Dr. Horst Schmidt Kliniken

Wiesbaden, Germany

Dr. Horst Schmidt Kliniken

Wiesbaden, Germany
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Lorenz D.,Dr. Horst Schmidt Kliniken | Origer J.,Dr. Horst Schmidt Kliniken | Pauthner M.,Dr. Horst Schmidt Kliniken | Graupe F.,Dr. Horst Schmidt Kliniken | And 3 more authors.
Annals of Surgery | Year: 2014

OBJECTIVE:: To define prognostic risk factors in patients with early adenocarcinomas of the esophagus (eACEs) who were treated by esophagectomy. BACKGROUND:: Although endoscopic resection (ER) is more accepted for eACEs limited to the mucosa, the reported prevalence of lymph node metastases once the tumor infiltrates the submucosa seems to necessitate surgery in these cases. METHODS:: We analyzed the results of 168 patients who had an esophageal resection because of an eACE. On the basis of specimen histologies and clinical follow-up (median, 64 months), we investigated the influence of lymph node metastases (N+), tumor infiltration depth, tumor differentiation (G1-3), and lymphatic or venous infiltration (L+ or V+) on overall and tumor-specific survival and recurrence rates. RESULTS:: The 5-year survival rate was 79%. Lymph node infiltration was the only prognostic factor for the overall survival [hazard ratio (HR), 2.856; 1.314-6.207; P = 0.008], tumor-specific survival (HR, 8.336; 2.734-25.418; P < 0.001), and tumor recurrence (HR, 8.031; 3.041-21.206; P < 0.001) that was consistently present in all multivariate hazard Cox regression analyses. A total of 47% of the patients who had an N+ status developed tumor recurrences compared with 5.2% of those who had no lymph node involvement (P = <0.001). We found a significant correlation between N+ status and increasing depth of tumor infiltration (P = 0.004), lymphatic vessel infiltration (P = 0.002), tumor differentiation (G1 + G2 vs G3; P = 0.014) and vascular infiltration (P = 0.01). CONCLUSIONS:: Lymph node status is the only independent risk factor for survival and recurrence rates. Tumor infiltration depth correlates with the rate of the lymph node metastases, but a clear watershed between deep mucosal and submucosal infiltration does not exist. As a consequence, careful staging procedures, including diagnostic ER, are mandatory to determine which patients can be treated by ER and which require an esophagectomy. © 2013 Lippincott Williams and Wilkins.

Dieckmann K.-P.,Albertinen Krankenhaus | Wilken S.,Albertinen Krankenhaus | Loy V.,Vivantes MVZ Am Urban | Matthies C.,Bundeswehrkrankenhaus Hamburg | And 6 more authors.
Annals of Oncology | Year: 2013

Background: The treatment of testicular intraepithelial neoplasia (TIN), the progenitor of testicular germ cell tumours (GCTs), is based on little data. Patients and methods: Two hundred and twenty-eight GCT patients with contralateral TIN were retrospectively enrolled. Ten had surveillance, 122 radiotherapy to testis with 18-20 Gy, 30 cisplatin-based chemotherapy (two cycles), 51 chemotherapy (three cycles), and 15 carboplatin. The study end point was a malignant event (ME), defined as detection of TIN upon control biopsy or occurrence of a second GCT. The Secondary end point was hypogonadism during follow-up. Results: Numbers, proportions of ME, and median event-free survival (EFS) times were: radiotherapy N = 3, 2.5%, 11.08 years; chemotherapy (two cycles) N = 15, 50%, 3.0 years; chemotherapy (three cycles) N = 12, 23.5%, 9.83 years; carboplatin N = 10, 66%, 0.9 years; surveillance N = 5, 50%, 7.08 years. EFS is significantly different among the groups. Hypogonadism rates were in radiotherapy patients 30.8%, chemotherapy (two cycles) 13%, chemotherapy (three cycles) 17.8%, carboplatin 40%, surveillance 40%. Conclusions: Local radiotherapy is highly efficacious in curing TIN. Chemotherapy is significantly less effective and the cure rates are dose-dependent. Though hypogonadism occurs in one-third of patients, radiotherapy with 20 Gy remains the standard management of TIN. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Pohl J.,Dr Horst Schmidt Kliniken | Aschmoneit I.,Dr Horst Schmidt Kliniken | Schuhmann S.,Dr Horst Schmidt Kliniken | Ell C.,Dr Horst Schmidt Kliniken
Endoscopy | Year: 2010

Computed virtual chromoendoscopy with the Fujinon intelligent color-enhancement (FICE) system was reported to improve visualization of neoplastic and non-neoplastic lesions at gastroscopy and colonoscopy. The technique is based on narrowing the bandwidth of the conventional endoscopic image arithmetically by a spectral estimation technology. Implementation of the FICE software in the video capsule workstation might also allow for contrast-enhanced assessment of nature and extent of small-bowel mucosal lesions. Here we propose this novel technique and report on 10 consecutive patients who underwent small-bowel video capsule endoscopy that was evaluated with FICE-enhanced imaging. © Georg Thieme Verlag KG Stuttgart.

