Universitatsklinik Heidelberg

Heidelberg, Germany

Universitatsklinik Heidelberg

Heidelberg, Germany
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Zech U.,Universitatsklinik Heidelberg
Atemwegs- und Lungenkrankheiten | Year: 2017

The adjustment of nutritional therapy to the individual stage of post-aggression metabolism in critically ill patients is of the utmost importance to the prognosis of the disease's course and a successful weaning.

Kussner T.,Universitatsklinik Heidelberg | Popp E.,Universitatsklinik Heidelberg
Notfall und Rettungsmedizin | Year: 2017

Under the special circumstances of emergency medicine, airway management is risky and fraught with complications. Despite being rarely necessary, securing the airway by endotracheal intubation or supraglottic airway devices is usually life-saving in these cases. The basis for this review is the algorithm for prehospital airway management. Some of the typical devices for safeguarding the respiratory tract are described and evaluated with regard to the current state-of-the-art, as found in the current literature. Simple measures such as the jaw thrust maneuver or inserting an Guedel or Wendl airway are often the first basic actions. Endotracheal intubation (ETI) remains the gold standard of airway management; nevertheless, it requires a high degree of expertise and is especially complex under the adverse conditions of emergency medicine. Supraglottic airway devices (SGA) are an effective alternative. In emergency medicine only laryngeal tubes or masks of the second generation should be used and cuff pressure should be controlled as early as possible. To facilitate ETI, the McCoy laryngoscope blade or video laryngoscopy can be used. Concerning the latter, the use of blades that alternatively allow direct laryngoscopy are recommended. Referring to cricothyrotomy, surgical techniques seem to have a slight advantage of being faster. Every operator should be familiar with the equipment that is locally available. For monitoring the position and effectiveness, capnography and oximetry must be used whenever ventilating a patient. © 2017 Springer Medizin Verlag Berlin

Berlit P.,Klinik fur Neurologie | Schonenberger S.,Universitatsklinik Heidelberg
Aktuelle Neurologie | Year: 2014

There is an increased incidence of stroke during pregnancy of 25 to 34 per 100.000. Important causes include preeclampsia, eclampsia, sinus- and vein thrombosis as well as the reversible cerebral vasoconstriction syndrome (RCVS, post partum angiopathy). Thrombotic thrombocytopenic purpura (TTP) and sickle cell anemia are coagulopathies which often manifest during pregnancy for the first time. Important are the early diagnosis and a focused interdisciplinary management of these patients. Intravenous thrombolysis and endovascular thrombectomy are individual treatment options during pregnancy. © Georg Thieme Verlag KG Stuttgart • New York.

Welfringer A.,Universitatsklinik Heidelberg | Leifert-Fiebach G.,Universitatsklinik Heidelberg | Babinsky R.,Universitatsklinik Heidelberg | Brandt T.,Universitatsklinik Heidelberg
Disability and Rehabilitation | Year: 2011

Purpose.The aim of this study was to investigate the feasibility of mental practice of positions and movements of the contralesional upper limb in sub-acute neglect patients and the efficacy of the approach in modifying visuospatial and representational neglect symptoms. Method.Fifteen sub-acute neglect patients received two daily half-hour sessions of visuomotor-imagery therapy over a 3-week period as an add-on treatment and were compared to a control group of 15 sub-acute neglect patients without supplementary therapy. Feasibility was assessed using verbal-feedback protocols. Efficacy was determined using various standardised functional-outcome measures and neuropsychological tests. Results.According to therapy protocols, compliance and subjective-gain ratings were high. The results suggest that imagined activation of the contralesional upper limb significantly reduces the severity of neglect in drawing/copying tasks as well as enhancing sensation in the affected arm. Conclusions.We conclude that (i) kinaesthetic visuomotor imagery is a feasible technique for sub-acute neglect patients and that (ii) imagery practice leads to improvements in the perception of body and space. Future research is required to specify criteria for indication and contraindication. © 2011 Informa UK, Ltd.

Schmidmaier G.,Universitatsklinik Heidelberg | Moghaddam A.,Universitatsklinik Heidelberg
Zeitschrift fur Orthopadie und Unfallchirurgie | Year: 2015

The percentage of delayed or non-unions after fractures of long bones depends on the individual risk profile at approximately 10%. The current definition states that a non-union is a fracture that will not consolidate without any further intervention - independent from the treatment time. At the early stage of a non-union a conservative treatment is possible in case of an adequately stable situation. The operative treatment depends on the type of the non-union. There are one-step or two-step procedures, all according to the principles of the diamond concept. This means improvement of the mechanical situation - in most cases by means of a reosteosynthesis - and vascularization, local application of osteoconductive carriers e.g. tricalciumphosphate, vital cells from autologous bone and osteoinductive substances like bone morphogenetic proteins (BMP-2 or BMP-7). Hypertrophic and atrophic non-unions without large defect gaps or signs of infection can be treated with a one-step procedure. For treating infected non-unions or non-unions with large defect gaps the Masquelet technique is recommended. © Georg Thieme Verlag KG Stuttgart New York•.

