Klinikum Vest

Tandem lesions (TLs) are a subtype of acute ischemic stroke, which involve an extracranial carotid lesion (ie, severe carotid stenosis ≥70%) with large vessel occlusion. While large vessel occlusion has a standard approach with mechanical thrombectomy (MT), the best practice for intervention of the carotid lesion is not well-established. Utilizing data from the ASSIST registry, we investigated the differences in clinical and procedural outcomes between acute versus nonacute stenting. The ASSIST registry (an international acute ischemic stroke MT prospective study) was utilized to identify the subgroup of patients with acute ischemic stroke secondary to TL who received MT. The TLs were grouped by MT+acute carotid stenting (CAS) versus MT+acute carotid nonstenting. The demographics and clinical outcomes (90-day modified Rankin Scale score) were compared between TL and non-TL groups, and between MT+CAS and MT+acute carotid nonstenting. Multivariable analyses were performed to determine independent predictors of clinical outcomes. A total of 183 of 1270 (14.4%) TLs were identified in the ASSIST registry. MT+CAS was performed in 83 of 183 (45.4%) subjects, and 100 of 183 (54.6%) received MT+acute carotid nonstenting. There are no significant differences at baseline between the 2 groups in the National Institutes of Health Stroke Scale score, Alberta Stroke Program Early Computed Tomography Score, or target vessel. Achieving a modified Rankin Scale score of 0 to 2 at 90 days was 70.9% in the MT+CAS group versus 48.9% in the MT+acute carotid nonstenting group (P=0.001), with a modified Rankin Scale score of 0 to 2 being significantly associated with the MT+CAS group in multivariable analysis (odds ratio, 2.14 [95% CI, 1.01-4.51]). There was no significant difference in mortality or symptomatic intracerebral hemorrhage between the groups. In acute ischemic stroke, secondary to TLs treatment with thrombectomy and acute carotid stenting is associated with improved 90-day functional outcome without an increase in symptomatic intracerebral hemorrhage compared with no acute stenting approach. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03845491.

ZusammenfassungDie photodynamische Therapie (PDT) ist international zur Behandlung von In‐situ‐Formen des keratinozytären Hautkrebses (aktinische Keratosen, Morbus Bowen, Basalzellkarzinome) zugelassen. Für diese Indikationen bestehen standardisierte Behandlungsprotokolle mit Schmalspektrum‐Lichtquellen oder (künstlichem) Tageslicht, die zu Heilung, geringer Rezidivrate der Läsionen und sehr gutem kosmetischen Ergebnis führen. Die Tageslicht‐PDT ist dabei im Hinblick auf die deutlich geringere Schmerzhaftigkeit und damit verbundene höhere Akzeptanz durch die Patienten der konventionellen PDT überlegen.Neuere Indikationen, für die noch keine Zulassung vorliegt, für die die Studienlage aber ausreichende Wirksamkeit belegt, sind entzündliche (Lichen sclerosus, Akne) und infektiöse Dermatosen (Viruswarzen, kutane Leishmaniose, atypische Mykobakteriose). Darüber hinaus wird die PDT zunehmend in der ästhetischen Dermatologie zur Hautverjüngung eingesetzt.

Zusammenfassung Hintergrund Die Professionalisierung im Umgang mit Verdachtsfällen von Kindesmisshandlung im Gesundheitswesen hat einen wachsenden Bedarf an Beratung und Fortbildung ausgelöst. Insbesondere die Einordnung von Verletzungen erfordert oft rechtsmedizinische Expertise, die in Flächenländern wie Nordrhein-Westfalen (NRW) ohne zusätzliche (Stellen)Finanzierung schwer zu decken ist. Ziel Im April 2019 wurde mit dem „Kompetenzzentrum Kinderschutz im Gesundheitswesen NRW“ (KKG NRW) ein Angebot, das rechtsmedizinische Beratung (am Hauptstandort, dem Institut für Rechtsmedizin Köln) und pädiatrische Expertise (an der Vestischen Kinder- und Jugendklinik Datteln) kombiniert, erschaffen. Gefördert wird das KKG NRW durch das Ministerium für Arbeit, Gesundheit und Soziales des Landes Nordrhein-Westfalen (MAGS). Ziel dieser Auswertung ist die Darstellung des Beratungsbedarfs und der Möglichkeiten, die ein landesgefördertes Projekt bieten kann. Methode Deskriptive Auswertung der unterschiedlichen Tätigkeiten des KKG NRW in der ersten Förderperiode und anteilig in der zweiten. Ergebnisse Neben telefonischer Beratung (432 Fälle) und E‑Mail-Kontakt (277 Fälle) ist mit dem Online-Konsil-System (1228 Fälle) eine datenschutzkonforme Beratung, inkl. Übermittlung von Bildmaterialien, möglich. Die Nutzung des Konsilsystems, hat sich etabliert, wobei körperliche Misshandlungsfälle hier am häufigsten beraten werden. Weiter unterstützt das KKG NRW durch Fachfortbildungen und Arbeitsmaterialien zu verschiedenen Themen. Durch die Einbeziehung des Öffentlichen Gesundheitsdienstes und der Kinderradiologie wurde das Angebot weiterausgebaut. Diskussion Die finanzielle Sicherstellung eines so umfassenden Beratungs- und Fortbildungsangebotes, wie dem des KKG NRW, bleibt eine Herausforderung. Langfristige Finanzierungen vonseiten öffentlicher Institutionen sind entscheidend, um Projekte wie diese zu stärken und qualifiziertes Personal in diesen Projekten zu halten, um somit einen nachhaltigen Beitrag zum Kinderschutz zu leisten.

