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Hockel K.,University of Tübingen | Merkle M.,Sankt Gertrauden Hospital | Roser F.,University of Tübingen
European Spine Journal | Year: 2014

Purpose: Lateral mass (LM) fixation has become a standard in cervical spine instability treatment; however, maximal biomechanical stability combined with low morbidity remains a challenge. We evaluated our own patient cohort for bicortical screw placement and complication rates and investigated optimal screw trajectories with preoperative multiplanar computed tomography (CT) scans. Methods: Fifty-five patients were retrospectively evaluated after LM fixation at various subaxial cervical spine levels with a modified Magerl technique. Postoperative CTs and clinical records were used to determine LM anatomy, screw lengths, bicortical screw percentages, and complication rates. Additionally, 3D CT subaxial cervical spine data sets from 45 additional subjects with clinical indications for cervical spine imaging were evaluated. Subject LM geometries (thickness) were evaluated at different sagittal angulations (strict sagittal, 20°, 30° and the optimal angulation) for the optimal screw trajectories at the C3-C7 segments. Results: In total, 284 LM screws were placed, with a mean screw length of 16 mm and an 88 % bicortical bone purchase. Additionally, a 3.8 % malplacement rate was observed. LM thickness varied substantially between each subaxial cervical level and at each of the investigated angulations. The optimal angulation, at which LM thickness was maximal, increased continuously from C3 (14°) to C7 (38°). This increase permitted 8 % (C3) to 39 % (C7) gains in screw length compared with the strict sagittal plane assessments. Conclusions: The optimal LM trajectory varied for each subaxial segment. The knowledge of LM geometry allows for safe, long and even bicortical screw placements using preoperative sagittal CT imaging evaluations. © 2014 Springer-Verlag.


Pfeifer Y.,Robert Koch Institute | Schlatterer K.,University of Greifswald | Engelmann E.,Sankt Gertrauden Hospital | Schiller R.A.,Institute of Microbiology and Hygiene | And 4 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2012

Nine carbapenem-resistant Enterobacteriaceae isolates collected from eight patients in five German hospitals were investigated. Six isolates produced the OXA-48 carbapenemase, and three isolates produced OXA-162, which is a point mutant form of OXA-48. Both carbapenemase genes were located on IncL/M-type conjugative plasmids. Insertion sequence IS1999 (truncated or not by IS1R) was located upstream of the bla OXA-48 and bla OXA-162 genes in all of the isolates. Pulsed-field gel electrophoresis typing indicated the clonal transmission of an OXA-48-producing Klebsiella pneumoniae strain in two hospitals. Copyright © 2012, American Society for Microbiology. All Rights Reserved.


Grauvogel J.,Albert Ludwigs University of Freiburg | Grauvogel T.D.,Albert Ludwigs University of Freiburg | Kaminsky J.,Sankt Gertrauden Hospital
Journal of Neurosurgical Sciences | Year: 2014

Aim. Rotating burs (RB), routinely used in skull base and cerebellopontine angle (CPA) surgery for craniotomy and opening of the internal auditory canal (IAC) carry some risks for neurovascular tissue due to their rotating power. This paper describes the use of piezosurgery (PS), which selectively cuts bone with preservation of soft tissue, in lateral suboccipital craniectomy and opening of the IAC in the rat. Methods. A lateral suboccipital craniectomy and opening of the bony IAC were performed with the Mectron® piezosurgical device under microsurgical conditions in the anesthezised rat. The piezosurgical device was evaluated with respect to practicability, safety, preciseness of craniectomy and IAC opening, and preservation of adjacent neurovascular tissue. The operation procedure is described in detail. Results. The present work shows that PS allows easy, safe and precise bone cutting with no injury to neurovascular tissue, such as dura, transverse or sigmoid sinus, brain, and cranial nerves. No complications were noted during the procedure. Due to the absence of rotating power near neurovascular structures the drilling process was easy and comfortable for the surgeon. Conclusion. PS proved to be a safe, precise and easy to handle tool to perform suboccipital craniectomy and opening of IAC in the rat. Since PS makes the drilling process safer and more comfortable compared to a rotating bur it may be used instead of rotating burs in all scientific applications in animal models where a safe removal of bone near delicate nervous or soft tissue structures is essential.


