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1. Serious Complications After Epidural Catheter Placement: Two Case Reports

Author

Seidel R, Tietke M, Heese O, and Walter U

Subjects
epidural analgesia, dabigatran, paraplegia, perioperative complications, Anesthesiology, RD78.3-87.3
Abstract

Ronald Seidel,1 Marc Tietke,2 Oliver Heese,3 Uwe Walter4 1Asklepios Medical Center, Department of Anesthesiology and Intensive Care, Schwedt, Germany; 2Helios Medical Center, Department of Neuroradiology, Schwerin, Germany; 3Helios Medical Center, Department of Neurosurgery, Schwerin, Germany; 4University Medical Center Rostock, Department of Neurology, Rostock, GermanyCorrespondence: Ronald SeidelAsklepios Medical Center, Department of Anesthesiology and Intensive Care, Am Klinikum 1, Schwedt, 16303, GermanyTel +49 3332 534521Email ronald-seidel@t-online.deAbstract: Thoracic epidural analgesia (TEA) is a standard procedure in multimodal analgesia applied in major thoracic and abdominal surgeries. Two cases are presented with serious complications related to TEA. In both cases, earlier reaction of the treating physicians to patient-reported sensory symptoms could have prevented the complicated course. The first case was a 73-year-old patient with bronchial carcinoma who underwent right lower lobe resection. In this case, dabigatran 150 mg/d (indication: permanent atrial fibrillation) had been discontinued 72 hours before surgery, and enoxaparin 80 mg (every 12 hours) had been started 11 hours after surgery. An epidural hematoma developed postoperatively. Magnetic resonance imaging (MRI) was performed only after paraplegia had developed the next day. Unfortunately, delayed hematoma evacuation could not prevent persistent paraplegia in this case, which was complicated by hospital-acquired pneumonia with sepsis and acute renal failure. The second case was a 39-year-old patient with ulcerative colitis and an initially undetected malposition of the epidural catheter. Immediately after test bolus injection, the patient reported paresthesia and overall discomfort, which however could not be safely attributed to either the test dose or the already started general anesthesia. The patient could only be extubated after stopping the epidural infusion. Accidental re-start of epidural infusion led to coma, conjugate eye deviation, and respiratory arrest, necessitating re-intubation. Computed tomography (CT) ruled out intracerebral pathology and showed a catheter position centrally in the spinal canal. Fortunately, no neurological deficits were detected after catheter removal.Keywords: epidural analgesia, dabigatran, paraplegia, perioperative complications

Published
2021

4. Prognose nach operativem Wirbelsäuleneingriff bei Bronchialkarzinommetastasen

Author

Hessler, C., Regelsberger, J., Raimund, F., Heese, O., Madert, J., and Eggers, C.

Abstract

Zusammenfassung: Hintergrund: Zur Präzisierung der Prognose von Patienten mit vertebralen Bronchialkarzinommetastasen müssen lebensdauerbeeinflussende Parameter definiert werden. In dieser Arbeit wurden die Überlebenszeiten von Patienten nach operativem Wirbelsäuleneingriff in Abhängigkeit der Dauer der präoperativ bestehenden Grunderkrankung sowie der Biologie der Wirbelkörpermetastase untersucht. Material und Methoden: Zwischen 01/1999 und 12/2003 wurden 68 Patienten im Traumatologischen Zentrum Hamburg St. Georg aufgrund vertebraler Bronchialkarzinommetastasen operiert. Anhand der Dokumentation in den Krankenakten wurden die genannten Zielgrößen evaluiert. Die Todeszeitpunkte des untersuchten Patientenguts entstammen dem Hamburger Krebsregister. Es erfolgte eine standardisierte Analyse der postoperativen Überlebenszeiten der Patienten in Abhängigkeit der ermittelten Zielgrößen. Ergebnisse: Es handelte sich um 24 weibliche und 44 männliche Patienten in einem Durchschnittsalter von 62,6 Jahren. Von 65 Patienten waren die Todeszeitpunkte bekannt. Die durchschnittliche postoperative Überlebenszeit betrug bei Patienten mit zum Operationszeitpunkt unbekannter Grunderkrankung (n=20) 88 Tage, bei Patienten mit zum Operationszeitpunkt seit =12 Monaten bekannter Grunderkrankung (n=35) 141 Tage, bei Patienten mit zum Operationszeitpunkt seit >12 Monaten bekanntem Bronchialkarzinom (n=13) 170 Tage, bei Patienten mit nichtkleinzelligen Bronchialkarzinomen (n=45) 122 Tage, bei Patienten mit kleinzelligen Bronchialkarzinomen (n=20) 128 Tage und bei Patienten mit sonstigen Bronchialkarzinomen (n=3) 247 Tage. Diskussion: Bei Patienten mit vertebralen Bronchialkarzinommetastasen, insbesondere bei denen mit primär unbekannter Grunderkrankung, sind aufgrund der ungünstigen Prognose nichtchirurgische Therapieansätze zu präferieren. Bezüglich der reduzierten Lebenserwartung sollte eine Sensibilisierung der Patienten selbst, aber auch der Angehörigen und des behandelnden Personals erfolgen.

