133 results on '"Müller, MK"'
Search Results
2. Frühzeitige Erkennung von Zweitmalignomen im Ösophagus bei Patienten mit Kopf-Hals-Tumoren durch Chromoendoskopie mit Lugol'scher-Lösung
- Author
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Frenkler, JE, Möschler, O, Müller, MK, and Christoph, B
- Published
- 2024
- Full Text
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3. Pankreas - Schockorgan und Schockmediator
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Singer Mv and Müller Mk
- Subjects
medicine.anatomical_structure ,Mediator ,business.industry ,Shock (circulatory) ,medicine ,General Medicine ,medicine.symptom ,Pancreas ,business ,Cell biology - Published
- 2008
4. Frühzeitige Erkennung von Zweitmalignomen im Ösophagus bei Hochrisikopatienten durch Chromoendoskopie
- Author
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Möschler, O, primary, Middelberg-Bisping, K, additional, Große-Thie, W, additional, Christoph, B, additional, Klöppel, G, additional, and Müller, MK, additional
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- 2015
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5. Endoskopische Vakuumtherapie bei Perforationen und Insuffizienzen des Ösophagus
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Möschler, O, primary and Müller, MK, additional
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- 2015
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6. Tumorlysesyndrom eines jugendlichen Patienten mit lymphoblastischem Lymphom vom Burkitt-Typ
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Schmidt Cg, R. Kath, H. Höfeler, K. Höffken, and Müller Mk
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musculoskeletal diseases ,medicine.medical_specialty ,Percutaneous ,business.industry ,Urinary system ,Lymphoblastic lymphoma ,nutritional and metabolic diseases ,Allopurinol ,General Medicine ,urologic and male genital diseases ,medicine.disease ,Gastroenterology ,Lymphoma ,Tumor lysis syndrome ,medicine.anatomical_structure ,Internal medicine ,medicine ,Hypocalcaemia ,business ,Renal pelvis ,medicine.drug - Abstract
A tumor lysis syndrome with hyperkalaemia, hyperphosphataemia, hyperuricaemia and hypocalcaemia developed 48 hours after start of combined cytostatic treatment in a 16-year-old boy with Burkitt's lymphoma. Despite prophylactic administration of allopurinol and urinary alkalization, postrenal precipitation of urates and calcium phosphate caused acute renal failure. Ureteric splinting and percutaneous fistulization of the contralateral renal pelvis became necessary. Elevated renal retention values became normal after these measures and infusions with balanced alkalized electrolyte solutions, and the hypocalcaemia was counteracted.
- Published
- 2008
7. Differentialdiagnose kardiale Amyloidose – ein Fallbericht. – Definitive Diagnosestellung durch kardiale Bildunggebung (Echokardiografie, kardiale MRT) sowie durch histologische Befundsicherung nach Myokardbiopsie
- Author
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Bültel, H, primary, Ueberschär, D, additional, Berndt, M, additional, Mundinger, A, additional, Müller, MK, additional, and Wichter, T, additional
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- 2010
- Full Text
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8. Endocrinologie/diabétologie: la chirurgie dans le traitement du diabète de type 2
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Berneis, K, primary and Müller, MK, additional
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- 2009
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9. Endokrinologie/Diabetologie: Chirurgie zur Behandlung des Diabetes mellitus Typ 2
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Berneis, K, primary and Müller, MK, additional
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- 2009
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10. Ergebnisse des prospektiven Registers für die Doppelballonenteroskopie in Deutschland
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Möschler, O, primary, May, A, additional, Müller, MK, additional, Ell, C, additional, and Study Group, DBE, additional
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- 2009
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11. Rezidivierende abdominelle Schmerzen
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Möschler, O, primary, Große-Thie, W, additional, and Müller, MK, additional
- Published
- 2007
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12. Embryonales Gallengang Rhabdomyosarkom – eine seltene Ursache für einen mechanischen Gallengangverschlusses beim 15 Monate alten Kind
- Author
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Risius, H, primary, Müller, MK, additional, and Rodeck, B, additional
- Published
- 2007
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13. Ergebnisse eines deutschlandweiten Registers für die Doppelballonenteroskopie
- Author
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Möschler, O, primary, May, A, additional, Müller, MK, additional, and Ell, C, additional
- Published
- 2006
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14. Unter Immunsuppression therapierefraktäre langjährige Pancolitis ulcerosa ... ein ungewöhnlicher Verlauf
- Author
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Risius, H, primary and Müller, MK, additional
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- 2006
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15. Frühzeitige Erkennung von Zweitmalignomen im Ösophagus bei Patienten mit Kopf-Hals-Tumoren durch Chromoendoskopie mit Lugol'scher-Lösung
- Author
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Frenkler, JE, primary, Möschler, O, additional, Müller, MK, additional, and Christoph, B, additional
- Published
- 2005
- Full Text
- View/download PDF
16. Frühzeitige Erkennung von Zweitmalignomen im Ösophagus bei Patienten mit Kopf-Hals-Tumoren durch Chromoendoskopie mit Lugol’scher-Lösung
- Author
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Frenkler, JE, primary, Möschler, O, additional, Müller, MK, additional, and Christoph, B, additional
- Published
- 2004
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17. Therapie des primär resistenten oder rezidivierenden kleinzelligen Bronchialkarzinoms mit Vindesin und Ifosfamid
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K. Höffken, B. Schoetensack, R. Kath, Müller Mk, H. Höfeler, U B. Wandl, Schmidt Cg, and N. Niederle
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Oncology ,medicine.medical_specialty ,Chemotherapy ,Ifosfamide ,business.industry ,Nausea ,medicine.medical_treatment ,General Medicine ,Gastroenterology ,Radiation therapy ,Internal medicine ,Vomiting ,medicine ,Every Three Weeks ,Vindesine ,medicine.symptom ,business ,Mesna ,medicine.drug - Abstract
A combination of vindesine (3 mg/m2, day 1) and ifosfamide (60 mg/kg, days 1-5 + Mesna) was administered every three weeks to 11 patients with primary resistant and 23 with recurrent small-cell bronchial carcinoma. All patients had been pre-treated with chemotherapy, 16 in addition with radiotherapy. At the onset of the vindesine-ifosfamide treatment the cancer was in a localized regional stage in ten patients, while in 24 it was in a more widely spread stage. In 29 patients whose treatment results could be evaluated the remission rate was 38%, with two complete and nine partial remissions. In a further eight patients the cancer was arrested. The patients with complete remission (for 46 and 53 weeks, respectively), those with partial remission (median of 39 weeks) and those with stationary disease (median of 31 weeks) survived significantly longer than those with progressing disease (13 weeks). There was no correlation between treatment result and pre-treatment. On recurrence after complete remission or in the localized regional stage the remission rate was 70% and 60%, respectively, and the survival time was extended in 90% of cases. In addition to nausea, alopecia and myelosuppression, side-effects included vomiting, reversible CNS symptoms, polyneuropathy and urotoxicity. On the basis of acceptable toxicity, combined vindesine and ifosfamide constitute an effective treatment of otherwise treatment-refractory cases of small-cell bronchial carcinoma.
- Published
- 1986
18. Obesity in general elective surgery.
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Pravinkumar E, Slim K, Kwiatkowski F, Chipponi J, McCarthy R, Leslie T, Williams DJ, Dindo D, Müller MK, Weber M, and Clavien P
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- 2003
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19. Development of predictive model for predicting postoperative BMI and optimize bariatric surgery: a single center pilot study.
