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Wesel, Germany

Rezek D.,Marienhospital | Taufig Z.,Praxisklinik fur Plastische und Asthetische Chirurgie
Journal fur Asthetische Chirurgie | Year: 2015

Autologous fat grafting is a surgical procedure for tissue augmentation which consists of three steps: the aspiration of fat, processing and transplantation. The aim of the operation is that the transferred fat remains in the transplanted area permanently without any complications in the donor and recipient areas. There are many methods to perform this operation and many commercial sets are available. These commercially available sets differ greatly in price and type of equipment. Standardized guidelines from experts and medical societies are available concerning all individual steps. Consensus opinion is that the procedure of lipofilling should be performed under sterile conditions. The aspiration of fat should be atraumatic with controlled vacuum suction. The tumescence solution for preparing the donor area should be as free of local anesthetics as possible and should be washed if local anesthetics are present. The lipoaspirate should be decontaminated and water removed. The transplantation of fat should be carried out from several directions in the form of microdroplets into a well-perfused area. Blunt, sterile disposable instruments should be used for both aspiration and transplantation in a closed system. The choice of method is left up to the operator but careful selection of patients and close follow-up surveillance are important for a successful outcome. © 2015, Springer-Verlag Berlin Heidelberg.

Van Strijen M.J.,St. Antonius Hospital | Grunhagen T.,Philips | Mauti M.,Philips | Zahringer M.,Marienhospital | And 6 more authors.
Journal of Vascular and Interventional Radiology | Year: 2015

Purpose To determine whether equivalent-quality images can be obtained from digital subtraction angiography (DSA) of the iliac artery after implementation of a novel imaging technology that reduces patient and scatter x-ray dose. Materials and Methods Imaging using two randomly ordered DSA runs was performed in 51 adults scheduled for iliac artery angiography or intervention or both. One DSA run used standard acquisition chain and image processing algorithms (referred to as " reference DSA"), and the other DSA run used dose-reduction and real-time advanced image noise reduction technology (referred to as "study DSA"). The quality of each pair of runs, consecutively performed without changes in working projection or injection parameters, was independently rated by five radiologists blinded to the imaging technology used. Patient radiation dose was evaluated using air kerma and dose area product, and scatter dose was evaluated using three dosimeters (DoseAware, Philips Healthcare, Best, The Netherlands), located at fixed positions. Results Comparable image pairs were available in 48 patients. There were 44 patients undergoing treatment involving the common (n = 33) or external (n = 29) iliac arteries. Study DSA images were rated as equal to or better than reference DSA images for 96% of comparisons, with an average overall agreement among raters of 0.93 (95% confidence interval, 0.65-0.96). Mean patient radiation dose (n = 48) and scatter dose rate for the three dosimeters (n = 50) was 83% ± 5 and 69% ± 10 lower, respectively, using the study technology (P <.001). Conclusions Iliac artery DSA performed using a dose-reduction and real-time advanced image noise reduction technology results in image quality that is noninferior to conventional DSA but with significantly lower patient and scatter radiation exposure (P <.001). © 2015 SIR.

Schill G.,University of Regensburg | Iesalnieks I.,Marienhospital | Haimerl M.,University of Regensburg | Muller-Wille R.,University of Regensburg | And 8 more authors.
Inflammatory Bowel Diseases | Year: 2013

Background: Magnetic resonance imaging (MRI) of the bowel is an increasingly used modality to evaluate patients with Crohn's disease. The Montreal classification of the disease behavior is considered as an excellent prognostic and therapeutic parameter for these patients. In our study, we correlated the behavior assessment performed by a radiologist based on MRI with the surgeons' clinical assessment based on the assessment during abdominal surgery. Methods: We evaluated 76 patients with Crohn's disease, who underwent bowel resection and had an MRI within 4 weeks before surgery. Radiological behavior assessment was performed by 2 radiologists based on MRI. Behavior was classified into B1 (nonstricturing and nonpenetrating), B2, and B3 (penetrating) disease. Surgical assessment was done by the same surgeon, who performed all bowel resections, based on intraoperative findings and histologic results. Results: The surgical assessment identified 4 patients (5%) as B1, 16 patients (21%) as B2, and 56 patients (74%) as B3. In 97% (n = 74) of all patients, the intraoperative and radiological assessment were identical with interobserver agreement of 0.937. In one case, B2 was radiological considered as B1, and in another case, B3 was diagnosed as B2. The diagnosis of a stricture had the highest sensitivity of 96%, whereas the detection of inflammatory mass showed the lowest sensitivity of 81%. Abscesses had the lowest positive predictive value of 68% with a specificity of 88%. Best correlation was found for fistulae (0.895). Conclusions: MRI represents an excellent imaging modality to correctly assess the Montreal classification-based disease behavior in patients scheduled for bowel resection with Crohn's disease. Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.

