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222. Cerebral microbleeds are not associated with postoperative delirium and postoperative cognitive dysfunction in older individuals

Author

Lachmann, G., Kant, I., Lammers, F., Windmann, V., Spies, C., Speidel, S., Borchers, F., Hadzidiakos, D., Hendrikse, J., Winterer, G., Bresser, J. de, Wolf, A., Yurek, F., Feinkohl, I., Ofosu, K., Olbert, M., Zacharias, N., Morgeli, R., Pischon, T., Gallinat, J., Kuhn, S., Slooter, A., Dellen, E. van, Montfort, S. van, Menon, D., Stamatakis, E., Preller, J., Moreno-Lopez, L., Winzeck, S., Melillo, D., Boraschi, D., Camera, G. della, Italiani, P., Schneider, R., Krause, R., Heidtke, K., Nurnberg, P., Helms-Chrodt, A., Bocher, A., Hafen, B., Armbruster, F.P., Diehl, I., Ruppert, J., Hartmann, K., Kronabel, M., Weyer, M., Dschietzig, T.B., Pietzsch, M., Weber, S., Ittermann, B., Fillmer, A., and BIOCOG Consortium

Subjects
Cardiovascular Procedures, Social Sciences, Vascular Surgery, 030204 cardiovascular system & hematology, Logistic regression, Diagnostic Radiology, 0302 clinical medicine, Medicine and Health Sciences, Image Processing, Computer-Assisted, Odds Ratio, Psychology, Medicine, Postoperative delirium, Cognitive Impairment, Brain Diseases, Multidisciplinary, medicine.diagnostic_test, Cognitive Neurology, Radiology and Imaging, Age Factors, Middle Aged, Magnetic Resonance Imaging, Hospitals, 3. Good health, Intensive Care Units, Neurology, Anesthesia, Female, Research Article, medicine.medical_specialty, Imaging Techniques, Cognitive Neuroscience, Science, Surgical and Invasive Medical Procedures, Neuroimaging, Context (language use), Research and Analysis Methods, 03 medical and health sciences, Imaging, Three-Dimensional, Postoperative Cognitive Complications, Diagnostic Medicine, Neuropsychology, Humans, Elective surgery, Neuropsychological Testing, Aged, Cerebral Hemorrhage, business.industry, Biology and Life Sciences, Delirium, Magnetic resonance imaging, Odds ratio, Vascular surgery, medicine.disease, Health Care, Cardiovascular and Metabolic Diseases, Health Care Facilities, Cognitive Science, business, Postoperative cognitive dysfunction, Biomarkers, 030217 neurology & neurosurgery, Neuroscience
Abstract

BackgroundCerebral microbleeds (CMB) occur in the context of cerebral small vessel disease. Other brain MRI markers of cerebral small vessel disease are associated with the occurrence of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), but for CMB this is unknown. We aimed to study the association between CMB and the occurrence of POD and POCD in older individuals.MethodsThe current study consists of 65 patients (72±5 years) from the BIOCOG study, which is a prospective, observational study of patients who underwent an elective surgery of at least 60 minutes. Patients in the current study received a preoperative cerebral MRI scan including a 3D susceptibility-weighted imaging sequence to detect CMB. The occurrence of POD was screened for twice a day until postoperative day 7 by using the DSM-5, NuDesc, CAM, and CAM-ICU. The occurrence of POCD was determined by the reliable change index model at 7 days after surgery or discharge, respectively, and 3 months after surgery. Statistical analyses consisted of logistic regression adjusted for age and gender.ResultsA total of 39 CMB were detected in 17 patients (26%) prior to surgery. POD occurred in 14 out of 65 patients (22%). POCD at 7 days after surgery occurred in 11 out of 54 patients (20%) and in 3 out of 40 patients at the 3 month follow-up (8%). Preoperative CMB were not associated with the occurrence of POD (OR (95%-CI): 0.28 (0.05, 1.57); p = 0.147) or POCD at 7 days after surgery (0.76 (0.16, 3.54); p = 0.727) or at 3 months follow-up (0.61 (0.03, 11.64); p = 0.740).ConclusionWe did not find an association between preoperative CMB and the occurrence of POD or POCD.Trial registrationclinicaltrials.gov (NCT02265263) on 23 September 2014.

Published
2019

223. S3-Leitlinie zur intensivmedizinischen Versorgung herzchirurgischer Patienten: Hämodynamisches Monitoring und Herz-Kreislauf-System

Author

Carl, M., Alms, A., Braun, J., Dongas, A., Erb, J., Goetz, A., Goepfert, M., Gogarten, W., Grosse, J., Heller, A. R., Heringlake, M., Kastrup, M., Kroener, A., Loer, S. A., Marggraf, G., Markewitz, A., Reuter, D., Schmitt, D. V., Schirmer, U., Wiesenack, C., Zwissler, B., and Spies, C.

