Universitatsklinikum Magdeburg Aor

Magdeburg, Germany

Universitatsklinikum Magdeburg Aor

Magdeburg, Germany
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Primary tumor resection in patients with synchronous metastatic renal cell carcinoma and a good performance status corresponds to a guideline recommendation which, however, is based on weak data from the era of cytokine therapy. This article presents arguments that weigh heavily against cytoreductive nephrectomy. From a molecular genetic viewpoint, the intervention eliminates only the easiest adversary but cannot prevent cancer-related death. Therefore, benefits and risks must be carefully and critically considered. Cytoreductive nephrectomy is not beneficial if treatment-induced morbidity will substantially affect the patient’s quality of life and/or life expectancy or if the size and topography of the primary tumor renders it less dangerous than the metastases. © 2017 Springer Medizin Verlag GmbH

Background Acute hepatic dysfunction in the form of acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) is a disease with a high risk of mortality and requires interdisciplinary intensive care. Aim This article explains the nomenclature, pathophysiology, prognosis and possible treatment options of ALF and ACLF, including the possibilities of extracorporeal liver support therapy at the point of liver transplantation (LTx). Method Narrative review with a selective literature review and representative case studies. Results/Corner Points ALF and ACLF may have several causes and are associated with high mortality. The causes of ALF must be accurately diagnosed because targeted treatment options are available. Both ALF and ACLF may require a liver transplantation for the patientÊs survival. For ALF and ACLF there are different criteria for decision-making on liver transplantation and graft allocation. For extracorporeal liver support therapy, two methods have been established (MARS [molecuar adsorbent recirculating system] and FPSA [fractionated plasma separation and adsorption] Prometheus ®). Both approaches may have the potential to increase the probability of survival of patients with ALF or ACLF. In some cases they can be used for bridging to liver transplantation, in individual cases also for primary poison elimination, e.g. after Amatoxin ingestion. Both methods are not suitable for long-term therapy. Conclusion Acute liver failure (ALF) and acute on chronic liver failure (ACLF) are serious diseases with a high risk of mortality. Affected patients should receive immediate interdisciplinary intensive care in a (tertiary) centre with the aim to clarify the cause of the disease as well as possible treatment options with respect to available extracorporeal liver support therapy and liver transplantation. © 2017 Georg Thieme Verlag KG Stuttgart New York.

Ricke J.,Universitatsklinikum Magdeburg AoR | Mohnike K.,Universitatsklinikum Magdeburg AoR | Pech M.,Universitatsklinikum Magdeburg AoR | Seidensticker M.,Universitatsklinikum Magdeburg AoR | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: To determine local tumor control after CT-guided brachytherapy at various dose levels and the prognostic impact of extensive cytoreduction in colorectal liver metastases. Methods and Materials: Seventy-three patients were treated on a single-center prospective trial that was initially designed to be randomized to three dose levels of 15 Gy, 20 Gy, or 25 Gy per lesion, delivered in a single fraction. However, because there was a high rate of cross-over of subjects from higher to lower dose levels, this study is better understood as a prospective trial with three dose levels. No upper size limit for the metastases was applied. We assessed time to local progression, progression-free survival, and overall survival. Results: According to safety constraints cross-over was performed. The final assignment was n = 98, n = 68, and n = 33 in the 15-Gy, 20-Gy, and 25-Gy groups, respectively. Median diameter of the largest tumor lesion in each patient was 5 cm (range, 1-13.5 cm). Estimated mean local recurrence-free survival for all lesions was 34 months (median not reached). The group assigned to 15 Gy after cross-over displayed 34 local recurrences out of 98 lesions; 20 Gy, 15 out of 68 lesions; 25 Gy, 1 out of 33 lesions. The difference between the 25-Gy and the 20-Gy or 15-Gy group was significant (p < 0.05). Repeated local tumor ablations were the most prominent factor for increased survival and dominated additional systemic antitumor treatments. Conclusions: Local tumor control after CT-guided brachytherapy of colorectal liver metastases demonstrated a strong dose dependency. The role of extensive minimally invasive tumor ablation in metastatic colorectal cancer needs to be further established. Copyright © 2010 Elsevier Inc. Printed in the USA. All rights reserved.

Jannasch O.,Universitatsklinikum Magdeburg Aor | Lippert H.,Universitatsklinikum Magdeburg Aor
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie | Year: 2011

Surgical site infections are the second or third most common type of nosocomial infections in Germany. For hospitals an annual incidence of 130000-160000 cases is estimated. Microbiological findings basically depend on type of surgery and wound location. A variety of risk factors is known. Discrimination of avoidable and unavoidable risk factors is the key for prevention. Most important points in prevention are perioperative prophylaxis with antibiotics 3060 minutes prior to incision and strict asepsis in the operation room. Clinical findings include a variety of symptoms. They can be assigned to an early course or a definitive infection. However, wound scores are better applicable when comparing clinical studies. The most important therapeutic procedure is clearing the source of infection. Subsequently the wound can be closed by secondary intention or lead to open wound healing. An accompanying therapy with antibiotics is recommendable in case of advanced local or systemic infection. To document wounds is an essential part of treating wounds.

