Haubrich C.,RWTH Aachen |
Pies K.,RWTH Aachen |
Dafotakis M.,RWTH Aachen |
Block F.,Helios Kliniken Schwerin |
And 2 more authors.
Ultrasound in Medicine and Biology | Year: 2010
Despite of precipitous blood pressure falls in Parkinson's Disease (PD) patients, they may not experience syncope or postural complaints. Can cerebral blood flow regulation explain why orthostatic hypotension (OH) has often no accompanying symptoms? In patients with PD and OH (18 asymptomatic; 8 symptomatic), arterial blood pressure (ABP) as well as Doppler-detected cerebral blood flow velocity (CBFV) in middle and posterior cerebral arteries (MCA and PCA) were monitored during head-up tilt and compared with 25 controls and eight non-PD-OH patients. Analysis included the transfer function between slow spontaneous pressure and flow-oscillations. ABP and CBFV were maintained at significantly higher levels in asymptomatic than symptomatic PD-OH (ABP: 85.7 ± 10.5 vs. 66.9 ± 12.5%; MCA-FV: 83.3 ± 9.3 vs. 66.1 ± 6.8%; PCA-FV: 84.4 ± 12.2 vs. 65.9 ± 9.3% of supine). When orthostatic complaints occurred, CBFV depended directly on ABP changes (MCA r2 = 0.64; PCA r2 = 0.62; both p < 0.05). Despite of a tilt-induced blood pressure instability in PD-OH, the transfer function parameters did not differ from normal [phase: MCA: 46.6 ± 20.5°; PCA 39.2 ± 28.8°, gain: MCA 2.0 ± 0.7; PCA 2.9 ± 1.6)]. Results showed a normal autoregulatory response to downward blood pressure shifts in PD. Moreover, orthostatic blood pressure instability is compensated equally sufficient in anterior and posterior parts of cerebral circulation. Whether in PD patients, OH becomes symptomatic rather seems to depend on blood pressure falling below the autoregulated range. (E-mail: Christina.Haubrich@t-online.de). © 2010 World Federation for Ultrasound in Medicine & Biology.
Compston J.E.,University of Cambridge |
Flahive J.,University of Massachusetts Medical School |
Hosmer D.W.,University of Massachusetts Amherst |
Watts N.B.,Mercy Health Osteoporosis and Bone Health Services |
And 21 more authors.
Journal of Bone and Mineral Research | Year: 2014
Low body mass index (BMI) is a well-established risk factor for fracture in postmenopausal women. Height and obesity have also been associated with increased fracture risk at some sites. We investigated the relationships of weight, BMI, and height with incident clinical fracture in a practice-based cohort of postmenopausal women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). Data were collected at baseline and at 1, 2, and 3 years. For hip, spine, wrist, pelvis, rib, upper arm/shoulder, clavicle, ankle, lower leg, and upper leg fractures, we modeled the time to incident self-reported fracture over a 3-year period using the Cox proportional hazards model and fitted the best linear or nonlinear models containing height, weight, and BMI. Of 52,939 women, 3628 (6.9%) reported an incident clinical fracture during the 3-year follow-up period. Linear BMI showed a significant inverse association with hip, clinical spine, and wrist fractures: adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) per increase of 5 kg/m2 were 0.80 (0.71-0.90), 0.83 (0.76-0.92), and 0.88 (0.83-0.94), respectively (all p < 0.001). For ankle fractures, linear weight showed a significant positive association: adjusted HR per 5-kg increase 1.05 (1.02-1.07) (p < 0.001). For upper arm/shoulder and clavicle fractures, only linear height was significantly associated: adjusted HRs per 10-cm increase were 0.85 (0.75-0.97) (p = 0.02) and 0.73 (0.57-0.92) (p = 0.009), respectively. For pelvic and rib fractures, the best models were for nonlinear BMI or weight (p = 0.05 and 0.03, respectively), with inverse associations at low BMI/body weight and positive associations at high values. These data demonstrate that the relationships between fracture and weight, BMI, and height are site-specific. The different associations may be mediated, at least in part, by effects on bone mineral density, bone structure and geometry, and patterns of falling. © 2014 American Society for Bone and Mineral Research. © 2014 American Society for Bone and Mineral Research.
Otto M.,University of Mannheim |
Elrefai M.,University of Mannheim |
Krammer J.,University of Mannheim |
Weiss C.,University of Heidelberg |
And 2 more authors.
