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Eichhorn K.W.,Universitatsklinikum Bonn
Acta neurochirurgica. Supplement | Year: 2011

Functional Endoscopic Surgery of Paranasal sinuses (FESS) and Skull Base surgery is one of the most frequent surgeries performed at the ENT department of the Bonn University, Germany. Beside of surgical Navigation Robotic is one of the upcoming fields of Computer assisted Surgery developments. This work presents novel research and concepts for Robot Assisted Endoscopic Sinus Surgery (RASS) of the Paranasal sinuses and the anterior Skull Base containing the analysis of surgical workflows, the segmentation and modelling of the Paranasal sinuses and the anterior Skull Base and the development of the robotic path planning. An interdisciplinary group of software engineers and surgeons in Braunschweig and Bonn, Germany are approximate to solutions by a clinical and technical research program financed through the DFG (Deutsche Forschungsgemeinschaft, German research Community).

Sinning J.M.,Universitatsklinikum Bonn
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology | Year: 2012

The first member of the next generation CoreValve "family" is the 23 mm CoreValve® Evolut™ (Medtronic, Minneapolis, MN, USA), which is indicated for an annulus range of 18 mm to 20 mm and extends the spectrum of patients with aortic stenosis that can be treated with the self-expanding CoreValve bioprosthesis. The Core-Valve Evolut provides several technical refinements and is designed to enable re-capturability in the future. Here, we report on the first case in a 93-year-old female patient who was implanted at the University Hospital Bonn, Germany, on June 1st, 2012.

Steinmetz M.,Universitatsklinikum Bonn | Nickenig G.,Universitatsklinikum Bonn | Werner N.,Universitatsklinikum Bonn
Hypertension | Year: 2010

Atherosclerosis is the most common cause for cardiovascular diseases and is based on endothelial dysfunction. A growing body of evidence suggests the contribution of bone marrow-derived endothelial progenitor cells, monocytic cells, and mature endothelial cells to vessel formation and endothelial rejuvenation. To this day, various subsets of these endothelial-regenerating cells have been identified according to cellular origin, phenotype, and properties in vivo and in vitro. However, the definition and biology, especially of endothelial progenitor cells, is complex and under heavy debate. In this review, we focus on current definitions of endothelial progenitor cells, highlight the clinical relevance of endothelial-regenerating cells, and provide new insights into cell-cell interactions involved in endothelial cell rejuvenation. Copyright © 2010 American Heart Association. All rights reserved.

Potzsch B.,Universitatsklinikum Bonn
Medizinische Klinik - Intensivmedizin und Notfallmedizin | Year: 2013

Anticoagulant drugs belong to the group of antithrombotic agents and are successfully used in the prophylaxis and treatment of thromboembolic disorders. The use of anticoagulants in the prevention of deep venous thrombosis has significantly lowered the risk of venous thrombosis and fatal pulmonary embolisms even in high-risk situations such as orthopedic surgery. Anticoagulants play a central role in the treatment of acute venous thrombosis and in the prevention of recurrent events. Long-term anticoagulation therapy with orally active anticoagulants significantly reduces the risk of thromboembolic complications in patients showing cardiac arrhythmias. Whereas a few years ago heparins and vitamin K antagonists were the dominant anticoagulants, today a wide range of anticoagulants with improved pharmacological profiles are available. It remains an open question whether these new anticoagulants will improve the efficacy, safety, and acceptance of anticoagulant treatment approaches. © 2013 Springer-Verlag Berlin Heidelberg.

