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Biomedical subjects

Martin Hatzinger

Publications and source records attributed to Martin Hatzinger.

10 recordsLinked to original sources
PubMed2006

Hypothalamic-pituitary-adrenocortical (HPA) activity in kindergarten children: importance of gender and associations with behavioral/emotional difficulties.

The current cross-sectional study investigated basal and stress-challenged hypothalamic-pituitary-adrenocortical (HPA) system function in 102 five-year old kindergarten children (59 boys, 43 girls) who had been assessed by a comprehensive psychological and behavioral test battery. Baseline HPA system activity was significantly increased in girls when compared to boys (p<0.001). Furthermore, basal HPA system activity predicted a high hormonal release during stress with--again--girls showing higher hormonal responses than boys (p<0.01). Importantly, increased HPA system activity (baseline and stress-challenged) was significantly associated with hyperactivity/impulsivity and emotional problems in boys and with positive emotions in girls (p<0.05). These results suggest an occurrence of neurobiological alterations early in development. The observed neurobiological changes are gender specific already at the age of 5 years. Prospective long-term follow up of the identified subjects with HPA axis alterations will clarify if these markers are predictive for the onset of psychiatric disorders.

Affective Symptoms↗
PubMed2006

Effect of flumazenil-augmentation on microsleep and mood in depressed patients during partial sleep deprivation.

The antidepressive effect of sleep deprivation (SD) in depressed patients disappears after sleep of the recovery night and after early morning naps. Both can provoke a rapid relapse into depression in SD-responders. In addition, the occurrence of short episodes of sleep (termed microsleep, MS) during partial SD (PSD) is associated with SD-nonresponse, suggesting that MS during the time awake may be related to relapse or PSD-nonresponse. The GABA-benzodiazepine receptor antagonist flumazenil augments vigilance and reduces NonREM-sleep pressure in early morning recovery sleep in volunteers after SD. Therefore, in this study 27 patients with major depression were subjected to a PSD. In a double blind randomized design either flumazenil or placebo was orally applied during PSD in order to examine whether the application of flumazenil reduces sleep propensity and thus, increases antidepressant efficacy of PSD. EEG was registered continuously for 60h by a portable device for the assessment of microsleep episodes at baseline and during PSD. Flumazenil application significantly suppressed frequency and total amount of MS. While the antidepressant efficacy of PSD was not different between flumazenil and placebo during PSD, the subjective mood improved after the recovery night in patients treated with flumazenil. It is concluded that GABAergic mechanisms are involved in the regulation of MS during PSD, which may be related to a mood stabilizing effect after the recovery night. However, the mechanisms underlying the association between the occurrence of MS during PSD and mood variation have to be further clarified.

Adult↗
PubMed2006

Hans Christian Jacobaeus: Inventor of human laparoscopy and thoracoscopy.

Hans Christian Jacobaeus performed the first clinical laparoscopic surgery in Stockholm. This pioneering procedure was based on the animal experiments of Georg Kelling (1866-1945), a German physician from Dresden, who performed the first laparoscopic intervention in 1901 using a Nitz cystoscope in a dog. In 1910, Jacobaeus published his initial experiences with laparoscopic surgery in the Münchner Medizinischen Wochenschrift under the title "The Possibilities for Performing Cystoscopy in Examinations of Serous Cavities." He used this technique for diagnostic purposes in undefined abdominal complaints and functional impairment. Jacobaeus was the first who pointed out the possibility of injuring organs, especially the intestines, by inserting the trocar. In 1910, Jacobaeus recognized the immense diagnostic and therapeutic possibilities of laparoscopic surgery, as well as its difficulties and limits. He also was the first to realize the need for initial endoscopic training in animals and corpses. He promoted the development of special laparoscopic instruments to optimize and simplify the procedure.

Animals↗
PubMed2005

Laparoscopic radical prostatectomy--the experience of the German Laparoscopic Working Group.

