1
|
Krauss P, Motov S, Bonk MN, Prescher A, Scorzin J, Hajiabadi MM, Schulte DM, Sommer B, Seiz-Rosenhagen M, Ahmadi R, Maciaczyk J, Lehmberg J, Shiban E. sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE): a prospective multicentre RCT. BMJ Open 2023; 13:e067784. [PMID: 37012023 PMCID: PMC10083801 DOI: 10.1136/bmjopen-2022-067784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION Persistent spine pain syndrome type 2 (PSPS2) represents a significant burden to the individual and society. Treatment options include revision surgery, stabilisation surgery of the spine, neuromodulation, analgesics and cognitive behavioural therapy. Nevertheless, structured treatment algorithms are missing as high-level evidence on the various treatments is sparse. The aim of this study is to compare higher frequency neuromodulation with instrumentation surgery in patients suffering from PSPS2. METHODS AND ANALYSIS The sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE) trial is a prospective randomised rater blinded multicentre study. Patients suffering from PSPS2 with a functional burden of Oswestry Disability Index (ODI) >20 points are randomised to treatment via spinal cord stimulation or spinal instrumentation. Primary outcome is back-related functional outcome according to the ODI 12 months after treatment. Secondary outcomes include pain perception (visual analogue scale), Short Form-36, EuroQOL5D, the amount of analgesics, the length of periprocedural hospitalisation and adverse events. Follow-up visits are planned at 3 and 12 months after treatment. Patients with previous lumbar instrumentation, symptomatic spinal stenosis, radiographical apparent spinal instability or severe psychiatric or systemic comorbidities are excluded from the study. In order to detect a significant difference of ≥10 points (ODI) with a power of 80%, n=72 patients need to be included. The recruitment period will be 24 months with a subsequent 12 months follow-up. The beginning of enrolment is planned for October 2022. ETHICS AND DISSEMINATION The PROMISE trial is the first randomised rater blinded multicentre study comparing the functional effectiveness of spinal instrumentation versus neuromodulation in patients with PSPS2 in order to achieve high-level evidence for these commonly used treatment options in this severely disabling condition. Patient recruitment will be performed at regular outpatient clinic visits. No further (print, social media) publicity is planned. The study is approved by the local ethics committee (LMU Munich, Germany) and will be conducted according to the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT05466110.
Collapse
Affiliation(s)
- Philipp Krauss
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Motov
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | | | | | | | | | | | - Bjoern Sommer
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | | | - Rezvan Ahmadi
- Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jens Lehmberg
- Neurosurgery, Munich Hospital Bogenhausen, Munchen, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| |
Collapse
|
2
|
Enders F, Rothfuss A, Brehmer S, Stallkamp J, Schulte DM, Hänggi D. Optimized Intraoperative Imaging for Stereotactic Planning with a Multiaxial Robotic C-arm System: Technical Note and Case Series. J Neurol Surg A Cent Eur Neurosurg 2021; 83:588-595. [PMID: 34781408 DOI: 10.1055/s-0041-1731754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The preoperative preparation of the planning dataset for frame-based stereotactic brain biopsy is often associated with logistical effort and burden on the patient. Intraoperative imaging modalities need to be investigated to overcome these limitations. OBJECTIVE The objective of the study was to develop and apply a new method for the intraoperative acquisition of the planning dataset with the multiaxial robotic C-arm system Artis zeego. METHODS An indication-customized dose-reduced protocol for Artis zeego was developed and implemented into the workflow. A sample of 14 patients who had undergone intraoperative imaging with Artis zeego was analyzed. A sample of 10 patients with conventional preoperative imaging by cranial computed tomography (CT) was used as a control group. Outcomes were compared with regard to target deviation, diagnostic value of the biopsies, complications, and procedure time. RESULTS In all patients, a suitable intraoperative planning dataset could be acquired with Artis zeego. Total procedure time was shorter for the Artis zeego group (p = 0.01), whereas time in the operating room area was longer in the Artis zeego group (p = 0.04). Biopsy results were diagnostic in 12 patients (86%) in the Artis zeego group and in 8 patients (80%) in the control group. There were no significant differences in target size, trajectory length, or target deviation. CONCLUSION Intraoperative imaging for frame-based stereotactic brain biopsy with Artis zeego is an easy and feasible method. Accuracy is comparable to conventional CT, whereas radiation exposure could be additionally reduced. It allows a significant reduction of the total procedure length and improves the comfort for the patient and staff.
