1
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Panagiotakis E, Selzer T, Böhm G, Schrem H, Vondran FWR, Qu Z, Ockenga J, Hertenstein B, Winterhalter M, Bektas H. Preoperative hemoglobin levels, extended resections and the body mass index influence survival after pancreaticoduodenectomy. Langenbecks Arch Surg 2023; 408:124. [PMID: 36935457 DOI: 10.1007/s00423-023-02863-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The negative influence of perioperative transfusion of packed red blood cells on the prognosis of various malignancies is the focus of recent research interest. The development of a propensity score for the prediction of perioperative transfusion of packed red blood cells (pRBCs) and the identification of independent risk factors for survival, that can either be known prior to or during surgery in patients undergoing pancreaticoduodenectomy for pancreatic head cancer are the two objectives of this study. METHODS Logistic regression analyses and Cox regression modeling were used to identify independent risk factors for perioperative transfusion of pRBCs and to determine individual risk factors for patient survival. A total of 101 adult patients who underwent surgery between 01/01/2016 and 12/31/2020 were investigated in a single-center retrospective analysis. RESULTS Preoperative hemoglobin levels (OR: 0.472, 95%-CI: 0.312-0.663, p < 0.001) and extended resections (OR: 4.720, 95%-CI: 1.819-13.296, p = 0.001) were identified as independent risk factors for perioperative transfusion of pRBCs, enabling the prediction of pRBC transfusion with high sensitivity and specificity (AUROC: 0.790). The logit of the derived propensity model for the transfusion of pRBCs (HR: 9.231, 95%CI: 3.083-28.118, p < 0.001) and preoperative Body Mass Index (BMI) (HR, 0.925; 95%-CI: 0.870-0.981, p = 0.008) were independent risk factors for survival. CONCLUSIONS Low preoperative hemoglobin levels, low BMI values, and extended resections are significant risk factors for survival that can be known and thus potentially be influenced prior to or during surgery. Patient blood management programs and prehabilitation programs should strive to increase preoperative hemoglobin levels and improve preoperative malnutrition.
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Affiliation(s)
- Emmanouil Panagiotakis
- General, Visceral and Oncologic Surgery, Gesundheit Nord, Klinikum Bremen Mitte, Bremen, Germany
| | - Tabea Selzer
- General, Visceral and Oncologic Surgery, Gesundheit Nord, Klinikum Bremen Mitte, Bremen, Germany
| | - Gabriele Böhm
- General, Visceral and Oncologic Surgery, Gesundheit Nord, Klinikum Bremen Mitte, Bremen, Germany
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Florian W R Vondran
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Zhi Qu
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Johann Ockenga
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany
| | - Bernd Hertenstein
- Department of Internal Medicine I, Klinikum Bremen Mitte, Bremen, Germany
| | | | - Hüseyin Bektas
- General, Visceral, and Oncologic Surgery, Gesundheit Nord, Klinikum Bremen Mitte, Sankt Jürgen Str. 1, 28177, Bremen, Germany.
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2
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Vajsbaher T, Schultheis H, Janssen S, Weyhe D, Bektas H, Uslar V, Francis N. The development of visuospatial abilities and their impact on laparoscopic skill acquisition: a clinical longitudinal study. Surg Endosc 2022; 36:8908-8917. [PMID: 35641701 PMCID: PMC9154204 DOI: 10.1007/s00464-022-09328-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/30/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To investigate how visuospatial abilities develop and influence intraoperative laparoscopic performance during surgical residency training programmes. BACKGROUND Laparoscopic surgery is a challenging technique to acquire and master. Visuospatial ability is an important attribute but most prior research have predominantly explored the influence of visuospatial abilities in lab-based settings and/or among inexperienced surgeons. Little is known about the impact of visuospatial profiles on actual laparoscopic performance and its role in shaping competency. METHOD A longitudinal observational cohort study using a pair-matched design over 27 months. At baseline, visuospatial profiles of 43 laparoscopic surgeons of all expertise levels and 19 control subjects were compared. The development of visuospatial abilities and their association with intraoperative performance of 18 residency surgeons were monitored during the course of their laparoscopic training. RESULTS Laparoscopic surgeons significantly outperformed the control group on the measure of spatial visualisation (U = 273.0, p = 0.03, η2 = 0.3). Spatial visualisation was found to be a significant predictor of laparoscopic expertise (R2 = 0.70, F (1.60) = 6.788, p = 0.01) and improved with laparoscopic training (B = 4.01, SE = 1.83, p = 0.02, 95% CI [0.40, 7.63]). From month 6 to 18, a strong positive correlation between spatial visualisation and intraoperative depth perception (r = 0.67, p < 0.01), bimanual dexterity (r = 0.60, p < 0.01), autonomy (r = 0.78, p < 0.01) and the total score (r = 0.70, p < 0.01) were observed but a strong relationship remained only with autonomy (r = 0.89, p < 0.01) and total score (r = 0.80, p < 0.01) at 18 months. CONCLUSION In this longitudinal cohort study, visuospatial abilities associate with laparoscopic skills and improve with training. Spatial visualisation may be characteristic of laparoscopic expertise as it has clear association with competency development during laparoscopy residency training programme.
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Affiliation(s)
- Tina Vajsbaher
- Bremen Spatial Cognition Center, University of Bremen, Enrique-Schmidt-Straße 5, 28359, Bremen, Germany.
- Faculty for Human and Health Sciences, University of Bremen, Bremen, Germany.
| | - Holger Schultheis
- Bremen Spatial Cognition Center, University of Bremen, Enrique-Schmidt-Straße 5, 28359, Bremen, Germany
- Institute for Artificial Intelligence, University of Bremen, Bremen, Germany
| | - Sonja Janssen
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Dirk Weyhe
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Hüseyin Bektas
- Department for General, Visceral-and-Surgical Oncology, Klinikum Bremen-Mitte, Germany
| | - Verena Uslar
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Nader Francis
- Division of Surgery and Interventional Science, University College London, London, UK
- The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Road, Harrow, HA1 3UJ, Middlesex, UK
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3
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Gorgulu U, Bayındır H, Bektas H, Kayipmaz AE, San I. Coexistence of neurological diseases with Covid-19 pneumonia during the pandemic period. J Clin Neurosci 2021; 91:237-242. [PMID: 34373034 PMCID: PMC8257424 DOI: 10.1016/j.jocn.2021.06.041] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/15/2021] [Accepted: 06/22/2021] [Indexed: 01/28/2023]
Abstract
Although clinical findings are related to respiration in the Covid-19 pandemic, the number of patients with neurological symptoms and signs is increasing. The purpose of this study was to assess the prevalence of Covid-19 pneumonia using thoracic CT in patients who presented to the emergency room with neurological complaints during the pandemic. We retrospectively examined the files of 1093 patients who admitted to the emergency room and had a Neurology consultation. The research involved patients who had a neurological diagnosis and had typical findings of COVID-19 pneumonia on thorax computed tomography (CT). The thoracic CT scans of 68 (6.2%) of 1093 patients with neurological disorders at the time of admission revealed results consistent with Covid-19 pneumonia. The “real-time reverse transcription polymerase chain reaction” (RT-PCR) was positive in 42 of the 68 patients (62%), and the patients were diagnosed with Covid-19. Ground glass opacity was the most common finding in thoracic CT in patients diagnosed with Covid-19 pneumonia, with a rate of 92.9% (n = 39). Ischemic stroke (n = 26, 59.5%), cerebral haemorrhage (n = 11, 28.6%), epilepsy (n = 3, 7.1%), transient ischaemic attack (TIA; n = 1, 2.4%), and acute inflammatory demyelinating polyneuropathy (n = 1, 2.4%) were the most common neurological diagnoses among the patients. Even though Covid-19 affects the central and peripheral nervous systems, eliminating the possibility of Covid-19 pneumonia with thorax CT is critical for early treatment and patient prognosis.
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Affiliation(s)
- U Gorgulu
- Department of Neurology, Ankara City Hospital, Turkey.
| | - H Bayındır
- Department of Neurology, Ankara City Hospital, Turkey
| | - H Bektas
- Department of Neurology, Ankara City Hospital, Ankara Yildirim Beyazit University, Turkey
| | - A E Kayipmaz
- Department of Emergency Medicine, Ankara City Hospital, Turkey
| | - I San
- Ankara City Hospital, University of Health Sciences, Ankara, Turkey; Head of Emergency Health Services, Ministry of Health, Ankara, Turkey
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4
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Beetz O, Weigle CA, Cammann S, Vondran FWR, Timrott K, Kulik U, Bektas H, Klempnauer J, Kleine M, Oldhafer F. Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma. Langenbecks Arch Surg 2020; 405:977-988. [PMID: 32815017 PMCID: PMC7541380 DOI: 10.1007/s00423-020-01962-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/04/2020] [Accepted: 08/09/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. METHODS This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. RESULTS Median postoperative follow-up time was 22.93 (0.10-234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. CONCLUSION Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.
