German Armed Forces Hospital

Neu-Ulm, Germany

German Armed Forces Hospital

Neu-Ulm, Germany
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Freund W.,University of Ulm | Weber F.,German Armed Forces Hospital | Billich C.,University of Ulm | Schuetz U.H.,University of Ulm
BMJ Open | Year: 2012

Objectives: 67 runners participated in the Trans Europe FootRace 2009 (TEFR09), a 4487 km (2789 mi) multistage ultra-marathon covering the south of Europe (Bari, Italy) to the North Cape. Reports on ultra-marathons are lacking, but the literature reports overuse injuries in athletes, especially to the Achilles tendon (AT), ankle or hind foot. Bone oedema may be related to exposure and is present in fatigue fractures. Therefore, the aim of this study was to determine prospectively if sustained maximal load during an ultra-marathon leads to damage to the foot. Design and participants: In a cohort study, repeated scanning of the 22 athletes participating in the study was performed before and during (approximately every 1000 km) the race. Using the obtained fat saturated inversion recovery sequence, two experienced readers blinded to the clinical data rated the images regarding foot lesions. Statistical analysis included regression analysis and computation of the inter-rater reliability. Setting: The TEFR09 course. MRI scanning was performed according to prearranged schedules for every participant, using a mobile 1.5 Tesla MRI unit on a trailer following the race. Primary outcome measures: MRI data such as AT diameter, bone or tendon lesions, subcutaneous, plantar fascia or intraosseous oedema. Results: The 22 study participants did not differ significantly from the total of the 67 TEFR09 runners regarding height, weight and age. The AT diameter increased significantly from 6.8 to 7.8 mm as did intraosseous signal, bone lesions and subcutaneous oedema. However, finishers differed only regarding plantar aponeurosis and subcutaneous oedema from participants aborting the TEFR09. Inter-rater reliability was 0.88-0.98. Conclusion: Under the extreme stress of the TEFR09, an increase of the AT diameter as well as bone signal are thought to be adaptive since only subcutaneous oedema and plantar fascia oedema were related to abortion of the race. Trial registration number: University of Ulm, Germany Ethics Committee Number 78/08-UBB/se.

Hartenbach M.,German Armed Forces Hospital | Hartenbach M.,Medical University of Vienna | Hartenbach S.,German Armed Forces Hospital | Bechtloff W.,German Armed Forces Hospital | And 5 more authors.
Clinical Cancer Research | Year: 2014

Purpose: The pretherapeutic assessment of prostate cancer is challenging and still holds the risk of over- or undertreatment. This prospective trial investigates positron emission tomography (PET) with [18F] fluoroethylcholine (FEC) combined with endorectal magnetic resonance imaging (MRI) for the assessment of primary prostate cancer. Experimental design: Patients with prostate cancer based on needle biopsy findings, scheduled for radical prostatectomy, were assessed by FEC-PET and MRI in identical positioning. After prostatectomy, imaging results were compared with histologic whole-mount sections, and the PET/MRI lesion-based semiquantitative FEC uptake was compared with biopsy Gleason scores and postoperative histology. Results: PET/MRI showed a patient-based sensitivity of 95% (36/38; 95% confidence interval (CI), 82%-99%). The analysis of 128 prostate lesions demonstrated a sensitivity/specificity/positive predictive value/negative predictive value/accuracy of 67%/35%/59%/44%/54% (P = 0.8295) for MRI and 85%/45%/68%/69%/68% (P = 0.0021) for PET, which increased to 84%/80%/85%/78%/82% (P < 0.0001) by combined FEC-PET/MRI in lesions >5 mm (n = 98). For lesions in patients with Gleason >6 tumors (n = 43), MRI and PET achieved 73%/31%/71%/33%/60% (P = 1.0000) and 90%/62%/84%/73%/81% (P = 0.0010), which were improved to 87%/92%/96%/75%/88% (P < 0.0001) by combined PET/MRI. Applying semiquantitative PET analysis, carcinomas with Gleason scores >6 were distinguished from those with Gleason ≤6 with a specificity of 90% and a positive predictive value of 83% (P = 0.0011; needle biopsy 71%/60%, P = 0.1071). Conclusions: In a prospective diagnostic trial setting, combined FEC-PET/MRI achieved very high sensitivity in the detection of the dominant malignant lesion of the prostate, and markedly improved upon PET or MRI alone. Noninvasive Gleason score assessment was more precise than needle biopsy in this patient cohort. Hence, FEC-PET/MRI merits further investigation in trials of randomized, multiarm design. ©2014 AACR.

