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  • 1
    Language: English
    In: Critical care (London, England), 2011, Vol.15(1), pp.R20
    Description: Deregulated apoptosis and overshooting neutrophil functions contribute to immune and organ dysfunction in sepsis and multiple organ failure (MOF). In the present study, we determined the role of soluble Fas (sFas) in the regulation of posttraumatic neutrophil extrinsic apoptosis and the development of sepsis. Forty-seven major trauma patients, 18 with and 29 without sepsis development during the first 10 days after trauma, were enrolled in this prospective study. Seventeen healthy volunteers served as controls. Blood samples from severely injured patients were analyzed at day 1, day 5 and day 9 after major trauma. sFas levels, plasma levels of neutrophil elastase (PMNE) and levels of interleukin (IL)-6 were quantified by enzyme-linked immunosorbent assay and related to patients' Sequential Organ Failure Assessment (SOFA) score and Multiple Organ Dysfunction Score (MODS). Neutrophil apoptosis was determined by propidium iodide staining of fragmented DNA and flow cytometry. sFas-mediated effects on neutrophil apoptosis were investigated in cells cultured with agonistic anti-Fas antibodies in the presence of recombinant sFas, sFas-depleted serum or untreated serum from septic patients. Serum levels of sFas in patients who later developed sepsis were significantly increased at day 5 (P 〈 0.01) and day 9 (P 〈 0.05) after trauma compared with patients with uneventful recovery. Apoptosis of patient neutrophils was significantly decreased during the observation period compared with control cells. Moreover, Fas-mediated apoptosis of control neutrophils was efficiently inhibited by recombinant sFas and serum from septic patients. Depletion of sFas from septic patient sera diminished the antiapoptotic effects. In septic patients, sFas levels were positively correlated with SOFA at day 1 (r = 0.7, P 〈 0.001), day 5 (r = 0.62, P 〈 0.01) and day 9 (r = 0.58, P 〈 0.01) and with PMNE and leukocyte counts (r = 0.49, P 〈 0.05 for both) as well as MODS at day 5 (r = 0.56, P 〈 0.01) after trauma. Increased sFas in patients with sepsis development impairs neutrophil extrinsic apoptosis and shows a positive correlation with the organ dysfunction scores and PMNE. Therefore, sFas might be a therapeutic target to prevent posttrauma hyperinflammation and sepsis.
    Keywords: Apoptosis -- Physiology ; Fas Ligand Protein -- Blood ; Neutrophils -- Physiology ; Sepsis -- Etiology ; Wounds and Injuries -- Blood
    ISSN: 13648535
    E-ISSN: 1466-609X
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  • 2
    Language: English
    In: International Journal of Surgery, September 2016, Vol.33, pp.72-77
    Description: Based upon our excellent previous experience with 151 adult patients and 39 children whom had the peritoneal catheter in ventriculoperitoneal shunting placed laparoscopically, we continued following this technique as a first-line-procedure in ventriculoperitoneal shunting. Now we analyzed our experience with additional 405 cases for a better comprehension of the complications, advantages and disadvantages of this procedure on this high number of patients. A strict interdisciplinary setting with the maximum of medical intraoperative competence was our goal and therefore better results. N = 405 patients with intraperitoneal shunt insertion from the years 2006–2013 (Follow-up period ranges from 2 to 9 years with a 5,9-year mean follow-up period) were retrospectively analyzed with a special focus on the possible peritoneal catheter complications after laparoscopical shunt insertion. In our department all the peritoneal catheters in ventriculoperitoneal shunting are inserted laparoscopically, when there is no contraindication for this technique. We had 0% peritoneal catheter misplacement rate with help of the laparoscopic technique. In two cases (0.49%) injury of the small bowel could be repaired immediately with no further action required. In two cases umbilical hernias have been accidently discovered and the repair of the hernias took place in the same surgical session. As this technique helps us to control the shunt position intraperitoneally by direct laparoscopic vision, the patients spared an extra radiation exposure, to control the position of the peritoneal catheter. A diagnostic laparoscopy is also possible if needed. The time of the operation is shortened in comparison with the needed time, which is mentioned in literature, for the open laparotomy and of course the needed anesthesia and its possible risks and complications decreased. No revision surgeries were required because of any misplacement of the peritoneal catheter, no additional technique related risks compared to the open surgical technique, no abdominal x-rays were needed, the operation time is shortened and the dose of anesthesia needed is decreased and of course its possible side effects' rate is also decreased. Another great benefit of this technique is the possibility of accidental diagnosis of intra-abdominal pathologies. Also, if a surgical treatment of this accidentally discovered intra-abdominal pathologies is needed, it can take place in the same surgical session. No prolonged surgery time as the laparoscopic technique is much easier, controllable and fast.
