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Gkika E, Kostyszyn D, Fechter T, Moustakis C, Ernst F, Boda-Heggemann J, Sarria G, Dieckmann K, Dobiasch S, Duma MN, Eberle F, Kroeger K, Häussler B, Izaguirre V, Jazmati D, Lautenschläger S, Lohaus F, Mantel F, Menzel J, Pachmann S, Pavic M, Radlanski K, Riesterer O, Gerum S, Röder F, Willner J, Barczyk S, Imhoff D, Blanck O, Wittig A, Guckenberger M, Grosu AL, Brunner TB. Interobserver agreement on definition of the target volume in stereotactic radiotherapy for pancreatic adenocarcinoma using different imaging modalities. Strahlenther Onkol 2023; 199:973-981. [PMID: 37268767 PMCID: PMC10598103 DOI: 10.1007/s00066-023-02085-7] [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: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate interobserver agreement (IOA) on target volume definition for pancreatic cancer (PACA) within the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and to identify the influence of imaging modalities on the definition of the target volumes. METHODS Two cases of locally advanced PACA and one local recurrence were selected from a large SBRT database. Delineation was based on either a planning 4D CT with or without (w/wo) IV contrast, w/wo PET/CT, and w/wo diagnostic MRI. Novel compared to other studies, a combination of four metrics was used to integrate several aspects of target volume segmentation: the Dice coefficient (DSC), the Hausdorff distance (HD), the probabilistic distance (PBD), and the volumetric similarity (VS). RESULTS For all three GTVs, the median DSC was 0.75 (range 0.17-0.95), the median HD 15 (range 3.22-67.11) mm, the median PBD 0.33 (range 0.06-4.86), and the median VS was 0.88 (range 0.31-1). For ITVs and PTVs the results were similar. When comparing the imaging modalities for delineation, the best agreement for the GTV was achieved using PET/CT, and for the ITV and PTV using 4D PET/CT, in treatment position with abdominal compression. CONCLUSION Overall, there was good GTV agreement (DSC). Combined metrics appeared to allow a more valid detection of interobserver variation. For SBRT, either 4D PET/CT or 3D PET/CT in treatment position with abdominal compression leads to better agreement and should be considered as a very useful imaging modality for the definition of treatment volumes in pancreatic SBRT. Contouring does not appear to be the weakest link in the treatment planning chain of SBRT for PACA.
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Affiliation(s)
- E Gkika
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany.
| | - D Kostyszyn
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T Fechter
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - C Moustakis
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - F Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, Faculty of Medicine Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | - G Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - K Dieckmann
- Department of Radiation Oncology, University Departments of the MedUni Vienna, Vienna General Hospital, Vienna, Austria
| | - S Dobiasch
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - M N Duma
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - F Eberle
- Department of Radiation Oncology, University Hospital Marburg, Marburg, Germany
| | - K Kroeger
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - B Häussler
- Radiation Oncology Dr. Häussler/Dr. Schorer, Munich, Germany
| | - V Izaguirre
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - D Jazmati
- Proton Therapy Centre, University Hospital Essen, Essen, Germany
| | - S Lautenschläger
- Department of Radiation Oncology, University Hospital, Marburg, Germany
| | - F Lohaus
- Department of Radiation Oncology, University Hospital Dresden, Dresden, Germany
| | - F Mantel
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - J Menzel
- Department of Radiation Oncology, University Hospital Hannover, Hannover, Germany
| | - S Pachmann
- Department of Radiation Oncology, Weilheim Clinic, Weilheim, Germany
| | - M Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - K Radlanski
- Department of Radiation Oncology, Charite, University Hospital Berlin, Berlin, Germany
| | - O Riesterer
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - S Gerum
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - F Röder
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - J Willner
- Department of Radiation Oncology, University Hospital Bayreuth, Bayreuth, Germany
| | - S Barczyk
- Center for Radiation Oncology, Belegklinik am St. Agnes-Hospital, Bocholt, Germany
| | - D Imhoff
- Department of Radiation Oncology, Saphir Radiosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - O Blanck
- Saphir Radiosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anca-L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T B Brunner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
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Landini M, Dogra N, Kroeger K, Hruby L, Donner T, Esslinger T. Erratum: Formation of a Spin Texture in a Quantum Gas Coupled to a Cavity [Phys. Rev. Lett. 120, 223602 (2018)]. Phys Rev Lett 2020; 125:069901. [PMID: 32845694 DOI: 10.1103/physrevlett.125.069901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 06/11/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.120.223602.
