1
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Möller K, Stock B, Ignee A, Zadeh ES, De Molo C, Serra C, Jenssen C, Lim A, Görg C, Dong Y, Klinger C, Tana C, Meloni MF, Sparchez Z, Francica G, Dirks K, Hollerweger A, Kinkel H, Weskott HP, Montagut NE, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesions - non-infectious, non-neoplastic. Med Ultrason 2023; 25:435-444. [PMID: 37369029 DOI: 10.11152/mu-4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of non-infectious and non-neoplastic focal liver lesions (FLL) are discussed. Improved detection and characterization of common FLL are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper is on non-infectious and non-neoplastic FLL and their appearance on B-mode, Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany.
| | - Bahar Stock
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - André Ignee
- Medical Clinic, Department for Gastroenterology and Rheumatology, Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Ehsan Safai Zadeh
- 4Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Germany
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Christian Görg
- 4Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Claudio Tana
- Geriatrics Clinic, University Hospital of Chieti, Chieti, Italy
| | - Maria Franca Meloni
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA, Department of Interventional Ultrasound Casa di Cura Igea, Milano, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pinetagrande, Hospital Castelvolturno (CE), Italy
| | | | - Alois Hollerweger
- 5Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Horst Kinkel
- 6Medical Care Center RUR, Gastroenterology, Düren, Germany
| | | | | | - David Srivastava
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence; Inselspital Bern, Hospital of the University of Bern, Switzerland
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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2
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Zander T, Zadeh ES, Möller K, Goerg C, Correas JM, Chaubal N, Dirks K, Hollerweger A, Jenssen C, Klinger C, Lim A, Dong Y, Cui XW, Montagut NE, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesion - infectious parasitic, fungus. Med Ultrason 2023; 25:423-434. [PMID: 36996385 DOI: 10.11152/mu-4091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of parasitic and fungus infections are discussed. Improved detection and characterization of common focal liver lesions (FLL) are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper on infectious (parasitic and fungus) focal liver lesions is on their appearance on B-mode and Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
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Affiliation(s)
- Tobias Zander
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | - Christian Goerg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Germany
| | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Department of Radiology and Center For Imaging Science, Centre, Mumbai, India
| | | | - Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg/ Wriezen, Germany, Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | | | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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3
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Safai Zadeh E, Görg C, Huber KP, Dirks K, Jenssen C, Lim A, Möller K, Götzberger M, Dong Y, Cui XW, Fetzer DT, Klinger C, Clevert DA, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare malignant hematological liver lesions. Med Ultrason 2023. [PMID: 38150695 DOI: 10.11152/mu-4305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Diagnosing rare hematological malignancies in the liver is often challenging owing to their infrequency, and confirmation generally necessitates histological examination. Due to the rarity of these lesions, there are limited data concerning their appearance on ultrasound and, specifically, contrast-enhanced ultrasound. In this review, we describe the pathological and ultrasound features of several hematological malignant liver lesions, including lymphoma of the liver and chloroma. Furthermore, two specific forms of liver lymphoma are described: mucosa-associated lymphoid tissue (MALT) lymphoma andplasmacytoma of the liver.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University, Marburg, Marburg
| | | | | | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Neuruppin
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin
| | - Manuela Götzberger
- Klinik für Gastroenterologie und Hepatologie Neuperlach und Harlaching, München Klinik Neuperlach
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, Dallas
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg
| | - Dirk Andre Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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4
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Buhr HJ, Kalff JC, Klinger C. [How does the surgical society (DGAV) support the continuing medical training in general and visceral surgery?]. Chirurgie (Heidelb) 2023; 94:911-920. [PMID: 37747486 DOI: 10.1007/s00104-023-01959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/26/2023]
Abstract
The medical councils (Ärztekammern) develop the contents of the further training regulations with the support of the specialist society. The hospitals with the training supervisors have to implement these contents for the trainees in continuing education and confirm the acquisition of competence for the individual tasks. Surveys of young surgeons in recent years have shown that many participants do not receive structured continuing education, so that there is general dissatisfaction. Therefore, the German Society for General and Visceral Surgery (DGAV) is required to provide assistance to its members to improve continuing education in the departments. For example, the DGAV organizes more than 100 surgical courses annually on all topics of visceral surgery, anatomy, skills courses and revision courses with the Further Education and Advanced Training Quality Center (WeiFoQ). This year a continuing education curriculum was developed over the 6‑year continuing education period, so that a structured continuing education is achievable. The contents of the continuing education regulations are included in this continuing education curriculum with explanations, video clips, and graphics, thus providing quick information on each individual surgical clinical picture. A digital surgical catalog provides a quick overview of the status of personal continuing education. It is planned to set up an interface to the eLogbook of the medical councils.
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Affiliation(s)
- H J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e. V., Schiffbauerdamm 40, 10117, Berlin, Deutschland.
| | - J C Kalff
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e. V., Schiffbauerdamm 40, 10117, Berlin, Deutschland
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn (AöR), Bonn, Deutschland
| | - C Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e. V., Schiffbauerdamm 40, 10117, Berlin, Deutschland
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5
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Ignee A, Möller K, Thees-Laurenz R, Zadeh ES, Görg C, Correas JM, Chaubal N, Sansone V, Jenssen C, Dong Y, Götzberger M, Meloni MF, Cui XW, Klinger C, DeMolo C, Carla S, Lim A, Huang P, Espinosa Montagut N, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesions - infectious (bacterial). Med Ultrason 2023; 25:312-324. [PMID: 36996384 DOI: 10.11152/mu-4065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of bacterial infections are discussed. Improved detection and characterization of common focal liver lesions (FLL) are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper on infectious (bacterial) focal liver lesions is on their appearance on B-mode and Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
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Affiliation(s)
- André Ignee
- Medical Clinic - Department for Gastroenterology and Rheumatology, Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin
| | - Ruth Thees-Laurenz
- Zentrum für Radiologie, Neuroradiologie, Sonographie und Nuklearmedizin. Krankenhaus der Barmherzigen Brüder Trier
| | - Ehsan Safai Zadeh
- 4Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg, Germany
| | - Jean Michel Correas
- 5Service de Radiologie Adultes, Hôpital Necker, Université Paris Cité, Paris
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research 23 Department of Radiology and Center For Imaging Science, Centre, Mumbai
| | - Vito Sansone
- IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Christian Jenssen
- 8Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Brandenburg Institute of Clinical Medicine at Medical University Brandenburg
| | - Yi Dong
- 9Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Manuela Götzberger
- Klinik für Gastroenterologie und Hepatologie, München Klinik Neuperlach und Harlaching, Germany
| | - Maria Franca Meloni
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA, Department of Interventional Ultrasound Casa di Cura Igea, Milano
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg
| | - Chiara DeMolo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna
| | - Serra Carla
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London
| | - Pintong Huang
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | | | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern.
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6
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Dong Y, Guggisberg E, Wang WP, Zadeh ES, Christian G, Möller K, Berzigotti A, Chaubal N, Cui XW, De Molo C, Dirks K, Montagut NE, Gilja OH, Hollerweger A, Jenssen C, Jung EM, Klinger C, Lim A, Sansone V, Schuler A, Serra C, Sparchez Z, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part II. Med Ultrason 2023. [PMID: 37632825 DOI: 10.11152/mu-4261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
It is important to be familiar with the typical imaging features of the uncommon or even extremely rare focal liver lesions (FLL). Current guidelines of the World Federation for Ultrasound in Medicine and Biology (WFUMB) is aimed at assessing the usefulness of contrast enhanced ultrasound (CEUS) in the management of various FLL. In this review, we aim to summarize the ultrasound and CEUS characteristics with literature review of some extremely rare benign FLL, which might be helpful for improving diagnostic efficiency clinically.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Elisa Guggisberg
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Görg Christian
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg,
Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nittin Chaubal
- Thane Ultrasound Centre: Jaslok Hospital and Research Centre, Mumbai, India
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland Strausberg, Germany, and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | | | - Adrian Lim
- 7Imperial College London and Healthcare NHS Trust, London, UK
| | - Vito Sansone
- Unit of Internal Medicine, Dpt of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Geislingen, DOC-da! MVZ GmbH, Goeppingen Germany
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David Srivastava
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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7
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Dong Y, Wang WP, Zadeh ES, Möller K, Görg C, Berzigotti A, Chaubal N, Cui XW, De Molo C, Dirks K, Montagut NE, Gilja OH, Hollerweger A, Jenssen C, Jung EM, Klinger C, Lim A, Sansone V, Schuler A, Serra C, Sparchez Z, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part I. Med Ultrason 2023. [PMID: 37632826 DOI: 10.11152/mu-4260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Improved detection and characterization of common focal liver lesions (FLL) are the main topics of the World Federation for Ultrasound in Medicine and Biology (WFUMB) guidelines on the use of contrast-enhanced ultrasound (CEUS). On stateof-the-art CEUS imaging, to create a library of rare FLL, especially concerning their atypical imaging characteristics, might be helpful for improving clinical diagnostic efficiency. In this review, we aim to summarize the ultrasound and CEUS features of rare benign FLL. Currently there are limited reports and images published.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nittin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Christian Jenssen
- Medical Department, Krankenhaus MaerkischOderland, Strausberg, Germany, and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | | | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Vito Sansone
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Germany
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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8
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Mueller RS, Zablotski Y, Baumann K, Boehm T, Kasper B, Klinger C, Monke M, Udraite-Vovk L, Weitzer T, Gedon NKY. A randomised, double-blinded comparison between subcutaneous rush and intralympathic allergen immunotherapy induction in atopic dogs. Vet Dermatol 2023; 34:91-98. [PMID: 36424528 DOI: 10.1111/vde.13138] [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] [Received: 02/18/2022] [Revised: 08/22/2022] [Accepted: 09/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common skin diseases in small animal practice. Allergen immunotherapy (AIT) is the only curative treatment for the disease, and oral, subcutaneous and intralymphatic administration of allergens are commonly employed. OBJECTIVES To compare the efficacy of AIT following an induction phase with intralymphatic injections (ILIT) or rush immunotherapy (RIT). ANIMALS Fifty privately owned dogs with AD. MATERIALS AND METHODS In a double-blinded study, dogs were randomly assigned to either four monthly ILIT of allergen extract or RIT with five injections administered subcutaneously at hourly intervals on the first day. They were assessed by validated scores; Canine Atopic Dermatitis Lesion Index (CADLI) and pruritus Visual Analog Scale (PVAS) at the beginning of the study and after 1, 3, 6 and 12 months. The latter were performed daily for 7 days before each revisit. Medication scores and a total clinical score were calculated and compared between each group and time point. RESULTS There was no significant difference in CADLI and PVAS scores, or CADLI and medication scores between groups at any of the time points. A significant improvement with both ILIT and RIT was seen in total and pruritus scores, respectively. An owner global assessment of good-to-excellent treatment efficacy was seen in 40% of the dogs; total scores improved by 27% and 35% in the RIT and ILIT group, respectively. Adverse effects were not seen. CONCLUSIONS AND CLINICAL RELEVANCE Induction of AIT can be conducted either as RIT or ILIT with no loss in efficacy.
