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Hamburg, Germany

Lowe B.,University of Hamburg | Andresen V.,Israelitisches Krankenhaus | Fraedrich K.,University of Hamburg | Gappmayer K.,University of Hamburg | And 7 more authors.
Clinical Gastroenterology and Hepatology | Year: 2014

Background & Aims: From May through July 2011 in northern Germany, there was a large outbreak of hemolytic uremic syndrome and bloody diarrhea, which was related to infections from Shiga toxin-producing Escherichia coli O104 (STEC). We investigated the depression, posttraumatic symptoms, fatigue, and health-related quality of life among patients within the first 6 months after STEC infection and aimed to identify factors associated with poor outcome. Methods: In a cohort study, we performed baseline assessments of 389 patients (69% female) 3 months after STEC infection (82 ± 36 days) and follow-up assessments of 308 of the patients 6 months afterward (199 ± 17 days). Data were collected at 13 hospitals in northern Germany. Patients completed validated self-report scales and a diagnostic interview. Results: At baseline, hemolytic uremic syndrome was diagnosed in 31% of the patients. Six months after the infection, mean self-reported severity of depression and posttraumatic symptoms and fatigue were significantly greater than in the general population, and the mean score from the mental component of health-related quality of life survey was significantly lower than average. Posttraumatic stress disorder had recently developed in 3% of patients (95% confidence interval, 1%-5%), and 43% of patients had clinically relevant fatigue (95% confidence interval, 41%-45%). The most important baseline factors associated with poor psychological health 6 months after STEC infection were previous traumatic events, neuroticism, and low social support (all P < .05). Conclusions: Six months after the major outbreak of STEC infection in northern Germany, a substantial number of patients had poor psychological health, persistent fatigue, and impaired quality of life. For future outbreaks, patients' premorbid risk factors should be considered, which might minimize the long-term effects of infections on mental health. © 2014 AGA Institute.


Fuchs K.H.,Agaplesion Markus Krankenhaus | Meining A.,TU Munich | Von Renteln D.,Universitatskrankenhaus Eppendorf | Fernandez-Esparrach G.,University of Barcelona | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background: The concept of natural orifice transluminal endoscopic surgery (NOTES) consists of the reduction of access trauma by using a natural orifice access to the intra-abdominal cavity. This could possibly lead to less postoperative pain, quicker recovery from surgery, fewer postoperative complications, fewer wound infections, and fewer long-term problems such as hernias. The Euro-NOTES Foundation has organized yearly meetings to work on this concept to bring it safely into clinical practice. The aim of this Euro-NOTES status update is to assess the yearly scientific working group reports and provide an overview on the current clinical practice of NOTES procedures. Methods: After the Euro-NOTES meeting 2011 in Frankfurt, Germany, an analysis was started regarding the most important topics of the European working groups. All prospectively documented information was gathered from Euro-NOTES and D-NOTES working groups from 2007 to 2011. The top five topics were analyzed. Results: The statements of the working group activities demonstrate the growing information and changing insights. The most important selected topics were infection issue, peritoneal access, education and training, platforms and new technology, closure, suture, and anastomosis. The focus on research topics changed over time. The principle of hybrid access has overcome the technical and safety limitations of pure NOTES. Currently the following NOTES access routes are established for several indications: transvaginal access for cholecystectomy, appendectomy and colon resections; transesophageal access for myotomy; transgastric access for full-thickness small-tumor resections; and transanal/transcolonic access for rectal and colon resections. Conclusions: NOTES and hybrid NOTES techniques have emerged for all natural orifices and were introduced into clinical practice with a good safety record. There are different indications for different natural orifices. Each technique has been optimized for the purpose of finding a safe and realistic solution to perform the procedure according to the specific indication. © 2013 Springer Science+Business Media New York.


Urban P.P.,Asklepios Klinik Barmbek | Wellach I.,Asklepios Klinik Barmbek | Faiss S.,Gastroenterology | Layer P.,Israelitisches Krankenhaus | Weis J.,RWTH Aachen
Movement Disorders | Year: 2010

We describe two patients who developed subacute axonal peripheral neuropathy under duodopa treatment. Comprehensive diagnostic workup including muscle and sural nerve biopsy revealed that the most probable cause of subacute axonal peripheral neuropathy was cobalamin and vitamin B6 deficiency in both the patients. © 2010 Movement Disorder Society.


Miehlke S.,Center for Digestive Diseases Eppendorf | Hruz P.,University of Basel | Vieth M.,Institute for Pathology | Bussmann C.,Institute for Pathology | And 17 more authors.
Gut | Year: 2016

Objective: To investigate the efficacy and safety of two different budesonide formulations (effervescent tablet for orodispersible use (BET) and viscous suspension (BVS)) with different daily dosages for short-term treatment of eosinophilic oesophagitis (EoE). Design: Adults with active EoE (n=76) randomly received 14 days' treatment with either BET 2×1 mg/day (BET1, n=19) or BET 2×2 mg/day (BET2, n=19), or BVS 2×5 mL (0.4 mg/mL)/day (BVS, n=19) or placebo (n=19) in a double-blind, double-dummy fashion, with a 2-week follow-up. Primary end point was histological remission (mean of <16 eosinophils/mm2 hpf). Secondary end points included endoscopy score, dysphagia score, drug safety and patient's preference for drug formulation. Results: Histological remission occurred in 100%, 94.7% and 94.7% of budesonide (BET1, BET2, BVS, respectively) and in 0% of placebo recipients (p<0.0001). The improvement in total endoscopic intensity score was significantly higher in the three budesonide groups compared with placebo. Dysphagia improved in all groups at the end of treatment; however, improvement of dysphagia persisted only in those treated with BET1 (p=0.0196 vs placebo). There were no serious adverse events. Local fungal infection (stained fungi) occurred in two patients of each budesonide group (10.5%). The effervescent tablet was preferred by 80% of patients. Conclusions: BET or BVS was highly effective and safe for short-term treatment of EoE. The 1 mg (twice daily) dosage was equally effective as the 2 mg twice daily dosage. The majority of patients preferred the effervescent tablet formulation. ClinicalTrials.gov number: NCT02280616; EudraCT number, 2009-016692-29.


Wenck C.,Israelitisches Krankenhaus | Zornig C.,Israelitisches Krankenhaus
Langenbeck's Archives of Surgery | Year: 2010

This article and video presents our Toupet procedure. It is a modern adaptation of Toupet's original technique. Toupet described his technique of fundoplication in 1963 (Toupet, Mem Aca Chir 89:394, 1963). He had little experience but saw the importance of a partial wrap to avoid postoperative dysphagia. He recommended closure of the hiatus only in case of large hernias and never divided the short gastric vessels. If we talk about a Toupet procedure today, we mean a posterior partial fundoplication. In contrary to his original technique, we have learned that hiatal closure is important to avoid recurrent hernia and that the wrap in most cases can be tailored more nicely if the short gastric vessels are divided. This modern adaptation of the Toupet's operation is a very successful tool to treat gastro-oesophageal reflux disease. © Springer-Verlag 2010.

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