Düsseldorf, Germany


Düsseldorf, Germany
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Duschek N.,Wilhelminenspital | Assadian A.,Wilhelminenspital | Lamont P.M.,Royal Infirmary | Klemm K.,Marienhospital | And 3 more authors.
Journal of Vascular Surgery | Year: 2013

Objective: Vascular surgeons perform numerous highly sophisticated and delicate procedures. Due to restrictions in training time and the advent of endovascular techniques, new concepts including alternative environments for training and assessment of surgical skills are required. Over the past decade, training on simulators and synthetic models has become more sophisticated and lifelike. This study was designed to evaluate the impact of a 3-day intense training course in open vascular surgery on both specific and global vascular surgical skills. Methods: Prospective observational cohort analysis with various parameter measurements of both surgical skills and the technical quality of the finished product, performed before and after 3 days of simulator training of 10 participants (seven male and three female) in a vascular surgery training course. The simulator model used was a conventional carotid endarterectomy with a Dacron patch plasty on a lifelike carotid bench model under pulsatile pressure. The primary end points were assessment of any changes in the participants' surgical skills and in the technical quality of their completed carotid patches documented by procedure-based assessment forms. Scores ranging from 1 (inadequate) to 5 (excellent) were compared by a related-sample Wilcoxon signed test. Interobserver reliability was estimated by Cronbach's alpha (CA). Results: A significant improvement in surgical skills tasks was observed (P <.001). The mean score increased significantly by 21.5% from fair (3.43 ± 0.93) to satisfactory (4.17 ± 0.69; P <.001). The mean score for the quality of the carotid patch increased significantly by 0.96 (27%) from fair (3.55 ± 0.87) to satisfactory (4.51 ± 0.76; P <.01). The median interassessor reliability for the quality of the carotid patch was acceptable (CA = 0.713) and for surgical skills was low (CA = 0.424). Conclusions: This study shows that lifelike simulation featuring pulsatile flow can increase surgical skills and technical quality in a highly sophisticated multistep vascular intervention. This training provides comparatively inexpensive and lifelike training possibilities for the adoption and assessment of surgical skills required to perform delicate vascular surgical procedures.

Monkemuller K.,Endoscopy Unit | Monkemuller K.,Marienhospital | Peter S.,Endoscopy Unit | Toshniwal J.,Marienhospital | And 5 more authors.
Digestive Endoscopy | Year: 2014

Background and Aim The 'bear-claw' or over-the-scope-clip system (OTSC; Ovesco Endoscopy, Tübingen, Germany) is a new clipping device developed for closure of large luminal gastrointestinal (GI) defects. The aim of the present study was to evaluate the clinical outcomes of patients treated with the OTSC. Methods The present study was an observational, open-label, retrospective, single-arm case series conducted at two hospitals with tertiary care endoscopy. It involved 20 clip applications in 16 patients (median age 65.8 years [range 51-90 years], seven women) with GI defects from fistulas and anastomotic dehiscence and peptic ulcer bleeding. Results The range of indications included gastrointestinal bleeding (n=6), gastrocutaneous fistulas (n=3), esophagotracheal and/or esophagopleural fistulae (n=3), resection ofsubmucosal tumor (n=2), stent fixation (n=1), and anastomotic leak after esophagectomy (n=1). The overall success rate for the OTSC device was 75% (12 out of 16 patients). The overall per case success rate was 70% (14 of 20 applications). Mean follow up was 10 months (range 1-10). There were no complications (0%) related to endoscopy, sedation or application of the clipping device. Conclusions The OTSC system is a useful device in a variety of clinical scenarios including the management of larger GI leaks and fistulas, GI bleeding, full-thickness resection of tumors, and stent anchoring, even in very old and frail patients. © 2013 Japan Gastroenterological Endoscopy Society.

Brenner S.A.,University of Hohenheim | Zacheja S.,Marienhospital | Schaffer M.,Marienhospital | Feilhauer K.,Katharinenhospital | And 2 more authors.
Immunology | Year: 2014

Summary: Mast cells are now considered sentinels in immunity. Given their location underneath the gastrointestinal barrier, mast cells are entrusted with the task of tolerating commensal microorganisms and eliminating potential pathogens in the gut microbiota. The aim of our study was to analyse the responsiveness of mast cells isolated from macroscopically normal and Crohn's disease-affected intestine to lipopolysaccharide (LPS). To determine the LPS-mediated signalling, human intestinal mast cells were treated with LPS alone or in combination with soluble CD14 due to their lack of surface CD14 expression. LPS alone failed to stimulate cytokine expression in human intestinal mast cells from both macroscopically normal and Crohn's disease tissue. Upon administration of LPS and soluble CD14, there was a dose- and time-dependent induction of cytokine and chemokine expression. Moreover, CXCL8 and interleukin-1β protein expression was induced in response to activation with LPS plus soluble CD14. Expression of cytokines and chemokines was at similar levels in mast cells from macroscopically normal and Crohn's disease-affected intestine after LPS/soluble CD14 treatment. In conclusion, human intestinal mast cells appear to tolerate LPS per se. The LPS-mediated activation in mast cells may be provoked by soluble CD14 distributed by other LPS-triggered cells at the gastrointestinal barrier. © 2014 John Wiley & Sons Ltd.

