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Mueller TC, Kehl V, Dimpel R, Blankenstein C, Egert-Schwender S, Strudthoff J, Lock JF, Wiegering A, Hadian A, Lang H, Albertsmeier M, Neuberger M, Von Ehrlich-Treuenstätt V, Mihaljevic AL, Knebel P, Pianka F, Braumann C, Uhl W, Bouchard R, Petrova E, Bork U, Distler M, Tachezy M, Izbicki JR, Reissfelder C, Herrle F, Vay C, Knoefel WT, Buia A, Hanisch E, Friess H, Reim D. Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy: A Randomized Clinical Trial by CHIR-Net. JAMA Surg 2024:2815372. [PMID: 38381428 PMCID: PMC10882507 DOI: 10.1001/jamasurg.2023.7985] [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: 02/22/2024]
Abstract
Importance Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking. Objective To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution. Design, Setting, and Participants The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial was a multicenter, 3-armed, randomized clinical trial. Patients and outcome assessors were blinded to the intervention. The clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis. Interventions Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure. Main Outcome and Measures The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition. Results Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups. Conclusions and Relevance In this study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting. Trial Registration drks.de Identifier: DRKS00012251.
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Affiliation(s)
- Tara Catharina Mueller
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebekka Dimpel
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christiane Blankenstein
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Judith Strudthoff
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Johan Friso Lock
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Ali Hadian
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - Michael Neuberger
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - Viktor Von Ehrlich-Treuenstätt
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - André L Mihaljevic
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Phillip Knebel
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Pianka
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum Hospitals, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum Hospitals, Bochum, Germany
| | - Ralf Bouchard
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ekaterina Petrova
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ulrich Bork
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Helmholtz Center Dresden-Rossendorf, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Helmholtz Center Dresden-Rossendorf, Dresden, Germany
| | - Michael Tachezy
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Florian Herrle
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Vay
- Department of General, Visceral, Thoracic, and Pediatric Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of General, Visceral, Thoracic, and Pediatric Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Buia
- Asklepios Clinic Langen, Department of General, Visceral and Thoracic Surgery, Langen, Germany
| | - Ernst Hanisch
- Asklepios Clinic Langen, Department of General, Visceral and Thoracic Surgery, Langen, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Daniel Reim
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Wagner A, Brielmaier MC, Kampf C, Baumgart L, Aftahy AK, Meyer HS, Kehl V, Höhne J, Schebesch KM, Schmidt NO, Zoubaa S, Riemenschneider MJ, Ratliff M, Enders F, von Deimling A, Liesche-Starnecker F, Delbridge C, Schlegel J, Meyer B, Gempt J. Fluorescein-stained confocal laser endomicroscopy versus conventional frozen section for intraoperative histopathological assessment of intracranial tumors. Neuro Oncol 2024:noae006. [PMID: 38243410 DOI: 10.1093/neuonc/noae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The aim of this clinical trial was to compare Fluorescein-stained intraoperative confocal laser endomicroscopy (CLE) of intracranial lesions and evaluation by a neuropathologist with routine intraoperative frozen section (FS) assessment by Neuropathology. METHODS In this phase II non-inferiority, prospective, multicenter, non-randomized, off-label clinical trial (Eudra-CT: 2019-004512-58), patients above the age of 18 years with any intracranial lesion scheduled for elective resection were included. The diagnostic accuracies of both CLE and FS referenced with the final histopathological diagnosis were statistically compared in a non-inferiority analysis, representing the primary endpoint. Secondary endpoints included the safety of the technique and time expedited for CLE and FS. RESULTS 210 patients were included by 3 participating sites between November 2020 and June 2022. Most common entities were high grade gliomas (37.9%), metastases (24.1%), and meningiomas (22.7%), A total of 6 serious adverse events in 4 (2%) patients were recorded. For the primary endpoint, the diagnostic accuracy for CLE was inferior with .87 versus .91 for FS, resulting in a difference of .04 (95% confidence interval -.10; .02; p=.367). The median time expedited until intraoperative diagnosis was 3 minutes for CLE and 27 minutes for FS, with a mean difference of 27.5 minutes (standard deviation 14.5; p<.001). CONCLUSION CLE allowed for a safe and time-effective intraoperative histological diagnosis with a diagnostic accuracy of 87% across all intracranial entities included. The technique achieved histological assessments in real-time with a tenfold reduction of processing time compared to FS, which may invariably impact surgical strategy on the fly.
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Affiliation(s)
- Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
| | - Maria Charlotte Brielmaier
- Department of Neurosurgery, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
| | - Charlotte Kampf
- Department of Neurosurgery, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
| | - Lea Baumgart
- Department of Neurosurgery, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
| | - Amir Kaywan Aftahy
- Department of Neurosurgery, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
| | - Hanno-Sebastian Meyer
- Department of Neurosurgery, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria Kehl
- Institute for AI and Informatics in Medicine, Technical University Munich, Germany
| | - Julius Höhne
- Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany
- Department of Neurosurgery, Paracelsus Medical University, Nürnberg, Germany
| | - Karl-Michael Schebesch
- Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany
- Department of Neurosurgery, Paracelsus Medical University, Nürnberg, Germany
| | - Nils O Schmidt
- Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany
| | - Saida Zoubaa
- Department of Neuropathology, Regensburg University Hospital, Regensburg, Germany
| | | | - Miriam Ratliff
- Department of Neurosurgery, University Hospital Mannheim Germany
| | - Frederik Enders
- Department of Neurosurgery, University Hospital Mannheim Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Cancer Center (DKFZ), Heidelberg, Germany
| | | | - Claire Delbridge
- Department of Neuropathology, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
| | - Jürgen Schlegel
- Department of Neuropathology, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar Technical University Munich School of Medicine, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Joerger AK, Laho X, Kehl V, Meyer B, Krieg SM, Ille S. The impact of intraoperative MRI on cranial surgical site infections-a single-center analysis. Acta Neurochir (Wien) 2023; 165:3593-3599. [PMID: 37971620 PMCID: PMC10739228 DOI: 10.1007/s00701-023-05870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The use of intraoperative MRI (ioMRI) contributes to an improved extent of resection. Hybrid operating room MRI suites have been established, with the patient being transferred to the MRI scanner. In the present descriptive analysis, we compared the rate of surgical site infections (SSI) after intracranial tumor surgery with and without the use of ioMRI. METHODS In this retrospective study, we included 446 patients with open craniotomy performed for brain tumor surgery. One hundred fourteen patients were operated on with the use of ioMRI between June 1, 2018, and June 30, 2019 (group 1). During the same period, 126 patients were operated on without ioMRI (group 2). As an additional control group, we analyzed 206 patients operated on from February 1, 2017, to February 28, 2018 when ioMRI had not yet been implemented (group 3). RESULTS The rate of SSI in group 1 (11.4%), group 2 (9.5%), and group 3 (6.8%) did not differ significantly (p = 0.352). Additional resection after ioMRI did not result in a significantly elevated number of SSI. No significant influence of re-resection, prior radio-/chemotherapy, blood loss or duration of surgery was found on the incidence of SSI. CONCLUSION Despite the transfer to a non-sterile MRI scanner, leading to a prolonged operation time, SSI rates with and without the use of ioMRI did not differ significantly. Hence, advantages of ioMRI outweigh potential disadvantages as confirmed by this real-life single-center study.
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Affiliation(s)
- Ann-Kathrin Joerger
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Xhimi Laho
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Victoria Kehl
- Institute for AI and Informatics in Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
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Müller AM, Löhn-Kannengießer L, Bradaric C, Dirschinger R, Koppara T, Bergmann K, Kehl V, Cassese S, Xhepa E, Kastrati A, Laugwitz KL, Ibrahim T. Outcomes of endovascular treatment for popliteal artery disease. VASA 2023; 52:386-393. [PMID: 37840269 DOI: 10.1024/0301-1526/a001096] [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] [Indexed: 10/17/2023]
Abstract
Background: Finding the appropriate endovascular revascularization strategy for patients with peripheral artery disease and a popliteal artery lesion remains particulary challenging. Data regarding predictors for a beneficial outcome are scarce. Patients and methods: All endovascular procedures of popliteal artery lesions (n=227) performed in 197 patients between February 2009 and May 2018 at our institution were retrospectively analyzed. Hemodynamically relevant restenosis represented the primary endpoint. Results: The overall technical success rate was 98% and yielded 99% for stenoses (n=145) and 97% for occlusions (n=82). In a median follow-up of 10 months, the overall rate of restenosis was 23%. After 1 and 2 years, the primary patency rates were 76% and 55% and the secondary patency rate was 100%, respectively. The estimated probability of restenosis was significantly higher in stented lesions (stent vs. no stent; 36.0% vs. 19.1%; p=0.030). Multivariate analysis identified stent implantation (hazard ratio: 2.4; overall P=0.010) and diabetes (hazard ratio 2.0; P=0.023) as significant predictors for the development of restenosis. Conclusions: Endovascular therapy for popliteal artery disease was associated with high technical success rates and accompanied with a promising mid-term outcome, particularly in lesions treated with balloon angioplasty alone.
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Affiliation(s)
- Arne M Müller
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Leoni Löhn-Kannengießer
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Christian Bradaric
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Ralf Dirschinger
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Tobias Koppara
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Katharina Bergmann
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
| | - Victoria Kehl
- Institut für KI und Informatik in der Medizin, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin I., Klinikum rechts der Isar, Technische Universität München, Germany
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Bernhardt D, Peeken JC, Kehl V, Eitz K, Guckenberger M, Andratschke N, Mayinger MC, Lindel K, Dieckmann K, El Shafie R, Debus J, Riesterer O, Rogers S, Blanck O, Wolff R, Grosu A, Bilger A, Henkenberens C, Schulze K, Gani C, Müller AC, Radlanski K, Janssen S, Ferentinos K, Combs SE. Post-Operative Stereotactic Radiotherapy for Resected Brain Metastases: Results of the Multicenter Analysis (AURORA) of the German Working Group "Stereotactic Radiotherapy". Int J Radiat Oncol Biol Phys 2023; 117:e87-e88. [PMID: 37786203 DOI: 10.1016/j.ijrobp.2023.06.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While the results of prospective studies support the use of postoperative stereotactic radiotherapy (RT) to the resection cavity (RC) as the standard of care after surgery, there are several issues that need to be investigated such as factors for improving local control, risk of leptomeningeal disease and radiation necrosis. Further, the optimal dose and fractionation is still under debate. MATERIALS/METHODS The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology (DEGRO) analyzed its multi-institutional database with 661 patients who received postoperative stereotactic RT to the RC. Treatment was performed at 13 centers between 2008 and 2021. Patient characteristics, treatment details, and follow-up data including overall survival (OS), local control (LC) were evaluated. Cox Regression and Kaplan-Meier curves with Log-rank Tests were calculated for selected variables. RESULTS In this retrospective study, overall survival was 61.5% at 1 year, 47.6% at 2 years, and 35.5% at 3 years, and local control was 84.6% at 1 year, 74.8% at 2 years, and 72.8% at 3 years. 96% of patients were treated with hypofractionated stereotactic radiotherapy (HSRT), only 26 patients received single fraction radiosurgery (4%). Prognostic factors associated with overall survival were Karnofsky Performance Status, RPA and GPA class, controlled primary tumor and absence of extracranial metastases, whereas prognostic factor associated with local control was planning target volume (23 mL or less). CONCLUSION HSRT is the most common fractionation form in the treatment of RCs in this multicenter analysis. This approach results in excellent OS and LC outcomes. OS in patients with resected brain metastases is mainly influenced by performance status. In regard to local control, RT of large cavities remain a challenge with significantly worse outcome.
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Affiliation(s)
- D Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany, Munich, Germany
| | - J C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Center Munich, Munich, Germany
| | - V Kehl
- Institute for AI and Informatics in Medicine, Munich, NA, Germany
| | - K Eitz
- Department of Radiation Oncology - Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - M C Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - K Lindel
- Municipal Hospital, Department for Radiation Oncology, Karlsruhe, Germany
| | - K Dieckmann
- Department of Radiation Oncology, Vienna, Austria
| | - R El Shafie
- 8Department of Radiation Oncology, University Hospital Göttingen, Göttingen, Germany
| | - J Debus
- CCU Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Radiation Oncology University Hospital Heidelberg, Heidelberg, Germany
| | - O Riesterer
- Center for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - S Rogers
- Radiation Oncology Center KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - O Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - R Wolff
- University Hospital Frankfurt, Department of Neurosurgery, Frankfurt, Germany
| | - A Grosu
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Bilger
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | - K Schulze
- Klinikum Fulda, 36251 Bad Hersfeld, Germany
| | - C Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A C Müller
- Department of Radiotherapy, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K Radlanski
- Radiation Oncology and Radiotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - K Ferentinos
- Radiation Oncology Department, German Oncology Center, Limassol, Cyprus
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
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Kölbel B, Novotny A, Willms A, Kehl V, Meyer B, Mauer UM, Krieg SM. Study protocol for a multicenter randomized controlled pilot study on decompressive laparotomy vs. decompressive craniectomy for intractable intracranial pressure after traumatic brain injury: The SCALPEL study. Brain Spine 2023; 3:102677. [PMID: 37822567 PMCID: PMC10562836 DOI: 10.1016/j.bas.2023.102677] [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] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
Introduction Decompressive craniectomy (DC) is the ultimate intervention to lower intracranial pressure (ICP) following severe traumatic brain injury (TBI). However, this intervention is associated with considerable adverse events and a higher proportion of survivors with poor functional outcomes. Research question In a multicompartment system ICP is associated with intraabdominal pressure (IAP) due to cerebral venous outflow from the brain. This is the rationale for decompressive laparotomy (DL) to control ICP after TBI as reported by experimental and retrospective clinical data. The safety profile of DL is superior to DC. This study aims to randomly assign patients with intractable high ICP after severe TBI to DL or DC. Material and methods Among other inclusion criteria, ICP must be above 20 mmHg (1-12 h) despite sedation and all other measures according to current guidelines. The primary outcome is the Extended Glasgow Outcome Scale assessed after twelve months. Further secondary outcome measures are compartmental pressure values, complications, etc. After 20 initial patients, results will be reviewed by the ethics committees and safety monitoring board to decide on the enrolment of 80 additional patients. Results The study is designed to provide not only high-quality prospective data for the first time on this treatment approach, its two-stage design (20 + 80 pts) also provides maximum patient safety. This protocol conforms with the SPIRIT 2013 Statement. Ethics approval was granted by our but also 5 other university ethics committees (registration 473/18S). Conclusion Registration was performed prior to study initiation in November 2021 (registration number NCT05115929).
