Binder C.,Helios Klinikum Emil von Behring |
Beyer K.,Charité - Medical University of Berlin
Allergologie | Year: 2016
Adequate elimination diet is recommended as the mainstay of food allergy management. Patients with food allergies should be treated by a dietician specialized in allergies and long-term elimination diet. Patients will receive information regarding allergy labeling (according to the Food Information Regulations) and will learn about possible pitfalls in the system. Essential foods that are deleted from the menu, due to allergic reactions, must be replaced by other suitable and equivalent foods. Allergic patients should be re-provoked in regularly intervals, in order to determine whether the patient has outgrown the allergy or if new allergies have emerged. © 2016 Dustri-Verlag Dr. Karl Feistle.
Binder C.,Helios Klinikum Emil von Behring
Allergologie | Year: 2016
Diagnostic elimination diet, sensitization tests and dietary history are all crucial elements for the diagnosis of food allergies. The goal is to make sure that that the nutritional needs of the child remain the same during the entire elimination process of the allergen from the diet. A detailed diet history, possibly with evaluation of a symptom diary, is the basis for creating an individual elimination diet. Strict diets, such as oligo-allergenic based diet, are no longer used, as the risk of severe dietary defciencies in children is too pronounced. An elimination diet needs to incorporate the food preferences of the child and should not restrict the quality of life of the child and its family. © 2016 Dustri-Verlag Dr. Karl Feistle.
Bernhardt A.,Robert Koch Institute |
Sedlacek L.,Institute For Med Mikrobiologie Und Hygiene |
Wagner S.,HELIOS Klinikum Emil von Behring |
Schwarz C.,Charité - Medical University of Berlin |
And 2 more authors.
Journal of Cystic Fibrosis | Year: 2013
Background: Scedosporium and Pseudallescheria species are the second most common lung-colonising fungi in cystic fibrosis (CF) patients. For epidemiological reasons it is important to trace sources of infection, routes of transmission and to determine whether these fungi are transient or permanent colonisers of the respiratory tract. Molecular typing methods like multilocus sequence typing (MLST) help provide this data. Methods: Clinical isolates of the P. boydii complex (including S. apiospermum and P. boydii) from CF patients in different regions of Germany were studied using MLST. Five gene loci, ACT, CAL, RPB2, BT2 and SOD2, were analysed. Results: The S. apiospermum isolates from 34 patients were assigned to 32 sequence types (STs), and the P. boydii isolates from 14 patients to 8 STs. The results revealed that patients can be colonised by individual strains for years. Conclusions: The MLST scheme developed for S. apiospermum and P. boydii is a highly effective tool for epidemiologic studies worldwide. The MLST data are accessible at http://mlst.mycologylab.org/. © 2013 European Cystic Fibrosis Society.
Muderis M.A.,Macquarie University |
Bohling U.,Helios Klinikum Emil Von Behring |
Grittner U.,Charité - Medical University of Berlin |
Gerdesmeyer L.,Sankt Elisabeth KrankenHaus Kiel |
Scholz J.,Helios Klinikum Emil Von Behring
Journal of Bone and Joint Surgery - Series A | Year: 2011
Background: We present the results of cementless total hip arthroplasty performed with use of an anatomically adapted femoral stem and hemispherical cup with a fully coated Spongiosa-I metal surface, which was designed to achieve a surface similar to human cancellous bone. The purpose of the present retrospective case series was to determine the long-term outcomes of this hip arthroplasty system after a minimum of twenty years of follow-up. Methods: Between 1983 and 1985, 209 consecutive total hip arthroplasty procedures (199 patients) were performed with use of the first-generation Spongiosa metal-surface chromium-cobalt total hip implant with an articulating surface consisting of a ceramic head and an ultra-high-molecular-weight polyethylene liner. We report the clinical and radiographic outcomes, the rates of and reasons for revision, and the influence of sex and age on outcome and complications. Results: At the time of the latest follow-up, twenty-seven patients had died and thirteen patients had been lost to follow-up; none of these forty patients had had revision surgery. The outcomes for 159 patients (169 prostheses) were reviewed. The mean duration of follow-up was 262 months (range, 242 to 275 months). There were nineteen revisions, including fourteen revisions of the femoral stem, two revisions of the acetabular cup, and three revisions of both components. The mean Harris hip score for patients who did not undergo revision surgery was 82 points. The probability of survival of both components at twenty years, with revision for any reason as the end point, was 97%. The probability of survival of the acetabular component was 98%, and the probability of survival of the femoral component only was 86%. The probability of component survival was significantly increased among older patients. Conclusions: The results of cementless hip arthroplasty with use of the first-generation Spongiosa implant were excellent at a minimum of twenty years of follow-up. The probability of survival of the acetabular component exceeded that of the femoral stem. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated.
