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Wagner E, Strube W, Görlitz T, Aksar A, Bauer I, Campana M, Moussiopoulou J, Hapfelmeier A, Wagner P, Egert-Schwender S, Bittner R, Eckstein K, Nenadić I, Kircher T, Langguth B, Meisenzahl E, Lambert M, Neff S, Malchow B, Falkai P, Hirjak D, Böttcher KT, Meyer-Lindenberg A, Blankenstein C, Leucht S, Hasan A. Effects of Early Clozapine Treatment on Remission Rates in Acute Schizophrenia (The EARLY Trial): Protocol of a Randomized-Controlled Multicentric Trial. Pharmacopsychiatry 2023; 56:169-181. [PMID: 37506738 PMCID: PMC10484642 DOI: 10.1055/a-2110-4259] [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] [Received: 04/21/2023] [Accepted: 05/15/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Quick symptomatic remission after the onset of psychotic symptoms is critical in schizophrenia treatment, determining the subsequent disease course and recovery. In this context, only every second patient with acute schizophrenia achieves symptomatic remission within three months of initiating antipsychotic treatment. The potential indication extension of clozapine-the most effective antipsychotic-to be introduced at an earlier stage (before treatment-resistance) is supported by several lines of evidence, but respective clinical trials are lacking. METHODS Two hundred-twenty patients with acute non-treatment-resistant schizophrenia will be randomized in this double-blind, 8-week parallel-group multicentric trial to either clozapine or olanzapine. The primary endpoint is the number of patients in symptomatic remission at the end of week 8 according to international consensus criteria ('Andreasen criteria'). Secondary endpoints and other assessments comprise a comprehensive safety assessment (i. e., myocarditis screening), changes in psychopathology, global functioning, cognition, affective symptoms and quality of life, and patients' and relatives' views on treatment. DISCUSSION This multicentre trial aims to examine whether clozapine is more effective than a highly effective second-generation antipsychotics (SGAs), olanzapine, in acute schizophrenia patients who do not meet the criteria for treatment-naïve or treatment-resistant schizophrenia. Increasing the likelihood to achieve symptomatic remission in acute schizophrenia can improve the overall outcome, reduce disease-associated burden and potentially prevent mid- and long-term disease chronicity.
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry and Psychotherapy, LMU University Hospital,
LMU Munich, Munich, Germany
| | - Wolfgang Strube
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
| | - Thomas Görlitz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
| | - Aslihan Aksar
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
| | - Ingrid Bauer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, LMU University Hospital,
LMU Munich, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, LMU University Hospital,
LMU Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of AI and Informatics in Medicine, School of Medicine,
Technical University of Munich, Munich, Germany
- Institute of General Practice and Health Services Research, School of
Medicine, Technical University of Munich, Munich, Germany
| | - Petra Wagner
- Münchner Studienzentrum, Technical University of Munich, School
of Medicine, Munich, Germany
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, Technical University of Munich, School
of Medicine, Munich, Germany
| | - Robert Bittner
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy,
University Hospital Frankfurt, Frankfurt, Germany
| | - Kathrin Eckstein
- Clinic for Psychiatry and Psychotherapy, University of
Tübingen, Tübingen, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps-University
Marburg, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University
Marburg, Marburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg,
Regensburg, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, LVR-Klinikum
Düsseldorf, Kliniken der Heinrich-Heine-Universität
Düsseldorf, Düsseldorf, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial
Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg,
Germany
| | - Sigrid Neff
- Department of Psychiatry and Psychotherapy 1 und 2,
Rheinhessen-Fachklinik Alzey, Academic Hospital of the University of Mainz,
Alzey, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center
Göttingen, Göttingen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital,
LMU Munich, Munich, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental
Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Kent-Tjorben Böttcher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental
Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental
Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Christiane Blankenstein
- Münchner Studienzentrum, Technical University of Munich, School
of Medicine, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of
Munich, School of Medicine, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
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Varga M, Köckerling F, Mayer F, Lechner M, Fortelny R, Bittner R, Borhanian K, Adolf D, Bittner R, Emmanuel K. Are immunosuppressive conditions and preoperative corticosteroid treatment risk factors in inguinal hernia repair? Surg Endosc 2021; 35:2953-2964. [PMID: 32556698 DOI: 10.1007/s00464-020-07736-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Immunosuppressive conditions and/or preoperative corticosteroid treatment have a negative influence on wound healing and can, therefore, lead to higher rates of surgical site infections (SSIs) and seromas. For inguinal hernia, no such studies have been carried out to date. METHODS In an analysis of data from the Herniamed Registry, 2312 of 142,488 (1.6%) patients with primary unilateral inguinal hernia repair had an anamnestic history of an immunosuppressive condition and/or preoperative corticosteroid treatment. Using propensity score matching, 2297 (99.4%) pairs with comparative patient characteristics were formed. These were then compared using the following primary outcome criteria: intra- and postoperative complications, complication-related reoperations, recurrence at one-year follow-up, pain on exertion, pain at rest, and chronic pain requiring treatment at one-year follow-up. Of the 2297 matched pairs with primary unilateral inguinal hernia repair, 82.76% were male patients. 1010 (44.0%) were operated in laparo-endoscopic techniques (TEP, TAPP), 1225 (53.3%) in open techniques (Bassini, Shouldice, Lichtenstein, Plug, TIP, Gilbert, Desarda), and 62 (2.7%) in other techniques. RESULTS The matched pair analysis results did not identify any disadvantage in terms of the outcome criteria for patients with an anamnestic history of immunosuppressive condition and/or preoperative corticosteroid treatment (yes vs no). In particular, no disadvantage was noted in the rate of surgical site infections (0.65% vs 0.70%; ns) or seromas (1.22% vs 1.57%; ns). The overall rates of postoperative complications were 3.40% vs 4.31% (p = ns) (plus 0.22% concordant events in five matched pairs). CONCLUSION In primary unilateral inguinal hernia surgery, an immunosuppressive condition and/or preoperative corticosteroid treatment does not appear to have a negative influence on wound complications.
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Affiliation(s)
- M Varga
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany.
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - M Lechner
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Fortelny
- Sigmund Freud Medical University, Vienna, Austria
| | - R Bittner
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - K Borhanian
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - R Bittner
- Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenow University), Trubetskaya Street 8, b. 2., Moscow, Russia, 119992
| | - K Emmanuel
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
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Koelkebeck K, Baessler F, Bittner R, Frodl T, Gradl-Dietsch G, Janowitz D, Jordan KD, Kluge I, Matthes O, Pinilla S, Robitzsch A, Strauß M, Speerforck S, Watzke S, Spitzer P. [Medical education in psychosocial disciplines in times of the COVID-19 pandemic - first experiences]. Fortschr Neurol Psychiatr 2021; 89:573-577. [PMID: 33946123 DOI: 10.1055/a-1480-7258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM In specialties that heavily rely on communication skills such as psychiatry, psychotherapy and psychosomatic medicine, teaching in times of the COVID-19 pandemic is especially challenging. In this overview, educators and course directors report their experiences in eteaching and share their innovative solutions. METHODS We present a collection of methods that relate to teaching and assessment as well as student activation. RESULTS A range of helpful tools for teaching were compiled. This includes instructional videos with simulated patients, structured homework to document a mental status examination, structured hand-offs, and practical examinations in video format. Motivational techniques include podcasts with interviews with clinicians and patients and teaching with the use of cinematic material. DISCUSSION Switching to online formats creates opportunities and advantages for the advancement of time- and location-independent learning. A fast conversion in this direction might also pose some disadvantages. A direct patient-student interaction is critical for engaging with transference, countertransference and situational aspects for teaching in psychosocial disciplines. Empirical studies of the effectiveness of these newly developed formats and faculty development for digital teaching are necessary.
