Bad Münster am Stein-Ebernburg, Germany
Bad Münster am Stein-Ebernburg, Germany

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Donas K.P.,University of Munster | Torsello G.,University of Munster | Bisdas T.,University of Munster | Austermann M.,University of Munster | And 3 more authors.
Journal of Endovascular Therapy | Year: 2014

Purpose: To report a novel indication for the use of chimney grafts to preserve flow to the inferior mesenteric artery (IMA) in patients undergoing endovascular aneurysm repair (EVAR) for aortobi-iliac aneurysms with coexistent bilateral occlusion of the internal iliac arteries (IIA). Technique: Via a cutdown over the left axillary artery, a 5-F vertebral catheter was delivered over a conventional 0.035-inch hydrophilic guidewire to selectively catheterize the IMA via a 7-F shuttle sheath, which was then advanced at least 2 cm into the target vessel. The first chimney graft was advanced into the sheath, and a standard EVAR procedure followed. The chimney graft was deployed at least 2 cm in the IMA; a second chimney graft was advanced and deployed with at least 2 cm overlapping with the first chimney stent parallel and outside of the main abdominal endograft and below the lowest renal artery. The chimney grafts were lined with additional bare nitinol stents. The technique is demonstrated in two male patients who suffered from symptomatic aortobi-iliac aneurysm with patent IMAs and bilateral IIA occlusion. The procedure was completed successfully in both cases without bowel ischemia. At 12 and 6 months, respectively, the chimney grafts remained patent without endoleak. The patients are asymptomatic. Conclusion: The IMA chimney endovascular technique can be considered in EVAR cases with coexistent bilateral IIA occlusion to minimize the risk for bowel ischemia. © 2014 International Society of Endovascular Specialists.


Siebert S.,St Franziskus Hospital Munster | Elkeles B.,Klinik fur Geriatrische Rehabilitation Maria Frieden Telgte | Hempel G.,Institute For Pharmazeutische Und Medizinische Chemie | Kruse J.,Institute For Pharmazeutische Und Medizinische Chemie | Smollich M.,St Franziskus Hospital Munster
Zeitschrift fur Gerontologie und Geriatrie | Year: 2013

Background: Certain drugs are classified as potentially inappropriate medications (PIM) for the elderly. In 2010, the PRISCUS list was published, specifically designed for its applicability in the German pharmaceutical market. The aim of this study was to evaluate the PRISCUS list compared to international PIM lists. Methods: Based on selected PIM lists (PRISCUS, STOPP/START, Beers), the medications of 308 patients at a clinic of geriatric rehabilitation were screened for PIMs. Applying START criteria, omission of indicated drug therapies was detected. Results: Regarding the rate of PIM detection, the PRISCUS list was less sensitive than the application of STOPP criteria. While hospitalized, the mean number of administered PIMs per patient was 1. 2 based on STOPP criteria and 0. 5 based on the PRISCUS list. The lowest number of PIMs per patient was detected by applying the Beers list (0. 4 PIMs). Conclusion: The Beers list should not be used in the German pharmaceutical market. The amendment of diagnosis-related STOPP criteria to the PRISCUS list would be useful to significantly advance therapeutic success and drug safety in the elderly. © 2012 Springer-Verlag.


Hoffmann B.,University of Duisburg - Essen | Gross C.R.,St Franziskus Hospital Munster | Jockel K.-H.,University of Duisburg - Essen | Kroger K.,University of Duisburg - Essen
Thrombosis Research | Year: 2010

Background: Evidence from several clinical and epidemiological studies suggests a decreasing incidence and mortality of pulmonary embolism (PE), but results are still controversial. We analysed time trends of fatal pulmonary embolism in several countries across Europe and North America. Methods: We extracted age-, sex-, and country-specific number of deaths due to PE (415.1 ICD-9; I26 ICD-10) from 1980 to 2004 as available from the WHO mortality database, which comprises mortality data and population density in 5-year age groups based on national vital statistics. Yearly age- and sex-standardised mortality rates and their 95% confidence intervals for PE were calculated. We compared overall and sex-specific age-standardised mortality rates across different European countries and the USA over time. Results: Age- and sex-standardised PE-specific mortality in 1990 varied between 2.7/100,000 (2.5-3.0/100,000) in The Netherlands and 12.8/100,000 (12.0-13.5/100,000) in Austria. While in most countries PE mortality decreased over time, PE mortality increased distinctly in Poland from 4.0/100,000 (3.75-4.27/100,000) to 7.7/100,000 (7.45-8.03/100,000) in 2003. In Germany, we observed a continuous slight increase and in The Netherlands no clear change of PE mortality was seen. Discussion: While comparison of cause of death data over time and across countries should be undertaken with caution due to inaccuracies in assigning the cause of death and national conventions in coding, the general trend of a decline in PE mortality could not be shown in several European countries. © 2009 Elsevier Ltd. All rights reserved.


