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  • Springer Science and Business Media LLC  (50)
  • 2020-2024  (50)
  • 1
    Online Resource
    Online Resource
    Therapie der intraoperativen Hypotonie mit Cafedrin/Theodrenalin vs. Ephedrin : Ergebnisse der HYPOTENS-Studie, einer prospektiven, nationalen, multizentrischen, nicht-interventionellen Untersuchung bei Patienten, die eine Vollnarkose erhalten
    Springer Science and Business Media LLC ; 2021
    In:  Der Anaesthesist Vol. 70, No. 4 ( 2021-04), p. 298-307
    Details
    In: Der Anaesthesist, Springer Science and Business Media LLC, Vol. 70, No. 4 ( 2021-04), p. 298-307
    Abstract: Die medikamentöse Therapie mit Sympathomimetika bildet einen Grundpfeiler der Behandlung relevanter Blutdruckabfälle, so auch der intraoperativen Hypotonie (IOH). Dieses häufige Problem ist mit Endorganschäden assoziiert, wobei Nierenversagen und eine erhöhte Rate kardiovaskulärer Komplikationen am besten dokumentiert sind. Die Datenlage verdeutlicht die Notwendigkeit, dass eine IOH schnell und konsequent therapiert werden muss. Obwohl Cafedrin/Theodrenalin (C/T) in Deutschland häufig in dieser Indikation eingesetzt wird, fehlte bislang ein Wirksamkeitsvergleich mit international verfügbaren Alternativen wie Ephedrin (E). Methoden HYPOTENS ist eine prospektive, nationale, multizentrische (53 Kliniken mit 66 operativen Abteilungen), offene, zweiarmige, nicht-interventionelle Studie zum Vergleich der Wirksamkeit von C/T und E bei der IOH-Therapie unter klinischen Routinebedingungen. Diese Studie beschreibt eine prospektiv definierte Kohorte von Patienten im Alter von ≥50 Jahren mit Komorbiditäten, deren Allgemeinanästhesie mit Propofol und Fentanyl (≥0,2 mg oder Äquivalent) eingeleitet wurde. Alle Patienten hatten intraoperativ eine therapiepflichtige IOH entwickelt und wurden nach dem jeweiligen lokalen Standard mit C/T oder E therapiert. Die primären Studienziele waren Präzision und Schnelligkeit des Blutdruckanstiegs auf einen vor der Behandlung individuell festgelegten Mindest-Zielblutdruck, ohne dabei einen relevanten Anstieg der Herzfrequenz zu verursachen. Die Therapiezufriedenheit der Anästhesisten und die Anzahl zusätzlicher Bolusinjektionen oder weiterer kreislaufstabilisierender Maßnahmen waren sekundäre Endpunkte. Ergebnisse Insgesamt 1496 Patienten wurden protokollgemäß behandelt und ausgewertet. Eine Kreislaufstabilisierung wurde mit beiden Therapieoptionen erreicht. Post-hoc-Analysen zeigen, dass der Blutdruckanstieg unter C/T ausgeprägter war und gleichzeitig weniger zusätzliche Boli der jeweiligen Substanz appliziert und zusätzliche kreislaufstabilisierende Interventionen durchgeführt werden mussten. Die Inzidenz von Tachykardien war in beiden Behandlungsgruppen vergleichbar. Unter E kam es jedoch zu einer dosisabhängigen Erhöhung der Herzfrequenz, während bei den mit C/T behandelten Patienten die Herzfrequenz stabil blieb. Die Therapiezufriedenheit der Anästhesisten war im C/T-Arm höher. Schlussfolgerung Hinsichtlich der Kreislaufstabilisierung war keine der beiden Therapieoptionen überlegen. Post-hoc-Analysen deuten darauf hin, dass C/T unter Routinebedingungen eine zielorientiertere und einfacher zu steuernde Kreislaufstabilisierung ermöglicht. Die seltener erforderlichen erweiterten Therapiemaßnahmen zur ergänzenden IOH-Korrektur stellen einen möglichen Grund für die höhere Anwenderzufriedenheit dar.