Thierbach R.,German Armed Forces Hospital
Quintessence international (Berlin, Germany : 1985) | Year: 2013

The replacement of missing teeth with dental implants has been standard practice in dentistry for many years. The success of dental implants depends on many factors, among which the diagnosis, clinical severity, and treatment of peri-implant diseases play a key role. In this prospective case series, the influence of cumulative treatment modalities on peri-implantitis with and without pus formation on clinical outcome was assessed. During 2010, 28 patients were referred for peri-implantitis treatment. They presented two different types of peri-implant diseases: peri-implantitis with (17 implants) or without pus formation (33 implants). After microbiologic diagnosis, all patients were treated at baseline with full-mouth scaling and root planing. Two months later, further full-mouth scaling and root planing and additional antimicrobial photodynamic therapy (aPDT) was applied. Four months after baseline, patients with pus formation additionally underwent access flap surgery. Active human matrix metalloproteinase-8 (aMMP-8) levels were measured in eluates before and after all treatment modalities and 7 months after baseline. Clinical parameters (probing depth, bleeding on probing) and aMMP-8-levels improved in both groups after treatment and the final examination. In periimplantitis patients without pus formation, all parameters decreased after full-mouth scaling and root planing and the additional aPDT and no surgery was necessary to improve the parameters. In patients with pus formation, the parameters decreased only after access flap surgery. The presence of pus influences the clinical outcome of the treatment of peri-implant diseases. Whereas peri-implantitis cases without pus formation can be successfully managed nonsurgically, peri-implantitis with pus formation can be effectively treated after an additional observation time of 3 months postoperatively only with additional flap surgery.

In the past 30 years, the use of a voice prosthesis has become the treatment of choice for the restoration of speech following laryngectomy. Not only is the placement of a voice prosthesis a simple surgical procedure, but it is also associated with a low rate of complications and an excellent success rate. Approximately, 20–30 % of all patients with voice prostheses, however, develop periprosthetic leakage with aspiration over time. Periprosthetic leakage is usually caused by an enlargement of the tracheo-oesophageal fistula and substantially affects the quality of life of the patients concerned. In a retrospective analysis of our patients, the incidence of periprosthetic leakage was 35.7 % in a total of 232 patients who underwent laryngectomy during a period of 20 years. Substantial enlargement of the tracheo-oesophageal fistula which required multiple treatments occurred in 12.5 % of the patients. In this review, the various causes of fistula enlargement are discussed on the basis of the literature and the experience that we have accumulated during the past 20 years in the management of patients with voice prostheses. © 2014, Springer-Verlag Berlin Heidelberg.

In the past 30 years, the use of voice prostheses has become the gold standard for voice rehabilitation after total laryngectomy. The placement of a voice prosthesis is a simple procedure that is associated with only a minor increase in operating time and a low rate of complications. Most problems with voice prostheses are minor and can be easily managed. Enlargement of the tracheo-oesophageal fistula, however, can be a severe complication. Approximately 25 % of all patients with voice prostheses develop periprosthetic leakage with aspiration within 1–4 years after the placement of a voice prosthesis. Depending on the severity of fistula enlargement, treatment ranges from conservative approaches to maximally invasive procedures. In some cases, however, these measures prove unsuccessful. The causes of treatment failure and fistula enlargement are not yet fully understood. Apart from a discussion of treatment options, an algorithm for the management of this complication is presented on the basis of the literature and the experience that we have accumulated at our institution during the past 20 years in the treatment of 232 laryngectomised patients. © 2014, Springer-Verlag Berlin Heidelberg.

Lorenz K.J.,German Armed Forces Hospital | Maier H.,German Armed Forces Hospital
European Archives of Oto-Rhino-Laryngology | Year: 2010

The functional and cosmetic reconstruction of the upper lip after a subtotal defect is a highly demanding challenge, especially when the columella is involved. In the majority of cases, the surgical techniques described in the literature are suitable only for restoring the function and appearance of the upper lip but not for reconstructing adjacent areas. In this article, we present the case of an 85-yearold female patient with an extensive, aggressive and highly invasive basal cell carcinoma of the upper lip and the columella. We describe a modification of the nasolabial flap technique using cheek tissue for the reconstruction of the defect. The modified flap is used for both the full-thickness reconstruction of the subtotal upper-lip defect and the restoration of the function and appearance of the columella. This technique allows excellent cosmetic and functional results to be obtained in a single-stage procedure. © Springer-Verlag 2009.

Mauer U.M.,German Armed Forces Hospital | Kunz U.,German Armed Forces Hospital
Journal of Neurosurgery | Year: 2011

Object. In recent years, the authors have noticed a growing number of programmable valve defects at their institution. Therefore, they conducted this study to evaluate the increased incidence of malfunctioning valves. Methods. They investigated all revisions that had been performed at their institution between 1994 and 2010 for dislodgement of the stator of a standard Medos Hakim programmable valve with a prechamber. Results. Fifteen valves were removed because of dislodged stators. The valves had been implanted between May 16, 1993, and December 27, 2002, and were explanted between February 19, 2006, and January 22, 2010. Thus, the valves had been in place for a mean period of 11 years (median 11 years, range 7-14 years). The percentage of dislodged stators was almost 3% (15 of 546 valves). Particularly noteworthy is that all malfunctioning valves were found in children who had been younger than 1 year of age at the time of implantation. Conclusions. Medos Hakim programmable valve malfunctions are rare events but should receive careful attention. When the pressure setting cannot be adjusted, a malfunction should always be suspected and radiographic imaging should be performed to assess the valve. Stator dislodgement is the most serious form of valve adjustment failure.