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Ochs V, Tobler A, Wolleb J, Bieder F, Saad B, Enodien B, Fischer LE, Honaker MD, Drews S, Rosenblum I, Stoll R, Probst P, Müller MK, Lavanchy JL, Taha-Mehlitz S, Müller BP, Rosenberg R, Frey DM, Cattin PC, and Taha A
- Abstract
Background: The pilot study addresses the challenge of predicting postoperative outcomes, particularly body mass index (BMI) trajectories, following bariatric surgery. The complexity of this task makes preoperative personalized obesity treatment challenging., Objectives: To develop and validate sophisticated machine learning (ML) algorithms capable of accurately forecasting BMI reductions up to 5 years following bariatric surgery aiming to enhance planning and postoperative care. The secondary goal involves the creation of an accessible web-based calculator for healthcare professionals. This is the first article that compares these methods in BMI prediction., Setting: The study was carried out from January 2012 to December 2021 at GZOAdipositas Surgery Center, Switzerland. Preoperatively, data for 1004 patients were available. Six months postoperatively, data for 1098 patients were available. For the time points 12 months, 18 months, 2 years, 3 years, 4 years, and 5 years the following number of follow-ups were available: 971, 898, 829, 693, 589, and 453., Methods: We conducted a comprehensive retrospective review of adult patients who underwent bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy), focusing on individuals with preoperative and postoperative data. Patients with certain preoperative conditions and those lacking complete data sets were excluded. Additional exclusion criteria were patients with incomplete data or follow-up, pregnancy during the follow-up period, or preoperative BMI ≤30 kg/m
2 ., Results: This study analyzed 1104 patients, with 883 used for model training and 221 for final evaluation, the study achieved reliable predictive capabilities, as measured by root mean square error (RMSE). The RMSE values for three tasks were 2.17 (predicting next BMI value), 1.71 (predicting BMI at any future time point), and 3.49 (predicting the 5-year postoperative BMI curve). These results were showcased through a web application, enhancing clinical accessibility and decision-making., Conclusion: This study highlights the potential of ML to significantly improve bariatric surgical outcomes and overall healthcare efficiency through precise BMI predictions and personalized intervention strategies., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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20. Maternal inflammation has a profound effect on cortical interneuron development in a stage and subtype-specific manner.
- Author
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Vasistha NA, Pardo-Navarro M, Gasthaus J, Weijers D, Müller MK, García-González D, Malwade S, Korshunova I, Pfisterer U, von Engelhardt J, Hougaard KS, and Khodosevich K
- Subjects
- Animals, Cell Movement, Cell Proliferation, Cognitive Dysfunction etiology, Cognitive Dysfunction pathology, Female, GABAergic Neurons pathology, Male, Mice, Mice, Inbred C57BL, Pregnancy, Prenatal Exposure Delayed Effects pathology, Cerebral Cortex pathology, Inflammation, Interneurons classification, Interneurons pathology, Mothers, Neurogenesis
- Abstract
Severe infections during pregnancy are one of the major risk factors for cognitive impairment in the offspring. It has been suggested that maternal inflammation leads to dysfunction of cortical GABAergic interneurons that in turn underlies cognitive impairment of the affected offspring. However, the evidence comes largely from studies of adult or mature brains and how the impairment of inhibitory circuits arises upon maternal inflammation is unknown. Here we show that maternal inflammation affects multiple steps of cortical GABAergic interneuron development, i.e., proliferation of precursor cells, migration and positioning of neuroblasts, as well as neuronal maturation. Importantly, the development of distinct subtypes of cortical GABAergic interneurons was discretely impaired as a result of maternal inflammation. This translated into a reduction in cell numbers, redistribution across cortical regions and layers, and changes in morphology and cellular properties. Furthermore, selective vulnerability of GABAergic interneuron subtypes was associated with the stage of brain development. Thus, we propose that maternally derived insults have developmental stage-dependent effects, which contribute to the complex etiology of cognitive impairment in the affected offspring.
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- 2020
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21. Functional Development of Principal Neurons in the Anteroventral Cochlear Nucleus Extends Beyond Hearing Onset.
- Author
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Müller MK, Jovanovic S, Keine C, Radulovic T, Rübsamen R, and Milenkovic I
- Abstract
Sound information is transduced into graded receptor potential by cochlear hair cells and encoded as discrete action potentials of auditory nerve fibers. In the cochlear nucleus, auditory nerve fibers convey this information through morphologically distinct synaptic terminals onto bushy cells (BCs) and stellate cells (SCs) for processing of different sound features. With expanding use of transgenic mouse models, it is increasingly important to understand the in vivo functional development of these neurons in mice. We characterized the maturation of spontaneous and acoustically evoked activity in BCs and SCs by acquiring single-unit juxtacellular recordings between hearing onset (P12) and young adulthood (P30) of anesthetized CBA/J mice. In both cell types, hearing sensitivity and characteristic frequency (CF) range are mostly adult-like by P14, consistent with rapid maturation of the auditory periphery. In BCs, however, some physiological features like maximal firing rate, dynamic range, temporal response properties, recovery from post-stimulus depression, first spike latency (FSL) and encoding of sinusoid amplitude modulation undergo further maturation up to P18. In SCs, the development of excitatory responses is even more prolonged, indicated by a gradual increase in spontaneous and maximum firing rates up to P30. In the same cell type, broadly tuned acoustically evoked inhibition is immediately effective at hearing onset, covering the low- and high-frequency flanks of the excitatory response area. Together, these data suggest that maturation of auditory processing in the parallel ascending BC and SC streams engages distinct mechanisms at the first central synapses that may differently depend on the early auditory experience.
- Published
- 2019
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22. NMDA receptors mediate synaptic depression, but not spine loss in the dentate gyrus of adult amyloid Beta (Aβ) overexpressing mice.
- Author
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Müller MK, Jacobi E, Sakimura K, Malinow R, and von Engelhardt J
- Subjects
- Action Potentials drug effects, Action Potentials genetics, Alzheimer Disease genetics, Amyloid beta-Peptides chemistry, Amyloid beta-Peptides genetics, Amyloid beta-Peptides pharmacology, Amyloid beta-Protein Precursor genetics, Animals, Calcium-Calmodulin-Dependent Protein Kinase Type 2 genetics, Calcium-Calmodulin-Dependent Protein Kinase Type 2 metabolism, Disease Models, Animal, Excitatory Amino Acid Agents pharmacology, Excitatory Postsynaptic Potentials drug effects, Excitatory Postsynaptic Potentials genetics, Female, Gene Expression Regulation drug effects, Gene Expression Regulation genetics, HEK293 Cells, Humans, Male, Mice, Mice, Inbred C57BL, Mice, Transgenic, Mutation genetics, Neurons drug effects, Neurons physiology, Neurons ultrastructure, Presenilin-1 genetics, Receptors, N-Methyl-D-Aspartate genetics, Synapses drug effects, Alzheimer Disease pathology, Amyloid beta-Peptides metabolism, Dendritic Spines pathology, Dentate Gyrus cytology, Receptors, N-Methyl-D-Aspartate metabolism, Synapses physiology
- Abstract
Amyloid beta (Aβ)-mediated synapse dysfunction and spine loss are considered to be early events in Alzheimer's disease (AD) pathogenesis. N-methyl-D-aspartate receptors (NMDARs) have previously been suggested to play a role for Amyloid beta (Aβ) toxicity. Pharmacological block of NMDAR subunits in cultured neurons and mice suggested that NMDARs containing the GluN2B subunit are necessary for Aβ-mediated changes in synapse number and function in hippocampal neurons. Interestingly, NMDARs undergo a developmental switch from GluN2B- to GluN2A-containing receptors. This indicates different functional roles of NMDARs in young mice compared to older animals. In addition, the lack of pharmacological tools to efficiently dissect the role of NMDARs containing the different subunits complicates the interpretation of their specific role. In order to address this problem and to investigate the specific role for Aβ toxicity of the distinct NMDAR subunits in dentate gyrus granule cells of adult mice, we used conditional knockout mouse lines for the subunits GluN1, GluN2A and GluN2B. Aβ-mediated changes in synaptic function and neuronal anatomy were investigated in several-months old mice with virus-mediated overproduction of Aβ and in 1-year old 5xFAD mice. We found that all three NMDAR subunits contribute to the Aβ-mediated decrease in the number of functional synapses. However, NMDARs are not required for the spine number reduction in dentate gyrus granule cells after chronic Aβ-overproduction in 5xFAD mice. Furthermore, the amplitude of synaptic and extrasynaptic NMDAR-mediated currents was reduced in dentate gyrus granule of 5xFAD mice without changes in current kinetics, suggesting that a redistribution or change in subunit composition of NMDARs does not play a role in mediating Amyloid beta (Aβ) toxicity. Our study indicates that NMDARs are involved in AD pathogenesis by compromising synapse function but not by affecting neuron morphology.