Hepatocellular steatosis constitutes the most frequent liver disease in western countries and may progress to steatohepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). The lipid droplet (LD)-associated proteins perilipin, adipophilin, TIP47 (“tail interacting protein of 47 kDa”), S3-12 and myocardial LD protein (MLDP), so-called perilipins 1–5 (PAT family) govern formation, maintenance and degradation of LDs. A lack of perilipin in mice inhibits obesity and a lack of adipophilin or TIP47 inhibit the development of fatty liver disease. In long-term cell culture models as well as in liver biopsies of patients with different acute and chronic liver diseases, LD-associated proteins are sequentially recruited to LDs and regulated via peroxisome proliferator-activated receptor (PPAR) α and PPARγ as well as posttranscriptionally via alternative splicing, LD fusion and lipolysis. Whereas TIP47 and MLDP coat small newly formed LDs in acute microvesicular steatosis, adipophilin constitutes a robust general marker for LDs in many different cell types. Perilipin is important for the long-term storage of lipids in macrovesicular steatosis and controls lipolysis via hormone-dependent phosphorylation. During malignant transformation, increased formation of small LDs and overexpression of adipophilin, TIP47 and MLDP are detected, possibly as the expression of an altered tumor metabolism analogous to a Warburg effect. Adipophilin correlates positively with the proliferation rate of HCC cells. Cultured cells with downregulation of TIP47 or adipophilin via small interfering RNA (siRNA) or small hairpin RNA (shRNA) show less but larger LDs with reduced neutral fat content. © 2015, Springer-Verlag Berlin Heidelberg.

Kloos W.,Universitatsklinik Heidelberg | Katus H.A.,Universitatsklinik Heidelberg | Meder B.,Universitatsklinik Heidelberg
Herz | Year: 2012

Dilated cardiomyopathy (DCM) is a multifactorial disease of the heart muscle and a leading cause of congestive heart failure. Human genetic studies and the establishment of suitable animal models such as mice and zebrafish have already revealed parts of its genetic etiology. With the next generation of genomic sequencing technologies (NGS) on the rise, the comprehensive genetic dissection of DCM patients will reveal clinically relevant information, novel causes, and modifiers of this complex disorder. The recent exploration of the epigenome as another mechanism of cardiac gene regulation will further elucidate unexplained variations observed in the correlation between the patient's genotype and phenotype. Some of these intriguing advances being made in basic genetic research will soon find their way into clinical practice for more individualized treatment of cardiomyopathy patients. © 2012 Urban & Vogel, Muenchen.

Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors worldwide with poor prognosis. Based on high-throughput screening technology, we and others have identified factors and pathways that are pivotal for tumor progression including trans- cription factors and microtubule-interacting proteins. In addition, aberrant activation of the IGF signalling pathway is frequently observed in HCCs which is predominantly based on high level expression of its ligand IGF-II. Because protumorigenic effects of IGF-II such as proliferation, anti-apoptosis, and migration are transmitted through its receptor IGF-1R, selective inhibition of this tyrosine kinase by small molecule compounds might reduce IGF-II-driven tumor growth. Indeed, administration of IGF-1R-selective inhibitors reduces IGF-II-induced effects and was associated with a significant reduction of tumor growth in a xenograft transplantation model. In conclusion, the IGF-II/IGF-1R signalling pathway is critically involved in the regulation of tumor growth and tumor cell dissemination, representing a promising therapeutic target structure in the treatment of HCC. © Springer-Verlag 2010.

Kordy H.,Universitatsklinik Heidelberg | Theis F.,Universitatsklinik Heidelberg | Wolf M.,Universitatsklinik Heidelberg
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2011

Internet and mobile phones open new avenues for the optimization of health services in medical rehabilitation. Various models of Internet-delivered aftercare after psychosomatic inpatient treatment have shown promising results. The focus of this report is on the experience in translating one of the promising models, the Internet-Bridge ("Internet-Brücke"), to every day health care. Effectiveness was estimated through comparison of 254 patients who were treated in a hospital specialized in psychosomatic medicine and who participated in the Internet-Bridge as well as in the 1-year follow-up in the frame of standard quality assurance between 2003-2010 with 364 patients of the same hospital who also participated in the 1-year follow-up, but did not utilize the aftercare. Sustainable, reliable, and clinically significant improvements were more frequent in participants of the Internet-Bridge, especially with regard to psychological well-being, social problems, and psychosocial competence-at small additional costs. Results are understood as encouragement to start translation to routine care accompanied by research. © 2011 Springer Medizin Verlag.

Up to 5% of all bone fractures show impaired healing and the bridging of large bony defects still represents a challenge for the orthopedic surgeon. In recent years, methods to promote in-situ regeneration based on non-vital components like bone substitute materials and growth factors have found successful entrance to the clinic. However, the application of vital components such as in-vitro cultured cells in combination with supporting carriers and/or biomolecules, thus tissue-engineered products, is less common for the regeneration of bone. In contrast to cartilage, bone tissue represents a cell-rich and well-vascularized tissue. Consequently, a functional interplay of supporting osteoconductive bone graft substitutes, osteoinductive stimuli and osteogenic cells is important and necessary for the regeneration of large bone defects. The additional provision of high quantities of autologous stem cells for bone tissue engineering strategies may be promising for a steadily aging population as well as for high-performance sports, where fast regeneration and full load-bearing capacity of the reconstructed bone are required. The article summarizes donor-dependent aspects of human mesenchymal stem cells and their suitability for bone tissue engineering. Additionally, new approaches for the in-situ regeneration of bone and relevant regulatory statutes due to the classification of tissue-engineered products as pharmaceuticals in Europe will be discussed.

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