[Subsequent treatment following proximal femoral fracture - who, when, where? Assessment of the current situation in Germany]. [Weiterbehandlung nach proximaler Femurfraktur - Wer, wann, wohin? Eine deutschlandweite Statuserhebung mit Unterstützung der AG Alterstraumatologie der DGU.]
Bliemel C.,Universitatsklinikum Marburg
Zeitschrift für Orthopädie und Unfallchirurgie | Year: 2012
Geriatric fractures are an increasing challenge for the German health-care system. While the acute care for patients with proximal femoral fractures is already standardised, differences remain in the further treatment and rehabilitation. A survey was conducted in cooperation with the section of geriatric trauma (AG Alterstraumatologie) of the German Association of Trauma Surgery (DGU) to point out existing problems in this group of patients. In October/November 2010 an electronic questionnaire, assessing the medical care for patients after proximal femoral fracture, was sent to 1080 medical directors of trauma and orthopaedic surgery departments in Germany. 339 (31.4 %) departments participated. The analysis revealed that 57 % of the hospitals had cooperation agreements with aftercare hospitals. 37 % of all hospitals had problems in finding a rehabilitation hospital. The initiation of a rehabilitation procedure is almost exclusively based on the doctors' decision. Influence of employees with other professions is marginal. Mobility and Barthel index before the release from the acute care hospital are major factors in the decision making. The questionnaire confirms that there are problems in the aftercare service of geriatric patients all around Germany. A further improvement of collaboration between acute and aftercare hospitals is required. © Georg Thieme Verlag KG Stuttgart · New York.
Bliemel C.,Universitatsklinikum Marburg |
Oberkircher L.,Universitatsklinikum Marburg |
Eschbach D.-A.,Universitatsklinikum Marburg |
Struewer J.,Universitatsklinikum Marburg |
And 2 more authors.
Zeitschrift fur Orthopadie und Unfallchirurgie | Year: 2013
Background: Proximal femoral fractures are common in the elderly. Surgical and postoperative complications are of major importance in this population. Numerous factors affecting the treatment results could be identified so far. The effect of surgeons experience in terms of educational status is not entirely clarified yet. The aim of the present study was to analyse the effect of surgeons educational status on the outcome in proximal femoral fractures. Therefore treatment results were compared in terms of individual surgeons experience. Furthermore, the surgical education concept of our department was evaluated. Material and Methods: At a national trauma centre, patients of at least 60 years of age with proximal femoral fractures were prospectively screened. Patient-specific parameters like Barthel index, ASA score, Charlson score, patients age and type of fracture were collected at the time of hospital admission. During the in-hospital stay type of fracture treatment, surgery time, number of blood transfusions, perioperative complications, duration of in-hospital stay as well as in-hospital mortality were recorded. Results were analysed for osteosynthesis and prosthesis depending on the surgeons educational status. Four different groups of surgeons were distinguished (inexperienced senior house officer; experienced senior house officer; specialist in orthopaedics and accident surgery; specialist in orthopaedics and accident surgery with an additional qualification for special accident surgery). Results: 402 patients with coxal femoral fractures could be included into the study. 160 patients (40 %) sustained complications of different severity. In-hospital mortality was shown to be 6.2 %. Separate consideration of osteosynthesis and prosthesis revealed no difference between the four groups of surgeons regarding mortality rate, number of blood transfusions and in-hospital stay. In terms of cutting/suture time consultants with a further specialisation in trauma surgery were significantly faster. Conclusion: Apart from cutting/suture time, surgeons educational status had no statistically significant impact on the rate of complications, rate of blood transfusions, hospital mortality and in-hospital stay. It can be presumed that surgical education according to our educational concept has no negative effects on treatment quality of patients with proximal femoral fractures. Differences in cutting/suture time give a hint for the additional expense that is connected with surgical education. © Georg Thieme Verlag KG Stuttgart - New York.
[In situ hybridization in clinical pathology. Significance of polysomy 17 for HER2 determination and genetic tumor heterogeneity in breast cancer]. [In-situ-Hybridisierung in der klinischen Pathologie. Bedeutung der Polysomie 17 für die HER2-Bestimmung und genetische Tumorheterogenität im Mammakarzinom.]
Gaiser T.,Universitatsklinikum Marburg
Der Pathologe | Year: 2012
The introduction of total genome sequencing led to the confirmation that tumors show substantial genetic heterogeneity. This phenomenon, which describes the presence of different genetic cell clones within a tumor also complicates the diagnostics of HER2. This article gives a review of new knowledge on polysomy 17 and genetic tumor heterogeneity in connection with HER2 determination of breast cancer.
