Schönau am Königssee, Germany
Schönau am Königssee, Germany

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Belsey J.,JB Medical Ltd | Crosta C.,Italian National Cancer Institute | Epstein O.,Royal Free Hospital | Fischbach W.,Klinikum Aschaffenburg | And 3 more authors.
Current Medical Research and Opinion | Year: 2012

Objective: It is unclear whether small bowel visibility in video capsule endoscopy (VCE) is enhanced by the use of bowel preparation in addition to pre-procedural fasting. The objective of this study was to clarify this issue by means of a systematic review of the literature and meta-analysis. Methods: Randomised controlled trials comparing the use of laxative bowel preparation with fasting alone were identified using a literature search. Categorical measures of treatment efficacy were extracted from qualifying studies and pooled using random-effects meta-analyses. Primary analysis compared any bowel preparation with fasting alone; subsidiary analyses assessed diagnostic yield and results for each regimen. Results: Eight studies were identified, using either polyethylene glycol (PEG) or sodium phosphate (NaP) based regimens. No qualifying studies were identified using other laxatives. Study quality was sufficiently high to warrant meta-analysis. Use of any form of bowel preparation yielded significantly better visibility than fasting alone (OR=2.31; 95% CI=1.46-3.63; p<0.0001). Similar results were seen for diagnostic yield (OR=1.88; 95% CI=1.24-2.84; p=0.023). When sub-analysed according to the treatment used, PEG-based regimens showed benefit (OR=3.11; 95% CI=1.96-4.94; p<0.0001), while NaP-based regimens yielded no significant difference from fasting alone (OR=1.32; 95% CI=0.59-2.96; p<0.0001). Limitations: The study did not consider results from retrospective studies, nor those which did not give a categorical measure of efficacy. The impact of prokinetic and other adjunctive treatments was not considered. The results are only relevant to the most commonly used video capsule, as data for newer alternative devices have not yet been published. Conclusion: Based on the results of this analysis, the use of bowel preparation alongside fasting is recommended for VCE. PEG-based regimens offer a clear advantage in these patients, while the currently available evidence base does not support the use of NaP. For VCE, lower volume PEG appears to be as efficacious as higher volumes traditionally used for colonoscopy preparation. © 2012 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.


Hartel C.,University of Lübeck | Pagel J.,University of Lübeck | Rupp J.,University of Lübeck | Bendiks M.,University of Lübeck | And 11 more authors.
Journal of Pediatrics | Year: 2014

Objective To evaluate outcome data in an observational cohort of very low birth weight infants of the German Neonatal Network stratified to prophylactic use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics. Study design Within the observational period (September 1, 2010, until December 31, 2012, n = 5351 infants) study centers were categorized into 3 groups based on their choice of Lactobacillus acidophilus/Bifidobacterium infantis use: (1) no prophylactic use (12 centers); (2 a/b) change of strategy nonuser to user during observational period (13 centers); and (3) use before start of observation (21 centers). Primary outcome data of all eligible infants were determined according to center-specific strategy. Results The use of probiotics was associated with a reduced risk for necrotizing enterocolitis surgery (group 1 vs group 3: 4.2 vs 2.6%, P =.028; change of strategy: 6.2 vs 4.0%, P <.001), any abdominal surgery, and hospital mortality. Infants treated with probiotics had improved weight gain/day, and probiotics had no effect on the risk of blood-culture confirmed sepsis. In a multivariable logistic regression analysis, probiotics were protective for necrotizing enterocolitis surgery (OR 0.58, 95% CI 0.37-0.91; P =.017), any abdominal surgery (OR 0.7, 95% CI 0.51-0.95; P =.02), and the combined outcome abdominal surgery and/or death (OR 0.43; 95% CI 0.33-0.56; P <.001). Conclusions Our observational data support the use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics to reduce the risk for gastrointestinal morbidity but not sepsis in very low birth weight infants. Copyright © 2014 Elsevier Inc. All rights reserved.


Renner C.,Klinikum Aschaffenburg | Whyte J.,Klinikum Aschaffenburg | Singh S.,Klinikum Aschaffenburg | Friedl W.,Klinikum Aschaffenburg
Archives of Orthopaedic and Trauma Surgery | Year: 2010

