Dr. Horst Schmidt Klinik

Wiesbaden, Germany

Dr. Horst Schmidt Klinik

Wiesbaden, Germany
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Ambrose C.S.,MedImmune LLC | Wu X.,MedImmune LLC | Knuf M.,Dr. Horst Schmidt Klinik | Knuf M.,University Mainz | Wutzler P.,Friedrich - Schiller University of Jena
Vaccine | Year: 2012

Background: Nine randomized controlled clinical trials, including approximately 26,000 children aged 6 months to 17 years, have evaluated the efficacy of live attenuated influenza vaccine (LAIV) against culture-confirmed influenza illness compared with placebo or trivalent inactivated influenza vaccine (TIV). The objective of the current analysis was to integrate available LAIV efficacy data in children aged 2-17 years, the group for whom LAIV is approved for use. Methods: A meta-analysis was conducted using all available randomized controlled trials and a fixed-effects model. Cases caused by drifted influenza B were analyzed as originally classified and with all antigenic variants classified as dissimilar. Results: Five placebo-controlled trials (4 were 2-season trials) and 3 single-season TIV-controlled trials were analyzed. Compared with placebo, year 1 efficacy of 2 doses of LAIV was 83% (95% CI: 78, 87) against antigenically similar strains; efficacy was 87% (95% CI: 78, 93), 86% (95% CI: 79, 91), and 76% (95% CI: 63, 84) for A/H1N1, A/H3N2, and B, respectively. Classifying B variants as dissimilar, efficacy against all similar strains was 87% (95% CI: 83, 91) and 93% (95% CI: 83, 97) against similar B strains. Year 2 efficacy was 87% (95% CI: 82, 91) against similar strains. Compared with TIV, LAIV recipients experienced 44% (95% CI: 28, 56) and 48% (95% CI: 38, 57) fewer cases of influenza illness caused by similar strains and all strains, respectively. LAIV efficacy estimates for children from Europe, the United States, and Middle East were robust and were similar to or higher than those for the overall population. Conclusions: In children aged 2-17 years, LAIV demonstrated high efficacy after 2 doses in year 1 and revaccination in year 2, and greater efficacy compared with TIV. This meta-analysis provides precise estimates of LAIV efficacy among the approved pediatric age group. © 2011 Elsevier Ltd.

Pohl J.,Dr. Horst Schmidt Klinik | Schneider A.,Stadtkrankenhaus Korbach | Vogell H.,Stadtkrankenhaus Korbach | Mayer G.,Dr. Horst Schmidt Klinik | And 2 more authors.
Gut | Year: 2011

Objective: Colonoscopy is the accepted gold standard for detecting colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. The aim of this study was to determine whether enhanced mucosal contrast using pancolonic chromoendoscopy (PCC) allows higher rates of adenoma detection. Methods: In a prospective, randomised two-centre trial, PCC (with 0.4% indigo carmine spraying during continuous extubation) was compared with standard colonoscopy (control group) in consecutive patients attending for routine colonoscopy. The histopathology of the lesions detected was confirmed by evaluating the endoscopic resection or biopsy specimens. Results: A total of 1008 patients were included (496 in the PCC group, 512 in the control group). The patients' demographic characteristics and indications for colonoscopy were similar in the two groups. The proportion of patients with at least one adenoma was significantly higher in the PCC group (46.2%) than in the control group (36.3%; p=0.002). Chromoendoscopy increased the overall detection rate for adenomas (0.95 vs 0.66 per patient), flat adenomas (0.56 vs 0.28 per patient) and serrated lesions (1.19 vs 0.49 per patient) (p<0.001). There was a non-significant trend towards increased detection of advanced adenomas (103 vs 81; p=0.067). Mean extubation times were slightly but significantly longer in the PCC group in comparison with the control group (11.6±3.36 min vs 10.1±2.03 min; p<0.001). Conclusions: Pancolonic chromoendoscopy markedly enhances adenoma detection rates in an average-risk population and is practicable enough for routine application.

