Nürnberg, Germany
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Herth F.J.F.,Pneumology and Critical Care Medicine | Eberhardt R.,Pneumology and Critical Care Medicine | Gompelmann D.,Pneumology and Critical Care Medicine | Ficker J.H.,Klinikum Nurnberg | And 4 more authors.
European Respiratory Journal | Year: 2013

One-way endobronchial valves (EBVs) have been shown to relieve symptoms of emphysema, particularly in patients without collateral ventilation (CV) between the target and adjacent lobes. In this study, we investigated the ability of the bronchoscopic ChartisTM Pulmonary Assessment System to predict treatment response by determining the presence of CV. 80 EBV patients underwent a pre-treatment Chartis assessment. Before and 30 days after implantation, high-resolution computed tomography scans were taken to determine target lobe volume reduction (TLVR). A pre- to post-treatment reduction of o350 mL was defined as significant. In addition, clinical outcomes (forced expiratory volume in 1 s (FEV1), 6-min walk test and St George's Respiratory Questionnaire) were compared over the same time period. Of the 51 patients classified as having an absence of CV according to their Chartis reading, 36 showed a TLVR o350 mL. 29 patients were classified as having CV, and of these 24 did not meet this TLVR cut-off. Chartis showed an accuracy level of 75% in predicting whether or not the TLVR cut-off would be reached. Those predicted to respond showed significantly greater TLVR (p<0.0001) and FEV1 improvement (p=0.0013) than those predicted not to respond. Chartis is a safe and effective method of predicting response to EBV treatment.

Katsargyris A.,Klinikum Nurnberg | Oikonomou K.,Klinikum Nurnberg | Klonaris C.,National and Kapodistrian University of Athens | Topel I.,Krankenhaus Barmherzige Bruder | And 2 more authors.
Journal of Endovascular Therapy | Year: 2013

Purpose: To review the literature reporting open surgical and endovascular treatment of juxtarenal aortic aneurysm (JAA). Methods: A systematic search of the PubMed database was carried out to identify English-language articles published between January 2001 and July 2012 on the management of JAA with open surgery, fenestrated endovascular aneurysm repair (F-EVAR), and the chimney graft technique (Ch-EVAR). The search found 20 studies with a total of 1725 patients (76% men; age range 66-74 years) undergoing open surgery, 10 studies detailing 931 patients (87.6% men; age range 72-75 years) receiving F-EVAR, and 5 studies comprising 94 patients (75% men; age range 68-82) reporting Ch-EVAR. Results: A total of 2465 vessels were targeted with fenestrations and 151 with chimney grafts (CG); intraoperative target vessel preservation was 98.6% and 98.0%, respectively. Cumulative 30-day mortality was 3.4%, 2.4%, and 5.3% for open surgery, F-EVAR and Ch-EVAR, respectively (p=NS). Impaired renal function was noted in 18.5%, 9.8%, and 12% following open surgery, F-EVAR, and Ch-EVAR, respectively (open vs. F-EVAR: p<0.001). New-onset dialysis was required postoperatively in 3.9%, 1.5%, and 2.1%, respectively (open vs. F-EVAR: p<0.001). Postoperative cardiac complications were noted in 11.3%, 3.7%, and 7.4%, respectively (open vs. F-EVAR: p<0.001). The incidence of ischemic stroke was 0.1% and 0.3% following open surgery and F-EVAR, but 3.2% after Ch-EVAR (open vs. Ch-EVAR: p=0.002; F-EVAR vs. Ch-EVAR: p=0.012). Early proximal type I endoleak was lower after F-EVAR compared to Ch-EVAR (4.3% vs. 10%, respectively, p=0.002). Conclusion: Open surgery remains a safe and effective treatment option for good risk patients with JAA. F-EVAR is associated with low operative mortality, compares favorably to open surgery in terms of morbidity, and current midterm data indicate that it can be a valid treatment option in both low- and high-risk patients. Early results of Ch-EVAR demonstrate feasibility only. In view of the limited number of reports and the lack of long-term data, the technique should be considered only in acute poor surgical risk patients, as a bailout in case of unintentional renal artery coverage, or in elective poor surgical cases that are not suitable for F-EVAR. © 2013 by the International Society of Endovascular Specialists.

