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1.
Chirurg ; 87(9): 775-784, 2016 Sep.
Article in German | MEDLINE | ID: mdl-27356924

ABSTRACT

BACKGROUND: The medical dissertation represents an independently processed scientific project. In the field of medicine this has for many years displayed the basis for controversial discussions. The aim of the study presented here was to evaluate the prerequisites of all current promotion regulations in German medical faculties in order to develop a comparability on the basis of a scoring system. METHOD: An independent analysis of all promotion regulations from German medical faculties for the year 2014 was carried out according to 12 primary outcome measures and a scoring system. RESULTS: The average total score of promotion regulations at 37 German medical faculties was 57.2 points (SD ±9.5) out of a possible 100 scoring points. The highest scores with 72-85 points were achieved by 3 faculties and 5 achieved scores of only 42-45 points. The range of the different criteria tested was broad. While the written thesis, the review process, the examination requirements as well as the grading of the thesis were defined in all regulations, the introduction into good clinical practice, knowledge of methodology as well as a check for plagiarism only seem to play minor roles. CONCLUSION: The promotion regulations at German medical faculties show a great variation using the scoring system presented here for the first time. Standardized federal promotion regulations might help to establish a structured transparency as well as a national equality of opportunity.


Subject(s)
Academic Dissertations as Topic , Academic Performance , Education, Medical , Faculty, Medical , Germany , Humans
3.
Chirurg ; 82(9): 789-94, 796, 2011 Sep.
Article in German | MEDLINE | ID: mdl-21904973

ABSTRACT

Nowadays surgical intervention is an essential part of the treatment of idiopathic gynecomastia. Choosing the right method is crucial and is based on the current status in the clinical and histological evaluation. Before finalizing the process of choosing a specific method a prior interdisciplinary evaluation of the patient is necessary to ascertain clear indications for a surgical intervention. Liposuction is one of the methods which have become popular in recent years. The advantages are the possible combination with traditional techniques, such as subcutaneous mastectomy or periareolar mastopexy. The main indication is for gynecomastia stage IIa/b and is justifiable due to the reduction in surgical complications and scarring. Furthermore this technique provides an excellent aesthetical outcome for the patient. A total of 162 patients suffering from gynecomastia stages I-III (according to Simon) were surgically treated between 2000 and 2010 and these cases were retrospectively evaluated. The results showed a decline in the use of a T-shaped incision in combination with subcutaneous mastectomy with periareolar tightening compared to an increase in the use of subcutaneous mastectomy in combination with liposuction. The excised tissue should always be sent for histological examination to make sure no malignant cells were present.


Subject(s)
Gynecomastia/surgery , Age Factors , Cooperative Behavior , Diagnosis, Differential , Esthetics , Estrogens/blood , Gynecomastia/classification , Gynecomastia/etiology , Humans , Interdisciplinary Communication , Lipectomy/methods , Male , Mastectomy, Subcutaneous/methods , Prognosis , Risk Factors , Testosterone/blood
4.
J Plast Reconstr Aesthet Surg ; 64(2): 240-7, 2011 Feb.
Article in English | MEDLINE | ID: mdl-20542747

ABSTRACT

INTRODUCTION: Extravasations of chemotherapeutic drugs may lead to tissue necrosis and subsequent tissue defects, sometimes resulting in loss of function. In the absence of therapy, approximately one-third of vesicant extravasations will result in ulcerations, some of which necessitate plastic microsurgery to cover the soft tissue defects. The aim of this study was to describe the surgical technique itself and to present clinical results of the procedure in a clinical series of chemotherapeutic extravasation injuries that benefitted from a subcutaneous wash-out procedure (SWOP) by minimisation of serious complications. PATIENTS AND METHODS: Over a time period of 3 years, we treated 13 female patients following chemotherapeutic extravasation injury. Nine of the cases involved a high vesicant chemotherapy agent, and four patients involved chemotherapy with low vesicant potential. The therapeutic approach was performed using SWOP exclusively without the application of specific antidotes. RESULTS: The mean time interval between the extravasation injury and the SWOP was 345min (140-795min). In none of the cases was there a tissue breakdown, but there was a steady decrease in the inflammatory reaction of the cutaneous and subcutaneous soft tissues without additional complications over a 3-month follow-up period. CONCLUSION: The results of the study suggest that SWOP is a minimally invasive, safe and effective emergency treatment for chemotherapeutic extravasation injury. Based on the absence of comparative studies with regard to the efficacy of conservative therapy, SWOP should be offered as a therapeutic option for chemotherapeutic extravasations, especially in cases of medical malpractice and also as a defence in case of a legal conflict.