Background: ERCP and PTCD are considered the gold standard in the interventional treatment of biliary obstruction, in particular, with palliative intention. If ERCP and PTCD are not possible, an alternative drainage procedure such as the EUS-guided cholangiodrainage (EUCD) can be used. Aim/Method: By the mean of a compact review, indication, technique, variants of approach, number of treated patients and therapeutic procedures reported by various authors, success rate, spectrum and management of complications as well as recommendations for an appropriate follow-up-investigation protocol for EUCD based on our own clinical experiences and compared to published data are described. Results: EUCD is an interventionally endoscopic/-sonografic procedure, which is used in case of postoperatively changed anatomy of the upper GI tract (BII gastric resection, PPPHR, Whipple procedure, [sub-]total gastrectomy, Roux-en-Y reconstruction) and, thus, if papilla of Vater (papilla) can not be reached or catheterized or if the patient denies PTCD in subjects with recurrent, advanced or metastasized tumor lesion(s) of the upper abdomen, hepatobiliary system as well as pancreas and associated obstruction of the biliary tree /+ jaundice. Principle: EUS-guided transluminal puncture from the upper GI tract into various extra-/intrahepatic segments of the biliary system, recanalization of the tumor stenosis with stent insertion through the access site or bypassing the tumor (stent-based retro- or antegrade drainage of the biliary tree). Derived from this, there are various approaches and procedures- EUCD i)combined with rendesvouz technique, ii/iii)transhepatically with retro- (permanent hepaticoenterostomy)/antegrade internal drainage, iv)extrahepatically with antegrade drainage (permanent choledocho-enterostomy), which are distinguished according to tumor site, possible direction of translumenal puncture, insertion of a guide wire and final stent placement. Within the spectrum of complications (rate 0-25%), bleeding, perforation, stent dislocation/-migration/-occlusion and slight postinterventional pain are relevant. Currently, approximately 200 cases have been published worldwide; the clinical experience of the reporting institution is based on more than >70interventions. Discussion: With regard to the limited diffusion process, EUCD cannot be considered a standard procedure yet. The advantages comprise low tissue trauma, primary internal drainage and the possible endoscopic re-intervention in case of complications. The high technical challenge in performing EUCD is a disfavourable aspect for broader use in clinical practice. However, the disclosed treatment results demonstrating an acceptable complication rate show that EUCD can be competitively considered to ERCP und PTCD with a great chance for primary success. Conclusion: EUCD is an elegant, not yet fully established, but rather still experimental procedure of interventional endoscopy/EUS, which needs great expertise of the endoscopist in an interdisciplinary centre of visceral medicine as one of the main predictions. In experienced hands, a safe procedure can be provided, for which a systematic follow-up and a multicentre evaluation of periinterventional management are still needed in order to achieve a final assessment of EUCD for guideline approval. © Georg Thieme Verlag KG Stuttgart · New York.

Background: Although 80 % of adolescent and young adult (AYA) patients survive beyond 5 years from the cancer diagnosis, the majority of patients are faced with specific forms of psychosocial stress and distress; however, they are distinguished from other cancer patient groups because of several developmental challenges between early adolescence and young adulthood. In accordance with research-based knowledge, the purpose of the present review is to derive psycho-oncological recommendations for an AYA-specific cancer care. Results: Clinical requirements of an integrated AYA cancer care involve: (1) clearly decreased mental health and quality of life with an impact on awareness of the problems, inclination to regression, coping with illness and cancer-related stress in everyday life, (2) often disregarded AYA-specific supportive care needs, e.g. information sharing and communication needs with respect to the need for information to reduce anxiety and fear, informed decision-making and assistance in skill acquisitions and (3) increased treatment non-adherence and developing a sustainable therapeutic patient-oncologist alliance. Psychological and behavioral adaptation as the primary aims of cancer situations are contrasted by the development of a strong identity and social bonding as primary aims of AYA stages of psychosocial development. This scenario is accentuated by tension and is therefore a challenge for AYA cancer care providers. Discussion: Existing healthcare structures and approaches are insufficient for AYA cancer patients. Current efforts of AYA networks aim at reducing cancer treatment-related distress and late sequelae. If regional AYA cancer care is to be initiated, an assessment of the psychosocial needs of AYA patients should be incorporated into the care planning and appropriate training programs in AYA oncology need to be worked out. © 2015, Springer-Verlag Berlin Heidelberg.