Collapse
Affiliation(s)
- Frederik Enders
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Andreas Rothfuss
- Fraunhofer IPA Mannheim - Fraunhofer-Projektgruppe für Automatisierung in der Medizin und Biotechnologie PAMB, Mannheim, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Jan Stallkamp
- Fraunhofer IPA Mannheim - Fraunhofer-Projektgruppe für Automatisierung in der Medizin und Biotechnologie PAMB, Mannheim, Germany
| | | | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany.,Department of Neurosurgery, University Hospital Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| |
Collapse
|
3
|
Wolf ME, Klockziem M, Majewski O, Schulte DM, Krauss JK, Blahak C. Implementation of New Technology in Patients with Chronic Deep Brain Stimulation: Switching from Non-Rechargeable Constant Voltage to Rechargeable Constant Current Stimulation. Stereotact Funct Neurosurg 2020; 97:362-368. [PMID: 31945765 DOI: 10.1159/000505076] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) for movement disorders has been mainly performed with constant voltage (CV) technology. More recently also constant current (CC) systems have been developed which theoretically might have additional advantages. Furthermore, rechargeable (RC) system implantable pulse generators (IPG) are increasingly being used rather than the former solely available non-rechargeable (NRC) IPGs. OBJECTIVE To provide a systematic investigation how to proceed and adapt settings when switching from CV NRC to CC RC technology. METHODS We prospectively collected data from 11 consecutive patients (10 men, mean age at DBS implantation 52.6 ± 14.0 years) with chronic DBS for dystonia (n = 7), Parkinson disease (n = 3), and essential tremor (n = 1) who underwent IPG replacement switching from a CV NRC system (Activa® PC; Medtronic®) to a CC RC system (Vercise® RC; Boston Scientific®). Systematic assessments before and after IPG replacement were performed. RESULTS DBS technology switching at the time of IPG replacement due to battery depletion was at a mean of 108.5 ± 46.2 months of chronic DBS. No perioperative complications occurred. Clinical outcome was stable with overall mild improvements or deteriorations, which could be dealt with in short-term follow-up. Patients were satisfied with the new RC IPG. CONCLUSIONS This study confirms both the safety and feasibility of switching between different DBS technologies (CV to CC, NRC to RC, different manufacturers) in patients with chronic DBS. Furthermore, it shows how the management can be planned using available information from the previous DBS settings. Individual assessment is needed and might partly be related to the DBS target and the underlying disease. MR safety might be a problem with such hybrid systems.
Collapse
Affiliation(s)
- Marc E Wolf
- Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany, .,Department of Neurology, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany,
| | - Matti Klockziem
- Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Olaf Majewski
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dirk Michael Schulte
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Christian Blahak
- Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Neurology, Ortenau Klinikum Lahr-Ettenheim, Lahr, Germany
| |
Collapse
|
4
|
Schulte DM, Paulsen K, Türk K, Brandt B, Freitag-Wolf S, Hagen I, Zeuner R, Schröder JO, Lieb W, Franke A, Nikolaus S, Mrowietz U, Gerdes S, Schreiber S, Laudes M. Small dense LDL cholesterol in human subjects with different chronic inflammatory diseases. Nutr Metab Cardiovasc Dis 2018; 28:1100-1105. [PMID: 30143407 DOI: 10.1016/j.numecd.2018.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/06/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Chronic inflammatory diseases (CID) are associated with a profound increase in cardiovascular (CV) risk resulting in reduced life expectancy. However, LDL-cholesterol is reported to be low in CID patients which is referred to as the "LDL paradoxon". The aim of the present study was to investigate whether LDL-particles in CID exhibit an increased content of the highly atherogenic small-dense LDL subfraction (sdLDL). METHODS AND RESULTS In this prospective, single center, observational study we enrolled 141 patients with CID (RA n = 59, inflammatory bowel disease (IBD) n = 35, ankylosing spondylitis (SpA) n = 25, Psoriasis n = 22) in 2011 through 2013 to evaluate sdLDL levels before as well as 6 and 26 weeks after initiation of different anti-cytokine therapies (anti-TNFα, anti-IL-6R antibodies). sdLDL levels were compared to 141 healthy individuals in a case control design. Compared to healthy controls, all CID patients displayed a significantly higher sdLDL content within the LDL cholesterol fraction: RA 35.0 ± 9.2% (p < 0.001), SpA 42.5 ± 10.5% (p < 0.001), IBD 37.5 ± 7.1% (p < 0.001), Psoriasis 33.6 ± 4.6% (p < 0.01). Furthermore, the sdLDL/LDL ratio was significantly higher in male compared to female RA subjects (p < 0.05). Neither anti-TNFα nor anti-IL6R medication altered sdLDL levels despite a significant improvement of disease activity. CONCLUSION In several different chronic inflammatory disease entities, LDL-cholesterol is shifted toward a pro-atherogenic phenotype due to an increased sdLDL content which might in part explain the LDL paradoxon. Since premature CV disease is a major burden of affected patients, specifically targeting lipid metabolism should be considered routinely in clinical patient care. CLINICAL TRIALS Registration at German Clinical Trial Register (DRKS): DRKS00005285.
