Neumann E.,Justus Liebig University |
Lefevre S.,Justus Liebig University |
Zimmermann B.,Justus Liebig University |
Geyer M.,Justus Liebig University |
And 5 more authors.
Cell Cycle | Year: 2010
Cell migration is a central part of physiological and pathophysiological processes including wound healing, immune defense, matrix remodeling and organ homeostasis. Different cell types have migratory potential including cells of the immune system and cells required in wound healing and tissue repair. These cells migrate locally through the tissue to the site of damage. The fibroblast is a central cell type of wound healing. In rheumatoid arthritis (RA), activated synovial fibroblasts (SFs) have the ability to invade joint cartilage, actively contributing to joint destruction in RA. Recently, RASFs have been shown to be able to migrate to non-affected areas and joints through the blood stream and to invade distant cartilage. RASFs most likely use similar mechanisms comparable to lymphocytes and tumor cells for long-distance and vascular trans-migration. Future experiments will address the goal to keep the transformed-appearing fibroblasts in the affected joints using therapeutical strategies that inhibit the pathophysiological changes of transformed-appearing RASFs but do not interfere with the physiological processes of 'normal' fibroblasts. © 2010 Landes Bioscience.
Layer P.,Israelitic Hospital in Hamburg |
Bronisch H.-J.,Katholisches Krankenhaus St. Nepomuk |
Henniges U.M.,Israelitic Hospital in Hamburg |
Koop I.,Amalie Sieveking Krankenhaus |
And 5 more authors.
Pancreas | Year: 2011
Objectives: Intravenous local anesthetics may ameliorate pain and clinical course in patients with major abdominal surgery. Aim: To investigate their effects in acute pancreatitis. Methods: Forty-six consecutive patients with acute pancreatitis randomly received intravenous procaine (2 g/24 h) or placebo for 72 hours in a double-blind fashion. Pain severity (visual analog scale, 0-100), on-demand pain medication (metamizole and/or buprenorphine), and the clinical course were monitored every 24 hours. Results: Data of 44 patients were subjected to intention-to-treat analysis. Although there were no differences between groups before treatment, procaine treatment was associated with a stronger decrease in pain compared with placebo (median visual analog scale decrement, -62 vs -39, P = 0.025). Moreover, there was a greater proportion of patients with adequate (≥67%) pain reduction (75% vs 43%, P = 0.018), less use of additional analgesics (P = 0.042), and overall analgesic superiority (P = 0.015). Compared with placebo, the proportion of patients hospitalized after 2 weeks was reduced by 80% after procaine treatment (P = 0.012). Conclusions: These findings support the hypothesis that systemic administration of local anesthetics might improve pain and accelerate clinical recovery in acute pancreatitis. Copyright © 2011 by Lippincott Williams & Wilkins.
Dignass A.U.,Markus Krankenhaus |
Eriksson A.,Sahlgrenska University Hospital |
Kilander A.,Sahlgrenska University Hospital |
Pukitis A.,Riga Stradins University |
And 2 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2010
Ulcerative colitis is characterized by leucocyte infiltration into the colonic mucosa. Granulocyte-monocyte apheresis depletes these cells. Aim To assess the non-inferiority of 5-10 apheresis treatments in patients with steroid-dependent or steroid-refractory ulcerative colitis. Methods A total of 196 adults with moderate-severe ulcerative colitis were randomized 1:1 to 5 (n = 96) or 10 (n = 90) open label apheresis treatments. The primary endpoint was non-inferiority of clinical activity index score after 12 weeks. Results The intent-to-treat population comprised 82 and 80 patients for the 5- and 10-treatment groups, respectively. The difference between the two groups in mean clinical activity index was 0.24 with an upper 95% confidence interval of 1.17, which was below a predefined non-inferiority threshold of 1.33. Clinical activity index score improved from baseline in both groups (from 8.7 to 5.6 with 5 treatments, and from 8.8 to 5.4 with 10), with no significant difference between the groups (P = 0.200). Outcomes for the 5- and 10-treatment groups were similar - Clinical remission: 44% and 40%, respectively (P = 0.636); clinical response: 56% and 59%, respectively (P = 0.753). The treatment was well tolerated in both groups. Conclusions This prospective study comparing apheresis regimens in ulcerative colitis demonstrates that 5 treatments were not inferior to 10 treatments in steroid-refractory or -dependent ulcerative colitis. © 2010 Blackwell Publishing Ltd.
Blattmann C.,University of Heidelberg |
Oertel S.,University of Heidelberg |
Schulz-Ertner D.,Markus Krankenhaus |
Rieken S.,University of Heidelberg |
And 11 more authors.