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- 2018
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23. Vom Paintball gezeichnet.
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Sandner D, Bundi B, Müller D, Müller MK, and Kistler AD
- Subjects
- Abdominal Injuries diagnosis, Abdominal Injuries therapy, Abdominal Pain etiology, Adult, Diagnosis, Differential, Hematoma diagnosis, Hematoma etiology, Hematoma therapy, Humans, Magnetic Resonance Imaging, Male, Splenic Rupture diagnosis, Splenic Rupture therapy, Tomography, X-Ray Computed, Wounds, Nonpenetrating diagnosis, Wounds, Nonpenetrating therapy, Abdominal Injuries complications, Splenic Rupture etiology, Wounds, Nonpenetrating complications
- Abstract
We report the case of a 29-year-old patient who presented in the emergency room with severe abdominal pain. After initially inconspicuous medical history and laboratory evaluation, repeated focused history taking led to the correct diagnosis: a paintball projectile had left its mark. The patient had suffered a third-degree rupture of the spleen with delayed manifestation two weeks after the trauma. He could be successfully managed with an organ-preserving non-operative approach.
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- 2018
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24. Left-Sided Living Kidney Donation Leads to Transiently Reduced Adrenocortical Responsiveness.
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Burn F, Schirpenbach C, Bidlingmaier M, Reincke M, Vetter D, Weishaupt D, Brockmann JG, Müller MK, Weber M, Dahm F, and Nocito A
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- Female, Follow-Up Studies, Glomerular Filtration Rate, Hormones pharmacology, Humans, Kidney drug effects, Kidney pathology, Kidney Function Tests, Male, Middle Aged, Nephrectomy, Prognosis, Prospective Studies, Adrenocorticotropic Hormone pharmacology, Hydrocortisone metabolism, Kidney metabolism, Kidney Transplantation methods, Laparoscopy methods, Living Donors, Tissue and Organ Harvesting methods
- Abstract
Living kidney donation is safe and established, but can lead to long-term complications such as chronic fatigue. Since the adrenal vein is usually transected during left-sided donor nephrectomy-which is not necessary on the right-we hypothesized that venous congestion might lead to an impairment of adrenal function, offering a possible explanation. In this prospective open label, monocentric cohort study, adrenal function was compared in left- and right-sided living kidney donors. The primary endpoint was plasma cortisol response to low-dose adrenocorticotropic hormone (ACTH) stimulation. Secondary endpoints included plasma renin and ACTH concentration as well as adrenal volume in response to donor nephrectomy. A total of 30 healthy donors-20 left- and 10 right-sided donations-were included. On postoperative day 1, response to low-dose ACTH stimulation was intact, but significantly lower after left-sided donor nephrectomy. After 28 days, adrenal responsiveness to ACTH stimulation did not differ any longer. Magnetic resonance imaging volumetry showed no significant adrenal volume change over 4 weeks, neither after left- nor after right-sided nephrectomy. In conclusion, left-sided living kidney donation entails a transiently reduced adrenocortical responsiveness, which returns to baseline after 28 days., (© 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2017
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25. Age-Dependent Degeneration of Mature Dentate Gyrus Granule Cells Following NMDA Receptor Ablation.
- Author
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Watanabe Y, Müller MK, von Engelhardt J, Sprengel R, Seeburg PH, and Monyer H
- Abstract
N-methyl-D-aspartate receptors (NMDARs) in all hippocampal areas play an essential role in distinct processes of memory formation as well as in sustaining cell survival of postnatally generated neurons in the dentate gyrus (DG). In contrast to the beneficial effects, over-activation of NMDARs has been implicated in many acute and chronic neurological diseases, reason why therapeutic approaches and clinical trials involving receptor blockade have been envisaged for decades. Here we employed genetically engineered mice to study the long-term effect of NMDAR ablation on selective hippocampal neuronal populations. Ablation of either GluN1 or GluN2B causes degeneration of the DG. The neuronal demise affects mature neurons specifically in the dorsal DG and is NMDAR subunit-dependent. Most importantly, the degenerative process exacerbates with increasing age of the animals. These results lead us to conclude that mature granule cells in the dorsal DG undergo neurodegeneration following NMDAR ablation in aged mouse. Thus, caution needs to be exerted when considering long-term administration of NMDAR antagonists for therapeutic purposes.
- Published
- 2016
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26. Anesthetic management of patients undergoing bariatric surgery: two year experience in a single institution in Switzerland.
- Author
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Lindauer B, Steurer MP, Müller MK, and Dullenkopf A
- Subjects
- Adult, Airway Management methods, Female, Humans, Laparoscopy methods, Laparotomy methods, Male, Middle Aged, Obesity, Morbid complications, Obesity, Morbid surgery, Patient Care Team organization & administration, Perioperative Care methods, Postoperative Complications epidemiology, Reoperation, Retrospective Studies, Sleep Apnea, Obstructive complications, Switzerland, Anesthesia methods, Anesthetics administration & dosage, Bariatric Surgery methods, Gastric Bypass methods
- Abstract
Background: In the field of anesthesia for bariatric surgery, a wide variety of recommendations exist, but a general consensus on the perioperative management of such patients is missing. We outline the perioperative experiences that we gained in the first two years after introducing a bariatric program., Methods: The perioperative approach was established together with all relevant disciplines. Pertinent topics for the anesthesiologists were; successful airway management, indications for more invasive monitoring, and the planning of the postoperative period and deposition. This retrospective analysis was approved by the local ethics committee. Data are mean [SD]., Results: 182 bariatric surgical procedures were performed (147 gastric bypass procedures (GBP; 146 (99.3%) performed laparascopically). GBP patients were 43 [10] years old, 78% female, BMI 45 [7] kg/m(2), 73% ASA physical status of 2. 42 patients (28.6%) presented with obstructive sleep apnea syndrome. 117 GBP (79.6%) patients were intubated conventionally by direct laryngoscopy (one converted to fiber-optic intubation, one aspiration of gastric contents). 32 patients (21.8%) required an arterial line, 10 patients (6.8%) a central venous line. Induction lasted 25 [16] min, the procedure itself 138 [42] min. No blood products were required. Two patients (1.4%) presented with hypothermia (<35 °C) at the end of their case. The emergence period lasted 17 [9] min. Postoperatively, 32 patients (21.8%) were transferred to the ICU (one ventilated). The other patients spent 4.1 [0.7] h in the post anesthesia care unit. 15 patients (10.2%) required take backs for surgical revision (two laparotomies)., Conclusions: The physiology and anatomy of bariatric patients demand a tailored approach from both the anesthesiologist and the perioperative team. The interaction of a multi-disciplinary team is key to achieving good outcomes and a low rate of complications., Trial Registration: DRKS00005437 (date of registration 16(th) December 2013).
- Published
- 2014
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27. Endoluminal vacuum therapy for iatrogenic perforation of the proximal oesophagus.
