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Heilbronn, Germany

Medical providers have become subject to predatory competition in recent years which was deliberately created in the public policy process. However, this competition lacks a comprehensive set of rules. This brought up adverse economic incentives to carry out non-indicated treatments and disregard costly safety standards. Therefore, justice and medical experts must act as allies, define clear minimum standards and enforce them against all decision makers in hospitals and doctor's practices. In the event of damage, it is useful to review 11 medical case groups in which criminal investigations should be directed not only against direct practitioners but also against the responsible heads whether they are doctors or not. © Springer-Verlag 2012.

Since the statutory accident insurance in Germany defined the principle of"outpatient surgery" on 01.01.2005, treating physicians have had not only the option, but in some cases the obligation for all involved in treatment to perform certain operations on an outpatient basis. The lecture held as part of the third main topic at the 33rd Trauma Medicine Conference in Baden-Baden (Germany), as well as the ensuing discussion showed that there are still significant discrepancies between demand and reality. Policymakers and insurance companies must create an acceptable framework in which to make outpatient surgery appear more economically attractive than is currently the case. Moreover, the problem of adequate education and training within the new framework needs to be solved. In order to make the decision-makers aware of this issue, hospitals and medical practitioners need to act as like-minded partners. © 2010 Springer Medizin Verlag.

Since 1996 acute subretinal hemorrhages have been treated by intravitreal injections. Large proteins injected into the vitreous cavity can cross the retina as well as the underlying retinal pigment epithelium. After intravitreal injection of tissue plasminogen activator (TPA), plasminogen, which is part of a subretinal clot, is converted to plasmin in the presence of fibrin. Plasmin is a relatively unspecific protease that liquefies a formed fibrin clot. Simultaneous intravitreal injection causes an inferior displacement of the liquefied hemorrhage. Beside mechanical effects on subretinal clots plasmin inhibits choroidal neovascularization by hydrolysis of the extracellular matrix as well as growth factors. After successful displacement of a subretinal hemorrhage an additional anti-VEGF (vascular endothelial growth factor) therapy is required. © 2012 Springer-Verlag.

Sommer C.M.,Abteilung Radiologie | Stampfl U.,Abteilung Radiologie | Kauczor H.U.,Abteilung Radiologie | Pereira P.L.,SLK Kliniken Heilbronn GmbH
Radiologe | Year: 2014

Clinical/methodical issue: Evidence-based therapeutic and diagnostic algorithm for hepatocellular carcinoma. Standard radiological methods: Ultrasound, computed tomography, magnetic resonance imaging, image-guided percutaneous biopsy, percutaneous thermal ablation and transarterial chemoembolization. Methodical innovations: Diagnostic and therapy of hepatocellular carcinoma according to the official German interdisciplinary guidelines. Performance: The formulation of the German S3 guidelines on diagnosis and therapy of hepatocellular carcinoma was performed under special consideration of quality indicators and standardized quality improvement methods. Achievements: In 2013 the German S3 guidelines on diagnosis and therapy of hepatocellular carcinoma were published and clinically implemented as part of the nationwide guideline program in oncology of the Deutsche Krebsgesellschaft (German Cancer Society). Practical recommendations: The German S3 guidelines on diagnosis and therapy of hepatocellular carcinoma have to be considered as the national gold standard with the goal of optimization of patient care. © 2014 Springer-Verlag Berlin Heidelberg.

Hoffmann R.,University of Tubingen | Rempp H.,University of Tubingen | Schmidt D.,University of Tubingen | Pereira P.L.,SLK Kliniken Heilbronn GmbH | And 2 more authors.
Journal of Vascular and Interventional Radiology | Year: 2012

Purpose: To reduce risk of development of a hepatic abscess in patients with preexisting bilioenteric anastomosis (BEA) undergoing radiofrequency (RF) ablation of hepatic tumors by use of prolonged antibiotic prophylaxis over at least 10 days. Materials and Methods: Between April 2003 and June 2011, 184 patients underwent 206 percutaneous RF ablation procedures for hepatic malignancies. Eight patients presented with BEA and were treated in 10 sessions at 14 tumor locations. These 8 patients were male and ranged in age from 5573 years. Median follow-up was 34 months. Antibiotic prophylaxis was given before the intervention (n = 9, piperacillin/tazobactam; n = 1, ciprofloxacin). Oral antibiotic prophylaxis after the intervention was continued with ciprofloxacin for at least 10 days. In four cases, prophylaxis after the intervention was extended with additional antibiotics. Results: A liver abscess occurred 22 days after 1 of 10 RF ablation sessions in patients with preexisting BEA. The patient who developed an abscess presented with a large hepatocellular carcinoma (59 mm × 54 mm) and underwent transarterial chemoembolization 8 days before RF ablation. No hepatic abscess occurred after 196 RF ablation sessions in 176 patients without BEA. Conclusions: Preexisting BEA is a risk factor for formation of hepatic abscesses after RF ablation. An antibiotic prophylaxis regimen before the intervention and for a prolonged period after the intervention that covers anaerobic bacteria for at least 10 days is presented. Combined therapy of transarterial chemoembolization and RF ablation increases the risk for complications in patients with known BEA. © 2012 SIR.

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