Neu-Ulm, Germany


Neu-Ulm, Germany
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PubMed | Praxis fur Kinderchirurgie, Universitatsklinik and Klinik fur Kinderchirurgie
Type: | Journal: Der Urologe. Ausg. A | Year: 2016

Removing boys foreskins, even for medical reasons, is increasingly and critically discussed. The aim of this study is to retrospectively verify if the indication for theremoval of boys foreskins was justified. The study is based on the records of boys who underwent preputial operation in an outpatient medical office for pediatric surgery.Preoperative clinical findings, complaints, applied conservative and/or surgical procedures and histological results of the resected foreskins of boys, who underwent preputial operation between 2013-2015, were retrospectively analyzed.A total of 176 boys (age5 on average) underwent apreputial operation. In 85% of the cases it was completely removed. Most frequent clinical findings (80%) were that the prepuce was simply not retractable. 86% of the boys were free of complaints. The most frequent histological findings were adiscrete to moderately pronounced chronic fibrous posthitis (69%) and subepithelial fibrosis (18%), In the first case 78% of the boys had been free of complaints, in the latter 72%.The majority of the treated boys were free of complaints; however, most of them underwent acomplete removal of their foreskin simply because it was nonretractable. The foreskin represents the most sensitive part of the male genital, preputiolysis is anatural process that can go on until early adolescence. Irreversible surgical procedures, such as acomplete foreskin removal, should thus be restricted to aclear medical indication.

Hermans C.,Cliniques Universitaires Saint Luc | De Moerloose P.,Hopitaux Universitaires Of Geneva | Fischer K.,Van Creveld Clinic | Holstein K.,Universitatsklinik | And 6 more authors.
Haemophilia | Year: 2011

Acute haemarthrosis is a frequent type of bleeding in individuals with haemophilia. Delayed and/or inadequate treatment can trigger a series of pathological changes within the joint, leading to a painful and disabling arthropathy. The early management of intra-articular bleeding has the potential to prevent chronic joint disease and may include a combination of factor replacement, rest, ice, rehabilitation and, in certain cases, joint aspiration. Little data are, however, available regarding the optimal management of acute haemarthrosis, especially with respect to replacement therapy and the use of adjunctive therapies (aspiration, avoidance of weight bearing and immobilization, as well as the use of anti-inflammatory medication and embolization). To provide more insight into the management of acute haemarthrosis in patients with haemophilia, a literature review was conducted. Concomitantly, current management was surveyed in 26 European haemophilia comprehensive care centres representing 15 different countries. The review highlights the need for future robust studies to better define the appropriate replacement therapy and the role of adjunctive therapies such as aspiration. The survey reveals much heterogeneity in the management of acute haemarthrosis across the EU. Within the constraints discussed, treatment recommendations are presented that reflect the literature, current practice and the clinical experience of the European Haemophilia Therapy Standardisation Board (EHTSB). © 2011 Blackwell Publishing Ltd.

PubMed | Klinikum Dortmund S.R., Universitatsklinik and Klinikum Augsburg A.B.
Type: Journal Article | Journal: AJNR. American journal of neuroradiology | Year: 2016

Flow diversion emerged as a crucial treatment option for intracranial aneurysms. We report a multicenter retrospective analysis of the safety and efficacy in the treatment of intracranial aneurysms with the Flow-Redirection Endoluminal Device (FRED) flow diverter, a dual-layer flow-modulation device.All intracranial aneurysms treated with the FRED between March 2013 and February 2016 at 4 neurovascular centers were included. Angiographic and clinical results were retrospectively analyzed, including all follow-up examinations. Aneurysms were unruptured in 44 cases, whereas 8 treatments were due to an acute SAH from the target aneurysm.Successful implantation of the FRED was possible in 96.2% (50/52) of cases. At 3-month follow-up, complete occlusion was determined in 58.1% (25/43) and near-complete in 25.6% (11/43). At 12-month follow-up, aneurysm occlusion was complete in 75.0% (27/36) and near-complete in 22.2% (8/36). The overall acute and late thromboembolic and hemorrhagic complication rate was 17.3% (9/52), with a permanent treatment-related morbidity and mortality of 4.0% (2/50) and 2.0% (1/50), respectively, to date.The FRED device offers an effective tool in the treatment of intracranial aneurysms. The dual-layer design promotes contemporary and stable long-term occlusion rates. Sufficient device expansion should be documented by angiographic CT. Further studies might help to identify a more optimal antiplatelet regimen to avoid thromboembolic complications during the follow-up period.

Lunkenheimer P.P.,Universitatsklinik | Niederer P.,University of Zürich | Sanchez-Quintana D.,University of Badajoz | Murillo M.,University of Badajoz | Smerup M.,Aarhus University Hospital
Journal of Cardiovascular Translational Research | Year: 2013

The architectural arrangement of cardiomyocytes aggregated together within the ventricular walls remains controversial. Two models currently attract clinical attention, with neither model standing rigorous anatomical scrutiny. The first is based on the notion that ventricular mass can be unraveled consistently to produce a unique myocardial band. The second model was initially based on the notion that cardiomyocytes were bundled together in uniform fashion, with fibrous shelves interposed in transmural fashion. This concept was subsequently modified to accept the fact that the fibrous matrix supporting the cardiomyocytes within the ventricular walls does not form transmural sheets. Current observations demonstrate that not all cardiomyocytes are aggregated together in tangential fashion. A significant netting component is aligned in obliquely intruding and transversal fashion. The interaction between the tangential and transversal chains of cardiomyocytes with the fibrous matrix produces antagonistic forces, with both unloading and auxotonic forces necessary to explain normal and abnormal cardiodynamics. This article is part of a JCTR special issue on Cardiac Anatomy. © 2012 Springer Science+Business Media New York.

