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Schulte B, Göb M, Singh AP, Lotz S, Draxinger W, Heimke M, Pieper M, Heinze T, Wedel T, Rahlves M, Huber R, Ellrichmann M. High-resolution rectoscopy using MHz optical coherence tomography: a step towards real time 3D endoscopy. Sci Rep 2024; 14:4672. [PMID: 38409328 PMCID: PMC10897148 DOI: 10.1038/s41598-024-55338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/22/2024] [Indexed: 02/28/2024] Open
Abstract
Colonoscopy and endoscopic ultrasound play pivotal roles in the assessment of rectal diseases, especially rectal cancer and inflammatory bowel diseases. Optical coherence tomography (OCT) offers a superior depth resolution, which is a critical factor for individualizing the therapeutic concept and evaluating the therapy response. We developed two distinct rectoscope prototypes, which were integrated into a 1300 nm MHz-OCT system constructed at our facility. The rapid rotation of the distal scanning probe at 40,000 revolutions per minute facilitates a 667 Hz OCT frame rate, enabling real-time endoscopic imaging of large areas. The performance of these OCT-rectoscopes was assessed in an ex vivo porcine colon and a post mortem human in-situ colon. The OCT-rectoscope consistently distinguished various layers of the intestinal wall, identified gut-associated lymphatic tissue, and visualized a rectal polyp during the imaging procedure with 3D-reconstruction in real time. Subsequent histological examination confirmed these findings. The body donor was preserved using an ethanol-glycerol-lysoformin-based technique for true-to-life tissue consistency. We could demonstrate that the novel MHZ-OCT-rectoscope effectively discriminates rectal wall layers and crucial tissue characteristics in a post mortem human colon in-situ. This real-time-3D-OCT holds promise as a valuable future diagnostic tool for assessing disease state and therapy response on-site in rectal diseases.
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Affiliation(s)
- Berenice Schulte
- Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Madita Göb
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | | | - Simon Lotz
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | | | - Marvin Heimke
- Center of Clinical Anatomy, Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Mario Pieper
- Institute of Anatomy, University of Luebeck, Luebeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Tillmann Heinze
- Center of Clinical Anatomy, Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Thilo Wedel
- Center of Clinical Anatomy, Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Maik Rahlves
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Robert Huber
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Mark Ellrichmann
- Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Osmonov D, Wilson SK, Heinze T, Heimke M, Novak J, Ragheb A, Köhler T, Hatzichristodoulou G, Wedel T. Response to the Commentary on "Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops". Int J Impot Res 2023:10.1038/s41443-023-00786-2. [PMID: 37919461 DOI: 10.1038/s41443-023-00786-2] [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] [Received: 07/17/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Affiliation(s)
- D Osmonov
- European Institute of Sexual Health, Ballindamm 3, Hamburg, Germany.
| | - S K Wilson
- Institute of Urologic Excellence, La Quinta, CA, USA
| | - T Heinze
- Institute of Anatomy, Center of Clinical Anatomy, Kiel University, Kiel, Germany
| | - M Heimke
- Institute of Anatomy, Center of Clinical Anatomy, Kiel University, Kiel, Germany
| | - J Novak
- Department of Urology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Ragheb
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - T Köhler
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - T Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Kiel University, Kiel, Germany
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3
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Osmonov D, Wilson SK, Heinze T, Heimke M, Novak J, Ragheb A, Köhler T, Hatzichristodoulou G, Wedel T. Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops. Int J Impot Res 2023; 35:672-678. [PMID: 37179421 PMCID: PMC10622313 DOI: 10.1038/s41443-023-00715-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Surgical implantation of an inflatable penile prosthesis (IPP) remains the gold-standard treatment for severe erectile dysfunction. The ideal surgical technique requires a thorough understanding of the relevant anatomy. This includes anatomic considerations related to, but not limited to, dissection and exposure of penoscrotal fasciae and tissues, corporal configuration, and abdominal structures. Insights obtained from pre-dissected anatomic specimens can obviate urethral injury, nerve damage, corporal perforation, inappropriate sizing, crossover, or implant malposition. We present penile implant-specific anatomic dissections and topographic landmarks identified over the last decade in the course of surgical training programs provided for IPP implantation.
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Affiliation(s)
- D Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
| | - S K Wilson
- Institute of Urologic Excellence, La Quinta, CA, USA
| | - T Heinze
- Institute of Anatomy, Center of Clinical Anatomy, Kiel University, Kiel, Germany
| | - M Heimke
- Institute of Anatomy, Center of Clinical Anatomy, Kiel University, Kiel, Germany
| | - J Novak
- Department of Urology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Ragheb
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - T Köhler
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - T Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Kiel University, Kiel, Germany
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4
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Kerner AM, Biedermann U, Bräuer L, Caspers S, Doll S, Engelhardt M, Filler TJ, Ghebremedhin E, Gundlach S, Hayn-Leichsenring GU, Heermann S, Hettwer-Steeger I, Hiepe L, Hirt B, Hirtler L, Hörmann R, Kulisch C, Lange T, Leube R, Meuser AH, Müller-Gerbl M, Nassenstein C, Neckel PH, Nimtschke U, Paulsen F, Prescher A, Pretterklieber M, Schliwa S, Schmidt K, Schmiedl A, Schomerus C, Schulze-Tanzil G, Schumacher U, Schumann S, Spindler V, Streicher J, Tschernig T, Unverzagt A, Valentiner U, Viebahn C, Wedel T, Weigner J, Weninger WJ, Westermann J, Weyers I, Waschke J, Hammer N. The chemicals between us-First results of the cluster analyses on anatomy embalming procedures in the German-speaking countries. Anat Sci Educ 2023; 16:814-829. [PMID: 37183973 DOI: 10.1002/ase.2285] [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: 02/17/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/16/2023]
Abstract
Hands-on courses utilizing preserved human tissues for educational training offer an important pathway to acquire basic anatomical knowledge. Owing to the reevaluation of formaldehyde limits by the European Commission, a joint approach was chosen by the German-speaking anatomies in Europe (Germany, Austria, Switzerland) to find commonalities among embalming protocols and infrastructure. A survey comprising 537 items was circulated to all anatomies in German-speaking Europe. Clusters were established for "ethanol"-, formaldehyde-based ("FA"), and "other" embalming procedures, depending on the chemicals considered the most relevant for each protocol. The logistical framework, volumes of chemicals, and infrastructure were found to be highly diverse between the groups and protocols. Formaldehyde quantities deployed per annum were three-fold higher in the "FA" (223 L/a) compared to the "ethanol" (71.0 L/a) group, but not for "other" (97.8 L/a), though the volumes injected per body were similar. "FA" was strongly related to table-borne air ventilation and total fixative volumes ≤1000 L. "Ethanol" was strongly related to total fixative volumes >1000 L, ceiling- and floor-borne air ventilation, and explosion-proof facilities. Air ventilation was found to be installed symmetrically in the mortuary and dissection facilities. Certain predictors exist for the interplay between the embalming used in a given infrastructure and technical measures. The here-established cluster analysis may serve as decision supportive tool when considering altering embalming protocols or establishing joint protocols between institutions, following a best practice approach to cater toward best-suited tissue characteristics for educational purposes, while simultaneously addressing future demands on exposure limits.
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Affiliation(s)
- Alexander Michael Kerner
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Uta Biedermann
- Institute of Anatomy I, University Hospital Jena, Jena, Germany
| | - Lars Bräuer
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Svenja Caspers
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sara Doll
- Department of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Maren Engelhardt
- Institute of Anatomy and Cell Biology, Johannes Kepler University, Linz, Austria
| | - Timm J Filler
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Stefanie Gundlach
- Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | | | - Stephan Heermann
- Institute for Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Laura Hiepe
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Romed Hörmann
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Kulisch
- Institute of Functional Anatomy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Lange
- Institute of Anatomy I, University Hospital Jena, Jena, Germany
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Leube
- Department of Anatomy and Cell Biology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Annika Hela Meuser
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | | | | | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Ute Nimtschke
- Institute of Anatomy, Technical University Carl Gustav Carus Dresden, Dresden, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Prescher
- Department of Anatomy and Cell Biology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Michael Pretterklieber
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Stefanie Schliwa
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Bonn, Germany
| | - Katja Schmidt
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Andreas Schmiedl
- Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Christof Schomerus
- Institute of Anatomy, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Nuremberg, Germany
| | - Udo Schumacher
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Schumann
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Volker Spindler
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Johannes Streicher
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Thomas Tschernig
- Institute of Anatomy and Cell Biology, Saarland University, Homburg, Germany
| | - Axel Unverzagt
- Chair of Vegetative Anatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Ursula Valentiner
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Janet Weigner
- Institute of Veterinary Anatomy, Freie Universität Berlin, Berlin, Germany
| | - Wolfgang J Weninger
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Imke Weyers
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Jens Waschke
- Chair of Vegetative Anatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology Dresden, Dresden, Germany
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Lippross S, Wehrenpfennig C, Wedel T, Seekamp A, Osmonov D, Moradi B, Fitschen-Oestern S, Finn J, Klueter T, Kurz B, Alkatout I. The anterior transmuscular intrapelvic approach for the treatment of acetabular fractures-a new anterior surgical strategy. BMC Musculoskelet Disord 2023; 24:638. [PMID: 37559078 PMCID: PMC10411011 DOI: 10.1186/s12891-023-06775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
The anterior ilioinguinal and the posterior Kocher-Langenbeck approach have long been the standard surgical approaches to the acetabulum. The last decade has witnessed the development of so-called intrapelvic approaches for anterior pathologies because they provide better exposure of the quadrilateral plate. Currently, the modified Stoppa approach and the pararectus approach are frequently used by surgeons for the treatment of acetabular fractures. We investigated an even more direct access to the entire anterior column and the quadrilateral plate via the abdominal wall muscles, between the incisions for the ilioinguinal and the pararectus approach.After intensive study of anatomic specimens, a cadaver dissection was performed prior to clinical application. The approach was then used in 20 patients who were assessed retrospectively.Postoperative CT scans showed that, according to the Matta scoring system, the quality of fracture reduction was "anatomical" (≤ 1 mm) in 12 (60%), "imperfect" (2-3 mm) in four (20%), and "poor" (> 3 mm) in four (20%) patients. Numerous minor complications were observed; the majority of these had resolved at the time of discharge.In conclusion, the anterior transmuscular intrapelvic approach (ATI) is a safe and effective alternative to the ilioinguinal and pararectal approaches, and may be regarded as an evolutionary advancement of traditional procedures.
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Affiliation(s)
- Sebastian Lippross
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Clara Wehrenpfennig
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrecht University, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Daniar Osmonov
- Department of Urology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Babak Moradi
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stefanie Fitschen-Oestern
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Joerg Finn
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Tim Klueter
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Bodo Kurz
- Institute of Anatomy, Christian-Albrecht University, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynaecology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Heimke M, Richter F, Heinze T, Kunke M, Wedel T, Böttner M, Egberts JH, Lucius R, Cossais F. Localization Pattern of Dispatched Homolog 2 (DISP2) in the Central and Enteric Nervous System. J Mol Neurosci 2023; 73:539-548. [PMID: 37369878 PMCID: PMC10517031 DOI: 10.1007/s12031-023-02129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
Dispatched homolog (DISP) proteins have been implicated in the regulation of hedgehog signaling during embryologic development. Although DISP2 has recently been associated with neuronal development and control of cognitive functions, its localization pattern in the mammalian central and peripheral nervous system has not yet been investigated. In this study, the Disp2 expression profile was assessed in human tissues from publicly available transcriptomic datasets. The DISP2 localization pattern was further characterized in the human and rat central nervous system (CNS), as well as within the colonic enteric nervous system (ENS) using dual-label immunohistochemistry. Colocalization of DISP2 with neuronal and glial markers was additionally analyzed in murine primary ENS culture. At transcriptomic level, DISP2 expression was predominant in neuronal cell types of the CNS and ENS. DISP2 immunoreactivity was mainly located within PGP9.5-positive neurons rather than in S100-positive glial cells throughout the nervous system. Investigation of human and rat brain tissues, colonic specimens, and murine ENS primary cultures revealed that DISP2 was located in neuronal cell somata, as well as along neuronal processes both in the human and murine CNS and ENS. Our results indicate that DISP2 is prominently localized within neuronal cells of the CNS and ENS and support putative functions of DISP2 in these tissues.
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Affiliation(s)
- Marvin Heimke
- Institute of Anatomy, Kiel University, Olshausenstrasse 40, 24098, Kiel, Germany
| | - Florian Richter
- Department of General, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Tillmann Heinze
- Institute of Anatomy, Kiel University, Olshausenstrasse 40, 24098, Kiel, Germany
| | - Madlen Kunke
- Institute of Anatomy, Kiel University, Olshausenstrasse 40, 24098, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Kiel University, Olshausenstrasse 40, 24098, Kiel, Germany
| | - Martina Böttner
- Institute of Anatomy, Kiel University, Olshausenstrasse 40, 24098, Kiel, Germany
| | | | - Ralph Lucius
- Institute of Anatomy, Kiel University, Olshausenstrasse 40, 24098, Kiel, Germany
| | - François Cossais
- Institute of Anatomy, Kiel University, Olshausenstrasse 40, 24098, Kiel, Germany.
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Stelzner S, Heinze T, Heimke M, Gockel I, Kittner T, Brown G, Mees ST, Wedel T. Beyond Total Mesorectal Excision: Compartment-based Anatomy of the Pelvis Revisited for Exenterative Pelvic Surgery. Ann Surg 2023; 278:e58-e67. [PMID: 36538640 DOI: 10.1097/sla.0000000000005715] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Magnetic resonance imaging-based subdivision of the pelvis into 7 compartments has been proposed for pelvic exenteration. The aim of the present anatomical study was to describe the topographic anatomy of these compartments and define relevant landmarks and surgical dissection planes. BACKGROUND Pelvic anatomy as it relates to exenterative surgery is complex. Demonstration of the topographic peculiarities of the pelvis based on the operative situs is hindered by the inaccessibility of the small pelvis and the tumor bulk itself. MATERIALS AND METHODS Thirteen formalin-fixed pelvic specimens were meticulously dissected according to predefined pelvic compartments. Pelvic exenteration was simulated and illustrated in a stepwise manner. Different access routes were used for optimal demonstration of the regions of interest. RESULTS All the 7 compartments (peritoneal reflection, anterior above peritoneal reflection, anterior below peritoneal reflection, central, posterior, lateral, inferior) were investigated systematically. The topography of the pelvic fasciae and ligaments; vessels and nerves of the bladder, prostate, uterus, and vagina; the internal iliac artery and vein; the course of the ureter, somatic (obturator nerve, sacral plexus), and autonomic pelvic nerves (inferior hypogastric plexus); pelvic sidewall and floor, ischioanal fossa; and relevant structures for sacrectomy were demonstrated. CONCLUSIONS A systematic approach to pelvic anatomy according to the 7 magnetic resonance imaging-defined compartments clearly revealed crucial anatomical landmarks and key structures facilitating pelvic exenterative surgery. Compartment-based pelvic anatomy proved to be a sound concept for beyond TME surgery and provides a basis for tailored resection procedures.
