Nora Jahn

The challenge of liver resection in benign solid liver tumors in modern times – in which cases should surgery be done?

Background Due to improved diagnostical and therapeutical approaches, benign liver tumors represent a challenge in clinical management. We here report our experience with patients undergoing liver resection for benign liver tumors. Methods 188 One hundred eighty-eight consecutive patients, who underwent surgery for solid benign liver tumors from 1992 - 2014, were analyzed retrospectively. The focus was on diagnostic pathways, indications for surgery, and perioperative and postoperative quality of life (QoL). Results Of 188 patients, 100 had focal nodular hyperplasia (FNH) (53.2 %), 33 had hepatocellular adenoma (17.5 %), and 55 had hemangioma (29.3 %). In most patients, there was more than one 1 indication for liver resection, including tumor-associated symptoms (n = 82, 43.6 %), suspicion of malignancy (n = 104, 55.3 %), tumor disease in the medical history (n = 48, 25.5 %), or tumor enlargement (n = 27, 14.4 %). Serious complications (>grade III;, Clavien-Dindo) occurred in 9.5 % of patients. Perioperative mortality was 0.5 %. Patient pain scores decreased over time (p < 0.001). QoL after liver resection significantly improved (p = 0.007). Conclusion Uncertainty of the tumor entity remains an issue in preoperative diagnostics. If indicated, liver resection for benign liver tumors represents a safe approach and leads to significant improvements of QoL.

Interhospitaltransport von Patienten mit ARDS

ZusammenfassungDie Therapie von Patienten mit schwerer Gasaustauschstörung ist technisch und personell aufwendig und sollte in spezialisierten Zentren durchgeführt werden. Daher sollte ein zeitnaher Transport in ein solches Zentrum angestrebt werden. Wird der Transport durch ein erfahrenes Transportteam durchgeführt, überwiegen die Vorteile der dadurch gewährleisteten spezifischen Therapie deutlich gegenüber den Transportrisiken. Hierbei müssen jedoch die Wahl des Transportmittels, das Equipment und das Personal sorgfältig geplant werden. Patienten- und transportassoziierte Risiken müssen berücksichtigt und eine adäquate Konditionierung des Patienten vor Transportbeginn zur Abwendung drohender Komplikationen durchgeführt werden. Dieser Beitrag soll eine Übersicht geben, über patientenseitige Aspekte, verschiedene Transportformen und assoziierte Risiken. Zudem wird der optimale Ablauf eines Patiententransports, beginnend mit dem Erstkontakt der verlegenden Klinik bis zur praktischen Durchführung, erläutert.AbstractIn patients with severely compromised gas exchange, interhospital transportation is frequently necessary due to the need to provide access to specialized care. Risks are inherent during transport, so the anticipated benefits of transportation must be weighed against the possible negative outcome during the transport. The use of specialized teams during transportation can help to reduce adverse events. Diligent planning of the transportation, monitoring and medical staff during transport can decrease adverse events and reduce risks. This article defines the group of patients that may benefit from referral. This article discusses the risks associated with the transportation of patients with severely impaired gas exchange and the risks related to different means of transportation. The decisions required before transportation are described as well as the practical approach starting at the transferring hospital until arrival at the admitting hospital.

The effects of hemoglobin glutamer-200 and iNO on pulmonary vascular tone and arterial oxygenation in an experimental acute respiratory distress syndrome