Bolukbas S.,Dr. Horst Schmidt Klinik | Manegold C.,University of Mannheim | Eberlein M.,Johns Hopkins University | Bergmann T.,Dr. Horst Schmidt Klinik | And 2 more authors.
Lung Cancer | Year: 2011

Introduction: The role of surgery in the management of malignant pleural mesothelioma (MPM) is controversial and there are no established guidelines. We describe the feasibility and long-term outcomes associated with Radical Pleurectomy (RP) as surgical therapy modality in a standardized trimodality therapy concept of MPM. Methods: From November 2002 to October 2007, 35 out of 102 consecutive patients with MPM were enrolled in our prospective database. They underwent trimodality therapy, including RP followed by 4 cycles of chemotherapy with Cisplatin (75mg/m2)/Pemetrexed (500mg/m2) and radiotherapy 4-6 weeks after operation. Results: Median age was 65 years. Nineteen patients were in advanced stages III and IV (54.3%). Tumor histology was epithelial in 27 patients (77.1%). Macroscopic complete resection could be achieved in 18 patients (51.4%). Surgical morbidity/mortality and trimodality treatment-related mortality were 20.0%, 2.9% and 5.8%, respectively. Thirty-three patients completed the trimodality therapy. Median follow-up was 21.7 months. Overall median survival was 30.0 months. One-, 2-, and 3-year-survival were 69%, 50% and 31%, respectively. Advanced stages III/IV (p=0.06), macroscopic incomplete resections (p=0.001), non-epithelial histology (p=0.55) and nodal metastases (p=0.19) were associated with poorer survival. Conclusions: The trimodality therapy concept with RP demonstrates promising results in terms of long-term survival, morbidity and mortality. We propose that a surgical philosophy of limiting the procedure related morbidity while achieving comparable cytoreductive results allows patients to maintain physiological reserve to be eligible for multimodality treatment options in the long-term. The observed and theoretical benefits of this trimodality treatment approach warrant confirmation in larger RCT. © 2009 Elsevier Ireland Ltd.

Eberlein M.,University of Iowa | Diehl E.,University of Iowa | Bolukbas S.,Dr. Horst Schmidt Klinik | Merlo C.A.,Johns Hopkins University | Reed R.M.,University of Maryland Baltimore County
Journal of Heart and Lung Transplantation | Year: 2013

Background Idiopathic pulmonary arterial hypertension (IPAH) is associated with high short-term mortality after bilateral lung transplantation (BLT). Previous studies have suggested that oversized allografts are associated with improved outcomes and that this association was strongest within the first year after transplant. We hypothesized that oversizing the allograft is associated with improved survival after BLT for IPAH. Methods All adults in the United Network of Organ Sharing lung transplant registry who underwent first-time BLT for IPAH between October 1989 and April 2010 were studied. Lung size mismatch was assessed by calculating the predicted total lung capacity (pTLC) ratio of the donor to the recipient. The cohort was divided evenly into "undersized" (pTLC ratio less than the median pTLC ratio) and "oversized" (pTLC ratio exceeding the median pTLC ratio). Risk of death after BLT was analyzed using Kaplan-Meier survival and Cox proportional hazards models. Results The mean pTLC ratio was 0.93 ± 0.10 in the 302 undersized patients compared with 1.24 ± 0.14 in the 302 oversized patients. Cohorts had comparable baseline characteristics. Median survival was 831 days longer in the oversized cohort (2,166 vs 1,335 days, p = 0.006). In a multivariate model controlling for sex mismatch, recipient factors, acuity, donor factors, and transplant factors, oversizing was associated with decreased hazard for death at 5 years (hazard ratio, 0.73; 95% CI 0.56-0.96, p = 0.02). Conclusion Oversizing the allograft is associated with improved survival after BLT for IPAH. In the setting of donor organ shortages and waiting list mortality, it is not practical to intentionally oversize the allograft. However, the pTLC ratio could provide further refinement in the peri-transplant risk assessment. © 2013 International Society for Heart and Lung Transplantation.

