Klinikum Osnabruck

Schönau am Königssee, Germany

Klinikum Osnabruck

Schönau am Königssee, Germany
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Reuter I.,Justus Liebig University | Mehnert S.,Justus Liebig University | Sammer G.,Justus Liebig University | Oechsner M.,HELIOS Klinik Zihlschlacht AG | Engelhardt M.,Klinikum Osnabruck
Journal of Aging Research | Year: 2012

Mild cognitive impairment, especially executive dysfunction might occur early in the course of Parkinson's disease. Cognitive training is thought to improve cognitive performance. However, transfer of improvements achieved in paper and pencil tests into daily life has been difficult. The aim of the current study was to investigate whether a multimodal cognitive rehabilitation programme including physical exercises might be more successful than cognitive training programmes without motor training. 240 PD-patients were included in the study and randomly allocated to three treatment arms, group A cognitive training, group B cognitive training and transfer training and group C cognitive training, transfer training and psychomotor and endurance training. The primary outcome measure was the ADAS-Cog. The secondary outcome measure was the SCOPA-Cog. Training was conducted for 4 weeks on a rehabilitation unit, followed by 6 months training at home. Caregivers received an education programme. The combination of cognitive training using paper and pencil and the computer, transfer training and physical training seems to have the greatest effect on cognitive function. Thus, patients of group C showed the greatest improvement on the ADAS-Cog and SCOPA-COG and were more likely to continue with the training programme after the study. © 2012 I. Reuter et al.

Gantert M.,Klinikum Osnabruck | Gantert M.,Maastricht University | Been J.V.,Maastricht University | Gavilanes A.W.D.,Maastricht University | And 3 more authors.
Journal of Perinatology | Year: 2010

The bacterial infection of chorion and amnion is a common finding in premature delivery and is referred to as chorioamnionitis. As the mother rarely shows symptoms of a systemic inflammation, the course of chorioamnionitis is frequently asymptomatic and chronic. In contrast, the fetal inflammatory response syndrome represents a separate phenomenon, including umbilical inflammation and increased serum levels of proinflammatory cytokines in the fetus. Ascending maternal infections frequently lead to systemic fetal inflammatory reaction. Clinical studies have shown that antenatal exposure to inflammation puts the extremely immature neonates at a high risk for worsening pulmonary, neurological and other organ development. Interestingly, the presence of chorioamnionitis is associated with a lower rate of neonatal mortality in extremely immature newborns. In the following review, the pathogeneses of inflammation-associated perinatal morbidity are outlined. The concept of fetal multiorganic disease during intrauterine infection is introduced and discussed. © 2010 Nature America, Inc. All rights reserved.

Lorbach O.,Saarland University | Kieb M.,University of Rostock | Domnick C.,University of Munster | Herbort M.,University of Munster | And 3 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015

Purpose: To evaluate knee laxity after anatomic ACL reconstruction with additional suture repair of a medial meniscus tear. Methods: Kinematics of the intact knee were determined in 12 human cadaver specimens in response to a 134-N anterior tibial load (aTT) and a combined rotatory load of 10 Nm valgus and 4 Nm internal tibial rotation (aTTPS) using a robotic/universal force moment sensor testing system. Subsequently, the ACL was resected following the creation of a standardized tear of the medial meniscus, a standard meniscus repair and an ACL reconstruction using an anatomic single-bundle (6) or an anatomic double-bundle technique (6). Knee kinematics were determined following every sub-step. Results: Significant increase of aTT in the ACL-deficient knee was found (p ≤ 0.001) with a further increase in the ACL-deficient knee with additional medial meniscal rupture (p ≤ 0.001). ACL reconstructions significantly decreased aTT compared with the ACL and meniscus-ruptured knee. No significant differences were seen between the intact knee and the ACL-reconstructed knee with additional meniscal repair (p < 0.05). In response to a simulated pivot shift, aTTPS in the intact knee significantly increased in the ACL-deficient knee and meniscus-ruptured knee (p = 0.005). No significant differences in knee kinematics were found between SB as well as DB ACL reconstruction with additional medial meniscal repair compared with the intact knee. Comparison of SB versus DB ACL reconstruction did not reveal any significant differences in a simulated Lachman test or simulated pivot shift test (n.s.). Conclusions: aTT as well as aTTPS significantly increased with ACL deficiency compared with the intact knee; additional medial meniscal rupture further increased aTT. Anatomic ACL reconstruction with medial meniscal repair did not reveal significant differences in knee kinematics compared with the intact knee. Comparison of anatomic SB versus DB ACL reconstruction with additional repair of the medial meniscus did not show significant differences neither in a simulated Lachman nor in a simulated pivot shift test. © 2014, Springer-Verlag Berlin Heidelberg.

