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Bruer G, Krueger N, Weber K, Warfving N, Vitali A, Nolde J, Schuster T, Creutzenberg O, Janssen P, Wessely B, Stintz M, Moise V, Kellert M. P13-19 Enhanced study design for acute inhalation studies with hydrophobic surface treated particles to reveal the issue of suffocation through strong agglomeration of particles in the nose of test animals. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.558] [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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Lugo Gavidia LM, Burger D, Robinson S, Nolde J, Carnagarin R, Matthews VB, Schlaich MP. Circulating extracellular vesicles correlate with nocturnal blood pressure and vascular organ damage and may serve as an integrative biomarker of vascular health. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Council on Science and Technology, Mexico (CONACYT).
Background
Elevated blood pressure (BP) has been associated with increased levels of circulating extracellular vesicles (EVs) which could potentially serve as a novel integrative biomarker for vascular health.
Purpose
The present study therefore aimed to assess the relationship between increased EV release, blood pressure and macrovascular organ damage.
Methods
A total of 83 patients with BP ranging from normal to high were included in the present analysis. Extracellular vesicles were evaluated by flow cytometry (CD41+/Annexin v+). BP evaluation included unobserved automated office BP (AOBP) and ambulatory BP monitoring (24hr-BP, day-BP and night-BP). Carotid-femoral pulse wave velocity (PWV) was measured by the SphygmoCor XCEL as a marker of macrovascular organ damage.
Results
Hypertensive patients (n = 73, BP 132.9 ± 17.4/79.4 ± 14.0) compared to normotensive patients (n = 10, BP 113.4 ± 10.4/71.3 ± 9.6) had higher levels of EVs (10.6 ± 8.2 vs 6.5 ± 4.5 EV/µL; p = 0.02). Circulating EVs were positively correlated with nocturnal systolic BP (r= 0.3; p = 0.01) and night-time dipping (r= -0.26; p = 0.02) in univariable analysis. In contrast, systolic AOBP, 24hr-BP and day-BP did not show significant associations. No significant correlations were found with diastolic BP. EVs were significantly correlated with PWV (r = 0.26 p = 0.02).While all BP measures were associated with PWV, average systolic night-time BP demonstrated the strongest correlation with PWV (r = 0.55; p < 0.001) compared to systolic AOBP (r = 0.51; p < 0.001), 24hr-BP (r = 0.46; p < 0.001), and average day-BP (r = 0.48; p < 0.001). Multivariable regression models confirmed robustness of the models.
Conclusion
We demonstrate a close positive relationship between a variety of BP measures and levels of circulating EVs as well as macrovascular damage assessed by PWV. The strongest correlation with EVs was found for average systolic nocturnal BP. Given that average nocturnal BP is the strongest predictor of CV events, EVs may serve as a useful integrative marker of vascular health and useful biomarker for CV risk assessment, a proposition that will need to be tested in prospective clinical trials. Abstract Figure.
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Affiliation(s)
- L M Lugo Gavidia
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - D Burger
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - S Robinson
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - J Nolde
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - R Carnagarin
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - V B Matthews
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - M P Schlaich
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
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Lugo-Gavidia LM, Burger D, Bosio E, Robinson S, Nolde J, Carnagarin R, Matthews VB, Schlaich MP. A standarized protocol for evaluation of large extracellular vesicles using the attune™ NXT system. J Immunol Methods 2021; 499:113170. [PMID: 34662560 DOI: 10.1016/j.jim.2021.113170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/09/2021] [Revised: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022]
Abstract
Extracellular vesicles (EVs) represent a promising biomarker in several medical areas. Flow cytometry (FC) is one of the most widely-used methods to characterize EVs, providing quantitative information and determination of EV subtypes. EV evaluation represents a challenge as no standardized methods are available to facilitate assessment across different research centers. This is principally because their size falls below the detection limit of most standard flow cytometers and a thorough optimization process is required to ensure instrument-specific sensitivity. We provide an overview of a standardized method to evaluate large EVs using the Attune™ Nxt Acoustic Focusing Flow Cytometer system (Thermo Fisher Scientific).
