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Hesse U, Hesse A, Hesse L, Schultz E, Kaiser M. Lipödem heute: Zwischen konservativer Therapie, Liposuktion und Adipositaschirurgie. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1525-5956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie zunehmende Prävalenz des Lipödems geht einher mit einer demografischen Zunahme der Adipositas per magna.Konservative und operative Maßnahmen ermöglichen eine ausgeprägte Befund- und Beschwerdebesserung.Die exakte Diagnose und Differenzierung zwischen therapiebedürftiger Adipositas und therapiebedürftigem Lipödem entscheiden über Erfolg und Misserfolg der eingeleiteten Therapie.Nach konservativem Therapieversuch kann die operative Versorgung bei Ausbleiben einer entsprechenden Besserung durch Liposuktion oder adipositaschirurgische Intervention bei einem erheblichen Teil der Betroffenen die konservative Therapie reduzieren bzw. teilweise sogar ganz überflüssig machen.
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Affiliation(s)
- U. Hesse
- Adipositas und Metabolische Chirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
- Praxis für Chirurgie und Venentherapie, Sindelfingen
| | - A. Hesse
- Praxis für Allgemeinmedizin, Stuttgart
| | - L. Hesse
- Cand. Med. Universität Pécs, Ungarn
| | - E. Schultz
- Klinik für Dermatologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - M. Kaiser
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
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Abstract
BACKGROUND The introduction of robot-assisted surgery in the treatment of morbidly obese patients has enlarged the armamentarium for surgeons involved in bariatric surgery. This article describes the experiences with a conversion surgery from a complicated open Mason gastroplasty to a Roux en Y gastric bypass using the da Vinci Xi robotic system. CASE A 29-year-old female patient underwent a Mason reduction gastroplasty by laparotomy in 1995 (body mass index BMI 53.2 kg/m2). The course was complicated with a revision due to abscess formation and subsequent secondary healing. In 1996 an open revision of the gastroplasty due to persisting gastroesophageal reflux disease and outlet stenosis with dilatation of the outlet and an open cholecystectomy for cholecystolithiasis were performed . Abdominoplasty was performed for skin flaps in 2001 after the patient had lost 68 kg in weight. The patient presented at our hospital because of insufficient weight reduction even with weight gain since 2001 and treatment-refractive gastroesophageal reflux with adhesion problems. Clinical examination revealed normal scar tissue formation with no indications for an incisional hernia. The BMI was 48.2 kg/m2 with a body weight of 124 kg. The surgery was performed using a da Vinci Xi robotic system after access via a blunt dissection with the introduction of two trocars and adhesiolysis. The gastric pouch was created using Echelon 60 mm cartridges via an additional trocar. The gastroenterostomy was constructed with a 150 cm alimentary loop and a 60 cm biliodigestive loop resulting in a Roux en Y bypass. The operating time was 224 min. RESULTS The postoperative course was uneventful. Enteral nutrition was resumed on day 2 and the patient was discharged from the hospital 4 days postoperation. CONCLUSION This preliminary experience suggests that robotic revisional surgery can be performed safely even after complicated bariatric operations.
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Affiliation(s)
- U Hesse
- Adipositas- und metabolische Chirurgie Klinik für Allgemein‑, Viszeral und Thoraxchirurgie Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathanstr. 1, 90419, Nürnberg, Deutschland.
| | - J Lenz
- Adipositas- und metabolische Chirurgie Klinik für Allgemein‑, Viszeral und Thoraxchirurgie Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathanstr. 1, 90419, Nürnberg, Deutschland
| | - L Thumfart
- Adipositas- und metabolische Chirurgie Klinik für Allgemein‑, Viszeral und Thoraxchirurgie Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathanstr. 1, 90419, Nürnberg, Deutschland
| | - H Stein
- Adipositas- und metabolische Chirurgie Klinik für Allgemein‑, Viszeral und Thoraxchirurgie Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathanstr. 1, 90419, Nürnberg, Deutschland
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Lissau I, Rasmussen NK, Hesse NM, Hesse U. Social differences in illness and health-related exclusion from the labour market in Denmark from 1987 to 1994. Scand J Public Health 2017. [DOI: 10.1177/14034948010290011401] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The objectives were first to analyse differences in long-standing illness, limiting long-standing illness, and perceived health as below good in relation to different indicators of social class over time; and secondly to analyse the association of long-standing illness, educational level, age, and gender with employment status. Subjects and methods : Self-reported information on illness, educational level, employment status, and occupational class was obtained in two nationally representative Danish health interview surveys in 1987 (n= 4753) and 1994 (n= 4668). Results: There was a marked increase in long-standing illness from 1987 (33%) to 1994 (38%), especially among women with higher education (13% in 1987 to 26% in 1994). The prevalence of perceived health below good was unchanged (c. 20%) during the same period. Among employed men in 1987 the lowest prevalence of long-standing illness was seen in upper salaried employees (21%) and the highest in skilled workers (35%). In 1994, the difference had diminished and the prevalence rates for the same classes were 28% and 29%, respectively. Among employed women, a similar pattern was seen. The lowest rate in 1987 was seen among self-employed with subordinates (15%) and the highest in self-employed without subordinates (28%). In 1994, the difference was reduced with prevalence rates of 23% and 32%, respectively. In addition, substantial differences in health status between groups with different educational backgrounds were found. The proportion of the population with long-standing illnesses was clearly higher in the group with low education compared with the group with high education. A similar social gradient was found for perceived health as below good. Those with the highest odds ratio of being a disability pensioner are women with long-standing illness, only basic education, and above 55 years of age. Conclusion: In conclusion, the study showed that the prevalence of long-standing illness increased from the mid-1980s to the mid-1990s, whereas perceived health below good was unchanged. In 1994, there was a remarkable difference in health between employed and non-employed people, indicating a health-related exclusion from the labour market. This may explain why, in 1994, smaller occupational class differences were found in the prevalence of long-standing illness among employed people compared with the findings in 1987, whereas the health differences remained in the different educational groups. Women above 54 years of age with basic education only and long-standing illness have the highest odds ratio of permanent exclusion from the labour market.
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Affiliation(s)
- Inge Lissau
- National Institute of Public Health, Svanemøllevej 25,
2100 Copenhagen Ø,
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Schuerch M, Gasse C, Robinson NJ, Alvarez Y, Walls R, Mors O, Christensen J, Hesse U, de Groot M, Schlienger R, Reynolds R, Klungel O, de Vries F. Impact of varying outcomes and definitions of suicidality on the associations of antiepileptic drugs and suicidality: comparisons from UK Clinical Practice Research Datalink (CPRD) and Danish national registries (DNR). Pharmacoepidemiol Drug Saf 2017; 25 Suppl 1:142-55. [PMID: 27038360 DOI: 10.1002/pds.3928] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study is to quantify the impact of the different outcomes and definitions of suicidality on the association between antiepileptic drugs (AEDs) and suicidality. METHODS Retrospective cohort studies of selected AEDs (carbamazepine, gabapentin, lamotrigine, phenytoin, pregabalin, topiramate and valproate) using data from UK Clinical Practice Research Datalink (CPRD) alone and linked to UK Hospital Episode Statistics (HES) and UK Office of National Statistics (ONS), and from Danish national registries (DNR). Follow-up started at initiation of one of the study AEDs, divided into exposure periods, a maximum 90-day post-exposure period, and the reference period starting the day after the 90-day post-exposure period ended. Primary outcomes were completed suicide (SUI)/suicide attempt (SA) for CPRD and SUI/deliberate self-harm (DSH) for DNR. We applied adjusted Cox regression analyses and sensitivity analyses with varying outcome definitions. RESULTS We analyzed 84,524 AED users from CPRD-HES-ONS (1188 SUI/SA; 96 SUI) and 258,180 users from DNR (7561 SUI/DSH; 781 SUI). The adjusted hazard ratios (HRs) on SUI/SA ranged between 1.3 (95% confidence interval (CI): 0.84-2.00) for lamotrigine and 2.7 (1.24-5.81) for phenytoin in CPRD-HES-ONS, and between 0.9 (0.78-1.00) for valproate and 1.8 (1.10-3.07) for phenytoin on SUI/DSH in DNR. HRs for the primary outcomes varied consistently across exposure periods and data sources. HRs for SUI were in general lower, more stable and similar for periods of exposure and the 90-day post-exposure period. CONCLUSION Applying different outcomes and definitions of suicidality had an impact on the relative risks of suicidality associated with the investigated AEDs with results for SUI being most consistent and reliable.