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Affiliation(s)
- Katja Koelkebeck
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie, Kliniken und Institut der Universität Duisburg-Essen
| | - Franziska Baessler
- Universität Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik
| | - Robert Bittner
- Universität Frankfurt am Main, Klinik für Psychiatrie, Psychosomatik und Psychotherapie
| | - Thomas Frodl
- Universität Magdeburg, Medizinische Fakultät, Universitätsklinik für Psychiatrie und Psychotherapie
| | - Gertraut Gradl-Dietsch
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Kliniken und Institut der Universität Duisburg-Essen
| | - Deborah Janowitz
- Universität Greifswald, Klinik für Psychiatrie und Psychotherapie
| | - Katja-Daniela Jordan
- Universität Zürich, Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik
| | - Ina Kluge
- Philipps-Universität Marburg, Fachbereich Medizin, Klinik für Psychiatrie und Psychotherapie, Standort Marburg
| | - Oliver Matthes
- Universität Zürich, Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik
| | - Severin Pinilla
- Universität Bern, Universitätsklinik für Alterspsychiatrie und Psychotherapie
| | - Anita Robitzsch
- Klinik für Psychosomatische Medizin und Psychotherapie, Kliniken und Institut der Universität Duisburg-Essen
| | - Maria Strauß
- Universitätsklinikum Leipzig, Klinik für Psychiatrie und Psychotherapie
| | - Sven Speerforck
- Universitätsklinikum Leipzig, Klinik für Psychiatrie und Psychotherapie
| | - Stefan Watzke
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik
| | - Philipp Spitzer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Fakultät, Klinik für Psychiatrie und Psychotherapie
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Li B, Qin C, Yu J, Gong D, Nie X, Li G, Bittner R. Totally endoscopic sublay (TES) repair for lateral abdominal wall hernias: technique and first results. Hernia 2021; 25:523-533. [PMID: 33599899 DOI: 10.1007/s10029-021-02374-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal surgical treatment for lateral hernias of the abdominal wall remains unclear. The presented prospective study assesses for the first time in detail the clinical value of a totally endoscopic sublay (TES) technique for the repair of these hernias. METHODS Twenty-four consecutive patients with a lateral abdominal wall hernia underwent TES repair. This technique is naturally combined with a transversus abdominis release maneuver to create a sufficient retromuscular/preperitoneal space that can accommodate, if necessary, a giant prosthetic mesh. RESULTS The operations were successful in all but one patient who required open conversion because of dense intestinal adhesion. The mean defect width was 6.7 ± 3.9 cm. The mean defect area was 78.0 ± 102.4 cm2 (range 4-500 cm2). The mean mesh size used was 330.2 ± 165.4 cm2 (range 108-900 cm2). The mean operative time was 170.2 ± 73.8 min (range, 60-360 min). The mean visual analog scale score for pain at rest on the first day was 2.5 (range 1-4). The average postoperative stay was 3.4 days (range 2-7 days). No serious complications (Dindo-Clavien Grade 2-4) were seen within a mean follow-up period of 13.3 months. CONCLUSIONS A totally endoscopic technique (TES) for the treatment of lateral hernias is described. The technique revealed to be reliable, safe and cost-effective. The first results are promising, but larger studies with longer follow-up periods are recommended to determine the real clinical value.
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Affiliation(s)
- B Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - C Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - J Yu
- Department of General Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, 201999, China
| | - D Gong
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China
| | - X Nie
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China
| | - G Li
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China.
| | - R Bittner
- Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
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Meissner VH, Bittner R, Kron M, Schiele S, Schulwitz H, Gschwend JE, Herkommer K. Impact of a Changing Population Structure and Clustering of Cancer in Prostate Cancer Patients Depending on a First-Degree Family History. Urol Int 2019; 104:222-229. [PMID: 31865349 DOI: 10.1159/000504789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/16/2019] [Accepted: 11/13/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In the last century, there have been major changes within the population structure in Germany. The aim of this study was to determine the impact of a changing population structure on identification of familial prostate cancer (PCa), and to investigate how many and which types of other cancers have occurred in patients and their first-degree relatives. MATERIALS AND METHODS A total of 19,540 patients were evaluated in a prospectively collected PCa family database and divided into four birth cohorts: 1925-1934 (cohort A), 1935-1944 (cohort B), 1945-1954 (cohort C), and 1955-1964 (cohort D). Other primary cancers and cancers of first-degree relatives were evaluated. RESULTS The percentage of PCa patients with ≥2 sons declined (A: 28.9% to D: 21.6%). The percentage of patients whose fathers lived for ≥65 years increased (B: 64.2% to D: 73.0%). Malignancies of the skin, the urinary tract, and the lymphoid/hematopoietic tissue were more common in patients with a positive first-degree PCa family history and their first-degree relatives. Additionally, first-degree relatives reported more often neoplasms of respiratory/intrathoracic organs and the female breast. CONCLUSIONS A small family size, an early deceased father, and a high number of sporadic cases complicate the identification of familial PCa patients. Thus, a detailed family history should also include unaffected first-degree relatives to avoid any misclassification. Findings of other primary cancers in patients and their relatives warrant further investigation.
