Universitatsklinikum Schleswig

Lübeck, Germany

Universitatsklinikum Schleswig

Lübeck, Germany
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Reifferscheid F.,Universitatsklinikum Schleswig | Reifferscheid F.,Arbeitsgemeinschaft in Norddeutschland Tatiger Notarzte E.V. | Dorges V.,Universitatsklinikum Schleswig | Dorges V.,Arbeitsgemeinschaft in Norddeutschland Tatiger Notarzte E.V. | And 4 more authors.
Notarzt | Year: 2010

Due to a current shortage of doctors and an increasing number of emergency calls in an ageing population emergency physicians in Germany face new challenges. With the aim of providing a high level of quality nationwide a specialist designation in emergency medicine was introduced in 2003. While the curriculum regulates the contents of theoretical training, the duration and requirements to be met by physicians wishing to work in the field of pre-hospital emergency medicine differ between the various German State Chambers of Physicians. Also, there is no uniform regulation of training in the ambulance services. The specialist designation in emergency medicine is an attractive specialisation for the anaesthetist and raises the attractiveness of the speciality. However, further standardisation of specialist training is required. Uniform concepts for training and continuing medical education are needed to provide patients with life-threatening conditions with the highest level of medical care by a physician at the scene of the emergency. © Georg Thieme Verlag KG Stuttgart New York.

Reifferscheid F.,Universitatsklinikum Schleswig | Reifferscheid F.,Arbeitsgemeinschaft in Norddeutschland Tatiger Notarzte E.V. | Harding U.,Universitatsklinikum Munster | Harding U.,Arbeitsgemeinschaft in Norddeutschland Tatiger Notarzte E.V. | And 6 more authors.
Anasthesiologie und Intensivmedizin | Year: 2010

Background: With the aim of providing higher quality pre-hospital emergency care the German Medical Association reformed the specialist qualification programme in emergency medicine and defined a relevant curriculum. The present article analyses to what extend this new curriculum has been adopted by the 17 State Chambers of Physicians in Germany. Methods: All State Chambers of Physicians in Germany were invited to complete a standardised questionnaire regarding the requirements to be met by physicians wishing to work in the field of pre-hospital emergency medicine. Additional data was requested regarding the applicantś clinical experience, training in critical care, and the duration and requirements for practical training in emergency medicine. State Chambers that failed to return the questionnaire were contacted by telephone. Results: Eight State Chambers returned the completed questionnaire, and the relevant information from the other states was obtained by telephone interview as well as from a synopsis provided by the German Medical Association. Twelve State Chambers offer only the new curriculum whilst five offer both the old and new curriculum. Differences in the requirements for admission to the curriculum can be found with regard to the duration of clinical experience and practical training including the number of patients treated, and admission to the final exam. Conclusions: The new curriculum was introduced in order to create a uniform level of education for emergency physicians. However, in 2009 the qualification of emergency physicians remains heterogeneous: the new curriculum is mandatory only in some states, and official recognition of physicians who were trained in accordance with the old curriculum differs from state to state. © Anästh Intensivmed 2010.

Maass N.,Universitatsfrauenklinik Aachen | Harbeck N.,Ludwig Maximilians University of Munich | Mundhenke C.,Universitatsklinikum Schleswig | Lerchenmuller C.,Gemeinschaftspraxis Dres. Wehmeyer | And 16 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2013

