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Muller-Wille R.,University of Regensburg | Wohlgemuth W.A.,University of Regensburg | Heiss P.,University of Regensburg | Wiggermann P.,University of Regensburg | And 5 more authors.
CardioVascular and Interventional Radiology | Year: 2013

Purpose: To determine the feasibility and efficacy of transarterial endoleak embolization using the liquid embolic agent ethylene vinyl alcohol copolymer (Onyx). Methods: Over a 7-year period eleven patients (6 women, 5 men; mean age 68 years, range 37-83 years) underwent transarterial embolization of a type II endoleak after endovascular aortic aneurysm repair using the liquid embolic agent Onyx. Two patients (18 %) had a simple type II endoleak with only one artery in communication with the aneurysm sac, whereas 9 patients (82 %) had a complex type II endoleak with multiple communicating vessels. We retrospectively analyzed the technical and clinical success of transarterial type II endoleak embolization with Onyx. Complete embolization of the nidus was defined as technical success. Embolization was considered clinically successful when volume of the aneurysm sac was stable or decreased on follow-up CT scans. Result: Mean follow-up time was 26.0 (range 6-50) months. Clinical success was achieved in 8 of 11 patients (73 %). Transarterial nidus embolization with Onyx was technically successful in 6 of 11 patients (55 %). In three cases the nidus was embolized without direct catheterization from a more distal access through the network of collateral vessels. Conclusion: Onyx is a favorable embolic agent for transarterial endoleak embolization. To achieve the best clinical results, complete occlusion of the nidus is mandatory. © 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).


Ried M.,University of Regensburg | Lehle K.,University of Regensburg | Neu R.,University of Regensburg | Diez C.,University of Regensburg | And 3 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2015

OBJECTIVES: The effects of cisplatin on the lung parenchyma during hyperthermic intrathoracic chemotherapy perfusion have not been analysed in detail. The objective of this study was to evaluate both the concentration and depth of the penetration of cisplatin in human lung tissue after hyperthermic exposure under ex vivo conditions. METHODS: This experimental study was approved by the local ethics committee. Twelve patients underwent pulmonary wedge resections after elective thoracic lobectomies were performed (resected lobe), and the lung tissue (approximately 1-2 cm3) was incubated (in vitro) with cisplatin (0.05 mg/ml; 60 min, 42°C). Subsequent tissue beds (depth, 0.5 mm; median weight, 70-92 mg) were prepared from the outside to the middle, and the amount of cisplatin per tissue weight was analysed using atomic absorption spectrometry. Afterwards, the penetration of cisplatin depth was calculated and related to the different concentrations per tissue. RESULTS: Cisplatin penetrated into the human lung tissue after ex vivo hyperthermic exposure. The median amount of platinum [nmol cisplatin/g lung tissue] decreased significantly (P ≤ 0.05) depending on the penetration depth: 32 nmol/g (1 mm), 20 nmol/g (2 mm) and 6.8 nmol/g (4 mm). The calculated median concentrations of cisplatin (μg/ml) were 2.4 μg/ml (1 mm), 1.4 μg/ml (2 mm) and 0.5 μg/ml (4 mm), respectively. CONCLUSIONS: Under ex vivo hyperthermic conditions, cisplatin diffused into human lung tissue. The median penetration depth of the cisplatin was approximately 3-4 mm. The penetration of cisplatin into lung tissue may affect the local therapy of residual tumour cells on the lung surface using hyperthermic intrathoracic chemotherapy perfusion in patients with malignant pleural tumours. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.


PubMed | Krankenhaus Barmherzige Bruder Regensburg and University of Regensburg
Type: | Journal: Muscle & nerve | Year: 2016

Neurographic data on Wallerian degeneration (WD) following motor nerve injury are available only from animal studies and from human case reports of 9 patients altogether. A precise knowledge of neurographic features of WD would be highly relevant for diagnostic, prognostic, therapeutic, and forensic aspects of traumatic lesions.We prospectively studied WD in patients with a peripheral nerve injury. They underwent sequential neurographic examinations beginning no later than 3 days after the injury until a plateau of the amplitude of compound muscle action potential was reached.We examined 20 injured nerves from 16 patients. Four days after injury, all nerves showed amplitude decay to some extent while 85% had reached their plateau at day 8. A length dependency of WD could be demonstrated.In humans, WD starts no later than day 4, shows length dependency and is finished at day 8 in most nerves. This article is protected by copyright. All rights reserved.


