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Cuthbertson L, Löber U, Ish-Horowicz JS, McBrien CN, Churchward C, Parker JC, Olanipekun MT, Burke C, McGowan A, Davies GA, Lewis KE, Hopkin JM, Chung KF, O'Carroll O, Faul J, Creaser-Thomas J, Andrews M, Ghosal R, Piatek S, Willis-Owen SAG, Bartolomaeus TUP, Birkner T, Dwyer S, Kumar N, Turek EM, William Musk A, Hui J, Hunter M, James A, Dumas ME, Filippi S, Cox MJ, Lawley TD, Forslund SK, Moffatt MF, Cookson WOC. Genomic attributes of airway commensal bacteria and mucosa. Commun Biol 2024; 7:171. [PMID: 38347162 PMCID: PMC10861553 DOI: 10.1038/s42003-024-05840-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
Microbial communities at the airway mucosal barrier are conserved and highly ordered, in likelihood reflecting co-evolution with human host factors. Freed of selection to digest nutrients, the airway microbiome underpins cognate management of mucosal immunity and pathogen resistance. We show here the initial results of systematic culture and whole-genome sequencing of the thoracic airway bacteria, identifying 52 novel species amongst 126 organisms that constitute 75% of commensals typically present in heathy individuals. Clinically relevant genes encode antimicrobial synthesis, adhesion and biofilm formation, immune modulation, iron utilisation, nitrous oxide (NO) metabolism and sphingolipid signalling. Using whole-genome content we identify dysbiotic features that may influence asthma and chronic obstructive pulmonary disease. We match isolate gene content to transcripts and metabolites expressed late in airway epithelial differentiation, identifying pathways to sustain host interactions with microbiota. Our results provide a systematic basis for decrypting interactions between commensals, pathogens, and mucosa in lung diseases of global significance.
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Affiliation(s)
- Leah Cuthbertson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ulrike Löber
- Max Delbrück Center for Molecular Medicine (MDC), 13125, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, 10785, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Jonathan S Ish-Horowicz
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Mathematics, Imperial College London, London, UK
| | - Claire N McBrien
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Colin Churchward
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jeremy C Parker
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Conor Burke
- Department of Respiratory Medicine, Connolly Hospital, Dublin, Ireland
| | - Aisling McGowan
- Department of Respiratory Medicine, Connolly Hospital, Dublin, Ireland
| | - Gwyneth A Davies
- Population Data Science and Health Data Research UK BREATHE Hub, Swansea University Medical School, Swansea University, Swansea, UK
- College of Medicine, Institute of Life Science, Swansea University, Swansea, UK
| | - Keir E Lewis
- College of Medicine, Institute of Life Science, Swansea University, Swansea, UK
- Respiratory Medicine, Hywel Dda University Health Board, Llanelli, UK
| | - Julian M Hopkin
- College of Medicine, Institute of Life Science, Swansea University, Swansea, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Orla O'Carroll
- Department of Respiratory Medicine, Connolly Hospital, Dublin, Ireland
| | - John Faul
- Department of Respiratory Medicine, Connolly Hospital, Dublin, Ireland
| | - Joy Creaser-Thomas
- College of Medicine, Institute of Life Science, Swansea University, Swansea, UK
| | - Mark Andrews
- Respiratory Medicine, Hywel Dda University Health Board, Llanelli, UK
| | - Robin Ghosal
- Respiratory Medicine, Hywel Dda University Health Board, Llanelli, UK
| | - Stefan Piatek
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Theda U P Bartolomaeus
- Max Delbrück Center for Molecular Medicine (MDC), 13125, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, 10785, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Till Birkner
- Max Delbrück Center for Molecular Medicine (MDC), 13125, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Sarah Dwyer
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nitin Kumar
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Elena M Turek
- National Heart and Lung Institute, Imperial College London, London, UK
| | - A William Musk
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Department of Respiratory Medicine Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jennie Hui
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Michael Hunter
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Alan James
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Department of Respiratory Medicine Sir Charles Gairdner Hospital, Perth, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Marc-Emmanuel Dumas
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- U1283 INSERM / UMR8199 CNRS, Institut Pasteur de Lille, Lille University Hospital, European Genomic Institute for Diabetes, University of Lille, Lille, France
- McGill Genome Centre, McGill University, Montréal, QC, Canada
| | - Sarah Filippi
- Department of Mathematics, Imperial College London, London, UK
| | - Michael J Cox
- University of Birmingham College of Medical and Dental Sciences, 150183, Institute of Microbiology and Infection, Birmingham, UK
| | - Trevor D Lawley
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Sofia K Forslund
- Max Delbrück Center for Molecular Medicine (MDC), 13125, Berlin, Germany.
- Experimental and Clinical Research Center, A Cooperation of Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site, 10785, Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany.
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, Structural and Computational Biology Unit, 69117, Heidelberg, Germany.
| | - Miriam F Moffatt
- National Heart and Lung Institute, Imperial College London, London, UK.
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Lucas B, Lippisch R, Pliske G, Piatek S, Walcher F. [Conservative management of distal radius fractures]. Unfallchirurgie (Heidelb) 2023; 126:227-237. [PMID: 36881137 DOI: 10.1007/s00113-023-01293-1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Abstract
Distal radius fractures are the third most frequent fractures in Germany. The decision for conservative treatment and the weighing up of surgical treatment need an exact consideration of the indications based on instability criteria and the extent of possible articular involvement. Indications for an emergency operation must be excluded. In cases of stable fractures or multimorbid patients in a poor general condition conservative treatment is indicated. The principles for a successful treatment are the precise reduction and stable retention in a plaster splint. In the further course, fractures are closely monitored by biplanar radiography. This is necessary to rule out a secondary displacement until the swelling of the soft tissues has subsided and the plaster splint is changed to a circular cast approximately 11 days after the traumatic event. The total duration of immobilization is 4 weeks. Physiotherapy and ergotherapy including adjacent joints, starts after 2 weeks of treatment. This treatment is extended to the wrist after removal of the circular cast.
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Affiliation(s)
- Benjamin Lucas
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
| | - Roland Lippisch
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Gerald Pliske
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Stefan Piatek
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
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Behrens R, Pliske G, Piatek S, Walcher F, Elkmann N. A statistical model to predict the occurrence of blunt impact injuries on the human hand-arm system. J Biomech 2023; 151:111517. [PMID: 36893519 DOI: 10.1016/j.jbiomech.2023.111517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
Biomechanical limits based on pain thresholds ensure safety in workplaces where humans and cobots (collaborative robots) work together. Standardization bodies' decision to rely on pain thresholds stems from the assumption that such limits inherently protect humans from injury. This assumption has never been verified, though. This article reports on a study with 22 human subjects in which we studied injury onset in four locations of the hand-arm system using an impact pendulum. During the tests, the impact intensity was slowly increased over several weeks until a blunt injury, i.e., bruising or swelling, appeared in the body locations under load. A statistical model, which calculates injury limits for a given percentile, was developed based on the data. A comparison of our injury limits for the 25th percentile with existing pain limits confirms that pain limits provide suitable protection against impact injuries, albeit not for all body locations.