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Affiliation(s)
- Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Dylan Burger
- Kidney Research Centre, The Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Canada
| | - Erika Bosio
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Sandi Robinson
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Janis Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, Australia; Department of Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia; Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia.
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Nolde J, Lugo-Gavidia LM, Kannenkeril D, Chan J, Robinson S, Jose A, Joyson A, Schlaich L, Carnagarin R, Azzam O, Kiuchi M, Schlaich M. Simultaneously measured interarm blood pressure difference is not associated with pulse wave velocity in a clinical dataset of at-risk hypertensive patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2302] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Recent analysis of systolic inter-arm differences in blood pressure from the INTERPRESS-IPD Collaboration suggest an association with increased all-cause mortality, cardiovascular mortality and cardiovascular events, previous studies have demonstrated associations with other risk parameters.
Purpose
We aimed to reproduce these associations in a cohort of 199 treated, at-risk, hypertensive patients with pulse wave velocity (PWV) as a surrogate marker of cardiovascular (CV) damage.
Methods
Simultaneously measured Inter-arm blood pressure differences, 24 hour ambulatory BP and PWV were measured in 199 treated patients of a tertiary hospital hypertension outpatient clinic. Associations between systolic inter-arm BP difference and PWV were analyzed with uni- and multivariate regression models.
Results
Out of 199 participants, 90 showed an Inter-arm blood pressure difference of more than 5 mmHg. The Inter-arm difference was not associated with PWV. Furthermore, neither observed single blood pressure measurements nor 24 hour ambulatory blood pressure was associated with Inter-arm blood pressure differences.
Conclusion
In our clinical patient cohort we failed to observe an association between inter-arm BP differences and PWV. Mode of assessment, study design or the sample characteristics of this treated, hypertensive cohort may explain the negative results. The limited sample size of the study poses a challenge to the detection of smaller effects in our study.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Nolde
- The University of Western Australia, School of Medicine, Perth, Australia
| | - L M Lugo-Gavidia
- The University of Western Australia, School of Medicine, Perth, Australia
| | - D Kannenkeril
- University of Erlangen-Nuremberg, Department for Nephrology, Erlangen, Germany
| | - J Chan
- The University of Western Australia, School of Medicine, Perth, Australia
| | - S Robinson
- The University of Western Australia, School of Medicine, Perth, Australia
| | - A Jose
- The University of Western Australia, School of Medicine, Perth, Australia
| | - A Joyson
- The University of Western Australia, School of Medicine, Perth, Australia
| | - L Schlaich
- The University of Western Australia, School of Medicine, Perth, Australia
| | - R Carnagarin
- The University of Western Australia, School of Medicine, Perth, Australia
| | - O Azzam
- The University of Western Australia, School of Medicine, Perth, Australia
| | - M Kiuchi
- The University of Western Australia, School of Medicine, Perth, Australia
| | - M Schlaich
- The University of Western Australia, School of Medicine, Perth, Australia
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Azzam O, Carnagarin R, Lugo-Gavidia LM, Nolde J, Matthews VB, Schlaich MP. Bexagliflozin for type 2 diabetes: an overview of the data. Expert Opin Pharmacother 2021; 22:2095-2103. [PMID: 34292100 DOI: 10.1080/14656566.2021.1959915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a relatively novel glucose-lowering drugs (GLDs) which additionally promote weight loss and blood pressure reduction among other beneficial effects.Areas covered: This review reflects on the extra-glycemic effects of SGLT2 inhibitors and their impact on important clinical endpoints, and provides an overview of data relating to a newer member of the SGLT2 inhibitor class, bexagliflozin.Expert opinion: SGLT2 inhibitors, while consolidating glycemic control as adjunctive therapy, indisputably affect cardio-renal benefits in the T2D population which is prevalently afflicted by heightened cardiovascular risk and a disproportionately increased incidence of unfavorable cardiovascular and renal outcomes. The data from landmark trials demonstrate that beneficial effects of SGLT2 inhibitors extend to non-diabetic patients with chronic kidney disease (CKD) and/or heart failure with reduced ejection fraction (HFrEF). Preliminary findings from the BEST trial suggest that Bexagliflozin's effects reflect those of other licensed drugs in its class. Bexagliflozin has also been shown to be safe and effective in patients with diabetes and CKD stage 3b. If and when approved, it presents physicians with the prospect of an additional therapeutic option in managing patients with type 2 diabetes mellitus (T2D), and conceivably also, nondiabetic patients with established CKD and/or HFrEF.
