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Saha S, Hofmann S, Jebran AF, Waezi N, Kutschka I, Friedrich MG, Niehaus H. Safety and efficacy of digital chest drainage units compared to conventional chest drainage units in cardiac surgery. Interact Cardiovasc Thorac Surg 2021; 31:42-47. [PMID: 32249898 DOI: 10.1093/icvts/ivaa049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The use of digital chest drainage units (CDUs) has become increasingly common in thoracic surgery due to several advantages. However, in cardiac surgery, its use is still limited in favour of conventional analogue CDUs. In order to investigate the potential benefit of digital CDUs in cardiac surgery, we compared the safety and efficacy of both systems in patients undergoing cardiac surgery at our centre. METHODS We retrospectively investigated 265 consecutive patients who underwent cardiac surgery at our institution between June 2017 and October 2017. These patients were divided into 2 groups: patients with analogue (A, n = 65) and digital CDUs (D, n = 200). Postoperative outcome was analysed and compared between both groups. In addition, the 'user experience' was evaluated by means of a questionnaire. RESULTS The median age of the cohort was 70 years (P = 0.167), 25.3% of patients were female (P = 0.414). There were no differences in terms of re-explorative surgery or use of blood products. Nor was there a difference in the overall amount of fluid collected. However, during the first 6 h, more fluid was collected by the digital CDUs. The overall rate of technical failure was 0.4%. We observed a significantly higher rate of clotting in the tubing system of the digital CDUs (P = 0.042). Concerning the user experience, the digital CDUs were associated with a more favourable ease of use on the regular wards (P < 0.001). With regard to the overall user experience, the digital CDUs outperformed the analogue systems (P = 0.002). CONCLUSIONS Digital CDUs can be safely and effectively applied in patients after cardiac surgery. Due to the improved patient mobility and simplified chest tube management, the use of digital CDUs may be advantageous for patients after cardiac surgery. However, the issue of clotting of the tubing systems should be addressed by further technical improvements.
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Affiliation(s)
- Shekhar Saha
- Department of Thoracic and Cardiovascular Surgery, University Hospital Göttingen, Georg-August University, Goettingen, Germany.,Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Sandra Hofmann
- Department of Thoracic and Cardiovascular Surgery, University Hospital Göttingen, Georg-August University, Goettingen, Germany
| | - Ahmad Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, University Hospital Göttingen, Georg-August University, Goettingen, Germany
| | - Narges Waezi
- Department of Thoracic and Cardiovascular Surgery, University Hospital Göttingen, Georg-August University, Goettingen, Germany
| | - Ingo Kutschka
- Department of Thoracic and Cardiovascular Surgery, University Hospital Göttingen, Georg-August University, Goettingen, Germany
| | - Martin G Friedrich
- Department of Thoracic and Cardiovascular Surgery, University Hospital Göttingen, Georg-August University, Goettingen, Germany
| | - Heidi Niehaus
- Department of Thoracic and Cardiovascular Surgery, University Hospital Göttingen, Georg-August University, Goettingen, Germany
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Saha S, Karaca K, Jebran AF, Waezi N, Ort K, Brandes I, Hagl C, Niehaus H. Diagnostic Value of Cholinesterase Activity for the Development of Postoperative Delirium after Cardiac Surgery. Thorac Cardiovasc Surg 2020; 69:693-699. [PMID: 33225437 DOI: 10.1055/s-0040-1716897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depression of cholinesterase (CHE) activity has been reported to lead to an amplified neuroinflammatory response, which clinically manifests as postoperative delirium (PD). This observational study investigates the association between CHE activity and the development of PD following elective cardiac surgery. METHODS Patients with preexisting neurologic deficits or carotid artery disease as well as patients undergoing reoperations or procedures under circulatory arrest have been excluded from this study. The Mini-Mental State Examination, the Confusion Assessment Method for the Intensive Care Unit, and the Intensive Care Delirium Screening Checklist were performed at regular intervals. CHE activity was estimated pre- and postoperatively until postoperative day (POD) 5 and at discharge. RESULTS A total of 107 patients were included. PD was diagnosed in 34 (31.8%) patients, who have been compared with those without PD. Time on ventilator, length of ICU, and hospital stay were longer in patients with PD (p = 0.001, p < 0.001, and p = 0.004, respectively). MMSE scores were lower in patients with PD (p < 0.001; p = 0.015). CHE activity on POD 1 to 4 as well as at discharge were lower in the delirium group (p = 0.041; p = 0.029; p = 0.015; p = 0.035; p = 0.028, respectively). A perioperative drop of CHE activity of more than 50% and a postoperative CHE activity below 4,800 U/L (on POD 0) were independently associated with an increased risk of development of PD (p = 0.038; p = 0.008, respectively). CONCLUSION In addition to the established functional tests, routine estimation of CHE activity may serve as an additional diagnostic tool allowing for the timely diagnosis and treatment of PD in cardiac surgery patients.
