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Kappenschneider T, Bammert P, Maderbacher G, Greimel F, Parik L, Holzapfel DE, Schraag AD, Götz J, Michalk K, Grifka J, Meyer M. The impact of primary total hip and knee replacement on frailty: an observational prospective analysis. BMC Musculoskelet Disord 2024; 25:78. [PMID: 38245710 PMCID: PMC10799496 DOI: 10.1186/s12891-024-07210-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Osteoarthritis is a prevalent condition in frail older adults that requires hip or knee replacement in many patients. The aim of the study was to determine the impact of hip and knee arthroplasty on frailty. METHODS In this prospective short-term study, we used data from 101 participants of the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (GBA). Frailty, measured by Fried's Physical Frailty Phenotype (PFP), was assessed preoperatively, 7 days postoperatively, 4-6 weeks and 3 months after hip and knee arthroplasty. ANOVA with repeated measures and post-hoc tests for the subgroups were used for the statistical analysis. RESULTS Of the 101 participants, 50 were pre-frail (1-2 PFP criteria) and 51 were frail (≥ 3 PFP criteria) preoperatively. In the pre-frail group, the PFP score decreased from 1.56 ± 0.50 (median 2) preoperatively to 0.53 ± 0.73 (median 0) 3 months after surgery (p < 0.001). The PFP score in the frail cohort decreased from 3.39 ± 1.45 (median 3) preoperatively to 1.27 ± 1.14 (median 1) 3 months postoperatively (p < 0.001). While the PFP score of the pre-frail participants increased 7 days after surgery, the PFP score of the frail group decreased significantly. CONCLUSION Pre-frail individuals often regain robustness and patients with frailty are no longer assessed as frail after surgery. Joint replacement is an effective intervention to improve frailty in hip and knee osteoarthritis. TRIAL REGISTRATION This study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.
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Affiliation(s)
- Tobias Kappenschneider
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Philip Bammert
- Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Lukas Parik
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Dominik Emanuel Holzapfel
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Amadeus Dominik Schraag
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Julia Götz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Katrin Michalk
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Matthias Meyer
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
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Götz J, Maderbacher G, Leiss F, Zeman F, Meyer M, Reinhard J, Grifka J, Greimel F. Better early outcome with enhanced recovery total hip arthroplasty (ERAS-THA) versus conventional setup in randomized clinical trial (RCT). Arch Orthop Trauma Surg 2024; 144:439-450. [PMID: 37552325 PMCID: PMC10774173 DOI: 10.1007/s00402-023-05002-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Numbers of total hip arthroplasty (THA) are steadily rising and patients expect faster mobility without pain postoperatively. The aim of enhanced recovery after Surgery (ERAS) programs in a multidisciplinary setup was to keep pace with the needs of quality and quantity of surgical THA-interventions and patients' expectations. METHODS 194 patients undergoing THA procedures were investigated after single-blinded randomization to ERAS (98) or conventional setup group (96). Primary outcome variable was mobilization measured with the Timed Up and Go Test (TUG) in seconds. Secondary outcome variables were floor count and walking distance in meters as well as rest, mobilization and night pain on a numerous rating scale (NRS). All variables were recorded preoperatively and daily until the sixth postoperative day. To assess and compare clinical outcome and patient satisfaction, the PPP33-Score and PROMs were used. RESULTS No complications such as thromboembolic complications, fractures or revisions were recorded within the first week postoperatively in either study group. Compared to the conventional group, the ERAS group showed significantly better TUG (p < 0.050) and walking distance results after surgery up to the sixth, and floor count up to the third postoperative day. On the first and second postoperative day, ERAS patients showed superior results (p < 0.001) in all independent activity subitems. Regarding the evaluation of pain (NRS), PPP33 and PROMS, no significant difference was shown (p > 0.050). CONCLUSION This prospective single-blinded randomized controlled clinical trial was able to demonstrate excellent outcome with comparable pain after ERAS THA versus a conventional setup. Therefore, ERAS could be used in daily clinical practice.
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Affiliation(s)
- Julia Götz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Günther Maderbacher
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Franziska Leiss
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Matthias Meyer
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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Grifka J, Götz J, Fenk-Mayer A, Benditz A. [Injection treatment for cervical and lumbar syndromes: principles, indications and general performance]. Orthopadie (Heidelb) 2023; 52:1017-1024. [PMID: 38015212 DOI: 10.1007/s00132-023-04449-4] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/29/2023]
Abstract
An intensive conservative treatment that exhausts all treatment options should fundamentally be carried out before every surgical intervention in the region of the spinal column. The therapeutic measures are determined by the extent of the cervical or lumbar syndrome. As a rule, in cases of local complaints symptomatic measures with physiotherapy or digital healthcare applications are indicated. In cases of referred cervical and lumbar syndromes targeted injections can be employed. Before targeted injection treatment a detailed orthopedic clarification with respect to the intensity of local, radicular or pseudoradicular complaints must be carried out. When carrying out minimally invasive injection treatment specific prerequisites with respect to spatial, personnel and technical conditions must be fulfilled. The indications and contraindications must be strictly controlled.
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Affiliation(s)
- J Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Götz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Fenk-Mayer
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Klinikum Fichtelgebirge Marktredwitz, Schillerhain 1-8, 95615, Marktredwitz, Deutschland
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Kappenschneider T, Bammert P, Maderbacher G, Greimel F, Holzapfel DE, Schwarz T, Götz J, Pagano S, Scharf M, Michalk K, Grifka J, Meyer M. The impact of elective total hip and knee arthroplasty on physical performance in orthogeriatric patients: a prospective intervention study. BMC Geriatr 2023; 23:763. [PMID: 37990164 PMCID: PMC10664286 DOI: 10.1186/s12877-023-04460-6] [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: 08/06/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Osteoarthritis is a prevalent condition in older adults that leads to reduced physical function in many patients and ultimately requires hip or knee replacement. The aim of the study was to determine the impact of hip and knee arthroplasty on the physical performance of orthogeriatric patients with osteoarthritis. METHODS In this prospective study, we used data from 135 participants of the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (GBA). Physical function, measured by the Short Physical Performance Battery (SPPB), was assessed preoperatively, 3 and 7 days postoperatively, 4-6 weeks and 3 months after hip and knee arthroplasty. For the statistical analysis, the Friedman test and post-hoc tests were used. RESULTS Of the 135 participants with a mean age of 78.5 ± 4.6 years, 81 underwent total hip arthroplasty and 54 total knee arthroplasty. In the total population, SPPB improved by a median of 2 points 3 months after joint replacement (p < 0.001). In the hip replacement group, SPPB increased by a median of 2 points 3 months after surgery (p < 0.001). At 3 months postoperatively, the SPPB increased by a median of 1 point in the knee replacement group (p = 0.003). CONCLUSION Elective total hip and knee arthroplasty leads to a clinically meaningful improvement in physical performance in orthogeriatric patients with osteoarthritis after only a few weeks. TRIAL REGISTRATION This study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.