Introduction: Many different surgical methods and implants for the treatment of fifth metatarsal fractures have been established yet. A high rate of complications, such as nonunion, fragment dislocation, refracture, implant deformation and irritation are widely occurring due to the insufficient ability of the implants to compensate the tension applied to the proximal fragment through the peroneal tendon combined with an impaired blood supply at the fracture zone. Therefore, the search for improved surgical solutions is thoroughly understandable. Thus, we have introduced the XS-nail as an intramedullary nail system that bears the ability to provide a compression to the fracture zone through a grub screw. In this work, we have analyzed the position of the XS-nail in relationship to other methods with special regard to the tension-band wiring. Method: In a retrospective analysis, we examined 77 cases, where a proximal fifth metatarsal fracture has been treated with the XS-nail. As a comparison group, we collected data from 47 patients who had been treated with tension-band wiring for the same indication in our hospital. Altogether, we included 124 patients, representing the largest study population of surgically treated cases of proximal fifth metatarsal fractures as compared to the actual literature. Results: When compared with the tension-band wiring group, we found in mean a shorter duration of the surgery, a lower necessity of an open reduction (18 vs. 100%), fewer postsurgical weight-bearing restrictions (54 vs. 100%) and a shorter duration of rehabilitation (48 vs. 71 days). Especially, the fracture compression was distinctively higher in the XS-nail group (postsurgical lateral dislocation was 0-59%). The advantages of the tension-band wiring were found in the fixation of small fragments and an easier implant removal. Generally, nonunion and refracture were not seen in both methods. When compared with the results from literature, we found positive results regarding the hospitalization duration, the weight-bearing ability, the rehabilitation course and the patients' satisfaction. Conclusion: Thus, the XS-nail proved to be an effective and technical optimized implant for the treatment of proximal fifth metatarsal fractures that provides a rapid full-weight-bearing mobilization and shows good long-term results. © 2009 Springer-Verlag.


Due to professional independence of both midwifes and physicians, the obligation of mutual assistance in normal and pathological births generates conflicts and uncertanties between those two professionals. Although the legal framework seems to be clear, in practice cooperation is often jeopardized by ignoring or simply not knowing the according limits of responsibility. The principles of defining the field of midwifery as well as the criteria for allocating physicians duties and responsibilities in line with legal regulations are discussed in the article. © 2013 Springer-Verlag Berlin Heidelberg.


Lohr J.M.,University of Mannheim | Lohr J.M.,Karolinska Institutet | Haas S.L.,University of Mannheim | Haas S.L.,Karolinska Institutet | And 10 more authors.
Annals of Oncology | Year: 2012

Background: Paclitaxel embedded in cationic liposomes (EndoTAG™-1; ET) is an innovative agent targeting tumor endothelial cells. This randomized controlled phase II trial evaluated the safety and efficacy of ET in combination with gemcitabine (GEM) in advanced pancreatic cancer (PDAC). Patients and methods: Chemotherapy-naive patients with locally advanced or metastatic disease were randomly assigned to receive weekly GEM 1000 mg/m. 2 or GEM plus twice-weekly ET 11, 22 or 44 mg/m. 2 for 7 weeks. After a safety run-in of 100 patients, a second cohort continued treatment. End points included overall survival (OS), progression-free survival (PFS), tumor response and safety. Results: Two hundred and twelve patients were randomly allocated to the study and 200 were treated (80% metastatic, 20% locally advanced). Adverse events were manageable and reversible. Transient thrombocytopenia and infusion reactions with chills and pyrexia mostly grade 1 or 2 occurred in the ET groups. Disease control rate after the first treatment cycle was 43% with GEM and 60%, 65% and 52% in the GEM + ET cohorts. Median PFS reached 2.7 compared with 4.1, 4.6 and 4.4 months, respectively. Median OS was 6.8 compared with 8.1, 8.7 and 9.3 months, respectively. Conclusions: Treatment of advanced PDAC with GEM + ET was generally well tolerated. GEM + ET showed beneficial survival and efficacy. A randomized phase III trial should confirm this positive trend. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Pohl J.,Klinikum Friedrichshain | Halphen M.,Norgine Ltd | Kloess H.R.,Norgine GmbH | Fischbach W.,Klinikum Aschaffenburg
PLoS ONE | Year: 2015

Objectives: Efficacy of two low volume bowel cleansing preparations, polyethylene glycol plus ascorbate (PEG+Asc) and sodium picosulfate/magnesium citrate (NaPic/MgCit), were compared for polyp and adenoma detection rate (PDR and ADR) and overall cleansing ability. Primary endpoint was PDR (the number of patients with -1 polypoid or flat lesion recorded by the colonoscopist). Methods: Diagnostic, surveillance or screening colonoscopy patients were enrolled into this investigator-blinded, multi-center Phase IV study and randomized 1:1 to receive PEG+Asc (administered the evening before and the morning of colonoscopy, per label) or NaPic/MgCit (administered in the morning and afternoon the day before colonoscopy, per label). The blinded colonoscopist documented any lesion and assessed cleansing quality (Harefield Cleansing Scale). Results: Of 394 patients who completed the study, 393 (PEG+Asc, N=200; NaPic/MgCit, N=193) had a colonoscopy. Overall PDR for PEG+Asc versus NaPic/MgCit was 51.5%versus 44.0%, p=0.139. PDR and ADR on the right side of the bowel were significantly higher with PEG+Asc versus NaPic/MgCit (PDR: 56[28.0%] versus 32[16.6%], p=0.007; ADR: 42 [21.0%] versus 23[11.9%], p=0.015), as was detection of flat lesions (43[21.5%] versus 25 [13.0%], p=0.025). Cleansing quality was better with PEG+Asc than NaPic/MgCit (98.5% versus 57.5% considered successful cleansing). Overall, there were 132 treatment-emergent adverse events (93 versus 39 for PEG+Asc and NaPic/MgCit, respectively). These were mainly mild abdominal symptoms, all of which were reported for higher proportions of patients in the PEG+Asc than NaPic/MgCit group. Twice as many patients in the NaPic/MgCit versus the PEG+Asc group reported tolerance of cleansing solution as 'very good'. Conclusions: Compared with NaPic/MgCit, PEG+Asc may be more efficacious for overall cleansing ability, and subsequent detection of right-sided and flat lesions. This is likely attributable to the different administration schedules of the two bowel cleansing preparations, which may positively impact the detection and prevention of colorectal cancer, thereby improving mortality rates. Trial Registration: ClinicalTrials.gov NCT01689792. © 2015 Pohl et al.


