Jacobi G.,Goethe University Frankfurt |
Dettmeyer R.,Justus Liebig University |
Banaschak S.,Universitatsklinikum Cologne AoR |
Brosig B.,Justus Liebig University |
Herrmann B.,Kinderklinik des Klinikums Kassel
Deutsches Arzteblatt | Year: 2010
Background: The findings of studies on the frequency of violence against children imply that many cases go undetected. Methods: Selective literature review based on a search of different databases for publications on all types of violence against children, except sexual abuse. Results: The physical abuse of children can involve blunt trauma, thermal injury, and the so-called shaking trauma syndrome (STS). Physical and psychological child neglect have very serious long-term effects. It can be difficult to draw a clear distinction of child abuse and neglect on the one hand, and acceptable behavior on the other, because of the varying social acceptance of certain child-raising practices. Münchhausen's syndrome by proxy (MSbP) is a rare, special type of child abuse. Conclusion: At the beginning of the 21st century, wellestablished normative structures are in place to protect children against abuse and neglect, and the available help from social organizations can also have a preventive effect. Further improvements will depend on interdisciplinary coordination and better training of specialists in all of the involved disciplines.
Von Tempelhoff W.,Universitatsklinikum Cologne AoR |
Ulrich F.,Neuro Unit |
Schwarzmaier H.-J.,VDI Technologiezentrum
Photonics and Lasers in Medicine | Year: 2014
Background: The most common type of primary brain tumors are gliomas. For patients unsuitable for open microsurgery having been treated by radiochemotherapy, laser irradiation has proven to be an alternative palliative option. From summer 1997 until winter 2006 we performed about 60 laser-interstitial thermotherapy (LITT) treatments, starting with patients with large recurrent tumors who had no other therapeutic option. In the present article we report about the neurobiological background, the technique and our experience with LITT of cerebral gliomas. Materials and method: For laser irradiation we used a specially designed light guide (LITT standard applicator; Trumpf Medizintechnik, Umkirch, Germany). The tip of this light guide is a special optical diffuser which is characterized by a homogeneous spherical or ellipsoid emission profile. The light guide was introduced into an appropriate protective sheath (Somatex, Teltow, Germany). For the laser light source, we used a continuous wave 1064-nm Nd:YAG laser (mediLas fibertom 4060 N; Dornier MedTech, Weβling, Germany). Laser irradiation was performed under general anesthesia in a 0.5 T open configuration magnetic resonance (MR) system (Signa SP; General Electric, Milwaukee, WI, USA). Usually, the tip of the light guide was positioned in the center of the tumor using the built-in localization system (Flashpoint 3000; IGT, Boulder, CO, USA) in combination, where appropriate, with a specially designed navigation system (Localite, Bonn, Germany). The position of the light guide was then controlled using multiplanar reconstructions of T1-weighted sequences. For near real-time control, temperature monitoring was performed using an experimental software package based on the temperature- dependent shift of the MR signal. Laser irradiation was ceased when the temperature monitoring revealed a steady state temperature profile within the heated tissue. Since 2008 we have used traditional stereotactic targeting and methionine positron emission tomography/computed tomography (MET-PET/CT) instead of the 'open' MR system for planning and follow-up in LITT of brain tumors. Results: We started the LITT treatment of gliomas in the early 1990s (benign gliomas in eloquent regions/not suitable for surgery). In 1997 we started to treat patients with recurrent gliobastomas/anaplastic gliomas. All of these patients had an increased survival in comparison to the natural course of recurrent glioblastomas. There were no procedure-related deaths or permanent neurological deficits. Two factors seem to be important for the overall success of the LITT procedure: 1) an early enrollment in the LITT therapy after diagnosis of a tumor recurrence, and 2) a corresponding smaller tumor mass at the beginning of the therapy. Conclusion: Cytoreduction by laser irradiation seems to be a promising option for patients suffering from gliomas.
Mallmann P.,Universitatsklinikum Cologne AoR |
Mallmann C.,Franklin University
Oncology Research and Treatment | Year: 2016
Neoadjuvant chemotherapy is indicated in patients who can tolerate the side effects of a chemotherapy and with preoperative presentation of one of the following clinical risk situations: bulky disease with a maximal tumor diameter of > 4 cm, suspicious lymph nodes in magnetic resonance imaging (MRI), computed tomography (CT) scan or endosonography, histopathologically confirmed lymph node metastasis, or histopathologically documented risk factors such as G3 and L1V1. A neoadjuvant chemotherapy followed by surgery should be performed with cisplatin at a dosage of > 25 mg/m2 per week and an application interval of < 14 days. The previously published data suggests an improved rate of complete resection and reduced incidences of positive lymph nodes and parametric infiltration. Accordingly, the percentage of patients in need for adjuvant radiochemotherapy after operation can be significantly reduced. Some studies demonstrated a prolongation of progression-free and overall survival. Following the previously published studies, adjuvant chemotherapy after operation or after radiochemotherapy has no significant effect on the overall survival and, following the current guidelines, should be avoided. © 2016 S. Karger GmbH, Freiburg.
