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Schneider J.,Universitatsklinikum Giessen | Arhelger R.,Universitatsklinikum Giessen | Funk M.,Universitatsklinikum Giessen
Clinical Respiratory Journal | Year: 2014

Introduction: Exercise intolerance is typical for asbestosis. We examined the correlation of spiroergometric parameters with severity of asbestosis according to the International Labour Office (ILO) classification. Patients were compared to a healthy control group. Objectives: Nineteen consecutive male patients with compensated asbestosis and 24 healthy subjects were examined. Methods: All participants underwent pulmonary functional testing including maximal cardiopulmonary exercise testing (CPET). Results were compared to those of healthy subjects; the correlation to disease status was investigated. Results: Significantly lower VCin, FVC, FEV1, MEF50, TLC and PaO2 at rest (P<0.001) were observed in asbestosis patients. Lower peak (weight-related) work rate (WR, WR/kg), (weight-related) oxygen uptake (V'O2, V'O2/kg), oxygen pulse (V'O2/hr), ventilation volume (V'E), carbon dioxide output (V'CO2) and blood lactate was associated (P<0.001) with more severe asbestosis according to the ILO-classification. Significant positive correlations (P<0.001) were seen for alveolar-arterial oxygen difference [P(A-a)O2] and PaCO2. Multiple regression analysis revealed that asbestosis was the only significant factor associated with the spiroergometric parameters (P<0.001). A reduction of V'O2, V'O2/kg, V'O2/hr, V'E, or V'CO2 at identical submaximal workload could neither be detected among the asbestosis severity nor in comparison to healthy subjects. Only the respiratory frequency was depending on severity of asbestosis. Conclusions: The severity of asbestosis correlates with maximal WR, V'O2, V'O2/hr, V'E and gas exchange. At identical workload the discrimination between patients and controls was only possible concerning the respiratory frequency. For detection of limitations in asbestosis patients, maximal CPET is recommended. © 2013 John Wiley & Sons Ltd.


Maier G.S.,Justus Liebig University | Maier G.S.,Johannes Gutenberg University Mainz | Maier G.S.,Universitatsklinikum Giessen | Horas K.,University of Sydney | And 4 more authors.
International Orthopaedics | Year: 2014

Purpose: Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection. Methods: Serum 25-hydroxyvitamin D (25OHD) levels of every patient scheduled to receive a total prosthesis either of the hip, knee, or shoulder in the orthopaedic department of the Johannes-Guttenberg-University Hospital in Mainz, Germany (109 patients), were measured after admission. Furthermore, serum 25OHD levels were measured for every patient presenting with periprosthetic joint infection (n=50) or aseptic loosening of the prosthesis (n=31) scheduled to undergo revision surgery. The prevalence of normal (>30 ng/ml), insufficient (20-30 ng/ml), and deficient (<20 ng/ml) 25OHD levels was determined. Results: All tested patient subgroups showed low vitamin D levels. Statistical analysis found no significant difference in vitamin D levels comparing patients with prosthesis and patients with aseptic prosthesis loosening (p=0.58). Significant differences in 25OHD levels were found comparing patients with periprosthetic joint infection and patients scheduled for primary arthroplasty (p<0.001). In addition, we found a significant difference (p<0,001) in 25OHD levels of patients with periprosthetic joint infection compared with patients with aseptic prosthesis loosening. Conclusion: We found a high frequency of vitamin D deficiency in patients being treated by primary arthroplasty and those with aseptic joint prosthetic loosening and periprosthetic joint infection. Vitamin D deficiency was severe in patients with periprosthetic joint infection. © 2014 Springer-Verlag.


Bajanowski T.,University of Duisburg - Essen | Puschel K.,Universitatsklinikum Hamburg Eppendorf | Dettmeyer R.,Universitatsklinikum Giessen
Pathologe | Year: 2012

Sudden cardiac death is one of the most common causes of death and a significant number of sudden deaths occurs especially in young people. Sudden cardiac death is also frequently represented in forensic autopsy practice. In such cases pathological findings in the heart can often explain the reason for the acute death. These pathological changes include not only myocardial infarction, coronary thrombosis and all forms of myocarditis/endocarditis but also rare diseases, such as hereditary structural or arrythmogenic anomalies, lesions of the cardiac conduction system or primary cardiac tumors. © Springer-Verlag 2012.


