[Cost-benefit calculation of kyphoplasty in osteoporotic spine fractures]. / Prozesskostenanalyse von Kyphoplastien bei osteoporotischen Sinterungsfrakturen.

BACKGROUND: Kyphoplasty is an established procedure for the treatment of vertebral fractures secondary to osteoporosis. It leads to correction of kyphosis as well as significant pain reduction. However, the material costs of 53% are very expensive. Is kyphoplasty cost effective? METHOD: We performed a cost analysis from patient presentation until discharge. Personnel costs as well as time expenditure were measured exactly, and total costs per case were calculated. RESULTS: In 2009, 118 patients underwent single level kyphoplasty. The average hospital stay was 6 days. The total reimbursement per patient was 6189.77 EUR. Material expenses were 3134.99 EUR (53%) and personnel 1552.86 EUR (26%). Personnel costs were allotted according to physician (8 h 52 min = 551.93 EUR), nursing (20 h 9 min = 629.69 EUR), and medical technician (11 h 15 min = 371.24 EUR) costs. The total cost per patient was 5868.23 EUR. DRG reimbursement was 6189.77 €, yielding an average revenue of 321.54 EUR.

[Operative treatment of instable osteoporotic spine fractures. A good guide in coding of diagnosis]. / Operative Versorgung instabiler osteoporotischer Wirbelsäulenfrakturen. Eine wichtige Kodierhilfe.

The combination of kyphoplasty and fixateur interne is an essential therapy with osteoporotic unstable fractures. Material costs of 5500 Euro are not sufficiently covered by returns through DRG I09. Thus operations are often performed in 2 stages, an initial one and a second 30 days later. This means more strain for the patient and partly also loss of correction. Therefore in 2008 we requested the InEK that codes for one-and two-segmental implantation of material in a vertebrae with preceding restoration of vertebral height (5-839.a0 and 5-839.a1) combined with a percutaneous dorsal operation with a screw-rod system in the future would be represented by I19B in G-DRG system with returns of 11,110,40 Euro. Prerequirement is coding of kyphoplastiy as main procedure and percutaneous implantation of a fixateur with procedure 5-835.5. Some procedures in orthopedic surgery implying technical improvements and rising implant costs are not sufficiently rewarded. Thus is make sense to inform InEK by corresponding proposals.

Residual kidney function after donor nephrectomy. Assessment by 99mTc-MAG3-clearance.

AIM: We evaluated the long-term residual renal function after donor nephrectomy using 99mTc-mercaptoacetyltriglycin (MAG3)-clearance. DONORS, METHODS: Altogether 49 kidney donors were examined using 99mTc-MAG3-clearance after nephrectomy for donation to a relative (m:f = 11:38; age 55+/-27 years). The donors were examined 16+/-8 years postoperatively (1.5-26 years). 42 donors (86%) showed normal creatinine values, whereas the other seven (14%) exhibited slightly elevated levels. 20 donors were examined pre- and postoperatively and compared intraindividually. The kidney function was compared to the age adapted normal values of healthy persons with two kidneys (67-133% of age related mean). RESULTS: After nephrectomy all donors showed a normal perfusion, good secretion, merely physiological intrarenal transit and a normal elimination from the kidneys. The 99mTc-MAG3-clearance was 69+/-15% of the normal mean value of healthy carriers of two kidneys regardless of the gender. 20 donors with a preoperative examination showed a significantly reduced total renal function from 84+/-15% of the mean normal value preoperatively to 60+/-15% postoperatively (p <0.0005). 15 donors of this group exhibited a significant functional increase of the residual kidney from 40% initially to 60% after nephrectomy (p = 0.003). No correlation was found between the initial-99mTc-MAG3-clearance measured prior to nephrectomy and the clearance levels after nephrectomy. Also, no correlation between the preoperative 99mTc-MAG3-clearance and the postoperative serum creatinine values could be observed. Altogether, 22% of the donors (11/49) developed arterial hypertension 10+/-8 years after donation (1-23 years). This corresponds to the normal age prevalence of hypertension in the carriers of two kidneys. Three donors suffered from arterial hypertension prior to the operation. CONCLUSION: Kidney donors with normal or slightly elevated creatinine values postoperatively show a 99mTc-MAG3-clearance value of 69% of the mean value of healthy carriers of two kidneys. This may serve as a reference value for healthy carriers of one kidney. In our study we demonstrated a good compensation of the contralateral kidney via renal scintigraphy by means of 99mTc-MAG3-clearance.