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Affiliation(s)
- Omar Azzam
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Australia.,Department of Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Australia
| | - Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Australia
| | - Janis Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
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Shekarriz S, Keck T, Kujath P, Shekarriz J, Strate T, Keller R, Schlöricke E, Nolde J, Ehlert A, Shekarriz H. Comparison of conservative versus surgical therapy for acute appendicitis with abscess in five German hospitals. Int J Colorectal Dis 2019; 34:649-655. [PMID: 30671634 DOI: 10.1007/s00384-019-03238-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/10/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the effectiveness of initially conservative therapy compared to immediate appendectomy for acute appendicitis with abscess in terms of medical and economic outcomes. METHODS Of all the patients treated for appendicitis from January 2009 to December 2017 in five German hospitals, 240 were included in the study. Fifty-three patients received conservative (CON) and 195 patients received surgical (SUR) therapy as initial treatment. RESULTS Length of stay was similar (12.5 days in CON vs. 13.3 days in SUR, p = 0.530). Readmission rate was higher in the conservative group (54.7% vs. 6.2%, p < 0.001). The majority (53.7%) of the 41 operations in CON group were appendectomies (22 procedures), 1 (4.5%) of them was in the first hospital stay because of persisting symptoms, 21 (95.5%) after a recovery interval. Seven (33.3%) of the recovery appendectomies were performed due to persisting or recurrent symptoms and 14 (66.7%) due to the request of patient. Twenty-one patients (39.6%) in the CON group did not need surgery. The rates of complication-related operations per patient (0.04 versus 0.58, p < 0.001), conversions of surgical technique (1.9% vs. 34.9%, p = 0.0287), and extended resections (1.9% vs. 31.3%, p < 0.001) were higher in SUR group. Furthermore, morbidity, hospital costs, and loss in quality of life were significantly higher in the surgical group (17.0% vs. 66.2%, p < 0.001; € 5044 vs. € 8457, p < 0.001, and 4.3 days vs. 7.5 days, p < 0.001, CON vs. SUR). CONCLUSION Initially, conservative treatment for acute appendicitis with abscess is preferable to immediate surgical treatment in reduction of morbidity, hospital costs, and loss in quality of life.
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Affiliation(s)
- S Shekarriz
- University Hospital Schleswig-Holstein-Campus Luebeck, Lubeck, Germany.
| | - T Keck
- University Hospital Schleswig-Holstein-Campus Luebeck, Lubeck, Germany
| | - P Kujath
- University Hospital Schleswig-Holstein-Campus Luebeck, Lubeck, Germany
| | | | - T Strate
- Hospital Reinbek, Reinbek, Germany
| | - R Keller
- Segeberger Kliniken, Bad Segeberg, Germany
| | | | - J Nolde
- University Hospital Schleswig-Holstein-Campus Luebeck, Lubeck, Germany
| | - A Ehlert
- SmartStep Hamburg, Hamburg, Germany
| | - H Shekarriz
- Helios Klinikum Schleswig, Schleswig, Germany
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Horn M, Nolde J, Goltz J, Barkhausen J, Schade W, Waltermann C, Modersitzki J, Olesch J, Papenberg N, Keck T, Kleemann M. Ein Prototyp für die navigierte Implantation von Aortenstentprothesen zur Reduzierung der Kontrastmittel- und Strahlenbelastung: Das Nav-CARS-EVAR-Konzept (Navigated-Contrast-Agent and Radiation Sparing Endovascular Aortic Repair). Zentralbl Chir 2015; 140:e1. [DOI: 10.1055/s-0035-1568246] [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: 10/22/2022]