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Affiliation(s)
- Shekhar Saha
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany.,Department of Cardiac Surgery, Ludwig Maximilian University, München, Germany
| | - Kübra Karaca
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Ahmad Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Narges Waezi
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Katharina Ort
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Ivo Brandes
- Department of Anaesthesiology, University Hospital, Georg-August-University, Göttingen, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, München, Germany
| | - Heidi Niehaus
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
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Saha S, Jebran AF, Leistner M, Kutschka I, Niehaus H. Turning Things Around: The Role of Prone Positioning in the Management of Acute Respiratory Failure After Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 34:1434-1438. [PMID: 31812562 DOI: 10.1053/j.jvca.2019.10.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/12/2019] [Accepted: 10/30/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine the benefit of prone positioning (PP) in patients developing acute respiratory failure (ARF) after cardiac surgery. DESIGN A retrospective analysis. SETTING Review of the institutional database between October 2016 and October 2018 revealed 24 patients who underwent PP for the treatment of ARF after cardiac surgery. PARTICIPANTS The authors found 24 patients who underwent PP for the treatment of ARF after cardiac surgery. This included 10 patients who required extracorporeal membrane oxygenation (ECMO) therapy. Among them, 6 patients with simultaneous PP and ECMO therapy. INTERVENTIONS Data were collected at the time of PP, 6 hours after PP, at the end of PP, and 6 hours after return to supine position (SP). MEASUREMENTS AND MAIN RESULTS The median duration of postoperative mechanical ventilation was 281 hours (183-528 hours). Prone positioning was carried out on the fourth postoperative day (POD), with a total of 5 patients undergoing PP within 24 hours following surgery. The median duration of PP before return to SP was 12 hours (12-16 hours), with the maximal duration of PP being 22 hours in this cohort. The authors observed an increase in Horowitz index (HI) at the end of PP (p < 0.001) as well as 6 hours after supine positioning. In the subgroup of patients who underwent PP on ECMO (v-a ECLS = 3, v-v ECMO = 3), a significant reduction of ECMO support was achieved from 3.0 (2.2-5.6) liters/min to 2.5 (2.0-4.6) liters/min (p = 0.023). No adverse events occurred during the positioning of the patients. CONCLUSIONS Prone positioning can be considered for the treatment of ARF after cardiac surgery to improve short-term respiratory conditions and possibly facilitate ECMO weaning.
