Peter Diehl

University of Rostock, Rostock, Mecklenburg-Vorpommern, Germany

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Publications (38)62.13 Total impact

  • Peter Diehl · J. Schauwecker

    No preview · Article · Aug 2015
  • Peter Diehl · Johannes Schauwecker

    No preview · Article · Oct 2014 · MMW Fortschritte der Medizin
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    ABSTRACT: BACKGROUND: Chronic radicular pain can occur after disc pathology and failed back surgery. An evidence-based effective therapeutic option is not available nor does a gold standard exist. OBJECTIVES: A randomized controlled trial to analyze the clinical efficacy of percutaneous epidural lysis of adhesions in chronic radicular pain. STUDY DESIGN: Prospective randomized placebo controlled interventional trial. Power calculation based on a feasibility trial. SETTING: Medical university centers. METHODS: Within 4 years a total of 381 patients with chronic radicular pain lasting longer than 4 months which failed to respond to conservative treatments were screened and 90 patients were enrolled. They were randomly assigned to receive either percutaneous neurolysis or placebo with concealed allocation in permuted blocks of 4 to 8, stratified by treatment center. The primary outcome measure was the differences in percent change of Oswestry Disability Index (ODI) scores 3 months after intervention. Secondary outcome measures were difference in percent change of ODI scores and Visual Analog Scale (VAS) 6 and 12 months after intervention and success rates defined as at least 50% reduction in ODI scores and VAS scores (mean change from baseline) at 3, 6, and 12 months after treatment. Explorative, 2-sided group comparisons for baseline characteristics between active treatment and controls were done using the t-test for 2 independent samples for quantitative data and Fisher's exact test for binary data. RESULTS: The ODI and VAS scores as well as the success rates for ODI vs VAS were significantly better 3, 6, and 12 months in the lysis group vs the control group. The ODI in the lysis group improved from 55.3 ± 11.6 to 26.4 ± 10.8 after 3 months. The placebo group improved from 55.4 ± 11.5 to 41.8 ± 14.6 (P < 0.01). VAS improved from 6.7 ± 1.1 to 2.9 ± 1.9 in the active group and from 6.7 ± 1.1 to 4.8 ± 2.2 (P < 0.01) after placebo. Twelve month follow-up shows further improvement, the differences remain significant. In multiple linear regression, forward and backward variable selection methods resulted in the same covariate model confirming the univariate result for group comparison in the primary analysis. No severe side effects occurred but minor transient neurological effects such as partial sensomotoric deficits did. One dura puncture and one catheter displacement were found. LIMITATIONS: Specific effects of single treatment components cannot be specified because there was no imaging examination after treatment. CONCLUSION: Based on the findings of our study as well as other studies, we believe the minimally invasive percutaneous adhesiolysis procedure should be the first choice treatment option for patients with chronic lumbosacral radicular pain who present with clinical history and findings similar to those of the patients enrolled in our study.
    Full-text · Article · Nov 2012 · Pain physician
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    ABSTRACT: The aim of this study was to investigate if radial extracorporeal shock wave therapy (rESWT) induces new bone formation and to study the time course of ESWT-induced osteogenesis. A total of 4000 impulses of radial shock waves (0.16 mJ/mm²) were applied to one hind leg of 13 New Zealand white rabbits with the contralateral side used for control. Treatment was repeated after 7 days. Fluorochrome sequence labeling of new bone formation was performed by subcutaneous injection of tetracycline, calcein green, alizarin red and calcein blue. Animals were sacrificed 2 weeks (n = 4), 4 weeks (n = 4) and 6 weeks (n = 5) after the first rESWT and bone sections were analyzed by fluorescence microscopy. Deposits of fluorochromes were classified and analyzed for significance with the Fisher exact test. rESWT significantly increased new bone formation at all time points over the 6-week study period. Intensity of ossification reached a peak after 4 weeks and declined at the end of the study. New bone formation was significantly higher and persisted longer at the ventral cortex, which was located in the direction to the shock wave device, compared with the dorsal cortex, emphasizing the dose-dependent process of ESWT-induced osteogenesis. No traumata, such as hemorrhage, periosteal detachment or microfractures, were observed by histologic and radiologic assessment. This is the first study demonstrating low-energy radial shock waves to induce new bone formation in vivo. Based on our results, repetition of ESWT in 6-week intervals can be recommended. Application to bone regions at increased fracture risk (e.g., in osteoporosis) are possible clinical indications.
    No preview · Article · Nov 2012 · Ultrasound in medicine & biology
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    Full-text · Chapter · Mar 2012