Obesity Surgery | Year: 2016
Background: Bariatric surgery is a safe and established treatment option of morbid obesity. Mere percentage of excess weight loss (%EWL) should not be the only goal of treatment. Methods: One hundred seventy-three obese patients were included in the study. They underwent either Roux-en-Y gastric bypass (RYGB; n = 127, mean body mass index (BMI) 45.7 ± 5.7 kg/m2) or sleeve gastrectomy (SG; n = 46, mean BMI 55.9 ± 7.8 kg/m2) for weight reduction. Body weight and body composition were assessed periodically by bioelectrical impedance analysis. Results: After 1 year of observation, %EWL was 62.9 ± 18.0 % in RYGB and 52.3 ± 15.0 % in SG (p = 0.0024). Body fat was reduced in both procedures with a slight preference for SG, and lean body mass was better preserved in the RYGB group. Due to significant differences in the initial BMI between the two groups, an analysis of covariance was performed, which demonstrated no significant differences in the %EWL as well as in the other parameters of body composition 1 year after surgery. Using percentage of total weight loss to evaluate the outcomes between the two procedures, no significant difference was found (31.7 ± 8.4 % in RYGB and 30.5 ± 7.6 % in SG patients, p > 0.4). Conclusions: Excess weight loss is highly influenced by the initial BMI. Total weight loss seems to be a better measurement tool abolishing initial weight differences. SG and RYGB do not differ in terms of body composition and weight loss 1 year after surgery. © 2015, Springer Science+Business Media New York.
Fitzgerald G.,University of Massachusetts Medical School |
Boonen S.,Catholic University of Leuven |
Compston J.E.,University of Cambridge |
Pfeilschifter J.,Alfried Krupp Krankenhaus |
And 4 more authors.
Journal of Bone and Mineral Research | Year: 2012
The purposes of this study were to examine fracture risk profiles at specific bone sites, and to understand why model discrimination using clinical risk factors is generally better in hip fracture models than in models that combine hip with other bones. Using 3-year data from the GLOW study (54,229 women with more than 4400 total fractures), we present Cox regression model results for 10 individual fracture sites, for both any and first-time fracture, among women aged ≥55 years. Advanced age is the strongest risk factor in hip (hazard ratio [HR] = 2.3 per 10-year increase), pelvis (HR = 1.8), upper leg (HR = 1.8), and clavicle (HR = 1.7) models. Age has a weaker association with wrist (HR = 1.1), rib (HR = 1.2), lower leg (not statistically significant), and ankle (HR = 0.81) fractures. Greater weight is associated with reduced risk for hip, pelvis, spine, and wrist, but higher risk for first lower leg and ankle fractures. Prior fracture of the same bone, although significant in nine of 10 models, is most strongly associated with spine (HR = 6.6) and rib (HR = 4.8) fractures. Past falls are important in all but spine models. Model c indices are ≥0.71 for hip, pelvis, upper leg, spine, clavicle, and rib, but ≤0.66 for upper arm/shoulder, lower leg, wrist, and ankle fractures. The c index for combining hip, spine, upper arm, and wrist (major fracture) is 0.67. First-time fracture models have c indices ranging from 0.59 for wrist to 0.78 for hip and pelvis. The c index for first-time major fracture is 0.63. In conclusion, substantial differences in risk profiles exist among the 10 bones considered. © 2012 American Society for Bone and Mineral Research.
Schneider U.,Arthro Nova Clinic |
Rackwitz L.,University of Würzburg |
Andereya S.,RWTH Aachen |
Siebenlist S.,University of Würzburg |
And 6 more authors.
