Dortmund, Germany
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Li M.,University of Minnesota | Li M.,Regions Hospital | Luettringhaus T.,Klinikum Dortmund gGmbH | Walker K.R.,Gillette Childrens Specialty Healthcare | And 2 more authors.
Journal of Pediatric Orthopaedics Part B | Year: 2012

A digastric approach has been used successfully to treat adult patients with femoral neck osteochondromas; however, to our knowledge, this has not been described in pediatric patients with open proximal femur growth plates. A case of femoral neck osteochondroma in an 11-year-old boy is presented and treatment using a digastric approach is described. No intraoperative femoral neck fracture or postoperative avascular necrosis occurred. There is no recurrence of the tumor at the 7-year follow-up. Surgical hip dislocation through a digastric approach provides adequate exposure of the femoral neck for osteochondroma resection and this technique should be considered for such circumstances. © 2012 Lippincott Williams & Wilkins, Inc.


Nashan D.,Klinikum Dortmund gGmbH | Meiss F.,Albert Ludwigs University of Freiburg | Muller M.,Albert Ludwigs University of Freiburg | Muller M.,University of Basel
European Journal of Dermatology | Year: 2013

An exponentially increasing incidence, malignant potential and economical interest have made actinic keratoses (AKs) a strategic healthcare issue. The debate whether AKs are precursor lesions or in situ cancers with a continuum towards invasive squamous cell carcinoma has faded, given the millions of affected individuals. Cumulative exposure to ultraviolet light and increasing life expectancy, together with an overaged, therefore increasingly affected population, create responsibilities for clinicians. Guidelines in the UK (2007) and Europe (2011), metaanalyses and overviews of selected treatment options, as well as some selected combined treatment strategies, are available. No comprehensive overview providing explicit details of randomized studies, including the majority of approved and popular treatment options, and designating evidence-based criteria has been published so far, a goal desirable to avoid a biased perspective on therapeutic approaches. This reviewdefines the state of art for destructive and topical treatment options based on randomized trials which meet criteria like >30 patients in an intentionto- treat analysis, an easily reproducible study design with responses rated towards treatment as the major objective, measured as complete remission. Epidemiological data include grades and location of treated AKs, operational procedures, cryotherapy, laser therapy, 3% diclofenac in 2.5% hyaluronic acid, 2.5%, 3.75% and 5% imiquimod, 0.5% and 5% 5-fluorouracil, photodynamic therapy including ALA-patches. Sequential and combined approaches in daily practice and in developing study design might profit from the details of studies listed here. Divergent and treatment-specific proceedings, response rates after definite time intervals aiding physicians' further guidance and their management of patients are elucidated. Uncommon and new therapeutic options are discussed.


Brachmann J.,Klinikum Coburg GmbH | Bohm M.,Saarland University | Rybak K.,Kardiologische Praxis | Klein G.,Hannover Medical School | And 7 more authors.
European Journal of Heart Failure | Year: 2011

AimsThe Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink (OptiLink HF) study is designed to investigate whether OptiVol fluid status monitoring with an automatically generated wireless CareAlert notification via the CareLink Network can reduce all-cause death and cardiovascular hospitalizations in an HF population, compared with standard clinical assessment.MethodsPatients with newly implanted or replacement cardioverter-defibrillator devices with or without cardiac resynchronization therapy, who have chronic HF in New York Heart Association class II or III and a left ventricular ejection fraction ≤35 will be eligible to participate. Following device implantation, patients are randomized to either OptiVol fluid status monitoring through CareAlert notification or regular care (OptiLink 'on vs. 'off). The primary endpoint is a composite of all-cause death or cardiovascular hospitalization. It is estimated that 1000 patients will be required to demonstrate superiority of the intervention group to reduce the primary outcome by 30 with 80 power.ConclusionThe OptiLink HF study is designed to investigate whether early detection of congestion reduces mortality and cardiovascular hospitalization in patients with chronic HF. The study is expected to close recruitment in September 2012 and to report first results in May 2014. © 2011 The Author.


Pilarczyk K.,University of Duisburg - Essen | Bauer A.,MediClin Herzzentrum Coswig | Boening A.,Universitatsklinikum Giessen und Marburg GmbH | Von Der Brelie M.,University of Kiel | And 10 more authors.
Thoracic and Cardiovascular Surgeon, Supplement | Year: 2015