    Keywords: Hydrocephalus ; Ventriculoperitoneal Shunt ; Laparoscopy ; Peritoneal Catheter ; Complications
    ISSN: 1743-9191
    E-ISSN: 1743-9159
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  • 3
    Language: English
    In: Acta neurochirurgica, October 2012, Vol.154(10), pp.1821-3
    Keywords: Postoperative Complications ; Hypersensitivity -- Complications ; Internal Fixators -- Adverse Effects ; Lumbar Vertebrae -- Surgery ; Wound Infection -- Complications
    ISSN: 00016268
    E-ISSN: 0942-0940
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  • 4
    Language: English
    In: Clinical Neurology and Neurosurgery, April 2015, Vol.131, pp.64-68
    Description: There is a number of different methods to localize a glioma intraoperatively. Neuronavigation, intraoperative MRI, 5-aminolevulinic acid, as well as intraoperative sonography. Every method has its advantages and disadvantages. Low grade gliomas do not show a specific signal with 5-aminolevulinic acid and are difficult to distinguish macroscopically from normal tissue. In the present study we stress out the importance of intraoperative diagnostic ultrasound for localization of low grade gliomas. We retrospectively evaluated the charts and MRIs of 34 patients with low grade gliomas operated in our department from 2011 until December 2014. The efficacy of ultrasound as an intraoperative navigational tool was assessed. In 15 patients ultrasound was used and in 19 not. Only histologically proven low grades gliomas (astrocytomas grade II) were evaluated. In none of the patients where ultrasound (combined with neuronavigation) was used ( = 15) to find the tumors, the target was missed, whereas the exclusive use of neuronavigation missed the target in 5 of 19 cases of small subcortical low grade gliomas. Intraoperative ultrasound is an excellent tool in localizing low grade gliomas intraoperatively. It is an inexpensive, real time neuronavigational tool, which overcomes brain shift. Even when identifying the tumors with ultrasound is very reliable, the extend of resection and the decision to remove any residual tumor with the help of ultrasound is at the moment unreliable.
    Keywords: Intraoperative Sonography ; Low Grade Glioma ; Neuronavigation ; Medicine
    ISSN: 0303-8467
    E-ISSN: 1872-6968
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  • 5
    In: Zentralblatt für Chirurgie, 2018, Vol.143(01)
    In: Zentralblatt für Chirurgie, 2017, Vol.143(01), pp.35-41
    Description: Die Inzidenzrate einer Gallengangverletzung (BDI) im Rahmen einer laparoskopischen Cholezystektomie (LC) beträgt 0,3%. Eine routinemäßige Anwendung der intraoperativen Röntgencholangiografie (IOC) wird jedoch aufgrund der zusätzlichen Kosten und der Strahlenbelastung kontrovers diskutiert. Ziel dieser Studie war die klinische Evaluation der Fluoreszenzcholangiografie (FC). Die vorliegende prospektive Studie umfasste 230 Patienten, die sich einer LC unterzogen haben. 