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Neu-Ulm, Germany

Mennicken R.,Landschaftsverband Rheinland | Kolodziej I.W.K.,Westphalian Institute for Economic Research | Kolodziej I.W.K.,Ruhr University Bochum | Augurzky B.,Westphalian Institute for Economic Research | Kreienberg R.,Universitatsfrauenklinik Ulm
Health Policy | Year: 2014

Financial soundness will become more and more difficult in the future for all types of hospitals. This is particularly relevant for gynaecology and obstetrics departments: while some disciplines can expect higher demand due to demographic changes and progress in medicine and medical technology, the inpatient sector for gynaecology and obstetrics is likely to lose patients in line with these trends. In this paper we estimate future demand for gynaecology and obstetrics in Germany and develop a cost model to calculate the average profitability in this discipline. The number of inpatient cases in gynaecology and obstetrics can be expected to decrease by 3.62% between 2007 and 2020 due to the demographic change and a potential shift from inpatient to outpatient services. Small departments within the fields of gynaecology and obstetrics are already incurring heavy losses, and the anticipated decline in cases should increase this financial distress even more. As such, the further centralisation of services is indicated. We calculate travel times for gynaecology and obstetrics patients and estimate the anticipated changes in travel times by simulating different scenarios for this centralisation process. Our results show that the centralisation of hospital services in gynaecology and obstetrics may be possible without compromising comprehensive access as measured by travel times. © 2014 Elsevier Ireland Ltd.

A 21-year-old primipara at 30+3 weeks of gestation presented with symptoms of acute pancreatitis. Since she additionally complained of dyspnea, chest X-ray and computed tomography examinations were performed. A left-sided enterothorax was seen with stomach and bowel dislocation. Owing to the high maternal and fetal risk, an emergency laparotomy was carried out in which a congenital diaphragmatic defect in the left trigonum lumbocostale (Bochdalek hernia) was found. In addition to a cesarean section, relocation of the stomach and colon was performed with closure of the diaphragmatic defect. © Springer-Verlag 2014.

Bock C.,Ludwig Maximilians University of Munich | Rack B.,Ludwig Maximilians University of Munich | Huober J.,Universitatsfrauenklinik Ulm | Andergassen U.,Ludwig Maximilians University of Munich | And 2 more authors.
Future Oncology | Year: 2014

Aim: Circulating tumor cells (CTCs) appear as potential candidates to predict the ability of breast tumors to metastasize. Moreover, epithelial-mesenchymal transition (EMT) and stem cell features are major mechanisms for metastasis. Patients & methods: Using a triple fluorescence technique, the expression of EMT (N-cadherin) and stem cell markers (CD133) was analyzed in CTCs detected via cytokeratin in blood samples from 26 metastatic breast cancer patients. Results: We detected CTCs in 100% of the patients (n = 831 CTCs). In total, 67% of the CTCs were N-cadherin and CD133 negative. Nonetheless, 87.8 and 57.6%, respectively, of the CTCs that expressed one marker coexpressed the other. Both double-negative and double-positive CTCs were present in more than 90% of the patients. Within the CTCs of each patient, we demonstrated striking heterogeneities of marker expressions, cell shapes, clusters and sizes. Conclusion: These data outline the importance of characterizing CTCs, especially through stem cell and EMT markers. © 2014 Future Medicine Ltd.

Hampl M.,Heinrich Heine University Dusseldorf | Janni W.,Universitatsfrauenklinik Ulm
Gynakologe | Year: 2012

Whereas decades ago, vulvar cancer was a tumor primarily diagnosed in older women, nowadays, this tumor is increasingly seen in younger women. The rising incidence is mainly due to the increasing number of young women presenting with these tumors. Depending on the age of the women, persistent infection with high-risk human papillomavirus is responsible for the development of these lesions in 30-50% of the cases. More than 50% (our own data) of the tumors are located between the clitoris and urethra. Standard treatment is tumor resection with sufficient margin or (partial) vulvectomy and complete inguinofemoral lymphadenectomy or sentinel node biopsy in specialized centers. New therapy options include reconstruction of the vulva with local skin flaps to improve esthetic and functional outcome especially in young, sexually active women. © Springer-Verlag Berlin Heidelberg 2012.

Hancke K.,Universitatsfrauenklinik Ulm | Toth B.,Universitatsfrauenklinik Heidelberg | Kreienberg R.,Universitatsfrauenklinik Ulm
Gynakologe | Year: 2010

Nowadays, most gynecologists are female and the compatibility of family life and work schedule still remains a great challenge, especially for female physicians. The working group "gender and career" of the DGGG (German Society for Gynecology and Obstetrics) designed a survey to reflect the present situation of female and male gynecologists with special respect to family life, working hours, work-life balance and satisfaction with the choice of career itself. In this review the initial results are presented. © 2010 Springer-Verlag.

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