BMC Cancer | Year: 2010
Background: Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. For effective treatment, local control of the tumor is absolutely critical, because the chances of long term survival are <10% and might effectively approach zero if a complete surgical resection of the tumor is not possible. Up to date there is no curative treatment protocol for patients with non-resectable osteosarcomas, who are excluded from current osteosarcoma trials, e.g. EURAMOS1. Local photon radiotherapy has previously been used in small series and in an uncontrolled, highly individualized fashion, which, however, documented that high dose radiotherapy can, in principle, be used to achieve local control. Generally the radiation dose that is necessary for a curative approach can hardly be achieved with conventional photon radiotherapy in patients with non-resectable tumors that are usually located near radiosensitive critical organs such as the brain, the spine or the pelvis. In these cases particle Radiotherapy (proton therapy (PT)/heavy ion therapy (HIT) may offer a promising new alternative. Moreover, compared with photons, heavy ion beams provide a higher physical selectivity because of their finite depth coverage in tissue. They achieve a higher relative biological effectiveness. Phase I/II dose escalation studies of HIT in adults with non-resectable bone and soft tissue sarcomas have already shown favorable results.Methods/Design: This is a monocenter, single-arm study for patients ≥ 6 years of age with non-resectable osteosarcoma. Desired target dose is 60-66 Cobalt Gray Equivalent (Gy E) with 45 Gy PT (proton therapy) and a carbon ion boost of 15-21 GyE. Weekly fractionation of 5-6 × 3 Gy E is used. PT/HIT will be administered exclusively at the Ion Radiotherapy Center in Heidelberg. Furthermore, FDG-PET imaging characteristics of non-resectable osteosarcoma before and after PT/HIT will be investigated prospectively. Systemic disease before and after PT/HIT is targeted by standard chemotherapy protocols and is not part of this trial.Discussion: The primary objectives of this trial are the determination of feasibility and toxicity of HIT. Secondary objectives are tumor response, disease free survival and overall survival. The aim is to improve outcome for patients with non-resectable osteosarcoma. © 2010 Blattmann et al; licensee BioMed Central Ltd.
Meining A.,TU Munich |
Spaun G.,Krankenhaus der Barmherzigen Schwestern Linz |
Fernandez-Esparrach G.,Institute Of Malalties Digestives I Metaboliques |
Arezzo A.,University of Turin |
And 8 more authors.
Endoscopy | Year: 2013
The sixth EURO-NOTES workshop (4 - 6 October 2012, Prague, Czech Republic) focused on enabling intensive scientific dialogue and interaction between surgeons, gastroenterologists, and engineers/industry representatives and discussion of the state of the practice and development of natural orifice transluminal endoscopic surgery (NOTES) in Europe. In accordance with previous meetings, five working groups were formed. In 2012, emphasis was put on specific indications for NOTES and interventional endoscopy. Each group was assigned an important indication related to ongoing research in NOTES and interventional endoscopy: cholecystectomy and appendectomy, therapy of colorectal diseases, therapy of adenocarcinoma and neoplasia in the upper gastrointestinal tract, treating obesity, and new therapeutic approaches for achalasia. This review summarizes consensus statements of the working groups. © Georg Thieme Verlag KG Stuttgart ·New York.
Stein J.,Krankenhaus Sachsenhausen |
Stein J.,Crohn Colitis Clinical Research Center Rhein Main |
Dignass A.U.,Markus Krankenhaus |
Dignass A.U.,Crohn Colitis Clinical Research Center Rhein Main
Annals of Gastroenterology | Year: 2013
Although anemia is the most common systemic manifestation of inflammatory bowel disease (IBD), among the broad spectrum of extraintestinal disease complications encountered in IBD, including arthritis and osteopathy, it has generally received little consideration. However, not only in terms of frequency, but also with regard to its potential effect on hospitalization rates and on the quality of life and work, anemia is indeed a significant and costly complication of IBD. Anemia is multifactorial in nature, the most prevalent etiological forms being iron deficiency anemia (IDA) and anemia of chronic disease. In a condition associated with inflammation, such as IBD, the determination of iron status using common biochemical parameters alone is inadequate. A more accurate assessment may be attained using new iron indices including reticulocyte hemoglobin content, percentage of hypochromic red cells or zinc protoporphyrin. While oral iron supplementation has traditionally been a mainstay of IDA treatment, it has also been linked to extensive gastrointestinal side effects and possible disease exacerbation. However, many physicians are still reluctant to administer iron intravenously, despite the wide availability of a variety of new IV preparations with improved safety profiles, and despite the recommendations of international expert guidelines. This article discusses improved diagnostic and therapeutic strategies based on new clinical insights into the regulation of iron homeostasis. © 2013 Hellenic Society of Gastroenterology.
Stolt V.S.,University of Bern |
Chessa M.,Policlinico San Donato |
Aubry P.,Service de Cardiologie |
Juliard J.-M.,Service de Cardiologie |
And 3 more authors.
