Stuttgart, Germany


Stuttgart, Germany
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Eckle V.S.,Katharinenhospital | Schneider G.,TU Munich
Anaesthesist | Year: 2017

One of the aims of the Scientific Working Group Neuroanesthesia (WAKNA) of the German Society of Anesthesiology and Intensive Care Medicine is to disseminate new findings in the field of neuroscience and neuroanesthesia and to propagate novel therapeutic and diagnostic options into clinical practice. Once a year, the WAKNA displays and discusses recent noteworthy publications from the past 12 months at the German Anesthesia Meeting. In 2016, a new pharmacologic strategy with dexmedetomidine to prevent postoperative pain after craniotomy, the impact of the widely used anesthetic drug propofol on GABA receptor surface expression, a study highlighting the ultrasound-guided detection of increased intracranial pressure, and an article showing the interactions of neuromuscular blocking drugs on the BIS neuromonitoring were presented. © 2017 Springer Medizin Verlag GmbH

Background: Ethics consultations in a clinical setting can be challenging, specifically with respect to limiting therapeutic interventions in terminally ill patients. Some decisions will even be controversial. Objective: Can a clinical autopsy be used to confirm the recommendations given by the ethics committee, i. e. limitation of therapy to palliative care? Material and methods: We report an exemplary case of a patient with endocarditis and subsequent septic cerebral infarction. During treatment in the intensive care unit (ICU) two ethics consultations were held. Both times the patient’ s clinical condition and prognosis were controversially discussed. The patient died after a recommendation had been given for supportive care. The subsequent autopsy, which is described in detail, confirmed a fatal set of symptoms with extensive destruction of the heart and disseminated brain infarcts. Conclusion: Clinical autopsies are crucial for an objective description of diseases and can corroborate the decision to limit therapeutic intervention in end of life care. It is a valuable tool in evaluating the quality of decision making in ethics counseling. © 2017 Springer Medizin Verlag GmbH

Nydahl P.,University of Kiel | Ruhl A.P.,Johns Hopkins University | Ruhl A.P.,U.S. National Institutes of Health | Bartoszek G.,Witten/Herdecke University | And 9 more authors.
Critical Care Medicine | Year: 2014

Objectives: There is growing evidence to support early mobilization of adult mechanically ventilated patients in ICUs. However, there is little knowledge regarding early mobilization in routine ICU practice. Hence, the interdisciplinary German ICU Network for Early Mobilization undertook a 1-day point-prevalence survey across Germany. Design: One-day point-prevalence study. Setting: One hundred sixteen ICUs in Germany in 2011. Patients: All adult mechanically ventilated patients. Interventions: None. Measurements and Main Results: For a 24-hour period, data were abstracted on hospital and ICU characteristics, the level of patient mobilization and associated barriers, and complications occurring during mobilization. One hundred sixteen participating ICUs provided data for 783 patients. Overall, 185 patients (24%) were mobilized out of bed (i.e., sitting on the edge of the bed or higher level of mobilization). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 8%, 39%, and 53% were mobilized out of bed, respectively (p < 0.001 for difference between three groups). The most common perceived barriers to mobilizing patients out of bed were cardiovascular instability (17%) and deep sedation (15%). Mobilization out of bed versus remaining in bed was not associated with a higher frequency of complications, with no falls or extubations occurring in those mobilized out of bed. Conclusions: In this 1-day point-prevalence study conducted across Germany, only 24% of all mechanically ventilated patients and only 8% of patients with an endotracheal tube were mobilized out of bed as part of routine care. Addressing modifiable barriers for mobilization, such as deep sedation, will be important to increase mobilization in German ICUs. Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Brenner S.A.,University of Hohenheim | Zacheja S.,Marienhospital | Schaffer M.,Marienhospital | Feilhauer K.,Katharinenhospital | And 2 more authors.
Immunology | Year: 2014