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Affiliation(s)
- Valentin Henri Meissner
- Department of Urology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Robert Bittner
- Department of Urology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martina Kron
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Stefan Schiele
- Department of Urology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helga Schulwitz
- Department of Urology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jürgen Erich Gschwend
- Department of Urology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,
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Weiss S, Schatz U, Zschoke J, Wenninger S, Schoser B, Rudnik-Schoeneborn S, Muss W, Schossig A, Schmidt W, Bittner R, Bernert G, Baumann M. P.159Disease spectrum in nemaline myopathy due to LMOD3 mild founder mutation in Austria and southern Germany. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.214] [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: 11/16/2022]
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Weiss S, Birsak T, Ille A, Kellersmann A, Gosk-Tomek M, Bittner R, Schmidt W, Bernert G. P.157L-tyrosine in nemaline myopathy – what do we know? Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.212] [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: 11/26/2022]
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Birsak T, Ille A, Weiss S, Kellersmann A, Gosk-Tomek M, van Egmond-Froehlich A, Lechner Y, Maier I, Schmidt W, Bittner R, Bernert G. P.366Nusinersen improves motor function in ambulatory SMA III patients. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.528] [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: 11/29/2022]
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Lechner M, Meissnitzer M, Borhanian K, Bittner R, Kaufmann R, Mayer F, Jäger T, Mitterwallner S, Emmanuel K, Forstner R. Surgical and radiological behavior of MRI-depictable mesh implants after TAPP repair: the IRONMAN study. Hernia 2019; 23:1133-1140. [PMID: 31367964 PMCID: PMC6938468 DOI: 10.1007/s10029-019-02019-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/20/2019] [Indexed: 10/29/2022]
Abstract
PURPOSE Knowledge of postoperative behavior of mesh implants used for hernia repair is generally limited to cases of recurrence, local complications or return to the previous operative field in other pathological conditions. Previous studies with MRI-visible mesh implants in different parts of the abdominal wall have led to variable findings with regard to mesh properties and mostly described a reduction in size over time with subsequently limited mesh overlap over hernia defects which could contribute to recurrence. We aimed to evaluate implant properties in a mechanically stable anatomical region after TAPP repair of primary unilateral inguinal hernias in men with clinical and MRI examinations 4 weeks and 1 year after surgery. METHODS From 11/2015 to 01/2019, 23 men with primary, unilateral, inguinal hernias underwent TAPP repair with iron particle-loaded, MRI-visible mesh implants in a prospective cohort study. In 16 patients the operative outcome could be evaluated 4 weeks and 12 months after surgery by clinical examination and MRI evaluation with regard to postoperative course, possible adverse outcomes and radiological findings related to implant behavior-namely MRI-identifiability, mesh dislocation or reduction in surface area. RESULTS All included patients had an uneventful postoperative clinical course. MRI after 4 weeks revealed one postoperative seroma, which resolved spontaneously. No recurrence was detected. Mesh implants could be accurately delineated in DIXON-IN studies and showed neither clinically nor statistically significant changes in size or position. CONCLUSION 4 weeks and 1 year after a standardized TAPP procedure the mesh implant used in this study showed no tendency towards dislocation or reduction in size in this anatomical position. Its MRI visibility allows accurate delineation during the postoperative course by experienced radiologists in appropriate MRI protocols. Larger patient series are desirable to further support these findings. Shrinkage of implants in the groin as a reason for early recurrence may be overestimated.
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Affiliation(s)
- M Lechner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - M Meissnitzer
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - K Borhanian
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Bittner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Kaufmann
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - T Jäger
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - S Mitterwallner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - K Emmanuel
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Forstner
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D, Chen J, Chowbey P, Dietz UA, de Beaux A, Ferzli G, Fortelny R, Hoffmann H, Iskander M, Ji Z, Jorgensen LN, Khullar R, Kirchhoff P, Köckerling F, Kukleta J, LeBlanc K, Li J, Lomanto D, Mayer F, Meytes V, Misra M, Morales-Conde S, Niebuhr H, Radvinsky D, Ramshaw B, Ranev D, Reinpold W, Sharma A, Schrittwieser R, Stechemesser B, Sutedja B, Tang J, Warren J, Weyhe D, Wiegering A, Woeste G, Yao Q. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc 2019; 33:3069-3139. [PMID: 31250243 PMCID: PMC6722153 DOI: 10.1007/s00464-019-06907-7] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [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: 02/25/2019] [Accepted: 06/07/2019] [Indexed: 02/08/2023]
Abstract
Abstract In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.
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Affiliation(s)
- R Bittner
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya str., 8, b. 2, 119992, Moscow, Russia. .,Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
| | - K Bain
- Department of Surgery, New York University, New York, USA
| | - V K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - F Berrevoet
- Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - J Bingener-Casey
- Division of Breast, Endocrine, Metabolic & Gastrointestinal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D Chen
- Lichtenstein Amid Hernia Clinic at UCLA, Section of Minimally Invasive Surgery, UCLA Division of General Surgery, Los Angeles, USA
| | - J Chen
- Department of Hernia and Abdominal Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Fengtai, China
| | - P Chowbey
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - U A Dietz
- Klinik für Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - A de Beaux
- Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - G Ferzli
- Department of Surgery, New York University, New York, USA
| | - R Fortelny
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, 1160, Vienna, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - M Iskander
- Department of Surgery, Mount Sinai Hospital, 1010 5th Avenue, New York, NY, 10028, USA
| | - Z Ji
- Department of Surgery, Southeast University School of Medicine, Main Add. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, China
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen NV, Denmark
| | - R Khullar
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - P Kirchhoff
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - F Köckerling
- Visceral- und Gefäßchirurgie, Zentrum für Minimal Invasive Chirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Germany
| | - J Kukleta
- Klinik im Park, Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - K LeBlanc
- Our Lady of the Lake Physician Group, 7777 Hennessy Blvd., Suite 612, Baton Rouge, LA, 70808, USA
| | - J Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - D Lomanto
- Department of Surgery, YLL School of Medicine, National University Hospital, Level 2, Kent Ridge Wing 2, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - F Mayer
- Paracelsus Medizinische Universität Salzburg (PMU), Universitätsklinik für Chirurgie, Salzburg, Austria
| | - V Meytes
- Department of Surgery, New York University, New York, USA
| | - M Misra
- Mahatma Gandhi University of Medical Sciences & Technology, RIICO Institutional Area, Tonk Road, Sitapura, Jaipur, Rajasthan, 302 022, India
| | - S Morales-Conde
- Centro de Cirugía Mayor Ambulatoria Ave María, Avda. de la Palmera, 53, 41013, Seville, Spain
| | - H Niebuhr
- HANSECHIRURGIE, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - D Radvinsky
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - B Ramshaw
- Department of Surgery, University Surgeons Associates, 1930 Alcoa Highway, Bldg A, Ste 285, Knoxville, TN, 37920, USA
| | - D Ranev
- Lenox Hill Hospital-Northwell Health, New York, USA
| | - W Reinpold
- Abteilung für Chirurgie, Wilhelmsburger Krankenhaus, Groß-Sand 3, 21107, Hamburg, Germany
| | - A Sharma
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - R Schrittwieser
- Abteilung für Chirurgie, LKH Hochsteiermark, Standort Bruck an der Mur Tragösser Str. 1, 8600, Bruck an der Mur, Austria
| | - B Stechemesser
- Hernienzentrum Köln, Zeppelinstraße 1, 50667, Cologne, Germany
| | - B Sutedja
- Gading Pluit Hospital, Jl. Boulevard Timur Raya Kelapa Gading, Jakarta, 14250, Indonesia
| | - J Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - J Warren
- Minimally Invasive Surgery, Greenville Health System, Department of Surgery, University of South Carolina School of Medicine, Greenville, USA
| | - D Weyhe
- Pius-Hospital Oldenburg, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Georgstraße 12, 26121, Oldenburg, Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany
| | - G Woeste
- AGAPLESION ELISABETHENSTIFT gemeinnützige GmbH, Akademisches Lehrkrankenhaus, Landgraf-Georg-Strasse 100, 64287, Darmstadt, Germany
| | - Q Yao
- Department of Hernia and Abdominal Surgery, Huashan Hospital, Fudan University, Shanghai, China
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11
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Lechner M, Bittner R, Borhanian K, Mitterwallner S, Emmanuel K, Mayer F. Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years. Hernia 2019; 24:633-637. [PMID: 30900041 PMCID: PMC7210230 DOI: 10.1007/s10029-019-01928-6] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
Purpose Short-term effects of round ligament varicosity (RLV) in pregnancy have been investigated in small-scale studies. The long-term effects are unknown. This study aims to evaluate the risk of groin hernia manifestation after RLV in pregnancy, to delineate possible risk factors and to analyze the natural course of pregnancy and post-partum period with regard to RLV. Methods In a prospective analysis 28 pregnant women with RLV presented to the hernia clinic over 9 years. After clinical and ultrasound examination during pregnancy and publication of early results in 2013 a second structured follow-up was conducted. Demographic data, hernia-specific risk factors, comorbidities, pregnancy and birth-related data as well as post-partum period were documented without loss of follow-up. In these women, all pregnancies that occurred, including the ones without RLV, were analyzed. Results Median follow-up was 68 months (11.4–104.9). Only one groin hernia was found. No risk factors could be identified. After uncomplicated childbirth complaints subsided spontaneously in all but one patient within 4 weeks. Recurrence rates in subsequent pregnancies are up to 89%. Conclusion Temporary RLV-induced dilation of the deep inguinal ring in pregnancy is not a common precursor for the development of inguinal hernias later in life. All findings support the theory that the hindrance of venous blood flow caused by the gravid uterus is an important contributing factor for RLV in pregnancy, which is self-limited but has a high risk of recurrence and is not an indication for surgery before or after delivery or for cesarean section.