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Brera C, Debegnach F, Minardi V, Pannunzi E, Santis BD, Miraglia M, Bergamini C, Biancardi A, Bodda M, Bonassisa L, Burdaspal P, Cantamessa L, Chessa G, Commissati I, Corrao A, Dömsödi J, Esposito G, Focardi C, Garbini D, Gatti M, Gibellino C, Kroeger K, Lombardi FM, Mambelli P, Mastrantoni J, Michelet JY, Møller T, Pascale M, Petrini C, Pietri A, Piombino M, Piro R, Pittet A, Rizzi N, Stroka J, Thim AM, Ubaldi A, Villani A, Zanon F. Immunoaffinity Column Cleanup with Liquid Chromatography for Determination of Aflatoxin B1 in Corn Samples: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/90.3.765] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
An interlaboratory study was conducted to evaluate the effectiveness of an immunoaffinity column cleanup liquid chromatography (LC) method for the determination of aflatoxin B1 levels in corn samples, enforced by European Union legislation. A test portion was extracted with methanolwater (80 + 20); the extract was filtered, diluted with phosphate-buffered saline solution, filtered on a microfiber glass filter, and applied to an immunoaffinity column. The column was washed with deionized water to remove interfering compounds, and the purified aflatoxin B1 was eluted with methanol. Aflatoxin B1 was separated and determined by reversed-phase LC with fluorescence detection after either pre- or postcolumn derivatization. Precolumn derivatization was achieved by generating the trifluoroacetic acid derivative, used by 8 laboratories. The postcolumn derivatization was achieved either with pyridinium hydrobromide perbromide, used by 16 laboratories, or with an electrochemical cell by the addition of bromide to the mobile phase, used by 5 laboratories. The derivatization techniques used were not significantly different when compared by the Student's t-test; the method was statistically evaluated for all the laboratories. Five corn sample materials, both spiked and naturally contaminated, were sent to 29 laboratories (22 Italian and 7 European). Test portions were spiked with aflatoxin B1 at levels of 2.00 and 5.00 ng/g. The mean values for recovery were 82% for the low level and 84% for the high contamination level. Based on results for spiked samples (blind pairs at 2 levels) as well as naturally contaminated samples (blind pairs at 3 levels), the values for relative standard deviation for repeatability (RSDr) ranged from 9.9 to 28.7%. The values for relative standard deviation for reproducibility (RSDR) ranged from 18.6 to 36.8%. The method demonstrated acceptable within- and between-laboratory precision for this matrix, as evidenced by the HorRat values.
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Affiliation(s)
- Carlo Brera
- Italian National Institute for Health (ISS), National Center for Food Quality and Risk Assessment, GMO and Mycotoxins Unit, Viale Regina Elena, 299-00161 Rome, Italy
| | - Francesca Debegnach
- Italian National Institute for Health (ISS), National Center for Food Quality and Risk Assessment, GMO and Mycotoxins Unit, Viale Regina Elena, 299-00161 Rome, Italy
| | - Valentina Minardi
- Italian National Institute for Health (ISS), National Center for Food Quality and Risk Assessment, GMO and Mycotoxins Unit, Viale Regina Elena, 299-00161 Rome, Italy
| | - Elena Pannunzi
- Italian National Institute for Health (ISS), National Center for Food Quality and Risk Assessment, GMO and Mycotoxins Unit, Viale Regina Elena, 299-00161 Rome, Italy
| | - Barbara De Santis
- Italian National Institute for Health (ISS), National Center for Food Quality and Risk Assessment, GMO and Mycotoxins Unit, Viale Regina Elena, 299-00161 Rome, Italy
| | - Marina Miraglia
- Italian National Institute for Health (ISS), National Center for Food Quality and Risk Assessment, GMO and Mycotoxins Unit, Viale Regina Elena, 299-00161 Rome, Italy
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Oertel M, Scobioala S, Kroeger K, Baehr A, Stegger L, Haverkamp U, Schäfers M, Eich HT. Worth a local treatment? - Analysis of modern radiotherapy concepts for oligometastatic prostate cancer. Radiat Oncol 2018; 13:185. [PMID: 30241556 PMCID: PMC6150968 DOI: 10.1186/s13014-018-1118-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/29/2018] [Indexed: 12/03/2022] Open
Abstract
Background Prostate cancer (PCA) is the most-prevalent non-skin cancer in men worldwide. Nevertheless, the treatment of oligometastatic, especially lymph-node (ln) recurrent, PCA remains elusive. The aim of our study was to provide insights in radiotherapy (RT)-treatment of recurrent PCA exhibiting ln- or osseous (oss)-oligometastases. Methods Between April 2012 and April 2017, 27 oligometastatic PCA patients (19 ln and 8 single oss) were treated with RT at our institution. Results The metastasis-free survival (MFS) was 24.8 m (22.0–36.0 m) and 25.4 m (23.9–28.1 m) for the ln- and oss-subgroup resulting in 1-year MFS of 75.4 and 100% and 2-year MFS of 58.7 and 83.3% for ln- and oss-metastatic patients, respectively. Of notice, none of the recurrences for ln-patients was in the RT-field, constituting a local control of 100%. Within the ln-group, pre-RT median-PSA was 2.6 ng/ml, median post-RT PSA was 0.3 ng/ml, which was significant (p = 0.003). Median biochemical-free survival (bfS) was 12.2 m. PCA that was initially confined to the prostate had a better bfS (p < 0.001) and MFS (p = 0.013). The oss-group had a median PSA of 4.9 ng/ml pre-treatment which dropped to a median value of 0.14 ng/ml (p = 0.004). Toxicities were moderate, with only 1 case of III° toxicity. There were no deaths in the ln-group, thus overall survial was 100% here. Conclusion Our study points out the feasibility of RT as a treatment option in recurrent PCA and demonstrates an excellent local control with a low-toxicity profile.