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Affiliation(s)
- Oliver Beetz
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Clara A Weigle
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Sebastian Cammann
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Florian W R Vondran
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Kai Timrott
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Ulf Kulik
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Hüseyin Bektas
- Department of General, Visceral and Oncological Surgery, Hospital Group Gesundheit Nord, Bremen, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Moritz Kleine
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Felix Oldhafer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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5
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Oldhafer F, Ringe KI, Timrott K, Kleine M, Beetz O, Ramackers W, Cammann S, Klempnauer J, Bektas H, Vondran FWR. Response to "Critical appraisal of the modified ante situm liver resection-is the original method the better choice?". Langenbecks Arch Surg 2019; 404:649-651. [PMID: 31256253 DOI: 10.1007/s00423-019-01795-w] [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] [Received: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
- F Oldhafer
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - K I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, 30625, Hannover, Germany
| | - K Timrott
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Kleine
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - O Beetz
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - W Ramackers
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - S Cammann
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - J Klempnauer
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - H Bektas
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,General, Visceral and Oncologic Surgery, Klinikum Bremen-Mitte/Bremen-Ost, Bremen, Germany
| | - Florian W R Vondran
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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6
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Stockmann M, Vondran FWR, Fahrner R, Tautenhahn HM, Mittler J, Bektas H, Malinowski M, Jara M, Klein I, Lock JF. Randomized clinical trial comparing liver resection with and without perioperative assessment of liver function. BJS Open 2018; 2:301-309. [PMID: 30263981 PMCID: PMC6156169 DOI: 10.1002/bjs5.81] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/13/2018] [Indexed: 12/11/2022] Open
Abstract
Background Liver function tests may help to predict outcomes after liver surgery. The aim of this study was to evaluate the clinical impact on postoperative outcome and patient management of perioperative liver function testing using the LiMAx® test. Methods A multicentre RCT was conducted in six academic liver centres. Patients with intrahepatic tumours scheduled for open liver resection of at least one segment were eligible. Patients were randomized to undergo additional perioperative liver function tests (LiMAx® group) or standard care (control group). Patients in the intervention arm received two perioperative LiMAx® tests, one before the operation for surgical planning and another after surgery for postoperative management. The primary endpoint was the proportion of patients transferred directly to a general ward. Secondary endpoints were severe complications, length of hospital stay (LOS) and length of intermediate care/ICU (LOI) stay. Results Some 148 patients were randomized. Thirty‐six of 58 patients (62 per cent) in the LiMAx® group were transferred directly to a general ward, compared with one of 60 (2 per cent) in the control group (P < 0·001). The rate of severe complications was significantly lower in the LiMAx® group (14 per cent versus 28 per cent in the control group; P = 0·022). LOS and LOI were significantly shorter in the LiMAx® group (LOS: 10·6 versus 13·3 days respectively, P = 0·012; LOI: 0·8 versus 3·0 days, P < 0·001). Conclusion Perioperative use of the LiMAx® test improves postoperative management and reduces the incidence of severe complications after liver surgery. Registration number: NCT01785082 (
https://clinicaltrials.gov).
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Affiliation(s)
- M Stockmann
- Department of General, Visceral and Transplantation Surgery Charité - Universitätsmedizin Berlin Germany.,Department of General, Visceral and Vascular Surgery Evangelisches Krankenhaus Paul Gerhardt Stift Lutherstadt Wittenberg Germany
| | - F W R Vondran
- Department of General, Visceral and Transplant Surgery Hannover Medical School Hannover Germany
| | - R Fahrner
- Department of General, Visceral and Vascular Surgery University of Jena Jena Germany
| | - H M Tautenhahn
- Department of General, Visceral and Vascular Surgery University of Jena Jena Germany.,Department of Visceral, Transplant, Thoracic and Vascular Surgery University Hospital Leipzig Leipzig Germany
| | - J Mittler
- Department of Hepatobiliary and Transplantation Surgery Johannes Gutenberg University Mainz Germany
| | - H Bektas
- Department of General, Visceral and Transplant Surgery Hannover Medical School Hannover Germany.,Department of General, Visceral and Oncological Surgery Bremen Mitte Clinic Bremen Germany
| | - M Malinowski
- Department of General, Visceral and Transplantation Surgery Charité - Universitätsmedizin Berlin Germany.,Department of General, Visceral, Vascular and Paediatric Surgery University of Saarland Homburg Germany
| | - M Jara
- Department of General, Visceral and Transplantation Surgery Charité - Universitätsmedizin Berlin Germany
| | - I Klein
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital of Würzburg Würzburg Germany
| | - J F Lock
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital of Würzburg Würzburg Germany
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7
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Oldhafer F, Ringe KI, Timrott K, Kleine M, Beetz O, Ramackers W, Cammann S, Klempnauer J, Vondran FWR, Bektas H. Modified ante situm liver resection without use of cold perfusion nor veno-venous bypass for treatment of hepatic lesions infiltrating the hepatocaval confluence. Langenbecks Arch Surg 2018; 403:379-386. [PMID: 29470630 DOI: 10.1007/s00423-018-1658-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/13/2017] [Accepted: 02/01/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Treatment of malignancies invading the hepatic veins/inferior vena cava is a surgical challenge. An ante situm technique allows luxation of the liver in front of the situs to perform tumor resection. Usually, cold perfusion and veno-venous bypass are applied. Our experience with modified ante situm resection relying only on total vascular occlusion is reported. METHODS Retrospective analysis on an almost 15-year experience with ante situm resection without application of cold perfusion or veno-venous bypass RESULTS: The ante situm technique was applied on eight patients. Five individuals were treated due to intrahepatic cholangiocellular cancer and one case each for mixed cholangio-/hepatocellular carcinoma, colorectal liver metastasis, and pheochromocytoma. Trisectorectomy (n = 4), left hemihepatectomy, right hepatectomy, atypical resection, or mesohepatectomy (each n = 1) were performed, combined with dissection of suprahepatic/retrohepatic vena cava/hepatic veins. Venous reconstruction was achieved by reimplantation of hepatic veins with/without vascular replacement using allogeneic donor veins or PTFE grafts. Median total vascular occlusion of the liver was 23 min. Severe morbidity occurred in three patients (Dindo-Clavien > 3A). R0 status was achieved in six cases with a median overall survival of 33.5 months. CONCLUSIONS Ante situm liver resection can be applied without cold perfusion nor veno-venous bypass with acceptable morbidity and mortality. However, this procedure remains challenging even for the experienced hepato-pancreato-biliary surgeon.
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Affiliation(s)
- F Oldhafer
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - K I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, 30625, Hannover, Germany
| | - K Timrott
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Kleine
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - O Beetz
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - W Ramackers
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - S Cammann
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - J Klempnauer
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F W R Vondran
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - H Bektas
- ReMediES, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,General, Visceral and Oncologic Surgery, Klinikum Bremen-Mitte/Bremen-Ost, Bremen, Germany
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8
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Schweitzer N, Fischer M, Kirstein MM, Berhane S, Kottas M, Sinn M, Gonzalez-Carmona MA, Balta Z, Weismüller TJ, Strassburg CP, Reineke-Plaaß T, Bektas H, Manns MP, Johnson P, Weinmann A, Vogel A. Risk estimation for biliary tract cancer: Development and validation of a prognostic score. Liver Int 2017; 37:1852-1860. [PMID: 28695669 DOI: 10.1111/liv.13517] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Received: 01/06/2017] [Accepted: 07/01/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Biliary tract cancer is a rare tumour entity characterized by a poor prognosis. We aimed to identify prognostic factors and create a prognostic score to estimate survival. METHODS Clinical data of the training set, consisting of 569 patients treated from 2000 to 2010 at Hannover Medical School, were analysed. A prognostic model defining three prognostic risk groups was derived from Cox regression analyses. The score was applied and validated in an independent cohort of 557 patients from four different German centres. RESULTS Median overall survival (OS) was 14.5 months. If complete resection was performed, the patients had a significantly improved OS (23.9 months; n=242) as compared to patients with non-resectable tumours (9.1 months; n=329, P<.0001). Based on univariable and multivariable analyses of clinical data, a prognostic model was created using variables available before treatment. Those were age, metastasis, C-reactive protein (CRP), international normalized ratio (INR) and bilirubin. The prognostic score distinguished three groups with a median OS of 21.8, 8.6 and 2.6 months respectively. The validation cohort had a median OS of 20.2, 14.0 and 6.5 months respectively. The prognostic impact of the score was independent of the tumour site and of treatment procedures. CONCLUSIONS Here, we identified prognostic factors and propose a prognostic score to estimate survival, which can be applied to all patients independent of tumour site and before initial treatment. Further validation in prospective trials is required.
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Affiliation(s)
- Nora Schweitzer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Mareike Fischer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Cardiology, Angiology and Intensive Care, Klinikum Hildesheim, Hildesheim, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Sarah Berhane
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Martina Kottas
- Department for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Marianne Sinn
- Department of Medical Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Zeynep Balta
- Department of Internal Medicine 1, University of Bonn, Bonn, Germany
| | | | | | | | - Hüseyin Bektas
- Department of Visceral Surgery, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Clinical Registry Unit, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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9
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Cammann S, Oldhafer F, Ringe KI, Ramackers W, Timrott K, Kleine M, Klempnauer J, Lehner F, Bektas H, Vondran FWR. Use of the liver maximum function capacity test (LiMAx) for the management of liver resection in cirrhosis - A case of hypopharyngeal cancer liver metastasis. Int J Surg Case Rep 2017; 39:140-144. [PMID: 28841541 PMCID: PMC5568863 DOI: 10.1016/j.ijscr.2017.08.003] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023] Open
Abstract
A patient with a liver metastasis of pharyngeal cancer and aspect of severe cirrhosis is presented. Conventional laboratory tests are surrogate parameters and might underestimate cirrhosis. The LiMAx test provides a direct measurement of the liver function capacity even in cirrhosis. Safe resection was performed after LiMAx test proved operability.