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Affiliation(s)
- Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Tillmann Heinze
- Institute of Anatomy, Center of Clinical Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Marvin Heimke
- Institute of Anatomy, Center of Clinical Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Thomas Kittner
- Department of Radiology, Dresden-Friedrichstadt General Hospital, Dresden, Germany
| | - Gina Brown
- Department of Surgery and Cancer, Gastrointestinal Imaging, Imperial College, London, UK
| | - Sören T Mees
- Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Dresden, Germany
| | - Thilo Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
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Wedel T, Heimke M, Fletcher J, Miskovic D, Benz S, Stelzner S, Heinze T. The retrocolic fascial system revisited for right hemicolectomy with complete mesocolic excision based on anatomical terminology: do we need the eponyms Toldt, Gerota, Fredet and Treitz? Colorectal Dis 2022; 25:764-774. [PMID: 36457274 DOI: 10.1111/codi.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/04/2022]
Abstract
AIM Right hemicolectomy with complete mesocolic excision (CME) requires the removal of an intact mesocolic envelope. The study aimed to determine, on the basis of macroscopic and microscopic anatomical studies, the optimal surgical dissection planes for CME to preserve fascial integrity. Unequivocal anatomical nomenclature was applied to describe the retrocolic fascial system and compared to frequently used eponyms (Toldt, Gerota, Fredet, Treitz). METHOD Stepwise macroscopic dissections, cross-section studies and histological analysis were performed on body donors to identify the components of the retrocolic fascial system. Based on these anatomical findings, the optimal surgical dissection planes for CME were validated in laparoscopic training courses on body donors and in robot-assisted surgical procedures in patients. RESULTS The mesocolic tissue and lymphovascular pedicles were enveloped by the ventral and dorsal mesocolic leaf (mesocolic fascia). The mesocolic fascia was attached to the parietal peritoneal fascia ('fascia of Toldt') along the parieto-mesocolic interface, and further cranially to the pre-duodenopancreatic fascia along the mesocolic-duodenopancreatic interface ('space of Fredet'). Dorsally, the parietal peritoneal fascia was separated from the anterior renal fascia ('fascia of Gerota') by the parieto-renal interface. Dissection along this interface in front of the anterior renal fascia followed by incision of the parietal peritoneal fascia at the duodenal border and opening the mesocolic-duodenopancreatic interface yielded the best macroscopic appearance of specimens and was considered optimal for CME. CONCLUSION The retrocolic fascial system as well as the surgical dissection planes for CME can be described by clearly defined anatomical terms rather than potentially confusing eponyms.
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Affiliation(s)
- Thilo Wedel
- Center of Clinical Anatomy, Institute of Anatomy, Kurt-Semm Center for Minimally Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | - Marvin Heimke
- Center of Clinical Anatomy, Institute of Anatomy, Kurt-Semm Center for Minimally Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | | | | | - Stefan Benz
- Department for Abdominal and Pediatric Surgery, Klinikverbund-Suedwest, Kliniken Boeblingen, Boeblingen, Germany
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Tillmann Heinze
- Center of Clinical Anatomy, Institute of Anatomy, Kurt-Semm Center for Minimally Invasive and Robotic Surgery, Kiel University, Kiel, Germany
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9
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Wedel T, Gómez Ruiz M, Tou S, Stelzner S, Matzel KE. Surgical anatomy of the rectum: a series of video tutorials - a video vignette. Colorectal Dis 2022; 25:1047-1050. [PMID: 36451336 DOI: 10.1111/codi.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Thilo Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Kiel University, Kiel, Germany
| | - Marcos Gómez Ruiz
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, Santander, Spain.,Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Samson Tou
- Department of Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Klaus E Matzel
- Section Coloproctology, Department of Surgery, Friedrich-Alexander University Erlangen, Erlangen, Germany
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10
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Filz von Reiterdank ICLJ, Defize IL, de Groot EM, Wedel T, Grimminger PP, Egberts JH, Stein H, Ruurda JP, van Hillegersberg R, Bleys RLAW. The surgical anatomy of a (robot-assisted) minimally invasive transcervical esophagectomy. Dis Esophagus 2022; 36:6758199. [PMID: 36222066 DOI: 10.1093/dote/doac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/26/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transcervical esophagectomy allows for esophagectomy through transcervical access and bypasses the thoracic cavity, thereby eliminating single lung ventilation. A challenging surgical approach demands thorough understanding of the encountered anatomy. This study aims to provide a comprehensive overview of surgical anatomy encountered during the (robot-assisted) minimally invasive transcervical esophagectomy (RACE and MICE). METHODS To assess the surgical anatomy of the lower neck and mediastinum, MR images were made of a body donor after, which it was sliced at 24-μm intervals with a cryomacrotome. Images were made every 3 slices resulting in 3.200 images of which a digital 3D multiplanar reconstruction was made. For macroscopic verification, microscopic slices were made and stained every 5 mm (Mallory-Cason). Schematic drawings were made of the 3D reconstruction to demonstrate the course of essential anatomical structures in the operation field and identify anatomical landmarks. RESULTS Surgical anatomy 'boxes' of three levels (superior thoracic aperture, upper mediastinum, subcarinal) were created. Four landmarks were identified: (i) the course of the thoracic duct in the mediastinum; (ii) the course of the left recurrent laryngeal nerve; (iii) the crossing of the azygos vein right and dorsal of the esophagus; and (iv) the position of the aortic arch, the pulmonary arteries, and veins. CONCLUSIONS The presented 3D reconstruction of unmanipulated human anatomy and schematic 3D 'boxes' provide a comprehensive overview of the surgical anatomy during the RACE or MICE. Our findings provide a useful tool to aid surgeons in learning the complex anatomy of the mediastinum and the exploration of new surgical approaches such as the RACE or MICE.
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Affiliation(s)
| | - I L Defize
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E M de Groot
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Kurt Semm Center for Minimal Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - J H Egberts
- Department of Surgery, Jewish Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Stein
- Department of Surgical Applications Engineering, Intuitive Surgical, Sunnyvale CA, USA
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
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11
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Andresen V, Becker G, Frieling T, Goebel-Stengel M, Gundling F, Herold A, Karaus M, Keller J, Kim M, Klose P, Krammer H, Kreis ME, Kuhlbusch-Zicklam R, Langhorst J, Layer P, Lenzen-Großimlinghaus R, Madisch A, Mönnikes H, Müller-Lissner S, Rubin D, Schemann M, Schwille-Kiuntke J, Stengel A, Storr M, van der Voort I, Voderholzer W, Wedel T, Wirz S, Witzigmann H, Pehl C. Aktualisierte S2k-Leitlinie chronische Obstipation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie & Motilität (DGNM) – April 2022 – AWMF-Registriernummer: 021–019. Z Gastroenterol 2022; 60:1528-1572. [PMID: 36223785 DOI: 10.1055/a-1880-1928] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - G Becker
- Klinik für Palliativmedizin, Freiburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios-Klinikum Krefeld, Krefeld, Deutschland
| | | | - F Gundling
- Medizinische Klinik II (Gastroenterologie, Gastroenterologische Onkologie, Hepatologie, Diabetologie, Stoffwechsel, Infektiologie), Klinikum am Bruderwald, Bamberg, Deutschland
| | - A Herold
- Sozialstiftung Bamberg, End- und Dickdarm-Zentrum Mannheim, Mannheim, Deutschland
| | - M Karaus
- Abt. Innere Medizin, Evang. Krankenhaus Göttingen-Weende, Göttingen, Deutschland
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M Kim
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I) des Universitätsklinikums, Zentrum Operative Medizin (ZOM), Würzburg, Deutschland
| | - P Klose
- Universität Duisburg-Essen, Medizinische Fakultät, Essen, Deutschland
| | - H Krammer
- Sozialstiftung Bamberg, End- und Dickdarm-Zentrum Mannheim, Mannheim, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Knappschafts-Krankenhaus, Essen, Deutschland
| | - P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | | | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah-Oststadt-Heidehaus, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - D Rubin
- Klinik für Innere Medizin Schwerpunkt Gastroenterologie, DRK Kliniken Berlin Mitte, Berlin, Deutschland.,Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie, Vivantes Klinikum Spandau, Spandau, Deutschland
| | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Freising, Deutschland
| | - J Schwille-Kiuntke
- Innere Medizin VI Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - A Stengel
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Starnberg, Deutschland
| | - I van der Voort
- Klinik für Innere Medizin Gastroenterologie und Diabetologie, Jüdisches Krankenhaus Berlin, Berlin, Deutschland
| | | | - T Wedel
- Anatomisches Institut, Universität Kiel, Kiel, Deutschland
| | - S Wirz
- Cura Krankenhaus Bad Honnef, Bad Honnef, Deutschland
| | - H Witzigmann
- Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Dresden-Friedrichstadt, Dresden, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
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12
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Singh M, Akkaya S, Preuß M, Rademacher F, Tohidnezhad M, Kubo Y, Behrendt P, Weitkamp JT, Wedel T, Lucius R, Gläser R, Harder J, Bayer A. Platelet-Released Growth Factors Influence Wound Healing-Associated Genes in Human Keratinocytes and Ex Vivo Skin Explants. Int J Mol Sci 2022; 23:ijms23052827. [PMID: 35269967 PMCID: PMC8911300 DOI: 10.3390/ijms23052827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
Platelet-released growth factors (PRGFs) or other thrombocyte concentrate products, e.g., Platelet-Rich Fibrin (PRF), have become efficient tools of regenerative medicine in many medical disciplines. In the context of wound healing, it has been demonstrated that treatment of chronic or complicated wounds with PRGF or PRF improves wound healing in the majority of treated patients. Nevertheless, the underlying cellular and molecular mechanism are still poorly understood. Therefore, we aimed to analyze if PRGF-treatment of human keratinocytes caused the induction of genes encoding paracrine factors associated with successful wound healing. The investigated genes were Semaphorin 7A (SEMA7A), Angiopoietin-like 4 (ANGPLT4), Fibroblast Growth Factor-2 (FGF-2), Interleukin-32 (IL-32), the CC-chemokine-ligand 20 (CCL20), the matrix-metalloproteinase-2 (MMP-2), the chemokine C-X-C motif chemokine ligand 10 (CXCL10) and the subunit B of the Platelet-Derived Growth Factor (PDGFB). We observed a significant gene induction of SEMA7A, ANGPLT4, FGF-2, IL-32, MMP-2 and PDGFB in human keratinocytes after PRGF treatment. The CCL20- and CXCL10 gene expressions were significantly inhibited by PRGF therapy. Signal transduction analyses revealed that the PRGF-mediated gene induction of SEMA7A, ANGPLT4, IL-32 and MMP-2 in human keratinocytes was transduced via the IL-6 receptor pathway. In contrast, EGF receptor signaling was not involved in the PRGF-mediated gene expression of analyzed genes in human keratinocytes. Additionally, treatment of ex vivo skin explants with PRGF confirmed a significant gene induction of SEMA7A, ANGPLT4, MMP-2 and PDGFB. Taken together, these results describe a new mechanism that could be responsible for the beneficial wound healing properties of PRGF or related thrombocytes concentrate products such as PRF.
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Affiliation(s)
- Michael Singh
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
| | - Serhat Akkaya
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
| | - Mark Preuß
- Department for Vascular Medicine, Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Franziska Rademacher
- Department of Dermatology, Venerology and Allergology, Kiel University, 24105 Kiel, Germany; (F.R.); (R.G.); (J.H.)
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, 52074 Aachen, Germany; (M.T.); (Y.K.)
| | - Yusuke Kubo
- Department of Anatomy and Cell Biology, RWTH Aachen University, 52074 Aachen, Germany; (M.T.); (Y.K.)
| | - Peter Behrendt
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Jan-Tobias Weitkamp
- Department of Oral and Maxillofacial Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, 24015 Kiel, Germany;
| | - Thilo Wedel
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
| | - Ralph Lucius
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
| | - Regine Gläser
- Department of Dermatology, Venerology and Allergology, Kiel University, 24105 Kiel, Germany; (F.R.); (R.G.); (J.H.)
| | - Jürgen Harder
- Department of Dermatology, Venerology and Allergology, Kiel University, 24105 Kiel, Germany; (F.R.); (R.G.); (J.H.)