PURPOSE: To present the current status of laparoscopic radical prostatectomy (LRP) in Germany, Austria and Switzerland with respect to transferability, learning curve, and outcome. MATERIAL AND METHODS: The data of 5824 patients who underwent LRP in 18 centers by 50 urologists from March 1999 to August 2004 were analyzed retrospectively. Three centers performed more than 500, and six more than 250 cases. A transperitoneal descending technique with was used in 2701, a transperitoneal ascending in 1234, an extraperitoneal descending in 1814, and an extraperitoneal ascending modification in 75 cases. Specimen showed pT2 in 3535, pT3a in 1555, pT3b in 623, and pT4 in 111 cases. RESULTS: Mean operating time averaged 211 (131-292) minutes, with shorter duration of the extraperitoneal descending technique. Conversion to open surgery averaged 2.4 (0-14.1) %. Re-intervention rate amounted to 2.7 (0.3-7.7) %. Complication rate averaged 8.9 (1.8-10.8) % including bleeding (0.3-2.5%) and rectal lesion (1.5-2.5%). The rate of positive margins was 10.6 (3.2-18) % for pT2- and 32.7 (20-38.5) % for pT3a-tumors Continence after 12 months was 84.9 (72-94) %. Data about potency (7 centers) revealed 52.5 (35-67) % full erections following bilateral nerve preservation. 5 year-PSA recurrence rate (3 centers) was 8.6 (4-15.3) % for pT2-tumors and 17.5 (15-20.6) % for pT3a-stages. CONCLUSIONS: The results confirm the efficacy of the training program with safe transfer of LRP (i.e. low complication rate), however including all known problems of a retrospective study.

Adult↗
PubMed2003

Technical evolution of laparoscopic radical prostatectomy after 450 cases.

BACKGROUND AND PURPOSE: In 1998, laparoscopic radical prostatectomy with primary access to the seminal vesicles was introduced. In 1999, we developed a laparoscopic technique similar to the classic retropubic radical prostatectomy. We focus here on the continuous technical evolution of our technique. PATIENTS AND METHODS: From March 1999 to May 2002, we performed 450 laparoscopic radical prostatectomies. All important data of the patients; data concerning the performance of the procedure, including technical modifications, conversion, reintervention, and complication rate; as well as follow-up information were documented contemporaneously. The patients were divided into three groups of 150 individuals each in order to analyze the influence of the technical evolution of the procedure. Additionally, we studied the transferability of our technique, comparing the learning curves of the three surgeons involved in the program. RESULTS: The technical modifications included the routine use of a voice-controlled robot (AESOP) for the camera, exposure of the apex with 120 degrees retracting forceps, a free-hand suturing technique instead of the Endostitch device for the dorsal vein complex, 5-mm clipping instead of bipolar coagulation for the nerve-sparing technique, initial 6 o'clock suturing of the urethra before complete division, control of the prostatic pedicles by use of 12-mm Hemo-lok clips instead of the Ultracision or Endo-GIA, the bladder neck-sparing technique in cases of T(1c) and T(2a) tumors, and interrupted instead of continuous sutures for the vesicourethral anastomosis. All these modifications resulted in a significant decrease in operating time and the rates of transfusion, open conversion, and reintervention. The introduction of the nerve-sparing technique increased the number of tumor-positive margins. The mean operating time of the third surgeon was significantly less than that of the first surgeon, but the transfusion, conversion, and reintervention rates did not differ significantly among the surgeons. CONCLUSIONS: Laparoscopic radical prostatectomy has undergone continuous technical evolution resulting in a significant improvement of the operative results. Although we were able to demonstrate the transferability of this difficult procedure, we feel that it should be performed only at centers of expertise.

Adult↗
PubMed2003

Laparoscopic versus open radical prostatectomy: a comparative study at a single institution.

PURPOSE: There is an ongoing debate about the benefits of laparoscopic radical prostatectomy compared to the open retropubic approach. We compared the last 219 patients treated with open retropubic prostatectomy with 438 patients treated with laparoscopic radical prostatectomy at our institution, focusing on operative data, complications and mid-term outcome. MATERIALS AND METHODS: From December 1994 to November 1999 a total of 219 patients were treated with open prostatectomy and pelvic lymph node dissection (group 1). From March 1999 to September 2002, 219 patients underwent early (group 2) and 219 underwent late (group 3) laparoscopic radical prostatectomy and pelvic lymph node dissection. The same surgeons performed both operations. All 3 groups were similar with respect to mean patient age, mean prostate specific antigen value, median Gleason score, previous transurethral resection of the prostate and neoadjuvant treatment, although there was a slight stage shift in favor of the 2 laparoscopic groups. RESULTS: Mean operating time was significantly shorter after open surgery (196 minutes) compared to the early laparoscopic group (288) but it did not differ significantly from the late laparoscopic group (218). Mean blood loss (1,550 versus 1,100 versus 800 cc) and transfusion rates (55.7% versus 30.1% versus 9.6%) in groups 1 to 3 favored the laparoscopic groups. The complication rate in groups 1 to 3 was lower for laparoscopy (19.2% versus 13.7% versus 6.4%), but the spectrum differed. The early laparoscopic group had a higher incidence of rectal injuries (1.8% versus 3.2% versus 1.4% in groups 1 to 3, respectively) and urinary leakage (0.5% versus 2.3% versus 0.9%), whereas more lymphoceles (6.9% versus 0% versus 0%), wound infection (2.3% versus 0.5% versus 0%), embolism/pneumonia (2.3% versus 0.5% versus 0.5%) and anastomotic strictures (15.9% versus 6.4% versus 4.1%) occurred after open surgery. The amount of postoperative analgesia was significantly greater after open surgery (50.8 versus 33.8 versus 30.1 mg. in groups 1 to 3, respectively). Median catheter time was longer after open retropubic prostatectomy (12 versus 7 versus 7 days in groups 1 to 3, respectively) but the continence rates were similar in all 3 groups at 12 months (89.9% versus 90.3% versus 91.7%). The rate of positive margins did not differ significantly in groups 1 to 3 (28.2% versus 21.0% versus 23.2%), prostate specific antigen recurrence was equivalent related to the different observation periods. CONCLUSIONS: Laparoscopic radical prostatectomy is technically demanding, with an initially longer operative time, higher incidence of rectal injuries and urinary leakage. The overall outcome after 219 cases favors the laparoscopic approach. Consequently, at our institution laparoscopic radical prostatectomy has become the method of choice.