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Affiliation(s)
- Tobias Kappenschneider
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany.
| | - Philip Bammert
- Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | | | - Timo Schwarz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Julia Götz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Stefano Pagano
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Markus Scharf
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Katrin Michalk
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Matthias Meyer
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
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Pagano S, Müller K, Götz J, Reinhard J, Schindler M, Grifka J, Maderbacher G. The Role and Efficiency of an AI-Powered Software in the Evaluation of Lower Limb Radiographs before and after Total Knee Arthroplasty. J Clin Med 2023; 12:5498. [PMID: 37685563 PMCID: PMC10487842 DOI: 10.3390/jcm12175498] [Citation(s) in RCA: 1] [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: 07/17/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
The rapid evolution of artificial intelligence (AI) in medical imaging analysis has significantly impacted musculoskeletal radiology, offering enhanced accuracy and speed in radiograph evaluations. The potential of AI in clinical settings, however, remains underexplored. This research investigates the efficiency of a commercial AI tool in analyzing radiographs of patients who have undergone total knee arthroplasty. The study retrospectively analyzed 200 radiographs from 100 patients, comparing AI software measurements to expert assessments. Assessed parameters included axial alignments (MAD, AMA), femoral and tibial angles (mLPFA, mLDFA, mMPTA, mLDTA), and other key measurements including JLCA, HKA, and Mikulicz line. The tool demonstrated good to excellent agreement with expert metrics (ICC = 0.78-1.00), analyzed radiographs twice as fast (p < 0.001), yet struggled with accuracy for the JLCA (ICC = 0.79, 95% CI = 0.72-0.84), the Mikulicz line (ICC = 0.78, 95% CI = 0.32-0.90), and if patients had a body mass index higher than 30 kg/m2 (p < 0.001). It also failed to analyze 45 (22.5%) radiographs, potentially due to image overlay or unique patient characteristics. These findings underscore the AI software's potential in musculoskeletal radiology but also highlight the necessity for further development for effective utilization in diverse clinical scenarios. Subsequent studies should explore the integration of AI tools in routine clinical practice and their impact on patient care.
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Affiliation(s)
- Stefano Pagano
- Department of Orthopedic Surgery, University of Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany
| | - Karolina Müller
- Center for Clinical Studies, University of Regensburg, 93053 Regensburg, Germany
| | - Julia Götz
- Department of Orthopedic Surgery, University of Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany
| | - Jan Reinhard
- Department of Orthopedic Surgery, University of Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany
| | - Melanie Schindler
- Department of Orthopedic Surgery, University of Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University of Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany
| | - Günther Maderbacher
- Department of Orthopedic Surgery, University of Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany
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Sprute R, Salzberger B, Götz J, Jung N, Stocker L, Fätkenheuer G. Adjunctive Therapy With Clindamycin in Streptococcal Infection. Clin Infect Dis 2023; 76:2043-2044. [PMID: 36815297 DOI: 10.1093/cid/ciad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- Rosanne Sprute
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Clinic Regensburg, Regensburg, Germany
| | - Julia Götz
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Laura Stocker
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Kappenschneider T, Maderbacher G, Weber M, Greimel F, Holzapfel D, Parik L, Schwarz T, Leiss F, Knebl M, Reinhard J, Schraag AD, Thieme M, Turn A, Götz J, Zborilova M, Pulido LC, Azar F, Spörrer JF, Oblinger B, Pfalzgraf F, Sundmacher L, Iashchenko I, Franke S, Trabold B, Michalk K, Grifka J, Meyer M. Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement. BMC Musculoskelet Disord 2022; 23:1079. [PMID: 36494823 PMCID: PMC9733347 DOI: 10.1186/s12891-022-05955-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Due to demographic change, the number of older people in Germany and worldwide will continue to rise in the coming decades. As a result, the number of elderly and frail patients undergoing total hip and knee arthroplasty is projected to increase significantly in the coming years. In order to reduce risk of complications and improve postoperative outcome, it can be beneficial to optimally prepare geriatric patients before orthopaedic surgery and to provide perioperative care by a multiprofessional orthogeriatric team. The aim of this comprehensive interventional study is to assess wether multimorbid patients can benefit from the new care model of special orthopaedic geriatrics (SOG) in elective total hip and knee arthroplasty. METHODS The SOG study is a registered, monocentric, prospective, randomized controlled trial (RCT) funded by the German Federal Joint Committee (GBA). This parallel group RCT with a total of 310 patients is intended to investigate the specially developed multimodal care model for orthogeriatric patients with total hip and knee arthroplasty (intervention group), which already begins preoperatively, in comparison to the usual orthopaedic care without orthogeriatric co-management (control group). Patients ≥70 years of age with multimorbidity or generally patients ≥80 years of age due to increased vulnerability with indication for elective primary total hip and knee arthroplasty can be included in the study. Exclusion criteria are age < 70 years, previous bony surgery or tumor in the area of the joint to be treated, infection and increased need for care (care level ≥ 4). The primary outcome is mobility measured by the Short Physical Performance Battery (SPPB). Secondary outcomes are morbidity, mortality, postoperative complications, delirium, cognition, mood, frailty, (instrumental) activities of daily living, malnutrition, pain, polypharmacy, and patient reported outcome measures. Tertiary outcomes are length of hospital stay, readmission rate, reoperation rate, transfusion rate, and time to rehabilitation. The study data will be collected preoperative, postoperative day 1 to 7, 4 to 6 weeks and 3 months after surgery. DISCUSSION Studies have shown that orthogeriatric co-management models in the treatment of hip fractures lead to significantly reduced morbidity and mortality rates. However, there are hardly any data available on the elective orthopaedic care of geriatric patients, especially in total hip and knee arthroplasty. In contrast to the care of trauma patients, optimal preoperative intervention is usually possible. TRIAL REGISTRATION German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.
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Affiliation(s)
- Tobias Kappenschneider
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Günther Maderbacher
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopaedic and Trauma Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Felix Greimel
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Dominik Holzapfel
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Lukas Parik
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Timo Schwarz
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Franziska Leiss
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Michael Knebl
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Jan Reinhard
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Amadeus Dominik Schraag
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Max Thieme
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Agathe Turn
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Julia Götz
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Magdalena Zborilova
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Loreto C. Pulido
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Fady Azar
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Jan-Frederik Spörrer
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Britta Oblinger
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Frederik Pfalzgraf
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Leonie Sundmacher
- grid.6936.a0000000123222966Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- grid.6936.a0000000123222966Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Sebastian Franke
- grid.6936.a0000000123222966Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Benedikt Trabold
- Department of Anaesthesiology, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Katrin Michalk
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Joachim Grifka
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Matthias Meyer
- grid.411941.80000 0000 9194 7179Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
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Meyer M, Götz J, Parik L, Renkawitz T, Grifka J, Maderbacher G, Kappenschneider T, Weber M. Postoperative delirium is a risk factor for complications and poor outcome after total hip and knee arthroplasty. Acta Orthop 2021; 92:695-700. [PMID: 34607501 PMCID: PMC8635535 DOI: 10.1080/17453674.2021.1980676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Improving health care and demographic change have resulted in a steady increase in geriatric patients undergoing total hip (THA) and knee (TKA) arthroplasty. Postoperative delirium (POD) is a frequent and severe complication after major surgery. Therefore, we analyzed the impact of POD on outcome after THA and TKA.Patients and methods - In a consecutive series of 10,140 patients who had undergone elective THA or TKA between 2011 and 2020, rates of reoperation within 90 days, readmission within 90 days, complications, and responder rate as defined by the OMERACT-OARSI criteria were compared between patients with and without POD. Multivariable logistic regression models were used to assess the relationship between POD and other postoperative complications.Results - Patients with POD showed higher rates of reoperation (12% vs. 5%), readmission (15% vs. 5%), surgical complications (7% vs. 2%), non-surgical complications (8% vs. 4%), Clavien-Dindo IV° complications (10% vs. 2%) and transfusion (14% vs. 2%). POD led to lower responder rate (76% vs. 87%) 1 year after total joint replacement. All previous comparisons statistically significant. Multivariable logistic regression analyses revealed POD as an independent risk factor for reoperation (OR = 2; CI 1-3), readmission (OR = 2; CI 2-4) and Clavien-Dindo IV° complications (OR = 3; CI 2-5).Interpretation - POD is a serious problem in elective joint replacement. Affected patients suffer more complications and show poor patient-reported outcome 1 year postoperatively. Systematic prevention strategies and standardized therapy protocols are mandatory to avoid burden to patients and healthcare providers.
