Dr. Horst Schmidt Klinik Wiesbaden

Wiesbaden, Germany

Dr. Horst Schmidt Klinik Wiesbaden

Wiesbaden, Germany

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Neufang A.,Dr Horst Schmidt Klinik Wiesbaden | Dorweiler B.,Dr Horst Schmidt Klinik Wiesbaden | Doemland M.,Dr Horst Schmidt Klinik Wiesbaden | Schotten S.,Johannes Gutenberg University Mainz | Vahl C.F.,Dr Horst Schmidt Klinik Wiesbaden
Journal of Vascular Surgery | Year: 2014

Objective: Femorodistal autologous vein bypass proves to be the preferred surgical therapy for long arterial occlusions and provides excellent early and long-term results in critical lower limb ischemia. Whenever vein length was insufficient and two distal outflow arteries were present, a sequential composite bypass configuration was chosen with human umbilical vein (HUV) or ovine collagen prosthesis (Omniflow II; Bio Nova International Pty Ltd, North Melbourne, Australia) as the proximal prosthetic part of the bypass. Single-center experience with this technique regarding limb salvage, graft function, secondary reinterventions, and biodegeneration is presented. Methods: Between January 1998 and January 2009, 122 consecutive sequential composite bypass operations were performed on 116 patients for short-distance claudication (2), chronic critical ischemia (117), or acute ischemia (3) in the absence of sufficient autologous vein length. HUV was used in 90 cases and Omniflow II in 32 cases. Grafts were followed by duplex scan supplemented by angiography in case of recurrent ischemia with prospective documentation of follow-up data in a computerized vascular database. Retrospective analysis of graft patency, limb salvage, and aneurysmal degeneration of the biologic prosthesis was performed. Results: Mean follow-up was 59 ± 45.5 months (range, 1-161 months). The 30-day mortality was 4.1%. Early postoperative complete or partial bypass thrombosis developed in 16% (20 cases) and required successful revision in 16 cases. During follow-up, 30 complete and 12 partial bypass occlusions occurred, necessitating selective surgical or interventional revision. Primary, primary assisted, and secondary patency rates and the limb salvage rate were 48%, 62%, 71%, and 87%, respectively, after 5 years and 26%, 46%, 54%, and 77%, respectively, after 10 years for all bypasses. Late biodegeneration of HUV prostheses was detected in four instances. Conclusions: Late graft patency and limb salvage were good. These factors, combined with a tolerable rate of late aneurysmal degeneration, justify the use of biologic vascular conduits and autologous vein for complex femorodistal reconstructions. © 2014 by the Society for Vascular Surgery.


Muallem M.Z.,Charité - Medical University of Berlin | Dimitrova D.,Charité - Medical University of Berlin | Dimitrova D.,Young Academy of Gynecologic Oncology JAGO | Pietzner K.,Charité - Medical University of Berlin | And 13 more authors.
Anticancer Research | Year: 2016

Aim: To gather standardized information of current perioperative management of gynecological oncology patients and to evaluate up to what extent the Enhanced Recovery after Surgery (ERAS) elements are established in the clinical routine of gynecologic oncology units in Germany. Materials and Methods: We performed a multi-centric nationwide survey among 654 primary, secondary and maximal health care gynecological departments in Germany. A multiple-choice questionnaire based on the principles of ERAS was developed to gather information about perioperative management of two fictional cases in gynecological oncology. Results: One hundred four units (22%) have been taken the survey. Only 49.5% of surveyed hospitals claimed to be adherent to more than 70% of ERAS elements in managing perioperative period of primary cytoreductive surgery in ovarian cancer patients. 21% of these hospitals implemented more than 80% and only 8.4% implemented more than 90%. The results in border-line tumors operations did not differ from those of ovarian cancer operations. Conclusion: The implementation of ERAS elements in gynecologic oncology in Germany is still not satisfying as only half of the departments will now be able to apply 70% of these principles. Therefore, we plan the second step of this survey in order to be able to build a consistent structured reporting platform between gynecological oncology units in Germany to facilitate the wide implementation and standardization of ERAS protocol.


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

An epiphrenic diverticulum occurs from increased pressure during esophageal propulsive contractions against a closed lower esophagus. This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.