Published
2024
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14. Klinische Ergebnisse nach mikrochirurgischer bilateraler Dekompression in over-the-top Technik: Prospektive, Bi-Zentrische Studie mit einer Analyse von 756 Patienten

Author

Heese, O, Herold, T, Pirchner, S, Heinhold, K, Hoi, H, Kothe, R, Korge, A, and Siepe, C

Subjects
ddc: 610, Spinalkanalstenose, mikrochirurgische Dekompression, over the top, Claudicatio spinalis, minimalinvasiv, 610 Medical sciences, Medicine
Abstract

Fragestellung: Dekompressionsoperationen stellen einen der am häufigsten durchgeführten wirbelsäulenchirurgischen Eingriffe dar. Minimalinvasive, mikrochirurgische Techniken kommen zunehmend zum Einsatz mit dem Ziel, die perioperative Morbidität einer zumeist älteren und multimorbiden[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)

Published
2016
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15. A survey on clinical study participation and study infrastructure at non-university hospitals in Germany

Author

Heese O, Westphal M, and Böger Rh

Subjects
Pharmacology, Clinical Trials as Topic, medicine.medical_specialty, business.industry, Multidisciplinary study, Certification, University hospital, Local study, Hospitals, Clinical study, Clinical trial, Clinical research, Germany, Surveys and Questionnaires, Family medicine, medicine, Humans, Pharmacology (medical), Human resources, business
Abstract

OBJECTIVE In order to participate in multicenter clinical trials a fair amount of infrastructure and human resources has to be provided by hospitals. Therefore clinical trials are carried out predominantly in university hospitals. Data concerning participation in clinical trials and the infrastructure of study centers in non-university hospitals in Germany do not exist. A survey was thus conducted to evaluate the current status of clinical study performance in non-university hospitals. MATERIALS AND METHODS A questionnaire comprising 10 questions covering hospital infrastructure, local study history, and the individual interest in performing studies was sent to 790 non-university hospitals in Germany. RESULTS 58.7% of questionnaires were returned for evaluation. 74.1% of nonuniversity hospitals participate in clinical studies. Hospital size is a significant predictor of study participation. 25.5% of hospitals have established a multidisciplinary study center. 86.2% have a certified study nurse and in 34.5% this nurse is the only person running the study center. Only 25.5% of hospitals were not interested in participating in clinical studies at all, even if an individual tailored concept were to be offered. CONCLUSIONS The demand for more hospitals to participate in clinical trials is urgent since high quality studies are a fundamental part of clinical research. Even though 75% of non-university hospitals in Germany already participate in clinical trials, it may be possible to increase this number. In addition by establishing and developing study centers in hospitals the quality of studies will presumably rise, and due to the concentration of study resources, the number of clinical trials may increase.

Published
2011
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18. Highly diffuse recurrence pattern after anti-angiogenic therapy with bevacizumab

Author

Westphal, M., Heese, O., Panse, J., and Förster, F.

