Was ändert sich durch die neue Verordnung?

Mit dem „Gesetz zum Schutz vor nichtionisierender Strahlung bei der Anwendung am Menschen“ (NiSG) wollte der Gesetzgeber 2009 neben den schon seit Langem bestehenden Regelungen in der Anwendung ionisierender Strahlung auch diesem wachsenden Bereich Rechnung tragen und v. a. unkontrollierte Anwendungen regulieren. Details aber sollten in einer zusätzlichen Verordnung geregelt werden. Obwohl bereits 10 Jahre vorher die Strahlenschutzkommission Empfehlungen dazu abgegeben hat und diese zwischenzeitlich überarbeitet hat, brauchte es noch mal fast 10 Jahre, bis diese Rechtverordnung erstellt wurde. Die Vorlage des Bundesministeriums für Umweltschutz hätte dabei bestimmten Berufsgruppen diese kosmetischen Anwendungen vorbehalten. In der abschließenden Beratung des Bundesrates wurden diese wieder zurückgenommen, und es wurde den Empfehlungen der Strahlenschutzkommission aus dem Jahr 2016 gefolgt     

Leitlinien: Realit?t und Qualit?t

The aim of guidelines is to increase the quality of care in clinical practice. Any influence or financial support by the pharmaceutical industry must be excluded. In urology only two S3 guidelines have been published in German and all others are more or less recommendations (S1). The example of the second opinion project on testicular germ cell tumors shows that a reduction of recurrence, morbidity and mortality can be achieved by the consistent application of guidelines. Oncological guidelines are often focused on the unidirectional parameter overall survival but do not include other important aspects, such as long-term morbidity or quality of life.     

Welche vertikale Implantatposition ist die richtige?

Background

In many cases incorrect positioning of implants in the vertical plane can only corrected only by explantation, especially in the aesthetic zone; however, what vertical implant position is correct in order to achieve stable long-term aesthetic and functional results in the anterior and posterior dentition?

Material and methods

In order to answer this question the results of the 9th European Consensus Conference (EuCC) from March 2014 in Cologne under the leadership of the European Association of Dental Implantologists (BDIZ EDI) and a recent literature review were included.

Results

The results are discussed with respect to the resorption behavior of implants under conditions of varying depths of implant insertion.

     

Welche Inhalte sollte eine ?living guideline“ besetzen?

Background

Due to rapidly developing knowledge guidelines should be regularly, i.e. annually, checked for validity and amended.

Methods

Exemplified by the S3 guidelines on prostate cancer a contradiction between the need for updating and financial resources can be seen. Because the participating experts have only limited availability, the hurdles in the application procedure linked to bureaucracy should at least be dropped.

Results

In the living guidelines on prostate cancer key questions on 13 updating and 5 primary points in question have been formulated and resolved. Examples of updating are imaging, active surveillance and high-intensity focused ultrasound and for primary points, the benefits of new markers and the results of proton therapy. The work, supported by other disciplines, the ?ZQ (Medical Center for Quality in Medicine) and the BPS (Federal Association of Prostate Self-help) should be finished by September 2011.     

Welche Beziehungen hat die Skoliose zur Rachitis?

Ohne Zusammenfassung Mit 7 Textabbildungen.     

St. Corona – eine Fürsprecherin gegen Seuchen?

Die Urologie - Hagiographie spielt in der Wissenschaftsgeschichte noch immer, gerade bei lokalgeschichtlichen Analysen, eine wichtige Rolle. Während sich in der Urologie das Wissen um den Hl....     

Resektion colorectaler Lebermetastasen Welche Prognosefaktoren bestimmen die Patientenselektion?

