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Dortmund, Germany

Hametner C.,University of Heidelberg | Stanarcevic P.,University of Belgrade | Stampfl S.,University of Heidelberg | Rohde S.,Klinikum Dortmund | And 2 more authors.
Journal of Cerebral Blood Flow and Metabolism | Year: 2015

Implementing endovascular stroke care often impedes neurologic assessment in patients who need sedation or general anesthesia. Cerebral near-infrared spectroscopy (NIRS) may help physicians monitor cerebral tissue viability, but data in hyperacute stroke patients receiving endovascular treatment are sparse. In this observational study, the NIRS index regional oxygen saturation (rSO 2) was measured noninvasively before, during, and after endovascular therapy via bilateral forehead NIRS optodes. During the study period, 63 patients were monitored with NIRS; 43 qualified for analysis. Before recanalization, 10 distinct rSO 2 decreases occurred in 11 patients with respect to time to intubation. During recanalization, two kinds of unilateral rSO 2 changes occurred in the affected hemisphere: small peaks throughout the treatment (n=14, 32.6%) and sustained increases immediately after recanalization (n=2, 4.7%). Lower area under the curve 10% below baseline was associated with better reperfusion status (thrombolysis in cerebral infarction ≥ 2b, P=0.009). At the end of the intervention, lower interhemispheric rSO 2 difference predicted death within 90 days (P=0.037). After the intervention, higher rSO 2 variability predicted poor outcome (modified Rankin scale > 3, P=0.032). Our findings suggest that bi-channel rSO 2 -NIRS has potential for guiding neuroanesthesia and predicting outcome. To better monitor local revascularization, an improved stroke-specific set-up in future studies is necessary. © 2015 ISCBFM. Source

Eisfeld W.,HNO Praxis | Amler S.,University of Munster | Deitmer T.,Klinikum Dortmund
Laryngo- Rhino- Otologie | Year: 2010

Background: Tonsillotomy is accepted as a safe and effective method for treatment of obstructive sleep-related respiratory disturbances in children. However, the question of inflammatory complications in the remaining tonsillar tissue is still present for long-term progression. Investigations performed with multiple-year observations should contribute to a clarification of the indicative conditions. Patients and methods: A total of 181 patients were observed following a tonsillotomy performed with CO2 laser (age: 4.6 years;±1.9 years). Using a standardized questionnaire, 145 patients were evaluated over an observation period of up to 6 years (average 3.0 years) with respect to post-operative complications, as well as subsequent inflammatory illnesses. Of these, 131 patients were evaluated with regard to long-term development of obstructive symptoms. Results: Within the subsequent observation period no abscess formation occurred, a re-occurrence of tonsillitis was observed in fewer than 3% of the patients. Subsequent bleeding requiring treatment did not occur during the post-operative progress for any of the 145 patients. Obstructive symptoms in the form of snoring, respiratory interruptions, daytime symptoms, or dysphagy could also be significantly reduced (p<0.001) in the long-term. The overall success of the operation was evaluated by 95% of parents as "good" or "very good". Conclusions: A CO2 laser tonsillotomy using for treatment of obstructive tonsil hyperplasy in small children (with consideration of an inflammation-free anamnesis) represents a safe, effective, and low-complication method, also for long-term continued development. © Georg Thieme Verlag KG Stuttgart - New York. Source

Mathias K.,Klinikum Dortmund
Journal of Cardiovascular Surgery | Year: 2011

The different types of complications which might occur during CAS are described. Recommendations are given how to avoid and how to handle complications. Source

Mathias K.,Klinikum Dortmund
Journal of Cardiovascular Surgery | Year: 2013

Filters are a valuable aid for safe carotid artery stenting, but require good knowledge of their function, and their shortcomings. Filters capture visible particles in 5-20% and microscopically in about 70% of the cases. Transcranial Doppler ultrasound and diffusion weighted MRI investigations have shown that particles are released during filter placement and also during the next steps of the procedure. They can pass through the filter pores when they are small enough and through unprotected areas when the filter is not completely apposed to the arterial wall. Therefore, they do not reliably prevent transient ischemic attacks and minor strokes, but major strokes. They are easier to handle than proximal balloon protection in normal anatomy and are safe in patients with moderate plaque burden and effective medication with platelet inhibitors and anticoagulation. Source

Deitmer T.,Klinikum Dortmund | Neuwirth C.,Klinikum Ludenscheid
Laryngo- Rhino- Otologie | Year: 2010

Background: There is only little systematic evidence about blood-loss and management of cases of post-tonsillectomy hemorrhage. Method: 105 cases of post-tonsillectomy hemorrhage were identified and data as gender, age, time of hemorrhage, amount of blood loss, circumstances of hemorrhage and management of hemorrhage were detailed by chart review. Results: The typical two points of hemorrhage are the day of surgery and the fifth to eighth postoperative day, the latter as the time of debridement of the fibrin layers. The distribution of gender and age were similar to the cases operated on. In Germany tonsillectomy-patients are kept as inpatients until the fifth to seventh day after sugery to care for pain-management, food-intake and possible hemorrhage. It must be noted that 77 patients experienced hemorrhage after dismission from the ward. Concerning the blood loss, estimated from the hemoglobin-concentration before tonsillectomy and at the time of hemorrhage, we found declines of up to 5g/dl. Plotted against the time of hemorrhage or against the age of the patient we must state, that blood-loss does not correlate to the time after sugery nor to the age. Conclusions: We saw severe blood-loss even two weeks after surgery, whereas the events of hemorrhage around the time of debridement of fibrinlayers showed no accumulation of severe outcomes. © Georg Thieme Verlag KG Stuttgart - New York. Source

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