Collapse
Affiliation(s)
- D M Schulte
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany; Cluster of Excellence Inflammation at Interfaces, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - K Paulsen
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - K Türk
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - B Brandt
- Institute of Clinical Chemistry, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - S Freitag-Wolf
- Institute of Medical Informatics and Statistics, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - I Hagen
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - R Zeuner
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - J O Schröder
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany; Cluster of Excellence Inflammation at Interfaces, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - W Lieb
- Institute of Epidemiology, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - A Franke
- Cluster of Excellence Inflammation at Interfaces, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany; Institute of Clinical Molecular Biology, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - S Nikolaus
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany; Cluster of Excellence Inflammation at Interfaces, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - U Mrowietz
- Cluster of Excellence Inflammation at Interfaces, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany; Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - S Gerdes
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - S Schreiber
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany; Cluster of Excellence Inflammation at Interfaces, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany
| | - M Laudes
- Department of Internal Medicine I, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany; Cluster of Excellence Inflammation at Interfaces, University of Kiel, Arnold-Heller-Strasse 3, D-24105, Kiel, Germany.
| |
Collapse
|
5
|
Lammert A, Walter MS, Giordano FA, Al Zhgloul M, Krämer BK, Nittka S, Schulte DM, Ratliff M, Hänggi D, Seiz-Rosenhagen M. Neuro-Endocrine Recovery After Pituitary Apoplexy: Prolactin as a Predictive Factor. Exp Clin Endocrinol Diabetes 2018; 128:283-289. [DOI: 10.1055/a-0640-2915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Abstract
Objective Pituitary apoplexy is a serious medical complication of a pre-existing pituitary adenoma characterized by a variety of clinical symptoms ranging from mild headache to neurologically impaired and finally comatose patients. Management options are surgery or conservative treatment (e. g., with dexamethasone). Surgery is commonly performed in case of severe acute neurological and visual symptoms. However, prospective studies demonstrating a benefit of surgery over conservative treatment in terms of visual, neurological and even endocrine outcomes are lacking. Decision making is still controversial, and recommendations for surgery are based on low evidence grades and focus on visual impairment. Endocrine function and especially markers identifying patients with potential for pituitary recovery after surgery are not well described in the literature.
Patients and Design We analysed data from 24 patients (m:f/16:8) with a median age of 64 yrs (38 to 83yrs) that underwent surgery for pituitary apoplexy regardless of time from symptom onset. Apoplexies were necrotic in 14 cases and haemorrhagic in 10 cases.
Results Preoperatively, 7 patients (29.2%) showed complete anterior pituitary insufficiency, 16 patients (66.6%) had partial anterior pituitary insufficiency and one patient (4.17%) had normal pituitary functions. Persistent panhypopituitarism was found in 7 patients (29.2%), whereas an overall improvement of pituitary function was noted in 13 (57.1%) patients. Preoperative prolactin (PRL) levels were significantly associated with recovery of endocrine functions, whereas specifically all patients with preoperative PRL levels of at least 8.8 ng/ml recovered partially or fully. Time to surgery (0–7 days vs. 1–4 weeks vs.>4 weeks) was not significantly associated with outcome.
Conclusions Our data emphasize that normal and high preoperative PRL levels are associated with better endocrine outcome after surgery. We conclude that patients benefit from surgical intervention even after delayed diagnosis with the serum PRL levels is being a valid biomarker for clinical decision making.
Collapse
Affiliation(s)
- Alexander Lammert
- Praxis für Diabetes, Stoffwechsel- und Nierenerkrankungen, Grünstadt, Germany
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marc Sebastian Walter
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Anton Giordano
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mansour Al Zhgloul
- Department of Neuroradiology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, Mannheim, Germany
| | - Bernhard Karl Krämer
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefanie Nittka
- Institute for Clinical Chemistry, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dirk Michael Schulte
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Miriam Ratliff
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
6
|
Fangmann D, Knappe C, Zietzsch A, Schulte DM, Türk K, Franke A, Laudes M. Bile acids as possible mediators of microbiome-host interaction. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D Fangmann
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - C Knappe
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Zietzsch
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - DM Schulte
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - K Türk
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Franke
- Institute of Clinical Molecular Biology, University Kiel, Kiel, Germany
| | - M Laudes
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
7
|