170 Patienten erhielten sowohl eine FC als auch eine IOC entsprechend einem standardisierten Protokoll. In weiteren 60 Fällen wurden die Ergebnisse der FC mit einer LC ohne eine simultane Cholangiografie verglichen. Anschließend erfolgte die Analyse der Daten hinsichtlich des zeitlichen Aufwands und der Identifikation von biliären Strukturen. Das Durchschnittsalter und der Durchschnitts-BMI betrugen 54,4 ± 15,7 Jahre und 27,9 ± 5,7 kg/m² bei einer mittleren Operationszeit von 67,6 ± 23,3 min. Der zeitliche Aufwand der FC war dabei deutlich geringer als derjenige der IOC (1,5 ± 0,9 vs.7,3 ± 5,0 min). Die Detektionsraten für Ductus cysticus (DC) sowie Ductus hepaticus communis (DHC) im Rahmen einer FC betrugen vor Dissektion am Calot-Dreieck 67,5 bzw. 66,2% und währenddessen 95,9 bzw. 71,2%. Ein BMI 〉 25 kg/m² und männliches Geschlecht reduzierten signifikant die Darstellbarkeit der Strukturen. Der Nachweis einer galligen Sekretion aus dem Gallenblasenbett gelang in 3 Fällen (1,8%) durch eine FC. In 2 Fällen (1,2%) wurde der Abgang des DC aus dem Ductus hepaticus dexter durch IOC dargestellt und in einem Fall (0,6%) bereits durch FC beschrieben. Intraduktale Aussparungen ließen sich bei 9 Patienten (5,3%) mithilfe einer IOC und bei einem Patienten (0,6%) durch eine FC nachweisen. Bei Verzicht auf eine zusätzliche intraoperative Diagnostik betrugen die Detektionsraten von DC und DHC60,0 bzw. 43,3%, mithilfe einer FC80,0 bzw. 53,3%. Dementsprechend bestätigten die Operateure in 70,0% der Fälle eine Erhöhung der operativen Sicherheit durch eine FC. Die FC ist eine einfache, nicht invasive Methode zur Echtzeitdarstellung der Gallengangsanatomie während einer LC. Eine schnelle Identifizierung von anatomischen Normvarianten und galliger Sekretion aus dem Gallenblasenbett erhöht die operative Sicherheit und ermöglicht die simultane Versorgung. Bei Vorliegen einer intraabdominalen Adipositas besitzt die Untersuchung eine limitierte Aussagekraft.
    Keywords: Laparoskopische cholezystektomie ; Indocyaningrün ; Fluoreszenzcholangiografie ; Laparoscopic cholecystectomy ; Fluorescence cholangiography ; Indocyanine green
    ISSN: 0044-409X
    E-ISSN: 1438-9592
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  • 6
    Language: English
    In: Acta neurochirurgica, June 2013, Vol.155(6), pp.1095-100; discussion 1100
    Description: International guidelines for the management of unruptured intracranial aneurysms (UIAs) recommend observation in aneurysms 〈10 mm due to the estimated low risk of rupture. The aim of our study was analyse the data of recently treated patients with ruptured cerebral aneurysms with the special focus on size and configuration in view of the frequency scale in a daily routine setting. We reviewed the data of all patients with aneurysmal subarachnoid haemorrhage (SAH) during the last 24 months at our institution. Configuration and size of the aneurysms were measured. Clinical data were collected using the following classifications for analysis: Hunt and Hess (H&H), modified Rankin Scale (mRS) and Fisher classification. Data of 135 patients with aneurysmal SAH (98 women, 37 men; ratio 2.6:1) were analysed. Analysis showed that 19 aneurysms (14 %) were 〉10 mm (mean size, 19.2 mm) and 116 aneurysms (85.9 %) 10 mm), 18 as multi-lobar (n = 16 10 mm) and 5 as fusiform (n = 4 10 mm). Since the results of our study showed that the majority of the aneurysms are 〈10 mm (mean, 6.2 mm), it is justified to challenge the recommendations of the international guidelines in a daily routine setting. We believe that the published data are not convincing enough to play a guidance role in daily routine. Due to improving surgical and endovascular techniques with satisfying results and the high number of ruptured small aneurysms, we believe a change in attitude in management of small-sized aneurysms is needed. Further diagnostic models are needed to determine the risk of rupture of intracranial aneurysms properly to obtain adequate treatment for UIAs.