AIM OF THE STUDY: Based on a consecutive series of patients undergoing liver resection for colorectal metastases, indicators of prognosis and selection criteria were evaluated. PATIENTS AND METHODS: From 1960 to 1998, a total of 654 patients underwent resection of colorectal liver metastases. In 516 patients (78.9%) this was an R0 resection for initial metastatic disease. These patients form the basis for the investigation. RESULTS: 30-day mortality in this group was 5.8%, while the total procedure-related mortality was 8.3%. Significant morbidity was observed in 16% of patients. Follow-up information until 1 January, 2000 was achieved in 99.5% of patients. Including operative mortality, the actuarial 5-, 10-, and 20-year survival is 38 +/- 5%, 27 +/- 6% und 24 +/- 24%, rising to 41 +/- 5%, 29 +/- 6% and 26 +/- 26% after excluding operative deaths. Tumor-free survival is 35 +/- 5% at 5 years. In the multivariate analysis the following factors are associated with decreased crude survival: extrahepatic tumor (P < 0.0001), intraoperative hypotension (P = 0.0001), non-anatomical procedures (P = 0.0002), a metastasis diameter > or = 5 cm (P = 0.0002), unfavourable grading of the primary tumor (P = 0.0003), satellite metastases (P = 0.0069), mesenteric lymph node involvement (P = 0.0260), use of FFP (P = 0.0307) and synchronous diagnosis of metastases (P = 0.1240). With respect to disease-free survival metastasis diameter is first, followed by extrahepatic disease (P < 0.0001 each). Satellite metastases are removed, while the primary tumor site becomes important with inferior results for rectal cancer (P = 0.0188). The other factors remain stable and in the same order. The number of independent tumor nodules as well as the width of resection margin fail to be significant in both univariate and multivariate analysis. CONCLUSION: These results underline the paramount importance of an R0 resection, but diminish the relevance of most commonly used "contraindications". For the actual decision on liver resection, beside the possibility of achieving an R0 situation, safety aspects regarding comorbidity and acceptable extent of parenchyma loss represent the prime limitation.     

254. Welche Diagnostik bei Verdacht auf Appendicitis?

Zusammenfassung Ca. 100 Jahre nach der ersten elektiven Appendektomie bestehen weiterhin oft Unsicherheiten in der Diagnose der Appendicitis, erkennbar an zu häufigen fehlinduzierten Laparotomien. Mittels einer prospektiven Untersuchung bei 75 Patienten wurden die üblichen diagnostischen Tests und anamnestischen Angaben untersucht (Sensivität, Spezifität, pos. Vorhersagewahrscheinlichkeit). DieKombination von > 10,000 Leukocyten/m und Übelkeit zeigte eine hohe Treffsicherheit: Sensitivität 83%. Spezifität 87%, positiv 77%. Von nur 6 falsch positiven Fällen bestand bei 5 hingegen dennoch eine anders begründete Operationspflicht.     

Welche Lehrmethoden werden für die Ultraschallausbildung erwartet?

Background

Current teaching methods in graduate and postgraduate training often include frontal presentations. Especially in ultrasound education not only knowledge but also sensomotory and visual skills need to be taught. This requires new learning methods.

Aim

This study examined which types of teaching methods are preferred by participants in ultrasound training courses before, during and after the course by analyzing a blended learning concept. It also investigated how much time trainees are willing to spend on such activities.

Material and methods

A survey was conducted at the end of a certified ultrasound training course. Participants were asked to complete a questionnaire based on a visual analogue scale (VAS) in which three categories were defined: category (1) vote for acceptance with a two thirds majority (VAS 67–100?%), category (2) simple acceptance (50–67?%) and category (3) rejection (Results A total of 176 trainees participated in this survey. Participants preferred an e-learning program with interactive elements, short presentations (less than 20 min), incorporating interaction with the audience, hands-on sessions in small groups, an alternation between presentations and hands-on-sessions, live demonstrations and quizzes. For post-course learning, interactive and media-assisted approaches were preferred, such as e-learning, films of the presentations and the possibility to stay in contact with instructors in order to discuss the results. Participants also voted for maintaining a logbook for documentation of results.

Conclusion

The results of this study indicate the need for interactive learning concepts and blended learning activities. Directors of ultrasound courses may consider these aspects and are encouraged to develop sustainable learning pathways.     

Ambulante Anästhesie: Welche Voruntersuchungen sind notwendig?

The volume of preoperative screening investigations for outpatient anaesthesia ranges from few, selectively ordered investigations to extensive routine diagnostic procedures. It seem appropriate to reevaluate benefit and efficacy of routine preoperative assessment programs. The purpose of preoperative diagnostic is to assess the risk of anaesthesia and surgery for the patient. As shown by a number of studies, preoperative screening investigations seldom disclose new pathological findings of clinical relevance. Abnormal laboratory results in otherwise healthy patients rarely alter the anaesthetic management of the patient and are not related to perioperative complications. Extensive use of costly diagnostic procedures considerably increases health care budgets. A more selective approach to order preoperative investigations promises considerable savings. To achieve costeffective evaluation an efficient organisation of properative assessment must be established to avoid costly delay and on day-of-surgery-cancellations. There is no medicolegal obligation to perform routine diagnostic testing. The anaesthetist must be sufficiently informed in time to assess the perioperative risk of the patient and to alter anaesthetic management as necessary. According to the presented studies a clinical history and a through physical examination represent an effective method of screening for the presence of disease. Careful medical history evaluation and physical examination can avoid extensive investigations in apparently healthy individuals and the latter should only be ordered if indicated.     