Fangmann D, Theismann EM, Türk K, Schulte DM, Relling I, Hartmann K, Keppler J, Knipp J, Rehmann A, Freitag-Wolf S, Wätzig G, Seegert D, Rosenstiel P, Schwarz K, Schreiber S, Laudes M. Nutritional intervention by a novel slow-release niacin formulation beneficially alters the gut microbiome and promotes systemic metabolic effects in humans. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- D Fangmann
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - EM Theismann
- Department of Food Technology, University of Kiel, Kiel, Germany
| | - K Türk
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - DM Schulte
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - I Relling
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - K Hartmann
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Keppler
- Department of Food Technology, University of Kiel, Kiel, Germany
| | - J Knipp
- Department of Food Technology, University of Kiel, Kiel, Germany
| | - A Rehmann
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - S Freitag-Wolf
- Institute of Medical Informatics and Statistics, University of Kiel, Kiel, Germany
| | - G Wätzig
- CONARIS Research Institute AG, Kiel, Germany
| | - D Seegert
- CONARIS Research Institute AG, Kiel, Germany
| | - P Rosenstiel
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - K Schwarz
- Department of Food Technology, University of Kiel, Kiel, Germany
| | - S Schreiber
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Laudes
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
8
|
Kreutzer C, Graetz C, Schulz J, Mewes L, Türk K, Dörfer C, Schreiber S, Schulte DM, Laudes M. Antidiabetic sFRP5 is downregulated in patients with chronic periodontitis. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C Kreutzer
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Innere Medizin, Kiel, Germany
| | - C Graetz
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Zahnerhaltungskunde und Parodontologie, Kiel, Germany
| | - J Schulz
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Innere Medizin, Kiel, Germany
| | - L Mewes
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Zahnerhaltungskunde und Parodontologie, Kiel, Germany
| | - K Türk
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Innere Medizin, Kiel, Germany
| | - C Dörfer
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Zahnerhaltungskunde und Parodontologie, Kiel, Germany
| | - S Schreiber
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Innere Medizin, Kiel, Germany
| | - DM Schulte
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Innere Medizin, Kiel, Germany
| | - M Laudes
- Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Innere Medizin, Kiel, Germany
| |
Collapse
|
9
|
Ehrlich G, Kindling S, Wenz H, Hänggi D, Schulte DM, Schmiedek P, Seiz-Rosenhagen M. Immediate Titanium Mesh Implantation for Patients with Postcraniotomy Neurosurgical Site Infections: Safe and Aesthetic Alternative Procedure? World Neurosurg 2017; 99:491-499. [DOI: 10.1016/j.wneu.2016.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 12/01/2022]
|
10
|
Fangmann D, Heinsen FA, Schulte DM, Rühlemann MC, Türk K, Settgast U, Müller N, Lieb W, Baines JF, Schreiber S, Franke A, Laudes M. Dietary and weight loss effects on human gut microbiome diversity and metabolism. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Kreutzer C, Peters S, Schulte DM, Türk K, Wolff S, Rohr A, Kerby T, Riedel C, van Eimeren T, Schreiber S, Laudes M. Hypothalamic inflammation in humans is not reversed by a profound weight loss and an improved insulin sensitivity due to bariatric surgery. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Cupa N, Schulte DM, Ahrens M, Schreiber S, Laudes M. Vitamin B6 intoxication after inappropriate supplementation with micronutrients following bariatric surgery. Eur J Clin Nutr 2015; 69:862-3. [DOI: 10.1038/ejcn.2015.83] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 12/18/2022]
|
13
|
Schulte DM, Kragelund D, Müller N, Hagen I, Elke G, Titz A, Schädler D, Schumacher J, Weiler N, Bewig B, Schreiber S, Laudes M. The wingless-related integration site-5a/secreted frizzled-related protein-5 system is dysregulated in human sepsis. Clin Exp Immunol 2015; 180:90-7. [PMID: 25382802 DOI: 10.1111/cei.12484] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 12/11/2022] Open
Abstract
Sepsis and type 2 diabetes exhibit insulin resistance as a common phenotype. In type 2 diabetes we and others have recently provided evidence that alterations of the proinflammatory wingless-related integration site (wnt)-5a/anti-inflammatory secreted frizzled-related protein (sFRP)-5 system are involved in the pathogenesis of insulin resistance. The aim of the present study was to investigate whether this novel cytokine system is dysregulated in human sepsis, which may indicate a potential mechanism linking inflammation to metabolism. In this single-centre prospective observational study, critically ill adult septic patients were examined and proinflammatory wnt5a and wnt5a inhibitor sFRP5 were measured in serum samples by enzyme-linked immunosorbent assay (ELISA) at admission to the intensive care unit (ICU) and 5 days later. Sixty sepsis patients were included, and 30 healthy individuals served as controls. Wnt5a levels were found to be increased significantly in septic patients compared to healthy controls (2·21 ± 0·33 versus 0·32 ± 0·03 ng/ml, P < 0·0001). In contrast, sFRP5 was not altered significantly in septic patients (19·72 ± 3·06 versus 17·48 ± 6·38 ng/ml, P = 0·07). On admission to the ICU, wnt5a levels exhibited a significant positive correlation with the leucocyte count (rs = 0·3797, P = 0·004). Interestingly, in patients recovering from sepsis, wnt5a levels declined significantly within 5 days (2·17 ± 0·38-1·03 ± 0·28 ng/ml, P < 0·01). In contrast, if sepsis was worsening, wnt5a levels increased in the same time-period by trend (2·34 ± 0·59-3·25 ± 1·02 ng/ml, P > 0·05). sFRP5 levels did not change significantly throughout the study period. The wnt5a/sFRP5 system is altered in human sepsis and might therefore be of interest for future studies on molecular pathophysiology of this common human disease.