Maier G.S.,Justus Liebig University | Maier G.S.,Johannes Gutenberg University Mainz | Maier G.S.,Universitatsklinikum Giessen | Jakobs P.,Johannes Gutenberg University Mainz | And 3 more authors.
Clinical Orthopaedics and Related Research | Year: 2013

Background: Vitamin D plays an essential role in bone health and muscle function. Some studies have shown a widespread rate of vitamin D deficiency in the general population, but few have reported on the vitamin D status of orthopaedic patients. Questions/purposes: We investigated (1) the extent of hypovitaminosis D in orthopaedic patients, (2) seasonal variations in vitamin D levels, and (3) possible risk factors for insufficient vitamin D levels. Methods: Vitamin D levels in 1119 patients consecutively admitted to an orthopaedic surgery department in 2011 were measured. To investigate the correlation between climate factors and vitamin D levels, the sunshine hours for each month in 2011 were collected by Deutscher Wetterdienst (the German weather service) in the region where most tested patients lived. The prevalence of normal (> 30 ng/mL), insufficient (20-30 ng/mL), and deficient (< 20 ng/mL) 25-hydroxyvitamin D levels was determined. Univariate and multivariate analyses were used to assess risk factors for insufficient vitamin D levels. Results: Overall, 84% of patients had insufficient levels of vitamin D and 60% were vitamin D deficient. Only 15% were in the target range of 30 to 60 ng/mL. The prevalence of low vitamin D levels was greater during winter and months with fewer sunshine hours. Vitamin D levels did not vary according to age, sex, and disease. Individuals with obesity, hypertension, and osteoporosis were more likely to have low vitamin D levels compared with their healthy counterparts. Conclusions: There is an alarmingly high rate of hypovitaminosis D and vitamin D deficiency among orthopaedic patients in this region of Germany, whose latitude (50 N) is approximately the same as those of Vancouver (49, 15' N) and Paris (48, 51' N). Given the well-known effects on bone metabolism and muscle health, low vitamin D levels may negatively affect patients. Screening and treating hypovitaminosis D appears to be important in this patient population. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.


Beetz R.,Johannes Gutenberg University Mainz | Wagenlehner F.,Universitatsklinikum Giessen
Urologe - Ausgabe A | Year: 2013

In infants and young children, urinary tract infections (UTI) often present with unspecific symptoms. Appropriate techniques of urine sampling play an important role for accurate microbiological diagnosis. In infants urine sampling by bladder puncture or transurethral catheter is recommended. In young infants with suspected pyelonephritis, calculated antibiotic treatment should be initiated parenterally with a combination of a third generation cephalosporin or an aminoglycoside with ampicillin. After the age of 3-6 months group 3 oral cephalosporins can be used in uncomplicated pyelonephritis. With the first febrile UTI early sonography is recommended to provide information about renal parenchymal involvement and to exclude malformations of the kidneys and urinary tract. Strategies for the recognition of vesicoureteral reflux and renal damage are under discussion. Recently published guidelines by the American Academy of Pediatrics for the diagnosis and management of UTI in febrile children and infants aged 2-24 months will most likely influence the still pending German guidelines. © 2013 Springer-Verlag Berlin Heidelberg.


Seyfer P.,Universitatsklinikum Giessen
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren | Year: 2014

Purpose: To assess ultrasmall superparamagnetic iron oxide particles (USPIO) -enhanced MR imaging for the differentiation of malignant from benign, inflammatory lesions. Materials and Methods: In this study, approved by the local animal care committee, VX2 carcinoma and intramuscular abscesses were implanted into the hind thighs of New Zealand White rabbits. MR imaging was performed pre contrast and serially for 24 h after the injection of USPIO. MR findings were compared with histopathologic results based on Prussian blue stains for the presence of iron. Results: Twenty-four hours after the Ferumox-tran-injection, no changes were observed in VX2 carcinomas, whereas a mean reduction of the contrast-to-noise ratio (CNR) of approximately 90 % was noticed in abscesses as well as in necrotic tumors. On histopathologic examination, abscess and necrotic parts of the tumor were found to include iron-containing monocytes demonstrating that the reduction in CNR was caused by USPIO-tagged monocytes. Conclusion: Our results prove the ability of US-PIO-enhanced MRI to differentiate benign, inflammatory from malignant lesions. © Georg Thieme Verlag KG.


Lorch A.,Universitatsklinikum Giessen | Rick O.,Klinik Reinhardshohe | Wundisch T.,Universitatsklinikum Giessen | Hartmann J.-T.,University Hospital of Tuebingen | And 2 more authors.
Journal of Urology | Year: 2010

Purpose: We assessed the activity of high dose chemotherapy in patients with unresectable late relapse germ cell tumors. Materials and Methods: A total of 35 patients with late relapse were included in a group of 216 treated with high dose chemotherapy as first or subsequent salvage treatment in a prospective, randomized, multicenter phase III trial comparing single vs sequential high dose chemotherapy. Late relapse was defined as unequivocal evidence of relapse more than 2 years after completion of cisplatin based chemotherapy. All patients were considered to have unresectable, progressive, late relapse germ cell tumors. Responders were scheduled for surgical resection of all residual lesions when technically feasible. Results: We identified 4 late relapse groups, including late relapse in 20 of 35 patients (57%) after first line treatment (group 1), in 4 (11%) after first salvage treatment (group 2), in 4 (11%) after initial and after first salvage treatment (group 3), and in 7 (20%) after first line treatment and salvage treatment with rapid progression thereafter who were randomized to a high dose chemotherapy trial (group 4). Median time to late relapse was 4.7 years (range 2.1 to 18.3) in all groups. Resection of all residual lesions could be done in 15 of 35 patients (43%). At a median followup of 5.6 years (range 1.9 to 8.5) 5 of 35 patients (14%) had no progression, resulting in 15% projected progression-free survival. Conclusions: Management for unresectable late relapse germ cell tumors remains controversial. High dose chemotherapy followed by resection of all residual lesions can result in long-term remission in individuals. © 2010 American Urological Association Education and Research, Inc.