Lampe B.,Nightingale | Kroll N.,Nightingale | Piso P.,Krankenhaus Barmherzige Bruder Regensburg | Forner D.M.,Sana Klinikum Remscheid | Mallmann P.,Universitats Frauenklinik Cologne
International Journal of Gynecological Cancer | Year: 2015

Introduction: This study aimed to investigate Sugarbaker's peritoneal cancer index (PCI) as a prognostic indicator for the resectability of ovarian carcinoma (OC), as depicted in the study using the completeness of cytoreduction score (CCS). Currently, the intraoperative assessment of operability in OC surgery is primarily a subjective measurement that is dependent on the surgeon. Methods: The retrospective data from 98 patients with OC International Federation of Gynecology and Obstetrics (FIGO) III to IV who had received surgery between January 2010 and December 2011 were analyzed. The PCI and the CCS were determined retrospectively using surgical reports, histological findings, and intraoperative photographic documentation. Receiver operating characteristic curves and ordinal regression were applied to evaluate the predictability of CCS using the PCI. Results: Of 98 patients, 80 (81.6%) were staged FIGO III and 18 (18.4%) FIGO IV. A statistically significant correlation was demonstrated between the PCI and CCS (P G 0.01). A receiver operating characteristic curve with an area under the curve of 0.839 demonstrated the high precision in discrimination with which the PCI could predict the CCS. Using ordinal regression, it was possible to estimate the probabilities of achieving CCS 0, CCS 1, CCS 2, or CCS 3 for a given PCI (pseudo R2 according to Cox and Snell 0.428, Nagelkerke 0.476, and McFadden 0.244). Conclusions: The PCI more precisely defined the heterogeneous group of patients with OC FIGO III. The PCI provided objectivity and reproducibility, and it seems to be a possible prognostic indicator for OC resectability. Copyright © 2014 by IGCS and ESGO.


Uhl C.,Krankenhaus Barmherzige Bruder Regensburg | Hock C.,Krankenhaus Barmherzige Bruder Regensburg | Betz T.,Krankenhaus Barmherzige Bruder Regensburg | Topel I.,Krankenhaus Barmherzige Bruder Regensburg | Steinbauer M.,Krankenhaus Barmherzige Bruder Regensburg
Journal of Vascular Surgery | Year: 2014

Background Many centers choose endovascular intervention as their first-line treatment for crural occlusions in patients with critical limb ischemia (Rutherford 4-6). However, unsuccessful interventions often result in major amputation. Therefore, pedal bypass surgery should be considered as an alternative first-line treatment. We reviewed the impact of a prior endovascular intervention on the outcome of our patients' pedal bypass procedures. Methods A retrospective analysis was conducted for all patients who had undergone pedal bypass surgery in our department from February 2008 to October 2012. We performed 75 pedal bypass operations in 71 patients (male, 54; female, 17; median age, 72 years; range, 29-90 years). In 36 of those cases, patients had undergone a prior infrapopliteal endovascular intervention (PEI group). In 39 cases, patients underwent bypass surgery as first-line treatment because their prior angiography had resulted in either unsuccessful endovascular intervention, or intervention had been deemed 'not feasible' (BSF group). Only autologous vein grafts were used, and no retrograde intervention was done via the pedal arteries. Endpoints of the analysis were primary and secondary patency rates, mortality, and limb salvage at 1 year postoperatively. Results Overall primary patency at 1 year was 58.3%, and secondary patency was 61.3%. Limb salvage was 76.8% and survival was 80.4%. Graft occlusion within 30 days was 18.7%. Revision in those cases was futile and 78.6% of patients had to undergo major amputation. Primary patency at 1 year was 67.0% in PEI group vs 48.3% in BSF group (P =.409) and secondary patency was 73.5% vs 48.6% (P =.100). Prior endovascular intervention had no significant impact on either limb salvage (82.3% vs 71.6% at 1 year; P =.515) or graft occlusions within 30 days (19.4% vs 17.9%; P =.547). Survival rate at 1 year was 79.5% in PEI group and 81.3% in BSF group (P =.765). Risk factors and indications were similar in both groups. Conclusions Crural endovascular intervention does not seem to have a negative impact on the outcome of subsequent pedal bypass surgery. Requirements are avoiding a destruction of the target vessel and opting for timely bypass surgery whenever endovascular treatment does not achieve a sufficient perfusion for wounds to heal. Early graft occlusions are associated with a higher risk for major amputation. © 2014 by the Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.