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Affiliation(s)
- Ralf S Mueller
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Yuri Zablotski
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Katja Baumann
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Teresa Boehm
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Bettina Kasper
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | | | - Maarten Monke
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | | | - Tamara Weitzer
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Natalie K Y Gedon
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
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9
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Vladimirov M, Wellner UF, Klinger C, Buhr HJ, Seyfried F. [Impact of the COVID pandemic on treatment of bariatric patients in Germany-An analysis of the national StuDoQ/MBE register]. Chirurgie (Heidelb) 2023; 94:487-496. [PMID: 36894648 PMCID: PMC9998013 DOI: 10.1007/s00104-023-01838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic the standard inpatient care of patients was restricted to increase overall and intensive care capacity reserves for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected persons. OBJECTIVE This article presents the impact of the COVID-19 pandemic on the surgical and postoperative care of bariatric patients in Germany. MATERIAL AND METHODS A statistical analysis of the national StuDoQ/MBE register data for the period from 1 May 2018 until 31 May 2022 was performed. RESULTS Throughout the entire study period there was a continuous increase in documented operations, which continued even during the COVID-19 pandemic. A significant intermittent decline in surgery performed was observed only during the imposition of first lockdown in the months of March to May 2020, with a minimum number of 194 cases performed monthly in April 2020. The pandemic had no measurable effect on the surgically treated patient population, the type of surgical procedure, the perioperative and postoperative outcomes and follow-up care. CONCLUSION Based on the results of the StuDoQ data and the current literature, it can be deduced that bariatric surgery can be carried out with no increased risk during the COVID-19 pandemic and the quality of postoperative care is not impaired.
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Affiliation(s)
- M Vladimirov
- Metabolische und bariatrische Chirurgie, Klinik für Allgemein, Viszeral- und Thoraxchirurgie, PMU Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - U F Wellner
- Klinik für Chirurgie, UKSH Campus Lübeck, Lübeck, Deutschland
| | - C Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - H J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - F Seyfried
- Klinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, 97080, Würzburg, Deutschland
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Sturm L, Bettinger D, Klinger C, Krauss T, Engel H, Huber JP, Schmidt A, Caca K, Thimme R, Schultheiss M. Validation of color Doppler ultrasound and computed tomography in the radiologic assessment of non-malignant acute splanchnic vein thrombosis. PLoS One 2021; 16:e0261499. [PMID: 34929009 PMCID: PMC8687587 DOI: 10.1371/journal.pone.0261499] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/05/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION International guidelines propose color Doppler ultrasound (CDUS) and contrast-enhanced computed tomography (CT) as primary imaging techniques in the diagnosis of acute splanchnic vein thrombosis. However, their reliability in this context is poorly investigated. Therefore, the aim of our study was to validate CDUS and CT in the radiologic assessment of acute splanchnic vein thrombosis, using direct transjugular spleno-portography as gold standard. MATERIALS AND METHODS 49 patients with non-malignant acute splanchnic vein thrombosis were included in a retrospective, multicenter analysis. The thrombosis' extent in five regions of the splanchnic venous system (right and left intrahepatic portal vein, main trunk of the portal vein, splenic vein, superior mesenteric vein) and the degree of thrombosis (patent, partial thrombosis, complete thrombosis) were assessed by portography, CDUS and CT in a blinded manner. Reliability of CDUS and CT with regard to portography as gold standard was analyzed by calculating Cohen's kappa. RESULTS Results of CDUS and CT were consistent with portography in 76.6% and 78.4% of examinations, respectively. Cohen's kappa demonstrated that CDUS and CT delivered almost equally reliable results with regard to the portographic gold standard (k = 0.634 [p < 0.001] vs. k = 0.644 [p < 0.001]). In case of findings non-consistent with portography there was no clear trend to over- or underestimation of the degree of thrombosis in both CDUS (60.0% vs. 40.0%) and CT (59.5% vs. 40.5%). CONCLUSIONS CDUS and CT are equally reliable tools in the radiologic assessment of non-malignant acute splanchnic vein thrombosis.
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Affiliation(s)
- Lukas Sturm
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Klinger
- Department of Medicine, RKH Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Tobias Krauss
- Department of Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannes Engel
- Department of Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Patrick Huber
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karel Caca
- Department of Medicine, RKH Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bettinger D, Sturm L, Pfaff L, Hahn F, Kloeckner R, Volkwein L, Praktiknjo M, Lv Y, Han G, Huber JP, Boettler T, Reincke M, Klinger C, Caca K, Heinzow H, Seifert LL, Weiss KH, Rupp C, Piecha F, Kluwe J, Zipprich A, Luxenburger H, Neumann-Haefelin C, Schmidt A, Jansen C, Meyer C, Uschner FE, Brol MJ, Trebicka J, Rössle M, Thimme R, Schultheiss M. Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. J Hepatol 2021; 74:1362-1372. [PMID: 33508376 DOI: 10.1016/j.jhep.2021.01.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an effective and safe treatment for complications of portal hypertension. Survival prediction is important in these patients as they constitute a high-risk population. Therefore, the aim of our study was to develop an alternative prognostic model for accurate survival prediction after planned TIPS implantation. METHODS A total of 1,871 patients with de novo TIPS implantation for ascites or secondary prophylaxis of variceal bleeding were recruited retrospectively. The study cohort was divided into a training set (80% of study patients; n = 1,496) and a validation set (20% of study patients; n = 375). Further, patients with early (preemptive) TIPS implantation due to variceal bleeding were included as another validation cohort (n = 290). Medical data and overall survival (OS) were assessed. A Cox regression model was used to create an alternative prediction model, which includes significant prognostic factors. RESULTS Age, bilirubin, albumin and creatinine were the most important prognostic factors. These parameters were included in a new score named the Freiburg index of post-TIPS survival (FIPS). The FIPS score was able to identify high-risk patients with a significantly reduced median survival of 5.0 (3.1-6.9) months after TIPS implantation in the training set. These results were confirmed in the validation set (median survival of 3.1 [0.9-5.3] months). The FIPS score showed better prognostic discrimination compared to the Child-Pugh, MELD, MELD-Na score and the bilirubin-platelet model. However, the FIPS score showed insufficient prognostic discrimination in patients with early TIPS implantation. CONCLUSIONS The FIPS score is superior to established scoring systems for the identification of high-risk patients with a worse prognosis following elective TIPS implantation. LAY SUMMARY Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective treatment for patients with cirrhosis and clinically significant portal hypertension. However, risk stratification is a major challenge in these patients as currently available scoring systems have major drawbacks. Age, bilirubin, albumin and creatinine were included in a new risk score which was named the Freiburg index of post-TIPS survival (FIPS). The FIPS score can identify patients at high risk and may guide clinical decision making.
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Affiliation(s)
- Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Germany.
| | - Lukas Sturm
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Germany
| | - Lena Pfaff
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Lara Volkwein
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | | | - Yong Lv
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China; Department of Liver Diseases and Digestive Interventional Radiology, Digestive Diseases Hospital, Xi'an International Medical Center Hospital of Northwestern University, Xi'an, China
| | - Jan Patrick Huber
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Germany
| | - Marlene Reincke
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Christoph Klinger
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany
| | - Hauke Heinzow
- Department of Gastroenterology and Hepatology, University Hospital Münster, Germany
| | - Leon Louis Seifert
- Department of Gastroenterology and Hepatology, University Hospital Münster, Germany
| | - Karl Heinz Weiss
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany; Krankenhaus Salem der evang, Stadtmission Heidelberg, Heidelberg, Germany
| | - Christian Rupp
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Piecha
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Johannes Kluwe
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Alexander Zipprich
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hendrik Luxenburger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; IMM-PACT, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Frank E Uschner
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Maximilian J Brol
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Martin Rössle
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; PraxisZentrum für Gastroenterologie und Endokrinologie, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Schellhaas B, Bernatik T, Bohle W, Borowitzka F, Chang J, Dietrich CF, Dirks K, Donoval R, Drube K, Friedrich-Rust M, Gall C, Gittinger F, Gutermann M, Haenle MM, von Herbay A, Ho CH, Hochdoerffer R, Hoffmann T, Hüttig M, Janson C, Jung EM, Jung N, Karlas T, Klinger C, Kornmehl A, Kratzer W, Krug S, Kunze G, Leitlein J, Link A, Lottspeich C, Marano A, Mauch M, Moleda L, Neesse A, Petzold G, Potthoff A, Praktiknjo M, Rösner KD, Schanz S, Schultheiß M, Sivanathan V, Stock J, Thomsen T, Vogelpohl J, Vogt C, Wagner S, Wiegard C, Wiesinger I, Will U, Ziesch M, Zimmermann P, Strobel D. Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma - A Prospective Multicenter DEGUM Study. Ultraschall Med 2021; 42:e20. [PMID: 32717752 DOI: 10.1055/a-1220-8561] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Barbara Schellhaas
- Department of Internal Medicine 1, University Hospital Erlangen, Germany
| | - Thomas Bernatik
- Department of Internal Medicine 1, Kreisklinik Ebersberg gGmbH, Ebersberg, Germany
| | - Wolfram Bohle
- Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und Infektiologie, Katharinenhospital, Klinikum Stuttgart, Germany
| | - Fanny Borowitzka
- Department of Internal Medicine 2, Universitätsmedizin Rostock, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Germany
| | | | - Klaus Dirks
- Gastroenterologie und Innere Medizin, Rems-Murr-Klinikum Winnenden, Germany
| | - Robert Donoval
- Klinik für Gastroenterologie, Diabetologie und Infektiologie, Lausitzer Seenland Klinikum GmbH, Hoyerswerda, Germany
| | - Kristine Drube
- Department of Internal Medicine, Allgemeines Krankenhaus Celle, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Christine Gall
- Institut für Medizininformatik, Biometrie und Epidemiologie, FAU IMBE, Erlangen, Germany
| | - Fleur Gittinger
- Department of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Martin Gutermann
- Department of Internal Medicine, Hufeland-Hospital, Mühlhausen, Germany
| | | | - Alexandra von Herbay
- Department of Internal Medicine, Evangelisches Krankenhaus Hamm gGmbH, Hamm, Germany
| | - Chau Hong Ho
- Department of Internal Medicine, Hufeland-Hospital, Mühlhausen, Germany
| | - Rico Hochdoerffer
- Department of Internal Medicine, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Tatjana Hoffmann
- Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Matthias Hüttig