Subject(s)
Antineoplastic Agents/adverse effects , Extravasation of Diagnostic and Therapeutic Materials/surgery , Neoplasms/drug therapy , Subcutaneous Tissue/drug effects , Therapeutic Irrigation , Aged , Aged, 80 and over , Female , Humans , Middle Aged
5.
J Digit Imaging ; 23(4): 475-81, 2010 Aug.
Article in English | MEDLINE | ID: mdl-19513794

ABSTRACT

Reflectance-mode confocal laser scanning microscopy allows in vivo imaging of the human skin. We hypothesized that this high-resolution technique enables observation of dynamic changes of the cutaneous microcirculation. Twenty-two volunteers were randomly divided in two groups. Group 1 was exposed to local heating and group 2 to local cold stress. Confocal microscopy was performed prior t (0) (control), directly t (1) and 5 min t (2) after local temperature changes to evaluate quantitative blood cell flow, capillary loop diameter, and density of dermal capillaries. In group 1, blood flow increased at t (1) (75.82 +/- 2.86/min) and further at t (2) (84.09 +/- 3.39/min) compared to the control (61.09 +/- 3.21/min). The control capillary size was 9.59 +/- 0.25 microm, increased to 11.16 +/- 0.21 microm (t (1)) and 11.57 +/- 0.24 microm (t (2)). The dermal capillary density increased in t (1) (7.26 +/- 0.76/mm(2)) and t (2) (8.16 +/- 0.52/mm(2)), compared to the control (7.04 +/- 0.62/mm(2)). In group 2, blood flow decreased at t (1) (41.73 +/- 2.61/min) and increased at t (2) (83.27 +/- 3.29/min) compared to the control (60.73 +/- 2.90/min). The control capillary size was 9.55 +/- 0.25 microm, decreased at t (1) (7.78 +/- 0.26 microm) and increased at t (2) (11.38 +/- 0.26 microm). Capillary density decreased at t (1) (5.01 +/- 0.49/mm(2)) and increased at t (2) (7.28 +/- 0.53/mm(2)) compared to the control (7.01 +/- 0.52/mm(2)). Confocal microscopy is a sensitive and noninvasive imaging tool for characterizing and quantifying dynamic changes of cutaneous microcirculation on a histomorphological level.


Subject(s)
Image Interpretation, Computer-Assisted , Microcirculation/physiology , Microscopy, Confocal/methods , Skin/blood supply , Skin/ultrastructure , Adult , Capillaries/ultrastructure , Diagnostic Imaging/methods , Female , Humans , Male , Microscopy, Confocal/instrumentation , Reference Values , Regional Blood Flow , Sensitivity and Specificity , Young Adult
7.
Zentralbl Chir ; 131(6): 499-505, 2006 Dec.
Article in German | MEDLINE | ID: mdl-17206570

ABSTRACT

The surgical management of defects in the pelvic region is a great surgical challenge. Primary tumor recurrences have to be addressed and local infections require appropriate therapy such as rigorous debridement and antibiotic therapy. Plastic surgery provides tissue reconstruction by well perfused flaps and also reestablishment of anatomic structures in the ano-genital region. An early reconstruction also reduces the wound complications of adjuvant or post oncologic therapy and reduces the rate of wound healing problems.


Subject(s)
Pelvic Neoplasms/surgery , Surgery, Plastic/methods , Adult , Aged , Combined Modality Therapy , Debridement/methods , Female , Humans , Male , Middle Aged , Patient Care Team , Pelvic Neoplasms/radiotherapy , Postoperative Complications/surgery , Radiation Injuries/surgery , Radiotherapy, Adjuvant , Reoperation , Surgical Flaps
8.
Zentralbl Chir ; 129 Suppl 1: S98-100, 2004 May.
Article in German | MEDLINE | ID: mdl-15168301

ABSTRACT

Open fractures are complex injuries affecting the integrity of bones and adjacent soft tissue. The therapeutic goals in dealing with open fractures should consist of primary osteosynthesis in conjunction with functional reconstruction of soft tissue. In a period over 2 years, 26 patients were treated with extensive trauma in an interdisciplinary approach. These patients suffered from open fractures type 2 and 3. All patients were treated by primary osteosynthesis, and temporary wound closure with V.A.C.-system. Definitive wound closure was achieved by day 31 after injury. In contrast to a review of the pertinent literature we report the successful free tissue transfer in 21 patients during the critical period between 72 hours and several months preceded by the use of V.A.C.-system for the temporary coverage of open wounds.


