Helios Hospital

Berlin, Germany

Helios Hospital

Berlin, Germany

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Abdel-Wahab M.,University of Kiel | Horack M.,University of Heidelberg | Gerckens U.,HELIOS Hospital | Schuler G.,University of Leipzig | And 4 more authors.
Heart | Year: 2011

Background: Significant aortic regurgitation (AR) is rare following surgical aortic valve replacement and has been associated with worse outcome. Following transcatheter aortic valve implantation (TAVI), AR is common, but little is known about its determinants and its effect on clinical outcome. Objective: To evaluate early outcome and risk factors possibly associated with AR after TAVI. Methods: Data were analysed from 690 patients with severe aortic stenosis treated with TAVI enrolled in the prospective multicentre German transcatheter aortic valve interventions registry. The occurrence of AR was evaluated angiographically after device deployment and removal of the catheter and guidewire. Significant AR was defined as AR≥2/4. Results: The study population's mean age was 81.466.3 years and men represented 44%. The mean logistic Euroscore was 20.4613.1%. Overall, 84% of patients received the Medtronic CoreValve system and 16% received the Edwards Sapien valve. Significant AR occurred in 119 patients (17.2%). Factors independently associated with significant AR were aortic valve area (adjusted OR=0.10), annulus measurement by transoesophageal echocardiography (adjusted OR=1.94), male gender (adjusted OR=1.80), cardiogenic shock (adjusted OR=1.94) and renal failure (adjusted OR=0.53). In-hospital death rates were significantly higher in patients with significant AR than in those with no/mild AR (15.1% vs 6.7%, OR=2.50, 95% CI 1.37 to 4.55), as were rates of low cardiac output (20% vs 4.4%) and respiratory failure (16.5% vs 7.1%). Using multivariate analysis, the presence of post-procedural AR≥2/4 remained a strong independent predictor of inhospital death (adjusted OR=2.43, 95% CI 1.22 to 4.85). Conclusion: Significant AR after TAVI is common and is associated with increased in-hospital mortality. Long-term follow-up is critical to further define the impact of residual AR on clinical outcome. Until these data become available, every effort should be made to prevent and treat this complication.


Galsky M.D.,Mount Sinai School of Medicine | Moshier E.,Mount Sinai School of Medicine | Krege S.,Alexianer Krefeld GmbH | Lin C.-C.,National Taiwan University Hospital | And 6 more authors.
Cancer | Year: 2013

BACKGROUND The current study was conducted to develop a pretreatment prognostic model for patients with unresectable and/or metastatic urothelial cancer who were treated with first-line, cisplatin-based chemotherapy. METHODS Individual data were pooled from 399 patients who were enrolled on 8 phase 2 and 3 trials evaluating cisplatin-based, first-line chemotherapy in patients with metastatic urothelial carcinoma. Variables selected for inclusion in the model were combined in a Cox proportional hazards model to produce a points-based nomogram with which to predict the median, 1-year, 2-year, and 5-year survival. The nomogram was validated externally using data from a randomized trial of the combination of methotrexate, vinblastine, doxorubicin plus cisplatin versus docetaxel plus cisplatin. RESULTS The median survival of the development cohort was 13.8 months (95% confidence interval, 12.1 months-16.0 months); 68.2% of the patients had died at the time of last follow-up. On multivariable analysis, the number of visceral metastatic sites, Eastern Cooperative Oncology Group performance status, and leukocyte count were each found to be associated with overall survival (P <.05), whereas the site of the primary tumor and the presence of lymph node metastases were not. All 5 variables were included in the nomogram. When subjected to internal validation, the nomogram achieved a bootstrap-corrected concordance index of 0.626. When applied to the external validation cohort, the nomogram achieved a concordance index of 0.634. Calibration plots suggested that the nomogram was well calibrated for all predictions. CONCLUSIONS Based on routinely measured pretreatment variables, a nomogram was constructed that predicts survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy. This model may be useful in patient counseling and clinical trial design. © 2013 American Cancer Society.


Schrader A.J.,University of Ulm | Seseke S.,Diakonissenkrankenhaus | Keil C.,University of Marburg | Herrmann E.,Muenster University Medical Center | And 6 more authors.
European Urology | Year: 2014

