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Hagen am Teuteburger Wald, Germany

Fansa H.,Reconstructive and Aesthetic Surgery | Schirmer S.,Reconstructive and Aesthetic Surgery | Cervelli A.,Breast Center | Gehl H.B.,Klinikum Bielefeld
Annals of Plastic Surgery

The internal mammary artery (IMA) is the standard recipient vessel for autologous breast reconstruction. To save the IMA for bypass surgery, to keep flap pedicles short, and to allow better flap positioning, the IMA perforators were used. Forty-six flaps for immediate breast reconstructions were performed in 39 patients. In the first 22 patients, the decision to use the perforators was clinically based. In the second group of 17 patients, all patients received a thoracic computed tomographic angiography (CTA) to determine the perforators. In 13 flaps (6 deep inferior epigastric artery perforator, 3 superficial inferior epigastric artery, and 4 transverse myocutaneous gracilis), the perforators were used as recipient vessels. Of these flaps, 5 were anastomosed to perforators before the CTA was applied and 8 after the CTA was established. The CTA revealed the IMA and the perforators in detail. In immediate reconstructions, the IMA perforators can be used as recipient vessels. They allow better flap positioning for superficial inferior epigastric artery and transverse myocutaneous gracilis flaps in particular; moreover, it decreases donor site and recipient site morbidity. After introducing the CTA, the perforators were used more frequently for anastomosis. © 2013 Lippincott Williams & Wilkins. Source

Riesenberg H.,Klinikum Bielefeld | Lubbe A.S.,Cecilien Klinik
Supportive Care in Cancer

Purpose It has not previously been shown whether there is any benefit to multi-morbid patients with lung cancer who participate in complex interdisciplinary rehabilitation programmes after primary therapy. The purpose of this prospective study was to assess changes in exercise capacity and quality of life before and after an in-patient training programme. Patients and methods Forty-five patients with lung cancer (WHO I-III after surgery and/or radiotherapy and/or chemotherapy) were enrolled in a 28-day in-patient rehabilitation programme that included standardised aerobic training. Functional status and health-related quality of life (QLQ-C30, QLQ-LC13, SF-36, and MFI-20) were examined at the beginning of the study and at day 28. Results A substantial increase in work performance (bicycle ergometry from 68±3 to 86±4 W, p<0.001, and 6-minute walk test from 322±11 to 385±13 m, p<0.001) was registered. In addition, heart rate at rest was reduced (from 84±2 to 80± 1 beats per minute, p<0.05) and heart rate variability (indicator of the efficacy of endurance training) was significantly increased (from 9.7±1 to 12.9±1 root mean square of successive differences, p<0.001). Moreover, there was also a significant improvement in quality of life (48±3to62±2, p<0.001) while fatigue was reduced from 66±3 to 41±4, p<0.001. Conclusion A standardised, aerobic endurance training programme as part of the in-patient oncological rehabilitation of patients with lung cancer results in improvements in both physiological and psychological parameters after therapy. A follow-on study in order to determine to what extent this benefit persists over the long-term, particularly, in comparison with patients who have not participated in a rehabilitation programme, is currently being conducted. © Springer-Verlag 2009. Source

Heidemann J.,Klinikum Bielefeld | Bartels C.,University of Munster | Berssenbrugge C.,University of Munster | Schmidt H.,University of Munster | Meister T.,University of Gottingen
Gastroenterology Research and Practice

Aim. Treatment of hepatorenal syndrome (HRS) in patients with liver cirrhosis is still challenging and characterized by a very high mortality. This study aimed to delineate treatment patterns and clinical outcomes of patients with HRS intravenously treated with terlipressin. Methods. In this retrospective single-center cohort study, 119 patients (median [IQR]; 56.50 [50.75-63.00] years of age) with HRS were included. All patients were treated with terlipressin and human albumin intravenously. Those with response to treatment (n = 65) were compared to the patient cohort without improvement (n = 54). Patient characteristics and clinical parameters (Child stage, ascites, hepatic encephalopathy, HRS type I/II, and initial MELD score) were retrieved. Univariate analysis of factors influencing the success of terlipressin therapy and Cox regression analysis of factors influencing survival was carried out. Results. One-month survival was significantly longer in the group of responders (p = 0.048). Cox regression analysis identified age [Hazard ratio, 95% confidence interval (CI); 1.05, 1.01-1.09, resp.], alcohol abuse [HR 3.05, 95% CI 1.11-8.38], duration of treatment [HR 0.92, 95% CI 0.88-0.96], and MELD score [HR 1.08, 95% CI 1.02-1.14] to be independent predictors of survival. Conclusions. Survival of HRS patients after treatment depends on age, etiology of liver disease, and the duration of treatment. © 2015 Jan Heidemann et al. Source

Yoon U.,Charite - Medical University of Berlin | Kwok L.L.,Columbia University | Magkidis A.,Klinikum Bielefeld
Metabolism: Clinical and Experimental