Grauvogel J.,Albert Ludwigs University of Freiburg | Scheiwe C.,Albert Ludwigs University of Freiburg | Kaminsky J.,Sankt Gertrauden Hospital
Spine Journal | Year: 2014

Background context: The relatively new technique of Piezosurgery is based on microvibrations, generated by the piezoelectrical effect, which results in selective bone cutting with preservation of adjacent soft tissue. Purpose: To study the applicability of Piezosurgery in anterior cervical discectomy with fusion (ACDF) surgery. Study design/setting: Prospective clinical study at the neurosurgical department of the University of Freiburg, Germany. Patient sample: Nine patients with cervical disc herniation and retrovertebral osteophytes who underwent ACDF surgery. Outcome measures: Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, and preservation of adjacent neurovascular tissue. Pre- and postoperative clinical and radiological data were assessed. Methods: Piezosurgery was supportively used in ACDF in nine patients with either radiculopathy or myelopathy from disc herniation or ventral osteophytes. After discectomy, osteophytes were removed with Piezosurgery to decompress the spinal canal and the foramina. Angled inserts were used, allowing for cutting even retrovertebral osteophytes. Results: In all nine cases, Piezosurgery cut bone selectively with no damage to nerve roots, dura, or posterior longitudinal ligament. None of the patients experienced any new neurological deficit after the operation. The handling of the instrument was safe and the cut precise. Osteophytic spurs, even retrovertebral ones that generally only can be approached via corpectomies, could be safely removed because of the angled inserts through the disc space. Currently, a slightly prolonged operation time was observed for Piezosurgery. Furthermore, the design of the handpiece could be further improved to facilitate the intraoperative handling in ACDF. Conclusions: Piezosurgery proved to be a useful and safe technique for selective bone cutting and removal of osteophytes with preservation of neuronal and soft tissue in ACDF. In particular, the angled inserts were effective in cutting bone spurs behind the adjacent vertebra which cannot be reached with conventional rotating burs. © 2014 Elsevier Inc. All rights reserved.


Grauvogel J.,Albert Ludwigs University of Freiburg | Scheiwe C.,Albert Ludwigs University of Freiburg | Kaminsky J.,Sankt Gertrauden Hospital
Acta Neurochirurgica | Year: 2011

Background: Piezosurgery is based on microvibrations generated by the piezoelectrical effect and has a selective bone-cutting ability with preservation of soft tissue. This study examined the applicability of Piezosurgery compared to rotating drills (RD) for internal auditory canal (IAC) opening in acoustic neuroma (AN) surgery. Materials and methods: Piezosurgery was used in eight patients for IAC drilling in AN surgery. After exposition of the IAC and tumor, the posterior wall of the IAC was drilled using Piezosurgery instead of RD. Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, preservation of cranial nerves, influences on neurophysiological monitoring, and facial nerve and hearing outcome. Results: Piezosurgery was successfully used for selective bone cutting, while cranial nerves were structurally and functionally preserved, which could be measured by means of neuromonitoring. Piezosurgery guaranteed a safe and precise cut by removing bone layer by layer in a shaping way. Compared to RD, limited influence on neurophysiological monitoring attributable to Piezosurgery was noted, allowing for continuous neuromonitoring. No disadvantage due to microvibrations was noticed concerning hearing function. The angled tip showed better handling in right-sided than in left-sided tumors in the hands of a right-handed surgeon. The short, thick handpiece may be improved for more convenient handling. Conclusion: Piezosurgery is a safe tool for selective bone cutting for opening of the IAC with preservation of facial nerve and hearing function in AN surgery. Piezosurgery has the potential to replace RD for this indication because of its safe and precise bone-cutting properties. © 2011 Springer-Verlag.