Subject(s)
Debridement/instrumentation , Emergencies , External Fixators , Fractures, Open/surgery , Multiple Trauma/surgery , Occlusive Dressings , Soft Tissue Injuries/surgery , Suture Techniques/instrumentation , Adult , Equipment Design , Fluorocarbon Polymers , Fracture Fixation, Internal , Humans , Male , Microcomputers , Reoperation/instrumentation , Surgery, Computer-Assisted/instrumentation , Surgical Flaps , Vacuum , Wound Healing/physiology
9.
Pancreas ; 23(3): 266-72, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11590322

ABSTRACT

INTRODUCTION: In prospective clinical trials, octreotide improved quality of life and survival time in patients with pancreatic cancer. AIMS: To analyze whether octreotide modulates the hepatic oxygen radical metabolism and thus might decrease liver metastasis in an animal model of pancreatic cancer. METHODOLOGY: Syrian hamsters received 0.9% NaCl or N-nitrosobis(2-oxopropyl)amine (BOP) for 3 months. Therapy was performed for 12 weeks by 0.9% NaCl or octreotide. Hamsters received a standard diet (3.5% fat) or were fed a high-fat diet (21.4% fat). In the 25th week, the pancreas and liver were examined macroscopically and histologically. The level of lipid peroxidation and activities of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were determined intrahepatically. RESULTS: The number of liver metastases per animal and the size of liver metastases were increased by the high-fat diet, whereas they were decreased by octreotide. Octreotide increased activities of GSH-Px and SOD. The concentration of thiobarbituric acid reactive substances was increased by BOP and a high-fat diet and decreased by octreotide. CONCLUSION: Octreotide decreases the number and size of liver metastases in chemically induced pancreatic cancer in Syrian hamsters. This is accompanied by high hepatic GSH-Px and SOD activity and a low level of lipid peroxidation.


Subject(s)
Lipid Peroxidation/drug effects , Liver Neoplasms/prevention & control , Liver Neoplasms/secondary , Octreotide/therapeutic use , Pancreatic Neoplasms/pathology , Animals , Carcinogens , Cricetinae , Dietary Fats/administration & dosage , Glutathione Peroxidase/metabolism , Liver/drug effects , Liver/metabolism , Liver Neoplasms/pathology , Male , Mesocricetus , Nitrosamines , Octreotide/pharmacology , Pancreas/drug effects , Pancreas/metabolism , Pancreatic Neoplasms/chemically induced , Superoxide Dismutase/metabolism , Thiobarbituric Acid Reactive Substances/analysis
10.
Dig Surg ; 17(1): 29-35, 2000.
Article in English | MEDLINE | ID: mdl-10720829

ABSTRACT

BACKGROUND: Due to a low survival rate even after a R0 resection of cancer of the head of the pancreas, a strict indication for a pancreaticoduodenectomy seems to be sensible. We have therefore analyzed our patients for possible prognosis factors. METHODS: In a retrospective trial the courses of disease of all patients (1981-1996) with resected histologically proven carcinoma of the head of the pancreas were analyzed. The following patient-specific parameters were evaluated and examined in a single or multivariate analysis of prognosis factors: age, gender, tumor size (T status), lymph node involvement (N status), dimension of resection, operation method, time of operation, morbidity, clinic lethality and survival rate. RESULTS: Between 1981 and 1996, 500 patients with ductal adenocarcinoma of the head of the pancreas were treated surgically. The rate of resection increased from 32.1% (1981-1986) to 37.8% (1991-1996) whereas the mortality rate decreased from 13.3 to 7.3%. The 5-year survival rate after resection was 11.8% with a median survival time of 13.8 months. In a multivariate analysis, only small tumors (T1, p < 0.016), the R0 status (p < 0.017) and the resection had a significant influence on the survival rate. CONCLUSION: Prognosis factors in the treatment of pancreatic cancer were tumor size (T1), tumor resection and R0 status.


Subject(s)
Adenocarcinoma/surgery , Pancreatic Neoplasms/surgery , Adenocarcinoma/mortality , Female , Humans , Male , Middle Aged , Multivariate Analysis , Pancreatic Neoplasms/mortality , Pancreaticoduodenectomy/methods , Prognosis , Retrospective Studies , Risk Factors , Survival Rate , Time Factors
11.
Tumour Biol ; 20(6): 294-303, 1999.
Article in English | MEDLINE | ID: mdl-10567875

