Die initial lokal z. T. rasant und nunmehr verbreitet verhalten verlaufende SARS-CoV-2-Pandemie s... more Die initial lokal z. T. rasant und nunmehr verbreitet verhalten verlaufende SARS-CoV-2-Pandemie stellt hohe Anforderungen an alle involvierten Kliniken hinsichtlich der Rückkehr zur Elektivversorgung wie auch in Hinsicht auf die Planungen für ein Worst-case-Szenario einer zweiten Welle, z. B. nach wieder vermehrter Reisetätigkeit im Sommer oder im Rahmen wieder zunehmender Erkältungskrankheiten im Herbst. Neben der Vorhalte von Verbrauchsmaterialien und Medikamenten stoßen wünschenswerte Planungswege für die meisten Kliniken auf begrenzte Ressourcen. Dazu zählen v. a. bauliche und personelle Aspekte: Das langfristige Vorhalten von Räumen und Personal mit möglichst strikter Trennung von infektiologischer und nichtinfektiologischer Patientenbetreuung stößt häufig auf eine weniger ideale Realität. Umso größer ist die Bedeutung eines schlanken und flexibel reagierenden Patientenmanage-Die Autoren C. Waydhas und I. Hosbach teilen sich die Erstautorenschaft und haben an der Erstellung des Manuskripts den jeweils gleichen Anteil. Die Mitglieder der Pandemiegruppe sind am Ende des Artikels aufgeführt.
Miller D. M, Lavelle M. A streamlined pharynx airway liner: a pilot study in 22 patients in contr... more Miller D. M, Lavelle M. A streamlined pharynx airway liner: a pilot study in 22 patients in controlled and spontaneous ventilation. Anesthesia and Analgesia 2002; 94: 759-61.
The use of extracorporeal membrane oxygenation (ECMO) is discussed to improve patients’ outcome i... more The use of extracorporeal membrane oxygenation (ECMO) is discussed to improve patients’ outcome in severe COVID-19 with respiratory failure, but data on ECMO remains controversial. The aim of the study was to determine the characteristics of patients under invasive mechanical ventilation (IMV) with or without veno-venous ECMO support and to evaluate outcome parameters. Ventilated patients with COVID-19 with and without additional ECMO support were analyzed in a retrospective multicenter study regarding clinical characteristics, respiratory and laboratory parameters in day-to-day follow-up. Recruitment of patients was conducted during the first three COVID-19 waves at four German university hospitals of the Ruhr University Bochum, located in the Middle Ruhr Region. From March 1, 2020 to August 31, 2021, the charts of 149 patients who were ventilated for COVID-19 infection, were included (63.8% male, median age 67 years). Fifty patients (33.6%) received additional ECMO support. On ave...
Objective. Standardised quantitative analysis of the humoral immune response to SARS-CoV-2 antige... more Objective. Standardised quantitative analysis of the humoral immune response to SARS-CoV-2 antigens may be useful for estimating the extent and duration of immunity. The aim was to develop enzyme-linked immunosorbent assays (ELISAs) for the quantification of human IgG antibodies against SARS-CoV-2 antigens. Methods. Enzyme-linked immunosorbent assays were developed based on monoclonal antibodies against human IgG and recombinant SARS-CoV-2 antigens (Spike-S1 and Nucleocapsid). The WHO 67/086 immunoglobulin and WHO 20/136 SARS-CoV-2 references were used for standardisation. Sera of a study group of COVID-19-positive subjects (n = 144), pre-pandemic controls (n = 135) and individuals vaccinated with BioNTech-Pfizer BNT162b2 vaccine (n = 48) were