BackroundThe use of flow diverting stents in the treatment of intracranial aneurysms is associated with a risk of neurological morbidity due to their thrombogenicity. To reduce this risk different surface modifications have been developed. The Derivo 2 Embolization Device (Acandis, Pforzheim, Germany) has proven to be a safe and effective flow diverter. To overcome the risk of thrombo-embolism, the device was modified by adding an anti-thrombogenic fibrin-heparin coating. We aimed to assess the safety and effectiveness of the Derivo 2 heal Embolization Device.MethodsRetrospective multicenter data from nine German neurovascular centers between February 2022 until December 2023 were used. Patients treated with the Derivo 2 heal Embolization Device for unruptured or ruptured intracranial aneurysms were included. Peri- and postprocedural adverse events, clinical outcomes, and angiographic follow-up results were evaluated.Results84 patients (73.8% female; mean age 58.7 years) with 89 aneurysms (mean size 9.8 mm) were included. 87.6% were located in the anterior circulation. Most of them were sidewall aneurysms (88.8%). 96 flow diverters were used. 99.0% were successfully implanted. An in-stent balloon angioplasty was performed in 6.0% of the cases. An additional coiling was performed in 28.6%. Technical difficulties were present in 12.0% of the cases. Thrombotic events occurred in 4.8% with no neurological sequelae. Mortality and morbidity were 0 and 1.2% respectively. Adequate aneurysm occlusion was achieved in 80.7% with a mean follow-up time of 6.6 months.ConclusionThe Derivo 2 heal Embolization Device showed a satisfying aneurysm occlusion and safety with a low rate of neurological morbidity.

SummaryActinic keratosis (AK) are common lesions in light‐skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence‐based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office‐based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to AK, actinic cheilitis, Bowen's disease, occupational disease and care structures.

This article reviews the 2022 European Society for Photodynamic Therapy (Euro-PDT) Annual Congress. PDT has been investigated for the treatment of a broad number of oncologic, infectious and inflammatory indications. New studies confirm the potential for wider use of topical PDT for acne and photoaging, as well as several uncommon conditions including tinea capitis, Mycobacterium marinum, cutaneous alternariosis, resistant acral warts, eyelid Bowen's disease, mycosis fungoides, pseudolymphoma, and graft-versus-host disease. Hidradenitis suppurativa patients may also benefit from intra-lesional PDT. Several methods of delivering PDT have been validated, including conventional, daylight and artificial daylight PDT. Light-emitting fabrics have emerged as an innovative solution to the delivery of uniform light over the scalp as well as anatomically-challenging sites, with opportunities now to control and monitor these devices via mobile phone applications. Pre-treatment of patients with thicker, more difficult-to-treat actinic keratoses (AK) with calcitriol appears to be a practical approach to increasing efficacy, although this is associated with increased local skin reactions. Sequential treatment of AK and photoaging with daylight-PDT and injectable NASHA gel indicates that these two therapeutic approaches offer complementary effects. Potential biomarkers may help predict responsiveness of patients with field cancerization and AK receiving daylight PDT. Over-expression of the proto-oncogene, Myc, has been observed in poor responders, whilst the tumour suppressor gene, PTEN, showed under-expression. The potential for use and methods of delivery of topical PDT for dermatological indications continue to expand the enhanced choice of treatment offered to patients.