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Galata C, Schiller P, Müller L, Karampinis I, Stamenovic D, Buhl R, Kreuter M, Roessner ED. Thoracic skeletal muscle mass predicts mortality in patients with surgery for pleural empyema: A case control study. Thorac Cancer 2024. [PMID: 38597111 DOI: 10.1111/1759-7714.15307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/23/2024] [Accepted: 03/31/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND This study investigated the role of the thoracic skeletal muscle mass as a marker of sarcopenia on postoperative mortality in pleural empyema. METHODS All consecutive patients (n = 103) undergoing surgery for pleural empyema in a single tertiary referral center between January 2020 and December 2022 were eligible for this study. Thoracic skeletal muscle mass index (TSMI) was determined from preoperative computed tomography scans. The impact of TSMI and other potential risk factors on postoperative in-hospital mortality was retrospectively analyzed. RESULTS A total of 97 patients were included in this study. The in-hospital mortality rate was 13.4%. In univariable analysis, low values for preoperative TSMI (p = 0.020), low preoperative levels of thrombocytes (p = 0.027) and total serum protein (p = 0.046) and higher preoperative American Society of Anesthesiologists (ASA) category (p = 0.007) were statistically significant risk factors for mortality. In multivariable analysis, only TSMI (p = 0.038, OR 0.933, 95% CI: 0.875-0.996) and low thrombocytes (p = 0.031, OR 0.944, 95% CI: 0.988-0.999) remained independent prognostic factors for mortality. CONCLUSIONS TSMI was a significant prognostic risk factor for postoperative mortality in patients with pleural empyema. TSMI may be suitable for risk stratification in this disease with high morbidity and mortality, which may have further implications for the selection of the best treatment strategy.
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Affiliation(s)
- Christian Galata
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp Schiller
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Surgery, RoMed Hospital Rosenheim, Rosenheim, Germany
| | - Lukas Müller
- Department of Radiology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ioannis Karampinis
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Davor Stamenovic
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roland Buhl
- Department for Pulmonology, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Kreuter
- Center for Pulmonary Medicine, Department for Pulmonology, Center for Thoracic Diseases, University Medical Center Mainz, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Eric Dominic Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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Karampinis I, Ruckes C, Doerr F, Bölükbas S, Ricciardi S, Cardillo G, Galvez C, Vidmar B, Stupnik T, Fang V, Petersen RH, Roessner ED. ERASURE: early autologous blood pleurodesis for postoperative air leaks-a randomized, controlled trial comparing prophylactic autologous blood pleurodesis versus standard watch and wait treatment for postoperative air leaks following thoracoscopic anatomic lung resections. Trials 2024; 25:20. [PMID: 38166982 PMCID: PMC10763257 DOI: 10.1186/s13063-023-07875-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The prolonged air leak is probably the most common complication following lung resections. Around 10-20% of the patients who undergo a lung resection will eventually develop a prolonged air leak. The definition of a prolonged air leak varies between an air leak, which is evident after the fifth, seventh or even tenth postoperative day to every air leak that prolongs the hospital stay. However, the postoperative hospital stay following a thoracoscopic lobectomy can be as short as 2 days, making the above definitions sound outdated. The treatment of these air leaks is also very versatile. One of the broadly accepted treatment options is the autologous blood pleurodesis or "blood patch". The purpose of this trial is to investigate the impact of a prophylactic autologous blood pleurodesis on reducing the duration of the postoperative air leak and therefore prevent the air leak from becoming prolonged. METHODS Patients undergoing an elective thoracoscopic anatomic lung resection for primary lung cancer or metastatic disease will be eligible for recruitment. Patients with an air leak of > 100 ml/min within 6 h prior to the morning round on the second postoperative day will be eligible for inclusion in the study and randomization. Patients will be randomized to either blood pleurodesis or watchful waiting. The primary endpoint is the time to drain removal measured in full days. The trial ends on the seventh postoperative day. DISCUSSION The early autologous blood pleurodesis could lead to a faster cessation of the air leak and therefore to a faster removal of the drain. A faster removal of the drain would relieve the patient from all the well-known drain-associated complications (longer hospital stay, stronger postoperative pain, risk of drain-associated infection, etc.). From the economical point of view, faster drain removal would reduce the hospital costs as well as the costs associated with the care of a patient with a chest drain in an outpatient setting. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00030810. 27 December 2022.
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Affiliation(s)
- Ioannis Karampinis
- Department of Thoracic Surgery, Centre for Thoracic Diseases, Mainz University, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials (IZKS Mainz), Mainz University, Mainz, Germany
| | - Fabian Doerr
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandclinic, Essen, Germany
| | - Servet Bölükbas
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandclinic, Essen, Germany
| | - Sara Ricciardi
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Carlos Galvez
- Department of Thoracic Surgery, Hospital General Universitario Alicante, Alicante, Spain
| | - Bogdan Vidmar
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Tomaz Stupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Vincent Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | | | - Eric Dominic Roessner
- Department of Thoracic Surgery, Centre for Thoracic Diseases, Mainz University, Mainz, Germany.
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Stamenovic D, Dittmar E, Schiller P, Trenchev D, Karampinis I, Galata C, Roessner E. A randomized controlled trial: Comparison of 14 and 24 French thoracic drainage after minimally invasive lobectomy - MZ 14-24 study. Heliyon 2023; 9:e22049. [PMID: 38107303 PMCID: PMC10724532 DOI: 10.1016/j.heliyon.2023.e22049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
Background The optimal placement of a chest drain after video-assisted minimally invasive lobectomy should facilitate the aspiration of air and drainage of fluid. Typically, a conventional 24Ch polyvinyl chloride chest drain is used for this purpose. However, there is currently no scientific literature available on the impact of drain diameter on postoperative outcomes following anatomical lung resection. Methods This is a prospective, randomized, phase-1 trial that will include 40 patients, which will be randomly assigned into two groups. Group 1 will receive a 24 French chest drain according to current standards, while group 2 will receive a 14 French drain. Primary endpoint of the trial is the incidence of postoperative drainage-related complications, such as obstruction, dislocation, pleural effusion, and reintervention. Secondary endpoints are postoperative pain, chest drainage duration, incidence of complications, and hospital length of stay. The study aims to determine the number of subjects needed to achieve a sufficient test power of 0.8 for a non-inferiority study. Discussion Thoracic surgery is becoming more and more minimally invasive. One of the remaining unresolved problems is postoperative pain, with the intercostal drain being one of the main contributing factors. Previous data from other studies suggest that the use of small-bore drains can reduce pain and speed up recovery without an increase in drain-related complications. However, no studies have been conducted on patients undergoing anatomic lung resections to date. The initial step in transitioning from larger to smaller drains is to establish the safety of this approach, which is the primary objective of this trial.Trial registration: The study has been registered in the German Clinical Trials Register.Registration number: DRKS00029982.URL: https://drks.de/search/de/trial/DRKS00029982.
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Affiliation(s)
- Davor Stamenovic
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Hospital Mainz, Mainz University, Germany
| | - Eileen Dittmar
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Hospital Mainz, Mainz University, Germany
| | - Philipp Schiller
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Hospital Mainz, Mainz University, Germany
| | - Darko Trenchev
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Hospital Mainz, Mainz University, Germany
| | - Ioannis Karampinis
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Hospital Mainz, Mainz University, Germany
| | - Christian Galata
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Hospital Mainz, Mainz University, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Hospital Mainz, Mainz University, Germany
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4
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Stamenovic D, Schiller P, Karampinis I, Galata C, Roessner ED. Uniportal robotic assisted surgery for anatomical lung resection-First German experience. Int J Med Robot 2023:e2580. [PMID: 37792964 DOI: 10.1002/rcs.2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Uniportal robotic-assisted thoracic surgery (uRATS) has emerged as a promising technique with potential advantages over multiportal approaches. This study aims to evaluate our initial outcomes of uRATS. MATERIAL AND METHODS Five patients underwent anatomic lung resections with systematic nodal dissection through a uniportal robotic approach by one surgeon. The results were compared to the results of the first five uniportal video-assisted thoracic surgery (uVATS) anatomical resections performed by the same surgeon. RESULTS No adverse events occurred during the uRATS-procedures. Comparable surgical outcomes were observed between uRATS and uVATS, including hospital stays, complication rates, and blood loss. The average procedural time was slightly but non-significantly longer in the uRATS-group. Average pain-scores were lower in the uRATS group. One patient in each group experienced major postoperative complications, with one case of in-hospital mortality in the uRATS-group. CONCLUSION The outcomes of uRATS/uVATS were comparable, highlighting the potential and the feasibility of this technique. Prospective studies comparing the learning curves, complication rate and hospital-stay are required in order to justify the superiority of robotics over uVATS.
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Affiliation(s)
- Davor Stamenovic
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
| | - P Schiller
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
| | - I Karampinis
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
| | - C Galata
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
| | - E D Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
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5
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Galata C, Roessner ED, Dette F, Conradi R, Bastuck V, Stamenovic D, Karampinis I. An update on red blood cell transfusion in non-cardiac thoracic surgery. J Thorac Dis 2023; 15:2926-2935. [PMID: 37426114 PMCID: PMC10323595 DOI: 10.21037/jtd-22-1581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/03/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The aim of this study was to evaluate risk factors for red blood cell (RBC) transfusion in non-cardiac thoracic surgery. METHODS All patients undergoing non-cardiac thoracic surgery in a single tertiary referral center between January and December 2021 were eligible for this study. Data on blood requests and perioperative RBC transfusion were retrospectively analyzed. RESULTS A total of 379 patients were included, of whom 275 (72.6%) underwent elective surgery. The overall RBC transfusion rate was 7.4% (elective cases: 2.5%, non-elective cases: 20.2%). Patients with lung resections required transfusion in 2.4% of the cases versus 44.7% in patients undergoing surgery for empyema. In multivariable analysis, empyema (P=0.001), open surgery (P<0.001), low preoperative hemoglobin (P=0.001), and old age (P=0.013) were independent risk factors for RBC transfusion. The best predictor of blood transfusion was preoperative hemoglobin with a cut-off value <10.4 g/dL (sensitivity 82.1%, specificity 86.3%, area under the curve 0.882). CONCLUSIONS The rate of RBC transfusion in current non-cardiac thoracic surgery is low, especially in elective lung resections. In urgent cases and open surgery, transfusion rates remain high, particularly in empyema cases. Preoperative requesting of RBC units should be tailored to patient-specific risk factors.