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Affiliation(s)
- R Behrens
- Fraunhofer IFF, Sandtorstr. 22, 39106 Magdeburg, Germany.
| | - G Pliske
- Department of Trauma Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - S Piatek
- Department of Trauma Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - F Walcher
- Department of Trauma Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - N Elkmann
- Fraunhofer IFF, Sandtorstr. 22, 39106 Magdeburg, Germany
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Schüttrumpf JP, Stürmer KM, Piatek S. [Not Available]. Chirurgie (Heidelb) 2022; 93:1185. [PMID: 36422663 DOI: 10.1007/s00104-022-01780-y] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jan Philipp Schüttrumpf
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Klaus Michael Stürmer
- Klinik für Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Schüttrumpf JP, Stürmer KM, Piatek S. [S2e Guideline "Patella Fracture"]. Chirurgie (Heidelb) 2022; 93:1106. [PMID: 36279010 DOI: 10.1007/s00104-022-01691-y] [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] [Indexed: 06/16/2023]
Affiliation(s)
- Jan Philipp Schüttrumpf
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Klaus Michael Stürmer
- Klinik Für Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Schönrogge M, Lahodski V, Otto R, Adolf D, Damm R, Sitte-Zöllner A, Piatek S. Inter- and intraobserver reliabilities and critical analysis of the osteoporotic fracture classification of osteoporotic vertebral body fractures. Eur Spine J 2022; 31:2431-2438. [PMID: 35378632 DOI: 10.1007/s00586-022-07201-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The Osteoporotic Fracture Working Group (Spine Division of the German Orthopaedic and Trauma Society) has developed a classification system for osteoporotic thoracolumbar fractures, namely the osteoporotic fracture (OF) classification system. The purpose of this study was to determine the inter- and intraobserver reliabilities of the OF classification system for osteoporotic vertebral body fractures (VFs) at a level-one trauma centre. METHODS Conventional radiography, magnetic resonance imaging (MRI), and computed tomography (CT) scans of 54 consecutive women who sustained an osteoporotic VF were analysed by six orthopaedic traumatologists with varying levels of experience. The inter- and intraobserver reliabilities of the OF classification system were determined using intraclass correlation coefficients (ICCs) and Cohen's kappa. RESULTS The overall interobserver reliability of the OF classification system was good (ICC, 0.62 [0.51, 0.72]). The intraobserver reliability was found to be substantial (overall weighted Cohen's kappa estimate [95% confidence interval {CI}] = 0.74 [0.67, 0.80]) and better when the radiography, MRI, and CT scans were assessed together than when only the radiography and MRI scans were evaluated, although the difference was not significant. CONCLUSION The OF classification system is easy to use. It shows good interobserver reliability and substantial intraobserver reliability if diagnostic prerequisites (conventional radiography, MRI, and CT scans) are met.
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Affiliation(s)
- Maria Schönrogge
- University Hospital for Trauma Surgery, Otto Von Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany.
| | - Vadzim Lahodski
- University Hospital for Trauma Surgery, Otto Von Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Ronny Otto
- University Hospital for Trauma Surgery, Otto Von Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Daniela Adolf
- StatConsult Gesellschaft Für Klinische Und Versorgungsforschung mbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Robert Damm
- University Hospital for Radiology and Nuclear Medicine, Otto Von Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Albrecht Sitte-Zöllner
- University Hospital for Trauma Surgery, Otto Von Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Stefan Piatek
- University Hospital for Trauma Surgery, Otto Von Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
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Lucas B, Riebau C, Mohr J, Pliske G, Walcher F, Piatek S. Effect of 4DryField® PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture - a randomized clinical trial. BMC Musculoskelet Disord 2021; 22:113. [PMID: 33499843 PMCID: PMC7836593 DOI: 10.1186/s12891-021-03983-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the most common complications of hip arthroplasty is excessive blood loss that could necessitate allogenic blood transfusion, which is further associated with other complications, such as infections, transfusion reactions or immunomodulation. In gynecology, 4DryField®PH, an absorbable polysaccharide-based formulation, is used for hemostasis and adhesion prophylaxis. In this study, we evaluated its hemostatic effect in patients undergoing hip bipolar hemiarthroplasty following intracapsular femoral neck fracture. METHODS We studied 40 patients with intracapsular femoral neck fractures (Garden III or IV) admitted at our institution between July 2016 and November 2017. We included patients above 60 years with simple fracture and without pathologic fractures. Patients were randomized into intervention and control groups. The intervention group received 5 g of 4DryField® PH (subfascially and subcutaneously) during wound closure. Three drainages were inserted in a standardized manner (submuscular, subfascial, and subcutaneous) and drainage volume was measured immediately before extraction. Total blood loss was calculated using Mercuriali's formula and standard hemograms upon admission and five days after surgery. Volume of postoperative hematoma was measured using point-of-care ultrasound seven days after surgery. RESULTS Volume of the postoperative hematoma was reduced by 43.0 mL. However, significant reduction of total blood loss and drainage volume was not observed. CONCLUSIONS We observed that 4DryField® PH had a local hemostatic effect, thereby reducing volume of the postoperative hematoma. However, this reduction was small and had no effect on the total blood loss. Further studies are warranted to improve the application algorithm. TRIAL REGISTRATION DRKS, DRKS00017452 , Registered 11 June 2019 - Retrospectively registered.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany.
| | - Christian Riebau
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Juliane Mohr
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
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Witzel K, Ballaschk A, Altmann S, Haß HJ, Chiapponi C, Walcher F, Werwick K, Croner RS, Piatek S, Meyer F. [Magdeburg Medical School - Logbook for Surgical Training of Final Year Medical Students - an Interdisciplinary, Medical School-Specific Concept Based on the Guidelines Issued by the Medical School Association ("Medizinischer Fakultätentag") in 2012]. Zentralbl Chir 2020; 145:549-558. [PMID: 32268391 DOI: 10.1055/a-1084-4127] [Citation(s) in RCA: 1] [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: 10/24/2022]
Abstract
BACKGROUND The final year is the last part of the study of human medicine and can be regarded as an essential period, during which medical knowledge should be consequently converted into medical expertise. Since the amendment of the medical license policy ("Ärztliche Approbationsordnung" [ÄApprO]) from July 17, 2012, in particular, since April 01, 2013, German universities have been obliged to provide a training schedule such as a "logbook" for this final year, specifically for the mandatory time periods within surgery and internal medicine. In preparation for this innovation, the German Medical School Association ("Medizinischer Fakultätentag") presented basic logbooks as consensus documents in June 2012. The portfolio for each surgery discipline and the Magdeburg Medical School, had been developed on the basis of individual initiatives and used for years, and was revised, specified and further developed into a "logbook of the medical study's final year" - specific for daily practice and the Magdeburg Medical School, and to the guidelines of the Medical School Association ("Medizinischer Fakultätentag"). The aim of the present commentary is i) to present the Magdeburg Medical School logbook and its clinical planning for cases, diagnoses and (surgical) interventions, as a summary of institutional experience and ii) to describe the mandatory surgical part of the "Magdeburg's final year of the study of human medicine". METHOD Narrative short overview including individual teaching experiences and topic-related references from "PubMed" using terms for literature search such as "surgical logbook", "practical year" and "medical teaching". The background and aims of the document's modifications are explained for each surgical discipline. RESULTS The "Logbook" is subdivided into 6 chapters: introduction, basics, statement of requirement, selected surgical diseases and interventions as well as information on final year-associated events and courses and instructions for creating the obligatory case report. CONCLUSION The presented "Magdeburg Medical School Final Year Logbook of the Surgical Disciplines" has been created according to the requirements of the German Medical School Association ("Medizinischer Fakultätentag") and has been simultaneously adapted to the conditions and established medical teaching at the presenting Medical School. In particular, the medical students are given a document related to daily clinical practice, which allows them, within an overall teaching concept, to acquire indispensable expertise.
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Affiliation(s)
- Katharina Witzel
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Anne Ballaschk
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Silke Altmann
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Hans-Jürgen Haß
- Bereich Kinderchirurgie, Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Costanza Chiapponi
- Klinik für Allgemein-, Viszeral- und onkologische Chirurgie, Uniklinik Köln, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Katrin Werwick
- Studiendekanat, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Roland S Croner
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Frank Meyer
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
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von Winning D, Adolf D, Schirrmeister W, Piatek S. Correction: Surgical Treatment of Talar Neck and Body Fractures: Mid-Term Results of 24 Cases. Z Orthop Unfall 2020; 159:e3. [PMID: 32000265 DOI: 10.1055/a-1104-5739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Dominik von Winning
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät
| | - Daniela Adolf
- Gesellschaft für klinische und Versorgungsforschung mbH, StatConsult, Magdeburg
| | - Wiebke Schirrmeister
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät
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von Winning D, Adolf D, Schirrmeister W, Piatek S. Surgical Treatment of Talar Neck and Body Fractures: Mid-Term Results of 24 Cases. Z Orthop Unfall 2020; 159:67-74. [PMID: 31918443 DOI: 10.1055/a-1023-4715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Talar neck and body fractures are rare. Major posttraumatic complications with a potential reduction in the quality of life are arthrosis and necrosis due to the specific vascular supply. The aim of the study was to evaluate mid-term results of surgery for talar fractures of neck and body. Parameters that potentially affected/influenced treatment outcomes were analysed exploratively. METHODS 24 patients with 24 talar neck and body fractures (Marti type II n = 9, type III n = 12, type IV n = 3) were retrospectively examined for radiological and clinical functional outcomes. The independent parameters evaluated included age (< 40, ≥ 40 years), sex (male, female), general overall extent of injury (polytrauma/multiple injuries/multiple fractures of the extremities, additional injuries to the same foot, isolated talus fracture), soft tissue damage (open, closed), surgical latency (< 6, ≥ 6 h), fracture classification/displacement (undisplaced [= Marti II], displaced [= Marti III, IV]) and fracture type (talar body, neck fracture). The potential influencing parameters were analysed by univariate analyses. RESULTS With an average follow-up of 8.7 years (1,25 - 16 years) the AOFAS score was 71.4 ± 22.9 points, the Foot Function Index score 35.9 ± 28.3 points; the physical and mental component summary scores of the Short Form 36, version 2, was 43.8 ± 10.9 and 47.4 ± 13.6 points (mean ± standard deviation), respectively. Thus, the patient reported physical health of the patients was slightly reduced compared to the German population, while the mental health remained largely unaffected. Two patients developed partial avascular necrosis (8%), 10 patients developed osteoarthritis (42%). Of the independent parameters, only the general overall extent of injury showed a significant influence on osteoarthritis (p = 0.002). In the evaluation of undisplaced (n = 9) and displaced (n = 15) fractures, surgical treatment after more than 6 hours did not result in a worse outcome. CONCLUSION The clinical outcome of internal fixation of talar neck and body fractures can be classified as good. In the study group, there was no correlation between the occurrence of arthrosis and the Marti fracture classification.
