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  • 1
    In: PLoS ONE, 2014, Vol.9(12)
    Description: The increasing incidence of implant-associated infections induced by Staphylococcus aureus (SA) in combination with growing resistance to conventional antibiotics requires novel therapeutic strategies. In the current study we present the first application of the biofilm-penetrating antimicrobial peptide lysostaphin in the context of bone infections. In a standardized implant-associated bone infection model in mice beta-irradiated lysostaphin-coated titanium plates were compared with uncoated plates. Coating of the implant was established with a poly(D,L)-lactide matrix (PDLLA) comprising lysostaphin formulated in a stabilizing and protecting solution (SPS). All mice were osteotomized and infected with a defined count of SA. Fractures were fixed with lysostaphin-coated locking plates. Plates uncoated or PDLLA-coated served as controls. All mice underwent debridement and lavage on Days 7, 14, 28 to determine the bacterial load and local immune reaction. Fracture healing was quantified by conventional radiography. On Day 7 bacterial growth in the lavages of mice with lysostaphin-coated plates showed a significantly lower count to the control groups. Moreover, in the lysostaphin-coated plate groups complete fracture healing were observed on Day 28. The fracture consolidation was accompanied by a diminished local immune reaction. However, control groups developed an osteitis with lysis or destruction of the bone and an evident local immune response. The presented approach of terminally sterilized lysostaphin-coated implants appears to be a promising therapeutic approach for low grade infection or as prophylactic strategy in high risk fracture care e.g. after severe open fractures.
    Keywords: Research Article ; Medicine And Health Sciences ; Physical Sciences ; Research And Analysis Methods
    E-ISSN: 1932-6203
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  • 2
    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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  • 3
    Language: English
    In: Turkish neurosurgery, 2017, Vol.27(5), pp.837-841
    Description: There are a number of different surgical approaches in middle cerebral artery (MCA) aneurysm surgery. Evolution from the classical pterional approach towards smaller modified approaches took place over the years. In the present report, we describe a new modified approach in the treatment of MCA aneurysms, which is almost exclusively subfrontal. A modified approach was used on three patients with MCA bifurcation aneurysms. Craniotomy was subfrontal and suprapterional with minimal dissection of the temporal muscle and no drilling of the pterion. In all three cases, after establishing proximal control and dissecting the M1 carefully, retraction of the frontal lobe elevated the sylvian fissure and allowed opening of the fissure. The aneurysm could be identified easily and clips were applied. There was no infection and complete aneurysm clipping was achieved in all 3 patients. The described minimal craniotomy to the MCA through a subfrontal-suprapterional approach allows dissection of peripheral MCA bifurcation aneurysms without any problems.
    Keywords: Craniotomy -- Methods ; Intracranial Aneurysm -- Surgery ; Microsurgery -- Methods ; Temporal Muscle -- Surgery
    ISSN: 1019-5149
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  • 4
    Language: English
    In: South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 17 June 2016, Vol.106(7), pp.687-8
    Description: In patients with C2 rheumatoid pannus with spinal cord compression the treatment of choice is extensive surgery either through a transoral resection of the dens axis or a dorsal stabilisation, or both. We present a case of an 11-mm rheumatoid pannus with significant compression of the spinal cord, which failed surgical treatment with respect to dorsal stabilisation. Therefore, rigid cervical collar for 8 weeks followed by soft collar for another 4 weeks was chosen as a treatment option. During the follow-up period of 1 year, the pannus reduced significantly and the spinal cord decompressed. In cases where surgery is not an option or is technically very demanding, the alternative of cervical collar immobilisation is a satisfying option.
    Keywords: Orthotic Devices ; Arthritis, Rheumatoid -- Complications ; Immobilization -- Methods ; Spinal Cord Compression -- Etiology
    ISSN: 0256-9574
    E-ISSN: 20785135
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  • 5
    Language: English
    In: Clinical Neurology and Neurosurgery, 2010, Vol.112(3), pp.252-257
    Description: The authors discuss a rare case of hemorrhage in a filum terminale ependymoma presenting with acute paraparesis and transient hydrocephalic dementia in association with long-term phenprocoumon anticoagulation. The CT scan of the brain revealed the presence of blood in both occipital horns and communicating hydrocephalus. The symptoms gradually resolved after tumor removal and there was no need for shunting. This is a complex clinical presentation of a spinal cord tumor associated hemorrhage, which further illustrates the possibility of retrograde passage of blood from the lumbosacral region to the ventricles.
    Keywords: Intraventricular Hemorrhage ; Hydrocephalus ; Filum Terminale Ependymoma ; Oral Anticoagulation ; Hemorrhagic Spinal Cord Tumor ; Medicine
    ISSN: 0303-8467
    E-ISSN: 1872-6968
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  • 6
    Language: English
    In: Head & neck oncology, 05 July 2010, Vol.2, pp.16
    Description: The skull base surgery is one of the most demanding surgeries. There are different structures that can be injured easily, by operating in the skull base. It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures. Due to the pioneering work of Cushing, Hirsch, Yasargil, Krause, Dandy and other dedicated neurosurgeons, it is possible to address the tumor and other lesions in the anterior, the mid-line and the posterior cranial base. With the transsphenoidal, the frontolateral, the pterional and the lateral suboccipital approach nearly every region of the skull base is exposable.In the current state many different skull base approaches are described for various neurosurgical diseases during the last 20 years. The selection of an approach may differ from country to country, e.g., in the United States orbitozygomaticotomy for special lesions of the anterior skull base or petrosectomy for clivus meningiomas, are found more frequently than in Europe.The reason for writing the review was the question: Are there keyhole approaches with which someone can deal with a vast variety of lesions in the neurosurgical field?In my opinion the different surgical approaches mentioned above cover almost 95% of all skull base tumors and lesions. In the following text these approaches will be described.These approaches are:1) pterional approach2) frontolateral approach3) transsphenoidal approach4) suboccipital lateral approachThese approaches can be extended and combined with each other. In the following we want to enhance this philosophy.
    Keywords: Neurosurgical Procedures -- Methods ; Skull Base -- Surgery
    E-ISSN: 1758-3284
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  • 7
    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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  • 8
    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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  • 9
    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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  • 10
    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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