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Affiliation(s)
- Matthias Meyer
- Department of Orthopaedic Surgery, Regensburg University Hospital, Bad Abbach, Germany;;,Correspondence:
| | - Julia Götz
- Department of Orthopaedic Surgery, Regensburg University Hospital, Bad Abbach, Germany
| | - Lukas Parik
- Department of Orthopaedic Surgery, Regensburg University Hospital, Bad Abbach, Germany
| | | | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Hospital, Bad Abbach, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, Regensburg University Hospital, Bad Abbach, Germany
| | | | - Markus Weber
- Department of Orthopaedic Surgery, Regensburg University Hospital, Bad Abbach, Germany
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van Horn N, Kniep H, Broocks G, Meyer L, Flottmann F, Bechstein M, Götz J, Thomalla G, Bendszus M, Bonekamp S, Pfaff JAR, Dellani PR, Fiehler J, Hanning U. ASPECTS Interobserver Agreement of 100 Investigators from the TENSION Study. Clin Neuroradiol 2021; 31:1093-1100. [PMID: 33502563 PMCID: PMC8648648 DOI: 10.1007/s00062-020-00988-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
Purpose Evaluating the extent of cerebral ischemic infarction is essential for treatment decisions and assessment of possible complications in patients with acute ischemic stroke. Patients are often triaged according to image-based early signs of infarction, defined by Alberta Stroke Program Early CT Score (ASPECTS). Our aim was to evaluate interrater reliability in a large group of readers. Methods We retrospectively analyzed 100 investigators who independently evaluated 20 non-contrast computed tomography (NCCT) scans as part of their qualification program for the TENSION study. Test cases were chosen by four neuroradiologists who had previously scored NCCT scans with ASPECTS between 0 and 8 and high interrater agreement. Percent and interrater agreements were calculated for total ASPECTS, as well as for each ASPECTS region. Results Percent agreements for ASPECTS ratings was 28%, with interrater agreement of 0.13 (95% confidence interval, CI 0.09–0.16), at zero tolerance allowance and 66%, with interrater agreement of 0.32 (95% CI: 0.21–0.44), at tolerance allowance set by TENSION inclusion criteria. ASPECTS region with highest level of agreement was the insular cortex (percent agreement = 96%, interrater agreement = 0.96 (95% CI: 0.94–0.97)) and with lowest level of agreement the M3 region (percent agreement = 68%, interrater agreement = 0.39 [95% CI: 0.17–0.61]). Conclusion Interrater agreement reliability for total ASPECTS and study enrollment was relatively low but seems sufficient for practical application. Individual region analysis suggests that some are particularly difficult to evaluate, with varying levels of reliability. Potential impairment of the supraganglionic region must be examined carefully, particularly with respect to the decision whether or not to perform mechanical thrombectomy.
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Affiliation(s)
- Noel van Horn
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julia Götz
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Susanne Bonekamp
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | | | | | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Li S, Stöckl S, Lukas C, Götz J, Herrmann M, Federlin M, Grässel S. hBMSC-Derived Extracellular Vesicles Attenuate IL-1β-Induced Catabolic Effects on OA-Chondrocytes by Regulating Pro-inflammatory Signaling Pathways. Front Bioeng Biotechnol 2020; 8:603598. [PMID: 33425869 PMCID: PMC7793861 DOI: 10.3389/fbioe.2020.603598] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Human bone marrow-derived mesenchymal stromal cells (hBMSCs) provide a promising therapeutic approach in the cell-based therapy of osteoarthritis (OA). However, several disadvantages evolved recently, including immune responses of the host and regulatory hurdles, making it necessary to search for alternative treatment options. Extracellular vesicles (EVs) are released by multiple cell types and tissues into the extracellular microenvironment, acting as message carriers during intercellular communication. Here, we investigate putative protective effects of hBMSC-derived EVs as a cell-free approach, on IL-1β-stimulated chondrocytes obtained from OA-patients. Methods: EVs were harvested from the cell culture supernatant of hBMSCs by a sequential ultracentrifugation process. Western blot, scanning electron microscopy (SEM), and nanoparticle tracking analysis (NTA) were performed to characterize the purified particles as EVs. Intracellular incorporation of EVs, derived from PHK26-labeled hBMSCs, was tested by adding the labeled EVs to human OA chondrocytes (OA-CH), followed by fluorescence microscopy. Chondrocytes were pre-stimulated with IL-1β for 24 h, followed by EVs treatment for 24 h. Subsequently, proliferation, apoptosis, and migration (wound healing) were analyzed via BrdU assay, caspase 3/7 assay, and scratch assay, respectively. With qRT-PCR, the relative expression level of anabolic and catabolic genes was determined. Furthermore, immunofluorescence microscopy and western blot were performed to evaluate the protein expression and phosphorylation levels of Erk1/2, PI3K/Akt, p38, TAK1, and NF-κB as components of pro-inflammatory signaling pathways in OA-CH. Results: EVs from hBMSCs (hBMSC-EVs) promote proliferation and reduce apoptosis of OA-CH and IL-1β-stimulated OA-CH. Moreover, hBMSC-EVs attenuate IL-1β-induced reduction of chondrocyte migration. Furthermore, hBMSC-EVs increase gene expression of PRG4, BCL2, and ACAN (aggrecan) and decrease gene expression of MMP13, ALPL, and IL1ß in OA-CH. Notably, COL2A1, SOX9, BCL2, ACAN, and COMP gene expression levels were significantly increased in IL-1β+ EV groups compared with those IL-1β groups without EVs, whereas the gene expression levels of COLX, IL1B, MMP13, and ALPL were significantly decreased in IL-1β+ EV groups compared to IL-1β groups without EVs. In addition, the phosphorylation status of Erk1/2, PI3K/Akt, p38, TAK1, and NF-κB signaling molecules, induced by IL-1β, is prevented by hBMSC- EVs. Conclusion: EVs derived from hBMSCs alleviated IL-1β-induced catabolic effects on OA-CH via promoting proliferation and migration and reducing apoptosis, probably via downregulation of IL-1ß-activated pro-inflammatory Erk1/2, PI3K/Akt, p38, TAK1, and NF-κB signaling pathways. EVs released from BMSCs may be considered as promising cell-free intervention strategy in cartilage regenerative medicine, avoiding several adverse effects of cell-based regenerative approaches.