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Affiliation(s)
- Dominik von Winning
- Department for Trauma Surgery, Otto-von-Guericke University, Magdeburg Medical Faculty
| | - Daniela Adolf
- Company for Clinical and Healthcare Research mbH, StatConsult, Magdeburg
| | - Wiebke Schirrmeister
- Department for Trauma Surgery, Otto-von-Guericke University, Magdeburg Medical Faculty
| | - Stefan Piatek
- Department for Trauma Surgery, Otto-von-Guericke University, Magdeburg Medical Faculty
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von Winning D, Lippisch R, Pliske G, Adolf D, Walcher F, Piatek S. Surgical treatment of lateral and posterior process fractures of the talus: Mid-term results of 15 cases after 7 years. Foot Ankle Surg 2020; 26:71-77. [PMID: 30554933 DOI: 10.1016/j.fas.2018.11.013] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/20/2018] [Accepted: 11/23/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND We retrospectively evaluated the mid-term results of surgery for talar process fractures (lateral and posterior processes) and exploratively analyzed parameters that potentially impact treatment outcomes. METHODS Fifteen patients who underwent internal fixation (January 2000 to December 2015) were examined for radiological and clinical functional outcomes. The independent parameters evaluated were age, sex, extent of general injury, soft-tissue damage, surgical latency, and fracture type. RESULTS All fractures healed completely. Three patients developed osteoarthritis. The American Orthopaedic Foot and Ankle Society Ankle/Hindfoot Scale score was 79.5±18.6, the Functional Foot Index score was 31.1±31.4, and the physical and mental component summary scores of the Short Form 36, version 2, were 46.6±11.8 and 50.3±9.1, respectively. No influence on the above scores was determined. CONCLUSIONS The clinical outcomes of internal fixation of talar process fractures were good. Delayed surgical treatment (≥14days) did not significantly lead to poorer outcomes in our patients.
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Affiliation(s)
- Dominik von Winning
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany.
| | - Roland Lippisch
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Daniela Adolf
- Gesellschaft für klinische und Versorgungsforschung mbH, Halberstädter Str. 40a, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
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12
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Weinlich M, Martus P, Blau MB, Wyen H, Walcher F, Piatek S, Schüttrumpf JP. Competitive advantage gained from the use of helicopter emergency medical services (HEMS) for trauma patients: Evaluation of 1724 patients. Injury 2019; 50:1028-1035. [PMID: 30591228 DOI: 10.1016/j.injury.2018.12.018] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of the study was to analyze helicopter emergency medical service (HEMS) in comparison to EMS, in respect to patient's mortality and morbidity. DESIGN From a cohort of traumatized patients (n = 1724) prospectively enrolled in the German trauma registry (DGU-R) at Frankfurt University Hospital from 2009 to 2013, 1646 could be analyzed for in-hospital mortality and short-term outcome (GOS) at discharge and compared between HEMS and EMS. MEASUREMENTS AND MAIN RESULTS 129 patients (7.8%) died in the hospital. Unadjusted mortality was significantly lower in the HEMS group compared to EMS (p = 0.001). In a multiple logistic regression analysis after adjustment of variables including reanimation and age as the strongest predictors, in-hospital mortality was significantly reduced in HEMS (p = 0.014, OR = 0.21). Further predictors in the multiple logistic regression analysis were GCS > = 8 (p = 0.001), RRsys (p < 0.001), ISS at Head/Neck > = 3 (p = 0.003), and total ISS > = 9 (p < 0.001). Total rescue time and on scene time were associated with mortality (p < 0.001) but not included in the multiple logistic regression model. Without adjustment, short-term outcome (GOS) was significantly improved (p = 0.014). In a linear model, after adjusting for multiple variables including age, ISS Head/Neck > = 3, ISS Extremities > = 3, GCS > = 8, and RRsys as the strongest predictors (p < 0.001), the association remained significant (p = 0.043). Further predictors in the multiple linear regression analysis were total ISS > = 9 (p = 0.002), ISS abdomen (p = 0.001), and ISS Chest (p = 0.011). CONCLUSIONS A significant improvement for in-hospital survival for HEMS could be demonstrated. Especially in Germany, with a high number of secondary call outs (about 44%) after EMS has already reached the traumatized patient, HEMS must be the first choice for severely injured trauma patients. Dispatch criteria for immediate alarm of HEMS are recommended under practical considerations.
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Affiliation(s)
- M Weinlich
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - P Martus
- University of Tübingen, Medical Center, Otfried-Müller Str. 10, 72076, Tübingen, Germany
| | - M B Blau
- University of Tübingen, Medical Center, Otfried-Müller Str. 10, 72076, Tübingen, Germany
| | - H Wyen
- University of Frankfurt, Dept. of Traumatology, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - F Walcher
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - S Piatek
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - J P Schüttrumpf
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
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13
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Lucas B, Wiegand S, Jahn O, Greiner F, Walcher F, Piatek S. [Patient Motivation to Participate in Medical Education]. Zentralbl Chir 2019; 145:481-486. [PMID: 30808049 DOI: 10.1055/a-0820-5959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Student education focuses increasingly on case-related teaching. Often the consent of the patient to participate in student education is supposed to be provided. In most instances this is taken for granted - which it is not. Here, we investigated the motivation of the patients to participate in student education and influence factors using an anonymised survey. MATERIAL AND METHODS The survey was performed from 2017/01/01 until 2017/04/30 and recruited inpatients of a university department of trauma surgery. The questionnaire contained 10 multiple choice questions targeting socio-demographic factors and the motivation of the patients to participate in different aspects of medical education. This was captured using a 5-point Likert scale. The electronic analysis of the questionnaire was performed with the program KLAUS (Blubbsoft GmbH, Berlin, Germany) after digitalizing the data. RESULTS In total 162 questionnaires were analysed. The patients were generally highly motivated to participate in bedside teaching and a student examination as well as consenting to the collection of pictures, videos and X-ray images or subsequent contact. Patient satisfaction was a principle factor. There was a positive correlation between the satisfaction with the motivation to participate in bedside teaching and a student examination as well as giving consent to the collection of pictures, videos and X-ray images or subsequent contact. There was significantly decreased motivation for participation in a lecture. In comparison, male patients had greater motivation to participate in a lecture. Moreover 40- to 49-year-old patients were significantly less motivated to participate in a lecture than 20- to 29-year-old and 50- to 59-year-old patients. Patient satisfaction had no influence on motivation to participate in a lecture. CONCLUSION The motivation of the patients to participate in bedside teaching and a student examination as well as giving consent to the collection of pictures, videos and X-ray images or subsequent contact correlated with patient satisfaction. Socio-demographic factors are less important. Patient motivation to participate in a lecture is lower regardless of patient satisfaction.