Welche Leberfunktionen sind bei eitrigen Lungenprozessen gestört?

Ohne Zusammenfassung     

Welche H��ftgelenkgleitpaarung f��r welchen Patienten?

Replacement of the hip joint has become an exceptionally successful procedure since the inauguration of the low friction principle by Charnley. Aseptic osteolysis and joint dislocation have been addressed by the development of wear-optimized materials and the introduction of larger heads. As an increase in head diameter against polyethylene causes wear increase, larger hard-on-hard bearings were introduced, which exhibit reduced wear and reduced dislocation risk with increasing head diameter. These findings were derived from standard simulator testing, not sufficiently considering the risk of fluid film breakdown under adverse conditions, which can cause a dramatic increase in wear and friction proportional to the head diameter. Such adverse conditions can occur clinically in patients due to several factors and have caused the presently observed unexpected problems with these new designs. Standardized preclinical testing has to be viewed as a minimum requirement but certainly not as a guarantee for the clinical success of new materials and designs even if the testing is adapted to the current patient requirements, which is presently not the case. The future of tribology lies in the prevention of adverse conditions in patients, the improvement and optimized use of proven existing materials and not in the use of new materials.     

Welche rolle spielt die gastritis nach resektion wegen ulcus?

Zusammenfassung Nach neueren Mitteilungen ist die Gastritis nach Magenresektion wegen Ulcus au?erordentlich h?ufig und spielt in der Erkl?rung postoperativer Beschwerden eine gro?e Rolle. Bei 66 Kranken wurden die durch Resektion gewonnenen Pr?parate histologisch untersucht. Dabei fanden sich jedesmal an beiden Resektionsgrenzen ausgesprochene gastritische Ver?nderungen. 44 Patienten wurden klinisch und r?ntgenologisch nachuntersucht. Bei einem gro?en Teil der Magenresezierten konnte r?ntgenologisch eine sichere Gastritis nachgewiesen werden. Meist bestanden keine Beschwerden. Da? beim gleichen anatomischen Bild einmal gar keine, ein anderes Mal sehr starke Beschwerden bestehen, lenkt die Aufmerksamkeit auf die Bedeutung der psychischen Komponente der Erkrankung. Die Magenresektion eines ulcuskranken Neurotikers bedarf besonders genauer Indikationsstellung. Selbstverst?ndlich soll nicht geleugnet werden, da? Gastritis — besonders die akuten Schübe — Beschwerden machen kann. Wenn heute jedoch fast alle Klagen nach Magenresektion — was sehr an die frühere Rolle der Adh?sionen erinnert — auf Gastritis bezogen werden, so geht das über das Ziel hinaus. Die Gastritis ist in Gefahr, damit eine “Abbaukrankheit” zu werden.      

Standardtherapie von Hauttumoren gemäß Leitlinien

During the last decade the incidence of non-melanoma skin cancer has sharply increased. Changes of the age structure in society and the increased extent of skin exposure to the sun are major factors. This development represents a challenge for the treatment with prophylaxis, early recognition, surgical techniques and histological control. Under the non-melanoma skin tumors basal cell carcinoma, squamous cell carcinoma and Merkel cell carcinoma are the main entities. This paper highlights the epidemiology, diagnostics and therapy with consideration of the guidelines for treatment of these neoplasms. Furthermore this article presents current concepts for the reconstruction of skin defects of the face with local flaps. The treatment of skin cancer of the face requires particularly careful surgical treatment and is a challenge for aesthetic reconstruction.     

2000 ? 2005 ? 2010: Die neuen Leitlinien zur Reanimation in autorisierter deutscher übersetzung

Editorial

2000 ? 2005 ? 2010: Die neuen Leitlinien zur Reanimation in autorisierter deutscher übersetzung     

Welche Zugänge prädisponieren für Narbenhernien?

Incisional hernias are the most common long-term complication after laparotomy with a cumulative incidence up to 20%. Generally all injuries to the integrity of the abdominal wall can result in the development of an incisional hernia. Midline and transverse incisions cause similar hernia rates. By selection of a sufficient closure technique and appropriate suture material as well as taking appropriate accompanying treatment (antibiotic prophylaxis) and risk factors into consideration, surgery can reduce surgical site infections, wound dehiscence and incisional hernias. Results from randomized controlled trials have not yet demonstrated a superiority of laparoscope-assisted procedures compared to laparotomy for the prevention of incisional hernias. Access through natural orifices and removal of specimens through the same approach (NOTES) may prevent incisional hernias completely. The approach to the abdominal cavity has to be chosen according to the underlying disease of the patient, the anatomical conditions and further circumstances (e.g. urgency, extensibility, preservation of function of the abdominal wall and safety).     