Introduction The presence of liver cirrhosis goes along with a higher chance for the need of liver resection. As established laboratory parameters often underestimate the degree of cirrhosis this is associated with an increased risk for postoperative liver failure due to the preoperatively impaired liver function. Known liver function tests are unlikely to be performed in daily use because of high cost or expenditure of time. Liver maximum function capacity test (LiMAx) provides a novel tool for measurement of liver function and references for the safety of liver resection. Presentation of case A 63-year old patient presented at our hospital with a large, solitary liver metastasis from hypopharyngeal cancer in segments VII/VIII with infiltration of the diaphragm. Liver resection was unsuccessful in a peripheral hospital 10 months before due to considerable macroscopic liver cirrhosis (CHILD B). Upon presentation conventional laboratory parameters revealed sufficient liver function. LiMAx was performed and showed regular liver function (354 μg/kg/h; at norm >315 μg/kg/h). Consequently, atypical liver resection (R0) was performed resulting in a postoperative LiMAx value of 281 μg/h/kg (>150 μg/kg/h). The patient was discharged from hospital 37 days after surgery without any signs of postoperative liver failure. Conclusion The LiMAx-test enables determination of liver function at a so far unavailable level (metabolism via cytochrome P450 1A2) and hence might provide crucial additional diagnostic information to allow for safe liver resection even in cirrhotic patients.
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Affiliation(s)
- S Cammann
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany.
| | - F Oldhafer
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - K I Ringe
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - W Ramackers
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - K Timrott
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - M Kleine
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - J Klempnauer
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - F Lehner
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - H Bektas
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - F W R Vondran
- Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
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Cammann S, Timrott K, Vonberg RP, Vondran FWR, Schrem H, Suerbaum S, Klempnauer J, Bektas H, Kleine M. Cholangitis in the postoperative course after biliodigestive anastomosis. Langenbecks Arch Surg 2016; 401:715-24. [PMID: 27236290 DOI: 10.1007/s00423-016-1450-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 09/10/2015] [Accepted: 05/13/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course. METHODS Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis. RESULTS Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (p < 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (p = 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (n = 12, p = 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively. CONCLUSION The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.
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Affiliation(s)
- Sebastian Cammann
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
| | - Kai Timrott
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hanover Medical School, Hanover, Germany
| | - Florian W R Vondran
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Harald Schrem
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hanover Medical School, Hanover, Germany
| | - Sebastian Suerbaum
- Institute for Medical Microbiology and Hospital Epidemiology, Hanover Medical School, Hanover, Germany
| | - Jürgen Klempnauer
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Hüseyin Bektas
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Moritz Kleine
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
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Jäger MD, Vondran FWR, Ramackers W, Röseler T, Schlitt HJ, Bektas H, Klempnauer J, Timrott K. A Depleting Anti-CD45 Monoclonal Antibody as Isolated Conditioning for Bone Marrow Transplantation in the Rat. PLoS One 2016; 11:e0154682. [PMID: 27139494 PMCID: PMC4854389 DOI: 10.1371/journal.pone.0154682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 04/18/2016] [Indexed: 11/19/2022] Open
Abstract
Objective A monoclonal antibody (mAb) against the leukocyte common antigen CD45 (RT7 in rats) could facilitate bone marrow transplantation (BMT). This study in rats evaluates a depletive rat anti-RT7a mAb as isolated tool for BMT conditioning without using irradiation or any chemotherapeutic / immunosuppressive agent. Methods The model used a CD45 di-allelic polymorphism (RT7a/RT7b). The anti-RT7a mAb was intravenously administered to LEW.1W rats (RT1uRT7a) at 5, 10 and 15 mg/kg. 1x108 BM cells of MHC syngeneic (RT1u), MHC disparate (RT1l) or MHC haploidentical (RT1u/l) donors were transplanted. All BM donor strains carried the RT7b allele so that their CD45+ cells were not affected by the anti-RT7a mAb. Recipients were monitored for reconstitution and donor-chimerism in blood leukocytes. Results mAb dosages of 5 or 10 mg/kg were myelosuppressive, whereas 15 mg/kg was myeloablative. Multi-lineage donor-chimerism at day 100 indicated engraftment of MHC syngeneic BM after any used mAb dosage (5 mg/kg: 46+/-7%; 10 mg/kg: 62+/-5%; 15 mg/kg: 80+/-4%). MHC disparate BM resulted in autologous reconstitution after conditioning by 10 mg/kg of the mAb and caused transient chimerism ending up in death associated with aplasia after conditioning by 15 mg/kg of the mAb. MHC haploidentical BM (F1 to parental) engrafted only after conditioning by 15 mg/kg (chimerism at day 100: 78+/-7%). Abandonment of α/β TCR+ cell depletion from BM grafts impaired the engraftment process after conditioning using 15 mg/kg of the mAb in the MHC syngeneic setting (2 of 6 recipients failed to engraft) and the MHC haploidentical setting (3 of 6 recipients failed). Conclusion This depletive anti-RT7a mAb is myelosuppressive and conditions for engraftment of MHC syngeneic BM. The mAb also facilitates engraftment of MHC haploidentical BM, if a myeloablative dose is used. RT7b expressing, BM-seeded α/β TCR+ cells seem to impair the engraftment process after myeloablative mAb conditioning.
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Affiliation(s)
- Mark D. Jäger
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
- * E-mail:
| | - Florian W. R. Vondran
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolf Ramackers
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Tilmann Röseler
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Hans J. Schlitt
- Klinik und Poliklinik für Chirurgie, Klinikum der Universität Regensburg, Regensburg, Germany
| | - Hüseyin Bektas
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jürgen Klempnauer
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Kai Timrott
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
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12
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Kulik U, Lehner F, Bektas H, Klempnauer J. Liver Resection for Non-Colorectal Liver Metastases - Standards and Extended Indications. Viszeralmedizin 2016; 31:394-8. [PMID: 26889142 PMCID: PMC4748777 DOI: 10.1159/000439419] [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] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Due to the uncertain benefit of liver resection for non-colorectal liver metastases (NCLM), patient selection for surgery is generally difficult. Therefore, the aim of this article was to propose standard and extended indications for liver resection in this heterogeneous disease collective. Methods Review of the literature. Results The myriad of biologically different primary tumor entities as well as the mostly small and retrospective studies investigating the benefit of surgery for NCLM limits the proposal of general recommendations. Only resection of neuroendocrine liver metastases (NELM) appears to offer a clear benefit with a 5- and 10-year overall survival (OS) of 74 and 51%, respectively, in the largest series. Resection of liver metastases from genitourinary primaries might offer reasonable benefit in selected cases – with a 5-year OS of up to 61% for breast cancer and of 38% for renal cell cancer. The long-term outcome following surgery for other entities was remarkably poorer, e.g., gastric cancer, pancreatic cancer, and melanoma reached a 5-year OS of 20-42, 17-25, and about 20%, respectively. Conclusion Liver resection for NELM can be defined as a standard indication for the resection of NCLM while lesions of genitourinary origin might be defined as an extended indication.
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Affiliation(s)
- Ulf Kulik
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hanover, Germany
| | - Frank Lehner
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hanover, Germany
| | - Hüseyin Bektas
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hanover, Germany
| | - Jürgen Klempnauer
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hanover, Germany
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13
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Kaltenborn A, Matzke S, Kleine M, Krech T, Ramackers W, Vondran FWR, Klempnauer J, Bektas H, Schrem H. Prediction of survival and tumor recurrence in patients undergoing surgery for pancreatic neuroendocrine neoplasms. J Surg Oncol 2015; 113:194-202. [PMID: 26709239 DOI: 10.1002/jso.24116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/16/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study strives to define prognostic models for outcome after surgery for malignant pancreatic neuroendocrine tumors. METHODS Forty-one patients were included. Prognostic models for mortality and disease recurrence were developed with multivariate binary logistic regression. RESULTS The proposed prognostic model for tumor recurrence risk after surgery in percentage (AUROC = 0.774, 95%CI = 0.611-0.937) is: Risk in % = Exp(Y)/(1 + Exp(Y)), with Y = -4.360 + (0.015 × tumor diameter in cm) + (0.010 × preoperative platelet count in thousand/μl) + (1.077 × distant metastases, if yes = 1; if no = 0) + (-0.026 × Ki-67-positive cells in %) + (-1.086 × upper abdominal pain, if yes = 1; if no = 0). The proposed prognostic model for observed 3-year survival probability after surgery in % (AUROC = 0.932, 95%CI = 0.857-0.999) is: Survival probability in % = Exp(Y)/(1 + Exp(Y)), with Y = -12.492 + (0.054 × preoperative platelet count in thousand/μl) + (0.112 × minimal distance of the resection margin from the tumor in mm) + (-1.574 × number of positive lymph nodes) + (2.292 × histological tumor infiltration, if yes = 1; if no = 0) CONCLUSIONS: The platelet count was identified as a relevant risk factor. Proposed prognostic models with good model-fit display properties that indicate potential clinical usefulness.