    Type of Medium: Online Resource
    ISSN: 0003-2417 , 1432-055X
    URL: Article
    DOI: 10.1007/s00101-020-00877-5
    RVK:
    XA 22100
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 3122926-8
    detail.hit.zdb_id: 1458421-9
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  • 2
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    Influence of interrupted versus continuous suture technique on intestinal anastomotic leakage rate in patients with Crohn’s disease — a propensity score matched analysis
    Springer Science and Business Media LLC ; 2022
    In:  International Journal of Colorectal Disease Vol. 37, No. 10 ( 2022-10), p. 2245-2253
    Details
    In: International Journal of Colorectal Disease, Springer Science and Business Media LLC, Vol. 37, No. 10 ( 2022-10), p. 2245-2253
    Abstract: Intestinal anastomosis is a crucial step in most intestinal resections, as anastomotic leakage is often associated with severe consequences for affected patients. There are especially two different techniques for hand-sewn intestinal anastomosis: the interrupted suture technique (IST) and the continuous suture technique (CST). This study investigated whether one of these two suture techniques is associated with a lower rate of anastomotic leakage. Methods A retrospective review of 332 patients with Crohn’s disease who received at least one hand-sewn colonic anastomosis at our institution from 2010 to 2020 was performed. Using propensity score matching 183 patients with IST were compared to 96 patients with CST in regard to the impact of the anastomotic technique on patient outcomes. Results Overall anastomotic leakage rate was 5%. Leakage rate did not differ between the suture technique groups (IST: 6% vs. CST: 3%, p  = 0.393). Multivariate analysis revealed the ASA score as only independent risk factor for anastomotic leakage ( OR 5.3 (95% CI  = 1.2–23.2), p  = 0.026). Suture technique also showed no significant influence on morbidity and the re-surgery rate in multivariate analysis. Conclusion Our data suggest that the chosen suture technique (interrupted vs. continuous) has no influence on postoperative outcome, especially on anastomotic leakage rate. This finding should be confirmed by a randomized controlled trial.
    Type of Medium: Online Resource
    ISSN: 0179-1958 , 1432-1262
    URL: Article
    DOI: 10.1007/s00384-022-04252-1
    RVK:
    XA 50991
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1459217-4
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  • 3
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    The use of single-stapling techniques reduces anastomotic complications in minimal-invasive rectal surgery
    Springer Science and Business Media LLC ; 2022
    In:  International Journal of Colorectal Disease Vol. 37, No. 7 ( 2022-07), p. 1601-1609
    Details
    In: International Journal of Colorectal Disease, Springer Science and Business Media LLC, Vol. 37, No. 7 ( 2022-07), p. 1601-1609
    Abstract: Leakage of rectal anastomoses is one of the most important and feared complications in colorectal surgery. Apart from patient-specific risk factors, technical aspects may influence the occurrence of anastomotic complications. This study investigated whether using single-stapling techniques (SST) instead of the double-stapling technique (DST) for minimal-invasive rectal anastomosis is associated with a lower rate of anastomotic complications. Methods A retrospective review of 272 patients who received a minimally invasive stapled rectal anastomosis (3–16 cm from the anal verge) at our institution from 2015 to 2020 was performed. In 131 patients, rectal anastomosis was created by SST (SST group), while 141 patients received a rectal anastomosis with crossing stapler lines (DST group). The impact of the anastomotic technique on patient outcomes was determined by uni- and multivariate analyses. Results Overall anastomotic leakage rate was 6%. Patients with SST anastomoses had a lower leakage rate than patients with DST anastomoses (3% vs. 9% in the DST group, p  = 0.045). The rate of anastomotic stenosis was lower in the SST group than in the DST group (1% vs. 6%, p  = 0.037). Overall morbidity and mortality did not differ between the two groups. Multivariate analysis showed that single-stapling techniques significantly reduce the risk of anastomotic leakage (OR 3.5 [1.0–11.5], p  = 0.043). Conclusion The use of SST for rectal anastomosis may help to reduce anastomotic complications. This finding should be confirmed by a randomized controlled trial.