Collapse
Affiliation(s)
- D M Schulte
- Department of Internal Medicine I, Christian-Albrechts University Kiel, University Hospital Schleswig-Holstein, Kiel, Germany; Cluster of Excellence Inflammation at Interfaces, Christian-Albrechts University Kiel, Kiel, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Müller N, Türk K, Neumann K, Martinsen J, Schulte DM, Laudes M. The novel adipokine sFRP5 is associated with hypertriglyceridemia but not with insulin resistance in humans. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Schulte DM, Kragelund D, Müller N, Elke G, Titz A, Schädler D, Neumann K, Schumacher J, Weiler N, Bewig B, Schreiber S, Laudes M. A role for the novel cytokine wnt-5a in linking inflammation to metabolism in human sepsis. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
16
|
Müller N, Saggau C, Schulte DM, Laudes M. Regulation of a novel cytokine in low-grade inflammation of adipose tissue by fatty acids. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Schulte DM, Hahn M, Oberhäuser F, Malchau G, Schubert M, Heppner C, Müller N, Güdelhöfer H, Faust M, Krone W, Laudes M. Caloric restriction increases serum testosterone concentrations in obese male subjects by two distinct mechanisms. Horm Metab Res 2014; 46:283-6. [PMID: 24198220 DOI: 10.1055/s-0033-1358678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The concentration of serum testosterone is mainly regulated by the testicular function, which is under control of the central hypothalamic-pituitary-gonadal axis. A certain amount of testosterone is converted into β-estradiol by adipose tissue. Obesity in men is often associated with decreased androgen levels. The aim of the present study was to examine the effect of caloric restriction on serum testosterone levels in obese men. Dietary intervention study was performed with a very low calorie diet (800 kcal/d) for 12 weeks. Thirteen obese human male subjects (median body mass index: 42.7 kg/m2) were included. Body composition was assessed by impedance analysis. Insulin sensitivity was estimated by leptin-to-adiponectin ratio (LAR). Testosterone (T), β-estradiol, albumin, sex hormone-binding globulin (SHBG), LH, and FSH serum concentrations were measured by enzyme immunoassays. Statistical analysis was performed on baseline and values after 3 months. Caloric restriction significantly increased total testosterone (6.97 nmol/l to 13.21 nmol/l; p=0.001) and SHBG (22.11 nmol/l to 42.12 nmol/l; p=0.001) concentrations in serum. This is caused by a significant improvement of the testicular function (LH/T: 0.36-0.20; p=0.005) and a significant reduction of the T/β-estradiol conversion rate (73.59-104.29; p=0.003). There was a significant negative correlation of improvement of testicular function and LAR (rs=-0.683 (p=0.042)). In obese men caloric restriction significantly increases the serum testosterone concentration. This is achieved by 2 distinct mechanisms, that is, improvement of testicular function and reduced conversion of testosterone to β-estradiol by aromatase activity of the adipose tissue.
Collapse
Affiliation(s)
- D M Schulte
- Department of Internal Medicine I, University of Kiel, Kiel, Germany
| | - M Hahn
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - F Oberhäuser
- Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | - G Malchau
- Department of Clinical Chemistry, University of Cologne, Cologne, Germany
| | - M Schubert
- Department of Internal Medicine, SCIVIAS Hospital St. Josef, Rüdesheim am Rhein, Germany
| | - C Heppner
- Endokrinologikum Göttingen, Göttingen, Germany
| | - N Müller
- Department of Internal Medicine I, University of Kiel, Kiel, Germany
| | - H Güdelhöfer
- Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | - M Faust
- Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | - W Krone
- Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | - M Laudes
- Department of Internal Medicine I, University of Kiel, Kiel, Germany
| |
Collapse
|
18
|
Schulte DM, Kragelund D, Müller N, Elke G, Titz A, Schädler D, Schumacher J, Weiler N, Bewig B, Schreiber S, Laudes M. The wnt5a/sFRP5 system is dysregulated in human sepsis. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
19
|
Müller N, Hillebrand S, Schulte DM, Türk K, Neumann K, Stelmach-Mardas M, Hampe J, Schafmayer C, Brosch M, Schönfels WV, Ahrens M, Gutschow C, Zeuner R, Schröder JO, Blüher M, Schreiber S, Laudes M. B lymphocyte stimulator (BLyS) is a novel adipokine in humans in vivo being related to obesity but not to insulin resistance. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
20
|
Müller N, Neumann K, Schulte DM, Laudes M. Interleukin-6 is a major regulator of lipoprotein(a) in humans in vivo. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
21
|
Müller N, Hillebrand S, Schulte DM, Türk K, Neumann K, Hampe J, Kampen OV, Brosch M, Schönfels WV, Ahrens M, Zeuner R, Schröder JO, Blüher M, Schreiber S, Laudes M. B lymphocyte stimulator (BLyS) is a novel adipokine in humans in vivo being related to obesity but not to insulin resistance. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Schulte DM, Faust M, Schmidt M, Ruge MI, Grau S, Blau T, Kocher M, Krone W, Laudes M. Novel therapeutic approaches to CNS metastases in malignant phaeochromocytomas - case report of the first patient with a large cystic CNS lesion. Clin Endocrinol (Oxf) 2012; 77:332-4. [PMID: 22288775 DOI: 10.1111/j.1365-2265.2012.04354.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
23
|
Oberhauser F, Schulte DM, Faust M, Güdelhöfer H, Hahn M, Müller N, Neumann K, Krone W, Laudes M. Weight loss due to a very low calorie diet differentially affects insulin sensitivity and interleukin-6 serum levels in nondiabetic obese human subjects. Horm Metab Res 2012; 44:465-70. [PMID: 22438213 DOI: 10.1055/s-0032-1306341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Inflammatory mechanisms are involved in the pathogenesis of type 2 diabetes with interleukin (IL)-6 being particularly important. While long term exercise has been shown to be associated with reduction in IL-6 serum levels in several reports, the discussion on the effect of dietary intervention on IL-6 serum levels is controversial. In the present study, we aimed to investigate the effect of weight loss due to a very low calorie diet (VLCD) on insulin sensitivity and IL-6 serum levels in nondiabetic obese human individuals. 10 patients with obesity were examined during 12 weeks of a VLCD (800 kcal/d). Body composition was measured by impedance analysis. Blood samples were taken before, during, and after the dietary intervention. Leptin, adiponectin, and IL-6 serum levels were measured by ELISA. The body weight decreased significantly from 123.9±6.2-103.5±5.6 kg with a significant reduction in body fat content (43.2±2.3-36.1±3.1%). Leptin levels exhibited a significant decrease from 56.8±5.6-27.9±5.6 ng/ml while adiponectin levels increased significantly from 7.5±0.9-10.6±1.1 μg/ml. Thereby the leptin-to-adiponectin ratio, a novel marker for insulin sensitivity, significantly improved. Mean IL-6 serum concentrations were within the normal range (3.2±0.8 pg/ml) before the study and were not significantly altered by the nutritional therapy. Despite improvement of insulin sensitivity, IL-6 serum levels did not change throughout the study period, suggesting that in nondiabetic obese human subjects IL-6 might have only a minor role in the impairment of insulin sensitivity.
