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Nürnberg, Germany

Bastian D.,Klinikum Nurnberg
Herzschrittmachertherapie und Elektrophysiologie | Year: 2013

Apart from monitoring shock efficacy, proof of flawless detection of induced ventricular fibrillation (VF) is a decisive argument in favor of implantable cardioverter defibrillator (ICD) testing. On the other hand, it has been observed that undersensing of VF is extremely rare with good sensing of the intrinsic R wave of ≥ 5-7 mV. The case presented here shows limitations in both argumentations: Neither optimal R wave sensing during sinus rhythm nor repeated ICD testing could rule out or predict multiple erroneous detections of clinical VF episodes. This must be taken into consideration in the current discussion on the necessity of defibrillation testing. Further optimization of sensing technology should be a focus in the development of modern ICD systems so as to improve the safety and efficacy of ICD therapy. © 2013 Springer-Verlag Berlin Heidelberg. Source

Eitel I.,University of Leipzig | Eitel I.,University of Lubeck | De Waha S.,University of Leipzig | De Waha S.,Heart Center Bad Segeberg | And 9 more authors.
Journal of the American College of Cardiology | Year: 2014

METHODS: We enrolled 738 STEMI patients in this CMR study at 8 centers. The patients were reperfused by primary PCI <12 h after symptom onset. Central core laboratory-masked analyses for quantified left ventricular (LV) function, infarct size (IS), microvascular obstruction (MO), and myocardial salvage were performed. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events.RESULTS: Patients with cardiovascular events had significantly larger infarcts (p < 0.001), less myocardial salvage (p = 0.01), a larger extent of MO (p = 0.009), and more pronounced LV dysfunction (p < 0.001). In a multivariate model that included clinical and other established prognostic parameters, MO remained the only significant predictor in addition to the TIMI (Thrombolysis In Myocardial Infarction) risk score. IS and MO provided an incremental prognostic value above clinical risk assessment and LV ejection fraction (c-index increase from 0.761 to 0.801; p = 0.036).CONCLUSIONS: In a large, multicenter STEMI population reperfused by primary PCI, CMR markers of myocardial damage (IS and especially MO) provide independent and incremental prognostic information in addition to clinical risk scores and LV ejection fraction.BACKGROUND: Although the prognostic value of findings from cardiac magnetic resonance (CMR) imaging has been established in single-center center studies in patients with ST-segment elevation myocardial infarction (STEMI), a large multicenter investigation to evaluate the prognostic significance of myocardial damage and reperfusion injury is lacking.OBJECTIVES: The aim of this study was to assess the prognostic impact of CMR in an adequately powered multicenter study and to evaluate the most potent CMR predictor of hard clinical events in a STEMI population treated by primary percutaneous coronary intervention (PCI). © 2014 by the American College of Cardiology Foundation. Source

Groetzner P.,Klinikum Nurnberg | Weidner C.,Friedrich - Alexander - University, Erlangen - Nuremberg
Pain | Year: 2010

The effect of regional anesthesia of the brachial plexus on the size and intensity of the histamine-induced axon reflex flare (neurogenic inflammation) of the forearm and the upper arm was compared to that of the contralateral arm as control in humans. No changes in the axon reflex could be assessed. Thus the lateral spread of the axon reflex flare must be transmitted by peripheral nerve branches not affected by the anesthesia in the axilla. This excludes the existence of physiologically relevant amounts of proximal branchpoints, DRG neurons with multiple peripheral axons or spinal interneurons transmitting action potentials between peripheral C-afferents involved in the axon reflex flare. Mechanoinsensitive C-fibres are known to be activated by histamine and to be responsible for the neuropeptide release in the skin inducing the axon reflex flare. Reports on those proximal connections can therefore obviously not extend to mechanoinsensitive C-fibres and do not explain the origin of neurogenic inflammation in humans without prior sensitization. © 2010 International Association for the Study of Pain. Source

Dubecz A.,Klinikum Nurnberg | Solymosi N.,Szent Istvan University | Stadlhuber R.J.,Klinikum Nurnberg | Schweigert M.,Klinikum Nurnberg | And 2 more authors.
Journal of Gastrointestinal Surgery | Year: 2014

Background: The rising incidence and histological change to adenocarcinoma in esophageal cancer over the past four decades has been among the most dramatic changes ever observed in human cancer. Recent reports have suggested that its increasing incidence may have plateaued over the past decade. Our aim was to examine the latest overall and stage-specific trends in the incidence of esophageal adenocarcinoma. Patients and Methods: We used the Surveillance Epidemiology and End Results (SEER) database of the National Cancer Institute to identify all patients with adenocarcinoma of the esophagus and gastric cardia between 1973 and 2009. Both overall and stage-specific trends in incidence were analyzed using joinpoint regression analysis. Results: The overall incidence of adenocarcinoma of the esophagus and the gastric cardia increased from 13.4 per million in 1973 to 51.4 per million in 2009, a nearly 400 % increase. Jointpoint analysis demonstrated that the yearly increase in incidence has slowed somewhat from 1.27 per million before 1987 to 0.97 between 1987 and 1997 and 0.65 after 1997. Stage-specific analysis suggests that the incidence of noninvasive cancer has actually declined after 2003 with a yearly decrease of 0.22. The percentage of patients diagnosed with in situ cancer declined after 2000 and remained under 2.5 % through the study period. Conclusions: The incidence of esophageal adenocarcinoma continues to rise in the USA. The percentage of patients diagnosed with in situ cancer has declined in the twenty-first century. © 2013 The Society for Surgery of the Alimentary Tract. Source

Santarpino G.,Klinikum Nurnberg
The Journal of heart valve disease | Year: 2013

The introduction of transcatheter aortic valve implantation (TAVI), coupled with the increasing number of elderly patients requiring cardiac surgery, has given rise to an intense debate on the most appropriate treatment strategy for this high-risk population. The study aim was to compare clinical outcomes in older versus younger patients undergoing minimally invasive aortic valve replacement (AVR). Between March 2010 and July 2012, 66 patients undergoing minimally invasive isolated AVR with the sutureless Perceval S bioprosthesis (Sorin Group, Saluggia, Italy) were allocated to two groups according to age > or = 80 years (group A, n = 25) or < 80 years (group B, n = 41). In-hospital and follow up data were collected for all patients, including an evaluation of the patients' quality of life, using the SF-36 questionnaire. Mean age and logistic EuroSCORE were statistically different between groups (p < 0.001 and p = 0.002, respectively). The length of intensive care unit stay was similar in groups A and B (1.9 +/- 0.8 and 2.5 +/- 1.4 days, respectively; p = 0.061). In-hospital mortality occurred in only one patient of group A (1.5%). Postoperative transient cerebral ischemic events occurred with similar frequency in both groups (two in group A and four in group B; p = 0.59). One patient in group A and two patients in group B required pacemaker implantation (1.5 versus 3%; p = 0.68). The mean follow up was 13.9 +/- 7.4 months, during which time three patients died (two in group A, one in group B). All enrolled patients answered the SF-36 questionnaire, and there were no significant differences between groups in all eight domains of the test. Within the setting of minimally invasive isolated AVR, the study results showed that the clinical outcomes and quality of life in patients aged > or = 80 years were comparable to those of younger patients. Therefore, advanced age per se does not preclude successful AVR through a minimally invasive approach. Source

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