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Affiliation(s)
- Christian Galata
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric Dominic Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frank Dette
- Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roland Conradi
- Transfusion Center, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Victoria Bastuck
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Davor Stamenovic
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ioannis Karampinis
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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Karampinis I, Nowak K, Koett J, Mess C, Wagner L, Gaiser T, Mayer FT, Goertz L, Schneider SW, Bauer AT. Von Willebrand factor in the plasma and in the tumor tissue predicts cancer-associated thrombosis and mortality. Haematologica 2022; 108:261-266. [PMID: 36134455 PMCID: PMC9827172 DOI: 10.3324/haematol.2022.281315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ioannis Karampinis
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, Johannes Gutenberg University Mainz, Mainz,*IK, KN and JK contributed equally as co-first authors
| | - Kai Nowak
- Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim,*IK, KN and JK contributed equally as co-first authors
| | - Julian Koett
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg,*IK, KN and JK contributed equally as co-first authors
| | - Christian Mess
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Laura Wagner
- Center for Trauma Surgery, Orthopedics and Hand Surgery, Hospital Worms, Worms
| | - Timo Gaiser
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, Mannheim
| | - Frank Thomas Mayer
- Department of Dermatology and Venereology, University Hospital Frankfurt, Frankfurt
| | - Lukas Goertz
- Department of Neuroradiology, University Hospital of Cologne, Cologne
| | - Stefan Werner Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Alexander Thomas Bauer
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg,Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany,A.T. BAUER -
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Karampinis I, Galata C, Roessner ED. Management von Thoraxdrainagen nach elektiven, thorakoskopischen,
anatomischen Lungenresektionen an thoraxchirurgischen Zentren in Deutschland .
Eine Umfrage über die Deutsche Gesellschaft für Thoraxchirurgie
(DGT). Zentralbl Chir 2022; 147:S16-S20. [DOI: 10.1055/a-1737-4477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Einleitung Die zunehmende Adaptation minimalinvasiver Techniken sowie der
Prinzipien der „Enhanced Recovery After Surgery“ (ERAS) in der Thoraxchirurgie
haben zu einer deutlichen Reduktion des perioperativen Risikos nach anatomischen
Lungenresektionen geführt. Die persistierende postoperative Luftleckage bleibt
allerdings weiterhin eine der Hauptkomplikationen. Ziel dieser Umfrage war es,
das Management von Thoraxdrainagen sowie die klinische Praxis der Behandlung
persistierender Luftleckagen nach elektiven, thorakoskopischen, anatomischen
Lungenresektionen in Deutschland zu analysieren.
Methodik Wir führten über die Deutsche Gesellschaft für Thoraxchirurgie
(DGT) eine Online-Umfrage unter thoraxchirurgischen Zentren (n = 160) in
Deutschland durch. Die Ergebnisse wurden getrennt nach High-Volume- und
Low-Volume-Zentren ausgewertet.
Ergebnisse Die Rücklaufquote betrug 35,6%. Die Mehrheit der Kliniken
verwendet als Standard eine einzelne Thoraxdrainage (24 Ch), die an ein
digitales Thoraxdrainagesystem unter Sog angeschlossen wird. Eine postoperative
Luftleckage wird von 42,1% der Kliniken nach dem 7. postoperativen Tag
behandelt. Die Luftleckage wird von der Mehrheit entweder durch eine Reduktion
des Sogs oder durch andere konservative Maßnahmen behandelt. Es zeigte sich kein
signifikanter Unterschied im Drainagemanagement zwischen High-Volume- und
Low-Volume-Zentren.
Schlussfolgerung Die Krankenhausverweildauer nach einer unkomplizierten
Lobektomie beträgt heute im Regelfall nur wenige Tage, wobei die untere
Grenzverweildauer bei 2 Tagen liegt. Dennoch definieren über 80% der deutschen
Zentren eine Luftleckage erst dann als prolongiert, wenn sie nach dem 5.
postoperativen Tag besteht; 65% behandeln sie auch erst dann. Die Studienlage
hierzu ist nicht richtungsweisend. Weitere prospektive klinische Studien sind
nötig, um die Behandlung der häufigsten Komplikation nach Lungenresektionen zu
verbessern.
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Affiliation(s)
- Ioannis Karampinis
- Thoraxchirurgie, Universitäres Thoraxzentrum Mainz, Universitätsmedizin
Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland, Mainz,
Deutschland
| | - Christian Galata
- Thoraxchirurgie, Universitäres Thoraxzentrum Mainz, Universitätsmedizin
Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland, Mainz,
Deutschland
| | - Eric Dominic Roessner
- Thoraxchirurgie, Universitäres Thoraxzentrum Mainz, Universitätsmedizin
Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland, Mainz,
Deutschland
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8
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Galata C, Messerschmidt A, Kostic M, Karampinis I, Roessner E, El Beyrouti H, Schneider T, Stamenovic D. Prognostic factors for long-term survival following complete resection by lobectomy in stage I non-small cell lung cancer. Thorac Cancer 2022; 13:2861-2866. [PMID: 36054161 PMCID: PMC9575062 DOI: 10.1111/1759-7714.14630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate predictors for long-term overall survival (OS) in patients with stage I non-small cell lung cancer (NSCLC). METHODS All patients undergoing complete resection by lobectomy for stage I NSCLC between October 2012 and December 2015 at a single center were included. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors. RESULTS A total of 92 patients were included. Univariable and multivariable Cox regression analyses revealed preoperative neutrophil to lymphocyte ratio (NLR, p = 0.005), preoperative diffusion capacity of the lungs for carbon monoxide (DLCO, p = 0.010) and forced expiratory volume in 1 second (FEV1, p = 0.041) as well as male gender (p = 0.026) as independent prognostic factors for OS. Combining the calculated cutoff values for FEV1 (<73.0%) and NLR (>3.49) into one parameter resulted in a highly significant difference in survival times when stratified by this variable. CONCLUSIONS Recently, much emphasis has been put on the prognostic importance of blood biomarkers in NSCLC. In our study, NLR was an independent factor for OS, as were baseline characteristics such as DLCO, FEV1, and gender. Further studies on the association of biomarkers for systemic inflammation and lung function parameters with respect to patient survival are warranted.
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Affiliation(s)
- Christian Galata
- Department of Thoracic Surgery, University Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Antje Messerschmidt
- Department of Thoracic Surgery, ViDia Kliniken Karlsruhe, Karlsruhe, Germany
| | - Marko Kostic
- Clinic for Thoracic Surgery, Clinical Center Belgrade, Serbia
| | - Ioannis Karampinis
- Department of Thoracic Surgery, University Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, University Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hazem El Beyrouti
- Department for Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Schneider
- Department of Thoracic Surgery, ViDia Kliniken Karlsruhe, Karlsruhe, Germany
| | - Davor Stamenovic
- Department of Thoracic Surgery, University Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Thoracic Surgery, ViDia Kliniken Karlsruhe, Karlsruhe, Germany
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Karampinis I, Gerken A, Reissfelder C, Nowak K, Jakob J. Fluoreszenzgesteuerte Lymphgefäßversiegelung bei der systematischen Lymphknotendissektion zur Vermeidung von Lymphfisteln und Lymphozelen. Zentralbl Chir 2022. [DOI: 10.1055/a-1866-4120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Zusammenfassung
Hintergrund Die wichtigsten Morbiditäten der systematischen inguinalen und axillären Lymphknotendissektion sind Lymphfisteln und Serome. Die intraoperative, fluoreszenzgesteuerte
Versiegelung der Lymphgefäße könnte die Häufigkeit dieser postoperativen Komplikationen verringern.
Methoden Vor der Lymphadenektomie erfolgte die Intrakutaninjektion von Indocyanin-Farbstoff im Bereich der distalen Extremität. Die Lymphadenektomie wurde nach Standardprotokollen
durchgeführt. Während des gesamten Eingriffs wurde Nahinfrarot-Bildgebung eingesetzt, und es wurde eine fluoreszenzgesteuerte Lymphgefäßversiegelung in Echtzeit durchgeführt
(Videopräsentation).
Ergebnisse Die fluoreszenzgesteuerte Lymphgefäßversiegelung wurde bei 3 Patienten durchgeführt, die sich einer axillären systematischen Lymphknotendissektion unterzogen. Nach der
Injektion des Fluoreszenzfarbstoffs traten keine unerwünschten Ereignisse auf. Alle Patienten konnten ohne Wundkomplikationen entlassen werden.
Schlussfolgerung Die fluoreszenzgesteuerte Lymphgefäßversiegelung könnte eine vielversprechende neue Technik zur Verhinderung von Lymphfisteln nach systematischer Lymphadenektomie
sein.
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Affiliation(s)
| | - Andreas Gerken
- Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | | | - Kai Nowak
- Department of General, Vascular and Thoracic Surgery, RoMed Kliniken, Rosenheim, Deutschland
| | - Jens Jakob
- Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
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10
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Karampinis I, Galata C, Roessner ED. Erratum: Management von Thoraxdrainagen nach elektiven, thorakoskopischen, anatomischen Lungenresektionen an thoraxchirurgischen Zentren in Deutschland. Eine Umfrage über die
Deutsche Gesellschaft für Thoraxchirurgie (DGT). Zentralbl Chir 2022; 147:e1. [DOI: 10.1055/a-1852-7913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ioannis Karampinis
- Thoraxchirurgie, Universitäres Thoraxzentrum Mainz, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland, Mainz, Deutschland
| | - Christian Galata
- Thoraxchirurgie, Universitäres Thoraxzentrum Mainz, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland, Mainz, Deutschland
| | - Eric Dominic Roessner
- Thoraxchirurgie, Universitäres Thoraxzentrum Mainz, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland, Mainz, Deutschland
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Gül D, Schweitzer A, Khamis A, Knauer SK, Ding GB, Freudelsperger L, Karampinis I, Strieth S, Hagemann J, Stauber RH. Impact of Secretion-Active Osteoblast-Specific Factor 2 in Promoting Progression and Metastasis of Head and Neck Cancer. Cancers (Basel) 2022; 14:2337. [PMID: 35565465 PMCID: PMC9106029 DOI: 10.3390/cancers14092337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Treatment success of head and neck cancer (HNC) is still hampered by tumor relapse due to metastases. Our study aimed to identify biomarkers by exploiting transcriptomics profiles of patient-matched metastases, primary tumors, and normal tissue mucosa as well as the TCGA HNC cohort data sets. Analyses identified osteoblast-specific factor 2 (OSF-2) as significantly overexpressed in lymph node metastases and primary tumors compared to normal tissue. High OSF-2 levels correlate with metastatic disease and reduced overall survival of predominantly HPV-negative HNC patients. No significant correlation was observed with tumor localization or therapy response. These findings were supported by the fact that OSF-2 expression was not elevated in cisplatin-resistant HNC cell lines. OSF-2 was strongly expressed in tumor-associated fibroblasts, suggesting a tumor microenvironment-promoting function. Molecular cloning and expression studies of OSF-2 variants from patients identified an evolutionary conserved bona fide protein secretion signal (1MIPFLPMFSLLLLLIVNPINA21). OSF-2 enhanced cell migration and cellular survival under stress conditions, which could be mimicked by the extracellular administration of recombinant protein. Here, OSF-2 executes its functions via ß1 integrin, resulting in the phosphorylation of PI3K and activation of the Akt/PKB signaling pathway. Collectively, we suggest OSF-2 as a potential prognostic biomarker and drug target, promoting metastases by supporting the tumor microenvironment and lymph node metastases survival rather than by enhancing primary tumor proliferation or therapy resistance.