| | - Andreas Bayer
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
- Correspondence:
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13
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Keller J, Wedel T, Seidl H, Kreis ME, van der Voort I, Gebhard M, Langhorst J, Lynen Jansen P, Schwandner O, Storr M, van Leeuwen P, Andresen V, Preiß JC, Layer P, Allescher H, Andus T, Bischoff SC, Buderus S, Claßen M, Ehlert U, Elsenbruch S, Engel M, Enninger A, Fischbach W, Freitag M, Frieling T, Gillessen A, Goebel-Stengel M, Gschossmann J, Gundling F, Haag S, Häuser W, Helwig U, Hollerbach S, Holtmann G, Karaus M, Katschinski M, Krammer H, Kruis W, Kuhlbusch-Zicklam R, Lynen Jansen P, Madisch A, Matthes H, Miehlke S, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Posovszky C, Raithel M, Röhrig-Herzog G, Schäfert R, Schemann M, Schmidt-Choudhury A, Schmiedel S, Schweinlin A, Schwille-Kiuntke J, Stengel A, Tesarz J, Voderholzer W, von Boyen G, von Schönfeld J. Update S3-Leitlinie Intestinale Motilitätsstörungen: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM). Z Gastroenterol 2022; 60:192-218. [PMID: 35148561 DOI: 10.1055/a-1646-1279] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jutta Keller
- Medizinische Klinik, Israelitisches Krankenhaus in Hamburg, Hamburg, Deutschland
| | - Thilo Wedel
- Institut für Anatomie, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Holger Seidl
- Klinik für Gastroenterologie, Hepatologie und Gastroenterologische Onkologie, Isarklinikum München, München, Deutschland
| | - Martin E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité, Campus Benjamin Franklin, Berlin, Deutschland
| | - Ivo van der Voort
- Klinik für Innere Medizin - Gastroenterologie und Diabetologie, Jüdisches Krankenhaus Berlin, Deutschland
| | | | - Jost Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Klinikum Bamberg, Bamberg, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - Oliver Schwandner
- Abteilung für Proktologie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Martin Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg
| | - Pia van Leeuwen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - Viola Andresen
- Medizinische Klinik, Israelitisches Krankenhaus in Hamburg, Hamburg, Deutschland
| | - Jan C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Klinikum Neukölln, Berlin
| | - Peter Layer
- Medizinische Klinik, Israelitisches Krankenhaus in Hamburg, Hamburg, Deutschland
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14
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Wedel T, Heinze T, Möller T, van Hillegersberg R, Bleys RLAW, Weijs TJ, van der Sluis PC, Grimminger PP, Sallum RA, Becker T, Egberts JH. Surgical anatomy of the upper esophagus related to robot-assisted cervical esophagectomy. Dis Esophagus 2021; 34:6102595. [PMID: 33458744 DOI: 10.1093/dote/doaa128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
Robot-assisted cervical esophagectomy (RACE) enables radical surgery for tumors of the middle and upper esophagus, avoiding a transthoracic approach. However, the cervical access, narrow working space, and complex topographic anatomy make this procedure particularly demanding. Our study offers a stepwise description of appropriate dissection planes and anatomical landmarks to facilitate RACE. Macroscopic dissections were performed on formaldehyde-fixed body donors (three females, three males), according to the surgical steps during RACE. The topographic anatomy and surgically relevant structures related to the cervical access route to the esophagus were described and illustrated, along with the complete mobilization of the cervical and upper thoracic segment. The carotid sheath, intercarotid fascia, and visceral fascia were identified as helpful landmarks, used as optimal dissection planes to approach the cervical esophagus and preserve the structures at risk (trachea, recurrent laryngeal nerves, thoracic duct, sympathetic trunk). While ventral dissection involved detachment of the esophagus from the tracheal cartilage and membranous part, the dorsal dissection plane comprised the prevertebral compartment harboring the thoracic duct and right intercosto-bronchial artery. On the left side, the esophagus was attached to the aortic arch by the aorto-esophageal ligament; on the right side, the esophagus was bordered by the azygos vein, right vagus nerve, and cardiac nerves. The stepwise, illustrated topographic anatomy addressed specific surgical demands and perspectives related to the left cervical approach and dissection of the esophagus, providing an anatomical basis to facilitate and safely implement the RACE procedure.
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Affiliation(s)
- Thilo Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Kurt Semm Center for Minimal Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | - Tillmann Heinze
- Institute of Anatomy, Center of Clinical Anatomy, Kurt Semm Center for Minimal Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | - Thorben Möller
- Department for General, Visceral, Thoracic, Transplant, and Pediatric Surgery, Kurt Semm Center for Minimal Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | | | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Teun J Weijs
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Rubens A Sallum
- University of São Paulo, Department of Gastroenterology, São Paulo, Brazil
| | - Thomas Becker
- Department for General, Visceral, Thoracic, Transplant, and Pediatric Surgery, Kurt Semm Center for Minimal Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department for General, Visceral, Thoracic, Transplant, and Pediatric Surgery, Kurt Semm Center for Minimal Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Kiel, Germany
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15
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Layer P, Andresen V, Allescher H, Bischoff SC, Claßen M, Elsenbruch S, Freitag M, Frieling T, Gebhard M, Goebel-Stengel M, Häuser W, Holtmann G, Keller J, Kreis ME, Kruis W, Langhorst J, Jansen PL, Madisch A, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Raithel M, Röhrig-Herzog G, Schemann M, Schmiedel S, Schwille-Kiuntke J, Storr M, Preiß JC, Andus T, Buderus S, Ehlert U, Engel M, Enninger A, Fischbach W, Gillessen A, Gschossmann J, Gundling F, Haag S, Helwig U, Hollerbach S, Karaus M, Katschinski M, Krammer H, Kuhlbusch-Zicklam R, Matthes H, Menge D, Miehlke S, Posovszky MC, Schaefert R, Schmidt-Choudhury A, Schwandner O, Schweinlin A, Seidl H, Stengel A, Tesarz J, van der Voort I, Voderholzer W, von Boyen G, von Schönfeld J, Wedel T. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016. Z Gastroenterol 2021; 59:1323-1415. [PMID: 34891206 DOI: 10.1055/a-1591-4794] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - H Allescher
- Zentrum für Innere Medizin, Gastroent., Hepatologie u. Stoffwechsel, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - S C Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart, Deutschland
| | - M Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - S Elsenbruch
- Klinik für Neurologie, Translational Pain Research Unit, Universitätsklinikum Essen, Essen, Deutschland.,Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Freitag
- Abteilung Allgemeinmedizin Department für Versorgungsforschung, Universität Oldenburg, Oldenburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - M Gebhard
- Gemeinschaftspraxis Pathologie-Hamburg, Hamburg, Deutschland
| | - M Goebel-Stengel
- Innere Medizin II, Helios Klinik Rottweil, Rottweil, und Innere Medizin VI, Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - W Häuser
- Innere Medizin I mit Schwerpunkt Gastroenterologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
| | - G Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, Princess Alexandra Hospital, Brisbane, Australien
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Deutschland
| | - P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - B Niesler
- Abteilung Molekulare Humangenetik Institut für Humangenetik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
| | - D Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - M Raithel
- Medizinische Klinik II m.S. Gastroenterologie und Onkologie, Waldkrankenhaus St. Marien, Erlangen, Deutschland
| | | | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Deutschland
| | - S Schmiedel
- I. Medizinische Klinik und Poliklinik Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - J Schwille-Kiuntke
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg, Deutschland
| | - J C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Heimke M, Heinze T, Kuthe A, Wedel T, Strey C. P138 PREPERITONEAL ENDOSCOPIC GROIN HERNIA SURGERY - REASSESSMENT OF TOPOGRAPHIC ANATOMY AS A BASIS FOR STANDARDIZED DESCRIPTION OF SURGICAL STEPS. Br J Surg 2021. [DOI: 10.1093/bjs/znab395.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Fascial groin anatomy remains a conundrum. In particular, a clear anatomical allocation of the correct extraperitoneal dissection planes and spaces in total extraperitoneal endoscopic hernia surgery (TEP) has not yet agreed upon. The differing anatomical concepts are reflected by the variability of surgical approaches, the considerably long learning curves and subsequent complications. Thus, the aim of this study was to reassess the topographic anatomy of the groin region providing a basis to standardize the surgical steps of TEP according to clearly defined anatomical landmarks.
Material and Methods
Video analysis of intraoperative surgical anatomy of groin hernia patients was correlated with the findings retrieved by macroscopic anatomical studies. The groin region of formalin fixed body donors was subjected to a stepwise dissection exposing the fascial system of the abdominal wall layer-by-layer and via different angles. Selected areas of interest were processed for histological study. Surgically relevant anatomical landmarks were defined and termed according to the most appropriate anatomical nomenclature.
Results
The essential surgical dissection steps during TEP could be related to specific anatomical landmarks extending within the extraperitoneal space of the ventral and dorsolateral abdominal wall. The definition of fascial structures and interfaces and the identification of structures at risk allowed the identification of correct dissection planes for mesh placement.
Conclusions
Our study helps to clarify the definition and nomenclature of anatomical key structures required for a standardized description of TEP in a simplified model. The data may contribute to reduce complications and improve surgical teaching and training.
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Affiliation(s)
- Marvin Heimke
- Christian-Albrechts-Universität zu Kiel, Anatomisches Institut, Kiel, Germany
| | - Tilmann Heinze
- Christian-Albrechts-Universität zu Kiel, Anatomisches Institut, Kiel, Germany
| | - Andreas Kuthe
- Rentner, Clementinenhaus Hannover, Nn, Hannnover, Germany
| | - Thilo Wedel
- Anatomisches Institut, Christian-Albrechts-Universität zu Kiel, Universität Kiel, Kiel, Germany
| | - Christoph W Strey
- Clementinenhaus, Allgemein- und Viszeralchirurgie, Hannover, Germany
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17
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Alkatout I, Holthaus B, Bozzaro C, Wedel T, Westermann AM, Westermann M, Mettler L, Jünemann KP, Becker T, Maass N, Ackermann J. Surgeon and surgical conference attendee views on live surgery events. Br J Surg 2021; 108:e371-e372. [PMID: 34476469 DOI: 10.1093/bjs/znab297] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/25/2021] [Indexed: 12/21/2022]
Abstract
Based on the principles of biomedical ethics, the authors conducted a survey focusing on the ethical aspects of, didactic benefits of and possible alternatives to live surgery events. This work provides an investigation of the ethics of live surgery events in an interdisciplinary and multicentre setting. Critical ethical concerns regarding the justification of such events are highlighted through evaluation of attendees and surgeons.
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Affiliation(s)
- I Alkatout
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - B Holthaus
- Clinic of Obstetrics and Gynaecology, St. Elisabeth Hospital, Damme, Germany
| | - C Bozzaro
- Medical Ethics, Institute of Experimental Medicine, Christian-Albrechts University Kiel, Kiel, Germany
| | - T Wedel
- Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - A M Westermann
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany.,Medical Ethics, Institute of Experimental Medicine, Christian-Albrechts University Kiel, Kiel, Germany
| | - M Westermann
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - L Mettler
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - K-P Jünemann
- Department of Urology and Paediatric Urology, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - T Becker
- Department of General, Visceral, Thoracic, Transplant, and Paediatric Surgery, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - N Maass
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - J Ackermann
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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18
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Wong YL, Lautenschläger I, Hummitzsch L, Zitta K, Cossais F, Wedel T, Rusch R, Berndt R, Gruenewald M, Weiler N, Steinfath M, Albrecht M. Effects of different ischemic preconditioning strategies on physiological and cellular mechanisms of intestinal ischemia/reperfusion injury: Implication from an isolated perfused rat small intestine model. PLoS One 2021; 16:e0256957. [PMID: 34478453 PMCID: PMC8415612 DOI: 10.1371/journal.pone.0256957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023] Open
Abstract
Background Intestinal ischemia/reperfusion (I/R)-injury often results in sepsis and organ failure and is of major importance in the clinic. A potential strategy to reduce I/R-injury is the application of ischemic preconditioning (IPC) during which repeated, brief episodes of I/R are applied. The aim of this study was to evaluate physiological and cellular effects of intestinal I/R-injury and to compare the influence of in-vivo IPC (iIPC) with ex-vivo IPC (eIPC), in which blood derived factors and nerval regulations are excluded. Methods Using an established perfused rat intestine model, effects of iIPC and eIPC on physiological as well as cellular mechanisms of I/R-injury (60 min hypoxia, 30 min reperfusion) were investigated. iIPC was applied by three reversible occlusions of the mesenteric artery in-vivo for 5 min followed by 5 min of reperfusion before isolating the small intestine, eIPC was induced by stopping the vascular perfusion ex-vivo 3 times for 5 min followed by 5 min of reperfusion after isolation of the intestine. Study groups (each N = 8–9 animals) were: iIPC, eIPC, I/R (iIPC group), I/R (eIPC group), iIPC+I/R, eIPC+I/R, no intervention/control (iIPC group), no intervention/control (eIPC group). Tissue morphology/damage, metabolic functions, fluid shifts and barrier permeability were evaluated. Cellular mechanisms were investigated using signaling arrays. Results I/R-injury decreased intestinal galactose uptake (iIPC group: p<0.001), increased vascular perfusion pressure (iIPC group: p<0.001; eIPC group: p<0.01) and attenuated venous flow (iIPC group: p<0.05) while lactate-to-pyruvate ratio (iIPC group, eIPC group: p<0.001), luminal flow (iIPC group: p<0.001; eIPC group: p<0.05), goblet cell ratio (iIPC group, eIPC group: p<0.001) and apoptosis (iIPC group, eIPC group: p<0.05) were all increased. Application of iIPC prior to I/R increased vascular galactose uptake (P<0.05) while eIPC had no significant impact on parameters of I/R-injury. On cellular level, I/R-injury resulted in a reduction of the phosphorylation of several MAPK signaling molecules. Application of iIPC prior to I/R increased phosphorylation of JNK2 and p38δ while eIPC enhanced CREB and GSK-3α/β phosphorylation. Conclusion Intestinal I/R-injury is associated with major physiological and cellular changes. However, the overall influence of the two different IPC strategies on the acute phase of intestinal I/R-injury is rather limited.
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Affiliation(s)
- Yuk Lung Wong
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ingmar Lautenschläger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Lars Hummitzsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Karina Zitta
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - François Cossais
- Institute of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - Rene Rusch
- Department of Visceral and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rouven Berndt
- Department of Visceral and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Gruenewald
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Norbert Weiler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus Steinfath
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Martin Albrecht
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
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19
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Fletcher J, Heinze T, Wedel T, Miskovic D. 43 Digital Human Project: 3D Photogrammetry for Human Cadaveric Pelvic Specimens: An Innovation in Colorectal Anatomical Education. Br J Surg 2021. [DOI: 10.1093/bjs/znab135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Cadaveric dissection remains an essential aspect of anatomical education but is not readily available to the majority of surgical trainees. 3D photogrammetry is the process of creating a 3D model from a series of 2D images and has tremendous potential in anatomical education. We describe a novel low-cost single-camera 3D photogrammetry technique to reconstruct cadaveric specimens as digital models.
Method
A formalin preserved hemipelvis was mounted on a turntable. Photos were taken sequentially at 5 o increments through 360° at three different fixed viewing angles (n = 216 photos) using a mirrorless camera with a 12-60mm f3.5-5.6 kit lens. Four surroundings LED standing lights were used to ensure diffuse ambient lighting of the specimen. Photos were imported into Agisoft Metashape software in order to generate a point cloud and produce the final virtual model composed of a polygon mesh.
Results
The specimen was successfully reconstructed and can be visualised at; https://sketchfab.com/3d-models/pelvic-sidewall-b76450b787824c968f864791d47318f2. The total processing time was 20 hrs.
Conclusions
Through this technique, we can produce accurate, interactive, and accessible 3D prosection models for surgical education. The method could be employed to establish a digital library of human anatomy for surgical training worldwide.