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany.
| | - S Scobioala
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - K Kroeger
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - A Baehr
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - L Stegger
- Department of Nuclear Medicine, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - U Haverkamp
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - M Schäfers
- Department of Nuclear Medicine, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - H-T Eich
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
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Landini M, Dogra N, Kroeger K, Hruby L, Donner T, Esslinger T. Formation of a Spin Texture in a Quantum Gas Coupled to a Cavity. Phys Rev Lett 2018; 120:223602. [PMID: 29906155 DOI: 10.1103/physrevlett.120.223602] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 06/08/2023]
Abstract
We observe cavity mediated spin-dependent interactions in an off-resonantly driven multilevel atomic Bose-Einstein condensate that is strongly coupled to an optical cavity. Applying a driving field with adjustable polarization, we identify the roles of the scalar and the vectorial components of the atomic polarizability tensor for single and multicomponent condensates. Beyond a critical strength of the vectorial coupling, we infer the formation of a spin texture in a condensate of two internal states from the analysis of the cavity output field. Our work provides perspectives for global dynamical gauge fields and self-consistently spin-orbit coupled gases.
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Affiliation(s)
- M Landini
- Institute for Quantum Electronics, ETH Zurich, 8093 Zurich, Switzerland
| | - N Dogra
- Institute for Quantum Electronics, ETH Zurich, 8093 Zurich, Switzerland
| | - K Kroeger
- Institute for Quantum Electronics, ETH Zurich, 8093 Zurich, Switzerland
| | - L Hruby
- Institute for Quantum Electronics, ETH Zurich, 8093 Zurich, Switzerland
| | - T Donner
- Institute for Quantum Electronics, ETH Zurich, 8093 Zurich, Switzerland
| | - T Esslinger
- Institute for Quantum Electronics, ETH Zurich, 8093 Zurich, Switzerland
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Kroeger K, Elsayad K, Moustakis C, Haverkamp U, Eich H. Minimal Risk of Acute and Late Toxicities Following Low-Dose Total Skin Electron Beam for Cutaneous T Cell Lymphoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1627] [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: 11/27/2022]
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Guelker JE, Rock T, Ott R, Katoh M, Kroeger K, Guelker R, Klues HG, Shin DI, Bufe A. Acute outcome of chronic total occlusion (CTO) recanalizsation in the elderly. Med J Malaysia 2017; 72:236-240. [PMID: 28889135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Percutaneous coronary intervention (PCI) of total chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. There is only insignificant knowledge reported in the literature about age differences in CTO recanalization. We analyzed in this study the issue of the impact of age on procedural characteristics, complications and short-term outcome. METHODS Between 2012-2016 we included 440 patients. They underwent PCI for at least one CTO. Antegrade and retrograde CTO techniques were applied. The retrograde approach was used only after failed antegrade intervention. Continuous data are presented as the mean ± standard deviation; categorical data are presented as numbers and percentages unless otherwise specified. We used Twosamplet- t-test with equal variance to test the significant differences of the variables between the two cohorts. RESULTS Procedural success proved independently of age. There was no significant interaction between age and procedural success (p=0.5). Complication rates were low in both groups (2.7% vs. 4%; p=0,4) with no difference in statistical significance. CONCLUSIONS Our study suggests that in an aging society patients with severe coronary artery disease and chronical total occlusions an interventional therapy should be used more intensively. It can be performed safe and feasible.