Kamp-Becker I.,Universitatsklinikum Marburg
Nervenheilkunde | Year: 2013
Objective: Autism disorders are early onset, severe neurodevelopmental disorders. There is considerable heterogeneity in the expression and severity of core and associated symptoms which hampers a clear distinction from other disorders. The present study aims at an answer to the question whether Albert Einstein was suffering from an autistic disorder. Methods: Available biographic information was thoroughly checked looking for valid diagnostic criteria for autism. -Results: There is definitely no evidence for an autistic disorder. A comprehensive discussion tries to explain why such a disorder is attributed to Einstein. Conclusion: The attribution of a diagnosis to famous people creates a high identification potential. In return, however, this means that normality is pathologised in order to normalise pathology. Clinical relevance: Actual autism is a vogue diagnosis, whose differentiation to other disorders gets unrecognizable. © Schattauer 2013.
Hu X.,University of Georgia |
Yang D.,University of Georgia |
Zimmerman M.,University of Georgia |
Liu F.,University of Georgia |
And 8 more authors.
Cancer Research | Year: 2011
IFN regulatory factor 8 (IRF8) is a key transcription factor for myeloid cell differentiation and its expression is frequently lost in hematopoietic cells of human myeloid leukemia patients. IRF8-deficient mice exhibit uncontrolled clonal expansion of undifferentiated myeloid cells that can progress to a fatal blast crisis, thereby resembling human chronic myelogeneous leukemia (CML). Therefore, IRF8 is a myeloid leukemia suppressor. Whereas the understanding of IRF8 function in CML has recently improved, the molecular mechanisms underlying IRF8 function in CML are still largely unknown. In this study, we identified acid ceramidase (ACDase) as a general transcription target of IRF8. We demonstrated that IRF8 expression is regulated by IRF8 promoter DNA methylation in myeloid leukemia cells. Restoration of IRF8 expression repressed A-CDase expression, resulting in C16 ceramide accumulation and increased sensitivity of CML cells to FasL-induced apoptosis. In myeloid cells derived from IRF8-deficient mice, A-CDase protein level was dramatically increased. Furthermore, we demonstrated that IRF8 directly binds to the A-CDase promoter. At the functional level, inhibition of A-CDase activity, silencing A-CDase expression, or application of exogenous C16 ceramide sensitized CML cells to FasL-induced apoptosis, whereas overexpression of A-CDase decreased CML cells' sensitivity to FasL-induced apoptosis. Consequently, restoration of IRF8 expression suppressed CML development in vivo at least partially through a Fas-dependent mechanism. In summary, our findings determine the mechanism of IRF8 downregulation in CML cells and they determine a primary pathway of resistance to Fasmediated apoptosis and disease progression. © 2011 American Association for Cancer Research.
Waldegger S.,Universitatsklinikum Marburg
Intensivmedizin und Notfallmedizin | Year: 2010
Disturbances of phosphate homeostasis are a minor but - in view of potential life-threatening complications - important topic in intensive care medicine. Therapeutic strategies require knowledge of the cause of the disturbed phosphate homeostasis. In both hyper- and hypophosphatemia, the daily intake, the distribution over intra- and extracellular compartments, and the amount of renal elimination have to be considered. This report explains the essential components of normal phosphate homeostasis, describes its most important disturbances, and the most recent therapeutic recommendations. With respect to hyperphosphatemia, particular attention is paid to acute phosphate nephropathy caused by the application of salinic laxatives. Within the causes of hypophosphatemia, redistribution phenomena play a pivotal role, mainly caused by respiratory alkalosis and by insulin. Moreover, consequences of severe hypophosphatemia (e.g., rhabdomyolysis, hemolysis, and respiratory insufficiency) are described together with the recommended therapies. © 2010 Springer-Verlag.