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Affiliation(s)
- Shushan Li
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Centre for Medical Biotechnology (ZMB/Biopark 1), University of Regensburg, Regensburg, Germany
| | - Sabine Stöckl
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Centre for Medical Biotechnology (ZMB/Biopark 1), University of Regensburg, Regensburg, Germany
| | - Christoph Lukas
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Centre for Medical Biotechnology (ZMB/Biopark 1), University of Regensburg, Regensburg, Germany
| | - Julia Götz
- Department of Orthopaedic Surgery, Asklepiosklinikum, Bad Abbach, Germany
| | - Marietta Herrmann
- Interdisciplinary Center for Clinical Research (IZKF) Group Tissue Regeneration in Musculoskeletal Diseases, Bernhard-Heine-Centrum for Locomotion Research, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Marianne Federlin
- Department of Conservative Dentistry and Periodontology, University Medical Center Regensburg, Regensburg, Germany
| | - Susanne Grässel
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Centre for Medical Biotechnology (ZMB/Biopark 1), University of Regensburg, Regensburg, Germany.,Department of Orthopaedic Surgery, Asklepiosklinikum, Bad Abbach, Germany
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11
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Radtke JS, Götz J, Gielen S, Fischer F. [Bed capacity analysis for an intensive care unit : Retrospective analysis and projection for need of intensive care beds in over 65 year olds with selected cardiovascular diseases]. Med Klin Intensivmed Notfmed 2020; 116:322-331. [PMID: 32072196 PMCID: PMC8102283 DOI: 10.1007/s00063-020-00663-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/07/2019] [Accepted: 12/31/2019] [Indexed: 11/25/2022]
Abstract
Hintergrund Der Anstieg der älteren Bevölkerungsgruppe und der damit einhergehende Zuwachs des intensivmedizinischen Bedarfs betont die Notwendigkeit einer effizienten Bettenkapazitätsanalyse. Insbesondere Herz-Kreislauf-Erkrankungen stellen ein häufig auftretendes Erkrankungsbild bei über 65-Jährigen dar. Ziel dieser Arbeit war somit die Analyse des retrospektiven und zukünftigen Intensivbedarfs von älteren Patienten über 65 Jahre mit 6 ausgewählten (kardiovaskulären) Codes der Internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (ICD-10) am Beispiel einer Einrichtung der Maximalversorgung in einer ländlichen Region. Methodik Für die retrospektive Analyse wurden Daten für den Zeitraum 2015–2017 deskriptiv und bivariat ausgewertet. Die Analyse des Intensivbettenbedarfs erfolgte anhand der Warteschlangentheorie. Ergebnisse In dem betrachteten Zeitraum lagen die monatlichen Auslastungsraten kontinuierlich über der idealen Auslastungsrate von 80 % und zum Teil sogar über 100 %. Insbesondere die Nachfrage von Patienten mit I50.14 war im gesamten Krankenhaus sehr hoch. Die Bettenbedarfsanalyse zeigt einen Anstieg von 9 benötigten Betten im Jahr 2017 auf 11 Betten bis zum Jahr 2030 für die 6 Diagnosegruppen. Ohne Einschluss der Diagnosegruppe I50.14 wird sowohl retrospektiv als auch zukünftig etwa die Hälfte der Betten, die bei Einschluss aller 6 Diagnosen benötigt wurden, nachgefragt. Diskussion Der Effekt des demographischen Wandels auf den Intensivbettenbedarf ist bereits heute sichtbar. Zudem zeigen die Analysen, dass ein weiterer Anstieg des Bedarfs in Zukunft zu erwarten ist. Die Ergebnisse bestätigen die Notwendigkeit einer an den Bedarf angepassten Intensivkapazitätsplanung. Vor Erweiterung der Bettenkapazitäten wäre jedoch die Analyse von Kriterien, die eine intensivmedizinische Behandlung bedingen, notwendig, um primär Kapazitäten für Patienten mit einem realen Intensivbedarf vorzuhalten.
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Affiliation(s)
- J S Radtke
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland.
| | - J Götz
- Klinikum Lippe-Detmold, Detmold, Deutschland
| | - S Gielen
- Klinikum Lippe-Detmold, Detmold, Deutschland
| | - F Fischer
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland
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12
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Abstract
BACKGROUND Therapeutic strategies for cartilage repair of the talus are varied. With the use of biologic scaffolds and biologic agents new cell-based therapies have become the focus of attention. OBJECTIVES Ankle cartilage repair techniques are presented and assessed by current data. In addition, technical notes for each technique are given. MATERIAL AND METHODS Currently, the following established ankle cartilage repair procedures exist: microfracturing, AMIC (autologous matrix-induced chondrogenesis), OCT (osteochondral transplantation, mosaicplasty), allograft transplantation. DISCUSSION The success of each repair technique is dependent on the proper indication, addressing of co-morbidities like axis deviation or ligament instabilities, the experience of the surgeon and the appropriate rehabilitation. Mid- and long-term results are often good or excellent. Best results are seen in isolated cartilage defects without co-morbidities in patients younger than 40 years of age and non-smokers with normal BMI and early intervention. New cell-based therapies utilize scaffolds and biologic agents. They offer promising perspectives, although current data is inconsistent.
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Affiliation(s)
- S Anders
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Götz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - C Baier
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
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13
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Blumentrath CG, Boden B, Oeckinghaus R, Götz J, Bouzouina NL, Drewek-Platena S, Gielen S, Blaue JC. [Acute iron poisoning : Successful treatment of a potentially fatal suicidal attempt]. Med Klin Intensivmed Notfmed 2018; 115:52-55. [PMID: 30327817 DOI: 10.1007/s00063-018-0482-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 11/25/2022]
Abstract
We present the case of a patient who took 150 mg per kg bodyweight of iron in a suicidal attempt. We illustrate the diagnostic and therapeutic procedures required to successfully cope with this poisoning, which is, by surprise, potentially lethal.
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Affiliation(s)
- C G Blumentrath
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland.
| | - B Boden
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
| | - R Oeckinghaus
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
| | - J Götz
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
| | - N L Bouzouina
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
| | - S Drewek-Platena
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
| | - S Gielen
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
| | - J C Blaue
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
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14
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Abstract
The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.
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Affiliation(s)
- H R Springorum
- Orthopädisches Fachzentrum, Seehauser Straße 2, 82418, Murnau, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
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15
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Abstract
The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.
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Affiliation(s)
- H R Springorum
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
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16
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Felgendreher R, Härtel D, Brockmeier J, Bramlage K, Aschenbrenner T, Götz J, Bramlage P, Tebbe U. [Acute pulmonary embolism: still a diagnostic and therapeutic challenge?]. Med Klin Intensivmed Notfmed 2016; 112:499-509. [PMID: 27807613 DOI: 10.1007/s00063-016-0221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 06/14/2016] [Accepted: 07/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute pulmonary embolism (PE) is a cardiovascular emergency with high mortality in which a rapid diagnosis and the early initiation of therapy is vital. In the present study patients with acute PE hospitalized at the Clinic Lippe in Detmold were characterized and their prognosis examined. METHODS In our department at the hospital Detmold, all patients with acute PE admitted in 2012 and 2013 were documented with respect to the severity of PE, predisposing risk factors and diagnostic and therapeutic steps. RESULTS A total of 170 patients with acute PE were documented of which 80 patients (47 %) had low, 70 patients an intermediate (41 %) and 20 a high risk (12 %). The main diagnostic tool was thoracic computed tomography (82 %). All patients initially received unfractionated or low-molecular weight heparin; systemic intravenous fibrinolysis was carried out in 3 % of patients (intermediate risk n = 1, high risk n = 4). Nineteen percent (n = 13) of the patients at intermediate and 30 % (n = 6) of patients at high risk received local intrapulmonary fibrinolysis. Overall, the mortality rate in hospital was 10 % (low risk 2.5 %; intermediate risk 7 %; high risk 58 %). All 5 patients who received systemic emergency lysis died. One (5.3 %) of the 19 patients at intermediate risk, undergoing local intrapulmonary fibrinolysis, died. CONCLUSION In acute PE a rapid diagnosis and the initiation of an adequate therapy remains a big challenge. Further studies are required to evaluate if aggressive treatment options might reduce mortality especially among patients at intermediate or high risk.
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Affiliation(s)
- R Felgendreher
- Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland
| | - D Härtel
- Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland
| | - J Brockmeier
- Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland
| | - K Bramlage
- Institut für Pharmakologie und Präventive Medizin, Mahlow, Deutschland
| | - T Aschenbrenner
- Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland
| | - J Götz
- Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland
| | - P Bramlage
- Institut für Pharmakologie und Präventive Medizin, Mahlow, Deutschland
| | - U Tebbe
- Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland.
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17
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Abstract
The need for operative treatment of severe rheumatic deformities of the hand and wrist is decreasing due to the increased use of disease-modifying drugs; however, some patients do not tolerate or do not sufficiently respond to these drugs, which often results in the hands being affected and in advanced stages to severe deformity and loss of function. In these cases operative surgery can help to slow the progression of rheumatic destruction and restore the function of the patient's hand. This article describes the principles of surgery for rheumatoid arthritis of the hand. A meticulous synovectomy or tenosynovectomy is the first stage of treatment. With progression of rheumatic destruction various salvage procedures are necessary to preserve the best possible functional state.