INTRODUCTION Hemoglobin-based oxygen carriers (HBOC) have been developed as an alternative to blood transfusions. Their nitric-oxide-scavenging properties HBOC also induce vasoconstriction. In acute lung injury, an excess of nitric oxide results in a general vasodilation, reducing oxygenation by impairing the hypoxic pulmonary vasoconstriction. Inhaled nitric oxide (iNO) is used to correct the ventilation perfusion mismatch. We hypothesized that the additional use of HBOC might increase this effect. In a rodent model of ARDS we evaluated the combined effect of HBOC and iNO on vascular tone and gas exchange. METHODS ARDS was induced in anaesthetized Wistar rats by saline lavage and aggressive ventilation. Two groups received either hydroxyethylstarch 10% (HES; n = 10) or the HBOC hemoglobin glutamer-200 (HBOC-200; n = 10) via a central venous infusion. Additionally, both groups received iNO. Monitoring of the right ventricular pressure (RVP) and mean arterial pressure (MAP) was performed with microtip transducers. Arterial oxygenation was measured via arterial blood gas analyses. RESULTS Application of HBOC-200 led to a significant increase of MAP and RVP when compared to baseline and to the HES group. This effect was reversed by iNO. The application of HBOC and iNO had no effect on the arterial oxygenation over time. No difference in arterial oxygenation was found between the groups. CONCLUSION Application of HBOC led to an increase of systemic and pulmonary vascular resistance in this animal model of ARDS. The increase in RVP was reversed by iNO. Pulmonary vasoconstriction by hemoglobin glutamer-200 in combination with iNO did not improve arterial oxygenation in ARDS.

Soziale Aspekte von Einsätzen im Rettungsdienst

DeZusammenfassungHintergrundViele Einsätze in der präklinischen Notfallrettung erscheinen den Rettern als „Fehleinsätze“ oder falsche Indikationen im Sinne der Landesrettungsgesetze. Solche Einsätze werden oftmals durch soziale Aspekte getriggert, oder diese stehen gar im Vordergrund des Einsatzes. Mitarbeiter der Rettungsdienste werden mit sozialen Problemen konfrontiert und fühlen sich in der Folge häufig damit allein gelassen.Ziel der ArbeitDer vorliegende Beitrag fördert das Verständnis der Rettungsdienstmitarbeiter für die Zusammenhänge zwischen gesellschaftlichen Problemen und Gesundheit. Für häufige soziale Notfälle im Rettungsdienst werden Lösungsstrategien angeboten.Material und MethodeIn dieser Arbeit werden Zusammenhänge zwischen sozioökonomischem Status und Gesundheit bzw. Krankheit aufgezeigt. Typische Einsatzindikationen, bei denen soziale Aspekte eine große Rolle spielen, werden dargestellt und Lösungsstrategien für das Vorgehen vorgeschlagen. Diskutiert wird der Umgang mit Fällen von Kindesmisshandlung und häuslicher Gewalt. Drei klassische psychiatrische Problematiken mit häufig sozialer Komponente werden erörtert: psychomotorische Erregungszustände, Suizide und alkoholassoziierte Einsätze. Hier wird besonders auf Fremdgefährdung und aggressive Patienten eingegangen. Gerade bei älteren und chronisch-kranken Patienten spielen neben der Behandlung medizinischer Fragen soziale Probleme eine wichtige Rolle.Ergebnisse und SchlussfolgerungDie Möglichkeiten des Rettungsteams zur Lösung sozialer Probleme sind in aller Regel stark begrenzt. Es ist für das Rettungsteam jedoch wichtig, die Strukturen und nichtmedizinischen Ansprechpartner in der eigenen Region zu kennen und zielgerichtet an sie zu verweisen. Dazu gehören Sozialdienste, Jugendämter; Kriseninterventionsteams oder beispielsweise sozialpsychiatrische Dienste.AbstractBackgroundMany missions in the preclinical emergency services seem to be triggered by false indications as defined by the Federal State Rescue Act. These emergency calls are often a result of or associated with social issues. Emergency rescue personnel are confronted with social problems and as a result often feel left alone with the problem.AimThis article promotes the understanding of emergency service personnel for the associations between social problems and health. Solution strategies for frequent social emergencies are described.Material and methodsThis article demonstrates the associations between socioeconomic status, health and disease. Typical indications for missions in which social aspects play an important role are presented and solution strategies for the approach are suggested. A discussion is presented on how to deal with cases of child abuse and domestic violence. Three classical psychiatric problem areas with common social components are explained: psychomotor state of excitation, suicide and alcohol-associated incidents and special attention is paid to danger to third parties and aggressive patients. In addition to the treatment of medical conditions, social problems play an important role particularly for the elderly and chronically ill patients.Results and conclusionEmergency personnel have only limited options for dealing with such problems; however, it is important to be aware of regional structures and non-medical organizations, which might be of help in such situations. These include social services, youth welfare services, crisis interventions teams and social psychiatric services.