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Affiliation(s)
- Alexander Kaltenborn
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.,Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center-Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.,Department of Trauma and Orthopaedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany
| | - Svenja Matzke
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center-Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.,Department of Internal Medicine, Federal Armed Forces Hospital Hamburg, Hamburg, Germany
| | - Moritz Kleine
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Till Krech
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Wolf Ramackers
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Florian W R Vondran
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Hüseyin Bektas
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.,Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center-Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
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14
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Celik S, Ringe KI, Boru CE, Constantinica V, Bektas H. A case of pancreatic cancer with concomitant median arcuate ligament syndrome treated successfully using an allograft arterial transposition. J Surg Case Rep 2015; 2015:rjv161. [PMID: 26715412 PMCID: PMC4693142 DOI: 10.1093/jscr/rjv161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
An association of pancreatic cancer and median arcuate ligament syndrome (MALS) is a rare and challenging situation in terms of treatment. A 60-year-old man diagnosed with pancreatic cancer underwent laparotomy. A pancreaticoduodenectomy was planned, but during the resection part of the operation, a celiac artery stenosis was noticed. The patient was diagnosed with MALS causing almost total celiac artery occlusion, with no radiological solution. The patient was re-operated the next day, and an iliac artery allograft was used for aorta-proper hepatic artery reconstruction, concomitant with the total pancreaticoduodenectomy. Preoperative meticulous evaluation of vascular structures of the celiac trunk and its branches is important, especially in pancreatic surgery. A vascular allograft may be a lifesaving alternative when vascular reconstruction is necessary.
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Affiliation(s)
- Sebahattin Celik
- Department of General Surgery, Yüzüncü Yıl University, Van, Turkey
| | - Kristina I Ringe
- Department of Radiology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Cristian E Boru
- Department of General Surgery, Clinical Hospital 'Sf. Maria', Bucharest, Romani
| | | | - Hüseyin Bektas
- Department of General Surgery, Medizinische Hochschule Hannover, Hannover, Germany
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15
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Bektas H, Coskun H, Arikan F, Ozcan K, Tekeli A, Kondak Y, Sezgin M, Yangec E, Kalav S. 1545 Development and evaluation of the effectiveness of the online education programme among cancer patients undergoing treatment of systemic chemotherapy - first phase results. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30635-9] [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: 11/17/2022]
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16
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Özdemir M, Ringe K, Schrem H, Kleine M, Meyer zu Vilsendorf A, Klempnauer J, Lehner F, Jäger M, Bektas H. A case of successful renal transplantation for hydatid disease after surgical treatment of disseminated cysts. Transpl Infect Dis 2015; 17:406-10. [DOI: 10.1111/tid.12374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/08/2015] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Özdemir
- Department of General, Visceral and Transplant Surgery; Hannover Medical School; Hannover Germany
| | - K.I. Ringe
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
| | - H. Schrem
- Department of General, Visceral and Transplant Surgery; Hannover Medical School; Hannover Germany
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx); Hannover Medical School; Hannover Germany
| | - M. Kleine
- Department of General, Visceral and Transplant Surgery; Hannover Medical School; Hannover Germany
| | - A. Meyer zu Vilsendorf
- Department of General, Visceral and Transplant Surgery; Hannover Medical School; Hannover Germany
| | - J. Klempnauer
- Department of General, Visceral and Transplant Surgery; Hannover Medical School; Hannover Germany
| | - F. Lehner
- Department of General, Visceral and Transplant Surgery; Hannover Medical School; Hannover Germany
| | - M. Jäger
- Department of General, Visceral and Transplant Surgery; Hannover Medical School; Hannover Germany
| | - H. Bektas
- Department of General, Visceral and Transplant Surgery; Hannover Medical School; Hannover Germany
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17
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Höing K, Ringe KI, Bektas H, Klempnauer J, Jäger MD. Preduodenal superior mesenteric vein and Whipple procedure with vascular reconstruction-A case report. Int J Surg Case Rep 2015; 10:107-10. [PMID: 25853842 PMCID: PMC4429856 DOI: 10.1016/j.ijscr.2015.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/29/2015] [Accepted: 03/03/2015] [Indexed: 11/26/2022] Open
Abstract
A preduodenal superior mesenteric vein (SMV) is a rare portal vein disorder. Correct assessment of portal vein disorders can allow for hepato-pancreatic surgery. A preduodenal SMV does not contradict a Whipple procedure. Resection of a preduodenal SMV required a PTFE prosthesis. Preserved venous collateral pathways compensate late thrombosis of PTFE prosthesis.
Introduction Portal vein (PV) disorders are various, but rare. Here, we report a preduodenal superior mesenteric vein (PDSMV) in a patient who underwent a pancreaticoduodenectomy. Presentation of case A 67-year old woman with familial adenomatosis polyposis was suspicious for cancer of the papilla of vater and scheduled for surgery. Pre-operative diagnostic revealed a PDSMV continuing into the left PV. The splenic vein (SV) continued directly into the right PV without forming ananatomic PV confluence. Eight centimetre of the PDSMV were resected during the pancreaticoduodenectomy and reconnected using a polytetrafluoroethylene prosthesis. On day 1, early graft thrombosis was treated by thrombectomy and change to a larger graft. Pathology confirmed a R0-resection of the adenocarcinoma of the papilla of vater (pTis pN0,G2). At three-month follow-up, the patient was cancer-free and clinically asymptomatic, although, a late graft thrombosis with accompanying newly build venous collaterals passing mesenteric blood to the SV were found. Discussion Rare PV disorders like a PDSMV do not contradict pancreatic surgery, but should be treated in experienced centres. Skills of SMV/PV reconstruction and its peri-operative management might be beneficial for successful outcome. Despite late graft thrombosis no clinical disadvantage occurred most likely due to preservation of the SV and of potential venous collateral pathways. Conclusion Extended surgical procedures like a pancreaticoduodenectomy are realisable in patients with PV disorders, but require awareness, adequate radiological interpretation and specific surgical experience for secure treatment.
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Affiliation(s)
- Kristina Höing
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - Kristina I Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Hüseyin Bektas
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Jürgen Klempnauer
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Mark D Jäger
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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18
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Lankisch T, Bektas H, Dechêne A, Ehlken H, Kirchner GI, Lang H, Schramm C. Acute and Chronic Inflammation of the Biliary System. Visc Med 2015; 31:200-3. [PMID: 26468316 PMCID: PMC4569206 DOI: 10.1159/000434663] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Tim Lankisch
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hanover, Germany
- *Prof. Dr. med. Tim Lankisch, Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Germany,
| | - Hüseyin Bektas
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hanover, Germany
| | - Alexander Dechêne
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Germany
| | - Hanno Ehlken
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele I. Kirchner
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Mainz, Germany
| | - Christoph Schramm
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Bektas H, Yeyrek C, Kleine M, Vondran FWR, Timrott K, Schweitzer N, Vogel A, Jäger MD, Schrem H, Klempnauer J, Kousoulas L. Surgical treatment for intrahepatic cholangiocarcinoma in Europe: a single center experience. J Hepatobiliary Pancreat Sci 2014; 22:131-7. [PMID: 25159731 DOI: 10.1002/jhbp.158] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Intrahepatic cholangiocarcinoma is the second most common primary liver tumor. The aim of this study was to analyze retrospectively the outcome of surgical treatment and prognostic factors. Clinical, histopathological and treatment data of 221 patients treated from 1995 to 2010 at our institution were investigated. Univariate and multivariate analysis of the patient's data was performed. Patients after R0 and R1 resection presented an overall survival of 67% and 54.5% after 1 year and 40% and 36.4% after 3 years, respectively. The survival of patients without resection of the tumor was dismal with 26% and 3.4% after 1 and 3 years, respectively. Survival after resection was not statistically different in cases with R0 versus R1 resection (P = 0.639, log rank). Univariate Cox regression revealed that higher T stages are a significant hazard for survival (P = 0.048, hazard ratio (HR): 1.211, 95% confidence interval (CI): 1.002-2.465). Patients with tumor recurrence had a significantly inferior long-term survival when compared to patients without recurrence (P < 0.001, log rank). Presence of lymph node metastasis (N1) was an independent prognostic factor for survival after resection in risk-adjusted multivariate Cox regression (P < 0.001, HR: 2.577, 95% CI: 1.742-3.813). Adjuvant chemotherapy did not improve patient survival significantly (P = 0.550, log rank). Surgical resection is still the best treatment option for intrahepatic cholangiocarcinoma regarding the patient's long-term survival. R0 and R1 resection enable both better survival rates when compared to surgical exploration without resection. T status, N status, and tumor recurrence seem to be the most important prognostic factors after resection.