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Affiliation(s)
- Benny Kölbel
- Department of Surgery, Bundeswehrkrankenhaus Ulm, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Arnulf Willms
- Department of Surgery, Bundeswehrkrankenhaus Hamburg, Germany
| | - Victoria Kehl
- Münchner Studienzentrum, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe-Max Mauer
- Department of Neurosurgery, Bundeswehrkrankenhaus Ulm, Germany
| | - Sandro M. Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Jung NH, Egert-Schwender S, Schossow B, Kehl V, Wahlländer U, Brich L, Janke V, Blankenstein C, Zenker M, Mall V. Improvement of synaptic plasticity and cognitive function in RASopathies-a monocentre, randomized, double-blind, parallel-group, placebo-controlled, cross-over clinical trial (SynCoRAS). Trials 2023; 24:383. [PMID: 37280688 DOI: 10.1186/s13063-023-07392-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Cognitive impairment is a common medical issue in rat sarcoma (RAS) pathway disorders, so-called RASopathies, like Neurofibromatosis type 1 (NF1) or Noonan syndrome (NS). It is presumed to be caused by impaired synaptic plasticity. In animal studies, pathway-specific pharmacological interventions with lovastatin (LOV) and lamotrigine (LTG) have been shown to improve synaptic plasticity as well as cognitive function. The aim of this clinical trial is to translate the findings of animal studies to humans and to probe the effect of lovastatin (NS) and lamotrigine (NS and NF1) on synaptic plasticity and cognitive function/alertness in RASopathies. METHODS Within this phase IIa, monocentre, randomized, double-blind, parallel-group, placebo-controlled, cross-over clinical trial (syn. SynCoRAS), three approaches (approaches I-III) will be carried out. In patients with NS, the effect of LTG (approach I) and of LOV (approach II) is investigated on synaptic plasticity and alertness. LTG is tested in patients with NF1 (approach III). Trial participants receive a single dose of 300 mg LTG or placebo (I and III) and 200 mg LOV or placebo (II) daily for 4 days with a cross-over after at least 7 days. Synaptic plasticity is investigated using a repetitive high-frequency transcranial magnetic stimulation (TMS) protocol called quadri-pulse theta burst stimulation (qTBS). Attention is examined by using the test of attentional performance (TAP). Twenty-eight patients are randomized in groups NS and NF1 with n = 24 intended to reach the primary endpoint (change in synaptic plasticity). Secondary endpoints are attention (TAP) and differences in short interval cortical inhibition (SICI) between placebo and trial medication (LTG and LOV). DISCUSSION The study is targeting impairments in synaptic plasticity and cognitive impairment, one of the main health problems of patients with RASopathies. Recent first results with LOV in patients with NF1 have shown an improvement in synaptic plasticity and cognition. Within this clinical trial, it is investigated if these findings can be transferred to patients with NS. LTG is most likely a more effective and promising substance improving synaptic plasticity and, consecutively, cognitive function. It is expected that both substances are improving synaptic plasticity as well as alertness. Changes in alertness may be a precondition for improvement of cognition. TRIAL REGISTRATION The clinical trial is registered in ClinicalTrials.gov (NCT03504501; https://www. CLINICALTRIALS gov ; date of registration: 04/11/2018) and in EudraCT (number 2016-005022-10).
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Affiliation(s)
- Nikolai H Jung
- Social Pediatrics, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, School of Medicine, Technical University of Munich, Munich, Germany
| | - Beate Schossow
- Münchner Studienzentrum, School of Medicine, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- Münchner Studienzentrum, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ute Wahlländer
- Institut for General Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Louisa Brich
- Social Pediatrics, School of Medicine, Technical University of Munich, Munich, Germany
| | - Viktoria Janke
- Münchner Studienzentrum, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christiane Blankenstein
- Münchner Studienzentrum, School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Volker Mall
- Social Pediatrics, School of Medicine, Technical University of Munich, Munich, Germany
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Mueller T, Dimpel R, Kehl V, Friess H, Reim D. Surgical site infection prevention in abdominal surgery: is intraoperative wound irrigation with antiseptics effective? Protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e066140. [PMID: 36787980 PMCID: PMC9930547 DOI: 10.1136/bmjopen-2022-066140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) after laparotomy still represents the most frequent postoperative complicationin abdominal surgery. The effectiveness of reducing SSI rates by intra-operative irrigation of the incisional wound with antiseptic solutions or saline has been much debated, and recommendations on its use are divergent. Therefore, we aim to conduct a systematic review and meta-analysis, focusing specifically on procedures by laparotomy and considering recent evidence only. METHODS AND ANALYSIS The systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. On 1 July 2022, PubMed/MEDLINE, Cochrane, Central Register of Controlled Trials and EMBASE were searched for the following predefined terms: (Surgical site infection) AND ((irrigation) OR (wound irrigation) OR (lavage)) AND ((abdominal surgery) OR (laparotomy). The search was limited to peer-revied publications, dating after 1 January 2000 in English or German language. Systematic reviews and meta-analyses were included for reference screening. Case reports, case series, non-systematic reviews and studies without follow-up information were excluded. The primary outcome is the rate of postoperative SSI after abdominal surgery by laparotomy. Meta-analysis is pooled using the Mantel-Haenszel method for random effects. The risk of bias in randomised studies will be assessed using the Cochrane developed RoB 2-tool, and the ROBINS-I tool for non-randomised studies. Completion of the analysis and publication is planned in March 2023. ETHICS AND DISSEMINATION Ethical approval is not necessary for this study, as no new data will be collected. The results of the final study will be published in a peer-reviewed open-access journal. PROSPERO REGISTRATION NUMBER CRD42022321458.
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Affiliation(s)
- Tara Mueller
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rebekka Dimpel
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- Münchner Studienzentrum, School of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Reim
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Strassen U, Bas M, Wirth M, Wirth M, Gröger M, Stelter K, Volkenstein S, Kehl V, Kojda G, Hoffmann TK, Hahn J, Trainotti S, Greve J. Efficacy of human C1 esterase inhibitor concentrate for treatment of ACE-inhibitor induced angioedema. Am J Emerg Med 2023; 64:121-128. [PMID: 36516670 DOI: 10.1016/j.ajem.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND ACE inhibitor (ACEi) induced angioedema predominantly affects the upper aerodigestive tract. As ACEi induced angioedema is mediated by bradykinin, therapeutic response to antihistamines and glucocorticoids remains unsatisfactory. In bradykinin mediated hereditary angioedema, C1-esterase inhibitor (C1INH) is an effective and approved treatment since many years. Our aim was to evaluate the therapeutic effect of C1INH in ACEi induced angioedema. METHODS We performed a double-blind, parallel-group, multicentre randomised placebo-controlled trial between December 2013 and September 2018. Eligible were adults with ACEi induced angioedema with airway obstruction. Participants were randomised 1:1 to single doses of either C1INH (20 IU/kg) or placebo (0.9% NaCl) i.v in addition to standard care (i.v. 500 mg prednisolone and 2.68 mg clemastine) i.v. Composite symptom scores were assessed at baseline and up to 48 h, at discharge and 1 week after discharge. Physician assessed time to complete oedema resolution (TCER) and time to onset of relief (TOR). RESULTS 30 patients (16 C1INH, 14 placebo) were randomised and dosed. 25 (9 C1INH, 12 placebo) completed the study. TCER was 29.63 h ± 15.56 h in the C1INH and 17.29 h ± 10.40 h in the placebo arm (p = 0.0457). TORs were 4.13 h ± 3.38 h and 2.86 h ± 1.29 h for C1INH and placebo, respectively (p = 0.4443). There were no adverse events related to study medication. CONCLUSIONS In the context of baseline application of steroids and antihistamines C1INH was inferior in the treatment of ACEi induced angioedema when compared to placebo with respect to time to complete resolution of symptoms. Eudra-CT Number: 2012-001670-28.
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Affiliation(s)
- Ulrich Strassen
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, Germany.
| | - Murat Bas
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Magdalena Wirth
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Markus Wirth
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Moritz Gröger
- Department of Otorhinolaryngology, Grosshadern Medical Center of the University of Munich, Germany
| | - Klaus Stelter
- Department of Otorhinolaryngology, Grosshadern Medical Center of the University of Munich, Germany
| | - Stefan Volkenstein
- Department of Otorhinolaryngology, Ruhr-University of Bochum, St. Elisabeth-Hospital Bochum, Germany
| | - Victoria Kehl
- Munich Study Center, Faculty of Medicine, Technical University Munich, Germany; Institute for AI and Informatics in Medicine, Faculty of Medicine, Technical University Munich, Germany
| | - Georg Kojda
- Institute of Pharmacology and Clinical Pharmacology, University Hospital Düsseldorf, Düsseldorf (G.K.), Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University, Medical Center, Ulm, Germany
| | - Janina Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University, Medical Center, Ulm, Germany
| | - Susanne Trainotti
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University, Medical Center, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University, Medical Center, Ulm, Germany
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Weber S, Kehl V, Erber J, Wagner KI, Jetzlsperger AM, Burrell T, Schober K, Schommers P, Augustin M, Crowell CS, Gerhard M, Winter C, Moosmann A, Spinner CD, Protzer U, Hoffmann D, D’Ippolito E, Busch DH. CMV seropositivity is a potential novel risk factor for severe COVID-19 in non-geriatric patients. PLoS One 2022; 17:e0268530. [PMID: 35613127 PMCID: PMC9132318 DOI: 10.1371/journal.pone.0268530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/21/2022] [Accepted: 05/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND COVID-19 has so far affected more than 250 million individuals worldwide, causing more than 5 million deaths. Several risk factors for severe disease have been identified, most of which coincide with advanced age. In younger individuals, severe COVID-19 often occurs in the absence of obvious comorbidities. Guided by the finding of cytomegalovirus (CMV)-specific T cells with some cross-reactivity to SARS-CoV-2 in a COVID-19 intensive care unit (ICU) patient, we decided to investigate whether CMV seropositivity is associated with severe or critical COVID-19. Herpes simplex virus (HSV) serostatus was investigated as control. METHODS National German COVID-19 bio-sample and data banks were used to retrospectively analyze the CMV and HSV serostatus of patients who experienced mild (n = 101), moderate (n = 130) or severe to critical (n = 80) disease by IgG serology. We then investigated the relationship between disease severity and herpesvirus serostatus via statistical models. RESULTS Non-geriatric patients (< 60 years) with severe COVID-19 were found to have a very high prevalence of CMV-seropositivity, while CMV status distribution in individuals with mild disease was similar to the prevalence in the German population; interestingly, this was not detectable in older patients. Prediction models support the hypothesis that the CMV serostatus, unlike HSV, might be a strong biomarker in identifying younger individuals with a higher risk of developing severe COVID-19, in particular in absence of other co-morbidities. CONCLUSIONS We identified 'CMV-seropositivity' as a potential novel risk factor for severe COVID-19 in non-geriatric individuals in the studied cohorts. More mechanistic analyses as well as confirmation of similar findings in cohorts representing the currently most relevant SARS-CoV-2 variants should be performed shortly.
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Affiliation(s)
- Simone Weber
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- Institute for AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johanna Erber
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - Karolin I. Wagner
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | | | - Teresa Burrell
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Kilian Schober
- Mikrobiologisches Institut–Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Schommers
- Medical Faculty and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Max Augustin
- Medical Faculty and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Claudia S. Crowell
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - Markus Gerhard
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - Christof Winter
- Institute of Clinicl Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas Moosmann
- German Center for Infection Research (DZIF), Munich, Germany
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Christoph D. Spinner
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - Ulrike Protzer
- Institute of Virology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dieter Hoffmann
- Institute of Virology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Elvira D’Ippolito
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Dirk H. Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
- * E-mail:
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11
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Meyer B, Thomé C, Vajkoczy P, Kehl V, Dodel R, Ringel F. Lumbar dynamic pedicle-based stabilization versus fusion in degenerative disease: a multicenter, double-blind, prospective, randomized controlled trial. J Neurosurg Spine 2022; 37:1-10. [PMID: 35453106 DOI: 10.3171/2022.2.spine21525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 02/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Fusion is the standard of treatment for degenerative lumbar symptomatic instabilities. Dynamic stabilization is a potential alternative, with the aim of reducing pathological motion. Potential advantages are a reduction of surgical complexity and morbidity. The aim of this study was to assess whether dynamic stabilization is associated with a higher degree of functional improvement while reducing surgical complexity and thereby surgical duration and perioperative complications in comparison with lumbar fusion. METHODS This was a multicenter, double-blind, prospective, randomized, 2-arm superiority trial. Patients with symptomatic mono- or bisegmental lumbar degenerative disease with or without stenosis and instability were randomized 1:1 to instrumented fusion or pedicle-based dynamic stabilization. Patients underwent either rigid internal fixation and interbody fusion or pedicle-based dynamic stabilization. The primary endpoint was the Oswestry Disability Index (ODI) score, and secondary endpoints were pain, health-related quality of life, and patient satisfaction at 24 months. RESULTS Of 293 patients randomized to fusion or dynamic stabilization, 269 were available for analysis. The duration of surgery was significantly shorter for dynamic stabilization versus fusion, and the blood loss was significantly less for dynamic stabilization (380 ml vs 506 ml). Assessment of primary and secondary outcome parameters revealed no significant differences between groups. There were no differences in the incidence of adverse events. CONCLUSIONS Dynamic pedicle-based stabilization can achieve similar clinical outcome as fusion in the treatment of lumbar degenerative instabilities. Secondary failures are not different between groups. However, dynamic stabilization is less complex than fusion and is a feasible alternative.
