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Gerken ALH, Jawny P, Weigl H, Yang C, Hardt J, Menge F, Hohenberger P, Weiß C, Reißfelder C, Jakob J. Postoperative drainage management and wound complications following resection of lower limb soft tissue tumors: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:202. [PMID: 37209306 PMCID: PMC10199851 DOI: 10.1007/s00423-023-02939-9] [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: 03/15/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE Postoperative wound complications are common in patients undergoing resection of lower extremity soft tissue tumors. Postoperative drainage therapy ensures adequate wound healing but may delay or complicate it. The aim of this study is to evaluate the incidence of postoperative wound complications and delayed or prolonged drainage treatment and to propose a standardized definition and severity grading of complex postoperative courses. METHODS A monocentric retrospective analysis of 80 patients who had undergone primary resection of lower extremity soft tissue tumors was performed. A new classification was developed, which takes into account postoperative drainage characteristics and wound complications. Based on this classification, risk factors and the prognostic value of daily drainage volumes were evaluated. RESULTS According to this new definition, regular postoperative course grade 0 (no wound complication and timely drainage removal) occurred in 26 patients (32.5%), grade A (minor wound complications or delayed drainage removal) in 12 (15.0%), grade B (major wound complication or prolonged drainage therapy) in 31 (38.8%), and grade C (reoperation) in 11 (13.7%) patients. Tumor-specific characteristics, such as tumor size (p = 0.0004), proximal tumor location (p = 0.0484), and tumor depth (p = 0.0138) were identified as risk factors for complex postoperative courses (grades B and C). Drainage volume on postoperative day 4 was a suitable predictor for complex courses (cutoff of 70 ml/d). CONCLUSION The proposed definition incorporates wound complications and drainage management while also being clinically relevant and easy to apply. It may serve as a standardized endpoint for assessing the postoperative course after resection of lower extremity soft tissue tumors.
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Affiliation(s)
- A L H Gerken
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Jawny
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiothoracic Surgery, University Hospital Augsburg, Medical Faculty Augsburg, Augsburg University, Augsburg, Germany
| | - H Weigl
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Yang
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Hardt
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - F Menge
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Hohenberger
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - C Weiß
- Department of Biometry and Statistics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Reißfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Jakob
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Lindner S, von Rudno K, Gawlitza J, Hardt J, Sandra-Petrescu F, Seyfried S, Kienle P, Reissfelder C, Bogner A, Herrle F. Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal. Int J Colorectal Dis 2021; 36:413-417. [PMID: 33048240 PMCID: PMC7801265 DOI: 10.1007/s00384-020-03766-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE This study investigates whether contrast enema (CE) and flexible endoscopy (FE) should be performed routinely after low anterior resection (LAR) before ileostomy reversal. Additionally, the impact of previous anastomotic leakage (AL) on diagnostic test accuracy (DTA) was assessed. METHODS This is a retrospective analysis of prospectively collected tertiary care data of two centers. Consecutive rectal cancer patients undergoing LAR with loop ileostomy formation were included. Before ileostomy reversal, all patients were assessed by CE and FE. DTA of FE and CE for asymptomatic AL in patients who had previously suffered from clinically relevant AL (group 1) compared with those without apparent AL after LAR (group 0) were assessed separately. RESULTS Two hundred ninety-three patients were included in the analysis, 86 in group 1 and 207 in group 0. Overall sensitivity for detection of asymptomatic AL was 76% (FE) and 60% (CE). Specificity was 100% for both tests. DTA of FE was equal or superior to CE in all subgroups. Prevalence of asymptomatic AL at the time of testing was 1.4% in group 0 and 25.6% in group 1. CONCLUSION Flexible endoscopy is the more accurate diagnostic test for the detection of asymptomatic anastomotic leaks prior to ileostomy reversal. Contrast enema showed no gain of information. In the group without complications after the initial rectal resection, 104 must be tested to find one leak prior to reversal. In those patients, routine diagnostic testing additional to digital rectal examination may be questioned.
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Affiliation(s)
- S Lindner
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K von Rudno
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - J Gawlitza
- Department of Radiology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J Hardt
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F Sandra-Petrescu
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - S Seyfried
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus Mannheim, Mannheim, Germany
| | - C Reissfelder
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Bogner
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - F Herrle
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Hardt J, Conrad S, Muche-Borowski C, Raspe H. Epidemiology of depression and distress in patients with inflammatory bowel disease (IBD) and validation of an indicator scale of perceived stress for psychosocial impairments. Eur Psychiatry 2020. [DOI: 10.1016/s0924-9338(11)73920-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BackgroundPrevious studies showed associations of stress and episodes of active disease [1,2]. We reported survey data on psychosocial problems of IBD patients [3]. This study investigates associations of stress with health impairments and analyses a scale of perceived stress as an indicator for psychosocial impairments (construct/criterion validity) [4].MethodsIn a multiregional German survey in 2005, 1083 patients with Crohn's disease (CD) and ulcerative colitis were recruited (gastroenterological practices, university outpatient clinics, patient organization). The questionnaire incorporated WHO's ICF [5] and established items and scales (i.a. HADS [6]). Scale construction followed item response theory analysing psychometric properties.ResultsOf the survey responders (58% CD, 65% female, mean age 42yrs), ⅓ reported severe fatigue. Clinically relevant anxiety was observed in 24%, depression in 29% of men and 21% of women. With three items we constructed a scale with good psychometric properties. Three groups (low, moderate, high perceived stress) were identified, differing substantially in reported anxiety/depression and the GIBDI disease activity score.ConclusionsIBD patients report multiple psychosocial impairments. The scale of perceived stress may identify IBD patients with high demand for psychosocial attendance, if confirmed in independent samples. For enhanced secondary prevention [7] we propose integration of this psychosocial indicator into the diagnostic process.
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Seyfried S, Lucas V, Galata C, Reißfelder C, Weiß C, Kienle P, Hardt J. Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow-up of the randomized PATRASTOM trial. Colorectal Dis 2020; 22:445-451. [PMID: 31652025 DOI: 10.1111/codi.14887] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/08/2019] [Indexed: 02/08/2023]
Abstract
AIM Because damage to the rectus abdominis muscle during ileostomy placement and reversal might be a risk factor for the development of stoma-site incisional hernia (SSIH), we hypothesized that positioning of the stoma lateral to the rectus abdominis muscle might prevent SSIH. METHOD To investigate whether a lateral pararectal stoma position lowers the incidence of SSIH in comparison with a transrectal position, a follow-up study of the PATRASTOM trial, which had randomized stoma placement (lateral pararectal versus transrectal), was conducted. All former participants were invited simultaneously for a follow-up visit in September 2016, 2 years after database closure of the PATRASTOM trial. For patients who were not able to attend the follow-up, the electronic chart as well as MRI/CT scans were reviewed with regard to the presence of SSIH. RESULTS Follow-up - either clinical or radiological - was available for 47 of the 60 PATRASTOM participants. The median duration of follow-up was 3.4 years (interquartile range 3.0-4.1 years). SSIH occurred in 3 of 23 patients (13.0%) in the lateral pararectal group compared with 7 of 24 patients (29.2%) in the transrectal group (P = 0.287). Four of the 10 patients diagnosed with SSIH had already undergone or were scheduled for hernia repair. Of the patient and procedure characteristics which may have an impact on the development of incisional hernia none was a significant risk factor for SSIH. CONCLUSION In the present follow-up study, no difference in the incidence of SSIH was found between lateral pararectal and transrectal stoma construction in an elective setting.