- Author
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Möschler O and Müller MK
- Subjects
- Aged, Aged, 80 and over, Dental Prosthesis adverse effects, Female, Humans, Male, Negative-Pressure Wound Therapy methods, Suction instrumentation, Suction methods, Treatment Outcome, Vacuum, Esophageal Perforation etiology, Esophageal Perforation therapy, Esophagoscopy adverse effects, Foreign-Body Migration etiology, Foreign-Body Migration therapy, Negative-Pressure Wound Therapy instrumentation, Surgical Sponges
- Abstract
Iatrogenic perforation of the upper gastrointestinal tract is one of the most serious complications of upper gastrointestinal endoscopy, with high rates of morbidity and mortality. Treatment is challenging because stent placement or surgical repair of the perforation in this area is often impossible. We report on two cases of iatrogenic perforations of the very proximal oesophagus and distal hypopharynx which could be successfully closed by using an endoluminal vacuum sponge treatment for 5 days. Thus, the endoluminal vacuum therapy may be a useful alternative to surgery in such cases of difficultly managable perforations of the upper oesophagus., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2014
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28. Endoscopic resection of an adenocarcinoma occurring in ectopic gastric mucosa within the proximal esophagus.
- Author
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Möschler O, Vieth M, and Müller MK
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- Adenocarcinoma pathology, Aged, 80 and over, Choristoma surgery, Esophageal Neoplasms pathology, Esophagoscopy, Humans, Male, Adenocarcinoma surgery, Choristoma pathology, Esophageal Neoplasms surgery, Gastric Mucosa
- Published
- 2014
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29. Thoracolumbar spinal arachnoid diverticula in 5 pug dogs.
- Author
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Flegel T, Müller MK, Truar K, Löffler C, and Oechtering G
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- Animals, Anti-Inflammatory Agents therapeutic use, Arachnoid Cysts diagnosis, Arachnoid Cysts drug therapy, Arachnoid Cysts pathology, Arachnoid Cysts surgery, Dog Diseases diagnosis, Dog Diseases drug therapy, Dog Diseases surgery, Dogs, Female, Male, Prednisolone therapeutic use, Arachnoid Cysts veterinary, Dog Diseases pathology
- Abstract
Clinical features, myelography, and computed tomography imaging findings as well as neurological outcome with and without surgery in 5 pug dogs with thoracolumbar arachnoid diverticula are described. Short-term prognosis after surgical therapy may not be as good as reported for other canine breeds, since immediate postsurgical deterioration is possible. Improvement of neurological deficits beyond the presurgical status may take several months.
- Published
- 2013
30. Requirement for nuclear calcium signaling in Drosophila long-term memory.
- Author
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Weislogel JM, Bengtson CP, Müller MK, Hörtzsch JN, Bujard M, Schuster CM, and Bading H
- Subjects
- Animals, Animals, Genetically Modified, Animals, Newborn, Avoidance Learning physiology, Calcium metabolism, Cell Line, Cell Nucleus metabolism, Cells, Cultured, Drosophila melanogaster genetics, Drosophila melanogaster metabolism, Electric Stimulation, Heat-Shock Response physiology, Hippocampus cytology, Hippocampus metabolism, Immunoblotting, Mice, Mice, Inbred C57BL, Microscopy, Confocal, Mushroom Bodies metabolism, Neurons metabolism, Neurons physiology, Olfactory Pathways metabolism, Olfactory Pathways physiology, Calcium Signaling physiology, Drosophila melanogaster physiology, Memory, Long-Term physiology, Mushroom Bodies physiology
- Abstract
Calcium is used throughout evolution as an intracellular signal transducer. In the mammalian central nervous system, calcium mediates the dialogue between the synapse and the nucleus that is required for transcription-dependent persistent neuronal adaptations. A role for nuclear calcium signaling in similar processes in the invertebrate brain has yet to be investigated. Here, we show by in vivo calcium imaging of adult brain neurons of the fruit fly Drosophila melanogaster, that electrical foot shocks used in olfactory avoidance conditioning evoked transient increases in cytosolic and nuclear calcium concentrations in neurons. These calcium signals were detected in Kenyon cells of the flies' mushroom bodies, which are sites of learning and memory related to smell. Acute blockade of nuclear calcium signaling during conditioning selectively and reversibly abolished the formation of long-term olfactory avoidance memory, whereas short-term, middle-term, or anesthesia-resistant olfactory memory remained unaffected. Thus, nuclear calcium signaling is required in flies for the progression of memories from labile to transcription-dependent long-lasting forms. These results identify nuclear calcium as an evolutionarily conserved signal needed in both invertebrate and vertebrate brains for transcription-dependent memory consolidation.
- Published
- 2013
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31. Learning invariant face recognition from examples.
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Müller MK, Tremer M, Bodenstein C, and Würtz RP
- Subjects
- Action Potentials, Computer Simulation, Humans, Recognition, Psychology, Artificial Intelligence, Face, Models, Neurological, Neural Networks, Computer, Pattern Recognition, Visual
- Abstract
Autonomous learning is demonstrated by living beings that learn visual invariances during their visual experience. Standard neural network models do not show this sort of learning. On the example of face recognition in different situations we propose a learning process that separates learning of the invariance proper from learning new instances of individuals. The invariance is learned by a set of examples called model, which contains instances of all situations. New instances are compared with these on the basis of rank lists, which allow generalization across situations. The result is also implemented as a spike-time-based neural network, which is shown to be robust against disturbances. The learning capability is demonstrated by recognition experiments on a set of standard face databases., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2013
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32. The vacuum phenomenon in intervertebral disc disease of dogs based on computed tomography images.
- Author
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Müller MK, Ludewig E, Oechtering G, Scholz M, and Flegel T
- Subjects
- Animals, Dog Diseases pathology, Dogs, Intervertebral Disc Displacement diagnosis, Intervertebral Disc Displacement pathology, Prevalence, Retrospective Studies, Sensitivity and Specificity, Tomography, X-Ray Computed standards, Vacuum, Dog Diseases diagnosis, Intervertebral Disc Displacement veterinary, Tomography, X-Ray Computed veterinary
- Abstract
Objectives: Vacuum phenomenon is suspected to be indicative of disc degeneration and subsequent herniation. The objective of this study was to assess the reliability of vacuum phenomenon for identification of herniated discs causing neurological signs. Prevalence of vacuum phenomenon and influencing factors in dogs with disc herniation were determined., Methods: Retrospective review of computed tomography scans from dogs with suspected disc herniation for the presence of gas within intervertebral disc space with subsequent comparison of vacuum phenomenon and herniated disc as confirmed by surgery. Subgroups were created (chondrodystrophic, non-chondrodystrophic and unknown classification) to analyse prevalence and influencing factors (age, breed and gender) for vacuum phenomenon and agreement with herniated disc., Results: Prevalence of vacuum phenomenon in all dogs, chondrodystrophic, non-chondrodystrophic dogs and those with unknown classification was 19·8, 14·9, 35·7 and 24·5%, respectively. Corresponding correlation rate between vacuum phenomenon and herniated disc was 64, 67, 40 and 82%. Prevalence of vacuum phenomenon was significantly higher in nonchondrodystrophic dogs (P=0·04). Age was the only factor influencing prevalence of vacuum phenomenon (P=0·04)., Clinical Significance: In dogs with intervertebral disc disease, vacuum phenomenon is a frequent but inconsistent finding. Although helpful to identify degenerated discs, it is not suitable to identify currently herniated disc with sufficient accuracy., (© 2013 British Small Animal Veterinary Association.)
- Published
- 2013
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33. An aerobic oxidation/homolytic substitution-cascade for stereoselective methylsulfanyl-cyclization of 4-pentenols.