Hellmann W.,Institute For Kooperative Kundenorientierung Hanover | Meyer F.,Universitatsklinikum Magdeburg Aor
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2016

Background: Surgeons, more than other specialists, are required to combine high medical expertise with management competence. This is due to changing environments, new demands with respect to quality, the ongoing discussion on increased performance in the context of questionable target agreements, an increasing tendency of university hospitals and other departments and clinics to recruit leading personnel in medicine with management competence, but also to the understanding of oneʼs own role and surgeonsʼ distinguished public reputation. Aim: This narrative review describes the changing environments for surgeons in leading positions in hospitals and provides an overview on the practical use of management skills in surgery. In addition, it advises on how to acquire management competence and presents an educational concept appropriate for surgeons in leading positions. Key points: 1. The management of new challenges in the healthcare system – also in clinical surgery – requires management skills, which are indispensable for a surgeon in a leading position. 2. Management skills in surgery comprise aspects such as communication ability, social competence, cooperation and leadership skills, knowledge on business administration aspects and legal certainty. 3. The necessary knowledge can be acquired in courses leading to a certificate (e.g. “MHM® Medical Hospital Manager”) or by earning a “Master of Business Administration” (MBA). Conclusion: Management competence is essential in leading positions in clinical surgery today. The use of these skills is challenging in daily practice. Successfully applied, management competence not only guarantees comprehensive patient care and leadership of employees, but also provides satisfaction in leading positions of a surgical department. Copyright ©, Georg Thieme Verlag KG. All rights reserved.

Beck N.,Universitatsklinikum Magdeburg Aor | Meyer F.,Universitatklinikum Magdeburg Aor Deutschland
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2016

Background: Forensic medicine finds more and more resonance due to requests and queries from clinicians and acts as a mediator between the individual medical disciplines, in particular with regard to legal issues, and as an interface between the fields of medicine, police and judiciary. The aim of this short narrative overview is to make surgeons aware of the forensic aspects of their work, which is usually focused on clinical and curative aspects. Crucial points: Traditionally, the basic work in forensic medicine comprises sudden and unexpected deaths, for which it is important to definitely clarify the mode of death based on the detected cause of death. In addition to violent and unnatural deaths, there are sudden natural deaths, which are natural, but also unsolved. Clinical forensic medicine basically concentrates on the examination of victims of violence, which may comprise various types of bodily harm including sexual crime, child maltreatment and traffic accidents. The investigational results (autopsy findings, injury patterns, results from the investigation of traces) need to be presented and interpreted in public procedures at court by forensic medicine specialists, who act as experts answering questions while retaining a neutral position. Conclusion: Specialists in forensic medicine should not only be consulted for issues related to the inspection of corpses and to issue a death certification. Much rather, they should also be consulted as specialised partners of surgeons and other clinicians, e.g. for the documentation of specific findings and the description of injury patterns in injured persons who are still alive. Copyright ©, Georg Thieme Verlag KG. All rights reserved.

Grundmann R.T.,In den Gruben 144 | Meyer F.,Universitatsklinikum Magdeburg Aor
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2012

Background: Rising population age and advances in treatment with improved survival from cancer have led to more frequent survivors of cancer treatment and subsequently to more patients with a second primary tumour. The consequences are presented in this overview. Method: For the literature review, the Medline database (PubMed) was searched under the key words "multiple primary malignant tumorso" and "(Neoplasms, second primary) AND Neoplasms, Second Primary[Mesh]o". Primarily, publications in the last 7years (2005-2011) were sought. Results: The prevalence of patients with second primary cancer is reported in various cancer registries with 6.6% to 9%. Here, the risk of developing new primary cancer in cancer survivors, depending on age, compared to the general population is increased at least by 20%. Among childhood cancer survivors, the risk was even 3-to 6-times higher than would have been expected in the general population. The incidence of second malignant neoplasms is crucially dependent on the prognosis of the first tumour. Fifteen years after initial diagnosis, in patients with prognostically unfavourable tumours such as pancreatic or gastric carcinoma, second primary malignancies are detected in less than 5%. However, the cumulative incidence of all second cancers combined is approximately 15% at 25years in patients with colorectal or thyroid cancer. Conclusion: Implications from these data arise for primary diagnostics which must look at cancers with frequent synchronous second malignancies for respective tumours before treatment. Examples are synchronous colorectal lesions in patients with colorectal carcinoma or synchronous cancers of the oral cavity and pharynx in patients with oesophageal carcinoma. Another consequence is a targeted follow-up of corresponding risk populations. This includes the screening for metachronous colorectal cancer, the exclusion of gastrointestinal second malignancies in patients with GIST, or the breast cancer screening in young female thyroid cancer survivors. Since radiotherapy increases the rate of second primary neoplasms, adjuvant radiotherapy should be well justified. Nevertheless, this is true only for young patients, mainly in childhood. The risk of a second cancer after irradiation in adults is small.© Georg Thieme Verlag KG Stuttgart.New York.

Arens C.,Universitatsklinikum Magdeburg AoR
Laryngo- Rhino- Otologie | Year: 2014

Hoarseness can be the leading symptom of dysphonia. In combination with impaired vocal performance and subjective voice-related discomfort, it can represent an individually different handicap for patients and lead to limited participation in social and professional life. Since the reasons for dysphonia may be not only functional but also organic with a potentially poor prognosis, hoarseness must be clarified using differential diagnosis. In addition to the knowledge of possible diseases, pathogenesis, and treatment options for dysphonia, the differential diagnostic approach requires profound knowledge of the various diagnostic methods, and of the interpretation of the results in particular. The etiology of dysphonia is very diverse and rarely monocausal. Therefore, a team-based and interdisciplinary differential diagnostic approach is recommended. © Georg Thieme Verlag KG Stuttgart · New York.

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