Universitatsklinikum Gottingen

Göttingen, Germany

Universitatsklinikum Gottingen

Göttingen, Germany
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Saul D.,Universitatsklinikum Gottingen | Lehmann W.,Universitatsklinikum Gottingen
Trauma und Berufskrankheit | Year: 2017

Forearm fractures are common bony injuries in adults. Simple diaphyseal fractures of both radius and ulna must be distinguished from complex Galeazzi, Monteggia and Essex-Lopresti injuries. After radiological diagnosis, operative treatment is usually required. The forearm forms a functional joint; therefore, anatomical reconstruction must be carefully carried paying particular attention to the rotational and longitudinal axes. Reduction is conducted with a 3.5 mm limited-contact dynamic compression plate (LCDCP) using 2 separate approaches for both bones with at least 3 bicortical screws at each fracture site. Interfragmentary traction screws are used if necessary and early postoperative functional mobilization is desirable. Plate removal is indicated if the implant causes discomfort. © 2017 Springer Medizin Verlag GmbH

Caironi P.,University of Milan | Cressoni M.,University of Milan | Ranieri M.,University of Turin | Quintel M.,Universitatsklinikum Gottingen | And 5 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2010

Rationale:Theeffects of high positive end-expiratory pressure (PEEP) strictly depend on lung recruitability, which varies widely during acute respiratory distress syndrome (ARDS). Unfortunately, increasing PEEP may lead to opposing effects on two main factors potentially worsening the lung injury, that is, alveolar strain and intratidal opening and closing, being detrimental (increasing the former) or beneficial (decreasing the latter). Objectives: To investigate how lung recruitability influences alveolar strainandintratidalopeningandclosing after the application of high PEEP. Methods:We analyzed data from a database of 68 patients with acute lung injury or ARDS who underwent whole-lung computed tomography at 5, 15, and 45 cm H 2O airway pressure. Measurements and Main Results: End-inspiratory nonaerated lung tissue was estimated from computed tomography pressure - volume curves. Alveolar strain and opening and closing lung tissue were computed at 5 and 15 cm H 2O PEEP. In patients with a higher percentage of potentially recruitable lung, the increase in PEEPmarkedly reduced opening and closing lung tissue (P < 0.001), whereas no differences were observed in patients with a lower percentage of potentially recruitable lung. In contrast, alveolar strain similarly increased in the two groups (P = 0.89). Opening and closing lung tissuewasdistributedmainly in the dependent andhilar lung regions, andit appearedtobe an independent risk factor fordeath (odds ratio, 1.10 for each 10-g increase). Conclusions: In ARDS, especially in patients with higher lung recruitability, the beneficial impact of reducing intratidal alveolar opening and closing by increasing PEEP prevails over the effects of increasing alveolar strain.

PubMed | Anasthesiologie, Universitatsklinikum Marburg, Universitatsklinikum Gottingen, Klinik fur Anasthesiologie and 2 more.
Type: | Journal: Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen | Year: 2017

To improve perioperative quality and patient safety, the German S3guideline should be consistently implemented to avoid perioperative hypothermia. Perioperative normothermia is a quality indicator and should be achieved by anesthesiologists and surgeons. To detect hypothermia early during the perioperative process, measuring body temperature should be started 1-2h preoperatively. Patients should be actively warmed for 20-30min before starting anesthesia. Prewarming is most effective and should be included in the preoperative process. Patients should be informed about the risks of perioperative hypothermia and members of the perioperative team should be educated. Astandard operating procedure (SOP) to avoid hypothermia should be introduced in every operative unit. The incidence of postoperative hypothermia should be evaluated in operative patients every 3-6months. The goals should be to measure body temperature in >80% of patients undergoing surgery and for >70% to exhibit a core temperature >36C at the end of surgery.

Israel C.W.,Klinik fur Innere Medizin Kardiologie | Anker S.D.,Charité - 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.

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.