Collapse
Affiliation(s)
- F Oberhauser
- Centre of Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Müller N, Schulte DM, Neumann K, Oberhäuser F, Faust M, Güdelhöfer H, Krone W, Laudes M. Effekte einer Kalorienrestriktion auf einen neuen, wnt-abhängigen Regulationsmechanismus in der Mikroinflammation des Fettgewebes bei Adipositaspatienten. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
25
|
Bilkovski R, Schulte DM, Oberhauser F, Mauer J, Hampel B, Gutschow C, Krone W, Laudes M. Adipose tissue macrophages inhibit adipogenesis of mesenchymal precursor cells via wnt-5a in humans. Int J Obes (Lond) 2011; 35:1450-4. [PMID: 21285942 DOI: 10.1038/ijo.2011.6] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In patients with obesity and type 2 diabetes, adipose tissue is infiltrated by macrophages known to alter adipogenesis of mesenchymal precursor cells via secretion of proinflammatory cytokines. Recently, it has been shown that under certain conditions, immune cells can also express wnt-5a, a factor known to inhibit adipogenesis in humans. Therefore, in this study we aimed to investigate whether macrophages affect adipogenesis of mesenchymal precursor cells via wnt-5a. Wnt-5a was found to be expressed in adipose tissue macrophages in obese and type 2 diabetic human subjects in vivo by immunohistochemistry of adipose tissue biopsies. Furthermore, wnt-5a was detectable in circulating CD14(+) blood monocytes of human subjects with obesity and type 2 diabetes on RNA level by real-time PCR. Besides expression analysis in vivo, we also performed functional studies to explore the role of wnt-5a in low-grade inflammation of adipose tissue. In a cell culture experiment, macrophage-conditioned differentiation medium inhibited adipogenesis of 3T3-L1 cells. This inhibitory effect was restored by adding neutralising anti-wnt-5a antibodies. In conclusion, our data indicate that macrophages alter adipogenesis of 3T3-L1 cells not only via classical proinflammatory cytokines, but also via wnt signalling molecules.
Collapse
Affiliation(s)
- R Bilkovski
- Department of Internal Medicine II and Centre of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Laudes M, Oberhauser F, Schulte DM, Freude S, Bilkovski R, Mauer J, Rappl G, Abken H, Hahn M, Schulz O, Krone W. Visfatin/PBEF/Nampt and resistin expressions in circulating blood monocytes are differentially related to obesity and type 2 diabetes in humans. Horm Metab Res 2010; 42:268-73. [PMID: 20091460 DOI: 10.1055/s-0029-1243638] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Low-grade inflammation is important in the development of obesity related pathologies such as insulin resistance and type 2 diabetes, and also cardiovascular disease. Visfatin/PBEF/Nampt and resistin are proinflammatory adipokines secreted from adipocytes, monocytes, and macrophages, and have been linked to atherosclerotic plaque formation, recently. The aim of the present study was to investigate if the expression of these molecules in circulating blood monocytes is altered in obese and/or type 2 diabetic human subjects. Monocytes were isolated by CD14-antibody based magnetic cell sorting from blood samples of 17 lean controls, 20 obese nondiabetic subjects, and 19 obese patients with type 2 diabetes. FACS analysis was performed to test purity of the cell preparations. Expression of the different adipokines was measured by multiplex real-time PCR on RNA-level. Visfatin/PBEF/Nampt was found to be very strongly expressed in monocytes, whereas resistin levels were significantly lower. Furthermore, visfatin/PBEF/Nampt expression was significantly upregulated in obese type 2 diabetic patients, whereas obese nondiabetics exhibited similar levels compared to lean controls, indicating that visfatin/PBEF/Nampt levels are related to type 2 diabetes rather than to obesity. In contrast, resistin expression displayed a different pattern being significantly increased in obese subjects compared to controls but not related to type 2 diabetes. These data suggest a differential role for these two proinflammatory adipokines in linking metabolic diseases to atherosclerosis with visfatin/PBEF/Nampt being more important in patients with type 2 diabetes and resistin in obese but nondiabetic human subjects.