Lorenz K.J.,German Armed Forces Hospital | Grieser L.,German Armed Forces Hospital | Ehrhart T.,German Armed Forces Hospital | Maier H.,German Armed Forces Hospital
Annals of Otology, Rhinology and Laryngology | Year: 2010

Objectives: The purpose of this 2-year prospective nonrandomized study was to investigate the relationship between pathological supraesophageal reflux and the occurrence of speech fistula complications, especially severe fistula enlargement, in patients who underwent total laryngectomy and prosthetic voice restoration. Methods: We objectively assessed the presence of reflux disease using 24-hour dual-probe pH monitoring in 60 laryngectomized patients, correlated the incidence of tracheoesophageal fistula complications with the severity of reflux, and assessed the risk of problems by determining the absolute number of reflux events at the level of the speech fistula, the reflux area index score, and the DeMeester score. Results: All patients with fistula enlargement showed highly pathological results in the diagnostic tests for reflux disease. Depending on reflux severity, the relative risk of developing fistula complications was up to 10 times higher for these patients. Conclusions: We found a significant correlation between the occurrence of tracheoesophageal fistula complications and the severity of supraesophageal reflux. Potential chronic irritation of the esophageal and tracheal mucosa can possibly contribute to the development of these problems. If the presence of reflux disease has been confirmed by 24-hour dual-probe pH monitoring, patients with fistula complications should be treated with proton pump inhibitors. © 2010 Annals Publishing Company. All rights reserved.

Mauer U.M.,German Armed Forces Hospital
Neurosurgical focus | Year: 2010

For many years, the experience of neurosurgeons from the German Armed Forces was limited to the peacetime care of patients in Germany. In 1995, German military neurosurgeons were deployed abroad for the first time. Since the beginning of the International Security Assistance Force mission, there has been a rapidly increasing number of opportunities for military neurosurgeons to broaden their experience during deployments abroad. Since the first deployment of a neurosurgeon to the German field hospital in Mazar-e-Sharif, Afghanistan, a total of 140 neurosurgical procedures have been performed there. Sixty-four surgeries were performed for cranial or spinal neurotrauma management. During the entire period, only 10 International Security Assistance Force members required acute or urgent neurosurgical interventions. The majority of neurosurgical procedures were performed in Afghan patients who received acute and elective treatment whenever the necessary infrastructure was available in the field hospital. Fifteen patients from the Afghan National Army and Police and 115 local patients underwent neurosurgery. Sixty-two procedures were carried out under acute or urgent conditions, and 78 operations were elective.

Maxmauer U.,German Armed Forces Hospital | Danz B.,German Armed Forces Hospital of Ulm | Gottschalk A.,German Armed Forces Hospital of Ulm | Kunz U.,German Armed Forces Hospital
Spine | Year: 2011

Study Design.: Prospective cohort study. Objective.: To investigate whether the adjunctive use of endoscopy of the subarachnoid space (arachnoscopy) can improve the success of microsurgery for spinal arachnoid adhesions. Summary of Background Data.: Intradural adhesions that obstruct pulsatile cerebrospinal fluid (CSF) flow are a typical spinal cause of syringomyelia. Phase-contrast magnetic resonance imaging (MRI) allows CSF flow obstructions to be reliably localized. The treatment of choice is the microsurgical removal of CSF flow obstructions caused by adhesions. Microsurgery, however, does not lend itself to assessments of further adhesions beyond the borders of the exposed area. In this study, we therefore investigated whether endoscopic assistance allows adhesions in the vicinity of the exposed area to be detected. Methods.: From 2006 to 2009, a single neurosurgeon performed 27 consecutive microsurgical procedures with endoscopic assistance in 25 patients with spinal arachnoid adhesions. A MurphyScope endoscope was used for this purpose. CSF flow was studied before and after surgery in all patients using phase-contrast MRI in the region of the craniocervical junction, the cervical spine, the thoracic spine, and the lumbar spine. Results.: In all 27 procedures, CSF flow obstructions were detected at the level identified by phase-contrast MRI. In 25 procedures, image quality was sufficient for an inspection of the adjacent subarachnoid space. In six cases, the surgeon detected further adhesions that obstructed CSF flow in the adjacent subarachnoid space not visualized with the microscope. In all cases, these adhesions were identified and removed during microsurgery. Postoperative MRI scans demonstrated free CSF flow in all patients and a decrease in syrinx size in six patients. Conclusion.: Arachnoscopy is a helpful adjunct to microsurgery and can be performed safely and easily. It allows the surgeon to detect further adhesions in the subarachnoid space, which would remain undetected by microscopy alone. Copyright © 2011 Lippincott Williams & Wilkins.

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