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Affiliation(s)
- H-R Springorum
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - S Winkler
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Maderbacher
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - C Baier
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
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18
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Abstract
The term hindfoot deformity denotes many different disease patterns that are associated with malformations of the axis. Destruction of the hindfoot caused by chronic polyarthritis or diabetic diseases are complex examples. This article aims to qualify the reader to diagnose the most important and most common hindfoot deformities in adults and to make decisions about stage-adjusted conservative and surgical therapeutic options.
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Affiliation(s)
- J Götz
- Orthopädische Universitätsklinik Regensburg im Asklepios-Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Grifka
- Orthopädische Universitätsklinik Regensburg im Asklepios-Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - C Baier
- Orthopädische Universitätsklinik Regensburg im Asklepios-Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
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19
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Zeuner KE, Knutzen A, Granert O, Sablowsky S, Götz J, Wolff S, Jansen O, Dressler D, Schneider SA, Klein C, Deuschl G, van Eimeren T, Witt K. Altered brain activation in a reversal learning task unmasks adaptive changes in cognitive control in writer's cramp. Neuroimage Clin 2015; 10:63-70. [PMID: 26702397 PMCID: PMC4669532 DOI: 10.1016/j.nicl.2015.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 11/28/2022]
Abstract
Previous receptor binding studies suggest dopamine function is altered in the basal ganglia circuitry in task-specific dystonia, a condition characterized by contraction of agonist and antagonist muscles while performing specific tasks. Dopamine plays a role in reward-based learning. Using fMRI, this study compared 31 right-handed writer's cramp patients to 35 controls in reward-based learning of a probabilistic reversal-learning task. All subjects chose between two stimuli and indicated their response with their left or right index finger. One stimulus response was rewarded 80%, the other 20%. After contingencies reversal, the second stimulus response was rewarded in 80%. We further linked the DRD2/ANKK1-TaqIa polymorphism, which is associated with 30% reduction of the striatal dopamine receptor density with reward-based learning and assumed impaired reversal learning in A + subjects. Feedback learning in patients was normal. Blood-oxygen level dependent (BOLD) signal in controls increased with negative feedback in the insula, rostral cingulate cortex, middle frontal gyrus and parietal cortex (pFWE < 0.05). In comparison to controls, patients showed greater increase in BOLD activity following negative feedback in the dorsal anterior cingulate cortex (BA32). The genetic status was not correlated with the BOLD activity. The Brodmann area 32 (BA32) is part of the dorsal anterior cingulate cortex (dACC) that plays an important role in coordinating and integrating information to guide behavior and in reward-based learning. The dACC is connected with the basal ganglia-thalamo-loop modulated by dopaminergic signaling. This finding suggests disturbed integration of reinforcement history in decision making and implicate that the reward system might contribute to the pathogenesis in writer's cramp.
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Affiliation(s)
| | - Arne Knutzen
- Department of Neurology, Kiel University, Germany
| | | | | | - Julia Götz
- Department of Neurology, Kiel University, Germany
| | - Stephan Wolff
- Department of Radiology and Neuroradiology, Kiel University, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Kiel University, Germany
| | - Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Germany
| | | | | | | | | | - Karsten Witt
- Department of Neurology, Kiel University, Germany
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Götz J. XIV. Krystallographische Untersuchungen am Diopsid. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1886.11.1.236] [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: 11/24/2022]
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Granert O, Drzezga AE, Boecker H, Perneczky R, Kurz A, Götz J, van Eimeren T, Häussermann P. Metabolic Topology of Neurodegenerative Disorders: Influence of Cognitive and Motor Deficits. J Nucl Med 2015; 56:1916-21. [PMID: 26383147 DOI: 10.2967/jnumed.115.156067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 02/20/2015] [Accepted: 08/10/2015] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED Parkinson disease with and without dementia (PDD and PD, respectively), dementia with Lewy bodies (DLB), and Alzheimer dementia (AD) traditionally have been viewed as distinct clinical and pathologic entities. However, intriguing overlaps in biochemical, clinical, and imaging findings question the concept of distinct entities and suggest a continuous spectrum in which individual patients express PD-typical patterns and AD-typical patterns to a variable degree. METHODS Following this concept, we built a topological map based on regional patterns of the cerebral metabolic rate of glucose as measured with (18)F-FDG PET to rank and localize single subjects' disease status according to PD-typical (PD vs. controls) and AD-typical (AD vs. controls) pattern expression in patients clinically characterized as PD, PDD, DLB, amnestic mild cognitive impairment, and AD. RESULTS The topology generally confirmed an indivisible spectrum of disease manifestation according to 2 separable expression patterns. The expression values derived from the first pattern were highly correlated with individual cognitive, but not motor, disability. The opposite was found for the corresponding expression values of the second pattern. CONCLUSION The metabolic imaging analysis supports the notion that there is a continuous spectrum of neurodegeneration between AD and PD. Furthermore, PDD and DLB may in fact represent 1 overlapping disease entity, characterized by the presence of mixed neuropathology and only different by the time course.
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Affiliation(s)
| | | | | | - Robert Perneczky
- Neuroepidemiology and Ageing Research Unit, Imperial College of Science, Technology and Medicine, London, United Kingdom Cognitive Impairment and Dementia Services, West London Mental Health NHS Trust, London, United Kingdom Department of Psychiatry, TU Munich, Munich, Germany
| | | | - Julia Götz
- Department of Neurology, Kiel University, Kiel, Germany
| | | | - Peter Häussermann
- Department of Psychiatry, Kiel University, Kiel, Germany; and LVR Clinic Cologne, Academic Teaching Hospital, University of Cologne, Cologne, Germany
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Zeuner KE, Knutzen A, Granert O, Götz J, Wolff S, Jansen O, Dressler D, Hefter H, Hallett M, Deuschl G, van Eimeren T, Witt K. Increased volume and impaired function: the role of the basal ganglia in writer's cramp. Brain Behav 2015; 5:e00301. [PMID: 25642386 PMCID: PMC4309880 DOI: 10.1002/brb3.301] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 11/02/2014] [Accepted: 11/05/2014] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The pathophysiology of writer's cramp, a task-specific dystonia, remains unclear. The objective of this study was to investigate the basal ganglia circuit and the cerebellum during a complex motor sequence learning task carried out with the nonaffected hand in writer's cramp patients. METHODS We applied structural and functional imaging in 22 writer's cramp patients and 28 matched controls using 3T MRI. With the asymptomatic left hand all participants learned a complex, sequential, five-element sequence-tapping task as accurately and quickly as possible. Functional imaging was measured during a repeated (15 times), fixed block design with tapping (30 sec) and rest (30 sec). Additionally, gray matter volume of the basal ganglia was analyzed using voxel-based morphometry (VBM). RESULTS While behavior was comparable between groups, after small volume correction the anterior part of the right putamen and the left globus pallidus exhibited reduced blood oxygen level-dependent (BOLD) activity in patients during the sequential finger-tapping task. VBM analysis showed larger gray matter volume bilateral in the posterior part of the putamen and globus pallidus. There were no group differences in the cerebellum. CONCLUSION The results indicate an impairment of anterior basal ganglia loops involved in producing complex sequential movements of the unaffected hand. These findings are in line with previous reports of reduced neuronal activity in the globus pallidus internus. Higher gray matter volume of the putamen and globus pallidus may stem from elevated activity of the direct pathway, which could reflect a compensatory phenomenon or a primary predisposition, that is, endophenotypic trait.