Purpose: Everolimus has shown to stop formation and activity of osteoclasts. Breast cancer patients with bone metastases only are candidates for effective but low toxic treatment. Patients and methods: We evaluated everolimus in a double-blind, placebo-controlled, phase II, randomized discontinuation study in breast cancer patients with HER2 negative breast cancer patients with bone metastases only. After being stable on 8 weeks of everolimus 10 mg/day, patients were randomized to everolimus-continuation or placebo. Primary outcome was time (from randomization) to progression (TTP). Seventy-six patients would have had to be randomized to show a hazard ration (HR) of 0.5 for everolimus-continuation. Results: Eighty-nine patients were enrolled in 4 years. Thirty-nine patients with SD after 8 weeks on everolimus were randomized to everolimus-continuation or placebo. TTP in patients with everolimus- continuation was 37.0 (95 % CI 16.7-40.3) versus 12.6 weeks (95 % CI 7.1-17.9) with placebo [HR 0.554 (95 % CI 0.282-1.09) p = 0.0818], adjusted for endocrine therapy [HR 0.464 (95 % CI 0.226-0.954) p = 0.037]. TTP in everolimus responders (n = 6) was 86 weeks. Conclusion: The RADAR study is mainly hypothesis generating. It suggests that everolimus has single-agent activity, and patients with bone metastases only may retrieve long-term benefit from everolimus if they do not progress within 8 weeks of treatment. © 2013 Springer-Verlag Berlin Heidelberg.

Hanewinkel R.,Institute For Therapie Und Gesundheitsforschung Ift Nord | Hanewinkel R.,Universitatsklinikum Schleswig | Blohmke S.,Universitatsklinikum Schleswig | Sargent J.D.,Norris Cotton Cancer Center
Gesundheitswesen | Year: 2012

Aim: The aim of this study was to examine whether smoking in movies can predict established smoking in adolescence. Methods: A longitudinal study was conducted over a period of 13 months with 4112 German students. Adolescents exposure to smoking in movies was assessed by asking each student to indicate which film he or she had seen from a unique list of 50 movies, which was randomly selected for each individual survey from a sample of 398 popular contemporary movies. We calculated exposure to movie smoking for each respondent by summing the number of smoking occurrences for each movie that the respondent reported seeing. Results: At follow-up, a total of 272 young people had smoked more than 100 cigarettes during their lifetime. While 2.1% of the young people with the lowest exposure to movie smoking initiated established smoking, 13.4% of the group with the highest exposure to movie smoking initiated established smoking. The adjusted relative risk of initiation of established smoking was 2.05 times higher in the group with the highest movie smoking exposure compared to the group with the lowest exposure (95% confidence interval: 1.25-3.35). Conclusion: Our data indicate that smoking in movies can be regarded as an independent risk factor for the initiation of established smoking in adolescence. © Georg Thieme Verlag KG Stuttgart - New York.

Radke P.W.,Universitatsklinikum Schleswig | Wolfrum S.,Universitatsklinikum Schleswig | Elsasser A.,Integriertes Herzzentrum | Mockel M.,Charité - Medical University of Berlin | And 2 more authors.
Kardiologe | Year: 2011

Periprocedural complications during coronary angiography or percutaneous coronary interventions are relatively rare but potentially life-threatening events. The low incidence of fatal complications, e.g. coronary perforation, implies a relatively low level of routine experience regarding the management of these situations. The aim of this article is to provide a reference for periprocedural complications during coronary diagnostic and interventional procedures using standard operating procedures (SOPs) and checklists. The article thereby, provides the basis for a rational diagnostic and therapeutic approach for the most common complications in the catheter laboratory. © Springer-Verlag 2011.

Lettau I.,University of Kiel | Hattermann K.,University of Kiel | Held-Feindt J.,Universitatsklinikum Schleswig | Brauer R.,Institute of Molecular Genetics | And 2 more authors.
Journal of Neuropathology and Experimental Neurology | Year: 2010

