Das fortgeschrittene Urothelkarzinom der Harnblase beim ?lteren Patienten

Introduction

Age is suggested to be the greatest single risk factor for developing urothelial carcinoma of the bladder (UCB). This review presents an overview of the incidence, prognosis, surgical and medical therapy of UCB in elderly patients (>?65?years).

Results

Elderly patients have an approximate 11-fold increase in the incidence and a 15-fold increase in UCB mortality when compared to younger individuals. However, adequate surgical or medical treatment is less often or delayed offered to elderly patients. In properly selected cases, similar surgical outcomes and complication rates are reported in elderly patients, regardless of the type of urinary diversion. Application of perioperative systemic chemotherapy is dependent on physiologic deterioration and comorbidities. An adequate, restrictive case selection and early proactive postoperative rehabilitation are important factors to achieve good results.

Conclusions

In adequately selected elderly patients, radical cystectomy and urinary diversion as well as systemic chemotherapy are feasible, safe and efficacious treatment options for advanced UCB.     

Das Keimspektrum von heute – gegen wen k?mpfen wir?

Surgical site infections are mainly caused by bacteria from the patients' skin or gut flora representing endogenous infections. In orthopedic and trauma surgery the skin commensals dominate and as a consequence Gram-positive bacteria are the main pathogens, particularly S. aureus. Additionally and especially in the case of foreign body infections, less virulent pathogens, e.g. coagulase-negative staphylococci play an important role. Due to newer microbiological techniques in detecting pathogens the spectrum of causative organisms is steadily increasing. As known for other nosocomial infections the relevance of multidrug resistant bacteria in surgical site infections is growing and the key player is methicillin-resistant S. aureus (MRSA); however vancomycin-resistant enterococci (VRE), extended spectrum betalactamases and/or carbapenemases producing enterobacteria and recently even panresistant Acinetobacter baumannii isolates have to be considered.     

Das Erl?schen der Geschlechtskraft bedingt keine Minderung der Erwerbsf?higkeit

Ohne Zusammenfassung     

Das neue Patientenrechtegesetz – was müssen wir beachten?

The controversially discussed act of improving the rights of patients entered into force in Germany on 26 February 2013 without any transitional period. The current law of patients “rights brings together patients” rights at one uniform place in the civil code (BGB, “Bürgerlichen Gesetzbuch”) and should, therefore, attract the medical stakeholders’ interest. The new patients “rights law improves the patients” position concerning both treatment and doctor’s liability law and is supposed to strengthen a new “error culture” in health care. Similarly, clinical and daily practice becomes more complex with high levels of bureaucracy and the patient-physician relation shifts in favour of meticulous documentation.     

Das Stärkebindenkorsett

Ohne Zusammenfassung     

Das Erysipeloïd

Ohne Zusammenfassung     

Das ?onkofetale“ Gen Survivin – ein m?gliches Ziel-Gen regenerativer Therapiekonzepte im Gelenkknorpel

Survivin, the smallest member of the inhibitor of the apoptosis protein gene family (IAP) is a key molecule for mammalian cell cycle regulation and cellular survival. Of note these functions have been thought to be limited to embryonic and malignant tissues. However, a growing body of evidence indicates a limited expression of survivin in some highly specific adult tissues and cells. In the present study it has been demonstrated that the antiapoptotic protein survivin is re-expressed in osteoarthritic human cartilage and primary human chondrocytes. Furthermore, the data indicated that survivin significantly affects cell cycle regulation and cellular survival. The modulation of survivin expression and function in cartilaginous tissues might be important for understanding osteoarthritis and the development of regenerative strategies.     

Das Bild der Tuberkulose im Film ?Robert Koch �C Bek?mpfer des Todes��

Popular media have an immediate effect on an audience of millions. They are the base of social learning through the times. Therefore they deserve greater attention from professionals. The Nazi propaganda for example created an elaborate system, which made use of new technologies of the twentieth century, especially radio broadcasting and the movies. Escapism should be produced. Up to now those movies are shown on TV or in the cinema often without reference to their origin and intention which were later on regarded as harmless. As a consequence, "propaganda" is maintained in a very distinguished way. In 1945, the Allies first banned the showing of films made during the Nazi era and confiscated important documents. Those films regarded as "harmless" were soon released to the public again, but in the 1950s some 250 politically dubious films were still under lock and key. Interestingly, they often can be received via the Internet from other countries especially the USA. It only became clear over time that the propagandistic aims that found expression in some 1,100 films needed to be examined more carefully.     

Das Cholin-PET/CT in der Prim?r- und Rezidivdiagnostik des Prostatakarzinoms

Overdiagnosis and resulting overtreatment in prostate cancer are under intensive discussion both in the urologic communities and in the public media. Sensitive and specific diagnostic modalities could be one step forward to overcome this problem. Choline PET/CT provides fusion imaging that combines anatomical/morphological information with metabolic/functional data. Despite promising preclinical data and interesting initial clinical results, this cost-intensive and logistically demanding technology has not yet found its way into routine clinical practice; the German and European guideline recommendations are careful and reluctant. This review has the goal to give an overview of the recent data both on initial diagnosis and on staging/diagnosis for biochemical recurrence by choline PET/CT and to summarize the possible role of this innovative technology in the future, if adequate research projects can be realized.     

