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Mehdorn AS, Moulla Y, Mehdorn M, Dietrich A, Schönfels W, Becker T, Braun F, Beckmann JH, Linecker M. Bariatric surgery in liver cirrhosis. Front Surg 2022; 9:986297. [PMID: 36589626 PMCID: PMC9800004 DOI: 10.3389/fsurg.2022.986297] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Obesity is frequently associated with its hepatic manifestation, the nonalcoholic fatty liver disease (NAFLD). The most effective treatment for morbid obesity is bariatric surgery (BS) also improving NAFLD and liver function. In patients where NAFLD has already progressed to liver cirrhosis, BS can be considered a high-risk procedure. Hence, consideration of the procedure and the most appropriate timing is crucial. Material and Methods Obese patients suffering from NAFLD who underwent BS from two German University Medical Centers were retrospectively analyzed. Results Twenty-seven patients underwent BS. Most common procedures were laparoscopic Roux-en-Y-gastric (RYGB) and laparoscopic sleeve gastrectomy (SG). All patients suffered from liver cirrhosis Child A. A preoperative transjugular portosystemic shunt (TIPS) was established in three patients and failed in another patient. Postoperative complications consisted of wound healing disorders (n = 2), anastomotic bleeding (n = 1), and leak from the staple line (n = 1). This patient suffered from intraoperatively detected macroscopic liver cirrhosis. Excess weight loss was 73% and 85% after 1 and 2 years, respectively. Two patients suffered from postoperative aggravation of their liver function, resulting in a higher Child-Pugh score, while three could be removed from the waiting list for a liver transplantation. Conclusion BS leads to weight loss, both after SG and RYGB, and potential improvement of liver function in liver cirrhosis. These patients need to be considered with care when evaluated for BS. Preoperative TIPS implantation may reduce the perioperative risk in selected patients.
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Affiliation(s)
- A. S. Mehdorn
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Y. Moulla
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - M. Mehdorn
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - A. Dietrich
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - W. Schönfels
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - T. Becker
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - F. Braun
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - J. H. Beckmann
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - M. Linecker
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany,Correspondence: Michael Linecker
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Sabanov A, Mehdorn M, Gockel I, Stelzner S. [64/m-Fresh blood on the stool : Preparation for the medical specialist examination: part 20]. Chirurgie (Heidelb) 2022; 93:88-94. [PMID: 36156162 DOI: 10.1007/s00104-022-01724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Affiliation(s)
- A Sabanov
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - M Mehdorn
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - I Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - S Stelzner
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Lange UG, Moulla Y, Mehdorn M, Tuennemann J, Zabel-Langhennig A, Ouaid A, Dietrich A. Laparoscopic conversion of omega loop gastric bypass to Roux-en-Y gastric bypass for Barrett's esophagus: case report. BMC Surg 2022; 22:273. [PMID: 35836240 PMCID: PMC9284751 DOI: 10.1186/s12893-022-01695-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The number of mini gastric bypass / one anastomosis bypass (MGB-OAGB) procedures in bariatric patients that have been performed world-wide has drastically increased during the past decade. Nevertheless, due to the risk of subsequent biliary reflux and development of ulcer and neoplastic (pre)lesions caused by long-time bile exposure, the procedure is still controversially discussed. In here presented case report, we could endoscopically demonstrate a transformation from reflux oesophagitis to Barrett's metaplasia most likely caused by bile reflux after mini-gastric bypass. To our knowledge, this is a first case study that shows development of Barrett's metaplasia after MGB-OAGB. CASE PRESENTATION We present the case of a 50-year-old female which received a mini-gastric bypass due to morbid obesity (body mass index (BMI) 42.4 kg/m2). Because of history gastroesophageal reflux disease (GERD), a fundoplication had been performed earlier. Preoperative gastroscopy showed reflux esophagitis (Los Angeles classification grade B) with no signs of Barrett's metaplasia. Three months post mini-gastric bypass, the patient complained about severe bile reflux under 40 mg pantoprazole daily. Six months postoperative, Endoscopically Barrett's epithelium was detected and histopathologically confirmed (C1M0 after Prague classification). A conversion into Roux-en-Y gastric bypass was performed. The postoperative course was without complications. In a follow up after 6 months the patient denied reflux and showed no signs of malnutrition. CONCLUSIONS The rapid progress from inflammatory changes of the distal esophagus towards Barrett's metaplasia under bile reflux in our case is most likely a result of previous reflux disease. Nevertheless, bile reflux appears to be a potential decisive factor. Study results regarding presence of bile reflux or development of endoscopically de-novo findings after MGB-OAGB are widely non-conclusive. Long-term prospective studies with regular endoscopic surveillance independent of clinical symptoms are needed.
