Wagenlehner F.M.E.,Justus Liebig University |
Hoyme U.,Helios Klinikum Erfurt GmbH |
Kaase M.,Ruhr University Bochum |
Funfstuck R.,Sophien und Hufeland Klinikum GmbH |
And 2 more authors.
Deutsches Arzteblatt | Year: 2011
Background: Urinary tract infections (UTIs) are among the most common types of bacterial infection in outpatient medicine. Rising rates of antibiotic resistance and a better understanding of the ecological adverse effects (collateral damage) of antibiotics warrant a reevaluation of the treatment recommendations for uncomplicated UTI. The new S3 guideline contains updated recommendations. Methods: The new S3 guideline is based on a review of publications on uncomplicated UTI retrieved by a systematic search of the Medline and Cochrane Library databases. Guidelines from abroad were also considered in the review. Results: Uncomplicated UTI is classified as either uncomplicated cystitis (UC) or uncomplicated pyelonephritis (UP). The choice of a suitable antibiotic is determined by the following main criteria: the patient's individual risk profile and prior antibiotic treatment, if any; the spectrum of pathogens and antibiotic susceptibility; the proven efficacy of the antibiotic; the ecological adverse effects (collateral damage) of antimicrobial therapy; the side effects for the patient under treatment. On the basis of these criteria, co-trimoxazole/trimethoprim and fluoroquinolones can no longer be recommended as first-line empirical treatment for UC. Rather, the new recommended treatment of first choice consists of fosfomycin-trometamol, nitrofurantoin, or pivmecillinam. High-dose fluoroquinolones are still recommended, however, as first-line oral treatment for UP. Asymptomatic bacteriuria should only be treated in exceptional situations such as pregnancy or before urological procedures that will probably injure the mucosa of the urinary tract. Conclusion: The new S3 guideline on uncomplicated UTI incorporates a forward- looking approach to the use of antibiotics in treating this common type of infection. It is intended to bring about a sustained improvement in the quality of care.
Kunert K.S.,Helios Klinikum Erfurt GmbH |
Melle J.,Helios Klinikum Erfurt GmbH |
Sekundo W.,University of Marburg |
Dawczynski J.,University of Leipzig |
Blum M.,Helios Klinikum Erfurt GmbH
Klinische Monatsblatter fur Augenheilkunde | Year: 2015
Background: This clinical trial is focused on the 12-month results of a new method for refractive correction in myopia, called small incision lenticule extraction (SMILE). Patients and Methods: In a prospective study 91 eyes were treated with the new refractive procedure and the results were published after 6 months. A lenticule of intrastromal corneal tissue is cut utilising the Carl Zeiss Meditec AG (Jena, Germany) VisuMax femtosecond laser system. Thereafter, this lenticule is manually removed without lifting a flap. 55 eyes of 33 patients volunteered for a 12-month follow-up. UCVA and BSCVA after 12 months, objective and manifest refraction as well as slit-lamp examination and late side effects were documented. Results: 55 eyes of 33 patients were re-examined in this study 12 months after surgery. The spherical equivalent before surgery was - 4.66 (± 1.75) D; after 12 months - 0.11 (± 0.42) D was manifest. No significant change was observed compared to the 6-month control. Starting with UCVA of 0.1 (± 0.06) before surgery. UCVA was 1.02 (± 0.3) after 12 months. One eye lost more than two lines. All other patients did not have any late side effects. Conclusion: The one-year results of this new procedure are encouraging. Especially stability of the correction of myopia and myopic astigmatism with the SMILE procedure is very good.
Blum M.,HELIOS Klinikum Erfurt GmbH |
Sekundo W.,University of Marburg
Ophthalmologe | Year: 2010
Starting in 2006 a new "all femto" method of refractive correction for myopia and myopic astigmatism was introduced. This new method was originally introduced as femtosecond lenticule extraction (FLEx) and further developed with a small incision into SMILE (small incision lenticule extraction). To simplify the terminology the manufacturer brought this onto the market in April 2010 as ReLEx (refractive lenticule extraction). In this procedure a lenticule of intrastromal corneal tissue and a flap-like access cut are subsequently cut utilizing the VisuMax® femtosecond system (Carl Zeiss Meditec, Jena, Germany). The lenticule is then manually removed and the flap repositioned (only by FLEx). In approximately 1,000 successful surgical operations only few side effects were found. The number of eyes treated is currently being expanded in order to further standardize this new clinical procedure. © 2010 Springer-Verlag.
Blum M.,Helios Klinikum Erfurt GmbH |
Kunert K.S.,Helios Klinikum Erfurt GmbH |
Engelbrecht C.,Friedrich - Schiller University of Jena |
Dawczynski J.,Friedrich - Schiller University of Jena |
Sekundo W.,University of Marburg
Klinische Monatsblatter fur Augenheilkunde | Year: 2010
Background: This clinical trial is focussed on the 12-month results of a new method for refractive correction, femtosecond lenticule extraction (FLEx). Patients and Methods: In a prospective 6-month study 108 eyes were treated in Erfurt and Marburg. Both a flap and a lenticule of intrastromal corneal tissue were simultaneously cut utilising the Carl Zeiss Meditec AG (Jena, Germany) VisuMax femtosecond laser system. Thereafter, the lenticule was manually removed and the flap repositioned. 31 patients all treated in Erfurt volunteered for a 12-month follow-up. UCVA and BSCVA after 12 months, objective and manifest refraction as well as slit-lamp examination and late side effects were documented. Results: 62 eyes of 31 patients were examined in this study. The spherical equivalent before surgery was -4.81 (± 1.16) D; after 12 months -0.15 (± 0.46) D were manifest. No significant change was observed after the 6 months control. Starting with UCVA of 0.12 (± 0.09) before surgery UCVA was 1.10 (± 0.26) after 12 months. In one patient corneal ectasia was diagnosed. All other patients did not have any late side effects. Conclusion: The stability of the correction of myopic astigmatism with the FLEx procedure is very good. The fact that one patient presented with a corneal ectasia demonstrates that one general problem of refractive corneal surgery persists with this new fs technology. © 2010 Georg Thieme Verlag KG Stuttgart · New York.