Das hepatobiliäre Cystadenom

Zusammenfassung. Einleitung: Hepatobili?re Cystadenome sind seltene intrahepatische cystische Tumoren, deren pr?operative Diagnose sehr schwierig ist. Methode: Wir berichten über 4 Patienten mit einem solchen seltenen Tumor, die in der Zeit von Januar 1995 bis Dezember 1999 in unserer Klinik behandelt wurden. Ergebnisse: Die klinischen Symptome waren sehr unspezifisch. Pr?operativ bestand bei 2 Patienten radiologisch der Verdacht auf eine Echinokokkencyste, der jedoch weder serologisch noch intraoperativ best?tigt wurde. Die vollst?ndige Entfernung des Cystadenoms gelang bei 3 Patienten. Bei einer Patientin konnte auf Grund der Einbeziehung der Leberpforte nur eine subtotale Resektion erfolgen. Eine maligne Transformation zu einem Cystadenocarcinom beobachteten wir nicht. Schlu?folgerung: Eine komplette Resektion der Cystadenome ist dringend zu empfehlen, da über ein hohes Potential zur malignen Entartung berichtet wurde. Da die sichere pr?operative Diagnose eines mucin?sen Cystadenoms schwierig zu stellen ist, kommt der intraoperativen Schnellschnittuntersuchung eine besondere Bedeutung zu. Eine cystische, eventuell septierte Leberl?sion in Verbindung mit einem pr?operativ erh?hten CA 19–9 kann hiweisend auf ein mucin?ses Cystadenom oder Cystadenocarcinom der Leber sein.      

Das destruierte Hüftgelenk

Because of the considerable progress achieved in alloplastic hip joint replacement, very few indications for arthrodesis remain, for instance loss of the stabilizing muscles in the hip. The possibilities for total hip arthroplasty are not only limited to the generally accepted standard procedures, but should also take individually customized tumor prostheses into consideration including partial pelvis replacement as well as fallback options using a saddle prosthesis and combinations of alloplastic implants and corrective osteotomy. Pelvic support osteotomy represents a convincing functional alternative particularly for younger patients after bacterial coxitis in early childhood with corresponding loss of the femoral head and neck. Further options consist of Girdlestone resection arthroplasty and ultimately hip disarticulation. After hip arthroplasty accompanied by subsequent complaints in the neighboring joints the indication for reorienting de-arthrodesis should be assessed on an individual basis. Relevant examples are presented for all of the procedures and surgical techniques mentioned.     

Das diabetische Fußsyndrom

There are more than 6 million diabetic patients in Germany. The number of patients with “diabetic foot syndrome” has been increasing dramatically over the past years. Many of the 200.000 newly discovered diabetic foot ulcers per year become chronic wounds. Despite all efforts for prevention, early diagnosis and adequate wound care there are 20.000 diabetics undergoing major limb amputation in Germany every year. With a consistent strategy of prevention, many foot ulcers can be avoided, and the recurrence rate can be decreased. Also, many amputations can be avoided if an improvement of arterial perfusion was to be considered early. With consistent therapy in interdisciplinary centers and by applying all methods of arterial revascularization, the amputation rate in patients with diabetic foot problems can be reduced by 80%.     

Das diabetische Fußsyndrom

The number of patients with “diabetic foot syndrome” has been increasing dramatically over the past years. Many of the 200.000 newly discovered diabetic foot ulcers per year become chronic wounds. Still there are more than 10.000 diabetics undergoing major limb amputation in Germany every year. With a consistent strategy of prevention, early therapy in interdisciplinary centres, and by applying all methods of arterial revascularization many foot ulcers, recurrences or amputations could be avoided. This article describes the therapy as well as the follow-up and prevention of the diabetic foot syndrome from a vascular surgical point of view. The importance of endovascular, vascular-surgical as well as combined (hybrid) procedures of revascularization is emphasized.     

Das Hack’sche Bruchband

Ohne Zusammenfassung     

Das intraartikuläre Osteoidosteom

Intra- and, respectively, periarticular osteoid osteoma are accompanied by sympathical arthritis which itself can irreversibly destroy the cartilage of the joint. In contrast to other locations, intra- and periarticular osteoid osteoma are rare. Reactive and symptomatic accompanying arthritis may lead to irreversible cartilage destruction especially in chronic courses. Therefore early diagnosis and therapy is crucial. We present a case report and discuss these rare tumors by reviewing the literature.     

Das einfache Schädel-Hirn-Trauma

With regard to diagnosis and treatment, there is no general agreement about the management of mild head injury. The value of clinical discoveries and the indications for x-ray investigations are controversially discussed, as well as the risks of radiation exposure. Important criteria in the judgment of mild head injury are knowledge of its possible stages over time (primary and secondary unconsciousness and symptom free interval), the dynamics of secondary intracranial injury development (epidural or subdural hematoma, brain contusion, brain swelling, brain edema), and the priority given to neurologic findings, accompanying vegetative symptoms and computerized tomography and x-ray results. By means of these parameters, an algorithm for appropriately managing the diagnostics and processing of patients with mild head injury has been created.