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Affiliation(s)
| | - Arne Knutzen
- Department of Neurology, Kiel University Kiel, Germany
| | | | - Julia Götz
- Department of Neurology, Kiel University Kiel, Germany
| | - Stephan Wolff
- Department of Neuroradiology, Kiel University Kiel, Germany
| | - Olav Jansen
- Department of Neuroradiology, Kiel University Kiel, Germany
| | - Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School Hannover, Germany
| | - Harald Hefter
- Department of Neurology, University of Düsseldorf Düsseldorf, Germany
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland
| | | | | | - Karsten Witt
- Department of Neurology, Kiel University Kiel, Germany
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Springorum HR, Winkler S, Maderbacher G, Götz J, Heers G, Grifka J, Preissler P. [Wrist arthroscopy : challenging procedure of modern hand surgery]. Orthopade 2014; 44:89-102. [PMID: 25527300 DOI: 10.1007/s00132-014-3059-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Arthroscopy of the wrist has developed in the shadow of arthroscopy of the large joints. Nowadays, wrist arthroscopy has a relevant importance in the diagnostics and therapy in hand surgery and is indispensable for serious surgery of the wrist. Special equipment and extensive knowledge of the surgeon are necessary for carrying out the procedure.
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Affiliation(s)
- H-Robert Springorum
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland,
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Baier C, Springorum HR, Maderbacher G, Pickl C, Grifka J, Götz J. [Arthrodesis for patients with rheumatic arthritis of the ankle and hindfoot. A reasonable option?]. Z Rheumatol 2014; 73:796-805. [PMID: 25373549 DOI: 10.1007/s00393-014-1405-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ankle and hindfoot deformities as well as degenerative changes are often found in patients with rheumatological diseases. They often suffer from severe pain and complain of increasing immobility. Corrective procedures with ankle or hindfoot arthrodesis are promising options. OBJECTIVES This article presents epidemiological data and describes the clinical aspects, diagnostics and treatment options for patients with ankle and hindfoot osteoarthritis. MATERIALS AND METHODS The retrospective results of 56 patients after ankle or hindfoot arthrodesis are presented. RESULTS After an average follow-up of 52 months the majority of results were good or excellent with relief of pain and reconstruction of the function of the foot. CONCLUSION Ankle or hindfoot arthrodesis represents a promising option for patients with severe osteoarthritis and can safeguard patients from increasing immobility.
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Affiliation(s)
- C Baier
- Orthopädische Klinik, Universität Regensburg im Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland,
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25
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Heers G, Springorum HR, Baier C, Götz J, Grifka J, Renkawitz T. Proximal interphalangeal joint replacement with an unconstrained pyrocarbon prosthesis (Ascension(R)): a long-term follow-up. J Hand Surg Eur Vol 2013; 38:680-5. [PMID: 23234765 DOI: 10.1177/1753193412469898] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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] [Indexed: 02/03/2023]
Abstract
There have been limited publications that report long-term outcomes of pyrocarbon implants. This report describes both clinical and radiographic long-term results for patients who have been treated with pyrocarbon proximal interphalangeal implants. Thirteen implants in ten patients are reported for an average follow-up of 8.3 years (range 6.2-9.3). All patients were suffering from degenerative joint disease. Five of the 13 digits were free of pain, the remaining eight digits had mild to moderate pain (visual analogue scale 2-5). The average active range of motion was 58° (SD 19°) at latest examination. X-ray results were unremarkable in six digits with an acceptable position of the prosthesis. However, in seven patients significant radiolucent lines (≥ 1 mm) were observed. Three prostheses demonstrated a migration of the proximal component, and one a subsidence of the distal component. Our study does not support the use of this implant for treatment of osteoarthritis of the finger joint owing to high complication rates and limited range of motion.
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Affiliation(s)
- G Heers
- Division of Orthopedics, University of Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany.
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26
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Abstract
The differentiation of physiological pediatric flat feet and the pathological course as well as adequate initiation of therapeutic options represents a challenge the importance of which should not be underestimated. Fears and worries of parents and their insistence on inducement of therapeutic measures take center stage in the physician-patient relationship. The problem is that there are insufficient data from scientific studies dealing with the conservative treatment of flat feet in children. This paper intends to give a survey of the current status in the literature concerning indications and therapeutic success using insoles in the treatment of flat feet in children.
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Affiliation(s)
- J Götz
- Orthopädische Klinik für die Universität Regensburg, Asklepios-Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
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27
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Oeckinghaus R, Cuneo A, Brockmeier J, Oeckinghaus GS, Drewek-Platena S, Hochreuther S, Götz J, Tebbe U. [Acute hepatic failure after ingestion of mushrooms]. Internist (Berl) 2012; 53:619-24. [PMID: 22527661 DOI: 10.1007/s00108-011-3008-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This report is about a married couple who were admitted to hospital suffering from gastrointestinal complaints after eating mushrooms. With the suspicion of poisoning with Amanita phalloides treatment started with elimination of the toxins, symptomatic therapy and specific therapy with silibinin. After quantitative determination of the Amanita toxins the patients were immediately transferred to a university hospital.Poisoning by the death cap mushroom is responsible for acute hepatic and often also renal failure and is accompanied by a high mortality. Clinical symptoms follow a three-phase course with gastrointestinal complaints, an asymptomatic interval and finally the hepatorenal phase. Even in suspected cases of intoxication, treatment should be started by antidote therapy with silibinin.
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Affiliation(s)
- R Oeckinghaus
- Klinik für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe-Detmold, Röntgenstrasse 18, Detmold, Germany.
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Granert O, Perneczky R, Götz J, Boecker H, Drzezga AE, van Eimeren T, Häussermann P. A metabolic topology of cognitive ageing, Parkinson's disease and dementia. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301591] [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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Hundelt M, Fath T, Selle K, Oesterwind K, Jordan J, Schultz C, Götz J, von Engelhardt J, Monyer H, Lewejohann L, Sachser N, Bakota L, Brandt R. Altered phosphorylation but no neurodegeneration in a mouse model of tau hyperphosphorylation. Neurobiol Aging 2011; 32:991-1006. [DOI: 10.1016/j.neurobiolaging.2009.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 06/10/2009] [Accepted: 06/27/2009] [Indexed: 01/16/2023]
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Goghari VM, Lang DJ, Khorram B, Götz J, Vandorpe RA, Smith GN, Kopala LC, Barr AM, Honer WG. Anterior internal capsule volumes increase in patients with schizophrenia switched from typical antipsychotics to olanzapine. J Psychopharmacol 2011; 25:621-9. [PMID: 20360156 DOI: 10.1177/0269881110363314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abnormalities in connectivity are thought to contribute to the symptoms of schizophrenia. Accumulating evidence suggests that antipsychotic medication affects both subcortical and cortical grey and white matter volumes. The goal of this study was to investigate the effects of antipsychotic medication on two white matter tracts: a subcortical-cortical tract, the anterior and posterior limbs of the internal capsule; and a cortical-cortical tract, the corpus callosum. Magnetic resonance imaging was conducted on 10 chronic schizophrenia patients treated with typical antipsychotics and 20 healthy controls at baseline. Patients were switched to olanzapine and both groups were rescanned after 1 year. At baseline, the volume of the anterior limb of the internal capsule was 24% smaller in typical-treated patients than controls (p = 0.009). Patients treated with greater amounts of chlorpromazine-equivalent daily dosage had smaller anterior internal capsule volumes at baseline (r = -0.65, p = 0.04). At follow-up, after being switched to olanzapine, there were no significant differences between patients and controls. Patients with schizophrenia had a significant 25% increase in anterior internal capsule volume from baseline to follow-up compared with controls (p = 0.04). These effects were most prominent in the anterior limb of the internal capsule, which consists of fronto-thalamic pathways, and were not statistically significant in the posterior limb of the internal capsule or corpus callosum. Olanzapine may be effective in normalizing fronto-thalamic structural connectivity in schizophrenia.
