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Berlin, Germany

Infection, i.e. meningitis or ventriculitis, is a major complication of external ventricular drainage (EVD). In order to prevent this complication rifampin-impregnated and clindamycin-impregnated silicone catheters and EVDs impregnated with nanoparticles of silver and an insoluble silver salt have been developed. Sparse data are published concerning the efficacy of these catheters in reducing bacterial colonization. Between July 2003 and June 2006, 95 patients (age range 12-84 years, mean 53.6 years) underwent implantation of an EVD catheter for CSF diversion for several indications. All surgeries were performed in a standardized way at a single medical center. We used standard polyurethane catheters in 32 patients, Codman Bactiseal silicone catheters in 31 patients, and Spiegelberg Silverline catheters in 32 patients. Samples of the cerebrospinal fluid (CSF) were taken at the time of implantation, every 10 days and at the time of removal. The samples were microbiologically analyzed. In 32 standard catheters we saw infections in 5 patients (15.6%). By contrast, 2 of the 31 patients with a Bactiseal catheter (6.5%) and 3 with a Silverline catheter (9.4%) developed an infection. Rifampin-impregnated and clindamycin-impregnated EVDs as well as silver-impregnated EVDs decreased the infection rate. Randomized studies are needed to assess the advantage of these catheters compared with standard polyurethane catheters. Source

Lemcke J.,Unfallkrankenhaus Berlin
Acta neurochirurgica. Supplement | Year: 2012

The diagnosis and management of idiopathic normal-pressure hydrocephalus (iNPH) remains controversial, particularly in selecting patients for shunt insertion. Diagnostic criteria target the pathological features of the dynamics of the cerebrospinal fluid (CSF); however, the effectiveness in predicting the shunt success has room for improvement. The aim of our study was to systematically assess the influence of the co-morbidity determining the benefit from shunt surgery. Between 1997 and 2006 134 patients suffering from iNPH were treated with a ventriculo-peritoneal shunt with a gravity-controlled valve. The coincident disease processes were recorded. Shunt outcome was assessed at 2 years postsurgery in 116 patients (follow up rate 87%). The results of this follow-up examination (Kiefer score, NPH recovery rate) were compared using the preoperative co-morbidity index (CMI). Of the 134 patients 76 (56.7%) had a CMI of 0-3 and 58 patients (43.3%) had a CMI of 4-8. Two years after surgery 65 out of 70 shunt responders (93%) could be identified in the patients group with a CMI of 0-3 and only 29 of 46 (63%) in group with a CMI of 4-8. This difference was significant (p < 0.0001). Remarkably few patients scoring between 6 and 8 on the CMI scale experienced a favourable outcome. The patients in this latter group showed excellent outcomes in only 1% and poor outcomes in 33%. Data in this report affirm that co-morbidity is a statistically significant predictor of the quality of the clinical outcome for patients with iNPH undergoing shunt therapy. A CMI of more than 3 significantly decreases the chance of a favourable outcome and this should form part of the assessment when the risks and benefits of surgery are considered. According to these data, a successful outcome in patients with a CMI of 6 or more is not to be expected. Source

Ottomann C.,Unfallkrankenhaus Berlin | Stojadinovic A.,Combat Wound Initiative Program | Stojadinovic A.,Uniformed Services University of the Health Sciences | Lavin P.T.,Boston Biostatistics Research Foundation | And 5 more authors.
Annals of Surgery | Year: 2012

BACKGROUND: As extracorporeal shock wave therapy (ESWT) can enhance healing of skin graft donor sites, this study focused on shock wave effects in burn wounds. METHODS: A predefined cohort of 50 patients (6 with incomplete data or lost to follow-up) with acute second-degree burns from a larger study of 100 patients were randomly assigned between December 2006 and December 2007 to receive standard therapy (burn wound debridement/topical antiseptic therapy) with (n = 22) or without (n = 22) defocused ESWT (100 impulses/cm at 0.1 mJ/mm) applied once to the study burn, after debridement. Randomization sequence was computer-generated, and patients were blinded to treatment allocation. The primary endpoint, time to complete burn wound epithelialization, was determined by independent, blinded-observer. A worst case scenario was applied to the missing cases to rule out the impact of withdrawal bias. RESULTS: Patient characteristics across the 2 study groups were balanced (P > 0.05) except for older age (53 ± 17 vs. 38 ± 13 years, P = 0.002) in the ESWT group. Mean time to complete (≥95%) epithelialization (CE) for patients that did and did not undergo ESWT was 9.6 ± 1.7 and 12.5 ± 2.2 days, respectively (P < 0.0005). When age (continuous variable) and treatment group (binary) were examined in a linear regression model to control the baseline age imbalance, time to CE, age was not significant (P = 0.33) and treatment group retained significance (P < 0.0005). Statistical significance (P = 0.001) was retained when ESWT cases with missing follow-up were assigned the longest time to CE and when controls with missing follow-up were assigned the shortest time to CE. CONCLUSIONS: In this randomized phase II study, application of a single defocused shock wave treatment to the superficial second-degree burn wound after debridement/topical antiseptic therapy significantly accelerated epithelialization. Copyright © 2011 by Lippincott Williams & Wilkins. Source