Background Temsirolimus (TEMSR) was approved for treating advanced renal cell carcinoma (RCC) in 2007. Based on the data from a single phase 3 trial, it is recommended explicitly as first-line therapy for patients with a poor clinical prognosis. Objective The aim of this prospective multicentre trial (STARTOR) was to examine the effectiveness of TEMSR in daily clinical practice with a broader indication in the treatment of metastatic RCC. Design, setting, and participants Metastatic RCC patients treated with 25 mg of TEMSR weekly were submitted to a prospective systematic evaluation and follow-up in 87 German centres between January 2008 and October 2011 using standardised procedures. Outcome measurements and statistical analysis All data were centrally analysed by an independent clinical research organisation. Results and limitations This interim analysis of the STARTOR study included 386 patients. The observed toxicity was tolerable, the median dose intensity was 91% (interquartile range: 79-100%), and the median treatment duration was 20.1 wk (95% confidence interval [CI], 17.0-23.3 wk). Clinical benefit was seen in 157 patients (40.7%); the median progression-free and overall survival were 4.9 mo (95% CI, 4.2-5.6) and 11.6 mo (95% CI, 9.3-13.9), respectively. The effectiveness of TEMSR did not differ significantly in relation to the patient's age, histologic RCC subtype, or line of treatment. The major limitations were the noninterventional study design, limited information about Memorial Sloan-Kettering Cancer Center risk factors and detailed toxicity, and the lack of central radiologic review. Conclusions TEMSR is an effective and largely well-tolerated treatment alternative for metastatic RCC patients in daily clinical practice, irrespective of the patient's age, histologic RCC subtype, or line of treatment. © 2013 European Association of Urology.


Stroh C.,SRH Hospital Gera | Stroh C.,University Hospital | Groh C.,Helios Hospital | Weiner R.,Sachsenhausen Hospital | And 5 more authors.
Obesity Surgery | Year: 2013

Background: Since 1 January 2005, the situation of bariatric surgery has been examined in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. Methods: Data collection on the results of gastric banding procedures was started in 2005, and the data are registered in an online database. Follow-up data were collected once a year. Participation in the quality assurance study is voluntary. Results: Since 2005, 3,453 gastric banding procedures have been performed at 88 hospitals. The mean age of patients was 40.7 years, and the mean body mass index (BMI) was 45.2 kg/m2. BMI and comorbidities are significantly higher in male patients. Regarding gender-specific aspects, there are no significant differences in the perioperative complication rates. The amelioration rate of comorbidities in male patients is lower than in female patients. Conclusion: Gastric banding in Germany is generally performed in patients with a BMI below 45 kg/m2. The perioperative complication rate is low. Data from the nationwide survey of the German Bariatric Surgery Registry show significant differences in preoperative comorbidities and their amelioration between male and female patients. There is a need for further evaluation of gender-specific aspects of gastric banding procedures to optimize patient selection, reduce specific postoperative complications, and achieve long-term effects on weight loss and remission of comorbidities. © 2013 Springer Science+Business Media New York.


Gerullis H.,Lukas Hospital | Gerullis H.,German Center for Assessment and Evaluation of Innovative Techniques in Medicine | Eimer C.,Lukas Hospital | Ecke T.H.,HELIOS Hospital | And 4 more authors.
Anti-Cancer Drugs | Year: 2013

The role of pazopanib in the second-line setting of refractory metastatic transitional cell carcinoma of the urothelium has not been defined clearly. The aim of this phase I/II trial was to assess the safety, tolerability, and efficacy of combining pazopanib and vinflunine in patients with metastatic transitional cell carcinoma of the urothelium after failure of first-line platinum-containing therapy. From May 2011 to December 2011, five patients were enrolled in this trial. Pazopanib was the investigated compound; four levels were planned (200, 400, 600, and 800 mg/day). Vinflunine was dosed at 280 mg/m for the first dose and 320 mg/m every 3 weeks thereafter. After the definition of a tolerated dose for the combined therapy, a subsequent phase II study was planned. At the starting level, pazopanib 200 mg/day, dose-limiting toxicities were observed in two of five patients. One patient experienced grade 4 febrile neutropenia, which led to treatment discontinuation. A second patient showed grade 3 hepatobiliary disorder with an increase in γ-glutamyltransferase. The study was interrupted at dose level 1 for safety reasons. The initially planned phase II study was therefore not carried out. This phase I study showed that combined therapy of daily pazopanib (200 mg) and vinflunine (280/320 mg/m) every 3 weeks is poorly tolerated in patients with refractory advanced urothelial cancer. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Gross U.,University of Gottingen | Amuzu S.K.,Holy Family Hospital | de Ciman R.,St Francis Xavier Hospital | Kassimova I.,St Martin Of Porres Hospital | And 6 more authors.
Emerging Infectious Diseases | Year: 2011

Bacterial distribution and antimicrobial drug resistance were monitored in patients with bacterial bloodstream infections in rural hospitals in Ghana. In 2001?2002 and in 2009, Salmonella enterica serovar Typhi was the most prevalent pathogen. Although most S. enterica serovar Typhi isolates were chloramphenicol resistant, all isolates tested were susceptible to ciprofloxacin.