van Ahlen H.,Klinikum Osnabruck | Zumbe J.,Klinikum Leverkusen | Stauch K.,Bayer Vital GmbH | Hanisch J.U.,Bayer Vital GmbH
Journal of Sexual Medicine | Year: 2010

Introduction: The Real-Life Safety and Efficacy of vardenafil study is an international, open-label, prospective, noncomparative, noninterventional study in men with erectile dysfunction (ED). Aim: To determine the safety and efficacy of vardenafil in a large international pool of men with ED (aged ≥18 years) and associated underlying conditions (N = 73,946), in a real-life setting. Methods: Patients attended an initial physician visit and one to two follow-up visits. Data were acquired by physician interviews and patient diaries and recorded in case report forms (CRFs). Data were pooled from 47 countries in Europe, Asia-Pacific, Latin America, and the rest of the world (excluding the United States and Japan for methodological reasons). Results were stratified by baseline ED severity, body mass index (BMI), and the presence of hypertension, diabetes, lipid metabolism disorder, or cardiovascular disease (CVD). Main Outcome Measures: CRFs and patient questionnaires containing questions on overall improvement of erection, satisfaction with efficacy, and desire to continue vardenafil use. Results: Many participants had hypertension (32.0%), diabetes (22.1%), lipid metabolism disorder (14.6%), or CVD (42.2%). High percentages of patients reported improvements in erectile function, irrespective of baseline ED severity (mild, 97.0%; moderate, 96.2%; severe, 85.5%), BMI (<25, 94.1%; ≥25 and <30, 94.6%; ≥30, 92.9%), or the presence of hypertension (93.6%), diabetes (92.6%), lipid metabolism disorder (94.7%), or CVD (93.3%). Over 90% of patients, including those with underlying conditions, reported being " satisfied" or " very satisfied" with vardenafil efficacy, and stated their intention to continue vardenafil use after the end of the study period. The incidence of adverse events was low, and 97.0% of patients were either " satisfied" or " very satisfied" with vardenafil tolerability. Conclusions: These data from a worldwide population of men with ED and associated underlying conditions show that vardenafil is effective and well-tolerated for the treatment of ED in a real-life setting, supporting its use as a first-line ED therapy. © 2010 International Society for Sexual Medicine.

Lanfer B.,University of Munster | Roer C.,University of Munster | Scherg M.,BESA GmbH | Rampp S.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 2 more authors.
Brain Topography | Year: 2013

The simultaneous evaluation of the local electrocorticogram (ECoG) and the more broadly distributed electroencephalogram (EEG) from humans undergoing evaluation for epilepsy surgery has been shown to further the understanding of how pathologies give rise to spontaneous seizures. However, a well-known problem is that the disruption of the conducting properties of the brain coverings can render simultaneous scalp and intracranial recordings unrepresentative of the habitual EEG. The ECoG electrodes for measuring the potential on the surface of the cortex are commonly embedded into one or more sheets of a silastic material. These highly resistive silastic sheets influence the volume conduction and might therefore also influence the scalp EEG and ECoG measurements. We carried out a computer simulation study to examine how the scalp EEG and the ECoG, as well as the source reconstruction therefrom, employing equivalent current dipole estimation methods, are affected by the insulating ECoG grids. The finite element method with high quality tetrahedral meshes, generated using a constrained Delaunay tetrahedralization meshing approach, was used to model the volume conductor that incorporates the very thin ECoG sheets. It is shown that the insulating silastic substrate of the ECoG grids can have a large impact on the scalp potential and on source reconstruction from scalp EEG data measured in the presence of the grids. The reconstruction errors are characterized with regard to the location of the source in the brain and the mislocalization tendency. In addition, we found a non-negligible influence of the insulating grids on ECoG based source analysis. We conclude, that the thin insulating ECoG sheets should be taken into account, when performing source analysis of simultaneously measured ECoG and scalp EEG data. © 2012 Springer Science+Business Media, LLC.