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Affiliation(s)
- Hüseyin Bektas
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
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Bektas H, Nadalin S, Szabo I, Ploder B, Sharkhawy M, Schmidt J. Hemostatic efficacy of latest-generation fibrin sealant after hepatic resection: a randomized controlled clinical study. Langenbecks Arch Surg 2014; 399:837-47. [PMID: 25037462 DOI: 10.1007/s00423-014-1227-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 08/22/2013] [Accepted: 07/09/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE This randomized, controlled, single-blinded multicenter study evaluated the efficacy of latest-generation fibrin sealant containing synthetic aprotinin as fibrinolysis inhibitor as supportive treatment for hemostasis after elective partial hepatectomy. METHODS Adult subjects undergoing resection of at least one liver segment were assigned to treatment with fibrin sealant or manual compression with a surgical gauze swab if persistent oozing necessitated additional hemostatic measures after primary control of arterial and venous bleeding. The primary outcome measure was the proportion of subjects with intraoperative hemostasis at 4 min after start of randomized treatment application. Secondary efficacy outcome measures included intraoperative hemostasis at 6, 8, and 10 min, intra- and postoperative rebleedings, transfusion requirements, and drainage volume. RESULTS Seventy subjects were randomized. Hemostasis at 4 min was achieved in 29/35 (82.9 %) fibrin sealant subjects compared with 13/35 (37.1 %) control subjects (p < 0.001). Significantly more fibrin sealant subjects achieved hemostasis at 6 (p < 0.001), 8 (p = 0.028), and 10 min (p = 0.017). The number of rebleedings was low in both study arms. Transfusion requirements and 48-h drainage volumes were similar between the study arms. No adverse events related to study treatment were reported. CONCLUSIONS Fibrin sealant was shown to be safe and superior to manual compression in the control of parenchymal bleeding after hepatic resection. The use of synthetic aprotinin as fibrinolysis inhibitor further improves the safety margin of fibrin sealant by eliminating the risk of transmission of bovine spongiform encephalopathy and other bovine pathogens.
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Affiliation(s)
- Hüseyin Bektas
- Clinic for General, Visceral and Transplant Surgery, Medical University of Hannover, 30625, Hannover, Germany
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21
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Klose J, Stankov MV, Kleine M, Ramackers W, Panayotova-Dimitrova D, Jäger MD, Klempnauer J, Winkler M, Bektas H, Behrens GMN, Vondran FWR. Inhibition of autophagic flux by salinomycin results in anti-cancer effect in hepatocellular carcinoma cells. PLoS One 2014; 9:e95970. [PMID: 24816744 PMCID: PMC4015957 DOI: 10.1371/journal.pone.0095970] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 01/10/2014] [Accepted: 04/01/2014] [Indexed: 12/21/2022] Open
Abstract
Salinomycin raised hope to be effective in anti-cancer therapies due to its capability to overcome apoptosis-resistance in several types of cancer cells. Recently, its effectiveness against human hepatocellular carcinoma (HCC) cells both in vitro and in vivo was demonstrated. However, the mechanism of action remained unclear. Latest studies implicated interference with the degradation pathway of autophagy. This study aimed to determine the impact of Salinomycin on HCC-autophagy and whether primary human hepatocytes (PHH) likewise are affected. Following exposure of HCC cell lines HepG2 and Huh7 to varying concentrations of Salinomycin (0-10 µM), comprehensive analysis of autophagic activity using western-blotting and flow-cytometry was performed. Drug effects were analyzed in the settings of autophagy stimulation by starvation or PP242-treatment and correlated with cell viability, proliferation, apoptosis induction, mitochondrial mass accumulation and reactive oxygen species (ROS) formation. Impact on apoptosis induction and cell function of PHH was analyzed. Constitutive and stimulated autophagic activities both were effectively suppressed in HCC by Salinomycin. This inhibition was associated with dysfunctional mitochondria accumulation, increased apoptosis and decreased proliferation and cell viability. Effects of Salinomycin were dose and time dependent and could readily be replicated by pharmacological and genetic inhibition of HCC-autophagy alone. Salinomycin exposure to PHH resulted in transient impairment of synthesis function and cell viability without apoptosis induction. In conclusion, our data suggest that Salinomycin suppresses late stages of HCC-autophagy, leading to impaired recycling and accumulation of dysfunctional mitochondria with increased ROS-production all of which are associated with induction of apoptosis.
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Affiliation(s)
- Johannes Klose
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Metodi V. Stankov
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Moritz Kleine
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Wolf Ramackers
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Diana Panayotova-Dimitrova
- Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Mark D. Jäger
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Michael Winkler
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Hüseyin Bektas
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Georg M. N. Behrens
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Hannover, Germany
| | - Florian W. R. Vondran
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Hannover, Germany
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22
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Agac MT, Bektas H, Korkmaz L, Cetin M, Erkan H, Gurbak I, Hatem E, Celik S. Androgenetic alopecia is associated with increased arterial stiffness in asymptomatic young adults. J Eur Acad Dermatol Venereol 2014; 29:26-30. [PMID: 24628808 DOI: 10.1111/jdv.12424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Association of androgenetic alopecia (AGA) with increased incidence of hypertension, a strong risk factor for coronary artery disease, has been suggested. However, there are no data on arterial stiffness measures of asymptomatic young adults with AGA. OBJECTIVE In this study, we aimed to investigate the association of the AGA with arterial stiffness assessed by cardio-ankle vascular index (CAVI), in asymptomatic young men. METHODS A total of 162 asymptomatic men aged between 18 and 45 years were consecutively enrolled to the study. Subjects were considered to have AGA if they have ≥3 grade vertex alopecia according to Hamilton-Norwood scale. Arterial stiffness was assessed by CAVI and defined as abnormal if CAVI is ≥8. RESULTS Frequency of abnormal CAVI was higher in patients with AGA (29.3% vs. 10.0%, P = 0.003). Subjects with AGA had higher mean CAVI than subjects without AGA (7.56 ± 0.93 vs. 7.15 ± 0.79, P = 0.004). Binary logistic regression analysis demonstrated that presence of AGA (OR, 5.6; 95% CI, 1.7-20.0, P = 0.006), age (OR, 1.1; 95% CI, 1.0-1.2, P = 0.03) and diastolic blood pressure (OR, 1.1; 95% CI, 1.0-1.3, P = 0.005) were independently associated with abnormal CAVI. CONCLUSION We concluded that, AGA might be an indicator of arterial stiffness in asymptomatic young adults.
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Affiliation(s)
- M T Agac
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
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23
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Korkmaz L, Erkan H, Ağaç MT, Pelit E, Bektas H, Acar Z, Gurbak I, Kara F, Çelik Ş. Link between aortic valve sclerosis and myocardial no-reflow in ST-segment elevation myocardial infarction. Herz 2014; 40:502-6. [PMID: 24441390 DOI: 10.1007/s00059-013-4026-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/08/2013] [Accepted: 11/09/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The"no-reflow" phenomenon is associated with a worse prognosis at follow-up for patients with acute ST-segment elevation myocardial infarction (STEMI). Predicting and preventing no-reflow is therefore a crucial step in improving the prognosis of STEMI patients. The purpose of this study was to investigate the association between aortic valve sclerosis (AVS) and myocardial no-reflow in patients with STEMI. PATIENTS AND METHODS Patients with a first-time diagnosis of STEMI were enrolled consecutively. No-reflow was defined as a final TIMI 3 flow with a myocardial blush of grade < 2, temporary epicardial coronary no-reflow, and distal coronary occlusion. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow. RESULTS No-reflow developed in 41 patients. In univariate analysis, age, male gender, smoking, culprit lesion Syntax score (SX score), and hypertension were significantly associated with no-reflow. Multivariate binary logistic regression analyses demonstrated age [95 % confidence interval (CI), 1.024-1.096; p=0.001), AVS (95 % CI, 1.002-1.100; p=0.039], culprit lesion SX score (95 % CI, 1.08-1.021 p=0.008), and symptom-to-balloon time (95 % CI, 1.020-1.097; p=0.002) as independent determinants of myocardial no-reflow. CONCLUSION AVS was significantly and independently associated with myocardial no-reflow in STEMI patients.
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Affiliation(s)
- L Korkmaz
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey,
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24
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Ağaç MT, Korkmaz L, Bektas H, Acar Z, Erkan H, Kurt IH, Adar A, Çelik Ş. Increased frequency of fragmented QRS in patients with severe aortic valve stenosis. Med Princ Pract 2014; 23:66-9. [PMID: 24192444 PMCID: PMC5586837 DOI: 10.1159/000355474] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/05/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the presence of myocardial fibrosis determined by fragmented QRS in patients with severe aortic valve stenosis. SUBJECTS AND METHODS Eighty-seven consecutive patients with severe aortic valve stenosis and 83 age- and gender-matched control subjects were enrolled into this study. Severe aortic valve stenosis was defined as an aortic valve area <1 cm(2), a Vmax >4 m/s, or a mean gradient ≥40 mm Hg. Fragmented QRS was assessed using a 12-lead electrocardiogram. RESULTS Fragmented QRS was detected in 40 (46%) patients in the aortic valve stenosis group and in 15 (18%) control subjects (p < 0.001). In multivariate binary logistic regression analysis, the presence of aortic valve stenosis was the only independent factor associated with fragmented QRS (OR = 3.69; 95% CI 1.81-7.55, p < 0.001). CONCLUSION A higher frequency of fragmented QRS was detected in patients with severe aortic valve stenosis compared to controls.