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Affiliation(s)
- Markus Schuerch
- Real World Data Science, F. Hoffmann-La Roche, Basel, Switzerland
| | - Christiane Gasse
- National Center for Register-based Research, Aarhus University, Aarhus V, Denmark
| | | | | | - Robert Walls
- Real World Data Science, F. Hoffmann-La Roche, Basel, Switzerland
| | - Ole Mors
- CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus V, Denmark.,Department P, Research Unit, Aarhus University Hospital Risskov, Aarhus, Denmark
| | - Jakob Christensen
- CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus V, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrik Hesse
- National Institute for Health Data and Disease Control, Copenhagen, Denmark
| | - Mark de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | | | | | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Frank de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Villa C, Primeau C, Hesse U, Hougen HP, Lynnerup N, Hesse B. Body surface area determined by whole-body CT scanning: need for new formulae? Clin Physiol Funct Imaging 2015; 37:183-193. [DOI: 10.1111/cpf.12284] [Citation(s) in RCA: 15] [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] [Received: 08/11/2014] [Accepted: 06/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Chiara Villa
- Department of Forensic Medicine; University of Copenhagen; Copenhagen Denmark
| | - Charlotte Primeau
- Department of Forensic Medicine; University of Copenhagen; Copenhagen Denmark
| | - Ulrik Hesse
- Health data and Information and Communication Technology; Statens Serum Institut; Copenhagen Denmark
| | - Hans Petter Hougen
- Department of Forensic Medicine; University of Copenhagen; Copenhagen Denmark
| | - Niels Lynnerup
- Department of Forensic Medicine; University of Copenhagen; Copenhagen Denmark
| | - Birger Hesse
- Clinic of Clinical Physiology; Nuclear Medicine and PET; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Brauer R, Ruigómez A, Downey G, Bate A, Garcia Rodriguez LA, Huerta C, Gil M, de Abajo F, Requena G, Alvarez Y, Slattery J, de Groot M, Souverein P, Hesse U, Rottenkolber M, Schmiedl S, de Vries F, Tepie MF, Schlienger R, Smeeth L, Douglas I, Reynolds R, Klungel O. Prevalence of antibiotic use: a comparison across various European health care data sources. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:11-20. [PMID: 26152658 PMCID: PMC4918309 DOI: 10.1002/pds.3831] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 06/04/2015] [Accepted: 06/11/2015] [Indexed: 12/03/2022]
Abstract
Purpose There is widespread concern about increases in antibiotic use, but comparative data from different European countries on rates of use are lacking. This study was designed to measure and understand the variation in antibiotic utilization across five European countries. Methods Seven European healthcare databases with access to primary care data from Denmark, Germany, the Netherlands, Spain and the UK were used to measure and compare the point and 1‐year‐period prevalence of antibiotic use between 2004 and 2009. Descriptive analyses were stratified by gender, age and type of antibiotic. Separate analyses were performed to measure the most common underlying indications leading to the prescription of an antibiotic. Results The average yearly period prevalence of antibiotic use varied from 15 (Netherlands) to 30 (Spain) users per 100 patients. A higher prevalence of antibiotic use by female patients, the very young (0–9 years) and old (80+ years), was observed in all databases. The lowest point prevalence was recorded in June and September and ranged from 0.51 (Netherlands) to 1.47 (UK) per 100 patients per day. Twelve percent (Netherlands) to forty‐nine (Spain) percent of all users were diagnosed with a respiratory tract infection, and the most common type of antibiotic prescribed were penicillin. Conclusion Using identical methodology in seven EU databases to assess antibiotic use allowed us to compare drug usage patterns across Europe. Our results contribute quantitatively to the true understanding of similarities and differences in the use of antibiotic agents in different EU countries. © 2015 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Ruth Brauer
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Ruigómez
- Fundación Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain
| | | | | | | | - Consuelo Huerta
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Miguel Gil
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Francisco de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain.,Pharmacology Section, Department of Biomedical Sciences II, University of Alcalá (UAH), Madrid, Spain
| | - Gema Requena
- Pharmacology Section, Department of Biomedical Sciences II, University of Alcalá (UAH), Madrid, Spain
| | | | | | - Mark de Groot
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Patrick Souverein
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Ulrik Hesse
- Laegemiddelstyrelsen (Danish Medicines Agency), National Institute for Health Data and Disease Control, Copenhagen, Denmark
| | - Marietta Rottenkolber
- Institute of Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Wuppertal, Germany
| | - Frank de Vries
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.,School CAPHRI / Maastricht University, Maastricht, The Netherlands
| | | | | | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Douglas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert Reynolds
- Epidemiology, Pfizer Research & Development, New York, NY, USA
| | - Olaf Klungel
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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Huerta C, Abbing-Karahagopian V, Requena G, Oliva B, Alvarez Y, Gardarsdottir H, Miret M, Schneider C, Gil M, Souverein PC, De Bruin ML, Slattery J, De Groot MCH, Hesse U, Rottenkolber M, Schmiedl S, Montero D, Bate A, Ruigomez A, García-Rodríguez LA, Johansson S, de Vries F, Schlienger RG, Reynolds RF, Klungel OH, de Abajo FJ. Exposure to benzodiazepines (anxiolytics, hypnotics and related drugs) in seven European electronic healthcare databases: a cross-national descriptive study from the PROTECT-EU Project. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:56-65. [DOI: 10.1002/pds.3825] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Consuelo Huerta
- Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department; Spanish Agency for Medicines and Medical Devices (AEMPS); Madrid Spain
| | - Victoria Abbing-Karahagopian
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Gema Requena
- Pharmacology Unit, Department of Biomedical Sciences II, School of Medicine and Health Sciences; University of Alcalá; Madrid Spain
| | - Belén Oliva
- Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department; Spanish Agency for Medicines and Medical Devices (AEMPS); Madrid Spain
| | | | - Helga Gardarsdottir
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Cornelia Schneider
- Division Clinical Pharmacy and Epidemiology; University of Basel; Switzerland
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department; Spanish Agency for Medicines and Medical Devices (AEMPS); Madrid Spain
| | - Patrick C. Souverein
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Marie L. De Bruin
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | | | - Mark C. H. De Groot
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Ulrik Hesse
- National Institute for Health Data and Disease Control; Copenhagen Denmark
| | - Marietta Rottenkolber
- Institute for Medical Information Sciences, Epidemiology, and Biometry; Ludwig-Maximilians-Universitaet München; Munich Germany
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health; Witten/Herdecke University; Witten Germany
- Philipp Klee-Institute for Clinical Pharmacology; HELIOS Clinic Wuppertal; Wuppertal Germany
| | - Dolores Montero
- Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department; Spanish Agency for Medicines and Medical Devices (AEMPS); Madrid Spain
| | | | - Ana Ruigomez
- Spanish Center for Pharmacoepidemiological Research (CEIFE); Madrid Spain
| | | | | | - Frank de Vries
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
- MRC Epidemiology Resource Centre; Southampton General Hospital; Southampton UK
- School CAPHRI; Maastricht University; The Netherlands
| | | | | | - Olaf H. Klungel
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
- University Medical Center Utrecht (UMCU); Julius Center for Health Sciences and Primary Care; The Netherlands
| | - Francisco José de Abajo
- Pharmacology Unit, Department of Biomedical Sciences II, School of Medicine and Health Sciences; University of Alcalá; Madrid Spain
- Clinical Pharmacology Unit; University Hospital Príncipe de Asturias; Madrid Spain
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Abbing-Karahagopian V, Kurz X, de Vries F, van Staa TP, Alvarez Y, Hesse U, Hasford J, Dijk LV, de Abajo FJ, Weil JG, Grimaldi-Bensouda L, Egberts ACG, Reynolds RF, Klungel OH. Bridging differences in outcomes of pharmacoepidemiological studies: design and first results of the PROTECT project. ACTA ACUST UNITED AC 2014; 9:130-8. [PMID: 24218995 PMCID: PMC4083447 DOI: 10.2174/1574884708666131111211802] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/20/2013] [Accepted: 05/19/2013] [Indexed: 01/05/2023]
Abstract
Background: Observational pharmacoepidemiological (PE) studies on drug safety have produced discrepant
results that may be due to differences in design, conduct and analysis. Purpose: The pharmacoepidemiology work-package (WP2) of the Pharmacoepidemiological Research on Outcomes of
Therapeutics by a European ConsorTium (PROTECT) project aims at developing, testing and disseminating
methodological standards for design, conduct and analysis of pharmacoepidemiological studies applicable to different
safety issues using different databases across European countries. This article describes the selection of the safety issues
and the description of the databases to be systematically studied. Methods: Based on two consensus meetings and a literature search, we selected five drug-adverse event (AE) pairs to be
evaluated in different databases. This selection was done according to pre-defined criteria such as regulatory and public
health impact, and the potential to investigate a broad range of methodological issues. Results: The selected drug-AE pairs are: 1) inhaled long-acting beta-2 agonists and acute myocardial infarction; 2)
antimicrobials and acute liver injury; 3) antidepressants and/or benzodiazepines and hip fracture; 4) anticonvulsants and
suicide/suicide attempts; and 5) calcium channel blockers and malignancies. Six European databases, that will be used to
evaluate the drug-AE pairs retrospectively, are also described. Conclusion: The selected drug-AE pairs will be evaluated in PE studies using common protocols. Based on consistencies
and discrepancies of these studies, a framework for guiding methodological choices will be developed. This will increase
the usefulness and reliability of PE studies for benefit-risk assessment and decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082 3508 TB Utrecht, The Netherlands.
