TY - THES A1 - Röder, Daniel T1 - Tumorzelladhäsion an monofilen und polyfilen Nahtmaterialien: Empfehlungen für die onkologische Chirurgie T1 - Tumor cell adhesion on monofilament and polyfilament sutures: Recommendations in oncological surgery N2 - In der vorliegenden Arbeit wurde in einem in-vivo-Tiermodell das Ausmaß der Tumorzelladhäsion an chirurgischen Nahtmaterialien untersucht. In zwei Nacktmäusen wurde durch orthotope Implantation ein humanes Magenkarzinom induziert. Nach Laparotomie wurde das Magenkarzinom freigelegt und folgende acht kommerziell verfügbare Fadensorten in der Stärke 4/0 (USP) in vivo durch vitales Tumorgewebe gezogen: Prolene®, Monoplus®, Monosyn®, PDS II® und Maxon® (jeweils monofil), Polysorb®, Safil® und Vicryl® (jeweils polyfil). Anschließend wurde die Fadenoberfläche direkt hinter der Nadel sowie zehn Zentimeter hinter der Nadel raster-elektronenmikroskopisch dargestellt und immunzytochemisch sowie molekular-biologisch auf die Adhäsion humaner Tumorzellen hin untersucht. Als qualitatives Nachweisverfahren dienten die EPIMET®-Färbung, bei der das humane epitheliale Stukturprotein Zytokeratin CK-20 im Zytoplasma farblich markiert wird, sowie eine nested-reverse-Transkriptase-Polymerasekettenreaktion (PCR) mit human-CK-20-spezifischen Primerpaaren. Die Rasterelektronenmikroskopie zeigte bei jeder Fadensorte auf mindestens einer Probe Zellbeläge. Der immunzytologische Nachweis erwies sich als wenig sensitiv und gelang nur für Proben von Monoplus®, Maxon® und Safil®. Die PCR identifizierte CK-20-positive Zellen auf allen polyfilen Fäden (Polysorb®, Safil® und Vicryl®) sowie den monofilen Sorten Monosyn®, Monoplus® und Maxon®. Alle PCR-Proben von Prolene® oder PDS II® waren negativ. Damit fiel die Tumorzelladhäsion auf monofilen Proben in der PCR signifikant geringer aus als auf polyfilen Proben (p < 0.017). Dies kann im wesentlichen mit der ausgeprägten Traumatisierung des Gewebes durch den Sägeeffekt polyfiler Fäden begründet werden. Unterschiede in der Zelladhäsion zwischen den einzelnen monofilen Fadensorten lassen sich möglicherweise auf ihre unterschiedliche chemische Struktur (polare Gruppen, Wasserstoffbrückenbindungen) und deren Interaktion mit der Tumorzelloberfläche zurückführen. Für die gastrointestinale Tumorchirurgie wird empfohlen, weiterhin eine konsequente No-Touch-Technik einzuhalten, um eine Exfoliation viabler Tumorzellen, deren Adhäsion an Nahtmaterial und damit das Risiko eines Anastomosenrezidivs durch Implantation der am Faden adhärenten Tumorzellen zu reduzieren. Zusammenfassend kann gesagt werden, dass die monofilen Fäden aus PDS II® und Prolene® in der Gesamtschau der Ergebnisse die geringste Tendenz zur Tumorzelladhäsion aufweisen und somit im Vergleich zu den anderen untersuchten Fäden bei onkologischen Eingriffen bevorzugt werden sollten; die mehrfache Verwendung eines Fadens sollte wegen der verlängerten Kontaktzeit zwischen Faden und Anastomose vermieden und für jeden Durchstich ein neuer Faden verwendet werden. Geflochtene Nahtmaterialien sollten dagegen wegen des erhöhten Risikos für Tumorzelladhäsion und -implantation in der onkologischen Anastomosentechnik keine Anwendung finden. Es bedarf weiterer Studien zum Verständnis der unterschiedlich stark ausgeprägten Tumorzelladhäsion unter den verschiedenen monofilen Fäden. Als Ursachen denkbar wären Oberflächeneigenschaften wie z. B. elektrische Ladung, Hydrophilie/-phobie oder chemische Eigenschaften. Ein weiterer Ansatz wäre die Beschichtung von monofilen Nahtmaterialien mit Zytostatika zur Inhibition der Tumorzellvermehrung auf der Oberfläche der Anastomosennaht. N2 - The aim of the present study was to evaluate the adhesion of tumor cells on surgical sutures in an in-vivo animal model. A human gastric carcinoma was induced by orthotopic implantation into two nude mice. After laparotomy, the following eight commercial surgical sutures (4/0 USP) were pulled through vital tumor tissue: Prolene®, Monoplus®, Monosyn®, PDS II® and Maxon® (monofilament structure), and Polysorb®, Safil® and Vicryl® (multifilament structure). Three methods were used to evaluate the results: scanning electron microscopy (SEM) of the suture surface, detection of tumor cells by immunocytochemical EPIMET® staining (which stains the human epithelial structure protein cytokeratin CK-20 in cytoplasm) and by detection of tumor specific mRNA (encoding CK-20) by nested reverse transcriptase polymerase chain reaction (PCR). In SEM each type of suture showed cellular coating on the surface of at least one sample, although the cells could not be identified as of tumor origin. The sensitivity of