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Affiliation(s)
- Benjamin Lucas
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Stefan Wiegand
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Oliver Jahn
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Felix Greiner
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Felix Walcher
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
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Kraus A, Infanger M, Chiapponi C, Piatek S, Zardo P, Udelnow A, Haß HJ, Meyer F. Surgical teaching at the Medical School Otto-von-Guericke University of Magdeburg - basic conceptual description. Pol Przegl Chir 2018; 90:37-42. [PMID: 30015325 DOI: 10.5604/01.3001.0011.8173] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Teaching in surgery, one of the classical big clinical and main disciplines beside internal medicine, needs to be also associated with great attention in regard to a valuable final result at the end of the study of human medicine. In particular, surgery is not only the subject to a large number of lectures it also represents one third (four months) of the compulsory internship (practical year - in German, "Praktisches Jahr") at the end of the study of medicine. Therefore, medical teaching of students should be always part of serious and steady attempts to optimize course und contents as a component of guiding activities focussing onto the substantial improvement of the study of medicine. In detail, the classical and traditionally established type of teaching, the (oral) lecture, has to be further developed and reasonably completed by numerous interactive and practice-oriented teaching, learning and examining modalities (obligatory or facultative seminars / courses, training in [very] small groups of students, bed-side teaching, individual practical exercises within the SkillsLab, groups of young researchers, research projects in teaching, scientific publications on topics and recommendable experiences ot teaching including students, "Teach-the-teacher" projects etc.). Although many novel concepts have been inaugurated and considerable advances have been achieved, there is a steady need for further improvement. In the presented representative but medical school-specific overview, the current complex surgical teaching concept, which has been continuously optimized over the last couple of years, at the Otto-von-Guericke University Medical School with University Hospital of Magdeburg (Germany) is described as a scientific and systematizing document as well as a manuscript associated with the ongoing preparation of an institutional "Teaching Manual" on surgical teaching and training for medical students. It should - last but not least - provide the basis for a public discussion, which vice versa might hopefully and possibly result in further structural reforms of (surgical) teaching in the near future.
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Affiliation(s)
- Armin Kraus
- University Hospital at Magdeburg (Germany) Dept. of Plastic, Aesthetic and Hand Surgery
| | - Manfred Infanger
- University Hospital at Magdeburg (Germany) Dept. of Plastic, Aesthetic and Hand Surgery
| | - Costanza Chiapponi
- University Hospital at Cologne (Germany) Dept. of General, Abdominal and Tumor Surgery
| | - Stefan Piatek
- University Hospital at Magdeburg (Germany) Dept. of Trauma Surgery
| | - Patrick Zardo
- University Hospital at Hannover (Germany) Dept. of Heart and Thoracic Surgery Division of Thoracic Surgery
| | - Andrej Udelnow
- University Hospital at Magdeburg (Germany) Dept. of General, Abdominal and Vascular Surgery Division of Vascular Surgery
| | - Hans-Jürgen Haß
- University Hospital at Magdeburg (Germany) Dept. of General, Abdominal and Vascular Surgery Division of Pediatric Surgery
| | - Frank Meyer
- University Hospital at Magdeburg, Magdeburg (Germany) Dept. of General, Abdominal and Vascular Surgery
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15
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Weinlich M, Kurz P, Blau MB, Walcher F, Piatek S. Significant acceleration of emergency response using smartphone geolocation data and a worldwide emergency call support system. PLoS One 2018; 13:e0196336. [PMID: 29791450 PMCID: PMC5965832 DOI: 10.1371/journal.pone.0196336] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/11/2018] [Indexed: 11/18/2022] Open
Abstract
Importance When patients are disorientated or experience language barriers, it is impossible to activate the emergency response system. In these cases, the delay for receiving appropriate help can extend to several hours. Objectives A worldwide emergency call support system (ECSS), including geolocation of modern smartphones (GPS, WLAN and LBS), was established referring to E911 and eCall systems. The system was tested for relevance in quickly forwarding abroad emergency calls to emergency medical services (EMS). Design To verify that geolocation data from smartphones are exact enough to be used for emergency cases, the accuracy of GPS (global positioning system), Wi-Fi (wireless LAN network) and LBS (location based system) was tested in eleven different countries and compared to actual location. The main objective was analyzed by simulation of emergencies in different countries. The time delay in receiving help in unsuccessful emergency call cases by using the worldwide emergency call support system (ECSS) was measured. Results GPS is the gold standard to locate patients with an average accuracy of 2.0 ± 3.3 m. Wi-Fi can be used within buildings with an accuracy of 7.0 ± 24.1 m. Using ECSS, the emergency call leads to a successful activation of EMS in 22.8 ± 10.8 min (Median 21 min). The use of a simple app with one button to touch did never cause any delay. Conclusions and relevance The worldwide emergency call support system (ECSS) significantly improves the emergency response in cases of disorientated patients or language barriers. Under circumstances without ECSS, help can be delayed by 2 or more hours and might have relevant lifesaving effects. This is the first time that Wi-Fi geolocation could prove to be a useful improvement in emergencies to enhance GPS, especially within or close to buildings.
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Affiliation(s)
- Michael Weinlich
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
- * E-mail:
| | - Peter Kurz
- Hospital am Steinenberg Reutlingen, teaching facility affiliated with the University of Tübingen, Department of Trauma Surgery, Reutlingen, Germany
| | | | - Felix Walcher
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
| | - Stefan Piatek
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
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Westphal T, Lippisch R, Jürgens J, Piatek S. [Simultaneous fracture of the acromion and coracoid process : Rare variant of double disruption of the superior shoulder suspensory complex]. Unfallchirurg 2018; 121:968-975. [PMID: 29569025 DOI: 10.1007/s00113-018-0480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Simultaneous fracture of the acromion and coracoid process represents a double disruption of the superior shoulder suspensory complex (SSSC). To date, the two largest reported series have comprised five and eight cases. The aim of this study was to investigate the functional outcome in patients who sustained this rare injury and to provide a review of the relevant literature. MATERIAL AND METHODS In this retrospective study, patients who were surgically treated between 2009 and 2014 were identified from medical records and the patients were asked to attend a follow-up examination. Functional results, measured as the Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score, were the main outcomes of the study. RESULTS A total of six patients underwent surgery for this type of double disruption of the SSSC. All but one patient suffered a high-impact trauma with other associated injuries. The coracoid fracture was classified as type I according to Ogawa in all cases, and the acromion fracture was type III according to Kuhn in 5 out of 6 cases. At least one of the fracture sites was stabilized. Of the patients one showed a concurrent lateral clavicle fracture, representing a third disruption of the SSSC, and another had a fracture of the medial third of the clavicle, representing a strut fracture. In these cases, two fracture sites were operated on. At an average follow-up period of 47 months all but one fracture had healed. In one patient, asymptomatic non-union of the acromion was found. The average DASH score was 22 points and the average Constant score was 74 points. CONCLUSION This rare injury pattern is usually caused by high-impact trauma, and concomitant injuries frequently occur. Nevertheless, surgical stabilization of at least one of the fracture sites showed satisfactory functional results.
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Affiliation(s)
- Thomas Westphal
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Südstadt Rostock, Südring 81, Rostock, Deutschland.
| | - Roland Lippisch
- Klinik für Unfallchirurgie, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, Magdeburg, Deutschland
| | - Julian Jürgens
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, Magdeburg, Deutschland
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, Magdeburg, Deutschland
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17
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Pliske G, Heide S, Lucas B, Brandstädter K, Walcher F, Kropf S, Lessig R, Piatek S. [Legal medicine specialists within the framework of acute care : Analysis of legal medicine consultations in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt]. Unfallchirurg 2017; 121:391-396. [PMID: 28921014 DOI: 10.1007/s00113-017-0413-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In acute medical care, there are patients who have been injured by the influence of others. The aim of this study was to analyze all cases which were presented to the Institute for Legal Medicine of the University Halle (Saale). The cases where analyzed in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt. MATERIALS AND METHODS The consultations of the Institute for Legal Medicine Halle-Wittenberg for 2012-2015 were evaluated with regard to the age and gender distribution, the reasons for the consultation and time until the request for consultations. These cases were statistically compared to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt 2014-2015. RESULTS A total of 536 cases (55.6% male and 44.4% female patients) were evaluated. In all, 62.1% of patients were under 18 years of age; 43.5% of all consultations were requested by pediatric (surgery) clinics. The most common reasons for consultation were sexual child abuse or violence against children (50.7%). Compared to the victims' statistics, significantly more children were examined by legal medicine specialists than could have been expected (p < 0.001). In adult patients, the most common causes for consultation were acts of violence (20.4%) and domestic violence (10.1%). Among adults, significantly more women and fewer men were presented than expected (p = 0.001). CONCLUSION There were only a small number of consultations of legal medicine specialists in relation to the victims' statistics. Most of them were children and women. The temporal latency between the act of violence and the consultations was one day and more. The latency and the renunciation of the consultation of the legal medicine specialists can lead to loss of evidence.
