Sana Klinikum Offenbach

BackgroundCardiopulmonary resuscitation (CPR) is vital for improving patient outcomes in medical emergencies. Both laypersons and health care professionals often seek guidance on performing CPR. In today’s digital age, many turn to easily accessible platforms such as YouTube for practical skills.ObjectiveThis study evaluates the didactic and content quality of CPR videos on YouTube using comprehensive checklists and investigates the association between the assigned quality scores and type of publisher, view count, and video rankings.MethodsVideos were included based on defined search terms and exclusion criteria. Two emergency physicians rated each video independently using validated checklists concerning content and didactic quality. Linear regression analysis was performed to assess the relationships between video quality scores and view counts, as well as video rankings.ResultsOf the 250 videos identified, 74 (29.6%) met the inclusion criteria. On the content checklist, videos scored an average of 56.5% (SD 19.2%), and on the didactic checklist, they scored 66.6% (SD 14.3%); none achieved the maximum score. Videos from official medical institutions scored significantly higher in content quality compared to nonofficial sources (P=.04). Video quality scores were not associated with video rankings or view counts.ConclusionsThe study highlights substantial variability in the didactic and content quality of CPR-related videos on YouTube. For medical educators, this underlines the need to curate and recommend reliable online resources or to develop new high-quality content aligned with established checklists. For the general public, the findings caution against relying on popularity metrics as indicators of accuracy and emphasize the importance of guidance from trusted institutions.

Pregnancy rates in women on hemodialysis are low but increasing due to improvements in nephrological and obstetrical care. All pregnancies in dialysis patients qualify as high-risk pregnancies, but courses and outcomes of pregnancy vary depending on the underlying cause of renal failure. While more information about best practice in treatment of pregnant dialysis patients has accumulated recently, there are few cases described with systemic lupus erythematosus (SLE) as underlying disease and there is almost no information about twin pregnancies in this cohort. We report the case of a successful twin pregnancy in a 30-year old hemodialysis patient with SLE who had repeatedly miscarried before. Thanks to her remaining own diuresis the required augmentation of dialysis dose was moderate with 25–27.5 h/week, leading to largely physiological blood urea levels. In the course of pregnancy, the patient experienced severe preeclampsia, so anticipated C-section delivered both twins at 34 + 1 weeks of gestation. Both newborns were appropriate for gestational age. The boy was clinically stable but the girl initially needed intensive care. In the postpartum period the mother developed hypertensive encephalopathy and status epilepticus treated successfully. Both mother and children are well and do not suffer from any lasting damage acquired during pregnancy. Pregnancy in dialysis patients is feasible even in challenging conditions as the combination of end-stage renal disease, SLE and twin pregnancy. Our case demonstrates a possible treatment regimen in a special clinical situation. By changes in medication and augmented dialysis dose appropriate to the specific individual extent of uremia, we achieved a near normal duration of pregnancy. More data on rare conditions such as twin pregnancies on dialysis with underlying autoimmune disorders are necessary to give firm advice.

Background/Introduction: Margin assessment in Lentigo maligna (LM) and Lentigo maligna melanoma (LMM) is challenging. Many of these lesions require extensive surgical procedures for R0 resections with unclear histological and clinical features predicting lateral spread. Recently, PRAME was described as a useful antibody to determine margins in these entities. However, several questions, like acceptable PRAME+ cell number and density in resection margins and optimal safety margins, especially in head and neck areas, remain. Methods: We analyzed cases of LMIS and LMM since the introduction of PRAME and before the introduction of PRAME, with more than 171 cases in total. We re-stained security margins with PRAME. Results: We identified a correlation between reported dermal mitoses in LMM and the number of surgical procedures. In many LMM cases before the widespread use of PRAME from our archives, we detected a high density of PRAME+ cells in melanoma security margins previously labeled tumor-free. No local recurrence could be identified in these cases, with the caveat of limited follow-up and small case numbers. Conclusions: Our findings raise important questions regarding margin assessment with PRAME and the reporting of residual cells in margins.

ObjectivesData from the German Aortic Valve Registry (GARY) were analysed to determine whether there are differences between patients with and without chronic lung disease (CLD) undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) and whether TAVI or SAVR is more beneficial in patients with preexisting CLD.MethodsFollow-up data from GARY registry patients treated from 2014 to 2015 and from 2018 to 2019 were incorporated in the analysis. Demographic results for each of the 2 treatment modalities were evaluated, and patients with and without CLD were compared. In a second step, variables that would have influenced the treatment decision in CLD patients in direction of either SAVR or TAVI were accounted for in the adjusted analysis. This led to a subgroup of 1385 patients with CLD that was subjected to propensity score weighted analysis to compare outcomes of TAVI and SAVR.ResultsAfter exclusion, 11 457 SAVR patients and 2378 TAVI patients were analysed. CLD patients were sicker than patients without CLD, although the observed 30-day mortality was lower than expected by 3 risk scores. Accordingly, long-term survival in CLD patients was lower in both treatment groups than in patients without CLD. Thirty-day mortality was similar in the 2 treatment groups (SAVR 2.3%, TAVI 3.8%, P = .964) in spite of a possible selection bias in favour of SAVR. During a 5-year follow-up, survival after TAVI (44.6%) was significantly lower than after SAVR (56.7%), P = .029.ConclusionsPatients with CLD undergoing SAVR or TAVI are generally at higher risk for complications or death after the procedure than patients without CLD. After 5 years, patient-reported outcomes were similar in TAVI and in SAVR patients.

