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Search Results: 1 - 10 of 2766 matches for " Marcel Binneb?sel "
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Intrathoracic versus Cervical Anastomosis after Resection of Esophageal Cancer: A matched pair analysis of 72 patients in a single center study
Klink Christian D,Binnebsel Marcel,Otto Jens,Boehm Gabriele
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-159
Abstract: Background The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study. Methods 72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates. Results Anastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11%) vs. 11 of 36 patients (31%); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10–110) vs. 26 days (range 12 – 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28% vs. 0%; p = 0.002 and 11% vs. 0%; p = 0.046). The overall In-hospital mortality rate was 6% (4 of 72 patients) without any differences between the study groups. Conclusions The present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.
Direct intra-abdominal pressure monitoring via piezoresistive pressure measurement: a technical note
Jens Otto, Daniel Kaemmer, Marcel Binnebsel, Marc Jansen, Rolf Dembinski, Volker Schumpelick, Alexander Schachtrupp
BMC Surgery , 2009, DOI: 10.1186/1471-2482-9-5
Abstract: A prospective cohort study was performed in 20 patients randomly scheduled to receive PRM either by a Coach?-probe or an Accurate++?-probe (both MIPM, Mammendorf, Germany). Probes were placed on the greater omentum and passed through the abdominal wall paralleling routine drainages. PRM was compared with IVP measurement by t-testing and by calculating mean difference as well as limits of agreement (LA).There were no probe related complications. Due to technical limitations, data could be collected in 3/10 patients with Coach? and in 7/10 patients with Accurate++?. Analysis was carried out only for Accurate++?. Mean values did not differ to mean IVP values. Mean difference to IVP was 0.1 ± 2.8 mmHg (LA: -5.5 to 5.6 mmHg).Direct IAP measurement was clinically uneventful. Although results of Accurate++? were comparable to IVP, the device might be too fragile for IAP measurements in the clinical setting. Local ethical committee trial registration: EK2024Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been observed to occur in any patient population needing intensive care with an incidence rate of 37% and 7% respectively [1,2].Intra-abdominal pressure (IAP) measurement has been recommended in patients at risk to develop IAH and ACS [3]. The gold standard for intermittent IAP measurement is the intra-vesicular pressure measurement (IVP) [3]. This measurement principle is widely accepted in the clinical regard [4-6]. But it has inherent problems with regard to intrinsic bladder wall tension, reference level [7], body position, discontinuity and indirectness [8].In a previously described porcine model two different devices capable of automatic continuous piezoresistive pressure reading measurement (PRM) were used for direct IAP measurement. Both, a probe to be connected to a handheld reading device and the other with the ability to perform a reset to the atmospheric pressure showed a high precision and a good agreement with bladder pressure
A civilian perspective on ballistic trauma and gunshot injuries
Philipp Lichte, Reiner Oberbeck, Marcel Binnebsel, Rene Wildenauer, Hans-Christoph Pape, Philipp Kobbe
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-35
Abstract: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed.Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference.The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.In contrast to a stagnating incidence of civilian gunshot wounds in the United States, gunshot violence shows different trends in European countries. Firearm associated crime was increasing up to 30% in the UK between 1998 and 2002 [1]. In the same period firearm associated crime in Germany was markedly decreasing. In 2007 in Germany only 4558 criminal acts with the use of firearms were registered [2]. Additionally, in high income countries a significant number of gunshot wounds are related to suicide attempts [3]. As seen in the United States, gunshot violence has bes
Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass
Klaus T von Trotha, Marcel Binnebsel, Son Truong, Florian F Behrendt, Hermann E Wasmuth, Ulf P Neumann, Marc Jansen
BMC Surgery , 2011, DOI: 10.1186/1471-2482-11-14