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Affiliation(s)
- Shekhar Saha
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany; Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Ahmad Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Marcus Leistner
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Ingo Kutschka
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Heidi Niehaus
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
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Waezi N, Saha S, Bougioukas I, Emmert A, Danner BC, Baraki H, Kutschka I, Zenker D, Stojanovic T, Jebran AF. Viabahn stent graft compared with prosthetic surgical above-knee bypass in treatment of superficial femoral artery disease: Long-term results of a retrospective analysis. Medicine (Baltimore) 2018; 97:e12449. [PMID: 30290602 PMCID: PMC6200476 DOI: 10.1097/md.0000000000012449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prosthetic surgical above-knee bypass (pAKB) is a standard therapy in superficial femoral artery (SFA) occlusive disease in absence of suitable vein. Viabahn graft has been established as a promising alternative. Since limited comparative data are available, we conducted a retrospective study to compare long-term outcomes of these 2 therapies in a real-world setting.Records of 52 patients (60 limbs), who were treated by pAKB (29 limbs) or Viabahn (31 limbs) were reviewed. Patients were followed up by clinical assessment, physical examination, and resting ankle brachial index (ABI) after 3, 6, 12 months and yearly thereafter. Long-term data were available for 97% in the Viabahn and 93% for pAKB after 73 ± 3.7 months (mean ± standard error [SE]).Long-term primary and secondary patencies in Viabahn group were 40% and 70%, respectively, after 63 ± 2.8 months (mean ± SE). Total lesion length was 19 ± 11.06 cm (mean ± SE), graft size was 6 ± 0.72 mm (mean ± SE). Hospital stay was 4.8 ± 0.72 days (mean ± SE). Limb salvage was achieved in 90%. Patients in the pAKB group showed a total lesion length of 24.39 ± 1.97 cm (mean ± SE), graft size was 7 ± 0.99 mm (mean ± SE). Long-term analysis after 83 ± 6.8 months (mean ± SE) revealed a primary patency of 78% with a secondary patency of 94%. Hospital stay was 10.4 ± 1.27 days (mean ± SE). Limb salvage was ensured in 97%. Long-term primary patency was lower for Viabahn (P = .044), secondary patency (P = .245), and leg salvage (P = .389) were not significantly different. However, hospital stay was shorter (P = .0002) for Viabahn.Long-term analysis of Viabahn revealed a significantly lower primary patency, a similar secondary patency, limb salvage, and significantly shorter hospital stay when compared with pAKB. Our data suggest that pAKB is still a valuable option in patients suitable for an open operation. However, Viabahn can be used as a less invasive treatment in high risk patients.
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Affiliation(s)
- Narges Waezi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Shekhar Saha
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Ioannis Bougioukas
- Department of Cardiothoracic Surgery, Voelklingen Heart Centre, Völklingen
| | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Bernhard Christoph Danner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Hassina Baraki
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Ingo Kutschka
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | - Dieter Zenker
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
| | | | - Ahmad Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen
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Saha S, Varghese S, Ahmad AA, Jebran AF, Waezi N, Niehaus H, Baraki H, Kutschka I. Complex Valve Surgery in Elderly Patients: Increasingly Necessary and Surprisingly Feasible. Thorac Cardiovasc Surg 2018; 68:107-113. [PMID: 30218992 DOI: 10.1055/s-0038-1670663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The increasing proportion of elderly patients in cardiac surgery poses additional challenges for the clinical management and leads to a higher operative risk due to multiple comorbidities of these patients. We reviewed the outcome of patients who were 75 years and older and underwent complex multiple valve surgery at our institution. METHODS A retrospective review was performed to identify patients who were 75 years and older and underwent multiple valve surgery between January 2011 and May 2016 at our institution. Patients were assigned to one out of four subgroups: combined aortic and mitral valve surgery (group AM), aortic and tricuspid valve surgery (group AT), mitral and tricuspid valve surgery (group MT), and aortic, mitral, and tricuspid valve surgery (group AMT). RESULTS A total of 311 patients underwent multiple valve surgery, of whom 119 (38.3%) were 75 years and older (median: 78 [25th-75th quartile: 76-80]). The estimated operative mortality (EuroSCORE II) in the overall cohort was 10.7%. The observed 30-day mortality was 4.2% (7% in group AM, 0% in group AT, 2.2% in group MT, 3.8% in group AMT; p = 0.685). Main complications were reexplorative surgery in 16%, adverse cerebrovascular events in 6.7%, prolonged mechanical ventilation in 10.1%, renal replacement therapy in 15.1%, nosocomial pneumonia in 15.1%, and pacemaker implantation in 18.5%. CONCLUSIONS This study demonstrates the feasibility of complex multiple valve surgery in elderly patients. The observed perioperative mortality was lower than predicted. However, we observed a substantial rate of adverse events; therefore, careful patient selection is required in this high-risk patient population.
