016; 12:16-22. [PMID: 27330978 PMCID: PMC4913176 DOI: 10.1016/j.nicl.2016.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/29/2016] [Accepted: 06/05/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Locked-in syndrome and vegetative state are distinct outcomes from coma. Despite their differences, they are clinically difficult to distinguish at the early stage and current diagnostic tools remain insufficient. Since some brain functions are preserved in locked-in syndrome, we postulated that networks of spontaneously co-activated brain areas might be present in locked-in patients, similar to healthy controls, but not in patients in a vegetative state. METHODS Five patients with locked-in syndrome, 12 patients in a vegetative state and 19 healthy controls underwent a resting-state fMRI scan. Individual spatial independent component analysis was used to separate spontaneous brain co-activations from noise. These co-activity maps were selected and then classified by two raters as either one of eight resting-state networks commonly shared across subjects or as specific to a subject. RESULTS The numbers of spontaneous co-activity maps, total resting-state networks, and resting-state networks underlying high-level cognitive activity were shown to differentiate controls and locked-in patients from patients in a vegetative state. Analyses of each common resting-state network revealed that the default mode network accurately distinguished locked-in from vegetative-state patients. The frontoparietal network also had maximum specificity but more limited sensitivity. CONCLUSIONS This study reinforces previous reports on the preservation of the default mode network in locked-in syndrome in contrast to vegetative state but extends them by suggesting that other networks might be relevant to the diagnosis of locked-in syndrome. The aforementioned analysis of fMRI brain activity at rest might be a step in the development of a diagnostic biomarker to distinguish locked-in syndrome from vegetative state.
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Marzolf G, Sabou M, Lannes B, Cotton F, Meyronet D, Galanaud D, Cottier JP, Grand S, Desal H, Kreutz J, Schenck M, Meyer N, Schneider F, Dietemann JL, Koob M, Herbrecht R, Kremer S. Magnetic Resonance Imaging of Cerebral Aspergillosis: Imaging and Pathological Correlations. PLoS One 2016; 11:e0152475. [PMID: 27097323 PMCID: PMC4838310 DOI: 10.1371/journal.pone.0152475] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/15/2016] [Indexed: 11/21/2022] Open
Abstract
Cerebral aspergillosis is associated with a significant morbidity and mortality rate. The imaging data present different patterns and no full consensus exists on typical imaging characteristics of the cerebral lesions. We reviewed MRI findings in 21 patients with cerebral aspergillosis and correlated them to the immune status of the patients and to neuropathological findings when tissue was available. The lesions were characterized by their number, topography, and MRI signal. Dissemination to the brain resulted from direct spread from paranasal sinuses in 8 patients, 6 of them being immunocompetent. Hematogenous dissemination was observed in 13 patients, all were immunosuppressed. In this later group we identified a total of 329 parenchymal abscesses involving the whole brain with a predilection for the corticomedullary junction. More than half the patients had a corpus callosum lesion. Hemorrhagic lesions accounted for 13% and contrast enhancement was observed in 61% of the lesions. Patients with hematogenous dissemination were younger (p = 0.003), had more intracranial lesions (p = 0.0004) and had a higher 12-week mortality rate (p = 0.046) than patients with direct spread from paranasal sinuses. Analysis of 12 aneurysms allowed us to highlight two distinct situations. In case of direct spread from the paranasal sinuses, aneurysms are saccular and located on the proximal artery portions, while the hematogenous dissemination in immunocompromised patients is more frequently associated with distal and fusiform aneurysms. MRI is the exam of choice for cerebral aspergillosis. Number and type of lesions are different according to the mode of dissemination of the infection.