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Affiliation(s)
- G Pliske
- Klinik für Unfallchirurgie, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - S Heide
- Institut für Rechtsmedizin, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - B Lucas
- Klinik für Unfallchirurgie, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - K Brandstädter
- Institut für Rechtsmedizin, Universitätsklinikum Halle (Saale), Außenstelle Magdeburg, Magdeburg, Deutschland
| | - F Walcher
- Klinik für Unfallchirurgie, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - S Kropf
- Institut für Biometrie und Medizinische Informatik, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - R Lessig
- Institut für Rechtsmedizin, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - S Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Blau MB, Weinlich M, Lauchart W, Piatek S, Walcher F. Air Repatriation With a Medium-sized Pneumothorax Without Thoracic Tube: A Special Case of a Repatriation Accompanied by an Experienced Surgeon. Air Med J 2017; 36:268-271. [PMID: 28886789 DOI: 10.1016/j.amj.2017.05.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 06/07/2023]
Abstract
We report on the repatriation of a 28-year old female from Germany, who was involved in a serious bus accident and was transported to the nearest hospital in Oruro, Bolivia. CT scans and x-rays performed in this hospital demonstrated a complete pneumothorax right. Thorax drainage was inserted, which was removed after 5 days. Since the hospital refused to acknowledge the presence of a residual middle-sized pneumothorax on the repatriation day and did not want to insert another tube, the decision was made to repatriate the patient on commercial flight back home to Germany without a thoracic tube.
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Affiliation(s)
- Melissa B Blau
- Medical Center, University Hospital of Tübingen, Tübingen, Germany.
| | - Michael Weinlich
- Department of Trauma Surgery, University of Magdeburg, Magdeburg, Germany
| | - Werner Lauchart
- Department of General Surgery, University of Tübingen, Tübingen, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, University of Magdeburg, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, University of Magdeburg, Magdeburg, Germany
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Zardo P, Busk H, Piatek S, Zinne N, Kropivnitskaya I, Kutschka I. [The Patient with Chest Trauma: Surgical Management]. Anasthesiol Intensivmed Notfallmed Schmerzther 2017; 52:436-445. [PMID: 28614864 DOI: 10.1055/s-0042-118058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Even though isolated cases of penetrating chest wounds are exceptionally rare in Germany, chest trauma accounts for major morbidity and mortality in over 18 0000 multitrauma patients encountered every year. Injuries range from immediately fatal cardiac wounds and major vessel lacerations to intercostal bleeding, parenchymal damage, chronic haematothorax and secondary empyema. Placement of large-bore chest tubes constitutes a sufficient treatment for most of these pathologies. In select cases further treatment either by minimally invasive techniques (VATS) or conventional thoracotomy is warranted.
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20
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Sitte-Zöllner A, Walcher F, Geginat G, Piatek S. [Not Available]. Z Orthop Unfall 2017; 155:344-345. [PMID: 28683498 DOI: 10.1055/s-0043-103015] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Albrecht Sitte-Zöllner
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät
| | - Felix Walcher
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät
| | - Gernot Geginat
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät
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Westphal T, Woischnik S, Adolf D, Feistner H, Piatek S. Axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures through an extended lateral deltoid-split approach: electrophysiological findings. J Shoulder Elbow Surg 2017; 26:464-471. [PMID: 27727054 DOI: 10.1016/j.jse.2016.07.027] [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: 03/03/2016] [Revised: 07/03/2016] [Accepted: 07/19/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Axillary nerve injuries after shoulder surgery are rare. In most studies, the frequency of injury is usually determined using clinical examinations, but results from intraoperative neuromonitoring studies have revealed higher than expected rates. Few studies have investigated this topic. Our aim was to determine the frequency of axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures by using electrophysiological assessments and to provide a review of the relevant literature. METHODS This was a retrospective cohort study of 76 consecutive patients who received open reduction and internal fixation of a proximal humeral fracture using a locking plate through a deltoid-splitting approach. We performed a clinical and electrophysiological examination at a minimum follow-up time of 12 months. Functional results were assessed according to the Constant-Murley and Disabilities of the Arm, Shoulder and Hand scores. Electrophysiological examinations comprised electromyography, electroneurography, and motor and somatosensory evoked potentials. The main outcome was the frequency of axillary nerve lesions. RESULTS Forty patients were monitored for an average of 28 months. The mean raw Constant-Murley score was 61 points, the age- and gender-adjusted score was 71%, and the mean Disabilities of the Arm, Shoulder and Hand score was 33 points. Neurapraxia occurred in 1 patient, axonotmesis with incomplete reinnervation occurred in 3, and complete reinnervation occurred in 3. The latter group was classified as having a temporary axillary nerve lesion. CONCLUSIONS The 10% rate of permanent axillary nerve lesions in our cohort is higher than expected based on the clinical examination. Electrophysiological assessment is therefore more appropriate to detect axillary nerve injuries.
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Affiliation(s)
- Thomas Westphal
- Department of Trauma Surgery, Orthopedics, and Hand Surgery, Klinikum Südstadt Rostock, Rostock, Germany.
| | | | - Daniela Adolf
- Gesellschaft für klinische und Versorgungsforschung mbH, Magdeburg, Germany
| | - Helmut Feistner
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, Otto-von-Guericke University, Magdeburg, Germany
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Piatek S, Altmann S, Haß HJ, Werwick K, Winkler-Stuck K, Zardo P, von Daake S, Baumann B, Rahmanzadeh A, Chiapponi C, Reschke K, Meyer F. [Chances and Potential of a Modern Surgical Skills Lab as Substantial Practical Part of the Study of Human Medicine - "The Magdeburg Model"]. Zentralbl Chir 2015. [PMID: 26205985 DOI: 10.1055/s-0035-1545964] [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] [Indexed: 10/23/2022]
Abstract
Introduction: Surgical education of medical students within "skills labs" have not been standardised throughout Germany as yet; there is a substantial impact of available aspects such as personal and space at the various medical schools. Aim: The aim of this contribution is to illustrate the concept of a surgical skills lab in detail, including curricular teaching and integrated facultative courses at the Medical School, University of Magdeburg ("The Magdeburg Model") in the context of a new and reconstructed area for the skills lab at the Magdeburg's apprenticeship center for medical basic abilities (MAMBA). Method: We present an overview on the spectrum of curricular and facultative teaching activities within the surgical part of the skills lab. Student evaluation of this teaching concept is implemented using the programme "EvaSys" and evaluation forms adapted to the single courses. Results: By establishing MAMBA, the options for a practice-related surgical education have been substantially improved. Student evaluations of former courses presented within the skills lab and the chance of moving the skills lab into a more generous and reconstructed area led to a reorganisation of seminars and courses. New additional facultative courses held by student tutors have been introduced and have shown to be of great effect, in particular, because of their interdisciplinary character. Conclusion: Practice-related surgical education within a skills lab may have the potential to effectively prepare medical students for their professional life. In addition, it allows one to present and teach the most important basic skills in surgery, which need to be pursued by every student. An enthusiastic engagement of the Office for Student Affairs can be considered the crucial and indispensable link between clinical work and curricular as well as facultative teaching with regard to organisation and student evaluation. The practice-related teaching parts and contents at the surgical section of a skills lab should be integrated into the National Competence-based Catalogue of Teaching Aims in Medicine ("NKLM").