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Affiliation(s)
- M Lechner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria.
| | - R Bittner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
| | - K Borhanian
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
| | - S Mitterwallner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
| | - K Emmanuel
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
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12
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Lechner M, Borhanian K, Mitterwallner S, Bittner R, Klieser E, Köhler G, Emmanuel K, Mayer F. Retroperitoneal Liposarcoma: A Concern in Inguinal Hernia Repair. JSLS 2019; 23:JSLS.2018.00064. [PMID: 30700965 PMCID: PMC6345196 DOI: 10.4293/jsls.2018.00064] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background and Objectives: The goal of the study was to evaluate retroperitoneal sarcomas with continuous growth into the scrotum through the inguinal canal with regard to diagnostic approach, surgical treatment, and outcome. The analysis is based on a comprehensively documented case and a complete systematic review of published literature. Potential pitfalls are highlighted. Methods: We describe the case of a 57-year-old male Caucasian who presented with a swelling in the right groin. Suspecting a scrotal hernia, transabdominal preperitoneal plasty surgery was planned but intraoperatively a large retroperitoneal mass was revealed. After computed tomography scan and magnetic resonance imaging, a complete resection of the tumor was performed. Ten previously published cases describing the same pathology were retrieved from the PubMed database and analyzed systematically in a complete literature review. Results: Histology showed a well-differentiated liposarcoma with tumor-free resection margins. Twenty-two months postoperatively, the patient is in complete clinical remission. Conclusion: Preoperative clinical suspicion of retroperitoneal involvement is paramount for developing of a surgical strategy and in unclear cases demands extended preoperative diagnostic workup. Following the appropriate patient management is crucial to prognosis.
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Affiliation(s)
- M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Borhanian
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - S Mitterwallner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - R Bittner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - E Klieser
- Department of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - G Köhler
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
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13
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Safi F, Roscher R, Bittner R, Beger H. The Clinical Relevance of Tumor Marker Cea, Ca 19-9 in Regional Chemotherapy of Hepatic Metastases of Colorectal Carcinoma. Int J Biol Markers 2018; 3:101-6. [DOI: 10.1177/172460088800300205] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Up to December 1986, 50 patients with documented hepatic metastases from colorectal carcinoma were treated with 5-fluoro-2-deoxyuridine (FUDR) using Infusaid pumps. The response of liver metastases to regional chemotherapy was studied by computerized tomography (CT) and carcino-embryonal antigen (CEA), and/or CA 19-9 antigen serum assays. Preoperative CEA values were pathological in 94% of the patients but only 48% had a pathological concentration of the antigen CA 19-9 of over 37 U/ml. The course of CEA and CA 19-9 in combination with the arterial angio-CT reflected the response of liver metastases to regional chemotherapy. A decrease or normalisation of CEA and CA 19-9 after the beginning of therapy is an indication of partial or complete remission of metastases (68% of the patients showed lowered CEA serum values). If the marker continues to rise in serum this is a danger signal of progression of liver metastases or of extrahepatic tumor spread if the tumor stage in the liver remains unchanged.
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Affiliation(s)
- F. Safi
- Department of General Surgery, University of Ulm, Federal Republic of Germany
| | - R. Roscher
- Department of General Surgery, University of Ulm, Federal Republic of Germany
| | - R. Bittner
- Department of General Surgery, University of Ulm, Federal Republic of Germany
| | - H.G. Beger
- Department of General Surgery, University of Ulm, Federal Republic of Germany
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14
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Bittner R. Invited comment to: Laparoscopic inguinal hernioplasty after robot-assisted laparoscopic radical prostatectomy. Sakon M, Sekino Y, Okada M, Seki H, Munakata Y. Hernia 2017; 21:987-988. [DOI: 10.1007/s10029-017-1702-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/03/2017] [Indexed: 11/29/2022]
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15
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Bittner R, Hahn P, Novak C, Lancaster T, Linden D, Reif A. PB 22 Association between genetic risk for schizophrenia and deactivation of the right temporo-parietal junction during working memory encoding – An imaging genetics study. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.078] [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: 10/18/2022]
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16
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Bittner R, Seitz A, Hahn P, Raspor E, Novak C, Linden D, Goebel R, Reif A. FV 2 Reduced spatial variability in cortical working memory networks after macro-anatomical alignment – Converging evidence from multiple fMRI studies. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.044] [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: 10/18/2022]
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17
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Del Bianco Benedeti P, Shenkoru T, Fonseca M, Bittner R, Murphy K, Ivey D, Ribas B, Marostegan de Paula E, Galoro da Silva L, Monteiro H, Nicolis I, Mariz L, Costa H, Amaral P, Marcondes MI, Faciola A. 0234 Glycerin as alternative energy source for ruminants: In vitro fermentation, total gas and methane production. J Anim Sci 2016. [DOI: 10.2527/jam2016-0234] [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: 11/13/2022] Open
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18
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Zadura M, Szigat F, Hejazin B, Szigat P, Bittner R, Bischoff C, Motz W. PS156 Ecls Instead of Iabp in Acute Coronary Syndrome and Cardiogenic Shock – Promising Preliminary Results After 2 Years of Single Center Experience. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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19
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Vanini R, Kabbara S, Elia E, Piancastelli A, Guglielminetti D, Tuveri M, Tuveri A, Nicolo E, Tomizawa K, Kuroyanagi H, Matoba S, Moriyama J, Toda S, Hanaoka Y, Fukui Y, Haruta S, Clara ES, Tang S, Tan WB, Wijerathne S, Hu J, Shabbir A, Lomanto D, Son G, Park S, Pietrantoni S, Pietrantoni C, Nishihara M, Takehara H, Nakagawa H, Kuniyoshi N, Aka H, Takushi Y, Miyahira T, Hanashiro N, Okushima N, Mayer F, Lechner M, Öfner D, Bittner R, Köhler G, Fortelny R, Köckerling F, Lim R, Berney C, Kato J, Iuamoto L, Meyer A, Floridi A, Bombelli E, Giuliani D, Galli I, Monti M, Longo A, Pisano G, Li J, Tian D. Topic: Inguinal Hernia - Tailored surgery. Hernia 2015; 19 Suppl 1:S287-92. [PMID: 26518825 DOI: 10.1007/bf03355373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R Vanini
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - S Kabbara
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - E Elia
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | | | | | - M Tuveri
- U.O. Chirurgia Generale, Ospedale N.S. di Bonaria, San Gavino Monreale, Italy
| | - A Tuveri
- U. O. Chirurgia Generale, CDC Sant'Elena, Quartu Sant Elena, Italy
| | - E Nicolo