- Department of Internal Medicine, DRK-Kliniken Berlin-Köpenick, Berlin, Germany
| | - Christopher Janson
- Department of Internal Medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | | | - Norbert Jung
- Department of Internal Medicine, Klinikum Heidenheim, Germany
| | - Thomas Karlas
- Department of Internal Medicine, Division of Gastroenterology, Universitätsklinikum Leipzig, Germany
| | | | - Adam Kornmehl
- Department of Internal Medicine, Klinikum Weiden, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine, University Hospital Ulm, Germany
| | - Sebastian Krug
- Department of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Georg Kunze
- Internal Medicine, KH Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Jens Leitlein
- Department of Internal Medicine, Klinikum am Steinenberg Reutlingen, Germany
| | - Alexander Link
- Department of Internal Medicine, University Hospital Magdeburg, Germany
| | - Christian Lottspeich
- Medical Clinic and Policlinic IV, Division of Vascular Medicine, Hospital of the Ludwig Maximilians University Hospital, Munich, Germany
| | - Aldo Marano
- Department of Internal Medicine, ViDia Christliche Kliniken Karlsruhe, Germany
| | - Martin Mauch
- Department of Internal Medicine, Innere, Kreisklinik Sigmaringen, Germany
| | - Lukas Moleda
- Department of Internal Medicine, Universitätsklinikum Regensburg, Germany
| | - Albrecht Neesse
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Golo Petzold
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Andrej Potthoff
- Gastroenterology and Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Klaus-Dieter Rösner
- Department of Internal Medicine, Barmherzige Brüder Klinikum Sankt Elisabeth Straubing GmbH, Straubing, Germany
| | - Stefan Schanz
- Department of Internal Medicine, Kreisklinikum Siegen gGmbH, Siegen, Germany
| | - Michael Schultheiß
- Department of Internal Medicine, University of Freiburg Hospital, Freiburg, Germany
| | - Visvakanth Sivanathan
- Department of Internal Medicine, University Hospital Mainz, Department of Internal Medicine 3, Mainz, Germany
| | - Joachim Stock
- Department of Internal Medicine, Klinikum Barnim, Eberswalde, Germany
| | - Thomas Thomsen
- Department of Internal Medicine, Westküstenklinik Brunsbüttel, Brunsbüttel, Germany
| | - Johanna Vogelpohl
- Department of Internal Medicine I, Krankenhaus GmbH Alb-Donau-Kreis Blaubeuren, Germany
| | - Christoph Vogt
- Department of Internal Medicine, St.-Josef-Krankenhaus Moers, Germany
| | - Siegfried Wagner
- Department of Internal Medicine, Donau-Isar-Kliniken Deggendorf, Germany
| | - Christiane Wiegard
- Department of Internal Medicine, University Hospital Hamburg Eppendorf Center of Internal Medicine, Hamburg, Germany
| | - Isabel Wiesinger
- Department of Internal Medicine, Universitätsklinikum Regensburg, Germany
| | - Uwe Will
- Internal Medicine, Klinikum Gera, Gera, Germany
| | - Matthias Ziesch
- Department of Internal Medicine, Diakonissenkrankenhaus Dresden, Germany
| | | | - Deike Strobel
- Department of Internal Medicine 1, University Hospital Erlangen, Germany
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Schellhaas B, Bernatik T, Bohle W, Borowitzka F, Chang J, Dietrich CF, Dirks K, Donoval R, Drube K, Friedrich-Rust M, Gall C, Gittinger F, Gutermann M, Haenle MM, von Herbay A, Ho CH, Hochdoerffer R, Hoffmann T, Hüttig M, Janson C, Jung EM, Jung N, Karlas T, Klinger C, Kornmehl A, Kratzer W, Krug S, Kunze G, Leitlein J, Link A, Lottspeich C, Marano A, Mauch M, Moleda L, Neesse A, Petzold G, Potthoff A, Praktiknjo M, Rösner KD, Schanz S, Schultheiß M, Sivanathan V, Stock J, Thomsen T, Vogelpohl J, Vogt C, Wagner S, Wiegard C, Wiesinger I, Will U, Ziesch M, Zimmermann P, Strobel D. Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma - A Prospective Multicenter DEGUM Study. Ultraschall Med 2021; 42:178-186. [PMID: 32663881 DOI: 10.1055/a-1198-4874] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND This prospective multicenter study funded by the DEGUM assesses the diagnostic accuracy of standardized contrast-enhanced ultrasound (CEUS) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. METHODS Patients at high risk for HCC with a histologically proven focal liver lesion on B-mode ultrasound were recruited prospectively in a multicenter approach. Clinical and imaging data were entered via online entry forms. The diagnostic accuracies for the noninvasive diagnosis of HCC were compared for the conventional interpretation of standardized CEUS at the time of the examination (= CEUS on-site) and the two CEUS algorithms ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) and CEUS LI-RADS (Contrast-Enhanced UltraSound Liver Imaging Reporting and Data System). RESULTS 321 patients were recruited in 43 centers; 299 (93.1 %) had liver cirrhosis. The diagnosis according to histology was HCC in 256 cases, and intrahepatic cholangiocarcinoma (iCCA) in 23 cases. In the subgroup of cirrhotic patients (n = 299), the highest sensitivity for the diagnosis of HCC was achieved with the CEUS algorithm ESCULAP (94.2 %) and CEUS on-site (90.9 %). The lowest sensitivity was reached with the CEUS LI-RADS algorithm (64 %; p < 0.001). However, the specificity of CEUS LI-RADS (78.9 %) was superior to that of ESCULAP (50.9 %) and CEUS on-site (64.9 %; p < 0.001). At the same time, the negative predictive value (NPV) of CEUS LI-RADS was significantly inferior to that of ESCULAP (34.1 % vs. 67.4 %; p < 0.001) and CEUS on-site (62.7 %; p < 0.001). The positive predictive values of all modalities were high (around 90 %), with the best results seen for CEUS LI-RADS and CEUS on-site. CONCLUSION This is the first multicenter, prospective comparison of standardized CEUS and the recently developed CEUS-based algorithms in histologically proven liver lesions in cirrhotic patients. Our results reaffirm the excellent diagnostic accuracy of CEUS for the noninvasive diagnosis of HCC in high-risk patients. However, on-site diagnosis by an experienced examiner achieves an almost equal diagnostic accuracy compared to CEUS-based diagnostic algorithms.
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Affiliation(s)
- Barbara Schellhaas
- Department of Internal Medicine 1, University Hospital Erlangen, Germany
| | - Thomas Bernatik
- Department of Internal Medicine 1, Kreisklinik Ebersberg gGmbH, Ebersberg, Germany
| | - Wolfram Bohle
- Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und Infektiologie, Katharinenhospital, Klinikum Stuttgart, Germany
| | - Fanny Borowitzka
- Department of Internal Medicine 2, Universitätsmedizin Rostock, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Germany
| | | | - Klaus Dirks
- Gastroenterologie und Innere Medizin, Rems-Murr-Klinikum Winnenden, Germany
| | - Robert Donoval
- Klinik für Gastroenterologie, Diabetologie und Infektiologie, Lausitzer Seenland Klinikum GmbH, Hoyerswerda, Germany
| | - Kristine Drube
- Department of Internal Medicine, Allgemeines Krankenhaus Celle, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Christine Gall
- Institut für Medizininformatik, Biometrie und Epidemiologie, FAU IMBE, Erlangen, Germany
| | - Fleur Gittinger
- Department of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Martin Gutermann
- Department of Internal Medicine, Hufeland-Hospital, Mühlhausen, Germany
| | | | - Alexandra von Herbay
- Department of Internal Medicine, Evangelisches Krankenhaus Hamm gGmbH, Hamm, Germany
| | - Chau Hong Ho
- Department of Internal Medicine, Hufeland-Hospital, Mühlhausen, Germany
| | - Rico Hochdoerffer
- Department of Internal Medicine, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Tatjana Hoffmann
- Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Matthias Hüttig
- Department of Internal Medicine, DRK-Kliniken Berlin-Köpenick, Berlin, Germany
| | - Christopher Janson
- Department of Internal Medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | | | - Norbert Jung
- Department of Internal Medicine, Klinikum Heidenheim, Germany
| | - Thomas Karlas
- Department of Internal Medicine, Division of Gastroenterology, Universitätsklinikum Leipzig, Germany
| | | | - Adam Kornmehl
- Department of Internal Medicine, Klinikum Weiden, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine, University Hospital Ulm, Germany
| | - Sebastian Krug
- Department of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Georg Kunze
- Internal Medicine, KH Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Jens Leitlein
- Department of Internal Medicine, Klinikum am Steinenberg Reutlingen, Germany
| | - Alexander Link
- Department of Internal Medicine, University Hospital Magdeburg, Germany
| | - Christian Lottspeich
- Medical Clinic and Policlinic IV, Division of Vascular Medicine, Hospital of the Ludwig Maximilians University Hospital, Munich, Germany
| | - Aldo Marano
- Department of Internal Medicine, ViDia Christliche Kliniken Karlsruhe, Germany
| | - Martin Mauch
- Department of Internal Medicine, Innere, Kreisklinik Sigmaringen, Germany
| | - Lukas Moleda
- Department of Internal Medicine, Universitätsklinikum Regensburg, Germany
| | - Albrecht Neesse
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Golo Petzold
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Andrej Potthoff
- Gastroenterology and Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Klaus-Dieter Rösner
- Department of Internal Medicine, Barmherzige Brüder Klinikum Sankt Elisabeth Straubing GmbH, Straubing, Germany
| | - Stefan Schanz
- Department of Internal Medicine, Kreisklinikum Siegen gGmbH, Siegen, Germany
| | - Michael Schultheiß
- Department of Internal Medicine, University of Freiburg Hospital, Freiburg, Germany
| | - Visvakanth Sivanathan
- Department of Internal Medicine, University Hospital Mainz, Department of Internal Medicine 3, Mainz, Germany
| | - Joachim Stock
- Department of Internal Medicine, Klinikum Barnim, Eberswalde, Germany
| | - Thomas Thomsen
- Department of Internal Medicine, Westküstenklinik Brunsbüttel, Brunsbüttel, Germany
| | - Johanna Vogelpohl
- Department of Internal Medicine I, Krankenhaus GmbH Alb-Donau-Kreis Blaubeuren, Germany
| | - Christoph Vogt
- Department of Internal Medicine, St.-Josef-Krankenhaus Moers, Germany
| | - Siegfried Wagner
- Department of Internal Medicine, Donau-Isar-Kliniken Deggendorf, Germany
| | - Christiane Wiegard
- Department of Internal Medicine, University Hospital Hamburg Eppendorf Center of Internal Medicine, Hamburg, Germany
| | - Isabel Wiesinger
- Department of Internal Medicine, Universitätsklinikum Regensburg, Germany
| | - Uwe Will
- Internal Medicine, Klinikum Gera, Gera, Germany
| | - Matthias Ziesch
- Department of Internal Medicine, Diakonissenkrankenhaus Dresden, Germany
| | | | - Deike Strobel
- Department of Internal Medicine 1, University Hospital Erlangen, Germany
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Klinger C, Riecken B, Dietrich CF, Dirks K, Caca K, Fröhlich E. Use of Ultrasound in the Diagnostic Work-Up of Adult Intussusception - A Multicenter Retrospective Analysis. Ultraschall Med 2020; 41:418-427. [PMID: 29975971 DOI: 10.1055/a-0604-2676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate the use of ultrasound (US) in the diagnostic work-up of adult intussusception (AI). METHODS This multicenter study includes 26 consecutive patients diagnosed with AI between January 2010 and November 2017. A retrospective chart analysis was conducted with a focus on abdominal US findings and diagnostic accuracy of different imaging modalities (ultrasound, computed tomography (CT), magnetic resonance imaging). If available, surgical and pathological findings served as the gold standard (76.9 %). US examiners certified according to DEGUM grade 2 or 3 were classified as experts. Otherwise, they were regarded to have basic skills. RESULTS During diagnostic work-up, 92.3 % underwent abdominal US. US was the first-line imaging modality in 88.5 % of cases. The accuracy regarding the detection of AI (85 %), correct localization (95 %) and detection of complications (100 %) was excellent and comparable with CT (81 %, 90.5 %, and 91.7 %) when performed by experts. 72.7 % of tumorous lead points were detected by experienced examiners. In contrast, AI was detected in only 45.5 % of cases by examiners with basic skills. AI was diagnosed prior to surgery in all patients. CONCLUSION US is reliable in the diagnostic work-up of AI when performed by experienced examiners with high-quality equipment. US, CT and MRI should be used in a complementary fashion since combination provides excellent sensitivity regarding the detection and correct localization of AI as well as the detection of complications. The impact of real-time imaging is illustrated by supplementary videos.