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Affiliation(s)
- J Fletcher
- St Mark's Hospital, London, United Kingdom
- Imperial College, London, United Kingdom
| | - T Heinze
- Christian-Albrecht University of Kiel, Kiel, Germany
| | - T Wedel
- Christian-Albrecht University of Kiel, Kiel, Germany
| | - D Miskovic
- St Mark's Hospital, London, United Kingdom
- Imperial College, London, United Kingdom
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20
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Zheng T, Ellinghaus D, Juzenas S, Cossais F, Burmeister G, Mayr G, Jørgensen IF, Teder-Laving M, Skogholt AH, Chen S, Strege PR, Ito G, Banasik K, Becker T, Bokelmann F, Brunak S, Buch S, Clausnitzer H, Datz C, Degenhardt F, Doniec M, Erikstrup C, Esko T, Forster M, Frey N, Fritsche LG, Gabrielsen ME, Gräßle T, Gsur A, Gross J, Hampe J, Hendricks A, Hinz S, Hveem K, Jongen J, Junker R, Karlsen TH, Hemmrich-Stanisak G, Kruis W, Kupcinskas J, Laubert T, Rosenstiel PC, Röcken C, Laudes M, Leendertz FH, Lieb W, Limperger V, Margetis N, Mätz-Rensing K, Németh CG, Ness-Jensen E, Nowak-Göttl U, Pandit A, Pedersen OB, Peleikis HG, Peuker K, Rodriguez CL, Rühlemann MC, Schniewind B, Schulzky M, Skieceviciene J, Tepel J, Thomas L, Uellendahl-Werth F, Ullum H, Vogel I, Volzke H, von Fersen L, von Schönfels W, Vanderwerff B, Wilking J, Wittig M, Zeissig S, Zobel M, Zawistowski M, Vacic V, Sazonova O, Noblin ES, Farrugia G, Beyder A, Wedel T, Kahlke V, Schafmayer C, D'Amato M, Franke A. Genome-wide analysis of 944 133 individuals provides insights into the etiology of haemorrhoidal disease. Gut 2021; 70:gutjnl-2020-323868. [PMID: 33888516 PMCID: PMC8292596 DOI: 10.1136/gutjnl-2020-323868] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Haemorrhoidal disease (HEM) affects a large and silently suffering fraction of the population but its aetiology, including suspected genetic predisposition, is poorly understood. We report the first genome-wide association study (GWAS) meta-analysis to identify genetic risk factors for HEM to date. DESIGN We conducted a GWAS meta-analysis of 218 920 patients with HEM and 725 213 controls of European ancestry. Using GWAS summary statistics, we performed multiple genetic correlation analyses between HEM and other traits as well as calculated HEM polygenic risk scores (PRS) and evaluated their translational potential in independent datasets. Using functional annotation of GWAS results, we identified HEM candidate genes, which differential expression and coexpression in HEM tissues were evaluated employing RNA-seq analyses. The localisation of expressed proteins at selected loci was investigated by immunohistochemistry. RESULTS We demonstrate modest heritability and genetic correlation of HEM with several other diseases from the GI, neuroaffective and cardiovascular domains. HEM PRS validated in 180 435 individuals from independent datasets allowed the identification of those at risk and correlated with younger age of onset and recurrent surgery. We identified 102 independent HEM risk loci harbouring genes whose expression is enriched in blood vessels and GI tissues, and in pathways associated with smooth muscles, epithelial and endothelial development and morphogenesis. Network transcriptomic analyses highlighted HEM gene coexpression modules that are relevant to the development and integrity of the musculoskeletal and epidermal systems, and the organisation of the extracellular matrix. CONCLUSION HEM has a genetic component that predisposes to smooth muscle, epithelial and connective tissue dysfunction.
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Affiliation(s)
- Tenghao Zheng
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
- Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simonas Juzenas
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Institute of Biotechnology, Life Science Centre, Vilnius University, Vilnius, Lithuania
| | - François Cossais
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Greta Burmeister
- Department for General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Gabriele Mayr
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Isabella Friis Jørgensen
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Heidi Skogholt
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sisi Chen
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Peter R Strege
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Go Ito
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Institute of Advanced Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Becker
- Department of General-, Visceral- Transplant-, Thoracic and Pediatric Surgery, Kiel University, Kiel, Germany
| | | | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Buch
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Hartmut Clausnitzer
- University Hospital Schleswig-Holstein, Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, Campus Kiel & Lübeck, Kiel, Germany
| | - Christian Datz
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Oberndorf, Austria
| | - Frauke Degenhardt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Marek Doniec
- Medical office for Colo-Proctology Kiel, Kiel, Germany
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Tõnu Esko
- Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Michael Forster
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Lars G Fritsche
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Maiken Elvestad Gabrielsen
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tobias Gräßle
- Epidemiology of highly pathogenic microorganisms, Robert Koch-Institute, Berlin, Germany
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Andrea Gsur
- Department of Medicine I, Institute of Cancer Research, Medical University Vienna, Vienna, Austria
| | - Justus Gross
- Department for General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
- Center for Regenerative Therapies Dresden (CRTD), Technische Universität (TU) Dresden, Dresden, Germany
| | - Alexander Hendricks
- Department for General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Sebastian Hinz
- Department for General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johannes Jongen
- Department of Proctological Surgery Park Klinik Kiel, Kiel, Germany
- Proctological Office Kiel, Kiel, Germany
| | - Ralf Junker
- University Hospital Schleswig-Holstein, Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, Campus Kiel & Lübeck, Kiel, Germany
| | - Tom Hemming Karlsen
- Research Institute for Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway
| | - Georg Hemmrich-Stanisak
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Wolfgang Kruis
- Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Juozas Kupcinskas
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tilman Laubert
- Department of Proctological Surgery Park Klinik Kiel, Kiel, Germany
- Proctological Office Kiel, Kiel, Germany
- University of Lübeck, Lübeck, Germany
| | - Philip C Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- University Hospital of Schleswig-Holstein (UKSH), Kiel Campus, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Fabian H Leendertz
- Epidemiology of highly pathogenic microorganisms, Robert Koch-Institute, Berlin, Germany
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Verena Limperger
- University Hospital Schleswig-Holstein, Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, Campus Kiel & Lübeck, Kiel, Germany
| | | | - Kerstin Mätz-Rensing
- Pathology Unit, German Primate Center, Leibniz Institute for Primatology, Göttingen, Germany
| | - Christopher Georg Németh
- Department of General-, Visceral- Transplant-, Thoracic and Pediatric Surgery, Kiel University, Kiel, Germany
- Department of Ophthalmology, Hospital Frankfurt Hoechst, Frankfurt, Germany
| | - Eivind Ness-Jensen
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ulrike Nowak-Göttl
- University Hospital Schleswig-Holstein, Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, Campus Kiel & Lübeck, Kiel, Germany
| | - Anita Pandit
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | | | - Hans Günter Peleikis
- Department of Proctological Surgery Park Klinik Kiel, Kiel, Germany
- Proctological Office Kiel, Kiel, Germany
| | - Kenneth Peuker
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
- Center for Regenerative Therapies Dresden (CRTD), Technische Universität (TU) Dresden, Dresden, Germany
| | - Cristina Leal Rodriguez
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Martin Schulzky
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jurgita Skieceviciene
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jürgen Tepel
- Department of General and Thoracic Surgery, Hospital Osnabrück, Osnabrück, Germany
| | - Laurent Thomas
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- BioCore - Bioinformatics Core Facility, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ilka Vogel
- Department of Surgery, Community Hospital Kiel, Kiel, Germany
| | - Henry Volzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Witigo von Schönfels
- Department of General-, Visceral- Transplant-, Thoracic and Pediatric Surgery, Kiel University, Kiel, Germany
| | - Brett Vanderwerff
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Julia Wilking
- Department for General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Michael Wittig
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Zeissig
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
- Center for Regenerative Therapies Dresden (CRTD), Technische Universität (TU) Dresden, Dresden, Germany
| | - Myrko Zobel
- Department of Gastroenterology, Helios Hospital Weißeritztal, Freital, Germany
| | | | | | | | | | - Gianrico Farrugia
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Arthur Beyder
- Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Volker Kahlke
- Department of Proctological Surgery Park Klinik Kiel, Kiel, Germany
- Proctological Office Kiel, Kiel, Germany
- Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Clemens Schafmayer
- Department for General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Mauro D'Amato
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
- Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastrointestinal Genetics Lab, CIC bioGUNE - BRTA, Derio, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- University Hospital of Schleswig-Holstein (UKSH), Kiel Campus, Kiel, Germany
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21
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Kneusels J, Kaehler M, Cascorbi I, Wedel T, Neunlist M, Lucius R, Cossais F. Limited Impact of 6-Mercaptopurine on Inflammation-Induced Chemokines Expression Profile in Primary Cultures of Enteric Nervous System. Neurochem Res 2021; 46:1781-1793. [PMID: 33864170 PMCID: PMC8187225 DOI: 10.1007/s11064-021-03324-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/04/2021] [Accepted: 04/09/2021] [Indexed: 01/09/2023]
Abstract
Increasing evidences indicate that the enteric nervous system (ENS) and enteric glial cells (EGC) play important regulatory roles in intestinal inflammation. Mercaptopurine (6-MP) is a cytostatic compound clinically used for the treatment of inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease. However, potential impacts of 6-MP on ENS response to inflammation have not been evaluated yet. In this study, we aimed to gain deeper insights into the profile of inflammatory mediators expressed by the ENS and on the potential anti-inflammatory impact of 6-MP in this context. Genome-wide expression analyses were performed on ENS primary cultures exposed to lipopolysaccharide (LPS) and 6-MP alone or in combination. Differential expression of main hits was validated by quantitative real-time PCR (qPCR) using a cell line for EGC. ENS cells expressed a broad spectrum of cytokines and chemokines of the C-X-C motif ligand (CXCL) family under inflammatory stress. Induction of Cxcl5 and Cxcl10 by inflammatory stimuli was confirmed in EGC. Inflammation-induced protein secretion of TNF-α and Cxcl5 was partly inhibited by 6-MP in ENS primary cultures but not in EGC. Further work is required to identify the cellular mechanisms involved in this regulation. These findings extend our knowledge of the anti-inflammatory properties of 6-MP related to the ENS and in particular of the EGC-response to inflammatory stimuli.
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Affiliation(s)
- Jan Kneusels
- Institute of Anatomy, Kiel University, Kiel, Germany.
| | - Meike Kaehler
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Kiel University, Kiel, Germany
| | | | - Ralph Lucius
- Institute of Anatomy, Kiel University, Kiel, Germany
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Bayer A, Heinze T, Alkatout I, Osmonov D, Stelzner S, Wedel T. Embryological Development and Topographic Anatomy of Pelvic Compartments-Surgical Relevance for Pelvic Lymphonodectomy. J Clin Med 2021; 10:jcm10040708. [PMID: 33670197 PMCID: PMC7916954 DOI: 10.3390/jcm10040708] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/19/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/03/2023] Open
Abstract
Background: The oncological outcome of surgery for the treatment of pelvic malignancies can be improved by performing pelvic lymphonodectomy. However, the extent and regions of lymph node harvest are debated and require profound knowledge of anatomy in order to avoid collateral damage. Methods: The embryological development and topographic anatomy of pelvic compartments in relation to pelvic lymphonodectomy for rectal, uterine, and prostate cancer are reviewed. Based on pre-dissected anatomical specimens, lymph node regions and drainage routes of the posterior and urogenital pelvic compartments are described in both genders. Anatomical landmarks are highlighted to identify structures at risk of injury during pelvic lymphonodectomy. Results: The ontogenesis of urogenital and anorectal compartments and their lymphatic supply are key factors for adequate lymphonodectomy, and have led to compartment-based surgical resection strategies. However, pelvic lymphonodectomy bears the risk of injury to somatic and autonomic nerves, vessels, and organs, depending on the regions and extent of surgery. Conclusion: Embryologically defined, compartment-based resection of pelvic malignancies and their lymphatic drainage routes are based on clearly delineated anatomical landmarks, which permit template-oriented pelvic lymphonodectomy. Comprehensive knowledge of pelvic anatomy, the exchange of surgical concepts between specialties, and minimally invasive techniques will optimize pelvic lymphonodectomy and reduce complications.
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Affiliation(s)
- Andreas Bayer
- Kurt Semm Center for Minimally Invasive and Robotic Surgery, Center of Clinical Anatomy, Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (A.B.); (T.H.)
| | - Tillmann Heinze
- Kurt Semm Center for Minimally Invasive and Robotic Surgery, Center of Clinical Anatomy, Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (A.B.); (T.H.)
| | - Ibrahim Alkatout
- Kurt Semm Center for Minimally Invasive and Robotic Surgery, Department of Obstetrics and Gynecology, Campus Kiel, University Hospital Schleswig Holstein, 24105 Kiel, Germany
- Correspondence: (I.A.); (T.W.); Tel.: +49-431-500-21450 (I.A.); +49-431-880-2489 (T.W.)
| | - Daniar Osmonov
- Kurt Semm Center for Minimally Invasive and Robotic Surgery, Department of Urology, Campus Kiel, University Hospital Schleswig Holstein, 24105 Kiel, Germany;
| | - Sigmar Stelzner
- Department of General Surgery, Hospital Dresden-Friedrichstadt, 01067 Dresden, Germany;
| | - Thilo Wedel
- Kurt Semm Center for Minimally Invasive and Robotic Surgery, Center of Clinical Anatomy, Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (A.B.); (T.H.)
- Correspondence: (I.A.); (T.W.); Tel.: +49-431-500-21450 (I.A.); +49-431-880-2489 (T.W.)