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Affiliation(s)
- Désirée Gül
- Department of Otorhinolaryngology, Head and Neck Surgery, Molecular and Cellular Oncology, University Medical Center, 55131 Mainz, Germany; (A.S.); (A.K.); (L.F.); (J.H.)
| | - Andrea Schweitzer
- Department of Otorhinolaryngology, Head and Neck Surgery, Molecular and Cellular Oncology, University Medical Center, 55131 Mainz, Germany; (A.S.); (A.K.); (L.F.); (J.H.)
| | - Aya Khamis
- Department of Otorhinolaryngology, Head and Neck Surgery, Molecular and Cellular Oncology, University Medical Center, 55131 Mainz, Germany; (A.S.); (A.K.); (L.F.); (J.H.)
- Oral Pathology Department, Faculty of Dentistry, Alexandria University, El Azareta, Alexandria, Egypt
| | - Shirley K. Knauer
- Institute for Molecular Biology, Centre for Medical Biotechnology (ZMB), University Duisburg-Essen, Universitätsstraße, 45117 Essen, Germany;
| | - Guo-Bin Ding
- Institute of Biotechnology, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, Taiyuan 030006, China;
| | - Laura Freudelsperger
- Department of Otorhinolaryngology, Head and Neck Surgery, Molecular and Cellular Oncology, University Medical Center, 55131 Mainz, Germany; (A.S.); (A.K.); (L.F.); (J.H.)
| | - Ioannis Karampinis
- Academic Thoracic Center, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany;
| | - Sebastian Strieth
- Department of Otorhinolaryngology, University Medical Center Bonn, 53127 Bonn, Germany;
| | - Jan Hagemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Molecular and Cellular Oncology, University Medical Center, 55131 Mainz, Germany; (A.S.); (A.K.); (L.F.); (J.H.)
| | - Roland H. Stauber
- Department of Otorhinolaryngology, Head and Neck Surgery, Molecular and Cellular Oncology, University Medical Center, 55131 Mainz, Germany; (A.S.); (A.K.); (L.F.); (J.H.)
- Institute of Biotechnology, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, Taiyuan 030006, China;
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12
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Karampinis I, Al-Shammari A, Hartley P, Patel M, Arachchillage DRJ, Jordan S, Thakuria L, Garfield B, Ledot S, Buderi S. Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome. Perfusion 2022; 38:837-842. [PMID: 35514055 PMCID: PMC9082097 DOI: 10.1177/02676591221090618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical tracheostomy or thoracic surgery at a single tertiary centre whilst on ECMO support for COVID-19 related ARDS. METHODS 18 patients requiring thoracic input whilst on ECMO support during the first wave of COVID-19 (March-June 2020) were included. Thoracic surgery was required both for performing surgical tracheostomies in the operating theatre and for treating emergencies arising under the ECMO treatment such as bleeding complications. RESULTS Thirteen patients underwent a surgical tracheostomy, whilst five patients had an invasive thoracic procedure. Anticoagulation was withheld for at least 12 h in the perioperative setting regardless of the indication. One patient was re-operated for haemothorax immediately after the end of the primary operation. 94.5% of the patients were successfully decannulated from ECMO support. Overall 30-day mortality in the cohort was 5.5% (1/18). CONCLUSIONS Thoracic surgeons can play a valuable role in supporting an ECMO unit during the COVID pandemic, by treating ECMO related complications and by safely performing surgical tracheostomies. Withholding anticoagulation in the perioperative window was not associated with increased thromboembolic events and is desirable when interventions or surgery is indicated in this patient cohort to avoid excessive bleeding.
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Affiliation(s)
- Ioannis Karampinis
- Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Academic Thoracic Center, University Medical Center Mainz, Johannes Gutenberg University Mainz, Germany
| | - Abdullah Al-Shammari
- Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Philip Hartley
- Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mehul Patel
- Division of Critical Care, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Deepa R J Arachchillage
- Division of Hematology, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Centre for Hematology, Imperial College London, London, UK
| | - Simon Jordan
- Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Louit Thakuria
- Division of Critical Care, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ben Garfield
- Division of Critical Care, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stephane Ledot
- Division of Critical Care, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Silviu Buderi
- Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
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13
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Galata C, Porubsky S, Dohle DS, Karampinis I, Stamenovic D, Roessner ED. Open redo thymectomy for a large recurrent thymoma in a patient with myasthenia gravis: a case report. Mediastinum 2022; 6:8. [PMID: 35340829 PMCID: PMC8841549 DOI: 10.21037/med-21-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/13/2021] [Indexed: 06/14/2023]
Abstract
Thoracoscopic and robotic approaches are becoming increasingly popular for thymoma surgery. Yet open thymectomy must still be mastered today, as it may be the only viable option in challenging cases. In this study, we report a case of an extended local recurrence of myasthenia gravis associated thymoma and a history of previous sternotomy. The mediastinal mass infiltrated the left upper lobe of the lung, the pericardium, and presumably the aortic arch. Although the standard for thymoma resection at our institution is the robotic approach, we performed primary open redo thymectomy in standby of cardiopulmonary bypass in this case. Intraoperatively, bleeding from the aortic arch occurred, which was promptly controlled due to the open approach and due to immediate availability of cardiopulmonary bypass. The patient was transferred to the normal ward on the first postoperative day, was treated according to fast-track principles and recovered well. The pathology revealed a WHO B2:B1 thymoma with negative resection margins. Thymectomy is recommended as the principal treatment for thymoma and is also advised in the case of recurrence. However, there is no evidence regarding the optimal surgical approach. Our case indicates that in the era of minimally invasive thymectomy, the decision to conduct open surgery is wise when the risk of serious bleeding is anticipated or adherence to oncologic principles is challenged by tumor size or growth pattern.
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Affiliation(s)
- Christian Galata
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Porubsky
- Institute of Pathology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Sebastian Dohle
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ioannis Karampinis
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric Dominic Roessner
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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14
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Karampinis I, Dionysopoulou A, Galata C, Almstedt K, Grilli M, Hasenburg A, Roessner ED. Hyperthermic intrathoracic chemotherapy for the treatment of malignant pleural effusion caused by breast and ovarian cancer: A systematic literature review and pooled analysis. Thorac Cancer 2022; 13:883-888. [PMID: 35194945 PMCID: PMC8977169 DOI: 10.1111/1759-7714.14361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Breast and ovarian cancer account for over 30% of malignant pleural effusions (MPEs). Treatment of the metastatic disease requires control of the MPE. Even though primarily symptomatic, the treatment of the MPE can potentially affect the oncological course of the disease. The aim of this review is to analyze the effectiveness of intrathoracic chemotherapy in the treatment of MPE caused by breast and ovarian cancer. Methods A systematic literature research was conducted up until May 2021. Studies published in English on patients undergoing either surgical or interventional intrapleural chemotherapy were included. Results Thirteen studies with a total of 497 patients were included. Analysis was performed on 169 patients with MPE due to breast cancer and eight patients with MPE secondary to ovarian cancer. The pooled success rates of intrathoracic chemotherapy for controlling the MPE were 59.1% and 87.5%, respectively. A survival analysis was not possible with the available data. The overall toxicity of the treatment was low. Conclusions Intrathoracic chemotherapy achieves symptomatic control of the MPE in 59.1% of patients with metastatic breast cancer and 87.5% of patients with metastatic ovarian cancer. This is inferior to other forms of surgical pleurodesis. Data from small case series and studies on intraperitoneal chemotherapy show promising results. However, formal oncological studies on the use of intrathoracic chemotherapy for metastatic breast or ovarian cancer are lacking. Further prospective pilot studies are needed to assess the therapeutic oncological effects of this treatment.
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Affiliation(s)
- Ioannis Karampinis
- Division of Thoracic Surgery, Academic Thoracic Center, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Anna Dionysopoulou
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Christian Galata
- Division of Thoracic Surgery, Academic Thoracic Center, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Katrin Almstedt
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Annette Hasenburg
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Eric D Roessner
- Division of Thoracic Surgery, Academic Thoracic Center, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
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15
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Karampinis I, Rathmann N, Kostrzewa M, Diehl SJ, Schoenberg SO, Hohenberger P, Roessner ED. Computer tomography guided thoracoscopic resection of small pulmonary nodules in the hybrid theatre. PLoS One 2021; 16:e0258896. [PMID: 34731178 PMCID: PMC8565725 DOI: 10.1371/journal.pone.0258896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Thoracic surgeons are currently asked to resect smaller and deeper lesions which are difficult to detect thoracoscopically. The growing number of those lesions arises both from lung cancer screening programs and from follow-up of extrathoracic malignancies. This study analyzed the routine use of a CT-aided thoracoscopic approach to small pulmonary nodules in the hybrid theatre and the resulting changes in the treatment pathway. Methods 50 patients were retrospectively included. The clinical indication for histological diagnosis was suspected metastasis in 46 patients. Technically, the radiological distance between the periphery of the lesion and the visceral pleura had to exceed the maximum diameter of the lesion for the patient to be included. A spiral wire was placed using intraoperative CT-based laser navigation to guide the thoracoscopic resection. Results The mean diameter of the lesions was 8.4 mm (SD 4.27 mm). 29.4 minutes (SD 28.5) were required on average for the wire placement and 42.3 minutes (SD 20.1) for the resection of the lesion. Histopathology confirmed the expected diagnosis in 30 of 52 lesions. In the remaining 22 lesions, 9 cases of primary lung cancer were detected while 12 patients showed a benign disease. Conclusion Computer tomography assisted thoracoscopic surgery (CATS) enabled successful resection in all cases with minimal morbidity. The histological diagnosis led to a treatment change in 42% of the patients. The hybrid-CATS technique provides good access to deeply located small pulmonary nodules and could be particularly valuable in the emerging setting of lung cancer screening.