American Journal of Sports Medicine | Year: 2011
Background: The Cartilage Regeneration System (CaReS) is a novel matrix-associated autologous chondrocyte implantation (ACI) technique for the treatment of chondral and osteochondral lesions (Outerbridge grades III and IV). For this technology, no expansion of the chondrocytes in a monolayer culture is needed, and a homogeneous cell distribution within the gel is guaranteed.Purpose: To report a prospective multicenter study of matrix-associated ACI of the knee using a new type I collagen hydrogel (CaReS).Study Design: Case series; Level of evidence, 4.Methods: From 2003 to 2008, 116 patients (49 women and 67 men; mean age, 32.5 ± 8.9 years) had CaReS implantation of the knee in 9 different centers. On the basis of the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package 2000, the International Knee Documentation Committee (IKDC) score, pain score (visual analog scale [VAS]), SF-36 score, overall treatment satisfaction and the IKDC functional status were evaluated. Patient follow-up was performed at 3, 6, and 12 months after surgery and annually thereafter. Mean follow-up was 30.2 ± 17.4 months (range, 12-60 months). There were 67 defects of the medial condyle, 14 of the lateral, 22 of the patella/trochlea, and 3 of the tibial plateau, and 10 patients had 2 lesions. The mean defect size was 5.4 ± 2.4 cm2. Thirty percent of the defects were <4 cm2 and 70% were >4 cm2.Results: The IKDC score improved significantly from 42.4 ± 13.8 preoperatively to 70.5 ± 18.7 (P <.001) at latest follow-up. Global pain level significantly decreased (P <.001) from 6.7 ± 2.2 preoperatively to 3.2 ± 3.1 at latest follow-up. There also was a significant increase of both components of the SF-36 score. The overall treatment satisfaction was judged as very good or good in 88% by the surgeon and 80% by the patient. The IKDC functional knee status was grade I in 23.4%, II in 56.3%, III in 17.2%, and IV in 3.1% of the patients.Conclusion: Matrix-associated ACI employing the CaReS technology for the treatment of chondral or osteochondral defects of the knee is a safe and clinically effective treatment that yields significant functional improvement and improvement in pain level. However, further investigation is necessary to determine the long-term viability and clinical outcome of this procedure. © 2011 American Orthopaedic Society for Sports Medicine.
Kaestner S.,Klinikum Kassel |
Dimitriou I.,Alfried Krupp Krankenhaus
Journal of Neurological Surgery, Part A: Central European Neurosurgery | Year: 2013
Objective Posthemorrhagic hydrocephalus (pHC) is a serious complication following subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Besides known clinical predictors, different cytokines have drawn attention to the development of chronic hydrocephalus. Transforming growth factor (TGF) β1 and TGF β2 are involved in fibrogenesis, scar formation, cell survival, and tissue differentiation and may play a role in the occurrence of pHC. TGF β1 is stored in platelets in large amount and is released in the cerebrospinal fluid (CSF) after SAH and IVH. Both TGF β1 and TGF β2 can be expressed by various intracranial cells. Methods TGF β1 and β2 were measured in CSF and blood samples of 42 patients with SAH or IVH with acute hydrocephalus during the first 10 days after ictus. Furthermore, albumin was measured in CSF as an indicator for the amount of blood. Patients were categorized as developing pHC requiring shunt treatment or not-developing pHC within 6 months. Results After adjusting for age, SAH resulted significantly more often in pHC than did IVH. Plasma levels of TGF β1 showed a marked increase over time, whereas CSF levels of TGF β1 constantly decreased. The time course of TGF β1 and albumin in CSF was paralleled and did not correlate with the development of shunt dependent pHC. Also, TGF β1 plasma concentrations did not correlate with shunt dependent pHC. TGF β2 concentrations in plasma showed stable values over time without any variations. TGF β2 in CSF described a parabolic course with a peak at day 6 after ictus. No correlation was found concerning TGF β2 in plasma or CSF and shunt dependent pHC. Conclusion TGF β1 in CSF is derived by platelets from the cisternal or ventricular clot. TGF β2 in CSF is derived as a general reaction of traumatized brain tissue. These data do not confirm a crucial role of TGF β1 and TGF β2 release in the development of pHC. © 2013 by Thieme Medical Publishers, Inc.
Niedergethmann M.,Alfried Krupp Krankenhaus |
Nephuth O.,Alfried Krupp Krankenhaus |
Hasenberg T.,Alfried Krupp Krankenhaus
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen | Year: 2014
Chronic pancreatitis can lead to intractable pain, pancreatic duct obstruction, duodenal stenosis and vascular compression syndromes. Surgical interventions can effectively treat these symptoms. Endoscopic procedures are principally possible but rarely lead to a lasting relief of symptoms. The type of surgical intervention should be selected depending on the morphological changes of the pancreas. Up to 90 % of patients present with an inflammatory mass in the head of the pancreas. In these cases a duodenum-preserving pancreatic head resection (DPPHR) modified according to Beger, Frey or Berne should be preferred. These procedures are comparable in terms of the postoperative course. The Kausch-Whipple procedure is indicated in all cases where malignancy is suspected. According to the current literature, patients with an inflammatory mass in the pancreatic head benefit more from a DPPHR than a Kausch-Whipple procedure. Drainage procedures may be useful for the treatment of pseudocysts or in rare situations with purely ductal obstructions. The decision as to which procedure is appropriate should be taken in an interdisciplinary cooperation between gastroenterologists and surgeons.