Subjects
Postoperative Care, Blood Volume, volume therapy, Critical Care, cardiothoracic surgery, Intensivmedizin, lcsh:R, Hemodynamics, lcsh:Medicine, intensive care medicine, 610 Medical sciences, Medicine, Article, positive inotropic and vasoactive drugs, Volumentherapie, monitoring, positiv inotrope und vasoaktive Substanzen, Kardiochirurgie, ddc: 610, Germany, Practice Guidelines as Topic, Humans, Vasoconstrictor Agents, ddc:610, Cardiac Surgical Procedures, Monitoring, Physiologic
Abstract

Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF)., GMS German Medical Science; 8:Doc12; ISSN 1612-3174

Published
2019

224. Posters

Author

Ŝifrer, Fronc, Drinovec, Igor, Thomson, G., Baker, L., Mawby, E., Leach, R. M., Jensen, P. J., Michagin, G., Andersen, P. K., Peláez, J., Asensio, M. J., Jiménez, M., Yus, S., Villa, P., Vaquero, C., Imhoff, M., Lehner, J. H., Löhlein, D., Vignali, G., Guadagnucci, A., Mariotti, M., Baratta, A., Vignali, A., Rutili, A., Tulli, G., Sanft, C., Spies, C., Oschmann, G., Schaffartzik, W., Gondos, T., Arkosy, M., Jović M., Popović Z., Radomir B., Ilić V., Panić G., Babić M., Popović A., Bojić M., Pierucci, E., Ghermandi, C., Morigi, A., Morgagni, R., Nastasi, M., Rossi, R., Martinelli, G., Faenza, S., Cuccolini, F., Martinelli, G., Sarti, E., O’Hare, B., Betit, P., Thompson, J. E., Wessel, D. L., Kuhn, T. J., Bauer, B. L., Broomhead, C. J., Wright, S. J., Kiff, K. J., Withington, P. S., Strunin, L., Amaral, J. L. G., Rouby, J. -J., Gallart, L., Munechika, M., Coriat, P., Michard, F., Wysocki, M., Millet, H., Wolff, M. A., Herman, B., Peyerl, M., Gödje, O., Fischlein, T., Pfeiffer, U., Reichart, B., Krenn, C. G., Baker, A., Krafft, P., Narzt, E., Spiss, C. K., Steltzer, H., Theilen, H., Ragaller, M., Albrecht, D. M., Llagunes, J., Catala, J. C., Marques, J. I., Pena, J. J., Barbas, D., Aguar, F., Grau, F., Navarrete-Sánchez I., Ruiz-Bailén H., Guerrero-López F., Colmenero-Ruiz H., Fernández-Hondéjar E., Vázquez-Hata G., Lamb, F. J., Rhodes, A., Duane, D., Grounds, R. M., and Bennett, E. D.

Published
1996
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225. Posters

Author

Yao, Y. M., Tian, H. M., Liang, H. P., Yu, Y., Lu, L. R., Wang, Y. P., Sheng, Z. Y., Reith, H. B., Holzheimer, R. G., Thiede, A., Galstian, G. M., Danilina, A. V., Gorodetsky, V. M., Tutelian, A. V., Galley, H. F., Webster, N. R., Djugehev, A. N., Fomin, M. D., Satalkin, A. A., Sokolov, V. A., Maskin, B., Fontán, P., Spinedi, E., Badolati, A., Endo, S., Kasai, T., Inada, K., Takakuwa, T., Yamada, Y., Suzuki, T., Taniguchi, S., Kern, H., Wittich, R., Schaffartzik, W., Kox, W., Spies, C., Ilkka, L., Takala, J., Paiva, J. A., Sousa-Dias, C., Bodas, A., Ramos, J. P., Candeias, J., Pereira, A. C., Torrinha, F., Ribeiro, T., Milting, K., Sanft, C., Brede, K., Beller, S., Andresen, M., Dougnac, A., Letelier, L. M., Díaz, O., Laterre, F. F., Reynaert, M., Valdivieso, A., Geppert, A., Zorn, G., Huber, K., Siostrzonek, P., Oberhoffer, M., Bögel, D., Meier-Hellmann, A., Vogelsang, H., Reinhart, K., Tsidemiadou, F., Farmakis, M., Bobota, A., Pragastis, D., Bilancia, R., Posca, A., Margiotta, D., Spampani, E., Roselli, P., Caputo, G., Thio, J. M., Sinaasappel, M., Ince, C., Berger, D., Boelke, E., Hiki, N., Poch, B., Beier, A., Graf, M., Seidelmann, M., Beger, H. G., Nuvials, X., Ruiz Rodriguez, J. C., Martin, M. C., Esteban, F., Garcia-Allut, J. L., Burgueno, M. J., Mourelle, M., Monasterio, J., Angles, A., Boveda, J. L., Salgado, A., Segura, R. M., Sauri, R., Beck, B., Schimmer, R. C., Pasch, T., Ward, P. A., Gruson, D., Hilbert, G., Roux, C., Coulon, V., Juzan, M., Laffort, P., Parrens, E., Gualde, N., Gbikpi-Benissan, G., Cardinaud, J. P., Shi, Hanping, Xu, Renbao, Gao, Han, Marenović, T., Miloŝević, D., Brkan, Z., Ŝurbatović, M., Gundelach, K., Engelmann, L., Pilz, U., Werner, M., Reiger, J., Tatzber, F., Oberbichler, A., Grimm, G., de Abreu, M. Gama, Kirschfink, M., Quintel, M., Albrecht, D. M., Ragaller, M., Nakae, H., Koike, S., Mavrommatis, A., Theodoridis, Th., Stavropoulos, G., Zakynthinos, S., Orfanidou, A., Sfyras, D., Christopoulou-Kokkinou, V., Roussos, Ch., Właszczyk, A., Adamik, B., Zimecki, M., Kübler, A., Berezowicz, P. S., Vasilcov, V., Kelina, N., Gengin, M., Mitroshina, S., Filippova, L., Levachova, O., Gürlich, R., Maruna, P., and Čermák, J.