    Keywords: Aneurysm, Ruptured -- Surgery ; Intracranial Aneurysm -- Surgery ; Practice Guidelines As Topic -- Standards ; Subarachnoid Hemorrhage -- Surgery
    ISSN: 00016268
    E-ISSN: 0942-0940
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  • 7
    In: Neurology India, 2007, Vol.55(4), p.355-362
    Description: Background: Ventriculostomy is a common neuroendoscopic operation but one with disastrous complications in rare cases. Aims: The aim of this study was to perform an intravital analysis of the configuration at the floor of the third ventricle as a possible basis for selection of the ventriculostomy site. Materials and Methods: The study population consisted of 32 patients who underwent ventriculostomy for the treatment of hydrocephalus. Perforation of the floor of the third ventricle was carried out on an individual basis following evaluation of the anatomic situation. Video material and magnetic resonance images (MRI) were analyzed. Results: A classification system including three major groups was developed using the inner distance of the mamillary bodies as the key criterion. It was defined as narrow for values between 0 and 1 mm (observed range: 0-0.5 mm), medium for values between 1.1 and 3.4 mm (range 1.1-3.4 mm) and large for values greater than 3.4 mm (range: 3.8-6.9 mm). Statistical analysis of MR and video measurements revealed a good correlation. The ventriculostomy site was rostral of the mamillary bodies in 23 of the patients (n=27) and sligthly occipital in four. The ventriculostomy site was located more to the left in 22 patients and more to the right in five. Conclusion: As a conclusion the ventriculostomy site has to be chosen in each case following a careful review of all available information. A classification system for the anatomical variations as well as the exact size and site of ventriculostomy should be introduced.
    Keywords: Hydrocephalus; neuroendoscopy; third ventricle; ventriculostomy
    ISSN: 0028-3886
    E-ISSN: 1998-4022
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  • 8
    Language: English
    In: Immunobiology, 2011, Vol.216(3), pp.334-342
    Description: Posttrauma apoptosis resistance of neutrophils (PMN) is related to overshooting immune responses, systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF). Recently, we have shown that the apoptosis resistance in circulating PMN from severely injured patients which is known to be mediated by high serum levels of pro-inflammatory cytokines can be overcome by the activation of Fas death receptor. Here, we aimed to study whether stimulation of surface Fas leads to the inactivation of hyperactivated PMN from critically ill patients with SIRS. PMN from 23 multiple trauma patients (mean injury severity score (ISS) 34 ± 1.9) were isolated at day 1 after admission to the trauma center. PMN from 17 volunteer blood donors served as controls. Neutrophil activity has been determined after short (1 h) and long-term (4 h) stimulation of freshly isolated PMN with immobilized agonistic anti-Fas antibodies. We found neutrophil chemotactic migration in response to IL-8, phagocytosis and oxidative burst to be significantly inhibited in control cells already after short-term (1 h) Fas stimulation. In contrast, inactivation of trauma PMN by agonistic anti-Fas antibodies was found to be efficient only after long-term (4 h) incubation of cells with agonistic antibodies. Thus, in trauma PMN down-regulation of neutrophil activity seems to be delayed when compared to cells isolated from healthy controls, suggesting impaired susceptibility for Fas stimulation in these cells. Interestingly, whereas Fas-mediated inhibition of phagocytosis and oxidative burst could be prevented by the broad range caspase inhibitor t-butoxycarbonyl-aspartyl(O-methyl)-fluoromethyl ketone (BocD-fmk), the chemotactic activity in response to IL-8 was unaffected. In conclusion, we demonstrate that stimulation of neutrophil Fas does not only initiate apoptosis but also induces inhibition of neutrophil functions, partially by non-apoptotic signaling.