- Author
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Fries P, Müller MK, and Hartung J
- Subjects
- Cobalt chemistry, Cyclization, Furans chemistry, Methylation, Oxidation-Reduction, Stereoisomerism, Disulfides chemistry, Furans chemical synthesis, Oxygen chemistry, Propanols chemistry
- Abstract
4-Pentenols (dihomoallylic alcohols) are oxidized by cobalt(II)-activated dioxygen in solutions of dimethyl disulfide and cyclohexa-1,4-diene to afford methylsulfanyl (CH3S)-functionalized tetrahydrofurans in up to 74% yield. The reaction is a cascade, composed of oxidative alkenol cyclization providing tetrahydrofuryl-2-methyl radicals, which are trapped in dimethyl disulfide. Homolytic methylsulfanyl substitution by carbon radicals is a slow reaction, as exemplified by the rate constant of k(SCH(3)) = 3 × 10(4) M(-1) s(-1) (70 °C) derived from competition kinetics for the reaction between dimethyl disulfide and the trans-2-phenyltetrahydrofuryl-5-methyl radical. Methylsulfanyl-cyclizations therefore are experimentally performed in neat dimethyl disulfide, containing the minimum amount of cyclohexa-1,4-diene necessary for attaining almost quantitative alkenol conversion. The oxidative tetrahydrofuran synthesis occurs with noteworthy (>99%) 2,5-trans-stereoselectivity, as shown by the synthesis of diastereomerically pure 2,3- and 2,3,3-substituted 5-(methylsulfanyl)methyltetrahydrofurans from stereodefined 1,2-di- and 1,2,2-trisubstituted 4-pentenols. Changing the chemical nature of the disulfide reagent or the alkenol extends the scope of alkylsulfanyl-cyclization to ethylsulfanyl-cyclization, allylsulfanyl-transfer, or tetrahydropyran synthesis.
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- 2013
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34. Synthetic Aβ oligomers (Aβ(1-42) globulomer) modulate presynaptic calcium currents: prevention of Aβ-induced synaptic deficits by calcium channel blockers.
- Author
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Hermann D, Mezler M, Müller MK, Wicke K, Gross G, Draguhn A, Bruehl C, and Nimmrich V
- Subjects
- Animals, Calcium physiology, HEK293 Cells, Hippocampus drug effects, Hippocampus physiology, Humans, Rats, Rats, Wistar, Synapses physiology, omega-Agatoxin IVA pharmacology, omega-Conotoxins pharmacology, Amyloid beta-Peptides pharmacology, Calcium Channel Blockers pharmacology, Calcium Channels physiology, Calcium Channels, N-Type physiology, Peptide Fragments pharmacology, Synapses drug effects
- Abstract
Alzheimer's disease is accompanied by increased brain levels of soluble amyloid-β (Aβ) oligomers. It has been suggested that oligomers directly impair synaptic function, thereby causing cognitive deficits in Alzheimer's disease patients. Recently, it has been shown that synthetic Aβ oligomers directly modulate P/Q-type calcium channels, possibly leading to excitotoxic cascades and subsequent synaptic decline. Using whole-cell recordings we studied the modulation of recombinant presynaptic calcium channels in HEK293 cells after application of a stable Aβ oligomer preparation (Aβ1-42 globulomer). Aβ globulomer shifted the half-activation voltage of P/Q-type and N-type calcium channels to more hyperpolarized values (by 11.5 and 7.5 mV). Application of non-aggregated Aβ peptides had no effect. We then analyzed the potential of calcium channel blockers to prevent Aβ globulomer-induced synaptic decline in hippocampal slice cultures. Specific block of P/Q-type or N-type calcium channels with peptide toxins completely reversed Aβ globulomer-induced deficits in glutamatergic neurotransmission. Two state-dependent low molecular weight P/Q-type and N-type calcium channel blockers also protected neurons from Aβ-induced alterations. On the contrary, inhibition of L-type calcium channels failed to reverse the deficit. Our data show that Aβ globulomer directly modulates recombinant P/Q-type and N-type calcium channels in HEK293 cells. Block of presynaptic calcium channels with both state-dependent and state-independent modulators can reverse Aβ-induced functional deficits in synaptic transmission. These findings indicate that presynaptic calcium channel blockers may be a therapeutic strategy for the treatment of Alzheimer's disease., (Copyright © 2013 Elsevier B.V. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
35. Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany.
- Author
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Möschler O, May A, Müller MK, and Ell C
- Subjects
- Abdominal Pain diagnosis, Abdominal Pain etiology, Adolescent, Adult, Aged, Aged, 80 and over, Angiodysplasia surgery, Argon Plasma Coagulation, Child, Crohn Disease diagnosis, Diarrhea diagnosis, Diarrhea etiology, Female, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Germany, Humans, Intestinal Polyps surgery, Male, Middle Aged, Peutz-Jeghers Syndrome diagnosis, Peutz-Jeghers Syndrome surgery, Registries, Risk Factors, Time Factors, Young Adult, Angiodysplasia diagnosis, Double-Balloon Enteroscopy adverse effects, Gastrointestinal Hemorrhage diagnosis, Ileal Diseases etiology, Intestinal Perforation etiology, Intestinal Polyps diagnosis, Jejunal Diseases etiology, Pancreatitis etiology
- Abstract
Background and Study Aims: Double-balloon enteroscopy (DBE) has been established as an invaluable tool for the diagnosis and treatment of small-bowel diseases. To evaluate complications, procedural data, and diagnostic yield of DBE examinations in Germany the presented database was introduced., Methods: A prospective database of all DBE examinations in 62 endoscopic centers in Germany was developed using data from a standard questionnaire. Information requested included data on personal information, indications, procedural information, interventions, diagnostic yield, and complications., Results: In total, 2245 DBE examinations in 1765 patients were reported prospectively over a 2-year period. The most frequent indication was overt or occult bleeding in the small intestine and the most frequent intervention was argon plasma coagulation of angiodysplasia. The rate of complete enteroscopy was only 23 %. A clear dependency of indication and diagnostic yield could be documented, ranging widely from a diagnostic yield of 16 % in patients with abdominal pain and 82 % in patients with Peutz-Jeghers syndrome. A total of 27 complications produced a complication rate for all examinations of 1.2 %. Pancreatitis was diagnosed in four cases (0.3 % of oral-route DBE). Perforations occurred in three patients, two of whom had undergone polypectomy in the small bowel (1.5 % of 137 polypectomies)., Conclusion: DBE is a safe endoscopic technique according to this large prospective database, with a complication rate of 1.2 %. The diagnostic yield of DBE examinations depends upon the quality of indication, and is very low in patients with the single indications of "diarrhea" or "abdominal pain"., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2011
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36. Treatment of ureteral complications after kidney transplantation with native ureteropyelostomy reduces the risk of pyelonephritis.
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Lehmann K, Müller MK, Schiesser M, Wildi S, Fehr T, Wüthrich RP, Clavien PA, and Weber M
- Subjects
- Female, Humans, Incidence, Male, Middle Aged, Treatment Outcome, Kidney Transplantation adverse effects, Postoperative Complications, Pyelonephritis prevention & control, Ureterostomy, Urologic Diseases etiology
- Abstract
Urological complications contribute to morbidity and graft loss after kidney transplantation. Aim of this study was to assess the role of revisional surgery on patient outcome. From 1997 to 2007, 887 patients underwent kidney transplantation in our institution. Clinical data of patients with urological complications were analyzed. Ureteral complications were observed in 50 of 887 (5.6%) recipients, including ureteral necrosis (0.9%), stenosis (3.6%) and ureteral reflux with recurrent graft pyelonephritis (1.1%). Thirty-five patients underwent native ureteropyelostomy, and 14 patients had redo-ureterocystostomy. All patients treated for recurrent graft pyelonephritis had no further episodes. Overall, the rate of ureteral stenosis was significantly higher after secondary surgery, compared to the primary anastomosis (10% vs. 3.6%, p = 0.039). A significantly lower incidence of graft pyelonephritis was observed in patients after native ureteropyelostomy compared to patients treated with redo-ureterocystostomy (p = 0.019). In conclusion, reflux and recurrent graft pyelonephritis can be treated effectively by secondary surgery. The use of native ureteropyelostomy may offer protection from graft pyelonephritis after secondary surgery., (© 2010 John Wiley & Sons A/S.)
- Published
- 2011
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37. Protein assembly along a supramolecular wire.