Affiliation(s)
- M. Horn
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
| | - J. Nolde
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
| | - J. Goltz
- Klinik für Radiologie und Nuklearmedizin, UKSH Campus Lübeck, Deutschland
| | - J. Barkhausen
- Klinik für Radiologie und Nuklearmedizin, UKSH Campus Lübeck, Deutschland
| | - W. Schade
- EnergieCampus, Fraunhofer Heinrich-Hertz-Institut, Goslar, Deutschland
| | - C. Waltermann
- EnergieCampus, Fraunhofer Heinrich-Hertz-Institut, Goslar, Deutschland
| | - J. Modersitzki
- Projektgruppe Bildregistrierung, Fraunhofer MEVIS, Lübeck, Deutschland
| | - J. Olesch
- Projektgruppe Bildregistrierung, Fraunhofer MEVIS, Lübeck, Deutschland
| | - N. Papenberg
- Projektgruppe Bildregistrierung, Fraunhofer MEVIS, Lübeck, Deutschland
| | - T. Keck
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
| | - M. Kleemann
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
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Horn M, Nolde J, Goltz JP, Barkhausen J, Schade W, Waltermann C, Modersitzki J, Olesch J, Papenberg N, Keck T, Kleemann M. [An Experimental Set-Up for Navigated-Contrast-Agent and Radiation Sparing Endovascular Aortic Repair (Nav-CARS EVAR)]. Zentralbl Chir 2015; 140:493-9. [PMID: 26484440 DOI: 10.1055/s-0035-1546261] [Citation(s) in RCA: 2] [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: 10/22/2022]
Abstract
INTRODUCTION Over the last decade endovascular stenting of aortic aneurysm (EVAR) has been developed from single centre experiences to a standard procedure. With increasing clinical expertise and medical technology advances treatment of even complex aneurysms are feasible by endovascular methods. One integral part for the success of this minimally invasive procedure is innovative and improved vascular imaging to generate exact measurements and correct placement of stent prosthesis. One of the greatest difficulty in learning and performing this endovascular therapy is the fact that the three-dimensional vascular tree has to be overlaid with the two-dimensional angiographic scene by the vascular surgeon. MATERIAL AND METHODS We report the development of real-time navigation software, which allows a three-dimensional endoluminal view of the vascular system during an EVAR procedure in patients with infrarenal aortic aneurysm. We used the preoperative planning CT angiography for three-dimensional reconstruction of aortic anatomy by volume-rendered segmentation. At the beginning of the intervention the relevant landmarks are matched in real-time with the two-dimensional angiographic scene. During the intervention the software continously registers the position of the guide-wire or the stent. An additional 3D-screen shows the generated endoluminal view during the whole intervention in real-time. RESULTS We examined the combination of hardware and software components including complex image registration and fibre optic sensor technology (fibre-bragg navigation) with integration in stent graft introducer sheaths using patient-specific vascular phantoms in an experimental setting. From a technical point of view the feasibility of fibre-Bragg navigation has been proven in our experimental setting with patient-based vascular models. Three-dimensional preoperative planning including registration and simulation of virtual angioscopy in real time are realised. CONCLUSION The aim of the Nav-CARS-EVAR concept is reduction of contrast medium and radiation dose by a three-dimensional navigation during the EVAR procedure. To implement fibre-Bragg navigation further experimental studies are necessary to verify accuracy before clinical application.