Weber T.,University of Ulm | Eberle J.,University of Ulm | Messelhauser U.,University of Ulm | Schiffmann L.,University of Rostock | And 8 more authors.
JAMA Surgery | Year: 2013

Objective: To assess anxiety and depression symptoms, suicidal ideation, and health-related quality of life (HRQOL) in a large series of consecutive patients with primary hyperparathyroidism (pHPT) before and after parathyroidectomy. Design: This prospective multicenter study investigated preoperative and postoperative depression, anxiety, suicidal ideation, and HRQOL in patients with pHPT and compared these variables with a control group with nontoxic thyroid nodules. Patients: The study included 194 patients with pHPT and 186 control subjects. Main Outcome Measures: Depression was evaluated with the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9, which also assessed suicidal ideation. Anxiety was evaluated with the HADS. Health-related quality of life was measured with the 36-Item Short Form survey. Results: Parathyroidectomy achieved a 98% cure rate. Preoperatively, severe depression (HADS score≥11) was seen in 20% of the pHPT group and 9% of the control group. The Patient Health Questionnaire-9 detected moderate to severe depression in 17% of the patients with pHPT and 7% of the control subjects. Patients with pHPT had higher HADS anxiety scores (mean, 7.7) than control subjects (P<.01) or the German normative sample (P<.001). Compared with control subjects, patients with pHPT had significantly lower 36-Item Short Form survey preoperative physical and mental health summary scores (42.7 vs 49.5 and 41.2 vs 46.8, respectively; P=.001 for both comparisons). At 12 months follow-up, depression and anxiety decreased significantly in patients with pHPT; the prevalence of suicidal ideation was more than halved from the baseline (10.7% vs 22%; P=.008). Both physical and mental health scores (45.7 and 47.7, respectively) improved in patients with pHPT (P<.001 each) but not in control subjects. Conclusions: Depression, anxiety, and decreasedHRQOL appear to be related to pHPT. Successful parathyroidectomy seems to reduce psychopathologic symptoms and improve HRQOL in this setting. © 2013 American Medical Association. All rights reserved.

Vogl T.J.,Goethe University Frankfurt | Farshid P.,Marienhospital | Naguib N.N.N.,Goethe University Frankfurt | Naguib N.N.N.,Alexandria University | And 5 more authors.
Radiologia Medica | Year: 2014

Surgery is currently considered the treatment of choice for patients with colorectal cancer liver metastases (CRLM) when resectable. The majority of these patients can also benefit from systemic chemotherapy. Recently, local or regional therapies such as thermal ablations have been used with acceptable outcomes. We searched the medical literature to identify studies and reviews relevant to radiofrequency (RF) ablation, microwave (MW) ablation and laser-induced thermotherapy (LITT) in terms of local progression, survival indexes and major complications in patients with CRLM. Reviewed literature showed a local progression rate between 2.8 and 29.7 % of RF-ablated liver lesions at 12-49 months follow-up, 2.7-12.5 % of MW ablated lesions at 5-19 months follow-up and 5.2 % of lesions treated with LITT at 6-month follow-up. Major complications were observed in 4-33 % of patients treated with RF ablation, 0-19 % of patients treated with MW ablation and 0.1-3.5 % of lesions treated with LITT. Although not significantly different, the mean of 1-, 3- and 5-year survival rates for RF-, MW- and laser ablated lesions was (92.6, 44.7, 31.1 %), (79, 38.6, 21 %) and (94.2, 61.5, 29.2 %), respectively. The median survival in these methods was 33.2, 29.5 and 33.7 months, respectively. Thermal ablation may be an appropriate alternative in patients with CRLM who have inoperable liver lesions or have operable lesions as an adjunct to resection. However, further competitive evaluation should clarify the efficacy and priority of these therapies in patients with colorectal cancer liver metastases. © 2014 Italian Society of Medical Radiology.

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