Stadtisches Krankenhaus Dresden Friedrichstadt

Dresden, Germany

Stadtisches Krankenhaus Dresden Friedrichstadt

Dresden, Germany

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Diener M.K.,University of Heidelberg | Seiler C.M.,University of Heidelberg | Rossion I.,University of Heidelberg | Kleeff J.,TU Munich | And 23 more authors.
The Lancet | Year: 2011

The ideal closure technique of the pancreas after distal pancreatectomy is unknown. We postulated that standardised closure with a stapler device would prevent pancreatic fistula more effectively than would a hand-sewn closure of the remnant. This multicentre, randomised, controlled, parallel group-sequential superiority trial was done in 21 European hospitals. Patients with diseases of the pancreatic body and tail undergoing distal pancreatectomy were eligible and were randomly assigned by central randomisation before operation to either stapler or hand-sewn closure of the pancreatic remnant. Surgical performance was assessed with intraoperative photo documentation. The primary endpoint was the combination of pancreatic fistula and death until postoperative day 7. Patients and outcome assessors were masked to group assignment. Interim and final analysis were by intention to treat in all patients in whom a left resection was done. This trial is registered, ISRCTN18452029. Between Nov 16, 2006, and July 3, 2009, 450 patients were randomly assigned to treatment groups (221 stapler; 229 hand-sewn closure), of whom 352 patients (177 stapler, 175 hand-sewn closure) were analysed. Pancreatic fistula rate or mortality did not differ between stapler (56 [32] of 177) and hand-sewn closure (49 [28] of 175; OR 0·84, 95 CI 0·53-1·33; p=0·56). One patient died within the first 7 days after surgery in the hand-sewn group; no deaths occurred in the stapler group. Serious adverse events did not differ between groups. Stapler closure did not reduce the rate of pancreatic fistula compared with hand-sewn closure for distal pancreatectomy. New strategies, including innovative surgical techniques, need to be identified to reduce this adverse outcome. German Federal Ministry of Education and Research. © 2011 Elsevier Ltd.


Simonis G.,TU Dresden | Gerk U.,Stadtisches Krankenhaus Dresden Friedrichstadt | Pabst F.,Stadtisches Krankenhaus Dresden Friedrichstadt | Machetanz J.,Stadtisches Krankenhaus Dresden Neustadt | And 2 more authors.
Internist | Year: 2014

Background: Reflex syncope predominantly occurs in younger patients and is the most common type of syncope. Typical contributors to reflex syncope are orthostatic stress, followed by a delayed and inadequate circulatory response consisting of bradycardia (cardioinhibitory type) and hypotension (vasodepressor type). Comparably, syncope may occur after direct activation of the vagus nerve, after emotional distress or pain, and in specific situations, such as coughing and post-micturition. The latter situations are mediated by indirect vagus nerve activation by usually unknown mediators. Syncope mediated by orthostatic hypotension occurs in elderly patients and is mediated by insufficient sympathoadrenergic vasoconstriction, occurring shortly after the onset of the orthostatic situation.Diagnostics: A thorough examination of the patient history is the mainstay of diagnostics. Specific testing is only required in uncertain and recurrent cases. In addition to standard diagnostics, tilt table testing can be helpful. A negative tilt test is, however, not definitive. Implanted loop recorders are helpful to diagnose the cardioinhibitory component of reflex syncope and are more sensitive than tilt testing.Therapy: Treatment of both types of syncope consists of avoiding known situations leading to syncope, early reaction to prodromal syndromes, and physical counterpressure manoeuvers. Drug treatment (e.g. alpha-adrenergic agonists and fludrocortisone) are effective only in patients with orthostatic syncope. In selected patients with reflex syncope of a predominantly cardioinhibitory type, pacemaker implantation may be considered in selected patients. © 2014, Springer-Verlag Berlin Heidelberg.


Wagner A.,Paracelsus Medical University | Wiedmann M.,St Marys Hospital | Tannapfel A.,Ruhr University Bochum | Mayr C.,Paracelsus Medical University | And 5 more authors.
International Journal of Molecular Sciences | Year: 2015

Hilar cholangiocarcinoma (CC) is non-resectable in the majority of patients often due to intrahepatic extension along bile duct branches/segments, and even after complete resection (R0) recurrence can be as high as 70%. Photodynamic therapy (PDT) is an established palliative local tumor ablative treatment for non-resectable hilar CC. We report the long-term outcome of curative resection (R0) performed after neoadjuvant PDT for downsizing of tumor margins in seven patients (median age 59 years) with initially non-resectable hilar CC. Photofrin® was injected intravenously 24–48 h before laser light irradiation of the tumor stenoses and the adjacent bile duct segments. Major resective surgery was done with curative intention six weeks after PDT. All seven patients had been curatively (R0) resected and there were no undue early or late complications for the neoadjuvant PDT and surgery. Six of seven patients died from tumor recurrence at a median of 3.2 years after resection, the five-year survival rate was 43%. These results are comparable with published data for patients resected R0 without pre-treatment, indicating that neoadjuvant PDT is feasible and could improve overall survival of patients considered non-curatively resectable because of initial tumor extension in bile duct branches/segments—however, this concept needs to be validated in a larger trial. © 2015 by the authors; licensee MDPI, Basel, Switzerland.


PubMed | St Marys Hospital, Paracelsus Medical University, University of Leipzig, Stadtisches Krankenhaus Dresden Friedrichstadt and Ruhr University Bochum
Type: Journal Article | Journal: International journal of molecular sciences | Year: 2015

Hilar cholangiocarcinoma (CC) is non-resectable in the majority of patients often due to intrahepatic extension along bile duct branches/segments, and even after complete resection (R0) recurrence can be as high as 70%. Photodynamic therapy (PDT) is an established palliative local tumor ablative treatment for non-resectable hilar CC. We report the long-term outcome of curative resection (R0) performed after neoadjuvant PDT for downsizing of tumor margins in seven patients (median age 59 years) with initially non-resectable hilar CC. Photofrin() was injected intravenously 24-48 h before laser light irradiation of the tumor stenoses and the adjacent bile duct segments. Major resective surgery was done with curative intention six weeks after PDT. All seven patients had been curatively (R0) resected and there were no undue early or late complications for the neoadjuvant PDT and surgery. Six of seven patients died from tumor recurrence at a median of 3.2 years after resection, the five-year survival rate was 43%. These results are comparable with published data for patients resected R0 without pre-treatment, indicating that neoadjuvant PDT is feasible and could improve overall survival of patients considered non-curatively resectable because of initial tumor extension in bile duct branches/segments--however, this concept needs to be validated in a larger trial.


Therapy of venous thromboembolism (deep vein thrombosis and pulmonary embolism) consists of a sequence of 3 phases which follow the natural history of the disease. In the initial phase an intense anticoagulation is required for 5 to 10 days. It is followed by a less intense maintenance anticoagulation for 3 to 6 months. Patients with a high risk of recurrence should receive long term maintenance anticoagulation - depending on their bleeding risk. All new oral anticoagulants are being investigated in separate trial programs for the indication of VTE. Rivaroxaban already has been approved by European authorities for the treatment of deep vein thrombosis. The dose regimen is 15 bid in the first 3 weeks followed by 20 mg qd for maintenance anticoagulation. The maintenance dose of Dabigatran would be 150 mg bid, LMWH have been given as initial therapy. However, no approval exists so far. The development programs for Apixaban and for Edoxaban have not yet been completed. © Georg Thieme Verlag KG Stuttgart · New York.

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