Vergleich transurethraler Operationsverfahren zur Behandlung der benignen Prostatahyperplasie

Die gutartige Prostatavergrößerung stellt die häufigste Erkrankung des alternden Mannes dar und lässt sich medikamentös wie auch operativ behandeln. Es stehen verschiedene offene und transurethrale Operationsmöglichkeiten zur Verfügung, von denen in dieser Arbeit drei transurethrale Verfahren mit dem Goldstandard der monopolaren TUR-P verglichen wurden. Die Patienten wurden prospektiv, nicht randomisiert in die Gruppen konventionelle TUR-P, bipolare Elektroresektion, Greenlight-PV-Laser und Greenlight-HPS-Laser verteilt. In der Zeit von November 2006 bis Mai 2009 wurden insgesamt 401 Patienten einer transurethralen Prostataresektion zugeführt und in die Studie aufgenommen. Urologische Voroperationen oder maligne Erkrankungen waren Ausschlusskriterien. Von den Patienten wurden Daten prä-, peri- und postoperativ erhoben. Zudem wurden alle Patienten mittels Fragebogen zu ihrem Befinden im Verlauf nach der OP im Abstand von einem, sechs und zwölf Monaten befragt. Aus den peri- und direkt postoperativen Daten lässt sich schlussfolgern, dass die drei - neben dem Goldstandard der monopolaren TUR-P - getesteten Verfahren vom Outcome grundsätzlich mindestens ein ebenso gutes Ergebnis liefern. Es zeigen sich Unterschiede bei den Laserverfahren in Bezug auf signifikant kürzere Hospitalisierungszeiten und geringere Blutungskomplikationen. Jedoch gibt es mehr technische Probleme bei den Laserverfahren. Alle anderen Komplikationen zeigen sich nicht signifikant unterschiedlich. Bei der bipolaren Elektroresektion zeigen sich insbesondere signifikant weniger Erektionsprobleme. Bei den Komplikationen zeigt sich ein gering erhöhtes Risiko für Harnverhalte zwischen 6 Monaten und einem Jahr, ansonsten sind die Komplikationen nicht unterschiedlich zu den anderen Verfahren. Alle drei untersuchten Verfahren stellen eine relevante Alternative zur TUR-P dar. und die Laserverfahren haben ihre Stärken bei blutungsgefährdeten und multimorbiden Patienten. Die bipolare Resektionstechnik zeigt ihre Vorteile bei dem Erhalt der Sexualfunktion und eignet sich besonders für junge und sexuell aktive Patienten. Als Ausblick bleibt zu untersuchen, wie stark die Erfolge der einzelnen Verfahren vom Operateur abhängig sind und wie das langfristige Outcome (drei bis fünf Jahre) der verschiedenen Techniken sich darstellt

Endobronchial Lipomatous Hamartoma: An Incidental Finding in a Patient with Atrial Fibrillation—A Case Report

Introduction. Lung hamartomas are the most common benign tumors of the lung. Typically, they are located in the peripheral lung, while an endobronchial localisation is rare. Case Presentation. We present a case with the rare diagnosis of an endobronchial hamartoma as incidental finding in a 69-year-old male, caucasian patient with atrial fibrillation. At first admission, the patient's exertional dyspnea was caused by atrial fibrillation. Relapse of exertional dyspnea in the absence of arrhythmia was due to postobstructive pneumonia caused by an endobronchial hamartoma. Conclusion. Endobronchial tumors such as endobronchial lipoma or hamartoma should be considered as potential causes of exertional dyspnea and thus as differential diagnosis of atrial fibrillation. Although endobronchial hamartomas are benign, resection is recommended to prevent postobstructive lung damage

The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial.

Leppert F, Siebermair J, Wesemann U, et al. The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial. Clinical research in cardiology : official journal of the German Cardiac Society. 2020.BACKGROUND: Impact of telemedicine with remote patient monitoring (RPM) in implantable cardioverter-defibrillator (ICD) patients on clinical outcomes has been investigated in various clinical settings with divergent results. However, role of RPM on patient-reported-outcomes (PRO) is unclear. The INFRARED-ICD trial aimed to investigate the effect of RPM in addition to standard-of-care on PRO in a mixed ICD patient cohort.; METHODS AND RESULTS: Patients were randomized to RPM (n=92) or standard in-office-FU (n=88) serving as control group (CTL). At baseline and on a monthly basis over 1 year, study participants completed the EQ-5D questionnaire for the primary outcome Quality of Life (QoL), the Hospital Anxiety and Depression Scale, and the Florida Patient Acceptance Survey questionnaire for secondary outcomes. Demographic characteristics (82% men, mean age 62.3years) and PRO at baseline were not different between RPM and CTL. Primary outcome analysis showed that additional RPM was not superior to CTL with respect to QoL over 12months [+1.2 vs.+3.9 points in CTL and RPM group, respectively (p=0.24)]. Pre-specified analyses could not identify subgroups with improved QoL by the use of RPM. Neither levels of anxiety (-0.4 vs. -0.3, p=0.88), depression (+0.3 vs.±0.0, p=0.38), nor device acceptance (+1.1 vs.+1.6, p=0.20) were influenced by additional use of RPM.; CONCLUSION: The results of the present study show that PRO were not improved by RPM in addition to standard-of-care FU. Careful evaluation and planning of future trials in selected ICD patients are warranted before implementing RPM in routine practice