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Müller MK, Petkau K, and Brunsveld L
- Subjects
- Antibodies chemistry, Biotin chemistry, Biotin metabolism, Macromolecular Substances chemistry, Molecular Structure, Polymers chemistry, Streptavidin chemistry, Antibodies metabolism, Streptavidin metabolism
- Abstract
Discotic molecules self-assemble into supramolecular wires that act as platforms for directed protein assembly via appended biotin functionalities.
- Published
- 2011
- Full Text
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38. [Doctor, diets don't work for me - I want an operation immediately].
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Hanhart A, Jenni B, Lüthi S, Müller MK, and Suter PM
- Subjects
- Adult, Bariatric Surgery psychology, Body Mass Index, Follow-Up Studies, Gastric Bypass, Humans, Male, Obesity, Morbid classification, Obesity, Morbid psychology, Postoperative Complications etiology, Preoperative Care, Treatment Outcome, Bariatric Surgery methods, Diet, Reducing psychology, Obesity, Morbid surgery
- Published
- 2010
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39. Donor-specific antibody levels and three generations of crossmatches to predict antibody-mediated rejection in kidney transplantation.
- Author
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Riethmüller S, Ferrari-Lacraz S, Müller MK, Raptis DA, Hadaya K, Rüsi B, Laube G, Schneiter G, Fehr T, and Villard J
- Subjects
- Adult, Female, Flow Cytometry, Graft Rejection blood, Graft Rejection immunology, Graft Rejection prevention & control, HLA Antigens blood, HLA Antigens immunology, Histocompatibility Testing methods, Humans, Immunosuppression Therapy methods, Living Donors, Lymphocytes immunology, Male, Middle Aged, Prognosis, ROC Curve, Reoperation statistics & numerical data, Retrospective Studies, Tissue Donors, Graft Rejection diagnosis, Isoantibodies blood, Kidney Transplantation immunology
- Abstract
Background: This study evaluated the prognostic impact of pretransplant donor-specific anti-human leukocyte antigen antibodies (DSA) detected by single-antigen beads and compared the three generations of crossmatch (XM) tests in kidney transplantation., Methods: Thirty-seven T-cell complement-dependent cytotoxicity crossmatch (CXM) negative living donor kidney recipients with a retrospectively positive antihuman leukocyte antigen antibody screening assay were included. A single-antigen bead test, a flow cytometry XM, and a Luminex XM (LXM) were retrospectively performed, and the results were correlated with the occurrence of antibody-mediated rejections (AMRs) and graft function., Results: We found that (1) pretransplant DSA against class I (DSA-I), but not against class II, are predictive for AMR, resulting in a sensitivity of 75% and a specificity of 90% at a level of 900 mean fluorescence intensity (MFI); (2) with increasing strength of DSA-I, the sensitivity for AMR is decreasing to 50% and the specificity is increasing to 100% at 5200 MFI; (3) the LXM for class I, but not for class II, provides a higher accuracy than the flow cytometry XM and the B-cell CXM. The specificity of all XMs is increased greatly in combination with DSA-I values more than or equal to 900 MFI., Conclusions: In sensitized recipients, the best prediction of AMR and consecutively reduced graft function is delivered by DSA-I alone at high strength or by DSA-I at low strength in combination with the LXM or CXM.
- Published
- 2010
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40. [Surgery for diabetes type 2?].
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Müller MK, Nocito A, and Schiesser M
- Subjects
- Body Mass Index, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 etiology, Follow-Up Studies, Humans, Obesity, Morbid complications, Weight Loss, Bariatric Surgery methods, Diabetes Mellitus, Type 2 surgery
- Abstract
Diabetes mellitus type 2 is a chronic disease with increasing prevalence in western society. Obesity represents a well established risk factor for the development of diabetes mellitus type 2. Several studies on surgical procedures for the treatment of obesity have shown a postoperative reduction of obesity-related co-morbidities. Thus, diabetes mellitus type 2 was shown to resolve or improve in more than 75% of morbidly obese patients (BMI >35) after bariatric surgery. These insights paved the way for the advent of metabolic surgery - a novel field with the goal to improve glucose metabolism in patients with a BMI of less than 35. Encouraging results from mostly observational studies have sparked the interest in the surgical management of diabetes mellitus type 2.
- Published
- 2010
- Full Text
- View/download PDF
41. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery.
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Schiesser M, Kirchhoff P, Müller MK, Schäfer M, and Clavien PA
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Cohort Studies, Elective Surgical Procedures adverse effects, Electric Impedance, Female, Humans, Incidence, Male, Middle Aged, Predictive Value of Tests, Risk Assessment, Severity of Illness Index, Young Adult, Body Composition, Digestive System Surgical Procedures adverse effects, Malnutrition epidemiology, Nutrition Assessment, Nutritional Status
- Abstract
Background: Malnutrition in gastrointestinal (GI) surgery is associated with increased morbidity. Therefore, careful screening remains crucial to identify patients at risk for malnutrition and consequently postoperative complications. The aim of this study was to evaluate the ability of 3 established score systems to identify patients at risk of developing postoperative complications in GI surgery and to assess the correlation among the score systems., Methods: We evaluated prospectively 200 patients admitted for elective GI surgery using (1) nutrition risk index, (2) nutrition risk score, and (3) bioelectrical impedance analysis. Complications were assessed using a standardized complication classification. The findings of the score systems were correlated with the incidence and severity of complications. Parametric and nonparametric correlation analysis was performed among the different score systems., Results: All 3 score systems correlated significantly with the incidence and severity of postoperative complications and the duration of hospital stay. Using multiple regression analysis, only nutrition risk score and malignancy remained prognostic factors for the development of complications with odds ratios of 4.2 (P = .024) and 5.6 (P < .001), respectively. The correlation between nutrition risk score and nutrition risk index was only moderate (Pearson coefficient = 0.54). Bioelectrical impedance analysis displayed only weak to trivial correlation to the nutrition risk index (0.32) and nutrition risk score (0.19), respectively., Conclusion: The nutrition risk score, nutrition risk index, and bioimpedance analysis correlate with the incidence and severity of perioperative complications in GI surgery. The nutrition risk score was the best score in predicting patients who will develop complications in this study population. The correlation between the individual scores was only moderate, and therefore, they do not necessarily identify the same patients.
- Published
- 2009
- Full Text
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42. Impact of clinical pathways in surgery.
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Müller MK, Dedes KJ, Dindo D, Steiner S, Hahnloser D, and Clavien PA
- Subjects
- Adult, Cholecystectomy, Laparoscopic nursing, Cholecystectomy, Laparoscopic standards, Cost Savings statistics & numerical data, Cost-Benefit Analysis statistics & numerical data, Critical Pathways standards, Diagnostic Tests, Routine economics, Female, Gastric Bypass standards, Health Care Costs statistics & numerical data, Health Resources statistics & numerical data, Hernia, Inguinal nursing, Hospital Costs statistics & numerical data, Hospitals, Teaching economics, Humans, Laparoscopy standards, Length of Stay economics, Male, Middle Aged, National Health Programs economics, Nursing Staff, Hospital statistics & numerical data, Patient Readmission economics, Pilot Projects, Postoperative Complications nursing, Postoperative Complications prevention & control, Prospective Studies, Switzerland, Utilization Review statistics & numerical data, Cholecystectomy, Laparoscopic economics, Critical Pathways economics, Gastric Bypass economics, Health Resources economics, Hernia, Inguinal economics, Laparoscopy economics, Nursing Staff, Hospital economics, Postoperative Complications economics
- Abstract
Background: One strategy to reduce the consumption of resources associated to specific procedures is to utilize clinical pathways, in which surgical care is standardized and preset by determination of perioperative in-hospital processes. The aim of this prospective study was to establish the impact of clinical pathways on costs, complication rates, and nursing activities., Method: Data was prospectively collected for 171 consecutive patients undergoing laparoscopic cholecystectomy (n = 50), open herniorrhaphy (n = 56), and laparoscopic Roux-en-Y gastric bypass (n = 65)., Results: Clinical pathways reduced the postoperative hospital stay by 28% from a mean of 6.1 to 4.4 days (p < 0.001), while the 30-day readmission rate remained unchanged (0.5% vs. 0.45%). Total mean costs per case were reduced by 25% from euro 6,390 to euro 4,800 (p < 0.001). Costs for diagnostic tests were reduced by 33% (p < 0.001). Nursing hours decreased, reducing nursing costs by 24% from euro 1,810 to euro 1,374 (p < 0.001). A trend was noted for lower postoperative complication rates in the clinical pathway group (7% vs. 14%, p = 0.07)., Conclusions: This study demonstrates clinically and economically relevant benefits for the utilization of clinical pathways with a reduction in use of all resource types, without any negative impact on the rate of complications or re-hospitalization.