Antimuscarinic drugs are regarded as the standard treatment of detrusor overactivity (DO). However, side effects and lack of efficacy cause patients to discontinue long- term therapy. We evaluated the clinical efficacy of functional external electrostimulation (FES) as "second-line" therapy in patients with symptomatic idiopathic or neurogenic DO. In a retrospective study, 52 patients (38 women and 14 men) were evaluated at least 1 year after FES. Eighteen patients (32.7%) regarded FES as successful. No change occurred in 34 patients (65.4%) and 1 patient reported worsening of symptoms. Treatment success lasted for 13.2 months. In successfully treated patients, voiding frequency was significantly reduced from 13.3/24 h to 6.1/24 h under FES and to 6.75/24 h at follow-up. FES is a clinically useful, well-tolerated, conservative second- line treatment option after failed antimuscarinic treatment in patients with idiopathic or neurogenic DO. © 2010 Springer Medizin Verlag.

Although NG2 glial cells represent a frequent glial cell type in the brain, characterized by expression of the NG2 proteoglycan, the functional impact of these cells is still enigmatic. A large proportion of NG2 glia is proliferative active throughout live. These cells express a plethora of ion channels and transmitter receptors, which enable them to detect neuronal activity. Intriguingly, NG2 glial cells receive synaptic input from glutamatergic and GABAergic neurons. Since these postsynaptic glial currents are very small, their spatial and temporal integration mighttplay an important role. In white matter, most NG2 glial cells differentiate into oligodendrocytes and this process might be influenced through the activity of the above mentioned neuronglia synapses. Increasing evidence suggests that the properties of NG2 glia vary across brain regions, albeit the impact of this variability is not understood. © Springer-Verlag Berlin Heidelberg 2015.

For some entities, the spectrum and also the histomorphological pattern of pediatric lung diseases vary substantially from those of adults. Furthermore, some diseases are specific for neonates and infants, such as pulmonary alveolar proteinosis and the now mostly prenatally already known congenital pulmonary airway malformation (CPAM). The histopathological aspects of various pediatric lung pathologies are presented in this article. © 2015, Springer-Verlag Berlin Heidelberg.

Barth J.,Universitatsklinik
Krankenhauspharmazie | Year: 2013

Oral tumor therapeutics exist since the 1960ies. The eldest substances are chlorambucil and mercaptopurine, other followed, and are, from the present point of view, "old fellows". In the 1990ies, some more "classical", oral available cytotoxics joined the group. From the 2000-years the so called small molecular kinase inhibitors established in the clinical routine - with growing number. From the pharmaceutical perspective, there is a need for highly sophisticated skills in specialist knowledge and consulting service to the patient and the circle of experts. This applies for the "old" and the "new" drugs.

Inclusive education in schools for children with chronic disorders or handicaps is increasingly demanded by parents. It is a challenge for the society. This overview shall facilitate professional pediatric advice for parents and teachers. Inclusive education in common schools with joint learning of all students has various aims: graduation, individual educational success, development of the personality, and self-determined, active participation in the society. Inclusive education works with equal and diffent aims, with individual plans and adapted teaching materials. Disadvatages have to be compensated to compare individual performance. Persons with different professions and qualifications have to cooperate inside and outside the classes. Different laws, regulations and institutions have to be considered for the costs of inclusive education. The impact of chronic diseases like diabetes, epilepsy or ADHD, and of various handicaps on daily life in school is tremendous. The affected children suffer from exclusion from school activities and from the other students. Some students with handicaps are unable to cope with the demands of a common school in its actual structure. Parents and teachers need information on typical health problems, behavioral peculiarities and necessary interventions. Faithful consultations help to diminish fears of parents and teachers. Inclusive education should be achieved actively, deliberately and stepwise.

Reinhard A.,Universitatsklinik | Meyer T.,Universitatsklinik
Padiatrische Praxis | Year: 2014

Phimosis is a stricture of the foreskin which is characterized by the inability of retracting the prepuce over the glans penis. As this condition can lead to complications such as urinary tract obstruction, balanoposthitis and paraphimosis, a treatment is indicated most of the times. Regarding this a change of treatment option could be observed over the course of time. Previously, as a matter of routine performed circumcision has been replaced with the conservative treatment by use of topical application of steroids. Based on a retrospective analysis of data the therapy of patients which were treated in the university hospital of the Julius-Maximilians-University Würzburg between 2005-01-01 and 2010-12-31 were evaluated concerning choice of treatment and the corresponding success and complication rates. In addition, the foreskins of 36 patients were examined by the use of a masked light microscopic study in order to find hints for the causes of failure of the conservative treatment with Betnesol-Vointment 0.1%. As from 2009 the trend developed to the effect that the conservative treatment had been performed with increasing frequency and starting 2010 more often in absolute terms than the surgical treatment. While the success rate of circumcision is 99%, topical application of steroids turned out to be successful in only 70% of cases. However there are more side affects and risks linked with circumcision such as bleeding and infections as well as the surgical complications. In Würzburg no side effects were associated with the topical steroid treatment. Unfortunately the light microscopic study showed no groundbreaking difference between the foreskins from several groups of patients. In summary it can be stated that the topical application of steroids should be offered before any surgical intervention as far as there are no contraindications like balanitis xerotica obliterans, paraphimosis or scarring as surgery can then be avoided in 70% of the cases.

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