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Affiliation(s)
- U G Lange
- Clinic for Visceral, Transplant and Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Y Moulla
- Clinic for Visceral, Transplant and Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - M Mehdorn
- Clinic for Visceral, Transplant and Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - J Tuennemann
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University Hospital of Leipzig, Leipzig, Germany
| | - A Zabel-Langhennig
- Division of Gastroenterology, Department of Internal Medicine II, St. Elisabeth Hospital, Leipzig, Germany
| | - A Ouaid
- Division of Gastroenterology, Department of Internal Medicine II, St. Elisabeth Hospital, Leipzig, Germany
| | - A Dietrich
- Clinic for Visceral, Transplant and Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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4
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Gockel I, Jansen-Winkeln B, Holfert N, Rayes N, Thieme R, Maktabi M, Sucher R, Seehofer D, Barberio M, Diana M, Rabe SM, Mehdorn M, Moulla Y, Niebisch S, Branzan D, Rehmet K, Takoh JP, Petersen TO, Neumuth T, Melzer A, Chalopin C, Köhler H. [Possibilities and perspectives of hyperspectral imaging in visceral surgery]. Chirurg 2020; 91:150-159. [PMID: 31435721 DOI: 10.1007/s00104-019-01016-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
HyperSpectral Imaging (HSI) technology enables quantitative tissue analyses beyond the limitations of the human eye. Thus, it serves as a new diagnostic tool for optical properties of diverse tissues. In contrast to other intraoperative imaging methods, HSI is contactless, noninvasive, and the administration of a contrast medium is not necessary. The duration of measurements takes only a few seconds and the surgical procedure is only marginally disturbed. Preliminary HSI applications in visceral surgery are promising with the potential of optimized outcomes. Current concepts, possibilities and new perspectives regarding HSI technology together with its limitations are discussed in this article.
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Affiliation(s)
- I Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland.
| | - B Jansen-Winkeln
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - N Holfert
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - N Rayes
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - R Thieme
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - M Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Deutschland
| | - R Sucher
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - D Seehofer
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - M Barberio
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland.,Institut de Recherche contre les Cancers de l'Appareil Digestive (IRCAD), Straßburg, Frankreich
| | - M Diana
- Institut de Recherche contre les Cancers de l'Appareil Digestive (IRCAD), Straßburg, Frankreich
| | - S M Rabe
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - M Mehdorn
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - Y Moulla
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - S Niebisch
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - D Branzan
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - K Rehmet
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - J P Takoh
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - T-O Petersen
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - T Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Deutschland
| | - A Melzer
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Deutschland
| | - C Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Deutschland
| | - H Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Deutschland
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Renovanz M, Coburger J, Tabatabai G, Ringel F, Wirtz C, Mehdorn M, Goebel S. OS3.2 Relevant topics for brain tumor patients in the Distress Thermometer, first results of the HEAT study. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.026] [Citation(s) in RCA: 1] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Patient-centered assessments and disease-adjusted patient-reported outcome measures (PROMs) are crucial in neuro-oncology. The Distress Thermometer (DT) is a well-accepted screening tool for cancer patients including a numerical rating scale (1–10, cut-offs indicating relevant distress ≥4–6) and 40 items describing possible problem categories (emotional, social, physical, practical and spiritual). The aims of the first part of the “Adaption of the Distress Thermometer in patients with intracranial tumors” (HEAT) study were to evaluate the importance and relevance of items for brain tumor patients (BTP).
MATERIAL AND METHODS
The multicenter study included three University hospitals. After given informed consent patients were prospectively evaluated either during their hospital stay or in the outpatient setting using DT as well as the 40 item problem list. Clinical and demographic data were recorded. We performed an analysis regarding frequency of indicated topics and evaluated their relevance for patients’ psychosocial well-beings via Pearson correlations with the DT score.
RESULTS
Data of n = 670 patients were analyzed. Mean age was 52 years (SD = 14, range 18–81), most of the patients harbored WHO°I tumors (37%) and WHO°IV tumors (28%). Male to female ratio was 1:1, 17% were assessed preoperatively, 40% postoperatively and 43% during adjuvant therapy or follow-up. 14% of the patients faced a tumor recurrence at assessment. Mean score of DT was 5.23 (SD = 2.9, range 0–10). Applying a cut-off score ≥ 4, 61% reported distress (≥ 5: 46% and ≥ 6: 37%). Regarding the relevance of the problem list for BTP, emotional problems (e. g., anxiety, depression) were most frequently reported. A total of 14/40 (35 %) of items were endorsed by less than 10% of patients. With exception of emotional problems all areas were reflected: practical problems (e. g., problems with child care or insurance), social problems (e. g., problems with children), spiritual concerns (e. g., loss of faith), and physical problems (e. g., breathing, fever). However, some of these rarely reported problems were of relevance for patients’ psychosocial well-being as indicated by significant correlations between the respective item and the DT score. This was, for example, the case for problems with childcare (r = .106; p < .01) or breathing (r = .125; p = .001).
CONCLUSION
Tools developed for cancer patients do not yet perfectly reflect all needs of BTP. Based on our data, we suggest further adjustments of available tools. Yet, it should be taken into account that subgroups of BTP may require different problem lists in the DT, as we observed some topics (e.g. breathing) probably be related to BTP under chemotherapy or steroids only. Moreover, our data require cross-cultural validation as especially results regarding practical problems and insurance might differ in cultures with different social security systems.
