Oldenburg, Germany
Oldenburg, Germany

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Hirschelmann A.,Pius Hospital | Tchartchian G.,Klinik fur Minimal Invasive Chirurgie | Wallwiener M.,University of Heidelberg | De Wilde R.L.,Pius Hospital
Archives of Gynecology and Obstetrics | Year: 2012

Background Adhesions lead to considerable patient morbidity and are a mounting burden on surgeons and the health care system alike. Although adhesion formation is the most frequent complication in abdominal and pelvic surgery, many surgeons are still not aware of the extent of the problem. To provide the best care for their patients, surgeons should consistently inform themselves of antiadhesion strategies and include these methods in their daily routine. Methods Searches were conducted in PubMed and The Cochrane Library to identify relevant literature. Findings Various complications are associated with adhesion formation, including small bowel obstruction, infertility and chronic pelvic pain. Increasingly, an understanding of adhesion formation as a complex process influenced by many different factors has led to various conceivable anti-adhesion strategies. At present, a number of different anti-adhesion agents are available. Although some agents have proved effective in reducing adhesion formation in randomised controlled trials, none of them can completely prevent adhesion formation. Conclusion To fulfil our duty to provide best possible care for our patients, it is now time to regard adhesions as the most common complication in surgery. Further research is needed to fully understand adhesion formation and to develop new strategies for adhesion prevention. Large clinical efficacy trials of anti-adhesion agents will make it easier for surgeons to decide which agent to use in daily routine. © Springer-Verlag 2011.

Schoenfeld A.A.,Carl von Ossietzky University | Schoenfeld A.A.,Pius Hospital | Poppinga D.,Carl von Ossietzky University | Poppinga D.,Pius Hospital | And 4 more authors.
Physics in Medicine and Biology | Year: 2014

Optical experiments and theoretical considerations have been undertaken in order to understand the causes of the 'orientation effect' and the 'parabola effect', the artefacts impairing the desired light absorption measurement on radiochromic EBT3 films with flatbed scanners. EBT3 films exposed to doses up to 20.9 Gy were scanned with an Epson Expression 10000XL flatbed scanner in landscape and portrait orientation. The horizontally and vertically polarized light components of the scanner were determined, and another Epson Expression 10000XL flatbed scanner was disassembled to examine its optical components. The optical properties of exposed and unexposed EBT3 films were studied with incident polarized and unpolarized white light, and the transmitted red light was investigated for its polarization and scattering properties including the distribution of the scattering angles. Neutral density filters were studied for comparison. Guidance was sought from the theory of light scattering from rod-like macromolecular structures. The drastic dose-dependent variation of the transmitted total light current as function of the orientation of front and rear polarizers, interpreted by light scattering theory, shows that the radiation-induced polymerization of the monomers of EBT3 films produces light scattering oscillators preferably polarized at right angles with the coating direction of the film. The directional distribution of the scattered light is partly anisotropic, with a preferred scattering plane at right angles with the coating direction, indicating light scattering from stacks of coherently vibrating oscillators piled up along the monomer crystals. The polyester carrier film also participates in these effects. The 'orientation' and 'parabola' artefacts due to flatbed scanning of radiochromic films can be explained by the interaction of the polarization-dependent and anisotropic light scattering from exposed and unexposed EBT3 films with the quantitative difference between the scanner's horizontally and vertically polarized light supply and with the limited directional acceptance of the scanner's light recording system. © 2014 Institute of Physics and Engineering in Medicine.

Maier G.S.,Justus Liebig University | Maier G.S.,Johannes Gutenberg University Mainz | Maier G.S.,Universitatsklinikum Giessen | Jakobs P.,Johannes Gutenberg University Mainz | And 3 more authors.
Clinical Orthopaedics and Related Research | Year: 2013

Background: Vitamin D plays an essential role in bone health and muscle function. Some studies have shown a widespread rate of vitamin D deficiency in the general population, but few have reported on the vitamin D status of orthopaedic patients. Questions/purposes: We investigated (1) the extent of hypovitaminosis D in orthopaedic patients, (2) seasonal variations in vitamin D levels, and (3) possible risk factors for insufficient vitamin D levels. Methods: Vitamin D levels in 1119 patients consecutively admitted to an orthopaedic surgery department in 2011 were measured. To investigate the correlation between climate factors and vitamin D levels, the sunshine hours for each month in 2011 were collected by Deutscher Wetterdienst (the German weather service) in the region where most tested patients lived. The prevalence of normal (> 30 ng/mL), insufficient (20-30 ng/mL), and deficient (< 20 ng/mL) 25-hydroxyvitamin D levels was determined. Univariate and multivariate analyses were used to assess risk factors for insufficient vitamin D levels. Results: Overall, 84% of patients had insufficient levels of vitamin D and 60% were vitamin D deficient. Only 15% were in the target range of 30 to 60 ng/mL. The prevalence of low vitamin D levels was greater during winter and months with fewer sunshine hours. Vitamin D levels did not vary according to age, sex, and disease. Individuals with obesity, hypertension, and osteoporosis were more likely to have low vitamin D levels compared with their healthy counterparts. Conclusions: There is an alarmingly high rate of hypovitaminosis D and vitamin D deficiency among orthopaedic patients in this region of Germany, whose latitude (50 N) is approximately the same as those of Vancouver (49, 15' N) and Paris (48, 51' N). Given the well-known effects on bone metabolism and muscle health, low vitamin D levels may negatively affect patients. Screening and treating hypovitaminosis D appears to be important in this patient population. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.