Pech O.,Dr. Horst Schmidt Klinik Wiesbaden
Video Journal and Encyclopedia of GI Endoscopy | Year: 2013

Large hiatal hernias are usually asymptomatic, but can also accompany gastroesophageal reflux or iron deficiency anemia. Cameron lesions and ulcers are erosions or ulcers on the gastric folds at the level of the diaphragm and can sometimes be seen in patients with large hiatal hernias. The Cameron lesions can cause iron deficiency anemia due to acute or chronic bleeding. This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.


Pech O.,Dr. Horst Schmidt Klinik Wiesbaden
Video Journal and Encyclopedia of GI Endoscopy | Year: 2013

Schatzki rings (lower esophageal rings) are mostly asymptomatic. However, they are considered the most common cause of dysphagia or food impaction. Diagnosis can usually be made during upper gastrointestinal endoscopy by careful inspection of the esophago-gastric junction. This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.


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

Hyperplastic polyposis is a rare syndrome characterized by the development of multiple colorectal serrated lesions, most often a mixture of hyperplastic polyps and flat serrated adenomas. Patients with hyperplastic polyposis syndrome (HPS) have a high lifetime risk of developing colorectal cancer (up to 50%). However, at colonoscopy the diagnosis is often missed because the flat lesions are not recognized or the endoscopist is simply unaware of this syndrome. Here the author presents three cases with HPS and demonstrates the typical endoscopic features. This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.


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

This is a demonstration of endoscopic retrograde cholangiopancreatography and cholangioscopy with endoscopic placement of a biliary plastic stent in a 64-year-old woman with a first diagnosis of a cholangiocarcinoma classifed as Bismuth type I. The information presented here allows understanding of the precise technique needed for successful biliary stenting using straight plastic endoprosthesis. This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.


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

Pancreatic duct stones are a common complication of chronic pancreatitis. Although most pancreatic duct stones can be targeted by extracorporeal shock wave lithotripsy and extracted by endoscopic retrograde cholangiopancreatography, large and radiolucent stones remain a therapeutic challenge. The author describes a case of a 54-year-old man with chronic pancreatitis and a large pancreatic duct stone with a downstream stricture within the pancreatic head. After balloon dilation of the obstruction, direct pancreatoscopy with an ultraslim endoscope was performed and the stone under direct vision was extracted successfully. This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.


Neufang A.,Dr. Horst Schmidt Klinik Wiesbaden | Savvidis S.,Dr. Horst Schmidt Klinik Wiesbaden
Gefasschirurgie | Year: 2016

Background: The use of autologous superficial femoral veins (SFV) as an arterial or venous substitute represents a valuable technique in modern vascular surgery with versatile indications. The SFV autografts exhibit excellent control of infection and durable long-term results in terms of graft patency in prosthetic or arterial infections. In cases of elective use of the SFV, duplex ultrasound evaluation of the deep leg vein system should be implemented to confirm the patency of the profunda femoris vein. Material and methods: The SFV can be harvested distal to the adductor hiatus with a proximal portion of the popliteal vein but should not exceed the level of the knee joint. Formation of a stump of the proximal SFV must be avoided. Simultaneous harvesting of the ipsilateral greater saphenous vein should be avoided to reduce the risk of significant chronic edema. Results: Early postoperative swelling of the donor leg can be expected but resolves spontaneously in most cases. Chronic mild edema of the leg with a possible indication for compression therapy may occur in up to 20 % of cases but severe complications are very rare if the anatomical borders for vein harvesting are respected. Temporary therapeutic anticoagulation after vein harvest is subject to individual decision making. Conclusion: Duplex ultrasound is a reliable tool to assess the residual deep and superficial venous system in the long term. Excellent graft function and the tolerable adverse effects of vein harvest on the donor leg justify the use of the SFV in arterial and venous vascular surgery if indicated. © 2016, The Author(s).


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

Temporary biliary stenting allows healing of biliary leaks in more than 90% of cases. It is equally effective whether sphincterotomy is performed or not. We demonstrate the case of a young woman with severe liver trauma due to a car crash. Endoscopic retrograde cholangiography revealed multiple intrahepatic biliary leaks that were successfully treated with endoscopic stenting of the common bile duct. This article is part of an expert video encyclopedia. © 2013 Elsevier GmbH.

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