Teichgraber U.K.,Charité - Medical University of Berlin |
Pfitzmann R.,Helios Klinikum Emil Von Behring |
Hofmann H.A.F.,Zentrum fur Portimplantationen
Deutsches Arzteblatt | Year: 2011
Background: Port systems are easy to implant on an in- or outpatient basis and provide reliable, long-lasting central venous access. They are used mainly for cancer patients. Methods: This article is based on a selective literature review, the guidelines of the German Society for Nutrition Medicine and of the European Society for Clinical Nutrition and Metabolism, and the recommendations of the German Society for Pediatric Oncology and Hematology. Results: In modern oncology, central venous port systems are increasingly replacing short-term and permanently tunneled central venous catheters. They are indicated for patients who need long-term intravenous treatment involv ing, e.g., the repeated administration of chemotherapeutic drugs, parenteral nutrition, transfusions, infusions, injections, and/or blood sample collection. Port systems can markedly alleviate the burden of intravenous therapy and thereby improve these patients' quality of life. The planning, preparation, and performance of port system implantation require meticulous attention to detail. The rate of implantation-associated complications is less than 2% in experienced hands; overall complication rates have been reported from 4.3% to as high as 46%. The proper postoperative use and care of the port system are of decisive importance to the outcome. Reported infection rates during port system use range from 0.8% to 7.5% in current clinical studies. Conclusion: The treatment, follow-up care, and rehabilitation of cancer patients are interdisciplinary tasks. Optimal treatment and complication avoidance require a collaborative effort of all of the involved specialists - not just the physician implanting the port system, but also the oncologists, nutritionists, visiting nurses, and other home health care providers. Continuing medical education, too, plays a role in improving outcomes.
Flessenkamper I.H.,Helios Klinikum Emil von Behring
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2011
The average weight of the Western population increases year by year. As a consequence there are new surgical challenges concerning changing medical risks, an increase of technical expenditure and economic costs. This development creates problems also for vascular surgery. These concern those patients co-morbidities. On the other hand for this part of surgery the obesity paradox was proved as well. These problems, explanations and clinical results for different fields of vascular surgery as reported in the literature are discussed. Furthermore, we want to contribute to the acceptance of technical alternatives by describing our experiences in avoiding risks in obese patients. © Georg Thieme Verlag KG Stuttgart · New York.
Treasure T.,University College London |
Milosevic M.,University of Novi Sad |
Fiorentino F.,Imperial College London |
Pfannschmidt J.,HELIOS Klinikum Emil Von Behring
World Journal of Gastroenterology | Year: 2014
Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers, breast and lung, in that routine surveillance is recommended with the specific intent of detecting liver and lung metastases and undertaking liver and lung resections for their removal. We trace the history of this approach to colorectal cancer by reviewing evidence for effectiveness from the 1950s to the present day. Our sources included published citation network analyses, the documented proposal for randomised trials, large systematic reviews, and meta-analysis of observational studies. The present consensus position has been adopted on the basis of a large number of observational studies but the randomised trials proposed in the 1980s and 1990s were either not done, or having been done, were not reported. Clinical opinion is the mainstay of current practice but in the absence of randomised trials there remains a possibility of selection bias. Randomised controlled trials (RCTs) are now routine before adoption of a new practice but RCTs are harder to run in evaluation of already established practice. One such trial is recruiting and shows that controlled trial are possible. © 2014 Baishideng Publishing Group Inc. All rights reserved.
Ewig S.,Thoraxzentrum Ruhrgebiet Kliniken fur Pneumologie und Infektiologie |
Bauer T.,Helios Klinikum Emil von Behring |
Richter K.,Aqua Institute Gottingen |
Szenscenyi J.,Aqua Institute Gottingen |
And 3 more authors.