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Affiliation(s)
- Mustafa Tarık Ağaç
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
- *Mustafa Tarık Ağaç, MD, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Çamlık Street, TR-61187 Trabzon (Turkey), E-Mail
| | - Levent Korkmaz
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Hüseyin Bektas
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Zeydin Acar
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Hakan Erkan
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Ibrahim Halil Kurt
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Adem Adar
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Şükrü Çelik
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
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Winny M, Paroglou V, Bektas H, Kaltenborn A, Reichert B, Zachau L, Kleine M, Klempnauer J, Schrem H. Insulin dependence and pancreatic enzyme replacement therapy are independent prognostic factors for long-term survival after operation for chronic pancreatitis. Surgery 2013; 155:271-9. [PMID: 24287147 DOI: 10.1016/j.surg.2013.08.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 08/12/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND This retrospective, single-center, observational study on postoperative long-term results aims to define yet unknown factors for long-term outcome after operation for chronic pancreatitis. PATIENTS AND METHODS We analyzed 147 consecutive patients operated for chronic pancreatitis from 2000 to 2011. Mean follow-up was 5.3 years (range, 1 month to 12.7 years). Complete long-term survival data were provided by the German citizen registration authorities for all patients. A quality-of-life questionnaire was sent to surviving patients after a mean follow-up of 5.7 years. RESULTS Surgical principles were resection (n = 86; 59%), decompression (n = 29; 20%), and hybrid procedures (n = 32; 21%). No significant influences of different surgical principles and operative procedures on survival, long-term quality of life and pain control could be detected. Overall 30-day mortality was 2.7%, 1-year survival 95.9%, and 3-year survival 90.8%. Multivariate Cox regression analysis revealed that only postoperative insulin dependence at the time of hospital discharge (P = .027; Exp(B) = 2.111; 95% confidence interval [CI], 1.089-4.090) and the absence of pancreas enzyme replacement therapy at the time of hospital discharge (P = .039; Exp(B) = 2.102; 95% CI, 1.037-4.262) were significant, independent risk factors for survival with significant hazard ratios for long-term survival. Long-term improvement in quality of life was reported by 55 of 76 long-term survivors (73%). CONCLUSION Pancreatic enzyme replacement should be standard treatment after surgery for chronic pancreatitis at the time of hospital discharge, even when no clinical signs of exocrine pancreatic failure exist. This study underlines the potential importance of early operative intervention in chronic pancreatitis before irreversible endocrine dysfunction is present.
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Affiliation(s)
- Markus Winny
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Vagia Paroglou
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Hüseyin Bektas
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Kaltenborn
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany; Federal Armed Forces Medical Center Hannover, Hannover, Germany
| | - Benedikt Reichert
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany; Department of General and Thoracic Surgery, Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - Lea Zachau
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Moritz Kleine
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
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26
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Kleine M, Vondran FWR, Johanning K, Timrott K, Bektas H, Lehner F, Klempnauer J, Schrem H. Respiratory risk score for the prediction of 3-month mortality and prolonged ventilation after liver transplantation. Liver Transpl 2013; 19:862-71. [PMID: 23696476 DOI: 10.1002/lt.23673] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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] [Received: 10/15/2012] [Accepted: 04/28/2013] [Indexed: 02/07/2023]
Abstract
Survival of critically ill patients is significantly affected by prolonged ventilation. The goal of this study was the development of a respiratory risk score (RRS) for the prediction of 3-month mortality and prolonged ventilation after liver transplantation (LT). Two hundred fifty-four consecutive LT patients from a single center were retrospectively randomized into a training group for model design and a validation group. A receiver operating characteristic (ROC) curve analysis was used to test sensitivity and specificity. The accuracy of the predictions was assessed with the Brier score, and the model calibration was assessed with the Hosmer-Lemeshow test. Cutoff values were determined with the best Youden index. The RRS was calculated in the first 24 hours as follows: (laboratory Model for End-Stage Liver Disease score > 30 = 2.36 points) + (fresh frozen plasma > 13.5 U = 2.70 points) + (partial pressure of arterial oxygen/fraction of inspired oxygen ratio < 200 mm Hg = 2.23 points) + (packed red blood cells > 10.5 U = 3.50 points) + (preoperative mechanical ventilation = 3.87 points) + (preoperative dialysis = 2.83 points) + (donor steatosis hepatis > 40% = 2.95 points). The RSS demonstrated high predictive accuracy, good model calibration, and c statistics > 0.7 in the training and validation groups. The RSS was able to predict 3-month mortality [cutoff = 6.64, area under the (ROC) curve (AUROC) = 0.794] and prolonged ventilation (cutoff = 3.69, AUROC = 0.798) with sensitivities of 69% and 81%, specificities of 83% and 73%, and overall model correctness of 76% and 77%, respectively. In conclusion, this study provides the first prognostic model for the prediction of 3-month mortality and prolonged ventilation after LT with high sensitivity and specificity and good model accuracy. The application of the RRS to an external cohort would be desirable for its further validation and introduction as a clinical tool for intensive care resource planning and prognostic decision making.
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Affiliation(s)
- Moritz Kleine
- Department of General, Visceral, and Transplant Surgery, Hannover, Germany.
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Abstract
Abdominal seat belt marks can be an indication of abdominal wall rupture. The focused assessment with sonography for trauma (FAST) and computed tomography (CT) scanning are the diagnostic tools of choice in hemodynamically stable patients. The typical mechanism of trauma frequently leads to additional intra-abdominal injuries, spinal injuries and in some cases aortic rupture. Abdominal wall injuries of grade IV according to Dennis should be surgically treated. The increasing numbers of obese vehicle occupants and the resulting special risk of injury warrant optimization of technical restraint systems.
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Affiliation(s)
- S Bachmann
- Abteilung für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuber-Straße 1, 30625, Hannover, Deutschland,
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28
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Öllinger R, Mihaljevic AL, Schuhmacher C, Bektas H, Vondran F, Kleine M, Sainz-Barriga M, Weiss S, Knebel P, Pratschke J, Troisi RI. A multicentre, randomized clinical trial comparing the Veriset™ haemostatic patch with fibrin sealant for the management of bleeding during hepatic surgery. HPB (Oxford) 2013; 15:548-58. [PMID: 23458162 PMCID: PMC3692026 DOI: 10.1111/hpb.12009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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] [Received: 08/09/2012] [Accepted: 10/17/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bleeding during hepatic surgery is associated with prolonged hospitalization and increased morbidity and mortality. The Veriset™ haemostatic patch is a topical haemostat comprised of an absorbable backing made of oxidized cellulose and self-adhesive hydrogel components. It is designed to achieve haemostasis quickly and adhere to tissues without fixation. METHODS A prospective, randomized, multicentre, single-blinded study (n = 50) was performed to compare the use of a Veriset™ haemostatic patch with a fibrin sealant patch (TachoSil(®) ) (control) in the management of diffuse bleeding after hepatic surgery. Patients were randomized following the confirmation of diffuse bleeding requiring the use of a topical haemostat. Time to haemostasis was assessed at preset intervals until haemostasis was achieved. RESULTS Both groups were similar in comorbidities and procedural techniques. The median time to haemostasis in the group using the Veriset™ haemostatic patch was 1.0 min compared with 3.0 min in the control group (P < 0.001; 3-min minimum application time for the control patch). This result was independent of bleeding severity and surface area. Both products had similar safety profiles and no statistical differences were observed in the occurrence of adverse or device-related events. CONCLUSIONS Regardless of bleeding severity or surface area, the Veriset™ haemostatic patch achieved haemostasis in this setting significantly faster than the control device in patients undergoing hepatic resection. It was safe and easy to handle in open hepatic surgery.
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Affiliation(s)
- Robert Öllinger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University InnsbruckInnsbruck, Austria
| | - Andre L Mihaljevic
- Department of Surgery, Rechts der Isar Hospital, Technical University of MunichMunich, Germany
| | - Christoph Schuhmacher
- Department of Surgery, Rechts der Isar Hospital, Technical University of MunichMunich, Germany
| | - Hüseyin Bektas
- Department of General, Visceral and Transplant Surgery, Medical School HanoverHanover, Germany
| | - Florian Vondran
- Department of General, Visceral and Transplant Surgery, Medical School HanoverHanover, Germany
| | - Moritz Kleine
- Department of General, Visceral and Transplant Surgery, Medical School HanoverHanover, Germany
| | - Mauricio Sainz-Barriga
- Liver Transplantation Service, Department of General and Hepatobiliary Surgery, Ghent University Hospital Medical SchoolGhent, Belgium
| | - Sascha Weiss
- Department of Visceral, Transplant and Thoracic Surgery, Medical University InnsbruckInnsbruck, Austria
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University Hospital HeidelbergHeidelberg, Germany
| | - Johann Pratschke
- Department of Visceral, Transplant and Thoracic Surgery, Medical University InnsbruckInnsbruck, Austria
| | - Roberto I Troisi
- Liver Transplantation Service, Department of General and Hepatobiliary Surgery, Ghent University Hospital Medical SchoolGhent, Belgium
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Abstract
BACKGROUND Following resection of colorectal liver metastases (CLMs) up to 75 per cent of patients develop recurrent liver metastases. Although repeat resection remains the only curative therapy, data evaluating the outcome are deficient. This study analysed postoperative morbidity, mortality and independent predictors of survival following repeat resection of CLMs. METHODS Data on surgical treatment of primary and recurrent CLMs between 1994 and 2010 were collected retrospectively, and compared with those for single hepatic resections carried out during the same period. Independent predictors of survival were evaluated by means of univariable and multivariable Cox regression models. RESULTS In this interval 1026 primary resections of CLMs were performed and 94 patients underwent repeat CLM excision. Overall postoperative morbidity and mortality rates were low (15·8 and 1·3 per cent respectively), with no statistical difference in patients undergoing repeat surgery (P = 0·072). Compared with single liver resections, overall survival was improved in repeat resections (P = 0·003). Multivariable analysis revealed that size of primary CLM over 50 mm was an independent predictor of survival (hazard ratio (HR) 2·61; P = 0·008). Only major hepatic resection was associated with poorer outcome following repeat surgery (HR 2·62; P = 0·009). International Union Against Cancer stage, number of CLMs, age at surgery and need for intraoperative transfusion had no impact on survival after repeat resection. CONCLUSION Recurrent CLM surgery is feasible with similar morbidity and mortality rates to those of initial or single CLM resections.