analysed. The study group sera were also tested using EuroImmun SARS-CoV-2-ELISAs and a quantitative S1-specific fluorescence enzyme immunoassay (FEIA) from Thermo Fisher. Results. The ELISA results were repeatable and traceable to international units because of their parallelism to both WHO references. In the study group, median anti-S1-IgG concentrations were 102 BAU mL À1 , compared to 100 and 1457 BAU mL À1 in the vaccination group after first and second vaccination, respectively. The ELISAs achieved an area under the curve (AUC) of 0.965 (S1) and 0.955 (Nucleocapsid) in receiver operating characteristic (ROC) analysis, and a specificity of 1 (S1) and 0.963 (Nucleocapsid) and sensitivity of 0.903 (S1) and 0.833 (Nucleocapsid) at the maximum Youden index. In comparison, the commercial assays (S1-FEIA, S1 and Nucleocapsid ELISA EuroImmun) achieved sensitivities of 0.764, 0.875 and 0.882 in the study group, respectively. Conclusions. The quantitative ELISAs to measure IgG binding to SARS-CoV-2 antigens have good analytical
Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand
Neurology, 2003
Complex regional pain syndrome type I (CRPS I) develops as a consequence of trauma affecting the ... more Complex regional pain syndrome type I (CRPS I) develops as a consequence of trauma affecting the limbs, without obvious nerve lesion. Its features include pain, edema, autonomic dysfunction, movement disorder, and trophic changes. CNS involvement is suggested by the symptoms, but the pathophysiology of CRPS I is unknown. To assess excitability changes in the motor cortex in patients with CRPS I. The authors studied 25 patients with unilateral CRPS I involving the hand by means of transcranial magnetic stimulation using a paired-pulse paradigm. Motor threshold (MT) and intracortical inhibition and facilitation were determined on the affected and the clinically unaffected side. A control group of 20 healthy subjects was studied. The authors found a significant reduction of intracortical inhibition on both sides of patients with CRPS compared with control subjects, whereas intracortical facilitation and MT did not differ significantly. However, in the patients' group, the presence of allodynia significantly decreased MT. The authors showed a bilateral disinhibition of the motor cortex in patients with complex regional pain syndrome.
Die nunmehr zunehmend verhalten verlaufende SARS-CoV-2-Pandemie stellt hohe Anforderungen an alle... more Die nunmehr zunehmend verhalten verlaufende SARS-CoV-2-Pandemie stellt hohe Anforderungen an alle involvierten Kliniken hinsichtlich der Rückkehr zur Elektivversorgung wie auch in Hinsicht auf die Planungen für ein Worst-case-Szenario einer zweiten Welle, z. B. nach wieder vermehrter Reisetätigkeit im Sommer oder im Rahmen wieder zunehmender Erkältungskrankheiten im Herbst. Sowohl für die Erstsichtung und die Notaufnahme als auch innerklinisch ist nach Aufnahme des Patienten flexibel zu reagieren. Deshalb war es unser Ziel, eine Handlungsanweisung in Form eines Algorithmus zu entwickeln und zu implementieren, die den ärztlichen und Pflegemitarbeitern einen verlässlichen Entscheidungsrahmen an die Hand gibt und gleichzeitig Ressourcen schont, Patientenfehlallokationen minimiert und Patient*innen und Personal gleichermaßen Sicherheit und Rückhalt gibt. In dem Algorithmus sind wichtige Entscheidungsknoten wie klinische Symptomatik, Erstkontakt, Übergang in die stationäre Behandlung, Vo...