Uhl C.,Krankenhaus Barmherzige Bruder Regensburg | Hock C.,Krankenhaus Barmherzige Bruder Regensburg | Betz T.,Krankenhaus Barmherzige Bruder Regensburg | Brockner S.,Krankenhaus Barmherzige Bruder Regensburg | And 2 more authors.
International Journal of Surgery | Year: 2015

Background: Endovascular recanalization has become the accepted first-line treatment strategy for most lower extremity arterial occlusions, especially in patients with critical limb ischemia (Rutherford 4-6). Prior endovascular interventions have been described as risk factors for the outcome of subsequent lower extremity bypass surgery. The effect on subsequent tibial and peroneal bypasses is controversial. We analyzed the impact of prior endovascular lower extremity revascularization procedures on the short- and mid-term results of femoro-tibial and femoro-peroneal bypasses. Methods: A retrospective analysis was conducted of all patients who had undergone tibial or peroneal bypass surgery after prior endovascular interventions (PEI-Group, n=40) of the same extremity in our department from October 2007 to October 2012. We compared this group with a group of patients who had received a tibial or peroneal bypass as primary revascularization procedure (BF-Group, n=93) during the same period of time because primary endovascular therapy had been deemed unfeasible in those cases. Indication in all cases was critical limb ischemia; the median age was 78 years (range 50-90 years), 45.1% were diabetics, and 42.9% were female. The graft material was autologous vein in 80 cases and HePTFE in 53 cases. Endpoints of the analysis were primary and secondary patency rates, limb salvage and survival at 2 years postoperatively. Results: At 2 years overall primary patency was 68.4%, secondary patency was 69.5%, limb salvage was 83.6% and survival was 62.6%. Primary patency for the BF-Group was 74.3% vs. 55.1% for the PEI-Group (P = .310) at 2 years; secondary patency was 74.6% vs. 59.1% (P = .268). Prior endovascular intervention did not have any significant effects on limb salvage (83.7% vs. 83.6%; P = .470) or survival rates (61.0% vs. 65.0%; P = .258) at the 2-year mark, either. There were no significant differences in graft occlusion, death and major amputation rates within the first 30 postoperative days. Except for male gender, there were no significant differences in risk factors and indications between the two groups. Conclusions: Prior endovascular intervention of femoro-tibial vessels does not have a negative impact on the outcome of subsequent tibial or peroneal bypass surgery in patients with critical limb ischemia. © 2014 Surgical Associates Ltd.


Marz L.,Krankenhaus Barmherzige Bruder Regensburg | Piso P.,Krankenhaus Barmherzige Bruder Regensburg
Onkologe | Year: 2015

Background: Pseudomyxoma peritonei (PMP) is a rare malignancy of the abdomen with an incidence of only 1–2 cases per 1 million inhabitants per year. The most common site of origin of PMP is as a mucinous neoplasm of the appendix and other extra-abdominal or intra-abdominal organs as the primary site are much rarer. Method: Research and analysis of the current literature. Results: The classification into low-grade and high-grade PMP is carried out according to the morphological appearance and growth pattern. Low-grade PMP shows cells with smooth nuclei and mostly acellular mucin, whereas high-grade PMP is characterized by massive atypia of the nuclei partly with signet ring cells and a clearly increased cell architecture in the mucin. Low-grade PMP grows in a displacing manner and high-grade PMP can infiltrate abdominal organs. The cells in PMP show a so-called redistribution phenomenon where cancer cells are distributed within the abdominal cavity and settle in peritoneal folds. Hematogenous metastasis is rare. The most common symptom of PMP is an increase in abdominal girth, followed by an unclear pelvic tumor in women and a newly developed inguinal hernia in men. In 2 out of 10,000 laparotomies PMP is an incidental finding. For the diagnostics ultrasound examination and computer tomography (CT) are most often used. Best practice in diagnostics is laparoscopy during which tissue samples should be collected. The treatment of choice, when possible, is complete cytoreduction with removal of the mucin in combination with an intraperitoneal chemotherapy which can be performed during the operation as hyperthermic intraperitoneal chemotherapy (HIPEC) or afterwards as early postoperative intraperitoneal chemotherapy (EPIC). The intraperitoneal administration of chemotherapy as an aerosol, known as pressurized intraperitoneal aerosol chemotherapy (PIPAC) is at present in the trial stage with results still pending. Other forms of treatment, such as systemic chemotherapy and abdominal irradiation are only used with palliative intent. If complete cytoreduction is achieved the prognosis is good with an average survival time of 16.3 years but the prognosis is poorer if tumor cells remain within the abdomen. If intraperitoneal chemotherapy (HIPEC or EPIC) is administered the overall survival and the progression-free interval are also increased. © 2015 Springer-Verlag Berlin Heidelberg


