Universitatsklinikums Ulm

Schönau am Königssee, Germany

Universitatsklinikums Ulm

Schönau am Königssee, Germany

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Hauptmeier B.M.,Universitatsklinikums Bergmannsheil | Hauptmeier B.M.,Universitatsklinikums Ulm | Von Baum H.,Universitatsklinikums Bergmannsheil | Von Baum H.,Universitatsklinikums Ulm
Internistische Praxis | Year: 2012

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality world-wide. Just in Germany approximately 400000 to 600000 people per year become ill on CAP. The costs caused by this disease sum up to more than 500 million € per year. The most common pathogenic agent was in almost all studies the Streptococcus pneumoniae bacterium. Much less often Haemophilus influenzae or Staphylococcus aureus had been detected. The most common atypical pathogenic agent was Mycoplasma pneumoniae. In contrast to this Chlamydia pneumoniae is a rather rare (<1%) pathogenic agent of CAP. Also Enterobacteriaceae and Pseudomonas aeruginosa are very rare definite pathogenic agents of pneumonia. Viral participation is according to recent examinations about 15-20%. For non immunocompromised adults Influenza A is the most frequent pathogenic agent, followed by Influenza B and respiratory syncytial virus. Mortality rates are rather low (<2%) for CAP patients treated as outpatients, but they are higher (5 to 20%) among patients hospitalised due to CAP. They are highest (up to 50%) for patients admitted to the intensive care unit. The rate of Streptococcus pneumoniae isolates with reduced responsiveness to Penicillin G is in contrast to Spain and France in Germany still rather low (<10%), the rate of isolates with reduced responsiveness to macrolide is 20%. Up to now the risk of infections with fluoroquinolone-resistant pneumococci is very low in Germany, the rate of macrolid- resistant Mycoplasma pneumoniae is 3%.

Establishment of organ site-specific cancer centers by the German Cancer Society (GCS) is part of the basic politically driven reform of oncology care in Germany. Since 2007 an increasing number of prostate cancer centers have been guided toward certification by the OnkoZert GmbH of the GCS. Currently 68 centers are certified and together with ongoing certification proceedings will amount to 81 prostate cancer centers, which cover about one fourth of cases of primary prostate cancer. Urology is of particular importance in the management of these centers. For the most part, urologists belonging to a clinical unit are the initiators of the certification process, thus ensuring that uro-oncology is firmly entrenched in the specialty with involvement of outpatient service providers. Fears that authority will be lost are unfounded as long as responsibility for this task is taken seriously and active use is made of the possibilities for creativity. A similarly important function is fulfilled by the testicular cancer centers that offer second opinion services, which were initiated by urology conjointly with German Cancer Aid to pursue the goal of quality assurance for this tumor entity and therefore likewise secure the position of this tumor in the realm of urologists. By applying such strategic approaches, urologists will succeed in sustainably safeguarding their future importance in a very competitive environment and in counteracting the encroachments of other specialties by exhibiting clear orientation. © 2011 Springer-Verlag.

Bekes I.,Universitatsfrauenklinik Ulm | Fink V.,Universitatsfrauenklinik Ulm | Schwentner L.,Universitatsfrauenklinik Ulm | Leinert E.,Universitatsfrauenklinik Ulm | And 2 more authors.
Gynakologe | Year: 2016

Tumor affected surgical margins in breast cancer and ductal carcinoma in situ (DCIS) have a negative prognostic effect and are associated with an increased risk of local recurrence so that tumor-free resection margins are strongly recommended. A microscopically free resection margin in invasive breast carcinomas—“no cells on ink”—also with accompanying DCIS is currently considered sufficient. This refers to any tumor biology and is independent of the age of the patient. Postoperative guideline-recommended adjuvant radiotherapy and systemic therapy is required. This approach is already recommended in the American guidelines as well as in the recommendations of the German Arbeitsgemeinschaft Gynäkologische Onkologie (AGO). In the currently valid German S3 guideline from 2012 these recommendations are still missing. For DCIS only, a tumor-free resection margin of 2 mm should be achieved if radiotherapy is planned after breast-conserving surgery. © 2016 Springer-Verlag Berlin Heidelberg

Bruck S.,Universitatsklinikums Ulm | Skrabal C.,Universitatsklinikums Ulm | Trager K.,Universitatsklinikums Ulm | Reinelt H.,Universitatsklinikums Ulm
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie | Year: 2014

Protamine is a protein mainly used to reverse anticoagulant effects of heparin during cardiac or vascular surgery with extracorporeal circulation. Adverse events after protamine administration are rare but if they occur they can be catastrophic. Based on a case report with an elective cardiac surgery patient with known allergy to fish, we discuss the related events and risk factors for an adverse reaction after protamine. The patient management and its outcome are presented.