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Moon JC, Godman B, Petzold M, Alvarez-Madrazo S, Bennett K, Bishop I, Bucsics A, Hesse U, Martin A, Simoens S, Zara C, Malmström RE. Different initiatives across Europe to enhance losartan utilization post generics: impact and implications. Front Pharmacol 2014; 5:219. [PMID: 25339902 PMCID: PMC4189327 DOI: 10.3389/fphar.2014.00219] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 09/09/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction: There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry. Objective: Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance. Methodology: Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured. Results: Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan. Conclusion: Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent “spill over” effect from one class to another to influence future prescribing patterns even if these are closely related.
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Affiliation(s)
- James C Moon
- Heart Hospital Imaging Centre, The Heart Hospital, University College Hospital London, UK
| | - Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK ; National Institute for Science and Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz) Rio de Janeiro, Brazil
| | - Max Petzold
- Occupational and Environmental Medicine, Centre for Applied Biostatistics, University of Gothenburg Gothenburg, Sweden
| | - Samantha Alvarez-Madrazo
- Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James Hospital Dublin, Ireland
| | - Iain Bishop
- Public Health and Intelligence Business Unit, NHS National Services Scotland Edinburgh, UK
| | - Anna Bucsics
- Department of Finance, Faculty of Business, Economics and Statistics, University of Vienna Vienna, Austria ; Hauptverband der Österreichischen Sozialversicherungsträger Vienna, Austria
| | - Ulrik Hesse
- National Institute for Health Data and Disease Control Copenhagen, Denmark
| | - Andrew Martin
- NHS Greater Manchester Commissioning Support Unit Salford, Manchester, UK
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences Leuven, Belgium
| | - Corinne Zara
- Barcelona Health Region, Catalan Health Service Barcelona, Spain
| | - Rickard E Malmström
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna Stockholm, Sweden
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Requena G, Abbing-Karahagopian V, Huerta C, De Bruin ML, Alvarez Y, Miret M, Hesse U, Gardarsdottir H, Souverein PC, Slattery J, Schneider C, Rottenkolber M, Schmiedl S, Gil M, De Groot MCH, Bate A, Ruigómez A, García Rodríguez LA, Johansson S, de Vries F, Montero D, Schlienger R, Reynolds R, Klungel OH, de Abajo FJ. Incidence rates and trends of hip/femur fractures in five European countries: comparison using e-healthcare records databases. Calcif Tissue Int 2014; 94:580-9. [PMID: 24687523 DOI: 10.1007/s00223-014-9850-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003-2009 in five European countries. The study was performed using seven electronic health-care records databases (DBs) from Denmark, The Netherlands, Germany, Spain, and the United Kingdom, based on the same protocol. Yearly IRs of hip/femur fractures were calculated for the general population and for those aged ≥50 years. Trends over time were evaluated using linear regression analysis for both crude and standardized IRs. Sex- and age-standardized IRs for the UK, Netherlands, and Spanish DBs varied from 9 to 11 per 10,000 person-years for the general population and from 22 to 26 for those ≥50 years old; the German DB showed slightly higher IRs (about 13 and 30, respectively), whereas the Danish DB yielded IRs twofold higher (19 and 52, respectively). IRs increased exponentially with age in both sexes. The ratio of females to males was ≥2 for patients aged ≥70-79 years in most DBs. Statistically significant trends over time were only shown for the UK DB (CPRD) (+0.7% per year, P < 0.01) and the Danish DB (-1.4% per year, P < 0.01). IRs of hip/femur fractures varied greatly across European countries. With the exception of Denmark, no decreasing trend was observed over the study period.
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Affiliation(s)
- G Requena
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Alcalá, Madrid, Spain,
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de Groot MCH, Schuerch M, de Vries F, Hesse U, Oliva B, Gil M, Huerta C, Requena G, de Abajo F, Afonso AS, Souverein PC, Alvarez Y, Slattery J, Rottenkolber M, Schmiedl S, Van Dijk L, Schlienger RG, Reynolds R, Klungel OH. Antiepileptic drug use in seven electronic health record databases in Europe: A methodologic comparison. Epilepsia 2014; 55:666-673. [DOI: 10.1111/epi.12557] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Mark C. H. de Groot
- Division of Pharmacoepidemiology & Clinical Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - Markus Schuerch
- Epidemiology, Patient-Reported Outcomes, and Healthcare Data Strategy; F. Hoffmann-La Roche; Basel Switzerland
| | - Frank de Vries
- Division of Pharmacoepidemiology & Clinical Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Department of Clinical Pharmacy and Toxicology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Ulrik Hesse
- National Institute for Health Data and Disease Control; Copenhagen Denmark
| | - Belén Oliva
- Agencia Española de Medicamentos y Productos Sanitarios; Madrid Spain
| | - Miguel Gil
- Agencia Española de Medicamentos y Productos Sanitarios; Madrid Spain
| | - Consuelo Huerta
- Agencia Española de Medicamentos y Productos Sanitarios; Madrid Spain
| | - Gema Requena
- Pharmacology Section; Department of Biomedical Sciences II; University of Alcalá; Madrid Spain
| | - Francisco de Abajo
- Pharmacology Section; Department of Biomedical Sciences II; University of Alcalá; Madrid Spain
- Clinical Pharmacology Unit; University Hospital Príncipe de Asturias; Madrid Spain
| | - Ana S. Afonso
- Division of Pharmacoepidemiology & Clinical Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - Patrick C. Souverein
- Division of Pharmacoepidemiology & Clinical Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | | | - Jim Slattery
- European Medicines Agency; London United Kingdom
| | - Marietta Rottenkolber
- Institute for Medical Information Sciences, Biometry, and Epidemiology; Ludwig-Maximilians-Universität-München; Munich Germany
| | - Sven Schmiedl
- Department of Clinical Pharmacology; Faculty of Health; School of Medicine; Witten/Herdecke University; Witten Germany
- Philipp Klee-Institute for Clinical Pharmacology; Helios Clinic Wuppertal; Wuppertal Germany
| | - Liset Van Dijk
- Division of Pharmacoepidemiology & Clinical Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- NIVEL; Netherlands Institute for Health Services Research; Utrecht The Netherlands
| | | | | | - Olaf H. Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
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Hesse U, Godman B, Petzold M, Martin A, Malmström RE. Impact of delisting ARBs, apart from losartan, on ARB utilisation patterns in Denmark: implications for other countries. Appl Health Econ Health Policy 2013; 11:677-685. [PMID: 24105097 DOI: 10.1007/s40258-013-0059-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Renin-angiotensin inhibitor drugs have been a target for health authority initiatives across Europe with the potential for substantial savings once generic angiotensin-converting enzyme inhibitors (ACEIs) became available without compromising care. Recently, losartan was the first angiotensin receptor blocker (ARB) to lose its patent. In Denmark, the authorities removed all other ARBs from the reimbursement list, apart from losartan, as they were all seen as essentially similar for the management of hypertension or congestive heart failure at appropriate doses, but more expensive. Similarly, all other ARB fixed-dose combinations (FDCs), apart from losartan, were removed from the reimbursement list. OBJECTIVE The aims of the study were to (i) assess the impact of these reimbursement changes on the subsequent utilisation of losartan and other ARBs alone or as FDCs; (ii) assess changes in the prices of losartan and other ARBs post-generic losartan to calculate potential savings; and (iii) compare the impact of the policies in Denmark with other European countries to provide guidance. METHODOLOGY This was a retrospective segmented regression analysis of an interrupted time-series design comparing utilisation patterns before and after the changes in ARB reimbursement status. Utilisation was measured in defined daily doses (DDDs). Changes in total expenditure and expenditure/DDD were also assessed over time. RESULTS Losartan utilisation grew from 31 to 33 % of total single ARB utilisation before generic losartan, to 93 % by October 2011. There was a corresponding decrease in the utilisation of all other ARBs. Both changes were significant (p < 0.001). Total expenditure on single ARBs in 2011 was 77 % below 2009 levels despite a 16 % increase in utilisation. Estimated savings were 290.5 million Danish Kroner (DKK). A similar trend was seen for losartan FDCs, which was also significant (p < 0.001). DISCUSSION Losartan utilisation grew appreciable following the changes. The change was much greater than seen in countries that had eased prescribing restrictions for losartan but not the other ARBs. Active therapeutic switching programmes plus education and financial incentives also significantly enhanced losartan utilisation following generics in two countries and regions; however, the increase in losartan utilisation was less than that seen in Denmark.