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Affiliation(s)
- U Kulik
- Department of General, Visceral and Transplantation Surgery, Hanover Medical School, Carl-Neuberg-Strasse 1,, 30625, Hanover, Germany
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Schrem H, Reichert B, Frühauf N, Kleine M, Zachau L, Becker T, Lehner F, Bektas H, Klempnauer J. [Extended donor criteria defined by the German Medical Association : study on their usefulness as prognostic model for early outcome after liver transplantation]. Chirurg 2013; 83:980-8. [PMID: 22810545 PMCID: PMC7095839 DOI: 10.1007/s00104-012-2325-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Einleitung Die Expansion des Spenderpools durch die Verwendung von Spenderorganen, die erweiterte Spenderkriterien erfüllen, verringert die Wartelistenmortalität mit einem erhöhten Risiko für das Patienten- und Transplantatüberleben nach Lebertransplantation. Die Eignung der Anzahl der erfüllten erweiterten Spenderkriterien nach der aktuellen Definition der Bundesärztekammer (BÄK-Score) für die Voraussage der frühen Ergebnisse nach Lebertransplantation ist unbekannt. Patientenkollektiv Untersucht wurden 257 erwachsene Empfänger, die zwischen dem 01.01.2007 und dem 31.12.2010 insgesamt 291 konsekutive Lebertransplantate erhielten. Methoden Primäre Studienendpunkte waren die 30-Tage-Mortalität, 3-Monats-Mortalität, das 3-Monats-Patientenüberleben, 3-Monats-Transplantatüberleben und die Notwendigkeit einer akuten Retransplantation innerhalb von 30 Tagen. Der BÄK-Score wurde als prognostisches Modell mit der ROC-Kurven-Analyse mit Bestimmung der Sensitivität, Spezifität und Gesamtmodellkorrektheit des Modells für die Voraussage der primären Studienendpunkte untersucht. Weiterhin wurden Kaplan-Meier-Überlebensanalysen, Log-Rank-Tests, Cox-Regressionsanalysen, logistische Regressionen und χ2-Tests durchgeführt. Ergebnisse Die Anzahl der erfüllten erweiterten Spenderkriterien hatte keinen signifikanten Einfluss auf die primären Studienendpunkte (p > 0,05) und das Patientenüberleben (p > 0,05). Die ROC-Kurven-Analyse zeigte für die Voraussage der primären Studienendpunkte Flächen ≤ 0,561 mit einer Gesamtkorrektheit des Modells < 58% bei einer Sensitivität < 52%. Schlussfolgerung Die Anzahl der erfüllten erweiterten Spenderkriterien nach der aktuellen Definition der Bundesärztekammer kann die frühe Prognose innerhalb der ersten 3 Monate nach Lebertransplantation als prognostisches Modell nicht voraussagen.
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Affiliation(s)
- H Schrem
- Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland.
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Agaç MT, Korkmaz L, Cavusoglu G, Karadeniz AG, Agaç S, Bektas H, Erkan H, Varol MO, Vatan MB, Acar Z, Mentese U, Celik S. Response to the letter "nonalcoholic fatty liver disease may be associated with coronary artery disease complexity". Angiology 2013; 64:641. [PMID: 23620309 DOI: 10.1177/0003319713486013] [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: 11/15/2022]
Affiliation(s)
- Mustafa Tarik Agaç
- 1Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
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Schrem H, Reichert B, Frühauf N, Becker T, Lehner F, Kleine M, Bektas H, Zachau L, Klempnauer J. The Donor-Risk-Index, ECD-Score and D-MELD-Score all fail to predict short-term outcome after liver transplantation with acceptable sensitivity and specificity. Ann Transplant 2013; 17:5-13. [PMID: 23018250 DOI: 10.12659/aot.883452] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Expansion of the donor pool by the use of grafts with extended donor criteria reduces waiting list mortality with an increased risk for graft and patient survival after liver transplantation. This study investigates the ability of the Donor-Risk-Index (DRI), the Extended-Criteria-Donor-Score (ECD-score) and the D-MELD-score to predict early outcome after liver transplantation. MATERIAL/METHODS 291 consecutive adult liver transplants (01.01.2007-31.12.2010) were analysed in a single centre study with ongoing data collection. Primary study endpoints were 30-day mortality, 3-month mortality, 3-month patient and graft survival and the necessity of acute retransplantation within 30 days. For the primary study endpoints ROC-curve analysis was performed to calculate the sensitivity, specificity, and overall model correctness of the Donor-Risk-Index (DRI), Extended-Criteria-Donor-Score (ECD-score) and the D-MELD-Score as predictive models. Cut-off values were selected with the best Youden index. RESULTS ROC-curve analysis showed areas under the curve (AUROCs) <0.7 for the DRI, the ECD-Score and the D-MELD-Score as models for the prediction of 30-day mortality, 3-month mortality, 3-month patient survival, 3-month graft survival as well as the necessity of acute retransplantation within 30 days after transplantation with unacceptable low levels of overall model correctness (<62%) and specificity (<56%). CONCLUSIONS The DRI, the ECD-Score and the D-MELD-Score all fail to predict short-term outcome after liver transplantation with acceptable overall model correctness in a current European transplant setting.
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Affiliation(s)
- Harald Schrem
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
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Agaç MT, Korkmaz L, Cavusoglu G, Karadeniz AG, Agaç S, Bektas H, Erkan H, Varol MO, Vatan MB, Acar Z, Mentese U, Celik S. Association between nonalcoholic fatty liver disease and coronary artery disease complexity in patients with acute coronary syndrome: a pilot study. Angiology 2013; 64:604-8. [PMID: 23439214 DOI: 10.1177/0003319713479155] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary syndrome (ACS). We assessed the association between NAFLD and SYNTAX Score (SS) in patients with ACS. Eighty consecutive patients with ACS were enrolled. Patients were evaluated using ultrasound to detect NAFLD and hepatosteatosis stage. The prevalence of NAFLD was 81.2%; median SS was 15. The SS was significantly higher in patients with NAFLD (18 ± 8 vs. 11 ± 5, P = .001). Univariate analysis showed that the stage of NAFLD correlated with SS (r = .6, P < .001). In multivariate binary logistic analysis, increased age (odds ratio [OR], 1.05; 95% confidence interval [CI],1.00-1.10) and presence of NAFLD (OR, 13.20; 95% CI, 2.52-69.15) were independent factors associated with supramedian SS. In conclusion, among patients with ACS, those with NAFLD have more complex CAD as assessed by SS.
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Affiliation(s)
- Mustafa Tarik Agaç
- 1Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
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Ringe KI, Ringe BP, Bektas H, Opherk JP, Reichelt A, Lotz J, Wacker F, Meyer BC. Characterization and staging of central bile duct stenosis—Evaluation of the hepatocyte specific contrast agent gadoxetate disodium. Eur J Radiol 2012; 81:3028-34. [DOI: 10.1016/j.ejrad.2012.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/24/2012] [Accepted: 03/27/2012] [Indexed: 11/29/2022]
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Kleine M, Joahnning K, Kousoulas L, Schrem H, Lehner F, Bektas H, Klempnauer J, Kaaden S. Observations with impact on the indication for kinetic therapy in critically ill liver transplant patients. Ann Transplant 2012; 16:25-31. [PMID: 22210418 DOI: 10.12659/aot.882215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Severe pulmonary complications following orthotopic liver transplantation are a major cause of postoperative deaths. Kinetic therapy (KT) has been reported to prevent and treat respiratory complications in selected critically ill patients, but little has been reported about the value of different criteria for the use of this therapy and its side effects in liver transplant recipients. MATERIAL/METHODS We performed a prospective observational study of 27 patients treated post-transplantation in our ICU. 12 of 27 patients were treated with KT in case of either high number of blood transfusions (>20) or respiratory insufficiency (PaO2/FiO2 ratio <250 mmHg) or pretransplant pulmonary disease. Over a period of nine days we measured the PaO2/FiO2 ratio to evaluate the beneficial effect of KT. Liver perfusion was quantified by doppler ultrasound. Transplant function was measured by INR (international normalised ratio) and determination of indocyanine green elimination rate. RESULTS Side effects on graft perfusion and graft function were not seen. 7 of 12 patients decreased in their PaO2/FiO2 ratio significantly 48 hours postoperative to 53% as compared to early postoperative level and recovered under KT during the observed time period nearly to the early postoperative level (95%; p<0.001). The units of perioperative blood transfusions, the MELD-score, the decrease of PaO2/FiO2 ratio 24 h after transplantation and retransplantation for initial non-functioning of the graft all pointed to a likely beneficial effect of KT. CONCLUSIONS We conclude that these criteria may be helpful to identify patients who are likely to benefit from KT.
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Affiliation(s)
- Moritz Kleine
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-St. 1, Hannover, Germany.