Bauchlagerung von Patienten an der venovenösen ECMO ist möglich und sicher@@@Prone positioning of patients during venovenous extracorporeal membrane oxygenation is safe and feasible

BACKGROUND Prone positioning of patients with acute respiratory distress syndrome (ARDS) has been shown to significantly improve survival rates. Prone positioning reduces collapse of dorsal lung segments with subsequent reduction of alveolar overdistension of ventral lung segments, optimizes lung recruitment and enhances drainage. Patients with ARDS treated by extracorporeal membrane oxygenation (ECMO) can also benefit from prone positioning; however, the procedure is associated with a possible higher risk of serious adverse events. OBJECTIVE The aim of this study was to evaluate the safety and feasibility of prone positioning for patients with severe ARDS during ECMO therapy. MATERIAL AND METHODS This study involved a retrospective analysis of all patients placed in a prone position while being treated by venovenous ECMO (vvECMO) for severe hypoxemia in ARDS as bridge to recovery in the interdisciplinary intensive care unit at the University Hospital Leipzig between January 2009 and August 2013. Baseline data, hospital mortality and serious adverse events were documented. Serious adverse events were defined as dislocation or obstruction of endotracheal tube or tracheal cannula, ECMO cannulas and cardiac arrest. Prone positioning was carried out by at least one doctor and three nurses according to a standardized protocol. Results are given as the median (1st and 3rd quartiles). RESULTS A total of 26 patients were treated with vvECMO as bridge to recovery due to severe ARDS. Causes for ARDS were pneumonia (n = 20) and aspiration (n = 2) and four patients had different rare causes of ARDS. The median time on ECMO was 8 days (6;11) and during this period 134 turning events were documented. Patients were proned for a median of 5 (3;7) periods with a median duration of 12 h (8;12). No serious adverse events were recorded. The hospital mortality was 42% and mortality during the ECMO procedure was 35%. CONCLUSION Prone positioning significantly reduces the mortality of patients with severe ARDS. In this series of 26 patients with severe ARDS during ECMO therapy no serious adverse events were found during the use of prone positioning.

Prone positioning of patients during venovenous extracorporeal membrane oxygenation is safe and feasible

BACKGROUND Prone positioning of patients with acute respiratory distress syndrome (ARDS) has been shown to significantly improve survival rates. Prone positioning reduces collapse of dorsal lung segments with subsequent reduction of alveolar overdistension of ventral lung segments, optimizes lung recruitment and enhances drainage. Patients with ARDS treated by extracorporeal membrane oxygenation (ECMO) can also benefit from prone positioning; however, the procedure is associated with a possible higher risk of serious adverse events. OBJECTIVE The aim of this study was to evaluate the safety and feasibility of prone positioning for patients with severe ARDS during ECMO therapy. MATERIAL AND METHODS This study involved a retrospective analysis of all patients placed in a prone position while being treated by venovenous ECMO (vvECMO) for severe hypoxemia in ARDS as bridge to recovery in the interdisciplinary intensive care unit at the University Hospital Leipzig between January 2009 and August 2013. Baseline data, hospital mortality and serious adverse events were documented. Serious adverse events were defined as dislocation or obstruction of endotracheal tube or tracheal cannula, ECMO cannulas and cardiac arrest. Prone positioning was carried out by at least one doctor and three nurses according to a standardized protocol. Results are given as the median (1st and 3rd quartiles). RESULTS A total of 26 patients were treated with vvECMO as bridge to recovery due to severe ARDS. Causes for ARDS were pneumonia (n = 20) and aspiration (n = 2) and four patients had different rare causes of ARDS. The median time on ECMO was 8 days (6;11) and during this period 134 turning events were documented. Patients were proned for a median of 5 (3;7) periods with a median duration of 12 h (8;12). No serious adverse events were recorded. The hospital mortality was 42% and mortality during the ECMO procedure was 35%. CONCLUSION Prone positioning significantly reduces the mortality of patients with severe ARDS. In this series of 26 patients with severe ARDS during ECMO therapy no serious adverse events were found during the use of prone positioning.