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23
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Alkatout I, Günther V, Brügge S, Ackermann J, Krüger M, Bauerschlag D, Maass N, Lippross S, Cascorbi I, Egberts JH, Becker T, Osmonov D, Jünemann KP, Wedel T. Involvement of medical students in a surgery congress: impact on learning motivation, decision-making for a career in surgery, and educational curriculum. Wien Med Wochenschr 2021; 171:182-193. [PMID: 33443613 PMCID: PMC8057979 DOI: 10.1007/s10354-020-00802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
During the preclinical period of medical school, the clinical relevance of theoretical knowledge is given little attention. Medical students of the second year were invited to participate in an interdisciplinary congress for robot-assisted and digital surgery. The students had to evaluate the impact of the congress on their learning motivation, decision-making for a career in surgery, and relevance for their educational curriculum. Participation in the congress increased their learning motivation for preclinical subjects, and significantly increased their interest in a surgical career. Most students considered active involvement in medical congresses a valuable supplement to the medical curriculum. Congress participation during the preclinical period was ranked positively by medical students. Greater learning motivation and enthusiasm for the pilot teaching project as well as for surgical disciplines were registered. Thus, early involvement of medical students in scientific congresses should be an integral part of their educational curriculum.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany.
| | - Veronika Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Sandra Brügge
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Johannes Ackermann
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Magret Krüger
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Dirk Bauerschlag
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Sebastian Lippross
- Department of Trauma Surgery and Orthopaedics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General‑, Visceral‑, Thoracic‑, Transplant- and Paediatric Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Thomas Becker
- Department of General‑, Visceral‑, Thoracic‑, Transplant- and Paediatric Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Klaus-Peter Jünemann
- Department of Urology and Pediatric Urology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Thilo Wedel
- Center for Clinical Anatomy, Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Otto-Hahn-Platz 8, 24118, Kiel, Germany
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Alkatout I, Wedel T, Pape J, Possover M, Dhanawat J. Review: Pelvic nerves - from anatomy and physiology to clinical applications. Transl Neurosci 2021; 12:362-378. [PMID: 34707906 PMCID: PMC8500855 DOI: 10.1515/tnsci-2020-0184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 05/26/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/30/2022] Open
Abstract
A prerequisite for nerve-sparing pelvic surgery is a thorough understanding of the topographic anatomy of the fine and intricate pelvic nerve networks, and their connections to the central nervous system. Insights into the functions of pelvic nerves will help to interpret disease symptoms correctly and improve treatment. In this article, we review the anatomy and physiology of autonomic pelvic nerves, including their topography and putative functions. The aim is to achieve a better understanding of the mechanisms of pelvic pain and functional disorders, as well as improve their diagnosis and treatment. The information will also serve as a basis for counseling patients with chronic illnesses. A profound understanding of pelvic neuroanatomy will permit complex surgery in the pelvis without relevant nerve injury.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, Building 24, 24105 Kiel, Germany
| | - Thilo Wedel
- Department of Anatomy, Institute of Anatomy, Center of Clinical Anatomy, University Hospitals Schleswig-Holstein, Campus Kiel, Otto-Hahn-Platz 8, 24118 Kiel, Germany
| | - Julian Pape
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, Building 24, 24105 Kiel, Germany
| | - Marc Possover
- Possover International Medical Center, Zürich, Switzerland
- Department of Gynecology, University of Aarhus, Aarhus, Denmark
| | - Juhi Dhanawat
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, Building 24, 24105 Kiel, Germany
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Cossais F, Schaeffer E, Heinzel S, Zimmermann J, Niesler B, Röth R, Rappold G, Scharf A, Zorenkov D, Lange C, Barrenschee M, Margraf NG, Ellrichmann M, Berg D, Böttner M, Wedel T. Expression Profiling of Rectal Biopsies Suggests Altered Enteric Neuropathological Traits in Parkinson's Disease Patients. J Parkinsons Dis 2020; 11:171-176. [PMID: 33337386 DOI: 10.3233/jpd-202258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Still little is known about the nature of the gastrointestinal pathological alterations occurring in Parkinson's disease (PD). Here, we used multiplexed mRNA profiling to measure the expression of a panel of 770 genes related to neuropathological processes in deep submucosal rectal biopsies of PD patients and healthy controls. Altered enteric neuropathological traits based on the expression of 22 genes related to neuroglial and mitochondrial functions, vesicle trafficking and inflammation was observed in 9 out of 12 PD patients in comparison to healthy controls. These results provide new evidences that intestinal neuropathological alterations may occur in a large proportion of PD patients.
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Affiliation(s)
- François Cossais
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jessica Zimmermann
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Ralph Röth
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gudrun Rappold
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Amelie Scharf
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Dmitri Zorenkov
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christina Lange
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Mark Ellrichmann
- Interdisciplinary Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Martina Böttner
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
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26
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Ackermann J, Holthaus B, Wedel T, Baier M, Maass N, Mettler L, Peters G, Alkatout I. Demonstration of clinical anatomy by laparoscopy on human body donor embalmed by ethanol-glycerol-lysoformin fixation on live surgery events for minimally invasive surgery. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718015] [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: 10/23/2022] Open
Affiliation(s)
- J Ackermann
- Klinik für Gynäkologie und Geburtshilfe UKSH Campus Kiel
| | - B Holthaus
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus St. Elisabeth gGmbH
| | - T Wedel
- Institut für Anatomie, Christian-Albrechts-Universität
| | - M Baier
- Klinik für Gynäkologie und Geburtshilfe UKSH Campus Kiel
| | - N Maass
- Klinik für Gynäkologie und Geburtshilfe UKSH Campus Kiel
| | - L Mettler
- Klinik für Gynäkologie und Geburtshilfe UKSH Campus Kiel
| | - G Peters
- Klinik für Gynäkologie und Geburtshilfe UKSH Campus Kiel
| | - I Alkatout
- Klinik für Gynäkologie und Geburtshilfe UKSH Campus Kiel
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27
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Wong YL, Hummitzsch L, Lautenschläger I, Zitta K, Wedel T, Cossais F, Schafmayer C, Becker T, Berndt R, Gruenewald M, Weiler N, Steinfath M, Albrecht M. Putative function of goblet cells as epithelial sealing in ischaemia/reperfusion-induced intestinal barrier dysfunction. Gut 2020; 69:1888-1890. [PMID: 31666293 DOI: 10.1136/gutjnl-2019-319770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/08/2022]
Affiliation(s)
- Yuk Lung Wong
- Department of Anesthesiology and Intensive Care Medicine, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Lars Hummitzsch
- Department of Anesthesiology and Intensive Care Medicine, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Ingmar Lautenschläger
- Department of Anesthesiology and Intensive Care Medicine, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Karina Zitta
- Department of Anesthesiology and Intensive Care Medicine, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, University of Kiel, Kiel, Germany
| | | | - Clemens Schafmayer
- Department of General and Thoracic Surgery, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Thomas Becker
- Department of General and Thoracic Surgery, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Rouven Berndt
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Gruenewald
- Department of Anesthesiology and Intensive Care Medicine, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Norbert Weiler
- Department of Anesthesiology and Intensive Care Medicine, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus Steinfath
- Department of Anesthesiology and Intensive Care Medicine, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
| | - Martin Albrecht
- Department of Anesthesiology and Intensive Care Medicine, Universtiy Hospital Schleswig-Holstein, Kiel, Germany
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28
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Ackermann J, Wedel T, Holthaus B, Bojahr B, Hackethal A, Brucker S, Biebl M, Westermann M, Günther V, Krüger M, Maass N, Mettler L, Peters G, Alkatout I. Didactic Benefits of Surgery on Body Donors during Live Surgery Events in Minimally Invasive Surgery. J Clin Med 2020; 9:jcm9092912. [PMID: 32917056 PMCID: PMC7563950 DOI: 10.3390/jcm9092912] [Citation(s) in RCA: 4] [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] [Received: 08/08/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Live surgery events serve as a valuable tool for surgical education, but also raise ethical concerns about patient safety and professional performance. In the present study, we evaluate the technical feasibility and didactic benefits of live surgery on body donors compared to real patients. Methods: A live surgery session performed on a body donor’s cadaver embalmed in ethanol–glycerol–lysoformin was integrated into the live surgery program presented at a major gynecological convention of minimally invasive surgery. Surgical procedures carried out in real patients were paralleled in the body donor, including the dissection and illustration of surgically relevant anatomical landmarks. A standardized questionnaire was filled by the participants (n = 208) to evaluate the appropriateness, effectiveness, and benefits of this novel concept. Results: The live surgery event was appreciated as a useful educational tool. With regard to the use of body donors, authenticity was rated high (85.5%), and the overall value of body donors for surgical education and training was rated very high (95.0%). The didactic benefit of simultaneous operations performed on body donors and real patients was considered particularly useful (95.5%), whereas complete replacement of real patients by body donors was not favored (14.5%). Conclusions: The study demonstrated both the technical feasibility and didactic benefits of performing minimally invasive surgery in body donors as part of live surgery events. This novel concept has the potential to enhance anatomical knowledge, providing insights into complex surgical procedures, and may serve to overcome yet unresolved ethical concerns related to live surgery events.
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Affiliation(s)
- Johannes Ackermann
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts University Kiel, Otto-Hahn-Platz 8, 24118 Kiel, Germany;
| | - Bernd Holthaus
- Clinic of Obstetrics and Gynecology, St. Elisabeth Hospital, 49401 Damme, Germany;
| | - Bernd Bojahr
- Clinic of Minimally Invasive Surgery, Kurstraße 11, 14129 Berlin-Zehlendorf, Germany;
| | | | - Sara Brucker
- Department für Frauengesundheit, University Hospital Tübingen, Calwer Straße 7, 72076 Tübingen, Germany;
| | - Matthias Biebl
- Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Martina Westermann
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Veronika Günther
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Magret Krüger
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Liselotte Mettler
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Göntje Peters
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
- Correspondence: ; Tel.: +49-431-500-21450
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Anapolski M, Alkatout I, Wedel T, Panayotopoulos D, Soltesz S, Schiermeier S, Papathemelis T, Noé GK. Laparoscopic approaches to the retropubic space: three alternatives with anatomical considerations. MINIM INVASIV THER 2019; 30:154-162. [PMID: 31868557 DOI: 10.1080/13645706.2019.1699115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Many urogynecological and surgical laparoscopic interventions require access to the retropubic space, also known as the space of Retzius. Especially in patients with a history of previous surgery in this area or in general in the lower abdomen, the preparation may be complicated by adhesions and scar tissue. The necessity to combine several laparoscopic procedures in one surgical session may require consideration of the most appropriate way to approach the retropubic space. MATERIAL AND METHODS We describe and discuss three different options to access the space of Retzius via laparoscopy: the medial transperitoneal, the extraperitoneal and the lateral transperitoneal approach. For all approaches, we used one umbilical trocar and two trocars in the lower abdomen. RESULTS An algorithm was developed to select the most appropriate access route to the retropubic space, depending on the history of previous surgeries and accompanying interventions. CONCLUSION The knowledge of different access routes to the retropubic space offers the possibility of adjusting the surgical procedure to the individual constellation of the patient.
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Affiliation(s)
- Michael Anapolski
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Community Hospital Dormagen, Dormagen, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | | | - Stefan Soltesz
- Department of Anesthesiology, Community Hospital Dormagen, Dormagen, Germany
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, Witten, Germany
| | - Thomas Papathemelis
- Department of Obstetrics and Gynecology, Klinikum St. Marien Amberg, Amberg, Germany
| | - Günter K Noé
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Community Hospital Dormagen, Dormagen, Germany
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30
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Barrenschee M, Cossais F, Böttner M, Egberts JH, Becker T, Wedel T. Impaired Expression of Neuregulin 1 and Nicotinic Acetylcholine Receptor β4 Subunit in Diverticular Disease. Front Cell Neurosci 2019; 13:563. [PMID: 31920561 PMCID: PMC6930903 DOI: 10.3389/fncel.2019.00563] [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: 07/09/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022] Open
Abstract
Neuregulin 1 (NRG1) regulates the expression of the nicotinic acetylcholine receptor (nAChR) and is suggested to promote the survival and maintenance of the enteric nervous system (ENS), since deficiency of its corresponding receptor complex ErbB2/ErbB3 leads to postnatal colonic aganglionosis. As diverticular disease (DD) is associated with intestinal hypoganglionosis, the NRG1-ErbB2/ErbB3 system and the nAChR were studied in patients with DD and controls. Samples of tunica muscularis of the sigmoid colon from patients with DD (n = 8) and controls (n = 11) were assessed for mRNA expression of NRG1, ErbB2, and ErbB3 and the nAChR subunits α3, α5, α7, β2, and β4. Site-specific gene expression levels of the NRG1-ErbB2/3 system were determined in myenteric ganglia harvested by laser microdissection (LMD). Localization studies were performed by immunohistochemistry for the NRG1-ErbB2/3 system and nAChR subunit β4. Rat enteric nerve cell cultures were stimulated with NRG1 or glial-cell line derived neurotrophic factor (GDNF) for 6 days and mRNA expression of the aforementioned nAchR was measured. NRG1, ErbB3, and nAChR subunit β4 expression was significantly down-regulated in both the tunica muscularis and myenteric ganglia of patients with DD compared to controls, whereas mRNA expression of ErbB3 and nAChR subunits β2, α3, α5, and α7 remained unaltered. NRG1, ErbB3, and nAChR subunit β4 immunoreactive signals were reduced in neuronal somata and the neuropil of myenteric ganglia from patients with DD compared to control. nAChR subunit β4 exhibited also weaker immunoreactive signals in the tunica muscularis of patients with DD. NRG1 treatment but not GDNF treatment of enteric nerve cell cultures significantly enhanced mRNA expression of nAchR β4. The down-regulation of NRG1 and ErbB3 in myenteric ganglia of patients with DD supports the hypothesis that intestinal hypoganglionosis observed in DD may be attributed to a lack of neurotrophic factors. Regulation of nAChR subunit β4 by NRG1 and decreased nAChR β4 in patients with DD provide evidence that a lack of NRG1 may affect the composition of enteric neurotransmitter receptor subunits thus contributing to the intestinal motility disorders previously reported in DD.
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Affiliation(s)
- Martina Barrenschee
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
| | - François Cossais
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Martina Böttner
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Thilo Wedel
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
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Fritscher-Ravens A, Pflaum T, Mösinger M, Ruchay Z, Röcken C, Milla PJ, Das M, Böttner M, Wedel T, Schuppan D. Many Patients With Irritable Bowel Syndrome Have Atypical Food Allergies Not Associated With Immunoglobulin E. Gastroenterology 2019; 157:109-118.e5. [PMID: 31100380 DOI: 10.1053/j.gastro.2019.03.046] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/06/2019] [Accepted: 03/25/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Confocal laser endomicroscopy (CLE) is a technique that permits real-time detection and quantification of changes in intestinal tissues and cells, including increases in intraepithelial lymphocytes and fluid extravasation through epithelial leaks. Using CLE analysis of patients with irritable bowel syndrome (IBS), we found that more than half have responses to specific food components. Exclusion of the defined food led to long-term symptom relief. We used the results of CLE to detect reactions to food in a larger patient population and analyzed duodenal biopsy samples and fluid from patients to investigate mechanisms of these reactions. METHODS In a prospective study, 155 patients with IBS received 4 challenges with each of 4 common food components via the endoscope, followed by CLE, at a tertiary medical center. Classical food allergies were excluded by negative results from immunoglobulin E serology analysis and skin tests for common food antigens. Duodenal biopsy samples and fluid were collected 2 weeks before and immediately after CLE and were analyzed by histology, immunohistochemistry, reverse transcription polymerase chain reaction, and immunoblots. Results from patients who had a response to food during CLE (CLE+) were compared with results from patients who did not have a reaction during CLE (CLE-) or healthy individuals (controls). RESULTS Of the 108 patients who completed the study, 76 were CLE+ (70%), and 46 of these (61%) reacted to wheat. CLE+ patients had a 4-fold increase in prevalence of atopic disorders compared with controls (P = .001). Numbers of intraepithelial lymphocytes were significantly higher in duodenal biopsy samples from CLE+ vs CLE- patients or controls (P = .001). Expression of claudin-2 increased from crypt to villus tip (P < .001) and was up-regulated in CLE+ patients compared with CLE- patients or controls (P = .023). Levels of occludin were lower in duodenal biopsy samples from CLE+ patients vs controls (P = .022) and were lowest in villus tips (P < .001). Levels of messenger RNAs encoding inflammatory cytokines were unchanged in duodenal tissues after CLE challenge, but eosinophil degranulation increased, and levels of eosinophilic cationic protein were higher in duodenal fluid from CLE+ patients than controls (P = .03). CONCLUSIONS In a CLE analysis of patients with IBS, we found that more than 50% of patients could have nonclassical food allergy, with immediate disruption of the intestinal barrier upon exposure to food antigens. Duodenal tissues from patients with responses to food components during CLE had immediate increases in expression of claudin-2 and decreases in occludin. CLE+ patients also had increased eosinophil degranulation, indicating an atypical food allergy characterized by eosinophil activation.