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Affiliation(s)
- Ioannis Karampinis
- Division of Thoracic Surgery, The Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Kostrzewa
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Steffen J. Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eric D. Roessner
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Academic Thoracic Center, University Medical Center Mainz, Johannes Gutenberg University Mainz, Germany
- * E-mail:
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16
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Galata C, Karampinis I, Roessner ED, Stamenovic D. Risk factors for surgical complications after anatomic lung resections in the era of VATS and ERAS. Thorac Cancer 2021; 12:3255-3262. [PMID: 34693656 PMCID: PMC8636208 DOI: 10.1111/1759-7714.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to identify risk factors for surgical complications after anatomic lung resections in the era of video‐assisted thoracic surgery (VATS) and enhanced recovery after surgery (ERAS). Methods A retrospective analysis of all consecutive adult patients who underwent elective anatomic lung resections between January and December 2020 at our institution was performed. Results Eighty patients (40 VATS, 40 thoracotomy) were included. The 30‐day mortality rate was 1.3%. The overall rate of major postoperative complications was 18.8%. Most major complications occurred in patients who underwent open surgery (complication rate 32.5%, share of total complications 86.7%). Major morbidity after VATS resection was rare (complication rate 2.5%, share of total complications 13.3%). In univariable analysis, thoracotomy (p = 0.003), impaired preoperative lung function (p = 0.003), complex surgery (p = 0.004) and sleeve resection (p = 0.037) were associated with adverse outcomes. In multivariable analysis, thoracotomy (p = 0.044) and impaired preoperative lung function (p = 0.028) were the only independent risk factors for major postoperative morbidity. Conclusion Thoracotomy was associated with a 10‐fold increased risk for postoperative complications compared with minimally invasive surgery and was an independent risk factor for surgical complications. In the era of VATS and ERAS, the fact that thoracotomy is performed may be a reliable parameter to identify patients at risk for postoperative complications.
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Affiliation(s)
- Christian Galata
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ioannis Karampinis
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric D Roessner
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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17
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Krassas A, Diamantis I, Karampinis I, Vgenopoulou S, Misthos P. Primary Intrapulmonary Thymoma Appearing as a Solitary Pulmonary Nodule: The "Master of Disguise" of Lung Tumors?: Case Report. J Chest Surg 2021; 54:412-415. [PMID: 33293484 PMCID: PMC8548194 DOI: 10.5090/jcs.20.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
Primary intrapulmonary thymomas (PITs) are defined as thymomas arising in intrapulmonary locations, without an associated mediastinal component. They are rare lesions, the diagnosis of which can be very difficult. We present a case of PIT in an asymptomatic 74-year-old woman in whom pulmonary nodules were found on pulmonary angiography performed for an episode of pulmonary embolism. She underwent wedge resection and the pathology report revealed a PIT. We also summarize this patient’s clinicopathological features and discuss the diagnosis, pathogenesis, and treatment of PIT.
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Affiliation(s)
- Athanasios Krassas
- Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
| | - Ioannis Diamantis
- Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
| | - Ioannis Karampinis
- Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
| | | | - Panagiotis Misthos
- Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
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18
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Paraskevas A, Bellou E, Keramida E, Bracka I, Gkriniouk C, Mazarakis S, Karampinis I, Demertzis P, Hardavella G. Diabetes And Lung Cancer; A Sweet And Sour Relationship. CRMR 2021. [DOI: 10.2174/1573398x17666210917100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction:
Diabetes mellitus and lung cancer are two highly prevalent diseases on a global scale. The association between these two diseases has been the subject of study of many cohorts in the past, some of which presenting inconclusive results.
Aim:
To present existing evidence regarding the association of diabetes with lung cancer risk and survival as well as the impact of metformin and insulin on lung cancer.
Methods:
A narrative review of all the relevant published literature known to the authors was conducted. The references were identified by searching the Pubmed online database using the keywords such as diabetes and lung cancer risk, diabetes and lung cancer survival rates, metformin and lung cancer, insulin and lung cancer.
Results :
Although previous epidemiologic studies have failed to report any significant causal effect of diabetes on lung cancer risk, recent evidence from 2 large scale meta-analyses of observational studies and other studies showed a statistically significant correlation between nonsmoker diabetics and lung cancer risk (RR, 1.11; 95% CI, 1.02-1.20; I2 = 46.1% and RR, 1.14; 95% CI, 1.09-1.20; I2 = 0%). Recent evidence has shown that metformin is related to a lower risk of lung cancer incidence among never-smokers diabetic patients (HR, 0.57;95% CI, 0.33-0.99) and improved overall survival rates (HR=0.77, 95%CI=0.66-0.9, p=0.001) regardless of the histological type of lung cancer. On the other hand, a recently published large population-based retrospective cohort study has concluded that human insulin is associated with an increased risk of lung cancer (HR 1.545, 95% CI: 1.478-1.614). Interestingly, metformin has been reported to have an anti-resistant effect on lung cancer patients who are on Epidermal Growth Factor Receptor- Tyrosine Kinase Inhibitors, offering some protection against resistance to therapy.
Conclusion:
Published evidence shows that diabetes mellitus is associated with an increased risk of lung cancer and worse survival rates. Metformin plays a protective role in lung cancer pathogenesis and is also associated with prolonged progression-free survival in lung cancer patients with diabetes. There is a significant association between human insulin use and lung cancer risk. More randomized controlled studies are required to establish the positive association of diabetes and anti-diabetic drugs with lung cancer, taking into further consideration gender and lung cancer pathology as well as possible confounders such as smoking habits that can influence the results of these studies.
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Affiliation(s)
- Andreas Paraskevas
- 9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Greece
| | - Elena Bellou
- 9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Greece
| | - Elli Keramida
- 9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Greece
| | - Irma Bracka
- 9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Greece
| | - Christina Gkriniouk
- 9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Greece
| | - Spyros Mazarakis
- 9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Greece
| | - Ioannis Karampinis
- Department of Thoracic Surgery, ‘Agioi Anargiroi’ General Oncology Hospital, Athens, Greece
| | - Panagiotis Demertzis
- 9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Greece
| | - Georgia Hardavella
- 9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Greece
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Hardavella G, Babaliari E, Bellou E, Karampinis I, Keramida E, Demertzis P. Impact of the COVID19 pandemic on patterns of respiratory, thoracic oncology and thoracic surgery outpatient care. Lung Cancer 2021. [DOI: 10.1183/13993003.congress-2021.pa3843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Hardavella G, Babaliari E, Bellou E, Karampinis I, Keramida E, Bracka I, Demertzis P. Collateral impact of COVID19 pandemic on lung cancer services in a tertiary referral centre. Lung Cancer 2021. [DOI: 10.1183/13993003.congress-2021.pa3845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Karampinis I, Galata C, Arani A, Grilli M, Hetjens S, Shackcloth M, Buderi S, Stamenovic D, Roessner ED. Autologous blood pleurodesis for the treatment of postoperative air leaks. A systematic review and meta-analysis. Thorac Cancer 2021; 12:2648-2654. [PMID: 34477307 PMCID: PMC8520794 DOI: 10.1111/1759-7714.14138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/21/2023] Open
Abstract
Background Postoperative air leaks are a common complication after lung surgery. They are associated with prolonged hospital stay, increased postoperative pain and treatment costs. The treatment of prolonged air leaks remains controversial. Several treatments have been proposed including different types of sealants, chemical pleurodesis, or early surgical intervention. The aim of this review was to analyze the impact of autologous blood pleurodesis in a systematic way. Methods A systematic review of the literature was conducted until July 2020. Studies with more than five adult patients undergoing lung resections were included. Studies in patients receiving blood pleurodesis for pneumothorax were excluded. The search strategy included proper combinations of the MeSH terms “air leak”, “blood transfusion” and “lung surgery”. Results Ten studies with a total of 198 patients were included in the analysis. The pooled success rate for sealing the air leak within 48 h of the blood pleurodesis was 83.7% (95% CI: 75.7; 90.3). The pooled incidence of the post‐interventional empyema was 1.5%, with a pooled incidence of post‐interventional fever of 8.6%. Conclusions Current evidence supports the idea that autologous blood pleurodesis leads to a faster healing of postoperative air leaks than conservative treatment. The complication rate is very low. Formal recommendations on how to perform the procedure are not possible with the current evidence. A randomized controlled trial in the modern era is necessary to confirm the benefits.
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Affiliation(s)
- Ioannis Karampinis
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany.,Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Christian Galata
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alireza Arani
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Medical Faculty Mannheim, Institute of Medical Statistic and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Shackcloth
- Division of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Silviu Buderi
- Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric D Roessner
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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Paraskevas A, Bellou E, Keramida E, Karampinis I, Demertzis P, Hardavella G. Bronchial Asthma and Lung Cancer. CRMR 2021. [DOI: 10.2174/1573398x17666210611091829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim:
The aim of the study was to present existing evidence regarding the association between
bronchial asthma and lung cancer risk, the impact of lung cancer treatment on asthma control
as well as the impact of pre-existing asthma on lung cancer survival.
Methods:
A narrative review of all the relevant published literature has been conducted.
Results:
Published evidence suggests that patients with bronchial asthma are at a higher risk of developing
lung cancer with an estimated odds ratio for squamous and small cell lung carcinoma at
1.69 and 1.71, respectively, within 2 years of asthma diagnosis. Interestingly, regular use of inhaled
corticosteroids may protect asthmatics against lung cancer. Chemotherapy may temporarily
relieve asthma symptoms. Pneumonitis is a common adverse reaction in asthmatics receiving immunotherapy
for lung cancer treatment. Lung radiotherapy in asthma patients predisposes to
eosinophilic alveolitis and pneumonia. Asthmatics are considered high-risk candidates for invasive
surgical procedures because they carry a high risk of perioperative airway hyper responsiveness.
Asthma is associated with a reduced lung cancer survival compared to other pulmonary co-morbidities.
Conclusion:
Literature shows that bronchial asthma is associated with increased lung cancer risk
and worse survival rates. Chemotherapy may relieve asthma symptoms. However, asthmatics are
prone to complications related to lung cancer surgery or radiotherapy treatment. Μore randomised
controlled studies are required to strengthen the positive association between bronchial asthma and
lung cancer, taking into consideration that there may be confounders that may influence the results.
Finally, further studies must be conducted to investigate the impact of immunotherapy and specific
radiotherapy modalities on asthma control.
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Affiliation(s)
- Andreas Paraskevas
- 9th Department of Respiratory Medicine, Sotiria' Athens' Chest Diseases Hospital, GR, Athens, Greece
| | - Elena Bellou
- 9th Department of Respiratory Medicine, Sotiria' Athens' Chest Diseases Hospital, GR, Athens, Greece
| | - Elli Keramida
- 9th Department of Respiratory Medicine, Sotiria' Athens' Chest Diseases Hospital, GR, Athens, Greece
| | - Ioannis Karampinis
- Department of Thoracic Surgery, General Oncology Hospital ‘Agioi Anargiroi’, GR, Athens, Greece
| | - Panagiotis Demertzis
- 9th Department of Respiratory Medicine, Sotiria' Athens' Chest Diseases Hospital, GR, Athens, Greece
| | - Georgia Hardavella
- 9th Department of Respiratory Medicine, Sotiria' Athens' Chest Diseases Hospital, GR, Athens, Greece
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Karampinis I, Lion E, Hetjens S, Vassilev G, Galata C, Reissfelder C, Otto M. Trocar Site HERnias After Bariatric Laparoscopic Surgery (HERBALS): a Prospective Cohort Study. Obes Surg 2021; 30:1820-1826. [PMID: 31950317 PMCID: PMC7242489 DOI: 10.1007/s11695-020-04400-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The exact prevalence of trocar site hernias after bariatric procedures is not yet known. Recent metaanalysis data indicated concerning rates of up to 25%. We conducted a prospective cohort study to estimate the prevalence and analyze the role of fascia closure in the development of trocar hernias. Method A total of 365 patients who were operated for obesity in our department between 2009 and 2018 were included. All patients were invited for a follow-up ultrasonography scan in order to detect abdominal wall defects. The role of intraoperative fascia closure in the development of trocar site hernias was evaluated, and a logistic regression analysis was performed to detect potential risk factors. Results The overall prevalence of trocar hernias detected by ultrasonography was 34%. The prevalence of abdominal wall defects in patients who received a fascia closure was 37% compared with 34% in patients who did not receive a fascia closure (p = 0.37). The only factor that was associated with a higher risk for trocar site hernias was high excessive weight loss (p = 0.05). Conclusion Trocar site hernias are an underestimated complication of minimally invasive, multiportal bariatric surgery, and the prevalence of asymptomatic hernias is probably higher than initially expected. In this study, fascia closure did not protect against trocar hernias. However, opposing evidence from similar trials suggests closing the fascia. This clinical problem should therefore be further assessed in a prospective randomized setting.