    Type of Medium: Online Resource
    ISSN: 1432-1262
    URL: Article
    DOI: 10.1007/s00384-022-04197-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1459217-4
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  • 4
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    Preoperative thalamus volume is not associated with preoperative cognitive impairment (preCI) or postoperative cognitive dysfunction (POCD)
    Springer Science and Business Media LLC ; 2023
    In:  Scientific Reports Vol. 13, No. 1 ( 2023-07-20)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-07-20)
    Abstract: A growing body of literature suggests the important role of the thalamus in cognition and neurodegenerative diseases. This study aims to elucidate whether the preoperative thalamic volume is associated with preoperative cognitive impairment (preCI) and whether it is predictive for postoperative cognitive dysfunction at 3 months (POCD). We enrolled 301 patients aged 65 or older and without signs of dementia who were undergoing elective surgery. Magnetic resonance imaging was conducted prior to surgery. Freesurfer (version 5.3.) was used to automatically segment the thalamus volume. A neuropsychological test battery was administered before surgery and at a 3 month follow-up. It included the computerized tests Paired Associate Learning (PAL), Verbal Recognition Memory (VRM), Spatial Span Length (SSP), Simple Reaction Time (SRT), the pen-and-paper Trail-Making-Test (TMT) and the manual Grooved Pegboard Test (GPT). Using a reliable change index, preCI and POCD were defined as total Z-score  〉  1.96 (sum score over all tests) and/or Z-scores  〉  1.96 in ≥ 2 individual cognitive test parameters. For statistical analyses, multivariable logistic regression models were applied. Age, sex and intracranial volume were covariates in the models. Of 301 patients who received a presurgical neuropsychological testing and MRI, 34 (11.3%) had preCI. 89 patients (29.5%) were lost to follow-up. The remaining 212 patients received a follow-up cognitive test after 3 months, of whom 25 (8.3%) presented with POCD. Independently of age, sex and intracranial volume, neither preCI (OR per cm 3 increment 0.81 [95% CI 0.60–1.07] p = 0.14) nor POCD (OR 1.02 per cm 3 increment [95% CI 0.75–1.40] p = 0.87) were statistically significantly associated with patients’ preoperative thalamus volume. In this cohort we could not show an association of pre surgical thalamus volume with preCI or POCD. Clinical Trial Number: NCT02265263 ( https://clinicaltrials.gov/ct2/show/results/NCT02265263 ) .
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-023-38673-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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  • 5
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    Healthcare provision for insect venom allergy patients during the COVID-19 pandemic
    Springer Science and Business Media LLC ; 2020
    In:  Allergo Journal International Vol. 29, No. 8 ( 2020-12), p. 257-261
    Details
    In: Allergo Journal International, Springer Science and Business Media LLC, Vol. 29, No. 8 ( 2020-12), p. 257-261
    Abstract: The population prevalence of insect venom allergy ranges between 3–5%, and it can lead to potentially life-threatening allergic reactions. Patients who have experienced a systemic allergic reaction following an insect sting should be referred to an allergy specialist for diagnosis and treatment. Due to the widespread reduction in outpatient and inpatient care capacities in recent months as a result of the COVID-19 pandemic, the various allergy specialized centers in Germany, Austria, and Switzerland have taken different measures to ensure that patients with insect venom allergy will continue to receive optimal allergy care. A recent data analysis from the various centers revealed that there has been a major reduction in newly initiated insect venom immunotherapy (a 48.5% decline from March–June 2019 compared to March–June 2020: data from various centers in Germany, Austria, and Switzerland). The present article proposes defined organizational measures (e.g., telephone and video appointments, rearranging waiting areas and implementing hygiene measures and social distancing rules at stable patient numbers) and medical measures (collaboration with practice-based physicians with regard to primary diagnostics, rapid COVID-19 testing, continuing already-initiated insect venom immunotherapy in the outpatient setting by making use of the maximal permitted injection intervals, prompt initiation of insect venom immunotherapy during the summer season, and, where necessary, using outpatient regimens particularly out of season) for the care of insect venom allergy patients during the COVID-19 pandemic.
