Hegau-Bodensee-Klinikum Singen

Capillary hemangiomas (CH) are benign proliferative vascular neoplasms commonly present in skin and soft tissues but rarely found intracranially. We describe a case of a 14-year-old male patient with histologically proven CH of the optic nerve, who underwent surgical resection of the lesion due to progressive visual loss. Imaging studies revealed a cystic-solid formation in the suprasellar region lateralized to the right and located above the pituitary gland. This case shows that CH may originate from the optic nerve, leading to its gradual compression and causing optic neuropathy. While the correct differential diagnosis on the MRI may be difficult, surgical treatment is warranted in cases of progressive visual decline.

More extensive and cohesive studies on quadriceps tendon rupture (QTR) repair surgery are required to guide effective treatment strategies. Therefore, in this study, we aimed to identify predictors of subjective functional recovery following QTR repair surgery. This multicentre retrospective cohort study enrolled 191 adults (age ≥ 18years) who underwent surgical unilateral QTR repair (2010-2022) and had ≥ 1-year postoperative follow-up at three trauma centres in Germany. Multiple linear regression and moderation analyses evaluated seven patient-centred factors and eight treatment-related predictors of the International Knee Documentation Committee (IKDC) and Tegner-Lysholm Knee scores. The participants ( meanage = 62.3years) had mean (standard deviation) IKDC and Tegner-Lysholm Knee scores of 67.4 (19.4) and 74.8 (22.5), respectively. Male sex, lower body mass index (BMI), shorter time to surgery, and early rehabilitation adoption predicted higher functional scores (p < 0.05). Smoking and suturing techniques showed no significantmain effects. Age was negatively correlated with IKDC scores when transosseous sutures were applied but not when suture anchors were used. Notably, 6% of the cohort were affected by complications such as re-rupture or deep vein thrombosis. Patient-centred factors (sex and BMI) and treatment-related factors (timing of surgery and rehabilitation protocols) significantly influence postoperative functional outcomes in patients with QTR. Early surgical intervention and dynamic rehabilitation protocols are important for optimising recovery, and suture anchor techniques may be advantageous in older patients. Further research is essential to improve QTR management strategies and enhance patient outcomes. IV-Retrospective cohort study without a comparison group.

Background: The use of vascular closure devices is now common in clinical practice for femoral artery puncture, although manual compression remains the current gold standard. The development and use of vascular closure devices are aimed at improving patient comfort and avoiding complications such as hematoma, pseudoaneurysm formation, and the need for blood transfusion in the event of significant bleeding or surgical revision at the puncture site. Aims: The aim of this study is to evaluate the complication rate after femoral arterial puncture using different closure techniques. Furthermore, patient comfort will also be measured. Material and Methods: In this prospective, two-centre study, 142 patients were randomized into three groups: the Vascular Closure Device (VCD, Cordis), manual compression (MC) and External Compression Device (ECD, Maquet). The primary endpoint is combined with the evaluation of hematoma greater than 5 cm, pseudoaneurysm formation, the need for blood transfusion or relevant bleeding with a hemoglobin drop greater than 2 g/dl, the occurrence of retroperitoneal hematoma, pressure ulcers greater than grade 2, ischemia of the ipsilateral limb, or nerve damage. Follow-up visits are scheduled at 24 hours, 7 days, and 30 days. Results: The ratio of gender and pre-existing conditions within the randomized groups is almost equal. Medication before coronary angiography is comparable. Significantly more interventions are performed in the VCD group. Correspondingly, the procedure time is longer, and dual antiplatelet therapy is prescribed more often. Compression time and time to first hemostasis were significantly longer in the VCD group. The number of rebleeds after primary hemostasis is significantly higher in the ECD group. None of the enrolled patients suffered major bleeding or required a blood transfusion. No retroperitoneal hematoma was observed. Overall, there is one AV fistula in the MC group, two pseudoaneurysms in the VCD group, and one pseudoaneurysm in the ECD group. Pain was reported at significantly higher rates in the MC group than in either device group. The highest level of pain is reported within 48 hours in the MC group, and voiding dysfunction is significantly more frequent in the MC group. The same results are observed for sleep quality. Patients in the MC group reported significantly fewer hematomas greater than 5 cm at 7 days compared to patients who received a VCD. Conclusion: Our results show no significant difference in the achievement of the combined primary endpoint of all three groups. However, the rate of rebleeding after primary hemostasis is significantly lower in the VCD group, even with prolonged procedure time. There was no difference in the incidence of MACCE. Patient pain and voiding dysfunction within 24 hours are highest in the MC group. No difference is reported between 7 and 30 days.