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Affiliation(s)
- Ioannis Karampinis
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eliette Lion
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Galata
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Abstract
Der parapneumonische Pleuraerguss ist eine häufige Komplikation nach einer Pneumonie und kann zur Entwicklung eines Pleuraempyems führen. Das Pleuraempyem ist eine lebensbedrohliche Infektion, die mit Antibiotika, interventioneller Drainage oder in späteren Stadien operativ versorgt werden kann. Hier beschreiben wir den ersten Fall eines Pleuraempyems nach vorangegangener COVID-19-Infektion ohne respiratorische Insuffizienz bei einem zuvor gesunden, sportlichen Patienten. Der Patient wurde initial mit Antibiotika und interventioneller Drainage versorgt, musste aber aufgrund einer klinischen Verschlechterung erneut stationär aufgenommen werden. Operativ zeigte sich ein Pleuraempyem 3. Grades, das thorakoskopisch erfolgreich mittels Dekortikation versorgt werden konnte. Die präoperative SARS-CoV-2-Testung war negativ. Der Patient hat sich komplett erholt und konnte entlassen werden.
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Affiliation(s)
- Ioannis Karampinis
- Division of Thoracic Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, SW3 6NP, London, Großbritannien.
| | | | - Silviu Buderi
- Division of Thoracic Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, SW3 6NP, London, Großbritannien
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25
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Krassas A, Diamantis I, Karampinis I, Vgenopoulou S, Misthos P. Primary Intrapulmonary Thymoma Appearing as a Solitary Pulmonary Nodule: The "Master of Disguise" of Lung Tumors? Korean J Thorac Cardiovasc Surg 2020. [PMID: 33293484 DOI: 10.5090/kjtcs.20.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary intrapulmonary thymomas (PITs) are defined as thymomas arising in intrapulmonary locations, without an associated mediastinal component. They are rare lesions, the diagnosis of which can be very difficult. We present a case of PIT in an asymptomatic 74-year-old woman in whom pulmonary nodules were found on pulmonary angiography performed for an episode of pulmonary embolism. She underwent wedge resection and the pathology report revealed a PIT. We also summarize this patient's clinicopathological features and discuss the diagnosis, pathogenesis, and treatment of PIT.
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Affiliation(s)
- Athanasios Krassas
- Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
| | - Ioannis Diamantis
- Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
| | - Ioannis Karampinis
- Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
| | | | - Panagiotis Misthos
- Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
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26
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Bellou E, Keramida E, Karampinis I, Dimakakos E, Misthos P, Demertzis P, Hardavella G. Outpatient treatment of pulmonary embolism. Breathe (Sheff) 2020; 16:200069. [PMID: 33447272 PMCID: PMC7792861 DOI: 10.1183/20734735.0069-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Over the past decade there has been an increasing trend to manage many conditions traditionally treated during a hospital admission as outpatients. Evidence is increasing to support this approach in patients with pulmonary embolism (PE). In this article, we review the current status of outpatient management of confirmed PE and present a pragmatic approach for clinical healthcare settings. Outpatient management of pulmonary embolism should be considered in all eligible patients to prevent unnecessary hospital admissions and improve quality of carehttps://bit.ly/3mo5TX7
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Affiliation(s)
- Elena Bellou
- 9th Dept of Respiratory Medicine, Sotiria Athens Chest Diseases Hospital, Athens, Greece.,These authors contributed equally
| | - Elli Keramida
- 9th Dept of Respiratory Medicine, Sotiria Athens Chest Diseases Hospital, Athens, Greece.,These authors contributed equally
| | | | - Evaggelos Dimakakos
- Vascular Unit, 3rd Dept of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria Athens Chest Diseases Hospital, Athens, Greece
| | | | - Panagiotis Demertzis
- 9th Dept of Respiratory Medicine, Sotiria Athens Chest Diseases Hospital, Athens, Greece
| | - Georgia Hardavella
- 9th Dept of Respiratory Medicine, Sotiria Athens Chest Diseases Hospital, Athens, Greece
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27
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Hardavella G, Frille A, Theochari C, Keramida E, Bellou E, Fotineas A, Bracka I, Pappa L, Zagana V, Palamiotou M, Demertzis P, Karampinis I. Multidisciplinary care models for patients with lung cancer. Breathe (Sheff) 2020; 16:200076. [PMID: 33664831 PMCID: PMC7910033 DOI: 10.1183/20734735.0076-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, even though there is a relative lack of consistent evidence that this care model improves outcomes. In this review, we present the available literature regarding how to set up and run an efficient multidisciplinary care model for lung cancer patients with emphasis on team members' roles and responsibilities. Moreover, we present some limited evidence about multidisciplinary care and its impact on lung cancer outcomes and survival. This review provides simple guidance on setting up and running a multidisciplinary service for lung cancer patients. It highlights the importance of defined roles and responsibilities for team members. It also presents concise information based on the literature regarding the impact of multidisciplinary care in lung cancer outcomes (e.g. survival of patients undergoing lung cancer surgery).
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Affiliation(s)
- Georgia Hardavella
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Armin Frille
- Dept of Respiratory Medicine, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany
| | - Christina Theochari
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Elli Keramida
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Elena Bellou
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Andreas Fotineas
- Radiation Oncology Dept, IASO Maternity Hospital, Athens, Greece
| | - Irma Bracka
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Loukia Pappa
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Vaia Zagana
- Dept of Nursing, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Maria Palamiotou
- Dept of Nursing, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Panagiotis Demertzis
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
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28
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Seyfried S, Drazyk A, Vassilev G, Galata C, Gerken A, Karampinis I, Reißfelder C, Ronellenfitsch U, Otto M. [Erratum to: Still no evidence for drains in bariatric surgery]. Chirurg 2020; 91:669. [PMID: 32474614 DOI: 10.1007/s00104-020-01194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Steffen Seyfried
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Axel Drazyk
- BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - Geogi Vassilev
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Christian Galata
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Andreas Gerken
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Ioannis Karampinis
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Christoph Reißfelder
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Ulrich Ronellenfitsch
- Universitätsklinik und Poliklinik für Viszerale, Gefäß- und Endokrine Chirurgie Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - Mirko Otto
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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29
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Karampinis I, Lion E, Grilli M, Hetjens S, Weiss C, Vassilev G, Seyfried S, Otto M. Correction to: Trocar Site Hernias in Bariatric Surgery-an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis. Obes Surg 2020; 30:2860. [PMID: 32318994 DOI: 10.1007/s11695-020-04592-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The review was not registered for systematic reviews and meta-analyses, and should be disregarded.
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Affiliation(s)
| | - Eliette Lion
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | | | - Mirko Otto
- Department of Surgery, Heidelberg University, Mannheim, Germany. .,Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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30
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Nowak K, Karampinis I, Gerken ALH. Application of Fluorescent Dyes in Visceral Surgery: State of the Art and Future Perspectives. Visc Med 2020; 36:80-87. [PMID: 32355664 DOI: 10.1159/000506910] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background Through the improvement and implementation of advanced intraoperative imaging, the indications for intraoperative fluorescence have spread to various fields of visceral surgery. Indocyanine green (ICG)-based fluorescence angiography and the imaging systems using this certain dye are currently the cornerstone of intraoperative, fluorescence-based medical imaging. Summary The article focuses on principles and approaches of intraoperative fluorescence in general surgery. The current clinical practice of intraoperative fluorescence and its evidence are described. Emerging new fields of application are put in a perspective. Furthermore, the technique and possible pit-falls in the performance of intraoperative ICG fluorescence angiography are described in this review article. Key Messages Overall growing evidence suggests that intraoperative fluorescence imaging delivers valuable additional information to the surgeon, which might help to perform surgery more exactly and reduce perioperative complications. Perfusion assessment can be a helpful tool when performing critical anastomoses. There is evidence from prospective and randomized trials for the benefit of intraoperative ICG fluorescence angiography during esophageal reconstruction, colorectal surgery, and surgery for mesenteric ischemia. Most studies suggest the administration of 2.5-10 mg of ICG. Standardized settings and documentation are essential. The benefit of ICG fluorescence imaging for gastrointestinal sentinel node detection and detection of liver tumors and colorectal metastases of the liver cannot clearly be estimated duo to the small number of prospective studies. Critical points in the use of intraoperative fluorescence imaging remain the low standardization and reproducibility of the results and the associated difficulty in comparing the results of the existing trials. Furthermore, little is known about the influence of hemodynamic parameters on the quantitative assessment of ICG fluorescence during surgery.
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Affiliation(s)
- Kai Nowak
- Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Ioannis Karampinis
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Mannheim, Germany
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31
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Karampinis I, Lion E, Grilli M, Hetjens S, Weiss C, Vassilev G, Seyfried S, Otto M. Trocar Site Hernias in Bariatric Surgery-an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis. Obes Surg 2020; 29:1049-1057. [PMID: 30659465 DOI: 10.1007/s11695-018-03687-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms 'laparoscopy' and 'bariatric surgery', 'trocar/port' and 'hernia'. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0-39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.
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Affiliation(s)
| | - Eliette Lion
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | | | - Mirko Otto
- Department of Surgery, Heidelberg University, Mannheim, Germany.
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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32
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Hardavella G, Karampinis I, Styliara P, Kainis I. Lung Cancer Surgery in Patients with Chronic Obstructive Pulmonary Disease (COPD): Surgical Selection Challenges and Clinical Outcomes. CRMR 2019. [DOI: 10.2174/1573398x15666190531104506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health care systems worldwide are commonly burdened with COPD and lung cancer and
subsequently much has been studied and learnt of the interdependence between these two clinical
entities. Lung cancer surgical treatment options in patients with severe COPD remain a clinical
challenge for the multidisciplinary team. Appropriate patient selection and prediction of
postoperative pulmonary complications aid in surgical decision making and informed patient
consent. In this review, we present an overview of surgical selection tools (lung function parameters,
risk stratification for postoperative pulmonary complications) and lung cancer clinical outcomes
(recurrence, survival) in patients with COPD undergoing lung cancer surgery.