Bauchlagerung von Patienten an der venovenösen ECMO ist möglich und sicher

BACKGROUND Prone positioning of patients with acute respiratory distress syndrome (ARDS) has been shown to significantly improve survival rates. Prone positioning reduces collapse of dorsal lung segments with subsequent reduction of alveolar overdistension of ventral lung segments, optimizes lung recruitment and enhances drainage. Patients with ARDS treated by extracorporeal membrane oxygenation (ECMO) can also benefit from prone positioning; however, the procedure is associated with a possible higher risk of serious adverse events. OBJECTIVE The aim of this study was to evaluate the safety and feasibility of prone positioning for patients with severe ARDS during ECMO therapy. MATERIAL AND METHODS This study involved a retrospective analysis of all patients placed in a prone position while being treated by venovenous ECMO (vvECMO) for severe hypoxemia in ARDS as bridge to recovery in the interdisciplinary intensive care unit at the University Hospital Leipzig between January 2009 and August 2013. Baseline data, hospital mortality and serious adverse events were documented. Serious adverse events were defined as dislocation or obstruction of endotracheal tube or tracheal cannula, ECMO cannulas and cardiac arrest. Prone positioning was carried out by at least one doctor and three nurses according to a standardized protocol. Results are given as the median (1st and 3rd quartiles). RESULTS A total of 26 patients were treated with vvECMO as bridge to recovery due to severe ARDS. Causes for ARDS were pneumonia (n = 20) and aspiration (n = 2) and four patients had different rare causes of ARDS. The median time on ECMO was 8 days (6;11) and during this period 134 turning events were documented. Patients were proned for a median of 5 (3;7) periods with a median duration of 12 h (8;12). No serious adverse events were recorded. The hospital mortality was 42% and mortality during the ECMO procedure was 35%. CONCLUSION Prone positioning significantly reduces the mortality of patients with severe ARDS. In this series of 26 patients with severe ARDS during ECMO therapy no serious adverse events were found during the use of prone positioning.