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Affiliation(s)
- Christoph Klinger
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Germany
| | - Bettina Riecken
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Germany
| | - Christoph Frank Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim gGmbH, Bad Mergentheim, Germany
| | - Klaus Dirks
- Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Germany
| | - Karel Caca
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Germany
| | - Eckhart Fröhlich
- Internal Medicine I, University hospital Tuebingen, Tübingen, Germany
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Rössle M, Bettinger D, Trebicka J, Klinger C, Praktiknjo M, Sturm L, Caca K, Mücke VT, Radecke K, Engelmann C, Zipprich A, Heinzow H, Meyer C, Tappe U, Appenrodt B, Schmidt A, Lange C, Strassburg C, Zeuzem S, Grandt D, Schmidt H, Moessner J, Berg T, Lammert F, Thimme R, Schultheiß M. A prospective, multicentre study in acute non-cirrhotic, non-malignant portal vein thrombosis: comparison of medical and interventional treatment. Aliment Pharmacol Ther 2020; 52:329-339. [PMID: 32506456 DOI: 10.1111/apt.15811] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Received: 04/02/2020] [Revised: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non-cirrhotic, non-malignant portal vein thrombosis (PVT). METHODS This prospective, observational study enrolled 65 patients with acute (<28 days since begin of symptoms, no cavernoma) PVT in nine centres. Thirty patients received medical treatment and 35 patients received interventional treatment. PVT was graded into grade 1: short thrombosis and incomplete occlusion of the vessel lumen and grade 2: extended thrombosis or complete occlusion. Treatment response was classified as partial or complete, if thrombosis was reduced by one grade or to <25% of the vessel diameter respectively. RESULTS Partial and complete response rates were 7% and 30% in the medical compared to 17% and 54% (P < 0.001) in the interventional treatment group. In the multivariate analysis, interventional treatment showed a strong positive (OR 4.32, P < 0.016) and a myeloproliferative aetiology a negative (OR 0.09, P = 0.006) prediction of complete response. Complications were rare in the medical group and consisted of septicaemia and upper gastrointestinal bleeding of unknown origin in one patient each. Interventional treatment was accompanied by mild and self-limiting bleeding complications in nine patients, moderate intra-abdominal bleeding requiring transfusions (2 units) in one patient and peritoneal bleeding requiring surgical rescue in one patient. Four patients in each group developed intestinal gangrene requiring surgery. One patient died 52 days after unsuccessful interventional treatment. CONCLUSIONS Compared to medical treatment alone, interventional treatment doubled response rates at the cost of increased bleeding complications.
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Fröhlich E, Beller K, Muller R, Herrmann M, Debove I, Klinger C, Pauluschke-Fröhlich J, Hoffmann T, Kreppenhofer S, Dietrich CF. Point of Care Ultrasound in Geriatric Patients: Prospective Evaluation of a Portable Handheld Ultrasound Device. Ultraschall Med 2020; 41:308-316. [PMID: 31026863 DOI: 10.1055/a-0889-8070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The aim of the current study was to evaluate point of care ultrasound (POCUS) in geriatric patients by echoscopy using a handheld ultrasound device (HHUSD, VScan) at bedside in comparison to a high-end ultrasound system (HEUS) as the gold standard. MATERIALS AND METHODS Prospective observational study with a total of 112 geriatric patients. The ultrasound examinations were independently performed by two experienced blinded examiners with a portable handheld device and a high-end ultrasound device. The findings were compared with respect to diagnostic findings and therapeutic implications. RESULTS The main indications for the ultrasound examinations were dyspnea (44.6 %), fall (frailty) (24.1 %) and fever (21.4 %). The most frequently found diagnoses were cystic lesions 32.1 % (35/109), hepatic vein congestion 19.3 % (21/109) and ascites 13.6 % (15/110). HHUSD delivered 13 false-negative findings in the abdomen resulting in an "overall sensitivity" of 89.5 %. The respective "overall specificity" was 99.6 % (7 false-positive diagnoses). HHUSD (versus HEUS data) resulted in 13.6 % (17.3 %) diagnostically relevant procedures in the abdomen and 0.9 % (0.9 %) in the thorax. Without HHUSD (HEUS) 95.7 % (100 %) of important pathological findings would have been missed. CONCLUSION The small HHUSD tool improves clinical decision-making in immobile geriatric patients at the point of care (geriatric ward). In most cases, HHUSD allows sufficiently accurate yes/no diagnoses already at the bedside, thereby clarifying the leading symptoms for early clinical decision-making.
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Affiliation(s)
- Eckhart Fröhlich
- Department of Internal Medicine 1, University of Tuebingen, Tuebingen, Germany
| | | | - Reinhold Muller
- Professorial Research Fellow AITHM, James Cook University, Townsville, Australia
| | | | - Ines Debove
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Tatjana Hoffmann
- Department of Internal Medicine 1, University of Tuebingen, Tuebingen, Germany
| | - Sorina Kreppenhofer
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Christoph F Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
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Abstract
Introduction Due to technological changes, working time restrictions and the creation of specialized centers, surgical training has changed. A competence-based learning technique of surgical skills is the sub-step practice approach, which has been proven important in nationwide opinion surveys. The aim of this prospective multi-center trial was to determine the status quo of the sub-step concept in Germany. Methods Over 6 months, the voluntarily participating centers evaluated the following index procedures: laparoscopic cholecystectomy (LCHE), laparoscopic and open sigmoid resection, minimally invasive inguinal hernia repair, thyroid resection and pylorus-preserving pancreaticoduodenectomy (PPPD). Patients with private insurance were excluded. The detailed sub-steps were documented as well as the reason why these were not performed. In addition, an online survey regarding the sub-step concept was performed before and after the study. Results In total, 21 centers included 2969 surgical procedures in 2018 for final analyses. While 24.4% of the procedures were performed by residents, sub-steps were performed in 22.2%. LCHE was most often performed completely by residents (43.3%), and PPPD revealed the highest rate of performed sub-steps (43.3%). Reasons for not assisting sub-steps to residents were often organizational and other reasons. After an initial increase, the number of performed sub-steps decreased significantly during the second half of the survey. The opinion survey revealed a high importance of the sub-step concept. The number of resident procedures was overestimated, and the number of performed sub-steps was underestimated. After the study, these estimations were more realistic. Conclusion Even though the sub-step practice concept is considered highly important for surgical education, it needs to be put into practice more consequently. The current data suggest a low participation of surgical residents in the operating room, although the participating hospitals are most likely highly interested in surgical education, hence their voluntary participation. Conceptual changes and a control of surgical education are needed. Electronic supplementary material The online version of this article (10.1007/s00268-020-05539-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Huber
- Young Surgeons Working Group (CAJC) of the German Society for General and Visceral Surgery (DGAV), Berlin, Germany.
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - I Richardsen
- Young Surgeons Working Group (CAJC) of the German Society for General and Visceral Surgery (DGAV), Berlin, Germany
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Koblenz, Germany
| | - C Klinger
- German Society for General and Visceral Surgery (DGAV), Berlin, Germany
| | - M Mille
- Young Surgeons Working Group (CAJC) of the German Society for General and Visceral Surgery (DGAV), Berlin, Germany
- Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - A A Roeth
- Young Surgeons Working Group (CAJC) of the German Society for General and Visceral Surgery (DGAV), Berlin, Germany
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Meier B, Wannhoff A, Klinger C, Caca K. Novel technique for endoscopic en bloc resection (EMR+) - Evaluation in a porcine model. World J Gastroenterol 2019; 25:3764-3774. [PMID: 31391771 PMCID: PMC6676554 DOI: 10.3748/wjg.v25.i28.3764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic en bloc resection of larger polyps is relevant because risk of advanced neoplasia or malignancy correlates with tumor size. Recurrence rates after piecemeal endoscopic mucosal resection (EMR) are high and endoscopic submucosal dissection (ESD) is associated with higher complication rates in the western world.
AIM To develop a modified endoscopic en bloc resection technique using an external additional working channel and novel agent for submucosal injection.
METHODS EMR+ was considered as modified grasp and snare technique. For simultaneous use of a grasping and cutting device a novel additional working channel was used (AWC®, Ovesco Endoscopy, Tübingen, Germany). AWC® is installed on the outer surface of the endoscope, covered with a plastic sleeve and designed for single use. For submucosal injection a new agent consisting of poloxamers was used (LiftUp®, Ovesco Endoscopy, Tübingen, Germany). The agent is liquid at room temperature and forms a stable and permanent gel cushion after injection. Safety of LiftUp® has been shown in a pre-clinical study in domestic pigs. LiftUp® is commercially not yet available but approval is expected in early 2019. EMR+ was first developed ex vivo (explanted pig stomach) and subsequently evaluated in vivo (stomach, porcine model, 3 domestic pigs). Main outcome measurements were: Procedure time, macroscopic en bloc resection and adverse events.
RESULTS Concept of EMR+ was first developed ex vivo (explanted pig stomach). Ex vivo, 22 resections were performed after technique was established. Median procedure time (measured from begin of injection to extraction of resection specimen) was 7 min (range 5-11, SD 1.68) and median size of resection specimens was 30 mm × 26 mm × 11 mm ex vivo. Subsequently 13 resections were performed in vivo (stomach, porcine model, 3 domestic pigs). In vivo, median procedure time (measured from begin of injection to extraction of resection specimen) was 5 min (range 3-12, SD 2.72) and median size of resection specimens was 35 mm × 35 mm × 11 mm. In vivo, resection was macroscopic complete in 92.3%, major adverse events were not observed. In one case (7.7%) minor periprocedural bleeding was observed and managed by coagulation.
CONCLUSION EMR+ appeared to be effective and safe and was easy and fast to perform in the porcine model. EMR+ needs to be further evaluated clinically in comparative trials.
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Affiliation(s)
- Benjamin Meier
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Andreas Wannhoff
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Christoph Klinger
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Karel Caca
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
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Buhr HJ, Hardt J, Klinger C, Seyfried F, Wiegering A, Dietrich A, Bartsch DK, Lorenz D, Post S, Germer CT, Keck T, Wellner U. [Quality indicators with reference values and threshold limits in general and visceral surgery : For obesity and metabolic, pancreatic, colon carcinoma and rectal carcinoma surgery]. Chirurg 2019; 89:1-3. [PMID: 29330678 DOI: 10.1007/s00104-017-0562-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Haus der Bundespressekonferenz, Schiffbauerdamm 40, 10117, Berlin, Deutschland.
| | - J Hardt
- Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - C Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Haus der Bundespressekonferenz, Schiffbauerdamm 40, 10117, Berlin, Deutschland
| | - F Seyfried
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Wiegering
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Dietrich
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie Bereich Bariatrische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - D K Bartsch
- Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Marburg, Deutschland
| | - D Lorenz
- Klinik für Allgemein- und Viszeralchirurgie bzw. der Medizinischen Klinik II Gastroenterologie, Hepatologie, Endokrinologie, Infektiologie, Sana Klinikum Offenbach, Offenbach, Deutschland
| | - S Post
- Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - C T Germer
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - T Keck
- Klinik für Allgemeine Chirurgie, Universitätsklinikum S.-H. Campus Lübeck, Lübeck, Deutschland
| | - U Wellner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum S.-H. Campus Lübeck, Lübeck, Deutschland
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Hardt J, Buhr HJ, Klinger C, Benz S, Ludwig K, Kalff J, Post S. [Quality indicators for colon cancer surgery : Evidence-based development of a set of indicators for the outcome quality]. Chirurg 2019; 89:17-25. [PMID: 29189878 DOI: 10.1007/s00104-017-0559-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Quality assessment in surgery is gaining in importance. Although sporadic recommendations for quality indicators (QI) in oncological colon surgery can be found in the literature, these are usually not systematically derived from a solid evidence base. Moreover, reference ranges for QI are unknown. OBJECTIVE The aim of this initiative was the development of evidence-based QI for oncological colon resections by an expert panel invited by the German Society of General and Visceral Surgery (DGAV). Reference ranges from the literature and reference values from the Study, Documentation, and Quality Center (StuDoQ)|Colon Cancer Register were compared in order to deduce recommendations which are tailored to the German healthcare system. RESULTS Based on the most recent scientific evidence and agreed by expert consensus, five QI for oncological colon surgery were defined and evaluated according to the QUALIFY tool. Mortality, MTL30 (mortality, transfer to another acute care hospital, or length of stay ≥30 days), anastomotic leakage requiring reintervention, surgical site infections necessitating reopening of the wound and ≥12 lymph nodes in the specimen qualified as QI owing to their relevance, scientific nature, and practicability. Based on the results of the systematic literature search and the statistical analysis of the StuDoQ|Colon Cancer Register, preliminary reference values are proposed for each QI. CONCLUSION The presented set of QI seems appropriate for quality assessment of oncological colon surgery in the context of the German healthcare system. The validity of the QI and the reference values must be reviewed within the framework of their implementation. The StuDoQ|Colon Cancer Register provides a suitable infrastructure for collecting clinical data for quality assessment and risk adjustment.