Published
1996
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242. Anatomy of the trapeziometacarpal joint in the context of arthroplasty

Author

Unglaub, F., Langer, M. F., Hohendorff, B., Jung, M., Mueller, L. P., Spies, C. K., Unglaub, F., Langer, M. F., Hohendorff, B., Jung, M., Mueller, L. P., and Spies, C. K.

Abstract

The thumb has a crucial role in the hand due to its position with regard to the fingers. The CMC-1 joint enables an extraordinary range of motion, since its geometry allows for opposition. The former joint may often succumb to osteoarthritis because a great range of motion in combination with large forces, small contact areas, and thorough usage are always present. Joint replacement is challenged by the great range of motion based on the necessary joint stability and the demand for sufficient pain reduction. This review highlights the anatomy of the CMC-1 joint with regard to joint preplacement solutions.

Published
2019

243. Metacarpophalangeal joint replacement

Author

Spies, C. K., Langer, M. F., Loew, S., Oppermann, J., Hohendorff, B., Mueller, L. P., Unglaub, F., Spies, C. K., Langer, M. F., Loew, S., Oppermann, J., Hohendorff, B., Mueller, L. P., and Unglaub, F.

Abstract

BackgroundArthroplasty of metacarpophalangeal (MCP) joints is crucial for patients with rheumatoid arthritis. Motion preserving therapies are mandatory for this joint, since loss of function of the MCP joint is detrimental. Many protheses or spacers have been introduced over the last 80years, but most of them have been dismissed due to major complications.Current ProceduresSince the 1960s the Swanson spacer has been established as the reference standard for motion preserving procedures of the finger MCP joints. High fracture rates of the spacer do not seem to limit function and patient satisfaction after all. Current long-term studies show at least promising results for pyrolytic carbon protheses with respect to range of motion, survival, and revision rates in comparison to the Swanson spacer.

Published
2019

244. Anatomy of themetacarpophalangeal and proximal interphalangeal finger joint with respect to arthroplasty

Author

Hohendorff, B., Spies, C. K., Unglaub, F., Mueller, L. P., Ries, C., Hohendorff, B., Spies, C. K., Unglaub, F., Mueller, L. P., and Ries, C.

Abstract

BackgroundPrecise knowledge of the anatomy and biomechanics of the metacarpophalangeal and proximal interphalangeal joint is the basis for both indication and implantation of afinger joint prosthesis. Currently available finger joint prostheses inadequately take into account individual, ethnological, gender, age, and side differences. They can remain compromised despite the possible combination of their components.ObjectivesTo elucidate which problems of finger joint arthroplasty exist due to the anatomy and biomechanics of the metacarpophalangeal and proximal interphalangeal joints.MethodsThe anatomy and biomechanics of the metacarpophalangeal and proximal interphalangeal joint are described, and the problems and solutions of finger joint arthroplasty are presented.ResultsDespite precise knowledge of the anatomy and biomechanics of the metacarpophalangeal and proximal interphalangeal joint, not all problems of finger joint arthroplasty have been solved. However, a modular surface replacement appears promising for the proximal interphalangeal joint.ConclusionsArtificial joint replacement of the metacarpophalangeal and proximal interphalangeal joint is difficult with regard to morphology, small bone dimensions, complex biomechanics, and the strain of the hand. Further improvements, especially in design, should be achieved by exact anatomical imitation.

Published
2019

245. Surgical approaches to the hand

Author

Hohendorff, B., Unglaub, F., Spies, C. K., Wegmann, K., Mueller, L. P., Ries, C., Hohendorff, B., Unglaub, F., Spies, C. K., Wegmann, K., Mueller, L. P., and Ries, C.

Abstract

Objective Accessibility of any anatomical structure of the hand via surgical approach. Indications Any surgical treatment of the hand. Contraindications Any contraindication to surgical treatment of the hand. Surgical technique Skin incision at the hand with access to any anatomical structure. Postoperative management Postoperative treatment depends on the disease and hand surgery performed.

Published
2019

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