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Affiliation(s)
- Bernhard Meyer
- 1Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Claudius Thomé
- 2Department of Neurosurgery, Universitätsklinikum Innsbruck, Austria
| | - Peter Vajkoczy
- 3Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
| | - Victoria Kehl
- 4Institute for Medical Informatics, Statistics and Epidemiology, Technische Universität München, Germany
| | - Richard Dodel
- 5Department of Geriatric Medicine, Universität Duisburg-Essen, Geriatriezentrum Haus Berge, Essen, Germany; and
| | - Florian Ringel
- 1Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Germany
- 6Department of Neurosurgery, University Medical Center Mainz, Germany
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Ritschl LM, Wittmann M, von Bomhard A, Koerdt S, Unterhuber T, Kehl V, Deppe H, Wolff KD, Mücke T, Fichter AM. Results of a Clinical Scoring System Regarding Symptoms and Surgical Treatment of Isolated Unilateral Zygomatico-Orbital Fractures: A Single-Centre Retrospective Analysis of 461 Cases. J Clin Med 2022; 11:jcm11082187. [PMID: 35456282 PMCID: PMC9032597 DOI: 10.3390/jcm11082187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Systematic assessment of computed tomography (CT) scans and clinical symptoms is necessary to quickly indicate the correct treatment of zygomatico-orbital (ZMO) fractures. For this purpose, a clinical scoring system (=Clinical Score) was developed and correlated with CT scans to analyse its validity. Every operated, isolated, and unilateral ZMO fracture between January 2012 and December 2016 was screened retrospectively, including patient and treatment data. All available CT scans were analysed, and the grade of dislocation was measured for each case and plane. Four hundred and sixty-one cases were included and showed a median surgery time of 66.0 min (5.0−361.0) and a median postoperative hospital stay of three days (0−25). The distribution of gender, aetiologies and age groups was significantly different (each p = 0.001), and the aetiology had a significant influence on the Clinical Score (p = 0.038). The degree of dislocation in the coronary and sagittal planes correlated significantly with the Clinical Score with regard to the orbital involvement (p < 0.001, ρ = 0.566; p < 0.001, ρ = 0.609). The simple, quick, and easy-to-apply Clinical Score showed a significant correlation with the most important planes in CT scans as well as with the clinical course. It may facilitate fast risk stratification of the patient. However, the validity of the proposed score in determining indications must now be evaluated in a prospective setting, including both operated and non-operated fractures.
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Affiliation(s)
- Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
- Correspondence: ; Tel.: +49-89-4140-2932
| | - Matthias Wittmann
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Achim von Bomhard
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
| | - Tobias Unterhuber
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Victoria Kehl
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Grillparzerstrasse 18, 81675 Munich, Germany;
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery, St. Josefs Hospital, 47441 Moers, Germany;
| | - Andreas M. Fichter
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
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13
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Riedl L, Kiesel E, Hartmann J, Fischer J, Roßmeier C, Haller B, Kehl V, Priller J, Trojan M, Diehl-Schmid J. A bitter pill to swallow - Polypharmacy and psychotropic treatment in people with advanced dementia. BMC Geriatr 2022; 22:214. [PMID: 35296254 PMCID: PMC8925050 DOI: 10.1186/s12877-022-02914-x] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polypharmacy is common in people with dementia. The use of psychotropic drugs (PDs) and other, potentially inappropriate medications is high. The aims of this cross-sectional study were 1) to investigate the use of drugs in people with advanced dementia (PWAD), living at home or in long term care (LTC); 2) to focus on PD use; and 3) to identify determinants of PD use. METHODS The study was performed in the context of EPYLOGE (IssuEs in Palliative care for people in advanced and terminal stages of YOD and LOD in Germany). 191 PWAD were included. All drugs that were administered at the date of the examination were recorded. Multiple logistic regression analysis identified determinants of PD use. RESULTS 96% of PWAD received medication with a median number of four drugs. 49.7% received five or more drugs. According to the Beers Criteria 39% of PWAD ≥ 65 years received at least one potentially inappropriate medication. 79% of PWAD were treated with PDs. Older PWAD and PWAD living in LTC facilities received significantly more drugs than younger PWAD, and PWAD living at home, respectively. Dementia etiology was significantly associated with the use of antipsychotics, antidepressants and sedative substances. Place of living was associated with the use of pain medication. Behavioral disturbances were associated with the use of antipsychotics and sedative substances. CONCLUSIONS To mitigate the dangers of polypharmacy and medication related harm, critical examination is required, whether a drug is indicated or not. Also, the deprescribing of drugs should be considered on a regular basis. TRIAL REGISTRATION Clinicaltrial.gov, NCT03364179 . Registered 6 December 2017.
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Affiliation(s)
- Lina Riedl
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Esther Kiesel
- School of Medicine, Hospital Pharmacy, Technical University of Munich, Munich, Germany
| | - Julia Hartmann
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Julia Fischer
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carola Roßmeier
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haller
- School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- School of Medicine, Münchner Studienzentrum, Munich Germany, Technical University of Munich, Munich, Germany
| | - Josef Priller
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Neuropsychiatry, Charité - Universitätsmedizin Berlin and DZNE, Berlin, Germany.,University of Edinburgh and UK DRI, Edinburgh, UK
| | - Monika Trojan
- School of Medicine, Hospital Pharmacy, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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14
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Hartmann J, Roßmeier C, Riedl L, Dorn B, Fischer J, Slawik T, Fleischhaker M, Hartmann F, Egert-Schwender S, Kehl V, Haller B, Schneider-Schelte H, Dinkel A, Jox RJ, Diehl-Schmid J. Quality of Life in Advanced Dementia with Late Onset, Young Onset, and Very Young Onset. J Alzheimers Dis 2021; 80:283-297. [PMID: 33523011 PMCID: PMC8075393 DOI: 10.3233/jad-201302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Advanced stages of dementia are characterized by severe cognitive and physical impairment. It has not yet been investigated whether persons with young onset dementia (YOD) and late onset dementia (LOD) differ in advanced disease stages. Objectives: To compare quality of life (QoL) between persons with advanced YOD and LOD; to explore the determinants of QoL; to investigate whether YOD and LOD differ with regard to symptoms and care. Methods: The study was performed in the context of EPYLOGE (IssuEs in Palliative care for persons in advanced and terminal stages of YOD and LOD in Germany). Persons with advanced dementia (PWAD) were assessed and caregivers were interviewed. QoL was measured with the proxy rating Quality of Life in Late Stage Dementia (QUALID) scale. Results: 93 persons with YOD and 98 with LOD were included. No significant differences in QoL were detected. Determinants of QoL were similar in YOD and LOD. Behavioral and psychological symptoms of dementia (BPSD), suffering and other distressing symptoms were associated with a lower QoL. In YOD but not in LOD antipsychotic treatment was associated with low QoL. The group of persons who were younger than 65 years at the time of the study visit experienced significantly more distressing symptoms than older PWAD. Conclusion: Overall, persons with advanced YOD do not appear to be disadvantaged compared to old and oldest PWAD. Special attention, however, must be paid to the group of the very young persons who seem to be particularly vulnerable.
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Affiliation(s)
- Julia Hartmann
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Carola Roßmeier
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Lina Riedl
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Bianca Dorn
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Julia Fischer
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Till Slawik
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Mareike Fleischhaker
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Florentine Hartmann
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Silvia Egert-Schwender
- Technical University of Munich, School of Medicine, Münchner Studienzentrum, Munich, Germany
| | - Victoria Kehl
- Technical University of Munich, School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Munich, Germany
| | - Bernhard Haller
- Technical University of Munich, School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Munich, Germany
| | | | - Andreas Dinkel
- Technical University of Munich, School of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Munich, Germany
| | - Ralf J Jox
- Palliative and Supportive Care Service, Chair in Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Janine Diehl-Schmid
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Roβmeier C, Hartmann J, Riedl L, Dorn B, Fischer J, Hartmann F, Egert-Schwender S, Kehl V, Schneider-Schelte H, Jox RJ, Dinkel A, Diehl-Schmid J. How Do Persons with Young and Late Onset Dementia Die? J Alzheimers Dis 2021; 81:843-852. [PMID: 33843681 PMCID: PMC8203230 DOI: 10.3233/jad-210046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND End of life symptoms and symptom management as well as the quality of dying (QoD) of persons with advanced dementia (PWAD) have not yet been systematically studied in Germany. OBJECTIVE 1) To investigate symptoms, treatment and care at the end of life, advance care planning, and circumstances of death of recently deceased PWAD; 2) To determine whether there are differences between young and late onset dementia (YOD and LOD). METHODS The study was performed in the context of the project EPYLOGE (IssuEs in Palliative care for persons in advanced and terminal stages of Young-onset and Late-Onset dementia in Germany). Closest relatives of recently deceased patients with advanced YOD (N = 46) and LOD (N = 54) living at home or in long term care were interviewed. RESULTS Circumstances of death, symptoms, and treatment appeared to be similar between YOD and LOD, except that persons with LOD had significantly more somatic comorbidities and were admitted to hospital in the last three months of life more often than persons with LOD. At end of life, 60% of PWAD appeared to be "at peace". Difficulty swallowing, gurgling, shortness of breath, and discomfort were observed most frequently. Large interindividual differences in suffering and QoD were present. Determinants of QoD were not identified. CONCLUSION Our findings suggest that low QoD was caused by inadequate recognition and/or insufficient treatment of burdensome physical and emotional symptoms. PWADs' needs should be assessed regularly, and strategies focusing on treatment and implementing support for both the patient and caregiver must be established.
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Affiliation(s)
- Carola Roβmeier
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Julia Hartmann
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Lina Riedl
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Bianca Dorn
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Julia Fischer
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Florentine Hartmann
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Silvia Egert-Schwender
- Technical University of Munich, School of Medicine, Münchner Studienzentrum, Munich, Germany
| | - Victoria Kehl
- Technical University of Munich, School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Munich, Germany
| | | | - Ralf J Jox
- Palliative and Supportive Care Service, Chair in Geriatric Palliative Care, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas Dinkel
- Technical University of Munich, School of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Munich, Germany
| | - Janine Diehl-Schmid
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Ortner M, Riedl L, Jox RJ, Hartmann J, Roßmeier C, Dorn B, Kehl V, Egert-Schwender S, Fischer J, Diehl-Schmid J. Suicidal Ideations and Behavior in Patients With Young and Late Onset Dementia. Front Neurol 2021; 12:647396. [PMID: 34385968 PMCID: PMC8353362 DOI: 10.3389/fneur.2021.647396] [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: 12/29/2020] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Data on suicidal ideation, behavior and the risk factors in patients with dementia is scarce. To evaluate the prevalence of death wishes, suicidal ideation, and suicidal behavior of young (YOD) and late onset dementia (LOD) and to identify risk factors for suicidal ideation and behavior. Methods: We interviewed 157 family caregivers of patients with advanced dementia using questions from the Columbia-Suicide Severity Rating Scale to gather information about suicidal ideation and behavior before the onset of symptoms of dementia, after the onset of dementia and within 30 days prior to the interview. At the time of the interview, we also assessed disease severity, cognitive function, and other psychological, behavioral and physical symptoms of the patients as well as the caregivers' psychological well-being. Results: Forty four (28%) of the patients expressed suicidal ideation or behavior at some time after the onset of symptoms, and 14 (9%) of these within the month prior to the assessment. Two patients had attempted suicide after the onset of dementia. There were no statistically significant differences between patients with and without suicidal ideations or behavior with regards to demographics or age at onset of dementia. In patients with advanced dementia, Alzheimer's disease (rather than frontotemporal lobar degeneration), better cognitive function, more severe psychological, behavioral, and physical symptoms, and a reduced quality of life were associated with the expression of suicidal ideation. Conclusions: According to caregivers' reports, majority of patients with dementia did not express suicidal ideation or show suicidal behavior. Patients who expressed suicidal ideation during early stages of dementia often stopped expressing them in advanced stages. It remains unclear if this was due to reduced communication abilities, a reduction of disease awareness, and/ or an adjustment to their situation.
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Affiliation(s)
- Marion Ortner
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ralf J Jox
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Chair in Geriatric Palliative Care, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julia Hartmann
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carola Roßmeier
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bianca Dorn
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- School of Medicine, Klinikum rechts der Isar, Institute for Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany.,Münchner Studienzentrum, Technical University of Munich, Munich, Germany
| | | | - Julia Fischer
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany
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Stöß C, Nitsche U, Neumann PA, Kehl V, Wilhelm D, Busse R, Friess H, Nimptsch U. Acute Appendicitis: Trends in Surgical Treatment. Dtsch Arztebl Int 2021; 118:244-249. [PMID: 34114553 DOI: 10.3238/arztebl.m2021.0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/17/2020] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendectomy is the gold standard for treatment of acute appendicitis. However, recent studies favor primary antibiotic therapy. The aim of this observational study was to explore changes in the numbers of operations for acute appendicitis in the period 2010-2017, paying special attention to disease severity. METHODS Data from diagnosis-related group statistics were used to analyze the trends, mortality, and complication rates in the surgical treatment of appendicitis in Germany between 2010 and 2017. All cases of appendectomy after a diagnosis of appendicitis were included. RESULTS Altogether, 865 688 inpatient cases were analyzed. The number of appendectomies went down by 9,8%, from 113 614 in 2010 to 102 464 in 2017, while the incidence fell from 139/100 000 in 2010 to 123/100 000 in 2017 (standardized by age group). This decrease is due to the lower number of operations for uncomplicated appendicitis (79 906 in 2017 versus 93 135 in 2010). Hospital mortality decreased both in patients who underwent surgical treatment of complicated appendicitis (0.62% in 2010 versus 0.42% in 2017) and in those with a complicated clinical course (5.4% in 2010 versus 3.4% in 2017). CONCLUSION Decisions on the treatment of acute appendicitis in German hospitals follow the current trend towards non-surgical management in selected patients. At the same time, the care of acute appendicitis has improved with regard to overall hospital morbidity and hospital mortality.