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Affiliation(s)
- Shekhar Saha
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-Universitat, Magdeburg, Magdeburg, Germany.,Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-Universitat, Göttingen, Germany
| | - Sam Varghese
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-Universitat, Magdeburg, Magdeburg, Germany
| | - Ammar Al Ahmad
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-Universitat, Magdeburg, Magdeburg, Germany.,Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-Universitat, Göttingen, Germany
| | - Ahmad Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-Universitat, Göttingen, Germany
| | - Narges Waezi
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-Universitat, Göttingen, Germany
| | - Heidi Niehaus
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-Universitat, Göttingen, Germany
| | - Hassina Baraki
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-Universitat, Magdeburg, Magdeburg, Germany.,Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-Universitat, Göttingen, Germany
| | - Ingo Kutschka
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-Universitat, Magdeburg, Magdeburg, Germany.,Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-Universitat, Göttingen, Germany
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Bougioukas I, Jebran AF, Grossmann M, Friedrich M, Tirilomis T, Schoendube FA, Danner BC. Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires? J Cardiothorac Surg 2017; 12:3. [PMID: 28122567 PMCID: PMC5264443 DOI: 10.1186/s13019-017-0569-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Re-exploration for bleeding accounts for increased morbidity and mortality after major cardiac operations. The use of temporary epicardial pacemaker wires is a common procedure at many departments. The removal of these wires postoperatively can potentially lead to a serious bleeding necessitating intervention. METHODS From Jan 2011 till Dec 2015 a total of 4244 major cardiac procedures were carried out at our department. We used temporary epicardial pacemaker wires in all cases. We collected all re-explorations for bleeding and pericardial tamponade from our surgical database and then we focused on the late re-explorations, meaning on the 4th postoperative day and thereafter, trying to identify the removal of the temporary pacemaker wires as the definite cause of bleeding. Patients' records and medication were examined. RESULTS Thirty-nine late re-explorations for bleeding, consisting of repeat sternotomies, thoracotomies and subxiphoid pericardial drainages, were gathered. Eight patients had an acute bleeding incidence after removal of the temporary wires (0.18%). In four of these patients, a pericardial drainage was inserted, whereas the remaining patients were re-explorated through a repeat sternotomy. Two patients died of the acute pericardial tamponade, three had a blood transfusion and one had a wound infection. Seven out of eight patients were either on dual antiplatelet therapy or on combination of aspirin and vitamin K antagonist. CONCLUSIONS A need for re-exploration due to removal of the temporary pacemaker wires is a very rare complication, which however increases morbidity and mortality. Adjustment of the postoperative anticoagulation therapy at the time of removal of the wires could further minimize or even prevent this serious complication.
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Affiliation(s)
- Ioannis Bougioukas
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany.
| | - Ahmad Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany
| | - Marius Grossmann
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany
| | - Martin Friedrich
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany
| | - Theodor Tirilomis
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany
| | - Friedrich A Schoendube
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany
| | - Bernhard Christoph Danner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany
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Bireta C, Tirilomis T, Grossmann M, Unsöld B, Wachter R, Perl T, Jebran AF, Schoendube FA, Popov AF. Long term biventricular support with Berlin Heart Excor in a Septuagenarian with giant-cell myocarditis. J Cardiothorac Surg 2015; 10:14. [PMID: 25637129 PMCID: PMC4320566 DOI: 10.1186/s13019-015-0218-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/18/2015] [Indexed: 11/12/2022] Open
Abstract
Giant-cell myocarditis (GCM) is known as a rare, rapidly progressive, and frequently fatal myocardial disease in young and middle-aged adults. We report about a 76 year old male patient who underwent implantation with a biventricular Berlin Heart Excor system at the age of 74 due to acute biventricular heart failure caused by giant-cell myocarditis. The implantation was without any surgical problems; however, a difficulty was the immunosuppressive therapy after implantation. Meanwhile the patient is 76 years old and lives with circulatory support for about 3 years without major adverse events. Also, in terms of mobility in old age there are no major limitations. It seems that in even selected elderly patients an implantation of a long term support with the biventricular Berlin Heart Excor is a useful therapeutic option with an acceptable outcome.