Bolukbas S.,Dr. Horst Schmidt Klinik | Eberlein M.,University of Iowa | Schirren J.,Dr. Horst Schmidt Klinik
Journal of Thoracic Oncology | Year: 2012

Introduction: Malignant pleural mesothelioma (MPM) can reduce lung function by entrapping lung parenchyma via a rind of tumor with or without concurrent effusion. Radical pleurectomy (RP) allows expansion of the trapped lung. The purpose of this study was to investigate changes in pulmonary function and lung perfusion in patients undergoing RP. Methods: In a prospective, nonrandomized study, all patients with histologically proven MPM were evaluated from January to December 2010 for trimodality therapy including RP as surgical procedure. Pulmonary-function tests and perfusion scans were obtained before and 2 months after RP. Primary end points were pulmonary function (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1]) and ipsilateral lung perfusion. Results: Sixteen out of 25 consecutive patients (age 68.8±8.9 years) were enrolled in the study. Macroscopic complete resection could be achieved in 13 patients (81.3%). Diaphragm resection was necessary in 5 patients. Significant postsurgical improvement of pulmonary function at 2 months was observed for FVC and FEV1 (both absolute and percentage of predicted values) and ipsilateral perfusion (p < 0.001). Avoidance of diaphragm resection was associated with greater increase in FVC (+34.6±17.0% versus +13.5±5.4%; p = 0.002) and FEV1 (+29.2±18.1% versus +12.1±6.4%; p = 0.015), respectively. Conclusions: Lung-sparing RP leads to significant improvement of pulmonary function and perfusion after a recovery time of 2 months. Functional results are better after preservation of the diaphragm. Preservation of physiological reserve via lung-sparing RP might allow patients with MPM to be eligible for further therapeutic options in the long term. © 2012 by the International Association for the Study of Lung Cancer.

Pohl J.,Dr. Horst Schmidt Klinik
Video Journal and Encyclopedia of GI Endoscopy | Year: 2013

Intussusception of the appendix is a rare condition that can occasionally be observed at routine colonoscopy. Different clinical presentations have been described for appendiceal intussusception. Some mimic acute appendicitis, some present with typical symptoms of intussusception, and others are totally asymptomatic. Because it can be mistaken for a neoplastic lesion, awareness of such lesions in differential diagnosis is important. Lack of proper diagnosis will lead to complications after endoscopic removal of such polyps. Here we demonstrate a patient with asymptomatic intussusception of the appendix. This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.

Pohl J.,Dr. Horst Schmidt Klinik
Video Journal and Encyclopedia of GI Endoscopy | Year: 2013

Ninety percent of patients with intraductal biliary stones are successfully treated with sphincterotomy and subsequent stone extraction. However, technical difficulty increases with stone size and giant stones require fragmentation to facilitate endoscopic removal. For stones too large to be engaged in a basket for mechanical lithotripsy, laser and electrohydraulic lithotripsy have been proposed for stone fragmentation. Application of electrohydraulic lithotripsy (EHL) is best achieved under direct visualization during cholangioscopy, because shock waves can also injure normal tissue. We present the case of a patient who underwent direct cholangioscopy for EHL of a giant stone that could not be retrieved by endoscopic retrograde cholangiopancreatography (ERCP). This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.

Gieringer M.,Dr. Horst Schmidt Klinik | Gosepath J.,Dr. Horst Schmidt Klinik | Naim R.,Dr. Horst Schmidt Klinik
Oncology Reports | Year: 2011

Radiation therapy is a major therapeutic modality in the management of cancer patients. Over 60% of these patients receive radiotherapy at some point during their course of treatment and over 90% will develop skin reactions after therapy. Problematic wound healing in radiation-damaged tissue constitutes a major surgical difficulty and despite all efforts, irradiated skin remains a therapeutic challenge. This review provides an overview of the fundamental principles of radiation therapy with regards to the wound healing in normal and irradiated skin. Furthermore, it presents techniques that describe how to prevent and manage skin side effects as well as prospects that may improve cutaneous wound repair in general and in irradiated skin.