Kneisel A.,Universitatsklinikum Marburg |
Hertl M.,Universitatsklinikum Marburg
JDDG - Journal of the German Society of Dermatology | Year: 2011
Autoimmune bullous skin diseases represent a heterogenous group of disorders of skin and mucosa which are commonly associated with IgG or IgA autoantibodies against distinct adhesion molecules of the skin. The antibodyinduced loss of adhesion between epidermis and dermis results in blister formation and extensive erosions. There is a great need for rapidly establishing the diagnosis of these disorders since they may run a severe and potentially life-threatening course. In addition, because of their rarity and heterogeneous symptoms, autoimmune bullous skin diseases often pose a major diagnostic challenge. While histopathological examinations provide evidence for the level of blister formation, immunofluorescence microscopy has been established to identify tissue-bound and circulating autoantibodies. Direct immunofluorescence microscopy represents the gold standard for detecting tissue-bound autoantibodies. Indirect immunofluorescence microscopy with defined tissue substrates is considered the first step in detecting circulating autoantibodies. Confirmatory tests such as ELISA, immunoblot or immunoprecipitation analyses are performed utilizing recombinant proteins or keratinocyte extracts. The later assays can be used for primary diagnosis as well as for immunoserological follow-up. Systemic immunosuppressive drugs usually represent the main therapeutic regimen. Initially, systemic corticosteroids are commonly administered in combination with steroid-sparing, immunosuppressive agents. Novel targeted treatments such as immunoadsorption, rituximab or high-dose intravenous immunoglobulins have proven to be highly effective in severe and refractory pemphigus. This review presents a state-of-the-art algorithm for making the diagnosis of autoimmune bullous disorders and provides an overview on currently available therapeutic options. © The Authors.
Pfestroff A.,Universitatsklinikum Marburg |
Luster M.,Universitatsklinikum Marburg
Deutsche Medizinische Wochenschrift | Year: 2015
The prevalence of thyroid nodules in Germany - depending on the diagnostic technique used - ranges from 20 to 50 %. The overall incidence increases, partly because by the use of modern ultrasound modalities ever smaller morphological changes are detected. Most nodules are asymptomatic - and therefore often incidental findings. In this article you will learn how to identify and differentiate thyroid nodules using different diagnostic tests.
Kesting M.-L.,University of Marburg |
Bredenpohl M.,University of Marburg |
Klenke J.,TU Braunschweig |
Westermann S.,Universitatsklinikum Marburg |
Lincoln T.M.,University of Hamburg
Journal of Behavior Therapy and Experimental Psychiatry | Year: 2013
Background: Vulnerability-stress models propose that social stress triggers psychotic episodes in high risk individuals. Previous studies found not only stress but also a decrease in self-esteem to precede the formation of delusions. As evidence for causal conclusions has not been provided yet, the present study assessed the direct impact of social stress on paranoid beliefs using an experimental design and considered a decrease in self-esteem as a mediator and the proneness to psychosis and paranoia as moderators of the effect. Methods: A nonclinical population sample (n = 76) was randomly assigned to an experimental (EG) or a control group condition (CG). In the EG, participants were excluded during a virtual ball game (Cyberball) by the other two players and received a negative feedback after performing a test. The CG was included in the game and received a neutral feedback. Before and after the experimental conditions, emotions, self-esteem and paranoid beliefs were assessed using state-adapted questionnaires. Results: After the social stress induction, the EG reported a higher increase in subclinical paranoid beliefs compared to the CG. The impact of social stress on paranoid ideation was mediated by a decrease in self-esteem and moderated by proneness to paranoia. Individuals who felt distressed by paranoid thoughts at baseline were more likely to react with an increase in paranoid ideation under social stress. Limitations: The results need to be confirmed in a patient sample to draw conclusions about the processes involved in the formation of delusions in clinically relevant stages. Conclusions: The impact of social stress on symptom formation and self-esteem is discussed in terms of recent models of symptom formation and interventions in psychosis. © 2012 Elsevier Ltd. All rights reserved.
PubMed | Anasthesiologie, Universitatsklinikum Marburg, Universitatsklinikum Gottingen, Klinik fur Anasthesiologie and 2 more.
Type: | Journal: Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen | Year: 2017
To improve perioperative quality and patient safety, the German S3guideline should be consistently implemented to avoid perioperative hypothermia. Perioperative normothermia is a quality indicator and should be achieved by anesthesiologists and surgeons. To detect hypothermia early during the perioperative process, measuring body temperature should be started 1-2h preoperatively. Patients should be actively warmed for 20-30min before starting anesthesia. Prewarming is most effective and should be included in the preoperative process. Patients should be informed about the risks of perioperative hypothermia and members of the perioperative team should be educated. Astandard operating procedure (SOP) to avoid hypothermia should be introduced in every operative unit. The incidence of postoperative hypothermia should be evaluated in operative patients every 3-6months. The goals should be to measure body temperature in >80% of patients undergoing surgery and for >70% to exhibit a core temperature >36C at the end of surgery.