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Affiliation(s)
- Ulrik Hesse
- National Institute for Health Data and Disease Control, Copenhagen, Denmark
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Godman B, Bennie M, Bucsics A, Hesse U, Martin A, Miranda J, Simoens S, Zara C, Gustafsson L. PP062—Variable approaches in europe to the availability of generic losartan; implications for the future. Clin Ther 2013. [DOI: 10.1016/j.clinthera.2013.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fischer M, Mozet C, Hesse U, Dietz A, Strauss G. [Impact of transtympanic miniature endoscopy of the middle ear--a conceptual cadaver study]. Laryngorhinootologie 2011; 91:174-81. [PMID: 22016265 DOI: 10.1055/s-0031-1286320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Endoscopic inspections of the middle ear have already been described. So far, the low optical quality due to the small diameter is limiting this type of procedure. In this study the use of a miniature endoscope for visualization of the middle ear structures has been evaluated. MATERIAL AND METHODS 8 human cadaveric head specimens have been inspected. Following myringotomy, 2 miniature endoscopes were placed into the middle ear and the promontory, the incudostapedial joint, the round und oval window niche with stapes footplate were visualized and fotodocumentated. After endaural approach all middle ear structures were visualized microscopically and the quality of pictures was compared. Technical picture quality and anatomical visualization were evaluated by 5 ear surgeons. In addition, 2 interventional procedures were performed (control of ossicular chain mobility and intratympanic substance application). RESULTS Still, the technical picture quality was significantly better for the microscope. The anatomical visualization of the middle ear structures with the miniature endoscope was not inferior compared to the microscope. The feasibility of additional interventions, e.g. control of ossicular chain mobility or intratympanic substance application could be shown. An inspection of the correct prosthesis position after tympanoplasty could be evaluated, too. CONCLUSION This study showed that middle ear structures can be visualized by trans-tympanic miniature endoscopy equal or even better compared to conventional microscopy in spite of reduced technical quality.
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Affiliation(s)
- M Fischer
- Universitätsklinikum Leipzig AöR, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Leipzig, Germany.
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Nielsen KR, Oturai PS, Friis E, Hesse U, Callesen T, Nielsen MB, Chakera AH, Hesse B. Axillary sentinel node identification in breast cancer patients: degree of radioactivity present at biopsy is critical. Clin Physiol Funct Imaging 2011; 31:288-93. [PMID: 21672136 DOI: 10.1111/j.1475-097x.2011.01015.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The radioactivity present in the patient (Act(rem) ) at sentinel node (SN) biopsy will depend on injected activity amount as well as on the time interval from tracer injection to biopsy, which both show great variations in the literature. The purpose of this study was to analyse the influence of varying Act(rem) levels on the outcome of axillary SN biopsy in patients with breast cancer (BC). MATERIAL AND METHODS Eight hundred and fifty-eight patients with BC were consecutively referred to SN biopsy, 21% for a same-day and 79% of the patients for a 2-day procedure. Four hundred and nineteen patients underwent scintigraphy and 439 did not. For same-day procedures, 50 MBq (99m) Tc-nanocolloid (Nanocoll(®) ) was injected, and for 2-day procedures 110 MBq. For the analysis of SN biopsy outcome, the patients were divided into three Act(rem) groups: <10 (56% of the patients), 10-20 (23%), and >20 MBq (21%). During surgery, SNs were located using a hand-held gamma probe supported by image information when available and blue dye injection. Pathology included haematoxylin-eosin staining followed by immunohistochemistry. RESULTS The number of SNs removed (mean value 1·87 versus 2·14, P = 0·0003) and the probability of finding a malignant SN (P = 0·034) were lower in the <10 MBq group of patients compared with higher Act(rem) >20 MBq. Of the 25 patients with SN non-detection, 20 patients had an Act(rem) <10 MBq. Imaging had no significant influence on the number of patients with a malignant SN (P = 0·48). CONCLUSION Act(rem) above 10 MBq for nanocolloid tracer appears important for appropriate identification of SNs in patients with BC.
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Abstract
In the period from January 2003 to June 2009 923 complex laparoscopic colorectal procedures were performed by one surgeon. Data was assessed prospectively in a database including 152 variables. In 15 patients (10 f, 5 m), with a median age of 61 years (range: 35-83 years), discontinuity resection of the colon was performed including 3 patients with open discontinuity resection of the sigma and 12 patients with laparoscopic Hartmann procedures. In all cases continuity of the colon was recovered laparoscopically. Median operation time was 100 min, conversion to an open procedure was not necessary. No intra-operative complications occurred and only one wound infection (6.6 %) was recorded postoperatively with a median postoperative stay of 8 days. Although the laparoscopic approach to recover continuity of the colon is technically challenging, we conclude that the experienced bowel surgeon is able to perform the laparoscopic approach with a low morbidity and mortality by retaining the well known advantages of laparoscopic colonic surgery.
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Richter B, Roslind A, Hesse U, Nordling J, Johansen JS, Horn T, Hansen AB. YKL-40 and mast cells are associated with detrusor fibrosis in patients diagnosed with bladder pain syndrome/interstitial cystitis according to the 2008 criteria of the European Society for the Study of Interstitial Cystitis. Histopathology 2011; 57:371-83. [PMID: 20840668 DOI: 10.1111/j.1365-2559.2010.03640.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Bladder pain syndrome/interstitial cystitis (BPS/IC), diagnosed according to the new 2008 criteria of the European Society for the Study of Interstitial Cystitis (ESSIC), may lead to detrusor fibrosis. In some inflammatory diseases, fibrosis is related to YKL-40. The aims were to examine YKL-40 antigenic expression in bladder tissue and levels in serum and urine in BPS/IC and to evaluate whether YKL-40 could be a non-invasive, prognostic biomarker for bladder fibrogenesis and treatment intensity. METHODS AND RESULTS Immunohistochemistry, immunoelectron microscopy and enzyme-linked immunosorbent assay (ELISA) analyses in 45 patients showed YKL-40 expression in detrusor mast cell granules and submucosal macrophages, and elevated YKL-40 levels in serum and urine compared to healthy individuals (median 72 versus 7 μg/l, P < 0.001). Clinicopathological parameters showed associations of detrusor fibrosis with YKL-40-positive cells (P = 0.001), mast cells (P = 0.014) and urine YKL-40 (P = 0.009). Bladder capacity correlated inversely with YKL-40-positive cells (P < 0.001) and mast cells (P = 0.029). Treatment intensity was not associated with YKL-40. CONCLUSION Serum and urine levels of YKL-40 may be used as non-invasive biomarkers in BPS/IC for the evaluation of bladder fibrogenesis.
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Affiliation(s)
- Benedikte Richter
- Department of Urology, Copenhagen University Hospital Herlev, Copenhagen, Denmark.