PubMed | Sankt Gertrauden Hospital and Albert Ludwigs University of Freiburg
Type: Journal Article | Journal: The spine journal : official journal of the North American Spine Society | Year: 2014

The relatively new technique of Piezosurgery is based on microvibrations, generated by the piezoelectrical effect, which results in selective bone cutting with preservation of adjacent soft tissue.To study the applicability of Piezosurgery in anterior cervical discectomy with fusion (ACDF) surgery.Prospective clinical study at the neurosurgical department of the University of Freiburg, Germany.Nine patients with cervical disc herniation and retrovertebral osteophytes who underwent ACDF surgery.Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, and preservation of adjacent neurovascular tissue. Pre- and postoperative clinical and radiological data were assessed.Piezosurgery was supportively used in ACDF in nine patients with either radiculopathy or myelopathy from disc herniation or ventral osteophytes. After discectomy, osteophytes were removed with Piezosurgery to decompress the spinal canal and the foramina. Angled inserts were used, allowing for cutting even retrovertebral osteophytes.In all nine cases, Piezosurgery cut bone selectively with no damage to nerve roots, dura, or posterior longitudinal ligament. None of the patients experienced any new neurological deficit after the operation. The handling of the instrument was safe and the cut precise. Osteophytic spurs, even retrovertebral ones that generally only can be approached via corpectomies, could be safely removed because of the angled inserts through the disc space. Currently, a slightly prolonged operation time was observed for Piezosurgery. Furthermore, the design of the handpiece could be further improved to facilitate the intraoperative handling in ACDF.Piezosurgery proved to be a useful and safe technique for selective bone cutting and removal of osteophytes with preservation of neuronal and soft tissue in ACDF. In particular, the angled inserts were effective in cutting bone spurs behind the adjacent vertebra which cannot be reached with conventional rotating burs.


Landt S.,Heinrich Heine University Düsseldorf | Wehling M.,Breast Center | Heidecke H.,CellTrend GmbH | Jeschke S.,University Hospital Berlin | And 6 more authors.
Anticancer Research | Year: 2011

Background/Aim: Angiogenesis is pivotal in tumour development and progress, and targeted tumour therapies, such as bevacizumab, have shown promising results. However, in unselected patient populations, the treatment with angiogenesis-targeted combination regimens is marred by a variable response, non-negligible toxicity and questionable economy. The present study summarizes research to identify individual circulating angiogenic factors as markers for disease severity and possibly treatment response. Patients and Methods: A total of 125 patients with cervical cancer from the ongoing cervical cancer monitoring database of the University Hospital Charité, Berlin, Germany, were included. Information obtained from the database included tumour stage, malignancy grade, presence of nodal metastases, lymph vessel invasion, patient age, HER2, HPV, smoking and menopausal status, and serum concentrations of vascular endothelial growth factor (VEGF), VEGF-D, VEGF-C, endoglin, endostatin, angiogenin, basic fibroblast growth factor (FGFb), vascular endothelial growth factor receptor (VEGF-R1), VEGF-R2, soluble inter-cellular adhesion molecule 1 (sICAM 1), soluble vascular adhesion molecule 1 (sVCAM 1), insulin-like growth factor 1 (IFG-1) and insulin like growth factor binding protein 3 (IGF-BP3). Results: There was a clear association of angiogenic factor concentrations with stage of disease. Angiogenin showed an independent discrimination for cervical intraepithelial neoplasia (CIN) and invasive stages, and endoglin did so for invasive stages vs. recurrent disease. However, none of the potential markers under investigation was anywhere near selective enough to allow for a clinically meaningful prediction of prognosis or response. Conclusion: The association of circulating angiogenic factors with disease progression in cervical cancer is confirmed, but its utility for prognosis prediction and patient stratification for targeted therapies is doubtful.


Eiermann W.,The Interdisciplinary Center | Rezai M.,Luisen Hospital | Kummel S.,Senology Breast Care Center | Kuhn T.,Esslingen Hospital | And 12 more authors.
Annals of Oncology | Year: 2013