By evaluations of treatment protocols, the documentation of balloon kyphoplasty regarding efficacy, duration of action and safety should be expanded. In addition, the evaluations should help to clarify the differences in balloon kyphoplasty for patients with vertebral fractures concerning efficacy and safety in relation to the underlying diseases: osteoporosis, bone metastases or myeloma. In order to reposition the endplates of the vertebrae a balloon was inserted after placement of the working channels. After removal of the balloon, the resulting caverns were filled with PMMA. The radiological and clinical follow-up examinations were carried out over a period of up to 3 years. The clinical and radiological findings before and after treatment at specified visits were transferred to a statistical programme and evaluated. The comparisons of the postoperative results according to the initial diagnosis (metastases: n = 222, osteoporosis: n = 122, myeloma: n = 122) demonstrated significant differences with respect to the cement leakage (14 %, 5 %, 7.5 %), but in all cases without any clinical relevance. The small differences related to the reduction in pain intensity (VAS > 50 mm in each group) after surgery were up to 12 months with no clinical significance. Also in the Oswestry score no differences between the 3 groups were registered. In the case of osteoporosis patients, due to the lower starting position a more significant increase of vertebral body height could be achieved by the kyphoplasty than in the comparison groups of patients with metastases or myeloma (∅ 3.1 mm vs. 0.4-0.5 mm; P < 0.001). Consequently, the kyphosis angle decreased in the osteoporotic group also more strongly than in the comparison groups. It is evident that the pain relief in the vast majority of cases started immediately after surgery. Additionally, a significant improvement in functioning (Oswestry score) was registered. Both clinical parameters - as far as they could be checked - showed a steady degree of improvement over a period of at least 3 years. This comparative analysis led to the conclusion that balloon kyphoplasty can be successfully applied indiscriminately in patients with vertebral fractures as a result of osteoporosis and also to fractures associated with bone metastases or with myeloma. © Georg Thieme Verlag KG Stuttgart · New York.

Background: Hereditary gastrointestinal polyposis syndromes account for about 1% of all cases of colorectal cancer and are associated with a broad spectrum of extracolonic tumors. The early detection and accurate classification of these syndromes are essential, since effective methods for surveillance and treatment are available. Methods: This review article is based on a selective literature search, the author's own work, and evidence-based guidelines and recommendations. Results and Conclusions: The diagnosis is initially suspected on the basis of the endoscopic findings and polyp histology. Because different syndromes can resemble each other phenotypically, e.g., autosomal dominant familial adenomatous polyposis and autosomal recessive MUTYH-associated polyposis, molecular genetic studies are important for differential diagnosis and for assessing the risk of recurrence. Identification of the familial mutation in an affected patient is a prerequisite for predictive testing in asymptomatic persons at risk and sometimes enables prognostication. In recent years, the rate of detection of mutations has risen by 10% to 30%, and clinically relevant genotype-phenotype correlations have been described for juvenile polyposis syndrome. Except in cases of mild adenomatous polyposis, phenotypic overlap among the hamartomatous polyposes often causes difficulties in differential diagnosis. Thus, in unclear cases, a pathologist with special expertise in gastrointestinal disorders should be consulted for the evaluation of polyp tissue. Aside from the monogenic polyposes, there are many other types of polyposis that are non-hereditary or of unknown cause, including the hyperplastic and mixed polyposis syndromes. Risk-adapted surveillance programs have been established for the more frequently occurring polyposes.

Wall I.,Universitatsklinikum Bonn | Schmidt-Wolf I.G.H.,Universitatsklinikum Bonn
Anticancer Research | Year: 2014

Background/Aim: Activated Wnt signaling in cancer cells leads to cell proliferation. It has been shown that the Wnt pathway is activated in pancreatic adenocarcinoma cells. Therefore, we tested the effect of Wnt inhibitors in human and murine pancreatic cancer cell lines. Materials and Methods: The Wnt inhibitors ethacrynic acid (EA), ciclopirox olamine (CIC), piroctone olamine (PO) and griseofulvin (GF) were tested in murine and human pancreatic cancer cell lines with the 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Results: We showed that the Wnt inhibitors significantly reduced cell viability in murine, as well as human pancreatic cancer cell lines. Conclusion: These results may lead to a new therapeutic option with Wnt inhibitors for patients with pancreatic adenocarcinoma. © 2014, International Institute of Anticancer Research. All rights reserved.

Hammerstingl C.,Universitatsklinikum Bonn | Omran H.,St Marien Hospital Bonn Venusberg
Europace | Year: 2011