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Glintborg B, Hesse U, Houe T, Claus Munk J, Pødenphant J, Zerahn B. Osteoporosis among Fallers without Concomitant Fracture Identified in an Emergency Department: Frequencies and Risk Factors. Adv Orthop 2010; 2011:468717. [PMID: 21991414 PMCID: PMC3170766 DOI: 10.4061/2011/468717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 08/17/2010] [Accepted: 10/11/2010] [Indexed: 12/01/2022] Open
Abstract
We aimed to determine whether the Emergency Department (ED) is a suitable entrance point for osteoporosis screening among fallers without concomitant fracture compared to referral from general practice. Furthermore, to identify factors associated with osteoporosis among fallers. Methods. Patients aged 50-80 years sustaining a low-energy fall without fracture were identified from an ED (n = 199). Patients answered a questionnaire on risk factors and underwent osteodensitometry. Data was compared to a group of patients routinely referred to osteodensitometry from general practice (n = 201). Results. Among the 199 included fallers, 41 (21%) had osteoporosis. Among these, 35 (85%) reported either previous fracture or reduced body height (>3 cm). These two risk factors were more frequent among fallers with osteoporosis compared to fallers with normal bone mineral density or osteopenia (previous fracture P = .044, height reduction P = .0016). The osteoporosis frequency among fallers from ED did not differ from a similarly aged patient-group referred from general practice (P = .34). Conclusion. Osteodensitometry should be considered among fallers without fracture presenting in the ED, especially if the patient has a prior fracture or declined body height. Since fallers generally have higher fracture risk, the ED might serve as an additional entrance to osteodensitometry compared to referral from primary care.
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Affiliation(s)
- Bente Glintborg
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark
- Department of Rheumatology and Internal Medicine, 2900 Hellerup, Gentofte Hospital, Denmark
| | - Ulrik Hesse
- Danish Medicines Agency, 2300 Copenhagen, Denmark
| | - Thomas Houe
- Department of Orthopaedic Surgery, 2730 Herlev Hospital, Denmark
| | | | - Jan Pødenphant
- Department of Rheumatology and Internal Medicine, 2900 Hellerup, Gentofte Hospital, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark
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Christiansen MS, Hesse D, Ekbom P, Hesse U, Damm P, Hommel E, Feldt-Rasmussen B, Mathiesen E. Increased urinary orosomucoid excretion predicts preeclampsia in pregnant women with pregestational type 1 diabetes. Diabetes Res Clin Pract 2010; 89:16-21. [PMID: 20392509 DOI: 10.1016/j.diabres.2010.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 03/10/2010] [Accepted: 03/22/2010] [Indexed: 11/21/2022]
Abstract
AIMS We evaluated the urinary orosomucoid excretion (UOE) as a biomarker of preeclampsia and preterm delivery in pregnant women with type 1 diabetes. METHODS Singleton pregnant women with pregestational type 1 diabetes were included provided one urine sample had been collected before 17 gestational weeks. Serum and urinary orosomucoid were analysed by immunoturbidimetry. Primary outcome measurements were development of preeclampsia (blood pressure>140/90mmHg and proteinuria) and preterm delivery before 37 weeks. RESULTS In total 173 women were included. The UOE increased during pregnancy. Preeclampsia developed in 20 women and 65 women delivered preterm. Using logistic regression analysis we found that UOE>1.37mg/l (OR: 6.85 (95% CI: 1.97-23.88; p<0.003)), nulliparity (3.88 (1.10-13.72); p<0.04), systolic blood pressure>120mmHg (4.12 (1.35-12.59); p<0.02) and duration of diabetes>20 years (3.69 (1.18-11.52); p<0.03) independently predicted the development of preeclampsia. Independent predictors of preterm delivery were duration of diabetes and HbA1c>7%. The remaining covariates included in the regression models were BMI, serum creatinine, smoking and microalbuminuria. CONCLUSIONS Increased UOE early in pregnancy predicted preeclampsia in women with pregestational type 1 diabetes independently of albuminuria and other known risk factors. No association to preterm delivery was found.
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Affiliation(s)
- M S Christiansen
- Department of Clinical Biochemistry and Department of Medicine, Amager Hospital, Italiensvej 1, Copenhagen S, Denmark.
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Richter B, Hesse U, Hansen AB, Horn T, Mortensen SO, Nordling J. Bladder pain syndrome/interstitial cystitis in a Danish population: a study using the 2008 criteria of the European Society for the Study of Interstitial Cystitis. BJU Int 2010; 105:660-7. [DOI: 10.1111/j.1464-410x.2009.08847.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
AIMS The Danish National Institute of Public Health, University of Southern Denmark has carried out national representative health interview surveys among adult Danes in 1987, 1994, 2000 and 2005. The aim of this study is to describe the characteristics of the design, including the response rates of the four surveys. METHODS The samples in 1987 and 1994 are based on simple random sampling. The samples in 2000 and 2005 are based on stratified random sampling. In addition, all invited to the survey in 1994 were re-invited in both 2000 and 2005. Data were collected via face-to-face interview at the respondent's home. Following the interview in 1994, 2000 and 2005, all respondents were asked to complete a self-administered questionnaire. RESULTS The response rate for the face-to-face interview fell from 79.9% in 1987 to 66.7% in 2005 and the response rate for the self-administered questionnaire from 68.1% in 1994 to 51.5% in 2005. The decrease is particularly marked among the young. The mean interview length has increased from 33.3 minutes in 1987 to 50.2 minutes in 2005. CONCLUSIONS The declining response rate in the surveys is a major concern and can pose problems in generalizing data from the surveys to the Danish population. However, these surveys are essential, as the information collected cannot be gathered by means of official statistical registers. Hence, efforts to increase the response rate will be important in the forthcoming surveys.
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Affiliation(s)
- Ola Ekholm
- National Institute of Public Health, University of Southern Denmark.
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Hesse U. [Comments as requested by the editors: Quality assurance in bariatric surgery in Germany--results of the German multicentre trial 2005 to 2007; Stroh et al., Zentralblatt für Chirurgie]. Zentralbl Chir 2009; 134:271. [PMID: 19536724 DOI: 10.1055/s-0028-1098790] [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: 10/20/2022]
Affiliation(s)
- U Hesse
- Klinik für Allgemein- und Viszeralchirurgie, Adipositaszentrum Klinikum Stuttgart, Stuttgart.
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Gärtner D, Münz K, Hückelheim E, Hesse U. Ultrasound scissors: new single-use instruments vs. resterilised single-use instruments - a prospective randomised study. GMS Krankenhhyg Interdiszip 2008; 3:Doc20. [PMID: 20204092 PMCID: PMC2831255] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
BACKGROUND The aim of this study was to compare reliability in handling and function of resterilised and single-use disposable ultrasonic scissors. METHODS In a prospective randomized study, the surgeon blindly tested new and resterilised ultrasonic scissors. The parameters were force of activation, cutting effect, coagulation effect, error messages and disturbing generator noise. RESULTS 51 new and 49 resterilised instruments in 94 operations were evaluated. The differences in force of activation, cutting effect and coagulation were not significant. Error messages and disturbing noises were rare in both groups. 6 new instruments and 2 resterilised instruments had to be exchanged because of problems during surgery. CONCLUSION This study demonstrates comparable reliability in function and handling of resterilised and new ultrasonic scissors. The use of resterilised instruments leads to distinctly reduced costs and could contribute to efficiency in laparoscopic surgery.
