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Göttingen, Germany

Timmermann A.,DRK Kliniken Berlin Westend | Timmermann A.,Universitatsklinikum Gottingen | Byhahn C.,Goethe University Frankfurt | Wenzel V.,Innsbruck Medical University | And 4 more authors.
Anasthesiologie und Intensivmedizin | Year: 2012

Successful management of the airway is one of the central tasks in emergency care medicine since the absence of adequate oxygenation and ventilation render all other measures void. Out-ofhospital airway management is markedly more difficult than in the hospital, since such factors as the state of the patient, the ambient situation, limited equipment and the individual experience of the medical personel all have a role to play. Tracheal intubation (ETI) continues to be regarded as the "gold standard" for airway securement, although data on the best procedure to use are not forthcoming. In addition there is a lack of evidence identifying the minimum number of successful in-hospital applications of a specific technique and the justification for its regular use ETI should be performed only by those who have mastered the technique. For such persons there should be documented evidence of supervised training involving at least 100 ETI's, and subsequently 10 ETI's a year performed in selected patients. Under pre-hospital conditions not more than two intubation attempts, each lasting not more than 30 seconds, should be undertaken. Between two attempts, mask ventilation should be applied. In the event of a failed ETI, or when the necessary requirements are absent, not more than two attempts to establish an extraglottic airway (EGA) should be made. EGA with a drainage channel should be applied and a gastric tube placed. After successful ETI and/or EGA, the airway should be secured via a coniotomy. When the airway has been secured, respiration must be monitored via capnography. In the event of circulatory failure, a second method should be used to detect an oesophageal misplacement. © Anästh Intensivmed 2012. Source


Israel C.W.,Klinik fur Innere Medizin Kardiologie | Anker S.D.,Charite - Medical University of Berlin | Hasenfuss G.,Universitatsklinikum Gottingen
Kardiologe | Year: 2012

As part of the 2010 focused update of ESC guidelines on device therapy in heart failure, the guidelines on pacemakers in the treatment of heart failure were renewed. A new feature is that cardiac resynchronization therapy (CRT) is indicated for New York Heart Association (NYHA) class III and IV irrespective of the presence of left ventricular dilatation and specified for NYHA class IV (patient ambulatory, stable, life expectancy >6 months). Furthermore, NYHA class II (but not class I) has been added when there is left bundle branch block and QRS duration =150 ms. CRT is also indicated for patients in NYHA class III-IV with permanent atrial fibrillation and heart failure [left ventricular ejection fraction (LVEF) = 35%] when QRS is = 130 ms and ventricular rate has slowed either spontaneously or by AV node ablation. In patients with heart failure (NYHA class II-IV, LVEF = 35%) who need a pacemaker for AV block, CRT is generally indicated to avoid progression of heart failure caused by right ventricular stimulation, also in cases of intrinsic QRS <120 ms. For patients with terminal heart failure who are not eligible for heart transplantation, treatment with a left ventricular assist device can be performed as destination therapy. The new guidelines expand the indication for device therapy in heart failure based on the newest study findings, particularly for patients in NYHA class II, and specify the old guidelines. There are still uncertainties that must be investigated in randomized trials regarding patients with permanent atrial fibrillation, the indication for CRT in heart block, and the question of CRT with pacemaker or defibrillator. © Deutsche Gesellschaft für Kardiologie-Herz- und Kreislaufforschung e.V. Published by Springer-Verlag - all rights reserved 2012. Source


Murawski N.,Universitatsklinikum des Saarlandes | Pfreundschuh M.,Universitatsklinikum des Saarlandes | Zeynalova S.,University of Leipzig | Poeschel V.,Universitatsklinikum des Saarlandes | And 10 more authors.
Annals of Oncology | Year: 2014

