39 research outputs found
Adhärenz bei Lebertransplantierten : Erfahrungen am Universitätsklinikum Bonn
No full textMangelnde Adhärenz ist ein grundsätzliches Problem in vielen medizinischen Behandlungen und eine große Herausforderung für alle beteiligten Berufsgruppen. Gerade in der Transplantationsmedizin spielt Adhärenz in Form von therapiekonformen Verhaltensweisen des Patienten eine große Bedeutung und ist aufgrund der Rahmenbedingungen insbesondere im ambulanten Sektor ein therapierelevanter Baustein. Ziel der vorliegenden Arbeit war es, lebertransplantierte Patienten, die unter immunsuppressiver Medikation stehen, im Hinblick auf ihre Therapietreue, die sogenannte „Adhärenz“, zu untersuchen. Insgesamt wurden die Daten von 183 Patienten erfasst. Das Untersuchungskollektiv umfasste 144 Adhärente Patienten und 39 Non-Adhärente Patienten. Diese beiden Patientengruppen wurden in sozio-demographischen (Alter, Geschlechtsverteilung, Familienstand, Bildungsgrad) und klinischen Parametern miteinander verglichen. Die Adhärenzbereitschaft des gesamten Patientenkollektivs lag bei 78,7 %, die Non-Adhärenzquote lag bei 21,3 %. Bei der Betrachtung (Adhärent vs. Non-Adhärent) potentieller Einflussfaktoren der Adhärenz erwiesen sich zwei Variablen als Risikofaktoren, die die Adhärenz verringern: „weibliches Geschlecht“ und „niedriger Bildungsstand“. Die vorliegende Arbeit evidenziert die Tatsache, dass therapieuntreues Verhalten mit einer erhöhten Inzidenz von Abstoßungsreaktionen 56 % einhergeht. Zudem zeigen die Ergebnisse dieser Untersuchung, dass gerade bei dem Non-Adhärenten Patientenkollektiv eine höhere Prävalenz neurologischer (41,0 %) und psychiatrischer (42,6 %) Komplikationen zu erwarten ist, welche folglich therapieuntreues Verhalten weiterhin negativ beeinflussen kann und somit die Lebensqualität der lebertransplantierten Patienten beeinträchtigt und konsekutiv das Organüberleben schadet. Diese Analyse zeigt, dass gerade der Langzeitverlauf mit Problemen der Non-Adhärenz vergesellschaftet ist. Zusammenfassend wird durch die vorliegende Untersuchung deutlich, dass Faktoren, die Adhärenz beeinflussen sich nachteilig auf das Transplantatüberleben spiegeln, entsprechend den Daten die auch in der Literatur beschrieben werden. Kurzum ist zu betonen, dass präoperatives und postoperatives Patienten-Management noch erheblich verbessert werden muss, um ein besseres Langzeitergebnis zu erzielen. Da therapietreues Verhalten in vielfältiger Beziehung zu anderen beeinflussbaren Faktoren steht, sollte Adhärenz als Gesamtkonstrukt betrachtet werden. Eine isolierte Betrachtung einzelner Adhärenzkriterien erscheint demnach nicht sicher zielführend. Die positive Beeinflussung des Patientenverhaltens stellt eine Aufgabe dar, die von Seiten der Patienten, der Kostenträger, des Gesetzgebers und nicht zuletzt durch das eigene berufliche Selbstverständnis an den Behandler herangetragen werden sollte
Risikofaktoren für biliäre Komplikationen nach orthotoper Lebertransplantation : Eine retrospektive unizentrische Analyse
No full textBiliäre Komplikationen (BK) sind trotz gezielter Fortschritte ein Hauptrisikofaktor für ein verschlechtertes Outcome nach orthotoper Lebertransplantation. In dem Zeitraum von 2013 bis 2018 untersuchten wir 102 Patienten, die am Bonner Transplantationszentrum Vollorgantransplantiert wurden, im Hinblick auf Epidemiologie, Vorerkrankungen, Risikofaktoren und perioperative Charakteristika und deren Einfluss auf Morbidität und Mortalität. In diesem Zeitraum wurden alle Patienten mit Verdacht auf BK invasiv mittels endoskopisch-retrograder Cholangiopankreatikographie oder transkutaner radiologischer Punktion untersucht. Als bedeutende Risikofaktoren zur Entwicklung von BK nach einer Lebertransplantation ergaben sich in unserer Studie die Blutgruppe A, abdominale Voroperationen und die Ursache der Leberzirrhose. Als wichtige Risikofaktoren in Bezug auf die 1-Jahres-Mortalität erwiesen sich eine Leberzirrhose aus anderen Gründen als eine virale Hepatitis, kardiale Vorerkrankungen, eine Retransplantation oder ein verringertes Spenderorgangewicht.