ObjectiveTo assess the risk of bleeding and thromboembolism (TE) of bridging therapy with low molecular weight heparin (LMWH) in patients undergoing pacemaker implantation. BackgroundCurrent guidelines on peri-procedural management of patients with chronic oral anticoagulation (OAC) give no explicit recommendations on how to treat patients undergoing pacemaker implantations. Methods and ResultsSince 2000 all patients with chronic OAC undergoing pacemaker implantation were prospectively enrolled and treated following a pre- specified bridging regimen with enoxaparin using reduced LMWH doses in patients at non high TE risk and renal impairment. Patients were followed up for 30 days regarding bleeding complications, incidence of thromboembolism, length of therapy and adverse events following bridging therapy. 200 patients (age 78.4 ± 8.3 years; 60.5% male) were enrolled and treated with enoxaparin for a mean of 7.3 ± 4.2 days. 109 patients (54.4) were assigned to high TE risk and 91 (45.6%) to non high TE risk. Renal insufficiency (CrCl of <50 ml/min) was present in 92 patients (46). After risk stratification 72.5% of patients (n = 145) were treated with reduced LMWH doses. Outpatient treatment was feasible in 39 patients (19.5%). Nine bleeding complications were observed (4.5%; 95% confidence interval [CI] 2.1-8.4%), including one major bleed (0.5; 95% CI 0.01%-2.75%) and eight minor bleeds (4%; 95% CI 1.74%-7.73%). No thromboembolic complications evolved due to bridging therapy (0%; 95% CI 0.0-1.49%). After multivariate regression analysis independent predictors for bleedings were the development of thrombozytopenia (hazard ratio [HR] 6.0, 95% CI 0.3-139.8; P = 0.002), the prevalence of congestive heart failure (HR 4.5, 95% CI 0.9-22.2; P = 0.01), high TE risk (HR 6.9, 95% CI 1.9-25.6; P = 0.03) and an increasing CHADS2 score (HR 2.3, 95% CI 1.0-5.4; P = 0.05). Conclusion Oral anticoagulation can be safely interrupted before pacemaker implantation under overlapping therapy with enoxaparin. Reducing heparin doses in patients with low thromboembolic risk and renal insufficiency led to a low incidence of major bleeding without increasing thromboembolic events. © 2011 The Author.

Li M.,Max Planck Institute for Evolutionary Anthropology | Schroder R.,Max Planck Institute for Evolutionary Anthropology | Ni S.,Max Planck Institute for Evolutionary Anthropology | Madea B.,Universitatsklinikum Bonn | Stoneking M.,Max Planck Institute for Evolutionary Anthropology
Proceedings of the National Academy of Sciences of the United States of America | Year: 2015

Heteroplasmy in human mtDNA may play a role in cancer, other diseases, and aging, but patterns of heteroplasmy variation across different tissues have not been thoroughly investigated. Here, we analyzed complete mtDNA genome sequences at ∼ 3,500× average coverage from each of 12 tissues obtained at autopsy from each of 152 individuals. We identified 4,577 heteroplasmies (with an alternative allele frequency of at least 0.5%) at 393 positions across the mtDNA genome. Surprisingly, different nucleotide positions (nps) exhibit high frequencies of heteroplasmy in different tissues, and, moreover, heteroplasmy is strongly dependent on the specific consensus allele at an np. All of these tissue-related and allele-related heteroplasmies show a significant age-related accumulation, suggesting positive selection for specific alleles at specific positions in specific tissues. We also find a highly significant excess of liver-specific heteroplasmies involving nonsynonymous changes, most of which are predicted to have an impact on protein function. This apparent positive selection for reduced mitochondrial function in the liver may reflect selection to decrease damaging byproducts of liver mitochondrial metabolism (i.e., "survival of the slowest"). Overall, our results provide compelling evidence for positive selection acting on some somatic mtDNA mutations.

Hartmann G.,Universitatsklinikum Bonn
LaboratoriumsMedizin | Year: 2016

Modern techniques of deep sequencing and bioinformatics applied to nucleic acids circulating in the cell-free liquid compartment of blood are expected to substantially advance the diagnostic repertoire of laboratory medicine. At the crossroads of this newly evolving field in immunity, it is interesting to note that the innate immune system relies on nucleic acids to detect viral pathogens and cell damage. A number of receptors have been identified which are specialized to detect foreign nucleic acids. Tremendous progress has been made towards our understanding of the cellular and molecular processes that allow the distinction of self and foreign nucleic acids. Immune sensing of nucleic acids is critically involved in antiviral immunity and immune responses to intracellular bacteria. Infection and sterile inflammation are immanent consequences of dysfunctional immune sensing of self or non-self nucleic acids. A number of genetic diseases have been identified which are caused by erronous sensing of nucleic acids. This newly established field of nucleic acid immunity has great impact for the understanding of infectious and inflammatory diseases. New analytical measures are added to the current spectrum of immunodiagnostic procedures. This review intends to introduce this new exciting field and its consequences for the use of circulating nucleic acids in laboratory medicine. © 2016 Walter de Gruyter GmbH, Berlin/Boston.

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