Pub Date : 2024-11-15DOI: 10.3238/arztebl.m2024.0195
Markus Liebrich, Christoph Dingemann, Detlef Roser, Hartwig Schrimm, You-Shan Feng, Wolfgang Hemmer, Joerg Seeburger, Vladimir Voth
Background: The standard aortic valve replacement operations in young patients are bioprosthetic or mechanical aortic valve replacement. In this study, we present the long-term results of the Ross operation in young patients.
Methods: The Ross operation with root replacement was performed on 795 patients between 1995 and 2020. The endpoints were overall survival, re-operation/reintervention rates on the autograft and homograft/RV-PA conduit (RV, right ventricle; PA, pulmonary artery), and the occurrence of serious adverse events.
Results: 795 patients (75% male, 25% female; mean age 43 ± 14 years) underwent the Ross operation with root replacement. The 30-day mortality was 1% (8 patients) with a 95% confidence interval of [0.48; 1.9]. The follow-up was 96 % complete and covered 9540 patient-years, with a mean follow-up time of 12 ± 7 years. The survival rates at 5, 10, 15 and 20 years were 97% [96; 98], 96% [93; 96], 92% [89; 94] and 86% [83; 90]. The rate of autograft survival without reoperation was 94% [92; 96] at 10 years and 80% [76; 85] at 20 years. The rate of homograft/RV-PA conduit survival without reoperation was 95% [93; 97] at 10 years and 85% [81; 90] at 20 years. There were 5 cases of hemorrhage, 14 of thromboembolic complications or apoplexy, and 19 of endocarditis.
Conclusion: The Ross operation with root replacement was associated with high survival rates over 25 years of follow-up. The rates of reoperation and reintervention, the morbidity and mortality, and the rate of endocarditis are low. The Ross operation is thus an effective surgical treatment option for young patients with aortic valve disease.
{"title":"The Ross Operation in Young Patients—A Single-Center, Long-Term Follow-Up Study.","authors":"Markus Liebrich, Christoph Dingemann, Detlef Roser, Hartwig Schrimm, You-Shan Feng, Wolfgang Hemmer, Joerg Seeburger, Vladimir Voth","doi":"10.3238/arztebl.m2024.0195","DOIUrl":"10.3238/arztebl.m2024.0195","url":null,"abstract":"<p><strong>Background: </strong>The standard aortic valve replacement operations in young patients are bioprosthetic or mechanical aortic valve replacement. In this study, we present the long-term results of the Ross operation in young patients.</p><p><strong>Methods: </strong>The Ross operation with root replacement was performed on 795 patients between 1995 and 2020. The endpoints were overall survival, re-operation/reintervention rates on the autograft and homograft/RV-PA conduit (RV, right ventricle; PA, pulmonary artery), and the occurrence of serious adverse events.</p><p><strong>Results: </strong>795 patients (75% male, 25% female; mean age 43 ± 14 years) underwent the Ross operation with root replacement. The 30-day mortality was 1% (8 patients) with a 95% confidence interval of [0.48; 1.9]. The follow-up was 96 % complete and covered 9540 patient-years, with a mean follow-up time of 12 ± 7 years. The survival rates at 5, 10, 15 and 20 years were 97% [96; 98], 96% [93; 96], 92% [89; 94] and 86% [83; 90]. The rate of autograft survival without reoperation was 94% [92; 96] at 10 years and 80% [76; 85] at 20 years. The rate of homograft/RV-PA conduit survival without reoperation was 95% [93; 97] at 10 years and 85% [81; 90] at 20 years. There were 5 cases of hemorrhage, 14 of thromboembolic complications or apoplexy, and 19 of endocarditis.</p><p><strong>Conclusion: </strong>The Ross operation with root replacement was associated with high survival rates over 25 years of follow-up. The rates of reoperation and reintervention, the morbidity and mortality, and the rate of endocarditis are low. The Ross operation is thus an effective surgical treatment option for young patients with aortic valve disease.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"766-772"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.3238/arztebl.m2024.0229
Sebastian Michel, Christian Hagl
{"title":"The Ross Operation—A Demanding Cardiac Surgical Procedure That Yields Excellent Results for Young Patients.","authors":"Sebastian Michel, Christian Hagl","doi":"10.3238/arztebl.m2024.0229","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0229","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 23","pages":"764-765"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.3238/arztebl.m2024.0200
Johannes Dreiling, Norman Rose, Christin Arnold, Philipp Baumbach, Carolin Fleischmann-Struzek, Christine Kubulus, Marcus Komann, Ursula Marschall, Heike Lydia Rittner, Thomas Volk, Winfried Meißner, Daniel Schwarzkopf
Background: The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany.
Methods: We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between post - operative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated.
Results: 203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than preexisting risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and preexisting treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]).
Conclusion: The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.