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Affiliation(s)
- M Horn
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
| | - J Nolde
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
| | - J P Goltz
- Klinik für Radiologie und Nuklearmedizin, UKSH Campus Lübeck, Deutschland
| | - J Barkhausen
- Klinik für Radiologie und Nuklearmedizin, UKSH Campus Lübeck, Deutschland
| | - W Schade
- EnergieCampus, Fraunhofer Heinrich-Hertz-Institut, Goslar, Deutschland
| | - C Waltermann
- EnergieCampus, Fraunhofer Heinrich-Hertz-Institut, Goslar, Deutschland
| | - J Modersitzki
- Projektgruppe Bildregistrierung, Fraunhofer MEVIS, Lübeck, Deutschland
| | - J Olesch
- Projektgruppe Bildregistrierung, Fraunhofer MEVIS, Lübeck, Deutschland
| | - N Papenberg
- Projektgruppe Bildregistrierung, Fraunhofer MEVIS, Lübeck, Deutschland
| | - T Keck
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
| | - M Kleemann
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
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Kleemann M, Nolde J, Papenberg N, Modersitzki J, Keck T. Prototype of a 3D-navigation System for Interventional Therapy of Aortic Aneurysms. Eur J Vasc Endovasc Surg 2014. [DOI: 10.1016/j.ejvs.2014.03.020] [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: 10/25/2022]
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Schloericke E, Hoffmann M, Zimmermann M, Kraus M, Bouchard R, Roblick UJ, Hildebrand P, Nolde J, Bruch HP, Limmer S. Transperineal omentum flap for the anatomic reconstruction of the rectovaginal space in the therapy of rectovaginal fistulas. Colorectal Dis 2012; 14:604-10. [PMID: 21752173 DOI: 10.1111/j.1463-1318.2011.02719.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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] [Indexed: 12/15/2022]
Abstract
AIM Deep rectovaginal fistulas are a rare entity and pose a delicate challenge for the surgeon. The present study introduces different operative interventions involved in transperineal omental flap surgery. METHOD A retrospective analysis of all patients treated with a low or mid rectovaginal or enterovaginal fistula at the Department of Surgery of the University Hospital of Schleswig-Holstein, Campus Luebeck, was performed. Treatment results were discussed with respect to aetiology, localization, morbidity and outcome. RESULTS Between the years 2000 and 2010, a total of nine patients with a low or mid rectovaginal fistula were treated at our clinic. After local fistulectomy, all patients were additionally treated by a laparoscopically assisted omental flap reconstruction of the rectovaginal and perineal space. Eight of the nine patients received a protective ileostomy or colostomy. Only the patient with a history of Crohn's disease had no ileostomy raised. At a median follow-up of 22 months, no patient experienced recurrence of a rectovaginal fistula. Perioperative mortality was zero and minor complications were observed in 22%. Major complications were an anastomotic insufficiency after low anterior resection that was treated without further interventions. Another complication was a persistent fistula within the sphincter that needed re-operation and bovine plug repair combined with a mucosa flap. CONCLUSIONS Complete omental reconstruction of the rectovaginal space appears decisive in the operative therapy of deep rectovaginal or enterovaginal fistulas. Comparative studies on standard therapies are necessary although direct comparison of case series is difficult.
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Affiliation(s)
- E Schloericke
- Department of Surgery, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany.
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Schlöricke E, Zimmermann M, Hoffmann M, Laubert T, Nolde J, Hildebrand P, Bruch HP, Bouchard R. [Surgical treatment and prognosis of rectovaginal fistulae according to their origin]. Zentralbl Chir 2012; 137:390-5. [PMID: 22473673 DOI: 10.1055/s-0031-1283884] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The rectovaginal fistula is a rare entity with heterogenic causality. Its genesis seems to predict the extent of operative treatment and the prognostic outcome. The aim of this study was to present different surgical techniques in the treatment of rectovaginal fistulas and their results in correspondence to the genesis. MATERIAL AND METHODS Between 1 / 2000 and 1 / 2010, the data of patients with rectovaginal fistulas were collected. The retrospective analysis included biographic and anamnestic data as well as clinical parameters, general and specific complications and postoperative data. RESULTS In a timespan of ten years 36 patients with rectovaginal fistulas were treated. The most common causes were inflammatory diseases (n = 21) and earlier surgical measures (n = 6). Moreover tumour-associated fistulas (n = 5) and fistulas with unknown genesis (n = 4) were seen. As surgical techniques anterior resection (n = 21), transrectal flap plasty (n = 7), subtotal colectomy (n = 3), pelvine exenteration (n = 2) and rectal exstirpation (n = 1) were used. The closure of the vaginal lesion was performed by single suture (n = 25), flap plasty (n = 6), transvaginal omental plasty (n = 2) and posterior vaginal plasty (n = 1). All patients were provided with an omental plasty to perform a safe division of the concerned regions. Patients with a low fistula ( < 6 cm) were treated with transperineal omental plasty. The median follow-up was 12 months (6 - 36). Within this timespan 6 patients suffered from major complications [ARDS, anastomosis insufficiency, postoperative bleeding, recurrence of fistula (n = 3)]. Three patients died in the postoperative period (cerebellar infarct, septic complication associated with Crohn's disease, multiorgan failure in tumour recurrence). CONCLUSION The genesis of rectovaginal fistulae is an important predictor for the size of resection which can range from simple excision to exenteration. For optimal therapy the surgical intervention needs to be integrated into an interdisciplinary therapy concept.