Rothschild M.A.,Universitatsklinikum Cologne AoR |
Kneubuehl B.P.,University of Bern
Rechtsmedizin | Year: 2010
In ballistics, especially wound ballistics, a large number of misconceptions and false conclusions concerning findings and their causes exist. On the other hand these misconceptions can be easily corrected by using objective scientific methods and tools. For performing experiments in wound ballistics glycerine soap and gelatine should be used when human soft tissue has to be simulated. Gunshots into the air can be dangerous to life as the falling bullets have enough energy to penetrate skin and bones; exceptions are air gun and shotgun pellets which do not have enough energy to penetrate skin when descending. When a bullet hits bone the bone fragments will not receive enough energy to act as secondary projectiles themselves. Shots from handguns are not able to produce enough power to stop a person or throw a person backwards. Blank shots from alarm pistols are dangerous to life when fired at point blank range: the gas jet exiting the muzzle has such a high velocity that a high energy density will result which gives the jet the character of a solid projectile. The effect of a gunshot is an individual event which depends on a number of factors (e.g. localization of the entrance wound and wound canal, psychological state, intoxication and pathological state of organs). Effectiveness means the wounding potential and is dependent on the energy of the bullet and its ability to transfer the energy along the wound canal. © Springer-Verlag 2010.
Mosges R.,Universitatsklinikum Cologne AoR
HNO | Year: 2016
Georg Schlöndorff (1931–2011) developed the idea of computer-assisted surgery (CAS) during his time as professor and chairman of the Department of Otorhinolaryngology at the Medical Faculty of the University of Aachen, Germany. In close cooperation with engineers and physicists, he succeeded in translating this concept into a functional prototype that was applied in live surgery in the operating theatre. The first intervention performed with this image-guided navigation system was a skull base surgical procedure 1987. During the following years, this concept was extended to orbital surgery, neurosurgery, mid-facial traumatology, and brachytherapy of solid tumors in the head and neck region. Further technical developments of this first prototype included touchless optical positioning and the computer vision concept with three orthogonal images, which is still common in contemporary navigation systems. During his time as emeritus professor from 1996, Georg Schlöndorff further pursued his concept of CAS by developing technical innovations such as computational fluid dynamics (CFD). © 2016 Springer-Verlag Berlin Heidelberg
Rothschild M.A.,Universitatsklinikum Cologne AoR
Rechtsmedizin | Year: 2011
Gunshot injuries to the head usually present special findings due to the anatomical conditions of the head (brain enclosed in a relatively solid skull capsule). From a physical wound ballistic view the brain is a very inelastic and incompressable object/tissue. In general this is the reason why gunshots to the head lead to lethal fluid dynamic effects even when no vitally important structures have been directly injured. Severe brain injuries can occur even distant from the wound canal mainly due to distensional and shearing for-ces during the development of the temporary wound cavity. The lower the cross-sectional density and the more energy a bullet has, the more these effects will be pronounced. Even gunshots with caliber 9 mm Luger can result in hydraulic pressure effects with development of complex fracturing of the skull. © 2011 Springer-Verlag.