ABSTRACT

The expression of Fas ligand (FasL) by malignant cells might be a mechanism for tumor immune escape. We investigated FasL expression by LS 174T colon carcinoma cells. Furthermore, the effects of in vitro stimulation with rIL-2, rIFN-gamma and rTNF-alpha were investigated with regard to a possible regulation of the FasL expression by cytokines. FasL expression was detected by flow cytometry and RT-PCR. We observed a spontaneous expression of FasL by LS 174T cells. Incubation with high-dose rTNF-alpha induced an upregulation of FasL of 23%. rIL-2 and rIFN-gamma did not significantly affect FasL expression. To control whether our cytokine stimulation experiments were suitable to prove an upregulation of membrane proteins by tumor cells, we investigated the expression of ICAM-1, N-CAM, CD44s, CD44v6 and CD44v10. These adhesion molecules were spontaneously expressed by LS 174T cells. Only ICAM-1 and CD44v10 were significantly upregulated by rIFN-gamma and rTNF-alpha, respectively. These results could indicate that cytokines, released by tumor-infiltrating leukocytes, may induce the FasL-dependent apoptotic signal by which tumors downregulate an immunological host response.


Subject(s)
Adenocarcinoma/immunology , Alternative Splicing , Colonic Neoplasms/immunology , Cytokines/pharmacology , Gene Expression Regulation, Neoplastic/immunology , Hyaluronan Receptors/genetics , Membrane Glycoproteins/genetics , Antigens, CD/genetics , Fas Ligand Protein , Flow Cytometry , Gene Expression Regulation, Neoplastic/drug effects , Humans , Intercellular Adhesion Molecule-1/genetics , Interferon-gamma/pharmacology , Interleukin-2/pharmacology , Neural Cell Adhesion Molecules/genetics , Recombinant Proteins/pharmacology , Reverse Transcriptase Polymerase Chain Reaction , Tumor Cells, Cultured , Tumor Necrosis Factor-alpha/pharmacology
12.
Article in German | MEDLINE | ID: mdl-9931915

ABSTRACT

We studied the proliferative response of tumor-infiltrating lymphocytes (TIL) from colorectal carcinomas to rIL-2 as well as their cytotoxic activity which was reduced as compared to autologous peripheral blood lymphocytes. We observed TIL to be polyclonal and asked if Fas-ligand-expressing tumor cells are responsible for the elimination of specific T-cells. Therefore we studied the expression of Fas-ligand by LS174T colon carcinoma cells which we showed to be induced by cytokines.


Subject(s)
Colorectal Neoplasms/genetics , Cytokines/physiology , Membrane Glycoproteins/genetics , Colorectal Neoplasms/immunology , Cytotoxicity Tests, Immunologic , Fas Ligand Protein , Gene Expression Regulation, Neoplastic/physiology , Humans , Interleukin-2/physiology , Lymphocytes, Tumor-Infiltrating/immunology , Tumor Cells, Cultured/immunology
13.
Nurs Manage ; 28(1): 39-40, 1997 Jan.
Article in English | MEDLINE | ID: mdl-9004685

ABSTRACT

To gain a perspective on how the public views nurses' legal accountability, a group of jurors was surveyed. This study examines the conditions that RNs face, as well as their liability under these conditions.


Subject(s)
Attitude to Health , Liability, Legal , Nursing Staff/legislation & jurisprudence , Professional Competence , Humans , Malpractice/economics , Malpractice/legislation & jurisprudence , Surveys and Questionnaires , Texas
14.
Clin Genet ; 36(2): 92-9, 1989 Aug.
Article in English | MEDLINE | ID: mdl-2766573

ABSTRACT

Six German families segregating for Myotonia congenita (MC) and eight families from Germany and Great Britain with Paramyotonia congenita (PC) were tested for linkage relationships using 35 serological and biochemical markers. No linkage of MC to any of the markers was evident, but a positive sum of lod scores for PC vs. the HP locus (z = 1.16, theta = 0.16) was found. The results encourage further investigations involving chromosome 16 markers.


Subject(s)
Myotonia Congenita/genetics , Neuromuscular Diseases/genetics , Chromosome Mapping , Female , Genetic Linkage , Genetic Markers/analysis , Humans , Lod Score , Male
15.
Hum Hered ; 38(1): 12-7, 1988.
Article in English | MEDLINE | ID: mdl-3127321

ABSTRACT

Linkage analyses of locus pairs involving IGK, JK, CO, KEL and AHCY resulted in altogether negative lod scores, thereby dwindling the reported linkage relations.


Subject(s)
Blood Group Antigens/genetics , Chromosomes, Human, Pair 17 , Chromosomes, Human, Pair 20 , Chromosomes, Human, Pair 2 , Adenosylhomocysteinase , Female , Genetic Linkage , Humans , Hydrolases/genetics , Immunoglobulin kappa-Chains/genetics , Kell Blood-Group System/genetics , Kidd Blood-Group System/genetics , Male , Probability
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