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Affiliation(s)
- S Seyfried
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - V Lucas
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Galata
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus Mannheim, Mannheim, Germany
| | - J Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Buhr HJ, Hardt J, Klinger C, Seyfried F, Wiegering A, Dietrich A, Bartsch DK, Lorenz D, Post S, Germer CT, Keck T, Wellner U. [Quality indicators with reference values and threshold limits in general and visceral surgery : For obesity and metabolic, pancreatic, colon carcinoma and rectal carcinoma surgery]. Chirurg 2019; 89:1-3. [PMID: 29330678 DOI: 10.1007/s00104-017-0562-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Haus der Bundespressekonferenz, Schiffbauerdamm 40, 10117, Berlin, Deutschland.
| | - J Hardt
- Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - C Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Haus der Bundespressekonferenz, Schiffbauerdamm 40, 10117, Berlin, Deutschland
| | - F Seyfried
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Wiegering
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Dietrich
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie Bereich Bariatrische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - D K Bartsch
- Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Marburg, Deutschland
| | - D Lorenz
- Klinik für Allgemein- und Viszeralchirurgie bzw. der Medizinischen Klinik II Gastroenterologie, Hepatologie, Endokrinologie, Infektiologie, Sana Klinikum Offenbach, Offenbach, Deutschland
| | - S Post
- Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - C T Germer
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - T Keck
- Klinik für Allgemeine Chirurgie, Universitätsklinikum S.-H. Campus Lübeck, Lübeck, Deutschland
| | - U Wellner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum S.-H. Campus Lübeck, Lübeck, Deutschland
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Hardt J, Buhr HJ, Klinger C, Benz S, Ludwig K, Kalff J, Post S. [Quality indicators for colon cancer surgery : Evidence-based development of a set of indicators for the outcome quality]. Chirurg 2019; 89:17-25. [PMID: 29189878 DOI: 10.1007/s00104-017-0559-0] [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: 12/16/2022]
Abstract
BACKGROUND Quality assessment in surgery is gaining in importance. Although sporadic recommendations for quality indicators (QI) in oncological colon surgery can be found in the literature, these are usually not systematically derived from a solid evidence base. Moreover, reference ranges for QI are unknown. OBJECTIVE The aim of this initiative was the development of evidence-based QI for oncological colon resections by an expert panel invited by the German Society of General and Visceral Surgery (DGAV). Reference ranges from the literature and reference values from the Study, Documentation, and Quality Center (StuDoQ)|Colon Cancer Register were compared in order to deduce recommendations which are tailored to the German healthcare system. RESULTS Based on the most recent scientific evidence and agreed by expert consensus, five QI for oncological colon surgery were defined and evaluated according to the QUALIFY tool. Mortality, MTL30 (mortality, transfer to another acute care hospital, or length of stay ≥30 days), anastomotic leakage requiring reintervention, surgical site infections necessitating reopening of the wound and ≥12 lymph nodes in the specimen qualified as QI owing to their relevance, scientific nature, and practicability. Based on the results of the systematic literature search and the statistical analysis of the StuDoQ|Colon Cancer Register, preliminary reference values are proposed for each QI. CONCLUSION The presented set of QI seems appropriate for quality assessment of oncological colon surgery in the context of the German healthcare system. The validity of the QI and the reference values must be reviewed within the framework of their implementation. The StuDoQ|Colon Cancer Register provides a suitable infrastructure for collecting clinical data for quality assessment and risk adjustment.
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Affiliation(s)
- J Hardt
- Chirurgische Klinik, Universitätsmedizin Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - H-J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - C Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - S Benz
- Chirurgische Klinik, Klinikum Sindelfingen-Böblingen, Böblingen, Deutschland
| | - K Ludwig
- Chirurgische Klinik, Klinikum Südstadt Rostock, Rostock, Deutschland
| | - J Kalff
- Chirurgische Klinik, Universitätsklinikum Bonn (UKB), Bonn, Deutschland
| | - S Post
- Chirurgische Klinik, Universitätsmedizin Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Hardt J, Kienle P. Laparoscopic ventral pouch pexy with acellular dermal matrix (ADM)-a novel technique for the treatment of full-thickness pouch prolapse after restorative proctocolectomy and j-pouch. Int J Colorectal Dis 2018; 33:1643-1646. [PMID: 30032453 DOI: 10.1007/s00384-018-3135-2] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Ileal pouch prolapse is a rare complication after j-pouch formation with an incidence of about 0.3%. However, if a pouch prolapse occurs, it can be a debilitating complication for the patient. Full-thickness pouch prolapse usually warrants surgical repair as reported by Sagar and Pemberton (Br J Surg 99(4):454-468, 2012) and Sherman et al. (Inflamm Bowel Dis 20(9):1678-1685, 2014). This report presents our first experience with laparoscopic ventral pouch pexy with acellular dermal matrix (ADM). METHODS With the patient in the French position, four trocars were positioned: a camera port at the level of the umbilicus, two 5-mm trocars in the right lower quadrant, and a third 5-mm trocar in the left lower quadrant. The j-pouch was mobilized ventrally and laterally to the level of the sphincter. A 4 × 16-cm piece of ADM (EPIFLEX®, POLYTECH Health & Aesthetics, Dieburg, Germany) was sutured to the levators on both sides and to the ventral pouch directly cranial of the sphincter. In the next step, the ADM was attached to the promontory. Subsequently, further sutures were placed to attach the pouch to the ADM. Finally, the ADM was sewn to the cranial vaginal pole. RESULTS Operating time was 249 min. The postoperative course was uneventful except for a higher stool frequency which could be managed conservatively. The patient was discharged on POD 9. At the latest follow-up (12 months after surgery), the patient was still symptom free without any sign of recurrence. CONCLUSIONS Laparoscopic ventral pouch pexy with ADM performed by a surgeon experienced in laparoscopic pouch surgery is a safe and effective treatment option in patients with pouch prolapse.