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Affiliation(s)
- J Hardt
- Chirurgische Klinik, Universitätsmedizin Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - H-J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - C Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - S Benz
- Chirurgische Klinik, Klinikum Sindelfingen-Böblingen, Böblingen, Deutschland
| | - K Ludwig
- Chirurgische Klinik, Klinikum Südstadt Rostock, Rostock, Deutschland
| | - J Kalff
- Chirurgische Klinik, Universitätsklinikum Bonn (UKB), Bonn, Deutschland
| | - S Post
- Chirurgische Klinik, Universitätsmedizin Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Hardt J, Doyon F, Klinger C, Buhr HJ, Post S. MTL, a composite measure for objectively profiling hospitals on surgical performance in colorectal cancer surgery. Int J Colorectal Dis 2019; 34:889-898. [PMID: 30900012 DOI: 10.1007/s00384-019-03273-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE MTL is a composite outcome measure based on routine administrative data defined as (a) postoperative mortality and/or (b) postoperative transfer to another hospital and/or (c) length of hospital stay ≥ the prespecified time period. Aim of the present study was to investigate MTL for profiling hospitals on surgical performance in colorectal cancer surgery, using data from the national registers of the German Society of General and Visceral Surgery (DGAV) and to determine the time interval for length of stay with the highest accuracy regarding major complications (Clavien-Dindo grade ≥ 3). METHODS All patients undergoing colorectal cancer resection between January 2010 and February 2017 were included. MTL rates were calculated and compared to well-established single outcome measures using multivariate regression analysis. For each outcome measure, postoperative complications were tested regarding their predictability. RESULTS Data from 14,978 patients were analyzed. Length of stay was significantly prolonged if postoperative complications occurred (p < 0.0001). Thirty-day mortality and the indication for a transfer to another hospital mainly resulted from cardiopulmonary complications. MTL occurs significantly more often than any of the single-outcome parameters. The time interval of 22 days demonstrated the highest accuracy regarding severe complications (Clavien-Dindo grade ≥ 3). CONCLUSIONS MTL reflects the complete spectrum of postoperative complications. Compared to individual surgical outcome parameters, MTL may have a better discriminatory power and is therefore suitable to mirror surgical quality. Because of its high accuracy regarding surgical major morbidity, 22 days is the best cut-off for length of stay within the German healthcare system.
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Affiliation(s)
- Julia Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - Fabian Doyon
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - C Klinger
- German Society of General and Visceral Surgery (DGAV), Berlin, Germany
| | - H J Buhr
- German Society of General and Visceral Surgery (DGAV), Berlin, Germany
| | - Stefan Post
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
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Klinger C, Stuckmann G, Dietrich CF, Berzigotti A, Horger MS, Debove I, Gilot BJ, Pauluschke-Fröhlich J, Hoffmann T, Sipos B, Fröhlich E. Contrast-enhanced imaging in hepatic epithelioid hemangioendothelioma: retrospective study of 10 patients. Z Gastroenterol 2019; 57:753-766. [PMID: 30986884 DOI: 10.1055/a-0886-0081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Abstract
Purpose The purpose of this study was to analyze imaging findings in hepatic epithelioid hemangioendothelioma (HEHE) with a particular focus on contrast-enhanced ultrasound (CEUS).
Materials and Methods This retrospective multicenter study included 10 patients with histologically proven HEHE from 5 European centers. All existing ultrasound images/videos were independently analyzed by 2 experienced examiners (DEGUM level III, internal medicine) using a standardized evaluation form. Patterns of contrast enhancement were correlated with computed tomography (CT), magnetic resonance imaging (MRI), and pathological findings.
Results B-mode ultrasound, CEUS, CT, and MRI were performed in 90 %, 70 %, 100 %, and 90 % of patients, respectively. Multifocal HEHE could be observed in 80 % with affection of both liver lobes in 70 %. Analysis of CEUS revealed 3 characteristic patterns that correlated well with contrast patterns on CT and MRI: (a) peripheral nodular enhancement with centripetal fill-in and wash-out in the portal venous and late venous phase (PVLP), (b) rim-like arterial enhancement with wash-out in the PVLP, and (c) inversed target sign with/without wash-out in the PVLP. Wash-out in the PVLP as a sign suspicious of malignancy was observed in 6/7 patients (85.7 %).
Conclusions Knowledge of the different characteristic CEUS patterns is of importance to avoid misdiagnosis due to resemblance of patterns A and B to the much more common focal liver lesions hemangioma and intrahepatic cholangiocarcinoma. Of importance, sonographers should be aware that wash-out in the PVLP might be absent in some patients.
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Affiliation(s)
- Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Christoph F. Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Marius S. Horger
- Department of Radiology, University of Tuebingen, Tuebingen, Germany
| | - Ines Debove
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Bryant J. Gilot
- Department of Internal Medicine 1 – Center for Personalized Medicine, University of Tuebingen, Tuebingen, Germany
| | | | - Tatjana Hoffmann
- Department of Internal Medicine 1, University of Tuebingen, Tuebingen, Germany
| | - Bence Sipos
- Department of Pathology, University of Tuebingen, Tuebingen, Germany
| | - Eckhart Fröhlich
- Department of Internal Medicine 1, University of Tuebingen, Tuebingen, Germany
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Mackay TM, Wellner UF, van Rijssen LB, Stoop TF, Busch OR, Groot Koerkamp B, Bausch D, Petrova E, Besselink MG, Keck T, van Santvoort HC, Molenaar IQ, Kok N, Festen S, van Eijck CHJ, Bonsing BA, Erdmann J, de Hingh I, Buhr HJ, Klinger C. Variation in pancreatoduodenectomy as delivered in two national audits. Br J Surg 2019; 106:747-755. [DOI: 10.1002/bjs.11085] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
AbstractBackgroundNationwide audits facilitate quality and outcome assessment of pancreatoduodenectomy. Differences may exist between countries but studies comparing nationwide outcomes of pancreatoduodenectomy based on audits are lacking. This study aimed to compare the German and Dutch audits for external data validation.MethodsAnonymized data from patients undergoing pancreatoduodenectomy between 2014 and 2016 were extracted from the German Society for General and Visceral Surgery StuDoQ|Pancreas and Dutch Pancreatic Cancer Audit, and compared using descriptive statistics. Univariable and multivariable risk analyses were undertaken.ResultsOverall, 4495 patients were included, 2489 in Germany and 2006 in the Netherlands. Adenocarcinoma was a more frequent indication for pancreatoduodenectomy in the Netherlands. German patients had worse ASA fitness grades, but Dutch patients had more pulmonary co-morbidity. Dutch patients underwent more minimally invasive surgery and venous resections, but fewer multivisceral resections. No difference was found in rates of grade B/C postoperative pancreatic fistula, grade C postpancreatectomy haemorrhage and in-hospital mortality. There was more centralization in the Netherlands (1·3 versus 13·3 per cent of pancreatoduodenectomies in very low-volume centres; P < 0·001). In multivariable analysis, both hospital stay (difference 2·49 (95 per cent c.i. 1·18 to 3·80) days) and risk of reoperation (odds ratio (OR) 1·55, 95 per cent c.i. 1·22 to 1·97) were higher in the German audit, whereas risk of postoperative pneumonia (OR 0·57, 0·37 to 0·88) and readmission (OR 0·38, 0·30 to 0·49) were lower. Several baseline and surgical characteristics, including hospital volume, but not country, predicted mortality.ConclusionThis comparison of the German and Dutch audits showed variation in case mix, surgical technique and centralization for pancreatoduodenectomy, but no difference in mortality and pancreas-specific complications.
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Affiliation(s)
- T M Mackay
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - U F Wellner
- German Society for General and Visceral Surgery StuDoQ|Pancreas and Clinic of Surgery, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - L B van Rijssen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - T F Stoop
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - O R Busch
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - B Groot Koerkamp
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - D Bausch
- German Society for General and Visceral Surgery StuDoQ|Pancreas and Clinic of Surgery, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - E Petrova
- German Society for General and Visceral Surgery StuDoQ|Pancreas and Clinic of Surgery, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - T Keck
- German Society for General and Visceral Surgery StuDoQ|Pancreas and Clinic of Surgery, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - H C van Santvoort
- Sint Antonius Hospital, Nieuwegein
- University Medical Centre Utrecht, Utrecht
| | - I Q Molenaar
- Sint Antonius Hospital, Nieuwegein
- University Medical Centre Utrecht, Utrecht
| | - N Kok
- Antoni van Leeuwenhoek Hospital, Amsterdam
| | | | | | | | - J Erdmann
- Leiden University Medical Centre, Leiden
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Rodrigues SG, Sixt S, Abraldes JG, De Gottardi A, Klinger C, Bosch J, Baumgartner I, Berzigotti A. Systematic review with meta-analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis. Aliment Pharmacol Ther 2019; 49:20-30. [PMID: 30450634 DOI: 10.1111/apt.15044] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/23/2018] [Accepted: 10/10/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt has been increasingly used in patients with portal vein thrombosis to obtain patency, but evidenced-based decisions are challenging. AIM To evaluate published data on efficacy and safety of endovascular therapy in portal vein thrombosis. METHODS Systematic search of PubMed, ISI, Scopus, and Embase for studies (in English, until October 2017) reporting feasibility, safety, 12-month portal vein recanalisation, transjugular intrahepatic portosystemic shunt patency, and survival in patients with benign portal vein thrombosis undergoing endovascular treatment. An independent extraction of articles using predefined data fields and quality indicators was used; pooled analyses based on random-effects models; heterogeneity assessment by Cochran's Q, I2 statistic, subgroup analyses, and meta-regression. RESULTS Thirteen studies including 399 patients (92% cirrhosis; portal vein thrombosis: complete 46%, chronic 87%, cavernous transformation 17%, superior mesenteric vein involvement 55%) were included. Transjugular intrahepatic portosystemic shunt was technically feasible in 95% (95% CI: 89%-98%) with heterogeneity (I2 = 57%, P < 0.001) explained by cavernous transformation. Major complications occurred in 10% (95% CI: 6.0%-18.0%; I2 = 52%, P = 0.55). Additional catheter-directed thrombolysis was associated with more complications compared to transjugular intrahepatic portosystemic shunt alone or plus thrombectomy (17.6% vs 3.3%). Twelve-month portal vein recanalisation was 79% (95% CI: 67%-88%; I2 = 78%, P < 0.01). Shunt patency at 12 months was 84% (95% CI: 76%-90%; I2 = 62%, P < 0.01). Overall 12-month survival rate was 89%, with no heterogeneity. CONCLUSIONS Transjugular intrahepatic portosystemic shunt for portal vein thrombosis recanalisation was highly feasible, effective, and safe. Cavernous transformation was the main determinant of technical failure. Additional catheter-directed thrombolysis was associated with higher risk of severe complications.