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Affiliation(s)
- J E Guelker
- Helios Clinic Krefeld, Department of Cardiology, Heartcentre Niederrhein, Germany.
| | - T Rock
- Helios Clinic Krefeld, Department of Cardiology, Heartcentre Niederrhein, Germany
| | - R Ott
- Helios Clinic Krefeld, Department of Cardiology, Heartcentre Niederrhein, Germany
| | - M Katoh
- Helios Clinic Krefeld, Department of Diagnostic and Interventional Radiology, Germany
| | - K Kroeger
- Helios Clinic Krefeld, Department of Vascular Medicine, Germany
| | - R Guelker
- RWI - Leibniz-Institute for Economic Research, Essen, Germany
| | - H G Klues
- Helios Clinic Krefeld, Department of Cardiology, Heartcentre Niederrhein, Germany
| | - D I Shin
- Helios Clinic Krefeld, Department of Cardiology, Heartcentre Niederrhein, Germany
| | - A Bufe
- Helios Clinic Krefeld, Department of Cardiology, Heartcentre Niederrhein, Germany
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Guelker J, Bansemir L, Ott R, Rock T, Kroeger K, Guelker R, Klues H, Shin D, Bufe A. Validity of the J-CTO Score and the CL-Score for predicting successful CTO recanalization. Int J Cardiol 2017; 230:228-231. [DOI: 10.1016/j.ijcard.2016.12.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/21/2016] [Accepted: 12/25/2016] [Indexed: 11/28/2022]
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Abstract
Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patients' acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU.
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Affiliation(s)
- K Kroeger
- Angiologie, HELIOS Kliniken Krefeld, Deutschland
| | - M Storck
- Gefäßzentrum Karlsruhe, Städt. Klinikum Karlsruhe, Deutschland
| | - P Kujath
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - E Rabe
- Klinik für Dermatologie, Universitätsklinik Bonn, Deutschland
| | - J Dissemond
- Klinik für Dermatologie, Universitätsklinik Essen, Deutschland
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Luther B, Meyer F, Mamopoulos A, Zapenko A, Doerbecker R, Wullstein C, Kroeger K, Katoh M. [Options and Limitations in Endovascular Therapy for Acute and Chronic Mesenteric Arterial Occlusions]. Zentralbl Chir 2014; 140:486-92. [PMID: 25401371 DOI: 10.1055/s-0034-1383234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The significance of endovascular therapy for mesenteric ischaemia (MI) is being debated. Despite initially lower mortality and morbidity, inconsistent early and late results led to questions concerning indications and technical applications of the procedure. METHODS 91 patients with MI underwent endovascular treatment in a period of 11 years. In 78 (85.7 %) patients a stent was deployed and in 13 (14.3 %) an angioplasty was performed, principally of the superior mesenteric artery (n = 81/91, 89 %). Follow-up consisted of a clinical and an ultrasound examination in all cases. Mean follow-up was 4.2 years. Our results were compared to those in the literature. RESULTS Endovascular treatment of the intestinal arteries accounted for 0.6 % of all vascular procedures. Seven of 91 patients (7.7 %) died after an initial PTA/stenting. The overall peri-interventional morbidity was 6.6 % (n = 6/91). Medium- to long-term complications were encountered in 20 patients (22 %), primarily during the first year (85 %). Six of 91 patients developed an in-stent stenosis (6.6 %) and 14/91 patients (15.4 %) stent occlusion. Additionally 2 dislocated stents (2.2 %) and an arterial perforation with bleeding into the mesentery (1.1 %) were seen. Although 3 of these 20 patients were successfully treated with an additional PTA or stenting (15.0 %; n = 3/91, 3.3 %), surgical conversion was necessary in 9 (n = 9/20, 45 %; n = 9/91, 9.9 %). The postoperative mortality was respectively 22.2 % (n = 2/9; n = 2/91, 2.2 %). In the case of acute MI, endovascular procedures are only indicated for patients without peritonitis. In chronic MI, the indication for endovascular treatment depends on the type of occlusion and the vascular anatomy. Despite favourable early results, the outcome of endovascular treatment deteriorates with time reaching a 1-year patency rate of 63 % in a multicentre analysis. This leads to secondary procedures in 30 %. A surgical conversion carries a high mortality. CONCLUSION The endovascular treatment of intestinal artery disease cannot be considered the treatment of choice, it is rather an alternative method in patients with functional or local contraindications to surgery. Life-long follow-up is necessary to prevent stent complications with fatal consequences. A prospective randomised study concerning the evaluation of the advantages and disadvantages of surgical and endovascular therapy of intestinal artery occlusive disease is required.