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Affiliation(s)
- J Hardt
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus, Mannheim, Germany
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Germenis AE, Loules G, Zamanakou M, Psarros F, González-Quevedo T, Speletas M, Bork K, Wulff K, Steinmüller-Magin L, Braenne I, Staubach-Renz P, Witzke G, Hardt J. On the pathogenicity of the plasminogen K330E mutation for hereditary angioedema. Allergy 2018; 73:1751-1753. [PMID: 30009523 DOI: 10.1111/all.13324] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. E. Germenis
- Department of Immunology; School of Medicine; University of Thessaly; Larissa Greece
- CeMIA S.A.; Larissa Greece
| | | | | | - F. Psarros
- Department of Allergology; Navy Hospital; Athens Greece
| | - T. González-Quevedo
- Reference Unit for Angioedema in Andalusia; Allergy Department; Virgen del Rocío University Hospital; Seville Spain
| | - M. Speletas
- Department of Immunology; School of Medicine; University of Thessaly; Larissa Greece
| | - K. Bork
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - K. Wulff
- University Medicine; Ernst Moritz Arndt University; Greifswald Germany
| | | | - I. Braenne
- Center for Public Health Genomics; University of Virginia; Charlottesville VA USA
| | - P. Staubach-Renz
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - G. Witzke
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - J. Hardt
- Department of Medical Psychology and Medical Sociology; Johannes Gutenberg University; Mainz Germany
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Bork K, Wulff K, Steinmüller-Magin L, Braenne I, Staubach-Renz P, Witzke G, Hardt J. Hereditary angioedema with a mutation in the plasminogen gene. Allergy 2018; 73:442-450. [PMID: 28795768 DOI: 10.1111/all.13270] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) with normal C1-INH (HAEnCI) may be linked to specific mutations in the coagulation factor 12 (FXII) gene (HAE-FXII) or functional mutations in other genes that are still unknown. We sought to identify and characterize a hitherto unknown type of HAE with normal C1-INH and without mutation in the F12 gene. METHODS The study comprised analysis of whole-exome sequencing, Sanger sequencing, and clinical data of patients. RESULTS We detected a mutation in the plasminogen (PLG) gene in patients with HAEnCI. The mutation c.988A>G was located in exon 9 leading to the missense mutation p.Lys330Glu (K330E) in the kringle 3 domain of the PLG protein. The mutation was identified by next-generation sequencing in 14 patients with HAEnCI belonging to 4 of 7 families. Family studies revealed that this type of HAE was transmitted as an autosomal dominant trait. The PLG gene mutation was present in all studied symptomatic patients and was also found in 9 of 38 index patients from 38 further families with HAEnCI. Most patients had swelling of face/lips (78.3%) and tongue (78.3%). A total of 331 of all 3.795 tongue swellings (8.7%) were associated with dyspnea, voice changes, and imminent asphyxiation. Two women died by asphyxiation due to a tongue swelling. CONCLUSIONS Hereditary angioedema with a mutation in the PLG gene is a novel type of HAE. It is associated with a high risk of tongue swellings.
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Affiliation(s)
- K. Bork
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - K. Wulff
- University Medicine; Ernst Moritz Arndt University; Greifswald Germany
| | | | - I. Braenne
- Center for Public Health Genomics; University of Virginia; Charlottesville VA USA
| | - P. Staubach-Renz
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - G. Witzke
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - J. Hardt
- Department of Medical Psychology and Medical Sociology; Johannes Gutenberg University; Mainz Germany
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Hardt J, Pilz L, Magdeburg J, Kienle P, Post S, Magdeburg R. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection. Int J Colorectal Dis 2017; 32:1439-1446. [PMID: 28823064 DOI: 10.1007/s00384-017-2884-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE This study investigated the association of preoperative hypoalbuminemia and postoperative complications after elective resection for rectal cancer. METHODS From September 2009 to December 2014, all patients who underwent elective rectal resection for adenocarcinoma of the rectum were identified using a prospective colorectal cancer database. Hypoalbuminemia was defined as a serum albumin < 35 g/L. Characteristics and outcomes of hypoalbuminemic patients were compared to those of patients with normal albumin levels. Potential risk factors for postoperative major morbidity, defined as Clavien-Dindo ≥ grade 3, were analyzed by both univariate and multivariate analyses. RESULTS Three hundred seventy patients met the inclusion criteria. Hypoalbuminemic patients (67/370 (18%)) were significantly older and had more advanced tumor stages and more comorbidities (more ASA III, higher percentage of diabetics). Furthermore, they were more likely to undergo abdominoperineal resection instead of low anterior resection and less likely to be operated laparoscopically. On univariate analysis, a higher BMI, advanced tumor stages, diabetes, open procedures, pre- and postoperative hypoalbuminemia, a higher decrease in albumin (∆ preop-postop), and conversion were significantly associated with postoperative high-grade morbidity. On multivariate analysis, diabetes, advanced tumor stages, a higher decrease in the albumin level, as well as preoperative hypoalbuminemia turned out to be independent risk factors for postoperative high-grade morbidity. CONCLUSIONS Hypoalbuminemia is an independent risk factor for postoperative high-grade morbidity. As a low-cost and easy accessible test, serum albumin should be used as a prognostic tool to detect patients at risk for adverse outcomes after resection for rectal cancer.
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Affiliation(s)
- J Hardt
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - L Pilz
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J Magdeburg
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
| | - S Post
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - R Magdeburg
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
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Grott M, Horisberger K, Weiß C, Kienle P, Hardt J. Resection enterostomy versus Hartmann's procedure for emergency colonic resections. Int J Colorectal Dis 2017; 32:1171-1177. [PMID: 28389778 DOI: 10.1007/s00384-017-2808-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND If a primary anastomosis is considered too risky after emergency colon resection either a resection enterostomy or an end stoma with closure of the distal bowel (Hartmann's procedure) is possible. This study analyzes the rate of restoration of intestinal continuity and other surgical outcomes after resection enterostomy placement versus Hartmann's procedure for emergency colon resections. METHODS All patients who underwent emergency colorectal resections between August 2009 and June 2014 at the University Medical Center Mannheim were reviewed in regard to therapeutic approach, rate of restoration of bowel continuity, and surgical morbidity after the primary operation and after reversal surgery. RESULTS Fifty-five patients in whom both studied interventions would have been technically feasible were further analyzed. The rate of revisional surgery was significantly higher in the resection enterostomy cohort after the primary operation. There were no significant differences regarding morbidity, mortality, and the rate of restoration of intestinal continuity. Overall, bowel continuity could be restored in 63% (29/46) of the surviving patients. The median time of surgery of the initial as well as of the reversal surgery was significantly longer in the Hartmann's group. Five of 13 patients underwent protective ileostomy placement in the Hartmann's group at the time of the reversal (vs. none in the resection enterostomy group). CONCLUSIONS The bowel continuity can be restored in the majority of patients after emergency colonic resection. Conclusive evidence which surgical option should be preferred when a primary anastomosis is considered too risky-Hartmann's procedure or resection enterostomy-is still lacking.