Subjects
genetic structures, ddc: 610, 610 Medical sciences, Medicine
Abstract

Objective: To describe the unique pattern of recurrent glioblastoma after treatment with an antibody against the vascular endothelial growth factor (bevacizumab), which is a very effective anti-angiogenic treatment. Methods: The institutional series were reviewed for patients, who failed after the[for full text, please go to the a.m. URL], 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien

Published
2009

19. Detection of a possible epilepsy focus in a preoperated patient by perfusion SPECT and computer-aided subtraction analysis

Author

Apostolova I, Lindenau M, Fiehler J, Heese O, Wilke F, Clausen M, Stodieck S, and Ralph Buchert

Subjects
Adult, Tomography, Emission-Computed, Single-Photon, Treatment Outcome, Epilepsy, Temporal Lobe, Image Interpretation, Computer-Assisted, Image Processing, Computer-Assisted, Humans, Anticonvulsants, Electroencephalography, Female, Magnetic Resonance Imaging, Temporal Lobe
Published
2008

31. Training strategies for a sustainable medical care: a survey among assistant and chief physicians in a tertiary care hospital in Germany

Author

Kröplin Juliane, Zauner Eike-Ulrike, Dopp Hauke, Forberger Anke, Schön Gerhard, Bschorer Reinhard, Heese Oliver, and Ritz Jörg-Peter

Subjects
competency-based training, leadership, management, mentoring, surgical training, skills lab, Surgery, RD1-811
Abstract

As an essential part of the health care system, the requirements for specialist training are subject to a continuous process of change. The aim of the present study was to evaluate the current specialist training situation of all departments in a tertiary care hospital in Germany. Differences between assistant and chief physicians should be pointed out.

Published
2020
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32. End-of-life caregivers' perception of medical and psychological support during the final weeks of glioma patients: a questionnaire-based survey

Author

Heese, O, Vogeler, E, Martens, T, Schnell, O, Tonn, J C, Simon, M, Schramm, J, Krex, D, Schackert, G, Reithmeier, T, Nikkhah, G, Sabel, M, Steiger, H J, Schlegel, U, Löffler, M, Weller, M, Westphal, M, Heese, O, Vogeler, E, Martens, T, Schnell, O, Tonn, J C, Simon, M, Schramm, J, Krex, D, Schackert, G, Reithmeier, T, Nikkhah, G, Sabel, M, Steiger, H J, Schlegel, U, Löffler, M, Weller, M, and Westphal, M

Abstract

Background : The prognosis for glioma remains dismal, and little is known about the final disease phase. To obtain information about this period, we surveyed caregivers of patients who were registered in the German Glioma Network and who died from the disease.MethodsA questionnaire with 15 items, focusing on medical, logistic, and mental health support and symptom control during the final 4 weeks, was sent to caregivers. For some of the questions, a scale from 1 (inadequate) to 10 (excellent) was used.ResultsOf 1655 questionnaires, 605 were returned (36.6%) and evaluated. We found that 67.9% of the patients were taken care of at home for the last 4 weeks; 47.7% died at home, 22.6% died in hospitals, and 19.3% died in hospice facilities. Medical support was provided by general practitioners in 72.3% of cases, by physicians affiliated with a nursing home or hospice in 29.9%, and by general oncologists in 17%. Specialized neuro-oncologists were involved in 6%. The caregivers ranked the medical support with a mean of 7.2 (using a 10-point scale), nursing service with 8.1, and mental health support with 5.5. In 22.9% of cases, no support for the caregivers themselves was offered by medical institutions.ConclusionsAlthough these data reflect the caregivers' subjective views, they are useful in understanding and improving current patterns of care. While patients and their caregivers are supported mainly by neuro-oncologists for most of the disease phase, the end-of-life phase is managed predominantly by general practitioners and specialists in palliative care. Close cooperation between these specialties is necessary to meet the specific needs of glioma patients.