Lulay G.R.,Gefass und Lymphzentrum Nord West | Lulay G.R.,Pius Hospital
Vasomed | Year: 2011

Clinical lymphology takes place nearly exclusively at rehabilitation centers. The following review presents a new approach to treatment of patients with severe lymphedema. The excellent results were observed in 200 cases within a single year. The patients had either acute or severe comorbidities or had not responded to out-patient therapy. They underwent a stringent treatment concept on an in-patient basis in fewer than two weeks.

Agency: Cordis | Branch: FP7 | Program: CP | Phase: ICT-2007.3.6 | Award Amount: 3.89M | Year: 2008

The NANOMA project aims at proposing novel controlled nanorobotic delivery systems which will be designed to improve the administration of drugs in the treatment and diagnosis of breast cancer. Breast cancer is diagnosed in 1.2 million men and women globally every year and kills 500,000. The NANOMA project proposes a magnetic nanocapsule steering approach that relies on improved gradient coils for Magnetic Resonance Imaging (MRI) systems. MRI systems also provide concentration and tracking information, real-time interventional capabilities and are already widespread in hospitals. It is based on fundamental techniques and methods for the propulsion, navigation and effective targeted delivery of coated ferromagnetic capsules in the cardiovascular system through the induction of force from magnetic gradients generated by a clinical MRI. This proposed NANOMA platform will be a valuable tool to help enhance the efficiency of breast cancer treatments while improving patients recovery time.The project rests on the pillar of six work packages (WPs) , which are further divided into subprojects (SPs). Substantial RandD activities are carried out in WP1-WP4 with the goal to design, model and control the microcapsule. In WP5-WP6 new biocarriers and biosensors made of ferromagnetic particles and special functionalized materials reacting to environmental changes in infected cancer cells are being investigated. As proof-of-concept, an in-vivo breast cancer cell detection platform is realized and evaluated in WP7. WP8 deals with the effective Europe-wide exploitation and dissemination of the project results. Finally, WP9 manages the project.The project consortium gives almost a guarantee for the projects success.

Torsello G.B.,University of Munster | Torsello G.F.,University of Munster | Osada N.,University of Munster | Teebken O.E.,Leibniz University of Hanover | And 2 more authors.
Journal of Endovascular Therapy | Year: 2010

Purpose: To assess early and midterm outcomes after thoracic endovascular aortic repair (TEVAR) with the Valiant Thoracic Stent Graft. Methods: Data were reviewed retrospectively for 92 patients (69 men; mean age 65614.5 years) who underwent TEVAR in 52.2% elective and 47.8% urgent/emergent procedures for treatment of 56 degenerative aneurysms, 32 aortic dissections, and 4 traumatic injuries at 4 German centers between June 2005 and March 2008. Results: The technical success rate was 86.9%. Through 30 days, there were 3 (3.3%) deaths. Periprocedural complications included endoleak (n=6), systemic complications (n=6), arterial rupture or dissection (n=6), device-related complications (n=5), retrograde aortic dissection (n=1), aortic rupture (n=1), spinal cord ischemia (n=1), and stroke (n=1). Cumulative survival was 95.5% at 1 year, 87.4% at 2 years, and 76.4% at 3 years. The rate of aneurysm-related mortality was 2.2% (n=2). For aneurysm and dissection patients, respectively, the rates of major complications were 9.3% and 15.6%, and secondary procedures were required in 7.4% and 12.5%. Type I endoleaks were detected in 4 aneurysm and 2 dissection patients, and graft migration occurred in 1 patient each from the aneurysm and dissection groups. No patients were converted to open surgery during follow-up. Aortic diameter reduction >5 mm was confirmed for 58.4% of patients overall. Conclusion: The high technical and clinical success, the low all-cause and aneurysm-related mortality, the negligible rates of neurological complications and spinal cord ischemia, and the low incidence of endoleak support the safety and effectiveness of TEVAR with the Valiant Thoracic Stent Graft. However, some deployment-related complications could be avoided by enhancements of the deployment mechanism. © 2010 by the International Society of Endovascular Specialists.