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Affiliation(s)
- D. Gärtner
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Stuttgart, Krankenhaus Bad Cannstatt, Stuttgart, Deutschland
| | - K. Münz
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Stuttgart, Krankenhaus Bad Cannstatt, Stuttgart, Deutschland
| | - E. Hückelheim
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Stuttgart, Krankenhaus Bad Cannstatt, Stuttgart, Deutschland
| | - U. Hesse
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Stuttgart, Krankenhaus Bad Cannstatt, Stuttgart, Deutschland,*To whom correspondence should be addressed: U. Hesse, Klinik für Allgemein- und Viszeralchirurgie, Klinikum Stuttgart, Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374 Stuttgart, Deutschland, E-mail:
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Lorentz A, Hoppe J, Worthmann H, Gebhardt T, Hesse U, Bienenstock J, Bischoff SC. Neurotrophin-3, but not nerve growth factor, promotes survival of human intestinal mast cells. Neurogastroenterol Motil 2007; 19:301-8. [PMID: 17391246 DOI: 10.1111/j.1365-2982.2007.00899.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 02/08/2023]
Abstract
Neurotrophins are potent regulators of neuronal cell survival and function. Nerve growth factor (NGF) was shown to reduce apoptosis in cord blood-derived mast cells. Here, we examined the effect of the neurotrophins NGF and neurotrophin (NT)-3 on survival and mediator release of human intestinal mast cells. Mast cells isolated from normal intestinal tissue were cultured in the presence of NGF, NT-3, or stem cell factor (SCF) alone or in the presence of SCF together with each neurotrophin. NGF or NT-3 alone did not promote mast cell survival. In contrast, mast cell recovery was increased twofold when mast cells were cultured with NT-3 in addition to SCF for 14 days compared with control. Mast cell recovery was further increased following a combined addition of NT-3, SCF and IL-4. NT-3 mediated mast cell growth was dependent on the primary receptor for NT-3 TrkC. NGF in combination with SCF or with SCF and IL-4 showed no effect on mast cell survival. Histamine release and histamine content per mast cell remained unchanged, whereas leukotriene C4 release decreased if mast cells were cultured with NGF or NT-3 in addition to SCF. In summary, NT-3 affects mature human mast cells by promoting mast cell survival, whereas NGF does not.
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Affiliation(s)
- A Lorentz
- Department of Nutritional Medicine and Immunology, University of Hohenheim, Stuttgart, Germany.
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Abstract
Laparoscopic surgery of the pancreas has been used for diagnostic but also for therapeutic purposes in increasing number. Case reports and multicenter studies summarizing the European and world wide experience have been published recently. The results show that laparoscopic surgery can be used for tumor staging of pancreatic cancer but also for the treatment of acute necrotizing pancreatitis and treatment of chronic pancreatitis, benign cystic lesions and solid tumors. In particular left sided pancreatic resection (90 % of the cases) is the preferred approach delivering good results. Recent studies show that the conversion rate is 14 % and mortality can be as low as 0 %. The reoperation rate is 6.3 % and the fistula formation is 17 % which is comparable to the results of open pancreatic surgery. The postoperative hospital stay seems to be limited to a mean of 7 days as compared to pancreatic surgery in the open abdomen. The laparoscopic Whipple resection with less than 3 % of the cases in the literature remains the exception.
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Affiliation(s)
- U Hesse
- Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Klinikum Stuttgart, Krankenhaus Bad Cannstatt.
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Hesse U, Gärtner D. Adipositaschirurgie: Ablehnung der Kostenübernahme trotz ärztlicher Gutachten. Dtsch Med Wochenschr 2006. [DOI: 10.1055/s-2006-946569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gärtner D, Hoyer M, Hornung A, Andus T, Bischoff S, Hesse U. Adipositaschirurgie: Ablehnung der Kostenübernahme trotz ärztlicher Gutachten. Dtsch Med Wochenschr 2006; 131:258-62. [PMID: 16463228 DOI: 10.1055/s-2006-924958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Surgery is an effective method to treat patients with morbid obesity. However health insurance companies frequently refuse to cover the costs for the procedure despite an existing DRG-code for this operation. Individual medical expertise are necessary to receive reimbursement. In the present study the acceptance of medical expertise to receive cost coverage was analysed in our patients of the years 2000-2003 eligible for obesity surgery. PATIENTS AND METHODS 617 medical expertise of patients eligible for obesity surgery in our hospital were reviewed and the acceptance rate was evaluated. Parameters such as body mass index, personal medical history, diets, comorbidity and prognosis were included. Expertise were submitted to the health care insurance companies and in case of acceptance the operation was performed. RESULTS The average age of our patients was 39.1 +/- 11.2 years, 72.1% were female, 27.9% male. The average BMI was 47.5 +/- 7.4 kg/m2. There was a high incidence of comorbidity in these patients (58.7% arterial hypertension, 38.6% diabetes mellitus, 95.8% dyspnoea, 96.1% arthropathy, 89.0% psychosocial disorders). The difference between accepted and non-accepted regarding these secondary complications was not significant. 209 patients (33.8%) were operated. 14 patients of these paid the costs themselves. Only in 195 cases (31.6%) the health care insurance company covered the costs for the operation. CONCLUSION The high number of refusals of medical expertise is not justified in view of the strict criteria for indication, the high frequency of comorbidity and the good results after the operation.
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Affiliation(s)
- D Gärtner
- Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Krankenhaus Bad Cannstatt, Klinikum Stuttgart, Stuttgart
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Affiliation(s)
- B. Weyershausen
- Corresponding author: telephone: 49 + (201) 1731655; fax: 49 + (201) 1731839;
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Abstract
BACKGROUND Contact allergy to hair dye ingredients is a well-known entity seen both in consumers using hair dyes and among hairdressers with occupational contact dermatitis. Surveys show that consumers with even severe adverse skin reactions to hair dyes only rarely contact the healthcare services. The frequency of hair dye-induced skin reactions in the consumer population is unknown. OBJECTIVES An epidemiological investigation with the aim of establishing the proportion of hair dye-induced skin reactions was performed in a population-based sample. METHODS A representative random sample (n = 4000) was taken of the Danish adult population. Personal interview questions were asked regarding adverse skin reactions to hair dyes, either compatible with a classical allergic eczematous reaction with redness, scaling and itching or a severe allergic reaction with oedema of the forehead and face. The response rate was 65.2%. RESULTS A total of 18.4% of the male respondents and 74.9% of the female respondents had at some point dyed their hair. The median age at first hair dyeing was 16 years (range 1-80). Adverse skin reactions to hair dyes compatible with an allergic reaction were reported in 5.3% of individuals who had ever used hair dye. Of these, only 15.6% had been in contact with healthcare services after the hair dye reaction. Having had a temporary tattoo was not a significant risk factor for an adverse reaction to hair dyes. CONCLUSIONS The rate of adverse allergic skin reactions to hair dyes was higher than expected from patch-test studies. Only by studying the clinical types of adverse reactions to hair dyes will it be possible to gather a complete epidemiological picture of the nature and extent of the problems related to hair dye ingredients.
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Affiliation(s)
- H Søsted
- The National Allergy Research Centre, Department of Dermatology, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark.
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Chakera AH, Friis E, Hesse U, Al-Suliman N, Zerahn B, Hesse B. Factors of importance for scintigraphic non-visualisation of sentinel nodes in breast cancer. Eur J Nucl Med Mol Imaging 2004; 32:286-93. [PMID: 15791437 DOI: 10.1007/s00259-004-1681-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [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: 03/16/2004] [Accepted: 08/05/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to analyse different factors of possible significance for non-visualisation of sentinel nodes (SNs) by preoperative lymphoscintigraphy, in order to enable improvement of the success rate of SN visualisation through modification or alteration of some of the factors. METHODS Between March 1998 and January 2003 we analysed a series of 442 women with unilateral stage T1 and clinical N0 breast cancer. Lymphoscintigraphy was performed after periareolar or peritumoural injection of 99mTc-albumin nanocolloid, with image acquisition after 2-6 h or 18-24 h. Until January 2001, all patients received around 20 MBq tracer, irrespective of time to operation. From January 2001, patients injected on the day before surgery received at least 100 MBq while patients injected on the day of surgery received around 50 MBq. RESULTS An SN was visualised in 87% of the patients, and at surgery the SN was detected with the hand-held gamma probe in 42% of the remaining patients. By multiple logistic regression analysis, statistically significant independent variables that increased the risk for non-visualisation were increasing age (p=0.0007), increasing body weight (p=0.0189) and peritumoural injection (p<0.0001). Significant interaction was found for imaging time and injected activity (p=0.0017). CONCLUSION This study conclusively shows that the risk of unsuccessful SN imaging increases with age and body weight. Our findings suggest that the scintigraphic success rate may be improved by periareolar (rather than peritumoural) injection. Early and late imaging procedures are equally efficient, but if a late imaging procedure is used, activity (adjusted for physical decay) in the patient on day 2 should be more than 10 MBq.