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Ruppert E, Schenck M, Dhif N, Besancenot H, Pottecher J, Mutschler V. Aspects EEG chez quatre patients avec intoxication au baclofène. Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Dumas G, Géri G, Montlahuc C, Chemam S, Dangers L, Pichereau C, Brechot N, Duprey M, Mayaux J, Schenck M, Boisramé-Helms J, Thomas G, Baboi L, Mouthon L, Amoura Z, Papo T, Mahr A, Chevret S, Chiche JD, Azoulay E. Outcomes in critically ill patients with systemic rheumatic disease: a multicenter study. Chest 2016; 148:927-935. [PMID: 25996557 DOI: 10.1378/chest.14-3098] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patients with systemic rheumatic diseases (SRDs) may require ICU management for SRD exacerbation or treatment-related infections or toxicities. METHODS This was an observational study at 10 university-affiliated ICUs in France. Consecutive patients with SRDs were included. Determinants of ICU mortality were identified through multivariable logistic analysis. RESULTS Three hundred sixty-three patients (65.3% women; median age, 59 years [interquartile range, 42-70 years]) accounted for 381 admissions. Connective tissue disease (primarily systemic lupus erythematosus) accounted for 66.1% of SRDs and systemic vasculitides for 26.2% (chiefly antineutrophil cytoplasm antibodies-associated vasculitides). SRDs were newly diagnosed in 43 cases (11.3%). Direct admission to the ICU occurred in 143 cases (37.9%). Reasons for ICU admissions were infection (39.9%), SRD exacerbation (34.4%), toxicity (5.8%), or miscellaneous (19.9%). Respiratory involvement was the leading cause of admission (56.8%), followed by shock (41.5%) and acute kidney injury (42.2%). Median Sequential Organ Failure Assessment (SOFA) score on day 1 was 5 (3-8). Mechanical ventilation was required in 57% of cases, vasopressors in 33.9%, and renal replacement therapy in 28.1%. ICU mortality rate was 21.0% (80 deaths). Factors associated with ICU mortality were shock (OR, 3.77; 95% CI, 1.93-7.36), SOFA score at day 1 (OR, 1.19; 95% CI, 1.10-1.30), and direct admission (OR, 0.52; 95% CI, 0.28-0.97). Neither comorbidities nor SRD characteristics were associated with survival. CONCLUSIONS In patients with SRDs, critical care management is mostly needed only in patients with a previously known SRD; however, diagnosis can be made in the ICU for 12% of patients. Infection and SRD exacerbation account for more than two-thirds of these situations, both targeting chiefly the lungs. Direct admission to the ICU may improve outcomes.
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Lemiale V, Mokart D, Resche-Rigon M, Pène F, Mayaux J, Faucher E, Nyunga M, Girault C, Perez P, Guitton C, Ekpe K, Kouatchet A, Théodose I, Benoit D, Canet E, Barbier F, Rabbat A, Bruneel F, Vincent F, Klouche K, Loay K, Mariotte E, Bouadma L, Moreau AS, Seguin A, Meert AP, Reignier J, Papazian L, Mehzari I, Cohen Y, Schenck M, Hamidfar R, Darmon M, Demoule A, Chevret S, Azoulay E. Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial. JAMA 2015; 314:1711-9. [PMID: 26444879 DOI: 10.1001/jama.2015.12402] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure. However, its effectiveness for this indication remains unclear. OBJECTIVE To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized trial conducted among 374 critically ill immunocompromised patients, of whom 317 (84.7%) were receiving treatment for hematologic malignancies or solid tumors, at 28 intensive care units (ICUs) in France and Belgium between August 12, 2013, and January 2, 2015. INTERVENTIONS Patients were randomly assigned to early noninvasive ventilation (n = 191) or oxygen therapy alone (n = 183). MAIN OUTCOMES AND MEASURES The primary outcome was day-28 mortality. Secondary outcomes were intubation, Sequential Organ Failure Assessment score on day 3, ICU-acquired infections, duration of mechanical ventilation, and ICU length of stay. RESULTS At randomization, median oxygen flow was 9 L/min (interquartile range, 5-15) in the noninvasive ventilation group and 9 L/min (interquartile range, 6-15) in the oxygen group. All patients in the noninvasive ventilation group received the first noninvasive ventilation session immediately after randomization. On day 28 after randomization, 46 deaths (24.1%) had occurred in the noninvasive ventilation group vs 50 (27.3%) in the oxygen group (absolute difference, -3.2 [95% CI, -12.1 to 5.6]; P = .47). Oxygenation failure occurred in 155 patients overall (41.4%), 73 (38.2%) in the noninvasive ventilation group and 82 (44.8%) in the oxygen group (absolute difference, -6.6 [95% CI, -16.6 to 3.4]; P = .20). There were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays. CONCLUSIONS AND RELEVANCE Among immunocompromised patients admitted to the ICU with hypoxemic acute respiratory failure, early noninvasive ventilation compared with oxygen therapy alone did not reduce 28-day mortality. However, study power was limited. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01915719.