Social aspects of emergency calls in the rescue service

ZusammenfassungHintergrundViele Einsätze in der präklinischen Notfallrettung erscheinen den Rettern als „Fehleinsätze“ oder falsche Indikationen im Sinne der Landesrettungsgesetze. Solche Einsätze werden oftmals durch soziale Aspekte getriggert, oder diese stehen gar im Vordergrund des Einsatzes. Mitarbeiter der Rettungsdienste werden mit sozialen Problemen konfrontiert und fühlen sich in der Folge häufig damit allein gelassen.Ziel der ArbeitDer vorliegende Beitrag fördert das Verständnis der Rettungsdienstmitarbeiter für die Zusammenhänge zwischen gesellschaftlichen Problemen und Gesundheit. Für häufige soziale Notfälle im Rettungsdienst werden Lösungsstrategien angeboten.Material und MethodeIn dieser Arbeit werden Zusammenhänge zwischen sozioökonomischem Status und Gesundheit bzw. Krankheit aufgezeigt. Typische Einsatzindikationen, bei denen soziale Aspekte eine große Rolle spielen, werden dargestellt und Lösungsstrategien für das Vorgehen vorgeschlagen. Diskutiert wird der Umgang mit Fällen von Kindesmisshandlung und häuslicher Gewalt. Drei klassische psychiatrische Problematiken mit häufig sozialer Komponente werden erörtert: psychomotorische Erregungszustände, Suizide und alkoholassoziierte Einsätze. Hier wird besonders auf Fremdgefährdung und aggressive Patienten eingegangen. Gerade bei älteren und chronisch-kranken Patienten spielen neben der Behandlung medizinischer Fragen soziale Probleme eine wichtige Rolle.Ergebnisse und SchlussfolgerungDie Möglichkeiten des Rettungsteams zur Lösung sozialer Probleme sind in aller Regel stark begrenzt. Es ist für den Notarzt jedoch wichtig, die Strukturen und nichtmedizinischen Ansprechpartner in der eigenen Region zu kennen und zielgerichtet an sie zu verweisen. Dazu gehören Sozialdienste, Jugendämter; Kriseninterventionsteams oder beispielsweise sozialpsychiatrische Dienste.AbstractBackgroundMany missions in the preclinical emergency services seem to be triggered by false indications as defined by the Federal State Rescue Act. These emergency calls are often a result of or associated with social issues. Emergency rescue personnel are confronted with social problems and as a result often feel left alone with the problem.AimThis article promotes the understanding of emergency service personnel for the associations between social problems and health. Solution strategies for frequent social emergencies are described.Material and methodsThis article demonstrates the associations between socioeconomic status, health and disease. Typical indications for missions in which social aspects play an important role are presented and solution strategies for the approach are suggested. A discussion is presented on how to deal with cases of child abuse and domestic violence. Three classical psychiatric problem areas with common social components are explained: psychomotor state of excitation, suicide and alcohol-associated incidents and special attention is paid to danger to third parties and aggressive patients. In addition to the treatment of medical conditions, social problems play an important role particularly for the elderly and chronically ill patients.Results and conclusionEmergency personnel have only limited options for dealing with such problems; however, it is important to be aware of regional structures and non-medical organizations, which might be of help in such situations. These include social services, youth welfare services, crisis interventions teams and social psychiatric services.BACKGROUND Many missions in the preclinical emergency services seem to be triggered by false indications as defined by the Federal State Rescue Act. These emergency calls are often a result of or associated with social issues. Emergency rescue personnel are confronted with social problems and as a result often feel left alone with the problem. AIM This article promotes the understanding of emergency service personnel for the associations between social problems and health. Solution strategies for frequent social emergencies are described. MATERIAL AND METHODS This article demonstrates the associations between socioeconomic status, health and disease. Typical indications for missions in which social aspects play an important role are presented and solution strategies for the approach are suggested. A discussion is presented on how to deal with cases of child abuse and domestic violence. Three classical psychiatric problem areas with common social components are explained: psychomotor state of excitation, suicide and alcohol-associated incidents and special attention is paid to danger to third parties and aggressive patients. In addition to the treatment of medical conditions, social problems play an important role particularly for the elderly and chronically ill patients. RESULTS AND CONCLUSION Emergency personnel have only limited options for dealing with such problems; however, it is important to be aware of regional structures and non-medical organizations, which might be of help in such situations. These include social services, youth welfare services, crisis interventions teams and social psychiatric services.

Soziale Aspekte von Einsätzen im Rettungsdienst@@@Social aspects of emergency calls in the rescue service