- Dept. of General Surgery, Jefferson Hospital, Pittsburgh, USA
| | - K Tomizawa
- Toranomon Hospital Surgery, Tokyo, Japan
| | | | | | | | | | | | | | | | - E Sta Clara
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S Tang
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - W B Tan
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S Wijerathne
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore
| | - J Hu
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - A Shabbir
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - D Lomanto
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - G Son
- Yangsan Busan National Univ. Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
| | - S Park
- Yangsan Busan National Univ. Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
| | - S Pietrantoni
- General Surgery Department (Director: C. Pietrantoni), S.S. Filippo e Nicola Hospital, Avezzano, AQ, Italy
| | | | | | - H Takehara
- Heart-life Hospital, Nakagami-gun, Japan
| | - H Nakagawa
- Heart-life Hospital, Nakagami-gun, Japan
| | | | - H Aka
- Heart-life Hospital, Nakagami-gun, Japan
| | - Y Takushi
- Heart-life Hospital, Nakagami-gun, Japan
| | - T Miyahira
- Heart-life Hospital, Nakagami-gun, Japan
| | | | - N Okushima
- Heart-life Hospital, Nakagami-gun, Japan
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - D Öfner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - R Bittner
- Winghofer Medicum Hernia Center, Rottenburg, Germany
| | - G Köhler
- Department Surgery, Sisters of Charity Hospital, Linz, Austria
| | - R Fortelny
- Department of General Surgery, Wilhelminenspital, Vienna, Austria
| | - F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital, Berlin, Germany
| | - R Lim
- Department of Surgery, University of N.S.W., Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - C Berney
- Department of Surgery, University of N.S.W., Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - J Kato
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - L Iuamoto
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - A Meyer
- Director of Abdominal Wall Repair Center, Samaritano Hospital, Sao Paulo, Brazil
| | - A Floridi
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - E Bombelli
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - D Giuliani
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - I Galli
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - M Monti
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - A Longo
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - G Pisano
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - J Li
- The 2nd Affiliated Hospital of Jilin University, Changchun, China
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20
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Köckerling F, Jacob D, Wiegank W, Hukauf M, Schug-Pass C, Kuthe A, Bittner R. Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome? Surg Endosc 2015; 30:1146-55. [PMID: 26139485 PMCID: PMC4757618 DOI: 10.1007/s00464-015-4318-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/08/2015] [Indexed: 11/24/2022]
Abstract
Introduction
To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent inguinal hernias. It is therefore now attempted to answer that key question on the basis of registry data. Patients and methods In total, 20,624 patients were enrolled between September 1, 2009, and April 31, 2013. Of these patients, 18,142 (88.0 %) had a primary and 2482 (12.0 %) had a recurrent endoscopic repair. Only patients with male unilateral inguinal hernia and with a 1-year follow-up were included. The dependent variables were intra- and postoperative complications, reoperations, recurrence, and chronic pain rates. The results of unadjusted analyses were verified via multivariable analyses. Results Unadjusted analysis did not reveal any significant differences in the intraoperative complications (1.28 vs 1.33 %; p = 0.849); however, there were significant differences in the postoperative complications (3.20 vs 4.03 %; p = 0.036), the reoperation rate due to complications (0.84 vs 1.33 %; p = 0.023), pain at rest (4.08 vs 6.16 %; p < 0.001), pain on exertion (8.03 vs 11.44 %; p < 0.001), chronic pain requiring treatment (2.31 vs 3.83 %; p < 0.001), and the recurrence rates (0.94 vs 1.45 %; p = 0.0023). Multivariable analysis confirmed the significant impact of endoscopic repair of recurrent hernia on the outcome. Conclusion Comparison of perioperative and 1-year outcome for endoscopic repair of primary versus recurrent male unilateral inguinal hernia showed significant differences to the disadvantage of the recurrent operation. Therefore, endoscopic repair of recurrent inguinal hernias calls for particular competence on the part of the hernia surgeon.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - D Jacob
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany
| | - W Wiegank
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany
| | - M Hukauf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - C Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany
| | - A Kuthe
- Department of General and Visceral Surgery, German Red Cross Hospital, Lützerodestrasse 1, 30161, Hannover, Germany
| | - R Bittner
- Hernia Center, Winghofer Medicum, Winghofer Strasse 42, 72108, Rottenburg am Neckar, Germany
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21
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Mayer F, Lechner M, Adolf D, Öfner D, Köhler G, Fortelny R, Bittner R, Köckerling F. Is the age of >65 years a risk factor for endoscopic treatment of primary inguinal hernia? Analysis of 24,571 patients from the Herniamed Registry. Surg Endosc 2015; 30:296-306. [PMID: 25899813 PMCID: PMC4710662 DOI: 10.1007/s00464-015-4209-7] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/31/2015] [Indexed: 11/27/2022]
Abstract
Introduction
Several analyses of hernia registries have demonstrated that patients older than 65 years have significantly higher perioperative complication rates compared with patients up to the age of 65. To date, no special analyses of endoscopic/laparoscopic inguinal hernia surgery or of the relevant additional influence factors have been carried out. Besides, there is no definition to determine whether 65 years should really be considered to be the age limit. Methods In the Herniamed Hernia Registry, it was possible to identify 24,571 patients with a primary inguinal hernia and aged at least 16 years who had been operated on between September 1, 2009, and April 15, 2013, using either the TAPP technique (n = 17,214) or TEP technique (n = 7,357). Patients in the age group up to and including 65 years (≤65 years) were compared with those older than 65 years (>65 years) in terms of their perioperative outcome. That was done first using unadjusted analysis and then multivariable analysis. Results Unadjusted analysis revealed significantly different results for the intraoperative (1.19 vs 1.60 %; p = 0,010), postoperative surgical (2.72 vs 4.59 %; p < 0.001) and postoperative general complications (0.85 vs 1.98 %; p < 0.001) as well as for complication-related reoperations (1.07 vs 1.37 %; p = 0,044), which were more favorable in the ≤65 years age group. However, in multivariable analysis, it was not possible to confirm that for the intraoperative complications or the reoperations. Reoperations were needed more often for bilateral procedures (p < 0.001; OR 2.154 [1.699; 2.730]), higher ASA classification (IV vs I: p = 0.004; OR 6.001 [1.786; 20.167]), larger hernia defect and scrotal hernias. The impact of these factors, in addition to that of age >65 years, was also reflected in the postoperative complication rates. The age limit for increased onset of perioperative complication rates tends to be more than 80 rather than 65 years. Conclusion The higher perioperative complication rate associated with endoscopic/laparoscopic inguinal hernia surgery in patients older than 65 years is of multifactorial genesis and is observed in particular as from the age of 80 years.