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Affiliation(s)
- E Schlöricke
- Universitätsklinikum Schleswig-Holstein Campus Lübeck, Allgemeinchirurgie, Lübeck, Deutschland.
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Liu J, Bruch HP, Farke S, Nolde J, Schwandner O. Stoma formation for fecal diversion: a plea for the laparoscopic approach. Tech Coloproctol 2009; 9:9-14. [PMID: 15868492 DOI: 10.1007/s10151-005-0185-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Accepted: 10/20/2004] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to assess the results of laparoscopic stoma creation for fecal diversion, specifically focussing on feasibility, safety, and efficacy, as well as indications and techniques. METHODS Within a 10-year-period, all patients requiring laparoscopic stoma creation were evaluated prospectively. Patients' profiles and indications, procedures and results of operation, conversion, morbidity, mortality and short-term complications (stoma-related, laparoscopy-associated) were analyzed. RESULTS A total of 80 patients (39 males, 41 females) with a mean age of 55.5 years (range, 17-91) underwent laparoscopic stoma creation. Most common indications were unresectable advanced colorectal cancer (n=20), pelvic malignant cancer (e. g. ovarian, cervix and prostate cancer, n=16), and perianal Crohn's disease with complex fistulas (n=16). Only in one female patient with pelvic malignant disease was the procedure converted to laparotomy due to obesity (conversion rate, 1.3%). 79 patients underwent laparoscopic stoma creation (completion rate, 98.7%) including loop ileostomy (n=30), loop sigmoid colostomy (n=40) and end sigmoid colostomy (n=9). Postoperative complications were documented in 9 patients (overall morbidity rate, 11.4%), including 4 minor complications treated conservatively (2 cases of prolonged atonia and 1 case each of pneumonia and urinary tract infection) and 5 major complications requiring reoperation (reoperation rate, 6.3%): one parastomal abscess (drainage), one stoma retraction following rod dislocation (laparoscopic stoma recreation), small bowel obstruction in two patients (small bowel resection), one port-site hernia (fascial closure), and hemorrhage (managed by re-laparoscopy). Mean operation time was 74 min (range, 30-245 min). Mean blood loss volume was 80 ml (range, 30-400 ml). Patients were discharged from hospital after a mean of 10.3 days (range, 3-47). Within a 1-year follow-up, no further stoma complications were documented. CONCLUSIONS The advantages of laparoscopic stoma creation are low morbidity and reoperation rates, and no procedure-related mortality; our results suggest that laparoscopic stoma creation for fecal diversion is safe, feasible and effective. Therefore, at our institution, laparoscopic stoma creation is the method of choice for fecal diversion.
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Affiliation(s)
- J Liu
- Department of Oncological Surgery, 1st Affiliated Hospital of Medicine College, Zhejiang University, P. R. China
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Shekarriz H, Nolde J, Kujath P, Bruch H. Videoassistierte (VATS) pulmonale Lobektomie bei Bronchialcarcinom – Operative Technik und Taktik zur Unterlappenresektion (Videovortrag). Pneumologie 2008. [DOI: 10.1055/s-2008-1074094] [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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15
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Shekarriz H, Nolde J, Kujath P. Videoassistierte (VATS) pulmonale Lobektomie bei Bronchialcarcinom- Operative Technik und Taktik zur Unterlappenresektion. Pneumologie 2006. [DOI: 10.1055/s-2006-933788] [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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Abstract
Candida albicans is the fourth most germ that can be identified on surgical intensive care unit (SICU). During the course of severe peritonitis recognition of Candida is crucial for physicians but interpretation of Candida-positive microbiologic samples is difficult. The indication for antimycotic therapy requires differentiation between harmless contamination or severe invasive mycosis associated with high mortality. Therefore, we propose a four-stage classification. Stage I is the initial contamination of the abdominal cavity by Candida spp. Stage IIa is characterized by persistence of fungi in patients without risk factors, IIb with risk factors respectively. Stage III means histological evidence of Candida invasion into the peritoneal layer. Stage IV is a generalized infection with fungemia/fungal sepsis. We recommend antimycotic therapy in stage IIb or higher.