BK, postoperative Blutungen, eine Primäre Nichtfunktion des Spenderorgans und weitere operative Eingriffe wirkten sich negativ auf den postoperativen Verlauf innerhalb des ersten Jahres aus, während ein erhöhter Bilirubinminimalwert in den ersten 30 Tagen
postoperativ als guter Indikator in Bezug auf die Überlebensrate herangezogen werden kann
Chronic Liver Disease Increases Mortality Following Pancreatoduodenectomy
No full textAccording to the International Study Group of Pancreatic Surgery (ISGPS), data about the impact of pre-existing liver pathologies on delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) according to the definitions of the International Study Group of Pancreatic Surgery (ISGPS) are lacking. We therefore investigated the impact of DGE after PD according to ISGPS in patients with liver cirrhosis (LC) and advanced liver fibrosis (LF). Patients were analyzed with respect to pre-existing liver pathologies (LC and advanced LF, n = 15, 6% vs. no liver pathologies, n = 240, 94%) in relation to demographic factors, comorbidities, intraoperative characteristics, mortality and postoperative complications, with special emphasis on DGE. DGE was equally distributed (DGE grade A, p = 1.000; B, p = 0.396; C, p = 0.607). Particularly, the first day of solid food intake (p = 0.901), the duration of intraoperative administered nasogastric tube (NGT) (p = 0.812), the rate of re-insertion of NGT (p = 0.072), and the need for parenteral nutrition (p = 0.643) did not differ. However, patients with LC and advanced LF showed a higher ASA (American Society of Anesthesiologists) score (p = 0.016), intraoperatively received more erythrocyte transfusions (p = 0.029), stayed longer in the intensive care unit (p = 0.010) and showed more intraabdominal abscess formation (p = 0.006). Moreover, we did observe a higher mortality rate amongst patients with pre-existing liver diseases (p = 0.021), and reoperation was a risk factor for higher mortality (p ≤ 0.001) in the multivariate analysis. In our study, we could not detect a difference with respect to DGE classified by ISGPS; however, we did observe a higher mortality rate amongst these patients and thus, they should be critically evaluated for PD
Delayed Gastric Emptying Does Not Influence Cancer-Specific Survival after Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma
No full textBackground: Delayed gastric emptying (DGE) remains the most frequent complication following pancreatoduodenectomy (PD). The present study investigates the influence of delayed gastric emptying on cancer-specific survival after PD. Methods: We included 267 patients who underwent PD between 2014 and 2021. They were analyzed regarding demographic factors, pre- and perioperative characteristics, surgical complications, and long-term survival. Results: Patients with a higher Charlson Comorbidity Index (CCI) or pre-existing pulmonary disease suffered significantly more from DGE. When experiencing PPH, a prolonged hospital stay, or major overall complications (Clavien-Dindo °III-V) were more common in the DGE group. Tumor size over 3 cm negatively affected survival. Conclusions: DGE has no influence on long-term survival in PDAC patients, although it prolongs hospital stay
Operative Re-Intervention following Pancreatoduodenectomy: What Has Changed over the Last Decades
No full textBackground: To investigate changes over the last decades in the management of postoperative complications following pancreatoduodenectomy (PD) with special emphasis on reoperations, their indications, and outcomes. Methods: 409 patients who underwent PD between 2008 and 2021 were retrospectively analyzed with respect to their need for reoperations (reoperation, n = 81, 19.8% vs. no reoperation, n = 328, 80.2%). The cohort was then compared to a second cohort comprising patients who underwent PD between 1989 and 2007 (n = 285). Results: 81 patients (19.8%) underwent reoperation. The main cause of reoperation was the dehiscence of pancreatogastrostomy (22.2%). Reoperation was associated with a longer duration of the index operation, more blood loss, and more erythrocyte concentrates being transfused. Patients who underwent reoperation showed more postoperative complications and a higher mortality rate (25% vs. 2%, p < 0.001). Compared to the earlier cohort, the observed increase in reoperations did not lead to increased mortality (5% vs. 6%, p = 353). Conclusions: The main cause for reoperation has changed over the last decades and was the dehiscence of pancreatogastrostomy. Associated with a leakage of pancreatic fluid and clinically relevant PF, it remains the most devastating complication following PD. Strategies for prevention and treatment, e.g., by endoscopic vacuum-assisted-closure therapy are of utmost importance