  • No preview · Article · Jun 2011
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    ABSTRACT: Bone defects due to malignant tumor often lead to repeated surgery or amputation. Thus, a major objective in orthopedic surgery is the extracorporeal devitalization of tumor-bearing bone segments following reimplantation. Extracorporeal irradiation or autoclaving are possible methods even though they may cause severe loss of biomechanical and biological properties. Yet previous studies have shown that high hydrostatic pressure (HHP) allows for complete devitalization of tumor-afflicted bone segments, while the biomechanical and biological properties of bone tissue remained unchanged. The subject of the present study is revitalization of human bone segments after HHP treatment to acquire knowledge about the ingrowth and regeneration of osteoblast-like cells after such treatment. Bone pieces of 5 mm(3) were obtained from cancellous bone, taken from human femoral heads of 6 patients undergoing surgery for total hip arthroplasty, and exposed to hydrostatic pressure levels of 0, 300, and 600 MPa for 10 min at 37°C. Following the HHP treatment, bone segments were coated with primary human bone cells (10,000 cells/segment), cultured for 42 days and cell viability and proliferation quantified at different time points. An adhesion rate of 73.8% on day 1 and an increase in proliferation between day 14 and 42 were determined. Pretreatment of bone segments with 300 and 600 MPa did not affect cell adhesion or proliferation. Histology showed intact cells and new bone formation on the bone specimens; elevated expression of alkaline phosphatase, osteocalcin, and collagen type I was seen by immunohistochemistry. The present study demonstrates, for the first time, the successful revitalization of HHP-treated bone segments. Concerning proliferation and osteogenic differentiation, the findings are a promising demonstration of sufficient osseointegration. Along with previous results, we anticipate that a pressure of a maximum 350 MPa does induce devitalization of malignant bone tumor segments, while HHP treatment of bone matrix up to 600 MPa does not affect osteoconductivity and osteoinductivity.
    No preview · Article · Apr 2011 · Anticancer research
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    ABSTRACT: The purpose of total hip replacement (THR) is the restoration of a painless functioning hip joint with the main focus on the biomechanical properties. Advances in surgical techniques and biomaterial properties currently allow predictable surgical results in most patients. Despite the overwhelming success of this surgical procedure, the debate continues surrounding the optimal choice of implants and fixation. Femoral and acetabular implants with varying geometries and fixation methods are currently available. Problems inherent with acrylic bone cement, however, have encouraged surgeons to use alternative surfaces to allow biologic fixation. Optimal primary and secondary fixation of cementless hip stems is a precondition for long-term stability. Important criteria to achieve primary stability are good rotational and axial stability by press-fit fixation. The objective of the cementless secondary fixation is the biological integration of the implant by bony ingrowth. Nevertheless, current investigations show excellent results of cementless fixation even in older patients with reduced osseous quality. The main advantages of cementless fixation include biological integration, reduced duration of surgery, no tissue damage by cement polymerization and reduction of intraoperative embolisms. In comparison to cemented THR both, cementless sockets and stems provide good long-term results.
    No preview · Article · Oct 2010 · Biomedizinische Technik/Biomedical Engineering
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    ABSTRACT: Two new tumor-like cell lines were established which developed spontaneously in vitro from normal human primary osteoblast-like cells originating from non-oncogenic bone surgery. The tumor cell properties studied included morphology, proliferation characteristics in normal and low-serum media, and anchorage-independent growth in soft agarose. Karyotyping of the cells showed numerous rearrangements and abnormalities. These results pointed to the tumorigenic potential of the cells and demonstrate the importance of biosafety in tissue engineering and therapeutic cell applications when prolonged culture conditions are required.
    No preview · Article · Mar 2010
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    ABSTRACT: We studied a consecutive series of 81 cementless total hip arthroplasties in 80 patients using the second generation ESKA cementless spongy metal hip replacement. The study end-point was implant revision and both function as well as satisfaction with treatment outcome were assessed.Mean age at the time of surgery was 50.9 years [range 23-73]. No patient was lost to follow-up and 75 patients (76 hips) could be included in the final analysis at a mean follow-up of 7.9 years [range 7.0-10.0]. Survival rate without loosening as the end-point was 100% for the femoral component and 99% for the acetabular component (one cup revision). Two cups and one stem had to be revised for recurrent dislocation, resulting in a total implant survival at follow-up of 99% for the femoral component and 96% for the acetabular component. Very good functional results were obtained with a mean Merle d' Aubigné score of 15.5 +/- 2.9 at 7.9 years after surgery. Satisfaction with treatment outcome was reported in 88%. 95% of patients would recommend the performed procedure to a friend. Peri-operative complications without revision occurred in eleven patients (14%).We report excellent survival rates of the cementless spongy metal hip arthroplasty at a mean follow-up of eight years, particularly considering the young age of many of the patients.