Efficacy of the NMDA-receptor antagonist memantine in patients with chronic phantom limb pain – results of a randomized double-blinded, placebo-controlled trial
Pain, Jun 1, 2003
Phantom limb pain (PLP) associated neuroplastic changes are partly mediated by excitatory amino a... more Phantom limb pain (PLP) associated neuroplastic changes are partly mediated by excitatory amino acids at NMDA receptor sites. This study was undertaken to deduce if NMDA-receptor antagonists may be effective in patients with chronic PLP. Therefore a four week double-blinded, randomized placebo-controlled trial was performed to evaluate the efficacy of 30 mg memantine/day, an orally administrable NMDA receptor antagonist.Thirty-six patients, 18 per group, with a history of at least 12 months PLP and an average pain of at least 4 on the 11-point numeric rating scale (NRS) were enrolled. The patients completed a standardized questionnaire before the trial. PLP intensity and the level of eight complaints were assessed during the trial. Number needed to treat (NNT) was calculated based on the average PLP during the 3rd week (steady state). In both groups, PLP declined significantly in comparison with the baseline (verum: 5.1 (+/-2.1) to 3,8 (+/-2,3), placebo from 5.1 (+/-2.0) to 3.2 (+/-1,46) NRS) without a re-rising of the PLP during the washout period. Mean pain relief was 47% in the memantine group (10 patients reported more than 50% relief), 40% in the placebo group (6>50%): NNT were 4.5 (KI: 2.1-10.6). Analysis of covariance demonstrated a significant impact only on the prior PLP intensity, but no treatment effect. Two patients have demonstrated long-term pain relief under memantine until now (16 months). The total number of slight adverse events were comparable in both groups, but the overall number of severe events was higher in the memantine group (P<0.05). This trial failed to demonstrate a significant clinical benefit of the NMDA-receptor antagonist memantine in chronic PLP. The administration of a higher dosage is probably not tolerable.
[Correlation between intrathecal opioids and gynecomastia -- a case report]
Schmerz (Berlin, Germany), 2003
The intrathecal application of opioids is promoted as a safe and cost-efficient method to treat c... more The intrathecal application of opioids is promoted as a safe and cost-efficient method to treat chronic pain of nonmalignant origin. But the way of application could trigger the appearance of otherwise rare side-effects. One of those side-effects could be the alteration of androgen hormones. Can a long-time-application of intrathecal opioids result in gynecomastia? Case-report of a 49 year old with chronic back and limb pain. Research for publications. The close link between the begin of intrathecal application of opioids and the onset of gynecomastia in this patient refers to a causal correlation. Historic publications and new findings from animal research are supporting our hypothesis. Further research is needed to support the clinical suspicion of a correlation between intrathecal opioids and gynecomastia. In case of a opioid-produced gynecomastia tests of the oestrogen-testosterone-ratio should be performed. An early substitution of testosterone could prevent a full fledged gyne...
Vorschlag der deutschen Akupunkturfachgesellschaften zur Novellierung der Musterweiterbildungsordnung
Deutsche Zeitschrift für Akupunktur, 2013
ABSTRACT The German Associations for Acupuncture, after achieving consensus, have unanimously app... more ABSTRACT The German Associations for Acupuncture, after achieving consensus, have unanimously approved and submitted blueprints on the projected revision of professional development in acupuncture and specialization in Chinese Medicine. Subsequently, the propositions will be quoted in full and explained.
Zusammenfassung Fragestellung. Wenig ist bekannt über spezifische Auswirkungen der Opioide auf de... more Zusammenfassung Fragestellung. Wenig ist bekannt über spezifische Auswirkungen der Opioide auf den Sexualhormonhaushalt.Kann die intrathekale Opioidapplikation Gynäkomastien hervorrufen? Methodik. Schilderung des Krankheitsverlaufs eines Patienten und freie Literatursuche. Ergebnisse. Der enge zeitlichen Zusammenhang zwischen intrathekaler Opioidapplikation und Ausbildung einer Gynäkomastie bei einem Erwachsenen wie im vorliegenden Fall spricht für einen kausalen Zusammenhang. Die Literatur unterstützt die Hypothese. Schlussfolgerungen. Weitere Forschung ist nötig zur Sicherung des klinischen Verdachts, dass Opioidlangzeitapplikationen zu Gynäkomastien führen können.Im Falle der Ausbildung einer Gynäkomastie bei Patienten unter einer Langzeittherapie mit Opioiden sollten entsprechende Hormonbestimmungen erfolgen und eine Therapie eingeleitet werden (Verkleinerung des Östrogen/Testosteron-Index).