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Affiliation(s)
- M Grott
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - K Horisberger
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - C Weiß
- Department of Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - P Kienle
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
| | - J Hardt
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
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Abstract
BACKGROUND Restorative proctocolectomy (RPC) is the standard of care in the case of medically refractory disease and in neoplasia in ulcerative colitis (UC). OBJECTIVES This review aims at providing an overview of the current evidence on standards, innovations, and controversies with regard to the surgical technique of RPC. RESULTS RPC is the standard of care in the surgical management of UC refractory to medical treatment and in neoplasia. Due to its simplicity and good functional outcomes, the J‑pouch is the most used pouch design. RPC is usually performed as a two-stage procedure. In the presence of risk factors, a three-stage procedure should be performed. The technically more demanding mucosectomy and hand sewn anastomosis does not seem to result in a better oncologic outcome than stapled anastomosis. Functional results appear marginally better after stapled anastomosis, but the rectal cuff should not exceed 2 cm in this reconstruction. The laparoscopic approach is at least as good as the open approach. For the new, innovative surgical approaches such as robotics and transanal surgery, only feasibility but no advantages have yet been demonstrated. CONCLUSION The evidence in regard to controversial points remains limited.
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Affiliation(s)
- J Hardt
- Chirurgische Klinik, Universitätsmedizin Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - P Kienle
- Chirurgische Klinik, Universitätsmedizin Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Bork K, Wulff K, Witzke G, Hardt J. Treatment for hereditary angioedema with normal C1-INH and specific mutations in the F12 gene (HAE-FXII). Allergy 2017; 72:320-324. [PMID: 27905115 DOI: 10.1111/all.13076] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/28/2022]
Abstract
Hereditary angioedema with normal C1 esterase inhibitor and mutations in the F12 gene (HAE-FXII) is associated with skin swellings, abdominal pain attacks, and the risk of asphyxiation due to upper airway obstruction. It occurs nearly exclusively in women. We report our experience treating HAE-FXII with discontinuation of potential trigger factors and drug therapies. The study included 72 patients with HAE-FXII. Potential triggers included estrogen-containing oral contraceptives (eOC), hormonal replacement therapy, or angiotensin-converting enzyme inhibitors. Drug treatment comprised plasma-derived C1 inhibitor (pdC1-INH) for acute swelling attacks and progestins, tranexamic acid, and danazol for the prevention of attacks. Discontinuation of eOC was effective in 25 (89.3%) of 28 women and led to a reduction in the number of attacks (about 90%). After ending hormonal replacement therapy, three of eight women became symptom-free. Three women with exacerbation of HAE-FXII during intake of quinapril or enalapril had no further HAE-FXII attacks after discontinuation of those drugs. Eleven women were treated with pdC1-INH for 143 facial attacks. The duration of the treated facial attacks (mean: 26.6 h; SD: 10.1 h) was significantly shorter than that of the previous 88 untreated facial attacks in the same women (mean: 64.1 h; SD: 28.0 h; P < 0.01). The mean reduction in attack frequency was 99.8% under progestins after discontinuing eOC (16 women), 93.8% under tranexamic acid (four women), and 100% under danazol (three women). For patients with HAE-FXII, various treatment options are available which completely or at least partially reduce the number or duration of attacks.
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Affiliation(s)
- K. Bork
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - K. Wulff
- University Medicine; Ernst Moritz Arndt University; Greifswald Germany
| | - G. Witzke
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - J. Hardt
- Department of Medical Psychology and Medical Sociology; Johannes Gutenberg University; Mainz Germany
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Bork K, Wulff K, Witzke G, Rietz S, Hardt J. Tamoxifen may cause life-threatening angioedema attacks in patients with hereditary angioedema. J Eur Acad Dermatol Venereol 2016; 31:e237-e239. [DOI: 10.1111/jdv.14056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K. Bork
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - K. Wulff
- University Medicine; Ernst Moritz Arndt University; Greifswald Germany
| | - G. Witzke
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - S. Rietz
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - J. Hardt
- Department of Medical Psychology and Medical Sociology; Johannes Gutenberg University; Mainz Germany
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Hardt J, Herrle F, Kienle P. Reply to 'Response to a pilot single centre randomized trial: the PATRASTOM trial' and 'Assessing the efficacy of lateral rectus abdominis positioned stoma (LRAPS) formation in the PATRASTOM trial'. Colorectal Dis 2016; 18:623-4. [PMID: 27167184 DOI: 10.1111/codi.13380] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 02/08/2023]
Affiliation(s)
- J Hardt
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - F Herrle
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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16
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Hardt J, Seyfried S, Weiß C, Post S, Kienle P, Herrle F. A pilot single-centre randomized trial assessing the safety and efficacy of lateral pararectus abdominis compared with transrectus abdominis muscle stoma placement in patients with temporary loop ileostomies: the PATRASTOM trial. Colorectal Dis 2016; 18:O81-90. [PMID: 26713666 DOI: 10.1111/codi.13251] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/21/2015] [Indexed: 12/13/2022]
Abstract
AIM Transrectal stoma placement is considered the standard technique for positioning a stoma. A prospective series using a novel method of lateral pararectal stoma placement recently revealed a remarkably low stoma herniation rate. A randomized trial was conducted to compare the lateral pararectal with the transrectal stoma position with regard to parastomal herniation, stoma-related morbidity and quality of life. METHOD Adult patients undergoing elective placement of a temporary loop ileostomy were eligible for inclusion. Patients were intra-operatively randomized to undergo either a lateral pararectal or a transrectal ileostomy. The primary end-point was the rate of parastomal herniation. Secondary end-points included other stoma-related complications and quality of life. Sample size calculation resulted in 54 patients having to be analysed to detect a difference of parastomal herniation of 30% with an 80% power and a 5% significance level. The trial was registered with the German Clinical Trials Register (registration number DRKS00003534). RESULTS Between April 2012 and April 2014, 30 patients were randomized to each group. The incidence of parastomal herniation did not differ between the lateral pararectal (5 of 27) and the transrectal group (4 of 29; P = 0.725). There was also no significant difference regarding other stoma-related complications and the EORTC quality of life scales C30 and CR29. CONCLUSION The incidence of parastomal herniation and other stoma-related complications did not differ between the groups. However, due to the limited sample size a small difference in favour of one of the two stoma placement techniques cannot be entirely ruled out.
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Affiliation(s)
- J Hardt
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - S Seyfried
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - C Weiß
- Department of Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Post
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - P Kienle
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - F Herrle
- Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
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Bork K, Wulff K, Witzke G, Hardt J. Hereditary angioedema with normal C1-INH with versus without specific F12 gene mutations. Allergy 2015; 70:1004-12. [PMID: 25952149 DOI: 10.1111/all.12648] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hereditary angioedema with normal C1-INH may be linked to specific mutations in the coagulation factor 12 (FXII) gene (HAE-FXII) or mutations in genes that are still unknown (HAE-unknown). To assess the differences in transmission and inheritance, clinical features, and laboratory parameters between patients with HAE-FXII and HAE-unknown. METHODS Sixty-nine patients with HAE-FXII from 23 unrelated families and 196 patients with HAE-unknown from 65 unrelated families were studied. RESULTS Both HAE-FXII and HAE-unknown are inherited as autosomal-dominant traits with incomplete penetrance. The male to female ratio was 1 : 68 in HAE-FXII and 1 : 6.3 in HAE-unknown. The maternal to paternal transmission ratio was 35 : 14 for HAE-FXII and 109 : 12 for HAE-unknown. Mean age at onset of clinical symptoms was 20.3 years in patients with HAE-FXII and 29.6 years in patients with HAE-unknown. The incidence of asphyxiation due to angioedema was similar for HAE-FXII and HAE-unknown. Oral contraceptives and pregnancies had a significantly higher impact on HAE-FXII than on HAE-unknown. Slightly decreased C1-INH activity and C4 concentration were observed in more patients with HAE-FXII than HAE-unknown. Tests for FXI and FXII activity, plasminogen activator inhibitor 1, and activated partial thromboplastin time showed variability but no significant differences between the groups. No abnormalities were found for C1-INH protein, C1q, alpha2-macroglobulin, antithrombin III, and angiotensin-converting enzyme. In families with HAE-FXII, the number of female offspring with F12 mutations was significantly increased and that of male offspring was significantly decreased. CONCLUSIONS HAE-FXII and HAE-unknown differ in various respects, including gender distribution, genetics, symptoms, and estrogen impact.