Kellinghaus C.,Klinikum Osnabruck | Stogbauer F.,Klinikum Osnabruck
Epilepsy and Behavior | Year: 2012

Background: Status epilepticus (SE) is a neurological emergency usually requiring immediate medical treatment. Due to the lack of adequate studies, treatment guidelines and their application vary between countries and institutions. We intended to analyze current treatment of SE in a German community hospital. Methods: We retrospectively identified patients from a large community hospital in northern Germany who had been diagnosed with SE between August 2008 and December 2010. Their charts were reviewed regarding sociodemographic variables, treatment and outcome. Results: We studied the first SE episode in 172 patients with a median age of 69. years (range 18-90. years). The etiology was acute symptomatic in 30 patients, progressive symptomatic in 22 patients and remote symptomatic in 120 patients. Presentation was generalized convulsive in 60 patients, non-convulsive in 72 patients and simple motor/aura in 40 patients. Median latency from onset to treatment start was 0.75. h (range 0.2-336. h). Initial treatment had a success rate (SR) of 40%. Second line treatment had a success rate of 54%. In patients whose seizures were refractory to the first two drugs, success rates were between 31% and 55%, with only a minority of the patients receiving established drugs such as phenytoin or barbiturates.Multivariate analysis revealed non-convulsive semiology as the only factor significantly associated with refractoriness. SE could be terminated in 95% of the patients and in-hospital mortality was 10%. Benzodiazepines and phenytoin had the most severe side effects. Conclusions: Status epilepticus can be terminated successfully and with low in-hospital mortality in the vast majority of the patients treated in a large community hospital. The success rate of each treatment step is between 30% and 55% regardless of the substances used. © 2012 Elsevier Inc.

Kellinghaus C.,Klinikum Osnabruck | Berning S.,Klinikum Osnabruck | Stogbauer F.,Klinikum Osnabruck
Acta Neurologica Scandinavica | Year: 2014

Objectives: To compare intravenous phenytoin (PHT) and intravenous lacosamide (LCM) for treatment of status epilepticus after failure of the first and second drug. Methods: We retrospectively identified patients from a large community hospital in northern Germany who had been diagnosed with SE between August 2008 and December 2010. Patients who had failed to respond to the first two drugs were selected for this analysis. Results: Forty-six patients (23 female, median age 68 years) were identified. LCM was used as third drug in 21 patients (median bolus 400 mg) and PHT in 15 patients (median bolus 1500 mg). Pretreatment was similar regarding substance groups (benzodiazepine as first line, levetiracetam as second line drug) and bolus doses. Status epilepticus was terminated in six patients (40%) of the PHT group and in seven patients (33%) of the LCM group. Four patients (27%) of the PHT group and no patient of the LCM group suffered from a relevant, treatment-related side effect during administration of the third drug. Conclusion: Lacosamide and PHT showed similar success rates for treatment of SE when used after failure of benzodiazepines and levetiracetam. However, PHT was associated with relevant side effects that were not seen with LCM. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Krause L.U.,Klinikum Osnabruck | Brodowski K.O.,Klinikum Osnabruck | Kellinghaus C.,Klinikum Osnabruck
Epilepsy and Behavior | Year: 2011

Lacosamide (LCM) is a novel anticonvulsant that modulates voltage-dependent sodium channels. Although it is known to cause a slight, dose-dependent prolongation of the PR interval on the ECG, third-degree atrioventricular (AV) block has been described as an adverse event in only a few patients participating in diabetic neuropathic pain studies and in no patient with epilepsy. We describe an 89-year old patient with decreased renal function and taking two other negative dromotropic agents who accidentally received two intravenous boli of 400. mg LCM within 6. hours. She had a normal PQ interval before and after the first dose of LCM and developed a reversible complete AV block approximately 30. minutes after the second bolus. We conclude that particular caution must be exercised when using very high doses of LCM in patients with significant cardial and renal risk factors. © 2011 Elsevier Inc.