Die initial lokal z. T. rasant und nunmehr verbreitet verhalten verlaufende SARS-CoV-2-Pandemie s... more Die initial lokal z. T. rasant und nunmehr verbreitet verhalten verlaufende SARS-CoV-2-Pandemie stellt hohe Anforderungen an alle involvierten Kliniken hinsichtlich der Rückkehr zur Elektivversorgung wie auch in Hinsicht auf die Planungen für ein Worst-case-Szenario einer zweiten Welle, z. B. nach wieder vermehrter Reisetätigkeit im Sommer oder im Rahmen wieder zunehmender Erkältungskrankheiten im Herbst. Neben der Vorhalte von Verbrauchsmaterialien und Medikamenten stoßen wünschenswerte Planungswege für die meisten Kliniken auf begrenzte Ressourcen. Dazu zählen v. a. bauliche und personelle Aspekte: Das langfristige Vorhalten von Räumen und Personal mit möglichst strikter Trennung von infektiologischer und nichtinfektiologischer Patientenbetreuung stößt häufig auf eine weniger ideale Realität. Umso größer ist die Bedeutung eines schlanken und flexibel reagierenden Patientenmanage-Die Autoren C. Waydhas und I. Hosbach teilen sich die Erstautorenschaft und haben an der Erstellung des Manuskripts den jeweils gleichen Anteil. Die Mitglieder der Pandemiegruppe sind am Ende des Artikels aufgeführt.
Miller D. M, Lavelle M. A streamlined pharynx airway liner: a pilot study in 22 patients in contr... more Miller D. M, Lavelle M. A streamlined pharynx airway liner: a pilot study in 22 patients in controlled and spontaneous ventilation. Anesthesia and Analgesia 2002; 94: 759-61.
The use of extracorporeal membrane oxygenation (ECMO) is discussed to improve patients’ outcome i... more The use of extracorporeal membrane oxygenation (ECMO) is discussed to improve patients’ outcome in severe COVID-19 with respiratory failure, but data on ECMO remains controversial. The aim of the study was to determine the characteristics of patients under invasive mechanical ventilation (IMV) with or without veno-venous ECMO support and to evaluate outcome parameters. Ventilated patients with COVID-19 with and without additional ECMO support were analyzed in a retrospective multicenter study regarding clinical characteristics, respiratory and laboratory parameters in day-to-day follow-up. Recruitment of patients was conducted during the first three COVID-19 waves at four German university hospitals of the Ruhr University Bochum, located in the Middle Ruhr Region. From March 1, 2020 to August 31, 2021, the charts of 149 patients who were ventilated for COVID-19 infection, were included (63.8% male, median age 67 years). Fifty patients (33.6%) received additional ECMO support. On ave...
Objective. Standardised quantitative analysis of the humoral immune response to SARS-CoV-2 antige... more Objective. Standardised quantitative analysis of the humoral immune response to SARS-CoV-2 antigens may be useful for estimating the extent and duration of immunity. The aim was to develop enzyme-linked immunosorbent assays (ELISAs) for the quantification of human IgG antibodies against SARS-CoV-2 antigens. Methods. Enzyme-linked immunosorbent assays were developed based on monoclonal antibodies against human IgG and recombinant SARS-CoV-2 antigens (Spike-S1 and Nucleocapsid). The WHO 67/086 immunoglobulin and WHO 20/136 SARS-CoV-2 references were used for standardisation. Sera of a study group of COVID-19-positive subjects (n = 144), pre-pandemic controls (n = 135) and individuals vaccinated with BioNTech-Pfizer BNT162b2 vaccine (n = 48) were