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Affiliation(s)
- K. Bork
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - K. Wulff
- University Medicine; Ernst Moritz Arndt University; Greifswald Germany
| | - G. Witzke
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - J. Hardt
- Department of Medical Psychology and Medical Sociology; Johannes Gutenberg University; Mainz Germany
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18
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Hardt J, Bernert S, Matschinger H, Angermeier MC, Vilagut G, Bruffaerts R, de Girolamo G, de Graaf R, Haro JM, Kovess V, Alonso J. Suicidality and its relationship with depression, alcohol disorders and childhood experiences of violence: results from the ESEMeD study. J Affect Disord 2015; 175:168-74. [PMID: 25618003 DOI: 10.1016/j.jad.2014.12.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicidality constitutes a major health concern in many countries. The aim of the present paper was to analyse 10 of its risk factors and their interdependence. METHODS Data on suicidality, mental disorders and experience of childhood violence was collected from 8796 respondents in the European Study of the Epidemiology of Mental Disorders (ESEMeD). The CIDI was used to assess mental disorders. Individuals were randomly divided into two subgroups. In one, a Graphical Markov model to predict suicidality was constructed, in the second, predictors were cross-validated. RESULTS Lifetime suicidality was predicted mainly by lifetime depression and early experiences of violence, with a pseudo R-square of 12.8%. In addition, alcohol disorders predicted suicidality, but played a minor role compared with the other risk factors in this sample. CONCLUSION In addition to depression, early experience of violence constitutes an important risk factor of suicidality. LIMITATIONS This is a cross-sectional and retrospective study assessing risk factors for suicidality, not for suicide itself.
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Affiliation(s)
- J Hardt
- Medizinische Psychologie und Medizinische Soziologie, Klinik für Psycho-somatische Medizin und Psychotherapie, Universitätsmedizin Mainz, Germany.
| | - S Bernert
- Institute of Medical Sociology, Department of Rehabilitation Research, Charité - University Medicine Berlin
| | - H Matschinger
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig
| | - M C Angermeier
- Center for Public Mental Health, Gösing am Wagram, Austria; Department of Public Health, University of Cagliari, Italy
| | - G Vilagut
- Health Services Research Unit, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - R Bruffaerts
- Department of Psychiatry, University Hospital Gasthuisberg; Leuven, Belgium
| | - G de Girolamo
- IRCCS St John of God Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos-Instituut), Utrecht, Nl; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - J M Haro
- CIBER en Salud Mental (CIBERSAM), Spain
| | - V Kovess
- EA4069, Paris Descartes University, Ecole des Hautes Etudes en Santé Publique (EHESP), Paris, France
| | - J Alonso
- Health Services Research Unit, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
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Bork K, Wulff K, Hardt J, Witzke G, Lohse P. Characterization of a partial exon 9/intron 9 deletion in the coagulation factor XII gene (F12) detected in two Turkish families with hereditary angioedema and normal C1 inhibitor. Haemophilia 2014; 20:e372-5. [DOI: 10.1111/hae.12519] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 12/31/2022]
Affiliation(s)
- K. Bork
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - K. Wulff
- University Medicine; Ernst Moritz Arndt University; Greifswald Germany
| | - J. Hardt
- Department of Medical Psychology and Medical Sociology; Johannes Gutenberg University; Mainz Germany
| | - G. Witzke
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - P. Lohse
- Institute of Laboratory Medicine and Human Genetics; Singen Germany
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Puts MTE, Santos B, Hardt J, Monette J, Girre V, Atenafu EG, Springall E, Alibhai SMH. An update on a systematic review of the use of geriatric assessment for older adults in oncology. Ann Oncol 2013; 25:307-15. [PMID: 24256847 DOI: 10.1093/annonc/mdt386] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Our previous systematic review of geriatric assessment (GA) in oncology included a literature search up to November 2010. However, the quickly evolving field warranted an update. Aims of this review: (i) provide an overview of all GA instruments developed and/or in use in the oncology setting; (ii) evaluate effectiveness of GA in predicting/modifying outcomes (e.g. treatment decision impact, treatment toxicity, mortality, use of care). MATERIALS AND METHODS Systematic review of literature published between November 2010 and 10 August 2012. English, Dutch, French and German-language articles reporting cross-sectional or longitudinal, intervention or observational studies of GA instruments were included. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane Library. Two researchers independently reviewed abstracts, abstracted data and assessed the quality using standardized forms. A meta-analysis method of combining proportions was used for the outcome impact of GA on treatment modification with studies included in this update combined with those included in our previous systematic review on the use of GA. RESULTS Thirty-five manuscripts reporting 34 studies were identified. Quality of most studies was moderate to good. Eighteen studies were prospective, 11 cross-sectional and 5 retrospective. Three studies examined treatment decision-making impact and found decisions changed for fewer than half of assessed patients (weighted percent modification is 23.2% with 95% confidence interval (20.3% to 26.1%). Seven studies reported conflicting findings regarding predictive ability of GA for treatment toxicity/complications. Eleven studies examined GA predictions of mortality, and reported that instrumental activities of daily living, poor performance status and more numerous GA deficits were associated with increased mortality risk. Other outcomes could not be meta-analyzed. CONCLUSION Consistent with our previous review, several domains of GA are associated with adverse outcomes. However, further research examining effectiveness of GA on treatment decisions and oncologic outcomes is needed.