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Affiliation(s)
- A H Chakera
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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31
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Abstract
Somatostatin-14 and its analogue octreotide both exert inhibitory effects on gastrointestinal secretions and may therefore be beneficial in the treatment of gastrointestinal fistulae. There are no studies that have compared these two drugs directly and hence this paper aims to review studies that are available for each drug. There are only six controlled studies that have examined the effects of somatostatin-14 and octreotide on fistula output reduction, three for each drug. All studies compared conservative therapy and the drug in combination with conservative therapy. Of the somatostatin-14 studies, two showed a significant effect on output (p<0.05) and the other demonstrated an output reduction on day 1 that was twice that in the control group (NS). Of the octreotide studies, one showed a significant effect (p<0.01) and the other two showed no effect of the drug on output. No study with either drug has demonstrated an increase in the number of patients that have achieved closure. However, a positive effect on the time to achieve closure has been found. Of the five controlled studies with somatostatin-14, all showed a significant reduction in time to closure. Of the two controlled studies with octreotide, one showed a significant reduction (p=0.002) and the other showed no difference. Due to the limited number of trials, a definitive evaluation of the efficacies of somatostatin-14 and octreotide in the treatment of gastrointestinal fistulae is not possible. However, currently available information seems to suggest a considerable benefit of somatostatin-14 when administered in association with standard conservative treatment, but this needs to be confirmed in a large prospective controlled study.
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Affiliation(s)
- U Hesse
- Department of Surgery, Ghent University Hospitals, Heelkundige Kliniek, Universitair Ziekenhuis, Gent, Belgium.
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32
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Mortelé KJ, Pattijn P, Mollet P, Berrevoet F, Hesse U, Ceelen W, Ros PR. The Swedish laparoscopic adjustable gastric banding for morbid obesity: radiologic findings in 218 patients. AJR Am J Roentgenol 2001; 177:77-84. [PMID: 11418402 DOI: 10.2214/ajr.177.1.1770077] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence and radiologic features of postoperative complications after Swedish laparoscopic adjustable gastric banding surgery and to emphasize the role of the radiologist in the follow-up of those patients, especially in the treatment of complications. MATERIALS AND METHODS We reviewed the radiologic findings in 218 consecutive morbidly obese patients after laparoscopic placement of the Swedish gastric banding system. Radiographic studies of the stomach (obtained with liquid barium sulfate suspension) were performed before surgery and 1 month after band placement in every patient. Additional studies in symptomatic patients were performed when needed. RESULTS Surgical complications found included misplacement of the band (five patients, 2.3%), slippage of the band (17 patients, 7.8%), and pouch enlargement (eight patients, 3.7%). Technical problems encountered were inversion of the access port (three patients, 1.4%), leakage of the device (two patients, 0.9%), and spontaneous decrease of the stoma size caused by gastritis (seven patients, 3.2%) or the hyperosmolar properties of the IV contrast material (12 patients, 5.5%). Intrinsic abnormalities of gastroesophageal tract seen included trapping of food in the stoma (four patients, 1.8%) and esophagitis (11 patients, 5%). CONCLUSION Although, according to the available data, the gastric banding operation with the Swedish band meets the criteria of a low-risk laparoscopic alternative treatment of morbid obesity, the radiologic appearances of various complications may be seen on the images of patients who have undergone the procedure. The radiologist plays a key role in the early detection of those complications and treatment of specific abnormalities.
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Affiliation(s)
- K J Mortelé
- Department of Radiology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
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33
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Lissau I, Rasmussen NK, Hesse NM, Hesse U. Social differences in illness and health-related exclusion from the labour market in Denmark from 1987 to 1994. Scand J Public Health Suppl 2001; 55:19-30. [PMID: 11482793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE The objectives were first to analyse differences in long-standing illness, limiting long-standing illness, and perceived health as below good in relation to different indicators of social class over time; and secondly to analyse the association of long-standing illness, educational level, age, and gender with employment status. SUBJECTS AND METHODS Self-reported information on illness, educational level, employment status, and occupational class was obtained in two nationally representative Danish health interview surveys in 1987 (n=4753) and 1994 (n=4668). RESULTS There was a marked increase in long-standing illness from 1987 (33%) to 1994 (38%), especially among women with higher education (13% in 1987 to 26% in 1994). The prevalence of perceived health below good was unchanged (c. 20%) during the same period. Among employed men in 1987 the lowest prevalence of long-standing illness was seen in upper salaried employees (21%) and the highest in skilled workers (35%). In 1994, the difference had diminished and the prevalence rates for the same classes were 28% and 29%, respectively. Among employed women, a similar pattern was seen. The lowest rate in 1987 was seen among self-employed with subordinates (15%) and the highest in self-employed without subordinates (28%). In 1994, the difference was reduced with prevalence rates of 23% and 32%, respectively. In addition, substantial differences in health status between groups with different educational backgrounds were found. The proportion of the population with long-standing illnesses was clearly higher in the group with low education compared with the group with high education. A similar social gradient was found for perceived health as below good. Those with the highest odds ratio of being a disability pensioner are women with long-standing illness, only basic education, and above 55 years of age. CONCLUSION In conclusion, the study showed that the prevalence of long-standing illness increased from the mid-1980s to the mid-1990s, whereas perceived health below good was unchanged. In 1994, there was a remarkable difference in health between employed and non-employed people, indicating a health-related exclusion from the labour market. This may explain why, in 1994, smaller occupational class differences were found in the prevalence of long-standing illness among employed people compared with the findings in 1987, whereas the health differences remained in the different educational groups. Women above 54 years of age with basic education only and long-standing illness have the highest odds ratio of permanent exclusion from the labour market.
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Affiliation(s)
- I Lissau
- National Institute of Public Health, Copenhagen.
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34
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Van Vlem B, Vermassen F, Hesse U, Van der Vennet M, Vanholder R. [Aspects of kidney donation by living donors]. Acta Clin Belg 2001; 56:17-20. [PMID: 11307478 DOI: 10.1179/acb.2001.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- B Van Vlem
- Renal Division, University Hospital Ghent, De Pintelaan 185-B-9000 Gent
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35
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Lissau I, Rasmussen NK, Hesse NM, Hesse U. Social differences in illness and health-related exclusion from the labour market in Denmark from 1987 to 1994. Scand J Public Health 2001. [DOI: 10.1080/140349401750285719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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36
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Affiliation(s)
- WP Ceelen
- Department of Abdominal Surgery; Ghent University Hospital; De Pintelaan 185; B-9000 Ghent; Belgium
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37
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Abstract
BACKGROUND Surgical treatment of intra-abdominal cancer is often followed by local recurrence. In a subgroup of patients, local recurrence is the sole site of disease, reflecting biologically low-grade malignancy. These patients might, therefore, benefit from local treatment. Recently, debulking surgery followed by hyperthermic chemoperfusion has been proposed in the treatment of locally advanced or recurrent intra-abdominal cancer. This paper reviews the rationale and assesses the currently accepted indications for and results of this novel treatment. METHODS A systematic web-based literature review was performed. Information was also retrieved from handbooks, congress abstracts and ongoing clinical trials. RESULTS A growing body of experimental evidence supports the use of hyperthermia combined with chemotherapy as an adjunct to cytoreductive surgery. Randomized clinical trials are available to support its use in the treatment and prevention of peritoneal carcinomatosis following resection of pathological tumour stage pT3 or pT4 gastric cancer; several other phase III trials are ongoing. Numerous phase I and II trials have reported good results for various other indications, with acceptable morbidity and mortality rates. Case mix, limited patient numbers and absence of a standardized technique are, however, a drawback in many of these series. CONCLUSION For a subgroup of patients with peritoneal cancer without distant disease, debulking surgery followed by hyperthermic chemoperfusion may offer a chance of cure or palliation in this otherwise untreatable condition. This novel therapy should, however, be considered experimental until further results from ongoing phase III trials become available.
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Affiliation(s)
- W P Ceelen
- Department of Abdominal Surgery 2P4, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
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38
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Pattyn P, Cardon A, Monstrey S, Hesse U, de Hemptinne B. Unilateral pudendal thigh flap in the treatment of complex rectovaginal fistula. Acta Chir Belg 2000; 100:132-3. [PMID: 11280178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- P Pattyn
- Department of General Surgery, University Hospital Ghent, Belgium
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39
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Govaere F, Mortelé KJ, Hesse U, Van der Meersch F, Kunnen M. Giant intraluminal duodenal diverticulum: conventional barium study and computed tomography findings. JBR-BTR 2000; 83:71-2. [PMID: 10859900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A case is reported of an asymptomatic intraluminal duodenal diverticulum (IDD) in a 21-year-old male patient with associated congenital abnormalities. During endoscopy for anemia an ostium in the duodenum was visualized, presumed to be the entry to an extraduodenal diverticulum. Upper gastrointestinal (UGI) barium examination showed, however, findings compatible with IDD. This diagnosis was supported by an abdominal computed tomographic (CT) examination. Surgical resection revealed a web in D2 with coexistent large IDD.