Betzler M.,Alfried Krupp Krankenhaus
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2010
In the context of the controversy regarding the appropriate management of colon diverticulitis without generalised peritonitis conservative or operative a review of the literature was performed. The progress in diagnostic and therapeutic measures has led to a change in the therapeutic approach during the last 10years. Because of the lack of randomised controlled trials in patients with diverticulitis (without generalised peritonitis) comparing medical and surgical treatments, there are still several unanswered questions, such as whether and when to operate and what the recurrence rate is, especially after medical treatment. The therapeutic management should be oriented to the individual symptoms, the comorbidity and the age of the patients. © Georg Thieme Verlag KG Stuttgart.
Hach C.E.,Alfried Krupp Krankenhaus |
Krude J.,Alfried Krupp Krankenhaus |
Reitz A.,KontinenzZentrum Hirslanden |
Reiter M.,Goethe University Frankfurt |
And 3 more authors.
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2015
Introduction and hypothesis: Robotic assistance simplifies laparoscopic procedures. We hypothesize that robot-assisted sacrocolpopexy is a rapid and safe procedure with satisfying short-term and midterm functional results. Methods: After informed consent, we enrolled 101 consecutive patients undergoing sacrocolpopexy at Alfried Krupp Hospital, Essen, Germany. After a median follow-up of 22 months, we assessed midterm functional results as the primary endpoint. Secondary endpoints included surgical duration, blood loss, intraoperative complications, and postoperative complications. We described frequencies as counts (percent) and continuous data as median [interquartile range (Q1–Q3)] or mean [standard deviation (SD)], as appropriate. Results: We enrolled 101 patients. The mean age was 69 years (SD 11); 75 women (74.3 %) had undergone previous abdominal surgery. Among the patients, 95 (94.1 %) presented with anterior vaginal wall prolapse Baden-Walker grade 2–3, 74 (73.3 %) vaginal vault prolapse, and 9 (8.9 %) concomitant rectocele. Fifty (50 %) patients underwent a modified Burch procedure in addition to sacrocolpopexy. The median surgical duration was 96 min (Q1–Q3 83–130). There were six (5.9 %) minor intraoperative complications but no conversions to open surgery. Postoperatively, we registered five (4.9 %) Clavien-Dindo grade I complications, three (3.0 %) grade II complications, and one (1.0 %) grade III complication. After a median follow-up of 22 months (Q1–Q3 12–49), the patients reported significant decreased impact of pelvic organ prolapse (POP) on quality of life as well as bother resulting from POP symptoms. The overall success rate, defined as none or minor impact of POP on quality of life, was 75 %. Conclusions: In this single-surgeon study, robot-assisted sacrocolpopexy was a safe and rapidly performed procedure that achieved good medium-term functional results. © 2015, The International Urogynecological Association.
Kurre W.,Alfried Krupp Krankenhaus |
Chapot R.,Alfried Krupp Krankenhaus |
Du Mesnil De Rochemont R.,Goethe University Frankfurt |
Berkefeld J.,Goethe University Frankfurt
Neuroradiology | Year: 2010
Intracranial stenting is increasingly used as an add-on to medical therapy despite the fact that the overall clinical benefit remains a matter of debate, since we lack results of randomized trials. Decision making on interventional treatment is made on the grounds of the anticipated risk of stroke with antiplatelet medication on one hand and on the experience with stent treatment based on data from case series and registries on the other hand. This review will summarize the current knowledge on both topics serving as the fundament of patient selection for intracranial stenting. A second objective is to highlight some specific problems that are encountered when treating patients interventionally. Procedure-related complication rates and rates of in stent stenoses are still too high to be confident that endovascular treatment is superior to medical therapy of symptomatic stenoses. Optimization of patient selection criteria, stent technology, and periprocedural management are necessary to become undoubtedly competitive with antiplatelet therapy. With the current stage of development, interventional treatment of intracranial stenoses should be confined to specialized centers with a high expertise in neurovascular procedures. © 2010 Springer-Verlag.