Summary: Mast cells are now considered sentinels in immunity. Given their location underneath the gastrointestinal barrier, mast cells are entrusted with the task of tolerating commensal microorganisms and eliminating potential pathogens in the gut microbiota. The aim of our study was to analyse the responsiveness of mast cells isolated from macroscopically normal and Crohn's disease-affected intestine to lipopolysaccharide (LPS). To determine the LPS-mediated signalling, human intestinal mast cells were treated with LPS alone or in combination with soluble CD14 due to their lack of surface CD14 expression. LPS alone failed to stimulate cytokine expression in human intestinal mast cells from both macroscopically normal and Crohn's disease tissue. Upon administration of LPS and soluble CD14, there was a dose- and time-dependent induction of cytokine and chemokine expression. Moreover, CXCL8 and interleukin-1β protein expression was induced in response to activation with LPS plus soluble CD14. Expression of cytokines and chemokines was at similar levels in mast cells from macroscopically normal and Crohn's disease-affected intestine after LPS/soluble CD14 treatment. In conclusion, human intestinal mast cells appear to tolerate LPS per se. The LPS-mediated activation in mast cells may be provoked by soluble CD14 distributed by other LPS-triggered cells at the gastrointestinal barrier. © 2014 John Wiley & Sons Ltd.

Schroeder H.W.S.,University of Greifswald | Hickmann A.-K.,Katharinenhospital | Baldauf J.,University of Greifswald
Neurosurgical Review | Year: 2011

This study aims to determine the value of endoscope assistance in the microsurgical resection of skull base meningiomas. Fourty-six patients harboring a skull base meningioma underwent an endoscope-assisted microsurgical resection. In 30 patients (65%), tumor parts which could not be visualized under the microscope were detected with the endoscope. In 26 patients (56%), these tumor remnants were removed under endoscopic view. Gross total resection was achieved in 35 patients (76%) and near-total resection in 11 (24%). There was no surgical mortality. The major complication was new cranial nerve deficit. The application of endoscopes was most useful in the small supraorbital craniotomies to look under the ipsilateral optic nerve and internal carotid artery as well as to visualize the diaphragm sellae and olfactory groove. In the retrosigmoid craniotomies, the endoscope was beneficial to inspect the internal auditory canal, to look into Meckel's cave, or to inspect areas hidden behind the jugular tubercle and tentorial edge. There was no obvious complication related to the application of the endoscope. Endoscope assistance is particularly of value when skull base meningiomas are to be removed via small craniotomies to inspect blind corners which cannot be visualized in a straight line with the microscope. In addition, there is a benefit of using endoscopes with various angles of view in standard craniotomies and skull base approaches to look around bony and dural corners or to look behind neurovascular structures, by which the amount of skull base drilling and retraction to expose the tumor can be reduced. © 2011 Springer-Verlag.

Hickmann A.-K.,Katharinenhospital | Nadji-Ohl M.,Katharinenhospital | Hopf N.J.,NeuroChirurgicum
Journal of Neuro-Oncology | Year: 2015

Five-aminolevulinic-acid (5-ALA) is known for its benefits in surgery of primary gliomas, but has only been cautiously used in recurrent gliomas dreading over-resection, insufficient or false-positive fluorescence in adjuvantly treated tumors. We evaluated intraoperative fluorescence based on tumor pathology, pretreatment as well as surgical and neurological outcome in patients with recurrent gliomas. Patients who underwent fluorescence-guided surgery for recurrent gliomas between 6/2010 and 2/2014 at our institution were retrospectively selected. Degree of surgical resection, neurological status, pathology results, intraoperative fluorescence and follow up status were analyzed. Patients who underwent repeat surgery without 5-ALA were selected as controls. 58 patients with high grade gliomas (°III and °IV) were included. 10 of 63 tumors (15.9 %) failed to fluoresce intraoperatively of which nine (90 %) had been adjuvantly treated prior to recurrence, as were 46 of the 53 fluorescing tumors (86.8 %). Non-fluorescing tumors were IDH mutated significantly more often (p = 0.005). 30 tumors (47.6 %) were located eloquently. 51 (80.9 %) patients showed no new neurologic deficits postoperatively. 13 patients (20.6 %) showed no signs of recurrence at their latest follow up. Eight patients were lost to follow up. Overall survival was significantly longer in the 5-ALA group (p = 0.025). Fluorescence-guided surgery in recurrent gliomas is safe and allows for a good surgical and neurological outcome in a difficult surgical environment, especially when used in combination with neuronavigation and intraoperative ultrasound to prevent over-resection. Adjuvant therapy did not significantly influence fluorescing properties. © 2015, Springer Science+Business Media New York.