Paraneoplastic syndromes: detection of malignant tumors using [(18)F]FDG-PET.

AIM: Paraneoplastic syndromes (PS) comprise a variety of clinical symptoms and diseases associated with underlying malignancy. Differentiation towards benign autoimmune diseases is necessary due to different therapeutic options. This diagnostic challenge includes cost- and time-consuming methods and is not successful in many cases. The aim of this study was the evaluation of [(18)F]fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) for detecting or ruling out malignancy in these patients. METHODS: In this retrospective work-up a total of 30 patients with suspected PS (m:f = 17:13, mean age 55, range 22-76 years) were examined with [(18)F]FDG-PET between 1996 and 2001. Diagnoses were erythrodermia, cerebellar degeneration, dermatomyositis, polyneuropathia and others. PET scans were compared to histopathological (n=14), radiological and follow up data (mean follow up 3.6 years, range 1-6 years). RESULTS: In 7 out of 30 patients (23%) an underlying malignancy was detected. Six out of 7 malignant neoplasms showed a distinctly increased glucose consumption. One benign neoplasm caused increased tracer uptake, another PET positive patient refused biopsy and showed no growth of a malignant tumour during clinical follow up of 28 months. The remaining 21 patients without suspicious glucose consumption did not demonstrate a malignancy in other diagnostic modalities or during subsequent clinical follow-up. CONCLUSION: [(18)F]FDG-PET seems to be a useful tool in the diagnostic work-up of patients with suspected paraneoplastic syndrome.

Monitoring the efficacy of iodine-131-MIBG therapy using fluorine-18-FDG-PET.

BACKGROUND: The purpose of this study was to assess the potential of fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG-PET) for monitoring the efficacy of iodine-131 metaiodobenzylguanidine (131I-MIBG) therapy in neuroendocrine tumours. METHODS: A total of seven 131I-MIBG therapies with 3.7 to 10.2 GBq were carried out in three patients suffering respectively from a phaeochromocytoma, a paraganglioma and a metastatic neuroendocrine tumour of an unknown primary. The post-therapeutic whole-body scintigrams were compared with the results of six 18F-FDG-PET studies performed at the time of the therapies. One patient received three PET scans prior to each one of the MIBG therapies, and one patient was studied twice. RESULTS: 18F-FDG uptake in tumour sites seemed to correlate well with tumour differentiation, showing no uptake in one patient with a highly differentiated neuroendocrine tumour, and moderate-to-intense uptake in the two other patients with metastatic disease. Those tumour sites that had a simultaneous positive uptake in both the MIBG scintigram and the PET scan showed response to therapy as a continuous reduction in MIBG uptake over time. They also showed a qualitative decrease in FDG accumulation during the follow-up. This was associated with a decrease in the mean and maximum standard uptake values of more than 50 % in some metastases, while the X-ray computed tomography showed no decrease in tumour volume. Two patients revealed additional metastases that were unknown on the basis of prior diagnostic or therapeutic PET scans and radiological follow-up. CONCLUSIONS: It may be concluded from these cases that 18F-FDG-PET is a valuable tool for an initial metabolic staging of neuroendocrine tumours prior to 131I-MIBG therapy, as it can reveal tumour sites beyond the reach of radioisotope therapy. It may also be of importance in assessing therapeutic potential in those tumour sites that do show positive MIBG uptake.

[Sentinel lymph node excision. Treatment method of the N0 neck in patients with oral and oropharyngeal carcinoma]. / Sentinel-Lymphknotenexstirpation. Behandlungsmethode des N0-Halses bei Patienten mit oralen und oropharyngealen Karzinomen.

BACKGROUND: The clinically non-metastatic neck is an unsolved problem in the treatment of oral and oropharyngeal squamous cell carcinomas. A rational procedure is looked for which is neither exaggerated nor neglects the needed safety. PATIENTS AND METHODS: 15 patients with primary squamous cell carcinomas of the oral cavity and the oropharynx, staging T1-4N0M0 were examined. After peritumoral intramucodermal injection of tc99m-labeled colloidal albumin the lymphoscintigraphy using gamma-camera imaging prior and hand-held gamma-probe during operation were used for identification of the nodes. Selective sentinel lymph node exstirpation was followed by radical tumor resection. RESULTS: In all cases (n = 41) lymph nodes could be detected, 40 of them were sentinel lymph nodes, distributed to all neck levels, in 5 cases bilateral drainage. 92.5% of sentinel lymph nodes could be actually removed. All but 1 (97.5%) were true-negative. In the positive case modified radical neck dissection harvested another affected node. CONCLUSIONS: Methodically seen, the sentinel procedure works well and might lead to reduced post-surgical morbidity in about 50% of patients with oral cancer. To date, the procedure should be confined to studies with special requirements to diagnostics and subsequent treatment.