Abstract: In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient.Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.Among the most common causes of upper gastrointestinal bleeding are ulcers of the duodenum or stomach, accounting for approximately 50% of all cases. These are followed by erosions of the duodenum or stomach, varicosis of the oesophagus or gastric fundus, and reflux disease [1]. It has been shown that 4/5 of all ulcers are located on the lesser curvature of the stomach, while more atypical localisations include corpus, fundus, and greater curvature of the stomach.Gastric varicosis is often the result of portal hypertension in the liver. Such portal hypertension is caused by simultaneous increases in the portal vascular territory, the so-called "backward flow", as well as increased arterial blood flow within the splanchnic vascular territory, the "forward flow". This results in the development of a collateral circulation from the portal to the caval venous system. It is these portal gastric o
Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model
Christian D Klink, Marcel Binnebsel, Hamid P Alizai, Andreas Lambertz, Klaus T vonTrotha, Elmar Junker, Catherine Disselhorst-Klug, Ulf P Neumann, Uwe Klinge
BMC Surgery , 2011, DOI: 10.1186/1471-2482-11-36
Abstract: In rabbits we placed single polypropylene sutures (3/0) in skin, muscle, liver, stomach and small intestine. Six measurements for each single organ were determined by tension sensors for 60 minutes. We collected tissue specimens to analyse the connective tissue stability by measuring the collagen/protein content.We identified three phases in the process of suture loosening. The initial rapid loss of the first phase lasts only one minute. It can be regarded as cutting through damage of the tissue. The percentage of lost tension is closely related to the collagen content of the tissue (r = -0.424; p = 0.016). The second phase is characterized by a slower decrease of suture tension, reflecting a tissue specific plastic deformation. Phase 3 is characterized by a plateau representing the remaining structural stability of the tissue. The ratio of remaining tension to initial tension of phase 1 is closely related to the collagen content of the tissue (r = 0.392; p = 0.026).Knotted non-elastic monofilament sutures rapidly loose tension. The initial phase of high tension may be narrowed by reduction of the surgeons' initial force of the sutures' elasticity to those of the tissue. Further studies have to confirm, whether reduced tissue compression and less local damage permits improved wound healing.Surgery needs tissue approximation, which is achieved by sutures, for every tissue in a widely standardised manner [1]. Failure of surgical sutures leads to relevant complications after surgical interventions [2]. Amongst others burst abdomen after fascial closure [3] and anastomotic leakage after intestinal anastomosis [4] have to be mentioned. Dissection and extent of local devascularisation is known to be important, because it reduces the blood supply [5]. Furthermore, several experimental studies had demonstrated, that any high suture tension additionally has a negative influence on the quality of wound healing by inducing ischemia, oedema and tissue necrosis [6-8]. Despite, e
Gentamicin supplemented polyvinylidenfluoride mesh materials enhance tissue integration due to a transcriptionally reduced MMP-2 protein expression
Marcel Binnebsel, Klaus T von Trotha, Christina Ricken, Christian D Klink, Karsten Junge, Joachim Conze, Marc Jansen, Ulf P Neumann, Petra Lynen Jansen
BMC Surgery , 2012, DOI: 10.1186/1471-2482-12-1
Abstract: A PVDF mesh material was surface modified by plasma-induced graft polymerization of acrylic acid (PVDF+PAAc). Three different gentamicin concentrations were bound to the provided active sites of the grafted mesh surfaces (2, 5 and 8 μg/mg). 75 male transgenic MMP-2/LacZ mice harbouring the LacZ reporter gene under control of MMP-2 regulatory sequence -1241/+423, excluding the RE-1 were randomized to five groups. Bilateral of the abdominal midline one of the five different meshes was implanted subcutaneously in each animal. MMP-2 gene transcription (anti-?-galactosidase staining) and MMP-2 protein expression (anti-MMP-2 staining) were analyzed semiquantitatively by immunohistochemistry 7, 21 and 90 days after mesh implantation. The collagen type I/III ratio was analyzed by cross polarization microscopy to determine the quality of mesh integration.The perifilamentary ?-galactosidase expression as well as the collagen type I/III ratio increased up to the 90th day for all mesh modifications, whereas no significant changes could be observed for MMP-2 protein expression between days 21 and 90. Both the 5 and 8 μg/mg gentamicin group showed significantly reduced levels of ?-galactosidase expression and MMP-2 positive stained cells when compared to the PVDF group on day 7, 21 and 90 respectively (5 μg/mg: p < 0.05 each; 8 μg/mg: p < 0.05 each). Though the type I/III collagen ratio increased over time for all mesh modifications significant differences to the PVDF mesh were only detected for the 8 μg/mg group at all 3 time points (p < 0.05 each).Our current data indicate that lack of RE-1 is correlated with increased mesh induced MMP-2-gene expression for coated as well as for non-coated mesh materials. Gentamicin coating reduced MMP-2 transcription and protein expression. For the 8 μg/mg group this effect is associated with an increased type I/III collagen ratio. These findings suggest that gentamicin is beneficial for tissue integration after mesh implantation, which possib