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Affiliation(s)
- M Renovanz
- Interdisciplinary Division of Neurooncology, University Medical Center Tuebingen, Tuebingen, Germany
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - J Coburger
- Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany
| | - G Tabatabai
- Interdisciplinary Division of Neurooncology, University Medical Center Tuebingen, Tuebingen, Germany
| | - F Ringel
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - C Wirtz
- Department of Neurosurgery, University Medical Center Mainz, Ulm, Germany
| | | | - S Goebel
- Department of Psychology and Psychotherapy, University Medical Center Kiel, Kiel, Germany
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Piegeler T, Stehr SN, Pfirrmann D, Knödler M, Lordick F, Mehnert A, Selig L, Weimann A, Mehdorn M, Gockel I, Simon P. [Special situations of preconditioning and prehabilitation in oncological visceral surgery]. Chirurg 2019; 89:903-908. [PMID: 30377726 DOI: 10.1007/s00104-018-0708-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prehabilitation prior to complex visceral oncological surgery is playing an increasingly important role. OBJECTIVE The aim of this review article is to present special situations of preconditioning in visceral oncological patient cohorts. The following conditions were defined as special situations with subsequently increased risk profile: cardiopulmonary comorbidities, geriatric patients, neoadjuvant therapy and simultaneous fatigue. MATERIAL AND METHODS A selective literature review based on a search in the electronic databases MEDLINE, PubMed, Cochrane Library and the International Standard Randomization Controlled Trial Number (ISRCTN) was performed. RESULTS The identification of high-risk patients is an essential part of the preoperative evaluation conducted by the anesthesiologist prior to surgery. The cardiovascular and the pulmonary risk profile are determined by means of prediction indices evaluating patient-specific and surgery-related risk factors. The increased use of new oral anticoagulants and dual platelet aggregation inhibition requires individualized treatment strategies. Numerous studies have shown clinically relevant effects of exercise therapy interventions throughout all phases of oncological treatment. In addition to positive effects on therapy-associated side effects, sport can also counteract the effects of sedentary behavior in cancer patients and improve the health-related quality of life. The effectiveness of sport and exercise therapies as well as psychological interventions in oncological patients with fatigue (CRF) is broad, with important components being motivation and compliance. DISCUSSION In high-risk patients an interdisciplinary approach to planning and conduction of prehabilitation is essential for the early detection and optimization of perioperative risk factors and potential complications. The aim is faster recovery, reduced morbidity and mortality and the possibility to improve long-term survival and quality of life.
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Affiliation(s)
- T Piegeler
- Klinik und Poliklinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - S N Stehr
- Klinik und Poliklinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - D Pfirrmann
- Abteilung Sportmedizin, Prävention und Rehabilitation am Institut für Sportwissenschaft, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - M Knödler
- Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - F Lordick
- Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - A Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - L Selig
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie; Ernährungsteam, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - A Weimann
- Klinik und Poliklinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Leipzig, Deutschland
| | - M Mehdorn
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - I Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - P Simon
- Abteilung Sportmedizin, Prävention und Rehabilitation am Institut für Sportwissenschaft, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
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Niebisch S, Hadzijusufovic E, Mehdorn M, Müller M, Scheuermann U, Lyros O, Schulz HG, Jansen-Winkeln B, Lang H, Gockel I. Achalasia-an unnecessary long way to diagnosis. Dis Esophagus 2017; 30:1-6. [PMID: 28375437 DOI: 10.1093/dote/dow004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/22/2015] [Accepted: 10/17/2016] [Indexed: 02/06/2023]
Abstract
Although achalasia presents with typical symptoms such as dysphagia, regurgitation, weight loss, and atypical chest pain, the time until first diagnosis often takes years and is frustrating for patients and nevertheless associated with high costs for the healthcare system. A total of 563 patients were interviewed with confirmed diagnosis of achalasia regarding their symptoms leading to diagnosis along with past clinical examinations and treatments. Included were patients who had undergone their medical investigations in Germany. Overall, 527 study subjects were included (male 46%, female 54%, mean age at time of interview 51 ± 14.8 years). Dysphagia was present in 86.7%, regurgitation in 82.9%, atypical chest pain in 79%, and weight loss in 58% of patients before diagnosis. On average, it took 25 months (Interquartile Range (IQR) 9-65) until confirmation of correct diagnosis of achalasia. Though, diagnosis was confirmed significantly quicker (35 months IQR 9-89 vs. 20 months IQR 8-53; p < 0.01) in the past 15 years. The majority (72.1%) was transferred to three or more specialists. Almost each patient underwent at least one esophagogastroduodenoscopy (94.2%) and one radiological assessment (89.3%). However, esophageal manometry was performed in 70.4% of patients only. The severity of symptoms was independent with regard to duration until first diagnosis (Eckardt score 7.14 ± 2.64 within 12 months vs. 7.29 ± 2.61 longer than 12 months; P = 0.544). Fifty-five percent of the patients primarily underwent endoscopic dilatation and 37% a surgical myotomy. Endoscopic dilatation was realized significantly faster compared to esophageal myotomy (1 month IQR 0-4 vs. 3 months IQR 1-11; p < 0.001). Although diagnosis of achalasia was significantly faster in the past 15 years, it still takes almost 2 years until the correct diagnosis of achalasia is confirmed. Alarming is the fact that although esophageal manometry is known as the gold standard to differentiate primary motility disorders, only three out of four patients had undergone this diagnostic pathway during their diagnostic work-up. Better education of medical professionals and broader utilization of highly sensitive diagnostic tools, such as high-resolution manometry, are strictly necessary in order to correctly diagnose affected patients and to offer therapy faster.
