Universitatsklinikum Halle

Halle (Saale), Germany

Universitatsklinikum Halle

Halle (Saale), Germany
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Brauckhoff M.,University of Bergen | Brauckhoff M.,Haukeland University Hospital | Dralle H.,Universitatsklinikum Halle
Chirurg | Year: 2012

Organ preserving resection (subtotal adrenalectomy) or adrenocortical autotransplantation can preserve adrenocortical stress capacity in bilateral adrenal surgery. After adrenocortical autotransplantation approximately 30% of patients do not need exogenous steroids. Organ preserving surgery avoids steroid supplementation in more than 80% of cases. After organ preserving resections in secondary or familial diseases, however, there is a relevant risk of recurrent disease: the rate of ipsilateral recurrence in familial pheochromocytoma is approximately 20% during a follow-up of 20 years. Routine administration of exogenous steroids should be avoided after subtotal adrenalectomy as functional restitution of the residual tissue might be disturbed. Approximately 80% of patients, however, present with impaired adrenocortical stress capacity directly after surgery. Within a few weeks some 80% of patients show a sufficient functional restitution of the adrenocortical stress capacity. Organ preserving adrenal surgery should be performed endoscopically. The adrenal remnant should not be devascularized; the adrenal vein, however, can be divided without functional consequences. About one third of a normal adrenal gland usually provides sufficient adrenocortical function. © 2012 Springer-Verlag.

The shoulder joint and shoulder girdle are affected by numerous internal disorders. Heart diseases, but also pleurisy and diseases of the gall bladder and the biliary tract may manifest themselves by pain projected into the shoulder region. The shoulder joint is also affected by diseases that lead to an impairment of cartilage and bone metabolism, and also by disorders that come along with the deposition of pathological substances such as amyloid and hydroxy-apatite. The latter phenomena are characteristic for chronic kidney diseases. © Georg Thieme Verlag KG Stuttgart New York.

The standardized training of practical competences in skills labs is relatively new among German Medical Faculties. The broad acceptance and outstanding evaluation results do not provide objective data on the efficiency and cost-efficiency of these trainings. This study aims on the quantification of the teaching effect of the surgical scrubbing technique EN1500 and its comparison with clinical references of OR personnel. Methods: 161 4(th) year medical students were randomized into intervention and control group. The intervention group received a 45 minute standardized peer-teaching training of practical competences necessary in the OR including the scrubbing according to EN1500. Fluorescence dye was mixed in the disinfectant solution. After hand disinfection, standardized fotographs and semi-automated digital processing resulted in quantification of the insufficiently covered hand area. These results were compared with the control group that received the training after the test. In order to provide information on the achieved clinical competence level, the results were compared with the two clinical reference groups. Results: The intervention group remained with 4,99% (SD 2,34) insufficiently covered hand area after the training compared to the control group 7,33% (SD 3,91), p<0,01. There was no significant difference between control group and reference groups: surgeons 9,32% (SD 4,97), scrub nurses 8,46% (SD 4,66). The student intervention group showed results that were significantly better than the clinical references. The methodic mistake remained negligible. In the sub-group analysis, the students with low or medium experience in surgical scrubbing and hand disinfection derived highest benefit from the training, whereas students with no or high experience did benefit less. All participants showed better results on hand palms compared to back of hand areas. Discussion: A single standardized peer-teaching of surgical scrubbing and hand disinfection according to EN1500 is sufficient to improve the measurable coverage of hand area and reduce the disinfection gap by 1/3. In absolute measures, the competence level of experienced surgeons and scrub nurses is achieved or even exceeded.