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De Wit M, De Geeter P, Galli L, Hegele A, Schrader M, Schenck M, Vom Dorp F, Bolten M, Fahlenkamp D, Hampel C, Krause S, Riggi M, Fougeray R, De Almeida C, Edlich B, Pichler A. 2640 Vinflunine maintenance treatment following first-line therapy of advanced urothelial carcinoma - results from the JASiMA trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31457-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Klein D, Schmitz T, Verhelst V, Panic A, Schenck M, Reis H, Drab M, Sak A, Herskind C, Maier P, Jendrossek V. Endothelial Caveolin-1 regulates the radiation response of epithelial prostate tumors. Oncogenesis 2015; 4:e148. [PMID: 25985209 PMCID: PMC4450264 DOI: 10.1038/oncsis.2015.9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/24/2015] [Accepted: 03/20/2015] [Indexed: 02/08/2023] Open
Abstract
The membrane protein caveolin-1 (Cav1) recently emerged as a novel oncogene involved in prostate cancer progression with opposed regulation in epithelial tumor cells and the tumor stroma. Here we examined the role of stromal Cav1 for growth and radiation response of MPR31-4 prostate cancer xenograft tumors using Cav1-deficient C57Bl/6 mice. Syngeneic MPR31-4 tumors grew faster when implanted into Cav1-deficient mice. Increased tumor growth on Cav1-deficient mice was linked to decreased integration of smooth muscle cells into the wall of newly formed blood vessels and thus with a less stabilized vessel phenotype compared with tumors from Cav1 wild-type animals. However, tumor growth delay of MPR31-4 tumors grown on Cav1 knockout mice to a single high-dose irradiation with 20 Gray was more pronounced compared with tumors grown on wild-type mice. Increased radiation-induced tumor growth delay in Cav1-deficient mice was associated with an increased endothelial cell apoptosis. In vitro studies using cultured endothelial cells (ECs) confirmed that the loss of Cav1 expression increases sensitivity of ECs to radiation-induced apoptosis and reduces their clonogenic survival after irradiation. Immunohistochemical analysis of human tissue specimen further revealed that although Cav1 expression is mostly reduced in the tumor stroma of advanced and metastatic prostate cancer, the vascular compartment still expresses high levels of Cav1. In conclusion, the radiation response of MPR31-4 prostate tumors is critically regulated by Cav1 expression in the tumor vasculature. Thus, Cav1 might be a promising therapeutic target for combinatorial therapies to counteract radiation resistance of prostate cancer at the level of the tumor vasculature.
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Schenck M, Lümmen G. [Superficial bladder cancer: Transurethral resection and instillation therapy]. Urologe A 2015; 54:499-503. [PMID: 25794589 DOI: 10.1007/s00120-015-3778-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bladder cancer is the fifth most common tumor in men with the incidence of bladder tumors continuing to rise in industrialized and developed countries. Because 80% of all bladder tumors grow on the surface, endoscopic transurethral resection (TUR-B) can be used for complete removal. Due to continuous technical developments and improvements of endoscopic equipment, video imaging and bipolar resection (TUR-IS) offers a high level of safety. Despite optimal equipment, intra- and postoperative complications in transurethral electrosurgery of bladder tumors may occur.