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Affiliation(s)
- S Niebisch
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - E Hadzijusufovic
- Department of General, Visceral and Transplant Surgery, University of Mainz Medical Center, Mainz, Germany
| | - M Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - M Müller
- Department of Gastroenterorlogy, DKD (German Diagnostic Clinic) Helios Clinic, Wiesbaden, Germany
| | - U Scheuermann
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - O Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - H G Schulz
- Department of Surgery, EvK (Protestant Hospital) Castrop-Rauxel, Castrop-Rauxel, Germany
| | - B Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - H Lang
- Department of General, Visceral and Transplant Surgery, University of Mainz Medical Center, Mainz, Germany
| | - I Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
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Mehdorn M, Petersen TO, Kassahun W. Wirklich nur ein Abszess? – Eine Whipple-Operation für eine Metastase eines Zervixkarzinoms. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1586308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Mehdorn M, Gockel I. Röder-Schlinge oder Lineares Klammernahtgerät für die laparoskopische Appendektomie: Eine Kosten- und Effektivitätsanalyse. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1586290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schuepbach WMM, Rau J, Knudsen K, Volkmann J, Krack P, Timmermann L, Hälbig TD, Hesekamp H, Navarro SM, Meier N, Falk D, Mehdorn M, Paschen S, Maarouf M, Barbe MT, Fink GR, Kupsch A, Gruber D, Schneider GH, Seigneuret E, Kistner A, Chaynes P, Ory-Magne F, Brefel Courbon C, Vesper J, Schnitzler A, Wojtecki L, Houeto JL, Bataille B, Maltête D, Damier P, Raoul S, Sixel-Doering F, Hellwig D, Gharabaghi A, Krüger R, Pinsker MO, Amtage F, Régis JM, Witjas T, Thobois S, Mertens P, Kloss M, Hartmann A, Oertel WH, Post B, Speelman H, Agid Y, Schade-Brittinger C, Deuschl G. Neurostimulation for Parkinson's disease with early motor complications. N Engl J Med 2013; 368:610-22. [PMID: 23406026 DOI: 10.1056/nejmoa1205158] [Citation(s) in RCA: 851] [Impact Index Per Article: 77.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Subthalamic stimulation reduces motor disability and improves quality of life in patients with advanced Parkinson's disease who have severe levodopa-induced motor complications. We hypothesized that neurostimulation would be beneficial at an earlier stage of Parkinson's disease. METHODS In this 2-year trial, we randomly assigned 251 patients with Parkinson's disease and early motor complications (mean age, 52 years; mean duration of disease, 7.5 years) to undergo neurostimulation plus medical therapy or medical therapy alone. The primary end point was quality of life, as assessed with the use of the Parkinson's Disease Questionnaire (PDQ-39) summary index (with scores ranging from 0 to 100 and higher scores indicating worse function). Major secondary outcomes included parkinsonian motor disability, activities of daily living, levodopa-induced motor complications (as assessed with the use of the Unified Parkinson's Disease Rating Scale, parts III, II, and IV, respectively), and time with good mobility and no dyskinesia. RESULTS For the primary outcome of quality of life, the mean score for the neurostimulation group improved by 7.8 points, and that for the medical-therapy group worsened by 0.2 points (between-group difference in mean change from baseline to 2 years, 8.0 points; P=0.002). Neurostimulation was superior to medical therapy with respect to motor disability (P<0.001), activities of daily living (P<0.001), levodopa-induced motor complications (P<0.001), and time with good mobility and no dyskinesia (P=0.01). Serious adverse events occurred in 54.8% of the patients in the neurostimulation group and in 44.1% of those in the medical-therapy group. Serious adverse events related to surgical implantation or the neurostimulation device occurred in 17.7% of patients. An expert panel confirmed that medical therapy was consistent with practice guidelines for 96.8% of the patients in the neurostimulation group and for 94.5% of those in the medical-therapy group. CONCLUSIONS Subthalamic stimulation was superior to medical therapy in patients with Parkinson's disease and early motor complications. (Funded by the German Ministry of Research and others; EARLYSTIM ClinicalTrials.gov number, NCT00354133.).
