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Hamburg, Germany

Background: (Analgo-) sedations for diagnostic and/or therapeutic procedures form part of the daily clinical routine for pediatric patients. National and international medical specialist associations have published guidelines indicating the general conditions of these procedures, yet the recommendations are not always consistent. Since anesthesiological activities are increasingly performed by nonanesthesiologists at our hospital, the Pediatric Clinic of the University Hospital of Saarland considered it necessary to develop an in-house standard. Material and methods: On the basis of a standard dating back to 2005, which was developed and clinically applied by two of the authors of this article, we created our “Homburg standard”, taking into account the guidelines of the specialist associations and the international literature. This standard covers patient information, the consumption of food and drink, monitoring before, during and after the sedation as well as documentation. We will present the process of how our standard was established by analyzing protocols of the “old” standard—applied for a period of 18 months—and the application of our standard to two new studies performed at our hospital. Results: In total, 159 sedations of the 18-month reference period could be evaluated; the two studies accounted for 72 sedations for diagnostic and/or interventional cardiac catheter examinations and 40 sedations for outpatient TEE examinations. None of the procedures was associated with complications endangering the safety of a patient. Whereas the documentation of the two studies was nearly complete, it varied considerably in the case of the 159 sedations, depending on how much time had passed since the most recent training. Conclusion: Our standard is a practicable and safe method of performing sedations and analgosedations in pediatric patients. In addition, this standard allows clinical studies to be carried out and evaluated, taking into account certain organizational measures. The development of a specific guideline by the DGKJ and/or the GNPI is considered desirable. © 2015, Springer-Verlag Wien. Source


Konig K.,JenLab GmbH | Konig K.,Saarland University | Weinigel M.,JenLab GmbH | Buckle R.,JenLab GmbH | And 6 more authors.
Progress in Biomedical Optics and Imaging - Proceedings of SPIE | Year: 2015

Certified clinical multiphoton tomographs are employed to perform rapid label-free high-resolution in vivo histology. Novel tomographs include a flexible 360° scan head attached to a mechano-optical arm for autofluorescence and SHG imaging as well as rigid two-photon GRIN microendoscope. Mitochondrial fluorescent NAD(P)H, fluorescent elastin, keratin, and melanin as well as SHG-active collagen can be imaged with submicron resolution in human skin. The system was employed to study the healing of chronic wounds (venous leg ulcer) and acute wounds (curettage of actinic or seborrheic keratosis) on a subcellular level. Furthermore, a flexible sterile foil as interface between wound and focusing optic was tested. Source


Reich-Schupke S.,Ruhr University Bochum | Reich-Schupke S.,Artemed Vein Competence Center | Doerler M.,Ruhr University Bochum | Wollina U.,Academic Teaching Hospital Dresden Friedrichstadt | And 5 more authors.
JDDG - Journal of the German Society of Dermatology | Year: 2015

Background Secondary squamous cell carcinoma (SCC) is a rare complication of chronic venous leg ulcers. So far, little is known about its pathophysiology and clinical behavior. Initiated by the working group "Wound Healing" (AGW) of the German Society of Dermatology (DDG), it is the objective of the current Marjolin registry to collect cases of SCC arising in venous ulcers, in order to evaluate diagnostic characteristics. Patients and Methods All members of the AGW received questionnaires inquiring about basic patient data, ulcer characteristics, and therapy conducted. Results From 2010 to 2013, 30 patients (20 women, 10 men) from six tertiary wound care centers were registered. Mean age was 76.17 years. The average duration of venous leg ulcers prior to SCC diagnosis was 15.93 years. Suspicious wound characteristics primarily included: pain (n = 3), therapy resistance (n = 27), and fetor (n = 12) as well as clinical appearance (n = 10) with atypical morphology, nodular wound bed, and hypergranulation. Conclusions Atypical morphology or changes in appearance as well as therapy resistance despite optimal care (6-12 weeks) should prompt physicians to take spindle-shaped, if necessary multiple and serial, biopsies. Primary risk factors for malignant transformation include patient age and ulcer duration. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd. Source