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Affiliation(s)
- F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - D Öfner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - G Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - R Fortelny
- Department of General Surgery, Wilhelminenspital, Vienna, Austria
| | - R Bittner
- Hernia Center, Winghofer Medicum, Rottenburg am Neckar, Germany
| | - F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
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Bittner R, Beger HG, Kraas E, Gögler H. Surgical treatment of carcinoma of the stomach in geriatric patients. Front Gastrointest Res 2015; 5:152-9. [PMID: 499980 DOI: 10.1159/000402323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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Köckerling F, Bittner R, Jacob D, Schug-Pass C, Laurenz C, Adolf D, Keller T, Stechemesser B. Do we need antibiotic prophylaxis in endoscopic inguinal hernia repair? Results of the Herniamed Registry. Surg Endosc 2015; 29:3741-9. [PMID: 25786905 PMCID: PMC4648957 DOI: 10.1007/s00464-015-4149-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/06/2015] [Indexed: 11/29/2022]
Abstract
Introduction The use of antibiotic prophylaxis in inguinal hernia repair is a controversial issue. Accepted randomized controlled trials or registry data with specific analysis of endoscopic repaired patients do not exist. Patient and methods The data presented in this study compared the prospectively collected data from the Herniamed Registry on all patients who had undergone unilateral, bilateral or recurrent repair of inguinal hernias using either endoscopic or open techniques between September 1, 2009, and March 5, 2014. In total, 85,033 patients were enrolled. Of these patients, 48,201 (56.7 %) had an endoscopic and 36,832 (43.3 %) an open repair. The target variables analyzed were impaired wound healing and deep infections with mesh involvement within 30 days after the operation. Results Analysis of the patient group with endoscopic/laparoscopic inguinal hernia repair (n = 48,201) did not identify any significant influence of antibiotic prophylaxis on postoperative impaired wound healing, which occurred in 53 cases (p = 0.6431). Nor was it possible to identify any significant impact of antibiotic prophylaxis on the deep infections seen in 27 cases (p = 0.8409). Analysis of the open inguinal hernia repair group revealed that, unlike the laparoscopic/endoscopic group, antibiotic prophylaxis had a significant impact on the postoperative impaired wound healing and deep infection rates. The risk of postoperative impaired wound healing with antibiotic prophylaxis was significantly lower [OR 0.677 (0.479; 0.958), p = 0.027]. Conclusion The positive impact of the endoscopic/laparoscopic technique on avoidance of impaired wound healing and deep infections with mesh involvement is already so great that antibiotic prophylaxis has no additional benefit. In contrast, antibiotic prophylaxis should be administered for open inguinal hernia repair.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
| | - R Bittner
- Winghofer Medicum, Hernia Center, Winghofer Straße 42, 72108, Rottenburg am Neckar, Germany
| | - D Jacob
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany
| | - C Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany
| | - C Laurenz
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany
| | - T Keller
- StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany
| | - B Stechemesser
- Hernia Center Cologne, PAN - Hospital, Zeppelinstraße 1, 50667, Cologne, Germany
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Thiel S, Kollmeier J, Schäfer M, Griff S, Förster GJ, Bittner R, Bauer TT. Fallbericht: Ansprechen eines atypischen Karzinoides auf Temozolomid/Capecitabine in vierter Therapielinie. Pneumologie 2015. [DOI: 10.1055/s-0035-1544660] [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: 10/24/2022]
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25
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Gastmeier A, Müller I, Kollmeier J, Pfannschmidt J, Bittner R, Bauer TT. Iatrogener „situs inversus thoracalis“ nach Pneumonektomie. Pneumologie 2015. [DOI: 10.1055/s-0035-1544906] [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: 10/24/2022]
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26
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Fléchet C, Schönfeld N, Blum TG, Griff S, Grosswendt C, Wurps H, Bittner R, Mairinger T, Bauer TT. Pulmonale Manifestationsformen differenzierter und undifferenzierter Autoimmunerkrankungen. Pneumologie 2015. [DOI: 10.1055/s-0035-1544814] [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: 10/24/2022]
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27
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Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Köckerling F, Koeckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 2014; 29:289-321. [PMID: 25398194 PMCID: PMC4293469 DOI: 10.1007/s00464-014-3917-8] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 12/13/2022]
Affiliation(s)
- R Bittner
- Hernia Center, Winghofer Medicum Plus, Röntgenstr. 38, 72108, Rottenburg, Germany,
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Köhler G, Mayer F, Lechner M, Bittner R. Small bowel obstruction after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report and review of the literature. Hernia 2014; 19:389-94. [PMID: 25112384 DOI: 10.1007/s10029-014-1301-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 07/28/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Transabdominal preperitoneal hernioplasty (TAPP) is a common procedure for groin hernia repair in adults. The peritoneal closure after mesh placement can be performed in various ways. In any case, thorough closure is recommended to avoid mesh exposure to the viscera with the risk of adhesions and bowel incarceration into peritoneal defects. Postoperative intestinal obstructions can mainly occur due to adhesions or bowel herniation through peritoneal defects into the dissected preperitoneal space. Incarcerations can also occur as a consequence of trocar site herniation. RESULTS AND CONCLUSION Recently barbed self-anchoring knotless suturing devices are frequently used for peritoneal closure. The correct handling of such sutures is crucial to avoid potential complications. Despite of accurate management, bowel adherence and injuries or volvulus can occur. METHODS We present an unusual case of a postoperative small bowel obstruction owing to strained adhesions and ingrowth between a small bowel segment and a polyglyconate unidirectional self-anchoring barbed suture device. Medline and PudMed databases were searched using the below-mentioned keywords and the literature on efficacy and safety of barbed sutures for peritoneal closure is reviewed as well as the usage of such devices in other fields of surgery.