Published
2013

33. A new technique for attaching a stereotactic frame to the head: technical note

Author

Heese O, Arnold H, Uwe Kehler, Jan Gliemroth, and U. Knopp

Subjects
medicine.medical_specialty, Stereotactic surgery, External Fixators, business.industry, Stereotaxic surgery, Technical note, General Medicine, Surgery, Stereotaxic Techniques, Fixation (surgical), medicine, Humans, Neurology (clinical), business, Head, Biomedical engineering
Abstract

The aim of this study was to develop a device which allows an intermediate, painless fixation of a stereotactic frame prior to definite pin fixation. To stabilize the stereotactic frame rubber coated metal springs were used. By testing the springs on 30 volunteers with different head diameters and circumferences the optimal shape was determined. In the clinical setting 15 patients undergoing stereotactic surgery were tested, stability and patient's convenience were measured. The procedure was well tolerated and measurements revealed symmetric distances between head and frame. Therefore these metal springs are a useful accessory to the Leksell stereotactic system.

Published
2000

37. Molecular predictors of progression-free and overall survival in patients with newly diagnosed glioblastoma: a prospective translational study of the German Glioma Network

Author

Weller, M, Felsberg, J, Hartmann, C, Berger, H, Steinbach, J P, Schramm, J, Westphal, M, Schackert, G, Simon, M, Tonn, J C, Heese, O, Krex, D, Nikkhah, G, Pietsch, T, Wiestler, O, Reifenberger, G, von Deimling, A, Loeffler, M, Weller, M, Felsberg, J, Hartmann, C, Berger, H, Steinbach, J P, Schramm, J, Westphal, M, Schackert, G, Simon, M, Tonn, J C, Heese, O, Krex, D, Nikkhah, G, Pietsch, T, Wiestler, O, Reifenberger, G, von Deimling, A, and Loeffler, M

Abstract

PURPOSE: The prognostic value of genetic alterations characteristic of glioblastoma in patients treated according to present standards of care is unclear. PATIENTS AND METHODS: Three hundred one patients with glioblastoma were prospectively recruited between October 2004 and December 2006 at the clinical centers of the German Glioma Network. Two hundred fifty-eight patients had radiotherapy, 199 patients had temozolomide, 189 had both, and seven had another chemotherapy as the initial treatment. The tumors were investigated for TP53 mutation, p53 immunoreactivity, epidermal growth factor receptor, cyclin-dependent kinase CDK 4 or murine double minute 2 amplification, CDKN2A homozygous deletion, allelic losses on chromosome arms 1p, 9p, 10q, and 19q, O(6)-methylguanine methyltransferase (MGMT) promoter methylation, and isocitrate dehydrogenase 1 (IDH1) mutations. RESULTS: Median progression-free (PFS) and overall survival (OS) were 6.8 and 12.5 months. Multivariate analysis revealed younger age, higher performance score, MGMT promoter methylation, and temozolomide radiochemotherapy as independent factors associated with longer OS. MGMT promoter methylation was associated with longer PFS (relative risk [RR], 0.5; 95% CI, 0.38 to 0.68; P < .001) and OS (RR, 0.39; 95% CI, 0.28 to 0.54; P < .001) in patients receiving temozolomide. IDH1 mutations were associated with prolonged PFS (RR, 0.42; 95% CI, 0.19 to 0.91; P = .028) and a trend for prolonged OS (RR, 0.43; 95% CI, 0.15 to 1.19; P = .10). No other molecular factor was associated with outcome. CONCLUSION: Molecular changes associated with gliomagenesis do not predict response to therapy in glioblastoma patients managed according to current standards of care. MGMT promoter methylation and IDH1 mutational status allow for stratification into prognostically distinct subgroups.