Erker C.G.,St Franziskus Hospital Munster | Santamaria M.,St Franziskus Hospital Munster | Mollmann M.,St Franziskus Hospital Munster
Anaesthesist | Year: 2012

Life-threatening pediatric emergencies are rare events in which precise, correct and fast drug dosing is essential. Intravenous drugs are most commonly dosed based on the child's weight in mg/kg. Numerous tools exist for aiding the physician in the error prone calculation, none of which meet all criteria for the perfect tool. Besides frequent training of practical skills and awareness of the problem of calculating the exact drug dose, it seems indispensable to have a localized tool at hand for these critical events. © Springer-Verlag Berlin Heidelberg 2012.


Eisenblatter M.,University of Munster | Eisenblatter M.,The Interdisciplinary Center | Holtke C.,University of Munster | Persigehl T.,University of Munster | And 2 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2010

The process of angiogenesis, an essential hallmark for tumour development as well as for several inflammatory diseases and physiological phenomena, is of growing interest for diagnosis and therapy in oncology. In the context of biochemical characterisation of key molecules involved in angiogenesis, several targets for imaging and therapy could be identified in the last decade. Optical imaging (OI) relies on the visualisation of near infrared (NIR) light, either its absorption and scattering in tissue (non-enhanced OI) or using fluorescent contrast agents. OI offers excellent signal to noise ratios due to virtually absent background fluorescence in the NIR range and is thus a versatile tool to image specific molecular target structures in vivo. This work intends to provide a survey of the different approaches to imaging of angiogenesis using OI methods in preclinical research as well as first clinical trials. Different imaging modalities as well as various optical contrast agents are briefly discussed. © 2010 Springer-Verlag.


Bullmann V.,Universitatsklinikum Munster | Liljenqvist U.R.,St Franziskus Hospital Munster | Rodl R.,Universitatsklinikum Munster | Schulte T.L.,Universitatsklinikum Munster
Orthopade | Year: 2010

Severe osteoporosis is a serious problem in the instrumentation during spine surgery. Besides kyphosis, adjacent vertebral fractures and of course pedicle screw loosening and implant pullout are frequent challenges in instrumentation of the osteoporotic spine. In addition to screw diameter and length, bone mineral density has the most important impact on the stability of a pedicle screw. In cases of severe osteoporosis cement augmentation increases the stability of a pedicle screw. Pullout force can be increased with augmentation by 96-278%. Nowadays, there are two different procedures for augmentation: cement augmentation of the vertebra before inserting the screw into the soft, fresh cement or augmentation via a perforated screw that has already been inserted. The main problem in augmentation techniques are cement leakages. In both techniques leakages may occur. The problem of leakages seems to be less severe in the augmentation technique via the perforated screw, because cement application can be stopped immediately if the onset of leakage is noticed. Even surgical revision of cement augmented screws is not a major clinical problem based on recent biomechanical studies. The revision screw can be chosen 1 mm thicker and can be cement augmented again without technical problems. © 2010 Springer-Verlag.


Lommatzsch A.P.,St Franziskus Hospital Munster
Klinische Monatsblatter fur Augenheilkunde | Year: 2016

For decades there was a general consensus about diagnostic investigations and surgical treatment of symptomatic pathological changes in the vitreomacular interface (VMI). The introduction of SD-OCT imaging helped in the understanding of the pathogenetic processes at this interface and risk factors were defined for the macular traction syndrome, epiretinal membrane (ERM) and macular hole. After approval of ocriplasmin for non-surgical treatment, a new classification based on treatment outcome and new imaging techniques was established. Precise separation of physiological, age-related changes in the VMI and pathological changes was then possible. Clinically relevant aspects in the diagnostic testing and treatment of diseases of the VMI are reported in this literature review. © Georg Thieme Verlag KG Stuttgart · New York.