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Affiliation(s)
- Christian Stöß
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of MunichMünchner Studienzentrum, Klinikum rechts der Isar, School of Medicine,Technical University ofMunichDepartment of Health Care Management, Institute of Technology and Management, TechnischeUniversität Berlin
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18
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Klymenko O, Buchberger AMS, Wollenberg B, Wolff KD, Kehl V, Combs SE, Pickhard A, Pigorsch SU. Radiooncological View on Therapy Outcome after Multidisciplinary Treatment of Sinonasal Tumors. Cancers (Basel) 2021; 13:cancers13102364. [PMID: 34068905 PMCID: PMC8157068 DOI: 10.3390/cancers13102364] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Tumors of the nasal cavity and paranasal sinus are rare. Most are discovered at a locally advanced stage and require multimodal treatment consisting of surgery and radiotherapy with concomitant chemotherapy. Tumor localization between the eyes and near the brain makes treatment planning difficult due to the necessary consideration of both critical normal tissue with high protection priority and the curative aim of the best radiotherapy dose deposit. Thus, it is noteworthy how tumor volumes impact the five-year survival outcome. Therefore, we investigated initial tumor volumes before any therapy. Patients with larger mean initial tumor volumes of more than 75 cm3 had worse outcomes. There was no additional benefit of upfront surgery. Especially for patients with large tumor burdens of the nasal cavity or paranasal sinus, an interdisciplinary case discussion with the patient is essential in the process of shared decision-making. Abstract Purpose: We report the outcome of a mono-institutional retrospective study of sinonasal carcinoma with the primary focus on GTV (gross tumor volume) and the effect of radiotherapy. Methods: 53 patients with sinonasal carcinoma and that of the nasal cavity, paranasal sinus or both except lymphoma were included. All patients were treated between 1999 and 2017. For tumor volume delineation, all pre-therapeutic images were fused to the planning CT (computed tomography). Results: The median follow-up was 17 months [0.3–60], the median age 60 years, 35 males and 18 females were included. Squamous cell carcinoma (SCC) (60.4%) was the predominant histology, followed by adenocarcinoma (15.1%). The mean composite OS (overall survival) time was 33.3 ± 3.5 months. There was no significant difference in the 5 y composite OS between tumor localization or radiotherapy setting. The simultaneous integrated boost concept showed a trend towards improving five-year composite OS compared to the sequential boost concept. The only factor with a significant impact on the 5 y composite OS rate was the pre-therapeutic GTV (cutoff 75 cm3; p = 0.033). The GTV ≥ 100 cm3 has no effect on the 5 y composite OS rate for SCC. Conclusions: The pre-therapeutic GTV is a prognostic factor for five-year composite OS for the entire group of patients with sinonasal tumors, influencing the outcome after completion of all treatment strategies. The GTV seems to not influence five-year composite OS in SCC. For this rare tumor entity, an intensive, multidisciplinary discussion is essential to finding the best treatment option for the patient.
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Affiliation(s)
- Olena Klymenko
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (O.K.); (S.E.C.)
| | - Anna Maria Stefanie Buchberger
- Ear, Nose and Throat Department, Head and Neck Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (A.M.S.B.); (B.W.)
| | - Barbara Wollenberg
- Ear, Nose and Throat Department, Head and Neck Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (A.M.S.B.); (B.W.)
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany;
| | - Victoria Kehl
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675 Munich, Germany; (V.K.); (A.P.)
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (O.K.); (S.E.C.)
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany
| | - Anja Pickhard
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675 Munich, Germany; (V.K.); (A.P.)
| | - Steffi U. Pigorsch
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (O.K.); (S.E.C.)
- Correspondence: ; Tel.: +49-089-4140-4501
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Kotzur F, Bidner H, Bronger H, Egert S, Fasching PA, Fischer D, Kehl V, Lück HJ, Müller L, Reuning U, Rief L, Rösch R, Seitz S, Winter C, Kiechle M, Ettl J. Abstract OT-26-01: ABEMACARE: Abemaciclib in combination with endocrine therapy as first line therapy in metastatic breast cancer patients with symptomatic visceral metastases or high tumor burden. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-26-01] [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: 11/16/2022]
Abstract
Abstract
Background:
Cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors in combination with endocrine therapy are well established in the therapy of estrogen receptor (ER) positive, HER2 negative metastatic breast cancer. They have shown excellent results regarding disease control and survival in numerous trials while maintaining good quality of life for patients. In the subgroup analysis of the MONARCH 2 and MONARCH 3 trials, patients with liver metastases derived a particularly large benefit from the combined endocrine treatment with Abemaciclib. Despite this evidence, in real world many patients with endocrine sensitive metastatic breast cancer are still being treated with first line chemotherapy. Especially in patients with symptomatic visceral disease and/or high tumor burden, use of upfront chemotherapy remains common even in the absence of visceral crisis. With this study we aim to determine the efficacy of Abemaciclib in combination with endocrine therapy as first line treatment in this specific patient population.
Study design:
In this prospective multicenter observational study, we intend to enroll 120 patients in 10 German cancer treatment centers who will receive first line therapy with Abemaciclib in combination with endocrine therapy within clinical routine. Recruitment is planned to start in August 2020. Patients with documented ER positive, HER2 negative metastatic breast cancer with measurable visceral disease are eligible if they fulfill one of the following inclusion criteria: Presence of clinical signs or symptoms of visceral disease (e.g. pleural effusion, ascites, abdominal pain from liver or peritoneal metastases, dyspnea from pleural effusion or lymphangiosis of the lung, elevated liver enzymes or bilirubin level (> 2x ULN)) or signs of high tumor burden (e.g. LDH > 399 U/l with K in normal range, abnormal CEA or CA 15-3 level (> 2x ULN), radiographic signs of lymphangiosis of the lung, cytologically proven bone marrow infiltration). Patients may have received chemotherapy or endocrine therapy in the adjuvant setting, but no prior therapy with CDK 4/6 inhibitors and no first line therapy for metastatic disease. Primary endpoint is best objective response rate (ORR) defined by the proportion of patients who are evaluated as having partial (PR) or complete response (CR) while being on study treatment using RECIST V1.1. ORR will be analyzed using the one group χ2 test at the 5% significance level. The test hypotheses are as follows: H0: ORR = 0.43, HA: ORR ≠ 0.43. In addition, ORR will be reported with a 95% CI.Several additional endpoints regarding disease control and patient reported outcomes will also be evaluated. At the same time translational research to identify possible early predictive biomarkers for tumor response (e.g. circulating tumor DNA) will be conducted.
Contact information:
For further information please contact the leading physician Dr. Johannes Ettl via johannes.ettl@tum.de
This study is supported by Eli Lilly and Company.
Citation Format: Franziska Kotzur, Helen Bidner, Holger Bronger, Silvia Egert, Peter A Fasching, Dorothea Fischer, Victoria Kehl, Hans-Joachim Lück, Lothar Müller, Ute Reuning, Lukas Rief, Romina Rösch, Stephan Seitz, Christof Winter, Marion Kiechle, Johannes Ettl. ABEMACARE: Abemaciclib in combination with endocrine therapy as first line therapy in metastatic breast cancer patients with symptomatic visceral metastases or high tumor burden [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-26-01.
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Affiliation(s)
- Franziska Kotzur
- 1Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Helen Bidner
- 2Study Center Munich, School of Medicine of the Technical University of Munich (TUM), Munich, Germany
| | - Holger Bronger
- 1Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Silvia Egert
- 2Study Center Munich, School of Medicine of the Technical University of Munich (TUM), Munich, Germany
| | - Peter A Fasching
- 3University Hospital Erlangen, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Dorothea Fischer
- 4Department of Gynecology and Obstetrics, Klinikum Ernst von Bergmann, Academic Teaching Hospital Humboldt University Berlin (Charité), Potsdam, Germany
| | - Victoria Kehl
- 5Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich (TUM), Munich, Germany
| | | | | | - Ute Reuning
- 1Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Lukas Rief
- 1Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Romina Rösch
- 8Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich (TUM), Munich, Germany
| | - Stephan Seitz
- 9Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Winter
- 8Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich (TUM), Munich, Germany
| | - Marion Kiechle
- 1Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Johannes Ettl
- 1Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
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Müller AM, Räpple V, Bradaric C, Koppara T, Kehl V, Fusaro M, Cassese S, Ott I, Kastrati A, Laugwitz KL, Ibrahim T. Outcomes of endovascular treatment for infrapopliteal peripheral artery disease based on the updated TASC II classification. Vasc Med 2020; 26:18-25. [PMID: 33256573 DOI: 10.1177/1358863x20967091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 12/26/2022]
Abstract
We retrospectively analyzed all endovascular procedures of infrapopliteal arterial lesions (n = 383) performed in 270 patients at our institution between December 2008 and January 2018. The overall technical success rate was 97% and yielded 98% for stenoses (n = 214) and 95% for occlusions (n = 169). Trans-Atlantic Inter-Society Consensus (TASC II) classification had no impact on success rates (TASC A + B vs C + D; 96.5% vs 96.9%, p = 0.837). Freedom from clinically driven target lesion revascularization (TLR) after 6 and 12 months was 88.3% and 77.2%. TLR was comparable for TASC A to C lesions and no difference was observed comparing groups of moderately complex TASC A/B lesions and more complex TASC C/D lesions (TASC A + B vs C + D; 78.5% vs 74.2%, p = 0.457). Freedom from TLR was significantly lower in very complex TASC D lesions (TASC A + B + C vs D; 79.7% vs 42.5%, p < 0.001). Multivariate analysis identified TASC D lesions (hazard ratio D/A: 1.5; overall p = 0.002), Fontaine class III and IV (hazard ratio III or IV/IIa or IIb: 2.4; p = 0.041), and occlusive lesions (hazard ratio occlusion/stenosis: 2.4; p = 0.026) as predictors for TLR. In conclusion, endovascular therapy for infrapopliteal artery disease was safe and accompanied with a promising long-term outcome.
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Affiliation(s)
- Arne M Müller
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
| | - Veronika Räpple
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
| | - Christian Bradaric
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
| | - Tobias Koppara
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
| | - Victoria Kehl
- Klinikum rechts der Isar, Institut für Medizinische Informatik, Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Helios Klinikum Pforzheim, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Pforzheim, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
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21
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Butenschoen VM, Hubertus V, Janssen IK, Onken J, Wipplinger C, Mende KC, Eicker SO, Kehl V, Thomé C, Vajkoczy P, Schaller K, Gempt J, Meyer B, Wostrack M. Surgical treatment and neurological outcome of infiltrating intramedullary astrocytoma WHO II-IV: a multicenter retrospective case series. J Neurooncol 2020; 151:181-191. [PMID: 33094355 PMCID: PMC7875841 DOI: 10.1007/s11060-020-03647-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/09/2020] [Indexed: 01/19/2023]
Abstract
Introduction Primary malignant spinal astrocytomas present rare oncological entities with limited median survival and rapid neurological deterioration. Evidence on surgical therapy, adjuvant treatment, and neurological outcome is sparse. We aim to describe the treatment algorithm and clinical features on patients with infiltrating intramedullary astrocytomas graded WHO II–IV. Methods The following is a multicentered retrospective study of patients treated for spinal malignant glioma WHO II–IV in five high-volume neurosurgical departments from 2008 to 2019. Pilocytic astrocytomas were excluded. We assessed data on surgical technique, perioperative neurological status, adjuvant oncological therapy, and clinical outcome. Results 40 patients were included (diffuse astrocytoma WHO II n = 11, anaplastic astrocytoma WHO III n = 12, WHO IV n = 17). Only 40% were functionally independent before surgery, most patients presented with moderate disability (47.5%). Most patients underwent a biopsy (n = 18, 45%) or subtotal tumor resection (n = 15, 37.5%), and 49% of the patients deteriorated after surgery. Patients with WHO III and IV tumors were treated with combined radiochemotherapy. Median overall survival (OS) was 46.5 months in WHO II, 25.7 months in WHO III, and 7.4 months in WHO IV astrocytomas. Preoperative clinical status and WHO significantly influenced the OS, and the extent of resection did not. Conclusion Infiltrating intramedullary astrocytomas WHO II–IV present rare entities with dismal prognosis. Due to the high incidence of surgery-related neurological impairment, the aim of the surgical approach should be limited to obtaining the histological tissue via a biopsy or, tumor debulking in cases with rapidly progressive severe preoperative deficits.