Published
2009

49. Ongoing Clinical Trials

Author

Clarke, J. L., primary, Ennis, M. M., additional, Lamborn, K. R., additional, Prados, M. D., additional, Puduvalli, V. K., additional, Penas-Prado, M., additional, Gilbert, M. R., additional, Groves, M. D., additional, Hess, K. R., additional, Levin, V. A., additional, de Groot, J., additional, Colman, H., additional, Conrad, C. A., additional, Loghin, M. E., additional, Hunter, K., additional, Yung, W. K., additional, Chen, C., additional, Damek, D., additional, Liu, A., additional, Gaspar, L. E., additional, Waziri, A., additional, Lillehei, K., additional, Kavanagh, B., additional, Finlay, J. L., additional, Haley, K., additional, Dhall, G., additional, Gardner, S., additional, Allen, J., additional, Cornelius, A., additional, Olshefski, R., additional, Garvin, J., additional, Pradhan, K., additional, Etzl, M., additional, Goldman, S., additional, Atlas, M., additional, Thompson, S., additional, Hirt, A., additional, Hukin, J., additional, Comito, M., additional, Bertolone, S., additional, Torkildson, J., additional, Joyce, M., additional, Moertel, C., additional, Letterio, J., additional, Kennedy, G., additional, Walter, A., additional, Ji, L., additional, Sposto, R., additional, Dorris, K., additional, Wagner, L., additional, Hummel, T., additional, Drissi, R., additional, Miles, L., additional, Leach, J., additional, Chow, L., additional, Turner, R., additional, Gragert, M. N., additional, Pruitt, D., additional, Sutton, M., additional, Breneman, J., additional, Crone, K., additional, Fouladi, M., additional, Friday, B. B., additional, Buckner, J., additional, Anderson, S. K., additional, Giannini, C., additional, Kugler, J., additional, Mazurczac, M., additional, Flynn, P., additional, Gross, H., additional, Pajon, E., additional, Jaeckle, K., additional, Galanis, E., additional, Badruddoja, M. A., additional, Pazzi, M. A., additional, Stea, B., additional, Lefferts, P., additional, Contreras, N., additional, Bishop, M., additional, Seeger, J., additional, Carmody, R., additional, Rance, N., additional, Marsella, M., additional, Schroeder, K., additional, Sanan, A., additional, Swinnen, L. J., additional, Rankin, C., additional, Rushing, E. J., additional, Hutchins, L. F., additional, Damek, D. M., additional, Barger, G. R., additional, Norden, A. D., additional, Lesser, G., additional, Hammond, S. N., additional, Drappatz, J., additional, Fadul, C. E., additional, Batchelor, T. T., additional, Quant, E. C., additional, Beroukhim, R., additional, Ciampa, A., additional, Doherty, L., additional, LaFrankie, D., additional, Ruland, S., additional, Bochacki, C., additional, Phan, P., additional, Faroh, E., additional, McNamara, B., additional, David, K., additional, Rosenfeld, M. R., additional, Wen, P. Y., additional, Phuphanich, S., additional, Reardon, D., additional, Wong, E. T., additional, Plotkin, S. R., additional, Mintz, A., additional, Raizer, J. J., additional, Kaley, T. J., additional, Smith, K. H., additional, Chamberlain, M. C., additional, Graham, C., additional, Mrugala, M., additional, Johnston, S., additional, Kreisl, T. N., additional, Smith, P., additional, Iwamoto, F., additional, Sul, J., additional, Butman, J. A., additional, Fine, H. A., additional, Westphal, M., additional, Heese, O., additional, Warmuth-Metz, M., additional, Pietsch, T., additional, Schlegel, U., additional, Tonn, J.-C., additional, Schramm, J., additional, Schackert, G., additional, Melms, A., additional, Mehdorn, H. M., additional, Seifert, V., additional, Geletneky, K., additional, Reuter, D., additional, Bach, F., additional, Khasraw, M., additional, Abrey, L. E., additional, Lassman, A. B., additional, Hormigo, A., additional, Nolan, C., additional, Gavrilovic, I. T., additional, Mellinghoff, I. K., additional, Reiner, A. S., additional, DeAngelis, L., additional, Omuro, A. M., additional, Burzynski, S. R., additional, Weaver, R. A., additional, Janicki, T. J., additional, Burzynski, G. S., additional, Szymkowski, B., additional, Acelar, S. S., additional, Mechtler, L. L., additional, O'Connor, P. C., additional, Kroon, H.