    Keywords: Caspases ; Chemotaxis ; Neutrophils ; Oxidative Burst ; Phagocytosis ; Sirs ; Biology
    ISSN: 0171-2985
    E-ISSN: 1878-3279
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  • 9
    In: Journal of Neuropathology & Experimental Neurology, 2014, Vol.73(6), pp.580-584
    Description: ABSTRACT: Rosette-forming glioneuronal tumors (RGNTs) are rare glioneuronal tumors of the fourth ventricle region that preferentially affect young adults. Despite their histologic similarity with pilocytic astrocytomas (PAs), RGNTs do not harbor KIAA1549-BRAF fusions or BRAF mutations, which represent the most common genetic alteration in PAs. Recently, mutations affecting the hotspot codons Asn546 and Lys656 of fibroblast growth factor receptor 1 (FGFR1) have been described in PAs. They are considered to be the most frequent mechanism of mitogen-activated protein kinase activation, alternative to KIAA1549-BRAF fusion and BRAF mutations. To uncover possible molecular similarities between RGNTs and PAs, we performed a mutational study of FGFR1 in 8 RGNTs. An FGFR1 N546K mutation and an FGFR1 K656E mutation were found in the tumors of 2 patients. Notably, the patient with an FGFR1 K656E mutated RGNT had undergone a resection of a diencephalic pilocytic astrocytoma with pilomyxoid features 5 years before the discovery of the fourth ventricle tumor; the mutational analysis uncovered the presence of the same FGFR1 K656E mutation in the diencephalic tumor. These results indicate that, in addition to histologic similarities, at least a subgroup of RGNTs may show close molecular relationships with PAs. Whether FGFR1 mutated RGNTs represent a specific subset of this rare tumor entity remains to be determined.
    Keywords: MAP Kinase ; Ventricles (Cerebral) ; Astrocytoma ; Fibroblast Growth Factor Receptor 1 ; Codons ; Tumors ; Mutation ; Neurology & Neuropathology ; Brain Tumors ; Fgfr1 ; Mapk ; Pilocytic Astrocytoma ; Rgnt;
    ISSN: 0022-3069
    E-ISSN: 15546578
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  • 10
    In: Spine, 2009, Vol.34(4), pp.392-398
    Description: STUDY DESIGN.: A prospective analysis. OBJECTIVE.: The idea of this study was to evaluate a new miniature robotic system providing passive guidance for pedicle screw placement at the lumbar spine. Special focus was laid on the postoperative accuracy of screw placement. SUMMARY AND BACKGROUND DATA.: Recent technical developments lead to a minimization of pedicle screw fixation techniques. However, the use of navigational techniques is still under controversy. METHODS.: Patients selected for a minimal invasive posterior lumbar interbody fusion received a spiral computer tomographic scan before surgery. The miniature hexapod robot was mounted to the spinous process and the system moves to the exact entry point according to the trajectory of the surgeon’s preoperative plan. After minimal invasive screw placement all patients received routinely a postoperative spiral computer tomographic scan. Screws placed exactly within the pedicle were evaluated as group A, screws deviating 〈2 mm were evaluated as group B, ≥2 mm to 〈4 mm (group C); ≥4 mm to 〈6 mm (group D); and more than 6 mm (group E). RESULTS.: Thirty-one patients received a PLIF with percutaneous posterior pedicle screw insertion using the bone mounted miniature robotic device. A total of 133 pedicle screws were placed. The majority of the screws were placed in L5 (58 screws; 43.6%). In axial plane, 91.7% of the screws were evaluated as group A and 6.8% were evaluated as group B. In longitudinal plane, 81.2% of the screws were evaluated as group A and 9.8% were evaluated as group B. In 1 screw (L5 right) the postoperative evaluation was done as group C (axial plane) and D (longitudinal plane). In 29/31 cases the integration of the miniature robotic system was successful. CONCLUSION.: In our study the first clinical assessment of a new bone mounted robot system guiding percutaneous pedicle screw placement was done. A deviation 〈2 mm to the surgeon ′s plan in 91.0% to 98.5% verifies the system’s accuracy.
    Keywords: Medicine;
    ISSN: 0362-2436
    ISSN: 15281159
    E-ISSN: 15281159
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