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Affiliation(s)
- V M Goghari
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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Lüth S, Bergmann P, Cosma C, Enescu N, Giese R, Götz J, Ivanova A, Juhlin C, Kashubin A, Yang C, Zhang F. Time-lapse seismic surface and down-hole measurements for monitoring CO2 storage in the CO2SINK project (Ketzin, Germany). ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.egypro.2011.02.268] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Köhler C, Bista P, Götz J, Schröder H. Analysis of the cholinergic pathology in the P301L tau transgenic pR5 model of tauopathy. Brain Res 2010; 1347:111-24. [DOI: 10.1016/j.brainres.2010.05.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/21/2010] [Accepted: 05/24/2010] [Indexed: 01/28/2023]
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Baier C, Götz J, Rümmele P, Grifka J, Lüring C. [Ochronosis--a rare cause of secondary gonarthrosis]. Z Orthop Unfall 2009; 147:366-8. [PMID: 19551590 DOI: 10.1055/s-2008-1039225] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ochronosis is a manifestation of the rare disease alkaptonuria. The most common presentations include pain in the lumbar spine region starting during the 3rd decade, spreading over the large joints. There exists no curative therapy for the disease at the moment. In the long-term the patients will be dependent on total joint arthroplasty.
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Affiliation(s)
- C Baier
- Orthopädische Klinik für die Universität Regensburg, Bad Abbach.
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Abstract
Epidemiological studies establish a link between Type 2 diabetes (T2DM) and Alzheimer's disease (AD), both leading causes of morbidity and mortality in the elderly. These diseases also share clinical and biochemical features suggesting common pathogenic mechanisms. Specifically, both are amyloidoses as they are characterized by fibrillar protein aggregates - amylin in T2DM pancreatic islets, and beta-amyloid (Abeta) and neurofibrillary tangles (NFTs) in AD brain. Amylin aggregation is associated with pancreatic beta-cell loss, and Abeta and NFT formation with neuronal cell loss. We discuss the possibility that amylin and Abeta exert their toxicity by similar mechanisms, with components of the pathocascades shared, and that therapies based on amyloidogenic properties are beneficial for both T2DM and AD.
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Affiliation(s)
- J Götz
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
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37
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Ittner LM, Husmann K, Muff R, Götz J, Bonneick S, Suter U, Born W, Fischer JA. Defective hair formation in calcitonin-like receptor transgenic mice. Exp Dermatol 2008. [DOI: 10.1111/j.0906-6705.2004.212bg.x] [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: 11/30/2022]
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Abstract
A case report of a metastatic caused loosening of a total hip arthroplasty one year after primary implantation is presented. A primary cancer was unknown at surgery. Due to suspected low-grade infection, a revision surgery was performed and the diagnosis of a metastatically caused loosening could be made. A bronchial carcinoma was identified as primary cancer. In spite of the rare incidence of the described metastatic loosening, the significance of a differential diagnostic strategy and the importance of a histological examination in revision surgery is depicted.
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Affiliation(s)
- J Götz
- Orthopädie, Universität Regensburg, Bad Abbach.
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39
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Manvelyan M, Schreyer I, Höls-Herpertz I, Köhler S, Niemann R, Hehr U, Belitz B, Bartels I, Götz J, Huhle D, Kossakiewicz M, Tittelbach H, Neubauer S, Polityko A, Mazauric ML, Wegner R, Stumm M, Küpferling P, Süss F, Kunze H, Weise A, Liehr T, Mrasek K. Forty-eight new cases with infertility due to balanced chromosomal rearrangements: detailed molecular cytogenetic analysis of the 90 involved breakpoints. Int J Mol Med 2007; 19:855-64. [PMID: 17487417 DOI: 10.3892/ijmm.19.6.855] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/05/2022] Open
Abstract
A molecular cytogenetic study was performed on 48 infertile patients who were identified as carriers of balanced translocations (40 cases), inversions (6 cases) or insertions (2 cases) by means of banding cytogenetics. Cases with a Robertsonian translocation or pericentric inversion 2 or 9 were not included. In summary, 100 break-events occurred in these patients, and 90 different chromosomal regions were involved. Thus, this study confirmed the presence of abnormal karyotypes in a subgroup of patients seeking infertility treatment. Breaks were demonstrated to appear preferentially in GTG-light bands in these patients. Furthermore, the observed breakpoints were associated with genomic regions prone to instability due to the presence of segmental duplications. Nonetheless, further detailed molecular analysis will be necessary in the future to characterize the mechanisms and genetic basis for this phenomenon.
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Affiliation(s)
- M Manvelyan
- Department of Genetics and Laboratory of Cytogenetics, State University, Jerewan 375025, Armenia
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Rhein V, Baysang G, Meier F, Ozmen L, Bluethmann H, Savaskan E, Müller-Spahn F, Czech C, Götz J, Eckert A. Mitochondrial failure in a transgenic mice model of Alzheimer's disease with plaques and tangles. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Härtel D, Christel E, Brockmeier J, Cuneo A, Zellerhoff C, Götz J, Hundhausen T, Dammann T, Tebbe U. Verbesserung der Behandlung von Patienten mit akutem Koronarsyndrom durch Aufbau einer Netzwerkstruktur im ländlichen Raum. Notf Rett Med 2007. [DOI: 10.1007/s10049-007-0938-z] [Citation(s) in RCA: 2] [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: 10/22/2022]
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42
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Heer G, Götz J, Anders S, Grifka J, Hedtmann A. [Ultrasound evaluation of the acromioclavicular joint--a correlation of anatomical and sonographical findings]. Ultraschall Med 2006; 27:549-52. [PMID: 16596519 DOI: 10.1055/s-2005-858946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
AIM To compare ultrasound imaging to the anatomy of the acromioclavicular joint. METHODS 13 cadaveric acromioclavicular joints were examined by ultrasound (11 MHz linear array transducer) to determine the limits of the joint capsule and the width of the joint space. The results were compared to macroscopic sections. RESULTS Anatomical variations were observed. The joint space of one specimen was completely filled by fibrous tissue, leaving 12 specimens for a complete study. A hypoechoic meniscoid disc was attached to the superior joint capsule, resulting in a convex curvature of the cranial part. The mean sonographic width of the joint space was 3.9 mm +/- 1.7 mm standard deviation (SD). The mean distance of the joint capsule from the articular bone rim of the clavicle, the acromion, and from the middle of the joint space was 1.1 +/- 1.0 mm, 1.3 +/- 0.7 mm, and 2.1 +/- 0.9 mm, respectively. The distance from the joint space to the capsular insertion on the clavicle and on the acromion was 4.4 +/- 1.4 mm and 5.3 +/- 2 mm, respectively. The mean difference between ultrasound and anatomical measurements in the vertical (cranio-caudal) plane was 0.5 +/- 0.5 mm (SD), whereas the mean difference between measurements in the horinzontal (medio-lateral) plane was 1.3 +/- 1.1 mm (SD). CONCLUSION Due to low cost, safety and wide availability, sonography is suited for the evaluation of the acromioclavicular joint. However, when interpreting the results, errors in measuring, limitations in resolution of the system used, and the anatomy of the acromioclavicular joint and its anatomical variants have to be taken into consideration.
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Affiliation(s)
- G Heer
- Orthopädische Klinik der Universität Regensburg, Asklepios-Klinikum Bad Abbach GmbH, Bad Abbach.