Insertable cardiac monitor with a long sensing vector: Impact of obesity on sensing quality and safety

BACKGROUND Fat layers in obese patients can impair R-wave detection and diagnostic performance of a subcutaneous insertable cardiac monitor (ICM). We compared safety and ICM sensing quality between obese patients [body mass index (BMI) ≥ 30 kg/m$^{2}$] and normal-weight controls (BMI <30 kg/m$^{2}$) in terms of R-wave amplitude and time in noise mode (noise burden) detected by a long-sensing-vector ICM. MATERIALS AND METHODS Patients from two multicentre, non-randomized clinical registries are included in the present analysis on January 31, 2022 (data freeze), if the follow-up period was at least 90 days after ICM insertion, including daily remote monitoring. The R-wave amplitudes and daily noise burden averaged intraindividually for days 61-90 and days 1-90, respectively, were compared between obese patients (n = 104) and unmatched (n = 268) and a nearest-neighbour propensity score (PS) matched (n = 69) normal-weight controls. RESULTS The average R-wave amplitude was significantly lower in obese (median 0.46 mV) than in normal-weight unmatched (0.70 mV, P < 0.0001) or PS-matched (0.60 mV, P = 0.003) patients. The median noise burden was 1.0% in obese patients, which was not significantly higher than in unmatched (0.7%; P = 0.056) or PS-matched (0.8%; P = 0.133) controls. The rate of adverse device effects during the first 90 days did not differ significantly between groups. CONCLUSION Although increased BMI was associated with reduced signal amplitude, also in obese patients the median R-wave amplitude was >0.3 mV, a value which is generally accepted as the minimum level for adequate R-wave detection. The noise burden and adverse event rates did not differ significantly between obese and normal-weight patients.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04075084 and NCT04198220

Insertable cardiac monitor with a long sensing vector: Impact of obesity on sensing quality and safety

BackgroundFat layers in obese patients can impair R-wave detection and diagnostic performance of a subcutaneous insertable cardiac monitor (ICM). We compared safety and ICM sensing quality between obese patients [body mass index (BMI) ≥ 30 kg/m2] and normal-weight controls (BMI &lt;30 kg/m2) in terms of R-wave amplitude and time in noise mode (noise burden) detected by a long-sensing-vector ICM.Materials and methodsPatients from two multicentre, non-randomized clinical registries are included in the present analysis on January 31, 2022 (data freeze), if the follow-up period was at least 90 days after ICM insertion, including daily remote monitoring. The R-wave amplitudes and daily noise burden averaged intraindividually for days 61–90 and days 1–90, respectively, were compared between obese patients (n = 104) and unmatched (n = 268) and a nearest-neighbour propensity score (PS) matched (n = 69) normal-weight controls.ResultsThe average R-wave amplitude was significantly lower in obese (median 0.46 mV) than in normal-weight unmatched (0.70 mV, P &lt; 0.0001) or PS-matched (0.60 mV, P = 0.003) patients. The median noise burden was 1.0% in obese patients, which was not significantly higher than in unmatched (0.7%; P = 0.056) or PS-matched (0.8%; P = 0.133) controls. The rate of adverse device effects during the first 90 days did not differ significantly between groups.ConclusionAlthough increased BMI was associated with reduced signal amplitude, also in obese patients the median R-wave amplitude was &gt;0.3 mV, a value which is generally accepted as the minimum level for adequate R-wave detection. The noise burden and adverse event rates did not differ significantly between obese and normal-weight patients.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04075084 and NCT04198220

Association of Early Repolarization Pattern on ECG with Risk of Cardiac and All-Cause Mortality: A Population-Based Prospective Cohort Study (MONICA/KORA)

In a population-based cohort study of middle-aged people in Central Europe, Stefan Kääb and colleagues find an association between electrocardiographic early repolarization pattern and mortality risk

Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization.