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Affiliation(s)
- Susana G Rodrigues
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland
| | - Sebastian Sixt
- Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Berne, Switzerland
| | - Juan G Abraldes
- Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), CEGIIR, University of Alberta, Edmonton, Canada
| | - Andrea De Gottardi
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland
| | - Christoph Klinger
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Ludwigsburg, Germany
| | - Jaime Bosch
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland.,Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, Ciberehd, University of Barcelona, Barcelona, Spain
| | - Iris Baumgartner
- Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Berne, Switzerland
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland
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Affiliation(s)
- Christoph Klinger
- DVM, Residency ACVD / ECVD completed, Tierklinik Stuttgart Plieningen, Hermann-Fein-Strasse 15, 70599 Stuttgart, Germany
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Mirza R, Liu A, Klinger C. AGE-FRIENDLY INITIATIVES AND IMMIGRANT SENIORS: ADDRESSING SOCIAL ISOLATION USING TECHNOLOGY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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27
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Klinger C, Riecken B, Müller J, Westphal A, Löffler J, Froehlich E, Caca K. Doppler ultrasound surveillance of TIPS-patency in the era of covered stents – retrospective analysis of a large single-center cohort. Z Gastroenterol 2018; 56:1053-1062. [DOI: 10.1055/s-0044-102107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Abstract
Purpose The purpose of this study was to determine accuracy and necessity of long-term Doppler ultrasound (DU) surveillance of transjugular intrahepatic portosystemic shunt (TIPS) patency after implantation of an ePTFE-covered stent-graft (Viatorr).
Methods This single-center retrospective study includes 228 consecutive cirrhotic patients with TIPS implantation due to portal hypertensive complications. Standardized DU surveillance was scheduled 3 – 5 days, 3 months, and 6 months after TIPS implantation and every 6 months thereafter. Portal venography was performed in case of DU findings suspicious of TIPS dysfunction, clinical signs of recurrent portal hypertension, or refractory hepatic encephalopathy.
Results During a mean follow-up of 16.6 ± 23.4 months, 866 DU examinations were performed. Twenty-two cases of TIPS dysfunction were observed in 16 patients with no first dysfunction more than 4 years after implantation. Routine DU in asymptomatic patients had little therapeutic impact (0.75 %). DU and venography were concordant in 39/46 (84.8 %) paired examinations, and 1-, 2-, and 5-year primary TIPS patency was 87.4 %, 83.7 %, and 79.97 %, respectively. Patients with TIPS dysfunction and subsequent successful revision during the first 2 years of follow-up had a significantly higher risk (p = 0.001) of new dysfunction compared to those without TIPS dysfunction. Cumulative 1-, 2-, and 5-year survival was 68.7 %, 61.3 %, and 42.7 %, respectively.
Conclusions Despite acceptable accuracy, scheduled DU surveillance proved to have minor therapeutic impact. Thus, detailed DU surveillance is not useful in asymptomatic patients after 2 years of unremarkable follow-up. In contrast, long-term DU surveilleance should be performed in patients after successful revision of TIPS dysfunction and patients with prothrombotic states (e. g., portal vein thrombosis, Budd-Chiari syndrome).
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Affiliation(s)
| | | | | | - Anja Westphal
- Medizinische Klinik I, Klinikum Ludwigsburg, Germany
| | | | | | - Karel Caca
- Medizinische Klinik I, Klinikum Ludwigsburg, Germany
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28
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Abstract
We present a report on ultrasound findings in extragenital endometriosis and a literature review accompanied by illustrations. Intestinal endometriosis should be considered in female patients of reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhoea and pelvic pain. Although definitive preoperative diagnosis of endometriosis is difficult, clinical suspicion and appropriate imaging might prevent extensive surgical procedures with higher morbidity. Contrast-enhanced ultrasound is an efficient non-invasive imaging method without any radiation exposure that supports the early diagnosis of intestinal endometriosis and may help assess the vascularization of endometriotic lesions within the distinct layers of the intestinal wall.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | | | - Tomás Ripolles
- Department of Radiology, Dr Peset Universitary Hospital, Valencia, Spain
| | - Christoph F Dietrich
- Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
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Dong Y, Potthoff A, Klinger C, Barreiros AP, Pietrawski D, Dietrich CF. Ultrasound findings in autoimmune hepatitis. World J Gastroenterol 2018; 24:1583-1590. [PMID: 29686465 PMCID: PMC5910541 DOI: 10.3748/wjg.v24.i15.1583] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 02/06/2023] Open
Abstract
Ultrasound findings in autoimmune hepatitis (AIH) have not been reported systematically so far. The use of reliable and accurate noninvasive methods for determining fibrosis stage is important in evaluation of treatment efficacy and fibrosis regression in AIH. Imaging plays an important role in detection of complications and ruling out other possible causes of chronic liver diseases. Ultrasound elastography cut-off values in AIH patients are not the same as those in patients with chronic viral hepatitis or non-alcoholic fatty liver disease. AIH is characterized by wide fluctuations in inflammatory activity. Here we report on current knowledge of ultrasound findings in AIH.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover D-30625, Germany
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg D-71634, Germany
| | - Ana Paula Barreiros
- German Organ Transplantation Foundation, Region Mitte, Mainz D-55131, Germany
| | - Dariusz Pietrawski
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim D-97980, Germany
| | - Christoph F Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim D-97980, Germany
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Klinger C, Dengler B, Bauer T, Mueller RS. [Successful treatment of a necrotizing, multi-resistant bacterial pyoderma in a python with cold plasma therapy]. Tierarztl Prax Ausg K Kleintiere Heimtiere 2018. [PMID: 29536463 DOI: 10.15654/tpk-170190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 4-year-old ball python was presented 3 weeks after multiple bite wounds from a prey rat with large skin lesions, a concurrent deep bacterial pyoderma and clinical signs for septicemia, including neurolo -gical symptoms. Affected tissue separated from the underlying muscular layer revealing parts of the muscles. Clinical examination and cyto -logy was consistent with bacterial pyoderma; septicemia was an additional tentative clinical diagnosis. Empirical lincomycin and marbo -floxacin (bacterial culture revealed a multi-resistant Stenotrophomonas maltophilia susceptible to fluoroquinolones) treatment improved the patient's general condition but skin wounds deteriorated to multifocal eschars with intracellular rods. Further diagnostics were limited for financial reasons, euthanasia was considered. Cold atmospheric pressure plasma (CAPP) therapy was performed six times in 4 weeks. Within 1 week, inflammatory symptoms resolved. Re-epithelialization was completed few weeks later. In the following year, the snake sloughed three times without any signs of dysecdysis. CAPP therapy may offer a viable treatment option for bacterial (especially multiresistant) pyoderma and necrotizing dermatitis in snakes.
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Abstract
A 46-year-old woman presented with acute abdominal pain in the right upper quadrant. Esophagogastroduodenoscopy revealed a duodenal stenosis within the horizontal part of the duodenum. Based on the findings of abdominal computed tomography (CT), endosonography, Doppler duplex sonography and angiography, the diagnosis of an aneurysm of a branch of the inferior pancreaticoduodenal artery was established. This arterial branch was part of a collateral circulation between the superior mesenteric artery and the proper hepatic artery caused by obturation of the celiac artery. The symptomatic duodenal stenosis was the result of a local hematoma due to prior rupture of an aneurysm. After successful coiling of the afferent vessels to the aneurysm follow-up examinations showed progredient resorption of the hematoma and the patient was free of complaints.
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Affiliation(s)
- M Bauder
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland.
| | - A Fiala
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Ludwigsburg, Ludwigsburg, Deutschland
| | - C Klinger
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
| | - W Kersjes
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Ludwigsburg, Ludwigsburg, Deutschland
| | - K Caca
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
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Klinger C, Riecken B, Schmidt A, De Gottardi A, Meier B, Bosch J, Caca K. Transjugular local thrombolysis with/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis. Dig Liver Dis 2017; 49:1345-1352. [PMID: 28733177 DOI: 10.1016/j.dld.2017.05.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/05/2017] [Accepted: 05/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Therapeutic anticoagulation is the standard treatment in patients with acute non-cirrhotic portal vein thrombosis (PVT). In critically ill patients, anticoagulation only may not suffice to achive rapid and stable recanalization. This study evaluates efficacy and safety of transjugular interventional therapy in acute non-cirrhotic PVT. METHODS This retrospective study includes 17 consecutive patients with acute noncirrhotic, non-malignant PVT. Main indication for interventional therapy was imminent intestinal infarction (n=10). Treatment consisted of a combination of transjugular thrombectomy, local fibrinolysis and - depending on thrombus resolution - transjugular intrahepatic portosystemic shunt. RESULTS Recanalization was successful in 94.1%. One- and two-year secondary PV patency rates were 88.2%. Major complications (n=3) resolved spontaneously in all but one patient (heparin induced thrombocytopenia type 2 with intestinal infarction). Symptoms improved in all patients. However, segmental bowel resection had to be performed in two (11.8%). During a median follow-up of 28.6 months, no patient experienced portal hypertensive complications. Presence of JAK2 V617F mutation predicted both short-term and long-term technical success. CONCLUSIONS Transjugular recanalization is safe and effective in patients with acute non-cirrhotic, non-malignant PVT. It should be considered especially in patients with imminent bowel infarction and low likelihood of recanalization following therapeutic anticoagulation. Patients with JAK2 mutation ought to be followed meticulously.
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Affiliation(s)
- Christoph Klinger
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany
| | - Bettina Riecken
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany
| | - Arthur Schmidt
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany
| | | | - Benjamin Meier
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany
| | - Jaime Bosch
- Hepatology, Inselspital, University of Berne, Switzerland; Hepatic Hemodynamic Laboratory, Liver Unit Hospital Cliníc, IDIBAPS and Ciberehd, Barcelona, Spain
| | - Karel Caca
- Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany; Hepatology, Inselspital, University of Berne, Switzerland.
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Klinger C, Riecken B, Schmidt A, De Gottardi A, Meier B, Bosch J, Caca K. Transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis. Z Gastroenterol 2017; 56:221-237. [DOI: 10.1055/s-0043-121348] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Purpose To determine safety and efficacy of transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis (PVT).
Methods This retrospective study includes 17 consecutive patients with chronic non-cirrhotic PVT (cavernous transformation n = 15). PVR-TIPS was indicated because of variceal bleeding (n = 13), refractory ascites (n = 2), portal biliopathy with recurrent cholangitis (n = 1), or abdominal pain (n = 1). Treatment consisted of a combination of transjugular balloon angioplasty, mechanical thrombectomy, and—depending on extent of residual thrombosis—transjugular intrahepatic portosystemic shunt and additional stenting of the portal venous system.
Results Recanalization was successful in 76.5 % of patients despite cavernous transformation in 88.2 %. Both 1- and 2-year secondary PV and TIPS patency rates were 69.5 %. Procedure-related bleeding complications occurred in 2 patients (intraperitoneal bleeding due to capsule perforation, n = 1; liver hematoma, n = 1) and resolved spontaneously. However, 1 patient died due to subsequent nosocomial pneumonia. During follow-up, 3 patients with TIPS occlusion and PVT recurrence experienced portal hypertensive complications.
Conclusions PVR-TIPS is safe and effective in selected patients with chronic non-cirrhotic PVT. Due to technical complexity and possible complications, it should be performed only in specialized centers with high experience in TIPS procedures.
