Clostridium-difficile-Infektionen

In recent years, a global increase of Clostridium difficile-associated infections (CDI) and the emergence of new hypervirulent strains causing numerous outbreaks was noticed. The appearance of these strains was accompanied by increased morbidity and mortality, affecting patients previously unknown to be at risk for CDI. Meanwhile, these hypervirulent strains occur in Germany as well. So far, the changing epidemiology of CDI did neither change diagnosis nor therapy of CDI but necessitates a series of preventive measures like the surveillance of CDI and contact precautions while caring for affected patients. If there are complicated or severe cases of CDI, the hypervirulent strains should be suspected and stool culture for isolation of C. difficile should be aimed.     

Weiterbildung gestern, heute und morgen

Medical further training in gynecology has deteriorated dramatically in recent years. Structural alterations and shortage of personnel have led to a situation whereby first class training in clinics can only take place unsatisfactorily. Many institutions attempt to plug these gaps with often obscure and sometimes extremely expensive offers of courses. Even the major topics of training to attain medical specialist status show glaring deficits. This article describes the concepts of the German Society for Gynecology and Obstetrics (DGGG) to counteract these problems. The theoretical training can be ensured by a centralization of transparent course systems and a guarantee of the contents of practical training as laid down in the regulations for model further training. Whereas implementation of rotation positions between different clinics would lead to a“genuine” closing of gaps in the necessary practical achievements in the catalogue for specialist or major topics, unified and certified theoretical course models could be comprehensively inserted which reflect the whole spectrum. These course systems would be mutually authorized and certified by the DGGG and the working groups of the DGGG in order to guarantee a high quality with adequate and acceptable prices.     

Vorgehen bei Verdacht auf Kindestötung

Since 1^st April 1998 infanticide is categorized under §213 StGB (Penal code: less serious case of manslaughter). Mothers who kill their newborn babies are mostly young woman living either alone or at their parent’s house. Commonly the existence of the pregnancy is denied or blocked out the whole time. In cases of suspected infanticide the subject matter of forensic examination is the newborn baby as the object of a crime. The examination of a suspected woman after birth and also the diagnosis of a suppressed pregnancy should always be performed by a gynecologist. A concluding assessment of the medical findings and/or possible injuries should result from cooperation with a forensic medical expert if necessary.     

Regeneration des N. facialis im Vergleich zu anderen peripheren Nerven

Despite increasing knowledge of cellular and molecular mechanisms determining the success or failure of peripheral nerve regeneration, no effective treatments for peripheral nerve injury exist. Newly developed and validated approaches for precise numerical assessment of motor deficits have recently allowed testing of novel strategies in experimental animals. One of these approaches is the daily manual stimulation of the denervated musculature. This treatment is effective in cases of cranial nerve lesions with preservation of the sensory input (facial or hypoglossal nerve) and has the potential of direct translation in clinical settings. However, manual stimulation appears to be ineffective for the treatment of mixed peripheral nerve injuries. Generally, no long-term improvement of functional recovery is achieved by electrical stimulation in rodents. While short-term post-traumatic stimulation of the proximal nerve stump has no negative effects, direct electrical stimulation of the muscle during the period of de- and reinnervation appears to hinder muscle fibre reinnervation. Finally, experimental evidence suggests that application of peptides known as glycomimetics, which mimic functional properties of carbohydrate molecules, may provide significant benefits after injuries of mixed peripheral nerves.     

Bewegungstherapie bei pulmonaler Hypertonie

Pulmonary hypertension (PH) is associated with limited quality of life, reduced physical capacity, and poor prognosis due to right heart failure. A recent prospective, randomized study evaluated the effects of exercise and respiratory training in patients with symptomatic PH. At week 15, patients in the training group had improved 6MWD (mean difference 111 m; p<0.001). Exercise training was well tolerated and significantly improved scores of quality of life, WHO functional class, peak oxygen consumption, and achieved workload. This study indicates that respiratory and physical training could be a promising adjunct to medical treatment in severe PH.     

Radiologische Beckendiagnostik

Prostate cancer, bladder cancer, and pelvic floor weakness are among the most common diseases of the pelvis. Cardinal symptoms include painless macrohematuria in bladder cancer and urinary and fecal incontinence in pelvic floor weakness. Suspicion of prostate cancer currently is most frequently raised when the serum concentration of prostate-specific antigen is pathologically elevated. Besides extensive clinical and invasive diagnosis, clinical imaging is frequently applied for the localization, locoregional staging, and diagnosis of recurrence of prostate cancer and invasive bladder cancer, and in clinically difficult cases of cystocele, enterocele, rectocele, descensus or prolapse of vagina, uterus, and rectum, and rectal intussusception. Magnetic resonance imaging with T2-weighted TSE or FSE images in several planes combined with either axial, T1-weighted images and MR spectroscopy for the prostate, dynamic contrast-enhanced T1-weighted images for the urinary bladder, or dynamic T2-weighted functional images for pelvic floor incontinence are particularly well suited as clinical imaging methods.     

Tolvaptan (OPC-41061)

Ohne Zusammenfassung     

Lebensqualität bei Kindern in kieferorthopädischer Behandlung – Eine Cross-sectional-Erhebung

Studies measuring quality of life (QoL) during orthodontic treatment are rare in Germany. Therefore, the aim of the present study was to measure the impact of orthodontic treatment on QoL and to develop a reliable instrument for measuring this. The study was conducted in a large orthodontic practice and was designed as a prospective cross-sectional assessment. A total of 116 children or their parents were questioned before and 119 after the treatment. We used a validated questionnaire for children (KINDL) and a module for orthodontic patients. In addition, clinical parameters and economic outcomes were measured. The results differed significantly between children and parents for ratings of physical and psychological wellbeing. Expectations of “being teased” about wearing braces were significantly different before and after treatment. Aesthetic aspects were the main motivation for having the treatment. Tooth-cleaning became significantly more effective, although the children did not brush their teeth more frequently. This study has highlighted important factors in compliance in children during orthodontic treatment and the value of prophylactic measures. The assessment of QoL is thus relevant to quality assurance in the specialist practice.