    No preview · Article · Oct 2009 · Hip international: the journal of clinical and experimental research on hip pathology and therapy
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    ABSTRACT: Aseptic loosening of total hip replacement is mainly caused by wear particles. Abrasive wear occurs at articulating surfaces or as a consequence of micro-motions at the interface between femoral stem and bone cement. Direct impact of wear particles on osteolysis, the remodeling of the bone stock and a directly affected function of osteoblasts was described. The present study examined the response of human osteoblasts exposed to different wear particles, which were generated in a test device providing oscillating micro-motions at the interface between femoral stem and standard bone cement. Characterization of released particles was performed by quantifying the size distribution and the metal content of the wear debris. Human osteoblasts were incubated with particles obtained from hip stems with different material compositions (Ti-6Al-7Nb and Co-28Cr-6Mo) and rough and smooth surface finishings combined with standard bone cement (Palacos(R) R) containing zirconium oxide particles. Commercially pure titanium particles (cp-Ti) and particulate zirconium oxide (ZrO(2)) were used for comparative analyses. The results revealed significant (p < 0.05) reduction of the cell viability after exposure to higher concentration of metallic particles, particularly from Co-based alloys. In contrast, ZrO(2) alone showed significantly less adverse effects on the cells. When increasing metallic particle concentrations massive inhibition was also observed in the release of cytokines including interleukine-6 (IL-6) and interleukine-8 (IL-8), but the expression of Procollagen I and the cell viability showed the highest reduction after exposure to Co-based alloy particles from rough stems.
    No preview · Article · May 2009 · Journal of Biomedical Materials Research Part A
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    ABSTRACT: Extracorporeal shockwave therapy (ESWT) is applied successfully in various orthopedic disorders. Since shockwaves have demonstrated significant bactericidal effectiveness in vitro, safety and effectiveness of ESWT in vivo were evaluated in a rabbit model of osteomyelitis. Chronic osteomyelitis was induced by injecting sodium morrhuate and Staphylococcus aureus into the proximal tibia of 12 New Zealand white rabbits. Four and five wk after the initial operation, soft focused ESWT was applied twice to the infected limbs. Clinical parameters and laboratory values were followed and blood samples were taken for culture before and 30 min after ESWT. Following sacrifice after 8 wk, lungs, spleen and kidneys were studied histologically for signs of sepsis and secondary infection. Tibial osteomyelitis was assessed clinically, and by radiologic, microbiologic and histologic procedures. Signs of bacterial spreading were not detectable after ESWT, neither in blood cultures nor in histologic analyses of representative organs. Temperature, body weight, C-reactive protein and white blood cell levels also remained unchanged after ESWT. Of particular interest, histologic scores of osteomyelitis were significantly decreased in the ESWT-group compared to the untreated control (p = 0.019). However, S. aureus was still detectable in tissue samples of all animals. This is the first study investigating the effects of ESWT applied to infected target areas. ESWT of infected bone did neither induce bacterial spreading nor worsening of infection, and the results suggest the reported treatment protocol of ESWT to be beneficial in the treatment of chronic bone infections. (E-mail: [email protected] /* */).
    No preview · Article · Apr 2009 · Ultrasound in medicine & biology
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    ABSTRACT: Minimally invasive anterolateral approach in hip resurfacing with complete preservation of muscular integrity. Primary or secondary osteoarthritis of the hip. Approach: None. Onlay implant: Females>55 years with osteoporosis. Males>60 years with osteoporosis. Severe varus deformity (CCD [collodiaphyseal] angle<100 degrees). History of metal allergy. Clinically relevant renal insufficiency. Radiologic appearance of avascular necrosis stage 3 and 4 according to Ficat. Femoral head cysts>1 cm in diameter. Supine position with possible overextension of the hip, longitudinal incision along the intermuscular septum and blunt intermuscular dissection between gluteus medius and tensor fasciae latae, partial resection of the anterior capsule and anterior dislocation of the hip with complete proximal release of the capsule. Dislocation of the femoral head and dorsal positioning, reaming of the acetabulum to implant the cementless acetabular component, exposition and reaming of the femoral head in extension/adduction and external rotation, implantation of the cemented onlay endoprosthesis. Prophylaxis of thromboembolism and periarticular ossification. Rehabilitation with weight bearing as tolerated starting on the day of surgery, ergometer training from day 4 after surgery. 31 patients with osteoarthritis underwent onlay resurfacing via a minimally invasive approach. The Harris Hip Score improved from 43.9 to 97.1 at 12 months after surgery. Adverse events such as fracture, dislocation, nerve or muscle lesions did not occur, and clinically significant thromboembolism or infection was not observed.