-A., additional, Vora, T., additional, Kurkure, P., additional, Arora, B., additional, Gupta, T., additional, Dhamankar, V., additional, Banavali, S., additional, Moiyadi, A., additional, Epari, S., additional, Merchant, N., additional, Jalali, R., additional, Moller, S., additional, Grunnet, K., additional, Hansen, S., additional, Schultz, H., additional, Holmberg, M., additional, Sorensen, M. M., additional, Poulsen, H. S., additional, Lassen, U., additional, Reardon, D. A., additional, Vredenburgh, J. J., additional, Desjardins, A., additional, Janney, D. E., additional, Peters, K., additional, Sampson, J., additional, Gururangan, S., additional, Friedman, H. S., additional, Jeyapalan, S., additional, Constantinou, M., additional, Evans, D., additional, Elinzano, H., additional, O'Connor, B., additional, Puthawala, M. Y., additional, Goldman, M., additional, Oyelese, A., additional, Cielo, D., additional, Dipetrillo, T., additional, Safran, H., additional, Anan, M., additional, Seyed Sadr, M., additional, Alshami, J., additional, Sabau, C., additional, Seyed Sadr, E., additional, Siu, V., additional, Guiot, M.-C., additional, Samani, A., additional, Del Maestro, R., additional, Bogdahn, U., additional, Stockhammer, G., additional, Mahapatra, A. K., additional, Venkataramana, N. K., additional, Oliushine, V. E., additional, Parfenov, V. E., additional, Poverennova, I. E., additional, Hau, P., additional, Jachimczak, P., additional, Heinrichs, H., additional, Schlingensiepen, K.-H., additional, Shibui, S., additional, Kayama, T., additional, Wakabayashi, T., additional, Nishikawa, R., additional, de Groot, M., additional, Aronica, E., additional, Vecht, C. J., additional, Toering, S. T., additional, Heimans, J. J., additional, Reijneveld, J. C., additional, Batchelor, T., additional, Mulholland, P., additional, Neyns, B., additional, Nabors, L. B., additional, Campone, M., additional, Wick, A., additional, Mason, W., additional, Mikkelsen, T., additional, Ashby, L. S., additional, DeGroot, J. F., additional, Gattamaneni, H. R., additional, Cher, L. M., additional, Rosenthal, M. A., additional, Payer, F., additional, Xu, J., additional, Liu, Q., additional, van den Bent, M., additional, Nabors, B., additional, Fink, K., additional, Chan, M., additional, Trusheim, J., additional, Raval, S., additional, Hicking, C., additional, Henslee-Downey, J., additional, Picard, M., additional, Schiff, D., additional, Karimi, S., additional, DeAngelis, L. M., additional, Nolan, C. P., additional, Omuro, A., additional, Gavrilovic, I., additional, Norden, A., additional, Purow, B. W., additional, Lieberman, F. S., additional, Hariharan, S., additional, Perez-Larraya, J. G., additional, Honnorat, J., additional, Chinot, O., additional, Catry-Thomas, I., additional, Taillandier, L., additional, Guillamo, J. S., additional, Campello, C., additional, Monjour, A., additional, Tanguy, M. L., additional, Delattre, J. Y., additional, Franz, D. N., additional, Krueger, D. A., additional, Care, M. M., additional, Holland-Bouley, K., additional, Agricola, K., additional, Tudor, C., additional, Mangeshkar, P., additional, Byars, A. W., additional, Sahmoud, T., additional, Alonso-Basanta, M., additional, Lustig, R. A., additional, Dorsey, J. F., additional, Lai, R. K., additional, Recht, L. D., additional, Paleologos, N., additional, Groves, M., additional, Meech, S., additional, Davis, T., additional, Pavlov, D., additional, Marshall, M. A., additional, Slot, M., additional, Peerdeman, S. M., additional, Beauchesne, P. D., additional, Faure, G., additional, Noel, G., additional, Schmitt, T., additional, Kerr, C., additional, Jadaud, E., additional, Martin, L., additional, Carnin, C., additional, Peters, K. B., additional, Herndon, J. E., additional, Kirkpatrick, J. P., additional, Nayak, L., additional, Panageas, K. S., additional, and Deangelis, L. M., additional

Published
2010
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