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Affiliation(s)
- Vicki M Butenschoen
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Vanessa Hubertus
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Insa K Janssen
- Department of Neurosurgery, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Julia Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Wipplinger
- Department of Neurosurgery, University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Klaus C Mende
- Department of Neurosurgery, University Hospital Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Sven O Eicker
- Department of Neurosurgery, University Hospital Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Victoria Kehl
- School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University Munich, Grillparzerstr. 18, 81675, Munich, Germany
| | - Claudius Thomé
- Department of Neurosurgery, University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
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22
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Ritschl LM, Fichter AM, Bomhard AV, Koerdt S, Kehl V, Kolk A, Wolff KD, Grill FD. Comparison between Different Perforator Imaging Modalities for the Anterolateral Thigh Perforator Flap Transfer: A Prospective Study. J Reconstr Microsurg 2020; 36:686-693. [PMID: 32712944 DOI: 10.1055/s-0040-1714425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Perforator imaging is routinely performed before perforator flap harvest. Hand-held Doppler (hhD) and color duplex ultrasonography (CDU) are currently the most popular radiation-free methods for this purpose that can be applied by the surgeon alone. The aim of this study was to compare the accuracy, reliability, and feasibility of hhD and CDU with indocyanine green angiography (ICGA) in the anterolateral thigh perforator flap (ALTPF). METHODS All consecutive ALTPF procedures between May 2017 and April 2018 were included in this prospective study. The perforators were visualized by three investigators independently and randomized, applying hhD, CDU, and ICGA. The presence and the distance to the identified perforator were registered. Further, body mass index (BMI), American Society of Anesthesiologists-status, and the patient's history regarding smoking, alcohol use, and diabetes mellitus were registered alongside gender and age to analyze possible confounders. RESULTS A total of 12 patients were enrolled with a median age of 67 (52-87) years. In total, 30 perforators were detected intraoperatively as well as with the ICGA. The latter visualized the perforators significantly more precisely than hhD and CDU (p < 0.001 and p = 0.001). The sensitivity and positive predictive value were 67 and 62% for hhD, 73 and 64% for CDU, and 100 and 100% for ICGA, respectively. CONCLUSION According to this study, ICGA visualized perforators more accurately than the standard methods hhD and CDU. Further, it was associated with the highest sensitivity and positive predictive value. ICGA consistently delivered excellent results, whereas hhD and CDU showed variability.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Achim von Bomhard
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Steffen Koerdt
- Charité - Universitätsmedizin Berlin, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Berlin, Germany
| | - Victoria Kehl
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Florian D Grill
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
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23
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Riedl L, Blank D, Kohl M, Lang A, Kehl V, Brieger P, Hamann J. Return-to-work-experts for inpatient treatment of patients with mental illnesses- a proof-of-concept-study (RETURN): the study protocol. BMC Psychiatry 2020; 20:177. [PMID: 32306925 PMCID: PMC7168961 DOI: 10.1186/s12888-020-02504-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with mental illnesses often have massive difficulties returning to work after inpatient treatment at a psychiatric clinic and are often at risk of losing their jobs. The psychosocial support for this patient group at the interface of clinic/outpatient care is often insufficient. METHODS/DESIGN The RETURN-study prospectively assesses and surveys 200 patients with mental disorders in a cluster randomized intervention study, i.e. treatment teams and patients from intervention wards receive a return-to-work (RTW) intervention. Patients in control wards obtain treatment as usual (TAU). Pairs of comparable wards (similar patient population, similar staff density) have been identified and then randomized for control and intervention (n = 14 for each condition). On intervention wards return-to-work experts (RTW experts) who focus treatment on the workplace-related needs of patients with mental illnesses have been established. These RTW experts ensure the use of available resources within the framework of work-related discharge management and should lead to a more successful return to the workplace. The days at work in the year after release will be evaluated in a mixed methods approach as well as the return rate in the year after release, disability days in the year after return, relapse rate after 12 months, cost-benefit ratio of the intervention, analysis of the predictors / barriers for a successful return to the workplace (e.g. psychopathology, cognition, stigma, social-psychiatric support, company support, etc.), possibilities to implement the concept of RTW experts in standard psychiatric care (TAU - treatment as usual), the impact of the RTW experts' approach on the treatment process in standard psychiatric care. DISCUSSION This approach is already internationally established in the field of somatic rehabilitation and supported employment [Am J Psychiatry 171:1183-90, 2014; Lancet 370:1146-52, 2007; Cochrane Database Syst Rev, doi:10.1002/14651858.CD006237.pub3, 2014]; the innovative aspect of this project is to implement and evaluate it in standard psychiatric care in Germany. This project requires no new interventions to be developed and tested, as the techniques of the case manager/job coach is applied to the field of return to work. TRIAL REGISTRATION The study was registered in Deutsches Register Klinische Studien searchable via its Meta-registry (http://apps.who.int/trialsearch/), Trial registration number: DRKS00016037, Date of registration: 21/12/2018, URL of trial registry record.
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Affiliation(s)
- Lina Riedl
- Department of Psychiatry and Psychotherapy of Technische Universität München, School of Medicine, Ismaninger Str.22, 81675, Munich, Germany.
| | - Daniela Blank
- kbo-Isar-Amper-Klinikum, Academic Teaching Hospital LMU Munich, Munich-Haar, Germany
- Academic Teaching Hospital LMU, Munich, Germany
| | - Monika Kohl
- Department of Psychiatry and Psychotherapy of Technische Universität München, School of Medicine, Ismaninger Str.22, 81675, Munich, Germany
| | - Anne Lang
- kbo-Isar-Amper-Klinikum, Academic Teaching Hospital LMU Munich, Munich-Haar, Germany
- Academic Teaching Hospital LMU, Munich, Germany
| | - Victoria Kehl
- Department of Psychiatry and Psychotherapie, Technische Universität München, School of Medicine, Munich, Germany
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum, Academic Teaching Hospital LMU Munich, Munich-Haar, Germany
- Academic Teaching Hospital LMU, Munich, Germany
| | - Johannes Hamann
- Department of Psychiatry and Psychotherapy of Technische Universität München, School of Medicine, Ismaninger Str.22, 81675, Munich, Germany
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24
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Jilg S, Rassner M, Maier J, Waldeck S, Kehl V, Follo M, Philipp U, Sauter A, Specht K, Mitschke J, Lange T, Bauer S, Jost PJ, Peschel C, Duyster J, Gaiser T, Hohenberger P, Bubnoff N. Circulating
cKIT
and
PDGFRA
DNA indicates disease activity in Gastrointestinal Stromal Tumor (GIST). Int J Cancer 2019; 145:2292-2303. [DOI: 10.1002/ijc.32282] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/10/2019] [Accepted: 03/05/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Stefanie Jilg
- III Medical Department for Hematology and Oncology, Klinikum Rechts der IsarTechnische Universität München Munich Germany
| | - Michael Rassner
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - Jacqueline Maier
- Center for Internal Medicine, Department of Hematology/Oncology and HemostaseologyUniversity of Leipzig Leipzig Germany
| | - Silvia Waldeck
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg Germany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ) Heidelberg Germany
- Faculty of BiologyUniversity of Freiburg Freiburg Germany
| | - Victoria Kehl
- Institute for Medical Informatics, Statistics, and Epidemiology, Klinikum Rechts der IsarTechnische Universität München Munich Germany
| | - Marie Follo
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - Ulrike Philipp
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der IsarTechnische Universität München Munich Germany
| | - Katja Specht
- Institute of Pathology, Klinikum Rechts der IsarTechnische Universität München Munich Germany
| | - Jan Mitschke
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg Germany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ) Heidelberg Germany
| | | | - Sebastian Bauer
- Sarcoma Center, West German Cancer CenterUniversity Hospital Essen, University Duisburg‐Essen Essen Germany
| | - Philipp J. Jost
- III Medical Department for Hematology and Oncology, Klinikum Rechts der IsarTechnische Universität München Munich Germany
| | - Christian Peschel
- III Medical Department for Hematology and Oncology, Klinikum Rechts der IsarTechnische Universität München Munich Germany
| | - Justus Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg Germany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ) Heidelberg Germany
| | - Timo Gaiser
- Institute of Pathology, University Medical Center MannheimRuprecht‐Karl University of Heidelberg Mannheim Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic SurgeryUniversity Medical Center Mannheim, Ruprecht‐Karl University of Heidelberg Mannheim Germany
| | - Nikolas Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg Germany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ) Heidelberg Germany
- Department of Hematology and Oncology, Medical CenterUniversity of Schleswig Holstein Lübeck Germany
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25
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Diehl-Schmid J, Hartmann J, Roßmeier C, Riedl L, Förstl H, Egert-Schwender S, Kehl V, Schneider-Schelte H, Jox RJ. IssuEs in Palliative care for people in advanced and terminal stages of Young-onset and Late-Onset dementia in GErmany (EPYLOGE): the study protocol. BMC Psychiatry 2018; 18:271. [PMID: 30170575 PMCID: PMC6119330 DOI: 10.1186/s12888-018-1846-0] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scientific research on palliative care in dementia is still underdeveloped. In particular, there are no research studies at all on palliative care issues in young onset dementia (YOD), although significant differences compared to late onset dementia (LOD) are expected. Most studies have focused on persons with dementia in long term care (LTC) facilities but have neglected persons that are cared for at home. We hypothesize that unmet care needs exist in advanced and terminal stages of YOD and LOD and that they differ between YOD and LOD. METHODS/DESIGN The EPYLOGE-study (IssuEs in Palliative care for people in advanced and terminal stages of Young-onset and Late-Onset dementia in GErmany) aims to prospectively assess and survey 200 persons with YOD and LOD in advanced stages who are cared for in LTC facilities and at home. Furthermore, EPYLOGE aims to investigate the circumstances of death of 100 persons with YOD and LOD. This includes 1) describing symptoms and management, health care utilization, palliative care provision, quality of life and death, elements of advance care planning, family caregivers' needs and satisfaction; 2) comparing YOD and LOD regarding these factors; 3) developing expert-consensus recommendations derived from the study results for the improvement and implementation of strategies and interventions for palliative care provision; 4) and communicating the recommendations nationally and internationally in order to improve and adapt guidelines, to change current practice and to give a basis and perspectives for future research projects. The results will also be communicated to patients and their families in order to counsel and support them in their decision making processes and their dialogue with professional caregivers and physicians. DISCUSSION EPYLOGE is the first study in Germany that assesses palliative care and end-of-life issues in dementia. Furthermore, it is the first study internationally that focuses on the specific palliative care situation of persons with YOD and their families. EPYLOGE serves as a basis for the improvement of palliative care in dementia. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov ( NCT03364179 ; Registered: 6. December 2017.
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Affiliation(s)
- Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675, Munich, Germany.
| | - Julia Hartmann
- 0000000123222966grid.6936.aDepartment of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675 Munich, Germany
| | - Carola Roßmeier
- 0000000123222966grid.6936.aDepartment of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675 Munich, Germany
| | - Lina Riedl
- 0000000123222966grid.6936.aDepartment of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675 Munich, Germany
| | - Hans Förstl
- 0000000123222966grid.6936.aDepartment of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675 Munich, Germany
| | - Silvia Egert-Schwender
- 0000000123222966grid.6936.aMünchner Studienzentrum, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- 0000000123222966grid.6936.aInstitute for Medical Informatics, Statistics and Epidemiology of Technical University of Munich, Munich, Germany
| | | | - Ralf J. Jox
- 0000 0004 1936 973Xgrid.5252.0Institute of Ethics, History, and Theory of Medicine, Ludwig Maximilians Universität, Munich, Germany ,0000 0001 0423 4662grid.8515.9Geriatric Palliative Care, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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26
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Wostrack M, Ringel F, Eicker SO, Jägersberg M, Schaller K, Kerschbaumer J, Thomé C, Shiban E, Stoffel M, Friedrich B, Kehl V, Vajkoczy P, Meyer B, Onken J. Spinal ependymoma in adults: a multicenter investigation of surgical outcome and progression-free survival. J Neurosurg Spine 2018. [PMID: 29521579 DOI: 10.3171/2017.9.spine17494] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 11/06/2022]
Abstract
OBJECTIVE Spinal ependymomas are rare glial neoplasms. Because their incidence is low, only a few larger studies have investigated this condition. There are no clear data concerning prognosis and therapy. The aim of the study was to describe the natural history, perioperative clinical course, and local tumor control of adult patients with spinal ependymomas who were surgically treated under modern treatment standards. METHODS The authors performed a multicenter retrospective study. They identified 158 adult patients with spinal ependymomas who had received surgical treatment between January 2006 and June 2013. The authors analyzed the clinical and histological aspects of these cases to identify the predictive factors for postoperative morbidity, tumor resectability, and recurrence. RESULTS Gross-total resection (GTR) was achieved in 80% of cases. At discharge, 37% of the patients showed a neurological decline. During follow-up the majority recovered, whereas 76% showed at least preoperative status. Permanent functional deterioration remained in 2% of the patients. Transient deficits were more frequent in patients with cervically located ependymomas (p = 0.004) and in older patients (p = 0.002). Permanent deficits were independently predicted only by older age (p = 0.026). Tumor progression was observed in 15 cases. The 5-year progression-free survival (PFS) rate was 80%, and GTR (p = 0.037), WHO grade II (p = 0.009), and low Ki-67 index (p = 0.005) were independent prognostic factors for PFS. Adjuvant radiation therapy was performed in 15 cases. No statistically relevant effects of radiation therapy were observed among patients with incompletely resected ependymomas (p = 0.079). CONCLUSIONS Due to its beneficial value for PFS, GTR is important in the treatment of spinal ependymoma. Gross-total resection is feasible in the majority of cases, with acceptable rates of permanent deficits. Also, Ki-67 appears to be an important prognostic factor and should be included in a grading scheme for spinal ependymomas.