Methane in ocean waters: Concentration and carbon isotope variability at East Pacific Rise and in the Arabian Sea.

Methane concentrations and stable carbon isotope ratios of water samples from the East Pacific Rise (EPR) at 21°S and the Arabian Sea (24°N, 65°E) have been determined. EPR surface water is in equilibrium (ca. 50 nl/L and -50‰<δ(13)CH4<-46‰) with atmospheric methane. Deep "background" water has the signature of the remaining fraction of atmospheric methane partially oxidized in the water column by bacteria. Bottom near, hydrothermally influenced vent methane (>100nl/L and -30‰<δ(13)CH4<-22‰) is detectable only close to the seep site. There is no input of hydrothermal methane into the atmosphere. EPR water is considered to be rather a sink than a source of atmospheric methane. Surface waters of the Arabian Sea are enriched in methane relative to the atmosphere (source for atmospheric methane). Carbon isotope ratios point to a bacterial origin of methane (δ(13)CH4<-55‰) that is generated in the surface waters. Concentration changes and variations of carbon isotope ratios also suggest that methane seeping from the sea floor sediments of the Arabian Sea is oxidized by bacterial activity and does not reach the atmosphere.

[Do doctors understand their patients?]. / Verstehen die Arzte ihre Patienten?

The extent to which doctors understand the complaints of their patients has been investigated by comparing patient complaints with the observation and assessment of these by the doctor. This involved questioning 259 patients and 30 doctor. From the 259 patients, three groups (a total of 57 patients) were formed, having common main symptomatologies. The extent to which the complaints of each of these patients corresponded with the clinical assessment was evaluated. The results revealed a close agreement between patient complaints and clinical assessment, not only for those patients with organo-medically diffuse symptoms (feeling of illness, tiredness, nervousness) but also for those with organ-medically clearly defined, localised (cardiac and thoracic pain) and mixed diffuse-localised complaints.

Physician compliance in the management of hypertensive patients.

The aim of the present study was to investigate prospectively the value of different forms of intervention in the quality of diagnosis and treatment of essential hypertension in an Outpatient Clinic. In a first phase (phase 0) 115 patients with a blood pressure of greater than or equal to 140/greater than or equal to 90 mmHg at the initial visit in our Outpatient Clinic were registered. After a 3 months period the charts of these patients were reviewed. This review revealed that 61 (53%) of these patients were not followed by the treating physicians and that half of the patients who had an elevated blood pressure at the second visit and thereby an indication for therapy were not treated. In a first intervention the results of this investigation were discussed with the treating physicians and the necessity for an improved management of patients with essential hypertension was pointed out. After this intervention 116 patients with a blood pressure greater than or equal to 140/greater than or equal to 90 mmHg were again followed for 3 months without knowledge of the treating physicians (phase 1). The chart review of these patients revealed no improvement in the management of the patients, 57% of these 116 patients were again not followed by the treating physicians and 48% of the patients identified by a follow-up visit as hypertensives were not treated. Thereafter a second intervention took place which included a nurse who scheduled 295 patients with an initial blood pressure of greater than or equal to 140/greater than or equal to 90 mmHg automatically for a follow-up visit.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intestinal parasitosis in irritable colon]. / Darmparasitose bei "Colon irritabile".

Parasitic infestation of the intestinal tract was investigated in a prospective study of 177 patients from southern Europe and Turkey. In a group of patients (n = 127) who attended the Medical Outpatients Department because of abdominal pain, pathogenic parasites were isolated from a single stool sample in 69 (54%). 19 patients had 2 or more parasites. 22 out of 25 patients reviewed after treatment were free of parasites, and 17 were symptom-free. Abdominal pain persisted unchanged in 8 patients. In a second group of patients (n = 50) with extraabdominal symptoms, 11 (22%) had pathogenic parasites in stool. Multiple infestation did not occur in this group. The results show that in this population group stool examination for parasites should be carried out routinely in the investigation of abdominal pain. The high prevalence rate possibly justifies a search for parasites even where there are no intestinal symptoms.