Marz L.,Krankenhaus Barmherzige Bruder Regensburg | Hofheinz R.,Interdisziplinares Tumorzentrum Mannheim | Piso P.,Krankenhaus Barmherzige Bruder Regensburg
Onkologe | Year: 2016

Peritoneal carcinomatosis is defined as the seeding of malignant cells in the peritoneum. In primary peritoneal carcinomatosis, the cancer cells originate from the peritoneum itself, whereas they spread from another solid tumor in secondary peritoneal carcinomatosis. Amongst tumors of gastrointestinal origin, metastases from colorectal cancer are the most common, although the incidence in gastric cancer (30 %) is higher. The best method for diagnosis is computer tomography of the abdomen (with intravenous, oral, and rectal administration of contrast agent). Systemic chemotherapy is significantly less effective in patients with peritoneal metastases than in patients with metastases in solid organs (e. g. liver). Carefully chosen patients can be treated with cytoreductive surgery (CRS) in combination with intraabdominally applied hyperthermic intraperitoneal chemotherapy (HIPEC). The prognosis is highly dependent on the histology of the primary tumor as well as the extent of peritoneal seeding; the life expectancy can be between a few months and several years. © 2016, Springer-Verlag Berlin Heidelberg.


Brost A.,Friedrich - Alexander - University, Erlangen - Nuremberg | Wimmer A.,Friedrich - Alexander - University, Erlangen - Nuremberg | Liao R.,Siemens AG | Bourier F.,Krankenhaus Barmherzige Bruder Regensburg | And 4 more authors.
IEEE Transactions on Medical Imaging | Year: 2012

Fluoroscopic overlay images rendered from preoperative volumetric data can provide additional anatomical details to guide physicians during catheter ablation procedures for treatment of atrial fibrillation (AFib). As these overlay images are often compromised by cardiac and respiratory motion, motion compensation methods are needed to keep the overlay images in sync with the fluoroscopic images. So far, these approaches have either required simultaneous biplane imaging for 3-D motion compensation, or in case of monoplane X-ray imaging, provided only a limited 2-D functionality. To overcome the downsides of the previously suggested methods, we propose an approach that facilitates a full 3-D motion compensation even if only monoplane X-ray images are available. To this end, we use a training phase that employs a biplane sequence to establish a patient specific motion model. Afterwards, a constrained model-based 2-D/3-D registration method is used to track a circumferential mapping catheter. This device is commonly used for AFib catheter ablation procedures. Based on the experiments on real patient data, we found that our constrained monoplane 2-D/3-D registration outperformed the unconstrained counterpart and yielded an average 2-D tracking error of 0.6 mm and an average 3-D tracking error of 1.6 mm. The unconstrained 2-D/3-D registration technique yielded a similar 2-D performance, but the 3-D tracking error increased to 3.2 mm mostly due to wrongly estimated 3-D motion components in X-ray view direction. Compared to the conventional 2-D monoplane method, the proposed method provides a more seamless workflow by removing the need for catheter model re-initialization otherwise required when the C-arm view orientation changes. In addition, the proposed method can be straightforwardly combined with the previously introduced biplane motion compensation technique to obtain a good trade-off between accuracy and radiation dose reduction. © 2011 IEEE.


PubMed | Krankenhaus Barmherzige Bruder Regensburg and Neuroradiology and Nuclear Medicine
Type: | Journal: Surgical infections | Year: 2016

There are only a few options to replace infected infrainguinal synthetic vascular grafts in the absence of suitable autologous veins. To use a biosynthetic vascular graft (OmniflowWe retrospectively analyzed the clinical course of 29 patients who underwent replacement of an infected infrainguinal vascular prosthesis (Szilagyi 3) by an OmniflowBecause of the lack of suitable autologous veins, 15 above-knee femoro-popliteal, 5 below-knee femoro-popliteal, and 9 femoro-tibial bypasses were replaced with biosynthetic grafts. There were no in-hospital deaths, reinfections, or major amputations. The survival rate was 92% at one year and 87% at two years. During follow-up (median 24months; range 5-66months), no reinfections occurred. However, nine patients presented with bypass occlusions (primary patency 67.6% at one year and 61.5% at two years; secondary patency 85.3% at one year and 69% at two years). The limb salvage rate was 89% at one year and 83% at two years.Biosynthetic bypass grafts might be valuable to replace infected prosthetic grafts in the absence of a suitable vein. They have excellent re-infection resistance. Limb salvage, morbidity, and the mortality rate are similar to those obtained with autologous vein grafts in infected fields.

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