A methodology for the optimization of PCD compact core drilling in basalt rock
No full textThis work presents an optimization technique using genetic algorithm for efficient core drilling in basalt rock. Optimization of the compact core-drilling problem is based on maximizing a desirability function which accounts for (a) maximizing the drilling feed while minimizing tool-wear progression, (b) minimizing the thrust force and torque (power), and (c) satisfying realistic constraints related to process parameters. The resulting set of optimized cutting parameters is sought in order to make the tool last longer while effectively drilling with high productivity. A room temperature model to relate the experimental data on changing drill forces and torques required by the progressive tool wear, and developed in a previous paper, is used in this study. © 2011 Springer-Verlag London Limited.Ali-Tavoli M, 2006, MACH SCI TECHNOL, V10, P491, DOI 10.1080-10910340600996126; Bourgoyne Jr A.T., 1974, T AIME SOC PET ENG J, V257, P371; Choudhury SK, 2000, INT J MACH TOOL MANU, V40, P899, DOI 10.1016-S0890-6955(99)00088-7; Clayton R, 2005, SPE IADC DRILL C P A; Fergason RL, 2006, J GEOPHYS RES-PLANET, V111, DOI 10.1029-2005JE002583; Fernandes M, 2006, INT J MACH TOOL MANU, V46, P76, DOI 10.1016-j.ijmachtools.2005.03.016; GLOWKA DA, 1989, J PETROL TECHNOL, V41, P850; GLOWKA DA, 1989, J PETROL TECHNOL, V41, P797; Hamade R. F., 2009, P ASME INT MECH ENG; Hamade RF, 2008, CIRP ICME 08 NAPL IT; Hamade RF, 2010, J MATER PROCESS TECH, V210, P1326, DOI 10.1016-j.jmatprotec.2010.03.023; Hamade RF, 2006, INT J MACH TOOL MANU, V46, P387, DOI 10.1016-j.ijmachtools.2005.05.016; Holland John Henry, 1992, ADAPTATION NATURAL A; Judzis A, 2009, SPE DRILL COMPLETION, V24, P25; Lia ZC, 2005, INT J MACH TOOL MANU, V45, P1402; MALAKOOTI B, 1989, OPER RES, V37, P805, DOI 10.1287-opre.37.5.805; Myers RH, 1995, PROBABILITY STAT SER; Plinninger RJ, 2004, EUROCK 2004 53 GEOM; Plinninger RJ, 2002, 9 P C INT ASS ENG GE, P2226; Sardinas RQ, 2006, ENG APPL ARTIF INTEL, V19, P127, DOI 10.1016-j.engappai.2005.06.007; Tulu IB, 2008, 42 US ROCK MECH 2 US; VENET V, 1993, REV I FR PETROL, V48, P15; Wang X, 2005, INT J PROD RES, V43, P3543, DOI 10.1080-13629390500124465; Weaver GE, 2000, US Patent, Patent No. 6109368; WOJTANOWICZ AK, 1993, J ENERG RESOUR-ASME, V115, P247, DOI 10.1115-1.2906429; Yinghui Liu, 2007, Journal of Manufacturing Science and Engineering, V129, DOI 10.1115-1.2515345; Zacny KA, 2004, J GEOPHYS RES-PLANET, V109, DOI 10.1029-2003JE002204; Zhang JY, 2006, J INTELL MANUF, V17, P203, DOI 10.1007-s10845-005-6637-z11
Obesity Does Not Influence Delayed Gastric Emptying Following Pancreatoduodenectomy
No full textSIMPLE SUMMARY: Over the last decades the number of obese patients has been increasing. Not only is obesity associated with other diseases such as cardiovascular diseases, diabetes and asthma but obese patients are also at a higher risk for developing different types of cancers, for instance pancreatic cancer with a consecutive increased need for pancreatic surgery. Even though it is not life threatening, impaired gastric motility, also known as delayed gastric emptying, has still remained the most common complication after pancreatic surgery. However, the data about obesity on postoperative outcome after pancreatic surgery are inconsistent, specifically in relation to delayed gastric emptying. The goal of this study was to investigate the impact of obesity on postoperative outcome, specifically on delayed gastric emptying, after pancreatic surgery. Our data show no difference in the occurrence and severity of delayed gastric emptying in patients with obesity compared to non-obese patients. Moreover, the overall mortality rate did not differ between the two groups. In summary, our data show that obese patients are not put at a higher risk in regard to postoperative outcome, which makes pancreatic surgery a feasible procedure in the obese patient, specifically in relation to delayed gastric emptying. ABSTRACT: Background: The data about obesity on postoperative outcome after pancreatoduodenectomy (PD) are inconsistent, specifically in relation to gastric motility and delayed gastric emptying (DGE). Methods: Two hundred and eleven patients were included in the study and patients were retrospectively analyzed in respect to pre-existing obesity (obese patients having a body mass index (BMI) ≥ 30 kg/m(2) vs. non-obese patients having a BMI < 30 kg/m(2), n = 34, 16% vs. n = 177, 84%) in relation to demographic factors, comorbidities, intraoperative characteristics, mortality and postoperative complications with special emphasis on DGE. Results: Obese patients were more likely to develop clinically relevant pancreatic fistula grade B/C (p = 0.008) and intraabdominal abscess formations (p = 0.017). However, clinically relevant DGE grade B/C did not differ (p = 0.231) and, specifically, first day of solid food intake (p = 0.195), duration of intraoperative administered nasogastric tube (NGT) (p = 0.708), rate of re-insertion of NGT (0.123), total length of NGT (p = 0.471) or the need for parenteral nutrition (p = 0.815) were equally distributed. Moreover, mortality (p = 1.000) did not differ between the two groups. Conclusions: Obese patients do not show a higher mortality rate and are not at higher risk to develop DGE. We thus show that in our study, PD is feasible in the obese patient in regard to postoperative outcome with special emphasis on DGE
Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: How We Do It
No full text(1) Background: This study’s goals were to investigate possible risk factors for clinically relevant postoperative pancreatic fistula (POPF) grade B/C according to the updated definitions of the International Study Group of Pancreatic Surgery and to analyze possible treatment strategies; (2) Methods: Between 2017 and 2021, 200 patients were analyzed regarding the development of POPF grade B/C with an emphasis on postoperative outcome and treatment strategies; (3) Results: POPF grade B/C was observed in 39 patients (19.5%). These patients were younger, mainly male, had fewer comorbidities and showed a higher body mass index. Also, they had lower CA-19 levels, a smaller tumor size and softer pancreatic parenchyma. They experienced a worse outcome without affecting the overall mortality rate (10% vs. 6%, p = 0.481), however, this lead to a prolonged postoperative stay (28 (32–36) d vs. 20 (15–28) d, p ≤ 0.001). The majority of patients with POPF grade B/C were able to receive conservative treatment, followed by drainage placement, endoscopic vacuum-assisted therapy (EVT) and surgery. Conservative treatment resulted in a shorter length of the postoperative stay (24 (22–28) d vs. 34 (26–43) d, p = 0.012); (4) Conclusions: Patients developing POPF grade B/C had a worse outcome; however, this did not affect the overall mortality rate. The majority of the patients were able to receive conservative treatment, resulting in a shorter length of their hospital stay
Improved Functional Recovery After Facial Nerve Reconstruction by Temporary Denervation of the Contralateral Mimic Musculature With Botulinum Toxin in Rats
No full text Background. Even optimal nerve reconstruction after facial nerve damage leads to defective reinnervation because of misdirected axonal sprouting and polyinnervation of the end plates of the facial muscles. Objective. The authors studied whether temporary chemical denervation of the contralateral nonlesioned hemiface with botulinum toxin (BTX) would increase regeneration of the lesioned buccal branch of the facial nerve and improve functional recovery of the whisker pad. Methods. The experiments were performed in 65 adult rats distributed in 4 interventions: (1) buccal–buccal nerve anastomosis (BBA), (2) BBA plus ipsilateral injection of BTX into the whisker pad, (3) BBA plus contralateral BTX injection, or (4) BTX injection without any surgery. Sequential preoperative and postoperative retrograde fluorescence tracing at 4 weeks after surgery quantified the accuracy of reinnervation. Functional recovery was measured by biometrical image analysis of whisking behavior at 12 weeks after surgery. Results. After BTX injection without any surgery, muscle paralysis was transient, and the animals restored normal nerve terminals and normal vibrissal function at 8 weeks after treatment. After BBA and ipsilateral or contralateral BTX injection, the degree of correct reinnervation increased significantly to 61% in comparison to 27% after BBA without any other intervention. Enhanced correct reinnervation was accompanied by a significant improvement of whisking after contralateral but not after ipsilateral injection of BTX. Conclusions. These results provide evidence that transient contralateral muscle paralysis helps improve the morphological and functional regeneration after facial nerve repair. </jats:p
Deep-sea mining of seafloor massive sulfides
No full textAuthor Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Marine Policy 34 (2010): 728-732, doi:10.1016/j.marpol.2009.12.001.The potential emergence of an ocean mining industry to exploit seafloor massive sulfides could
present opportunities for oceanographic science to facilitate seafloor mineral development in
ways that lessen environmental harms.The authors are grateful for support from the Elisabeth and Henry Morss, Jr. Colloquia
Fund, the ChEss (Chemosynthetic Ecosystems) Project of the Census of Marine Life, InterRidge,
the Ridge 2000 Program of the National Science Foundation, and the authors’ institutions