Background: We carried out a prospective clinical study to evaluate the impact of the Recurrence Score (RS) on treatment decisions in early breast cancer (EBC). Patients and methods: A total of 379 eligible women with estrogen receptor positive (ER+), HER2-negative EBC and 0-3 positive lymph nodes were enrolled. Treatment recommendations, patients' decisional conflict, physicians' confidence before and after knowledge of the RS and actual treatment data were recorded. Results: Of the 366 assessable patients 244 were node negative (N0) and 122 node positive (N+). Treatment recommendations changed in 33% of all patients (N0 30%, N+ 39%). In 38% of all patients (N0 39%, N+ 37%) with an initial recommendation for chemoendocrine therapy, the post-RS recommendation changed to endocrine therapy, in 25% (N0 22%, N+ 39%) with an initial recommendation for endocrine therapy only to combined chemoendocrine therapy, respectively. A patients' decisional conflict score improved by 6% (P = 0.028) and physicians' confidence increased in 45% (P < 0.001) of all cases. Overall, 33% (N0 29%, N+ 38%) of fewer patients actually received chemotherapy as compared with patients recommended chemotherapy pre-test. Using the test was cost-saving versus current clinical practice. Conclusion: RS-guided chemotherapy decision-making resulted in a substantial modification of adjuvant chemotherapy usage in node-negative and node-positive ER+ EBC.


Gerber B.,University of Rostock | Loibl S.,German Breast Group | Eidtmann H.,University of Kiel | Rezai M.,Luisen Hospital | And 16 more authors.
Annals of Oncology | Year: 2013

Background: We evaluated the pathological complete response (pCR) rate after neoadjuvant epirubicin, (E) cyclophosphamide (C) and docetaxel containing chemotherapy with and without the addition of bevacizumab in patients with triple-negative breast cancer (TNBC). Patients and methods: Patients with untreated cT1c-4d TNBC represented a stratified subset of the 1948 participants of the HER2-negative part of the GeparQuinto trial. Patients were randomized to receive four cycles EC (90/600 mg/m2; q3w) followed by four cycles docetaxel (100 mg/m2; q3w) each with or without bevacizumab (15 mg/kg; q3w) added to chemotherapy. Results: TNBC patients were randomized to chemotherapy without (n = 340) or with bevacizumab (n = 323). pCR (ypT0 ypN0, primary end point) rates were 27.9% without and 39.3% with bevacizumab (P = 0.003). According to other pCR definitions, the addition of bevacizumab increased the pCR rate from 30.9% to 41.8% (ypT0 ypN0/+; P = 0.004), 36.2% to 46.4% (ypT0/is ypN0/+; P = 0.009) and 32.9% to 43.3% (ypT0/is ypN0; P = 0.007). Bevacizumab treatment [OR 1.73, 95% confidence interval (CI) 1.23-2.42; P = 0.002], lower tumor stage (OR 2.38, 95% CI 1.24-4.54; P = 0.009) and grade 3 tumors (OR 1.68, 95% CI 1.14-2.48; P = 0.009) were confirmed as independent predictors of higher pCR in multivariate logistic regression analysis. Conclusions: The addition of bevacizumab to chemotherapy in TNBC significantly increases pCR rates. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


PubMed | Sankt Gertrauden Hospital and Charité - Medical University of Berlin
Type: Journal Article | Journal: Archives of gynecology and obstetrics | Year: 2016

A positive margin status after breast conserving surgery (BCS) is one of the strongest predictors for local recurrence of intraductal (DCIS) and invasive carcinoma. As much as 20-50% of patients with BCS need to undergo a second operation to receive free margins. In this study we tested the clinical performance of MarginProbe (Dune Medical Devices, Paoli, PA, USA), a device for the intraoperative evaluation of surgical margins.A prospective clinical study was performed: The device was utilized in BCS of 150 patients treated at a single facility from November 2012 to June 2013. The re-excision rate was compared to the re-excision rate of a historical group of 172 patients treated with BCS at the same hospital without the application of the device. We analyzed whether the results of MarginProbe are affected by the morphology, grading, size of the tumor, breast density, age, BMI or the use of marker-wires.The application of MarginProbe resulted in an overall decreased re-excision rate of 14.6%. In the subgroup of DCIS the re-excision rate was reduced from 61.7 to 23.1%. In the subgroup of invasive lobular carcinomas the re-excision rate decreased from 37.0 to 19.0%. MarginProbe results were not affected by grading, tumor size, breast density, age, BMI or marker-wire application.MarginProbe detects positive margins in invasive carcinoma, DCIS as well as in invasive lobular carcinoma. The device decreases the re-excision rate after BCS significantly. It does not interfere with any of the factors we examined.

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