Chofor N.,Pius Hospital | Chofor N.,Carl von Ossietzky University | Harder D.,University of Gottingen | Willborn K.C.,Carl von Ossietzky University | And 2 more authors.
Physics in Medicine and Biology | Year: 2012

In clinical photon beams, the dose outside the geometrical field limits is produced by photons originating from (i) head leakage, (ii) scattering at the beam collimators and the flattening filter (head scatter) and (iii) scattering from the directly irradiated region of the patient or phantom (internal scatter). While the first two components can be modified, e.g. by reinforcement of shielding components or by re-modeling the filter system, internal scatter remains an unavoidable contributor to the peripheral dose. Its relative magnitude compared to the other components, its numerical variation with beam energy, field size and off-axis distance as well as its spectral distribution are evaluated in this study. We applied a detailed Monte Carlo (MC) model of our 6/15 MV Siemens Primus linear accelerator beam head, provided with ideal head leakage shielding conditions (multi-leaf collimator without gaps) to assess the head scatter contribution. Experimental values obtained under real shielding conditions were used to evaluate the head leakage contribution. It was found that the MC-computed internal scatter doses agree with the results of our previous measurements, that internal scatter is the major contributor to the peripheral dose in the near periphery while head leakage prevails in the far periphery, and that the lateral decline of the internal scatter dose can be represented by the sum of two exponentials, with an asymptotic tenth value of 18 to 19cm. Internal scatter peripheral doses from various elementary beams are additive, so that their sum increases approximately in proportion with field size. The ratio between normalized internal scatter doses at 6 and 15 MV is approximately 2:1. The energy fluence spectra of the internal scatter component at all points of interest outside the field have peaks near 500 keV. The fact that the energy-shifted internal scatter constitutes the major contributor to the dose in the near periphery has a general bearing for dosimetry, i.e. for energy-dependent detector responses and dose conversion factors, for the relative biological effectiveness and for second primary malignancy risk estimates in the peripheral region. © 2012 Institute of Physics and Engineering in Medicine.

Lulay G.R.,Chirurgische Klinik II | Lulay G.R.,Pius Hospital
Chirurg | Year: 2013

Swellings of the extremities are often observed in routine practice and are initially seen as a symptom; therefore, it is extremely important to find the cause and often produces differential diagnostic problems. As the diagnosis of lymphedema is mostly a clinical one it is especially necessary to thoroughly investigate an exact anamnesis and clinical examination which should be combined with as little technical equipment as possible. Implementation of the correct and consistent therapy of this chronic disease and continuous surveillance represents a special challenge for physicians and therapists. Operative solutions represent the last resort and often end in unsure results. © 2013 Springer-Verlag Berlin Heidelberg.

Looe H.K.,Pius Hospital | Looe H.K.,Carl von Ossietzky University | Harder D.,University of Gottingen | Poppe B.,Pius Hospital | Poppe B.,Carl von Ossietzky University
Physics in Medicine and Biology | Year: 2011

The subject of this study is the 'shift of the effective point of measurement', Δz, well known as a method of correction compensating for the 'displacement effect' in photon and electron beam dosimetry. Radiochromic EBT 1 films have been used to measure the 'true' TPR curves of 6 and 15 MV photons and 6 and 9 MeV electrons in the solid water-equivalent material RW3. For the Roos and Markus chambers, the cylindrical 'PinPoint', 'Semiflex' and 'Rigid-Stem' chambers, the 2D-Array and the E-type silicon diode (all from PTW-Freiburg), the positions of the effective points of measurement have been determined by direct or indirect comparison between their TPR curves and those of the EBT 1 film. Both for the Roos and Markus chambers, we found Δz = (0.4 0.1) mm, which confirms earlier experimental and Monte Carlo results, but means a shortcoming of the 'water-equivalent window thickness' formula. For the cylindrical chambers, the ratio Δz/r was observed to increase with r, confirming a recent Monte Carlo prediction by Tessier (2010 E2-CN-182, Paper no 147, IDOS, Vienna) as well as the experimental observations by Johansson et al (1978 IAEA Symp. Proc. (Vienna) IAEA-SM-222/35 pp 243-70). According to a theoretical consideration, the shift of the effective point of measurement from the reference point of the detector is caused by a gradient of the fluence of the ionizing particles. As the experiments have shown, the value of Δz depends on the construction of the detector, but remains invariant under changes of radiation quality and depth. Other disturbances, which do not belong to the class of 'gradient effects', are not corrected by shifting the effective point of measurement. © 2011 Institute of Physics and Engineering in Medicine.

De Wilde R.L.,Pius Hospital | Brosens I.,Catholic University of Leuven
Human Reproduction | Year: 2012

The transvaginal access for exploration of tubo-ovarian function in women with unexplained infertility has been revived since transvaginal hydrolaparoscopy (THL) was introduced in 1998. One prospective double-blind trial and several reviews have validated the diagnostic value of THL in comparison with laparoscopy for the exploration of women with unexplained infertility. A review of the recent literature confirms the efficacy and safety of the technique for first-line endoscopy-based exploration of fertility. The standard policy of 1-year delay for laparoscopic investigation in unexplained infertility is challenged. In older women and particularly in women experienced in fertility awareness methods, THL and minihysteroscopy can be performed after a waiting period of 6-12 months. © The Author 2012.

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