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Affiliation(s)
- W M M Schuepbach
- Assistance Publique–Hôpitaux de Paris, Centre d'Investigation Clinique (CIC) 9503, Institut du Cerveau et de la Moelle Épinière, Département de Neurologie, Université Pierre et Marie Curie–Paris 6 and INSERM, Centre Hospitalier Universitaire (CHU) Pitié–Salpêtrière, Paris, France
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Petridis AK, Doukas A, Barth H, Mehdorn M. Outcome of Craniocerebral Gunshot Injuries in the Civilian Population. Prognostic Factors and Treatment Options. ACTA ACUST UNITED AC 2010; 72:5-14. [DOI: 10.1055/s-0029-1241850] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Petridis AK, Dörner L, Doukas A, Eifrig S, Barth H, Mehdorn M. Acute Subdural Hematoma in the Elderly; Clinical and CT Factors Influencing the Surgical Treatment Decision. ACTA ACUST UNITED AC 2009; 70:73-8. [DOI: 10.1055/s-0029-1224096] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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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Hashemi M, Stark A, Hugo H, Mehdorn M. Intracranial trigeminal nerve metastasis of a desmoplastic neurotropic melanoma: case report. ACTA ACUST UNITED AC 2009; 70:91-4. [PMID: 19711263 DOI: 10.1055/s-0028-1082065] [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: 10/20/2022]
Abstract
BACKGROUND Desmoplastic neurotropic mela-noma is a rare and highly malignant variant of melanoma. Solitary nervus trigeminus and Gasserian ganglion metastasis of a neurotropic melanoma has not been previously described in the literature. CASE DESCRIPTION A 69-year-old man presented to our clinic with trigeminal neuralgia. 4 years previously he underwent tumor removal with an initial diagnosis of amelanotic malignant cutaneous melanoma; 1 year later, because of tumor recurrence, the patient underwent neck dissection, chemotherapy and radiation. Magnet resonance imaging (MRI) disclosed an enhancement of the Gasserian ganglion and tumor extension along the mandibular and maxillar nerves of the intracranial part of the trigeminal nerve suggestive of tumor. The intraoperative macroscopic appearance of the tumor was compatible with a neurinoma. Histopathological studies proved the tumor to be a desmoplastic neurotropic melanoma (DNM) that was related to the previously treated malignant melanoma. CONCLUSION A metastatic tumor arising solely in a trigeminal nerve from a cutaneous malignant melanoma is quite rare; to our knowledge this may be the first report of such a case in the literature.
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Affiliation(s)
- M Hashemi
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Bartsch T, Steigerwald F, Herzog J, Pinsker M, Kinfe T, Mehdorn M, Deuschl G, Krauss J, Volkmann J. 106. Functional properties of posterior hypothalamic neurones – Experience from microelectrode recordings in patients with cluster headache. Clin Neurophysiol 2009. [DOI: 10.1016/j.clinph.2008.07.105] [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: 11/25/2022]
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Pinsker M, Herzog J, Falk D, Volkmann J, Deuschl G, Mehdorn M. Accuracy and Distortion of Deep Brain Stimulation Electrodes on Postoperative MRI and CT. ACTA ACUST UNITED AC 2008; 69:144-7. [DOI: 10.1055/s-2008-1077075] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Pinsker MO, Volkmann J, Falk D, Herzog J, Alfke K, Steigerwald F, Deuschl G, Mehdorn M. Electrode implantation for deep brain stimulation in dystonia: a fast spin-echo inversion-recovery sequence technique for direct stereotactic targeting of the GPI. ACTA ACUST UNITED AC 2008; 69:71-5. [PMID: 18444217 DOI: 10.1055/s-2007-1004583] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [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
OBJECTIVE Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for medically refractory primary dystonia. We present our technique for direct preoperative visualization of the target using a fast spin-echo inversion-recovery (FSE-IR) sequence. METHODS Twenty-three consecutive patients (mean age 41 years, range 9-68 years, male to female ratio 11:12) with severe dystonia were operated using a combination of FSE-IR imaging for direct visualization of the globus pallidus internus with stereotactic, gadolinium-enhanced T1-MPRage images. The complete procedure, including stereotactic MRI, was performed under general anesthesia with propofol and remifentanyl. We used multichannel microdrive systems (Medtronic; Alpha-Omega) to introduce up to five parallel microelectrodes for microelectrode recordings (MER) and test stimulation with the central trajectory directed at the anatomically predefined target. The initial standard coordinates in relation to the mid-commissural point (mid-AC-PC) were as follows: lateral 21 mm, anterior 3 mm, and inferior 2 mm, which were then adapted to the individual case based on direct visualization of the target area and further refined by the intraoperative neurophysiology. RESULTS In ten patients (43%) atlas-based standard coordinates were modified based on the direct visualization of the GPi in the FSE-IR images (bilaterally in seven patients, unilaterally in three). The modified targets ranged from 18.5 to 23.5 mm (mean 20.76 mm) laterally, 1-7 mm (mean 2.75 mm) anteriorly and 1-2 mm (mean 1.95 mm) inferiorly to the mid-AC-PC. We implanted the permanent electrode based on the results of MER and intraoperative stimulation performed to determine the threshold for pyramidal tract responses on the central trajectory in 67%, medially in 16%, anteriorly in 11%, laterally in 4%, dorsally in 2%. The procedure resulted in excellent clinical benefits (average reduction of the Burke-Fahn-Marsden Dystonia Rating Score (BFMDRS) or the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) were respectively 65.9%, range 20.9-91.4%) within the first year after surgery. Safety was demonstrated by the absence of intracranial bleeding or other surgical complications causing neurological morbidity. CONCLUSION Inversion recovery sequences are an excellent tool for direct visualization of the GPi. These images can be fused to stereotactic MRI or CCT and may help to improve anatomical targeting of the GPi for the implantation of DBS electrodes.