    Type of Medium: Online Resource
    ISSN: 2197-0378
    URL: Article
    DOI: 10.1007/s40629-020-00157-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2759765-9
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  • 6
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    Effizienz, Kraft und Dynamik
    Springer Science and Business Media LLC ; 2020
    In:  Sonderprojekte ATZ/MTZ Vol. 25, No. S1 ( 2020-12), p. 128-133
    Details
    In: Sonderprojekte ATZ/MTZ, Springer Science and Business Media LLC, Vol. 25, No. S1 ( 2020-12), p. 128-133
    Type of Medium: Online Resource
    ISSN: 2509-4602 , 2509-4610
    URL: Article
    DOI: 10.1007/s41491-020-0076-1
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 7
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    A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease
    Springer Science and Business Media LLC ; 2023
    In:  Scientific Reports Vol. 13, No. 1 ( 2023-01-20)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-01-20)
    Abstract: The connection between Pediatric Inflammatory Multisystem Syndrome (PIMS) and Kawasaki Disease (KD) is not yet fully understood. Using the same national registry, clinical features and outcome of children hospitalized in Germany, and Innsbruck (Austria) were compared. Reported to the registry were 395 PIMS and 69 KD hospitalized patients. Patient age in PIMS cases was higher than in KD cases (median 7 [IQR 4–11] vs. 3 [IQR 1–4] years). A majority of both PIMS and KD patients were male and without comorbidities. PIMS patients more frequently presented with organ dysfunction, with the gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) systems being most commonly affected. By contrast, KD patients more often displayed dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), plus cervical lymph node swelling (51% vs. 34%). Intensive care admission (48% vs. 19%), pulmonary support (32% vs. 10%), and use of inotropes/vasodilators (28% vs. 3%) were higher among PIMS cases. No patients died. Upon patient discharge, potentially irreversible sequelae—mainly cardiovascular—were reported (7% PIMS vs. 12% KD). Despite differences in age distribution and disease severity, PIMS and KD cases shared many common clinical and prognostic characteristics. This supports the hypothesis that the two entities represent a syndrome continuum.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-022-26832-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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  • 8
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    Robot-assisted visceral surgery in Germany : Analysis of the current status and trends of the last 5 years using data from the StuDoQ|Robotics registry
    Springer Science and Business Media LLC ; 2023
    In:  Die Chirurgie
    Details
    In: Die Chirurgie, Springer Science and Business Media LLC
    Abstract: Robot-assisted systems have been increasingly used in general surgery for several years. Accordingly, the number of systems installed in Germany has also rapidly increased. While around 100 robot-assisted systems were used in German hospitals in 2018, this figure had already risen to more than 200 by 2022. The aim of this article is to present the current state of development and trends in robotic surgery in Germany. For this purpose, data from the StuDoQ|Robotics register were analyzed. Furthermore, a descriptive analysis of concomitant diagnosis-related groups (DRG) data was carried out via the Federal Statistical Office (Destatis), for a better assessment of the representativeness of the StuDoQ|Robotics register data. In both data sets, the annual number of robot-assisted visceral surgery procedures in Germany steadily increased. Compared to the DRG data, only 3.7% up to a maximum of 36.7% of all robot-assisted procedures performed were documented in the StuDoQ|Robotics register, depending on the type of procedure. Colorectal resections were the most frequent robot-assisted procedures (StuDoQ: 32.5% and 36.7% vs. DRG data: 24.2% and 29.7%) and had, for example, low mortality rates (StuDoQ: 1% and 1% vs. DRG data: 2.3% and 1.3%). Due to the low coverage rates of robot-assisted esophageal, gastric, pancreatic and liver interventions, no valid statements could be derived from the StuDoQ data for these areas. With the current coverage rates, the informative value of the StuDoQ|Robotics register is considerably limited for some types of intervention. In the future, measures should therefore be explored that lead to a significant increase in the coverage rates.