    Full-text · Article · Apr 2009 · Operative Orthopädie und Traumatologie
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    ABSTRACT: Autoclaving, heat, irradiation or chemical detergents are used to disinfect autografts, allografts and biomaterials for tissue reconstruction. These methods are often associated with deterioration of mechanical, physical, and biological properties of the bone grafts and synthetic implants. High hydrostatic pressure has been proposed as a novel method preserving biomechanical and biological properties of bone, tendon and cartilage. This is the first study to assess the inactivation of clinically relevant bacteria on biomaterials and human bone by high hydrostatic pressure. Bacterial suspensions of Staphylococcus aureus, Pseudomonas aeruginosa and Enterococcus faecium, implants covered with infected blood, human bone infected in vitro, and biopsies of patients with chronic osteomyelitis were subjected to different protocols of high hydrostatic pressure up to 600 MPa. Bacterial survival after high hydrostatic pressure treatment was determined and compared with bacterial growth in untreated controls. S. aureus and P. aeruginosa in suspension were completely inactivated by high hydrostatic pressure (> 5log levels), whereas E. faecium showed barotolerance up to 600 MPa. Blood and adherence to metal implants did not significantly alter inactivation of bacteria, and complete disinfection was achieved with barotolerant bacteria (S. aureus and P. aeruginosa). However, osteoarthritic bone demonstrated a non-homogeneous baroprotective effect, with single bone samples resistant to treatment resulting in unaltered bacterial growth, and complete disinfection of artificially infected bone specimens was achieved in 66% for S. aureus, 60% for P. aeruginosa and 0% for E. faecium. Human bone samples of patients with chronic osteomyelitis could be completely disinfected in 2 of 37 cases. High hydrostatic pressure offers new perspectives for disinfection of sensitive biomaterials and bone grafts, and contamination by blood did not significantly affect bacterial inactivation rates. However, a significant baroprotective effect was demonstrated in bone. Effectiveness is currently limited to colonization and / or infection with barosensitive micro-organisms.
    Full-text · Article · Feb 2009 · The Open Orthopaedics Journal
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    Full-text · Article · Jan 2009
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    ABSTRACT: High hydrostatic pressure (HHP) is widely used in the food processing industry, for example to inactivate vegetative microorganisms in meat products, milk and juice, thereby avoiding the addition of any chemical preservatives. Besides this, HHP is also an attractive novel approach to effectively kill vegetative microorganisms or tumor cells in bone, cartilage and tendon ex vivo while leaving the tissues' mechanical properties unimpaired, thus allowing reimplantation of the resected tissue explants. In contrast, sterilization by gamma irradiation and thermal or chemical inactivation of potentially infected autografts, allografts and other biomaterials considered for tissue regeneration and reconstruction is often associated with deterioration of the mechanical, physical and biological properties of the implant. HHP technology is now in preclinical testing with the aim of disinfecting/devitalizing grafts in order to inactivate both vegetative microorganisms and tumor cells in resected bone tissue segments, eventually allowing reimplantation of resected bone segments initially afflicted with osteomyelitis or tumors. The technical advantages, state-of-the-art, and potential application of HHP in orthopedic surgery are reviewed.
    Full-text · Article · Nov 2008 · Anticancer research
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    ABSTRACT: Radial extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis that can be administered to outpatients without anesthesia but has not yet been evaluated in controlled trials. There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis. Randomized, controlled trial; Level of evidence, 1. Three interventions of radial extracorporeal shock wave therapy (0.16 mJ/mm(2); 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks' follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients' and investigators' global judgment of effectiveness 12 weeks and 12 months after extracorporeal shock wave therapy. Radial extracorporeal shock wave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% (P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group (P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo (P < .025, 1-sided). No relevant side effects were observed. Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.
    Full-text · Article · Nov 2008 · The American Journal of Sports Medicine