Schneider J.,Universitatsklinikum Giessen | Baur X.,Charité - Medical University of Berlin
Atemwegs- und Lungenkrankheiten | Year: 2014

Asbestos-related diseases are the most common compensated occupational diseases. Diagnosis and evaluation of such diseases require particular expertise in causal relationship based on qualified work history with detailed information on the quality and quantity of the hazardous substance exposures. Lung dust analysis can not replace the findings from the work history and investigations by the occupational hygienist. Based on case reports i) of a patient with asbestos-related lung cancer the problems resulting by calculation of the cumulative asbestos dust exposure are reported, ii) of a patient with lung asbestosis following misinterpretation of bio-monitoring. Due to deficits in prescribed documentation and declaration of exposure, many occupational diseases procedures and lawsuits exhibit irreversible proof gaps. The detailed work history by the medical expert complements the technical investigations and is considered a centrally important source of information. © 2014 Dustri-Verlag Dr. Karl Feistle.


Akashi Y.J.,St. Marianna University School of Medicine | Nef H.M.,Universitatsklinikum Giessen | Lyon A.R.,Imperial College London
Nature Reviews Cardiology | Year: 2015

Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, often in a circumferential apical, mid-ventricular, or basal distribution. Several pathophysiological explanations have been proposed for this syndrome and its intriguing appearance, and awareness is growing that these explanations might not be mutually exclusive. The reversible apical myocardial dysfunction observed might result from more than one pathophysiological phenomenon. The pathophysiology of Takotsubo syndrome is complex and integrates neuroendocrine physiology, potentially involving the cognitive centres of the brain, and including the hypothalamic-pituitary-adrenal axis. Cardiovascular responses are caused by the sudden sympathetic activation and surge in concentrations of circulating catecholamines. The multiple morphological changes seen in the myocardium match those seen after catecholamine-induced cardiotoxicity. The acute prognosis and recurrence rate are now known to be worse than initially thought, and much still needs to be learned about the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways. © 2015 Macmillan Publishers Limited.


Stummer W.,Universitatsklinikum Munster | Tonn J.-C.,Ludwig Maximilians University of Munich | Mehdorn H.M.,Universitatsklinikum Schleswig Holstein Campus Kiel | Nestler U.,Universitatsklinikum Giessen | And 4 more authors.
Journal of Neurosurgery | Year: 2011

Object. Accumulating data suggest more aggressive surgery in patients with malignant glioma to improve outcome. However, extended surgery may increase morbidity. The randomized Phase III 5-aminolevulinic acid (ALA) study investigated 5-ALA-induced fluorescence as a tool for improving resections. An interim analysis demonstrated more frequent complete resections with longer progression-free survival (PFS). However, marginal differences were found regarding neurological deterioration and the frequency of additional therapies. Presently, the authors focus on the latter aspects in the final study population, and attempt to determine how safety might be affected by cytoreductive surgery. Methods. Patients with malignant gliomas were randomized for fluorescence-guided (ALA group) or conventional white light (WL) (WL group) microsurgery. The final intent-to-treat population consisted of 176 patients in the ALA and 173 in the WL group. Primary efficacy variables were contrast-enhancing tumor on early MR imaging and 6-month PFS. Among secondary outcome measures, the National Institutes of Health Stroke Scale (NIH-SS) score and the Karnofsky Performance Scale (KPS) score were used for assessing neurological function. Results. More frequent complete resections and improved PFS were confirmed, with higher median residual tumor volumes in the WL group (0.5 vs 0 cm3, p = 0.001). Patients in the ALA group had more frequent deterioration on the NIH-SS at 48 hours. Patients at risk were those with deficits unresponsive to steroids. No differences were found in the KPS score. Regarding outcome, a combined end point of risks and neurological deficits was attempted, which demonstrated results in patients in the ALA group to be superior to those in participants in the WL group. Interestingly, the cumulative incidence of repeat surgery was significantly reduced in ALA patients. When stratified by completeness of resection, patients with incomplete resections were quicker to deteriorate neurologically (p = 0.0036). Conclusions. Extended resections performed using a tool such as 5-ALA-derived tumor fluorescence, carries the risk of temporary impairment of neurological function. However, risks are higher in patients with deficits unresponsive to steroids.

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