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Emmert A, Jebran AF, Schmidt K, Hinterthaner M, Bohnenberger H, Bähr M, Schöndube FA, Danner BC. Aneurysm of the Pulmonary Vein: An Unusual Cause of Stroke. Ann Thorac Surg 2014; 98:1841-3. [DOI: 10.1016/j.athoracsur.2013.12.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 11/22/2013] [Accepted: 12/18/2013] [Indexed: 10/24/2022]
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Jebran AF, Schleicher U, Steiner R, Wentker P, Mahfuz F, Stahl HC, Amin FM, Bogdan C, Stahl KW. Rapid healing of cutaneous leishmaniasis by high-frequency electrocauterization and hydrogel wound care with or without DAC N-055: a randomized controlled phase IIa trial in Kabul. PLoS Negl Trop Dis 2014; 8:e2694. [PMID: 24551257 PMCID: PMC3923720 DOI: 10.1371/journal.pntd.0002694] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/29/2013] [Indexed: 12/30/2022] Open
Abstract
Background Anthroponotic cutaneous leishmaniasis (CL) due to Leishmania (L.) tropica infection is a chronic, frequently disfiguring skin disease with limited therapeutic options. In endemic countries healing of ulcerative lesions is often delayed by bacterial and/or fungal infections. Here, we studied a novel therapeutic concept to prevent superinfections, accelerate wound closure, and improve the cosmetic outcome of ACL. Methodology/Principal Findings From 2004 to 2008 we performed a two-armed, randomized, double-blinded, phase IIa trial in Kabul, Afghanistan, with patients suffering from L. tropica CL. The skin lesions were treated with bipolar high-frequency electrocauterization (EC) followed by daily moist-wound-treatment (MWT) with polyacrylate hydrogel with (group I) or without (group II) pharmaceutical sodium chlorite (DAC N-055). Patients below age 5, with facial lesions, pregnancy, or serious comorbidities were excluded. The primary, photodocumented outcome was the time needed for complete lesion epithelialization. Biopsies for parasitological and (immuno)histopathological analyses were taken prior to EC (1st), after wound closure (2nd) and after 6 months (3rd). The mean duration for complete wound closure was short and indifferent in group I (59 patients, 43.1 d) and II (54 patients, 42 d; p = 0.83). In patients with Leishmania-positive 2nd biopsies DAC N-055 caused a more rapid wound epithelialization (37.2 d vs. 58.3 d; p = 0.08). Superinfections occurred in both groups at the same rate (8.8%). Except for one patient, reulcerations (10.2% in group I, 18.5% in group II; p = 0.158) were confined to cases with persistent high parasite loads after healing. In vitro, DAC N-055 showed a leishmanicidal effect on pro- and amastigotes. Conclusions/Significance Compared to previous results with intralesional antimony injections, the EC plus MWT protocol led to more rapid wound closure. The tentatively lower rate of relapses and the acceleration of wound closure in a subgroup of patients with parasite persistence warrant future studies on the activity of DAC N-055. Trial Registration ClinicalTrails.gov NCT00947362 In many countries of the Middle East such as Afghanistan, cutaneous leishmaniasis is a highly prevalent, chronic and stigmatizing skin disease. Poor hygiene conditions frequently aggravate the lesions due to bacterial and fungal superinfections. Classical treatments with injections of pentavalent antimony are hampered by costs, side effects, resistance development, supply and manufactural quality problems. In the present study on Afghan patients with Leishmania tropica-induced skin lesions we evaluated the clinical effect of an initial removal of lesion tissue by electrocoagulation using a bipolar high-frequency electrosurgery instrument, followed by daily moist wound treatment with or without a preparation of pharmaceutical sodium chlorite (DAC N-055). DAC N-055 is a compound with anti-infective, immunomodulatory and tissue repair-promoting effects. Our analysis revealed that the carefully performed moist wound treatment led to a rapid healing of the wounds within an average period of 6 weeks, even in the absence of the sodium chlorite preparation. This is considerably faster than the time spans previously reported for local or systemic antimony treatment. We believe that the current standard for local care of chronic wounds should also be applied to Leishmania skin lesions. If combined with an initial single high-frequency electrocoagulation, it is a highly effective, inexpensive and well-tolerated treatment option for cutaneous leishmaniasis.