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Affiliation(s)
- Georgia Hardavella
- 10th Department of Respiratory Medicine, Athens Chest Diseases Hospital ‘Sotiria’, Athens, Greece
| | - Ioannis Karampinis
- Department of Thoracic Sur gery, ‘Sismanogleio’ General Hospital, Athens, Greece
| | - Panagiota Styliara
- 10th Department of Respiratory Medicine, Athens Chest Diseases Hospital ‘Sotiria’, Athens, Greece
| | - Ilias Kainis
- 10th Department of Respiratory Medicine, Athens Chest Diseases Hospital ‘Sotiria’, Athens, Greece
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Abstract
Oxygen use has extended from inpatient to outpatient settings for patients with chronic pulmonary diseases and complications of hypoxaemia. This article presents an overview of oxygen devices (oxygen concentrators, compressed gas cylinders and liquid oxygen) and delivery systems (high- and low-flow). The indications, advantages and disadvantages of each device and delivery system are presented, aiming to offer updated knowledge to the multidisciplinary team members managing patients with respiratory failure, and therefore allowing appropriate selection of devices and delivery systems that are tailored to the needs of each patient.
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Affiliation(s)
- Georgia Hardavella
- 10th Dept of Respiratory Medicine, Athens Chest Diseases Hospital "Sotiria", Athens, Greece
| | - Ioannis Karampinis
- Dept of Thoracic Surgery, General Hospital "Sismanogleio", Athens, Greece
| | - Armin Frille
- Dept of Respiratory Medicine, University of Leipzig, Leipzig, Germany.,Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany
| | | | - Ilona Rousalova
- 1st Dept of Tuberculosis and Respiratory Diseases, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Hardavella G, Xigki MD, Karampinis I, Tzonou A, Kainis I. Lent score and informed management decisions in malignant pleural effusions (MPE). When is little too much? Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa4656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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35
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Hardavella G, Xigki MD, Chrysouli K, Pandi A, Karampinis I, Kainis I. PERC (Pulmonary Embolism Rule-Out Criteria) puzzle in lung cancer (LC) patients and general population. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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36
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Hardavella G, Metaxas G, Mproupi K, Karampinis I, Kainis I. ERS Taskforce harmonised standards for lung cancer (LC) registration in Europe and the current Greek screenshot;Is it a long way to Tipperary? Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa3040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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37
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Di Meo G, Karampinis I, Gerken A, Lammert A, Pellicani S, Nowak K. Indocyanine Green Fluorescence Angiography Can Guide Intraoperative Localization During Parathyroid Surgery. Scand J Surg 2019; 110:59-65. [PMID: 31554490 DOI: 10.1177/1457496919877581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Intraoperative localization of pathologic parathyroid glands is of major importance for the hyperparathyroidism treatment. Based on the small size and the anatomic variability, the localization can be very challenging. The current practice is to compare preoperative ultrasonography with Technetium-99m sestamibi scintigraphy (MIBI) and plan the resection accordingly. In this study, we implemented indocyanine green angiography for the intraoperative localization of parathyroid glands. MATERIALS AND METHODS This is a retrospective analysis of 37 patients with primary, secondary, or tertiary hyperparathyroidism who were operated using indocyanine green angiography for the intraoperative localization of pathological parathyroid glands. An indocyanine green solution of 2.5 mg was were intravenously administered for parathyroid gland visualization. Different fluorescence scores were correlated with changes in postoperative parathyroid hormone levels. RESULTS Patients were divided into two groups depending on the presence of uniglandular or multiglandular disease. Sixty-four lesions were resected, and the final histopathologic analysis confirmed the parathyroid origin in 62 of them (96.8%). None of the patients with uniglandular disease developed postoperative hypoparathyroidism, whereas three patients in the multiglandular group developed temporary hypoparathyroidism symptoms. Indocyanine green imaging had higher sensitivity for the intraoperative detection of parathyroid glands compared with ultrasonography and MIBI (p < 0.001). CONCLUSION Indocyanine green angiography indicated high sensitivity for the intraoperative identification of pathologic parathyroid glands leading to a resection rate of 95.16%. The modality was useful, especially in cases of revisional surgery or ectopic parathyroid glands. Randomized trials have already proven the value of indocyanine green imaging in predicting postoperative hypocalcemia. Our results support the regular use of this method during parathyroid surgery.
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Affiliation(s)
- G Di Meo
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari, Bari, Italy.,Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - I Karampinis
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - A Gerken
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - A Lammert
- Dialyse-Praxis Grünstadt, Grünstadt, Germany
| | - S Pellicani
- Section of Hygiene and Preventive Medicine, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari, Bari, Italy
| | - K Nowak
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
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Galata C, Hodapp J, Weiß C, Karampinis I, Vassilev G, Reißfelder C, Otto M. Skeletal Muscle Mass Index Predicts Postoperative Complications in Intestinal Surgery for Crohn's Disease. JPEN J Parenter Enteral Nutr 2019; 44:714-721. [PMID: 31444789 DOI: 10.1002/jpen.1696] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the role of the skeletal muscle mass index (SMI) for major postoperative morbidity in patients with Crohn's disease (CD) and intestinal surgery at a tertiary referral center. METHODS A retrospective analysis of the prospectively maintained database for surgical patients with CD at our institution was performed. The cases of all patients operated on between December 2009 and December 2017 with sectional imaging prior to surgery were eligible for this study. RESULTS A total of 230 patients were included. Major postoperative complications were observed in 32 patients (13.9%). Common intestinal procedures were ileocecal resections (51.7%), segmental small-bowel resections (10%), and colectomy or proctocolectomy (8.3%). In multivariable analysis, SMI (P = .002; odds ratio = 0.914) was the only independent risk factor for major postoperative complications. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies were suitable to determine SMI. The cutoff values for SMI were 31.8 cm2 /m2 for females and 41.5 cm2 /m2 for males. CONCLUSION We present the largest published cohort investigating SMI with regard to major postoperative morbidity in surgery for CD. In multivariable analysis, SMI was the only significant risk factor for Clavien-Dindo complications grade ≥III. Lumbar SMI was reliably determined by CT and MRI alike. Because preoperative abdominal imaging with either modality is common for patients with CD, SMI could be a reliable and largely available tool to stratify the risk of postoperative complications.
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Affiliation(s)
- Christian Galata
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Janina Hodapp
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Visceral, General and Thoracic Surgery, Marienhospital Stuttgart, Stuttgart, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ioannis Karampinis
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Sachpekidis C, Karampinis I, Jakob J, Kasper B, Nowak K, Pilz L, Attenberger U, Gaiser T, Derigs HG, Schwarzbach M, Hohenberger P, Dimitrakopoulou-Strauss A, Ronellenfitsch U. Neoadjuvant Pazopanib Treatment in High-Risk Soft Tissue Sarcoma: A Quantitative Dynamic 18F-FDG PET/CT Study of the German Interdisciplinary Sarcoma Group. Cancers (Basel) 2019; 11:cancers11060790. [PMID: 31181713 PMCID: PMC6628287 DOI: 10.3390/cancers11060790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 02/07/2023] Open
Abstract
The outcome of high-risk soft tissue sarcoma (STS) is poor with radical surgery being the only potentially curative modality. Pazopanib is a multikinase inhibitor approved for the treatment of metastatic STS. Herein, in terms of the German Interdisciplinary Sarcoma Group (GISG-04/NOPASS) trial, we evaluate the potential role of kinetic analysis of fludeoxyglucose F-18 (18F-FDG) data derived from the application of dynamic positron emission tomography/computed tomography (PET/CT) in response assessment to pazopanib of STS patients scheduled for surgical resection. Sixteen STS patients treated with pazopanib as neoadjuvant therapy before surgery were enrolled in the analysis. All patients underwent dynamic PET/CT prior to and after pazopanib treatment. Data analysis consisted of visual (qualitative) analysis of the PET/CT scans, semi-quantitative evaluation based on standardized uptake value (SUV) calculations, and quantitative analysis of the dynamic 18F-FDG PET data, based on two-tissue compartment modeling. Resection specimens were histopathologically assessed and the percentage of regression grade was recorded in 14/16 patients. Time to tumor relapse/progression was also calculated. In the follow-up, 12/16 patients (75%) were alive without relapse, while four patients (25%) relapsed, among them one patient died. Median histopathological regression was 20% (mean 26%, range 5–70%). The studied population was dichotomized using a histopathological regression grade of 20% as cut-off. Based on this threshold, 10/14 patients (71%) showed partial remission (PR), while stable disease (SD) was seen in the rest 4 evaluable patients (29%). Semi-quantitative evaluation showed no statistically significant change in the widely used PET parameters, SUVaverage and SUVmax. On the other hand, 18F-FDG kinetic analysis revealed a significant decrease in the perfusion-related parameter K1, which reflects the carrier-mediated transport of 18F-FDG from plasma to tumor. This decrease can be considered as a marker in response to pazopanib in STS and could be due to the anti-angiogenic effect of the therapeutic agent.
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Affiliation(s)
- Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, 69120 Heidelberg, Germany.
| | - Ioannis Karampinis
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, 68167 Mannheim, Germany.
| | - Jens Jakob
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, 68167 Mannheim, Germany.
- Department of General, Visceral and Child Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany.
| | - Bernd Kasper
- Interdisciplinary Tumor Center Mannheim, Sarcoma Unit, Mannheim University Medical Center, 68167 Mannheim, Germany.
| | - Kai Nowak
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, 68167 Mannheim, Germany.
- Department of Abdominal, Vascular and Thoracic Surgery, Romed Klinikum, 83022 Rosenheim, Germany.
| | - Lothar Pilz
- Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Ulrike Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany.
| | - Timo Gaiser
- Institute of Pathology, University Medical Center Mannheim, 68167 Mannheim, Germany.
| | - Hans-Günter Derigs
- Department of Hematology and Oncology, Klinikum Frankfurt-Hoechst, 65929 Frankfurt am Main, Germany.
| | - Matthias Schwarzbach
- Department of Surgery, Klinikum Frankfurt-Hoechst, 65929 Frankfurt am Main, Germany.
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, 68167 Mannheim, Germany.
| | | | - Ulrich Ronellenfitsch
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, 68167 Mannheim, Germany.
- Department of Abdominal, Vascular, and Endocrine Surgery, University Hospital Halle, 06120 Halle (Saale), Germany.