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Affiliation(s)
- F Govaere
- Department of Radiology, University Hospital Gent, Belgium
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Fan YD, Leroux-Roels G, Praet M, Hesse U, de Hemptinne B. Evaluation of graft viability in heterotopic auxiliary liver transplantation in the rat. J INVEST SURG 1999; 12:327-34. [PMID: 10630396 DOI: 10.1080/089419399272313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In the rat model of heterotopic auxiliary liver transplantation, the coexistence of the engrafted liver and the recipient's native liver makes it difficult to evaluate the posttransplant graft viability. In this study, auxiliary liver transplantation was performed in Wistar rats, in which the recipient's native liver was handicapped with a 68% partial hepatectomy and a common bile duct ligation. Serum biochemistry of the liver was analyzed and compared with that of the selected control group. The surgical handicap of the liver showed severe damaging effects: the handicapped native livers appeared atrophic at autopsy, and no long-term animal survival could be achieved without an auxiliary liver transplantation. As the engrafted liver corrected the cholestasis of the handicapped native liver, significant differences of serum biochemistry were found between the transplanted group and the control group: for bilirubin concentration and gamma glutamyl transferase activity from postoperative day 3 to 28 (p < .05); for alkaline phosphatase on days 3, 7, 14, and 28 (p < .05); for alanine aminotransferase activity on days 3 and 14 (p < .05); and for aspartate aminotransferase activity on day 14 (p < .05). The efficiency to induce hepatic failure and to hamper its regeneration capacity in the native liver makes animal survival and liver biology as reliable parameters to evaluate the posttransplant graft viability in this rat model.
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Affiliation(s)
- Y D Fan
- Department of Surgery, University Hospital of Ghent, Belgium.
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41
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Cardon A, Berrevoet F, Pattyn P, Hesse U, de Hemptinne B. Alternative technique for creation of a proximal gastric pouch in laparoscopic adjustable silicone gastric banding. Obes Surg 1999; 9:410-2. [PMID: 10484304 DOI: 10.1381/096089299765553043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Laparoscopic adjustable silicone gastric banding (LASGB) has become a widely used procedure for the treatment of morbid obesity. The original operation, as described by Kuzmak, has been subjected to modifications. Construction of a proximal gastric pouch is an important part of the operation. Until now, we used the technique of Niville. Since this was often complicated by gastric bleeding and/or serosal tears, we developed a new technique to construct a pouch. SURGICAL TECHNIQUE A new technique, using a thread previously fixed to that portion of the fundus that will be used to construct the pouch, is described. CONCLUSION A safe and easy adaptation of the LASGB technique is proposed to create the gastric pouch.
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Affiliation(s)
- A Cardon
- Department of General and Digestive Surgery, University Hospital Ghent, Belgium.
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42
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Affiliation(s)
- A S Uch
- Johann Wolfgang Goethe University, Department of Pharmaceutical Technology, Biocenter, Frankfurt/Main, Germany
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43
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Vanholder R, Heering P, Loo AV, Biesen WV, Lambert MC, Hesse U, Vennet MV, Grabensee B, Lameire N. Reduced incidence of acute renal graft failure in patients treated with peritoneal dialysis compared with hemodialysis. Am J Kidney Dis 1999; 33:934-40. [PMID: 10213652 DOI: 10.1016/s0272-6386(99)70429-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In a case-control study performed in two centers, the incidence of delayed graft function (DGF), defined as the necessity to perform dialysis after transplantation, was analyzed according to prior treatment with continuous ambulatory peritoneal dialysis (CAPD; n = 117) or hemodialysis (HD; n = 117). The patients were matched for age, sex, HLA compatibility, and cold ischemia time. The patients were followed up for 6 months to monitor renal graft function (serum creatinine [Screa] level immediately after transplantation, at 6 weeks, at 6 months) and postoperative complications. No significant differences were found in the warm ischemia time of the graft or previous time on dialysis. DGF occurred in 27 CAPD patients (23.1%) and 59 HD patients (50.4%; P < 0.0001). The decline in Screa level after transplantation was faster in CAPD patients: the time for Screa level to decrease 50% after transplantation (T1/2Screa) was reached after 5.0 +/- 6.6 days in the CAPD group compared with 9.8 +/- 11.5 days in the HD group (P < 0.0001). A greater number of patients developed acute rejection episodes in the CAPD group (P < 0. 05), but Screa level was not different in the two groups 6 weeks and 6 months after transplantation. No differences were observed in infectious or surgical complications. This study shows that immediate renal function after transplantation is better in CAPD patients and that peritoneal dialysis should be considered as a first choice for pretransplantation therapeutic modality.
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Affiliation(s)
- R Vanholder
- Renal Division, University Hospital, Gent, Belgium.
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44
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Affiliation(s)
- A Cardon
- Department of General Surgery, University Hospital Ghent, Ghent, Belgium
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45
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Hesse U, Troisi R, Pattyn P, Mortier E, Decruyenaere J, de Hemptinne B. Successful sequential orthotopic liver transplantation in the treatment of familial amyloidotic polyneuropathy. Transpl Int 1998; 10:478-9. [PMID: 9428125 DOI: 10.1007/s001470050091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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46
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Hesse U, Troisi R, Mortier E, Decruyenaere J, Hemptinne B. Successful sequential orthotopic liver transplantation in the treatment of familial amyloidotic polyneuropathy. Transpl Int 1997. [DOI: 10.1111/j.1432-2277.1997.tb00729.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Troisi R, Hesse U, Pattyn P, Praet M, Defreyne L, Elewaut A, Berrevoet F, De Hemptinne B. Histological assessment of combined chemoembolization and alcoholization [corrected] for hepatocellular carcinoma in cirrhotic patients. Transplant Proc 1997; 29:2412-3. [PMID: 9270787 DOI: 10.1016/s0041-1345(97)00426-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R Troisi
- Department of Pathology, University Hospital Gent, Belgium
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48
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Tielemans C, Decruyenaer J, Kerremans H, Pattyn P, Hesse U, Hemptinne B. The impact of donor age on graft outcome after liver transplantation. Transpl Int 1996. [DOI: 10.1111/j.1432-2277.1996.tb01665.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Pattyn P, De Waele J, Cleyman S, Hesse U, de Hemptinne B. Surgical management of diverticulitis. A two year retrospective study. Acta Gastroenterol Belg 1996; 59:155-8. [PMID: 8903065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- P Pattyn
- Department of Surgery, University Hospital Ghent, Belgium
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50
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Ceelen W, Praet M, Villeirs G, Defreyne L, Pattijn P, Hesse U, de Hemptinne B. Initial experience with the use of preoperative transarterial chemoembolization in the treatment of liver metastasis. Acta Chir Belg 1996; 96:37-40. [PMID: 8629387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We retrospectively evaluated the influence of preoperative Transarterial Chemoembolization (TAE) on technique and complications, tumour histology, and disease-free survival after surgery for hepatic metastasis. In a 2-year period, a total of 23 patients were treated. In a first group of 14 patients, preoperative TAE was performed; in a second group of 9 patients only surgical resection was done. Extensive tumour necrosis was seen in the majority of patients treated with TAE; in tumours with an important fibrotic component, embolization was less effective. No significant effect was seen on operating time, transfusion requirement or perioperative complication rate. In the group of patients who underwent TAE, survival rate was 93% after a mean follow-up period of 15.5 months (SD: 12.5); recurrence was seen in only 8% of the survivors. In the second group, however, mortality was 33% after a median follow-up of 17.5 months (SD: 10), and recurrence was present in 66.7% of the survivors. These results indicate that preoperative TAE reduces the recurrence rate in the first postoperative year. Thereby survival may be improved in patients with resectable metastatic liver cancer.
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Affiliation(s)
- W Ceelen
- Department of Surgery, Gent University Hospital, Belgium
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