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Steinau an der Straße, Germany

Dettmers C.,Arztlichen Direktion | Dettmers C.,University of Konstanz | Nedelko V.,University of Konstanz | Nedelko V.,Lurija Institute For Rehabilitationswissenschaften | And 3 more authors.
Journal fur Neurologie, Neurochirurgie und Psychiatrie

The following text describes basic principles of the anatomical and functional concept of the mirror neuron system. It outlines mirror therapy, videotherapy, and mental training as examples of rehabilitation strategies based on new concepts of neurobiology and neurosciences. Mirror therapy and videotherapy are new approaches, developed by close collaboration with basic neurosciences. Neurorehabilitation is at the edge between traditional approaches, new experimental concepts, and evidence-based guidelines. Source

Dudenhausen J.W.,Charite - Medical University of Berlin | Maier R.F.,Universitatsklinik Magdeburg
Deutsches Arzteblatt

Background: Multiple pregnancies have become more common in the industrialized world because of rising maternal ages and advances in reproductive medicine. Methods: Selective literature review. Results: Multiple pregnancy carries a higher risk of prematurity, intrauterine growth restriction, and prenatal death, as well as elevated risks to the mother including preeclampsia, diabetes, and hemorrhage during delivery. Genetic tests and ultrasonography are the most important tests for monitoring during pregnancy. Ultrasound aids in the detection of the feto-fetal transfusion syndrome and in the determination of zygosity. Conclusions: The care of women with multiple pregnancies requires the collaboration of specialists in prenatal medicine, obstetrics, and neonatology as well as a properly functioning integration of outpatient and inpatient care. Source

Moehler M.,Universitatsmedizin Mainz | Ababneh Y.,Universitatsmedizin Mainz | Siebler J.,Friedrich - Alexander - University, Erlangen - Nuremberg | Schimanski C.C.,Universitatsmedizin Mainz | And 2 more authors.

Background: This prospective observational study in typical community-based outpatient clinics evaluated the efficacy and toxicity of weekly and biweekly irinotecan-based chemotherapies and their compatibility depending on age. Methods: 601 patients with advanced or metastatic colorectal cancer receiving first-, second-, or third-line irinotecanbased therapy were regularly analyzed for response and toxicity until the end of therapy. Results: The median age was 65 (28-87) years, approximately one-third of the patients were ≥70 years old. Of all patients, 405 were treated weekly and 68 biweekly. Median overall survival (OS) for first-line therapy was 26.5 months for the <70-year-old patients and 19.4 months for the ≥70-year-old patients. Toxicities were moderate in all groups. Tumor growth control rates (TCR) and median time to progression (TTP) were marginally better for patients <70 years old. Median TTP was 9.9 months in first-line therapy, 9.8 months after adjuvant therapy, 7.7 months in second-line, and 6.4 months in third-line therapy. Conclusions: Toxicity and response data from this observational study clearly confirm the positive results from previous clinical studies and show a slight ad-vantage in efficacy for the <70-year-old patients. © 2010 S. Karger GmbH, Freiburg. Source

Trobisch P.D.,Eifelklinik St. Brigida | Hwang S.W.,Tufts Medical Center | Drange S.,Universitatsklinik Magdeburg
European Spine Journal

Purpose: A decompensated sagittal imbalance has been associated with worsening health-related quality of life outcomes and increasing pain. Significant improvement in sagittal balance can be achieved using a pedicle subtraction osteotomy (PSO); however, this procedure has a high complication profile. A lumbar PSO has the advantages of direct visualization of all neural structures and safer retraction of the thecal sac. Sacrificing neuromonitoring may reduce anaesthesia time and lead to improved cost effectiveness of the surgery. However, there are no studies analyzing the complication rate of lumbar PSO without the use of neuromonitoring. We hypothesize that the neurologic complication rate remains comparable to published studies even without the use of intraoperative neuromonitoring. Methods: The medical records of all patients of a single institution who received a lumbar PSO for sagittal imbalance between July 2012 and June 2014 were retrospectively analyzed. All surgeries were performed by the first author and without the use of intraoperative neuromonitoring. We analyzed the 30-day complication rate. Results: Twenty-two patients were included in this study. The average age at surgery was 67 years. 16 patients had at least one previous lumbar surgery. The average fusion length was seven segments. All patients were instrumented to the sacrum and 19 patients additionally received spinopelvic instrumentation. The average amount of focal correction was 28°. The average surgical time was 362 min and blood loss was 2302 mL. A total of eight patients with complications were identified. There was a new neurologic postoperative deficit in two patients presenting as a foot drop. Five patients had an unplanned revision surgery. Conclusion: Historically, PSOs are associated with a high surgical complication rate and our results show comparable outcomes and complications to those previously reported. In our series, the absence of neuromonitoring in lumbar PSOs does not appear to increase the risk of neurological injury. © 2015 Springer-Verlag Berlin Heidelberg Source

Dorst J.,Universitatsklinik Ulm | Dupuis L.,French Institute of Health and Medical Research | Dupuis L.,University of Strasbourg | Petri S.,Hannover Medical School | And 16 more authors.
Journal of Neurology

Weight loss is increasingly considered as a negative prognostic marker in amyotrophic lateral sclerosis (ALS). Despite the critical importance of nutritional issues in ALS, and the common use of percutaneous endoscopic gastrostomy (PEG), there is a general lack of knowledge on peri-interventional treatment, optimal parameters of enteral nutrition, its timing during disease progression and its potential disease-modifying effects in ALS patients. Here we report the results of a multi-center prospective study of percutaneous endoscopic gastrostomy (PEG) in ALS. In this observational clinical trial, 89 ALS patients were prospectively enrolled over a 3-year period and longitudinal data were collected over 18 months. PEG was a safe procedure even in patients with low forced vital capacity, and prophylactic single-shot antibiosis as well as slow increase of caloric nutrition via PEG was beneficial to avoid complications. No signs of refeeding syndrome were observed. High-caloric intake (>1,500 kcal/d) via PEG in patients that lived at least 12 months after PEG insertion was correlated with prolonged survival. Additional oral food intake was not associated with a worse prognosis. Our results suggest that peri-interventional PEG management should include prophylactic single-shot antibiosis, slow increase of caloric intake, and long-term high-caloric nutrition. Although our results indicate that PEG might be more beneficial when applied early, we believe that it can also be performed safely in patients with far advanced disease. Because of its explorative and observational character, most of our results have to be confirmed by a randomized interventional trial. © 2015, Springer-Verlag Berlin Heidelberg. Source

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