Welche Rolle spielt die ernährung bei der colitis ulcerosa?

Zusammenfassung Rolle und Funktion der Ernährungstherapie bei der Behandlung der Colitis ulcerosa werden kontrovers diskutiert. Bei der Beurteilung von Studien — die sich in erster Linie mit der total-parenteralen (TPN) und total-enteralen (TEN) Ernährung befassen — mu v. a. zqischen unterschiedlichen therapeutischen Zielen differenziert werden. Hauptaugenmerk liegt auf einer Verbesserung des Ernährungsstatus, Remissionsinduktion, Vermeidung einer chirurgischen Intervention oder aber Verringerung postoperativer Komplikationen. Entsprechend schwer sind die vorliegenden Ergebnisse zu vergleichen. Deutlich wird aber, da der Schweregrad und die Ausdehnung der Kolitis, der Ernährungsstatus des Patienten sowie die entsprechende Indikation zur Durchführung einer Ernährungstherapie relevant sind. Primär in nichtkontrollierten Studien beobachtete, positive Effekte der TPN an gröeren Patientenkollektiven konnten in kontrollierten Studien nicht nachvollzogen werden. Vielmehr zeigt die TPN hier keinen Vorteil gegenüber einer oralen Diät. Im Hinblick auf die Remissionsinduktion oder Operationsvermeidung ist die nebenwirkungsreiche TPN der TEN ebenfalls nicht überlegen. Ein therapeutischer Nutzen der TEN scheint sich für bestimmte Patienten jedoch zu ergeben. So treten nach TEN signifikant weniger postoperative Komplikationen auf. Eine abschlieende Beurteilung zum Effekt der TEN sowie der TPN bei Colitis ulcerosa ist aber aufgrund der Heterogenit der bisher durchgeführten Studien nicht möglich. Besondere Beachtung sollte in diesem Zusammenhang dem Einsatz spezieller Fettsäuren in der Behandlung der Colitis ulcerosa gegeben werden. Prospektive, randomisierte und kontrollierte Studien haben einen therapeutischen Nutzen von -3-Fettsäuren gezeigt. Von den verschiedenen positiven Effekten ist die Reduktion der Steroiddosis als der wesentlichste einzustufen. Bei der Behandlung der distalen Colitis ulcerosa hat sich in mehreren Untersuchungen die rektale Applikation von kurzfettigen Fettsäuren als vorteilhaft erwiesen.

---

Influence of nutrition in ulcerative colitis —the significance of nutritional care in inflammatory bowel diseases

Nutritional therapy for ulcerative colitis (UC) is controversial. Studies are usually designed to investigate total parenteral (TPN) or total enteral nutrition (TEN), and before these can be compared it is necessary to differentiate between the different therapeutic aims. The aims of artifical nutritional support in patients with UC are the readjustment of the nutritional status, possible remission of disease activity, and decrease in the incidence of surgical intervention or postoperative complication. Owing to the heterogeneity of the results published so far, it is still difficult to compare studies. Nevertheless, they indicate that the extent and severity of the colitis and the patient selection are of paramount importance in the implementation of nutritional therapy. Positive effects of TPN reported from non-controlled studies were not confirmed by controlled trials. Moreover, TPN was no more effective than an oral diet. Regarding remission rates or operative interventions needed, TPN had more side effects than and no defined advantages over TEN. TEN seems to be useful for certain patients. In some patients with UC, it seems to be accompanied by fewer postoperative complications. However, a definitive conclusion on the effects of TEN or TPN is not yet possible. In this context, certain fatty acids may have an important role in the treatment of UC. In prospective, randomized and controlled studies omega-3 fatty acids were found to be therapeutically useful. A reduction of the steroid doses needed is particularly important. Another therapeutic approach in distal UC is seen in the rectal administration of short chain fatty acids.

     

Welche Biomarker zu Diagnosestellung und Steuerung der antiinfektiven Therapie bei Sepsis?

Die Anaesthesiologie - Die Identifikation eines Biomarkers, der idealerweise eine perfekte Sensitivität und Spezifität mitbringt, um eine Inflammation von einer Infektion zu...