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Eichelberg C, Goebell P, Vervenne W, De Santis M, Fischer von Weikersthal L, Lerchenmüller C, Zimmermann U, Bos M, Freier W, Schirrmacher-Memmel S, Staehler M, Pahernik S, Los M, Schenck M, Floercken A, van Arkel C, Hauswald K, Indorf M, Gottstein D, Michel M. Updated Os Analysis, Multivariate and Qtwist Analysis of a Randomized Sequential Open-Label Study (Switch) to Evaluate Efficacy and Safety of Sorafenib (So) / Sunitinib (Su) Versus Su/So in the Treatment of Metastatic Renal Cell Cancer (Mrcc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schenck M, Eder R, Rübben H, Niedworok C, Tschirdewahn S. [Organ and kidney function preservation in renal cell carcinoma]. Urologe A 2014; 53:1329-43. [PMID: 25142788 DOI: 10.1007/s00120-014-3558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The organ-preserving partial nephrectomy has increasingly established itself in small unilateral renal tumours (<4 cm) with contralateral healthy kidney and counter gained in recent years in importance. There was found a significantly increased cardiovascular mortality rate and deteriorated quality of life, the more intact kidney tissue has been removed. OBJECTIVES In the present study, the influence of pre- and perioperative factors on direct postoperative course was examined, including 5-year survival rate and relapse behaviour after open organ-preserving partial nephrectomy in our own collective. MATERIALS AND METHODS In this retrospective study of 1657 patients were collected, who underwent surgery between 2007 and 2013 in the Department of Urology at the University Hospital Essen because of a renal tumour. 38 % of these operations (n = 636) were performed organ-preserving. In this trial there are factors identified that have an impact on need of blood transfusion and length of hospitalization in organ-preserving operation method. RESULTS No independent parameter can be determined for the need of blood transfusion. Tumour size and thus time of resection procedure does not affect the need of erythrocytes administration. In addition, the tumour size influences neither the postoperative serum-haemoglobin nor serum-creatinine. Increased patient age and female gender are identified as non-modifiable factors, which cause a longer hospitalisation. Postoperative pain therapy can be considered as a variable size, which does not affect the length of hospital stay. Modifiable factors that increase the overall length of stay, however, are the type of direct postoperative monitoring (ICU vs. anaesthetic recovery room) and the administration of blood transfusions. CONCLUSIONS There are constant factors, which can be associated with a longer residence time in the framework of an organ-preserving partial nephrectomy. Further there is shown evidence of the independence of the tumour size - in addition to proven good oncological results - of an extension of indication of organ-preserving nephrectomy of tumours > 4 cm.
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Bellier M, Schenck M, Guillot M, Riehm S, Schneider F. Tamponnade localisée : une cause rare d’arrêt cardiaque inopiné. Presse Med 2014; 43:323-5. [DOI: 10.1016/j.lpm.2013.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 06/22/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022] Open
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Tschirdewahn S, Rübben H, Schenck M. [Urological surgery with analogosedation and local anesthesia. What makes sense?]. Urologe A 2013; 52:1302-11. [PMID: 23959458 DOI: 10.1007/s00120-013-3316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Analogosedation and local anesthesia, including regional nerve blocks are used for endoscopic diagnostic or radiological and ultrasound-guided procedures in which the patient should not move or has to be free of pain. We retrospectively analyzed patient satisfaction, complications and the risk of urological interventions with analgosedation and/or local anesthesia between 2008 and 2012. MATERIAL AND METHODS In total 21,690 urological patients underwent surgical treatment at the Department of Urology of the University Hospital of Essen between 2008 and 2012 and 3,327 of these cases were performed by urologists with the patient under analogosedation (n=1484) and local anesthesia (n=1843). In total 13 surgical and endoscopic procedures were separately analyzed and evaluated for safety and practicability. RESULTS In five cases (0.15%) the procedures with analgosedation or local anesthesia were interrupted because of agitation (n=3) and in one case the transurethal resection was stopped due to a large bladder tumor. One patient suffered anaphylactic shock after preoperative intravenous application of cefuroxim 1.5 g. After cardiopulmonary resuscitation and a short stay on the intensive care unit the patient was discharged after 2 days.Conclusions. Local anesthesia and analgosedation should be performed by urologists for minor surgery, endoscopic procedures and radiological or ultrasound-guided treatment. For safety reasons there should always be a second medical doctor present for assistance. Analgesia with deep sedation or loss of defensive reflexes should be administered by anesthesiologists.
