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Stuttgart Mühlhausen, Germany

Kluba T.,University of Tubingen | Fiedler K.,University of Tubingen | Kunze B.,University of Tubingen | Ipach I.,University of Tubingen | Suckel A.,Katharinenhospital
Archives of Orthopaedic and Trauma Surgery | Year: 2012

Background: Total knee arthroplasty is associated with a significant postoperative blood loss even without any form of perioperative anticoagulation. Methods: The potential role of QUIXIL®, a fibrin sealant used in orthopaedic surgery to control blood loss and avoid blood transfusions in patients undergoing total knee arthroplasty was evaluated in a prospective randomized trial with twenty-four patients diagnosed with primary osteoarthritis of the knee. Results: Results showed that application of 2 ml QUIXIL® adds costs to treatment without reducing the number of transfused red blood cell counts and postoperative haemoglobin loss. However, significant lower levels of postoperative fluid loss (P = 0.026) was detected in QUIXIL® treated patients. Conclusion: Regarding cost effectiveness and benefit no indication for the use of 2 ml QUIXIL® fibrin sealant in standard knee arthroplasty could be proofed statistically. © Springer-Verlag 2012. Source


Reisch R.,Center for Endoscopic and Minimally Invasive Neurosurgery | Fischer G.,Johannes Gutenberg University Mainz | Fischer G.,Saarland University | Stadie A.,University of Mannheim | And 3 more authors.
World Neurosurgery | Year: 2014

Objective To review our surgical experience in minimally invasive transcranial endoscope-assisted microsurgical treatment of intracranial aneurysms, using the supraorbital keyhole craniotomy.Methods The supraorbital keyhole approach was performed through an eyebrow skin incision in 793 cases for treatment of 989 intracranial aneurysms. Of patients, 474 were operated on after subarachnoid hemorrhage, and 319 were operated on under elective conditions. After lateral frontobasal burr hole trephination, a limited subfrontal craniotomy was created. To achieve adequate intraoperative exposure through the limited approach, endoscopes were used routinely. Surgical outcome was assessed using the modified Rankin scale.Results The transcranial endoscope-assisted microneurosurgery technique was used routinely via a supraorbital approach. In 152 operations (19.1%), the endoscope provided important visual information in the vicinity of the aneurysm, revealing subsequent clip repositioning. The results of incidental aneurysms were excellent with a modified Rankin scale score ≤2 in 96.52%. The overall outcome of ruptured aneurysms was good with a modified Rankin scale score ≤2 in 72.2% of patients. There were no approach-related intraoperative or postoperative complications.Conclusions The minimally invasive supraorbital keyhole approach allowed safe surgical treatment of intracranial aneurysms, including after subarachnoid hemorrhage. The markedly improved endoscopic visualization increased the assessment of clip placement with ideal control of surrounding vessels including perforators for identification of incorrect clip position. © 2014 Published by Elsevier Inc. Source


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. Source


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. Source


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. Source

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