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Landshut, Germany

Ambe P.C.,Witten/Herdecke University | Weber S.A.,St. Elisabeth Hospital Hohenlind | Wassenberg D.,Visceral and Thoracic Surgery
BMC Surgery | Year: 2015

Background: The male gender is considered a risk factor for complications in patients undergoing laparoscopic cholecystectomy. The reasons for this gender associated risk are not clearly understood. The extent of gallbladder inflammation has been shown to influence surgical outcome. The aim of this study was to investigate whether or not gallbladder inflammation is more severe in male patients presenting with acute cholecystitis. Methods: A retrospective gender dependent comparison of the data of patients undergoing laparoscopic cholecystectomy for acute cholecystitis in a primary care facility within a five-year period was performed. Results: 138 patients, 69 males and 69 females were included for analysis. Severe gallbladder inflammation (gangrenous and necrotizing cholecystitis) was seen in a significant portion of the male population compared to the female population (p = 0.002). The male gender was confirmed in a multivariate analysis as an independent risk factor for severe cholecystits (p = 0.018). Conclusion: The male gender is a risk factor for severe gallbladder inflammation. An early surgical intervention may be needed to prevent complications. © 2015 Ambe et al.; licensee BioMed Central. Source


Eckmann C.,Leibniz University of Hanover | Shekarriz H.,Visceral and Thoracic Surgery
European Infectious Disease | Year: 2012

Recommendations for the treatment of intra-abdominal infections (IAIs) caused by resistant bacteria often fail to mention bacteria of concern (e.g. methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum β-lactamase-producing Enterobacteriaceae, multi-drug-resistant Pseudomonas spp., carbapenem-resistant organisms and Acinetobacter spp.) and all available drugs. The group of patients with IAIs suffering from resistant bacteria comprises the entire group of post-operative and tertiary peritonitis or necrotising pancreatitis. This article tries to add some information for the management of a very important group of diseases with substantial morbidity and mortality. An individual patient-centred approach is mandatory for evaluating the optimal antimicrobial treatment regimen. Especially where the predominant cause is Gram-negative bacteria, only a few options remain for treatment. Clinical data with a high level of evidence are very limited. Future studies should focus on pharmacokinetic and pharmacodynamic aspects in critically ill patients in order to elucidate the 'real-life' efficacy and safety of antibiotics for the treatment of these life-threatening IAIs. Source


Julich H.,Saarland University | Willms A.,Visceral and Thoracic Surgery | Lukacs-Kornek V.,Saarland University | Kornek M.,Saarland University
Frontiers in Immunology | Year: 2014

Cell derived vesicles; in particular extracellular vesicles (EVs) such as microparticles (MPs) and microvesicles (MVs) besides exosomes are raising more and more attention as a novel and unique approach to detect diseases. It has recently become apparent, that disease specific MP signatures or profiles might be beneficial to differentiate chronic liver diseases such as non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CHC), to monitor their progression or possibly to assess treatment outcome. Therefore EVs might serve as a novel inexpensive and minimally invasive method to screen risk patients for the outbreak of a disease even before the initial symptoms, to follow up treatment complications and disease relapse. The purpose of the current review is to summarize already published EVs signatures for a limited number of exemplary diseases and to discuss their possible impact. Additionally, it will be discussed if the combination of EV profiling and miRNA profiling could be a future joint tool for the purpose of detecting cancer and from far larger interest to ultimately distinguish among various tumor entities. EVs might increase the chance of early detection of chronic diseases or cancers especially if applied as part of yearly health screenings in the future. © 2014 Mich, Willms, Lukacs-kornek and Kornek. Source


Hauer T.,Visceral and Thoracic Surgery | Huschitt N.,Visceral and Thoracic Surgery | Palm H.-G.,Military Hospital Ulm
Langenbeck's Archives of Surgery | Year: 2011