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Affiliation(s)
- S Piatek
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - S Altmann
- Klinik für Plastische, Ästhetische und Handchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - H-J Haß
- Arbeitsbereich Kinderchirurgie, Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - K Werwick
- Studiendekanat, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - K Winkler-Stuck
- Studiendekanat, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - P Zardo
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - S von Daake
- Studentenschaft des Humanmedizinstudiums, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - B Baumann
- Studentenschaft des Humanmedizinstudiums, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - A Rahmanzadeh
- Studentenschaft des Humanmedizinstudiums, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - C Chiapponi
- Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Germany
| | - K Reschke
- Klinik für Nieren- und Hochdruckkrankheiten, Diabetologie & Endokrinologie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - F Meyer
- Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Germany
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Röpke M, Piatek S, Ziai P. Akute Sprunggelenkinstabilität durch Distorsion. Arthroskopie 2015. [DOI: 10.1007/s00142-015-0013-6] [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: 11/24/2022]
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Jahn O, Wex T, Klose S, Kropf S, Adolf D, Piatek S. Cathepsin K in treatment monitoring following intravenous zoledronic acid. Biomed Rep 2014; 2:915-917. [PMID: 25279169 DOI: 10.3892/br.2014.360] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/27/2014] [Indexed: 12/12/2022] Open
Abstract
Cathepsin K (CatK) is mainly expressed by osteoclasts and plays an important role in bone resorption. As CatK is expressed and secreted by osteoclasts during active bone resorption, it may be a useful and specific biochemical marker of osteoclastic activity. Therefore, CatK serum levels were studied for monitoring the treatment of females with postmenopausal osteoporosis by zoledronic acid. The serum CatK levels were determined in nine postmenopausal females before and after 3, 6 and 12 months of treatment. The levels were significantly reduced after 3 and 6 months (P<0.05), whereas they returned to baseline after 1 year. Taken together, the serum level of CatK may be suitable for monitoring anti-osteoporotic therapy in association with treatment response.
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Affiliation(s)
- Oliver Jahn
- Department of Trauma Surgery, Otto von Guericke University, D-39120 Magdeburg, Germany
| | - Thomas Wex
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, D-39120 Magdeburg, Germany ; Medical Laboratory for Clinical Chemistry, Microbiology and Infectious Diseases, Department Molecular Genetics, Otto von Guericke University, D-39124 Magdeburg, Germany
| | - Silke Klose
- Department of Nephrology, Hypertension, Endocrinology and Metabolic Diseases, Otto von Guericke University, D-39120 Magdeburg, Germany
| | - Siegfried Kropf
- Department of Biometry and Medical Informatics, Otto von Guericke University, D-39120 Magdeburg, Germany
| | - Daniela Adolf
- Department of Biometry and Medical Informatics, Otto von Guericke University, D-39120 Magdeburg, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, Otto von Guericke University, D-39120 Magdeburg, Germany
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Ballaschk A, Kalaitzis N, Röpke M, Piatek S. [Atypical femoral fractures in bisphosphonate therapy]. Unfallchirurg 2013; 118:88-91. [PMID: 24352201 DOI: 10.1007/s00113-013-2526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bisphosphonates (BP) play an important role in the therapy of osteoporosis as they effectively reduce the risk of fractures. Atypical femoral fractures (AFF) have recently been described as an adverse effect of BP treatment. We present 3 women under therapy with BP, who had five AFF, among these three complete and two incomplete fractures. The incidence of AFF under therapy with BP is low, and the benefit regarding reduction of spinal fractures and fractures of the proximal femur is much higher than the risk for an AFF.
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Affiliation(s)
- A Ballaschk
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120, Magdeburg, Deutschland,
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Piatek S, Wex T, Adolf D, Klose S, Westphal S, Amthauer H, Halangk W, Jahn O, Riebau C, Winckler S. Präventive Knochendichtemessung bei postmenopausalen Frauen. Unfallchirurg 2013; 116:596-601. [DOI: 10.1007/s00113-012-2169-0] [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: 10/28/2022]
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Piatek S, Adolf D, Wex T, Halangk W, Klose S, Westphal S, Amthauer H, Winckler S. Multiparameter analysis of serum levels of C-telopeptide crosslaps, bone-specific alkaline phosphatase, cathepsin K, osteoprotegerin and receptor activator of nuclear factor κB ligand in the diagnosis of osteoporosis. Maturitas 2013; 74:363-8. [DOI: 10.1016/j.maturitas.2013.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/17/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
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Guia S, Jaeger BN, Piatek S, Mailfert S, Trombik T, Fenis A, Chevrier N, Walzer T, Kerdiles YM, Marguet D, Vivier E, Ugolini S. Confinement of activating receptors at the plasma membrane controls natural killer cell tolerance. Sci Signal 2011; 4:ra21. [PMID: 21467299 DOI: 10.1126/scisignal.2001608] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Natural killer (NK) cell tolerance to self is partly ensured by major histocompatibility complex (MHC) class I-specific inhibitory receptors on NK cells, which dampen their reactivity when engaged. However, NK cells that do not detect self MHC class I are not autoreactive. We used dynamic fluorescence correlation spectroscopy to show that MHC class I-independent NK cell tolerance in mice was associated with the presence of hyporesponsive NK cells in which both activating and inhibitory receptors were confined in an actin meshwork at the plasma membrane. In contrast, the recognition of self MHC class I by inhibitory receptors "educated" NK cells to become fully reactive, and activating NK cell receptors became dynamically compartmentalized in membrane nanodomains. We propose that the confinement of activating receptors at the plasma membrane is pivotal to ensuring the self-tolerance of NK cells.
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Affiliation(s)
- Sophie Guia
- Centre d'Immunologie de Marseille-Luminy, Université de la Méditerranée, Campus de Luminy, Marseille, France
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Westphal T, Piatek S, Halm JP, Schubert S, Winckler S. Outcome of surgically treated intraarticular calcaneus fractures—SF-36 compared with AOFAS and MFS. ACTA ACUST UNITED AC 2009; 75:750-5. [PMID: 15762267 DOI: 10.1080/00016470410004148] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [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: 10/25/2022]
Abstract
BACKGROUND There is no consensus as to which is the best treatment for intraarticular fractures of the calcaneus. Furthermore, few studies have assessed general health after calcaneus fractures. We therefore measured the state of general health after operation of calcaneal fractures and compared these data with usual foot-scores. PATIENTS AND METHODS We compared the general health of 71 patients with surgically treated calcaneal fractures 2.5 years after injury, with the general health of 71 people from the standard German population (German National Health Survey, 1998) using the SF-36 form. We compared the results of the examination with results of AOFAS Ankle Hindfoot Scale and Maryland Foot Score in the treated patients. RESULTS In patients with calcaneal fractures, there were significant limitations regarding general health in all 9 elements of the SF-36 form. Correlations between SF-36 and foot-scores were strong regarding function and pain scales, but moderate for all other scales. INTERPRETATION Patients face significant limitations regarding general health after calcaneal fractures. The usual foot-scores measure only 2 dimensions of outcome: function and pain. To measure all dimensions of outcome, SF-36 is a better alternative.
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Affiliation(s)
- Thomas Westphal
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Leipziger Strasse 44, DE-39120 Magdeburg, Germany.
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Piatek S, Westphal T, Holmenschlager F, Becker R, Winckler S. Retrograde cement removal in periprosthetic fractures following hip arthroplasty. Arch Orthop Trauma Surg 2007; 127:581-5. [PMID: 17143641 DOI: 10.1007/s00402-006-0249-8] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Revision of cemented hip arthroplasty after periprosthetic fractures of the femur is a demanding procedure. Many different technical devices have been developed for this purpose. This paper presents a new surgical technique of cement removal avoiding excessive exposure of the fracture site. MATERIALS AND METHODS In six patients with periprosthetic fractures of the femur following hip arthroplasty (Johansson Type II and III) cement removal was performed by means of advancing a retrograde nail through the intercondylar notch of the knee. RESULTS In all cases the cement was removed completely. Intraoperative complications or significant knee problems were not observed. CONCLUSION The intracondylar approach provides a simple, rapid and less invasive technique for cement removal in revision hip arthroplasty.
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Affiliation(s)
- Stefan Piatek
- Department of Trauma Surgery, Otto-von-Guericke-University, Leipziger Strasse 44, 39120 Magdeburg, Germany.