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Eisenhardt A, Schneider B, Schneider T, Rossi R, Schenck M. [Failure to attend appointments: data analysis of a urological group practice over 12 months]. Urologe A 2012; 51:1095-8. [PMID: 22733400 DOI: 10.1007/s00120-012-2953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE A well-structured system of appointments is mandatory in urological practices to provide a perfect work flow. A huge problem is appointments which are not cancelled by non-attending patients and remain free during consultation hours. METHODS An analysis of the electronic calendar of our group practice was performed from January 2010 to December 2010. RESULTS In 2010, 24,764 appointments in consultation hours were scheduled and of those 1,348 (5.4%) were not cancelled but not attended by the patients. Out of 1,760 X-ray investigations 59 (3.3%) patients did not show up and of 3,828 cystoscopy appointments, 109 (2.8%) patients did not cancel although they did not attend. A total of 440 outpatient appointments for surgery were scheduled and 8 (1.8%) patients did not attend but did not cancel surgery. Out of 176 (11.4%) scheduled spermiogram appointments, 20 patients did not bring a sample for analysis. CONCLUSIONS Due to the experiences of the authors, combined investigations, e.g. intravenous pyelogram (IVP) and cystoscopy on one day, should therefore be avoided in order to be able to cancel the second appointment when patients do not show up for the first appointment. In cases of surgical interventions, patients should be contacted by telephone 2-3 days prior to surgery for confirmation. Currently under German law there is no way to claim compensation for missed appointments from the patients. Thus, the only way to avoid large numbers of missed appointments is to keep those as low as possible, as soon as appointments are made and scheduled (e.g. no double appointments).
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Achard S, Kremer S, Schenck M, Renard F, Ong-Nicolas C, Namer JI, Mutschler V, Schneider F, Delon-Martin C. Global Functional Disconnections in Post-anoxic Coma Patient. Neuroradiol J 2011; 24:311-5. [DOI: 10.1177/197140091102400222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/03/2011] [Indexed: 11/15/2022] Open
Abstract
Disorders of consciousness have been related to different disconnection patterns as assessed by neuroimaging tools such as PET or fMRI. In this report, we use resting-state functional MRI acquisition and a functional connectivity analysis by graph of brain networks, to investigate the global residual connection pattern in a patient with consciousness disorders following post-anoxic injury. We then compare this pattern with those of a group of twenty controls. We observed that the patient's graph presents multiple disconnections in primary areas and in high-order associative areas. This pattern is consistent with a vegetative state, as reported by other groups. Further, the informations conveyed by this approach are consistent with those provided by PET, fMRI and EP. This new approach presents a very strong potential for diagnosis for consciousness disorder patients since it is applicable very early after the insult.
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Schenck M, Luetzke A, Ruebben H, Schneider T. [Perioperative antibiotic prophylaxis in radical retropubic prostatectomy: a randomised pilot study of perioperative and postoperative administration]. Aktuelle Urol 2011; 42:38-45. [PMID: 21267804 DOI: 10.1055/s-0030-1262748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE A standard protocol for perioperative antibiotic prophylaxis in radical retropubic prostatectomy has not been established until now. The present pilot study compared the perioperative single-dose of piperacillin/tazobactam to the administration of ciprofloxacin or cotrimoxazol for 5 days with regard to postoperative infections. For the first time these antibiotic regimes were described in radical retropubic prostatectomy. MATERIAL AND METHODS The patients were divided into three groups, each consisting of 17 patients: group 1: a single-dose of piperacillin / tazobactam 4.5 g i. v., group 2: ciprofloxacin 500 mg or cotrimoxazol 960 mg i. v. / p. o. and group 3: varying administration and duration of different kinds of antibiotics as control group. The basic characteristics of the patients such as age, body-mass-index, risk factors, diseases, former surgeries and medication were similar between all three groups. Also there were no significant differences in intraoperative parameters such as operation time, blood loss and other postoperative complications. RESULTS The piperacillin / tazobactam group showed a significantly lower body temperature on postoperative days (POD) 1-3. The laboratory values were not significantly different among the groups, except the piperacillin / tazobactam group showed a significantly lower CRP level on POD 1-3 than group 3. All antibiotic regimes could afford an efficient protection: None of the patients died and there were no cases of serious consequences such as pneumonia, urosepsis or bacteriuria. Although not statistically significant, the piperacillin / tazobactam group showed better clinical outcomes: here the length of hospitalisation was two days less than in the other groups, no cases of wound infection occurred, the antimicrobial resistance rates were lower and fewer patients were treated with antibiotics in the postoperative course. CONCLUSIONS Comparable to similar studies with a larger number of patients our pilot study demonstrated, although statistically not significant, better clinical results overall. We therefore conclude that a single-dose of piperacillin / tazobactam appears to be an efficient antibiotic prophylaxis in radical retropubic prostatectomy and even in some clinical parameters piperacillin / tazobactam seems to be equivalent or better than the usual 5-day administration of antimicrobial prophylaxis.