Although intra-aortic balloon pumping (IABP) is the most frequently used mechanical cardiac assist device in cardiothoracic surgery, there are only guidelines for substantive sections of aortic counterpulsation including prophylactic and postoperative use. In contrast, evidence-based recommendations are still lacking concerning intraoperative use, management, contraindication and other relevant issues. According to international surveys, important aspects of IABP usage show a wide variation in clinical practice. The results of a national questionnaire performed before initiation of this guideline confirmed these findings and demonstrated a clear need for the development of a consensus-based guideline. Therefore, the presented multidisciplinary S-3-guideline was developed under the direction of the German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG) to make evidence-based recommendations for the usage of aortic counterpulsation after cardiothoracic surgery according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF) and the Medical Centre for Quality (Ärztliches Zentrum für Qualität - (ÄZQ)). Main topics discussed in this guideline involve IABP support in the prophylactic, preoperative, intraoperative and postoperative setting as well as the treatment of right heart failure, contraindications, anticoagulation, monitoring, weaning, and limitations of IABP therapy. The presented 15 key messages of the guideline were approved after two consensus meetings under moderation of the AWMF with participation of the German Society of Cardiology (DGK), German Society of Anaesthesiology and Intensive Care Medicine (DGAI), German Interdisciplinary Association for Intensive Care (DIVI) and the German Society for Cardiovascular Engineering (DGfK). © 2015 Georg Thieme Verlag KG.


Hennes E.,Heinrich Heine University Düsseldorf | Zahn S.,Heinrich Heine University Düsseldorf | Lopes L.F.,Heinrich Heine University Düsseldorf | Lopes L.F.,Hospital Do Cancer Infantil Of Barretos | And 6 more authors.
Klinische Padiatrie | Year: 2012

Background: Ovarian germ cell tumors (oGCTs) are rare and highly heterogeneous with regard to their clinical and histologic appearance. The risk of tumor development is higher in children with aberrant sexual differentiation. Development of gonadoblastomas is seen in young women with 46,XY gonadal dysgenesis. At least 50 % of gonadoblastomas may develop into malignant oGCTs, mostly dysgerminomas. In this study, we evaluated bilateral oGCTs in clinically inapparent patients for sex chromosomal aberrations. Patients and methods: We analyzed tumor samples of 15 patients with synchronous bilateral oGCTs enrolled onto the consecutive MAKEI trials for non-testicular GCTs. Paraffin embedded samples from the Kiel German Childhood Tumor Registry were evaluated for the presence of Y-chromosomal sequences. Molecular genetic techniques included comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization. Results: Among 15 patients with bilateral oGCTs, Y-chromosomal DNA sequences were detected in 6 tumors. Both mature teratomas were negative for Y-chromosomal DNA. Thus, 5 of 12 malignant oGCTs and 1 immature teratoma (with elevated AFP) showed Y-chromosomal material. A 45(X,0) karyotype could not be demonstrated. Conclusions: These investigations provide additional insight into the development of oGCTs: mature teratomas, which develop from postmeiotic germ cells, are not associated with gonadal dysgenesis. Bilateral immature teratomas, dysgerminomas and mixed malignant oGCTs may frequently show Y-chromosomal DNA, indicating underlying but clinically inapparent gonadal dysgenesis. Thus, the presence of aberrant Y-chromosomal sequences appears to be involved in tumor development in about half of these patients. © Georg Thieme Verlag KG Stuttgart · New York.


PubMed | Clinic Offenburg, University Medical Center Dresden, St Franziskus Hospital Bielefeld, Clinic Herzoghoehe Bayreuth and 8 more.
Type: Journal Article | Journal: Medical oncology (Northwood, London, England) | Year: 2016

Complementary and alternative medicine (CAM) is used widely among cancer patients. Beside the risk of interaction with cancer therapies, interactions with treatment for comorbidities are an underestimated problem. The aim of this study was to assess prevalence of interactions between CAM and drugs for comorbidities from a large CAM usage survey on melanoma patients and to classify herb-drug interactions with regard to their potential to harm. Consecutive melanoma outpatients of seven skin cancer centers were asked to complete a standardized CAM questionnaire including questions to their CAM use and their taken medication for comorbidities and cancer. Each combination of conventional drugs and complementary substances was evaluated for their potential of interaction. 1089 questionnaires were eligible for evaluation. From these, 61.6% of patients reported taking drugs regularly from which 34.4% used biological-based CAM methods. Risk evaluation for interaction was possible for 180 CAM users who listed the names or substances they took for comorbidities. From those patients, we found 37.2% at risk of interaction of their co-consumption of conventional and complementary drugs. Almost all patients using Chinese herbs were at risk (88.6%). With a high rate of CAM usage at risk of interactions between CAM drugs and drugs taken for comorbidities, implementation of a regular assessment of CAM usage and drugs for comorbidities is mandatory in cancer care.