Extrathyroidal thyroid cancer invading the laryngotracheal system (UICC stage pT4a) represents a progressive process of infiltration of the tracheal wall layers from the outer to the inner parts of the trachea. These tumors usually present with high proliferation activity correlating with a reduced long-term prognosis. In contrast to intraluminal manifestation requiring complete wall resection, in cases of non-transmural invasion, complete tumor removal can be sometimes achieved by extraluminal tangential resection (shaving). Tangential resections, however, are associated with a higher frequency of microscopically invaded resection margins (R1 resection rate >40%). The available comparative studies (all retrospective, maximum EBM level 3) analyzing oncological outcome show inconsistent results. In more recently published studies, however, complete wall resection in well-differentiated thyroid cancer with tracheal invasion only was found to be associated with longer recurrence-free and tumor-specific survival when compared to shaving. Deep larynx invasion is associated with reduced long-term prognosis when compared to invasion of the trachea. Salvage resections should therefore be performed in selected cases only. © 2010 Springer-Verlag.

Simm A.,Universitatsklinikum Halle
Deutsche Medizinische Wochenschrift | Year: 2011

Geriatrics is in comparison to the other medical professions a relatively new discipline. The calendarical age is not suitable for the characterization of its patient population, the multimorbid old patients. The biofunctional age in terms of the ICF is a better choice. It is characterized in part by physical, psychical, and social context-factors, which can be analysed by geriatric assessments. A better cooperation between basic science orientated gerontological disciplines with the geriatrics will be, beside the implementation into the university medicine and the standardized uniform professional training, of essential importance for the further development of geriatric medicine. © Georg Thieme Verlag KG - Stuttgart - New York.

Achenbach S.,Universitatsklinikum Giessen und Marburg GmbH | Szardien S.,Kerckhoff Klinik | Gielen S.,Universitatsklinikum Halle | Hamm C.W.,Universitatsklinikum Giessen und Marburg GmbH
Kardiologe | Year: 2012

Non-ST-elevation acute coronary syndromes (NSTE-ACS) comprise a wide spectrum of disease severities and mortality risks. Next to establishing the diagnosis, clinical management therefore also requires risk stratification in order to adequately select the intensity and urgency of further work-up and treatment. In September 2011 updated recommendations for the management of patients with NSTE-ACS were published by the European Society of Cardiology. Major innovations included the use of highly sensitive troponin assays, including the resulting possibility of establishing a fast-track protocol, the routine recommendation of echocardiography in all patients and the introduction of coronary computed tomography (CT) angiography as a possibility to rule out coronary disease in selected individuals. The importance of risk stratification is emphasized throughout the document and routine use of the GRACE risk score as well as the CRUSADE bleeding risk score is encouraged. The recommendations reflect the availability of new antithrombotic agents and new timelines for invasive work-up are introduced. This comment in German summarizes the ESC guidelines and highlights relevant amendments as compared to the previous version. © Deutsche Gesellschaft für Kardiologie -Herz- und Kreislaufforschung e.V.Published by Springer-Verlag -all rights reserved 2012.

Mlynski R.,Universitatsklinikum Wurzburg | Plontke S.,Universitatsklinikum Halle
HNO | Year: 2013

Cochlear implants (CI) have become standard in the treatment of prelingual, postlingual and perilingual deafness and hearing loss in children. Bilateral implants are considered standard for bilaterally affected children. The benefits for speech and language development, as well as speech intelligibility brought by CI-enabled hearing are greatest if these are received as soon after diagnosis as possible. Continued improvements in preoperative diagnostics, electrode design, speech coding strategies and surgical techniques, have broadened the CI applications spectrum. Nowadays-with the exception of cochlear- and cochlear nerve aplasia-almost all malformations are manageable with CIs. New indications concern partial and unilateral deafness. Treatment with CIs requires exceptional team work. In addition to ongoing medical care of the children, the involvement of parents and relatives in the cooperation between surgeons, audiologists, teachers and specialist centers is important for successful rehabilitation. © 2013 Springer-Verlag Berlin Heidelberg.