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Affiliation(s)
- G Köhler
- Academic Teaching Hospital of the Universities Graz and Innsbruck, Linz, Austria,
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29
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Thiel S, Kollmeier J, Misch D, Griff S, Theissig F, Bittner R, Mairinger T, Bauer TT. EBV-assoziiertes diffus-großzelliges B-Zell-Lymphom (DLBCL) des Älteren – Zwei Fälle einer thorakalen Erstmanifestation. Pneumologie 2014. [DOI: 10.1055/s-0034-1367976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Köckerling F, Jacob DA, Bittner R, Chowbey P, Lomanto D, Kukleta J. Risk of postoperative urinary retention after laparoscopic (TAPP) or endoscopic (TEP) inguinal hernia repair. Surg Endosc 2012; 27:1049-50. [PMID: 23052529 DOI: 10.1007/s00464-012-2554-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/20/2012] [Indexed: 11/28/2022]
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31
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Koeckerling F, Jacob DA, Lomanto D, Chowbey P, Bittner R. Slit versus non-slit mesh placement in total extraperitoneal inguinal hernia repair. World J Surg 2012; 36:1445-6; author reply 1447-8. [PMID: 22430671 DOI: 10.1007/s00268-012-1436-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Affiliation(s)
- R Bittner
- Department of General, Visceral and Vascular Surgery, Herniacenter, EuromedClinic Fürth, Europaallee 1, 90763, Fürth, Germany.
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33
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Probstel AK, Dornmair K, Bittner R, Sperl P, Jenne D, Magalhaes S, Villalobos A, Breithaupt C, Weissert R, Jacob U, Krumbholz M, Kuempfel T, Blaschek A, Stark W, Gartner J, Pohl D, Rostasy K, Weber F, Forne I, Khademi M, Olsson T, Brilot F, Tantsis E, Dale RC, Wekerle H, Hohlfeld R, Banwell B, Bar-Or A, Meinl E, Derfuss T. Antibodies to MOG are transient in childhood acute disseminated encephalomyelitis. Neurology 2011; 77:580-8. [DOI: 10.1212/wnl.0b013e318228c0b1] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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34
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Abstract
Laparoscopic hernioplasty is assessed as a difficult operation. Operative technique determines the frequency of complications, the time of recovery and the rate of recurrences. A proper technique is absolutely necessary to achieve results that are superior to open hernia surgery.
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Affiliation(s)
- R Bittner
- Department for General and Visceral Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, D-70199 Stuttgart
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35
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Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 2011; 25:2773-843. [PMID: 21751060 PMCID: PMC3160575 DOI: 10.1007/s00464-011-1799-6] [Citation(s) in RCA: 392] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 05/12/2011] [Indexed: 12/14/2022]
Affiliation(s)
- R Bittner
- Hernia Center, Department of General,-Visceral, and Vascular Surgery, EuromedClinic, Europaallee 1, 90763 Fürth, Germany.
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36
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Pellkofer HL, Krumbholz M, Berthele A, Hemmer B, Gerdes LA, Havla J, Bittner R, Canis M, Meinl E, Hohlfeld R, Kuempfel T. Long-term follow-up of patients with neuromyelitis optica after repeated therapy with rituximab. Neurology 2011; 76:1310-5. [PMID: 21482945 DOI: 10.1212/wnl.0b013e3182152881] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Neuromyelitis optica (NMO) is a severe autoimmune disease targeting optic nerves and spinal cord. The monoclonal anti-CD20 B-cell antibody rituximab is an emerging therapeutic option in NMO. However, neither long-term efficacy or safety of rituximab, nor the correlation between B-cell counts, B-cell fostering cytokines, aquaporin-4 antibodies (AQP4-ab), and disease activity in NMO, have been investigated prospectively. METHODS We performed a prospective long-term cohort study of 10 patients with NMO who were treated up to 5 times with rituximab as a second-line therapy. Clinical examinations, B-cell counts, and serum concentrations of BAFF (B-cell activating factor of the TNF family; also called TNFSF13b), APRIL (a proliferation-inducing ligand; also called TNFSF13), AQP4-ab, and immunoglobulin levels were measured every 3 months. RESULTS Repeated treatment with rituximab led to sustained clinical stabilization in most patients with NMO. Disease activity correlated with B-cell depletion, but not clearly with AQP4-ab or levels of APRIL. BAFF levels increased after application of rituximab and indicated persisting efficacy of the drug but did not correlate with disease activity. Overall, rituximab was well-tolerated even after up to 5 consecutive treatment courses; however, we observed several severe adverse reactions. CONCLUSION Our data indicate that long-term therapy with rituximab is effective in NMO as a second-line therapy and has an acceptable safety profile. Retreatment with rituximab should be applied before reappearance of circulating B cells. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that repeated doses of rituximab result in stabilization in most patients.
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Affiliation(s)
- H L Pellkofer
- Institute of Clinical Neuroimmunology, Ludwig Maximilians University, D-81377 Munich, Germany.
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37
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Bittner R, Schmedt CG, Leibl BJ, Schwarz J. Early Postoperative and One Year Results of a Randomized Controlled Trial Comparing the Impact of Extralight Titanized Polypropylene Mesh and Traditional Heavyweight Polypropylene Mesh on Pain and Seroma Production in Laparoscopic Hernia Repair (TAPP). World J Surg 2011; 35:1791-7. [DOI: 10.1007/s00268-011-1148-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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38
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Crolow C, Samulowski M, Blum T, Kollmeier J, Grüning W, Schönfeld N, Bittner R, Bauer TT. Häufigkeit thrombembolischer Komplikationen beim Lungenkarzinom zum Zeitpunkt der Diagnosestellung und im Verlauf. Pneumologie 2011. [DOI: 10.1055/s-0031-1272241] [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: 10/18/2022]
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39
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Neudecker J, Klein F, Bittner R, Carus T, Stroux A, Schwenk W. Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg 2010. [DOI: 10.1002/bjs.7075] [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: 11/12/2022]
Abstract
Abstract
The original article to which this Corrigendum refers was published in British Journal of Surgery 2009; 96: 1458–1467.