analysed. The study group sera were also tested using EuroImmun SARS-CoV-2-ELISAs and a quantitative S1-specific fluorescence enzyme immunoassay (FEIA) from Thermo Fisher. Results. The ELISA results were repeatable and traceable to international units because of their parallelism to both WHO references. In the study group, median anti-S1-IgG concentrations were 102 BAU mL À1 , compared to 100 and 1457 BAU mL À1 in the vaccination group after first and second vaccination, respectively. The ELISAs achieved an area under the curve (AUC) of 0.965 (S1) and 0.955 (Nucleocapsid) in receiver operating characteristic (ROC) analysis, and a specificity of 1 (S1) and 0.963 (Nucleocapsid) and sensitivity of 0.903 (S1) and 0.833 (Nucleocapsid) at the maximum Youden index. In comparison, the commercial assays (S1-FEIA, S1 and Nucleocapsid ELISA EuroImmun) achieved sensitivities of 0.764, 0.875 and 0.882 in the study group, respectively. Conclusions. The quantitative ELISAs to measure IgG binding to SARS-CoV-2 antigens have good analytical
Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand
Neurology, 2003
Complex regional pain syndrome type I (CRPS I) develops as a consequence of trauma affecting the ... more Complex regional pain syndrome type I (CRPS I) develops as a consequence of trauma affecting the limbs, without obvious nerve lesion. Its features include pain, edema, autonomic dysfunction, movement disorder, and trophic changes. CNS involvement is suggested by the symptoms, but the pathophysiology of CRPS I is unknown. To assess excitability changes in the motor cortex in patients with CRPS I. The authors studied 25 patients with unilateral CRPS I involving the hand by means of transcranial magnetic stimulation using a paired-pulse paradigm. Motor threshold (MT) and intracortical inhibition and facilitation were determined on the affected and the clinically unaffected side. A control group of 20 healthy subjects was studied. The authors found a significant reduction of intracortical inhibition on both sides of patients with CRPS compared with control subjects, whereas intracortical facilitation and MT did not differ significantly. However, in the patients' group, the presence of allodynia significantly decreased MT. The authors showed a bilateral disinhibition of the motor cortex in patients with complex regional pain syndrome.
Die nunmehr zunehmend verhalten verlaufende SARS-CoV-2-Pandemie stellt hohe Anforderungen an alle... more Die nunmehr zunehmend verhalten verlaufende SARS-CoV-2-Pandemie stellt hohe Anforderungen an alle involvierten Kliniken hinsichtlich der Rückkehr zur Elektivversorgung wie auch in Hinsicht auf die Planungen für ein Worst-case-Szenario einer zweiten Welle, z. B. nach wieder vermehrter Reisetätigkeit im Sommer oder im Rahmen wieder zunehmender Erkältungskrankheiten im Herbst. Sowohl für die Erstsichtung und die Notaufnahme als auch innerklinisch ist nach Aufnahme des Patienten flexibel zu reagieren. Deshalb war es unser Ziel, eine Handlungsanweisung in Form eines Algorithmus zu entwickeln und zu implementieren, die den ärztlichen und Pflegemitarbeitern einen verlässlichen Entscheidungsrahmen an die Hand gibt und gleichzeitig Ressourcen schont, Patientenfehlallokationen minimiert und Patient*innen und Personal gleichermaßen Sicherheit und Rückhalt gibt. In dem Algorithmus sind wichtige Entscheidungsknoten wie klinische Symptomatik, Erstkontakt, Übergang in die stationäre Behandlung, Vo...