Lorbach O.,Klinikum Osnabruck | Lorbach O.,Saarland University | Anagnostakos K.,Saarland University | Scherf C.,Saarland University | And 3 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2010

Hypothesis: Oral and intra-articular injections of cortisone will lead to significant improvement and comparable results in the treatment of adhesive capsulitis of the shoulder. Materials and methods: In a prospective randomized evaluation, 40 patients with idiopathic adhesive capsulitis of the shoulder were treated with an oral corticoid treatment regimen or 3 intra-articular injections of corticosteroids. Follow-up was after 4, 8, and 12 weeks, and 6 and 12 months. For the clinical evaluation, the Constant-Murley (CM) score, the Simple Shoulder Test (SST) and visual analog scales (VAS) for pain, function, and satisfaction were used. Results: In the patients treated with oral glucocorticoids, significant improvements were found for the CM score (P < .0001), SST (P=.035), VAS (P < .0001), and range of motion (P < .05) at the 4-week follow-up. The patients treated with an intra-articular glucocorticoid injection series also significantly improved in the CM score (P < .0001), SST (P < .0001), the VAS (P < .0001), and range of motion (P < .05) after 4 weeks. These results were confirmed at all other follow-up visits. Superior results were found for intra-articular injections in range of motion, CM score, SST, and patient satisfaction (P < .05). Differences in the VAS for pain and function were not significant (P > .05). Discussion: The use of cortisone in the treatment of idiopathic shoulder adhesive capsulitis leads to fast pain relief and improves range of motion. Intra-articular injections of glucocorticoids showed superior results in objective shoulder scores, range of motion, and patient satisfaction compared with a short course of oral corticosteroids. © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.

BACKGROUND: The influence of the anteromedial and posterolateral bundles of the anterior cruciate ligament on tibiofemoral rotation might be of great value to detect anterior cruciate ligament injuries and investigate the postoperative restoration of rotational stability. HYPOTHESIS: The anterior cruciate ligament and especially the posterolateral bundle will have a significant influence on isolated tibiofemoral rotation. STUDY DESIGN: Controlled laboratory study. METHODS: Tibiofemoral rotation was measured in 20 human cadaveric knees using a noninvasive external measurement device (Rotameter) and a knee navigation system. The measurements of the knees with the intact anterior cruciate ligament were compared with the measurements after isolated resection of the posterolateral bundle and after a complete resection of the anterior cruciate ligament at an applied torque of 5,10, and 15 N.m. Statistical analysis was made using analysis of variance and the post hoc Scheffé test. The Pearson coefficient was used to compare both measurement techniques. RESULTS: In comparison with knees with an intact anterior cruciate ligament, the knees after isolated resection of the posterolateral bundle showed significant increase of tibiofemoral rotation at almost all applied torques (P <.05). Total resection of the anterior cruciate ligament also produced significant increases compared with the intact anterior cruciate ligament at torques of 5, 10, and 15 N.m as measured by the Rotameter (P <.05). Total resection of the anterior cruciate ligament yielded increases in rotation compared with posterolateral bundle resection alone, but these differences were not significant. The results of the knee navigation system confirmed the measured results of the Rotameter. Comparison of the 2 measurement methods revealed a high correlation at all applied torques, with Pearson correlation coefficients ranging from .85 to .95. CONCLUSION: The anterior cruciate ligament and especially the posterolateral bundle of the anterior cruciate ligament have a significant effect on isolated tibiofemoral rotation. Therefore, the developed noninvasive device might be of great importance to investigate the status and the postoperative reconstruction of the anterior cruciate ligament in the clinical setting. CLINICAL RELEVANCE: Noninvasive measurement of tibiofemoral rotation might be useful to detect anterior cruciate ligament tears and to evaluate the restoration of rotational stability after anterior cruciate ligament surgery.

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