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Affiliation(s)
- P Kujath
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, D-23538 Lübeck, Germany.
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17
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Klaus S, Heringlake M, Block K, Nolde J, Staubach K, Bahlmann L. Metabolic changes detected by microdialysis during endotoxin shock and after endotoxin preconditioning. Intensive Care Med 2003; 29:634-41. [PMID: 12577159 DOI: 10.1007/s00134-002-1602-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2002] [Accepted: 11/13/2002] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Preconditioning with low doses of endotoxin has been shown to induce endotoxin hyporesponsiveness. The present study was designed to assess the metabolic response of various tissues during endotoxemia and after pretreatment with endotoxin. DESIGN Controlled experimental animal study. SETTING Research laboratory of a university hospital. MEASUREMENTS AND RESULTS Ten pigs were randomly assigned to a control ( n = 5) or a treatment group ( n = 5), the latter receiving incremental doses of endotoxin 5-2 days prior the experiments. Apart from hemodynamics and oxygen transport variables, lactate, glucose, and glycerol were measured in muscle, subcutaneous fat, and hepatic tissue using microdialysis. Endotoxin was infused (1 micro g.kg.h) until the animals died. A significant increase in tissue lactate (eightfold) and glycerol (fivefold) was observed in the control animals. This effect was almost completely abolished in the endotoxin pretreated group. Endotoxin pretreatment had no significant effects on mean arterial pressure [56 (range 34-89) mmHg vs 70 (47-88) mmHg, n.s.] or cardiac output [4.8 (3.0-5.9) l/min vs 3.2 (2.1-4.2) l/min, n.s.], but significantly improved arterial pO(2) and pH ( P<0.05). Increase of oxygen extraction was higher in control animals [from 34% (range 24-47%) to 72% (range 61-79%)] compared to the pretreatment group [from 30% (range 22-42%) to 44% (range 34-50%), P<0.05]. Endotoxin pretreatment increased survival time from 5.3 h (5.0-5.8) to 8.0 h (7.0-8.5) ( P<0.05), respectively. CONCLUSIONS Microdialysis monitoring revealed that endotoxin preconditioning ameliorates the increase in tissue metabolism during endotoxemia, accompanied by decreased systemic oxygen demand despite unchanged global hemodynamics.
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Affiliation(s)
- S Klaus
- Department of Anaesthesiology, Medical University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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18
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Birth M, Iblher P, Hildebrand P, Nolde J, Bruch HP. [Ultrasound-guided interventions using magnetic field navigation. First experiences with Ultra-Guide 2000 under operative conditions]. Ultraschall Med 2003; 24:90-95. [PMID: 12698373 DOI: 10.1055/s-2003-38668] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
AIM Ultrasound-guided interventions are presently performed as free-hand-type procedures or using biopsy transducers. In this article we report on our experience with a new navigation-system for sonographically guided interventional procedures under OR-conditions. METHODS The US-Guide 2000 trade mark is an electromagnetic guidance system that assists physicians in ultrasound-guided interventional procedures. This system accommodates both in-plane and out-of-plane needle placement. We evaluated this system for the first time under OR-conditions. Overall, for 39 interventional procedures (23 thermoablations of malignant liver lesions, 16 diagnostic punctures) were performed. RESULTS All targets were reached successfully without any complications. No interactions with other OR-devices were seen. CONCLUSION The US-Guide 2000 trade mark as a virtual needle-guiding system allows a safe and accurate sonographically assisted intervention. The major advantage is the possibility of out-of-plane needle placement and the combination of flexibility of free-hand-type procedures with the accuracy of a biopsy transducer. This increases the safety of punctures especially when lesions are difficult to reach and/or are situated next to vulnerable structures. It also reduces the interventional trauma.
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Affiliation(s)
- M Birth
- Klinik für Chirurgie des Universitätsklinikums Lübeck.