Background: To improve outcome of elderly patients with diffuse large B-cell lymphoma, dose-dense rituximab was evaluated in the prospective DENSE-R-CHOP-14 trial. Patients and methods: Rituximab (375 mg/m2) was given on days 0, 1, 4, 8, 15, 22, 29, 43, 57, 71, 85, and 99 together with six CHOP-14 cycles. Results were to be compared with patients who had received the same chemotherapy in combination with eight 2-week applications of rituximab in RICOVER-60. Results: One hundred twenty-four patients are assessable. Dose-dense rituximab resulted in considerably higher serum levels during the first 50 days of treatment, but rituximab exposure time was not prolonged. Grade 3 and 4 infections were exceptionally high in the first 20 patients without anti-infective prophylaxis, but decreased after introduction of prophylaxis with aciclovir and cotrimoxazole in the remaining 104 patients (from 13% to 6% per cycle and from 35% to 18% per patient; P = 0.007 and P = 0.125, respectively). Patients with international prognostic index = 3-5 had higher complete response/complete response unconfirmed rates (82% versus 68%; P = 0.033) than in the respective RICOVER-60 population, but this did not translate into better long-term outcome, even though male hazard was decreased (event-free survival: from 1.5 to 1.1; progression-free survival: from 1.7 to 1.1; overall survival: from 1.4 to 1.0). Conclusions: Dose-dense rituximab achieved higher rituximab serum levels, but was not more effective than eight 2-week applications in the historical control population, even though minor improvements in poor-prognosis and male patients cannot be excluded. The increased, though manageable toxicity, precludes its use in routine practice. Our results strongly support anti-infective prophylaxis with aciclovir and cotrimoxazole for all patients receiving R-CHOP. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source


Anders S.,Universitatsklinikum Hamburg Eppendorf | Strobel L.,Universitatsklinikum Gottingen | Krampe H.,Charite - Medical University of Berlin | Raupach T.,Universitatsklinikum Gottingen | Raupach T.,University College London
Deutsche Medizinische Wochenschrift | Year: 2013

Background and objective: Smoking and alcohol use disorders (AUD) are associated with significant morbidity and mortality in Germany. However, it has recently been shown that German medical students in years 1 to 5 do not feel competent to treat patients who are addicted to tobacco or alcohol. This study examined whether these deficits are also prevalent in students in the final (sixth) year of training. Methods: Students enrolled in the final year at University Medical Centre Hamburg-Eppendorf were invited to complete a questionnaire assessing smoking status and self-reported knowledge of health consequences of and treatment options for AUD and smoking as well as arterial hypertension and diabetes mellitus. Students were also asked to provide effectiveness estimates for different methods to treat AUD and smoking. Results: A total of 228 out of 345 students participated in the survey (response rate 66%). Smoking prevalence was 24%. Approximately 90% of students believed they knew how to treat arterial hypertension and diabetes mellitus, but less than a third thought they knew how to treat smokers and patients with AUD. Effectiveness ratings of treatments for the two addictive disorders revealed severe misconceptions. Conclusion: The deficits in undergraduate medical education regarding the treatment of addictive disorders reported for students from years 1 to 5 extend to students in the sixth year. Just before graduation, students still have severe knowledge gaps. In order to prevent tobacco- and alcohol-related deaths, medical school curricula need to be urgently improved. © 2013 Georg Thieme Verlag KG · Stuttgart · New York. Source


Patschan D.,Universitatsklinikum Gottingen | Patschan S.,Universitatsklinikum Gottingen | Wessels J.T.,Universitatsklinikum Gottingen | Becker J.U.,Institute For Pathologie | And 4 more authors.
American Journal of Physiology - Renal Physiology | Year: 2010

Endothelial progenitor cells (EPCs) protect kidneys from acute ischemic damage. The aim of this study was to identify "treatment parameters" that optimize an EPC-based therapy of acute ischemic renal failure. Male C57BL/6N mice underwent unilateral nephrectomy with simultaneous contralateral renal artery clamping for 30, 35, and 40 min. Tagged murine EPCs were systemically injected at the time of reperfusion. In some experiments, EPCs were pretreated with the Epac (exchange protein directly activated by cAMP-1) activator 8-pCPT-2′-O-Me-cAMP (Epac-1 Ac) and the integrin binding antagonist cyclic Arg-Gly-Asp peptide (cRGD). Injections of 106 EPCs after 30 and 35 min of renal ischemia protected animals from acute renal failure. The same effect occurred with 0.5 x 106 EPCs after a 35-min period of ischemia. If ischemia lasted for 40 min, 0.5 x 106 cells mice did not prevent acute renal failure. To analyze whether EPC integrin receptor activation would modify the cells' renoprotective activity, EPCs were pretreated with Epac-1 Ac. Such animals did not develop acute renal failure, even if ischemia lasted for 40 min. This effect was negated if the cells were pretreated with both Epac-1 Ac and cRGD. In kidneys from those animals medullopapillary EPCs were significantly accumulated. In vitro Epac-1 Ac preactivation of EPCs did not increase the overall expression intensity but induced a redistribution of β1-integrins toward the cell membranes. We conclude that EPC pretreatment with the integrin receptor activator 8-pCPT-2′-O-Me-cAMP augments the anti-ischemic potential of the cells. Copyright © 2010 the American Physiological Society. Source

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