The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain ∼8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD

Health Related Quality of Life and Device-Acceptance in Patients with Implantable Cardioverter-Defibrillators and Telemonitoring

Leppert F, Siebermair J, Martens E, Kääb S, Greiner W. Health Related Quality of Life and Device-Acceptance in Patients with Implantable Cardioverter-Defibrillators and Telemonitoring. Value in Health. 2013;16(7):A535.HEALTH RELATED QUALITY OF LIFE AND DEVICE-ACCEPTANCE IN PATIENTS WITH IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS AND TELEMONITORING Florian Leppert, Johannes Siebermair, Stefan Kääb, Wolfgang Greiner OBJECTIVES: Telemedical systems (TMS) and data management for implantable cardioverter-defibrillators (ICD) promise to reduce costs and optimize patient care. Depressive symptoms are common among patients with an ICD and the health related quality of life (HRQoL) is affected by the underlying disease and the implanted device, respectively. TMS might improve the HRQoL of patients and ICDs acceptance due to a closer monitoring and, thereby, an increased level of perceived safety. In this study, changes in the level of depression, HRQoL and device acceptance over a period of six months after ICD-implantation were investigated. METHODS: In this randomized controlled trial, 161 (80.7% male; age: 64,1 ± 14,6; 82% with coronary disease, 11% with dilated cardiomyopathy) patients with an ICD were randomized at the day of implantation into intervention (n=82) or control group (n=79). Patients in the intervention group were equipped with a telemonitoring system that transferred device data (e.g. critical events, status of battery, heart function) from the patients’ home to the medical practitioner via internet. The control group received regular care. Patients were asked to fill out three questionnaires (the generic EQ-5D, the depression specific Hospital Anxiety and Depression Scale (HADS) and the device specific Florida Patient Acceptance Survey (FPAS)); the follow-up period was six month, with postal surveys on a monthly basis (7 times in total). Collected data were analyzed in a pseudonymized manner. Datasets with missing values were filled by applying the Expectation-Maximization (EM) method. RESULTS: Nine patients dropped out before survey completion at month six for different reasons (e.g. draw back consent or death). Of the remaining 152 patients 140 patients filled out at least two sets of questionnaires and were included in the analyses. After six months the mean improvement in the health related quality of life (EQ-5D-Index) in the telemonitoring group was 10.7 points compared to baseline (p=.006) while the mean change in HRQoL in the control group was 5.5 points (p=.138). FPAS and HADS-D showed small but non-significant advantage for the telemonitoring group concerning acceptance and level of depression, respectively. CONCLUSIONS: Preliminary results suggest that telemonitoring systems have the ability to improve the health related quality of life of patients with implantable cardioverter-defibrillators. Results on effects towards the level of depression and anxiety and the enhancement of ICDs acceptance are also promising. Since ICDs are used in chronic heart diseases a longer follow-up period seems to be required to validate the effects

Health related quality of life and Device-Acceptance in patients with implantable cardioverter-defibrillators and telemonitoring

Siebermair J, Martens E, Leppert F, et al. Health related quality of life and Device-Acceptance in patients with implantable cardioverter-defibrillators and telemonitoring. Clinical Research in Cardiology. 2014;103(Suppl 1):V548

Accuracy of high-sensitive troponin depending on renal function for clinical outcome prediction in patients with acute heart failure

High-sensitive troponin T (hs-TnT) is increasingly used for clinical outcome prediction in patients with acute heart failure (AHF). However, there is an ongoing debate regarding the potential impact of renal function on the prognostic accuracy of hs-TnT in this setting. The aim of the present study was to assess the prognostic value of hs-TnT within 6 h of admission for the prediction of 30-day mortality depending on renal function in patients with AHF. Patients admitted to our institution due to AHF were retrospectively included. Clinical information was gathered from electronic and paper-based patient charts. Patients with myocardial infarction were excluded. A total of 971 patients were enrolled in the present study. A negative correlation between estimated glomerular filtration rate (eGFR) and hsTnT was identified (Pearson r = - 0.16; p &amp;lt; 0.001) and eGFR was the only variable to be independently associated with hsTnT. The area under the curve (AUC) of hs-TnT for the prediction of 30-mortality was significantly higher in patients with an eGFR ≥ 45 ml/min (AUC 0.74) compared to those with an eGFR &amp;lt; 45 ml/min (AUC 0.63; p = 0.049). Sensitivity and specificity of the Youden Index derived optimal cut-off for hs-TnT was higher in patients with an eGFR ≥ 45 ml/min (40 ng/l: sensitivity 73%, specificity 71%) compared to patients with an eGFR &amp;lt; 45 ml/min (55 ng/l: sensitivity 63%, specificity 62%). Prognostic accuracy of hs-TnT in patients hospitalized for AHF regarding 30-day mortality is significantly lower in patients with reduced renal function