Kuendgen A.,Heinrich Heine University Düsseldorf | Lauseker M.,Ludwig Maximilians University of Munich | List A.F.,H. Lee Moffitt Cancer Center and Research Institute | Fenaux P.,University of Paris 13 | And 6 more authors.
Leukemia | Year: 2013

Data comparing long-term outcomes in lenalidomide-treated and untreated patients with myelodysplastic syndromes (MDS) with del(5q) are limited. We evaluated clinical outcomes of 295 lenalidomide-treated patients from two clinical trials (MDS-003 and MDS-004) and 125 untreated red blood cell (RBC) transfusion-dependent patients with del(5q) Low- or Intermediate-1 (Int-1)-risk MDS from a large multicenter registry. Risk factors for acute myeloid leukemia (AML) progression and mortality were assessed using Cox proportional hazards models with left truncation to adjust for study entry differences between cohorts. Baseline characteristics were well balanced across cohorts, except for a higher RBC transfusion burden in lenalidomide-treated patients (median, 6 vs 2 units/8 weeks). Median follow-up was 4.3 years from first dose for lenalidomide-treated patients and 4.6 years from diagnosis for untreated patients. Two-year cumulative AML progression incidences were 6.9% (95% confidence interval (CI): 3.3-13.9) and 12.1% (95% CI: 7.0-20.3) and 2-year overall survival (OS) probabilities were 89.9% (95% CI: 84.1-96.0) and 74.4% (95% CI: 66.1-83.7), respectively. AML progression risk was similar in both cohorts (hazard ratio (HR) 0.969, P=0.930); however, lenalidomide treatment was associated with significant improvement in survival (HR 0.597, P=0.012), after adjusting for all other covariates. In conclusion, lenalidomide treatment does not increase AML progression risk, but instead confers a possible survival benefit in RBC transfusion-dependent patients with del(5q) Low- or Int-1-risk MDS. © 2013 Macmillan Publishers Limited All rights reserved.

Hagenlocher Y.,University of Hohenheim | Bergheim I.,University of Hohenheim | Zacheja S.,Marienhospital | Schaffer M.,Marienhospital | And 2 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2013

Background: Mast cells (MC) are main effector cells of allergic and other inflammatory reactions; however, only a few anti-MC agents are available for therapy. It has been reported that cinnamon extract (CE) attenuates allergic symptoms by affecting immune cells; however, its influence on MC was not studied so far. Here, we analyzed the effects of CE on human and rodent MC in vitro and in vivo. Methods: Expression of MC-specific proteases was examined in vivo in duodenum of mice following oral administration of CE. Release of mediators and phosphorylation of signaling molecules were analyzed in vitro in human MC isolated from intestinal tissue (hiMC) or RBL-2H3 cells challenged with CE prior to stimulation by FcεRI cross-linking. Results: Following oral treatment with CE, expression of the mast cell proteases MCP6 and MC-CPA was significantly decreased in mice. In hiMC, CE also caused a reduced expression of tryptase. Moreover, in hiMC stimulated by IgE cross-linking, the release of β-hexosaminidase was reduced to about 20% by CE. The de novo synthesis of cysteinyl leukotrienes, TNFα, CXCL8, CCL2, CCL3, and CCL4, was almost completely inhibited by CE. The attenuation of mast cell mediators by CE seems to be related to particular signaling pathways, because we found that activation of the MAP kinases ERK, JNK, and p38 as well as of Akt was strongly reduced by CE. Conclusion CE decreases expression of mast cell-specific mediators in vitro and in vivo and thus is a new plant-originated candidate for anti-allergic therapy. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Korchounov A.,Goethe University Frankfurt | Korchounov A.,Marienhospital | Ziemann U.,Goethe University Frankfurt
Neuropsychopharmacology | Year: 2011