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Affiliation(s)
- M T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto
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Hardt J, Schwarzbach M, Hasenberg T, Post S, Kienle P, Ronellenfitsch U. The effect of a clinical pathway for enhanced recovery of rectal resections on perioperative quality of care. Int J Colorectal Dis 2013; 28:1019-26. [PMID: 23371335 DOI: 10.1007/s00384-013-1650-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE There is ample evidence of the benefits of clinical pathways (CPs), but this study is the first to investigate the potential additional benefits of a CP for rectal resections in a setting with an already established policy of enhanced postoperative recovery. METHODS We compared 36 patients who underwent rectal resections with ileostomy placement and were treated according to a CP (CP group) with 67 patients treated before CP implementation (prepathway group). Indicators of process quality were placement of central venous line and epidural catheter, day of removal of Foley catheter in relation to removal of the epidural catheter, day of first mobilization, day of resumption of regular diet, day of first passage of stool through the stoma, and length of stay. Outcome quality was assessed by morbidity, mortality, reoperation, and readmission rates. RESULTS We found that patients in the CP group resumed regular diet significantly sooner (p = 0.001). There were no significant differences regarding the day of first mobilization (p = 0.69), epidural catheter (p = 0.74), central venous line placement (p = 0.92), and removal of Foley catheter (p = 0.23). The first stool was passed through the stoma earlier (p = 0.04) in the prepathway group. Median length of hospital stay was significantly shorter in the CP group (12.5 vs. 15.0 days; p = 0.008). There were no significant changes in outcome quality, except for a significantly higher need for revisional surgery in the CP group (13.9 vs. 3%, p = 0.05). CONCLUSIONS After implementation of a CP for rectal resections, one parameter of process quality improved and length of stay decreased.
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Affiliation(s)
- J Hardt
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim, Germany
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Bokemeyer B, Hardt J, Hüppe D, Prenzler A, Conrad S, Düffelmeyer M, Hartmann P, Hoffstadt M, Klugmann T, Schmidt C, Weismüller J, Mittendorf T, Raspe H. Clinical status, psychosocial impairments, medical treatment and health care costs for patients with inflammatory bowel disease (IBD) in Germany: an online IBD registry. J Crohns Colitis 2013; 7:355-68. [PMID: 22503168 DOI: 10.1016/j.crohns.2012.02.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 02/08/2012] [Accepted: 02/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this cross-sectional study was to establish an online inflammatory bowel disease (IBD) registry for a first picture of the situation of IBD outpatients' treatment in Germany. METHODS Between March 2006 and July 2007 IBD outpatients from 24 gastroenterological specialist practices and two hospitals in Germany were enrolled in an Internet-based registry to evaluate the outpatients' clinical status, psychological impairments, provided health care, as well as medical treatment and medication costs. RESULTS 1032 IBD patients (ulcerative colitis/UC: 519; Crohn's disease/CD: 511; indeterminate colitis: 2) were enrolled in the study (age: 43 ± 14 years/M ± SD). Disease duration of all patients averaged 10 ± 8.5 years. In 519 UC-patients (49% male; 33% pancolitis), 66% were in remission as were 55% of CD patients (37 % male; 41 % active smokers). Associated with higher rates of disease activity (CDAI ≥ 150; CAI>4) were corticosteroids (CD, UC), topical medication (UC), relevant reported depressive symptoms (15%; 6-31%) and impairments in sexuality (21%; 9-42%). Relevant medication groups prescribed were oral aminosalicylates (UC: 70%; CD: 47%); immunosuppressive therapy - mostly azathioprine/6 MP (CD: 47%; UC: 26%), and Infliximab (CD: 8%; UC: 3%). Strongly associated with their clinical disease activity in UC as well as CD patients, 15% (6-31%) reported relevant depressive symptoms and 21% (9-42%) relevant impairments in sexuality. CONCLUSIONS The registry constitutes a large complemental database for the patient population in Germany. About one third of the IBD patients were not in clinical remission (CDAI ≥150/CAI >4) (CD: 45%; UC: 27%), although high rates of immunosuppressive drugs (CD: 47%; UC 26%) were administered. This study shows a large burden of active disease associated with an unexpectedly high (co)morbidity and high psychosocial impairments, indicating a reduced health state in IBD patients.
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March S, Iskenius M, Hardt J, Swart E. [Methodological considerations for data linkage of primary and secondary data in occupational epidemiology studies]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:571-8. [PMID: 23467849 DOI: 10.1007/s00103-013-1682-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Within the scope of an aging population, the topic age, work and health becomes more and more important. So far, research in occupational epidemiology utilizes various primary or secondary data sources. However, data linkage has rarely been used as an instrument in this field. The study presented here combines two large databases within a so-called "age-work matrix", stratified by sex, age group and occupational group. This matrix is based on the German classification of occupations and uses its occupation codes as a key variable. The first database is the representative BIBB/BAuA employment survey for employees of all occupations in Germany 2005/06. The second database consists in sickness absence data of the insurees of a German statutory health insurance fund. Using the matrix approach, the study investigates associations of reported subjectively perceived psychosocial work strains and health impairments provided by health insurance claims data. These claims data offer sickness absence data as an indicator for health impairments. Usability of sickness absence data for studies in occupational epidemiology, their methodological challenges and the solutions realized in this study are discussed.
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Affiliation(s)
- S March
- Institut für Sozialmedizin und Gesundheitsökonomie (Institutsleitung Prof. Dr. med. B.-P. Robra, M.P.H.), Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
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Puts MTE, Hardt J, Monette J, Girre V, Springall E, Alibhai SMH. Use of geriatric assessment for older adults in the oncology setting: a systematic review. J Natl Cancer Inst 2012; 104:1133-63. [PMID: 22851269 PMCID: PMC3413614 DOI: 10.1093/jnci/djs285] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [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: 01/23/2023] Open
Abstract
Background Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult’s medical, psychological, social, and functional capacity. No systematic review of the use of geriatric assessment in oncology has been conducted. The goals of this systematic review were: 1) to provide an overview of all geriatric assessment instruments used in the oncology setting; 2) to examine the feasibility and psychometric properties of those instruments; and 3) to systematically evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes (including the impact on treatment decision making, toxicity of treatment, and mortality). Methods We searched Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library for articles published in English, French, Dutch, or German between January 1, 1996, and November 16, 2010, reporting on cross-sectional, longitudinal, interventional, or observational studies that assessed the feasibility or effectiveness of geriatric assessment instruments. The quality of articles was evaluated using relevant quality assessment frameworks. Results We identified 83 articles that reported on 73 studies. The quality of most studies was poor to moderate. Eleven studies examined psychometric properties or diagnostic accuracy of the geriatric assessment instruments used. The assessment generally took 10–45min. Geriatric assessment was most often completed to describe a patient’s health and functional status. Specific domains of geriatric assessment were associated with treatment toxicity in 6 of 9 studies and with mortality in 8 of 16 studies. Of the four studies that examined the impact of geriatric assessment on the cancer treatment decision, two found that geriatric assessment impacted 40%–50% of treatment decisions. Conclusion Geriatric assessment in the oncology setting is feasible, and some domains are associated with adverse outcomes. However, there is limited evidence that geriatric assessment impacted treatment decision making. Further research examining the effectiveness of geriatric assessment on treatment decisions and outcomes is needed.
