Stellenwert der Stammzelltherapie für die Behandlung der Belastungsinkontinenz

Parallel to a fundamental change in the therapeutic approach to managing stress incontinence, an increasing number of patients ask for reconstruction of the outer, striated urethral sphincter as therapy for urinary stress incontinence. Regenerative medicine is starting to offer solutions using stem cells as a part of oncological therapy or in reconstructive surgery. In addition to the many auspicious experimental approaches, one published study reports the effective therapeutic use of myogenic stem cells in urinary stress incontinent patients. Before this procedure is adopted into general clinical practice, further studies with validated evaluations and a sound legal basis are needed.     

Aktueller Stellenwert der Laparoskopie für die Nierentransplantation

Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.     

Stellenwert der Sonographie in der Frühdiagnostik des Nierenzellkarzinoms

The importance of ultrasonography in early detection of renal cell carcinoma was analyzed for 1854 patients, who were operated from 1975 to 1997. The 5-year survival rate of all patients amounts to 75%, the 10- and 20-year survival rate was 68% and 64%. While from 1975 to 1986 tumor symptoms like hematuria (30%), abdominal pain (19%) and palpable mass (3%) lead to diagnosis of renal cell carcinoma in 56% of all cases, there were only 26% from 1987 to 1997. 83% of asymptomatical tumors from 1987 to 1997 were accidentally detected by means of ultrasonography in a kidney independent examination. These tumors are significantly smaller (5.5 cm) than the tumors of symptomatical patients (7.8 cm) and show often a significantly lower local tumor stage, a better tumor grade, frequently lymph nodes, which are free of tumor infiltration and more rarely distant metastasis. The 5-year survival rate of patients with incidental tumors, detected by ultrasonography (82%) was significantly better (log rank < 0.001) in comparison with the symptomatical patients (72%). These results verify 1. The effectivity of ultrasonography in early diagnosis of renal cell carcinoma and 2. The advantage of survival on patients with early tumor detection. That's why asymptomatic patients, who selected under risk factors should be examinated by ultrasonography consistently too.     

Intelligente Implantate für das Monitoring der Knochenheilung

Background

Monitoring of fracture healing is a complex problem. Radiographs solely enable the estimation of calcification.

Telemetric determination of bone healing

A telemetric system to mechanically assess bone healing was developed. The system consists of an electronic unit applied to a locked plate, an external reader and a ground sensor to measure externally applied loads. By correlating the externally applied load and deformation in the implant, the elasticity of the osteosynthesis is calculated. Elasticity decreases with ongoing consolidation of a fracture or nonunion and is appropriate to monitor the course of bone healing.

Clinical application

Clinical application was performed in 56 patients suffering nonunions or a fracture of the femur; in 47 cases treatment was completed. In 46 of 47 patients, consolidation was achieved. Different types of healing curves could be differentiated (fast healing, slow healing, plateau with following fast healing, nonhealing).

Conclusion

The system proved to be valuable for the judgement of bone healing in difficult healing situations. Routine cost-effective manufacturing is possible, because the used electronic components are derived from mass products.     

Ein neues Modell der Fixationsplatte für das Kniegelenk

Ohne ZusammenfassungMit 3 Textabbildungen     

Der operative Zugang für retroperitoneale Tumoren

Ohne Zusammenfassung Mit 4 Textabbildungen     

Vorhersageparameter für das Vorliegen eines Residualtumors bei der TUR-B-Nachresektion

Background

European Association of Urology (EAU) guidelines recommend a follow-up transurethral resection of bladder tumors (reTUR-B) for intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) 2-6 weeks after the initial resection. The purpose of this study was to find parameters which indicate the presence of residual tumor in reTUR-B and to evaluate the prognostic value.

Patients and methods

The data from all patients treated with TUR-B between January 2005 and December 2008 were retrospectively evaluated. The residual tumor rate was correlated with age, sex, staging, grading, risk group, multifocality and surgeon’s level of training.

Results

A total number of 555 TUR-B operations were carried out and 179 patients received reTUR-B according to the EAU guidelines. Age (p=0.8), sex (p=0.7), initial staging (p=0.2), initial grading (p=0.3) and surgeon’s level of training (p=0.7) did not have an impact on the rate of residual tumor in reTUR-B. Tumors categorized as high risk according to the EAU risk score in initial TUR-B (p<0.01) and multifocality (p=0.01) were associated with significantly higher rates of residual tumor.

Conclusions

A reTUR-B is strongly indicated in high risk bladder tumors as well as multifocal tumors showing a significantly increased residual tumor rate. Other clinical parameters showed no prognostic value for the existence of residual tumor in reTUR-B.     

Stellenwert der Psychoonkologie und ihre Versorgungslage an Zentren für Tumororthop?die

Introduction

Psychosocial screening has not been implemented into diagnosis-related guidelines for the treatment of orthopedic tumor patients. The aim of the study was to evaluate the significance of psycho-oncology in orthopedic institutions specialized in musculoskeletal tumors as well as the opinion and clinical experience of the treating physicians.

Methods

In total 60 orthopedic institutions were recruited. Data were assessed and analyzed by a newly developed, standardized questionnaire. To detect specific, demographic differences results were additionally analyzed according to gender, age and professional experience.

Results

A total of 118?physicians from 47 institutions participated. Significant differences between professional experience groups were obtained regarding the wish for psychosocial treatment in cases of own illness (p=0.032) and the difficulty of addressing patient feelings (p=0.05).

Conclusions

The majority of orthopedic physicians deemed psycho-oncology important. To ensure a holistic approach to the treatment of orthopedic tumor patients, psycho-oncological aspects should be implemented in diagnosis-related guidelines.     