- Published
- 2009
- Full Text
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43. A supramolecular polymer as a self-assembling polyvalent scaffold.
- Author
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Müller MK and Brunsveld L
- Subjects
- Escherichia coli metabolism, Fluorescent Dyes chemistry, Mannose chemistry, Polymers chemistry
- Abstract
Binding bacteria: Discotic molecules self-assemble into columnar supramolecular polymers that show strong polyvalent binding to bacteria by virtue of mannose ligands attached at their periphery (orange; see picture). The reversible formation of the supramolecular polymers allows simple mixing of differently substituted monomers and the optimization of bacterial aggregation.
- Published
- 2009
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- View/download PDF
44. Quality of life after bariatric surgery--a comparative study of laparoscopic banding vs. bypass.
- Author
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Müller MK, Wenger C, Schiesser M, Clavien PA, and Weber M
- Subjects
- Body Mass Index, Gastric Bypass, Gastroplasty, Health Status Indicators, Humans, Matched-Pair Analysis, Patient Satisfaction, Postoperative Period, Treatment Outcome, Quality of Life
- Abstract
Unlabelled: Laparoscopic gastric banding and Roux-en-Y gastric bypass are widely used for the treatment of morbid obesity. The impact of these two procedures on health-related quality of life has not been analyzed in comparative studies., Methods: A matched-pair analysis of a prospectively collected database was performed. Fifty-two consecutive patients with laparoscopic gastric bypass were randomly matched to fifty-two patients with laparoscopic gastric banding according to age, BMI, and gender. Quality of life was assessed using two standardized questionnaires (SF 36 and Moorehead-Ardelt II)., Results: Mean preoperative BMI was 45.7 kg/m(2) for the bypass patients and 45.3 kg/m(2) for the banding patients. Mean BMI after 3 years follow-up of was 30.4 kg/m(2) and 33.1 kg/m(2) (p=0.036). In the SF 36 questionnaire, gastric bypass patients yielded a mean total score of 613 versus 607 points in the gastric banding group (p=0.543), which is comparable to the normal population in Europe. In the Moorhead-Ardelt II questionnaire, the gastric bypass patients scored a mean total of 1.35 points and the gastric banding patients 1.28 points (p=0.747). Of the patients, 97% with a gastric bypass and 83% with a gastric banding were satisfied with the result of the operation (p=0.145)., Conclusion: The patients after laparoscopic gastric bypass and laparoscopic gastric banding have a high level of satisfaction 3 years after the operation and have similar quality of life scores compared to the normal population. Quality of life indexes were not different between the two procedures and were independent of weight loss in successfully operated patients.
- Published
- 2008
- Full Text
- View/download PDF
45. Laparoscopic versus open splenectomy for nontraumatic diseases.
- Author
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Maurus CF, Schäfer M, Müller MK, Clavien PA, and Weber M
- Subjects
- Adult, Aged, Aged, 80 and over, Cohort Studies, Elective Surgical Procedures, Female, Humans, Laparotomy, Length of Stay, Male, Middle Aged, Retrospective Studies, Splenectomy adverse effects, Splenic Diseases mortality, Splenic Diseases pathology, Treatment Outcome, Young Adult, Laparoscopy, Splenectomy methods, Splenic Diseases surgery
- Abstract
Background: Laparoscopic splenectomy (LS) is the standard procedure for normal size or moderately enlarged spleens; open splenectomy (OS) is preferred in cases of splenomegaly. In this study, indications for and complications of open and laparoscopic splenectomy were analyzed, with the aim to identify patients who will benefit from either technique., Method: A consecutive series of 52 patients undergoing elective open or laparoscopic splenectomy between January 2001 and December 2006 was analyzed. Spleen volume was calculated as length x width x depth from the pathologist's measurements., Results: LS was performed in 25 patients with a median age of 41 years (range = 24-65). OS was performed in 27 patients with a median age of 60 years (range = 24-86) (p < 0.001). Conversion to OS was necessary in two patients (8%). Operation time was significantly shorter in LS (p < 0.05). Spleen volume was significantly greater in patients who underwent open (median = 2520 ml, range = 150-16,800 ml) versus laparoscopic (median = 648 ml, range = 150-4860 ml) splenectomy (p = 0.001). In 36% of all laparoscopic procedures, spleen volume exceeded 1000 ml. The underlying disease was mainly immunothrombocytopenia in LS patients and lymphoma and osteomyelofibrosis in OS patients. Five patients died after OS. Significantly more patients were hospitalized longer than 7 days following OS than following LS (p < 0.05). Overall complication rate was higher after OS (LS, 8; OS, 13 patients; p < 0.05)., Conclusions: LS was preferred in younger patients with moderate splenomegaly, while massive splenomegaly mostly led to OS. In view of the absence of technique-related differences, LS can primarily be attempted in all patients.
- Published
- 2008
- Full Text
- View/download PDF
46. Long-term follow-up of proximal versus distal laparoscopic gastric bypass for morbid obesity.
- Author
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Müller MK, Räder S, Wildi S, Hauser R, Clavien PA, and Weber M
- Subjects
- Adult, Body Mass Index, Feasibility Studies, Female, Follow-Up Studies, Gastric Bypass adverse effects, Humans, Length of Stay, Male, Middle Aged, Postoperative Complications surgery, Treatment Outcome, Weight Loss, Gastric Bypass methods, Laparoscopy, Obesity, Morbid surgery, Postoperative Complications etiology
- Abstract
Background: Laparoscopic gastric bypass is the 'gold standard' for treatment of morbidly obese patients in many centres. There is debate regarding the optimal length for small bowel limbs. This study aimed to determine whether the proximal or distal approach is better., Methods: Twenty-five patients undergoing primary distal gastric bypass in 2000-2002 were randomly matched for age, sex and preoperative body mass index (BMI) with 25 patients having a primary proximal bypass. All distal operations were performed laparoscopically; one proximal procedure was converted to open surgery., Results: Mean operating time was 170 min for proximal and 242 min for distal bypasses (P = 0.004); median hospital stay was similar in the two groups. There were no deaths and the overall complication rate was similar, as was weight loss at 4 years: BMI decreased from 45.9 to 31.7 kg/m2 for the proximal and from 45.8 to 33.1 kg/m2 for the distal approach. Co-morbidities decreased after surgery in both groups; the prevalence of diabetes, arterial hypertension and dyslipidaemia at all time points was similar in the two groups., Conclusion: Proximal and distal laparoscopic gastric bypass operations are feasible and safe, with no differences in weight loss or reduction of co-morbidity in unselected morbidly obese patients., (Copyright (c) 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)
- Published
- 2008
- Full Text
- View/download PDF
47. Reconstruction of the gastric passage by a side-to-side gastrogastrostomy after failed vertical-banded gastroplasty: a case report.