Glial tumors exhibit a high morbidity and mortality because of their invasive nature. Matrix metalloproteinase 19 (MMP19) is a secreted protease that together with epilysin (MMP28) forms a structural subgroup of MMPs. We analyzed their expression by quantitative reverse transcription polymerase chain reaction, Western blot, and immunohistochemistry in tumor and normal control brain tissues and in glioblastoma (GB) cells and performed MMP19 silencing functional assays. Matrix metalloproteinase 28 was transcribed to the same extent in normal brain samples and gliomas but was undetectable in GB cell lines. In contrast, MMP19 was detected by immunohistochemistry in normal brain samples only in endothelial cells but was found at high levels in astrocytomas of different World Health Organization grades in situ and in GB cells in vitro. Matrix metalloproteinase 19 was upregulated in GB cells after exposure to proinflammatory cytokines. In Transwell invasion assays, MMP19-silenced cells migrated more slowly through laminin-, basal lamina-, and brevican-coated membranes than controls. Matrix metalloproteinase 19-silenced GB cells also migrated into brain tissue slices compared with control cells. Brevican, a brain-specific proteoglycan and major component of brain extracellular matrix, was degraded by recombinant human MMP19. Taken together, these results indicate that MMP19 is highly expressed in proliferating astrocytoma/glioma cells, and that its expression may facilitate their invasion through brain extracellular matrix components. Copyright © 2010 by the American Association of Neuropathologists, Inc.

Schloricke E.,Universitatsklinikum Schleswig | Zimmermann M.,Universitatsklinikum Schleswig | Hoffmann M.,Universitatsklinikum Schleswig | Laubert T.,Universitatsklinikum Schleswig | And 4 more authors.
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2012

Introduction: The rectovaginal fistula is a rare entity with heterogenic causality. Its genesis seems to predict the extent of operative treatment and the prognostic outcome. The aim of this study was to present different surgical techniques in the treatment of rectovaginal fistulas and their results in correspondence to the genesis. Material and Methods: Between 1 /2000 and 1 /2010, the data of patients with rectovaginal fistulas were collected. The retrospective analysis included biographic and anamnestic data as well as clinical parameters, general and specific complications and postoperative data. Results: In a timespan of ten years 36patients with rectovaginal fistulas were treated. The most common causes were inflammatory diseases (n= 21) and earlier surgical measures (n= 6). Moreover tumour-associated fistulas (n= 5) and fistulas with unknown genesis (n= 4) were seen. As surgical techniques anterior resection (n= 21), transrectal flap plasty (n= 7), subtotal colectomy (n= 3), pelvine exenteration (n= 2) and rectal exstirpation (n= 1) were used. The closure of the vaginal lesion was performed by single suture (n= 25), flap plasty (n= 6), transvaginal omental plasty (n= 2) and posterior vaginal plasty (n= 1). All patients were provided with an omental plasty to perform a safe division of the concerned regions. Patients with a low fistula (< 6 cm) were treated with transperineal omental plasty. The median follow-up was 12months (6 - 36). Within this timespan 6patients suffered from major complications [ARDS, anastomosis insufficiency, postoperative bleeding, recurrence of fistula (n= 3)]. Three patients died in the postoperative period (cerebellar infarct, septic complication associated with Crohn's disease, multiorgan failure in tumour recurrence). Conclusion: The genesis of rectovaginal fistulae is an important predictor for the size of resection which can range from simple excision to exenteration. For optimal therapy the surgical intervention needs to be integrated into an interdisciplinary therapy concept.

Dorner L.,Universitatsklinikum Schleswig | Ulmer S.,Universitatsklinikum Schleswig | Rohr A.,Universitatsklinikum Schleswig | Mehdorn H.M.,Universitatsklinikum Schleswig | Nabavi A.,Universitatsklinikum Schleswig
Journal of Clinical Neuroscience | Year: 2011