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Abstract
ILEAL POUCH RECONSTRUCTION: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice in mucosal ulcerative colitis (MUC) and familial adenomatous polyposis (FAP). Because the disease is cured by surgical resection, functional results, pouch survival prognosis, and disease or dysplasia control are the major determinants of success. There is controversy as to whether the IPAA should be handsewn with mucosectomy or stapled, preserving the mucosa of the anal transitional zone. Crohn's disease is a contraindication for IPAA, but long-term outcome after IPAA is similar to that for MUC in patients with indeterminate colitis who do not develop Crohn's disease. As development of dysplasia and cancer in the ileal pouch have been reported, a standardized surveillance program is mandatory in cases of MUC, FAP, and chronic pouchitis. COLONIC POUCH RECONSTRUCTION: Construction of a colonic pouch is a widely accepted technique to improve functional outcome after low or intersphincteric resection for rectal cancer. Several randomized studies comparing colo-pouch-anal anastomosis (CPA) with straight coloanal anastomosis (CAA) have found the pouch functionally superior. Most controlled studies cover only 1-year follow-up, but randomized studies with 2-year follow-up show similar functional results of CPA and CAA. Evacuation difficulty as initially observed was related to pouch size, and the results with smaller pouches (5-6 cm) are more favorable, showing adequate reservoir function without compromising neorectal evacuation. The transverse coloplasty pouch may offer several advantages to J-pouch reconstruction. Current series question whether the neorectal reservoir is the physiological key of the pouch, but rather the decreased motility. The major advantage reported with colonic pouch reconstruction is the lower incidence of anastomotic complications.
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Affiliation(s)
- H-P Bruch
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Staubach KH, Nolde J, Brade H, Woltmann A, Bruch HP. New approach in flow-cytometric determination of endotoxin during endotoxic shock. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01544-63.x] [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: 11/20/2022]
Abstract
Abstract
Background
Serum endotoxin was formerly measured with the non-specific Limulus lysate assay. The present approach was to quantitate the amount of endotoxin bound by peripheral mononuclear cells in order to develop a method for the diagnosis of early septic shock.
Methods
Using a murine monoclonal antibody (WN1-222/5), which binds highly specifically to lipopolysaccharide (LPS), a new method for measuring the amount of LPS bound to peripheral mononuclear cells was developed. Ten pigs were studied under sedation and peripheral mononuclear cells were taken every 4 h to determine the concentration of endotoxin by flow cytometry. The results are shown in the Table.
Results
The percentage of marked mononuclear cells increased during shock. Only in the last hours before death did the rate of increase decline.
Conclusion
Preliminary data on marked mononuclear cells showed that the amount of natural incorporated endotoxin, i.e. the quantity of bound endotoxin before infusion, was 32 per cent.
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Affiliation(s)
- K-H Staubach
- Department of Surgery, Medical University of Lübeck, Lübeck, Germany
| | - J Nolde
- Department of Surgery, Medical University of Lübeck, Lübeck, Germany
| | - H Brade
- Department of Surgery, Medical University of Lübeck, Lübeck, Germany
| | - A Woltmann
- Department of Surgery, Medical University of Lübeck, Lübeck, Germany
| | - H-P Bruch
- Department of Surgery, Medical University of Lübeck, Lübeck, Germany
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Staubach KH, Nolde J, Block K, Woltmann A, Brade H. A new approach of endotoxic testing by using a monoclonal antibody against endotoxin (WN1-222/5) and flow cytometry. Crit Care 2001. [PMCID: PMC3333241 DOI: 10.1186/cc1121] [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: 11/10/2022] Open
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Staubach KH, Nolde J, Song L, Brade H, Bruch HP. Differences in phagocytosis by polymorphonuclear leucocytes (PMNs) and monocytes (Mos) in endotoxemia and endotoxin (ET) tolerance. Crit Care 2000. [PMCID: PMC3332979 DOI: 10.1186/cc775] [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: 11/30/2022] Open
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Klaus S, Bahlmann L, Nolde J, Eichler W, Staubach K, Klotz K. STOFFWECHSELMONITORING PER MIKRODIALYSE WÄHREND DES SEPTISCHEN SCHOCKS NACH ENDOTOXIN-IMPFUNG. BIOMED ENG-BIOMED TE 2000. [DOI: 10.1515/bmte.2000.45.s1.359] [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: 11/15/2022]
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