Collapse
Affiliation(s)
- M Laudes
- Department of Internal Medicine II and Centre of Molecular Medicine, Universität zu Köln, Köln, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Laudes M, Oberhauser F, Walgenbach K, Schubert M, Schulte DM, Faust M, Krone W. Comparison of phenotypes in male and female individuals of a new family with Dunnigan type of familial partial lipodystrophy due to a lamin A/C R482W mutation. Horm Metab Res 2009; 41:414-7. [PMID: 19204888 DOI: 10.1055/s-0028-1128138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Laudes
- Department of Internal Medicine II and Centre of Molecular Medicine, University of Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|
28
|
Schulte DM, Oberhäuser F, Walgenbach K, Faust M, Schubert M, Krone W, Laudes M. Metabolic phenotypes in male subjects with Dunnigan type of familial partial Lipodystrophy due to a lamin A/C R482W mutation. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
29
|
Bilkovski R, Oberhäuser F, Schulte DM, Hampel B, Gutschow C, Brüning JC, Krone W, Laudes M. Macrophages inhibit adipogenesis of mesenchymal precursor cells via wnt-5a in humans. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
30
|
Tirakotai W, Sure U, Yin Y, Benes L, Schulte DM, Bien S, Bertalanffy H. Surgery of intracranial aneurysms previously treated endovascularly. Clin Neurol Neurosurg 2007; 109:744-52. [PMID: 17706339 DOI: 10.1016/j.clineuro.2007.05.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 05/21/2007] [Accepted: 05/26/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To perform a retrospective study on the patients who underwent aneurysmal surgery following endovascular treatment. PATIENTS AND METHODS We performed a retrospective study on eight patients who underwent aneurysmal surgery following endovascular treatment (-attempts) with gugliemi detachable coils (GDCs). The indications for surgery, surgical techniques and clinical outcomes were analyzed. RESULTS The indications for surgical treatment after GDC coiling of aneurysm were classified into three groups. First group: surgery of incompletely coiled aneurysms (n=4). Second group: surgery of mass effect on the neural structures due to coil compaction or rebleeding (n=2). Third group: surgery of vascular complications after endovascular procedure due to parent artery occlusion or thrombus propagation from aneurysm (n=2). Aneurysm obliterations could be performed in all cases confirmed by postoperative angiography. Six patients had an excellent outcome and returned to their profession. Patient's visual acuity was improved. One individual experienced right hemiparesis (grade IV/V) and hemihypesthesia. CONCLUSIONS Microsurgical clipping is rarely necessary for previously coiled aneurysms. Surgical treatment is uncommonly required when an acute complication arises during endovascular treatment, or when there is a dynamic change of a residual aneurysm configuration over time that is considered to be insecure.
Collapse
|
31
|
Schulte DM, Reincke M, Beuschlein F. Expression and distribution of differentiation and proliferation markers during mouse adrenal development. Exp Clin Endocrinol Diabetes 2005. [DOI: 10.1055/s-2005-862812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
32
|
Hellwig D, Grotenhuis JA, Tirakotai W, Riegel T, Schulte DM, Bauer BL, Bertalanffy H. Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev 2004; 28:1-34; discussion 35-8. [PMID: 15570445 DOI: 10.1007/s10143-004-0365-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 10/13/2004] [Indexed: 12/31/2022]
Abstract
The indications for neuroendoscopy are not only constantly increasing, but even the currently accepted indications are constantly being adjusted and tailored. This is also true for one of the most frequently used neuroendoscopic procedures, the endoscopic 3rd ventriculostomy (ETV) for obstructive hydrocephalus. ETV has gained popularity and widespread acceptance during the past few years, but little attention has been paid to the techniques of the procedure. After a short introduction describing the history of ETV, an overview is given of all the different techniques that have been and still are employed to open the floor of the 3rd ventricle. The spectrum of indications for ETV has been widely enlarged over the last years. Initially, the use of this procedure was restricted to patients older than 2 years, to patients with an obvious triventricular hydrocephalus, and to those with a bulging, translucent floor of the 3rd ventricle. Nowadays, indications include all kinds of obstructive hydrocephalus but also communicating forms of hydrocephalus. The results of endoscopic procedures in treating these pathologies are given under special consideration of shunt technologies. In summary, from the review of the publications since the first ETV performed by Mixter in 1923, this technique is the treatment of choice for obstructive hydrocephalus caused by different etiologies and is an alternative to cerebrospinal fluid shunt application.