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Affiliation(s)
- B Luther
- Gefäßmedizin, Helios-Klinik, Krefeld, Deutschland
| | - F Meyer
- Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - A Mamopoulos
- Gefäßmedizin, Helios-Klinik, Krefeld, Deutschland
| | - A Zapenko
- Gefäßmedizin, Helios-Klinik, Krefeld, Deutschland
| | | | - C Wullstein
- Allgemein- & Viszeralchirurgie, Helios-Klinik, Krefeld, Deutschland
| | - K Kroeger
- Gefäßmedizin, Helios-Klinik, Krefeld, Deutschland
| | - M Katoh
- Radiologie, Helios-Klinik, Krefeld, Deutschland
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Kroeger K, Luther B. [The future of vascular medicine]. Zentralbl Chir 2014; 139:487-90. [PMID: 25313887 DOI: 10.1055/s-0034-1382896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In the future vascular medicine will still have a great impact on health of people. It should be noted that the aging of the population does not lead to a dramatic increase in patient numbers, but will be associated with a changing spectrum of co-morbidities. In addition, vascular medical research has to include the intensive care special features of vascular patients, the involvement of vascular medicine in a holistic concept of fast-track surgery, a geriatric-oriented intensive monitoring and early geriatric rehabilitation. For the future acceptance of vascular medicine as a separate subject area under delimitation of cardiology and radiology is important. On the other hand, the subject is so complex and will become more complex in future specialisations that mixing of surgery and angiology is desirable, with the aim to preserve the vascular surgical knowledge and skills on par with the medical and interventional measures and further develop them. Only large, interdisciplinary guided vascular centres will be able to provide timely diagnosis and therapy, to deal with the growing multi-morbidity of the patient, to perform complex therapies even in an acute emergency and due to sufficient number of cases to present with well-trained and experienced teams. These requirements are mandatory to decrease patients' mortality step by step.
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Affiliation(s)
- K Kroeger
- Klinik für Gefäßmedizin, HELIOS Kliniken Krefeld, Deutschland
| | - B Luther
- Klinik für Gefäßmedizin, HELIOS Kliniken Krefeld, Deutschland
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Kroeger K, Willilams S, Alexander-Pender C, Ford J, Vasani V. P4.018 “Just One Thing on the Plate”–Views of Community Members and Providers on Sexual Health Services in the Fort McPherson Area of Southwest Atlanta: Findings from a Rapid Ethnographic Assessment. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0916] [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: 11/04/2022]
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Williams SP, Kroeger K, Avey H, Fuller E, Branscomb J, Wong N. P4.005 From Policy to Practice: Utilizing a Health in All Policies Approach to Enhance Public Health and Promote Sexual Health in Communities Affected by Structural Change and Redevelopment. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0904] [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: 11/04/2022]
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Kroeger K, Sangaramoorthy T, Vallila-Buchman P, Robitz R, Moore P, Clymore J. P2-S2.04 Sex workers, mobility and migrant Latino men in the US South: findings from an exploratory rapid ethnographic assessment in North Carolina. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.300] [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: 11/04/2022]
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Abstract
BACKGROUND Azrin & Foxx pioneered an intensive toilet training protocol for individuals with intellectual disability living in a residential setting. Since the development of the Rapid Toilet Training (RTT) protocol, many have replicated the efficacy, most notably in educational and outpatient treatment settings, but often training over longer periods of time. This study presents data from a parent training model that replicates Azrin and Foxx's results and training time. METHOD This multiple baseline across subjects design study employs an ABA design where two boys diagnosed with autism were toilet trained using a modified Azrin & Foxx intensive teaching protocol. The first subject, a 4-year-old boy, did not have a history of attempted toilet training. The second subject, a 6-year-old boy, demonstrated a history of failed toilet training attempts in both the home and school settings. The trainings were conducted in the home setting where a novel parent-training approach was implemented. RESULTS Participant 1 was continent at the end of the second day of training, and completely toilet trained (including initiation and communication) by day 10 of the intervention. Participant 2 was continent after day 1 and completely toilet trained by day 5 of the intervention. CONCLUSIONS Long-term follow-up demonstrates maintenance of skills 3 years post training. Social validity via parent satisfaction was assessed. Limitations to the current study and recommendations for future research were discussed.
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Affiliation(s)
- K Kroeger
- Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders, Cincinnati, OH, USA.