Bolukbas S.,Dr. Horst Schmidt Kliniken | Bergmann T.,Dr. Horst Schmidt Kliniken | Fisseler-Eckhoff A.,Institutes for Pathology and Cytology | Schirren J.,Dr. Horst Schmidt Kliniken
European Journal of Cardio-thoracic Surgery | Year: 2010

Objective: We evaluated the short- and long-term results of sleeve resections in a cohort of elderly patients with centrally located non-small-cell lung cancer. Methods: We retrospectively reviewed our prospective database of all patients aged ≥70 years who underwent sleeve resection for non-small-cell lung cancer. Clinical data, morbidity, mortality and survival were analysed. Results: Between January 1999 and December 2005, 31 consecutive patients (26 men) of a mean age of 72.8 ± 2.4 years (range: 70-78 years) underwent bronchial (n = 21) and bronchovascular (n = 10) sleeve resections. A negative bronchial and vascular margin was achieved in all. No bronchial or vascular complications resulted. Morbidity and mortality were 41.9% and 6.2%, respectively. Calibre mismatch (p = 0.89), laterality (p = 0.22) and previous induction chemotherapy (p = 0.28) were not significantly related to morbidity. The overall 5-year survival rate was 56%. The nodal status did not influence the long-term survival in this study (p = 0.41). The type of sleeve resection (bronchial or bronchovascular) had no impact on survival (p = 0.62). Excessive dynamic airway collapse was associated with higher morbidity (p = 0.016) and poorer survival (p = 0.037). Conclusion: In the hands of experienced thoracic surgeons, bronchial and bronchovascular sleeve resections can be performed safely, even in elderly patients. Excessive dynamic airway collapse may be an important negative prognostic determinant of morbidity and mortality. © 2009 European Association for Cardio-Thoracic Surgery.

Kammerer W.,Dr. Horst Schmidt Kliniken
Arzneimitteltherapie | Year: 2012

CYP2C19 is involved in the metabolism of some important drugs. Among these are clopidogrel, all proton pump inhibitors, some antidepressive and antipsychotic drugs. Metabolism of these substrates can be significantly altered due to inhibition or induction of CYP2C19 and polymorphisms in the CYP2C19 gene. Substrates, inhibitors and inducers of CYP2C19 and relevant genetic polymorphisms are reviewed and the clinically relevant drug drug interactions are demonstrated.

Poddubnyy D.,Charite Campus Benjamin Franklin | Rudwaleit M.,Evangelisches Krankenhaus Hagen Haspe | Haibel H.,Charite Campus Benjamin Franklin | Listing J.,German Rheumatism Research Center | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objective: To assess the progression of radiographic sacroiliitis in a cohort of patients with early axial spondyloarthritis over a period of 2 years and to explore predictors of progression. Methods: 210 patients with axial spondyloarthritis from the German Spondyloarthritis Inception Cohort have been selected for this analysis based on availability of radiographs at baseline and after 2 years of follow-up. Radiographs were centrally digitised and the sacroiliac joints were scored independently according to the grading system of the modified New York criteria for ankylosing spondylitis (AS) by two trained readers. The readers scored both time points simultaneously but were blinded for the time point and for all clinical data. Results: 115 patients (54.8%) fulfilled the modified New York criteria for AS in their radiographic part in the opinion of both readers at baseline, while 95 patients (45.2%) were classified as non-radiographic axial spondyloarthritis. More patients with non-radiographic spondyloarthritis (10.5%) compared with AS (4.4%) showed an estimated 'true' progression by at least one grade according to both readers, although the difference between the two groups was statistically non-significant. The rate of progression from non-radiographic axial spondyloarthritis to AS was 11.6% over 2 years. An elevated level of C-reactive protein (CRP) at baseline was a strong positive predictor of radiographic sacroiliitis progression in non-radiographic axial spondyloarthritis and AS (OR 3.65 and 5.08, respectively, p<0.05). Conclusion: Progression of radiographic sacroiliitis by at least one grade after 2 years occurs only in a small percentage of patients with early axial spondyloarthritis. An elevated level of CRP was found to be a strong positive predictor of sacroiliitis progression.