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Affiliation(s)
- Maria Wostrack
- 1Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich
| | - Florian Ringel
- 1Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich.,8Department of Neurosurgery, University Clinic Johannes Gutenberg-University Mainz
| | - Sven O Eicker
- 4Department of Neurosurgery, University Medical Center Hamburg-Eppendorf
| | - Max Jägersberg
- 3Department of Neurosurgery, University of Geneva Medical Center, Geneva, Switzerland; and
| | - Karl Schaller
- 3Department of Neurosurgery, University of Geneva Medical Center, Geneva, Switzerland; and
| | | | - Claudius Thomé
- 5Department of Neurosurgery, Medical University Innsbruck, Austria
| | - Ehab Shiban
- 1Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich
| | - Michael Stoffel
- 1Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich.,9Department of Neurosurgery, Helios Clinic, Krefeld, Germany
| | - Benjamin Friedrich
- 7Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich
| | - Victoria Kehl
- 6Institute for Medical Statistics and Epidemiology, Technical University of Munich
| | | | - Bernhard Meyer
- 1Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich
| | - Julia Onken
- 2Department of Neurosurgery, Charité University, Berlin
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Mueller TC, Schirren R, Kehl V, Friess H, Reim D, Martignoni ME. Parenteral nutrition during neoadjuvant chemotherapy for patients with non-metastatic gastric or esophago-gastric cancer to reduce postoperative morbidity (PERCOG): study protocol for a randomized controlled trial. Trials 2017; 18:621. [PMID: 29282145 PMCID: PMC5745916 DOI: 10.1186/s13063-017-2388-3] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/21/2017] [Indexed: 01/04/2023] Open
Abstract
Background The majority of patients with gastric or esophago-gastric cancer are at risk for malnutrition. Preoperative malnutrition was shown to increase the incidence of postoperative complications following abdominal surgery. However, it remains unclear if preoperative parenteral nutritional support during neoadjuvant chemotherapy (NACT) may be effective to reduce the rate of postoperative complications in these patients. Methods/Design The PERCOG trial is a randomized controlled multicenter observer-blinded trial, investigating if the improvement of the general condition of patients with non-metastasized gastric cancer or cancer of the esophago-gastric junction during NACT by supplemental parenteral nutrition can decrease the postoperative Comprehensive Complication Index (CCI). Statistical analysis of the primary endpoint measure (CCI on postoperative day 30) will be based on the intention-to-treat population. The global level of significance is set at 5% and the sample size (n = 150) is determined to assure a power of 80%. Discussion The results of the PERCOG trial will provide high-level evidence for clinical recommendations regarding the administration of preoperative supportive parenteral nutrition and provide all participating patients the opportunity of an improved treatment. Trial registration German Clinical Trials Register, DRKS00009451. Registered on 3 July 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2388-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tara C Mueller
- Department of Surgery, Technical University of Munich School of Medicine Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany
| | - Rebekka Schirren
- Department of Surgery, Technical University of Munich School of Medicine Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Technical University of Munich School of Medicine Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany
| | - Daniel Reim
- Department of Surgery, Technical University of Munich School of Medicine Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany.
| | - Marc E Martignoni
- Department of Surgery, Technical University of Munich School of Medicine Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany
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28
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Mueller TC, Nitsche U, Kehl V, Schirren R, Schossow B, Goess R, Friess H, Reim D. Intraoperative wound irrigation to prevent surgical site infection after laparotomy (IOWISI): study protocol for a randomized controlled trial. Trials 2017; 18:410. [PMID: 28870242 PMCID: PMC5584516 DOI: 10.1186/s13063-017-2154-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 07/11/2017] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative surgical site infection (SSI) is one of the most common hospital infections and contributes substantially to postoperative morbidity and mortality. In addition, SSIs dramatically increase the treatment cost and length of hospital stay. Following visceral surgery by laparotomy, SSI rates are especially high (14–25%). Therefore, measures to prevent SSI in this field are urgently needed. Prophylactic intraoperative wound irrigation (IOWI) of the subcutaneous soft tissue before skin closure hypothetically represents an easy and economical option to reduce SSI rates and is already frequently used in clinical practice. However, there are currently no definite recommendations on the use of IOWI since high-level evidence supporting its use is lacking. Consequently, clinical practice varies widely. Antiseptic polyhexanide (PHX)-based solutions are approved for soft-tissue wound irrigation in surgery but have not been specifically evaluated in randomized clinical trials for the prevention of SSI following laparotomy for visceral surgery. Methods/design The IOWISI trial is a multicentre, randomized, observer- and patient-blinded clinical trial with three parallel treatment groups, comparing IOWI with a 0.04% PHX solution to no irrigation (test 1) or saline (test 2) before skin closure after laparotomy for visceral surgery (contamination level II–IV). The primary endpoint of the trial is the SSI rate within 30 days postoperatively. Statistical analysis of the primary endpoint measure will be based on the intention-to-treat population. The global level of significance is set at 2.5% for test 1 and 5% for test 2 and the sample size (n = 540) is determined to assure a power of 94% (test 1) and 85% (test 2). Discussion The IOWISI trial will provide high-level evidence as a basis for clinical recommendations regarding the use of IOWI with PHX or saline and will potentially impact on future clinical guidelines and practice. The pragmatic trial design guarantees high external validity. Trial registration Registered at the German Clinical Trials Register, DRKS00012251. Registered on 3 July 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2154-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tara C Mueller
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Ulrich Nitsche
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universtität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Rebekka Schirren
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Beate Schossow
- Munich Centre for Clinical Trials (Münchner Studienzentrum), Technische Universtität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Ruediger Goess
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Daniel Reim
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
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Kolk A, Haidari S, Wolff KD, Fichter A, Kehl V, Götz C, Kesting M, Weitz J. The Osteocutaneous Fibular Flap for Mandibular Replacement—Which Factors Influence Long-Term Success? J Reconstr Microsurg Open 2017. [DOI: 10.1055/s-0037-1604343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background The free fibular flap (FFF) is established for mandibular reconstruction. Some complications, such as non-union, fistulas, and complete graft loss, are sometimes unavoidable. There are no clinically relevant data regarding the optimum selection of osteosynthesis and risk analysis prior to reconstruction.
Methods Eighty-three FFFs with up to four osteotomies were analyzed for possible complications during the course of a longitudinal analysis. Forty-one patients underwent simultaneous mandibular reconstruction after tumor resection, and another 42 subjects received FFFs due to infected osteoradionecrosis (ORN). Patients who experienced transplant losses due to vascular occlusion in the grafts were excluded from the study.
Results The most common complications were fistulas, bony non-union, and failure of osteosynthesis material. Major contributing risk factors were radiotherapy (p = 0.004), number of osteosynthesis plates >6 (p = 0.002), length of the harvested fibula (p = 0.027), the size of the skin island (p = 0.002), and the number of osteotomies (p = 0.001).
Conclusion For the success of FFF, there are many influencing factors. If the mentioned risk factors are considered, the number of osteotomies, size of the skin paddle, and fibula are as small as possible, and a suitable osteosynthesis material is chosen, the FFF is a safe solution for mandibular reconstruction.
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Affiliation(s)
- Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - S. Haidari
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - K.-D. Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - A. Fichter
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - V. Kehl
- Department of Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - C. Götz
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - M. Kesting
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - J. Weitz
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
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Bette S, Huber T, Gempt J, Boeckh-Behrens T, Wiestler B, Kehl V, Ringel F, Meyer B, Zimmer C, Kirschke JS. Local Fractional Anisotropy Is Reduced in Areas with Tumor Recurrence in Glioblastoma. Radiology 2017; 283:499-507. [DOI: 10.1148/radiol.2016152832] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stefanie Bette
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Thomas Huber
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Jens Gempt
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Tobias Boeckh-Behrens
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Benedikt Wiestler
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Victoria Kehl
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Florian Ringel
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Bernhard Meyer
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Claus Zimmer
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Jan S. Kirschke
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
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Foreman SC, Schwaiger BJ, Gempt J, Jungmann PM, Kehl V, Delbridge C, Wantia N, Zimmer C, Kirschke JS. MR and CT Imaging to Optimize CT-Guided Biopsies in Suspected Spondylodiscitis. World Neurosurg 2017; 99:726-734.e7. [DOI: 10.1016/j.wneu.2016.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
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Pigorsch SU, Wilkens JJ, Kampfer S, Kehl V, Hapfelmeier A, Schläger C, Bier H, Schwaiger M, Combs SE. Do selective radiation dose escalation and tumour hypoxia status impact the loco-regional tumour control after radio-chemotherapy of head & neck tumours? The ESCALOX protocol. Radiat Oncol 2017; 12:45. [PMID: 28249612 PMCID: PMC5333380 DOI: 10.1186/s13014-017-0776-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 12/30/2016] [Accepted: 02/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background Standard of care primary treatment of carcinoma of locally advanced squamous cell head and neck cancer (LAHNSCC) consists of platinum-based concomitant chemo-irradiation. Despite progress in the treatment of LAHNSCC using modern radiotherapy techniques the outcome remains still poor. Using IMRT with SIB the escalation of total dose to the GTV is possible with the aim to improve clinical outcome. This study tests the hypothesis if radiation dose escalation to the GTV improves 2-year-LRC and -OS after concomitant chemo-irradiation. Methods The ESCALOX trial is a prospective randomized phase III study using cisplatin chemo-irradiation and the SIB-IMRT concept in patients with LAHNSCC of the oral cavity, oropharynx or hypopharynx to escalate the total dose to the GTV up to 80.5 Gy. Chemotherapy is planned either in the 1st and 5th week (cisplatin 20 mg/m2/d d 1–5 and d 29–33) or weekly (cisplatin 40 mg/m2/d) during RT. RT is delivered as SIB with total doses of 80.5 Gy/70.0 Gy/56.0 Gy with 2.3 Gy/2.0 Gy and 1.6 Gy in the experimental arm and in the control arm with 70.0 Gy/56.0 Gy with 2.0 Gy and 1.6 Gy. A pre-study with dose escalation up to 77.0 Gy/70.0 Gy/56.0 Gy with 2.2 Gy/2.0 Gy and 1.6 Gy is demanded by the German federal office of radiation protection (BfS). In the translational part of the trial 100 of the randomised patients will be investigated by 18-F-FMiso-PET-CT for the presence and behaviour of tumor hypoxia twice in the week before treatment start. Discussion The primary endpoint of the pre-study is acute radiation induced toxicity. Primary endpoint of the main trial is 2-year-LRC. By using the dose escalation up to 80.5 Gy to the GTV of the primary tumor and lymph nodes > 2 cm a LRC benefit of 15% at 2 years should be expected. The ESCALOX trial is supported by Deutsche Forschungsgemeinschaft (DFG); Grant No.: MO-363/4-1. Trial registration ClinicalTrials.gov Identifier: NCT 01212354, EudraCT-No.: 2010-021139-15
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Affiliation(s)
- Steffi U Pigorsch
- Department of Radiaton Oncology, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany. .,Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, Ingolstaedter Landstrasse 1, D-85764, Oberschleissheim, Germany.
| | - Jan J Wilkens
- Department of Radiaton Oncology, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany.,Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, Ingolstaedter Landstrasse 1, D-85764, Oberschleissheim, Germany
| | - Severin Kampfer
- Department of Radiaton Oncology, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany.,Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, Ingolstaedter Landstrasse 1, D-85764, Oberschleissheim, Germany
| | - Victoria Kehl
- Institute of Medical Statistics and Epidemiology (IMSE), Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Statistics and Epidemiology (IMSE), Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Christian Schläger
- Münchner Studienzentrum (MSZ Coordination Centre for Clinical Trials), Technical University of Munich, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Henning Bier
- Department of Ear, Neck and Throat (ENT), Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiaton Oncology, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675, Munich, Germany.,Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, Ingolstaedter Landstrasse 1, D-85764, Oberschleissheim, Germany
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Lange R, Voss B, Kehl V, Mazzitelli D, Tassani-Prell P, Günther T. Right Minithoracotomy Versus Full Sternotomy for Mitral Valve Repair: A Propensity Matched Comparison. Ann Thorac Surg 2017; 103:573-579. [DOI: 10.1016/j.athoracsur.2016.06.055] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/23/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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Melchart D, Löw P, Wühr E, Kehl V, Weidenhammer W. Effects of a tailored lifestyle self-management intervention (TALENT) study on weight reduction: a randomized controlled trial. Diabetes Metab Syndr Obes 2017; 10:235-245. [PMID: 28684917 PMCID: PMC5484507 DOI: 10.2147/dmso.s135572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Overweight and obesity are globally increasing risk factors for diseases in the context of metabolic syndrome. A randomized controlled trial was conducted to investigate whether there are any existing differences between two lifestyle intervention strategies with respect to weight reduction after 1 year. SUBJECTS AND METHODS A total of 166 subjects with a body mass index of 28-35 kg/m2 were enrolled in this trial at seven study centers; 109 were randomly allocated to the intervention group (comprehensive lifestyle modification program: web-based Individual Health Management [IHM]) with 3-month reduction phase plus 9-month maintenance phase, and 57 were allocated to the control group (written information with advice for healthy food habits: usual care [UC]). Body weight, waist circumference, blood pressure, laboratory findings, and bioimpedance analysis used to determine body composition were measured at baseline and after 3, 6, 9, and 12 months. The primary outcome parameter was body weight at month 12 compared to baseline. RESULTS With respect to baseline status there were no statistically significant differences between the groups. Based on the intent-to-treat population, body weight showed a mean decrease of 8.7 kg (SD 6.1) in the intervention group (IHM) and 4.2 kg (SD 5) in the control group (UC) at month 12. This statistically significant difference (P<0.001) was confirmed by various sensitivity analyses. Body mass index, waist circumference, high-density lipid cholesterol, body fat, and the ratio of fat and body cell mass improved to a significantly higher degree in the IHM group. CONCLUSION IHM proved to be superior to UC in weight reduction after 1 year. With a mean loss of about 10% of the baseline weight, a clinically high relevant risk reduction for cardio-metabolic diseases is achievable.