immunocytochemical staining was poor; positive staining was successful in Monoplus®, Maxon® and Safil® samples only. PCR identified CK-20 positive cells on each multifilament suture and on monofilament Monosyn®, Monoplus® and Maxon®. No Prolene® and PDS II® samples were positive in PCR. Thus, there was significantly less tumor cell adhesion in PCR on monofilament than on multifilament sutures (p < 0.017). This is mainly due to gross tissue damage by the “sawing effect” of multifilament sutures. Differences in the tumor cell adhesion among monofilament sutures may be due to different chemical structure (polar groups, hydrogen bonds) and their interaction with the tumor cell surface. A consequent no-touch-technique in gastrointestinal tumor surgery is recommended in order to prevent exfoliation of viable tumor cells, cell adhesion on suture threads and to reduce the risk of local anastomostic recurrence by implantation of adherent tumor cells. Regarding the results, monofilament PDS II® and Prolene® show the least tendency for tumor cell adhesion. Multiple use of one thread should be avoided and a new thread should be taken for each stitch in order to minimize contact time between thread and anastomosis. Evidence of a higher risk of both tumor cell adhesion and implantation makes the use of braided suture obsolete in oncological surgery. Further studies are needed to better understand the differences in tumor cell adhesion among different monofilament sutures due to surface qualities like electrical charge, hydrophilia/-phobia or chemical qualities. Other approaches should include cytostatic coating of monofilament threads in order to inhibit tumor cell growth on the surface of threads used for anastomotic sutures. KW - Rezidiv KW - Gastrointestinaler Tumor KW - Anastomose KW - Nacktmaus KW - Naht KW - Anastomosenrezidiv KW - Tumorzelladhäsion KW - chirurgisches Nahtmaterial KW - Zytokeratin KW - anastomotic recurrence KW - tumor cell adhesion KW - surgical sutures KW - CK-20 KW - mouse Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-38824 ER - TY - JOUR A1 - Sitter, Magdalena A1 - Fröhlich, Corinna A1 - Kranke, Peter A1 - Markus, Christian A1 - Wöckel, Achim A1 - Rehn, Monika A1 - Bartmann, Catharina A1 - Frieauff, Eric A1 - Meybohm, Patrick A1 - Pecks, Ulrich A1 - Röder, Daniel T1 - ECMO-Therapie bei COVID-19-ARDS in der Schwangerschaft ermöglicht den Erhalt einer Schwangerschaft mit termingerechter Entbindung T1 - ECMO therapy for COVID-19 ARDS (Acute Respiratory Distress Syndrome) during pregnancy enables preservation of pregnancy and full-term delivery JF - Die Anaesthesiologie N2 - No abstract available. KW - ECMO-Therapie KW - COVID-19-ARDS KW - Schwangerschaft KW - ECMO therapy KW - COVID-19-ARDS KW - pregnancy Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-346762 VL - 72 IS - 3 ER - TY - JOUR A1 - Helmer, Philipp A1 - Hottenrott, Sebastian A1 - Steinisch, Andreas A1 - Röder, Daniel A1 - Schubert, Jörg A1 - Steigerwald, Udo A1 - Choorapoikayil, Suma A1 - Meybohm, Patrick T1 - Avoidable blood loss in critical care and patient blood management: scoping review of diagnostic blood loss JF - Journal of Clinical Medicine N2 - Background: Anemia remains one of the most common comorbidities in intensive care patients worldwide. The cause of anemia is often multifactorial and triggered by underlying disease, comorbidities, and iatrogenic factors, such as diagnostic phlebotomies. As anemia is associated with a worse outcome, especially in intensive care patients, unnecessary iatrogenic blood loss must be avoided. Therefore, this scoping review addresses the amount of blood loss during routine phlebotomies in adult (>17 years) intensive care patients and whether there are factors that need to be improved in terms of patient blood management (PBM). Methods: A systematic search of the Medline Database via PubMed was conducted according to PRISMA guidelines. The reported daily blood volume for diagnostics and other relevant information from eligible studies were charted. Results: A total of 2167 studies were identified in our search, of which 38 studies met the inclusion criteria (9 interventional studies and 29 observational studies). The majority of the studies were conducted in the US (37%) and Canada (13%). An increasing interest to reduce iatrogenic blood loss has been observed since 2015. Phlebotomized blood volume per patient per day was up to 377 mL. All interventional trials showed that the use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn. Conclusion: Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia. Therefore, a comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes. KW - PBM KW - critically ill KW - intensive care KW - iatrogenic anemia KW - avoidable blood loss KW - diagnostic blood loss Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-255145 SN - 2077-0383 VL - 11 IS - 2 ER - TY - JOUR A1 - Zeiner, Carsten A1 - Schröder, Malte A1 - Metzner, Selina A1 - Herrmann, Johannes A1 - Notz, Quirin A1 - Hottenrott, Sebastian A1 - Röder, Daniel A1 - Meybohm, Patrick A1 - Lepper, Philipp M. A1 - Lotz, Christopher T1 - High-dose methylprednisolone pulse therapy during refractory COVID-19 acute respiratory distress syndrome: a retrospective observational study JF - BMC Pulmonary Medicine N2 - Background Current COVID-19 guidelines recommend the early use of systemic corticoids for COVID-19 acute respiratory distress syndrome (ARDS). It remains unknown if high-dose methylprednisolone pulse therapy (MPT) ameliorates refractory COVID-19 ARDS after many days of mechanical ventilation or rapid deterioration with or without extracorporeal membrane oxygenation (ECMO). Methods This is a retrospective observational study. Consecutive patients with COVID-19 ARDS treated with a parenteral high-dose methylprednisolone pulse therapy at the intensive care units (ICU) of two University Hospitals between January 1st 2021 and November 30st 2022 were included. Clinical data collection was at ICU admission, start of MPT, 3-, 10- and 14-days post MPT. Results Thirty-seven patients (mean age 55 ± 12 years) were included in the study. MPT started at a mean of 17 ± 12 days after mechanical ventilation. Nineteen patients (54%) received ECMO support when commencing MPT. Mean paO2/FiO2 significantly improved 3- (p = 0.034) and 10 days (p = 0.0313) post MPT. The same applied to the necessary FiO2 10 days after MPT (p = 0.0240). There were no serious infectious complications. Twenty-four patients (65%) survived to ICU discharge, including 13 out of 20 (65%) needing ECMO support. Conclusions Late administration of high-dose MPT in a critical subset of refractory COVID-19 ARDS patients improved respiratory function and was associated with a higher-than-expected survival of 65%. These data suggest that high-dose MPT may be a viable salvage therapy in refractory COVID-19 ARDS. KW - corticoid KW - methylprednisolone KW - pulse therapy KW - SARS-CoV2 KW - ECMO KW - salvage therapy Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357231 VL - 23 ER - TY - JOUR A1 - Döhler, Ida A1 - Röder, Daniel A1 - Schlesinger, Tobias A1 - Nassen, Christian Alexander A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin A1 - Lock, Johan Friso T1 - Risk-adjusted perioperative bridging anticoagulation reduces bleeding complications without increasing thromboembolic events in general and visceral surgery JF - BMC Anesthesiology N2 - Background Perioperative bridging of oral anticoagulation increases the risk of bleeding complications after elective general and visceral surgery. The aim of this study was to explore, whether an individual risk-adjusted bridging regimen can reduce bleeding events, while still protecting against thromboembolic events. Methods We performed a quality improvement study comparing bridging parameters and postoperative outcomes before (period 1) and after implementation (period 2) of a new risk-adjusted bridging regimen. The primary endpoint of the study was overall incidence of postoperative bleeding complications during 30 days postoperatively. Secondary endpoints were major postoperative bleeding, minor bleeding, thromboembolic events, postoperative red blood cell transfusion, perioperative length-of-stay (LOS) and in-hospital mortality. Results A total of 263 patients during period 1 and 271 patients during period 2 were compared. The included elective operations covered the entire field of general and visceral surgery. The overall incidence of bleeding complications declined from 22.1% during period 1 to 10.3% in period 2 (p < 0.001). This reduction affected both major as well as minor bleeding events (8.4% vs. 4.1%; p = 0.039; 13.7% vs. 6.3%; p = 0.004). The incidence of thromboembolic events remained low (0.8% vs. 1.1%). No changes in mortality or length-of-stay were observed. Conclusion It is important to balance the individual thromboembolic and bleeding risks in perioperative bridging management. The risk adjusted bridging regimen reduces bleeding events in general and visceral surgery while the risk of thromboembolism remains comparably low. KW - low-molecular heparin KW - atrial fibrillation KW - postoperative bleeding KW - thromboembolism KW - anticoagulation KW - bridging Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357305 VL - 23 ER -