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Affiliation(s)
- M O Pinsker
- Department of Neurosurgery, UK-SH, Kiel, Kiel, Germany.
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Pinsker MO, Bartsch T, Falk D, Volkmann J, Herzog J, Steigerwald F, Diener HC, Deuschl G, Mehdorn M. Failure of deep brain stimulation of the posterior inferior hypothalamus in chronic cluster headache - report of two cases and review of the literature. ACTA ACUST UNITED AC 2008; 69:76-9. [PMID: 18444218 DOI: 10.1055/s-2007-1022558] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) has become a standard procedure for movement disorders such as Parkinson's disease, essential tremor or dystonia. Recently, deep brain stimulation of the posterior hypothalamus has been shown to be effective in the treatment of drug-resistant chronic cluster headache. METHODS DBS of the posterior inferior hypothalamus was performed on two patients with chronic cluster headaches, one 55-year-old man with medically intractable chronic cluster headache since 1996, and one 31-year-old woman with a chronic form since 2002. Both patients showed continuous worsening headaches in the last years despite high dose medical treatment. The patients fulfilled the published criteria for DBS in chronic cluster headaches. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to the published coordinates (2 mm lateral, 3 mm posterior, 5 mm inferior) referenced to the mid-AC-PC line. RESULTS The intra- and postoperative course was uneventful and postoperative MRI control documented regular position of the DBS electrodes. The current stimulation parameters were at 12 months postoperatively 0 neg., G pos.; 5.5 V; 60 micros; 180 Hz (Case 1) and 0 neg., G pos.; 3.0 V; 60 micros; 185 Hz, at 3 months postoperatively (Case 2). Surgery- or stimulation-related side effects were not observed. Both patients showed initial pain reduction in the first days whereas 12 respectively 3 month follow-up did not show a significant reduction in attack frequency or intensity. CONCLUSION Deep brain stimulation of the posterior inferior hypothalamus is an experimental procedure and should be restricted to selected therapy-refractory patients and should be performed in centers experienced in patient selection and performance of DBS as well as postoperative pain treatment. A prospective multi-centre study is necessary to evaluate its effectiveness.
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Affiliation(s)
- M O Pinsker
- Department of Neurosurgery, UK-SH, Kiel, Kiel, Germany.
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Bartsch T, Steigerwald F, Herzog J, Pinsker M, Kinfe T, Mehdorn M, Deuschl G, Krauss J, Volkmann J. Functional properties of posterior hypothalamic neurones – experience from microelectrode recordings in patients with Cluster headache. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1072900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bartsch T, Volkmann J, Pinsker M, Wasner M, Steigerwald F, Herzog J, Baron R, Mehdorn M, Deuschl G. Tiefe Hirnstimulation des posterioren Hypothalamus bei therapierefraktären chronischen Cluster Kopfschmerzen. Akt Neurol 2006. [DOI: 10.1055/s-2006-953239] [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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Bogdahn U, Hau P, Brawanski A, Schlaier J, Mehdorn M, Wurm G, Pichler J, Kunst M, Stauder G, Schlingensiepen KH. Specific therapy for high-grade glioma by convection-enhanced delivery of the TGF-β2 specific antisense oligonucleotide AP 12009. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- U. Bogdahn
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - P. Hau
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - A. Brawanski
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - J. Schlaier
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - M. Mehdorn
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - G. Wurm
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - J. Pichler
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - M. Kunst
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - G. Stauder
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
| | - K.-H. Schlingensiepen
- Klinik und Poliklinik für Neurologie, Regensburg, Germany; Klinik und Poliklinik für Neurochirurgie, Regensburg, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Landesnervenklinik Wagner-Jauregg, Linz, Austria; Antisense Pharma GmbH, Regensburg, Germany
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Hau P, Bogdahn U, Brawanski A, Freudenstein D, Goldbrunner M, Grisold W, Hundsberger T, Koch D, Kostron H, Kunst M, Mehdorn M, Meixensberger J, Pichler J, Schackert G, Schlaier J, Schlingensiepen R, Schmaus S, Schneider T, Spitznagel L, Stauder G, Stockhammer G, Wassmann H, Weller M, Winking M, Wurm G, Schlingensiepen KH. TGF-beta2 suppression by the antisense oligonucleotide AP 12009 as therapy for high-grade glioma: safety and efficacy results of phase I/II clinical studies. Akt Neurol 2004. [DOI: 10.1055/s-2004-832961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hau P, Bogdahn U, Schlaier J, Mehdorn M, Wurm G, Pichier J, Kunst M, Goldbrunner M, Schlingensiepen K, Stauder G. 34 The TGF-beta2 antisense ollgonucleotide ap 12009 as a therapeutic agent in recurrent high-grade glloma: safety and efficacy results of phase I/II clinical trials. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90068-1] [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: 10/26/2022] Open
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Kopper F, Volkmann J, M�ller D, Mehdorn M, Deuschl G. Die tiefe Hirnstimulation zur Behandlung von M. Parkinson, Tremor und Dystonie. Der Nervenarzt 2003. [DOI: 10.1007/s00115-003-1555-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lehnung M, Leplow B, Herzog A, Benz B, Ritz A, Stolze H, Mehdorn M, Ferstl R. Children's spatial behavior is differentially affected after traumatic brain injury. Child Neuropsychol 2001; 7:59-71. [PMID: 11935414 DOI: 10.1076/chin.7.2.59.3129] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Spatial behavior in 20 children with severe traumatic brain injury (TBI) and 20 healthy controls was investigated using the Kiel Locomotor Maze. Children had to remember defined locations in an experimental chamber with completely controlled intra- and extra-maze cues until learning criterion was reached. In a second experiment, spatial orientation strategies were assessed. Children with TBI were shown to be impaired in spatial learning and spatial memory. Spatial orientation was found to be deficient even in cases where spatial learning and memory proved to be unimpaired, especially in tasks that demanded the use of relational place strategies. Children who suffered a TBI at an early age proved to be more severely impaired in spatial learning and orientation than older children.