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16
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Lowenstein PR, Mineharu Y, King G, Candolfi M, Xiong W, Assi H, Yagiz K, Kroeger K, Bannykh S, Castro M. Comparison of intratumoral loading of Flt3L/TK-recruited dendritic cells and systemic vaccination with tumor-lysate loaded dendritic cells in the stringent syngeneic CNS1 rat glioma model: Effect of temozolomide on anti-glioma immunity. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2093] [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: 11/20/2022] Open
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17
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Kälsch HIM, Eggebrecht H, Mayringer S, Konorza T, Sievers B, Sack S, Erbel R, Kroeger K. Randomized comparison of effects of suture-based and collagen-based vascular closure devices on post-procedural leg perfusion. Clin Res Cardiol 2007; 97:43-8. [PMID: 17874036 DOI: 10.1007/s00392-007-0575-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vascular closure devices (VCD) are well established to facilitate hemostasis after cardiac catheterization procedures. However, impairment of flow due to the reduction of femoral artery diameter remains a major concern. The present study aims to evaluate leg perfusion before and after application of collagen- and suture-based vascular closure devices. METHODS A total of 366 patients (age: 64.3 years+/-10.7, male: 71.3%) were randomized to receive femoral access site closure with either a collagen-based closure device (group A) (n=214) or a suture-mediated device (group B) (n=152), immediately following coronary catheterization procedures. In all patients, the ankle-brachial-index (ABI) was measured before and the day after closure device application. RESULTS In group A, mean ABI at baseline was 1.09+/-0.2, in group B 1.11+/-0.2. In both groups, there was a significant, albeit clinically not relevant, reduction in post-procedural ABI (group A: 1.04+/-0.2, p<0.01 vs baseline, group B: 1.06+/-0.2, p<0.01 vs baseline). DeltaABI was not different between both VCD groups (p=0.55). In patients with peripheral vascular disease (PVD), neither the Angioseal device (mean ABI at baseline 0.76+/-0.1) nor the Perclose-device (mean ABI at baseline 0.79+/-0.1) induced a remarkable impairment of leg perfusion (Angioseal: 0.77+/-0.1, p=0.9 vs baseline, Perclose: 0.78+/-0.1, p=1.0 vs baseline). Clinically, no aggravation of claudication was observed in the PVD patient group. CONCLUSION Both vascular closure devices are not associated with clinically relevant reduction in ABI. There was no difference between the two groups with respect to the level of flow impairment. Both devices may be safely used in patients with reduced ABI.
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Affiliation(s)
- H I M Kälsch
- Department of Cardiology, West-German Heart Center, Hufelandstr. 55, 45122, Essen, Germany.
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18
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Abstract
Blue rubber bleb nevi (BRBN) are rare vascular malformations of the integument and mucous membranes. Little is known about coherence between these nevi and malignant diseases. We report on a young man with progressive BRBN syndrome representing a thitherto unknown malignant melanoma.
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Affiliation(s)
- S Kinner
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen.
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19
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Ose C, Rudofsky G, Roesener J, Hirche H, Kroeger K. CEAP-classes and symptoms in people with varicose veins. Phlebologie 2005. [DOI: 10.1055/s-0037-1617291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryIndividual symptoms of patients with varicose veins are not considered in the CEAP-classification. Method: We analysed how far people with CEAP class 1 and 2 differ in their symptoms from people without varicose veins in the Duesseldorf/ Essen civil servants study recruiting 9935 employees. All volunteers were asked to fill out a questionnaire and were clinically examined. Primarily the clinical findings were documented adapted to the Basel Study and later modified according to the CEAP classification: 64% class 0 (no visible or palpable clinical signs of venous disease), 27% class 1 (small cutaneous veins and/or reticular veins) and 9 class 2 (varicose veins). Results: Leg swelling and muscle cramps during night were the most frequent symptoms in both classes. Statistically the frequency of symptoms in volunteers classified as CEAP class 1 respectively 2 were different from volunteers showing CEAP class 0 but were not different from each other. Grouping the symptoms restless legs, itching and cramps and calculating odds ratios for none of these showed significant results. Especially in women suffering from CEAP class 2 a significant small odds ratio of 0.5 (95%CI: 0.4–0.6) indicated that women rid of all these three symptoms had less frequently a varicosis disease. Conclusion: It can be assumed that the clinical differentiation into CEAP classes also differentiates groups of people with different symptoms.
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20
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Abstract
Cold injury is an objective danger in mountain climbing as well as in many outdoor sports. With increasing number of people practising so-called extreme tourisms physicians can be confronted with frostbite. Thus we present a case of frostbite in a 35 year-old female mountaineer. She took part at a demanding high alpine trekking tour in the Himalayan-area requesting well trained mountaineers experienced in ice- and securing-techniques and good physical condition. At day 12, when the group reached the top of the Parchamo (Nepal, 6273 m), she developed frostbite at all toes leading to amputation finally. Risk factors, prognosis and options for initial treatment are discussed.