Thiele H.,University of Leipzig | Thiele H.,University of Lubeck | De Waha S.,University of Leipzig | De Waha S.,Heart Center Bad Segeberg | And 12 more authors.
Journal of the American College of Cardiology | Year: 2014

BACKGROUND Aspiration thrombectomy in ST-segment elevation myocardial infarction is recommended by current guidelines based on several randomized trials. There are no trials assessing thrombectomy in non-ST-segment elevation myocardial infarction (NSTEMI) patients. OBJECTIVES The TATORT-NSTEMI (Thrombus Aspiration in Thrombus Containing Culprit Lesions in Non-ST-Elevation Myocardial Infarction) trial sought to assess the effect of aspiration thrombectomy on microvascular injury in patients with NSTEMI compared with standard percutaneous coronary intervention (PCI). METHODS This prospective, controlled, multicenter study randomized 440 patients to adjunctive thrombectomy (n = 221) compared with conventional PCI (n = 219) in NSTEMI patients with thrombus-containing lesions. The primary endpoint of the extent of microvascular obstruction (MO) in the percentage of left ventricular mass (%LV) was assessed by cardiac magnetic resonance imaging within 4 days. Secondary endpoints included infarct size, myocardial salvage index, and angiographic parameters including myocardial blush grade and Thrombolysis In Myocardial Infarction flow grade. The combined clinical endpoint consisted of death, reinfarction, target vessel revascularization, and new congestive heart failure within 6 months. RESULTS The primary endpoint of MO was not different between the thrombectomy and the standard PCI group with 2.0%LV (interquartile range [IQR]: 0.8 to 4.1) versus 1.4%LV (IQR: 0.7 to 2.6) (p = 0.17). Similarly, no significant differences were observed for infarct size (8.6%LV; IQR: 4.0 to 14.7 vs. 7.4%LV; IQR: 4.1 to 13.1; p = 0.46), myocardial salvage index (63.3; IQR: 35.4 to 87.2 vs. 65.6; IQR: 46.9 to 82.6; p = 0.45), or angiographic parameters such as blush grade (p = 0.63) and Thrombolysis In Myocardial Infarction flow grade (p = 0.66). Clinical follow-up at 6 months revealed no differences in the combined clinical endpoints (p = 0.22). CONCLUSIONS Aspiration thrombectomy in conjunction with PCI in NSTEMI with a thrombus-containing lesion does not lead to a reduction in MO. (Thrombus Aspiration in Thrombus Containing Culprit Lesions in Non-ST-Elevation Myocardial Infarction [TATORT-NSTEMI]; NCT01612312) (J Am Coll Cardiol 2014;64:1117-24) © 2014 by the American College of Cardiology Foundation. Source

Lemcke J.,Unfallkrankenhaus Berlin | Meier U.,Unfallkrankenhaus Berlin
Zentralblatt fur Neurochirurgie | Year: 2010

Introduction: Low pressure valves with ventriculoperitoneal shunts have been proven to lead to good outcomes in the treatment of idiopathic normal pressure hydrocepahlus. However, overdrainage complications are often seen with low opening pressures. Efforts have been made to obtain good outcomes without overdrainage complications by decreasing the hydrostatic pressure component using special valve constructions. The aim of this study was to ascertain whether it is possible to optimise outcome with the implantation of both an adjustable valve and a gravitational unit. Materials and Methods: Between July 2003 and July 2006, 42 patients underwent ventriculoperitoneal shunt surgery with a Codman Hakim programmable valve (Codman, Johnson & Johnson, Raynham, USA) and a Miethke ShuntAssistant (Miethke Gmbh, Potsdam, Germany). These patients were followed up for a period between 2 years (35 patients) and 4 years (18 patients) after surgery. Results: The systematic re-programming of the valves from 100mmH 2O to 70mmH 2O and then to 50mmH 2O after 3 months allowed the brain to adapt to the implanted valve without the complication of overdrainage. The responder rates were 86% after two years and 83% after four years. Overdrainage was seen in 3% of the cases, mechanical complications occurred in 6%. Conclusion: Our results indicate that the combination of a Codman Hakim programmable valve with a Miethke ShuntAssistant could improve outcomes in shunted iNPH. This finding has yet to be proven in a larger, prospective randomized trial. © Georg Thieme Verlag Stuttgart - New York. Source

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