Aktueller Stellenwert der konventionellen Radiographie und Sonographie in der frühen Versorgung traumatisierter Patienten

Conventional radiography (CR) and ultrasound are an elementary part of the diagnostic workflow in the early phase of trauma management. In recent years their clinical value has decreased due to the innovations of computed tomography (CT). The diagnostic superiority of CT has been shown by the higher sensitivity for the detection of traumatic organ lesions. As a result CR has already been become obsolete for head injuries. Furthermore, CT is continuously gaining importance concerning the management of thoracic, pelvic and spinal injuries; however, CR remains the first-line method for the evaluation of simple trauma of the extremities and in contrast, ultrasound is considered to be a sensitive modality for the detection of free fluid after blunt abdominal trauma. In addition the combination of widespread availability, easy handling and the lack of ionizing radiation contribute to the value of ultrasound as a screening method.     

Ausbildungsinitiative der Deutschen Gesellschaft für Urologie für innovative Forschung

The tasks of the Working Group on Urological Research (AuF) of the German Society of Urology (DGU) are to support communication and initiation of joint ventures in German urology and to cooperate with associated subjects and neighboring countries. The annual “wet lab workshops” needs a space between annual and “wet lab workshops” on the topics of tumor cell culture, gene silencing, proteomics, and tissue engineering and the use instead of annual topic-related symposium“urological research,” organized and carried out by the AuF as of 2009, serve to achieve a close change to closer integration of praxis and theory. This should contribute to a lasting quality improvement of the scientific work in urology. Accomplishing these objectives seems urgently necessary to preserve the interests of urologists, because more than ever research has become indispensable in an increasingly difficult environment of health care policy.     

Bericht über das Kolloquium der Deutschen Gesellschaft für Neurochirurgie

Ohne Zusammenfassung     

Stellenwert der Sonographie in Traumatologie und Orthopädie

A wide variety of modern ultrasound systems - including linear probes (7.5-15 MHz) and curved array probes (3.5-7.5 MHz), with color Doppler and duplex as well as harmonic imaging are used in trauma surgery and orthopedics to image and investigate almost all regions of the body. It is generally possible to assess all joints by ultrasonography. Valid procedures for ultrasonographic examination of the elbow, hip, knee, and ankle joints have been described in the literature. In the clinical setting, the use of ultrasound to examine the Achilles tendon and joints such as the shoulder and knee is particularly well documented. An important feature of ultrasound is that it allows dynamic examinations and side-to-side comparisons. Because ultrasonography is a very widely used imaging modality, it is a useful tool for screening and monitoring and especially for investigating venous thrombosis and diseases and injuries of the tendons and muscles.     

Institut für das Entgeltsystem im Krankenhaus

The Institute for the Remuneration System in Hospitals (InEK) was founded in 2001 following the introduction of the flat rate remuneration system for general full and partial inpatient somatic hospital services in Germany by the partners of the joint self-administration. It undertakes the administration and further development of the German diagnosis-related groups system (G-DRG). This includes the definitions and maintenance of the G?DRG considering the comorbidities and complexities, processing and updating of the German coding guidelines. It also includes calculation of the assessment relations of the G?DRG with appropriate supplementary and deduction charges from real costs data of hospitals. With the processing of the procedure for new investigation and treatment methods the InEK plays a decisive role in the integration of new innovative treatment methods and medications in the G?DRG system. The calculation of assessment relations to investment cost financing of hospitals is also a task of the InEK. In addition to these functions the InEK developed the flat rate remuneration system for psychiatry and psychosomatics (PEPP) and in cooperation with other states supported the implementation of flat rate remuneration systems in healthcare services.     

Simulationstraining für das Team im Rettungsdienst

Background

Simulator based training is extensively used in many non-medical high-risk industries. Critical scenarios and standard situations can be trained in complete safety.

Results and objectives

Situations which are regularly met in the field by the emergency team can be simulated. Careful planning and preparation of realistic scenarios is vital to ensure acceptance by the participants and a high rate of transfer of skills to the daily working environment. Only training which is carried out by all emergency medical personnel in the region can achieve a high level of effectiveness. The instructors of the simulation team at the Saint Josef Hospital in Freiburg developed a 1?day seminar with practical as well as theoretical contents. This was implemented over 1 year for more than 100 paramedics in the region. The concept focused on short lectures and intensive debriefings following scenarios in which the participants developed strategies for crew resource management, non technical skills and learned to put it into practice. The organizers wanted to demonstrate the practicability of a regionwide education concept in simulation and team training for the emergency medical service.

Conclusions

With the help of the carefully developed course concept an impressive training course was offered. The participants, when questioned directly after the course, were satisfied with the training and the results. In a further evaluation after some months the success and aftereffects of the project were confirmed.

     

Risikofaktoren für das Versagen von Osteosynthesen

Background

The increasing number of implantations of total knee endoprostheses shows a correlation with an increase in revision operations and periprosthetic fractures.

Objective

This article presents strategies for prevention of complications after open reduction internal fixation (ORIF) of periprosthetic fractures in addition to the classification of periprosthetic fractures of the knee joint.

Therapy strategies

Osteosynthetic treatment is only applicable in some of the cases. Although special periprosthetic, angle locking plates are available for osteosynthesis, treatment of periprosthetic fractures of the knee joint remains a challenge with a high complication rate. If the prosthesis becomes loosened, the prosthesis should be replaced and ORIF should not be performed.

Risk factors

The risk factors for failure of osteosynthesis include the prosthesis model and the associated reduction of residual bone and the mostly osteoporotic bone structures.