{"title":"The Incidence and Risk Factors of Persis tent Opioid Use After Surgery—A Retrospective Secondary Data Analysis.","authors":"Johannes Dreiling, Norman Rose, Christin Arnold, Philipp Baumbach, Carolin Fleischmann-Struzek, Christine Kubulus, Marcus Komann, Ursula Marschall, Heike Lydia Rittner, Thomas Volk, Winfried Meißner, Daniel Schwarzkopf","doi":"10.3238/arztebl.m2024.0200","DOIUrl":"10.3238/arztebl.m2024.0200","url":null,"abstract":"<p><strong>Background: </strong>The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany.</p><p><strong>Methods: </strong>We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between post - operative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated.</p><p><strong>Results: </strong>203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than preexisting risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and preexisting treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]).</p><p><strong>Conclusion: </strong>The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"757-763"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.3238/arztebl.m2024.0088
Judith U Harrer-Haag, Anette Voran
{"title":"Hallucinations While Using Guanfacine in ADHD.","authors":"Judith U Harrer-Haag, Anette Voran","doi":"10.3238/arztebl.m2024.0088","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0088","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"739"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.3238/arztebl.m2024.0135
Bernd Kowall, Susanne Stolpe, Wolfgang Galetzka, Michael Nonnemacher, Andreas Stang
Background: Observational epidemiological studies often yield different results on the same research question. In this article, we explain how this comes about.
Methods: In this review, which is based on publications retrieved by a selective search in PubMed and the Web of Science, we use information from international publications, simulation studies on sampling error, and a quantitative bias analysis on fictitious data to demonstrate why the results of epidemiological studies are often uncertain, and why it is, therefore, generally necessary to perform more than one study on any particular question.
Results: Sampling errors, imprecise measurements, alternative but equally appropriate methods of data analysis, and features of the populations being studied are common reasons why studies on the same question can yield different results. Simulation studies are used to illustrate the fact that effect estimates such as relative risks or odds ratios can deviate markedly from the true value because of sampling error, i.e., by chance alone. Quantitative bias analysis is used to show how strongly effect estimates can be distorted by misclassification of exposures or outcomes. Finally, it is shown through illustrative examples that different but equally appropriate methods of data analysis can lead to divergent study results.
Conclusion: The above reasons why epidemiological study results can be heterogeneous are explained in this review. Quantitative bias analyses and sensitivity analyses with alternative data evaluation strategies can help explain divergent results on one and the same question.
背景:观察性流行病学研究往往会对同一问题得出不同的结果。在本文中,我们将解释这种情况是如何产生的:这篇综述基于在 PubMed 和 Web of Science 上有选择性地搜索到的出版物,我们利用国际出版物中的信息、对抽样误差的模拟研究以及对虚构数据的定量偏差分析,来说明为什么流行病学研究的结果常常是不确定的,以及为什么通常有必要对任何特定问题进行不止一项研究:结果:抽样误差、不精确的测量、其他同样合适的数据分析方法以及被研究人群的特征,都是对同一问题进行研究得出不同结果的常见原因。模拟研究用来说明,相对风险或几率比率等效应估计值可能会因为抽样误差(即仅仅是偶然因素)而明显偏离真实值。定量偏差分析用于说明暴露或结果的错误分类会如何强烈地扭曲效果估计值。最后,通过举例说明不同但同样适当的数据分析方法会导致不同的研究结果:本综述解释了上述流行病学研究结果可能存在差异的原因。定量偏倚分析和采用其他数据评估策略的敏感性分析有助于解释同一问题的不同结果。
{"title":"One Question, Many Results—Why Epidemiological Studies Yield Heterogeneous Findings. Part 34 of a Series on Evaluation of Scientific Publications.","authors":"Bernd Kowall, Susanne Stolpe, Wolfgang Galetzka, Michael Nonnemacher, Andreas Stang","doi":"10.3238/arztebl.m2024.0135","DOIUrl":"10.3238/arztebl.m2024.0135","url":null,"abstract":"<p><strong>Background: </strong>Observational epidemiological studies often yield different results on the same research question. In this article, we explain how this comes about.</p><p><strong>Methods: </strong>In this review, which is based on publications retrieved by a selective search in PubMed and the Web of Science, we use information from international publications, simulation studies on sampling error, and a quantitative bias analysis on fictitious data to demonstrate why the results of epidemiological studies are often uncertain, and why it is, therefore, generally necessary to perform more than one study on any particular question.</p><p><strong>Results: </strong>Sampling errors, imprecise measurements, alternative but equally appropriate methods of data analysis, and features of the populations being studied are common reasons why studies on the same question can yield different results. Simulation studies are used to illustrate the fact that effect estimates such as relative risks or odds ratios can deviate markedly from the true value because of sampling error, i.e., by chance alone. Quantitative bias analysis is used to show how strongly effect estimates can be distorted by misclassification of exposures or outcomes. Finally, it is shown through illustrative examples that different but equally appropriate methods of data analysis can lead to divergent study results.</p><p><strong>Conclusion: </strong>The above reasons why epidemiological study results can be heterogeneous are explained in this review. Quantitative bias analyses and sensitivity analyses with alternative data evaluation strategies can help explain divergent results on one and the same question.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"740-745"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.3238/arztebl.m2024.0116
Wolfram J Herrmann, Hendrik Napierala
{"title":"Care Models for Psychosocial Problems in Primary Care—A Survey on Awareness and Health Policy Assessment.","authors":"Wolfram J Herrmann, Hendrik Napierala","doi":"10.3238/arztebl.m2024.0116","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0116","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"748-749"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.3238/arztebl.m2024.0084
Doris Bardehle
{"title":"Better Health Strategies for Men.","authors":"Doris Bardehle","doi":"10.3238/arztebl.m2024.0084","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0084","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"752"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.3238/arztebl.m2024.0156
Jonas Willmann, Nicolaus Andratschke, Jens Peter Klußmann, Jürgen E Gschwend, Ghazaleh Tabatabai, Maximilian Niyazi
Background: The treatment options for patients with progressive malignant tumors despite primary radiotherapy are often limited. In selected cases, re-irradiation can be offered. This article concerns the selection criteria and results of re-irradiation for certain types of cancer.
Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, with particular attention to glio - blastoma, head and neck tumors, and prostatic carcinoma.
Results: The published studies of re-irradiation are few in number and often of limited methodological quality. For glioblastoma, a randomized controlled trial (RCT) found that adding re-irradiation to treatment with bevacizumab yielded no significant improvement in either median progression-free survival or median overall survival (hazard ratio [HR] 0.73; p = 0.05 and HR 0.98; p = 0.46, respec - tively). Re-irradiation is a treatment option for locoregional recurrences of head and neck tumors after primary radiotherapy, but it carries a risk of serious side effects. For unresectable recurrences of nasopharyngeal carcinoma, an RCT has shown that hyperfractionated re-irradiation is more effective than normofractionated re-irradiation (overall survival: HR 0.54, p = 0.014). For locally recurrent prostatic carcinoma after radiotherapy, re-irradiation can yield good oncologic outcomes with an acceptable level of urogenital and gastrointestinal side effects (5-year recurrence-free survival: stereotactic body radiation therapy (SBRT), 58%; high dose rate (HDR) brachytherapy, 77%; versus salvage prostatectomy, 72%). RCTs on this topic are lacking.
Conclusion: Re-irradiation is a treatment option for selected cancer patients. As the available scientific evidence is limited, multidisciplinary collaboration and participatory decision-making are particularly important.
{"title":"Criteria for Re-Irradiation.","authors":"Jonas Willmann, Nicolaus Andratschke, Jens Peter Klußmann, Jürgen E Gschwend, Ghazaleh Tabatabai, Maximilian Niyazi","doi":"10.3238/arztebl.m2024.0156","DOIUrl":"10.3238/arztebl.m2024.0156","url":null,"abstract":"<p><strong>Background: </strong>The treatment options for patients with progressive malignant tumors despite primary radiotherapy are often limited. In selected cases, re-irradiation can be offered. This article concerns the selection criteria and results of re-irradiation for certain types of cancer.</p><p><strong>Methods: </strong>This review is based on pertinent publications retrieved by a selective search in PubMed, with particular attention to glio - blastoma, head and neck tumors, and prostatic carcinoma.</p><p><strong>Results: </strong>The published studies of re-irradiation are few in number and often of limited methodological quality. For glioblastoma, a randomized controlled trial (RCT) found that adding re-irradiation to treatment with bevacizumab yielded no significant improvement in either median progression-free survival or median overall survival (hazard ratio [HR] 0.73; p = 0.05 and HR 0.98; p = 0.46, respec - tively). Re-irradiation is a treatment option for locoregional recurrences of head and neck tumors after primary radiotherapy, but it carries a risk of serious side effects. For unresectable recurrences of nasopharyngeal carcinoma, an RCT has shown that hyperfractionated re-irradiation is more effective than normofractionated re-irradiation (overall survival: HR 0.54, p = 0.014). For locally recurrent prostatic carcinoma after radiotherapy, re-irradiation can yield good oncologic outcomes with an acceptable level of urogenital and gastrointestinal side effects (5-year recurrence-free survival: stereotactic body radiation therapy (SBRT), 58%; high dose rate (HDR) brachytherapy, 77%; versus salvage prostatectomy, 72%). RCTs on this topic are lacking.</p><p><strong>Conclusion: </strong>Re-irradiation is a treatment option for selected cancer patients. As the available scientific evidence is limited, multidisciplinary collaboration and participatory decision-making are particularly important.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"725-732"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.3238/arztebl.m2024.0119
Tina Gürlich, Peter Szatmary, Ulrich Ronellenfitsch, Heike Schmidt, Jörg Kleeff
{"title":"The Understanding and Emotional State of Patients About to Undergo Visceral Surgery for Cancer.","authors":"Tina Gürlich, Peter Szatmary, Ulrich Ronellenfitsch, Heike Schmidt, Jörg Kleeff","doi":"10.3238/arztebl.m2024.0119","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0119","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"750-751"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}