Gliadel® (Eisai Inc., Woodcliff Lake, NJ, USA) is the only therapeutic agent approved by the Food and Drug Administration and the European Medicines Agency for local chemotherapy of malignant gliomas. With increasing use of this treatment, characteristic side effects have become evident. While most side effects can be managed conservatively, cyst formation requires further intervention. From 2004 to 2009 at our institution 88 patients with malignant gliomas were treated with Gliadel®. Ten patients (11%) developed a space-occupying cyst in the resection cavity, seven of which caused clinical symptoms of mass effect that was most prominent 2 weeks after Gliadel® implantation (median = 16, range = 9-30). Despite dexamethasone treatment symptoms progressed, necessitating various surgical interventions. In four patients the cysts were drained percutaneously through a burrhole using a 19-gauge needle. If puncture was not possible (three patients) or not sufficient (two patients), an Ommaya reservoir was implanted for repetitive drainage. In two patients this treatment was combined with open decompression of the cyst. On average, cysts were drained three times. Eventually the symptoms subsided, corresponding to shrinkage of the cysts as shown on follow-up imaging. We describe a serious side effect of local chemotherapy, which may cause rapid clinical deterioration and require direct intervention. While reservoir implantation apparently represents a more elegant treatment option, our experience shows that draining the cyst, even only a few times, sufficiently ameliorates the symptoms and subsequently reverses and halts further cyst enlargement. © 2010 Elsevier Ltd. All rights reserved.

Bergmann P.A.,Berufsgenossenschaftliche Kliniken Bergmannstrost | Bergmann P.A.,Universitatsklinikum Schleswig | Mauss K.L.,Universitatsklinikum Schleswig | Liodaki M.E.,Universitatsklinikum Schleswig | And 3 more authors.
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2014

Introduction: Infections of the hand are common diseases in hand surgery departments. The correct diagnosis and subsequent treatment is difficult and is often underestimated. In literature different and often conflicting treatments are recommended. The present study retrospectively analysed our two-stage surgical treatment. Patients and Methods: 60 patients (mean age: 51 years, 38 male, 22 female) were studied retrospectively on the basis of the diagnosis hand infection (ICD L03.-). In all patients, a rapid and radical surgical debridement without wound closure was performed. An antibiotic therapy was initiated. We investigated how often wound closure during a second-look operation, following a period of open wound treatment with antiseptic dressing was successful possible. Furthermore, the patients were followed up in our outpatient clinic. Results: A successful secondary wound closure was possible after on average 38.7 h and in 92% of the patients. 8% of patients required further surgical treatment. These patients presented with either an existing disease or a delayed presentation with initial antibiotic treatment. Antibiotic therapy was performed on an average for 8.7 days. Altogether for 85% of the 58 patients examined in our outpatient clinic the therapy could be terminated after 3 weeks with a full recovery of function of the injured hand and with full force measurements. The inability to work was on average 16 days. Discussion: The two-stage surgical treatment, with radical debridement and open wound dressing in our collective is an adequate treatment for infections of the hand. It is a safe procedure, that allows for combination with an antibiotic therapy by which a rapid restoration of function of the injured hand is possible. © Georg Thieme Verlag KG Stuttgart, New York.

Laubert T.,Universitatsklinikum Schleswig | Kleemann M.,Universitatsklinikum Schleswig | Roblick U.J.,Universitatsklinikum Schleswig | Burk C.,Universitatsklinikum Schleswig | And 3 more authors.
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2012

Anorectal outlet obstruction constitutes one form of chronic constipation. Combinations of morphological alterations of the pelvis, the pelvic floor and the colorectum are nearly always evident. The goal of the diagnostic work-up is to identify those patients who will profit from a surgical intervention. Resection rectopexy aims at restoring the physiological anatomy thereby ameliorating the functional interaction of structures effected with the laparoscopic approach entailing all advantages of minimally invasive surgery. Besides a detailed description of the surgical technique used and an algorithm for indications to operate we present our results after 19 years of experience. Throughout this period, 264 laparoscopic resection rectopexies for outlet obstruction were performed. With a mean follow-up of 58.2 months the rate of improvement of obstructive symptoms was 79.5 % (n = 128 of 161 available for follow-up). Present studies suggest that (laparoscopic) resection rectopexy entails better results in comparison to non-resecting procedures and procedures with the implantation of allogenic material. Certainly, in order to achieve these results a correct patient selection and an expertise in laparoscopic surgery are essential. Both the perioperative and the functional results of our own collective fortify the advantages of laparoscopic resection rectopexy in patients with an outlet obstruction. © Georg Thieme Verlag KG Stuttgart · New York.

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