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Piatek S, Westphal T, Arbter D, Winckler S. Wertigkeit einer kombinierten Ossifikationsprophylaxe mit Indometacin und Bestrahlung bei Azetabulumfrakturen. Unfallchirurg 2006; 109:556-62. [PMID: 16786326 DOI: 10.1007/s00113-006-1083-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Heterotopic ossification is a complication in patients with surgically treated acetabular fractures. The incidence is related to the surgical approach (extended iliofemoral, posterior or a combined approach). The objective of this study was to evaluate the incidence of heterotopic ossification in patients with acetabular fractures who received a combined prophylaxis with both a single dose of radiation and indomethacin compared to those who received only a prophylaxis with radiation or indomethacin. PATIENTS AND METHODS A total of 24 patients with a combined prophylaxis after surgery were examined retrospectively 24 months after trauma. A systematic literature review was performed and our own results were compared with different methods for prophylaxis of heterotopic ossification from the literature. RESULTS Only one patient developed a heterotopic ossification. In accordance with the literature, combined prophylaxis showed the least incidence of ossification compared to the other methods. Differences in incidence frequencies were significant between the different prophylaxis methods. CONCLUSION A combined prophylaxis for heterotopic ossification in surgically treated acetabular fractures seems to be a better alternative than a prophylaxis with radiation or indomethacin alone.
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Affiliation(s)
- S Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität, Leipziger Strasse 44, 39120 Magdeburg.
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Westphal T, Piatek S, Schubert S, Winckler S. Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF. Arch Orthop Trauma Surg 2005; 125:507-14. [PMID: 16177886 DOI: 10.1007/s00402-005-0023-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to determine the most appropriate surgical treatment from three procedures used for fractures of the distal radius. In a retrospective comparative study, 166 out of 237 patients who underwent surgery for AO/ASIF A3 or C2 distal radius fractures were evaluated. Surgical procedures were external fixation or open reduction and internal fixation with either palmar or dorsal plates. Radiological outcomes were palmar tilt, radial angle, radial length and ulnar variance. Functional outcomes were range of motion and grip strength. In addition, outcomes according to Gartland and Werley and the Disabilities of the Arm, Shoulder and Hand questionnaire were compared. Further outcome criteria were the treatment time and the number of complications. Data were analysed using an analysis of variance statistical procedure respective of the chi2-test. Open reduction and internal fixation, in particular palmar plate fixation, demonstrated the best radiological and functional results. Subjective assessment of ORIF proved better than that of external fixation as treatment time was shorter and complications were more rarely seen. However, most of the differences between groups were not significant. Although there were no significant differences between groups, our data indicates that most dorsally displaced distal radius fractures can be treated successfully by open reduction and internal fixation. Palmar plate fixation seems to have slight advantages compared to both the external fixation and dorsal plate fixation surgical procedure.
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Affiliation(s)
- Thomas Westphal
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany.
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Westphal T, Halm JP, Piatek S, Schubert S, Winckler S. [Quality of life after calcaneal fractures. A matched-pairs trial with a standardised German control group]. Unfallchirurg 2003; 106:313-8. [PMID: 12719852 DOI: 10.1007/s00113-002-0565-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of the study was the assessment of the limitations of health related quality of life after open reduction and internal fixation (ORIF) of calcaneal fractures and the comparison of these results with those of normal foot-scores. The quality of life of 55 patients with calcaneal fractures treated by ORIF was compared 2.9 years after injury with that of 55 people from the standardised German population of the German-Health-Survey 1998 using the Short Form 36 (SF-36) (Wilcoxon test). The results of SF-36 of patients were correlated with results of the calcaneus score according to Zwipp and AOFAS Ankle Hindfoot Scale (Spearman's correlation coefficient). Health related quality of life showed significant limitations in patients with calcaneal fractures in 9 of 10 scales of the SF-36. Correlations between SF-36 and foot-scores were strong in the function and pain scale and moderate in all other scales. The quality of life of shows significant limitations after calcaneal fractures. Usual foot-scores measure only the function and pain dimension of the outcome. To measure all dimensions, application of the SF-36 can be recommended. International comparisons of results and comparison with a standardised German population is possible.
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Affiliation(s)
- T Westphal
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg.
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Piatek S, Westphal T, Bischoff J, Schubert S, Holmenschlager F, Winckler S. [Intramedullary stabilisation of metastatic fractures of long bones]. Zentralbl Chir 2003; 128:131-8. [PMID: 12632281 DOI: 10.1055/s-2003-37767] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Surgical treatment of metastatic fractures of long bones is mostly a palliative one. Intramedullary stabilisation without resection of metastases follows the aim of the palliative therapy concept. PATIENTS AND METHODS From 01.01.1995 to 30.08.2001 36 manifest and 4 impending long bone fractures were registered in 22 female and 16 male patients, with a mean age of 63 years. In addition, one revision was necessary due to persisting instability after humeral intramedullary bundle nailing. Pathological fractures were found in the humerus (n=11), femoral neck (n=6), per- and subtrochanteric region (n=12), femoral shaft (n=10) and tibia (n=2). Most of them were malignancies of the kidneys (n=13), bronchi (n=7) and breast (n=6). One patient with a solitary metastasis in the humerus received curative treatment by resection, open reduction and internal fixation. All other cases underwent palliative stabilisation. Metastatic lesions of the femoral neck were treated by resection and prosthetic replacement. The remaining fractures were stabilized intramedullarily without resection of metastases or use of bone cement. In 9 cases, a locking nail was implanted in the humerus, and one patient received humeral bundle nailing. In the lower extremities, we used a classic-nail or gamma-nail in 15 and a locking nail in 8 cases. Two moribund patients did not undergo surgery. RESULTS No intraoperative complications occurred. 63 % of the patients with stabilisation of the leg were able to walk at the time of discharge. The mean survival time (Kaplan-Meier) of patients after palliative operation amounted to 161.5 days (95 % CI 92.7; 230.3). We found 6 postoperative complications: temporary palsy of the radial nerve (n=1), soft tissue infection (n=1), dislocation of the nail (n=2), loosening of the distal locking screw (n=1), proceeding osteolysis with high fracture risk (n=1). CONCLUSION Intramedullary stabilisation without resection of metastases using locking nails meets the requirements of palliative therapy. This procedure is less invasive and allows early weight bearing.
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Affiliation(s)
- S Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität, Magdeburg.
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Abstract
PURPOSE OF THE STUDY Antegrade intramedullary nailing is seen as a most effective method in the management of femoral fractures. However, complications may arise due to the surgical approach.Can these disadvantages be avoided by using a retrograde approach? MATERIAL AND METHODS In a prospective study 70 femoral fractures in 62 patients were stabilised using a long intramedullary nail by a retrograde approach. RESULTS We were able to re-examine 50 patients (57 fractures) 13,3 (3-36) months after the operation. Apart from one non-union by infection, all fractures healed in time. Flexion of the knee joint was within a normal ROM in 81% of shaft fractures 12 months or more after the operation, as was the case in 44% of distal fractures. A inhibition of extension was not found in any patient. Two patients had a femoral shortening of up to one centimeter. We observed no rotational malalignment of more than 5 degrees. The clinical results were excellent in 89% of shaft fractures, and in 50% of supra-/diacondylar fractures. In 18 cases a nail removal was already performed, thereby allowing an arthroscopic follow-up inspection of the knee joint. No knee pathology due to nailing was found in either case. CONCLUSION Our results show the advantages of retrograde intramedullary nailing in comparison to the antegrade method.
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Affiliation(s)
- F Holmenschlager
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität, Magdeburg.
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Westphal T, Piatek S, Schubert S, Schuschke T, Winckler S. [Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures]. Z Orthop Ihre Grenzgeb 2002; 140:447-51. [PMID: 12183797 DOI: 10.1055/s-2002-33396] [Citation(s) in RCA: 30] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM The purpose of the study was to verify test criteria of the upper-limb DASH questionnaire in patients with Colles' fractures. METHODS 107 of 139 patients with Colles' fractures treated operatively were examined and asked to complete the questionnaire. To establish reliability, the item answers of all questionnaires were analysed by using Cronbach's Alpha correlation coefficient and corrected item total correlation. Construct validity was evaluated by comparing the DASH points with clinical measures according to Gartland/Werley and Castaing (Spearman correlation coefficient). Discriminant validity was assessed by comparing the DASH points of patients with AO-type A/B fractures and AO-type C fractures (Mann-Whitney U-Test). RESULTS 2.7 percent of all questionnaires were unusuable. The time to fill out the questionnaire was on average 12 minutes. Cronbach's alpha values were high in all scales (alpha > 0.8). No items were found unsuitable (corrected item total correlation > 0.5 in 28 of 30 questions). DASH scores were correlated with ROM deficits and clinical measures of wrist function (r = 0.53; r = 0.59; r = 0.52, p < 0.01). The questionnaire could discriminate patients with different fracture types (p < 0.05). CONCLUSIONS DASH is a workable, reliable and valid instrument for patients with Colles' fractures.