Herten M.,University of Munster | Torsello G.B.,University of Munster | Torsello G.B.,St Franziskus Hospital Munster | Schonefeld E.,University of Munster | And 4 more authors.
Journal of Vascular Surgery | Year: 2015

Objective Although drug-eluting balloons (DEBs) have shown promising results treating de novo (DN) atherosclerotic lesions and appear to have been widely adopted in Europe, their long-term efficacy in the broad spectrum of femoropopliteal restenosis (RE) remains to be proven. The purpose of the study was to assess the efficacy of paclitaxel-DEBs in restenotic (stented and nonstented) vs DN stenotic femoropopliteal arteries. Methods The study prospectively enrolled 100 patients undergoing femoropopliteal endovascular intervention by DEB for RE or DN stenosis. Patients who received additive atherectomy were excluded. The primary end point was the primary patency (PP) rate at 12 months. Secondary end points were sustained clinical improvement and clinically driven target lesion revascularization. Results DEBs were used to treat 105 limbs for intermittent claudication (82 [78%]) or critical limb ischemia (23 [22%]) in 100 patients. Of these, 111 lesions were DN stenosis (46 [41%]) or RE (65 [59%]). The overall PP was 86% at 6 months and 74% at 12 months. PP of DN stenosis was higher at 6 months (93% vs 81%) and was significantly (P =.021) better than RE at 12 months (85% vs 68%). Sustained clinical improvement based on Rutherford classification was significant in both groups (P <.001). Target lesion revascularization was significantly lower in DN stenosis compared with RE at 12 months (15% vs 32%; P =.021). Conclusions DEB angioplasty is an effective therapy for DN femoropopliteal lesions. The results of DEB angioplasty for RE are inferior compared with DN stenosis after 12 months. Nevertheless, results of DEB angioplasty for RE seem comparable with technically more demanding literature-derived strategies. © 2015 Society for Vascular Surgery.


Koch J.M.,St Franziskus Hospital Munster | Heiligenhaus A.,St Franziskus Hospital Munster | Heinz C.,St Franziskus Hospital Munster
Klinische Monatsblatter fur Augenheilkunde | Year: 2011

Objective: An attempt has been made to evaluate transient anterior chamber haemorrhage after canaloplasty. Method: In the period from November 2008 to October 2009 a total of 21 eyes in 17 patients underwent canaloplasty for primary open angle glaucoma in our clinic. At the end of surgery all eyes left the surgical table with an intraocular pressure (IOP) of 5 - 10 mmHg and a deep anterior chamber without any bleeding. Results: The IOP on day 1 after surgery was 9.6 mmHg in average. By that time 15 of 21 eyes showed anterior chamber haemorrhage with a hyphaema between 0.5 - 2 mm in height. Eyes without hyphaema showed an IOP of > 15 mmHg at the same time. In no case was there further haemorrhage, the blood was absorbed in all cases within a maximum of 1 week without further complications. Conclusion: In contrast to trabeculectomy, where the natural anterior chamber water outflow is by-passed via an artificial fistula, canaloplasty attempts to re-establish the physiological anterior chamber water draining system by means of a 360 degree viscocanalostomy and a thread mediated dilation of Schlemm's canal and its collector channels. If the anterior chamber pressure temporarily lowers the level of the venous capillary pressure, it is consistent with a patent piping system when a reverse flow with blood reflux into the anterior chamber can be observed as long as a minimal physiological pressure gradient from the anterior chamber in the direction of channel Schlemm's canal has been restored. Thus, in the authors opinion, anterior chamber haemorrhage shows the desired consistency of the water draining system and should therefore logically be expected after each successful operation in all cases where hypotony in the postoperative period occurs. © Georg Thieme Verlag KG Stuttgart · New York.


In the medical treatment of children drugs are frequently used outside the boundaries of the approved licensing and use under the terms of off-label use is possible. However, this requires critical reasoning and experience with the drug involved. With help of a traffic light colored spreadsheet this article illustrates the limitations, problems and possibilities of pharmacotherapy in pediatric emergencies or pediatric anesthesia. Of the 45 emergency drugs listed in this article most can be used in childhood, at least under specific conditions. Licensing restrictions occur especially in the newborn period and infancy resulting in frequent off-label use. Severe pitfalls, such as the propofol infusion syndrome after long-term sedation with propofol under the age of 16 years, emphasize the need for serious reflection on the substances involved. Decisions regarding pharmaceutical therapy should be based on the current standard of medical knowledge. When official recommendations from pharmaceutical companies are missing, treatment decisions for off-label use can be based on guidelines, study and literature databases or recommendations in medical journals. © 2013 Springer-Verlag Berlin Heidelberg.

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