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Stuttgart Mühlhausen, Germany

Germany has approximately 6 millions of type-2 diabetics. Due to pathophysiologic considerations different treatment options for type-2 diabetes like insulin, insulinotropic and non-insulinotropic medication are available. The optimal point in time for the beginning of insulin treatment can be determined only by individual criteria considering the individual disease stage, comorbidities and patients preference after careful consideration of pros and cons of therapeutic options.

Huemer G.M.,Sect. of Plast. and Reconstr. Surg. | Puelzl P.,Marienhospital Stuttgart | Schoeller T.,Sect. of Plast. and Reconstr. Surg.
Plastic and Reconstructive Surgery | Year: 2012

Poland syndrome is a complex chest wall deformity with unilateral hypoplasia of the breast and pectoralis muscle, with a missing anterior axillary fold in its most common form. The authors report their combined experience and technique with the transverse myocutaneous gracilis flap to reconstruct the chest wall and breast either alone or simultaneously. Between June of 2004 and July of 2010, 11 patients (two male patients) were operated on and 14 flaps were transplanted. The authors found that the transverse myocutaneous gracilis flap proved to be a very valuable microsurgical alternative for reconstructing the chest wall and female breast in Poland syndrome with autologous tissue. The flap provides the surgeon maximal freedom of flap insetting for optimal symmetry together with a very inconspicuous donor site regardless of unilateral or bilateral harvesting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Copyright © 2012 by the American Society of Plastic Surgeons.

Muller A.,University of Tubingen | Eckert F.,University of Tubingen | Heinrich V.,University of Tubingen | Bamberg M.,University of Tubingen | And 2 more authors.
BMC Cancer | Year: 2011

Background: Repeat radiation is a rarely used treatment strategy that must be performed with caution. The efficacy and toxicity of a second curative radiotherapy series was investigated in cases of recurrent breast cancer.Methods: Forty-two patients treated from 1993 to 2003 with resection (n = 30) and postoperative re-irradiation or definitive re-irradiation (n = 12) for recurrent breast cancer were enrolled in the study. Concurrent hyperthermia was performed in 29 patients. The median age was 57 years. The median pre-radiation exposure was 54Gy. Re-irradiation was conventionally fractionated to a median total dose of 60Gy.Results: After a median follow-up of 41 months (range 3-92 months) higher graded late toxicity > G3 according to CTC 3.0 and LENT-SOMA was not observed. The estimated 5-year local control rate reached 62%. The estimated 5-year overall survival rate was 59%. Significantly inferior survival was associated with recurrence within two years (40 vs. 71%, p < ([0-9]).01) and presence of macroscopic tumour load (24 vs. 75%, p = 0.03).Conclusions: Repeat radiotherapy for recurrent breast cancer with total radiation doses of 60 Gy and the addition of hyperthermia in the majority of patients was feasible, with acceptable late morbidity and improved prognosis, particularly in patients with previous resection of recurrent tumours. © 2011 Müller et al; licensee BioMed Central Ltd.

Rapp A.M.,University of Tubingen | Langohr K.,University of Tubingen | Mutschler D.E.,Marienhospital Stuttgart | Klingberg S.,University of Tubingen | And 2 more authors.
PLoS ONE | Year: 2013

Ironic remarks are frequent in everyday language and represent an important form of social cognition. Increasing evidence indicates a deficit in comprehension in schizophrenia. Several models for defective comprehension have been proposed, including possible roles of the medial prefrontal lobe, default mode network, inferior frontal gyri, mirror neurons, right cerebral hemisphere and a possible mediating role of schizotypal personality traits. We investigated the neural correlates of irony comprehension in schizophrenia by using event-related functional magnetic resonance imaging (fMRI). In a prosody-free reading paradigm, 15 female patients with schizophrenia and 15 healthy female controls silently read ironic and literal text vignettes during fMRI. Each text vignette ended in either an ironic (n = 22) or literal (n = 22) statement. Ironic and literal text vignettes were matched for word frequency, length, grammatical complexity, and syntax. After fMRI, the subjects performed an off-line test to detect error rate. In this test, the subjects indicated by button press whether the target sentence has ironic, literal, or meaningless content. Schizotypal personality traits were assessed using the German version of the schizotypal personality questionnaire (SPQ). Patients with schizophrenia made significantly more errors than did the controls (correct answers, 85.3% vs. 96.3%) on a behavioural level. Patients showed attenuated blood oxygen level-dependent (BOLD) response during irony comprehension mainly in right hemisphere temporal regions (ironic>literal contrast) and in posterior medial prefrontal and left anterior insula regions (for ironic>visual baseline, but not for literal>visual baseline). In patients with schizophrenia, the parahippocampal gyrus showed increased activation. Across all subjects, BOLD response in the medial prefrontal area was negatively correlated with the SPQ score. These results highlight the role of the posterior medial prefrontal and right temporal regions in defective irony comprehension in schizophrenia and the mediating role of schizotypal personality traits. © 2013 Rapp et al.

Bokeler U.,Marienhospital Stuttgart | Schwarz J.,Hernia Center | Bittner R.,Hernia Center | Zacheja S.,Marienhospital Stuttgart | Smaxwil C.,Diakonie Hospital Stuttgart
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background: On the basis of lower incidence of postoperative pain and faster recovery compared with open techniques, the laparoscopic transabdominal preperitoneal patch plastic (TAPP) technique was established as a leading mode of inguinal hernia repair. In contrast to open hernia repairs, which are well integrated in the training of young surgeons, TAPP is still considered a more difficult surgical procedure, raising the questions of how to include this technique in trainee programs and how to provide appropriate training. Methods: Out of 15,101 TAPP procedures performed in our department between 1993 and 2007, we analyzed 254 operations that occurred from April 2004 to February 2007 by young trainees (between the second and fourth years of surgical training). The analysis compared the trainees' TAPP operations with 3,200 TAPP procedures performed by experienced surgeons in the same time period, and with the first 254 TAPP operations in our department performed by pioneers who introduced this technique in 1993. Results: In the 254 operations performed by young trainees, the mean operation time was 59 min, the morbidity rate was 3.2 %, and the recurrence rate was 0.4 %. Compared to experienced surgeons, we found no significant difference in recurrence rate and morbidity. For operation time, however, the young trainees demonstrated a learning curve with continuous improvement until the end of the study period approaching expert level. Pioneers also demonstrated a clear learning curve in operation time and additionally also regarding morbidity and recurrence rate. Conclusions: Our study demonstrates that the TAPP learning curve of young trainees is only related to operation time. Therefore, TAPP is a safe and reproducible technique when performed by young trainees under the supervision of experienced laparoscopic surgeons. With an adequate program, the technique can be learned quickly, skillfully, and safely when a standardized technique is used. It should be included as a fundamental part of state-of-the-art trainee programs. © 2013 Springer Science+Business Media New York.

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