Patschan D.,Universitatsklinikum Gottingen | Hildebrandt A.,Universitatsklinikum Gottingen | Rinneburger J.,Universitatsklinikum Gottingen | Wessels J.T.,Universitatsklinikum Gottingen | And 5 more authors.
American Journal of Physiology - Renal Physiology | Year: 2012

Endothelial progenitor cells (EPCs) protect the kidney from acute ischemic injury. The aim of this study was to analyze whether pretreatment of murine "early outgrowth" EPCs (eEPCs) with the hormone melatonin increases the cells' renoprotective effects in the setting of murine acute ischemic renal failure. Male (8-12 wk old) C57Bl/6N mice were subjected to unilateral ischemia-reperfusion injury postuninephrectomy (40 min). Postischemic animals were injected with either 0.5×106 untreated syngeneic murine eEPCs or with cells, pretreated with melatonin for 1 h. Injections were performed shortly after reperfusion of the kidney. While animals injected with untreated cells developed acute renal failure, eEPC pretreatment with melatonin dramatically improved renoprotective actions of the cells. These effects were completely reversed after cell pretreatment with melatonin and the MT-1/-2 antagonist luzindole. In vitro analysis revealed that melatonin reduced the amount of tumor growth factor-β-induced eEPC apoptosis/necrosis. Secretion of vascular endothelial growth factor by the cells was markedly stimulated by the hormone. In addition, migratory activity of eEPCs was enhanced by melatonin and supernatant from melatonin-treated eEPCs stimulated migration of cultured mature endothelial cells. In summary, melatonin was identified as a new agonist of eEPCs in acute ischemic kidney injury. © 2012 the American Physiological Society.

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.

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.

Wittekind C.,University of Leipzig | Strobel P.,Universitatsklinikum Gottingen
Onkologe | Year: 2015

Background and aims: The profile of pathology is changing and therefore the demands on the specialty are increasing. Several special aspects have to be considered when dealing with tumors after neoadjuvant therapy. This review covers developments from translational research with implications for the histopathological work-up of patients with rectal cancer. Methods: Based on a manual review of English and German language scientific articles covering the years 2002–2014 new aspects of the molecular pathogenesis of rectal cancer were evaluated as to their relevance for the diagnostics, therapy and pathological classification of rectal cancer. Results: Several specific aspects in the diagnostic work-up of rectal cancer specimens after neoadjuvant treatment have to be considered by the pathologist. In spite of a clearer understanding of the biology of colorectal cancer, there are currently no generally accepted biomarkers that allow prediction of the response to neoadjuvant therapy. Conclusion: Neoadjvant therapy in patients with rectal cancer induces a spectrum of different reactions both local and systemic that are not yet fully understood. Only a better conception of the tumor biology will help to develop therapeutic strategies that will help to improve the prognosis of these patients. © 2015, Springer-Verlag Berlin Heidelberg.

Van Neerven S.,RWTH Aachen | Regen T.,Universitatsklinikum Gottingen | Wolf D.,RWTH Aachen | Nemes A.,RWTH Aachen | And 4 more authors.
Journal of Neurochemistry | Year: 2010

The production of chemokines by astrocytes constitutes an important component of neuroinflammatory processes in the brain. As the transcriptional activator retinoic acid (RA), used for chemotherapy and dermatological applications, exerts anti-inflammatory effects on monocytes and lymphocytes, we have tested whether the physiologically occurring isomer, all-trans RA, affects chemokine expression by astrocytes. Under control conditions, primary cultures of murine cortical astrocytes expressed no or very low levels of CCL and CXCL chemokines. After treatment with bacterial lipopolysaccharides to simulate inflammation in vitro, we detected a strong increase in the release of CCL2 (to > 4 ng/mL in cell culture supernatant), CCL3 (> 20 ng/mL), CCL5 (> 25 ng/mL), CXCL1 (> 30 ng/mL) and CXCL2 (> 20 ng/mL). Although simultaneous exposure to RA did not significantly affect this response, 12 h pre-treatment with 0.1 μM all-trans RA strongly suppressed mRNA expression and protein release of all chemokines. The anti-inflammatory activity of RA engaged RA and retinoid X receptors and correlated with a decreased expression of the lipopolysaccharides co-receptor CD14. A minor reduction of nuclear NF-κB was observed but not significant, activation of Jun amino-terminal kinase, p38 and signal transducer and activator of transcription 3 were not altered by RA. The results suggest that retinoids should be further investigated as candidates for the treatment of neuroinflammation. © 2010 International Society for Neurochemistry.

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