Korper S.,Universitatsklinikums Ulm | Hochsmann B.,Universitatsklinikums Ulm | Schrezenmeier H.,Universitatsklinikums Ulm
LaboratoriumsMedizin | Year: 2015

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare benign clonal disorder of hematopoiesis. Its etiologic basis is the clonal dominance of a PIGA-mutated hematopoietic progenitor that gives rise to GPI-deficient blood cells that are unable to express complement inhibitors like CD55 or CD59. These cells are prone to complement-induced hemolysis. In classic hemolytic PNH, granulocyte clone sizes can be up to 90% or more. Much progress has been made during the last years in understanding the interrelations of complement-dependent hemolysis; its consequences like thrombosis, renal failure or pulmonal hypertension; and possible treatment strategies. To gain clinical relevance, the PNH clone has to make a relevant contribution to blood cell generation; however, a minimal clone size as a threshold for the occurrence of symptoms such as thrombosis, dyspnea, chest or abdominal pain cannot be given. Such symptoms can be seen in a relevant proportion of patients with clone size smaller than 10%. The driver for the clonal dominance of the PIGA-mutated hematopoiesis is still not clear. Recently, data about coexisting mutations in cancer genes have been published and new mechanisms for autoimmunity have been presented. The success of eculizumab in the treatment of PNH patients has stimulated the development of a variety of new strategies for complement inhibition. This review will focus on the most important findings in pathophysiology, clinical course and treatments during the last years. © 2015 by De Gruyter.

Illness behaviour involves cultural, situational and personal predispositions. World Wide Web search statistics provided by internet applications like Google Insights for Search have the potential to facilitate our research on the distribution of mental disorders, our understanding of both sociocultural imprintings and trends in psychophenomenology and could make a remarkable contribution to medical research and public health. © Georg Thieme Verlag KG Stuttgart - New York.

Schmid M.,University Hospital Freiburg | Hummler H.,Universitatsklinikums Ulm
Padiatrische Praxis | Year: 2011

In Germany about 700000 children are born every year. Most of them are healthy and do not need resuscitation immediately after birth. Nevertheless birth is one of the most dangerous situations in life, for both the mother as well as for the newborn infant. To ensure the highest level of care for both the mother and the infant, pregnant women at risk for complications should be transferred to perinatal centers according to german national regulations and current clinical guidelines. However, perinatal complications cannot always be anticipated and may occur unexpectedly during the course of an uneventful pregnancy or during delivery. In this case, the obstetric team has the responsibility for the care of the newborn infant until the neonatologist is available to take over. Therefore, obstetricians, midwifes, anaesthesiologists or any other health care personel should be familiar with the principles of resuscitation of the newborn after birth. Wherever babies are born, there should be one person who is able to take care on the newborn infant and who is able to perform a complete resuscitation according to the ILCOR guidelines, if needed. Our objective is to present the ILCOR guidelines and to provide practical advice for the management of the sick neonate immediately after birth. The main steps of support are easily provided with some basic knowledge and practical training. This training is now offered at various places in Germany in the context of curricula based on the ERC or AAP/AHA course systems. Using the skills taught in these courses the number of infants dying or suffering from permanent sequelae of birth asphyxia or other complications may be reduced significantly.

Weber T.,Universitatsklinikums Ulm | Elser H.,Universitatsklinikums Ulm | Luster M.,Universitatsklinikums Ulm
Tagliche Praxis | Year: 2013

Preoperative localization studies such as sonography and sestamibi-scintigraphy are recommended before surgery of primary hyperparathyroidism. These procedures enable a focused, unilateral or even minimally invasive surgical approach. In case of negative localization studies or when reoperations are planned, modern techniques of image fusion such as Sesta- mibi-SPECT-CT or Methionine-PET/CT, which are providing true positive results in up to 90%, should be applied.

Schmid M.,Kinder und Jugendpsychiatrische Klinik der Universitaren Psychiatrischen Kliniken Basel | Goldbeck L.,Universitatsklinikums Ulm
Praxis der Kinderpsychologie und Kinderpsychiatrie | Year: 2010

Complex Posttraumatic Stress Disorder and Developmental Trauma Disorder are discussed as new diagnostic entities representing the broad spectrum of trauma-related symptoms of children and adolescents. However, the psychotherapy of severe and complex trauma during adolescence is challenging because trauma-associated symptoms like attachment problems, the expectation of self-inefficacy and dissociation may complicate therapeutic work and limit treatment outcome. Therefore it is necessary to develop evidence-based treatment approaches for these mental disorders. Trauma-focused cognitive-behavioral therapy has been successfully evaluated for the treatment of posttraumatic stress disorder. Actual treatment approaches combine strategies from Dialectal Behavioral Therapy (DBT) with cognitive behavioral techniques of trauma therapy for the treatment of complex trauma disorder. This article gives a practical overview about cognitive-behavioral treatment approaches and discusses problems of their implementation in the clinical routine of child and adolescent psychiatrists/psychotherapists. © Vandenhoeck & Ruprecht GmbH & Co. KG, Göttingen 2010.

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