Tatsch K.,Municipal Hospital Karlsruhe Inc. | Poepperl G.,Katharinenhospital
Journal of Nuclear Medicine | Year: 2013

This article gives an update on nigrostriatal dopamine terminal imaging, with emphasis on SPECT performed with the presynaptic dopamine transporter (DAT) ligand 123I-FP-CIT. The paper covers the rational use of this technique in the diagnostic work-up of patients with known or suspected parkinsonian syndromes. In detail, it addresses the impact of the method for the proof or exclusion of neurodegenerative parkinsonism, for its early and preclinical diagnosis, and for the evaluation of disease progression. The importance of normal DAT binding for differentiating symptomatic parkinsonism and relevant tremor syndromes from neurodegeneration is highlighted. Particularly emphasized is the role of DAT SPECT for diagnosing Lewy body dementia and its separation from Alzheimer dementia. Finally, some remarks deal with the economic aspects of the use of these imaging techniques in the clinical setting. COPYRIGHT © 2013 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Olbricht C.J.,Katharinenhospital
Clinica Chimica Acta | Year: 2012

Immunosuppressive therapy is administered to all solid organ transplant recipients to help prevent acute rejection and the loss of allograft function. Adequate immunosuppression is a delicate balance between rejection rates and chronic allograft dysfunction on the one hand and immunological and nonimmunological side effects on the other hand. The general strategy is to minimize the toxicity associated with triple immunosuppressive regimens and possibly enhance long-term allograft survival without compromising short-term allograft survival. There are no criteria that enable the clinician to predict who will do well with the decrease or complete avoidance of immunosuppression. It becomes more and more clear that randomized controlled trials will not be able to solve the problem of defining the optimal immunosuppression for a given individual. The most promising road to achieve this goal and to improve chronic allograft survival may be personalized immunosuppression guided by biomarkers complementary to conventional drug monitoring strategies. © 2012 Elsevier B.V..

The documentation of a quality management system (QMS) usually includes evaluation, measuring and monitoring of the QMS, responsibility of staff members and the perview of the QMS. Requests on the documentation can diverge in different guidelines and laws (e. g. the German Ordinance on the Operation of Pharmacies or GMP-Guidelines).

Friedl A.,Katharinenhospital
Diabetes Aktuell | Year: 2016

Diabetes mellitus and dementia are common diseases of old age. By demography the numbers of those affected are rising steadily. In diabetic patients, and even in non-diabetics, there are statistical correlations between the level of the respective blood glucose levels and the development of dementia. Neurobiological research results suggest causal relationships. Continuous reductions in the incidence of dementia in comparable age groups in recent decades raise hope for the preventive effect of improved medical care. There is evidence for acute deterioration of mental ability at reduced and at elevated blood glucose levels. Thus, the therapeutic goal of near-normal glycemic diabetic control at least when cognitive deficits are preexisting can help to obtain still persisting independence as long as possible. The peculiarities of the growing group of older people with diabetes and dementia are to be considered specifically and comprehensively also in diabetological treatment. They require good and knowledgeable cooperation of all concerned. © Georg Thieme Verlag KG Stuttgart. New York.

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