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Kulik U, Framke T, Grosshennig A, Ceylan A, Bektas H, Klempnauer J, Lehner F. Liver resection of colorectal liver metastases in elderly patients. World J Surg 2011; 35:2063-72. [PMID: 21717239 DOI: 10.1007/s00268-011-1180-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The percentage of elderly patients with colorectal liver metastases (CLM) has increased. Liver resection remains the only curative therapy; data evaluating the outcome in this age group is limited. Aim of the present study was to determine if postoperative morbidity, mortality, and other independent predictors influence survival in patients ≥ 70 years undergoing liver resection for CLM. METHODS Clinical data on primary tumor and metastases of 939 patients after liver resection for CLM between 1994 and 2008 were retrospectively collected and subdivided in three age-groups (≥ 70, 40-69, <40). Independent predictors of survival were evaluated with overall and age-specific univariate and multivariate Cox regression models. RESULTS A total of 939 patients underwent liver resection for CLM, 20.3% aged ≥ 70 years. Overall postoperative mortality and morbidity were 1.08 and 14.82%, revealing no age-related differences. With 5-year survival of 31.8% in the elderly and 37.5% in the mid-age population, age ≥ 70 years was linked with decreased survival (Hazard Ratio [HR] = 1.305; P = 0.0186). Multivariate overall analyses showed size of CLM > 50 mm (HR = 1.376; P = 0.0060), a high amount of transfusion during surgery (HR = 1.676; P = 0.0110), duration of surgery >210 min (HR = 1.241; P = 0.0322), primary UICC (International Union Against Cancer) stage IV (HR = 2.297; P < 0.0001), and performance of repeat resections (HR = 0.652; P = 0.0107) as independent predictors of survival. In the elderly group, effects of UICC IV (HR = 3.260; P = 0.0148) and high numbers of transfusions (HR = 3.647; P = 0.0129) were confirmed; the others did not show statistical significance. CONCLUSIONS Resection of CLM at older age is feasible with morbidity and mortality rates similar to those in younger patients. Although age ≥ 70 was shown to be associated with poorer overall outcome, reasonable 5-year survival was observed.
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Affiliation(s)
- U Kulik
- Department of General-, Visceral- and Transplantation Surgery, Hannover Medical School, Hannover, Germany
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Kleine M, Schrem H, Vondran FWR, Krech T, Klempnauer J, Bektas H. Extended surgery for advanced pancreatic endocrine tumours. Br J Surg 2011; 99:88-94. [PMID: 22135173 DOI: 10.1002/bjs.7681] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pancreatic endocrine tumours are often diagnosed at an advanced stage with hepatic metastasis. This study investigated whether extended resections for advanced malignant pancreatic endocrine tumours influenced disease-free and disease-specific survival. METHODS Patients who had curative resection of pancreatic endocrine tumours were analysed retrospectively for disease-free and disease-specific survival, with a focus on the role of extended surgical resection. RESULTS Forty-one patients were included in the analysis, 13 of whom underwent extended surgical resection in addition to pancreatic resection. This included partial liver resection in nine patients, portal vein resection in three, partial gastric resection in five and liver transplantation in three patients. There were no deaths in hospital or within 30 days. Median follow-up was 40 (range 2-239) months. Thirty-five, 24 and 13 patients survived more than 1, 3 and 5 years respectively. Patients who underwent extended resection had similar disease-specific survival to those who had pancreatic resection alone (hazard ratio (HR) 1·50, 95 per cent confidence interval (c.i.) 0·35 to 6·35; P = 0·581) but with a higher frequency of complications (odds ratio (OR) 4·28, 95 per cent c.i. 1·04 to 17·62; P = 0·044). Among patients with liver metastases, the mortality rate was higher in those in whom liver resection was not possible than in patients who had liver resection (HR 9·24, 1·00 to 85·18; P = 0·049). Patients who had liver resection had similar disease-specific survival to those without liver metastases (HR 0·84, 0·09 to 7·57; P = 0·877). CONCLUSION Extended surgical resection for locally advanced and metastatic pancreatic endocrine tumours is feasible with encouraging disease-specific survival.
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Affiliation(s)
- M Kleine
- Department of General, Visceral and Transplant Surgery, Hanover, Germany.
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Aysan E, Bektas H, Ersoz F, Behzat K. Role of Single-Dose Clostridiopeptidase A Collagenase in Peritoneal Adhesions. Eur Surg Res 2011; 47:130-4. [DOI: 10.1159/000330236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 05/31/2011] [Indexed: 11/19/2022]
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Bektas H, Altin A. P120 Pain management in cancer patients. Eur J Oncol Nurs 2010. [DOI: 10.1016/s1462-3889(10)70182-4] [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: 11/29/2022]
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Bektas H, Ozkan I. P52 Management of sexual dysfunction in breast cancer. Eur J Oncol Nurs 2010. [DOI: 10.1016/s1462-3889(10)70115-0] [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: 11/28/2022]
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Bektas H, Yigit G. P12 Standards for safe use of antineoplastic drugs. Eur J Oncol Nurs 2010. [DOI: 10.1016/s1462-3889(10)70076-4] [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: 11/26/2022]
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Bektas H, Ozkan I. P66 Sexual dysfunction in breast cancer. Eur J Oncol Nurs 2010. [DOI: 10.1016/s1462-3889(10)70129-0] [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: 11/26/2022]
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Bektas H, Yigit G. P11 Training of patients and relatives in cancer. Eur J Oncol Nurs 2010. [DOI: 10.1016/s1462-3889(10)70075-2] [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: 11/29/2022]
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Bektas H, Yigit G. P111 Nursing care of neutropenic patient. Eur J Oncol Nurs 2010. [DOI: 10.1016/s1462-3889(10)70173-3] [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: 11/30/2022]
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Abstract
Cavernous hemangiomas are the most common benign tumors of the liver. They can reach enormous sizes and cause various complications. Kasabach-Merritt syndrome is a rare but serious complication characterized by consumptive coagulopathy caused by the hemangioma; mortality rate ranges between 10 and 37%. More than 80% of cases occur within the first year of life. Goals of the treatment are to control the coagulopathyand thrombocytopenia as well as to eradicate the hemangioma. Different nonsurgical treatment regimens are performed, includingsystemic corticosteroids, irradiation and various chemicals. Surgery should be limited to symptomatic or complicated cases. Although difficult, resection of the tumor is usually curative. Here we present a 44-year-old woman with giant hepatic hemangioma causing Kasabach-Merritt syndrome managed by enucleation.
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Affiliation(s)
- Ahmet Aslan
- Department of General Surgery, Faculty of Medicine, Mustafa Kemal University, Antakya-Hatay, Turkey
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Lehner F, Ramackers W, Bektas H, Becker T, Klempnauer J. Leberresektion bei nicht kolorektalen, nicht neuroendokrinen Lebermetastasen – ist die Resektion im Rahmen des „onko-chirurgischen“ Therapiekonzeptes gerechtfertigt? Zentralbl Chir 2009; 134:430-6. [DOI: 10.1055/s-0029-1224601] [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]
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Aysan E, Bektas H, Kaygusuz A, Huq GE. Efficacy of flax oil in preventing postoperative peritoneal adhesions. Eur Surg 2009. [DOI: 10.1007/s10353-009-0453-1] [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]
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Bektas H, Winny M, Schrem H, Becker T, Klempnauer J. [Late stage stenoses of bile ducts after iatrogenic bile duct injuries following cholecystectomy]. Zentralbl Chir 2008; 132:523-8. [PMID: 18098080 DOI: 10.1055/s-2007-981372] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Iatrogenic bile duct injuries represent a severe complication after cholecystectomy. For the attending physician therapy and management of these injuries are a challenge. Inadequate and delayed treatment can lead to stenoses at a late stage, which can necessitate further surgical intervention. METHODS In a study data of 74 patients, who were treated in our clinic for bile duct injuries following cholecystectomy, were analysed retrospectively. RESULTS A total of 8 patients with late stage bile duct strictures following iatrogenic bile duct injury including the subsequent therapy could be identified. The data of these patients were analysed in respect of cause and strategies to prevent late stage stenoses. In 62 patients the bile duct injury occurred following laparoscopic and in 12 patients following open cholecystectomy. In 16 patients the injury was combined with a vascular lesion. The interval between primary intervention and definitive therapy was 11 days in 53 patients and 1-15 years in 21 patients. In 8 patients the reason for the re-operation after a long interval (1-15 years) was a late stage stenosis. A hepatico-jejunostomy was performed subsequently and during follow-up 5 / 8 patients were symptom-free; 7 patients were re-operated due to a stenosed primary biliodigestive anastomosis and 3 patients each due to atrophy of the right liver lobe and recurrent cholangitis. One patient complained of recurrent cholangitis and a further patient of symptoms due to adhesions. DISCUSSION If treated inadequately bile duct injuries occurring during cholecystectomy can in the long-term lead to considerable problems such as recurrent cholangitis, late stage stenoses and even to secondary biliary cirrhosis. Therefore, a complex inter-disciplinary therapeutic concept aiming at timely treatment is necessary.
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Affiliation(s)
- H Bektas
- Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover.
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Bektas M, Bektas H, Gören D, Altan M, Cetinkaya H. Development of Myasthenia gravis due to treatment of chronic hepatitis C with a combination of interferon-alpha and ribavirin. Digestion 2008; 75:208-9. [PMID: 17934275 DOI: 10.1159/000109410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 02/04/2023]
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