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Boultadakis E, Samanidis G, Karampinis I, Misthos P, Lioulias A. Acute dyspnoea due to an unusual giant thymic cyst. Clin Case Rep 2019; 7:1103-1105. [PMID: 31110755 PMCID: PMC6509672 DOI: 10.1002/ccr3.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/22/2019] [Accepted: 03/01/2019] [Indexed: 11/15/2022] Open
Abstract
Does a percutaneous needle aspiration of thymic cyst should be considered? In case when a surgical excision is contradicted, the percutaneous needle aspiration should be performed. Surgical resection can be performed with a thoracotomy or a videothoracoscopic procedure, but sometimes, a median sternotomy is unavoidable.
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Affiliation(s)
- Evangelos Boultadakis
- Department of Thoracic SurgerySismanoglio General Hospital of AthensMaroussi, AthensGreece
| | - George Samanidis
- Department of Thoracic SurgerySismanoglio General Hospital of AthensMaroussi, AthensGreece
| | - Ioannis Karampinis
- Department of Thoracic SurgerySismanoglio General Hospital of AthensMaroussi, AthensGreece
| | - Panagiotis Misthos
- Department of Thoracic SurgerySismanoglio General Hospital of AthensMaroussi, AthensGreece
| | - Achilleas Lioulias
- Department of Thoracic SurgerySismanoglio General Hospital of AthensMaroussi, AthensGreece
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Ronellenfitsch U, Karampinis I, Dimitrakopoulou-Strauss A, Sachpekidis C, Jakob J, Kasper B, Nowak K, Pilz L, Attenberger U, Gaiser T, Derigs HG, Schwarzbach M, Hohenberger P. Preoperative Pazopanib in High-Risk Soft Tissue Sarcoma: Phase II Window-of Opportunity Study of the German Interdisciplinary Sarcoma Group (NOPASS/GISG-04). Ann Surg Oncol 2019; 26:1332-1339. [DOI: 10.1245/s10434-019-07183-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Indexed: 11/18/2022]
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Rother U, Amann K, Adler W, Nawroth N, Karampinis I, Keese M, Manap S, Regus S, Meyer A, Porubsky S, Hilgers K, Krämer BK, Lang W, Nowak K, Gerken ALH. Quantitative assessment of microperfusion by indocyanine green angiography in kidney transplantation resembles chronic morphological changes in kidney specimens. Microcirculation 2019; 26:e12529. [PMID: 30656790 DOI: 10.1111/micc.12529] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/12/2018] [Accepted: 01/04/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE ICG fluorescence angiography enables a quantitative real-time perfusion assessment in kidney transplantation. The results of intraoperative microperfusion of the kidney allograft were compared to the renal chronicity score in pre-transplantation kidney biopsy specimens. The intrarenal resistance index was calculated by duplex sonography as a method of reference. METHODS Seventy-seven patients with end-stage renal disease undergoing kidney transplantation were prospectively included in two centers. Correlation analysis of chronic changes in kidney biopsy specimens and the IN of ICG fluorescence signal were investigated. RESULTS The results yielded a significantly negative correlation for the renal chronicity (r = -0.294, P = 0.017) as well as the intestinal fibrosis and tubular atrophy score (r = -0.328, P = 0.007). There was a significant inverse relationship between the IN and the mean RI values of the upper pole of the kidney allograft. CONCLUSIONS In summary, fluorescence angiography reflects preexisting morphological changes of the renal cortex. ICG angiography may serve as an alternative method for the assessment of microperfusion of the kidney allograft.
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Affiliation(s)
- Ulrich Rother
- Department of Vascular Surgery, University of Erlangen, Erlangen, Germany
| | - Kerstin Amann
- Department of Nephropathology, University of Erlangen, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Nina Nawroth
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ioannis Karampinis
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Keese
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Serhat Manap
- Department of Vascular Surgery, University of Erlangen, Erlangen, Germany
| | - Susanne Regus
- Department of Vascular Surgery, University of Erlangen, Erlangen, Germany
| | - Alexander Meyer
- Department of Vascular Surgery, University of Erlangen, Erlangen, Germany
| | - Stefan Porubsky
- Department of Pathology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Karl Hilgers
- Department of Nephrology, University of Erlangen, Erlangen, Germany
| | - Bernhard K Krämer
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Werner Lang
- Department of Vascular Surgery, University of Erlangen, Erlangen, Germany
| | - Kai Nowak
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas L H Gerken
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Karampinis I, Keese M, Jakob J, Stasiunaitis V, Gerken A, Attenberger U, Post S, Kienle P, Nowak K. Indocyanine Green Tissue Angiography Can Reduce Extended Bowel Resections in Acute Mesenteric Ischemia. J Gastrointest Surg 2018; 22:2117-2124. [PMID: 29992520 DOI: 10.1007/s11605-018-3855-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/18/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Surgical exploration and bowel resection are frequently required for treating non-occlusive mesenteric ischemia. Intraoperative evaluation of intestinal perfusion is subjective and challenging. In this feasibility study, ICG fluorescence angiography was performed in order to evaluate intestinal perfusion in patients with acute mesenteric ischemia. METHODS This is a retrospective analysis of 52 patients who were operated for acute mesenteric ischemia using ICG fluorescence angiography. Patients with occlusive disease requiring recanalization were excluded. The SPY and PinPoint imaging systems were used for open and laparoscopic surgery, respectively. Intraoperative macroscopic assessment of perfusion was compared with the ICG angiography results. RESULTS Surgical exploration was performed for ischemia of the colon (n = 12), the small bowel (n = 23), or both (n = 16). One patient had ischemia of the esophagus and stomach. All patients had a preoperative CT angiography to rule out stenosis or occlusion of the mesenteric vessels. In 18 cases (34.6%), ICG fluorescence angiography provided information that was supplemental to macroscopic evaluation, but most patients did not survive the postoperative course. However, in six of those cases (11.5%), ICG angiography led to a major change in operative strategy resulting in a significant clinical benefit for those patients. For two cases, ICG fluorescence produced false negative results. DISCUSSION ICG tissue angiography is feasible and technically reliable for evaluating intestinal perfusion in acute mesenteric ischemia and led to a significant clinical benefit in 11% of our patients. A relevant discrepancy between surgical visual assessment and fluorescence angiography was found in 35% of the cases, which may help to define resection margins more accurately and thus support surgical decision-making.
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Affiliation(s)
- Ioannis Karampinis
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Michael Keese
- Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Jens Jakob
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Vytautas Stasiunaitis
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Andreas Gerken
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ulrike Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Stefan Post
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Peter Kienle
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Mindt S, Karampinis I, John M, Neumaier M, Nowak K. Stability and degradation of indocyanine green in plasma, aqueous solution and whole blood. Photochem Photobiol Sci 2018; 17:1189-1196. [PMID: 30028469 DOI: 10.1039/c8pp00064f] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Fluorescence-based imaging has evolved into an important technology during recent years. Specifically indocyanine green (ICG) has invaded most fields of diagnostic and interventional medicine. Considering the numerous advantages of the substance like the rapid degradation and rare adverse reactions, ICG is currently the most commonly used fluorescing agent. High-performance liquid chromatography (HPLC) was used for measuring absorbance and fluorescence of ICG and its potential degradation compounds. Stability and degradation were evaluated under light exposure or in darkness at various temperatures. Under these conditions, degradation of ICG was evaluated over a period of 11 days. Additional, stability measurements of ICG were performed in EDTA whole blood samples at 37 °C incubation temperature while monitoring. Furthermore, we used mass spectrometric (MS) and nuclear magnetic resonance (NMR) analyses for the identification of supposed ICG degradation compound. Potential quenching effect of ICG was examined in aqueous and plasma solutions at concentrations ranging from 0.01-100 μg ml-1. When diluted in water and stored at 4 °C in the dark, ICG is stable for three days with only 20% of fluorescence intensity lost in this time-span. ICG incubated at 37 °C in whole blood under light exposure is stable for 5 h. In our study we observed the degradation of ICG into two degradation compounds with a mass of m/z 785.32 and m/z 1501.57, respectively. Based on our observations we suggest that ICG should be used within one or two days after preparation, if the ICG solution is stored at 4 °C.
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Affiliation(s)
- Sonani Mindt
- Institut for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Karampinis I, Di Meo G, Gerken A, Stasiunaitis V, Lammert A, Nowak K. [Intraoperative Indocyanine Green Fluorescence to Assure Vital Parathyroids in Thyroid Resections]. Zentralbl Chir 2018; 143:380-384. [PMID: 30134496 DOI: 10.1055/a-0655-7881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Total thyreoidectomy is associated with high rates of temporary or permanent hypoparathyroidism. During surgery, ICG fluorescence angiography can be used to detect and preserve well vascularised parathyroid glands; this technique has been recently introduced in retrospective and prospective trials as an intraoperative technical support to avoid postoperative hypoparathyroidism. MATERIALS UND METHODS 27 patients undergoing total thyreoidectomy were prospectively enrolled in our study. The vascularisation of the parathyroid glands was analysed intraoperatively using ICG tissue angiography. 5 mg indocyanine green were intravenously administered. Fluorescence angiography was evaluated in real time using the PinPoint (Novadaq, Canada) imaging system. The study was approved by the local ethics committee. RESULTS ICG fluorescence angiography was performed uneventfully in all cases. There was no case of postoperative hypoparathyroidism when at least one parathyroid gland with high fluorescence intensity was preserved. In 4 cases, only low fluorescence intensity was detected in the remaining parathyroid glands after completing the resection. All 4 patients received activated vitamin D3 prophylactically. Two of 4 developed symptomatic hypocalcaemia due to temporary hypoparathyroidism. CONCLUSION Implementation of ICG fluorescence angiography can help in predicting and therefore preventing postoperative hypoparathyreoidism after total thyreoidectomy. If a well vascularised parathyroid gland with high ICG fluorescence intensity can be secured, calcium substitution and postoperative prophylaxis of hypoparathyreoidism may become obsolete in the future.