Schulz T.,HELIOS Klinikum Erfurt GmbH |
Esser D.,HELIOS Klinikum Erfurt GmbH
Laryngo- Rhino- Otologie | Year: 2013
Bleeding in the oral cavity, nose or ear are common events in the daily routine of ENT specialists. Apart from trivial cases that often get outpatient treatment, there are numerous cases of serious bleeding that require stationary treatment and if necessary, an operative or interven-tional therapy. In the following section the most frequent types of bleeding, their diagnosis and therapy will be explained. © Georg Thieme Verlag KG Stuttgart.
Schmidt T.,Universitatsklinikum Jena |
Baljic I.,Helios Klinikum GmbH Erfurt
HNO | Year: 2016
Background: The Freiburg monosyllabic test (FBE) was introduced into clinical routine almost 60 years ago. Recently, there has been renewed scientific interest in the FBE. Nevertheless, neither the earlier nor the later publications showed any evidence for a training effect. For this reason, this aspect is examined in more detail in the present study. Methodology: All 20 test lists of the FBE were presented in a fixed, predetermined order to 40 suitable otologically normal subjects. According to DIN 45626-1, the 50 % speech discrimination score is expected at a level of 29.3 dB SPL (Sound Pressure Level). In this study, the test material was presented at a level of 29 dB SPL. The speech discrimination scores were analyzed depending on the particular test run. Results: The mean speech recognition score (43.2 %) depended on the test run. An increase in speech recognition by 13 percent points was observed in the first three test runs. After two test runs, no further increase in speech recognition was observed. Conclusion: When using the FBE in clinical routine, two test lists should be heard by the patients before the actual test starts. This procedure helps to improve the quality of the FBE. © 2016 Springer-Verlag Berlin Heidelberg
Kellner I.,HELIOS Klinikum Erfurt GmbH |
Herbst R.A.,HELIOS Klinikum Erfurt GmbH
Hautarzt | Year: 2016
Case reports: We present two patients who were referred to us from other hospitals for further therapy as metastasized occult melanoma patients with extensive stage III and stage IV disease, respectively. On thorough clinical examination, we found a slightly thickened nail plate on the right thumb with barely visible pigmentation and a tiny skin-colored tumor at the proximal nail fold of a 60-year-old man. In a 60-year-old woman, we saw an anatomically almost hidden small nonpigmented tumor on the labia majora close to the posterior commissure. The patients were histologically diagnosed with an ulcerated acrolentigineous melanoma and a nodular mucosal melanoma, respectively. Conclusion: With these two case reports we want to emphasize that although extensive radiographic and invasive diagnostic procedures to detect a primary in patients with suspected melanoma of unknown primary are no longer recommended by current guidelines, repeated and thorough clinical examinations can sometimes revise the diagnosis metastasized “occult” melanoma. © 2015, Springer-Verlag Berlin Heidelberg.
Aschenbach R.,Helios Klinikum Erfurt GmbH |
Esser D.,Helios Klinikum Erfurt GmbH
HNO | Year: 2010
Post-therapeutic imaging is crucial for treatment planning and control in patients with malignant lesions in the head and neck. Focussed on CT, PET-CT and MRI, imaging strategies for post-therapeutic follow-up have been developed and investigated during the last few years. This review should help to interpret the results of these studies and make the reader familiar with the latest developments. © 2010 Springer-Verlag.
Hoyme U.B.,HELIOS Klinikum Erfurt GmbH |
Huebner J.,HELIOS Klinikum Erfurt GmbH
Gynecologic and Obstetric Investigation | Year: 2010
Abnormal vaginal flora as well as bacterial vaginosis have a significant relative risk for miscarriage or preterm birth of 1.4-6.9. In the initial Erfurt trial, 0.3% of the neonates with gestational age <32+0 weeks were seen in an intervention group vs. 3.3% (p < 0.01) in the control group; in the larger Thuringia campaign, the figures were 0.94 vs. 1.36% (p < 0.01). The rate of newborns <1,000 g was reduced to 0.38%, the lowest incidence ever seen in any of the German states. This should count even more, as there was no success in reducing the rate of low-birth-weight children in the decades preceding these prospective studies. However, after discontinuation of the campaign in 2000, the preterm birth rates mounted in 2005 in our hospital and the state to the same rate as prior to the programme. Copyright © 2010 S. Karger AG, Basel.
Steiner T.,Helios Klinikum Erfurt GmbH |
Mickisch G.H.,Helios Klinikum Erfurt GmbH
Urologe - Ausgabe A | Year: 2013
Systemic treatment of metastatic renal cell carcinoma has changed fundamentally in recent years. So-called targeted therapy gives patients with incurable renal cell cancer the chance of prolonged survival with acceptable quality of life and manageable side effects. Several tyrosine kinase inhibitors and mTOR inhibitors have been evaluated in various clinical settings within prospective trials. Therefore, recent medical guidelines are able to give recommendations for the management of advanced renal cell carcinoma in daily practice. The optimal therapeutic sequence of the available substances has not been defined until now; however recent data recommend the use of a tyrosine kinase inhibitor as the first line treatment. Besides standard treatment, new approaches are currently being evaluated in clinical trials. © 2013 Springer-Verlag Berlin Heidelberg.