ZusammenfassungHintergrundViele Einsätze in der präklinischen Notfallrettung erscheinen den Rettern als „Fehleinsätze“ oder falsche Indikationen im Sinne der Landesrettungsgesetze. Solche Einsätze werden oftmals durch soziale Aspekte getriggert, oder diese stehen gar im Vordergrund des Einsatzes. Mitarbeiter der Rettungsdienste werden mit sozialen Problemen konfrontiert und fühlen sich in der Folge häufig damit allein gelassen.Ziel der ArbeitDer vorliegende Beitrag fördert das Verständnis der Rettungsdienstmitarbeiter für die Zusammenhänge zwischen gesellschaftlichen Problemen und Gesundheit. Für häufige soziale Notfälle im Rettungsdienst werden Lösungsstrategien angeboten.Material und MethodeIn dieser Arbeit werden Zusammenhänge zwischen sozioökonomischem Status und Gesundheit bzw. Krankheit aufgezeigt. Typische Einsatzindikationen, bei denen soziale Aspekte eine große Rolle spielen, werden dargestellt und Lösungsstrategien für das Vorgehen vorgeschlagen. Diskutiert wird der Umgang mit Fällen von Kindesmisshandlung und häuslicher Gewalt. Drei klassische psychiatrische Problematiken mit häufig sozialer Komponente werden erörtert: psychomotorische Erregungszustände, Suizide und alkoholassoziierte Einsätze. Hier wird besonders auf Fremdgefährdung und aggressive Patienten eingegangen. Gerade bei älteren und chronisch-kranken Patienten spielen neben der Behandlung medizinischer Fragen soziale Probleme eine wichtige Rolle.Ergebnisse und SchlussfolgerungDie Möglichkeiten des Rettungsteams zur Lösung sozialer Probleme sind in aller Regel stark begrenzt. Es ist für den Notarzt jedoch wichtig, die Strukturen und nichtmedizinischen Ansprechpartner in der eigenen Region zu kennen und zielgerichtet an sie zu verweisen. Dazu gehören Sozialdienste, Jugendämter; Kriseninterventionsteams oder beispielsweise sozialpsychiatrische Dienste.AbstractBackgroundMany missions in the preclinical emergency services seem to be triggered by false indications as defined by the Federal State Rescue Act. These emergency calls are often a result of or associated with social issues. Emergency rescue personnel are confronted with social problems and as a result often feel left alone with the problem.AimThis article promotes the understanding of emergency service personnel for the associations between social problems and health. Solution strategies for frequent social emergencies are described.Material and methodsThis article demonstrates the associations between socioeconomic status, health and disease. Typical indications for missions in which social aspects play an important role are presented and solution strategies for the approach are suggested. A discussion is presented on how to deal with cases of child abuse and domestic violence. Three classical psychiatric problem areas with common social components are explained: psychomotor state of excitation, suicide and alcohol-associated incidents and special attention is paid to danger to third parties and aggressive patients. In addition to the treatment of medical conditions, social problems play an important role particularly for the elderly and chronically ill patients.Results and conclusionEmergency personnel have only limited options for dealing with such problems; however, it is important to be aware of regional structures and non-medical organizations, which might be of help in such situations. These include social services, youth welfare services, crisis interventions teams and social psychiatric services.BACKGROUND Many missions in the preclinical emergency services seem to be triggered by false indications as defined by the Federal State Rescue Act. These emergency calls are often a result of or associated with social issues. Emergency rescue personnel are confronted with social problems and as a result often feel left alone with the problem. AIM This article promotes the understanding of emergency service personnel for the associations between social problems and health. Solution strategies for frequent social emergencies are described. MATERIAL AND METHODS This article demonstrates the associations between socioeconomic status, health and disease. Typical indications for missions in which social aspects play an important role are presented and solution strategies for the approach are suggested. A discussion is presented on how to deal with cases of child abuse and domestic violence. Three classical psychiatric problem areas with common social components are explained: psychomotor state of excitation, suicide and alcohol-associated incidents and special attention is paid to danger to third parties and aggressive patients. In addition to the treatment of medical conditions, social problems play an important role particularly for the elderly and chronically ill patients. RESULTS AND CONCLUSION Emergency personnel have only limited options for dealing with such problems; however, it is important to be aware of regional structures and non-medical organizations, which might be of help in such situations. These include social services, youth welfare services, crisis interventions teams and social psychiatric services.