    Type of Medium: Online Resource
    ISSN: 2731-6971 , 2731-698X
    URL: Article
    DOI: 10.1007/s00104-023-01940-8
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 3120893-9
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  • 9
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    The outcome of patients with inflammatory bowel disease–associated colorectal cancer is not worse than that of patients with sporadic colorectal cancer–a matched-pair analysis of survival
    Springer Science and Business Media LLC ; 2022
    In:  International Journal of Colorectal Disease Vol. 37, No. 2 ( 2022-02), p. 381-391
    Details
    In: International Journal of Colorectal Disease, Springer Science and Business Media LLC, Vol. 37, No. 2 ( 2022-02), p. 381-391
    Abstract: Patients with inflammatory bowel disease (IBD) have an increased risk for colorectal cancer (CRC). In IBD patients, cancer is often diagnosed in advanced stages and conflicting data on survival compared to sporadic CRC have been reported. The aim of this study was to directly compare clinical characteristics and prognosis of patients with IBD-CRC and sporadic CRC. Methods The clinical and pathological data of 63 patients with IBD-CRC and 3710 patients with sporadic CRC treated at the University Hospital of Erlangen between 1995 and 2015 were compared. Forty-seven M0 patients with IBD were matched with sporadic CRC patients after curative resection (R0) according to tumor localization, stage, sex, and year of treatment. Overall and disease-free survival were compared. Results Sixty-three patients presented IBD-CRC. Fifty were affected with ulcerative colitis (UC) and 13 with Crohn’s disease (CD). CRC was diagnosed within 1.45 years since last endoscopic surveillance. Twelve patients (19%) had a diagnosis of primary sclerosing cholangitis. In matched analysis, IBD patients were diagnosed with CRC at younger age compared to sporadic CRC and were more likely to have right-sided CRC (40% versus 23.3%) and rare histological subtypes (19% versus 9.2%). No differences in 5-year overall (78.7 versus 80.9 months) and 5-year disease-free survival (74.5 versus 70.2 months) were noted. Conclusion IBD-CRC patients were younger and more frequently had right-sided carcinomas compared to sporadic CRC. CRC in IBD patients did not show survival difference compared to matched-pair sporadic CRC patients without distant metastases after curative resection. Surveillance might be important for early detection of CRC in IBD patients.
    Type of Medium: Online Resource
    ISSN: 0179-1958 , 1432-1262
    URL: Article
    DOI: 10.1007/s00384-021-04072-9
    RVK:
    XA 50991
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1459217-4
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  • 10
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    Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management
    Springer Science and Business Media LLC ; 2023
    In:  Journal of Neurology
    Details
    In: Journal of Neurology, Springer Science and Business Media LLC
    Abstract: This manuscript presents practical recommendations for managing acute attacks and implementing preventive immunotherapies for neuromyelitis optica spectrum disorders (NMOSD), a rare autoimmune disease that causes severe inflammation in the central nervous system (CNS), primarily affecting the optic nerves, spinal cord, and brainstem. The pillars of NMOSD therapy are attack treatment and attack prevention to minimize the accrual of neurological disability. Aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) are a diagnostic marker of the disease and play a significant role in its pathogenicity. Recent advances in understanding NMOSD have led to the development of new therapies and the completion of randomized controlled trials. Four preventive immunotherapies have now been approved for AQP4-IgG-positive NMOSD in many regions of the world: eculizumab, ravulizumab - most recently-, inebilizumab, and satralizumab. These new drugs may potentially substitute rituximab and classical immunosuppressive therapies, which were as yet the mainstay of treatment for both, AQP4-IgG-positive and -negative NMOSD. Here, the Neuromyelitis Optica Study Group (NEMOS) provides an overview of the current state of knowledge on NMOSD treatments and offers statements and practical recommendations on the therapy management and use of all available immunotherapies for this disease. Unmet needs and AQP4-IgG-negative NMOSD are also discussed. The recommendations were developed using a Delphi-based consensus method among the core author group and at expert discussions at NEMOS meetings.
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    URL: Article
    DOI: 10.1007/s00415-023-11910-z
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1421299-7
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