Bolukbas S.,Dr. Horst Schmidt Klinik | Schirren J.,Dr. Horst Schmidt Klinik
Thoracic and Cardiovascular Surgeon | Year: 2010

Objective: We evaluated our experience with parenchyma-sparing bronchial sleeve resections in trauma, benign and malign disease to determine the operative morbidity, mortality and long-term outcome. Methods: We retrospectively reviewed our prospective database of all patients who underwent bronchial sleeve resection without parenchymal loss. Clinical data, morbidity, mortality and survival were analyzed. Results: From January 1999 through December 2008, 19 patients (11 male) underwent bronchial sleeve resection without removal of pulmonary parenchyma. Median age was 42.2±12.2 years (range 18 to 70 years). Indications were carcinoid tumors (n=14), adenoid cystic carcinoma (n=1), non-small cell lung cancer (n=1), blunt chest trauma (n=2) and stenosis (n=1). Isolated resection of the bifurcation (n=4), resection of the bifurcation en bloc with the right main bronchus with reconstruction of a neo-trifurcation (n=1), resection of the right main stem bronchus (n=6), resection of the bronchus intermedius (n=2) and resection of the middle lobe bronchus (n=1) were right-sided procedures. Left-sided procedures included resection of the left main stem bronchus (n=3) and left main stem bronchus resection en bloc with the upper lobe and lower lobe bronchus (n=2). Follow-up was complete and ranged from 11 to 108 months (median follow-up 62.7±28.6 months). Morbidity was 26.4%. The cure was delayed in 1 out of 19 anastomoses. No anastomotic dehiscence was seen. No mortality occurred. Resections were complete except for the resection of the adenoid cystic carcinoma (n=1, R1 resection). No anastomotic stenosis or recurrence of cancer occurred in the late outcome. Conclusions: In properly selected patients, traumatic bronchial ruptures, localized malign or benign disease can be safely resected without parenchymal loss. Excellent morbidity and mortality rates and a good long-term outcome can be achieved. © Georg Thieme Verlag KG.

Pohl J.,Dr. Horst Schmidt Klinik | Ell C.,Dr. Horst Schmidt Klinik
Gastrointestinal Endoscopy | Year: 2011

Background: Direct cholangioscopy using an ultraslim endoscope is an attractive alternative to the conventional mother-baby endoscope system because it provides a single-operator platform and high-resolution image quality and allows advanced therapeutic interventions. However, biliary access is cumbersome and usually requires previous guidewire placement via retrograde cholangiography. Objective: To evaluate the feasibility of a 1-step transnasal cholangioscopy (TNC) technique using an ultraslim endoscope with an intraductal balloon to maintain access without previous guidewire placement. Design: Prospective, observational clinical feasibility study. Setting: Single tertiary referral center. Main Outcome Measurements: Overall procedure success rates and complications. A successful procedure was defined as one in which the endoscope was advanced into the bifurcation or stenotic segment of the biliary system. Patients and Methods: Twenty-five patients with biliary disease and previous sphincterotomy underwent direct TNC. Results: TNC was successful in 18 of the 25 patients (72%). The procedure revealed 3 common bile duct stones, 4 benign biliary strictures, 1 intraductal adenoma, and 3 cholangiocarcinomas. Eight patients underwent forceps biopsies under direct visualization, and 7 patients underwent therapeutic interventions, including argon plasma coagulation (n = 2), laser lithotripsy (n = 1), stent (n = 1), and stone extraction (n = 3). Other than 1 patient with procedure-related cholangitis, no complications were observed. Limitations: Small number of patients and no comparison with conventional cholangioscopy. Conclusions: One-step TNC with an ultraslim endoscope allows direct visual examination and therapeutic intervention in the bile ducts in the majority of patients with biliary disease. However, development of further accessory instruments will be needed to improve the success rate. © 2011 American Society for Gastrointestinal Endoscopy.

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