[Transparent operative training in visceral surgery : Analysis at a German university medical center]. / Transparente operative Weiterbildung in der Viszeralchirurgie : Analyse an einer deutschen Universitätsklinik.

BACKGROUND: Practical operative training in the discipline of visceral surgery is currently under discussion. Aside from surveys, data on this topic in Germany are sparse. The aim of the study was an objective collation of surgical residents' practical training in the operating room in our department. METHODS: All surgical cases from 2015 were prospectively included. Procedures were stratified into resident and non-resident operations and complex cases with sub-steps which could potentially be performed by residents. We analyzed whether an operation or surgical sub-steps were performed by a resident. If this was not achieved, the reasons were analyzed. An anonymous online survey was conducted among employees in the surgery department regarding surgical training. RESULTS: Out of 2896 surgical cases 1141 (39.4 %) were classified as potential resident training operations, which were actually performed by a resident in 743 cases (65.1 %). The survey showed an underestimation of this proportion, where sub-steps were assisted in 30.3 % (n = 265) of 876 potential cases. This proportion significantly increased during the observation period (p < 0.001); however, it was highly overestimated by residents as well as fellows and senior consultants. Often organizational reasons were responsible when resident operations or sub-steps were not performed by a trainee (13.1 % and 30.0 %, respectively). CONCLUSION: The monocentric analysis per se resulted in an improvement in practical surgical training. In the training environment, assisting with sub-steps provides a great potential. Multicenter studies are needed.

Virtual reality laparoscopy: which potential trainee starts with a higher proficiency level?

PURPOSE: Minimally invasive surgery requires technical skills distinct from those used in conventional surgery. The aim of this prospective study was to identify personal characteristics that may predict the attainable proficiency level of first-time virtual reality laparoscopy (VRL) trainees. METHODS: Two hundred and seventy-nine consecutive undergraduate medical students without experience attended a standardized VRL training. Performance data of an abstract and a procedural task were correlated with possible predictive factors providing potential competence in VRL. RESULTS: Median global score requirement status was 86.7% (interquartile range (IQR) 75-93) for the abstract task and 74.4% (IQR 67-88) for the procedural task. Unadjusted analysis showed significant increase in the global score in both tasks for trainees who had a gaming console at home and frequently used it as well as for trainees who felt self-confident to assist in a laparoscopic operation. Multiple logistic regression analysis identified frequency of video gaming (often/frequently vs. rarely/not at all, odds ratio: abstract model 2.1 (95% confidence interval 1.2; 3.6), P = 0.009; virtual reality operation procedure 2.4 (95% confidence interval 1.3; 4.2), P = 0.003) as a predictive factor for VRL performance. CONCLUSION: Frequency of video gaming is associated with quality of first-time VRL performance. Video game experience may be used as trainee selection criteria for tailored concepts of VRL training programs.

Leigh disease with brainstem involvement in complex I deficiency due to assembly factor NDUFAF2 defect.

Mitochondrial NADH: ubiquinone oxidoreductase (complex I) deficiency accounts for most defects in mitochondrial oxidative phosphorylation. Pathogenic mutations have been described in all 7 mitochondrial and 12 of the 38 nuclear encoded subunits as well as in assembly factors by interfering with the building of the mature enzyme complex within the inner mitochondrial membrane. We now describe a male patient with a novel homozygous stop mutation in the NDUFAF2 gene. The boy presented with severe apnoea and nystagmus. MRI showed brainstem lesions without involvement of basal ganglia and thalamus, plasma lactate was normal or close to normal. He died after a fulminate course within 2 months after the first crisis. Neuropathology verified Leigh disease. We give a synopsis with other reported patients. Within the clinical spectrum of Leigh disease, patients with mutations in NDUFAF2 present with a distinct clinical pattern with predominantly brainstem involvement on MRI. The diagnosis should not be missed in spite of the normal lactate and lack of thalamus and basal ganglia changes on brain MRI.

Communists, Social Democrats, and the homosexual movement in the Weimar Republic.

Two cliches of gay historiography concerning the relationship between homosexuals and the political parties of the Weimar Republic are here subjected to critical examination. The notion that the political left of that era was similar in its homophobia to the right-wing and centrist parties is challenged with a number of particulars showing that the goals of the homosexual movement were supported almost exclusively by the left, especially the Communist Party, and that leftist homophobia was an atypical exception. Attention is also devoted to the active involvement of homosexual men in the Nazi movement and the destruction of the Weimar Republic, which casts doubt on the notion that homosexuals were merely passive victims of Nazi homophobia and persecution. The possibility of a special affinity between homosexual men and the Nazi movement is explored using the example of the Nazi leader Ernst Röhm.

[Percutaneous aspiration thromboembolectomy: an additional transluminal angioplasty method]. / Die perkutane Aspirations-Thromboembolektomie: eine weitere transluminale Angioplastiemethode.