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Affiliation(s)
- K Kroeger
- Department of Angiology, University of Essen, Germany.
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21
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Kroeger K, Mouradi H, Kreuzfelder E, Rudofsky G, Grosse-Wilde H. Antinuclear and antiphospholipid autoantibodies in patients with peripheral arterial occlusive disease. Ann Rheum Dis 2004; 64:333-4. [PMID: 15115712 PMCID: PMC1755369 DOI: 10.1136/ard.2004.022145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Herrmann BL, Kroeger K, Neumann T, Erbel R, Mann K. Increased blood flow of the brachial artery in acromegalics without cardiomegaly or cardiomyopathy. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-819175] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kroeger K, Ose C, Rudofsky G, Roesener J, Hirche H. Risk factors for varicose veins. INT ANGIOL 2004; 23:29-34. [PMID: 15156127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM To determine the prevalence of varicose veins in the German population and specify possible risk factors the data of the Duesseldorf/Essen civil servants study were analysed. METHODS From December 1989 to July 1993 a total of 9 935 employees were recruited. All volunteers filled out a questionnaire regarding family history and risk factors and were clinically examined. Venous findings were classified and adapted to the CEAP-classification. For the analysis of risk factors only volunteers classified as CEAP-class 0 or as CEAP-class II were considered: 4 250 men, 10% belonged to CEAP-class II and 2 380 women including 16% CEAP-class II. RESULTS In general, age and gender were the most relevant risk factors for varicose veins. Odds ratio age: male: 3.4 (95%-CI: 2.6-4.4), age female 6.5 (95%-CI: 5.0-8.5), gender 2.3 (95%-CI 1.9-2.7). In addition in females the most frequent risk factors were oral contraception and in both genders a predominately sitting posture at work. Regarding the family history, varicose veins by the mother was most frequent compared to varicose veins by the father or both. After adjusting for age and gender heridity became the most important risk factor with an odds ratio of 5.2 (95%-CI:3.7-7.3-4.50) in case of varicose veins present in both parents, followed by a standing posture at work 2.2 (95%-CI: 1.2-3.9). In contrast, smoking also reached a significant level, but with a decreased odds ratio of 0.66 (95%-CI: 0.57-0.77) indicating a protective effect. CONCLUSION In addition to age and gender a family history of varicose veins is the most important risk factor in the total population. Despite significant influence of other risk factors their relevance for varicose veins in the investigated population is low either due to low frequencies or low odds ratios.
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Affiliation(s)
- K Kroeger
- Department of Angiology, University of Essen, Essen, Germany.
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Herborn C, Goyen M, Stoesser D, Kroeger K, Massing S, Debatin JF, Ruehm SG. Wertigkeit der Ganzkörper-MR-Angiographie bei Patienten mit peripherer arterieller Verschlusskrankheit. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827548] [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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Sulik SM, Kroeger K, Schultz JK, Brown JL, Becker LA, Grant WD. Are fluid-based cytologies superior to the conventional Papanicolaou test? A systematic review. J Fam Pract 2001; 50:1040-1046. [PMID: 11742605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE We compared fluid-based cytologies (FBC) with conventional Papanicolaou (Pap) tests (CT) to determine if either is superior. STUDY DESIGN This was a systematic review of original research reports evaluating both CT and FBC with respect to specimen adequacy, comparison with a reference standard, or both. Two reviewers independently reviewed the titles, abstracts, and full articles to determine inclusion status, with differences resolved by consensus with a third author. Risk differences (RD) between occurrence rates for FBC and CT were used for the specimen adequacy data. Sensitivity and specificity were pooled independently and weighted by the inverse of the variance using a random effects model. DATA SOURCES Studies published between 1985 and November 1999 were identified from MEDLINE, Best Evidence, EMBASE, Biological Abstracts/RRM, and The Cochrane Library. OUTCOMES MEASURED Sensitivity, specificity, area under the receiver operating characteristic curve (AuROC), and the proportion of satisfactory, unsatisfactory, and "satisfactory but limited by" test results were measured. RESULTS There was no significant difference in AuROC (P = .37). FBC specimens were more likely to be satisfactory (RD=0.06; 95% confidence interval [CI], 0.03-0.09) or to have absent endocervical cells (RD=0.06; 95% CI, 0.02-0.10) but had 10% fewer "satisfactory but limited by - other" reports (RD = -0.10; 95% CI, -0.14 to -0.06). There was no difference in unsatisfactory Pap test results. CONCLUSIONS For most women there is no reason to replace CT with FBC. For women at high risk of cervical cancer or who are screened infrequently, the possible increase in FBC sensitivity may outweigh the potential harms from additional false positives.