Background: We aimed to evaluate the feasibility of a non-contrast time-of-flight magnetic resonance angiography (TOF-MRA) protocol for the pre-procedural access route assessment of transcatheter aortic valve implantation (TAVI) in comparison with contrast-enhanced cardiac dual-source computed tomography angiography (CTA). Methods and Results: In total, 51 consecutive patients (mean age: 82.69 ± 5.69 years) who had undergone a pre-TAVI cardiac CTA received TOF-MRA for a pre-procedural access route assessment. The MRA image quality was rated as very good (median of 5 [IQR 4-5] on a five-point Likert scale), with only four examinations rated as non-diagnostic. The TOF-MRA systematically underestimated the minimal effective vessel diameter in comparison with CTA (for the effective vessel diameter in mm, the right common iliac artery (CIA)/external iliac artery (EIA)/common femoral artery (CFA) MRA vs. CTA was 8.04 ± 1.46 vs. 8.37 ± 1.54 (p < 0.0001) and the left CIA/EIA/CFA MRA vs. CTA was 8.07 ± 1.32 vs. 8.28 ± 1.34 (p < 0.0001)). The absolute difference between the MRA and CTA was small (for the Bland-Altman analyses in mm, the right CIA/EIA/CFA was -0.36 ± 0.77 and the left CIA/EIA/CFA was -0.25 ± 0.61). The overall correlation between the MRA and CTA measurements was very good (with a Pearson correlation coefficient of 0.87 (p < 0.0001) for the right CIA/EIA/CFA and a Pearson correlation coefficient of 0.9 (p < 0.0001) for the left CIA/EIA/CFA). The feasibility agreement between the MRA and CTA for transfemoral access was good (the right CIA/EIA/CFA agreement was 97.9% and the left CIA/EIA/CFA agreement was 95.7%, Kohen's kappa: 0.477 (p = 0.001)). Conclusions: The TOF-MRA protocol was feasible for the assessment of the access route in an all-comer pre-TAVI population. This protocol might be a reliable technique for patients at an increased risk of contrast-induced nephropathy.

Aparanglioma is arare, extra-adrenal neuroendocrine tumour. Paraganglioma of the urinary bladder is very rare, accounting for < 1% of all paranglioma and only 0.05% of all bladder tumours. Presentation varies greatly and its clinical significance is dependent on the tumour functionality. Since paranglioma may look histologically very similar to urothelial carcinomas, the risk of misdiagnosis is relatively high, with considerable therapeutic and medicolegal consequences. This case describes an incidental paraganglioma of the urinary bladder, diagnosed cystoscopically due to painless microhaematuria and confirmed histologically after performing several immunohistochemical examinations.