Interventional closure of symptomatic paravalvular leaks (PVL) after valve replacement has developed to an attractive treatment option for patients at high operative risk. However, prospective and long-term data are sparse. We analysed data from a multicentre prospective registry on interventional PVL closure. 41 patients with symptomatic PVL were included in the plug registry at nine German hospitals from 2014 until 2020. In total 50 interventions with 67 plug implantations were recorded, 46.3% of procedures were performed for aortic and 53.7% for mitral PVLs. In 82% of patients PVL closure was performed once, in 16% twice and 2% underwent three procedures. Indication for PVL closure was symptomatic heart failure with NYHA class ≥ II (63.4%), haemolysis (4.9%), or NYHA class ≥ II and haemolysis (31.7%). PVL closure was completely successful in 76%, partially successful in 10% and failed in 14%. Acute improvement of one NYHA class was achieved in 56.4% and of two NYHA classes in 15.4%. Postprocedural no residual severe aortic PVL was described and residual severe mitral PVL was seen in 4.8%. Postinterventional complications occurred in 21.9%. In-hospital mortality rate was 4.9%. A follow-up was performed after 30days, 12months, 3 and 5years. Calculated mortality rates were 10.1% at 1-year-, 18.5% at 3-year- and 32.5% at 5-year-follow-up. The estimated rates for mortality and/or reintervention (surgical or interventional) were 25.6% at 1-year, 36.8% at 3-year and 45.1% at 5-year follow-up. The multicentre German Plug-Registry describes a high procedural success rate with clinical improvement in most patients and acceptable long-term outcomes after percutaneous PVL closure. NCT03179969.

BackgroundProphylactic application of a haemostatic gel to the resection field may be an easy way to prevent delayed bleeding, a frequent complication after endoscopic mucosal resection (EMR).ObjectiveWe aimed to evaluate if the prophylactic application of a haemostatic gel to the resection field directly after EMR can reduce the rate of clinically significant delayed bleeding events.DesignWe conducted a prospective randomised trial of patients undergoing hot-snare EMR of flat lesions in the duodenum (≥10 mm) and colorectum (≥20 mm) at 15 German centres. Prophylactic clip closure was not allowed, but selective clipping or coagulation could be used prior to randomisation to treat intraprocedural bleeding or for prophylactic closure of visible vessels. Patients were randomised to haemostatic gel application or no prophylaxis. The primary endpoint was delayed bleeding within 30 days.ResultsThe trial was stopped early due to futility after an interim analysis. The primary endpoint was analysed in 232 patients (208 colorectal, 26 duodenal). Both groups were comparable in age, sex, comorbidities and lesion characteristics. Preventive measures, such as selective clipping or coagulation, were applied prior to randomisation in 51.9% of cases, with no difference between groups. Delayed bleeding occurred in 14 cases (11.7%; 95% CI 7.1% to 18.6%) after Purastat and in 7 cases (6.3%; 95% CI 3.1% to 12.3%) in the control group (p=0.227), with no difference between colorectal and duodenal subgroups.ConclusionThe application of a haemostatic gel following EMR of large flat lesions in the duodenum and colorectum does not reduce the rate of delayed bleeding.

Als ich im August 1969 zunächst als Volontär in das Lektorat der Frankfurter Verlage Suhrkamp und Insel eintrat, konnte einem Hermann-Hesse-Editionsarchiv, noch lange nicht die Rede sein. Spezielle Lektorate oder Archive für Stammautoren wie Bertolt Brecht und Hermann Hesse, welche die Existenz des Unternehmens langfristig sicherten, gab es erst Jahrzehnte später. Zwar war es Hesse, der Peter Suhrkamp nach dessen Trennung von den emigrierten Erben des Fischer Verlags 1950 die Gründung eines neuen Verlages ermöglicht hatte (finanziert wurde dies durch Hesses Schweizer Freund und Mäzen Georg Reinhart). Zunächst wurden nach Suhrkamps Tod 1959 im Kulturbetrieb der 1960er-Jahre aber andere Verlagsautoren wie Brecht und Max Frisch favorisiert.

BackgroundTotal knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. Pain control is crucial for rapid mobilisation and reduces side effects as well as the length of hospital stay. In this context, a variety of multimodal pain control regimes show good pain relief, including several nerve blocks, iPACK and local infiltration analgesia (LIA). To compare the analgesic potency of LIA and the combination of continuous femoral nerve block + sciatic single-shot nerve block under general anaesthesia, we conducted a prospective, randomized, controlled, non-blinded single-centre study.Method 139 ASA I-III Patients were enrolled in the study, randomised into two groups. The LIA group received an intra- and periarticular infiltration containing a mix of ropivacaine 0,2%, adrenaline and ketorolac, followed by an infusion of the same mixture for 48 h via an intraarticular catheter. The patients in the FEM group received a combination of continuous femoral nerve block with a catheter using 30 ml prilocaine 1% and ropivacaine 0,2% plus a single-shot sciatic nerve block via an antero-medial approach (landmark-based technique) with 20 ml ropivacaine 0,75%. Postoperative pain scores were analysed during the first two postoperative days, as well as opioid consumption, the degree of knee movement and the occurrence of infections in both groups applying the Wilcoxon-Mann-Whitney test, Friedman chi-square test and the Log-rank-test.ResultsNo significant difference in pain scores, opioid consumption, time to first rescue analgesia, knee range of motion, age, height, weight and ASA could be detected. No severe side effects, such as secondary bleeding or infections, were reported.ConclusionBoth techniques are well established, provide equal pain relief for TKA and support early postoperative mobilisation.Trial RegistrationDRKS 00027145 08/12/2021. “retrospectively registered”.