- Author
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Soll C, Müller MK, Wildi S, Clavien PA, and Weber M
- Abstract
Introduction: Vertical-banded gastroplasty, a technique that is commonly performed in the treatment of morbid obesity, represents a nonadjustable restrictive procedure which reduces the volume of the upper stomach by a vertical stapler line. In addition, a textile or silicone band restricts food passage through the stomach., Case Presentation: A 71-year-old woman presented with a severe gastric stenosis 11 years after vertical gastroplasty. We describe a side-to-side gastrogastrostomy as a safe surgical procedure to restore the physiological gastric passage after failed vertical-banded gastroplasty., Conclusion: Occasionally, restrictive procedures for morbid obesity cannot be converted into an alternative bariatric procedure to maintain weight control. This report demonstrates that a side-to-side gastrogastrostomy is a feasible and safe procedure.
- Published
- 2008
- Full Text
- View/download PDF
48. [Complications in double-balloon-enteroscopy: results of the German DBE register].
- Author
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Möschler O, May AD, Müller MK, and Ell C
- Subjects
- Female, Germany epidemiology, Humans, Incidence, Intestinal Polyps diagnosis, Intestinal Polyps surgery, Male, Postoperative Complications epidemiology, Risk Assessment methods, Risk Factors, Catheterization statistics & numerical data, Endoscopy, Gastrointestinal statistics & numerical data, Gastrointestinal Hemorrhage epidemiology, Intestinal Perforation epidemiology, Intestinal Polyps epidemiology, Pancreatitis epidemiology, Registries statistics & numerical data
- Abstract
Introduction: The introduction of double-balloon enteroscopy for the investigation of the small bowel in 2001 was a milestone in GI endoscopy because it allows us to carry out therapeutic interventions as well as diagnostic procedures in the small bowel. Because interventional procedures in endoscopy increase the risk of complications, e.g., in colonoscopy and only limited data were reported regarding the risk of DBE, we introduced a double-balloon enteroscopy register (DBE Register) in Germany., Aim and Methods: The purpose of this study was to evaluate the complication rate of DBE in a larger group of patients. We contacted all endoscopic units using DBE in Germany in January 2006 and asked for their participation in the register, the examination data and their present complications beginning in January 2003 until 15.07.2006 using a questionnaire., Results: The participation rate of 85 endoscopic centres using the DBE technique was 75 % (64 centres). They reported 3894 DBE examinations (2685 using the oral route, 1209 using the anal route) with 1086 interventions. 48 complications were reported (1.2 %). Acute pancreatitis occurred in 9 patients with 1 lethal course of disease, all of them receiving a DBE using the oral route. Thus, the pancreatitis rate after oral DBE was 0.34 %. Perforation happened in 8 cases, all of them needed surgery. One patient died during the course of the disease. 6 perforations occurred after polypectomy, so the perforation rate after polypectomy during DBE is 3.4 % in this study. In 6 cases major bleeding was reported, 4 in the context of polypectomy and 2 after biopsy. All patients received endoscopic treatment and recovered from this complication., Conclusion: DBE is in this by now largest collection of cases a safe endoscopic procedure with an overall complication rate of approximately 1%. For diagnostic DBE pancreatitis is the most frequent complication and has to be taken in consideration in the written informed consent.
- Published
- 2008
- Full Text
- View/download PDF
49. High secondary failure rate of rebanding after failed gastric banding.
- Author
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Müller MK, Attigah N, Wildi S, Hahnloser D, Hauser R, Clavien PA, and Weber M
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Reoperation, Treatment Failure, Gastric Bypass, Gastroplasty, Laparoscopy
- Abstract
Background: Over the last decade, more than 130,000 laparoscopic adjustable gastric bandings (LAGB) have been performed for the treatment of morbid obesity. Nowadays, longer follow-up data are available in the literature and increasing numbers of late complications and treatment failures of gastric banding have been reported. The aim of the present study was the long-term evaluation of two different rescue operations after failed LAGB: conversion to laparoscopic Roux-en-Y bypass (LRYGB) versus laparoscopic gastric rebanding., Methods: Between January 1997 and November 2002, 74 consecutive patients underwent either laparoscopic gastric rebanding (n = 44) or LRYGB (n = 30) after failed LAGB. There were 14 men and 60 women, with a median age of 42 (23-60) years. The indication for reoperation was an increasing body mass index (BMI) and band-related complications such as pouch dilatation, band slippage, and penetration after LAGB. Rebandings were done by preference during the initial period of the study and LRYGB was the treatment of choice during the latter period. The success of the rescue operation was assessed by postoperative changes in the BMI, improvements of co-morbidities, and the need for further reoperations (secondary failure). The median follow-up was 36 months (range, 24-60 months)., Results: Patients who underwent LRYGB had a significantly better weight loss than patients with a rebanding operation (mean -6.1 versus +1.5 BMI points). In addition, the LRYGB patients showed a significantly better control of serum cholesterol during the long term follow-up (-0.6 versus +0.1 mmol/l). Almost half of the patients (45%) in the rebanding group needed a further operative revision, whereas only 20% underwent reoperation after rescue LRYGB. Thus, the secondary failure rate in the rebanding group was significantly higher compared to the bypass group (p = 0.028)., Conclusions: The present long-term study confirms our previous finding that LRYGB is a better treatment than rebanding after failed laparoscopic gastric banding regarding weight loss and treatment of co-morbidities. During the long-term follow-up the reoperation rate due to secondary failure became significantly higher in the rebanding group. We therefore recommend that LRYGB should be preferred as rescue procedure after failed laparoscopic adjustable gastric banding.
- Published
- 2008
- Full Text
- View/download PDF
50. Three-year follow-up study of retrocolic versus antecolic laparoscopic Roux-en-Y gastric bypass.
- Author
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Müller MK, Guber J, Wildi S, Guber I, Clavien PA, and Weber M
- Subjects
- Adult, Female, Follow-Up Studies, Gastric Bypass adverse effects, Humans, Male, Matched-Pair Analysis, Middle Aged, Prospective Studies, Time Factors, Treatment Outcome, Weight Loss, Gastric Bypass methods, Laparoscopy, Obesity, Morbid surgery
- Abstract
Background: Since 1994, laparoscopic Roux-en-Y gastric bypass (LRYGBP) has gained popularity for the treatment of morbid obesity. In analogy to open surgery, the operation was initially performed in a retrocolic fashion. Later, an antecolic procedure was introduced. According to short-term studies, the antecolic technique is favorable. In this study, we compared the retrocolic vs the antecolic technique with 3 years of follow-up. We hypothesized that the antecolic technique is superior to the retrocolic in terms of operation time and morbidity., Methods: 33 consecutive patients with retrocolic technique and 33 patients with antecolic technique of LRYGBP were compared, using a matched-pair analysis. Data were extracted from a prospectively collected database. The matching criteria were: BMI, age, gender and type of bypass (proximal or distal). The end-points of the study were: operation time, length of hospital stay, incidence of early and late complications, reoperation rates and weight loss in the follow-up over 36 months., Results: In the retrocolic group, operation time was 219 min compared to 188 min in the antecolic group (P = 0.036). In the retrocolic group, 3 patients (9.1%) developed an internal hernia and 4 patients (12.1%) suffered from anastomotic strictures. In the antecolic group, 2 patients (6.1%) developed internal hernias and in 3 patients (9.1%) anastomotic strictures occurred. Median hospital stay in the retrocolic group was 8 days compared to 7 days in the antecolic group. In the antecolic group, the mean BMI dropped from 46 kg/m2 to 32 kg/m2 postoperatively after 36 months. This corresponds to an excess BMI loss of 66%. In the retrocolic group, we found a similar decrease in BMI from preoperative 45 kg/m2 to 34 kg/m2 after 36 months (P = 0.276)., Conclusion: The results of our study demonstrate a reduction of operation time and hospital stay in the antecolic group compared to the retrocolic group. No differences between the two groups were found regarding morbidity and weight loss. Taken together, the antecolic seems to be superior to the retrocolic technique.
- Published
- 2007
- Full Text
- View/download PDF
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