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Rossi Neto R, Hess J, Rose A, Schenck M, vom Dorp F, Rübben H. [Treatment of vesico-enteric fistulae in men. Pedicled bladder flap]. Urologe A 2010; 49:827-31. [PMID: 20625873 DOI: 10.1007/s00120-010-2317-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Genitourinary fistulae represent a rare condition for patients submitted to salvage radiotherapy due to local tumour relapse after radical prostatectomy. Nevertheless, it is associated with great morbidity and in many cases with repetitive surgeries limiting their quality of life. Many techniques have been proposed to reduce the incidence of early and late postsurgical complications, but up to now a safe and unique method to treat this disease has not been reported in the literature. Here we report on three cases of male patients who developed a vesicoenteric fistula after radiation salvage therapy following radical prostatectomy. A rotation bladder flap was used to cover the pelvic floor attempting to reduce the common complications. All of the patients underwent a urinary diversion and a protective colostomy. The 1-year follow-up showed good postsurgical outcomes with minor early complications and no signs of intestinal obstruction or recurrent fistula. Furthermore, perineal and pelvic pain improvement was also achieved.The small number of cases is a limiting factor in defining standard techniques for the treatment of actinic vesicoenteric fistulae. Nevertheless, the use of a rotational bladder flap for repair of the pelvic floor defect has shown promising results and should be indicated in special situations.
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Kremer S, Renard F, Noblet V, Mialin R, Wolfram-Gabel R, Delon-Martin C, Achard S, Schenck M, Mohr M, Dietemann JL, Schneider F. Diffusion tensor imaging in human global cerebral anoxia: correlation with histology in a case with autopsy. J Neuroradiol 2010; 37:301-3. [PMID: 20378174 DOI: 10.1016/j.neurad.2009.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 12/30/2009] [Accepted: 12/31/2009] [Indexed: 11/30/2022]
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Schenck M. Bildgebung 2010. Urologe A 2010; 49:337. [DOI: 10.1007/s00120-010-2274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schenck M, Schneider T. Einfache und effektive Beurteilung der Anastomose nach radikaler retropubischer Prostatektomie. Urologe A 2010; 49:364-8. [DOI: 10.1007/s00120-010-2270-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schenck M, Kliner S, Achilles M, Schenck C, Berkovic K, Ruebben H, Stuschke M. [Pudendal block or combined spinal-epidural anaesthesia in high-dose-rate brachytherapy for prostate carcinoma?]. Aktuelle Urol 2010; 41:43-51. [PMID: 19950054 DOI: 10.1055/s-0029-1224722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In male patients the pudendal block has been applied only in rare cases as a therapy for neuralgia of the pudendal nerve. Up to now there is no comparison of pudendal block with an anaesthesia form close to the spinal cord. In this pilot study the bilateral perineal infiltration of the pudendal nerve was compared to combined spinal-epidural anaesthesia in high-dose-rate (HDR) brachytherapy. MATERIAL AND METHODS In 30 patients (68.8 +/- 5.4 years) who underwent a core needle biopsy for high-risk prostate carcinoma, an HDR brachytherapy in CSE or NPB was carried out. Both anaesthesia forms were examined concerning the perioperative compatibility, the subjective feeling (German school marks principle 1-6), the pain feeling (VAS, 1-10) and the early postoperative course (mobility, complications). RESULTS Both anaesthesia procedures were offered to all patients. For 2 patients the NPB was favoured primarily, because they had undergone surgery of the lumbal spine, so that the CSE was not applicable. There was no change of anaesthesia form necessary. The expense of time for NPB was 10.5 +/- 2.5 min, for CSE 30.5 +/- 5.5 min (p < 0.005). The hollow needles remained in place on average for 79 +/- 11.7 min (p = 0.23). Inter- and postoperative pain feelings were in both groups between 1.3 +/- 1.1 and 1.1 +/- 1.0 (p = 0.61 and p = 0.29). The difference is not significant. The NPB group considered postoperative mobility as an advantage. All patients felt the bladder catheter as annoying, but the NPB group considered postoperative mobility as more important than complete lack of pain. The subjective feeling in the NPB group was described as 2.06 +/- 0.59 and in the CSE group 2.73 +/- 0.79. This is a significant difference (p < 0.005). No side effects or complications in both anaesthesia forms appeared. CONCLUSIONS The perineal pudendal block is equivalent to epidural anaesthesia in HDR brachytherapy. Concerning the objectifiable pain score measurement and the subjective feeling there are no essential significant differences.