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Affiliation(s)
- Dieter Melchart
- Competence Center for Complementary Medicine and Naturopathy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Löw
- Medical Practice for Internal Medicine, Treuchtlingen
| | - Erich Wühr
- Faculty for Applied Health Care Science, Deggendorf Institute of Technology, Deggendorf
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Munich Trial Centre, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Wolfgang Weidenhammer
- Competence Center for Complementary Medicine and Naturopathy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
- Correspondence: Wolfgang Weidenhammer, Competence Center for Complementary Medicine and Naturopathy, Klinikum Rechts der Isar, Technische Universität München, 9 Kaiserstrasse, Munich 80801, Germany, Tel +49 89 726 6970, Email
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Strassen U, Greve J, Stelter K, Havel M, Rotter N, Veit J, Schossow B, Hapfelmeier A, Kehl V, Kojda G, Hoffmann TK, Bas M. A Randomized Trial of Icatibant in ACE-Inhibitor–Induced Angioedema. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Winkler S, Springorum HR, Vaitl T, Handel M, Barta S, Kehl V, Craiovan B, Grifka J. Comparative clinical study of the prophylaxis of heterotopic ossifications after total hip arthroplasty using etoricoxib or diclofenac. Int Orthop 2016; 40:673-80. [PMID: 26728611 DOI: 10.1007/s00264-015-3077-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 09/23/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE This study investigated whether etoricoxib (COX-II blocker) has a superior efficacy of preventing heterotopic ossification (HO) after total hip arthroplasty (THA) compared to diclofenac (non-selective NSAID). METHODS One hundred patients were included (50 in each group) in this single centre, prospective, double-blinded, randomized, controlled trial. Etoricoxib (90 mg) was administered once and diclofenac (75 mg) twice per day for a perioperative period of nine days. The incidence of HO was evaluated on radiographs of the pelvis six months after surgery. RESULTS Eighty nine of 100 (89 %) patients could be analysed. The overall HO incidence was 37.8 %. There was no significant difference between both study groups. Twelve patients (27.3 %) of the DIC group and 13 patients (28.9 %) of the ETO group showed Brooker grade I ossifications. Five patients (11.4 %) of the DIC and four patients of the ETO (8.9 %) group showed grade II HO formations. No class III or IV HO formations occured in both groups. Ad hoc analysis detected a negative correlation between HO incidence and limited abduction and internal rotation of the hip. CONCLUSIONS Etoricoxib and diclofenac are equally effective for oral HO prophylaxis after primary cementless THA when given for nine peri-operative days to ensure a full recovery and high patient satisfaction.
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Affiliation(s)
- Sebastian Winkler
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Hans-Robert Springorum
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Tobias Vaitl
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Martin Handel
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Sabine Barta
- Münchner Studienzentrum, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Technische Universität, Munich, Germany
| | - Benjamin Craiovan
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
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Winkler SH, Barta S, Kehl V, Schröter C, Wagner F, Grifka J, Springorum HR, Craiovan B. Perioperative blood loss and gastrointestinal tolerability of etoricoxib and diclofenac in total hip arthroplasty (ETO-DIC study): a single-center, prospective double-blinded randomized controlled trial. Curr Med Res Opin 2016; 32:37-47. [PMID: 26414653 DOI: 10.1185/03007995.2015.1100987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Non-selective NSAIDs can cause serious gastrointestinal side-effects. Selective COX-2 blockers are a reasonable alternative for pain treatment. They do not seem to affect platelet function and consequently cause a lower perioperative blood loss than non-selective NSAIDs. This study compared etoricoxib and diclofenac during a perioperative (9 days) period after THA to investigate total blood loss and gastrointestinal tolerability. The hypothesis was that etoricoxib is superior to diclofenac. METHODS A total of 100 patients (50 in each group) were included in this trial. Etoricoxib (90 mg) was administered once and diclofenac sodium (75 mg) twice daily for 9 days. Total blood loss during and after primary cementless THA was detected. The rate of adverse events (AEs) and serious adverse events (SAEs) was analyzed to detect gastrointestinal tolerability. RESULTS The mean total blood loss (calculated) was 1548 ± SD 468 ml in the etoricoxib (ETO) group and 1649 (SD 547) ml in the diclofenac (DIC) group. The mean duration of THA was 81 min (SD 29) in the DIC and 75 min (SD 30) in the ETO group. Hence, the mean calculated total blood loss was 101 ml higher in the DIC group. This difference was not statistically significant (p = 0.334). Fifty-six patients (28 in each group) received a cell saver retransfusion, but only one patient (ETO group) needed an additional red blood cell transfusion. The hidden blood loss was 1067 ml (SD 603) in the DIC group and 999 ml (SD 378) in the ETO group. The gastrointestinal tolerability (number of adverse and serious adverse events) was not significantly different between groups. CONCLUSION There was no statistically significant difference in perioperative blood loss after primary THA under etoricoxib (90 mg) compared to diclofenac (75 mg). Furthermore, no gastrointestinal superiority of etoricoxib could be detected during a short period of 9 days.
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Affiliation(s)
- Sebastian H Winkler
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Sabine Barta
- b b Münchner Studienzentrum, Klinikum rechts der Isar der Technischen Universität München , Munich , Germany
| | - Victoria Kehl
- c c Institute for Medical Statistics and Epidemiology, Technische Universität , Munich , Germany
| | - Christoph Schröter
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Ferdinand Wagner
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Joachim Grifka
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Hans Robert Springorum
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Benjamin Craiovan
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
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Röper B, Heinrich C, Kehl V, Rechl H, Specht K, Wörtler K, Töpfer A, Molls M, Kampfer S, von Eisenharth-Rothe R, Combs SE. Study of Preoperative Radiotherapy for Sarcomas of the Extremities with Intensity-Modulation, Image-Guidance and Small Safety-margins (PREMISS). BMC Cancer 2015; 15:904. [PMID: 26573139 PMCID: PMC4647667 DOI: 10.1186/s12885-015-1633-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/28/2015] [Indexed: 11/17/2022] Open
Abstract
Background The aim of the trial is to demonstrate that with the use of modern IMRT/IGRT and reduction of safety margins postoperative wound complications can be reduced. Methods/ Design The trial is designed as a prospective, monocentric clinical phase II trial. The treatment is performed with helical IMRT on the Tomotherapy HiArt System© or with RapidArc© IMRT as available. All treatments are performed with 6 MV photons and daily online CT-based IGRT. A dose of 50 Gy in 2 Gy single fractions (5 fractions per week) is prescribed. Restaging including MRI of the primary tumor site as well as CT of the thorax/abdomen is planned 4 weeks after RT. PET-examinations or any other imaging can be performed as required clinically. In cases of R1 resection, brachytherapy is anticipated in the 2nd postoperative week. Brachytherapy catheters are implanted into the tumor bed depending on the size and location of the lesion. Surgery is planned 5–6 weeks after completion of neoadjuvant RT. All patients are seen for a first follow-up visit 2 weeks after wound healing is completed, thereafter every 3 months during the first 2 years. The endpoints of the study are evaluated in detail during the first (2 weeks) and second (3 months) follow-up. Functional outcome and QOL are documented prior to treatment and at year 1 and 2. Treatment response and efficacy will be scored according to the RECIST 1.1 criteria. A total patient number of 50 with an expected 20 % rate of wound complications were calculated for the study, which translates into a 95 % confidence interval of 10.0-33.7 % for wound complication rate in a binomial distribution. Discussion The present study protocol prospectively evaluates the use of IMRT/IGRT for neoadjuvant RT in patients with soft tissue sarcomas of the extremity with the primary endpoint wound complications, which is the major concern with this treatment sequence. Besides complications rates, local control rates and survival rates, as well as QOL, functional outcome and treatment response parameters (imaging and pathology) are part of the protocol. The data of the present PREMISS study will enhance the current literature and support the hypothesis that neoadjuvant RT with IMRT/IGRT offers an excellent risk-benefit ratio in this patient population. Trial registration NCT01552239
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Affiliation(s)
- Barbara Röper
- Department of Radiation Oncology, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany.
| | - Christine Heinrich
- Department of Radiation Oncology, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany.
| | - Victoria Kehl
- Department of Biometrics, Institut für Medizinische Statistik und Epidemiologie, Technische Universität München (TUM), Ismaninger Strasse 22, 81675, München, Germany.
| | - Hans Rechl
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, München, Germany.
| | - Katja Specht
- Department of Pathology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, München, Germany.
| | - Klaus Wörtler
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, München, Germany.
| | - Andreas Töpfer
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, München, Germany.
| | - Michael Molls
- Department of Radiation Oncology, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany
| | - Severin Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany
| | | | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany. .,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
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Mihaljevic AL, Schirren R, Müller TC, Kehl V, Friess H, Kleeff J. Postoperative negative-pressure incision therapy following open colorectal surgery (Poniy): study protocol for a randomized controlled trial. Trials 2015; 16:471. [PMID: 26482031 PMCID: PMC4617637 DOI: 10.1186/s13063-015-0995-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality, and remain one of the most frequent surgical complications. In prospective trials with adequate follow-up, more than 20 % of patients undergoing elective colorectal surgery are affected and methods to reduce surgical site infections are urgently needed. Negative-pressure incision therapy is a novel intervention that holds promise to reduce postoperative wound infection rates, but has not yet been rigorously tested in a randomized controlled trial. METHODS/DESIGN The aim is to investigate whether the postoperative application of a negative-pressure incision therapy device for 5-7 days reduces the rate of surgical site infections following open elective colorectal surgery by 50 %. This is a randomized, controlled, observer-blinded multicentre clinical trial with two parallel study groups. The primary outcome measure will be the rate of surgical site infections within 30 days postoperatively. Surgical site infections are defined according to criteria of the US Centers for Disease Control and Prevention. Statistical analysis of the primary endpoint measure will be based on the intention-to-treat population. The global level of significance is set at 5 % (two-sided) and the sample size (n = 170 per group) is determined to assure a power of 80 %. DISCUSSION The Poniy trial will explore whether the rate of surgical site infections can be reduced by the application of a negative-pressure incision therapy device in patients undergoing open elective colorectal surgery. Its pragmatic design guarantees high external validity and clinical relevance. TRIAL REGISTRATION Deutsches Register Klinischer Studien DRKS00006199 .
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Affiliation(s)
- André L Mihaljevic
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Rebekka Schirren
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Tara C Müller
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universtität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Jörg Kleeff
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany. .,Current affiliation: The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool L7 8XP, UK. .,Department of General-, Visceral- and Pediatric Surgery, University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Thalgott M, Rack B, Eiber M, Souvatzoglou M, Heck MM, Kronester C, Andergassen U, Kehl V, Krause BJ, Gschwend JE, Retz M, Nawroth R. Categorical versus continuous circulating tumor cell enumeration as early surrogate marker for therapy response and prognosis during docetaxel therapy in metastatic prostate cancer patients. BMC Cancer 2015; 15:458. [PMID: 26051431 PMCID: PMC4459665 DOI: 10.1186/s12885-015-1478-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 06/01/2015] [Indexed: 01/13/2023] Open
Abstract
Background Circulating tumor cell (CTCs) counts might serve as early surrogate marker for treatment efficacy in metastatic castration-resistant prostate cancer (mCRPC) patients. We prospectively assessed categorical and continuous CTC-counts for their utility in early prediction of radiographic response, progression-free (PFS) and overall survival (OS) in mCRPC patients treated with docetaxel. Methods CTC-counts were assessed in 122 serial samples, as continuous or categorical (<5 vs. ≥5 CTCs) variables, at baseline (q0) and after 1 (q1), 4 (q4) and 10 (q10) cycles of docetaxel (3-weekly, 75 mg/m2) in 33 mCRPC patients. Treatment response (TR) was defined as non-progressive (non-PD) and progressive disease (PD), by morphologic RECIST or clinical criteria at q4 and q10. Binary logistic and Cox proportional hazards regression analyses were used as statistical methods. Results Categorical CTC-count status predicted PD at q4 already after one cycle (q1) and after 4 cycles (q4) of chemotherapy with an odds ratio (OR) of 14.9 (p = 0.02) and 18.0 (p = 0.01). Continuous CTC-values predicted PD only at q4 (OR 1.04, p = 0.048). Regarding PFS, categorical CTC-counts at q1 were independent prognostic markers with a hazard ratio (HR) of 3.85 (95 % CI 1.1-13.8, p = 0.04) whereas early continuous CTC-values at q1 failed significance (HR 1.02, 95 % CI 0.99-1.05, p = 0.14). For OS early categorical and continuous CTC-counts were independent prognostic markers at q1 with a HR of 3.0 (95 % CI 1.6-15.7, p = 0.007) and 1.02 (95 % CI 1.0-1.040, p = 0.04). Conclusions Categorical CTC-count status is an early independent predictor for TR, PFS and OS only 3 weeks following treatment initiation with docetaxel whereas continuous CTC-counts were an inconsistent surrogate marker in mCRPC patients. For clinical practice, categorical CTC-counts may provide complementary information towards individualized treatment strategies with early prediction of treatment efficacy and optimized sequential treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1478-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Thalgott
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Klinikum Innenstadt, Maistrasse 11, 80337, Munich, Germany.
| | | | | | - Matthias M Heck
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Caroline Kronester
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Ulrich Andergassen
- Department of Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Klinikum Innenstadt, Maistrasse 11, 80337, Munich, Germany.
| | - Victoria Kehl
- Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Bernd J Krause
- Department of Nuclear Medicine, Universitätsklinikum Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | - Jurgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Margitta Retz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Roman Nawroth
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
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Stimmer H, Niedermeyer HP, Kehl V, Rummeny EJ. Nontumorous Enlargement of the Internal Auditory Canal: A Risk Factor for Sensorineural Hearing Loss? A High Resolution CT-Study. ROFO-FORTSCHR RONTG 2015; 187:450-8. [PMID: 25905691 DOI: 10.1055/s-0034-1399009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE First aim of the study was to define normal shape and diameter of the internal auditory canal (IAC). In the second part the clinical relevance of IAC-enlargement was analyzed, considering also lesions of the subtle structures at the fundus of the internal auditory canal. MATERIALS AND METHODS 440 high resolution CT-scans of the temporal bone were used for retrospective analysis of the internal auditory canal and its fundus region. RESULTS The mean value of the IAC diameter in axial and coronal plane was determined. In 20 of 440 patients IAC enlargement was found. In the group with pronounced enlargement (3fold SD) nearly all patients suffered from hearing impairment. In some of them we found structural abnormalities near the IAC fundus in the CSF/perilymph border zone. CONCLUSION A new CT-based definition of normal shape and diameter of the internal auditory canal is presented. There is some evidence that a pathologic transmission of CSF-pressure in case of IAC-enlargement and/or abnormal fistulous communications could play an important role in the pathophysilogy of hearing loss. KEY POINTS • New CT-based definition of normal internal auditory canal.• Nearly all patients showing pronounced IAC-enlargement suffer from hearing impairment.• Possible pathomechanism: Transmission of CSF-pressure on the inner ear.
