Beeinflusst Rauchen das Überleben von Prostatakarzinompatienten?

In the last few years, prostate cancer has become one of the most common causes of mortality worldwide. It is therefore important to detect possible risk factors for this malignant disease. Besides risk factors which increase incidence, attention should be paid to factors which have a possible influence on the course of the disease. In our analysis, we demonstrate a worse course for the disease in patients with prostate cancer who smoked cigarettes at the time of first diagnosis. In spite of comparable staging, grading and PSA values at the time of primary diagnosis, individuals who smoked had a threefold higher risk of dying from prostate cancer. This effect is probably caused by metabolic changes which are activated by cigarette smoking and promote tumor growth and the development of metastases.     

Schwerwiegende kindliche Anomalien des Harntrakts Vorkommen, Diagnostik und Therapie in Deutschland

Zusammenfassung Die kindliche Harntransportstörung kann abhängig vom Grad der Obstruktion eine Schädigung der Nierenfunktion verursachen. Ein frühzeitiges Erkennen und die Bewertung der Auswirkung der Obstruktion auf die betroffene Niere durch adäquate Diagnostik ist Voraussetzung für die Entscheidung zu einer konservativen oder operativen Therapie. Die vorliegende Untersuchung des Arbeitskreises für Kinderurologie der Deutschen Urologen in Zusammenarbeit mit der Arbeitsgemeinschaft für Pädiatrische Nephrologie fasst im Sinne einer qualitätssichernden Untersuchung den Stand der diagnostischen (Sonographie, Urinsediment, Labor, nuklearmedizinische Untersuchungen, MCU und i.v.-Urogramm) und therapeutischen (konservativen oder operativen) Verfahren bei kindlicher Harntransportstörung zusammen. Die Bedeutung der Sonographie wird durch den hohen Anteil der Kinder (57,2%) deutlich, die bei Screeninguntersuchungen aufgefallen sind. Bei pränatal diagnostizierter Harntransportstörung wurde zu 25% eine begleitende Refluxerkrankung detektiert. Diese Studie zeigt den derzeitigen Stand der durchgeführten diagnostischen und therapeutischen Methoden bei kindlicher Harntransportstörung in der deutschsprachigen Urologie. Abstract As urinary tract obstruction in children may impair renal function, the early detection and evaluation of the degree of obstruction using adequate diagnostic tools is necessary for the choice of the optimal therapeutic procedure. This study describes diagnostic and therapeutic standards in relation to the quality of management of pediatric hydronephrosis in Germany in the first 6 months of the year 2000. In our study 407 of 711 (57.2%) children with a hydronephrotic condition were detected by routine ultrasound. This, and the fact that 25% of the patients, who were prenatally detected, had a diagnosis of vesicoureteral reflux, underlines the importance of this routine procedure. Our study illustrates the panel of diagnostic and therapeutic procedures used in the management of pediatric hydronephrosis in Germany.     

Autologous breast reconstruction with the transverse myocutaneous gracilis flap: aesthetic improvements with tissue expansion before free flap transfer

The transverse myocutaneous gracilis (TMG) flap provides an alternative to commonly used free flaps from the lower abdomen and buttocks for breast reconstruction. Excellent aesthetic results can be achieved in primary breast reconstruction after subcutaneous and skin-sparing mastectomy. However, in delayed breast reconstruction after mastectomy, an obvious skin island and conspicuous scars often compromise the final appearance. A two-stage approach with tissue expansion of the skin followed by free deepithelialised TMG flap reconstruction avoids these disadvantages and leads to improved aesthetic results. We treated two patients who asked for an autologous breast reconstruction after mastectomy due to primary breast cancer. Reconstruction with lower abdominal tissue was not feasible in one patient because of a previous abdominoplasty and in the other because of insufficient lower abdominal tissue. Both patients declined an implant-based breast reconstruction as well as a procedure using a flap from the buttock, favouring reconstruction with autologous tissue from the superior inner thigh. In the first stage, a tissue expander was inserted endoscopically assisted via a transaxillary approach. The expander was gradually filled over a 3-month period and finally replaced by a free deepithelialised TMG flap. The postoperative period was uneventful in both patients. We achieved satisfying results in both patients with good breast symmetry and uniform colour of the breast skin. Disadvantages and limitations of traditional one-stage breast reconstructions by free TMG flaps can be avoided by this two-stage approach. This reconstructive procedure leads to inconspicuous scars and a matching skin colour of both breasts. Level of Evidence: Level V, therapeutic study.     

Überprüfung des Einsatzes von Triclosan bei Dauerkatheterträgern

Background

This article presents the first randomized, double blind, multicenter, placebo-controlled, non-interventional trial with a medical product after approval by the ethical committee of the medical council of North-Rhine. The study investigated the use of the antimicrobial agent triclosan (Farco-fill® Protect) as a liquid for inflation of catheter balloons in patients with chronic indwelling catheters.

Patients and objectives

In this study 84 patients were investigated (43 in the treatment group and 41 in the placebo group) all with a suprapubic catheter and a positive history of catheter incrustation. The catheters were changed after 6 weeks and endpoints were the quantitative analysis of the incrustation, weight of the catheter, pain during catheter change and the number of urinary tract infections. The maintenance of the catheter was a secondary endpoint.

Results

The primary endpoint could not be reached because the study, which was initially planned with 70 patients in each arm, had to be terminated due to logistical and technical problems with the catheter weighing. The maintenance of the catheter as the most important clinical parameter showed statistically significant differences with a longer indwelling time in the triclosan group. Adverse events with respect to the product were not recorded.

Conclusions

Using the antimicrobial solution triclosan as a fluid for inflation of catheter balloons led to a statistically significant extension in the catheter indwelling time. The reduction of pain during changing the catheter and the reduction of incrustation, although not statistically significant, led to an improvement in the quality of life of these patients.     

Terminausf?lle in der Praxis

Purpose

A well-structured system of appointments is mandatory in urological practices to provide a perfect work flow. A huge problem is appointments which are not cancelled by non-attending patients and remain free during consultation hours.

Methods

An analysis of the electronic calendar of our group practice was performed from January 2010 to December 2010.

Results

In 2010, 24,764 appointments in consultation hours were scheduled and of those 1,348 (5.4%) were not cancelled but not attended by the patients. Out of 1,760 X-ray investigations 59 (3.3%) patients did not show up and of 3,828 cystoscopy appointments, 109 (2.8%) patients did not cancel although they did not attend. A total of 440 outpatient appointments for surgery were scheduled and 8 (1.8%) patients did not attend but did not cancel surgery. Out of 176 (11.4%) scheduled spermiogram appointments, 20 patients did not bring a sample for analysis.

Conclusions

Due to the experiences of the authors, combined investigations, e.g. intravenous pyelogram (IVP) and cystoscopy on one day, should therefore be avoided in order to be able to cancel the second appointment when patients do not show up for the first appointment. In cases of surgical interventions, patients should be contacted by telephone 2-3 days prior to surgery for confirmation. Currently under German law there is no way to claim compensation for missed appointments from the patients. Thus, the only way to avoid large numbers of missed appointments is to keep those as low as possible, as soon as appointments are made and scheduled (e.g. no double appointments).     

245. Die Arteriosklerose als chirurgische Aufgabe

Langenbeck's Archives of Surgery - Die Spatergebnisse der rekonstruktiven Arterienchirurgie werden an 5245 operierten Kranken der Chirurgischen Universitätskliniken Köln und...