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Börgermann C, vom Dorp F, Rossi R, Schenck M, Luboldt HJ, Rübben H. [Informed consent for patients on early recognition of prostate carcinoma is insufficient]. Urologe A 2009; 48:997-8, 1000-1. [PMID: 19680621 DOI: 10.1007/s00120-009-2074-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Men that undergo an early detection investigation should be informed of the advantages and disadvantages as well as of the therapeutic consequences. In this study the quality of information was checked using the state of scientific knowledge of the patients.An informative consultation was carried out before the early detection investigation using a clarification brochure and an examination by a urologist. A questionnaire was also filled out after the investigation. A total of 1,536 men were questioned. Although 47% of the men had previously undertaken a PSA at least once, only 55% knew their own test result. Subjectively 82% of men felt well informed. In contrast one-third did not know the significance of an increased PSA level. In the field of patient clarification for the early detection for prostate cancer there are considerable deficits but the information received was considered adequate by the participants. However, more than one-third did not understand the significance of the PSA level.
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Schenck M, Rübben H, Gulbins E. [Molecular aspects of lymph node metastasis]. Urologe A 2009; 48:6-11. [PMID: 19156338 DOI: 10.1007/s00120-008-1752-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The risk of local and systemic lymphatic metastasis of a tumor increases with the size of the malignant neoplasia. Lymph vessels are generated in the tumor and seem to follow anatomically defined pathways. However, the precise molecular and biological mechanisms seem to be complex and require definition. At present, molecules belonging to the vascular endothelial growth factors family and podoplanin have been identified as key for the proliferation of the tumor's lacteals. Molecular mechanisms of the tumor origin and the hematogenic and lymphatic dissemination are increasingly better defined by the use of new diagnostic and therapeutic approaches for tumor patients. Simultaneously, we might be able to influence processes such as cell growth, apoptosis, angiogenesis, and lymphogenic dissemination by novel drugs and thereby develop novel approaches for tumor treatment. Chemokine receptors seem to control essential steps of lymphogenic dissemination such as migration, invasion, and proliferation of tumor cells.
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vom Dorp F, Boergermann C, Schenck M, Becker M, Rose A, Szarvas T, Rübben H. Rolle der Lymphadenektomie bei Patienten mit invasivem Urothelkarzinom der Harnblase. Urologe A 2008; 48:51-3. [DOI: 10.1007/s00120-008-1760-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schenck M, Börgermann C, vom Dorp F, Groneberg M, Busch Y, Carpinteiro A, Wilker B, Keitsch S, Moyrer S, Schmid KW, Stuschke M, Rübben H, Gulbins E. [Proapoptotic antibodies as new therapeutic agents for tumor treatment]. Urologe A 2008; 46:1262-5. [PMID: 17598083 DOI: 10.1007/s00120-007-1385-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To convert the concept already successful in mice into clinical practice and commercialize it, a human anti-CD95-antibody must be produced. In a second step experiments must be performed on various normal healthy cells and tissues to determine whether these human anti-CD95-antibodies administered in very low doses have any effect on human cells (particularly hepatocytes) or at least cause only minimal side effects. If these studies yield positive results, then clinical trials can be conducted in which increasing doses are given to exclude an acute hepatotoxic effect and then the effect exerted by the antibody in combination with irradiation on tumor growth can be investigated.The advantage of this concept lies in the fact that systemic stimulus (low doses of anti-CD95-antibodies) is highly intensified by local radiotherapy and only then initiates cell death. Since the anti-CD95-antibodies trigger apoptosis primarily in tumor endothelia, this approach could be employed not only for prostate cancer and melanomas, which have already been tested, but also for many other tumors.
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