Collapse
Affiliation(s)
- Dieter Hellwig
- Department of Neurosurgery, Philipps University Marburg, Baldingerstrasse, 35033, Marburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
OBJECTS The purpose of this study was to describe the indications, surgical techniques and postoperative outcome of neuroendoscopic interventions in a heterogeneous group of intracranial cystic pathologies. PATIENTS AND METHODS Between 1992 and 2003, 127 patients with symptomatic intracranial cysts and cystic tumours underwent neuroendoscopic treatment in our department. In 22 patients indication for surgery was colloid cysts, in 9 patients pineal cysts and in 3 patients cavum vergae cysts. Twelve arachnoid cysts, 10 cystic craniopharyngiomas, 2 Rathke's cleft cysts and 69 malignant cystic tumours were operated on. The patients' mean age was 45 years and their clinical presentations varied from typical signs of increased intracranial pressure to focal neurological deficits. RESULTS One hundred and twenty-seven patients with intracerebral cystic space-occupying lesions were operated on using stereotactic frameless or frame-based endoscopic techniques. There was no operative mortality. The operative morbidity was 3.1% including 1 memory deficit due to fornix injury, 1 hemiparesis due to postoperative haematoma after lesion biopsy, 1 aseptic meningitis and 1 subdural fluid collection. CONCLUSIONS Endoscopic interventions enable neurosurgeons to manage intracranial cystic lesions. Via the same approach, the obstructed CSF pathways may be restored and consequently the increased intracranial pressure diminishes. With the aid of stereotactic guidance or a neuronavigation system, access to the lesion can be gained rapidly and with high accuracy.
Collapse
Affiliation(s)
- Wuttipong Tirakotai
- Department of Neurosurgery, Philipps University, Baldingerstrasse, 35033 Marburg, Germany.
| | | | | | | | | |
Collapse
|
34
|
Tirakotai W, Riegel T, Schulte DM, Bertalanffy H, Hellwig D. Neuroendoscopic stent procedure in obstructive hydrocephalus due to both foramina of monro occluding craniopharyngioma: technical note. ACTA ACUST UNITED AC 2004; 61:293-6; discussion 296. [PMID: 14985010 DOI: 10.1016/s0090-3019(03)00424-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Accepted: 03/26/2003] [Indexed: 11/21/2022]
Abstract
BACKGROUND The development of various neuroendoscopic surgical instruments has offered more options for endoscopic procedures in the treatment of intraventricular tumors. Not only tumor biopsy or tumor resection but also restoration of an obstructed cerebral spinal fluid (CSF) pathway can be performed using the same approach. METHOD A 76-year-old woman with a cardiac pacemaker for an underlying heart disease was diagnosed with obstructive hydrocephalus because of a third ventricular tumor 8 years ago. The patient had been treated with ventriculo-peritoneal shunt placement. At admission she presented with a subcutaneous infection of the shunt catheter and an abdominal mass of unknown etiology. Neuroendoscopic stenting between lateral and third ventricle was performed to restore the obstructed CSF pathway, and the infected shunt system was removed in the same setting. RESULT The postoperative course was uneventful. Contrast ventriculography demonstrated a restored CSF pathway between the lateral and third ventricle. Histologic examination of the intraventricular tumor revealed a craniopharyngioma, and the abdominal mass was diagnosed as a gastrointestinal adenocarcinoma. CONCLUSION The neuroendoscopic foraminoplasty technique should be considered as an alternative treatment for patients who present with an obstructive hydrocephalus caused by a tumor that occludes both foramina of Monro when shunt placement or endoscopic third ventriculostomy is not feasible.
Collapse
|
35
|
Schulte DM, Reincke M, Beuschlein F. Spatio-temporal expression of the ACTH receptor during mouse adrenal development: Implication for adrenal growth and differentiation. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-819181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
36
|
Tirakotai W, Sure U, Benes L, Aboul-Enein H, Schulte DM, Riegel T, Bertalanffy H. Successful management of a symptomatic fusiform dilatation of the internal carotid artery following surgery of childhood craniopharyngioma. Childs Nerv Syst 2002; 18:717-21. [PMID: 12483358 DOI: 10.1007/s00381-002-0666-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2002] [Revised: 07/05/2002] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The development of fusiform dilatation of internal carotid artery is one of the vascular complications that can follow surgery for craniopharyngioma and other suprasellar tumours in children, but its pathogenesis and the line of management are still controversial. CASE REPORT AND DISCUSSION We report a child who presented with a giant fusiform aneurysm involving the supraclinoid portion of the internal carotid artery after total removal of a craniopharyngioma and review the literature on related cases. The treatment of this phenomenon and its possible pathogenesis are discussed.
Collapse
Affiliation(s)
- Wuttipong Tirakotai
- Department of Neurosurgery, Philipps University, Baldingerstrasse, 35033, Marburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
37
|
Sure U, Benes L, Riegel T, Schulte DM, Bertalanffy H. Image fusion for skull base neuronavigation. Technical note. Neurol Med Chir (Tokyo) 2002; 42:458-61; discussion 462. [PMID: 12416573 DOI: 10.2176/nmc.42.458] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An automatic image fusion module (BrainLab, Munich, Germany) is used for the fusion of the magnetic resonance (MR) imaging and computed tomography (CT) data sets. The procedure of image fusion takes 5 minutes prior to surgery. The image fusion of CT and MR imaging data visualizes the skull base and tumor margins clearly. Color display of the different data sets allows the tumor and the skull base to be distinguished easily. The fused CT data in bone window mode provides useful additional information on the osseous skull base.
Collapse
Affiliation(s)
- Ulrich Sure
- Department of Neurosurgery, Philipps-University Marburg, Germany.
| | | | | | | | | |
Collapse
|