Cornely O.A.,Uniklinik Cologne |
Mellinghoff S.C.,Uniklinik Cologne
Deutsche Medizinische Wochenschrift | Year: 2017
Fever in cancer patients is a medical emergency until a severe infection has been ruled out. In case of neutropenia prompt diagnostic work-up should be paralleled by empiric antibiotic treatment. Underlying malignancy as well as treatments may impair immune response and thus pave the way for less virulent pathogens. So the spectrum of infections comprises both pathogens that cause disease in immunocompetent patients and a variety of rarer organisms. After collecting two pairs of blood cultures, broad-spectrum antibiotic treatment should commence within one to two hours. Depending on the individual patient's risk antimicrobial prophylaxis should be considered. © Georg Thieme Verlag KG Stuttgart, New York.
Riedl V.,TU Munich |
Bienkowska K.,TU Munich |
Strobel C.,TU Munich |
Tahmasian M.,TU Munich |
And 5 more authors.
Journal of Neuroscience | Year: 2014
Over the last decade, synchronized resting-state fluctuations of blood oxygenation level-dependent (BOLD) signals between remote brain areas [so-called BOLD resting-state functional connectivity (rs-FC)] have gained enormous relevance in systems and clinical neuroscience. However, the neural underpinnings of rs-FC are still incompletely understood. Using simultaneous positron emission tomography/magnetic resonance imaging we here directly investigated the relationship between rs-FC and local neuronal activity in humans. Computational models suggest a mechanistic link between the dynamics of local neuronal activity and the functional coupling among distributed brain regions. Therefore, we hypothesized that the local activity (LA) of a region at rest determines its rs-FC. To test this hypothesis, we simultaneously measured both LA (glucose metabolism) and rs-FC (via synchronized BOLD fluctuations) during conditions of eyes closed or eyes open. During eyes open, LA increased in the visual system, and the salience network (i.e., cingulate and insular cortices) and the pattern of elevated LA coincided almost exactly with the spatial pattern of increased rs-FC. Specifically, the voxelwise regional profile of LA in these areas strongly correlated with the regional pattern of rs-FC among the same regions (e.g., LA in primary visual cortex accounts for ~50%, and LA in anterior cingulate accounts for ~20% of rs-FC with the visual system). These data provide the first direct evidence in humans that local neuronal activity determines BOLD FC at rest. Beyond its relevance for the neuronal basis of coherent BOLD signal fluctuations, our procedure may translate into clinical research particularly to investigate potentially aberrant links between local dynamics and remote functional coupling in patients with neuropsychiatric disorders. © 2014 the authors.
Dopfner M.,Uniklinik Cologne |
Kinnen C.,Uniklinik Cologne |
Petermann F.,University of Bremen
Kindheit und Entwicklung | Year: 2010
During recent decades numerous treatment manuals for mental disorders in childhood and adolescence have been published, both internationally and in German-speaking countries. While there is substantial debate over the potential advantages and disadvantages of working with therapy manuals, both widespread acceptance and flexible use of therapy manuals have been shown in a survey with licensed child and adolescent psychologists. Requirements for the improvement of manuals regarding flexibility, individualization, user-friendliness, attractiveness of the material as well as empirical evidence are outlined in this paper. Behavior therapy for children and adolescents and, presumably, its efficacy, have been improved by therapy manuals. The risks of therapy manuals can be handled if their limitations are properly respected. Individual therapy planning and case supervision should be included as further components of quality assurance in child and adolescent psychology. © Hogrefe Verlag, Göttingen 2010.
Foth D.,Uniklinik Cologne |
Goretzlehner G.,Parkstrasse 11
Geburtshilfe und Frauenheilkunde | Year: 2010
During perimenopause, the time immediately prior to and the first year after the last menstrual period, female reproductive capacity is low, but pregnancy is still possible. Ovulation may occur without warning and effective contraception is still necessary if pregnancy is not desired. There is no contraceptive method that is contraindicated due to age. Various contraceptive options may be offered to perimenopausal women, including oral contraceptives with low dosages of ethinylestradiol, vaginal ring, progestin pills, injectables, implants, intrauterine system with levonorgestrel, natural estrogen (estradiol) in combination with a progestin, intrauterine devices, barrier methods and tubal ligations. However, women need to receive accurate individual advice about the risks and benefits of each contraceptive method. Oral hormonal contraceptives are a safe option for healthy, normotonic non-smokers without any contraindications up until one or two years beyond menopause. In addition to the effective contraception, non-contraceptive benefits such as the treatment of bleeding disorders or dysmenorrhea play an important role. For women with contraindications against estrogens progestin-only methods (pills, injectables, implants) offer possible choices. The intrauterine system (IUS) with levonorgestrel remains the most effective contraceptive method, even in women with bleeding disorders. For smokers all estrogen-progestin combinations are contraindicated because of the known increased risk for cardiovascular disease. © Georg Thieme Verlag KG Stuttgart.