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Affiliation(s)
- H Stimmer
- Department of Radiology, Klinikum rechts der Isar Technical University Munich, Germany
| | - H P Niedermeyer
- ENT-Clinic, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - V Kehl
- Institute for medical Statistics and Epidemiology, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - E J Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
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Wostrack M, Reeb T, Martin J, Kehl V, Shiban E, Preuss A, Ringel F, Meyer B, Ryang YM. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: the role of intrathecal interleukin-6. Neurocrit Care 2015; 21:78-84. [PMID: 24840896 DOI: 10.1007/s12028-014-9991-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECT Aneurysmal subarachnoid hemorrhage (SAH) has been reported to induce an intrathecal inflammatory reaction reflected by cytokine release, particularly interleukin-6 (IL-6), which correlates with early brain damage and poor outcome. The present study examines intrathecal IL-6 production together with clinical parameters, as a predictor of posthemorrhagic shunt dependency. METHODS Among 186 SAH patients admitted between July 2010 and December 2012, 82 received external ventricular drainage due to acute hydrocephalus. In these patients, cerebrospinal fluid (CSF) concentrations of IL-6 were measured within the first 14 days after SAH. Patients whose IL-6 values were not determined regularly and those who did not survive until discharge were excluded. The peak value of IL-6, ventricular infection during the hospital stay, microbial CSF culture, patient's age and sex, Hunt and Hess grade, and aneurysm location were assumed as predictive for shunt dependency. RESULTS Sixty-nine patients were included, 24 of whom underwent shunt surgery. Peak IL-6 values of ≥10,000 pg/ml were significantly associated with a higher incidence of shunt dependency (p = 0.009). Additional risk factors were aneurysm location on the anterior cerebral artery and its branches or in the posterior circulation (p = 0.025), and age ≥60 years (p = 0.014). In a multivariate analysis, IL-6 ≥10,000 pg/ml appeared to be the only independent predictor for shunt dependency (p = 0.029) CONCLUSION: CSF IL-6 values of ≥10,000 pg/ml in the early post-SAH period may be a useful diagnostic tool for predicting shunt dependency in patients with acute posthemorrhagic hydrocephalus. The development of shunt-dependent posthemorrhagic hydrocephalus remains a multifactorial process.
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Affiliation(s)
- Maria Wostrack
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany,
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Tholen S, Schmaderer C, Kusmenkov E, Chmielewski S, Förstl H, Kehl V, Heemann U, Baumann M, Grimmer T. Variability of cognitive performance during hemodialysis: standardization of cognitive assessment. Dement Geriatr Cogn Disord 2015; 38:31-8. [PMID: 24556891 DOI: 10.1159/000357803] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Up to 70% of hemodialysis patients over the age of 54 have relevant cognitive impairment. No standardized protocol for the evaluation and monitoring of this population is available today. We hypothesized that the dialysis procedure and the testing environment induce fluctuations of cognitive performance. METHODS 26 hemodialysis patients were randomly tested using the Montreal Cognitive Assessment (MoCA) before, during and after hemodialysis and inside the dialysis room or alone in a separate room. Tests were performed at weekly intervals using five test variations to prevent learning effects. The Mini-Mental State Examination (MMSE) was performed as a reference test. RESULTS MoCA scores significantly differed between the conditions: 'before hemodialysis' revealed the best MoCA score as compared to 'during hemodialysis' or 'after hemodialysis' (p = 0.013). During the combined condition 'before dialysis AND separate room', best performance was achieved (p < 0.001). The BP decline had no significant influence on cognitive performance, whereas the fluid shift showed a significant impact (p = 0.008). CONCLUSION Cognitive performance in hemodialysis patients highly depends on the time point and testing environment. Therefore, we strongly suggest a standardization, using the MoCA before hemodialysis in a separate room, in order to make testing results of future research in this field comparable.
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Affiliation(s)
- Susanne Tholen
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Thalgott M, Heck MM, Eiber M, Souvatzoglou M, Hatzichristodoulou G, Kehl V, Krause BJ, Rack B, Retz M, Gschwend JE, Andergassen U, Nawroth R. Circulating tumor cells versus objective response assessment predicting survival in metastatic castration-resistant prostate cancer patients treated with docetaxel chemotherapy. J Cancer Res Clin Oncol 2015; 141:1457-64. [PMID: 25708944 DOI: 10.1007/s00432-015-1936-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/09/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Circulating tumor cell (CTC) counts might display a superior prognostic value for overall survival (OS) compared to objective response criteria (OR) in metastatic castration-resistant prostate cancer (mCRPC) patients. METHODS CTCs were detected using the CellSearch™ System out of 122 samples during docetaxel chemotherapy (75 mg/m(2)) at baseline (q0) and after 1 (q1), 4 (q4) and 10 (q10) cycles, in mCRPC patients (n = 33). OR was evaluated by morphologic RECIST and clinical criteria after 4 (q4) and 10 (q10) cycles. RESULTS For OS, analyses revealed a significant prognostic value for categorical (<5 vs. ≥5) CTC counts (q0, p = 0.005; q1, p = 0.001; q4, p < 0.001; q10, p = 0.002), RECIST (q4, p < 0.001; q10, p = 0.02) and clinical criteria (q4, p < 0.001; q10, p = 0.02). Concordance of CTC counts with OR revealed a sensitivity of 83.3-87.5 % and a specificity of 68.0-76.5 % with complementary discriminatory power for OS. Comparing CTC counts with concomitant OR at q4 in multivariate analyses, an independent prognostic value for OS was found for CTC counts (HR 3.3; p = 0.02) similar to clinical (HR 4.9; p = 0.02) and radiologic response (HR 3.4; p = 0.051). Comparing the predictive value for death, early post-treatment CTC counts at q1 demonstrated significant accuracy with an area under the curve of 79.5 % (p = 0.004) similar to CTC counts at q4 (76.7 %; p = 0.009). Radiologic and clinical response at q4 displayed accuracy similar to early CTC counts at q1 (72.2 %; p = 0.03 and 75.0 %; p = 0.02) despite low sensitivities. CONCLUSIONS CTC counts appear to be an earlier and more sensitive predictor for survival and treatment response than current OR approaches and may provide complementary information toward individualized treatment strategies.
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Affiliation(s)
- M Thalgott
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany,
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Baş M, Greve J, Stelter K, Havel M, Strassen U, Rotter N, Veit J, Schossow B, Hapfelmeier A, Kehl V, Kojda G, Hoffmann TK. A randomized trial of icatibant in ACE-inhibitor-induced angioedema. N Engl J Med 2015; 372:418-25. [PMID: 25629740 DOI: 10.1056/nejmoa1312524] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Angioedema induced by treatment with angiotensin-converting-enzyme (ACE) inhibitors accounts for one third of angioedema cases in the emergency room; it is usually manifested in the upper airway and the head and neck region. There is no approved treatment for this potentially life-threatening condition. METHODS In this multicenter, double-blind, double-dummy, randomized phase 2 study, we assigned patients who had ACE-inhibitor-induced angioedema of the upper aerodigestive tract to treatment with 30 mg of subcutaneous icatibant, a selective bradykinin B2 receptor antagonist, or to the current off-label standard therapy consisting of intravenous prednisolone (500 mg) plus clemastine (2 mg). The primary efficacy end point was the median time to complete resolution of edema. RESULTS All 27 patients in the per-protocol population had complete resolution of edema. The median time to complete resolution was 8.0 hours (interquartile range, 3.0 to 16.0) with icatibant as compared with 27.1 hours (interquartile range, 20.3 to 48.0) with standard therapy (P=0.002). Three patients receiving standard therapy required rescue intervention with icatibant and prednisolone; 1 patient required tracheotomy. Significantly more patients in the icatibant group than in the standard-therapy group had complete resolution of edema within 4 hours after treatment (5 of 13 vs. 0 of 14, P=0.02). The median time to the onset of symptom relief (according to a composite investigator-assessed symptom score) was significantly shorter with icatibant than with standard therapy (2.0 hours vs. 11.7 hours, P=0.03). The results were similar when patient-assessed symptom scores were used. CONCLUSIONS Among patients with ACE-inhibitor-induced angioedema, the time to complete resolution of edema was significantly shorter with icatibant than with combination therapy with a glucocorticoid and an antihistamine. (Funded by Shire and the Federal Ministry of Education and Research of Germany; ClinicalTrials.gov number, NCT01154361.).
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Affiliation(s)
- Murat Baş
- From the Department of Otorhinolaryngology (M.B., U.S.), Münchner Studienzentrum (B.S.), and Institut für Medizinische Statistik und Epidemiologie (A.H., V.K.), Klinikum rechts der Isar, Technische Universität München, and the Department of Otorhinolaryngology, Grosshadern Medical Center of the University of Munich (K.S., M.H.), Munich, the Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm ( J.G., N.R., J.V., T.K.H), and the Institute of Pharmacology and Clinical Pharmacology, University Hospital Düsseldorf, Düsseldorf (G.K.) - all in Germany
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Ratschiller T, Guenther T, Knappich C, Guenzinger R, Kehl V, Voss B, Lange R. Do transvalvular pacemaker leads influence functional outcome after tricuspid ring annuloplasty? Eur J Cardiothorac Surg 2014; 48:363-9. [DOI: 10.1093/ejcts/ezu449] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 06/14/2014] [Accepted: 10/28/2014] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas Ratschiller
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Thomas Guenther
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Christoph Knappich
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Ralf Guenzinger
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Victoria Kehl
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Ruediger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
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Gunther T, Kehl V, Voss B, Lange R. 090 * VIDEO-ASSISTED RIGHT MINI-THORACOTOMY VERSUS FULL STERNOTOMY FOR ISOLATED MITRAL VALVE REPAIR: A PROPENSITY-MATCHED COMPARISON. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ristow O, Gerngroß C, Schwaiger M, Hohlweg-Majert B, Kehl V, Jansen H, Hahnefeld L, Otto S, Pautke C. Is Bone Turnover of Jawbone and Its Possible Over Suppression by Bisphosphonates of Etiologic Importance in Pathogenesis of Bisphosphonate-Related Osteonecrosis? J Oral Maxillofac Surg 2014; 72:903-10. [DOI: 10.1016/j.joms.2013.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/17/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
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Ristow O, Pautke C, Kehl V, Koerdt S, Hahnefeld L, Hohlweg-Majert B. Kinesiologic taping reduces morbidity after oral and maxillofacial surgery: a pooled analysis. Physiother Theory Pract 2014; 30:390-8. [PMID: 24575949 DOI: 10.3109/09593985.2014.891068] [Citation(s) in RCA: 21] [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] [Indexed: 11/13/2022]
Abstract
BACKGROUND Postoperative morbidity is a major disadvantage after oral and maxillofacial (OMF) surgery, often caused by pain, trismus and swelling affecting patients' quality of life. The goal of this study was to examine the effect of kinesiologic taping (KT) on swelling, pain, trismus and patients' satisfaction after OMF surgery. MATERIALS AND METHODS Performing a pooled analysis of 96 patients that were assigned for maxillofacial treatment (midface fractures n = 30, mandibular fractures n = 26, wisdom tooth removal n = 40) divided into treatment either with or without kinesiologic tape application. Tape was applied directly after surgery and maintained for at least 5 d postoperatively. Facial swelling was quantified at six specific points in time using a five-line measurement. Pain and degree of mouth opening was measured. Patients' objective feeling and satisfaction was queried. RESULTS Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for 60% during the first 2 d after surgery. Evaluating all patients swelling was significantly lower in the KT treatment group (T2: 63.5 cm ± 4.3; T3: 62.5 cm ± 4.2; T4: 61.6 cm ± 4.2) than in the no-KT group (T2: 67.6 cm ± 5.0; T3: 67.0 cm ± 5.0; T4: 64.8 cm ± 4.8) at T2 (p < 0.001), T3 (p < 0.001), and T4 (p = 0.001). VAS Pain values were scored significantly lower for the KT group (T1: 2.5 ± 2.0 (p = 0.006); T2: 1.7 ± 2.0 (p < 0.001); T3: 1.5 ± 2.3 (p = 0.004); T4: 0.6 ± 1.1 (p = 0.001) compared to the no-KT group (T1: 3.8 ± 2.5; T2: 3.5 ± 2.7; T3: 2.9 ± 2.2; T4: 1.6 ± 1.7). A statistically significant amelioration in mean mouth opening ability was observed in the KT group (T1-BL: -0.08 cm ± 0.49 (p = 0.025); T2-BL: 0.07 cm ± 0.59 (p = 0.012); T3-BL: 0.20 ± 0.63 (p = 0.013); T4-BL: 0.42 ± 0.59 (p = 0.003)) compared to the no-KT group (T1-BL: -0.47 cm ± 0.86; T2-BL: -0.39 cm ± 0.84; T3-BL: -0.24 ± 0.89; T4-BL: -0.13 ± 1.02). CONCLUSION KT after OMF surgery is a promising, simple, less traumatic, economical approach free from systemic adverse reaction upgrading patients' quality of life.
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Affiliation(s)
- Oliver Ristow
- Medizin und Aesthetik, Clinic for Oral and Maxillofacial and Plastic Surgery , Munich , Germany
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Jilek C, Krenn M, Sebah D, Obermeier R, Braune A, Kehl V, Schroll S, Montalvan S, Riegger GA, Pfeifer M, Arzt M. Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study. Eur J Heart Fail 2014; 13:68-75. [DOI: 10.1093/eurjhf/hfq183] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Clemens Jilek
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
| | - Marion Krenn
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
| | - Daniela Sebah
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
| | - Ruth Obermeier
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
| | - Astrid Braune
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Technical University Munich; Munich Germany
| | - Stephan Schroll
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
| | - Sylvia Montalvan
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
| | - Günter A.J. Riegger
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
| | - Michael Pfeifer
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
- Center for Pneumology; Donaustauf Hospital; Donaustauf Germany
| | - Michael Arzt
- Department of Internal Medicine II; University Hospital Regensburg; Franz-Josef-Strauβ-Allee 11, 93042 Regensburg Germany
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