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Affiliation(s)
- M T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
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Hardt J, Brendler C, Greiser KH, Timmer A, Seidler A, Weikert C, Latza U. [Directed acyclic graphs (DAGs) - basic concepts and application of an approach for causal analyses in epidemiology]. Gesundheitswesen 2011; 73:878-9. [PMID: 22193895 DOI: 10.1055/s-0031-1287844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Causal graphs such as directed acyclic graphs (DAGs) are a novel approach in epidemiology to conceptualize confounding and other sources of bias. DAGs visually encode the causal relations based on a priori knowledge among the exposure of interest and the outcome while considering several covariates. The application of formal rules on these diagrams enables the identification of the causal and non-causal structures in the DAG. The causal effects are of interest and require no adjustment. Whereas the non-causal effects have to be checked for confounding and for which covariates adjustment is necessary. The identification of the adjustment set depends on the causal relations among the variables. The consideration of these relations is valuable because adjusting for more variables increases the risk of introducing bias. Considering every single path of a DAG allows the systematic identification of the causal structures in the DAG, and the determination of minimally sufficient adjustment sets for estimating the causal effect of the exposure on the outcome based on the underlying DAG. The aim of this paper is to provide an introduction to the basic assumptions as well as the steps for drawing and applying a DAG.
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Affiliation(s)
- S Schipf
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald.
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Hardt J, Gordon S, Benjanuvatra N. Injury prevention and management program for competitive swimming: Design and implementation. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.116] [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: 10/28/2022]
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Hardt J, Gordon S, Benjanuvatra N. Injury prevention and management in competitive swimming: Intervention and evaluation. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.117] [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: 11/28/2022]
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Scherer M, Hardt J, Blozik E, Preiß J, Bokemeyer B, Hüppe A, Raspe H. Medikamentöse Versorgung von Patienten mit Colitis ulcerosa. Z Gastroenterol 2011; 49:820-6. [DOI: 10.1055/s-0031-1273276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Retrospective assessment of adverse childhood experiences is widely used in research, although there are concerns about its validity. In particular, recall bias is assumed to produce significant artifacts. Data from a longitudinal cohort (the British National Child Development Study; N = 7,710) and the retrospective Mainz Adverse Childhood Experiences Study ( N = 1,062, Germany) were compared on 10 adverse childhood experiences and psychological adjustment at age 42 yr. Between the two methods, no significant differences in risk effects were detected. Results held for bivariate analyses on all 10 childhood adversities and a multivariate model; the later comprises the childhood adversities which show significant long-term sequelae (not always with natural parent, chronically ill parent, financial hardship, and being firstborn) and three covariates. In conclusion, the present data did not show any bias in the retrospective assessment.
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Affiliation(s)
- J. Hardt
- Institute for Medical Psychology and Medical Sociology, University Medical Center, Mainz
| | - P. Vellaisamy
- Department of Mathematics, Indian Institute of Technology, Bombay
| | - I. Schoon
- Faculty of Policy and Society, Institute of Education, University of London
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Hardt J, Iskenius M, du Prel J, Rose U, Peter R. Methodological aspects of the lidA cohort study – pretest analyses of response and psychometric properties. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266756] [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: 10/19/2022]
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Stehr M, Hardt J, Lengerke TV. Eine Kurzskala zur emotionalen sozialen Unterstützung auf Basis des F-SozU-K14: Vergleichende Analysen mittels klassischer und probabilistischer Testtheorie. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266259] [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: 10/19/2022]
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Rauch A, Tisch A, Tophoven S, Bender S, Hardt J, Hasselhorn H, Müller B, Peter R, Promberger M, Schröder H, Steinwede J, Swart E, Trappmann M. Die Vorteile der Verknüpfung unterschiedlicher Datenquellen zur Abbildung des Einflusses von Arbeit auf Gesundheit – Vorstellung eines neuen Forschungsprojektes (eingeladener Vortrag). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266265] [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: 10/19/2022]
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Hardt J, Vödisch K, Raspe H. Prävalenz des Metabolischen Syndroms bei Patienten mit chronischen unspezifischen Rückenschmerzen (Low Back Pain) im Vergleich verschiedener Definitionen des Metabolischen Syndroms. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266736] [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: 10/19/2022]
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Hardt J, Muche-Borowski C, Conrad S, Balzer K, Bokemeyer B, Raspe H. Chronisch entzündliche Darmerkrankungen als multifokale Erkrankungen: körperliche und psychosoziale Probleme von Patienten mit CED. Ergebnisse eines Fragebogen-Surveys. Z Gastroenterol 2009; 48:381-91. [DOI: 10.1055/s-0028-1109524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hardt J, Muche-Borowski C, Conrad S, Raspe H. Körperliche und psychosoziale Probleme von Patienten mit chronisch entzündlichen Darmerkrankungen (CED). Ergebnisse eines ICF-orientierten Fragebogen-Surveys. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239272] [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: 10/20/2022]
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Hardt J, Conrad S, Muche-Borowski C, Raspe H. Stresserleben und psychische Beeinträchtigungen bei Patienten mit chronisch entzündlichen Darmerkrankungen (CED). Ergebnisse zur Validierung einer Kurzskala. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239189] [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: 10/20/2022]
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Affiliation(s)
- R Nickel
- Klinik für Psychosomatische Medizin und Psychotherapie , Dr. Horst Schmidt Klinik Wiesbaden, Rheingauer Strasse 35, 65388, Schlangenbad, Deutschland.
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Hardt J, Fischbeck S, Laubach W. Eltern-Kind-Beziehungen und Suizidversuche: Eine retrospektive Studie. Psychother Psychosom Med Psychol 2009. [DOI: 10.1055/s-0029-1208215] [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: 10/21/2022]
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Bork K, Wulff K, Hardt J, Witzke G, Staubach P. Hereditary Angioedema Due to Missense Mutations in the Factor XII Gene: Clinical Features, Trigger Factors, and Therapy. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.368] [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: 11/25/2022]
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Mclaughlin A, Hardt J, Canavan J, Donnelly MB. Diagnosis-related group-based reimbursement is unrealistic for ICUs. Crit Care 2009. [PMCID: PMC4084371 DOI: 10.1186/cc7649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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McLaughlin AM, Hardt J, McKay AP, Fitzpatrick GJ, Donnelly MB. Alcohol, drug misuse and suicide attempts: unrecognised causes of out of hospital cardiac arrests admitted to intensive care units. Ir J Med Sci 2008; 178:29-33. [PMID: 18953626 DOI: 10.1007/s11845-008-0242-z] [Citation(s) in RCA: 3] [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] [Received: 01/15/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
Abstract
AIM To assess the contribution of alcohol, drug abuse and suicide attempts to out of hospital cardiac arrests (OHCA) who are admitted to our intensive care unit (ICU). METHODS Retrospective review of all OHCA admitted to the ICU over a 2-year period. RESULTS There were 26 OHCA. Six patients survived, all of whom had a cardiac aetiology for their arrest. Ten patients arrested due to external factors (drug misuse n = 4, alcohol excess n = 1, suicide attempts n = 4 and accidental choking n = 1). All of the patients who arrested secondary to external factors were young (37.2 +/- 13.58 years), 90% were male and all died in hospital. All of the cases of drug misuse involved cocaine. CONCLUSION Alcohol, drug misuse and suicide attempts contribute significantly to the number of OHCA which are admitted to ICU. Moreover, cocaine usage has contributed to a number of OHCA in our study.