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Affiliation(s)
| | - Giovanna Di Meo
- Abteilung für Biomedizinische Wissenschaft und Onkologie, Universitätsmedizin "A. Moro", Bari, Italien
| | - Andreas Gerken
- Chirurgische Klinik, Universitätsmedizin Mannheim, Deutschland
| | | | - Alexander Lammert
- Facharztpraxis für Diabetologie, Endokrinologie und Nephrologie, Grünstadt, Deutschland
| | - Kai Nowak
- Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, RoMed Klinikum Rosenheim, Deutschland
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Goertz L, Schneider SW, Desch A, Mayer FT, Koett J, Nowak K, Karampinis I, Bohlmann MK, Umansky V, Bauer AT. Heparins that block VEGF-A-mediated von Willebrand factor fiber generation are potent inhibitors of hematogenous but not lymphatic metastasis. Oncotarget 2018; 7:68527-68545. [PMID: 27602496 PMCID: PMC5356571 DOI: 10.18632/oncotarget.11832] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 08/21/2016] [Indexed: 12/31/2022] Open
Abstract
Von Willebrand factor (VWF) serves as a nidus for platelet aggregation and thrombosis. We hypothesize that VWF fibers contribute to the development of venous thromboembolism (VTE) and to metastasis formation. Here, we show that vascular and lymphatic endothelial cells (ECs) express VWF in vitro and release VWF fibers after activation by tumor cell supernatants. In contrast, an ex vivo analysis of primary mouse tumors revealed the presence of VWF fibers in the blood microvasculature but not in lymphatic vessels. Unlike the anticoagulant Fondaparinux, an inhibitor of thrombin generation, the low-molecular-weight heparin (LMWH) Tinzaparin inhibited VWF fiber formation and vessel occlusion in tumor vessels by blocking thrombin-induced EC activation and vascular endothelial growth factor-A (VEGF-A)-mediated VWF release. Intradermal tumor cell inoculation in VWF- and ADAMTS13-deficient mice did not alter lymph node metastases compared with wild type animals. Interestingly, multiple tumor-free distal organs exhibited hallmarks of malignancy-related VTE, including luminal VWF fibers, platelet-rich thrombi and vessel occlusions. Furthermore, ADAMTS13 deficiency, characterized by prolonged intraluminal VWF network lifetimes, resulted in a severely increased number of metastatic foci in an experimental model of hematogenous lung seeding. Treatment with Tinzaparin inhibited tumor-induced release of VWF multimers, impeded platelet aggregation and decreased lung metastasis. Thus, our data strongly suggest a critical role of luminal VWF fibers in determining the occurrence of thrombosis and cancer metastasis. Moreover, the findings highlight LMWHs as therapeutic strategy to treat thrombotic complications while executing anti-metastatic activities.
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Affiliation(s)
- Lukas Goertz
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan Werner Schneider
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Desch
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Thomas Mayer
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Julian Koett
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, Mannheim University Medical Center, Heidelberg University, Mannheim, Germany
| | - Ioannis Karampinis
- Department of Surgery, Mannheim University Medical Center, Heidelberg University, Mannheim, Germany
| | - Michael K Bohlmann
- Department of Obstetrics and Gynaecology, Mannheim University Medical Center, Heidelberg University, Mannheim, Germany
| | - Viktor Umansky
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Alexander Thomas Bauer
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Karampinis I, Joas E, Dreyer A, Ronellenfitsch U, Jakob J, Hohenberger P, Nowak K. The evaluation of circulating endothelial progenitor cells and related angiogenic markers as prognostic factors in soft-tissue tumors. Eur J Surg Oncol 2018; 44:496-501. [PMID: 29397265 DOI: 10.1016/j.ejso.2018.01.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/14/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Neovascularisation is a critical step in the progression of malignant tumors. Circulating endothelial progenitor cells (cEPC) have been proposed as surrogate markers of vasculogenesis in malignancies. In this project, we studied the impact of tumor-specific therapy on cEPC and associated angiogenic factors in patients with soft tissue tumors. MATERIALS AND METHODS Fifty-three patients with soft tissue tumors (25 soft tissue sarcomas, 19 GIST, 9 desmoids) and 15 healthy controls were included. Blood samples were obtained at two time points, before and 8 weeks after start of tumor-specific therapy. Peripheral blood mononuclear cells (PBMCs) were isolated. cEPCs were characterised as CD34+, CD133+, CD45dim, CD31+ and vascular endothelial growth factor 2 (VEGFR-2) positive cells. Serum concentrations of VEGF-A and angiopoetin-2 were determined by enzyme-linked immunosorbent assay. RESULTS VEGF-A and Ang-2 concentrations were significantly higher in tumor patients than in healthy controls in both samples (p < .01). Sarcoma patients with progressive disease developed a significant increase in cEPC levels between the two blood samples compared to those with stable disease (p = .002). GIST patients with progressive tumor or metastatic disease showed significant increase in VEGF-A values (p = .01). DISCUSSION The pre-treatment values of the angiogenic markers did not correlate with the clinical course of the disease. However, cEPCs levels were significantly higher in sarcoma patients with progressive disease compared to those with stable disease and should be further evaluated as early markers of disease progression in sarcoma patients. VEGF-A and angiopoetin-2 clearly play a role as mediators of the vasculogenesis contributing to tumor progression.
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Affiliation(s)
- Ioannis Karampinis
- Department of Surgery, Mannheim University Medical Center, University of Heidelberg, Germany
| | - Elena Joas
- Department of Gastroenterology, Mannheim University Medical Center, University of Heidelberg, Germany
| | - Anna Dreyer
- Department of Surgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Jens Jakob
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Germany.
| | - Kai Nowak
- Department of Surgery, Mannheim University Medical Center, University of Heidelberg, Germany.
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Karampinis I, Ronellenfitsch U, Mertens C, Gerken A, Hetjens S, Post S, Kienle P, Nowak K. Indocyanine green tissue angiography affects anastomotic leakage after esophagectomy. A retrospective, case-control study. Int J Surg 2017; 48:210-214. [PMID: 29146267 DOI: 10.1016/j.ijsu.2017.11.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/15/2017] [Accepted: 11/02/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Optimal perfusion of the gastric conduit during esophagectomy is elementary for the anastomotic healing since poor perfusion has been associated with increased morbidity due to anastomotic leaks. Until recently surgical experience was the main tool to assess the perfusion of the anastomosis. We hypothesized that anastomoses located in the zone of optimal ICG perfusion of the gastric conduit ("optizone") have a reduced anastomotic leakage rate after esophagectomy. METHODS Indocyanine green (ICG) fluorescence tissue angiography was used to evaluate the anastomotic perfusion in 35 patients undergoing esophagectomy with gastric conduit reconstruction. The transition point of the "optizone" to the malperfused area of the conduit was defined macroscopically and with the use of ICG angiography during the operation. The anastomosis was performed in the optizone whenever possible. The results of the ICG patients were retrospectively reviewed and compared with 55 patients previously operated without ICG angiography. RESULTS The visual assessment of the conduit perfusion concurred with the ICG angiography in 27 cases. In 8 cases (22.8%) the ICG angiography deviated from the visual aspect. One case of anastomotic leakage was observed in the group of patients in which the anastomosis could be performed in the optizone (1/33; 3%) compared with 10 cases in the control group (18%; p = 0.04). In two cases we had to perform the anastomosis in an area of compromised ICG perfusion. Both patients developed an anastomotic leakage. CONCLUSIONS ICG tissue angiography represents a feasible and reliable technical support in the evaluation of the anastomotic perfusion after esophagectomy. In this retrospective analysis we observed a significant decrease in anastomotic leakage rate when the anastomosis could be placed in the zone of good perfusion defined by ICG fluorescence. A prospective trial is needed in order to provide higher level evidence for the use of ICG fluorescence in reducing leakage rates after esophagectomy.
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Affiliation(s)
- Ioannis Karampinis
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Ulrich Ronellenfitsch
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Christina Mertens
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Andreas Gerken
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Mannheim University Medical Centre, University of Heidelberg, Ludolf-Krehl Strasse 13-17, 68167, Mannheim, Germany.
| | - Stefan Post
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Peter Kienle
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Kai Nowak
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
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Karampinis I, Ronellenfitsch U, Mertens C, Gerken A, Hetjens S, Post S, Kienle P, Nowak K. Indocyanine green tissue angiography affects anastomotic leakage after esophagectomy. A retrospective, case-control study. Int J Surg 2017. [PMID: 29146267 DOI: 10.1016/j.ijsu.2017.11.00] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Optimal perfusion of the gastric conduit during esophagectomy is elementary for the anastomotic healing since poor perfusion has been associated with increased morbidity due to anastomotic leaks. Until recently surgical experience was the main tool to assess the perfusion of the anastomosis. We hypothesized that anastomoses located in the zone of optimal ICG perfusion of the gastric conduit ("optizone") have a reduced anastomotic leakage rate after esophagectomy. METHODS Indocyanine green (ICG) fluorescence tissue angiography was used to evaluate the anastomotic perfusion in 35 patients undergoing esophagectomy with gastric conduit reconstruction. The transition point of the "optizone" to the malperfused area of the conduit was defined macroscopically and with the use of ICG angiography during the operation. The anastomosis was performed in the optizone whenever possible. The results of the ICG patients were retrospectively reviewed and compared with 55 patients previously operated without ICG angiography. RESULTS The visual assessment of the conduit perfusion concurred with the ICG angiography in 27 cases. In 8 cases (22.8%) the ICG angiography deviated from the visual aspect. One case of anastomotic leakage was observed in the group of patients in which the anastomosis could be performed in the optizone (1/33; 3%) compared with 10 cases in the control group (18%; p = 0.04). In two cases we had to perform the anastomosis in an area of compromised ICG perfusion. Both patients developed an anastomotic leakage. CONCLUSIONS ICG tissue angiography represents a feasible and reliable technical support in the evaluation of the anastomotic perfusion after esophagectomy. In this retrospective analysis we observed a significant decrease in anastomotic leakage rate when the anastomosis could be placed in the zone of good perfusion defined by ICG fluorescence. A prospective trial is needed in order to provide higher level evidence for the use of ICG fluorescence in reducing leakage rates after esophagectomy.
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Affiliation(s)
- Ioannis Karampinis
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Ulrich Ronellenfitsch
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Christina Mertens
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Andreas Gerken
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Mannheim University Medical Centre, University of Heidelberg, Ludolf-Krehl Strasse 13-17, 68167, Mannheim, Germany.
| | - Stefan Post
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Peter Kienle
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Kai Nowak
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Germany.
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Rother U, Gerken ALH, Karampinis I, Klumpp M, Regus S, Meyer A, Apel H, Krämer BK, Hilgers K, Lang W, Nowak K. Dosing of indocyanine green for intraoperative laser fluorescence angiography in kidney transplantation. Microcirculation 2017; 24. [DOI: 10.1111/micc.12392] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/25/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Ulrich Rother
- Department of Vascular Surgery; University of Erlangen; Erlangen Germany
| | - Andreas L. H. Gerken
- Department of Surgery; University Medical Center Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Ioannis Karampinis
- Department of Surgery; University Medical Center Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Madeline Klumpp
- Department of Vascular Surgery; University of Erlangen; Erlangen Germany
| | - Susanne Regus
- Department of Vascular Surgery; University of Erlangen; Erlangen Germany
| | - Alexander Meyer
- Department of Vascular Surgery; University of Erlangen; Erlangen Germany
| | - Hendrik Apel
- Department of Urology; University of Erlangen; Erlangen Germany
| | - Bernhard K. Krämer
- Department of Medicine V; University Medical Center Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Karl Hilgers
- Department of Nephrology; University of Erlangen; Erlangen Germany
| | - Werner Lang
- Department of Vascular Surgery; University of Erlangen; Erlangen Germany
| | - Kai Nowak
- Department of Surgery; University Medical Center Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
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