PubMed | Max Planck Institute for Neurological Research, Charité - Medical University of Berlin and Uniklinik Cologne
Type: | Journal: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism | Year: 2016
Perfusion-weighted (PW) magnetic resonance imaging (MRI) is used to detect penumbral tissue in acute stroke, but the selection of optimal PW-maps and thresholds for tissue at risk detection remains a matter of debate. We validated the performance of PW-maps with 15O-water-positron emission tomography (PET) in a large comparative PET-MR cohort of acute stroke patients. In acute and subacute stroke patients with back-to-back MRI and PET imaging, PW-maps were validated with 15O-water-PET. We pooled two different cerebral blood flow (CBF) PET-maps to define the critical flow (CF) threshold, (i) quantitative (q)CBF-PET with the CF threshold <20ml/100g/min and (ii) normalized non-quantitative (nq)CBF-PET with a CF threshold of <70% (corresponding to <20ml/100g/min according to a previously published normogram). A receiver operating characteristic (ROC) curve analysis was performed to specify the accuracy and the optimal critical flow threshold of each PW-map as defined by PET. In 53 patients, (stroke to imaging: 9.8h; PET to MRI: 52min) PW-time-to-maximum (Tmax) with a threshold >6.1s (AUC=0.94) and non-deconvolved PW-time-to-peak (TTP) >4.8s (AUC=0.93) showed the best performance to detect the CF threshold as defined by PET. PW-Tmax with a threshold >6.1s and TTP with a threshold >4.8s are the most predictive in detecting the CF threshold for MR-based mismatch definition.
Wolfgarten E.,Uniklinik Cologne |
Monig S.P.,Uniklinik Cologne |
Fetzner U.K.,Uniklinik Cologne |
Schroder W.,Uniklinik Cologne |
Bollschweiler E.,Uniklinik Cologne
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2012
Background: There is a lack of well-trained surgeons in Germany. The medical students get their last contact to a surgical discipline in the final year of their medical education. The student's decision for a medical discipline is surely influenced by bad experiences during the last practical training in surgery. The aim of our project was to give the medical students an engaged and structured understanding of surgery with the aid of a logbook. It was tested in a pilot phase and should increase the number of final year students and their interest in surgery in the long-term. Methods: From 5 /2009 the structure of the surgical part of the final year was worked over by the Clinics for General, Visceral und Tumour Surgery, Vascular Surgery, Heart and Thoracic Surgery and Trauma Surgery. A logbook was developed which includes the rotation through the 4 different surgical departments, lists the targets of study and the practical exercises in obligatory and optional schedules, defines one patient care per rotation and introduces a mentoring system. The logbook is clearly represented and the required signatures of the senior doctors are minimized. After the surgical term the students filled out a questionnaire and were interviewed about the pros and cons of the logbook. Results: In December 2009 the new logbook was distributed for the first time. Until now 113 final year students have used it. The first evaluation of45students showed a positive rating of the clinical organization and structure of the clinic, the list of the learning targets and the practical skills. The implementation of the mentoring system and the required signatures were still incomplete. The final year students wished for more training time for the doctors. The positive response of the final year students results in an increasing number of final year students chosing a career in surgery. Conclusion: The new logbook for the surgical part of the final year at the University of Cologne helps the students with the daily routine of the surgical departments, gives a review of the learning targets and emphasizes a good surgical training. © 2012 Georg Thieme Verlag KG Stuttgart • New York.