Poddubnyy D.,Charité - Medical University of Berlin | Rudwaleit M.,Endokrinologikum | Haibel H.,Charité - Medical University of Berlin | Listing J.,German Rheumatism Research Center | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Objective: To investigate the influence of non-steroidal anti-inflammatory drugs (NSAIDs) intake on radiographic spinal progression over 2 years in patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (SpA). Methods: 164 patients with axial SpA (88 with AS and 76 with non-radiographic axial SpA) were selected for this analysis based on availability of spinal radiographs at baseline and after 2 years of follow-up and the data on NSAIDs intake. Spinal radiographs were scored by two trained readers in a concealed randomly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) system. An index of the NSAID intake counting both dose and duration of drug intake was calculated. Results: High NSAIDs intake (NSAID index≥50) in AS was associated with lower likelihood of significant radiographic progression defined as an mSASSS worsening by ≥2 units: OR=0.15, 95% CI 0.02 to 0.96, p=0.045 (adjusted for baseline structural damage, elevated C reactive protein (CRP) and smoking status) in comparison with patients with low NSAIDs intake (NSAID index<50). This effect was most pronounced in patients with baseline syndesmophytes plus elevated CRP: mean mSASSS progression was 4.36±4.53 in patients with low NSAIDs intake versus 0.14±1.80 with high intake, p=0.02. In non-radiographic axial SpA, no significant differences regarding radiographic progression between patients with high and low NSAIDs intake were found. Conclusion: A high NSAIDs intake over 2 years is associated with retarded radiographic spinal progression in AS. In non-radiographic axial SpA this effect is less evident, probably due to a low grade of new bone formation in the spine at this stage..

Hoeh A.E.,University of Heidelberg | Pollithy S.,University of Heidelberg | Dithmar S.,Dr. Horst Schmidt Kliniken
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2015

Purpose: To evaluate the effect of patient-associated factors on the minimum laser power needed for a mild visible burn in focal laser treatments using the 532 nm Navilas laser system. Methods: We conducted a monocentric prospective pilot study of 58 eyes of 40 patients with diabetic macular edema. The following parameters were analysed: axial length, refraction, iris pigmentation, lens status, lens grading and densitometry, retinal and choroidal thickness and focus setting during treatment. Laser power was adjusted to produce mild, barely visible burns. Retinal laser burn size was measured 30 min after treatment. Results: Focus setting is significantly correlated with retinal lesion size (r = 0.50, p = 0.001) and laser power (r = 0.44, p < 0.001). Axial length only correlated with laser power when the effect of focus was controlled. Phakic eyes needed more laser power than pseudophakic eyes (78.3 versus 67.2 mW, p = 0.051). No correlation of laser power with any other factor could be found. Conclusions: Among the examined parameters, focus setting had the strongest effect on the laser power needed to produce a mild visible burn. The association of focus with laser power can be explained by the focus-dependent change of retinal spot size. Lens status (phakic versus pseudophakic patients) seems to influence laser light transmission in the examined age group. © 2014, Springer-Verlag Berlin Heidelberg.

Schiff J.H.,Katharinenkrankenhaus | Schiff J.H.,James Cook University | Welker A.,Dr Horst Schmidt Kliniken | Fohr B.,University of Heidelberg | And 6 more authors.
British Journal of Anaesthesia | Year: 2014

Background Improved anaesthesia safety has made severe anaesthesia-related incidents, complications, and deaths rare events, but concern about morbidity and mortality in anaesthesia continues. This study examines possible severe adverse outcomes or death recorded in a large national surveillance system based on a core data set (CDS). Methods Cases from 1999 to 2010 were filtered from the CDS database. Cases were defined as elective patients classified as ASA physical status grades I and II (without relevant risk factors) resulting in death or serious complication. Four experts reviewed the cases to determine anaesthetic involvement. Results Of 1 374 678 otherwise healthy, ASA I and II patients in the CDS database, 36 met the study inclusion criteria resulting in a death or serious complication rate of 26.2 per million [95% confidence interval (CI), 19.4-34.6] procedures, and for those with possible direct anaesthetic involvement, 7.3 per million cases (95% CI, 3.9-12.3). Conclusions This is the first study assessing severe incidents and complications from a national outcome-tracking database. Annual identification and review of cases, perhaps with standardized database queries in the respective departments, might provide more detailed information about the cascades that lead to unfortunate outcomes. © 2014 The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

Rafat N.,University of Heidelberg | Tonshoff B.,University of Heidelberg | Bierhaus A.,University of Heidelberg | Beck G.C.,Dr. Horst Schmidt Kliniken
American Journal of Respiratory Cell and Molecular Biology | Year: 2013

Acute lunginjury (ALI) and acute respiratory distress syndrome(ARDS) are common disorders in patients requiring critical care. The clinical management of these disorders is difficult and unrewarding, and thus they are among the most common causes of death in intensive care units. The activation and damageof pulmonary endothelium comprise the hallmark of ALI/ARDS. Therefore, the recruitment of circulating endothelial progenitor cells (EPCs) to these lesions may exert a beneficialeffectonthe clinical course ofALI/ARDS.Consequently, cell-based therapies using stem cells to regenerate lung tissue have emerged as potential novel treatment strategies. Although initial studies suggested implantations of exogenously administered bone marrow- derived progenitor cells into damaged vessel walls, recent evidence indicates that this is rather a rare occurrence with uncertain physiologic significance. In the past few years, different populations of progenitor cells were identified, with different functional capacities. This review (1) highlights the different populations of EPCs identified or administered in different models of ALI/ARDS, (2) reports on whether beneficial effects of EPCs could be demonstrated, and (3) puts the conflicting results of different studies into perspective. © 2013 by the American Thoracic Society.

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