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Frankfurt am Main, Germany

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. Source

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. Source

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. Source

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. Source

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. Source

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