Efficacy of the NMDA-receptor antagonist memantine in patients with chronic phantom limb pain – results of a randomized double-blinded, placebo-controlled trial
Pain, Jun 1, 2003
Phantom limb pain (PLP) associated neuroplastic changes are partly mediated by excitatory amino a... more Phantom limb pain (PLP) associated neuroplastic changes are partly mediated by excitatory amino acids at NMDA receptor sites. This study was undertaken to deduce if NMDA-receptor antagonists may be effective in patients with chronic PLP. Therefore a four week double-blinded, randomized placebo-controlled trial was performed to evaluate the efficacy of 30 mg memantine/day, an orally administrable NMDA receptor antagonist.Thirty-six patients, 18 per group, with a history of at least 12 months PLP and an average pain of at least 4 on the 11-point numeric rating scale (NRS) were enrolled. The patients completed a standardized questionnaire before the trial. PLP intensity and the level of eight complaints were assessed during the trial. Number needed to treat (NNT) was calculated based on the average PLP during the 3rd week (steady state). In both groups, PLP declined significantly in comparison with the baseline (verum: 5.1 (+/-2.1) to 3,8 (+/-2,3), placebo from 5.1 (+/-2.0) to 3.2 (+/-1,46) NRS) without a re-rising of the PLP during the washout period. Mean pain relief was 47% in the memantine group (10 patients reported more than 50% relief), 40% in the placebo group (6>50%): NNT were 4.5 (KI: 2.1-10.6). Analysis of covariance demonstrated a significant impact only on the prior PLP intensity, but no treatment effect. Two patients have demonstrated long-term pain relief under memantine until now (16 months). The total number of slight adverse events were comparable in both groups, but the overall number of severe events was higher in the memantine group (P<0.05). This trial failed to demonstrate a significant clinical benefit of the NMDA-receptor antagonist memantine in chronic PLP. The administration of a higher dosage is probably not tolerable.
[Correlation between intrathecal opioids and gynecomastia -- a case report]
Schmerz (Berlin, Germany), 2003
The intrathecal application of opioids is promoted as a safe and cost-efficient method to treat c... more The intrathecal application of opioids is promoted as a safe and cost-efficient method to treat chronic pain of nonmalignant origin. But the way of application could trigger the appearance of otherwise rare side-effects. One of those side-effects could be the alteration of androgen hormones. Can a long-time-application of intrathecal opioids result in gynecomastia? Case-report of a 49 year old with chronic back and limb pain. Research for publications. The close link between the begin of intrathecal application of opioids and the onset of gynecomastia in this patient refers to a causal correlation. Historic publications and new findings from animal research are supporting our hypothesis. Further research is needed to support the clinical suspicion of a correlation between intrathecal opioids and gynecomastia. In case of a opioid-produced gynecomastia tests of the oestrogen-testosterone-ratio should be performed. An early substitution of testosterone could prevent a full fledged gyne...
Vorschlag der deutschen Akupunkturfachgesellschaften zur Novellierung der Musterweiterbildungsordnung
Deutsche Zeitschrift für Akupunktur, 2013
ABSTRACT The German Associations for Acupuncture, after achieving consensus, have unanimously app... more ABSTRACT The German Associations for Acupuncture, after achieving consensus, have unanimously approved and submitted blueprints on the projected revision of professional development in acupuncture and specialization in Chinese Medicine. Subsequently, the propositions will be quoted in full and explained.
Zusammenfassung Fragestellung. Wenig ist bekannt über spezifische Auswirkungen der Opioide auf de... more Zusammenfassung Fragestellung. Wenig ist bekannt über spezifische Auswirkungen der Opioide auf den Sexualhormonhaushalt.Kann die intrathekale Opioidapplikation Gynäkomastien hervorrufen? Methodik. Schilderung des Krankheitsverlaufs eines Patienten und freie Literatursuche. Ergebnisse. Der enge zeitlichen Zusammenhang zwischen intrathekaler Opioidapplikation und Ausbildung einer Gynäkomastie bei einem Erwachsenen wie im vorliegenden Fall spricht für einen kausalen Zusammenhang. Die Literatur unterstützt die Hypothese. Schlussfolgerungen. Weitere Forschung ist nötig zur Sicherung des klinischen Verdachts, dass Opioidlangzeitapplikationen zu Gynäkomastien führen können.Im Falle der Ausbildung einer Gynäkomastie bei Patienten unter einer Langzeittherapie mit Opioiden sollten entsprechende Hormonbestimmungen erfolgen und eine Therapie eingeleitet werden (Verkleinerung des Östrogen/Testosteron-Index).
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