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Affiliation(s)
- S M Sulik
- Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, NY 13057, USA.
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Greenhill LL, Pliszka S, Dulcan MK, Bernet W, Arnold V, Beitchman J, Benson RS, Bukstein O, Kinlan J, McClellan J, Rue D, Shaw JA, Stock S, Kroeger K. Summary of the practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry 2001; 40:1352-5. [PMID: 11699811 DOI: 10.1097/00004583-200111000-00020] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed salts of amphetamine, and pemoline. They carry U.S. Food and Drug Administration indications for the treatment of attention-deficit hyperactivity disorder.
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Masters KJ, Bellonci C, Bernet W, Arnold V, Beitchman J, Benson S, Bukstein O, Kinlan J, McClellan J, Rue D, Shaw JA, Stock S, Kroeger K. Summary of the practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions with special reference to seclusion and restraint. J Am Acad Child Adolesc Psychiatry 2001; 40:1356-8. [PMID: 11699812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.
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Eggebrecht H, Haude M, von Birgelen C, Woertgen U, Schmermund A, Baumgart D, Kaiser C, Naber CK, Kroeger K, Erbel R. Early clinical experience with the 6 French Angio-Seal device: immediate closure of femoral puncture sites after diagnostic and interventional coronary procedures. Catheter Cardiovasc Interv 2001; 53:437-42. [PMID: 11514989 DOI: 10.1002/ccd.1198] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/06/2022]
Abstract
The objective of this study was to assess the early safety and efficacy of the novel 6 Fr Angio-Seal device for routine clinical use after diagnostic cardiac catheterization and coronary angioplasty. In a prospective study, we used the 6 Fr Angio-Seal device in 180 consecutive patients (131 male, 49 female, mean age 60.7 years) for closure of femoral arterial puncture sites immediately after diagnostic (n = 108) or interventional (n = 72) coronary procedures independent of the coagulation status. All patients were monitored for 24 hr after the procedure and followed for 30 days. The closure device was successfully deployed in 95.4% after diagnostic catheterization versus 98.6% after coronary angioplasty (P = 0.963). Immediate hemostasis was achieved in 91.5% versus 90.1% of the patients (P = 0.993). Major complications were observed 1.9% versus 2.8% of the patients (P = 0.885). During 30-day follow-up, no late events or complications were reported. The 6 Fr Angio-Seal device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.
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Affiliation(s)
- H Eggebrecht
- Department of Cardiology, Center of Internal Medicine, University Hospital Essen, Essen, Germany.
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29
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Thaulow E, Guth BD, Heusch G, Gilpin E, Schulz R, Kroeger K, Ross J. Characteristics of regional myocardial stunning after exercise in dogs with chronic coronary stenosis. Am J Physiol 1989; 257:H113-9. [PMID: 2750931 DOI: 10.1152/ajpheart.1989.257.1.h113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Persistent impairment of regional contraction of the left ventricle after restoration of blood flow following transient coronary occlusion has been termed "stunning," and reversible regional dysfunction has also been observed during recovery from exercise-induced regional ischemia. To determine whether limitation of subendocardial blood flow after exercise is a determinant of such dysfunction in the presence of chronic coronary stenosis, nine conscious chronically instrumented dogs having an Ameroid constrictor were studied before, during, and after treadmill runs that induced regional ischemia. During exercise, systolic wall thickening (%WTh, sonomicrometers) in the ischemic region decreased from a normal level of 22.1 +/- 9.1% at rest to 8.8 +/- 5.2% (+/- SD, P less than 0.01), whereas subendocardial blood flow (microspheres) in the ischemic region decreased from 0.75 +/- 0.25 to 0.45 +/- 0.27 ml.min-1.g-1 (P less than 0.05). %WTh in the ischemic region gradually improved after exercise but remained depressed (75% of control) at 30 min after the run (P less than 0.05). Postexercise dysfunction was not related to simultaneous regional hypoperfusion, since at 5 and 10 min after running there was a tendency toward subendocardial hyperemia (control 0.75 vs. 1.33 and 1.30 ml.min-1.g-1, NS) with a return to control by 30 min. Thus persistent regional dysfunction after exercise-induced regional ischemia in the conscious dog is not due to sustained subendocardial ischemia in the presence of chronic coronary stenosis and represents an example of myocardial stunning.
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Affiliation(s)
- E Thaulow
- Seaweed Canyon Laboratory, Department of Medicine, University of California, San Diego, La Jolla 92093
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