Ambe P.,RWTH Aachen |
Esfahani B.J.,RWTH Aachen |
Tasci I.,RWTH Aachen |
Christ H.,Uniklinik Cologne |
Kohler L.,RWTH Aachen
Surgical Endoscopy and Other Interventional Techniques | Year: 2011
Background: Laparoscopic cholecystectomy (LC) seems to be more challenging in males than in females. The surgery seems to be longer in male patients. There also seems to be an increased rate of conversion to open surgery in male patients. We sought to objectively verify this widespread belief. Methods: We performed a retrospective analysis of laparoscopic cholecystectomies performed between January 2004 and November 2009 in our hospital. Within this period 1844 cholecystectomies were performed in our community-based hospital. After a strict inclusion procedure, 1571 cases of LC for symptomatic gallbladder disease were analyzed (501 males, 1071 females). The time for surgery, defined as the interval from placement of the Veress needle to wound closure in minutes, and the rate of conversion to open surgery were the main parameters considered. Results: The time for surgery in male patients was significantly longer compared to that for females (p < 0.0001). The male cohort was significantly older than the female cohort at the time of surgery (p < 0.001). The rate of conversion to open surgery was significantly higher in male patients (5.6%) compared to 2.9% for females (p < 0.0001). Conclusion: Based on our analysis, LC had a significantly longer duration of surgery in the male cohort. The rate of conversion to open surgery was also significantly higher in male cohort. Thus, LC could be more challenging in male patients. © 2011 Springer Science+Business Media, LLC.
PubMed | Ludwig Maximilians University of Munich, Georgetown University, Uniklinik Cologne and University College London
Type: Journal Article | Journal: Proceedings of the National Academy of Sciences of the United States of America | Year: 2016
Directionality of signaling among brain regions provides essential information about human cognition and disease states. Assessing such effective connectivity (EC) across brain states using functional magnetic resonance imaging (fMRI) alone has proven difficult, however. We propose a novel measure of EC, termed metabolic connectivity mapping (MCM), that integrates undirected functional connectivity (FC) with local energy metabolism from fMRI and positron emission tomography (PET) data acquired simultaneously. This method is based on the concept that most energy required for neuronal communication is consumed postsynaptically, i.e., at the target neurons. We investigated MCM and possible changes in EC within the physiological range using eyes open versus eyes closed conditions in healthy subjects. Independent of condition, MCM reliably detected stable and bidirectional communication between early and higher visual regions. Moreover, we found stable top-down signaling from a frontoparietal network including frontal eye fields. In contrast, we found additional top-down signaling from all major clusters of the salience network to early visual cortex only in the eyes open condition. MCM revealed consistent bidirectional and unidirectional signaling across the entire cortex, along with prominent changes in network interactions across two simple brain states. We propose MCM as a novel approach for inferring EC from neuronal energy metabolism that is ideally suited to study signaling hierarchies in the brain and their defects in brain disorders.
PubMed | Uniklinik Cologne
Type: Journal Article | Journal: Fortschritte der Neurologie-Psychiatrie | Year: 2016
Bipolar affective disorders (BD) are severe, recurrent and disabling disorders with devastating consequences for individuals, families and the society. Although this personal burden and costs for the health system provide a compelling rationale for development of early detection and early intervention strategies in BD, the development of at-risk criteria for BD is still in an early stage of research. In this paper we review the literature of clinical data that investigate at-risk criteria. Moreover, we will discuss methodological problems associated with the definition of being at high-risk for developing bipolar disorders and show the different research approaches that deal with the investigation of at-risk criteria and appropriate intervention for BD. If prospective studies confirm the at-risk criteria for BD, then there is potential to develop preventive measures in BD with opportunities to ameliorate the severity of or even prevent BD.
Von Tresckow B.,Uniklinik Cologne |
Engert A.,Uniklinik Cologne
Onkologe | Year: 2014
Background. Brentuximab vedotin is a new antibody drug conjugate consisting of a monoclonal antibody which is specifically linked to a potent synthetic cytostatic drug. This construct is directed against the CD30 antigen that is highly expressed on the malignant cells of Hodgkin's lymphoma (HL) tumors. Objective. A systematic review of the current status of therapy of HL with brentuximab vedotin is presented. Material and methods. A systematic literature search was performed in Pubmed, MEDLINE, current guidelines and by manual searching. Relevant publications from the last 5 years were analyzed and the results are summarized in a structured review. Results. Brentuximab vedotin has demonstrated high clinical activity in trials performed in intensively pretreated patients with HL showing an overall response rate (ORR) of 75%. The most commonly observed side effects include moderate neutropenia and more rarely peripheral neuropathy. Brentuximab vedotin was registered by the European Medicines Agency (EMA) in October 2012 for the treatment of relapsed and refractory HL patients in Europe. Conclusion. With the approval of brentuximab vedotin a new standard of care for patients with relapsed or refractory HL has become available. Current clinical trials are evaluating brentuximab vedotin as a combination partner for conventional chemotherapy in first and second line treatment. Moreover, brentuximab vedotin has been used as bridging treatment before allogeneic stem cell transplantation in patients with multiple recurrences. © 2014 Springer-Verlag.