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Affiliation(s)
- T Westphal
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg.
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Holmenschlager F, Halm JP, Piatek S, Schubert S, Winckler S. [Comminuted radial head fractures. Initial experiences with a Judet radial head prosthesis]. Unfallchirurg 2002; 105:344-52. [PMID: 12066473 DOI: 10.1007/s00113-001-0350-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF THE STUDY Comminuted fractures of the radial head represent a particular therapeutic problem. Due to characteristic complications the resection as well as the implantation of the Swanson-prothesis could not convince. MATERIAL AND METHODS We applied the radial head prothesis of Judet in 16 cases (14 type IV and 4 type III by Mason). RESULTS At the moment we survey the follow up of 15 patients after 12 to 45 months (average 18.2), the evaluation was performed using the score of Radin and Riseborough and the score of Morrey. With the score of Radin and Riseborough we found in 7 cases good, in 6 case fair and in 2 case poor results. With the score of Morrey we found 2 excellent, 11 good and 1 fair and poor results. The radiological examination did not show an increase of the carrying angle of the elbow, an osteoporosis, a proximal migration of the radius and a distal radio-ulnar dissociation. CONCLUSION Compared with resection or Swanson-prothesis the bipolar prothesis of Judet has definite advantages.
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Affiliation(s)
- F Holmenschlager
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120 Magdeburg
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Abstract
OBJECTIVE Assessment of quality of life after foot injuries. METHODS All patients with foot injuries treated operatively from July 1995 to December 1999 were asked to complete the SF-36 health survey. Values of four subgroups (male with foot injuries without any other injury, multiple injured male with foot injuries, male without any other injury and both calcaneus fractures or other injuries) were compared with the standardized German population (Mann-Whitney-U-Test, alpha = 0.05). RESULTS 110 of 201 patients completed the questionnaire (follow-up 54.7 %). Values of most of the subscales showed significant differences in comparison with the standardized population for three of four groups. Men with calcaneus fractures revealed the highest disabilities especially for the pain subscale. Quality of life in multiple injured patients is dominantly influenced by foot injuries. CONCLUSIONS Foot injuries cause a strong limitation of quality of life. The SF-36 health survey provides a very suitable outcome measurement for foot injuries.
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Affiliation(s)
- T Westphal
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Germany.
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Abstract
We analyzed reasons, numbers and results of arterial lesions accompanying fractures (n = 21) and luxations (n = 6) in a 6-year-period (1993-1998) retrospectively. Traffic accidents were in nearly 50% responsible for the injuries. 8 patients had suffered multiple injuries. In 17 patients the lower, and in 10 patients the upper extremities were affected. The vascular wall was completely disrupted or severed in 74%. In 7 cases (26%), patients had suffered blunt or indirect arterial trauma with intima- and media-lacerations due to subcapital fracture of the humerus (n = 2), fractured femoral bone (n = 1), luxation of the knee joint (n = 3) or the elbow (n = 1). The mean preoperative time period was 6 hours and 20 minutes (2 to 16 hours) in patients with complete ischaemia. Vascular reconstruction was performed by interposition of an autologous vein graft or an autologous venous bypass (n = 20), by direct reconstruction and primary suturing (n = 2), by use of a venous patch plasty (n = 2) and, in a single case, by autologous bypass procedure. In one case, a crural artery was ligated, in another case with a Mangled Extremity Severity Score (MESS) of 7 points a primary amputation of the lower leg was necessary. In 5 patients (19%) secondary amputations were performed. No patient died. The final outcome is mostly influenced by the preoperative period of ischaemia.
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Affiliation(s)
- S Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg
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41
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Abstract
BACKGROUND Its considerable size at the time of diagnosis and low grade of malignancy are typical features of the solid-pseudopapillary tumor, which has a tendency to predominantly affect young females. A relationship to the long-term intake of oral contraceptives is discussed. Invasive tumor growth or metastases have been observed only rarely until now. METHODS The 53-yr-old female patient we report on here was treated by radical partial pancreatoduodenectomy for a nonmetastasizing solid-pseudopapillary tumor of the pancreatic head (T1bN0M0) 19 mo ago. RESULTS Histopathological studies made a definitive diagnosis of solid-pseudopapillary tumor. The patient is recurrence-free, and there are no signs of metastases at present. Since a microscopically invasive tumor growth is assumed, oncologically curative resection should be preferred vs the less radical enucleation. CONCLUSION In this report, a case of the rare solid-pseudopapillary tumor of the pancreas is described. In contrast to other pancreatic tumors, the semimalignant solid-pseudopapillary tumor has a favorable prognosis.
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Affiliation(s)
- S Piatek
- Department of General Surgery, Otto-von-Guericke-University, Medical Faculty, Magdeburg, Germany
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42
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Abstract
Fractures in the midline of the sacrum are rare, a pseudarthrosis has not been described previously. We report about a 53-year-old woman with a midline fracture of the sacrum which has not been recognized, although there were indirect fracture signs on the native x-rays and a CT was performed. The surgical treatment with sacral compression bars was successful and pseudarthrosis healing resulted but the patient continued to have mild low back pain. The case reported here confirms that low back pain may caused by pathologic changes of the posterior part of the pelvis. The unusual fracture location could be caused by a bifid spinous process.
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Affiliation(s)
- T Westphal
- Klinik für Unfallchirurgie, Zentrum für Chirurgie, Otto-von-Guericke-Universität Magdeburg
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43
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Piatek S, Manger T, Kunz D, Pross M, Schmidt SC, Fahlke J, Luley C, Lippert H. [Laparoscopic transperitoneal adrenalectomy--technique and personal experiences]. Zentralbl Chir 1998; 122:1103-7. [PMID: 9499535] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopic transperitoneal and endoscopic extraperitoneal adrenalectomy are two safe options in minimally invasive surgery associated with very low morbidity. The anterior transperitoneal approach we prefer yields a better exposure of the anatomic structures and allows the surgeon to orient himself more easily. In addition, various other laparoscopic maneuvers may be performed synchronously. We report on our own experience with eight laparoscopic transperitoneal adrenalectomies performed in four cases unilaterally and in two additional cases bilaterally during April, 1996, and January, 1997, in six patients aged 20 to 56 years. The indications were in four cases pheochromocytoma (operated on bilaterally in two cases), and in the remaining two cases adrenal Cushing's syndrome. The duration of surgery was approximately 240 min for bilateral adrenalectomy and 166 min for unilateral adrenalectomy, respectively, with an intraoperative blood loss of about 50 to 400 ml. Except for haematoma of the abdominal wall there were no other postoperative complications. The serum levels of interleukin 6 and 10 underline the minimal invasiveness of this technique, since there were only small increases of interleukin 6 and interleukin 10.
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Affiliation(s)
- S Piatek
- Klinik für Chirurgie, Otto-Von-Guericke-Universität Magdeburg
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44
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Manger T, Piatek S, Klose S, Kopf D, Kunz D, Lehnert H, Lippert H. [Bilateral laparoscopic transperitoneal adrenalectomy in pheochromocytoma]. Langenbecks Arch Chir 1997; 382:37-42. [PMID: 9157231] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Laparoscopic transperitoneal and endoscopic extraperitoneal adrenalectomy are two safe options in minimally invasive surgery associated with a very low morbidity. Comparative studies with the conventional access to the adrenal gland demonstrated the advantages of the endoscopic technique. The anterior transperitoneal approach yields a better exposure of the anatomic structures and allows the surgeon to orient himself more easily, while at the same time he may perform additional laparoscopic maneuvers. In two cases of bilateral pheochromocytoma a bilateral laparoscopic adrenalectomy was performed simultaneously by employing the transperitoneal approach. The duration of surgery was approximately 210 and 270 min, respectively, with an intraoperative blood loss of about 350 and 400 ml. There were no complications following this procedure. Already on the 1st postoperative day, the patients could be fully mobilized. Furthermore, immunological data obtained perioperatively support the minimal invasiveness of this technique.
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Affiliation(s)
- T Manger
- Klinik für Chirurgie, Otto-von-Guericke-Universität Magdeburg
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45
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Abstract
The management of wound healing problems in a patient with diabetes mellitus receiving immunosuppressants
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