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Affiliation(s)
- M Lehnung
- Department of Psychology, University of Kiel, Olshausenstrasse 62, 24098 Kiel, Germany.
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Abstract
Gait disorders are a frequent symptom of cervical spondylotic myelopathy (CSM). Twelve patients with CSM underwent gait analysis before and after decompressive surgery. They were assessed on a walkway and a treadmill and compared with a healthy matched control group. The following features were observed in the CSM group before surgery: significantly reduced gait velocity and step length (P<0. 05), prolonged double support, increased step width, and reduced ankle joint extension during treadmill walking. Knee and hip kinematics did not differ from controls. Two months after surgery, spatio-temporal parameters had moved towards normal values, velocity, step length and cadence had increased significantly, and there was reduction of step width during treadmill walking, indicating improved equilibrium. Gait analysis is an objective tool to document functional recovery after decompressive surgery in CSM.
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Affiliation(s)
- J P Kuhtz-Buschbeck
- Department of Physiology, Christian-Albrechts-Universität Kiel, Olshausenstrasse 40, D 24098, Kiel, Germany.
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Lehnung M, Leplow B, Friege L, Herzog A, Ferstl R, Mehdorn M. Development of spatial memory and spatial orientation in preschoolers and primary school children. Br J Psychol 1998; 89 ( Pt 3):463-80. [PMID: 9734301 DOI: 10.1111/j.2044-8295.1998.tb02697.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present study addresses the question of what kind of information children use when orientating in new environments, if given proximal and distal landmarks, and how spatial memory develops in the investigated age groups. Ten 5-year-old, ten 7-year-old and ten 10-year-old children were presented with the 'Kiel Locomotor Maze', containing features of the Radial Arm Maze and the Morris Water Maze, in order to assess spatial memory and orientation. Children had to learn to approach baited locations only. Task difficulty was equated with respect to the children's age. Training was given until the children reached criterion. During testing, the maze configuration and response requirements were systematically altered, including response rotation, cue rotation, cue deletion and response rotation with cue deletion in order to assess the spatial strategies used by the children. During training and testing, working-memory errors (WM), reference-memory errors (RM) and working-reference memory errors (WR) were recorded. As expected, no difference between age groups appeared during training, thus confirming comparable task difficulty across age groups. During testing, age groups differed significantly with regard to the orientation strategy used. The 5-year-olds were bound to a cue strategy, orientating towards local, proximal cues. The 10-year-olds mastered all tasks, thus displaying a place strategy, being able to use distal cues for orientation, and were even able to do so after being rotated 180 degrees. The 7-year-olds proved to be at an age of transition: five of them were bound to a cue strategy, five children were able to adopt a place strategy. The differences in the orientation strategies used by children of different age groups was reflected by the sum of errors they made, also by RM. WM were found to be rare, especially in older children. We conclude that preschoolers use a cue strategy, that the development of place strategies occurs during primary school age and seems to be complete by the age of 10 years.
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Affiliation(s)
- M Lehnung
- Department of Psychology, University of Kiel, Germany
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Abstract
Remote memory was investigated in an unselected sample of 26 patients with either unilateral tumours in the temporal lobes or traumatic brain injuries. Six patients underwent excisions within the left temporal lobe, and nine patients were operated on within the right temporal lobe. In both groups, patients with excisions including and sparing the hippocampal formation were studied. Their performance was compared to that of 11 patients with moderate to severe head trauma and to a normative sample of 214 healthy controls. Remote memory was assessed using a famous events test with items of extremely low salience that had been proven to be of low difficulty for those old enough at the time of the event's actuality. The results show severely disturbed retrograde memory functions in the left temporal tumour group. These patients achieved similar scores to patients with severe traumatic brain injury. Right hemispheric patients showed a pattern of results comparable to that of healthy controls. The strongest effects were in the free recall part of the test. In most of the patients, no graded memory loss was observable. No consistent association to recent memory function could be identified. Since most of the remote memory test items used denoted famous names which were cued by rich semantic information, the type of deficit seen may be best understood in terms of a specific dysfunction of the semantic stores containing information about famous proper names.