Unnewehr M.,Klinikum Dortmund gGmbH | Schaaf B.,Klinikum Dortmund gGmbH | Marev R.,Medical University-Pleven | Fitch J.,St Georges Healthcare Nhs Trust | Friederichs H.,University of Munster
Postgraduate Medicine | Year: 2015

Objective. Although doctors’ discharge summaries (DS) are important forms of communication between the physicians in patient care, deficits in the quality of DS are common. This review aims to answer the following question: according to the literature, how can the quality of DS be improved by 1) interventions; 2) reviews and guidelines of regulatory bodies; and 3) other practical recommendations? Methods. Systematic review of the literature. Results. The scientific papers on optimizing the quality of DS (n = 234) are heterogeneous and do not allow any meta-analysis. The interventional studies revealed that a structured approach of writing, educational training including feedback and the use of a checklist are effective methods. Guidelines are helpful for outlining the key characteristics of DS. Additionally, the articles in the literature provided practical proposals on improving form, structure, clinical content, treatment recommendations, follow-up plan, medications and changes, addressees, patient data, length, language, dictation, electronic processing and timeliness of DS. Conclusion. The literature review revealed various possibilities for improving the quality of DS. © 2015 Informa UK Ltd.


Brummel B.,Klinikum Dortmund GGmbH | Bernbeck B.,Klinikum Dortmund GGmbH | Schneider D.T.,Klinikum Dortmund GGmbH
Klinische Padiatrie | Year: 2010

Background: Ataxia telangiectasia (AT, Louis-Bar-syndrome) is a rare autosomal-recessive inherited neurocutaneous syndrome characterized by ataxia, occulocutaneous telangiectasia, combined immunodeficiency and an increased risk of malignancies. Pediatric patients may develop lymphomas and acute lymphoblastic leukaemia (ALL), especially of the T-lineage. The prognosis of the malignancies is impaired by the immunodeficiency and the susceptibility to ionising radiation and chemotherapeutics. Case report: Here, we first report on a patient with AT and pre B-cell ALL. The therapy was administered according to the medium risk arm of the ALL-BFM 2000 study protocol of the German Society of Pediatric Oncology and Hematology. Doses primarily of all alkylating agents, anthracyclins and methotrexate were individually reduced. During reinduction, the patient suffered from a candida pneumonia and sepsis aggravated by a parainfectious encephalitis. Over 1 year after the end of the maintenance therapy the patient is still in complete first remission. Conclusion: A general recommendation for dose modification in these patients group cannot be made due to the low number of patients suffering from AT and leukaemia. Central registration of these rare patients will potentially facilitate to develop effective chemotherapeutic strategies with tolerable toxicity. © Georg Thieme Verlag KG Stuttgart New York.


PubMed | Klinikum Dortmund gGmbH
Type: Case Reports | Journal: Klinische Padiatrie | Year: 2010

Ataxia telangiectasia (AT, Louis-Bar-syndrome) is a rare autosomal-recessive inherited neurocutaneous syndrome characterized by ataxia, occulocutaneous telangiectasia, combined immunodeficiency and an increased risk of malignancies. Pediatric patients may develop lymphomas and acute lymphoblastic leukaemia (ALL), especially of the T-lineage. The prognosis of the malignancies is impaired by the immunodeficiency and the susceptibility to ionising radiation and chemotherapeutics.Here, we first report on a patient with AT and pre B-cell ALL. The therapy was administered according to the medium risk arm of the ALL-BFM 2000 study protocol of the German Society of Pediatric Oncology and Hematology. Doses primarily of all alkylating agents, anthracyclins and methotrexate were individually reduced. During reinduction, the patient suffered from a candida pneumonia and sepsis aggravated by a parainfectious encephalitis. Over 1 year after the end of the maintenance therapy the patient is still in complete first remission.A general recommendation for dose modification in these patients group cannot be made due to the low number of patients suffering from AT and leukaemia. Central registration of these rare patients will potentially facilitate to develop effective chemotherapeutic strategies with tolerable toxicity.


PubMed | Klinikum Dortmund gGmbH
Type: Journal Article | Journal: Postgraduate medicine | Year: 2015

Although doctors discharge summaries (DS) are important forms of communication between the physicians in patient care, deficits in the quality of DS are common. This review aims to answer the following question: according to the literature, how can the quality of DS be improved by (1) interventions; (2) reviews and guidelines of regulatory bodies; and (3) other practical recommendations?Systematic review of the literature.The scientific papers on optimizing the quality of DS (n = 234) are heterogeneous and do not allow any meta-analysis. The interventional studies revealed that a structured approach of writing, educational training including feedback and the use of a checklist are effective methods. Guidelines are helpful for outlining the key characteristics of DS. Additionally, the articles in the literature provided practical proposals on improving form, structure, clinical content, treatment recommendations, follow-up plan, medications and changes, addressees, patient data, length, language, dictation, electronic processing and timeliness of DS.The literature review revealed various possibilities for improving the quality of DS.

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