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Affiliation(s)
- Annette Fritscher-Ravens
- Unit Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Theresa Pflaum
- Unit Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Marie Mösinger
- Unit Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Zino Ruchay
- Unit Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Peter J Milla
- UCL Institute of Child Health, University College London, London, United Kingdom
| | - Melda Das
- Unit Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Martina Böttner
- Department of Anatomy, Christian Albrecht University, Kiel, Germany
| | - Thilo Wedel
- Department of Anatomy, Christian Albrecht University, Kiel, Germany
| | - Detlef Schuppan
- Institute of Translational Immunology, University Medical Center, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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32
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Schafmayer C, Harrison JW, Buch S, Lange C, Reichert MC, Hofer P, Cossais F, Kupcinskas J, von Schönfels W, Schniewind B, Kruis W, Tepel J, Zobel M, Rosendahl J, Jacobi T, Walther-Berends A, Schroeder M, Vogel I, Sergeev P, Boedeker H, Hinrichsen H, Volk A, Erk JU, Burmeister G, Hendricks A, Hinz S, Wolff S, Böttner M, Wood AR, Tyrrell J, Beaumont RN, Langheinrich M, Kucharzik T, Brezina S, Huber-Schönauer U, Pietsch L, Noack LS, Brosch M, Herrmann A, Thangapandi RV, Schimming HW, Zeissig S, Palm S, Focke G, Andreasson A, Schmidt PT, Weitz J, Krawczak M, Völzke H, Leeb G, Michl P, Lieb W, Grützmann R, Franke A, Lammert F, Becker T, Kupcinskas L, D'Amato M, Wedel T, Datz C, Gsur A, Weedon MN, Hampe J. Genome-wide association analysis of diverticular disease points towards neuromuscular, connective tissue and epithelial pathomechanisms. Gut 2019; 68:854-865. [PMID: 30661054 DOI: 10.1136/gutjnl-2018-317619] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Diverticular disease is a common complex disorder characterised by mucosal outpouchings of the colonic wall that manifests through complications such as diverticulitis, perforation and bleeding. We report the to date largest genome-wide association study (GWAS) to identify genetic risk factors for diverticular disease. DESIGN Discovery GWAS analysis was performed on UK Biobank imputed genotypes using 31 964 cases and 419 135 controls of European descent. Associations were replicated in a European sample of 3893 cases and 2829 diverticula-free controls and evaluated for risk contribution to diverticulitis and uncomplicated diverticulosis. Transcripts at top 20 replicating loci were analysed by real-time quatitative PCR in preparations of the mucosal, submucosal and muscular layer of colon. The localisation of expressed protein at selected loci was investigated by immunohistochemistry. RESULTS We discovered 48 risk loci, of which 12 are novel, with genome-wide significance and consistent OR in the replication sample. Nominal replication (p<0.05) was observed for 27 loci, and additional 8 in meta-analysis with a population-based cohort. The most significant novel risk variant rs9960286 is located near CTAGE1 with a p value of 2.3×10-10 and 0.002 (ORallelic=1.14 (95% CI 1.05 to 1.24)) in the replication analysis. Four loci showed stronger effects for diverticulitis, PHGR1 (OR 1.32, 95% CI 1.12 to 1.56), FAM155A-2 (OR 1.21, 95% CI 1.04 to 1.42), CALCB (OR 1.17, 95% CI 1.03 to 1.33) and S100A10 (OR 1.17, 95% CI 1.03 to 1.33). CONCLUSION In silico analyses point to diverticulosis primarily as a disorder of intestinal neuromuscular function and of impaired connective fibre support, while an additional diverticulitis risk might be conferred by epithelial dysfunction.
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Affiliation(s)
- Clemens Schafmayer
- Department of Visceral and Thoracic Surgery, Kiel University, Kiel, Germany
| | | | - Stephan Buch
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany.,Center for Regenerative Therapies Dresden (CRTD), Technische Universität Dresden (TU Dresden), Dresden, Germany
| | | | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Philipp Hofer
- Institute of Cancer Research, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | | | - Juozas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Wolfgang Kruis
- Department of Internal Medicine, Gastroenterology and Pulmonology, Evangelic Hospital Köln-Kalk, Cologne, Germany
| | - Jürgen Tepel
- Department of General and Thoracic Surgery, Hospital Osnabrück, Osnabrück, Germany
| | - Myrko Zobel
- Department of Gastroenterology, Helios Hospital Weißeritztal, Freital, Germany
| | - Jonas Rosendahl
- Medical Department 1, University Hospital Halle, Martin-Luther Universität Halle-Wittenberg, Halle, Germany
| | | | | | | | - Ilka Vogel
- Department of Surgery, Community Hospital Kiel, Kiel, Germany
| | - Petr Sergeev
- Department of Internal Medicine II, Hospital Riesa, Kiel, Germany
| | - Hans Boedeker
- Department of Internal Medicine, Hospital Freiberg, Freiberg, Germany
| | | | - Andreas Volk
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Jens-Uwe Erk
- Medical Department 1, University Hospital Halle, Martin-Luther Universität Halle-Wittenberg, Halle, Germany
| | - Greta Burmeister
- Department of Visceral and Thoracic Surgery, Kiel University, Kiel, Germany
| | | | - Sebastian Hinz
- Department of Visceral and Thoracic Surgery, Kiel University, Kiel, Germany
| | - Sebastian Wolff
- Department of Internal Medicine, Gastroenterology and Pulmonology, Evangelic Hospital Köln-Kalk, Cologne, Germany
| | | | - Andrew R Wood
- University of Exeter Medical School, University of Exeter, United Kingdom, Exeter, UK
| | - Jessica Tyrrell
- University of Exeter Medical School, University of Exeter, United Kingdom, Exeter, UK
| | - Robin N Beaumont
- University of Exeter Medical School, University of Exeter, United Kingdom, Exeter, UK
| | | | | | - Stefanie Brezina
- Institute of Cancer Research, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Ursula Huber-Schönauer
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Oberndorf, Austria
| | - Leonora Pietsch
- Medical Department 1, University Hospital Halle, Martin-Luther Universität Halle-Wittenberg, Halle, Germany
| | - Laura Sophie Noack
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Mario Brosch
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany.,Center for Regenerative Therapies Dresden (CRTD), Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Alexander Herrmann
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Raghavan Veera Thangapandi
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | | | - Sebastian Zeissig
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany.,Center for Regenerative Therapies Dresden (CRTD), Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Stefan Palm
- Outpatient Center for Gastroenterology, Dippoldiswalde, Germany
| | - Gerd Focke
- Outpatient Center for Gastroenterology Dresden-Blasewitz, Dresden, Germany
| | - Anna Andreasson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Peter T Schmidt
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Juergen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gernot Leeb
- Department of Gastroenterology, Hospital Oberpullendorf, Oberpullendorf, Austria
| | - Patrick Michl
- Medical Department 1, University Hospital Halle, Martin-Luther Universität Halle-Wittenberg, Halle, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology & Popgen Biobank, Kiel University, Kiel, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Thomas Becker
- Department of Visceral and Thoracic Surgery, Kiel University, Kiel, Germany
| | - Limas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mauro D'Amato
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Thilo Wedel
- Institute of Anatomy, Kiel University, Kiel, Germany
| | - Christian Datz
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Oberndorf, Austria
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Michael N Weedon
- University of Exeter Medical School, University of Exeter, United Kingdom, Exeter, UK
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany.,Center for Regenerative Therapies Dresden (CRTD), Technische Universität Dresden (TU Dresden), Dresden, Germany
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Hummitzsch L, Zitta K, Berndt R, Wong YL, Rusch R, Hess K, Wedel T, Gruenewald M, Cremer J, Steinfath M, Albrecht M. Remote ischemic preconditioning attenuates intestinal mucosal damage: insight from a rat model of ischemia-reperfusion injury. J Transl Med 2019; 17:136. [PMID: 31036020 PMCID: PMC6489261 DOI: 10.1186/s12967-019-1885-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/24/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
Background Remote ischemic preconditioning (RIPC) is a phenomenon, whereby repeated, non-lethal episodes of ischemia to an organ or limb exert protection against ischemia–reperfusion (I/R) injury in distant organs. Despite intensive research, there is still an apparent lack of knowledge concerning the RIPC-mediated mechanisms, especially in the intestine. Aim of this study was to evaluate possible protective effects RIPC on intestinal I/R injury. Methods Thirty rats were randomly assigned to four groups: I/R; I/R + RIPC; Sham; Sham + RIPC. Animals were anesthetized and the superior mesenteric artery was clamped for 30 min, followed by 60 min of reperfusion. RIPC-treated rats received 3 × 5 min of bilateral hindlimb I/R prior to surgery, sham groups obtained laparotomy without clamping. After I/R injury serum/tissue was analyzed for: Mucosal damage, Caspase-3/7 activity, expression of cell stress proteins, hydrogen peroxide (H2O2) and malondialdehyde (MDA) production, Hypoxia-inducible factor-1α (HIF-1α) protein expression and matrix metalloproteinase (MMP) activity. Results Intestinal I/R resulted in increased mucosal injury (P < 0.001) and elevated Caspase-3/7 activity (P < 0.001). RIPC significantly reduced the histological signs of intestinal I/R injury (P < 0.01), but did not affect Caspase-3/7 activity. Proteome profiling suggested a RIPC-mediated regulation of several cell stress proteins after I/R injury: Cytochrome C (+ 157%); Cited-2 (− 39%), ADAMTS1 (+ 74%). Serum concentrations of H2O2 and MDA remained unchanged after RIPC, while the reduced intestinal injury was associated with increased HIF-1α levels. Measurements of MMP activities in serum and intestinal tissue revealed an attenuated gelatinase activity at 130 kDa within the serum samples (P < 0.001) after RIPC, while the activity of MMPs within the intestinal tissue was not affected by I/R injury or RIPC. Conclusions RIPC ameliorates intestinal I/R injury in rats. The underlying mechanisms may involve HIF-1α protein expression and a decreased serum activity of a 130 kDa factor with gelatinase activity. Electronic supplementary material The online version of this article (10.1186/s12967-019-1885-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars Hummitzsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany.
| | - Karina Zitta
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany
| | - Rouven Berndt
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Yuk Lung Wong
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany
| | - Rene Rusch
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Katharina Hess
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - Matthias Gruenewald
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Markus Steinfath
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany
| | - Martin Albrecht
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany
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Cossais F, Lange C, Barrenschee M, Möding M, Ebsen M, Vogel I, Böttner M, Wedel T. Altered enteric expression of the homeobox transcription factor Phox2b in patients with diverticular disease. United European Gastroenterol J 2019; 7:349-357. [PMID: 31019703 DOI: 10.1177/2050640618824913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/22/2018] [Indexed: 12/17/2022] Open
Abstract
Background Diverticular disease, a major gastrointestinal disorder, is associated with modifications of the enteric nervous system, encompassing alterations of neurochemical coding and of the tyrosine receptor kinase Ret/GDNF pathway. However, molecular factors underlying these changes remain to be determined. Objectives We aimed to characterise the expression of Phox2b, an essential regulator of Ret and of neuronal subtype development, in the adult human enteric nervous system, and to evaluate its potential involvement in acute diverticulitis. Methods Site-specific gene expression of Phox2b in the adult colon was analysed by quantitative polymerase chain reaction. Colonic specimens of adult controls and patients with diverticulitis were subjected to quantitative polymerase chain reaction for Phox2b and dual-label immunochemistry for Phox2b and the neuronal markers RET and tyrosine hydroxylase or the glial marker S100β. Results The results indicate that Phox2b is physiologically expressed in myenteric neuronal and glial subpopulations in the adult enteric nervous system. Messenger RNA expression of Phox2b was increased in patients with diverticulitis and both neuronal, and glial protein expression of Phox2b were altered in these patients. Conclusions Alterations of Phox2b expression may contribute to the enteric neuropathy observed in diverticular disease. Future studies are required to characterise the functions of Phox2b in the adult enteric nervous system and to determine its potential as a therapeutic target in gastrointestinal disorders.