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Affiliation(s)
| | | | - Arthur Schmidt
- Medizinische Klinik I, Klinikum Ludwigsburg, Germany
- Gastroenterologie, Universität Freiburg, Germany
| | | | | | - Jaime Bosch
- Hepatology, Inselspital Universitatsspital Bern, Switzerland
- Hepatic Hemodynamic Laboratory, Liver Unit Hospital Cliníc, IDIBAPS and Ciberehd, Barcelona, Spain
| | - Karel Caca
- Medizinische Klinik I, Klinikum Ludwigsburg, Germany
- Hepatology, Inselspital Universitatsspital Bern, Switzerland
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Böhm T, Klinger C, Classen J, Udraite L, Linek M, Mueller RS. [Repeatability and variability of total T4 measurements at three German veterinary laboratories]. Tierarztl Prax Ausg K Kleintiere Heimtiere 2017; 45:161137. [PMID: 29099903 DOI: 10.15654/tpk-161137] [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] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/02/2017] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the reproducibility of serum testing for total thyroxine (T4) in three German laboratories. MATERIALS AND METHODS Serum was taken from 53 dogs with suspected hypothyroidism and divided into five aliquots. Three aliquots of each sample were marked with different names and sent to one laboratory (two aliquots simultaneously and one aliquot 1-3 days later). The remaining aliquots were sent to two other laboratories. Laboratory 1 used an enzyme immunoassay for T4 measurements, whereas laboratories 2 and 3 used a chemiluminescence immunoassay. The agreement between the three laboratories (values within or below the reference interval) was determined using the Cohen's Kappa test. The intra- and interassay variability was calculated for each laboratory and the agreement between samples submitted to the same laboratory was also determined using the Cohen's Kappa test. RESULTS For n = 23/41 patients tested simultaneously in the three laboratories, all three values were either uniformly below, within or above the respective reference interval. The Cohen's Kappa value for intra- and interassay agreement was 1.0 in laboratory 2 (n = 15, complete agreement), 0.33 in laboratory 1 (n = 16) and 0.37 (intra-) and 0.19 (interassay agreement) in laboratory 3 (n = 16, low agreement). There was a low agreement between laboratories 1 and 2 and between laboratories 1 and 3 (κ = 0.30 and 0.25, respectively), while a high agreement was determined between laboratories 2 and 3 (κ = 0.68). The intrassay variability of laboratories 1, 2 and 3 was 13.6%, 5.0% and 10.4%, the interassay variability 17.2%, 5.1% and 17.4%, respectively. CONCLUSION AND CLINICAL RELEVANCE The differences in the measurement of thyroxine concentrations of the same serum sample in different laboratories and at different time points in the same laboratory underline the high relevance of interpreting laboratory results in context with the clinical signs of hypothyroidism as well as other laboratory values such as TSH concentration.
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Affiliation(s)
- Teresa Böhm
- Teresa Böhm, Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München, Veterinärstraße 13, 80539 München, E-Mail:
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McDonald L, Burton R, Lombardo A, Mirza R, Iafolla V, Klinger C, Hollister B. NEW COMMUNICATION TECHNOLOGIES FOR ENGAGING OLDER PATIENTS, FAMILIES, AND CAREGIVERS IN HEALTHCARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L. McDonald
- University of Toronto, Toronto, Ontario, Canada,
| | - R. Burton
- University of Toronto, Toronto, Ontario, Canada,
| | - A. Lombardo
- University of Toronto, Toronto, Ontario, Canada,
| | - R.M. Mirza
- University of Toronto, Toronto, Ontario, Canada,
| | - V. Iafolla
- University of Alberta, Edmonton, Alberta, Canada
| | - C. Klinger
- University of Toronto, Toronto, Ontario, Canada,
| | - B. Hollister
- University of Toronto, Toronto, Ontario, Canada,
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McDonald L, Hussain A, Mirza R, Relyea E, Beaulieu M, Gutman G, Klinger C, MacDonald B. SCREENING AND ASSESSMENT OF ELDER ABUSE: AN EVALUATION OF NICE TOOLS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L. McDonald
- Social Work, University of Toronto, Toronto, Ontario, Canada,
| | - A. Hussain
- Social Work, University of Toronto, Toronto, Ontario, Canada,
| | - R.M. Mirza
- Social Work, University of Toronto, Toronto, Ontario, Canada,
| | - E. Relyea
- Social Work, University of Toronto, Toronto, Ontario, Canada,
| | - M. Beaulieu
- Universite de Sherbrooke, Montreal, Quebec, Canada,
| | - G.M. Gutman
- Simon Fraser University, Vancouver, British Columbia, Canada,
| | - C. Klinger
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - B. MacDonald
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
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Fujioka J, Klinger C, Mirza R, Sahar M, Dillman A, Akhtar D, Tamblyn-Watts L, McDonald L. IMPLEMENTATION OF MEDICAL ASSISTANCE IN DYING (MAID): SCOPING HEALTH CARE PROVIDERS’ PERSPECTIVES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Fujioka
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada,
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,
| | - C. Klinger
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada,
- National Institute for the Care of the Elderly, Toronto, Ontario, Canada,
| | - R.M. Mirza
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada,
- National Institute for the Care of the Elderly, Toronto, Ontario, Canada,
| | - M. Sahar
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada,
- National Institute for the Care of the Elderly, Toronto, Ontario, Canada,
| | - A. Dillman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada,
- National Institute for the Care of the Elderly, Toronto, Ontario, Canada,
| | - D. Akhtar
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - L. McDonald
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada,
- National Institute for the Care of the Elderly, Toronto, Ontario, Canada,
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Wagner I, Geh KJ, Hubert M, Winter G, Weber K, Classen J, Klinger C, Mueller RS. Preliminary evaluation of cytosine-phosphate-guanine oligodeoxynucleotides bound to gelatine nanoparticles as immunotherapy for canine atopic dermatitis. Vet Rec 2017; 181:118. [PMID: 28526774 DOI: 10.1136/vr.104230] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/04/2022]
Abstract
Cytosine-phosphate-guanine oligodeoxynucleotides (CpG ODN) are a promising new immunotherapeutic treatment option for canine atopic dermatitis (AD). The aim of this uncontrolled pilot study was to evaluate clinical and immunological effects of gelatine nanoparticle (GNP)-bound CpG ODN (CpG GNP) on atopic dogs. Eighteen dogs with AD were treated for 8 weeks (group 1, n=8) or 18 weeks (group 2, n=10). Before inclusion and after 2 weeks, 4 weeks, 6 weeks (group 1+2), 8 weeks, 12 weeks and 16 weeks (group 2) 75 µg CpG ODN/dog (bound to 1.5 mg GNP) were injected subcutaneously. Pruritus was evaluated daily by the owner. Lesions were evaluated and serum concentrations and mRNA expressions of interferon-γ, tumour necrosis factor-α, transforming growth factor-β, interleukin (IL) 10 and IL-4 (only mRNA expression) were determined at inclusion and after 8 weeks (group 1+2) and 18 weeks (group 2). Lesions and pruritus improved significantly from baseline to week 8. Mean improvements from baseline to week 18 were 23 per cent and 44 per cent for lesions and pruritus, respectively, an improvement of ≥50 per cent was seen in six out of nine and three out of six dogs, respectively. IL-4 mRNA expression decreased significantly. The results of this study show a clinical improvement of canine AD with CpG GNP comparable to allergen immunotherapy. Controlled studies are needed to confirm these findings.
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Affiliation(s)
- I Wagner
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - K J Geh
- Department of Pharmacy, Pharmaceutical Technology & Biopharmaceutics, LMU Munich, Butenandtstrasse 5, 81377 Munich, Germany
| | - M Hubert
- Department of Pharmacy, Pharmaceutical Technology & Biopharmaceutics, LMU Munich, Butenandtstrasse 5, 81377 Munich, Germany
| | - G Winter
- Department of Pharmacy, Pharmaceutical Technology & Biopharmaceutics, LMU Munich, Butenandtstrasse 5, 81377 Munich, Germany
| | - K Weber
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - J Classen
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - C Klinger
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - R S Mueller
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
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De Gottardi A, Trebicka J, Klinger C, Plessier A, Seijo S, Terziroli B, Magenta L, Semela D, Buscarini E, Langlet P, Görtzen J, Puente A, Müllhaupt B, Navascuès C, Nery F, Deltenre P, Turon F, Engelmann C, Arya R, Caca K, Peck-Radosavljevic M, Leebeek FWG, Valla D, Garcia-Pagan JC. Antithrombotic treatment with direct-acting oral anticoagulants in patients with splanchnic vein thrombosis and cirrhosis. Liver Int 2017; 37:694-699. [PMID: 27778440 DOI: 10.1111/liv.13285] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 10/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Direct-acting oral anticoagulants (DOACs) are used in patients with splanchnic vein thrombosis (SVT) and cirrhosis, but evidence for safety and efficacy in this setting is limited. Our aim was to identify indications and reasons for starting or switching to DOACs and to report adverse effects, complications and short-term outcome. METHODS Data collection including demographic information, laboratory values, treatment and complications through the Vascular Liver Disease Interest Group Consortium. RESULTS Forty-five centres (90%) of the consortium completed the initial eCRF. We report here a series of 94 patients from 17 centres. Thirty-six patients (38%) had cirrhosis. Child-Pugh score was 6 (range 5-8), and MELD score 10.2 (range 6-19). Indications for anticoagulation were splanchnic vein thrombosis (75%), deep vein thrombosis (5%), atrial fibrillation (14%) and others (6%). DOACs used were rivaroxaban (83%), dabigatran (11%) and apixaban (6%). Patients were followed up for a median duration of 15 months (cirrhotic) and 26.5 months (non-cirrhotic). Adverse events occurred in 17% of patients and included one case of recurrent portal vein thrombosis and five cases of bleeding. Treatment with DOACs was stopped in three cases. The major reasons for choosing DOACs were no need for monitoring or inadequacy of INR to guide anticoagulation in cirrhotic patients. Renal and liver function did not change during treatment. CONCLUSIONS A consistent number of patients with SVT and/or cirrhosis are currently treated with DOACs, which seem to be effective and safe. These data provide a basis for performing randomized clinical trials of DOACs vs. low molecular weight heparin or vitamin K antagonists.
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Affiliation(s)
- Andrea De Gottardi
- Hepatology, Department of Clinical Research and Clinic of Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland
| | | | | | | | | | | | | | - David Semela
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | | | | | - Angela Puente
- HUMV and Investigation Institute Marques de Valdecilla, Santander, Spain
| | | | | | | | | | - Fanny Turon
- Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain
| | | | | | - Karel Caca
- Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hobi S, Klinger C, Classen J, Mueller RS. The effects of a topical lipid complex therapy on dogs with atopic dermatitis: a double blind, randomized, placebo-controlled study. Vet Dermatol 2017; 28:369-e84. [DOI: 10.1111/vde.12430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Stefan Hobi
- Small Animal Medicine Clinic; Centre for Clinical Veterinary Medicine; Ludwig Maximilian University; Veterinaerstraße 13 80539 Munich Germany
| | - Christoph Klinger
- Small Animal Medicine Clinic; Centre for Clinical Veterinary Medicine; Ludwig Maximilian University; Veterinaerstraße 13 80539 Munich Germany
| | - Janine Classen
- Small Animal Medicine Clinic; Centre for Clinical Veterinary Medicine; Ludwig Maximilian University; Veterinaerstraße 13 80539 Munich Germany
| | - Ralf S. Mueller
- Small Animal Medicine Clinic; Centre for Clinical Veterinary Medicine; Ludwig Maximilian University; Veterinaerstraße 13 80539 Munich Germany
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Affiliation(s)
| | | | - Ines Debove
- Inselspital, Universitätsklinik für Neurologie, Bern, Switzerland
| | - Werner Vey
- Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany
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Holmer C, Klinger C, Buhr HJ. [Are there too many conferences for general and visceral surgery in Germany? : A survey of DGAV members]. Chirurg 2015; 86:1059-63. [PMID: 26374650 DOI: 10.1007/s00104-015-0089-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Human and financial resources are increasingly bound due to economic pressure and the working hours Act whereby the already restricted further training times are further limited. The industry also has less funding available for sponsorship of conferences and workshops. Against this background the question arises whether a reduction or focusing of the conferences is necessary; therefore, the aim of this survey was to obtain an opinion from members of the German Society of General and Visceral Surgery (DGAV) and possibly to derive a need for action to submit to the board members. METHODS From 7 February to 18 March 2015 an online survey was conducted by the DGAV with their members regarding the number of necessary congress events in Germany. RESULTS A total of 670 responses were received (return rate 16 %). In total, 56 % of participants felt that there are too many conferences. A differentiation according to the position of the respondent and the level of the associated hospital resulted in the following: 69.3 % of the participating head physicians (HP) shared this opinion, compared to 48.6 % of senior physicians (SP) and 34.4 % of residents (RP). Of the participants from basic and standard care hospitals (B/SC) 50 % shared this opinion, compared to 59.2 % from maximum care hospitals (MC) and 63.6 % from university hospitals (UH). In addition, a total of 75 % of the participants (HP 82.9 %, SP 78.4 %, RP 70.5 %) were in favor of keeping the congress of the DGAV (annual meeting of the German Society for Digestive and Metabolic Diseases in conjunction with the Autumn meeting of the DGAV) in its previous form, regardless of the underlying level of care of the associated hospital (B/SC 77 %, MC 79 %, UC 68 %). CONCLUSION More experienced surgeons in particular tended to favor a reduction of events with a focus on the major conferences; however, younger colleagues preferred a wider spectrum of meetings. In order to comply with both positions a wide range of events should be continued to be provided in the future so that surgeons can choose which to attend according to the individual preferences.