Lessig R.,Universitatsklinikum Halle
Rechtsmedizin | Year: 2016

This article is concerned with the problems involved in mass disasters with large numbers of victims. One aspect that must be taken into consideration is globalization. In cases of aircraft crashes, natural disasters and terrorist attacks it must be assumed that victims from different countries are involved. The reliable identification of victims is an essential aspect and requires international cooperation in this field. In order to minimize errors it is necessary that the different nations involved adhere to internationally accepted standards in this field. Interpol plays an important role in these cases. The various specialist disciplines involved must also adapt and coordinate their workflow procedures. This necessitates regular training of the specialist personnel involved. Not only is it important to train personnel in each of the discipline-specific procedures but also to know and understand the other specialist procedures and organization of the identification workflow. © 2016, Springer-Verlag Berlin Heidelberg.

Stang A.,Universitatsklinikum Halle | Stang A.,Boston University | Buchel C.,Universitatsklinikum Halle
BMC Urology | Year: 2014

Background: Representative statistics of surgical care among patients with kidney cancer are scant. With the introduction of the diagnosis related group system in Germany, it is now possible to provide nationwide statistics on surgical care. We studied in-hospital mortality risk in relation to comorbidity and complications, length of hospital stay in relation to surgical approach and comorbidity, and risk of complications in relation to surgical approach among kidney cancer patients undergoing nephrectomy. Methods: We analyzed the nationwide hospitalization file of the years 2005 and 2006 including 23,753 hospitalizations with a diagnosis of renal cancer and partial or complete nephrectomy and classified comorbidity (Charlson comorbidity index) and complications. Length of stay, risk of in-hospital complications and in-hospital death were analyzed by linear regression and log-linear regression (relative risks (RR) and 95% confidence intervals (95% CI)). Results: The overall in-hospital mortality was 1.4%. Per one unit increase of the Charlson comorbidity index, the adjusted risk of in-hospital mortality increased by 53% (95% CI 47-59%). The risks of bleeding or acute posthaemorrhagic anemia, respiratory, urological and gastrointestinal complications and infections ranged between 1.1% and 2.7% with the exception of bleeding or acute posthaemorrhagic anemia with 18.4%. Complications were associated with an increased adjusted in-hospital mortality risk. Highest adjusted mortality risk ratios were observed for gastrointestinal (RR = 3.61, 95% CI 2.32-5.63) and urological complications (RR = 3.62, 95% CI 2.62-5.00). The risk of haemorrhage or acute posthaemorrhagic anemia was lower for total laparoscopic nephrectomies than total open nephrectomies. The adjusted risk of gastrointestinal complications was lower for partial open compared to total open nephrectomy (adjusted RR = 0.66, 95% CI 0.45-0.97). Total laparoscopic nephrectomy was associated with shorter length of stay (-3.3 days; 95% CI 2.9-3.7 days) compared to total open nephrectomy. The estimated age-adjusted increase of length of stay per one unit increase of the Charlson comorbidity index was 1.3 days (95% CI 1.2-1.4 days). Conclusions: In this representative population-based analysis, we found that the surgical approach is associated with the risk of complications and length of hospital stay. Furthermore, in the era of ageing populations, renal cancer patients with comorbidities should be counseled about their increased in-hospital mortality risk. © 2014 Stang and Büchel; licensee BioMed Central Ltd.

The diagnosis of polymyalgia rheumatica can often be made based on symptoms and signs only. Aching muscle pain in the shoulder girdle, gluteal region and thighs may occur with a rapid onset, accompanied by lasting morning stiffness. The immediate pain relief after the initiation of the treatment with corticosteroids is a helpful diagnostic sign as well. The clinical image of giant cell arteritis is more variable and depends on the vascular region affected by the inflammatory process. Headache is a typical sign of temporal arteritis, as well as jaw claudication. A prominent, painful temporal artery is a classical sign. There are no pathognomonic laboratory abnormalities for both polymyalgia rheumatica and temporal arteritis. Both are accompanied by elevated acute phase reactants, although few exceptions exist to this rule. © Georg Thieme Verlag KG Stuttgart · New York.

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