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Affiliation(s)
- François Cossais
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christina Lange
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Marie Möding
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Michael Ebsen
- Department of Pathology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Ilka Vogel
- Department of Surgery, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Martina Böttner
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
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35
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Strey CW, Wullstein C, Adamina M, Agha A, Aselmann H, Becker T, Grützmann R, Kneist W, Maak M, Mann B, Moesta KT, Runkel N, Schafmayer C, Türler A, Wedel T, Benz S. Laparoscopic right hemicolectomy with CME: standardization using the "critical view" concept. Surg Endosc 2018; 32:5021-5030. [PMID: 30324463 PMCID: PMC6208708 DOI: 10.1007/s00464-018-6267-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 06/07/2018] [Indexed: 12/12/2022]
Abstract
Background Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding and carries the risk of serious complications, especially when performed laparoscopically. A standardized procedure that minimizes technical hazards and facilitates teaching is, therefore, highly desirable. Methods An expert group of surgeons and one anatomist met three times. The initial aim was to achieve consensus about the surgical anatomy before agreeing on a sequence for dissection in laparoscopic CME. This proposal was evaluated and discussed in an anatomy workshop using post-mortem body donors along with videos of process-informed procedures, leading to a definite consensus. Results In order to provide a clear picture of the surgical anatomy, the “open book” model was developed, consisting of symbolic pages representing the corresponding dissection planes (retroperitoneal, ileocolic, transverse mesocolic, and mesogastric), vascular relations, and radicality criteria. The description of the procedure is based on eight preparative milestones, which all serve as critical views of safety. The chosen sequence of the milestones was designed to maximize control during central vascular dissection. Failure to reach any of the critical views should alert the surgeon to a possible incorrect dissection and to consider converting to an open procedure. Conclusion Combining the open-book anatomical model with a clearly structured dissection sequence, using critical views as safety checkpoints, may provide a safe and efficient platform for teaching laparoscopic right hemicolectomy with CME. Electronic supplementary material The online version of this article (10.1007/s00464-018-6267-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Werner Strey
- Clinic for General-, Visceral- and Vascular Surgery, Diakovere Hospital Friederikenstift, Humboldtstrasse 5, 30169, Hannover, Germany.
| | - Christoph Wullstein
- Department of Visceral and Minimal Invasive Surgery, Helios Hospital Krefeld, Lutherplatz 40, 47805, Krefeld, Germany
| | - Michel Adamina
- Department Chirurgie, Klinik für Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, 8401, Winterthur, Switzerland
| | - Ayman Agha
- Klinik für Allgemein-, Viszeral-, Endokrine und Minimal-invasive Chirurgie, Klinikum Bogenhausen, Englschalkinger Straße 77, 81925, Munich, Germany
| | - Heiko Aselmann
- General and Visceral Surgery, DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - Thomas Becker
- Klinik für Allgemeine, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital of Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Werner Kneist
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Matthias Maak
- Department of Surgery, University Hospital of Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Benno Mann
- Klinik für Viszeralchirurgie, Augusta Klinikum Bochum, Bergstrasse 26, 44791, Bochum, Germany
| | - Kurt Thomas Moesta
- Department of General-, Visceral- and Minimalinvasive Surgery, KRH Klinikum Hannover GmbH, Klinikum Siloah, Stadionbrücke 4, 30459, Hannover, Germany
| | - Norbert Runkel
- Sana Klinikum, Starkenburgring 66, 63069, Offenbach, Germany
| | - Clemens Schafmayer
- Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, 24105, Kiel, Germany
| | - Andreas Türler
- Department of Visceral Surgery, Johanniter Hospital Bonn, Johanniterstr. 3, 53113, Bonn, Germany
| | - Thilo Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Christian-Albrechts University Kiel, Otto-Hahn-Platz 8, 24118, Kiel, Germany
| | - Stefan Benz
- Department for Abdominal and Pediatric Surgery, Klinkverbund-Suedwest, Klinken Boeblingen, Bunsenstrasse 120, 71032, Boeblingen, Germany
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Ackermann J, Hagedorn H, Maass N, Wedel T, Alkatout I. The glycerin-based cadaver preservation – A technique that enables training of laparoscopic surgery on human body donor. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671081] [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: 10/28/2022] Open
Affiliation(s)
- J Ackermann
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - H Hagedorn
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - N Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - T Wedel
- Anatomisches Institut der Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - I Alkatout
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
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Jongen J, Kahlke V, Wedel T. Anatomically Incorrect. Dtsch Arztebl Int 2018; 115:112. [PMID: 29510822 DOI: 10.3238/arztebl.2018.0112b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the management of individual patients. This should take into account the severity of the disease and whether the patient desires to have children. Particular emphasis is laid on the anatomical intersections which, when injured, can lead to persistent damage of the anterior, middle or posterior compartment and are not infrequently the cause of urological and urogynaecological follow-up measures. Typical symptoms of endometriosis include chronic pelvic pain, subfertility, dysmenorrhoea, deep dyspareunia, cyclical bowel or bladder symptoms (e. g. dyschezia, bloating, constipation, rectal bleeding, diarrhoea and haematuria), abnormal menstrual bleeding, chronic fatigue and low back pain. Approx. 50 % of all female teenagers and up to 32 % of all women of reproductive age who have been operated for chronic pelvic pain or dysmenorrhoea suffer from endometriosis. The time interval between the first unspecific symptoms and the medical diagnosis of endometriosis is about 7 years. This is caused not only by the non-specific nature of the symptoms but also by the frequent lack of awareness on the part of the cooperating disciplines with which the patients have first contact. As the pathogenesis of endometriosis is not clearly understood, causal treatment is still impossible. Treatment options include expectant management, analgesia, hormonal medical therapy, surgical intervention and the combination of medical treatment before and/or after surgery. The treatment should be as radical as necessary and as minimal as possible. The recurrence rate among treated patients lies between 5 % and > 60 % and is very much dependent on integrated management and surgical skills. Consequently, to optimise the individual patient's treatment, a high degree of interdisciplinary cooperation in diagnosis and treatment is crucial and should be reserved to appropriate centres - especially in the case of deep infiltrating endometriosis.
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Affiliation(s)
- Ibrahim Alkatout
- Klinik für Gynäkologie und Geburtshilfe, Kiel School of Gynecological Endoscopoy, Universitätsklinikum Schleswig-Holstein
| | - Thilo Wedel
- Institut für Anatomie, Zentrum für Klinische Anatomie, Christian-Albrechts Universität zu Kiel
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Kiel School of Gynecological Endoscopoy, Universitätsklinikum Schleswig-Holstein
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Stelzner S, Böttner M, Kupsch J, Kneist W, Quirke P, West NP, Witzigmann H, Wedel T. Internal anal sphincter nerves - a macroanatomical and microscopic description of the extrinsic autonomic nerve supply of the internal anal sphincter. Colorectal Dis 2018; 20:O7-O16. [PMID: 29068554 DOI: 10.1111/codi.13942] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/03/2017] [Indexed: 12/13/2022]
Abstract
AIM The internal anal sphincter (IAS) contributes substantially to anorectal functions. While its autonomic nerve supply has been studied at the microscopic level, little information is available concerning the macroscopic topography of extrinsic nerve fibres. This study was designed to identify neural connections between the pelvic plexus and the IAS, provide a detailed topographical description, and give histological proof of autonomic nerve tissue. METHODS Macroscopic dissection of pelvic autonomic nerves was performed under magnification in seven (five male, two female) hemipelvises obtained from body donors (67-92 years). Candidate structures were investigated by histological and immunohistochemical staining protocols to visualize nerve tissue. RESULTS Nerve fibres could be traced from the anteroinferior edge of the pelvic plexus to the anorectal junction running along the neurovascular bundle anterolaterally to the rectum and posterolaterally to the prostate/vagina. Nerve fibres penetrated the longitudinal rectal muscle layer just above the fusion with the levator ani muscle (conjoint longitudinal muscle) and entered the intersphincteric space to reach the IAS. Histological and immunohistochemical findings confirmed the presence of nerve tissue. CONCLUSIONS Autonomic nerve fibres supplying the IAS emerge from the pelvic plexus and are distinct to nerves entering the rectum via the lateral pedicles. Thus, they should be classified as IAS nerves. The identification and precise topographical location described provides a basis for nerve-sparing rectal resection procedures and helps to prevent postoperative functional anorectal disorders.
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Affiliation(s)
- S Stelzner
- Department of General, Visceral and Thoracic Surgery, Dresden-Friedrichstadt General Hospital, Dresden, Germany
| | - M Böttner
- Institute of Anatomy, Center of Clinical Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - J Kupsch
- Department of General, Visceral and Thoracic Surgery, Dresden-Friedrichstadt General Hospital, Dresden, Germany
| | - W Kneist
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - P Quirke
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - N P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - H Witzigmann
- Department of General, Visceral and Thoracic Surgery, Dresden-Friedrichstadt General Hospital, Dresden, Germany
| | - T Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
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Franke J, Homeier A, Metz L, Wedel T, Alt V, Spät S, Hohendorff B, Schnettler R. Infrapatellar vs. suprapatellar approach to obtain an optimal insertion angle for intramedullary nailing of tibial fractures. Eur J Trauma Emerg Surg 2017; 44:927-938. [PMID: 29159663 DOI: 10.1007/s00068-017-0881-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND During intramedullary nailing of tibial fractures, the insertion angle of the nail is of great importance. When the nail impacts the posterior cortex due to a large insertion angle with a dorsal target course, higher insertion forces are needed, and the danger of iatrogenic fractures increases. Accordingly, the insertion direction should be as parallel as possible to the longitudinal axis of the tibia. We aimed to confirm the hypothesis that intramedullary nailing of tibial fractures can be performed with smaller insertion angles via a suprapatellar approach rather than infrapatellar approach. METHODS In 19 human bodies of donors with intact tibiae, we performed intramedullary nailing by both a suprapatellar and an infrapatellar approach. The correct entry point was determined by fluoroscopy. Subsequently, the medullary canal was reamed up to a diameter of 10 mm, and a 9 mm polytetrafluorethylen tube was inserted instead of a tibia nail. The angle between the proximal aspect of the tube and the longitudinal axis of the tibia was measured using a computer-assisted surgery system. RESULTS The angle between the proximal aspect of the inserted tube, simulating the tibial nail, and the longitudinal tibial axis was significantly larger when using the infrapatellar approach. CONCLUSIONS We achieved an insertion angle significantly more parallel to the longitudinal axis when using a suprapatellar approach for intramedullary nailing of tibial fractures. Thereby, both the risk of iatrogenic fracture of the posterior cortex and apex anterior angulation of the short proximal fragment can be reduced during intramedullary nailing of tibial fractures.
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Affiliation(s)
- Joerg Franke
- Department of Trauma and Orthopaedic Surgery, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Germany.
| | - Annika Homeier
- Stryker Trauma GmbH, Prof.-Küntscher-Str. 1-5, 24232, Schönkirchen, Germany
| | - Lars Metz
- Stryker Trauma GmbH, Prof.-Küntscher-Str. 1-5, 24232, Schönkirchen, Germany
| | - Thilo Wedel
- Centre of Clinical Anatomy, Institute of Anatomy, Christian-Albrechts University of Kiel, Otto-Hahn-Platz 8, 24118, Kiel, Germany
| | - Volker Alt
- Department of Traumatology, Hand- and Reconstructive Surgery, Justus-Liebig-University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Sven Spät
- Department of Trauma and Orthopaedic Surgery, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Germany
| | - Bernd Hohendorff
- Department of Trauma and Orthopaedic Surgery, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Germany
| | - Reinhard Schnettler
- Justus-Liebig-University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
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Wunsch M, Jabari S, Voussen B, Enders M, Srinivasan S, Cossais F, Wedel T, Boettner M, Schwarz A, Weyer L, Göcer O, Schroeter M, Maeurer M, Woenckhaus M, Pollok K, Radbruch H, Klotz L, Scholz CJ, Nickel J, Friebe A, Addicks K, Ergün S, Lehmann PV, Kuerten S. The enteric nervous system is a potential autoimmune target in multiple sclerosis. Acta Neuropathol 2017; 134:281-295. [PMID: 28620692 DOI: 10.1007/s00401-017-1742-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 01/29/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) in young adults that has serious negative socioeconomic effects. In addition to symptoms caused by CNS pathology, the majority of MS patients frequently exhibit gastrointestinal dysfunction, which was previously either explained by the presence of spinal cord lesions or not directly linked to the autoimmune etiology of the disease. Here, we studied the enteric nervous system (ENS) in a B cell- and antibody-dependent mouse model of MS by immunohistochemistry and electron microscopy at different stages of the disease. ENS degeneration was evident prior to the development of CNS lesions and the onset of neurological deficits in mice. The pathology was antibody mediated and caused a significant decrease in gastrointestinal motility, which was associated with ENS gliosis and neuronal loss. We identified autoantibodies against four potential target antigens derived from enteric glia and/or neurons by immunoprecipitation and mass spectrometry. Antibodies against three of the target antigens were also present in the plasma of MS patients as confirmed by ELISA. The analysis of human colon resectates provided evidence of gliosis and ENS degeneration in MS patients compared to non-MS controls. For the first time, this study establishes a pathomechanistic link between the well-established autoimmune attack on the CNS and ENS pathology in MS, which might provide a paradigm shift in our current understanding of the immunopathogenesis of the disease with broad diagnostic and therapeutic implications.
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Affiliation(s)
- Marie Wunsch
- Department of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Samir Jabari
- Institute of Anatomy and Cell Biology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Barbara Voussen
- Institute of Physiology, University of Würzburg, Würzburg, Germany
| | - Michael Enders
- Institute of Anatomy and Cell Biology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - François Cossais
- Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Martina Boettner
- Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Anna Schwarz
- Department of Anatomy and Cell Biology, University Hospital Cologne, Cologne, Germany
| | - Linda Weyer
- Department of Anatomy and Cell Biology, University Hospital Cologne, Cologne, Germany
| | - Oktay Göcer
- Department of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Michael Schroeter
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Mathias Maeurer
- Department of Neurology, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Matthias Woenckhaus
- Department of Pathology, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Karolin Pollok
- Deutsches Rheuma-Forschungszentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Luisa Klotz
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Claus-Jürgen Scholz
- Core Unit Systems Medicine, University of Würzburg, Würzburg, Germany
- LIMES Institute, University of Bonn, Bonn, Germany
| | - Joachim Nickel
- Institute of Tissue Engineering and Regenerative Medicine, University of Würzburg, Würzburg, Germany
| | - Andreas Friebe
- Institute of Physiology, University of Würzburg, Würzburg, Germany
| | - Klaus Addicks
- Department of Anatomy and Cell Biology, University Hospital Cologne, Cologne, Germany
| | - Süleyman Ergün
- Department of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | | | - Stefanie Kuerten
- Department of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany.
- Institute of Anatomy and Cell Biology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
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Barrenschee M, Wedel T, Lange C, Hohmeier I, Cossais F, Ebsen M, Vogel I, Böttner M. No neuronal loss, but alterations of the GDNF system in asymptomatic diverticulosis. PLoS One 2017; 12:e0171416. [PMID: 28152033 PMCID: PMC5289619 DOI: 10.1371/journal.pone.0171416] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/20/2017] [Indexed: 12/15/2022] Open
Abstract
Background Glial cell line-derived neurotrophic factor (GDNF) is a potent neurotrophic factor known to promote the survival and maintenance of neurons not only in the developing but also in the adult enteric nervous system. As diverticular disease (DD) is associated with reduced myenteric neurons, alterations of the GDNF system were studied in asymptomatic diverticulosis (diverticulosis) and DD. Methods Morphometric analysis for quantifying myenteric ganglia and neurons were assessed in colonic full-thickness sections of patients with diverticulosis and controls. Samples of tunica muscularis (TM) and laser-microdissected myenteric ganglia from patients with diverticulosis, DD and controls were analyzed for mRNA expression levels of GDNF, GFRA1, and RET by RT-qPCR. Myenteric protein expression of both receptors was quantified by fluorescence-immunohistochemistry of patients with diverticulosis, DD, and controls. Results Although no myenteric morphometric alterations were found in patients with diverticulosis, GDNF, GFRA1 and RET mRNA expression was down-regulated in the TM of patients with diverticulosis as well as DD. Furthermore GFRA1 and RET myenteric plexus mRNA expression of patients with diverticulosis and DD was down-regulated, whereas GDNF remained unaltered. Myenteric immunoreactivity of the receptors GFRα1 and RET was decreased in both asymptomatic diverticulosis and DD patients. Conclusion Our data provide evidence for an impaired GDNF system at gene and protein level not only in DD but also during early stages of diverticula formation. Thus, the results strengthen the idea of a disturbed GDNF-responsiveness as contributive factor for a primary enteric neuropathy involved in the pathogenesis and disturbed intestinal motility observed in DD.