Dubecz A.,Klinikum Nurnberg | Gall I.,Klinikum Nurnberg | Solymosi N.,Eötvös Loránd University | Schweigert M.,Klinikum Nurnberg | And 3 more authors.
Journal of Thoracic Oncology | Year: 2012

Purpose: To assess long-term temporal trends in population-based survival and cure rates in patients with esophageal cancer and compare them over the last 3 decades in the United States. Methods: We identified 62,523 patients with cancer of the esophagus and the gastric cardia diagnosed between 1973 and 2007 from the Surveillance, Epidemiology, and End Results database. Longterm cancer-related survival and cure rates were calculated. Stageby-stage disease-related survival curves of patients diagnosed in different decades were compared. Influence of available variables on survival and cure was analyzed with logistic regression. Results: Ten-year survival was 14% in all patients. Disease-related survival of esophageal cancer improved significantly since 1973. Median survival in Surveillance, Epidemiology, and End Results stages in local, regional, and metastatic cancers improved from 11, 10, and 4 months in the 1970s to 35, 15, and 6 months after 2000. Early stage, age 45 to 65 years at diagnosis and undergoing surgical therapy were independent predictors of 10-year survival. Cure rate improved in all stages during the study period and were 73%, 37%, 12%, and 2% in stages 0, 1, 2, and 4, respectively, after the year 2000. Percentage of patients undergoing surgery improved from 55% in the 1970s to 64% between 2000 and 2007. Proportion of patients diagnosed with in situ and local cancer remains below 30%. Conclusion: Long-term survival with esophageal cancer is poor but survival of local esophageal cancer improved dramatically over the decades. Complete cure of nonmetastatic esophageal cancer seems possible in a growing number of patients. Early diagnosis and treatment are crucial. Copyright © 2012 by the International Association for the Study of Lung Cancer.

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.

Eitel I.,University of Leipzig | Eitel I.,University of Lübeck | 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.

Groetzner P.,Klinikum Nurnberg | Weidner C.,Friedrich - Alexander - University, Erlangen - Nuremberg | Weidner C.,Bavarian Health and Food Safety Authority
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.

Santarpino G.,Klinikum Nurnberg | Pfeiffer S.,Klinikum Nurnberg | Jessl J.,Klinikum Nurnberg | Dell'Aquila A.M.,Universitatsklinikum Munster | And 3 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Objective This propensity-matched study compared clinical and echocardiographic outcomes between patients undergoing transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement. Methods From January 2010 to March 2012, 122 patients (age 79.4 ± 5.3 years, logistic euroSCORE 12% ± 8.4%) underwent minimally invasive sutureless aortic valve replacement, and 122 (age 84.6 ± 6.2 years, logistic euroSCORE 20.9% ± 2.5%) underwent TAVI. After propensity matching, 37 matched pairs were available for analysis. Results Preoperative characteristics and risk scores of matched groups were comparable. In-hospital mortalities were 0% in the sutureless group and 8.1% (n = 3) in the TAVI group (P =.24). Permanent pacemaker implantation was required in 4 patients in the sutureless group and 1 patient in the TAVI group (10.8% vs 2.7%; P =.18). A neurologic event was recorded in 2 patients of each group. Predischarge echocardiographic data showed higher paravalvular leak rate in the TAVI group (13.5% vs 0%; P =.027). At mean follow-up of 18.9 ± 10.1 months, overall cumulative survival was 91.9% and significantly differed between groups (sutureless 97.3% vs TAVI 86.5%; P =.015). In the TAVI group, a significant difference in mortality was observed between patients with (n = 20) and without (n = 17) paravalvular leak (25% vs 0%; P =.036). Conclusions Combining the advantage of standard diseased valve removal with shorter procedural times, minimally invasive sutureless aortic valve replacement may be the first-line treatment for high-risk patients considered in the "gray zone" between TAVI and conventional surgery. Copyright © 2014 by The American Association for Thoracic Surgery.

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.

Biber R.,Klinikum Nurnberg | Brem M.,Klinikum Nurnberg | Bail H.J.,Klinikum Nurnberg
International Orthopaedics | Year: 2014

Purpose: Internal fixation versus joint replacement for treating intracapsular hip fractures is still a major debate. The Targon® FN fixation concept is innovative; two small case series are promising. We present the first larger series. Methods: We conducted prospective documentation of all Targon® FN cases since 2006. The implant was used for all undisplaced fractures, and for displaced fractures in patients of a biological age ≤60 years. Besides demographic data and fracture classification, we analysed infection, haematoma, implant perforation, nonunion and operative revision procedures. Results: In 135 cases (mean age 71 years; average operation time 60 minutes; average hospital stay ten days), we found a surgical complication rate of 16.4 %. Conversion to joint replacement was necessary in 9.6 %. Complication rate was significantly higher in displaced fractures. Conclusions: Our study confirms low general complication rates. However, implant perforation seems to be underestimated. Optimised reduction technique may help to reduce this complication. © 2013 Springer-Verlag Berlin Heidelberg.

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.

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