Abstract Introduction: Learning motivation is essential to obtain and maintain ultrasound competencies in emergency medicine. Where refresher training is not mandatory, self-assessment is required to evaluate one’s competencies and the need for further training. This can be flawed by overconfidence effects, which inhibits learners´ metacognition and possibly learning motivation. Methods: In this cross-sectional multicentre project, we presented eight ultrasound loops of different pathologies to emergency physicians of different specialities. In addition, the physicians assessed their own and others’ competence and learning motivation using the Situational Motivation Scale comprising intrinsic motivation, external and identified regulation, and amotivation. Results: We were unable to detect generalized overconfidence effects in 86 physicians. However, the subgroup analysis revealed that some specialist physicians with completed training were overconfident, while those still in training were not. Overplacement negatively correlated with intrinsic learning motivation and identified regulation and positively correlated to amotivation. Further analyses revealed that learning motivation was associated with the interactions of the physicians’ risk perception, speciality, and self-assessment. Discussions Our results show that some overconfidence effects are present even in the advanced skill of emergency ultrasound. However, an absence of feedback can lead to a misjudgement of own competencies and even reduce their willingness to participate in training. Particularly trainers and experts whose skills are not further assessed could pose a risk to the patient as they may overconfidently train learners incorrectly. Therefore, lifelong training in emergency ultrasound should include ongoing expert training to avoid misconceptions and ensure patient safety.

Journal Article Cangrelor in patients with percutaneous coronary intervention for acute myocardial infarction after cardiac arrest and/or with cardiogenic shock Get access Uwe Zeymer, Uwe Zeymer Klinikum Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, GermanyStiftung, Institut für Herzinfarktforschung Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany Corresponding author. Tel: ++49-621-503-2941, Fax: ++49-621-503-4002, Email: uwe.zeymer@t-online.de https://orcid.org/0000-0001-7077-283X Search for other works by this author on: Oxford Academic Google Scholar Christiane Lober, Christiane Lober Stiftung, Institut für Herzinfarktforschung Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany Search for other works by this author on: Oxford Academic Google Scholar Stephan Richter, Stephan Richter Hegau-Bodensee Klinikum, Singen, Germany Search for other works by this author on: Oxford Academic Google Scholar Christoph B Olivier, Christoph B Olivier Klinik für Kardiologie, Universitätsherzzentrum Freiburg, Freiburg, Germany Search for other works by this author on: Oxford Academic Google Scholar Kurt Huber, Kurt Huber Klinikum Ottakring, Wien, Austria https://orcid.org/0000-0003-1695-3378 Search for other works by this author on: Oxford Academic Google Scholar Bernhard Haring, Bernhard Haring Kardiologie, Universitätsklinikum Homburg-Saar, Homburg/Saar, Germany Search for other works by this author on: Oxford Academic Google Scholar Peter Schwimmbeck, Peter Schwimmbeck Klinikum Leverkusen, Leverkusen, Germany Search for other works by this author on: Oxford Academic Google Scholar Martin Andrassy, Martin Andrassy RKH Fürst-Stirum-Klinik, Bruchsal, Germany Search for other works by this author on: Oxford Academic Google Scholar Ibrahim Akin, Ibrahim Akin Kardiologie, Universitätsklinikum Mannheim, Kardiologie, Mannheim, Germany Search for other works by this author on: Oxford Academic Google Scholar Alessandro Cuneo, Alessandro Cuneo Krankenhaus und MVZ Maria-Hilf Stadtlohn, Stadtlohn, Germany Search for other works by this author on: Oxford Academic Google Scholar ... Show more Steffen Desch, Steffen Desch Kardiologie: Innere Medizin III, Universitäres Herzzentrum Leipzig, Leipzig, Germany Search for other works by this author on: Oxford Academic Google Scholar Holger Thiele, Holger Thiele Kardiologie: Innere Medizin III, Universitäres Herzzentrum Leipzig, Leipzig, Germany https://orcid.org/0000-0002-0169-998X Search for other works by this author on: Oxford Academic Google Scholar Tobias Geisler Tobias Geisler Universitätsklnikum Tübingen, Innere Medizin III, Tübingen, Germany Search for other works by this author on: Oxford Academic Google Scholar European Heart Journal. Acute Cardiovascular Care, Volume 12, Issue 7, July 2023, Pages 462–463, https://doi.org/10.1093/ehjacc/zuad041 Published: 12 April 2023 Article history Received: 03 January 2023 Revision received: 05 March 2023 Accepted: 30 March 2023 Published: 12 April 2023 Corrected and typeset: 04 May 2023