Adult↗
PubMed2002

Simulators and endourological training.

Acquisition of skills laboratory training seems to be of importance in the training of surgeons, and is intended to cover the gap between theoretical learning and real practice. Economic and ethical reasons limit the use of animals during the learning process, while trends in medical change have severely restricted the available time to teach and to learn. With the incorporation of laparoscopy and the blossoming of minimally invasive techniques, mainly endoscopy, simulators have gained wide acceptance as an important tool in the surgeon's learning process. Two types of simulators are currently available: inanimates or mannequins and virtual reality simulators. A review of the recent literature shows that there is generally a significant improvement in dexterity after using simulators, whichever type is used. It is still unknown whether training simulation influences the patient's outcome positively.

Clinical Competence↗
PubMedDate not supplied

Electroencephalographic sleep profiles in treatment course and long-term outcome of major depression: association with DEX/CRH-test response.

Altered electroencephalographic (EEG) sleep patterns are among the most prominent neurobiological findings in depression. Several of these alterations have been suggested to be associated with an unfavorable long-term outcome. However, the impact of pathological sleep parameters on a more recurrent course of illness or vice versa still warrants clarification. Underlying mechanisms may involve systems known to be related to both sleep regulation and long-term course of depression such as the hypothalamic-pituitary-adrenocortical (HPA) axis. Thus, EEG sleep profiles of patients with depression were examined to determine whether (1) the retrospective clinical course of depression, and (2) the prospective long-term outcome in follow-up are associated with EEG sleep parameters. To elucidate related mechanisms HPA system functioning was evaluated by using the combined DEX/CRH test. Fifteen patients with affective disorders who participated in an earlier controlled antidepressant treatment study over 6 weeks were consecutively enrolled in an exploratory follow-up study. The retrospective analysis revealed that during the acute state of depression predominantly sleep continuity measures were associated with the number of previously experienced episodes. While this relation disappeared during treatment and did not correlate with the prospective course, decreased slow wave sleep variables especially in the first sleep period and increased rapid eye movement density were predictive for the occurrence of recurrences in follow-up and, hence, probably reflect more trait-like markers. Additionally, EEG sleep variables unfavorable for long-term outcome were related to excessive stress hormone response in the DEX/CRH-test. These disturbances may reflect important mechanisms responsible of causing and maintaining the disease process of depression.

Adult↗
PubMedDate not supplied

The combined DEX-CRH test in treatment course and long-term outcome of major depression.

Neuroendocrine studies strongly suggest that the hypothalamic-pituitary-adrenocortical (HPA) system plays a crucial role in the development and course of depression. The interaction between the disease process and HPA system function in long-term course, however, is unclear. Since improvement of HPA system deterioration has been demonstrated to be associated with treatment response, the question has arisen whether the course of therapy response as reflected by, for example, early improvement or response (after 1 or 2 weeks of therapy) is also based on HPA system dysfunction and whether the course of HPA regulation during treatment is only a state marker or has additional predictive implications for long-term outcome. In order to elucidate these questions a long-term study was carried out to investigate whether HPA system disturbance is associated (1) with the course of treatment response, predominantly early treatment response, during acute depression and (2) with the long-term course of depression, i.e. number of episodes. Twenty patients with affective disorders who participated in earlier controlled antidepressant treatment studies over 6 weeks were enrolled in an exploratory follow-up study. Using the combined DEX/CRH test it was demonstrated that (1) early improvement, early treatment response and beneficial treatment outcome after 6 weeks were associated with a lower HPA system activity and that (2) in long-term course of depression the HPA system deterioration increases in parallel with the number of previous episodes. These findings suggest that HPA system alterations are closely related to treatment response and long-term outcome of depression.

Anti-Inflammatory Agents↗