Objective: Every year over 3.8 million people are dying of diabetes and its complications. Lifestyle intervention was suggested to have beneficial effects in preventing and reducing diabetes incidence. Interventions in patients with impaired glucose tolerance (IGT), who belong to a high risk group in developing diabetes, are supposed to be especially effective. According to the evidence hierarchy, a 1a level of evidence is missing and therefore a systematic review verifying the efficacy of lifestyle intervention is needed. Materials/Methods: Systematic review: The electronic database PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health Technology Assessment database were searched. Main inclusion criteria were randomized controlled trials, impaired glucose tolerance, lifestyle intervention with control group and observation time > 6 months. Outcome measures were all diabetes events, as defined by the authors of each study, all-cause mortality, diabetes mortality, and quality adjusted life years (QALY). Two independent reviewers abstracted the studies by title, abstract and full-text analysis. Furthermore the reporting quality of each study was assessed by using the CONSORT criteria (Consolidated Standards of Reporting Trials) and the methodological quality by SIGN 50 instrument (Scottish Intercollegiate Guidelines Network methodology checklist for randomized controlled trials). The primary outcome measure was diabetes incidence. Secondary outcome measures were overall mortality, disease-specific mortality, quality adjusted life years (QALY), and clinical parameters; body mass index (BMI), weight change, blood pressure, blood parameter, smoking, alcohol consumption. Results: 7 trials which included 25 relevant publications were identified. Kappa Cohens for title-analysis were K = 0.77, (CI = 0.71-0.83), abstract-analysis K = 0.81 (CI = 0.64-0.92) and full-text analysis K = 0.78 (CI = 0.57-0.98). Overall 5663 patients were analyzed with primary follow-up time: India (3 y), Japan (4 y), Sweden (5 y), Da Qing (6 y), SIM (3 y), DPP (5 y), DPS (4 y) and drop-out rate ranges from 5% to 28%. Diabetes incidence ranges from 3% to 46% in the intervention group and 9.3% to 67.7% in the control group. The India study reported ARR = 16%, RRR = 29% (p = 0.018), Japan: ARR = 6.3%, RRR = 65% (p < 0.001), Sweden: ARR = 4%, RRR = 25% (p = not significant), Da Qing: ARR = 22%, RRR = 32% (p < 0.05), SLIM: ARR = 20%, RRR = 53% (p = 0.025), DPP: ARR = 15%, RRR = 58% (significant, no p-value reported), and DPS: ARR = 12%, RRR = 52% (significant, no p-value reported). Mortality and morbidity were only analyzed in Da Qing study which showed no statistical differences (overall mortality: HRR 0.96, CI 0.65-1.41, CVD-mortality: HRR 0.83; CI 0.48-1.40, CVD event: HRR 0.98; CI 0.71-1.37). Conclusion: Under consideration of heterogeneity in lifestyle interventions and follow up time of the included studies, this systematic review illustrated that lifestyle intervention can have a beneficial effect on the incidence of diabetes in patients with impaired glucose tolerance. However, several studies found the effect of lifestyle intervention decreased after intervention was terminated. No long-term benefit in mortality and morbidity was found. Development of standardized lifestyle intervention program is strongly needed and further long-term intervention trials using this program are crucial in evidencing the long-term efficacy. © 2013 Elsevier Inc. Source

Schirmer S.,Reconstructive and Aesthetic Surgery | Ritter R.-G.,Klinikum Bielefeld | Fansa H.,Reconstructive and Aesthetic Surgery

Introduction:Diabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Such ulcers are responsible for a prolonged period of hospitalization and co- morbidities caused by infected diabetic foot ulcers. Small, superficial ulcers can be treated by special conservative means. However, exposed bones or tendons require surgical intervention in order to prevent osteomyelitis. In many cases reconstructive surgery is necessary, sometimes in combination with revascularization of the foot.There are studies on non surgical treatment of the diabetic foot ulcer. Most of them include patients, classified Wagner 1-2 without infection. Patients presenting Wagner 3D and 4D however are at a higher risk of amputation. The evolution of microsurgery has extended the possibilities of limb salvage. Perforator based flaps can minimize the donorsite morbidity.Patients and Methods:41 patients were treated with free tissue transfer for diabetic foot syndrome and chronic defects. 44 microvascular flaps were needed. The average age of patients was 64.3 years. 18 patients needed revascularization. 3 patients needed 2 microvascular flaps. In 6 cases supramicrosurgical technique was used.Results:There were 2 flap losses leading to amputation. 4 other patients required amputation within 6 months postoperatively due to severe infection or bypass failure. Another 4 patients died within one year after reconstruction. The remaining patients were ambulated.Discussion:Large defects of the foot can be treated by free microvascular myocutaneous or fasciocutaneous tissue transfer. If however, small defects, exposing bones or tendons, are not eligible for local flaps, small free microvascular flaps can be applied. These flaps cause a very low donor site morbidity. Arterialized venous flaps are another option for defect closure.Amputation means reduction of quality of life and can lead to an increased mortality postoperatively. © 2013 schirmer et al. Source

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