Schaper A.,University of Gottingen | Ceschi A.,University of Zürich | Deters M.,Helios Hospital | Kaiser G.,University of Gottingen
European Journal of Internal Medicine | Year: 2013

The organization and work of a poisons center are demonstrated on the basis of GIZ-Nord Poisons Center Annual Report for 2011. In a short summary the basic principles of clinical toxicology are elucidated: the indications for gastric lavage and the application of activated charcoal. Moreover the means of enhanced elimination are presented: hemodialysis, hemoperfusion, multi-dose activated charcoal and molecular absorbent recirculating system (MARS). Gastric lavage is indicated within one hour after ingestion of a life-threatening dose of a poison. In intoxications with CNS penetrating substances gastric lavage should be performed only after endotracheal intubation due to the risk of aspiration. The basic management of the intoxicated patient by emergency medicine personnel out of hospital and on the way into the hospital is presented. The "Bremen List", a compilation of five antidotes (atropine, 4-DMAP, tolonium chloride, naloxone, activated charcoal) for the out of hospital treatment by emergency doctors is introduced. © 2012 European Federation of Internal Medicine.


Dai Y.,Helios Hospital | Chopra S.S.,University of Medicine | Kneif S.,Helios Hospital | Hunerbein M.,Helios Hospital
Journal of Thoracic and Cardiovascular Surgery | Year: 2011

Objective: Esophageal anastomotic leaks, perforations, and fistulae are associated with considerable morbidity and mortality. The aim of the present study was to assess the efficacy of self-expanding plastic stents in the treatment of esophageal leaks. Methods: From 2001 to 2009, 41 patients with postoperative anastomotic leaks (n = 30), esophageal perforations (n = 6), or fistulae (n = 5) were treated by endoscopic insertion of self-expanding plastic stents. The clinical outcome of the patients was analyzed, including leak healing, morbidity, and mortality. Results: Self-expanding plastic stents were successfully inserted in all 41 patients without procedure-related complications. Non-ventilated patients received oral feeding an average of 3.9 days after stent placement. Complete leak healing was obtained in 27 of 30 patients (90%) with anastomotic leaks and 5 patients (83%) with perforation. Sealing of fistulae by the stents was achieved in all 5 patients, and closure of the fistula was observed in 2 patients (40%). The mean healing time was 30 days for anastomotic leaks, 15 days for esophageal perforations, and 16 days for fistulae. Stent migration occurred in 14 cases, but endoscopic reintervention and new stent placement were successful in all cases. In-hospital mortality after treatment of esophageal leaks with stents was 10%. Conclusions: In combination with effective interventional or surgical drainage, stenting is a viable option for the treatment of esophageal anastomotic leaks and perforations, but the success in tracheoesophageal fistula is limited. Copyright © 2011 by The American Association for Thoracic Surgery.


Dai Y.,Helios Hospital | Chopra S.S.,University of Medicine | Steinbach M.,Helios Hospital | Kneif S.,Helios Hospital | Hunerbein M.,Helios Hospital
Seminars in Thoracic and Cardiovascular Surgery | Year: 2011

Stenting of esophageal leaks, ie, anastomotic leaks or perforations, might be a minimally invasive alternative to surgery in most clinical situations. However, it must be emphasized that surgery should be considered if stent treatment in combination with drainage and antibiotics does not improve the clinical condition of the patient. Stent insertion should be performed as soon as possible after diagnosis of the leak. © 2011 Elsevier Inc.


Ecke T.H.,HELIOS Hospital | Bartel P.,HELIOS Hospital | Hallmann S.,HELIOS Hospital | Ruttloff J.,HELIOS Hospital
Urology | Year: 2010

Objectives: To evaluate safety and patients' comfort by using the ureteral stent symptom questionnaire. Ureteral stents are used to provide upper urinary-tract drainage. Methods: A total of 133 JJ-ureteral stents with and without antireflux-membrane valve as consecutive referrals for therapy of hydronephrosis have been inserted. Four weeks after insertion of the ureteral stent, the patients were asked about pain while urination, flank pain due to reflux, and the comparison with former stents. Ultrasound of the kidney for hydronephrosis grade and creatinine value as follow-up have been documented. Statistical analysis included χ2 test after Pearson correlation computed and performed by SPSS software. Results: We found a high correlation between the JJ-ureteral stent used and the detection of a hydronephrosis (P = .004). More patients who had a JJ-ureteral stent without valve complained of flank pain (P <.0005) and pain in the bladder (P <.0005). Patients who had a ureteral stent before were asked to compare new stents with the former ones. No patients with a JJ-ureteral stent with valve found this one to be worse than what they had before. Conclusions: JJ-stent related symptoms are a major problem for these patients. New stent designs and materials will be developed in the future to reduce stent-related morbidity and improve patient comfort. JJ-ureteral stents with an antireflux-membrane valve have a lower complication rate and provide a higher patient comfort compared with stents without valve. Crown Copyright © 2010.

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