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    ABSTRACT: Meniscal allograft processing procedures, in particular gamma irradiation, deteriorate the biomechanical and biological properties of the transplanted tissue. High hydrostatic pressure (HHP) treatment, widely used in food technology to inactivate microorganisms while preserving natural compounds, might serve as a gentle alternative to gamma irradiation in the processing of meniscal allografts. We therefore investigated the effects of HHP treatment on the biomechanical and immunohistochemical properties of meniscal cartilage. Specimens of bovine menisci were treated with HHP for 10 min (20 degrees C) at 300 MPa and 600 MPa. Untreated control samples were left at room temperature and ambient pressure. We performed repetitive cycling indentation-tests to assess the biomechanical properties-in particular the viscoelastic behavior-of HHP treated and untreated meniscal specimens. Immunohistochemical analysis for collagens type I, II, and III and for the proteoglycans versican, aggrecan and for link-protein was performed by immunolabeling cross-sections of untreated and at 600 MPa HHP treated specimens. Comparing untreated and HHP treated meniscal specimens there were no significant differences for all tested biomechanical parameters. All cross-sections of untreated and HHP treated specimens stained positive for the collagens and proteoglycans. We demonstrated that meniscal cartilage can be treated by HHP at levels as high as 600 MPa without affection of the biomechanical and immunochistochemical properties. Therefore, HHP treatment might serve as a gentle alternative to gamma irradiation in the processing of meniscal allografts. Further research is necessary to verificate the present results in vivo.
    No preview · Article · Oct 2008 · Journal of Biomedical Materials Research Part B Applied Biomaterials
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    ABSTRACT: Allogeneic bone transplantation is at risk of infection, and established disinfection methods typically compromise bone quality. High hydrostatic pressure (HHP) is well established for disinfection in food technology, and also it does protect biomechanical and biological properties of bone. This study is the first investigation of HHP regarding disinfection of bone biopsies. Bone biopsies of 34 patients with chronic infections were subjected to HHP and assessed for persisting bacterial growth. In series 1, bone biopsies were proceeded directly to HHP (10 min; maximal pressure Pmax 600 MPa). In series 2, HHP was applied after 5-day incubation in growth media (10 min or 2x30 min; Pmax 600 MPa). Furthermore, HHP-induced changes of bacterial morphology on artificially infected bone samples were evaluated by scanning electron microscopy (SEM). For series 1, 71% of the bone samples were sterilised by HHP (n=17), compared to 38% of the untreated control samples, which were obtained during the same surgery (n=8). For series 2, after prior incubation, HHP disinfected 7% of the bone specimens (n=55), all control samples showed bacterial growth (n=33). Destruction of cell wall integrity of Gram-negative strains was observed by SEM. The effectiveness of HHP for bone disinfection should be improved by optimising treatment parameters. Infections with barosensitive Gram-negative bacteria or yeast might represent possible clinical indications.
    No preview · Article · Aug 2008 · Biomedizinische Technik
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    ABSTRACT: Clindamycin is an antibiotic frequently used in different local application forms for the treatment of prosthetic joint infections, chronic osteomyelitis or as infection prophylaxis in bone cement. No information is available regarding its direct effects on bone cells, although very high local effective antibiotic concentrations can be achieved. We cultured pooled osteoblasts, previously derived from human trabecular bone specimens of four healthy donors, with different concentrations of clindamycin (0-500 microg/ml) for 24, 48 and 72 h. Cell proliferation (MTT), cytotoxicity [lactate dehydrogenase (LDH)-activity], cell metabolism [alkaline phosphatase (ALP)-activity] and extracellular matrix calcification (Alizarin staining) were assessed after antibiotic treatment. Proliferation significantly decreased in a dose-dependent manner and reached 3.5% of control samples at 500 microg/ml at 72 h. LDH-activity was unaffected at lower concentrations but significantly increased at 500 microg/ml at 48 and 72 h. ALP-activity significantly increased at 10 microg/ml at 24 and 48 h and then decreased in a time- and dose-dependent manner. Calcification increased at 10 and 25 microg/ml, while it decreased or no calcification was found at concentrations of 50 microg/ml and above. We could demonstrate that clindamycin at lower concentrations stimulated the cell metabolism of human osteoblasts and that higher clindamycin levels of 500 microg/ml had cytotoxic effects. The observed effects of high clindamycin levels on human osteoblasts highlight a potential alteration of bone metabolism in vivo and have to be taken into account in local antibiotic administration, e.g., in clindamycin-impregnated bone cement, where such high antibiotic concentrations can be achieved.
    No preview · Article · Apr 2008 · Archives of Orthopaedic and Trauma Surgery

Publication Stats

545 Citations
62.13 Total Impact Points

Institutions

  • 2007-2012
    • University of Rostock
      • Orthopädische Klinik und Poliklinik
      Rostock, Mecklenburg-Vorpommern, Germany
  • 2004-2009
    • Technische Universität München
      • Klinik für Orthopädie
      München, Bavaria, Germany
  • 2008
    • Ludwig-Maximilian-University of Munich
      • Orthopedic Clinic
      München, Bavaria, Germany
  • 2003-2005
    • Deutsches Herzzentrum München
      München, Bavaria, Germany