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40
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Förster G, Lauer C, Kollmeier J, Bittner R, Mairinger T, Kaiser D. Beeinflussung des therapeutischen Vorgehens beim nichtkleinzelligen Lungenkarzinom durch die Einführung der modernen PET/CT Diagnostik an einem Thoraxzentrum: erste Ergebnisse. Pneumologie 2010. [DOI: 10.1055/s-0030-1251232] [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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41
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Junker A, Krumbholz M, Eisele S, Mohan H, Augstein F, Bittner R, Lassmann H, Wekerle H, Hohlfeld R, Meinl E. MicroRNA profiling of multiple sclerosis lesions identifies modulators of the regulatory protein CD47. ACTA ACUST UNITED AC 2010; 132:3342-52. [PMID: 19952055 DOI: 10.1093/brain/awp300] [Citation(s) in RCA: 429] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We established microRNA profiles from active and inactive multiple sclerosis lesions. Using laser capture microdissection from multiple sclerosis lesions to pool single cells and in vitro cultures, we assigned differentially expressed microRNA to specific cell types. Astrocytes contained all 10 microRNA that were most strongly upregulated in active multiple sclerosis lesions, including microRNA-155, which is known to modulate immune responses in different ways but so far had not been assigned to central nervous system resident cells. MicroRNA-155 was expressed in human astrocytes in situ, and further induced with cytokines in human astrocytes in vitro. This was confirmed with astrocyte cultures from microRNA-155-|-lacZ mice. We matched microRNA upregulated in phagocytically active multiple sclerosis lesions with downregulated protein coding transcripts. This converged on CD47, which functions as a 'don't eat me' signal inhibiting macrophage activity. Three microRNA upregulated in active multiple sclerosis lesions (microRNA-34a, microRNA-155 and microRNA-326) targeted the 3'-untranslated region of CD47 in reporter assays, with microRNA-155 even at two distinct sites. Our findings suggest that microRNA dysregulated in multiple sclerosis lesions reduce CD47 in brain resident cells, releasing macrophages from inhibitory control, thereby promoting phagocytosis of myelin. This mechanism may have broad implications for microRNA-regulated macrophage activation in inflammatory diseases.
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Affiliation(s)
- Andreas Junker
- Institute for Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany
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42
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Neudecker J, Klein F, Bittner R, Carus T, Stroux A, Schwenk W. Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg 2009; 96:1458-67. [PMID: 19918852 DOI: 10.1002/bjs.6782] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [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: 12/14/2022]
Abstract
BACKGROUND Randomized trials in low-risk populations have failed to show any benefit for laparoscopic compared with open colorectal resection in terms of morbidity. Furthermore, it is not known whether laparoscopic colorectal resection would yield advantages if randomization were revealed during surgery after a diagnostic laparoscopy. METHODS Patients with cancer of the colon or upper rectum were randomly assigned to laparoscopic or open resection. All patients underwent diagnostic laparoscopy to assess whether laparoscopic resection was feasible and the result of randomization was then revealed to the surgeon. Main endpoints were overall, general and surgical morbidity, and mortality. RESULTS Some 679 patients underwent diagnostic laparoscopy which led to the exclusion of 207; 250 patients were allocated to laparoscopic and 222 to open resection. Conversion to laparotomy occurred in 28 patients (11.2 per cent). There were no differences in morbidity (overall 25.2 versus 23.9 per cent) or mortality (1.2 versus 0.9 per cent) between laparoscopic and open groups. Postoperative hospital stay was shorter after laparoscopic resection (median (range) 10 (1-123) versus 12 (4-109) days; P = 0.032). CONCLUSION Laparoscopic resection of colorectal cancer is associated with increased operating time but does not decrease morbidity even in a moderate-risk population.
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Affiliation(s)
- J Neudecker
- Universitätsklinik für Allgemein-, Visceral-, Gefäss- und Thoraxchirurgie, Berlin, Germany
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43
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Schwarz C, Bittner R, Kirsch A, Loddenkemper C, Mairinger T, Schönfeld N, Serke M, Loddenkemper R. A 62-Year-Old Woman with Bilateral Pleural Effusions and Pulmonary Infiltrates Caused by Extramedullary Hematopoiesis. Respiration 2009; 78:110-3. [DOI: 10.1159/000150913] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 06/10/2008] [Indexed: 11/19/2022] Open
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44
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Urmson C, Anhalt J, Bagnell D, Baker C, Bittner R, Clark MN, Dolan J, Duggins D, Galatali T, Geyer C, Gittleman M, Harbaugh S, Hebert M, Howard TM, Kolski S, Kelly A, Likhachev M, McNaughton M, Miller N, Peterson K, Pilnick B, Rajkumar R, Rybski P, Salesky B, Seo YW, Singh S, Snider J, Stentz A, Whittaker W“R, Wolkowicki Z, Ziglar J, Bae H, Brown T, Demitrish D, Litkouhi B, Nickolaou J, Sadekar V, Zhang W, Struble J, Taylor M, Darms M, Ferguson D. Autonomous driving in urban environments: Boss and the Urban Challenge. J FIELD ROBOT 2008. [DOI: 10.1002/rob.20255] [Citation(s) in RCA: 1053] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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45
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Bittner R. Highlights der Radiologie-Literatur 2007. Pneumologie 2008. [DOI: 10.1055/s-2008-1038187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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46
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Bittner R. Ware Gesundheit – Auswirkungen von Wettbewerb im Gesundheitswesen auf die medizinische Versorgungsqualität. Gesundheitswesen 2008; 70:352-3. [DOI: 10.1055/s-2008-1062736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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47
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Lammert F, Neubrand MW, Bittner R, Feussner H, Greiner L, Hagenmüller F, Kiehne KH, Ludwig K, Neuhaus H, Paumgartner G, Riemann JF, Sauerbruch T. [Short version of the updated S3 (level 3) guidelines for diagnosis and treatment of gallstones of the German Society for Digestive and Metabolic Diseases and the German Society for the Surgery of the Alimentary Tract]. Dtsch Med Wochenschr 2008; 133:311-6. [PMID: 18253923 DOI: 10.1055/s-2008-1046712] [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: 10/22/2022]
Abstract
This short version of the guidelines summarizes the evidence-based key recommendations for the diagnosis and treatment of gallstones. The guidelines were developed by an interdisciplinary team of gastroenterologists, surgeons, radiologists, geneticists, and patient support groups, under the auspice of the German Society for Gastroenterology and Metabolic Diseases and the German Society for General Surgery and Surgery of the Alimentary Tract. It used structural level 3 consensus-based methodology and includes statements on clinical practice, prevention, quality assurance, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone disease.
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Affiliation(s)
- F Lammert
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Homburg/Saar.
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49
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Lammert F, Neubrand MW, Bittner R, Feussner H, Greiner L, Hagenmüller F, Kiehne KH, Ludwig K, Neuhaus H, Paumgartner G, Riemann JF, Sauerbruch T. [S3-guidelines for diagnosis and treatment of gallstones. German Society for Digestive and Metabolic Diseases and German Society for Surgery of the Alimentary Tract]. Z Gastroenterol 2007; 45:971-1001. [PMID: 17874360 DOI: 10.1055/s-2007-963437] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This guideline provides evidence-based key recommendations for diagnosis and therapy of gallstones and upgrades version 2000. It was developed by an interdisciplinary team of gastroenterologists, surgeons, radiologists, geneticists, external comparative quality assurance and patient support groups under the auspices of the German Society for Digestive and Metabolic Diseases and the German Society for Surgery of the Alimentary Tract. The guideline used structural S3 consensus-based methodology and includes statements on clinical practice, prevention, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone diseases.
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Affiliation(s)
- F Lammert
- Die Institutsangaben sind am Ende des Beitrags gelistet.
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Bittner R. Highlights der Radiologie-Literatur 2006. Pneumologie 2007. [DOI: 10.1055/s-2007-959251] [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: 10/23/2022]
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