Ungeplante Zweiteingriffe nach Frakturen des oberen Sprunggelenks

The purpose of the present study was to analyze the risk factors associated with unexpected second procedures and strategies of revision surgery. Within a 5 year period 647 patients with closed ankle fractures AO type 44 were identified of which 77 (11.9%) needed revision surgery. Complications were addressed to 4 main groups: deep infections (IG) were seen in 29 patients (4.5%), problems with primary wound closure (WG) in 22 patients (3.4%), insufficient reduction (KG) in 22 patients (3.4%) and other causes (RG) included 4 patients (0.6%). Significant predictive factors for soft tissue complications were higher age, comorbidities with peripheral arteriosclerosis, high American Society of Anesthesiologists (ASA) score and diabetes mellitus. AO 44 type B2 and B3 fractures were often associated with soft tissue problems. The more complex fracture types AO 44 C1-C3 and A2-A3 were significantly associated with problems of insufficient congruency post-surgery. The distribution of the mean revision rate was significantly different (p<0.01) for all groups: IG 4.59, WG 3.5, KG 1.55, RG 1.25. In summary, we strongly recommend immediate reduction of displaced fractures and to consider a more detailed fracture classification. To reduce the amount of unexpected ankle procedures individual risk factors should be weighed against the advantages of optimal open reduction and internal fixation.     

Herz und Diabetes

Antidiabetic therapies have to prove cardiovascular safety and efficacy in addition to blood glucose lowering potential. In recent studies metformin administration and dipeptidyl peptidase-4 (DPP-4) inhibition both reduced hypoglycemic and cardiovascular events in comparison to sulfonylurea. High-density lipoprotein (HDL) cholesterol has recently received much attention as a modulator of cardiovascular risk; however, drug-induced increase of HDL cholesterol was unable to reduce cardiovascular events in patients on optimal statin therapy. Therefore, HDL cholesterol levels remain an important risk predictor without being a therapeutic target. In the field of interventional cardiology the FREEDOM trial demonstrated bypass operations to be superior to drug-eluting stent implantation in patients with diabetes and advanced coronary heart disease.     

Kosten und Nutzen eines Qualitätsmanagements

The establishment of quality management (QM) has been mandatory for health care providers of the national health insurance since 2004; however, certification is so far only compulsory for rehabilitation clinics. The costs have so far only been quantified in a few medical studies, while they are widely known in business administration with a basic distinction made between planning, steering, auditing, and declaration costs. Another business economics approach differentiates between prevention, appraisal, and non-conformance costs. The benefits of QM relates to customers, employees, external service providers, and health insurance providers. Also important in our consideration of the patient as a customer is that they should not be considered a customer in the usual business sense because the patient is in an emergency situation and can not freely decide. Improvements in treatment quality and in reducing the rate of adverse events make up the largest portion of the benefits of QM. Furthermore, QM can have a positive influence on motivation and employee recruitment. In addition, the cost savings that result despite costs for QM must not be forgotten.     

Operation hämatogener Metastasen

Urological malignancies represent approximately 40?% of all solid tumors. Synchronous or metachronous organ metastases develop in 30?% of patients. Depending on the tumor entity and tumor characteristics, resection of metastases can improve patient survival. Surgical resection of residual tumors is an integral part of the multimodal therapy concept of patients with nonseminomatous metastatic germ-cell cancer. Surgical inoperability is the only reason not to resect. Resection of hematogenous metastases from renal cell carcinoma has been postulated as a standard therapy for decades. Appropriate patient selection is the key for a survival benefit. Prognosticators such as patient’s general condition as well as number, location, and size of metastases help to counsel and select patients accordingly. Metastases of transitional cell or penile carcinoma should only be resected when a response to systemic treatment is evident in the individual case. There is no evidence in favor of resecting organ-metastases of prostate cancer in the current guidelines and the literature. In this article, arguments against resection of metastases following the current literature and guidelines are described.     

Dokumentation der Dachverbands Prostatazentren (DVPZ)

For certification of a prostate center according to the guidelines of the Governing Body of Prostate Centers (DVPZ) an amalgamation of at least five practicing urologists with a main urology department of a hospital and further cooperation partners for the interdisciplinary approach to prostate cancer is necessary. The DVPZ certificate incorporates benign prostatic syndrome and prostatitis in addition to prostate cancer and is therefore a real organ certificate in the urological sense. The aim of the DVPZ certificate is the integrated, interdisciplinary and interinstitutional treatment of patients with diseases of the prostate.     

Spontane H?matomneigung und Hüftschmerzen bei einer 65-j?hrigen Patientin

The case of a 65-year-old woman with acquired hemophilia is reported. Acquired hemophilia is characterized by the development of inhibitors directed against coagulation factors. Impairment of plasmatic hemostasis leads to a severe bleeding tendency in individuals without a preexisting coagulation defect with considerable mortality. Pathophysiology, diagnostic work-up, and treatment are summarized and discussed.