Catheterization and Cardiovascular Interventions | Year: 2010
Objectives: This multicentre study sought to report the safety and efficacy of the ATRIASEPT septal occluder to repair atrial septal defect (ASD). Background: The ATRIASEPT is a low profile, flexible, double disk occluder with centering system specifically designed for closure of ostium secundum ASD. Method: Patients were enrolled from four participating European sites and followed up for 12 months post procedure. Outcomes were evaluated, including closure success and incidence of adverse events. Results: Seventy-six patients received the ATRIASEPT device. Mean size of the defect was 15 ± 4 mm. Closure success was observed in 69 patients (89%) at the end of the procedure. Sixty-four patients had a six-month follow up with a complete closure by 58 patients (90%). Minor adverse events occurred in two patients. Significant functional improvement was reported by all symptomatic patients. Conclusion: Percutaneous closure of ASD ostium secundum type defects with the ATRIASEPT is safe and effective with high success rate and excellent mid-term outcome. © 2010 Wiley-Liss, Inc.
Dignass A.U.,Markus Krankenhaus |
Stein J.,Crohn Colitis Center Frankfurt
Practical Gastroenterology | Year: 2012
Anaemia represents the most frequent systemic manifestation of inflammatory bowel disease (IBD), and may not only affect quality of life and the ability to work, but also lead to an increased hospitalisation rate in these patients. Although the causes of anaemia in IBD are multifactorial, iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are the most prevalent. In a condition associated with inflammation, such as IBD, assessment of iron status using the common biochemical values is insufficient. However, new iron indices such as reticulocyte haemoglobin content (CHr), percentage of hypochromic red cells (%HYPO) or zinc protoporphyrin (ZPP), may help to improve the assessment of iron status in IBD. Common treatment of IDA traditionally involves oral iron supplementation. However, because of extensive gastrointestinal side effects and data showing the use of oral iron in IBD to be possibly associated with disease exacerbation, recent guidelines suggest that, in IBD, the intravenous administration of iron supplementation should be preferred. On the basis of new experimental and clinical findings on the regulation of iron homeostasis, this article discusses improved diagnostic and therapeutic strategies, with special emphasis on new intravenous iron preparations.
Exner K.,Markus Krankenhaus
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen | Year: 2010
The goals in surgical treatment of unilateral long-standing facial paralysis are individual concepts restoring mimetic function, aesthetic facial symmetry at rest and protection of the eye by complete eyelid closure. Facial reanimation with free neuromuscular flaps is the actual standard treatment. The reanimation of the paralysed eyelid is still a major problem. Gillies described in 1934 his technique using the transposition of the temporal muscle with two strips of its own fascia performing a dynamic support of the upper and lower eyelid. McLaughlin was using the temporal muscle in combination with fascia lata for the reanimation of the oral muscle sling (1953). There are still some indications for these procedures. The long-term follow-up of 93 patients with Gillies procedure and 180 patients with McLaughlin's muscle support gives a sound base for decision making in facial reanimation. (c) Georg Thieme Verlag KG Stuttgart-New York.
Baumeister S.,Markus Krankenhaus |
Sohn M.,Markus Krankenhaus |
Domke C.,Markus Krankenhaus |
Exner K.,Markus Krankenhaus
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2011
Background: The free radial forearm flap is state of the art for a phalloplasty in female-to-male transsexuals. Alternatives are the free fibula flap or the pedicled groin flap. Method: In a retrospective study, 269 phalloplasties performed between 1993 and 2009 were analysed for success rates and complications. The operative technique for the radial forearm flap in 2 designs and the groin flap penile reconstruction are described. Results: Indications for penile reconstruction were transsexualism in 96.3%. We used 135 radial forearm flaps, 119 groin flap reconstructions, 2 fibula, one scapula and 2 pedicled randomised flaps. Of the radial forearm flaps, 10 flaps had a thrombosis (3 arterial, 4 venous, 3 combined) on postoperative day 0, 1 (n=5), 4, 4, 5 and 24. Six revisions were successful; 4 flaps failed (3%). 12 flaps (9%) showed a partial or superficial necrosis which required an operative revision. Conclusion: The radial forearm flap can be performed in various designs. If the patient wishes a glans plasty the Gottlieb design is favoured. In obese patients with a short forearm the Chang design is recommended as it provides a sufficient pedicle length for anastomosis without a venous interpositional graft. The radial forearm flap has a high success rate, but late thromboses and partial necrosis are particular problems. Surgically, we recommend a trapezoid design, a skin graft if there is any sign of tension, a subfascial dissection and sufficient subcutaneous veins for drainage of the ulnar urethra. The groin flap penile reconstruction is a rare alternative for patients who wish a larger bulk, refuse to accept a stigmatising scar on the forearm and whose priority is not voiding while standing. © Georg Thieme Verlag KG Stuttgart - New York.