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Affiliation(s)
| | - Thilo Wedel
- Institute of Anatomy, Kiel University, Kiel, Germany
| | | | - Ines Hohmeier
- Institute of Anatomy, Kiel University, Kiel, Germany
| | | | - Michael Ebsen
- Department of Pathology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Ilka Vogel
- Department of Surgery, Städtisches Krankenhaus Kiel, Kiel, Germany
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Barrenschee M, Zorenkov D, Böttner M, Lange C, Cossais F, Scharf AB, Deuschl G, Schneider SA, Ellrichmann M, Fritscher-Ravens A, Wedel T. Distinct pattern of enteric phospho-alpha-synuclein aggregates and gene expression profiles in patients with Parkinson's disease. Acta Neuropathol Commun 2017; 5:1. [PMID: 28057070 PMCID: PMC5217296 DOI: 10.1186/s40478-016-0408-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/18/2016] [Indexed: 01/16/2023] Open
Abstract
Phosphorylated alpha-synuclein (p-α-syn) containing Lewy bodies (LBs) and Lewy neurites (LNs) are neuropathological hallmarks of Parkinson’s disease (PD) in the central nervous system (CNS). Since they have been also demonstrated in the enteric nervous system (ENS) of PD patients, the aim of the study was to analyze enteric p-α-syn positive aggregates and intestinal gene expression. Submucosal rectal biopsies were obtained from patients with PD and controls and processed for dual-label-immunohistochemistry for p-α-syn and PGP 9.5. p-α-syn positive aggregates in nerve fibers and neuronal somata were subjected to a morphometric analysis. mRNA expression of α-syn and dopaminergic, serotonergic, VIP (vaso intestinal peptide) ergic, cholinergic, muscarinergic neurotransmitter systems were investigated using qPCR. Frequency of p-α-syn positive nerve fibers was comparable between PD and controls. Although neuronal p-α-syn positive aggregates were detectable in both groups, total number and area of p-α-syn positive aggregates were increased in PD patients as was the number of small and large sized aggregates. Increased expression of dopamine receptor D1, VIP and serotonin receptor 3A was observed in PD patients, while serotonin receptor 4 and muscarinic receptor 3 (M3R) were downregulated. M3R expression correlated negative with the number of small sized p-α-syn positive aggregates. The findings strengthen the hypothesis that the CNS pathology of increased p-α-syn in PD also applies to the ENS, if elaborated morphometry is applied and give further insights in altered intestinal gene expression in PD. Although the mere presence of p-α-syn positive aggregates in the ENS should not be regarded as a criterion for PD diagnosis, elaborated morphometric analysis of p-α-syn positive aggregates in gastrointestinal biopsies could serve as a suitable tool for in-vivo diagnosis of PD.
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Kaiser B, Böttner M, Wedel T, Brunner RM, Goldammer T, Lesko S, Gäbel G, Gleich A, Pfannkuche H. Establishment and Characterization of an SV40 Large T Antigen-Transduced Porcine Colonic Epithelial Cell Line. Cells Tissues Organs 2017; 203:267-286. [DOI: 10.1159/000453394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 11/19/2022] Open
Abstract
Continuous cell lines have become indispensable tools that have enabled investigations into cellular mechanisms by increasing experimental reproducibility and sample availability, and decreasing the use of experimental animals. To facilitate studies of epithelial barrier function of the porcine colon, we aimed to establish an epithelial cell line with an extended replicative capacity. Cells were isolated from the proximal colon of a 3-week-old piglet and transduced using a recombinant retroviral vector construct containing the simian virus 40 large T antigen (SV40 TAg). We established a clonal epithelial cell line, referred to as PoCo83-3, that stably expressed the SV40 TAg, verified at mRNA and protein levels. PoCo83-3 showed epithelial cell-specific features, such as cobblestone-like morphology, dome structure formation, the presence of apical microvilli, and the expression of keratin 18, E-cadherin and the tight junction-associated proteins zonula occludens-1, occludin, and claudin-1. To validate PoCo83-3 as an in vitro model in epithelial barrier research, proinflammatory cytokine-inducible alterations in barrier integrity were demonstrated by incubating the cells with TNF-α and IFN-γ for 48 h. These cytokine treatments promoted a decreased transepithelial electrical resistance. In summary, PoCo83-3 exhibited an extended life span and a differentiated phenotype while maintaining epithelial characteristics. Based on these results, we present this cell line as a valuable in vitro model for investigations of epithelial barrier function in the porcine colon.
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Abstract
This paper provides some of the underlying mathematical derivations for the one-hit, multihit, multistage, Weibull, and pharmacokinetic risk models. Our purposes are to remove for the nonmathematician some of the mystery as to the derivation of the formulas for each particular risk model and to discuss some of the assumptions contained in the risk models. Confidence limits and maximum likelihood estimates of the model parameters are not discussed, since they are not pertinent to our objectives. Rai and Van Ryzin(1)have outlined these procedures in sufficient detail.
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Affiliation(s)
- B. Hanes
- Department of Health Science, California State University, and Division Risk Analyses and Quality Assurance, Bureau of Business Services and Research, School of Business Administration and Economics, California State University, Northridge, California
| | - T. Wedel
- Department of Management Science, School of Business Administration and Economics, California State University, Northridge, California
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Stelzner S, Hohenberger W, Weber K, West NP, Witzigmann H, Wedel T. Anatomy of the transverse colon revisited with respect to complete mesocolic excision and possible pathways of aberrant lymphatic tumor spread. Int J Colorectal Dis 2016; 31:377-84. [PMID: 26546443 DOI: 10.1007/s00384-015-2434-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Although lymph node metastases to pancreatic and gastroepiploic lymph node stations in transverse colon cancer have been described, the mode of lymphatic spread in this area remains unclear. This study was undertaken to describe possible pathways of aberrant lymphatic spread in the complex anatomic area of the proximal superior mesenteric artery and vein, the greater omentum, and the lower pancreatic border. METHODS Abdominal specimens obtained from four cadaveric donors were dissected according to the principles of complete mesocolic excision. The vascular architecture of the transverse colon was scrutinized in search of possible pathways of lymphatic spread to the pancreatic and gastroepiploic lymph nodes. RESULTS Vascular connections between the transverse colon and the greater omentum at the level of both the hepatic and the splenic flexures could be identified. In addition, small vessels running from the transverse mesocolon to the lower pancreatic border in the area between the middle colic artery and the inferior mesenteric vein were demonstrated. Moreover, venous tributaries to the gastrocolic trunk could be exposed to highlight its surgical importance as a guiding structure for complete mesocolic excision. CONCLUSION The technical feasibility to clearly separate embryologic compartments by predefined tissue planes in complete mesocolic excision was confirmed. However, the vicinity of all three endodermal intestinal segments (foregut, midgut, and hindgut) obviously gives way to vascular connections that might serve as potential pathways for lymphatic metastatic spread of transverse colon cancer.
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Affiliation(s)
- Sigmar Stelzner
- Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Friedrichstr. 41, 01067, Dresden, Germany.
| | - Werner Hohenberger
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Weber
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Nicholas P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Helmut Witzigmann
- Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Friedrichstr. 41, 01067, Dresden, Germany
| | - Thilo Wedel
- Department of Anatomy, Center of Clinical Anatomy, Christian Albrechts University of Kiel, Kiel, Germany
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Borggrefe J, Bolte H, Worms W, Mahlke L, Seekamp A, Menzdorf L, Varoga D, Müller M, Weuster M, Zorenkov D, Wedel T, Lippross S. Comparison of intraoperative flat panel imaging and postoperative plain radiography for the detection of intraarticular screw displacement in volar distal radius plate ostheosynthesis. Orthop Traumatol Surg Res 2015; 101:913-7. [PMID: 26522382 DOI: 10.1016/j.otsr.2015.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 05/03/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate if intraoperative 3D flat panel imaging improves the detection of radiocarpal intraarticular screw misplacement (RCSM) in comparison to standard postoperative x-ray. METHODS In a study on cadaver specimens, we evaluated the sensitivity and specificity to detect RCSM using X-ray, intraoperative 3D-fluoroscopy as well as the digital volume tomography. The gold standard reference was computed tomography. RESULTS Sensitivity for the detection of RCSM for X-ray was 58% and specificity 88%. For DVT, the sensitivity to detect RCSM was 88% and the specificity 53%. For 3D-fluoroscopy, the sensitivity for RCSM was 68% and specificity 95%. When combining the methods, the best performance was found, when combining the two intraoperative imaging methods, with a resulting sensitivity of 88% and a specificity of 73%. CONCLUSIONS Intraoperative 3D fluoroscopy and digital volume tomography appear to be at least as sensitive and specific to detect RCSM than the regular postoperative radiography in two planes. However, especially discrete screw misplacements can be missed with either method. LEVEL OF EVIDENCE Level IV. Diagnostic device study.
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Affiliation(s)
- J Borggrefe
- University medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of radiology, Uniklinik Köln, Köln, Germany.
| | - H Bolte
- University medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of nuclear medicine, university-Clinics Münster, Münster, Germany
| | - W Worms
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - L Mahlke
- Saint-Vincenz hospital, Paderborn, Germany
| | - A Seekamp
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - L Menzdorf
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - D Varoga
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Müller
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Weuster
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - D Zorenkov
- Department of neurology, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Wedel
- Department of anatomy, Christian-Albrecht-aniversity, Kiel, Germany
| | - S Lippross
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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49
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Barrenschee M, Lange C, Cossais F, Egberts JH, Becker T, Wedel T, Böttner M. Expression and function of Neuregulin 1 and its signaling system ERBB2/3 in the enteric nervous system. Front Cell Neurosci 2015; 9:360. [PMID: 26441531 PMCID: PMC4585281 DOI: 10.3389/fncel.2015.00360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/28/2015] [Indexed: 12/12/2022] Open
Abstract
Neuregulin 1 (NRG1) is suggested to promote the survival and maintenance of the enteric nervous system (ENS). As deficiency in its corresponding receptor signaling complex ERBB2/ERBB3 leads to postnatal colonic hypo/aganglionosis we assessed the distributional and expressional pattern of the NRG1-ERBB2/ERBB3 system in the human colon and explored the neurotrophic capacity of NRG1 on cultured enteric neurons. Site-specific mRNA expression of the NRG1-ERBB2/3 system was determined in microdissected samples harvested from enteric musculature and ganglia. Localization of NRG1, ERBB2 and ERBB3 was determined by dual-label-immunohistochemistry using pan-neuronal and pan-glial markers. Morphometric analysis was performed on NRG1-stimulated rat enteric nerve cultures to evaluate neurotrophic effects. mRNA expression of the NRG1-ERBB2/3 system was determined by qPCR. Co-localization of NRG1 with neuronal or synaptic markers was analyzed in enteric nerve cultures stimulated with glial cell line-derived neurotrophic factor (GDNF). The NRG1 system was expressed in both neurons and glial cells of enteric ganglia and in nerve fibers. NRG1 significantly enhanced growth parameters in enteric nerve cell cultures and ErB3 mRNA expression was down-regulated upon NRG1 stimulation. GDNF negatively regulates ErbB2 and ErbB3 mRNA expression. The NRG1-ERBB2/3 system is physiologically present in the human ENS and NRG1 acts as a neurotrophic factor for the ENS. The down-regulation of ErbB3/ErbB2 in GDNF stimulated nerve cell cultures points to an interaction of both neurotrophic factors. Thus, the data may provide a basis to assess disturbed signaling components of the NRG1 system in enteric neuropathies.
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Affiliation(s)
- Martina Barrenschee
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts-University of Kiel Kiel, Germany
| | - Christina Lange
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts-University of Kiel Kiel, Germany
| | - François Cossais
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts-University of Kiel Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel Kiel, Germany
| | - Thomas Becker
- Department of General, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel Kiel, Germany
| | - Thilo Wedel
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts-University of Kiel Kiel, Germany
| | - Martina Böttner
- Neurogastroenterology, Institute of Anatomy, Christian-Albrechts-University of Kiel Kiel, Germany
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50
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Abstract
Diverticular disease is associated with a high incidence, morbidity and burden of the healthcare system. However, the pathogenesis is not yet satisfactorily clarified and thought to be multifactorial. Non-influenceable risk factors include increasing age, genetic predisposition and rare congenital connective tissue diseases. Influenceable risk factors are low-fiber diet, increased meat consumption and obesity. Alterations of connective tissue lead to a weakening of preformed emergence sites of diverticula ("loci minoris resistentiae") and may explain the increased incidence of diverticular disease in diseases caused by a systematic connective tissue disorder. The impact of neuromuscular alterations and disturbed colonic motility on triggering diverticula formation has been previously underestimated. Moreover, intestinal innervation disorders are considered to be responsable for persisting recurrent pain symptoms in chronic diverticular disease.
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Affiliation(s)
- Thilo Wedel
- Arbeitsgruppe Neurogastroenterologie, Zentrum für Klinische Anatomie, Anatomisches Institut, Christian-Albrechts-Universität zu Kiel
| | - Martina Barrenschee
- Arbeitsgruppe Neurogastroenterologie, Zentrum für Klinische Anatomie, Anatomisches Institut, Christian-Albrechts-Universität zu Kiel
| | - François Cossais
- Arbeitsgruppe Neurogastroenterologie, Zentrum für Klinische Anatomie, Anatomisches Institut, Christian-Albrechts-Universität zu Kiel
| | - Christina Lange
- Arbeitsgruppe Neurogastroenterologie, Zentrum für Klinische Anatomie, Anatomisches Institut, Christian-Albrechts-Universität zu Kiel
| | - Martina Böttner
- Arbeitsgruppe Neurogastroenterologie, Zentrum für Klinische Anatomie, Anatomisches Institut, Christian-Albrechts-Universität zu Kiel
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