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Affiliation(s)
- B Leplow
- Department of Psychology, University of Kiel, Germany
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Rauhut F, Mehdorn M, Benker G, Reinhardt V. Diagnostic problems and operative treatment of pituitary microadenomas. Neurochirurgia (Stuttg) 1988; 31 Suppl 1:186-91. [PMID: 3231287 DOI: 10.1055/s-2008-1053932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Over an average observation period of 53 months 26 patients with endocrinological active microadenoma of the hypophysis (12 M. Cushing, 14 acromegaly) were retrospectively examined. Only in 11 cases did the CT-examination demonstrate intrasellar tumour expansion. Both the problems of and the criteria for CT-diagnosis of microadenoma were demonstrated. In 22 cases (84%) the microsurgical transsphenoidal exstirpation of the adenoma led to an adequate reduction in both ACTH and HGH. No postoperative deterioration of the other hypophysial functions was seen. It could be further demonstrated that where the surgical therapy failed local radiation therapy with high voltage radiation of the hypophysis region led to a reduction of the abnormal hormone secretion. The comparism of our results with those reported in the literature led us to suggest a combined therapy concept in which the indication for operative, conservative and radiation therapy is delineated.
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Affiliation(s)
- F Rauhut
- Department of Neurosurgery, University Hospital GHS Essen Federal Republic of Germany
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Quilitz B, Rimpel J, Mehdorn M, Rohm N, Lehmann HJ. Cerebrovascular reserve capacity (CRC) in carotid artery disease: a routine test in selection for surgical treatment? Thorac Cardiovasc Surg 1988; 36:217-20. [PMID: 3187982 DOI: 10.1055/s-2007-1020082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
An increase of arterial carbon dioxide (CO2) partial pressure induces an increase of cerebral blood flow by dilatation of the resistance vessels. By the Transcranial Doppler sonographic technique (TCD) blood flow velocity as a correlate of flow volume can be measured within the great basal intracranial arteries. We investigated 8 patients with an internal carotid artery occlusion or high-grade stenosis and 5 cerebrovascular diseased patients without extracranial stenosis. 12 healthy volunteers and patients without vascular disease served as the control group. Blood flow velocities in the middle cerebral arteries were evaluated before and after 5 minutes of breathing a 5% CO2 gas mixture. In a prestudy the end tidal pCO2 was monitored during this procedure. As a result of the close parallelity of pCO2 increase in the prestudy group we planned to standardize the CO2 reactivity tests without consideration of the individual pCO2 values. The CO2 inhalation provoked a flow velocity increase of at least 20% in the control subjects (47.1 +/- 17.3%). The vascular diseased without extracranial stenosis responded with 34.8 +/- 17.4% (minimum: 23.5%, n. s.). The CO2 reactivity in cases of occlusion or greater than 50% stenosis was significantly decreased (p less than 0.001) both when considering only the affected sides (12.4 +/- 7.5%, maximum: 20%) and when including the non affected sides (22.6 +/- 15.0%). It is concluded that the CO2 reactivity test is a simple and valid method to evaluate the cerebrovascular reserve capacity in any case of uncertainty about the benefits of surgical treatment of a carotid stenosis. In future this technique might become one fundamental argument beside others in selecting adequate treatment.
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Affiliation(s)
- B Quilitz
- Department of Neurology, University Medical School, Essen/FRG
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Kalff R, Jamjoom Z, Mehdorn M, Towigh AH. [Bilateral lateral tibial syndrome following a military march]. Nervenarzt 1984; 55:108-9. [PMID: 6700801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Spetzler RF, Selman WR, Weinstein P, Townsend J, Mehdorn M, Telles D, Crumrine RC, Macko R. Chronic reversible cerebral ischemia: evaluation of a new baboon model. Neurosurgery 1980; 7:257-61. [PMID: 7207743 DOI: 10.1227/00006123-198009000-00009] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The authors describe their experience with a baboon model of reversible cerebral ischemia. Middle cerebral artery occlusion was achieved by external compression with an implantable, inflatable balloon cuff in awake, unanesthetized baboons. Selective cerebral angiography confirmed consistent, reliable occlusion. Computed tomography demonstrated early density changes after ischemia, which were reversible with reperfusion. Neurological evaluation demonstrated a "recruitment response" of increasingly persistent deficit with repeated occlusion. Permanent deficits were noted after extensive angiography during periods of occlusion. This was accompanied by the dropout of small vessels in the middle cerebral artery distribution. The results of pathological examinations were consistent with the clinical examinations. No gross or microscopic changes were noted after repeated occlusions that caused deficits like those of transient ischemic attacks. Consistent infarctions were noted in animals with permanent deficits after permanent occlusion or after repeated occlusion and extensive angiography.
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