Abstract Background: In current guidelines H. pylori eradication is recommended as first-line therapy in patients with gastric MALT lymphoma irrespective of stage and H. pylori status. However, data on treatment and clinical course of patients with H. pylori negative MALT lymphoma are rare. Aim: To evaluate therapeutical results in patients with H. pylori negative gastric MALT lymphoma. Methods: 21 patients (13 male and 8 female; 63.9 years, range 43 - 80) with gastric MALT lymphoma were analysed retrospectively on the basis of medical reports in all cases and repeated outpatient visits at our center in 17 cases. H. pylori infection was excluded by negative histology, rapid urease test, or C13 urease breath test, and serology in all cases. Follow-up was 56.4 (5 - 142) months. Results: Ten of 21 patients were treated with H. pylori eradication, and four of them received no further therapy. The other six patients underwent surgery, chemotherapy, and radiation, after eradication therapy. Those eleven patients without H. pylori eradication received radiation (n = 3), chemotherapy (n = 1), PPIs (n = 2), no treatment (n = 4) as first-line and radiation (n = 2) as second-line therapy while initial therapy remained unknown in one case. 13 patients (61.9 %) reached complete remission of lymphoma, and seven patients (33.3 %) showed minimal histological residuals. Overall and disease-free survival was found in 95 % and 90 %, respectively. Conclusion: Patients with H. pylori negative gastric MALT lymphoma have a good prognosis. We favor initial H. pylori eradication therapy and a watch-and-wait strategy in case of minimal histological residuals of MALT lymphoma. Non-responders to eradication therapy can be successfully treated by radiation and chemotherapy. © Georg Thieme Verlag KG.


Klepper J.,Klinikum Aschaffenburg
Developmental Medicine and Child Neurology | Year: 2013

This commentary is on the original article by Ramm-Pettersen et al on pages 440-447 of this issue. Developmental Medicine & Child Neurology © 2013 Mac Keith Press555 May 2013 10.1111/dmcn.12104 Commentaries Commentaries © The Author. Developmental Medicine & Child Neurology © 2013 Mac Keith Press.


Al-Taie O.H.,Sankt Elisabeth Hospital | Bauer Y.,Klinikum Aschaffenburg | Dietrich C.G.,Bethlehem Hospital | Fischbach W.,Klinikum Aschaffenburg
Clinical and Experimental Gastroenterology | Year: 2012

Background: Endoscopic resection has become the standard treatment for noninvasive gastrointestinal malignancies. In fat mucosal tumors, normal saline is frequently used for submucosal fluid injection in order to reduce the risk of complications during endoscopic resection. Recent studies have demonstrated longer-lasting mucosa elevation by injection of agents such as hyaluronic acid or glyceol, rather than normal saline. We investigated the efficacy of different blood components in comparison with other solutions for use as a submucosal fluid cushion. Methods: Normal saline, sodium hyaluronate, glyceol, hydroxyethyl starch, serum, plasma, and whole blood were evaluated for their effectiveness in creating a submucosal cushion. One milliliter of each solution was injected into the submucosa of 5 × 5 cm specimens of resected porcine stomach. Mucosa elevation was measured before and up to 60 minutes after injection. Results: The shortest duration of mucosa elevation was observed after injection of normal saline, glyceol, and 0.125% hyaluronic acid. A significantly longer duration was obtained after injection of hydroxyethyl starch, 0.25% and 0.5% hyaluronic acid, serum, and plasma. However, whole blood generated a longer-lasting mucosa elevation than all other agents. Conclusion: The results of the current study suggest that whole blood is more effective in generating long-lasting mucosa elevation than any other commonly used solution. Because autologous blood is readily available at almost no cost, this seems to be an optimal agent for creating the mucosa elevation needed for endoscopic resection. Further in vivo studies in humans are needed to clarify the potential role of autologous blood for long-lasting endoscopic mucosa resection or endoscopic submucosal dissection. © 2012 Al-Taie et al, publisher and licensee Dove Medical Press Ltd.


PubMed | Klinikum Aschaffenburg
Type: Journal Article | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016

Ganglion of the humeroradial joint is a relatively rare condition, which may cause local compressive neuropathy. It is usually diagnosed in adults. Sonography of peripheral nerves can be of high value in finding the exact localization of the nerve lesion. We present a case of a healthy 55-year-old woman with radial palsy caused by an elbow ganglion which was resolved following a surgical procedure.

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