Simvastatin Reduces Endotoxin-Induced Acute Lung Injury by Decreasing Neutrophil Recruitment and Radical Formation
Jochen Grommes, Santosh Vijayan, Maik Drechsler, Helene Hartwig, Matthias M?rgelin, Rolf Dembinski, Michael Jacobs, Thomas Andreas Koeppel, Marcel Binnebsel, Christian Weber, Oliver Soehnlein
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038917
Abstract: Introduction Treatment of acute lung injury (ALI) remains an unsolved problem in intensive care medicine. As simvastatin exerts protective effects in inflammatory diseases we explored its effects on development of ALI and due to the importance of neutrophils in ALI also on neutrophil effector functions. Methods C57Bl/6 mice were exposed to aerosolized LPS (500 μg/ml) for 30 min. The count of alveolar, interstitial, and intravasal neutrophils were assessed 4 h later by flow cytometry. Lung permeability changes were assessed by FITC-dextran clearance and albumin content in the BAL fluid. In vitro, we analyzed the effect of simvastatin on neutrophil adhesion, degranulation, apoptosis, and formation of reactive oxygen species. To monitor effects of simvastatin on bacterial clearance we performed phagocytosis and bacterial killing studies in vitro as well as sepsis experiments in mice. Results Simvastatin treatment before and after onset of ALI reduces neutrophil influx into the lung as well as lung permeability indicating the protective role of simvastatin in ALI. Moreover, simvastatin reduces the formation of ROS species and adhesion of neutrophils without affecting apoptosis, bacterial phagocytosis and bacterial clearance. Conclusion Simvastatin reduces recruitment and activation of neutrophils hereby protecting from LPS-induced ALI. Our results imply a potential role for statins in the management of ALI.
Images documentaires dans le récit décolonisateur. Le cinéma politique latino-américain des années 60 et 70
Susana Sel
Cahiers de Narratologie , 2009, DOI: 10.4000/narratologie.1060
Abstract: Cet article évalue l’apport au genre documentaire du Nouveau Cinéma Latino-américain des années soixante et soixante-dix. Dépassant l’opposition fiction-réalité, le Nouveau Cinéma Latino-américain promeut un cinéma de critique sociale grace à des récits dont les formes varient, mais qui tous contestent la réalité de la domination impérialiste et plaident pour une réhabilitation des cultures et des identités réprimées. Ces nouveaux créateurs, engagés dans la lutte de libération de leurs peuples, sont à l’origine d’ uvres ouvertes , destinées à être poursuivies et achevées par l’action des nouveaux spectateurs latino-américains. El artículo aborda la incidencia del documental en el Nuevo Cine Latinoamericano de las décadas del ’60 y principios de los ’70. Superando la dicotomía ficción-realidad, y en una gran diversidad de discursos, el Nuevo Cine Latinoamericano impulsó un cine crítico, de sentido social, en relatos que niegan la realidad de la dominación imperialista y proponen recuperar culturas e identidades colectivas avasalladas. Estos nuevos enunciadores comprometidos con las luchas de liberación de sus pueblos, crearon “obras abiertas” que se completarían y articularían con la acción de nuevos espectadores latinoamericanos.
Making Sense of Environmental Complexity in a Reform Context: The Case of Megaproject Alpha  [PDF]
Marcel Veenswijk
American Journal of Industrial and Business Management (AJIBM) , 2012, DOI: 10.4236/ajibm.2012.24015
Abstract: In this paper, new concepts on environmental complexity and sense making are developed and explored and analysed. The article based on a case study regarding a public-private collaboration in a Dutch infrastructural mega project. It is argued that the ability to influence the direction of the change process of the mega project “Alpha” depends on the way actors are able to influence the so aleed “cultural interfaces” into the power arena by means of a specific group of organizational stakeholders. After a short theoretical introduction, we describe the case in terms of two dominant cultural stages and their specific interface dynamics. The paper concludes with a general reflection on the central concepts.
On the Behavior of Solutions of the System of Rational Difference Equations:,, and
Abdullah Sel uk Kurbanli
Discrete Dynamics in Nature and Society , 2011, DOI: 10.1155/2011/932362
Abstract: We investigate the solutions of the system of difference equations
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