Foelster Holst R.,Clinic for Dermatology | Reitamo S.,Iho ja Allergiasairaala | Yankova R.,Dermatology and Venereology Clinic | Worm M.,Charite - Medical University of Berlin | And 8 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2010

Background: There is evidence that excessive protease activity in the skin is an important factor in the development of atopic dermatitis. SRD44 is a topically formulated novel protease inhibitor that selectively inhibits Staphylococcal-derived aureolysin and matrix metalloproteinases (MMPs). Methods: This was a double-blind, vehicle-controlled randomized trial conducted in thirteen hospital dermatology outpatient clinics in Germany (9), Bulgaria (3) and Finland (1). Ninety-three out of 103 screened adult subjects with confirmed atopic dermatitis affecting &20% of body surface area, with an IGA score of 2 or 3 at randomization were randomized following a washout period to either SRD441 ointment or matching vehicle twice daily for 28days. The primary efficacy endpoint was the clearance of Atopic dermatitis (AD score of 0 or 1 IGA) at Day 21. Secondary endpoints included measures of SCORing Atopic Dermatitis, pruritus self-assessment, rescue medication use and occurrence of new exacerbations. A range of safety and tolerance endpoints were included. Results: There were no significant treatment differences in IGA success rates at Day 21 (SRD441 ointment, 11.1%; vehicle ointment, 12.5%; P=1.000). Evaluation of secondary efficacy variables revealed no clinical or important statistical differences between treatment groups. Eighteen subjects (19.4%) discontinued the study drug because of an AE (seven subjects [15.6%] in the SRD441 group and 11 subjects [22.9%] in the vehicle group). Twenty-seven subjects (60.0%) in the SRD441 group and 34 subjects (70.8%) in the vehicle group reported an adverse event (AE). Conclusions: SRD441 ointment did not demonstrate efficacy in the treatment of atopic dermatitis raising questions on the effectiveness of MMPs as a target for the treatment of atopic dermatitis. NCT00882245. © 2010 John Wiley ;amp Sons A/S. Source


Schubert-Fritschle G.,Ludwig Maximilians University of Munich | Schlesinger-Raab A.,Ludwig Maximilians University of Munich | Hein R.,TU Munich | Stolz W.,Clinic for Dermatology | And 3 more authors.
International Journal of Dermatology | Year: 2013

Background Incidences of malignant melanoma continue to increase in fair-skinned populations. At least 80% of patients are diagnosed with localized disease and can expect a 5-year relative survival rate of >90%. Given that the median age at diagnosis of malignant melanoma is 59years, many patients already suffer chronic diseases when they are confronted with cancer. Objectives The aim of this study was to analyze the effect of additional chronic diseases on health-related quality of life (QoL) in a population-based cohort of melanoma patients twoyears after presumably curative treatment. Methods In 2003-2004, 1085 patients with localized malignant melanoma were recruited from the population-based Munich Cancer Registry to answer validated QoL questionnaires. Information about comorbidities was also obtained. Factors predicting QoL were analyzed using multivariate logistic regression models. Results A total of 781 patients (72%) returned completed questionnaires, of which 664 (61%) could be included in the analyses. Quality of life scores and differences in subgroups (e.g. sex and age) were essentially similar to those in the general population. Age, number of comorbidities, and several chronic diseases (e.g. heart and kidney disease, diabetes, former depression) were the strongest predicting factors and influenced almost every aspect of QoL. Conclusions Localized malignant melanoma does not worsen QoL per se, compared with QoL in the general population. Comorbidities have similar effects on QoL in malignant melanoma patients as they do in the general population. Therefore, cohorts of patients with localized malignant melanoma can represent a basis for comparisons with other cohorts of cancer patients to determine the respective impacts of cancer-related and non-cancer-related factors on QoL. © 2013 The International Society of Dermatology. Source

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