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Affiliation(s)
- A M McLaughlin
- Department of Intensive Care, Adelaide & Meath Hospital incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland.
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Conrad S, Hardt J, Raspe H, Muche-Borowski C. Stresserleben und Wahrnehmung von Präventionsangeboten bei Betroffenen mit chronisch entzündlichen Darmerkrankungen (CED). Gesundheitswesen 2008. [DOI: 10.1055/s-0028-1086245] [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: 10/21/2022]
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Abstract
BACKGROUND Skin swellings are the most frequent symptoms in hereditary angio-oedema (HAE) arising out of C1-inhibitor (C1-INH) deficiency. They may be painful and impact daily activities of patients. Detailed clinical data concerning the treatment of skin swellings by C1-INH concentrate have not been reported yet. METHODS From 1976 through 2007, a total of 2104 skin-swelling attacks in 47 patients with HAE were treated with the C1-INH concentrate. Time to relief and duration of the swellings were documented during personal interviews using standardized questionnaires. The results were compared with 9046 untreated skin swellings in the same patients. RESULTS The first clinical sign of efficacy was a slowdown of progress of symptoms accompanied by a decreased feeling of tension and pain in the swollen area. The mean time to the first relief of symptoms was 1.1 +/- 1.4 h in treated skin swellings and 50.4 +/- 33 h in untreated skin swellings. Improvement of facial skin swellings took longer than swellings of the extremities, genitals or trunk. The duration of treated skin swellings was 1.7 day in treated and 3.2 day in untreated ones. In treated swellings, there was long-lasting control and no rebound within the 48 h following the drug administration and no laryngeal oedema following facial oedema were observed. No severe side-effects occurred. CONCLUSIONS The C1-INH concentrate has proven to be highly effective and safe for treating skin swellings in patients with HAE arising out of C1-INH deficiency.
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Affiliation(s)
- K Bork
- Department of Dermatology, Johannes Gutenberg University, Mainz, Germany
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Abstract
Homeobox (HOX) A10 is essential for fertility as demonstrated in transgenic mice, specifically affecting implantation and decidualization. Its role in human decidualization, however, remains unknown. In this study, we used gene silencing followed by microarray analysis to decipher the role of HOXA10 during decidualization of human endometrial stromal cells (HESCs). HOXA10 was knocked down using siRNA oligonucleotide transfection and cells were treated with estradiol, medroxyprogesterone acetate and dibutyryl cAMP (H + cAMP) to induce decidualization. Genes significantly regulated were identified using the Affymetrix microarray chip. With this method, 2361 transcripts were significantly altered by 1.5-fold or higher (P < 0.05) with H + cAMP treatment only. Of these genes, 258 were significantly up-regulated by HOXA10 knockdown and 236 transcripts were significantly down-regulated by more than 1.5-fold, totaling 494 genes that were regulated by HOXA10 during decidualization. Data analysis using the Ingenuity System revealed that many of the genes regulated by HOXA10 knockdown during H + cAMP treatment were associated with cell cycle. Real-time PCR was used to confirm that HOXA10 knockdown decreased expression of the cell cycle genes CDC2 and CCNB2. In addition, a higher percentage of cells were arrested in the G2/M phase. Next, we observed that cell proliferation as measured by BrdU incorporation was decreased upon HOXA10 knockdown and H + cAMP treatment. Apoptosis, on the other hand, as measured by Annexin V staining was not influenced by siHOXA10 in decidualizing cells. Together, these data demonstrate that during decidualization of HESC, HOXA10 is actively involved in promoting cell proliferation through the regulation of hundreds of genes.
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Affiliation(s)
- Z Lu
- Division of Reproductive Biology Research, Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
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Mclaughlin A, Canavan J, McAdam E, Mcdonagh R, Brar H, Hardt J, Sinead K, Fitzpatrick G, Donnelly M. What do people really know about MRSA? A survey of knowledge and attitudes in the general public and hospital visitors. Crit Care 2008. [PMCID: PMC4088373 DOI: 10.1186/cc6223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hardt J, Egle U, Johnson J. Suicide attempts and retrospective reports about parent-child relationships: evidence for the affectionless control hypothesis. Psychosoc Med 2007; 4:Doc12. [PMID: 19742293 PMCID: PMC2736528] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To compare the characteristics of recalled parent-child relationships in suicide attempters vs. non-attempters METHODS A total of 509 patients - 249 presenting with pain at a psychosomatic clinic and 260 from the offices of general practitioners - were interviewed retrospectively about suicide attempts and parent-child relationships. RESULTS The overall rate of those reporting a suicide attempt was 17%. Bivariate analyses showed associations of poor parent-child relationships with suicide attempts throughout. In a multivariate analysis, the combinations high maternal control*low perceived love (p<.001) and high control*high role reversal (p=.002) were associated with particularly elevated risks for suicide attempts. CONCLUSION Beside the two most extensively explored dimensions of parent-child relationships, parental affection and control, one other dimension, role reversal, also contributes strongly to risk for offspring suicide attempts and should be considered in future studies.
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Affiliation(s)
- J. Hardt
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duesseldorf, Duesseldorf, Germany,*To whom correspondence should be addressed: J. Hardt, Rheinische Kliniken Duesseldorf, Heinrich-Heine Universität Duesseldorf, Bergische Landstr. 2, 40629 Duesseldorf, Phone 0049 211 922 4723, Fax 0049 211 922 4709, E-mail:
| | - U.T. Egle
- Klinik Kinzigtal, Gengenbach, Germany
| | - J.G. Johnson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
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Abstract
Symptom checklists, in particular the SCL-90-R, are widely used in screening for psychological distress in patients with chronic pain. A detailed analysis reveals that this may lead to wrong diagnoses in many cases. The problem of using the SCL-90-R in patients with chronic pain is (a) that scale means are elevated due to items asking for pain-associated symptoms and (b) that there is a lack of specificity of the various dimensions of the SCL-90-R. Numerous short forms of the SCL-90-R are compared to the original one and analysed with respect to their applicability in patients with chronic pain. Other screening questionnaires not related to the SCL-90-R were analysed for the same purpose. As a result, the SCL-27, K9, HADS and PHQ are judged to be applicable for screening in patients with chronic pain.
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Affiliation(s)
- J Hardt
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum, Mainz, Deutschland.
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Hardt J, Bracko M, Sidor A, Egle UT. Die retrospektive Erfassung von Kindheitsbelastungen: Objektivität und Reliabilität. Psychother Psychosom Med Psychol 2007. [DOI: 10.1055/s-2007-970648] [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: 10/21/2022]
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Hardt J, Beutel ME. Die SCL-90-R als Screening Instrument im Psychosomatischen Konsil- und Liaisondienst. Psychother Psychosom Med Psychol 2007. [DOI: 10.1055/s-2007-970649] [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: 10/21/2022]
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