Introduction: In 2010, the world witnessed 32 wars and other armed conflicts. Epidemiological analyses of mechanisms and patterns of injury of soldiers sent into these conflicts can be utilised to identify the surgical expertise that is required in a combat setting providing important parameters to adjust medical infrastructure and training requirements for future Military Surgeons. Experiences: Today in 2011, the German Bundeswehr runs a combat support hospital (role 3) in Mazar-e-Sharif in Northern Afghanistan providing a multidisciplinary capability profile. Furthermore, there are two role 2 medical treatment facilities (rescue centres) in Kunduz and Feyzabad for life-saving procedures and damage control operations in order to enable rapid evacuation to a higher level of care. Epidemiological analyses of injury patterns and mechanisms have shown that 2,299 soldiers of the coalition forces have been killed in Afghanistan until January 15, 2011. Of these, 21.4% died in non-hostile action (2010). The leading causes of injury were explosive devices (up to 60%) followed by gunshot wounds. Chest or abdominal injuries (40%) and traumatic brain injuries (35%) were the main causes of death for soldiers killed in action. The analysis of all surgical procedures performed in Northern Afghanistan demonstrates that most of the patients who underwent surgery until 2009 were local civilians. Most of these operations involved osteosynthesis and soft tissue debridement. Due to the recently aggravated tactical situation within the theatre, a significant increase of mass casualty situations and combat-related injuries was noticed. Dicussion: The casualties in this military conflict present with injury patterns that are not seen in routine surgical practice at home. In an era of increasing surgical sub-specialisation, the deployed military surgeon needs to acquire and maintain a wide range of skills including a variety of surgical fields. In order to create this kind of military surgeon, the so-called DUO plus model for the training of military surgeons (specialisation general surgery plus a second sub-specialisation either in visceral surgery or orthopaedics/trauma surgery) has been developed in the Joint Medical Service of the German Bundeswehr. Other relevant skills, such as emergency neurotraumatology, battlefield surgery with integrated oral and craniomaxillofacial surgery, and emergency gynaecology are also integrated into this concept and will be addressed in special courses. On successful completion of this training programme, military surgeons will be officially appointed as "Einsatzchirurg" for a duration of 5 years. After this time, it will be obligatory to renew this "combat ready" status. Conclusion: The buildings and materials in German military medical treatment facilities provide for excellent working conditions. The training programme for military surgeons in its end-2010 version has been designed specifically with data about injury pattern and non-battle diseases as well as the political situation and professional requirements in the civilian sphere in mind. © 2011 Springer-Verlag. Source


Isbert C.,Visceral and Thoracic Surgery | Reibetanz J.,University of Wurzburg | Jayne D.G.,Leeds General Infirmary | Kim M.,University of Wurzburg | And 2 more authors.
Colorectal Disease | Year: 2010

Aim: Stapled transanal rectal resection (STARR) is a promising new treatment for obstructed defecation syndrome (ODS). It may be performed using either a double-stapling technique (PPH-STARR) or with the new Contour Transtar (CT) device. The aim of this study was to evaluate the two techniques with respect to morbidity and functional outcomes. Method: Patients presenting with ODS were evaluated using standardized clinical and radiological investigations and prospectively entered into a database. A total of 150 Patients were treated with either PPH-STARR (n = 68) or CT (n = 82) and further evaluated at 12 month postoperatively. Results: The mean size of the resected specimen was 27 cm2 (SD ±4.86 cm2) in the PPH-STARR group and 46 cm2 (SD ±10.6 cm2) in the CT group [P < 0.001]. Morbidity was 7.3% (n = 5) in the PPH-STARR group and 7.5% (n = 6) in the CT group. The most common complication was minor postoperative bleeding in both groups (PPH-STARR: n = 2, 2.9%; CT: n = 2, 2.4%) Overall there were no septic complications and no surgical re-interventions. There was a tendency for more postoperative pain following CT (n = 3, 3.6%) as compared with PPH-STARR (n = 1, 1.4%). Constipation Scores (CCS) were 15.50 ± 5.71 in the PPH-STARR group and 15.70 ± 5.84 in the CT group preoperatively and decreased significantly to 8.25 (SD ±1.45) and 8.01 (SD ±2.31) 12-months after surgery. Values did not differ significantly between the two groups. Conclusions: Contour Transtar is as safe and effective as PPH-STARR and provides a true circumferential resection of rectal intussusception. This may benefit selected patients and result in improved long-term durability of the technique. © 2010 The Authors. Journal Compilation © 2010 The Association of Coloproctology of Great Britain and Ireland. Source

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