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Berlin, Germany

Beyer K.,Charite - Medical University of Berlin | Grabenhenrich L.,Charite - Medical University of Berlin | Hartl M.,Charite - Medical University of Berlin | Beder A.,Charite - Medical University of Berlin | And 14 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2015

Background Oral challenges are the gold standard in food allergy diagnostic, but time-consuming. Aim of the study was to investigate the role of peanut- and hazelnut-component-specific IgE in the diagnostics of peanut and hazelnut allergy and to identify cutoff levels to make some challenges superfluous. Methods In a prospective and multicenter study, children with suspected peanut or hazelnut allergy underwent oral challenges. Specific IgE to peanut, hazelnut, and their components (Ara h 1, Ara h 2, Ara h 3, and Ara h 8, Cor a 1, Cor a 8, Cor a 9, and Cor a 14) were determined by ImmunoCAP-FEIA. Results A total of 210 children were challenged orally with peanut and 143 with hazelnut. 43% of the patients had a positive peanut and 31% a positive hazelnut challenge. With an area under the curve of 0.92 and 0.89, respectively, Ara h 2 and Cor a 14-specific IgE discriminated between allergic and tolerant children better than peanut- or hazelnut-specific IgE. For the first time, probability curves for peanut and hazelnut components have been calculated. A 90% probability for a positive peanut or hazelnut challenge was estimated for Ara h 2-specific IgE at 14.4 kU/l and for Cor a 14-specific IgE at 47.8 kU/l. A 95% probability could only be estimated for Ara h 2 at 42.2 kU/l. Conclusions Ara h 2- and Cor a 14-specific IgE are useful to estimate the probability for a positive challenge outcome in the diagnostic work-up of peanut or hazelnut allergy making some food challenges superfluous. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source

Papanikolaou I.S.,National and Kapodistrian University of Athens | Rosch T.,Universitatskrankenhaus Hamburg Eppendorf | Schulz H.-J.,Sana Klinikum Lichtenberg
Endoskopie heute | Year: 2012

he report on the 19th United European Gastroenterology Week (UEGW: 22.-26. October 2011, Stockholm, Sweden) presents an update of gastrointestinal endoscopy, focussing on oral presentations and selected poster presentations and aims to review them in the light of recent literature, in particular endoscopy resection and other endotherapy techniques, new endoscopy imaging methods, Barrett's esophagus, gastrointestinal bleeding, enteroscopy, colonoscopy, ERCP, EUS, NOTES, PEG. © Georg Thieme Verlag. Source

Schulz H.-J.,Sana Klinikum Lichtenberg
Viszeralmedizin: Gastrointestinal Medicine and Surgery | Year: 2010

In most people with cholangiocarcinoma, the tumor, when first diagnosed, is non-resectable. Endoscopic or percutaneous stent insertion offers a valid palliation in these cases. In malignant bile obstruction either plastic or metal stents can be used. Plastic stents are often preferred in patients with poor prognosis. Metal stents remain functional for a longer time than plastic stents and require significantly fewer interventions and stent exchanges. Advances in stent design have led to a substantial increase in the use of self-expanding metal stents. Covered stents have been introduced to minimize tumor ingrowth. The higher rates of spontaneous migration accompanying the use of covered stents could be minimized by leaving the stent ends uncovered. Drugeluting and biodegradable stents are also likely to become available in the near future. Although stents appear to be the preferred form of palliation, many patients will benefit from a multidisciplinary approach that includes surgeons and oncologists. © 2010 S. Karger GmbH, Freiburg. Source

Diener M.K.,University of Heidelberg | Knebel P.,University of Heidelberg | Kieser M.,University of Heidelberg | Schuler P.,University of Gottingen | And 30 more authors.
The Lancet | Year: 2014

