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Dortmund, Germany

Nashan D.,Klinikum Dortmund GGmbH | Meiss F.,Albert Ludwigs University of Freiburg | Muller M.,Albert Ludwigs University of Freiburg | Muller M.,University of Basel
European Journal of Dermatology | Year: 2013

An exponentially increasing incidence, malignant potential and economical interest have made actinic keratoses (AKs) a strategic healthcare issue. The debate whether AKs are precursor lesions or in situ cancers with a continuum towards invasive squamous cell carcinoma has faded, given the millions of affected individuals. Cumulative exposure to ultraviolet light and increasing life expectancy, together with an overaged, therefore increasingly affected population, create responsibilities for clinicians. Guidelines in the UK (2007) and Europe (2011), metaanalyses and overviews of selected treatment options, as well as some selected combined treatment strategies, are available. No comprehensive overview providing explicit details of randomized studies, including the majority of approved and popular treatment options, and designating evidence-based criteria has been published so far, a goal desirable to avoid a biased perspective on therapeutic approaches. This reviewdefines the state of art for destructive and topical treatment options based on randomized trials which meet criteria like >30 patients in an intentionto- treat analysis, an easily reproducible study design with responses rated towards treatment as the major objective, measured as complete remission. Epidemiological data include grades and location of treated AKs, operational procedures, cryotherapy, laser therapy, 3% diclofenac in 2.5% hyaluronic acid, 2.5%, 3.75% and 5% imiquimod, 0.5% and 5% 5-fluorouracil, photodynamic therapy including ALA-patches. Sequential and combined approaches in daily practice and in developing study design might profit from the details of studies listed here. Divergent and treatment-specific proceedings, response rates after definite time intervals aiding physicians' further guidance and their management of patients are elucidated. Uncommon and new therapeutic options are discussed.

Li M.,University of Minnesota | Luettringhaus T.,Klinikum Dortmund GGmbH | Walker K.R.,Gillette Childrens Specialty Healthcare | Cole P.A.,University of Minnesota
Journal of Pediatric Orthopaedics Part B | Year: 2012

A digastric approach has been used successfully to treat adult patients with femoral neck osteochondromas; however, to our knowledge, this has not been described in pediatric patients with open proximal femur growth plates. A case of femoral neck osteochondroma in an 11-year-old boy is presented and treatment using a digastric approach is described. No intraoperative femoral neck fracture or postoperative avascular necrosis occurred. There is no recurrence of the tumor at the 7-year follow-up. Surgical hip dislocation through a digastric approach provides adequate exposure of the femoral neck for osteochondroma resection and this technique should be considered for such circumstances. © 2012 Lippincott Williams & Wilkins, Inc.

Thoden J.,Private Practice | Potthoff A.,Interdisciplinary Immunologic Clinic | Bogner J.R.,Ludwig Maximilians University of Munich | Brockmeyer N.H.,Interdisciplinary Immunologic Clinic | And 29 more authors.
Infection | Year: 2013

Introduction: There was a growing need for practical guidelines for the most common OIs in Germany and Austria under consideration of the local epidemiological conditions. Materials and methods: The German and Austrian AIDS societies developed these guidelines between March 2010 and November 2011. A structured Medline research was performed for 12 diseases, namely Immune reconstitution inflammatory syndrome, Pneumocystis jiroveci pneumonia, cerebral toxoplasmosis, cytomegalovirus manifestations, candidiasis, herpes simplex virus infections, varizella zoster virus infections, progressive multifocal leucencephalopathy, cryptosporidiosis, cryptococcosis, nontuberculosis mycobacteria infections and tuberculosis. Due to the lack of evidence by randomized controlled trials, part of the guidelines reflects expert opinions. The German version was accepted by the German and Austrian AIDS Societies and was previously published by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF; German Association of the Scientific Medical Societies). Conclusion: The review presented here is a translation of a short version of the German-Austrian Guidelines of opportunistic infections in HIV patients. These guidelines are well-accepted in a clinical setting in both Germany and Austria. They lead to a similar treatment of a heterogeneous group of patients in these countries. © The Author(s) 2013.

Unnewehr M.,Klinikum Dortmund GGmbH | Schaaf B.,Klinikum Dortmund GGmbH | Marev R.,Medical University-Pleven | Fitch J.,St Georges Healthcare NHS Trust | Friederichs H.,University of Munster
Postgraduate Medicine | Year: 2015

Objective. Although doctors’ discharge summaries (DS) are important forms of communication between the physicians in patient care, deficits in the quality of DS are common. This review aims to answer the following question: according to the literature, how can the quality of DS be improved by 1) interventions; 2) reviews and guidelines of regulatory bodies; and 3) other practical recommendations? Methods. Systematic review of the literature. Results. The scientific papers on optimizing the quality of DS (n = 234) are heterogeneous and do not allow any meta-analysis. The interventional studies revealed that a structured approach of writing, educational training including feedback and the use of a checklist are effective methods. Guidelines are helpful for outlining the key characteristics of DS. Additionally, the articles in the literature provided practical proposals on improving form, structure, clinical content, treatment recommendations, follow-up plan, medications and changes, addressees, patient data, length, language, dictation, electronic processing and timeliness of DS. Conclusion. The literature review revealed various possibilities for improving the quality of DS. © 2015 Informa UK Ltd.

Hennes E.,Heinrich Heine University Dusseldorf | Zahn S.,Heinrich Heine University Dusseldorf | Lopes L.F.,Heinrich Heine University Dusseldorf | Schonberger S.,Heinrich Heine University Dusseldorf | And 5 more authors.
Klinische Padiatrie | Year: 2012

Background: Ovarian germ cell tumors (oGCTs) are rare and highly heterogeneous with regard to their clinical and histologic appearance. The risk of tumor development is higher in children with aberrant sexual differentiation. Development of gonadoblastomas is seen in young women with 46,XY gonadal dysgenesis. At least 50 % of gonadoblastomas may develop into malignant oGCTs, mostly dysgerminomas. In this study, we evaluated bilateral oGCTs in clinically inapparent patients for sex chromosomal aberrations. Patients and methods: We analyzed tumor samples of 15 patients with synchronous bilateral oGCTs enrolled onto the consecutive MAKEI trials for non-testicular GCTs. Paraffin embedded samples from the Kiel German Childhood Tumor Registry were evaluated for the presence of Y-chromosomal sequences. Molecular genetic techniques included comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization. Results: Among 15 patients with bilateral oGCTs, Y-chromosomal DNA sequences were detected in 6 tumors. Both mature teratomas were negative for Y-chromosomal DNA. Thus, 5 of 12 malignant oGCTs and 1 immature teratoma (with elevated AFP) showed Y-chromosomal material. A 45(X,0) karyotype could not be demonstrated. Conclusions: These investigations provide additional insight into the development of oGCTs: mature teratomas, which develop from postmeiotic germ cells, are not associated with gonadal dysgenesis. Bilateral immature teratomas, dysgerminomas and mixed malignant oGCTs may frequently show Y-chromosomal DNA, indicating underlying but clinically inapparent gonadal dysgenesis. Thus, the presence of aberrant Y-chromosomal sequences appears to be involved in tumor development in about half of these patients. © Georg Thieme Verlag KG Stuttgart · New York.

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