Marnitz S.,Universitatsklinikum Cologne AoR
Onkologe | Year: 2016
Chemoradiotherapy is an integral component of cervical cancer treatment in cases where surgery alone is not sufficient to achieve an optimal oncological outcome. The present German interdisciplinary guidelines on treatment of cervical cancer recommend performing either radical hysterectomy or primary chemoradiotherapy. The frequently used practice of trimodal therapy (i.e. radical hysterectomy, radiation and chemotherapy) doubles the risk for treatment-related delayed toxicity and should be avoided whenever possible. If risk factors are known prior to therapy, e. g. lymph node metastases, parametrial infiltration or a combination of tumor size >4 cm, grade 3, lymphovascular space invasion (LVSI) or deep stromal infiltration, primary chemoradiotherapy should be recommended. The purely clinical FIGO classification does not consider lymph node involvement. This leads to a high rate of adjuvant chemoradiotherapy after radical surgery due to lymph node involvement. This could have been avoided in 90 % of patients, if surgical (laparoscopic) lymph node staging would have been used routinely. Whether this can result in advantages for patients with respect to the prognosis, was one of the aims of the Uterus-11 study of the working group for gynecological oncology (AGO) and the working group on radiological oncology (ARO).Mature data are expected to be available in 2018. For chemoradiotherapy sophisticated irradiation techniques should be used, which are available in all German treatment facilities. This is the only way to reduce acute and delayed side effects. Although ovarian preservation by ovarian transposition and organ sparing can be provided to premenopausal patients, a pregnancy after full-dose chemoradiotherapy is unlikely because of the resulting atrophy of the endometrium and fibrosis of the myometrium. Oncological results depend on treatment quality, full-dose external beam radiation, the use of brachytherapy and the administration of concomittant chemotherapy. The experience of the treatment facility is a predictor for patient outcome. The value of neoadjuvant chemotherapy in locally advanced cervical cancer is unclear and still under discussion. © 2016, Springer-Verlag Berlin Heidelberg.
Loeser J.,Universitatsklinikum Cologne AoR |
Pilgram B.,Universitatsklinikum Cologne AoR |
Dagtekin O.,Universitatsklinikum Cologne AoR
Schmerz | Year: 2012
We report the case of a 39-year-old female patient who suffered from trigeminal neuralgia of the left lingual nerve for 6 years. The previous therapy according to the guidelines including a Jannetta operation was unsuccessful. Only after beginning with daily mastication and consumption of very hot chilli peppers has the patient become reliably pain-free. © Deutsche Schmerzgesellschaft e.V.
Ninke T.,Ludwig Maximilians University of Munich |
Thoma-Jennerwein S.,Ludwig Maximilians University of Munich |
Blunk J.,Universitatsklinikum Cologne AoR |
Annecke T.,Universitatsklinikum Cologne AoR
Anaesthesist | Year: 2015
During the perioperative and postoperative care of pregnant women it is prudent to pay close attention to the changed physiology of these patients. The main principles of care are the preservation of maternal and fetal homeostasis as well as avoidance of any substances with toxic effects on the fetus. In order to provide pregnant patients with good quality care, all relevant disciplines should be involved as early as possible. Modern anesthetic drugs can be used as they seem to be without teratogenic effects. Adequate perioperative surveillance and assessment of the fetus is also important. The mainstay of pain management during pregnancy is the World Health Organization (WHO) pain ladder. It is of the utmost importance to use only substances without teratogenic or fetotoxic properties. Considering non-opioid drugs, the use of paracetamol is a viable option, whereas non-steroidal anti-inflammatory drugs (NSAID) should only be used with rigorous restrictions. Tramadol is a first-line drug when using opioids with low potency, whereas morphine can be used as an opioid with a higher potency after careful consideration of the risk-benefit ratio. If possible anticonvulsives should not be used as an adjunct in pain management during pregnancy. The use of thoroughly investigated antidepressants seems to be a better alternative. Apart from drug therapy it is important to use all available conservative pain treatment options. © 2015, Springer-Verlag Berlin Heidelberg.
Drinhaus H.,Universitatsklinikum Cologne AoR |
Nusgen S.,Feuerwehr der Stadt Bruhl |
Hinkelbein J.,Universitatsklinikum Cologne AoR
Anaesthesist | Year: 2016
Background: Being called to a firefighting operation is a rare albeit typical scenario for emergency physicians, which apart from medical expertise requires efficient collaboration with the firefighting team. Aim: This article outlines the characteristics of collaboration with the team and incident commanders of the fire service and of the medical aspects in firefighting operations, whereby treating the victims of fire as well as hazards to the firefighters are considered. Method: This overview is based on a selective search of the literature and own experiences in emergency medicine and firefighting. Results: Collaboration with the fire service needs to respect the organizational and leadership structures at the scene. Firefighting staff are mainly endangered by the enormous cardiopulmonary strain of the mission, by the rapid development of fire phenomena as well as diverse kinds of accidents. The main features of fire victims are smoke intoxication, burns as well as other injuries. Choosing the right hospital for optimal treatment is crucial. Conclusion: Medical expertise and basic knowledge of methods and tactics employed by the fire service are prerequisites for successful participation as an emergency physician in a firefighting operation. An integrative view of all aspects of injuries of the fire victims and the subsequent therapeutic decisions represent special challenges, which have not yet received much attention in the medical literature. © 2015, Springer-Verlag Berlin Heidelberg.