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Affiliation(s)
- C Holmer
- DGAV - Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Haus der Bundespressekonferenz, Schiffbauerdamm 40, 10117, Berlin, Deutschland
| | - C Klinger
- DGAV - Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Haus der Bundespressekonferenz, Schiffbauerdamm 40, 10117, Berlin, Deutschland
| | - H J Buhr
- DGAV - Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Haus der Bundespressekonferenz, Schiffbauerdamm 40, 10117, Berlin, Deutschland.
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Kachuik L, Welsh C, Klinger C, Foreman T, Scott J, Wheatley-Price P, Wooller K, Pereira J. P-23 Enhanced end-of-life care decision making (EELCD): An interventional study toward advance care planning and difficult discussions at two ontario hospital sites. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Treatment of non-malignant portal vein thrombosis (PVT) in patients with cirrhosis has been neglected in the past because of the fear of bleeding complications when using anticoagulation and due to the technical difficulties associated with the implantation of the transjugular intrahepatic portosystemic shunt (TIPS). However, PVT has a negative impact on outcome and compromises liver transplantation, warranting treatment by using anticoagulation and TIPS. METHODS This review considers studies on the treatment of PVT in cirrhosis published in the last 10 years. Unfortunately, many of these studies are limited by their retrospective design and a small sample size. RESULTS Anticoagulation using low-molecular-weight heparin (LMWH) or vitamin K antagonists is effective in the treatment of patients with limited and recent PVT, resulting in a recanalization in up to 50% of the patients. TIPS (plus local measures) results in a recanalization of up to 100% and reduces the rebleeding rate considerably in patients with recent or chronic PVT. CONCLUSION Based on the presently limited knowledge, a therapy algorithm is suggested favouring the TIPS as a first-line treatment for PVT in patients with symptomatic portal hypertension. Patients with thus far asymptomatic portal hypertension may first receive anticoagulation, preferably using LMWH. If these patients have a condition where anticoagulation is not promising (complete, extended, chronic PVT) or ineffective, or if they are candidates for liver transplantation, the TIPS may be implanted without delay.
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Affiliation(s)
- Martin Rössle
- 'PraxisZentrum für Gastroenterologie und Endokrinologie' and University Hospital Freiburg, Freiburg i.Br., Germany
| | - Birke Bausch
- Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Hospital Freiburg, Freiburg i.Br., Germany
| | - Christoph Klinger
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Abstract
The ultrasound-guided liver biopsy is an important tool to obtain histological samples of suspicious lesions. The technique is effective and complications are rare. After the procedure a standardized monitoring of the patient is necessary. We describe the procedure and the post-interventional monitoring of a liver biopsy step by step.
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Affiliation(s)
- Benjamin Meier
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie, Ludwigsburg
| | - Karel Caca
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie, Ludwigsburg
| | - Christoph Klinger
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie, Ludwigsburg
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Schmidt A, Riecken B, Rische S, Klinger C, Jakobs R, Bechtler M, Kähler G, Dormann A, Caca K. Wing-shaped plastic stents vs. self-expandable metal stents for palliative drainage of malignant distal biliary obstruction: a randomized multicenter study. Endoscopy 2015; 47:430-6. [PMID: 25590188 DOI: 10.1055/s-0034-1391232] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND STUDY AIMS Previous studies have shown superior patency rates for self-expandable metal stents (SEMS) compared with plastic stents in patients with malignant biliary obstruction. The aim of this study was to compare stent patency, patient survival, and complication rates between a newly designed, wing-shaped, plastic stent and SEMSs in patients with unresectable, malignant, distal, biliary obstruction. PATIENTS AND METHODS A randomized, multicenter trial was conducted at four tertiary care centers in Germany. A total of 37 patients underwent randomization between March 2010 and January 2013. Patients underwent endoscopic retrograde cholangiography with insertion of either a wing-shaped, plastic stent without lumen or an SEMS. RESULTS Stent failure occurred in 10/16 patients (62.5 %) in the winged-stent group vs. 4/18 patients (22.2 %) in the SEMS group (P = 0.034). The median time to stent failure was 51 days (range 2 - 92 days) for the winged stent and 80 days (range 28 - 266 days) for the SEMS (P = 0.002). Early stent failure (< 8 weeks after placement) occurred in 8 patients (50 %) vs. 2 patients (11.1 %), respectively (P = 0.022). After obtaining the results from this interim analysis, the study was discontinued because of safety concerns. CONCLUSIONS The frequency of stent failure was significantly higher in the winged-stent group compared with the SEMS group. A high incidence of early stent failure within 8 weeks was observed in the winged-stent group. Thus, the winged, plastic stent without central lumen may not be appropriate for mid or long term drainage of malignant biliary obstruction. Study registration ClinicalTrials.gov (NCT01063634).
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Affiliation(s)
- Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Bettina Riecken
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Susanne Rische
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Christoph Klinger
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Ralf Jakobs
- Department of Gastroenterology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Bechtler
- Department of Gastroenterology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Georg Kähler
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Arno Dormann
- Department of Medicine, Cologne City Hospital, Holweide, Cologne, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Schmidt A, Klinger C, Caca K. [Stents in visceral medicine]. Zentralbl Chir 2013; 138:381-4. [PMID: 24137637 DOI: 10.1055/s-0033-1354302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Arthur Schmidt
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie, Klinikum Ludwigsburg, 71 640 Ludwigsburg.
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Furlan J, Chan K, Sandoval G, Lam K, Klinger C, Patchell R, Laporte A, Fehlings M. Palliative Care of Patients with Metastatic Spinal Cord Cancer: A Cost-Utility Analysis Comparing the Standard of Care with Direct Decompressive Surgical Resection Followed by Radiotherapy (S38.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s38.004] [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: 11/15/2022] Open
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Leins U, Goth G, Hinterberger T, Klinger C, Rumpf N, Strehl U. Neurofeedback for Children with ADHD: A Comparison of SCP and Theta/Beta Protocols. Appl Psychophysiol Biofeedback 2007; 32:73-88. [PMID: 17356905 DOI: 10.1007/s10484-007-9031-0] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 02/07/2007] [Indexed: 10/23/2022]
Abstract
Behavioral and cognitive improvements in children with ADHD have been consistently reported after neurofeedback-treatment. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This study addresses previous methodological shortcomings while comparing a neurofeedback-training of Theta-Beta frequencies and training of slow cortical potentials (SCPs). The study aimed at answering (a) whether patients were able to demonstrate learning of cortical self-regulation, (b) if treatment leads to an improvement in cognition and behavior and (c) if the two experimental groups differ in cognitive and behavioral outcome variables. SCP participants were trained to produce positive and negative SCP-shifts while the Theta/Beta participants were trained to suppress Theta (4-8 Hz) while increasing Beta (12-20 Hz). Participants were blind to group assignment. Assessment included potentially confounding variables. Each group was comprised of 19 children with ADHD (aged 8-13 years). The treatment procedure consisted of three phases of 10 sessions each. Both groups were able to intentionally regulate cortical activity and improved in attention and IQ. Parents and teachers reported significant behavioral and cognitive improvements. Clinical effects for both groups remained stable six months after treatment. Groups did not differ in behavioural or cognitive outcome.
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Affiliation(s)
- Ulrike Leins
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Osianderstrasse 24, 72076, Tübingen, Germany.
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Strehl U, Leins U, Goth G, Klinger C, Hinterberger T, Birbaumer N. Self-regulation of slow cortical potentials: a new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics 2006; 118:e1530-40. [PMID: 17060480 DOI: 10.1542/peds.2005-2478] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.7] [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: 11/24/2022] Open
Abstract
OBJECTIVE We investigated the effects of self-regulation of slow cortical potentials for children with attention-deficit/hyperactivity disorder. Slow cortical potentials are slow event-related direct-current shifts of the electroencephalogram. Slow cortical potential shifts in the electrical negative direction reflect the depolarization of large cortical cell assemblies, reducing their excitation threshold. This training aims at regulation of cortical excitation thresholds considered to be impaired in children with attention-deficit/hyperactivity disorder. Electroencephalographic data from the training and the 6-month follow-up are reported, as are changes in behavior and cognition. METHOD Twenty-three children with attention-deficit/hyperactivity disorder aged between 8 and 13 years received 30 sessions of self-regulation training of slow cortical potentials in 3 phases of 10 sessions each. Increasing and decreasing slow cortical potentials at central brain regions was fed back visually and auditorily. Transfer trials without feedback were intermixed with feedback trials to allow generalization to everyday-life situations. In addition to the neurofeedback sessions, children exercised during the third training phase to apply the self-regulation strategy while doing their homework. RESULTS For the first time, electroencephalographic data during the course of slow cortical potential neurofeedback are reported. Measurement before and after the trials showed that children with attention-deficit/hyperactivity disorder learn to regulate negative slow cortical potentials. After training, significant improvement in behavior, attention, and IQ score was observed. The behavior ratings included Diagnostic and Statistical Manual of Mental Disorders criteria, number of problems, and social behavior at school and were conducted by parents and teachers. The cognitive variables were assessed with the Wechsler Intelligence Scale for Children and with a computerized test battery that measures several components of attention. All changes proved to be stable at 6 months' follow-up after the end of training. Clinical outcome was predicted by the ability to produce negative potential shifts in transfer sessions without feedback. CONCLUSIONS According to the guidelines of the efficacy of treatments, the evidence of the efficacy of slow cortical potential feedback found in this study reaches level 2: "possibly efficacious." In the absence of a control group, no causal relationship between observed improvements and the ability to regulate brain activity can be made. However, it could be shown for the first time that good performance in self-regulation predicts clinical outcome. "Good performance" was defined as the ability to produce negative potential shifts in trials without feedback, because it is known that the ability to self-regulate without feedback is impaired in children and adults with attention problems. Additional research should focus on the control of unspecific effects, medication, and subtypes to confirm the assumption that slow cortical potential feedback is a viable treatment option for attention-deficit/hyperactivity disorder. Regulation of slow cortical potentials may involve similar neurobiological pathways as medical treatment. It is suggested that regulation of frontocentral negative slow cortical potentials affects the cholinergic-dopaminergic balance and allows children to adapt to task requirements more flexibly.
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Affiliation(s)
- Ute Strehl
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Gartenstrasse 29, 72074 Tübingen, Germany.
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