Background Postoperative surgical site infections are one of the most frequent complications after open abdominal surgery, and triclosan-coated sutures were developed to reduce their occurrence. The aim of the PROUD trial was to obtain reliable data for the effectiveness of triclosan-coated PDS Plus sutures for abdominal wall closure, compared with non-coated PDS II sutures, in the prevention of surgical site infections. Methods This multicentre, randomised controlled group-sequential superiority trial was done in 24 German hospitals. Adult patients (aged ≥18 years) who underwent elective midline abdominal laparotomy for any reason were eligible for inclusion. Exclusion criteria were impaired mental state, language problems, and participation in another intervention trial that interfered with the intervention or outcome of this trial. A central web-based randomisation tool was used to randomly assign eligible participants by permuted block randomisation with a 1:1 allocation ratio and block size 4 before mass closure to either triclosan-coated sutures (PDS Plus) or uncoated sutures (PDS II) for abdominal fascia closure. The primary endpoint was the occurrence of superficial or deep surgical site infection according to the Centers for Disease Control and Prevention criteria within 30 days after the operation. Patients, surgeons, and the outcome assessors were masked to group assignment. Interim and final analyses were by modified intention to treat. This trial is registered with the German Clinical Trials Register, number DRKS00000390. Findings Between April 7, 2010, and Oct 19, 2012, 1224 patients were randomly assigned to intervention groups (607 to PDS Plus, and 617 to PDS II), of whom 1185 (587 PDS Plus and 598 PDS II) were analysed by intention to treat. The study groups were well balanced in terms of patient and procedure characteristics. The occurrence of surgical site infections did not differ between the PDS Plus group (87 [14·8%] of 587) and the PDS II group (96 [16·1%] of 598; OR 0·91, 95% CI 0·66-1·25; p=0·64). Serious adverse events also did not differ between the groups-146 of 583 (25·0%) patients treated with PDS Plus had at least one serious adverse event, compared with 138 of 602 (22·9%) patients treated with PDS II; p=0·39). Interpretation Triclosan-coated PDS Plus did not reduce the occurrence of surgical site infection after elective midline laparotomy. Innovative, multifactorial strategies need to be developed and assessed in future trials to reduce surgical site infections. Source

Hartmann D.,Sana Klinikum Lichtenberg | Philipper M.,Evangelisches Krankenhaus | Gralnek I.M.,Technion - Israel Institute of Technology | Jakobs R.,Klinikum der Stadt Ludwigshafen | And 2 more authors.
Endoscopy | Year: 2012

Background and study aims: Colon capsule endoscopy (CCE) offers an alternative approach for endoscopic visualization of the colon. Some of the current CCE bowel cleansing regimens use sodium phosphate, which has raised safety concerns. Therefore, the aim of the current study was to test the feasibility and efficacy of a new low-volume, sodium phosphate-free polyethylene glycol (PEG) bowel preparation. Methods: The first 26 patients (original cleansing procedure) received a colon cleansing regimen of PEG plus ascorbic acid: patients drank 1 L in the evening and 0.75 L in the morning before capsule ingestion. Patients also drank an additional 0.5 L PEG boost and an optional 0.25 L PEG boost during the capsule procedure. Following an interim analysis, the cleansing procedure of the subsequent 24 patients was modified, with the morning intake before capsule ingestion being increased to 1 L, as well as the second boost (0.25 L) being administered 1 - 2 hours earlier (modified cleansing procedure). Results: The overall colon cleanliness was considered to be good or excellent in 83 % (original cleansing procedure) and 82 % (modified cleansing procedure) of patients, without any significant difference between regimens (P > 0.05). In 37 /49 (76 %) of the CCE procedures, the hemorrhoidal plexus was identified and thus the examination was considered complete, with no significant differences between the two CCE cleansing procedures. The capsule sensitivity and specificity for detecting colonic polyps 6 mm were 91 % (95 %CI 70 % - 98 %) and 94 % (95 %CI 87 % - 97 %), respectively, compared with standard optical colonoscopy. Conclusion: A colon cleansing procedure using PEG + ascorbic acid for capsule colonoscopy yielded an adequate cleansing level in > 80 % of patients, a completion rate of 76 %, and good accuracy for detecting polyps. This procedure may be considered as an alternative, particularly for patients in whom sodium phosphate-based preparations are contraindicated. © Georg Thieme Verlag KG Stuttgart. New York. Source

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