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Heitland W.,Stadtisches Klinikum Munich GmbH
Viszeralmedizin: Gastrointestinal Medicine and Surgery | Year: 2011

Tumor centers should improve the quality of care. Wellstructured operational sequences of diagnostics and therapy based on established guidelines of the scientific societies provide the basis for treatment success. The cooperation of the participating specialized units -gastroenterology, gastroenterological oncology, visceral surgery, radiotherapy, diagnostic and interventional radiology, pathology and psychooncology -is guaranteeing the best treatment possible in the interest of our patients. Personal and administrative expenditure is high and should be financially awarded by health insurance funds -provided that the results are transparent, verifiable and excellent. High case load as well as low peritherapeutic morbidity and mortality are attracting patients to be treated in highly specialized, certified centers; furthermore, they represent an essential basis to educate the next generation of doctors and nurses. Participation in treatment studies is mandatory. Copyright © 2011 S. Karger AG, Basel. Source

Heitland W.,Stadtisches Klinikum Munich GmbH
Chirurg | Year: 2012

Cryptoglandular anal fistula: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is determined by the anatomy of the anal sphincter and perianal fistulas will not heal on their own. The therapy of a fistula is oriented between a more aggressive approach (operation) and a conservative treatment with fibrin glue or a plug. Definitive healing and the development of incontinence are the most important key points. Anal fissures: Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation. © 2012 Springer-Verlag Berlin Heidelberg. Source

Other types of diabetes include diabetes forms which are induced by diseases of the pancreas or liver as well as drug-induced diabetes. In this context endocrine disorders as the cause of secondary diabetes are of special clinical interest: On the one hand a chronically insufficient metabolic control of diabetes can change endocrine parameters (e.g. thyroid hormone, growth hormone), while on the other hand acute imbalance of glucose control in diabetic patients could be induced by endocrine diseases. Hyperthyroidism in diabetics leads to increased insulin resistance and reduced insulin secretion, resulting in pronounced hyperglycemia. In contrast, hypothyroidism leads to increased insulin sensitivity and greater risk of hypoglycemia, especially in insulin-dependent diabetes. Pathologically increased growth hormone secretion and diseases of the adrenal gland may have pronounced effects on glucose metabolism. Given the known association between type 1 diabetes and other autoimmune endocrinopathies (polyglandular autoimmune syndrome, PAS), annual screening for these patients and their near relatives is recommended. © Springer-Verlag 2010. Source

Hubert G.J.,Stadtisches Klinikum Munich GmbH | Muller-Barna P.,Neurology | Audebert H.J.,Charite - Medical University of Berlin
International Journal of Stroke | Year: 2014

TeleStroke has become an increasing means to overcome shortage of stroke expertise in underserved areas. This rapidly growing field has triggered a large amount of publications in recent years. We aimed to analyze recent advances in the field of telemedicine for acute stroke, with main focus on prehospital management, Stroke Unit treatment and network implementations in developing countries. Out of 260 articles, 25 were selected for this systematic review: 9 regarding prehospital management, 14 regarding Stroke Unit treatment and 2 describing a network in developing countries. Prehospital management showed that stroke recognition can start at the dispatch emergency call, important clinical information can be electronically transmitted to hospitals before admission and even acute treatment such as thrombolysis can be initiated in the prehospital field if ambulances are equipped with CT scan and point-of-care laboratory. Articles on remote clinical examination, telemedical imaging interpretation, trial recruitment and cost-effectiveness described various aspects of Stroke Unit treatment within TeleStroke networks, underlining reliability, safety and cost savings of these systems of care. Only one network was described to have been implemented in a developing/emerging nation. TeleStroke is a growing field expanding its focus to a broader spectrum of stroke care. It still seems to be underused, particularly in developing countries. © 2014 World Stroke Organization. Source

Muller-Barna P.,Stadtisches Klinikum Munich GmbH | Schwamm L.H.,Massachusetts General Hospital | Haberl R.L.,Stadtisches Klinikum Munich GmbH
Current Opinion in Neurology | Year: 2012

Purpose of review: This review provides a comprehensive overview of the management of acute stroke within the framework of telestroke services. Recent findings: The remote neurological examination using high quality videoconferencing coupled with remote review of neuroimaging has gained acceptance and proved its reliability in various publications. Telestroke networks confirmed the safety and efficiency of telethrombolysis, with an increase in the rate of thrombolysis in recent years. The analysis of a telestroke network in Europe showed improved outcomes in a cohort of ischemic stroke patients. Summary: At the beginning of the millennium, telestroke networks started to develop. Ten years later, there is a collection of about 40 various networks in North America and Europe performing teleconsultations on a regular basis. Telestroke is not a new therapeutic modality, but rather a set of tools to enable more efficient delivery of acute stroke care and to improve the quality of stroke care in neurologically underserved areas. Depending on the level of available regional resources, telestroke networks can support affiliated hospitals by implementing measures that improve the quality of stroke management such as regional campaigns, stroke units and stroke teams, medical education and programs encouraging the usage of guidelines. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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