Long-term potentiation (LTP) of synaptic efficacy is considered a fundamental mechanism of learning and memory. At the cellular level a large body of evidence demonstrated that the major neuromodulatory neurotransmitters dopamine (DA), norepinephrine (NE), and acetylcholine (ACh) influence LTP magnitude. Noninvasive brain stimulation protocols provide the opportunity to study LTP-like plasticity at the systems level of human cortex. Here we applied paired associative stimulation (PAS) to induce LTP-like plasticity in the primary motor cortex of eight healthy subjects. In a double-blind, randomized, placebo-controlled, crossover design, the acute effects of a single oral dose of the neuromodulatory drugs cabergoline (DA agonist), haloperidol (DA antagonist), methylphenidate (indirect NE agonist), prazosine (NE antagonist), tacrine (ACh agonist), and biperiden (ACh antagonist) on PAS-induced LTP-like plasticity were examined. The antagonists haloperidol, prazosine, and biperiden depressed significantly the PAS-induced LTP-like plasticity observed under placebo, whereas the agonists cabergoline, methylphenidate, and tacrine had no effect. Findings demonstrate that antagonists in major neuromodulatory neurotransmitter systems suppress LTP-like plasticity at the systems level of human cortex, in accord with evidence of their modulating action of LTP at the cellular level. This provides further supportive evidence for the known detrimental effects of these drugs on LTP-dependent mechanisms such as learning and memory. © 2011 American College of Neuropsychopharmacology. All rights reserved.

Heppt W.,Academic Teaching Hospital | Gubisch W.,Marienhospital
Facial Plastic Surgery | Year: 2011

In general, septoplasty precedes all other procedures in rhinoplasty because a straight, stable septum dictates profoundly the aesthetic and functional outcome. The patient's history and expectations, proper preoperative analysis, and the surgeon's skills determine the way to proceed in septum correction. As a rule of thumb, slight deviations (e.g., single vomer spurs, maxillary crests, the septal tilt, and simple C-shaped deformities) may be managed endonasally using the hemitransfixion incision and procedures such as the swinging door technique, scoring incisions, batten grafts, or caudal septal replacement grafts. By contrast, for S-shaped and severe wavelike deviations, the cleft nose, the multiple fractured septum, and for most revisional cases, the open approach with extracorporeal septum reconstruction has been found to be the method of choice. After initial general remarks on the basic procedures, this article focuses on current concepts of septum correction that have to be adapted to the individual pathologic condition. Copyright © 2011 by Thieme Medical Publishers, Inc.

Fischer H.,Marienhospital
Facial Plastic Surgery | Year: 2014

This article is focused on technical details for successfully reconstructing the nasal skin cover in parts or totally. Nasal reconstruction is based on the successful reconstruction of the inner lining and the nasal framework in three-layer defects. The details to be considered include planning the flap, subunit reconstruction and outline of margins, dealing with hair-bearing forehead skin, sequence of stages, intermediate debulking, details of pedicle dissection, brow reconstruction, forehead closure, forehead expansion, and complication management. © 2014 by Thieme MedicalPublishers, Inc.

Trobs R.-B.,Marienhospital
Padiatrische Praxis | Year: 2011

The spectrum of ovarian tumors in childhood and puberty includes teratomas (2/3 of all cases), epithelial tumors (serous/mucinous cystadenoma), and sex cord-stromal tumors (granulosa and SERTOLI-LEYDIG cell tumors). In addition rare entities were observed. Clinical symptoms are commonly unspecific. Sex cord-stromal tumors are hormonal active (pubertas praecox, secundary amenorrhoe). In general ovarian tumors in infancy and childhood carry a malignant potential. Treatment of malignant germ cell tumours occurs in risk adapted multicentric and prospective trials (German Cooperative Protocols for Malignant Germ Cell Tumors; MAKEI). The goals of surgical management are complete tumour resection, accurate staging, and preservation of reproductive capability as well as hormonal function. Incomplete resection and immaturity or malignancy within teratomas predisposes to malignant relapses. Gonad preserving resections for ovarian tumors carry specific oncological risks. They are reserved for selected, commonly bilateral cases. A long-term follow-up of patients with germ cell tumors is strongly recommended.

Gubisch W.,Marienhospital
Facial Plastic Surgery Clinics of North America | Year: 2015

A septal deformity with severe deviation of the septal L strut is seen in nearly every crooked or scoliotic nose. Unless the underlying septal deformity is properly diagnosed and treated, the nasal axis cannot be completely straightened. In addition, because standard septoplasty techniques often fail to adequately address severe L-strut deformities, extracorporeal septoplasty is often a prerequisite for straightening the crooked nose. This article presents a detailed explanation of the extracorporeal technique, as well as representative long-term clinical results showing the efficacy and durability of extracorporeal septoplasty. Extracorporeal septoplasty a safe and reliable method for straightening the severely deviated nose. © 2015 Elsevier Inc.

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