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Affiliation(s)
- Ahmad Fawad Jebran
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ulrike Schleicher
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Reto Steiner
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Pia Wentker
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Farouq Mahfuz
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Hans-Christian Stahl
- Waisenmedizin e.V. Promoting Access to Care with Essential Medicine, Non-Profit Organization, Freiburg, Germany
| | - Faquir Mohammad Amin
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Christian Bogdan
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- * E-mail: (CB); (KWS)
| | - Kurt-Wilhelm Stahl
- Waisenmedizin e.V. Promoting Access to Care with Essential Medicine, Non-Profit Organization, Freiburg, Germany
- * E-mail: (CB); (KWS)
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Bireta C, Popov AF, Zenker D, Jebran AF, Schoendube FA, Stojanovic T. Reconstruction of Extrapericardial Rupture of Inferior Vena Cava Without Cardiopulmonary Bypass Due to Blunt Trauma. Ann Thorac Surg 2013; 95:e73. [DOI: 10.1016/j.athoracsur.2012.09.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/11/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
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Hinz J, Gehoff P, Schotola H, Hosseini MT, Didilis VN, Jebran AF, Gehoff A, Wiese CH, Schulz EG, Schoendube FA, Popov AF. Hemodynamic effects of peri-operative statin therapy in on-pump cardiac surgery patients. J Cardiothorac Surg 2012; 7:39. [PMID: 22533985 PMCID: PMC3398842 DOI: 10.1186/1749-8090-7-39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 04/25/2012] [Indexed: 01/13/2023] Open
Abstract
Background Peri-operative statin therapy in cardiac surgery cases is reported to reduce the rate of mortality, stroke, postoperative atrial fibrillation, and systemic inflammation. Systemic inflammation could affect the hemodynamic parameters and stability. We set out to study the effect of statin therapy on perioperative hemodynamic parameters and its clinical outcome. Methods In a single center study from 2006 to 2007, peri-operative hemodynamic parameters of 478 patients, who underwent cardiac surgery with cardiopulmonary bypass, were measured. Patients were divided into those who received perioperative statin therapy (n = 276; statin group) and those who did not receive statin therapy (n = 202; no-statin group). The two groups were compared together using Kolmogorov-Smirnov-Test, Fisher’s-Exact-Test, and Student’s-T-test. A p value < 0.05 was considered as significant. Results There was no significant difference in the preoperative risk factors. Onset of postoperative atrial fibrillation was not affected by statin therapy. Extended hemodynamic measurements revealed no significant difference between the two groups, apart from Systemic Vascular Resistance Index (SVRI) . The no-statin group had a significantly higher SVRI (882 ± 206 vs. 1050 ± 501 dyn s/cm5/m2, p = 0.022). Inotropic support was the same in both groups and no significant difference in the mortality rate was noticed. Also, hemodynamic parameters were not affected by different types and doses of statins. Conclusions Perioperative statin therapy for patients undergoing on-pump coronary bypass grafting or valvular surgery, does not affect the hemodynamic parameters and its clinical outcome.
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Affiliation(s)
- Jose Hinz
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
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