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Pennanen L, Wolfer DP, Nitsch RM, Götz J. Impaired spatial reference memory and increased exploratory behavior in P301L tau transgenic mice. Genes Brain Behav 2006; 5:369-79. [PMID: 16879631 DOI: 10.1111/j.1601-183x.2005.00165.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The neuropathological hallmark shared between Alzheimer's disease (AD) and familial frontotemporal dementia (FTDP-17) are neurofibrillary tangles (NFT) which are composed of filamentous aggregates of the microtubule-associated protein tau. Their formation has been reproduced in transgenic mice, which express the FTDP-17-associated mutation P301L of tau. In these mice, tau aggregates are found in many brain areas including the hippocampus and the amygdala, both of which are characterized by NFT formation in AD. Previous studies using an amygdala-specific test battery revealed an increase in exploratory behavior and an accelerated extinction of conditioned taste aversion in these mice. Here, we assessed P301L mice in behavioral tests known to depend on an intact hippocampus. Morris water maze and Y-maze revealed intact spatial working memory but impairment in spatial reference memory at 6 and 11 months of age. In addition, a modest disinhibition of exploratory behavior at 6 months of age was confirmed in the open field and the elevated O-maze and was more pronounced during aging.
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Affiliation(s)
- L Pennanen
- Division of Psychiatry Research, University of Zurich, Zurich, Switzerland
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44
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Eisenreich N, Geißler A, Geißler E, Götz J. Structure Characterization of Filled Polymers by Means of MRI. Chem Eng Technol 2006. [DOI: 10.1002/ceat.200600042] [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: 11/07/2022]
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45
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Tam CW, Husmann K, Clark NC, Clark JE, Lazar Z, Ittner LM, Götz J, Douglas G, Grant AD, Sugden D, Poston L, Poston R, McFadzean I, Marber MS, Fischer JA, Born W, Brain SD. Enhanced Vascular Responses to Adrenomedullin in Mice Overexpressing Receptor-Activity–Modifying Protein 2. Circ Res 2006; 98:262-70. [PMID: 16373602 DOI: 10.1161/01.res.0000200737.63865.58] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adrenomedullin (AM) levels are elevated in cardiovascular disease, but little is known of the role of specific receptor components. AM acts via the calcitonin receptor-like receptor (CLR) interacting with a receptor-activity–modifying protein (RAMP). The AM
1
receptor is composed of CLR and RAMP2, and the calcitonin gene–related peptide (CGRP) receptor of CLR and RAMP1, as determined by molecular and cell-based analysis. This study examines the relevance of RAMP2 in vivo. Transgenic (TG) mice that overexpress RAMP2 in smooth muscle were generated. The role of RAMP2 in the regulation of blood pressure and in vascular function was investigated. Basal blood pressure, acute angiotensin II–raised blood pressure, and cardiovascular properties were similar in wild-type (WT) and TG mice. However, the hypotensive effect of IV AM, unlike CGRP, was enhanced in TG mice (
P
<0.05), whereas a negative inotropic action was excluded by left-ventricular pressure–volume analysis. In aorta relaxation studies, TG vessels responded in a more sensitive manner to AM (EC
50
, 8.0±1.5 nmol/L) than WT (EC
50
, 17.9±3.6 nmol/L). These responses were attenuated by the AM receptor antagonist, AM
22-52
, such that residual responses were identical in all mice. Remaining relaxations were further inhibited by CGRP receptor antagonists, although neither affected AM responses when given alone. Mesenteric and cutaneous resistance vessels were also more sensitive to AM in TG than WT mice. Thus RAMP2 plays a key role in the sensitivity and potency of AM-induced hypotensive responses via the AM
1
receptor, providing evidence that this receptor is a selective target for novel therapeutic approaches.
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Affiliation(s)
- C W Tam
- Cardiovascular Division, King's College London, United Kingdom
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46
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Abstract
Preiser's disease--first described by Preiser in 1910--presents the rare avascular necrosis of the carpal scaphoid. There is no consensus with regard to cause and therapeutic procedure to this day. The initially postulated idiopathic origin of the disease is controversial and rare. It is mainly caused by trauma or repetitive microtrauma, but can also occur as a complication of drug therapy. The rare occurrence of necrosis of the carpal scaphoid following chemotherapy is presented. The treatment was resection of the scaphoid and mediocarpal arthrodesis. Clinical appearance, diagnostic work-up, and therapy of the disease are discussed.
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Affiliation(s)
- J Beckmann
- Abteilung für Orthopädie und Extremitätenchirurgie, Bürgerspital, Schöngrünstrasse 42, CH-4500 Solothurn, Switzerland.
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47
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Heers G, Götz J, Schachner H, Neumaier U, Grifka J, Hedtmann A. Wertigkeit der Ultraschalldiagnostik des Acromioclaviculargelenks. Ein Vergleich mit kernspintomografischen Messungen. Sportverletz Sportschaden 2005; 19:177-81. [PMID: 16369905 DOI: 10.1055/s-2005-858871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Ultrasound is useful in detecting acromioclavicular pathologies in cases of trauma, inflammations and degenerative changes in sports medicine. Many studies compare joint space and capsular dimensions of symptomatic and asymptomatic patients. However, no study has examined the reproducibility and reliability of these measurements. The aim of this study was to evaluate the reliability of ultrasonographic measurements in assessing the acromioclavicular joint. MATERIALS AND METHODS 27 acromioclavicular joints of 15 healthy subjects were examined by T1 weighted magnetic resonance imaging (MRI) to determine the normal limits of joint space (a) and joint capsule (b). These measurements were compared to standardised ultrasonographic (11 Mhz) measurements, which were repeated three times. RESULTS The mean difference between MRI and ultrasound measurements was 1.5 +/- 1.3 mm and 1.3 +/- 1.2 mm for distance a and b, respectively. Reproducibility of ultrasonographic measurements was high with a mean standard deviation of 0.3 +/- 0.2 mm and 0.4 +/- 0.3 mm for distance a and b, respectively. CONCLUSION Due to low costs, safety and wide availability ultrasonography is suited for the evaluation of the acromiocalvicular joint. However, when interpreting the results measurement errors, limitations in resolution of the system used, and the anatomy of the acromioclavicular joint and its anatomic variants have to be taken into consideration.
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Affiliation(s)
- G Heers
- Orthopädische Klinik der Universität Regensburg, Bad Abbach.
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48
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Götz J. Alzheimer's Disease: A Challenge for BAPtists and TAUists. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-831989] [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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49
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Götz J, Streffer JR, David D, Schild A, Hoerndli F, Pennanen L, Kurosinski P, Chen F. Transgenic animal models of Alzheimer's disease and related disorders: histopathology, behavior and therapy. Mol Psychiatry 2004; 9:664-83. [PMID: 15052274 DOI: 10.1038/sj.mp.4001508] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.6] [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] [Indexed: 01/16/2023]
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease that affects more than 15 million people worldwide. Within the next generation, these numbers will more than double. To assist in the elucidation of pathogenic mechanisms of AD and related disorders, such as frontotemporal dementia (FTDP-17), genetically modified mice, flies, fish and worms were developed, which reproduce aspects of the human histopathology, such as beta-amyloid-containing plaques and tau-containing neurofibrillary tangles (NFT). In mice, the tau pathology caused selective behavioral impairment, depending on the distribution of the tau aggregates in the brain. Beta-amyloid induced an increase in the numbers of NFT, whereas the opposite was not observed in mice. In beta-amyloid-producing transgenic mice, memory impairment was associated with increased levels of beta-amyloid. Active and passive beta-amyloid-directed immunization caused the removal of beta-amyloid plaques and restored memory functions. These findings have since been translated to human therapy. This review aims to discuss the suitability and limitations of the various animal models and their contribution to an understanding of the pathophysiology of AD and related disorders.
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Affiliation(s)
- J Götz
- Division of Psychiatry Research, University of Zürich, August Forel Str. 1, CH-8008 Zürich, Switzerland.
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Hinrichs R, Götz J, Weisser H. Water-holding capacity and structure of hydrocolloid-gels, WPC-gels and yogurts characterised by means of NMR. Food Chem 2003. [DOI: 10.1016/s0308-8146(02)00539-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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