European Respiratory Journal | Year: 2013
C(U)RB-65 (confusion, (urea >7 mol.L-1,) respiratory frequency ≥30 breaths.min-1, systolic blood pressure <90 mmHg or diastolic blood pressure f60 mmHg and age ≥65 years) is now the generally accepted severity score for patients with community-acquired pneumonia (CAP) in Europe. In an observational study based on the large database from the German nationwide performance measurement programme in healthcare quality, including data from all hospitalised patients with CAP during 2008-2010, different CRB-age groups (<50 and <60 years) across the total CAP population and three entities of CAP (younger population aged <65 years, patients aged ≥65 years not residing in nursing homes and those with nursing home-acquired pneumonia (NHAP)) were validated for their potential to predict in-hospital death. 660 594 patients were investigated. Mortality was n593 958 (14.0%). In the total population, CRB-80 had the optimal area under the curve (0.690, 95% CI 0.688-0.691). However, in the younger cohort, CRB-50 performed best (0.730, 95% CI 0.724-0.736), with good identification of low-risk patients (CRB-50 risk class 1: 1.28% deaths, negative predictive value 98.7%). In the elderly, CRB-80 as the optimal age group performed worse (0.663, 95% CI 0.660-0.655 in patients not residing in nursing homes; 0.608, 95% CI 0.605-0.611 in those with NHAP). In the latter group, all CRB-age groups failed to identify low-risk patients (CRB-80 risk class 1: 22.75% deaths, negative predictive value 81.8%). Patients with hospitalised CAP aged <65 years may be assessed by the CRB-50 score. In those aged ≥ 65 years (not NHAP) assessed by the CRB-65 score, low-risk patients are already are at an increased risk of death. In NHAP patients, even the use of CRB-80 does not identify low-risk patients and should be accompanied by the evaluation of functional status and comorbidity. Copyright © ERS 2013.
Timmermann A.,Helios Klinikum Emil von Behring |
Timmermann A.,University of Gottingen
Anaesthesia | Year: 2011
Supraglottic airway devices (SAD) play an important role in the management of patients with difficult airways. Unlike other alternatives to standard tracheal intubation, e.g. videolaryngoscopy or intubation stylets, they enable ventilation even in patients with difficult facemask ventilation and simultaneous use as a conduit for tracheal intubation. Insertion is usually atraumatic, their use is familiar from elective anaesthesia, and compared with tracheal intubation is easier to learn for users with limited experienced in airway management. Use of SADs during difficult airway management is widely recommended in many guidelines for the operating room and in the pre-hospital setting. Despite numerous studies comparing different SADs in manikins, there are few randomised controlled trials comparing different SADs in patients with difficult airways. Therefore, most safety data come from extended use rather than high quality evidence and claims of efficacy and particularly safety must be interpreted cautiously. © 2011 The Association of Anaesthetists of Great Britain and Ireland.
Giesen C.,Humboldt University of Berlin |
Giesen C.,BAM Federal Institute of Materials Research and Testing |
Mairinger T.,HELIOS Klinikum Emil von Behring |
Khoury L.,HELIOS Klinikum Emil von Behring |
And 4 more authors.
Analytical Chemistry | Year: 2011
We optimized multiplexed immunohistochemistry (IHC) on breast cancer tissue. Up to 20 tumor markers are routinely evaluated for one patient, and thus, a common analysis results in a series of time consuming staining procedures. As an alternative, we used lanthanides for labeling of primary antibodies, which are applied in IHC. Laser ablation (LA) ICPMS was elaborated as a detection tool for multiplexed IHC of tissue sections. In this study, we optimized sample preparation steps and LA ICPMS parameters to achieve a sufficient signal-to-background ratio. The results prove the high selectivity of applied antibodies, which was sustained after labeling. Up to three tumor markers (Her 2, CK 7, and MUC 1) were detected simultaneously in a single multiplex analysis of a 5 μm thin breast cancer tissue at a laser spot size of 200 μm. Furthermore, the LA ICPMS results indicate a significantly higher expression level of MUC 1 compared to Her 2 and CK 7, which was not obvious from the conventionally stained tissue sections. © 2011 American Chemical Society.