Percutaneous aspiration-thromboembolectomy is a simple method for removal of thrombo-embolic material of diverse origin. It is highly effective with small material outlay. As a third angioplasty method it has considerably improved the success rates of balloon dilatation and local lysis treatment with urokinase or streptokinase. The procedure was used alone or in combination on 71 occasions involving 69 limbs in 66 patients. An angiographically demonstrable success was seen in 96% and clinical improvement in 91.6%. Local lysis treatment with streptokinase or urokinase was shortened, less hazardous and, because of removal of non-lysable material, more successful. Embolectomy with the Fogarty catheter remains the method of choice for treating emboli arising from the heart in vessels of the aorto-iliac system. For smaller vessels below the inguinal ligament, however, we consider the new, lesser invasive method to be an alternative to vessel surgery.

[Conservative treatment of esophageal stenoses with balloon catheters]. / Konservative Behandlung von Osophagusstenosen mit Ballonkatheter.

A total of 92 dilatations using the balloon-catheter were carried out in 46 patients with oesophageal strictures. Of these 73 were in 36 patients having a benign primary disease, predominantly stenoses following anastomotic operations or with stenoses resulting from reflux oesophagitis. The average relapse-free period after balloon-catheter dilatation was 6.3 times greater than with bougienage. Balloon-catheter dilatation has proved to be a simple and safe procedure that can be applied inexpensively in an outpatient department. It has now become the method of choice in our hospital for the non-operative treatment of strictures of the oesophagus.

Kertbeny and the nameless love.

The word homosexuality, in its German form Homosexualität, was first used in an anonymous pamphlet published in Germany in 1869. Documentary evidence is given here confirming that the writer Karl Maria Kertbeny was its author. A sketch of Kertbeny's life is given, along with a discussion of the historical background and reasons for his introduction of the new terminology. The role that this and rival terminologies played in the changing attitudes toward homosexuality is traced through the following century in Germany, concluding with the reclaiming of the derogatory word schwul by the modern gay movement.

Esophageal stenosis: treatment with balloon catheters.

We have performed 84 balloon dilatations in 40 patients who had esophageal strictures. Of these patients, 31 who had benign diseases improved, and the procedure proved to be safe, reliable, and easy to perform; in 77% of these patients, only one or two dilatations were necessary. In 10 patients who had previously undergone treatment with bougienage, the symptom-free interval of 9.3 months following balloon dilatation is four times longer than that experienced following bougienage. In patients who have malignant disease, though the symptom-free intervals are short, the procedure can be repeated easily and is accepted well by patients so that palliation can be achieved. Since only readily controlled transverse forces act in the balloon therapy, rupture is virtually eliminated, while the use of a flexible angiographic guidewire to traverse the strictures practically excludes perforation. Balloon dilatation offers distinct advantages compared with bougienage for the treatment of esophageal strictures.

A morphometric study of the dopamine-containing cell groups in the mesencephalon of normals, Parkinson patients, and schizophrenics.

A quantitative study of the melanin-containing dopaminergic neurons of the nigrostriatal system (A 9) and of the mesolimbic system (A 10) was carried out on Nissl-stained serial sections of nine normal brains, six age-matched brains of schizophrenics, five brains of paralysis agitans, and six brains of postencephalitic parkinsonism. By contrast with most laboratory animals the A 10 cell group is not well developed in the human brain. Both in Parkinson's disease with a known hypoactivity of dopamine neurons and in schizophrenia with a postulated hyperfunction of these systems, pathological alterations of the dopamine cell groups can be observed. In paralysis agitans the nigrostriatal and the mesolimbic cell groups exhibit a significant loss of neurons, while the remaining mesolimbic cells appear to be in better condition. In the postencephalitic parkinsonism both systems have almost completely disappeared with a significant loss of nerve and glial cells. In schizophrenia there is a significant decrease in the volume of the nigrostriatal area. Here the mean volume of the glial nuclei is reduced, whereas the mean volume of the nerve cells is diminished in the mesolimbic part.

[Digital subtraction angiography in percutaneous transluminal angioplasty of vessels of the extremities and renal vessels]. / Digitale Subtraktionsangiographie bei perkutaner transluminaler Angioplastie der Extremitäten- und Nierengefässe.

The new imaging method digital subtraction angiography (DSA) permits intravenous arteriography. 1259 patients were thus investigated over one year. The lower extremities comprised 21,4% of assessment areas. 120 investigations in 95 patients were based on an indication of percutaneous transluminal angioplasty (PTA). DSA can be used before and after the PTA. The small extent of invasiveness and the shortening of in-patient admission are particular advantages preoperatively. These advantages, in addition to the possibility of out-patient evaluation, are also true for DSA in comparison to the conventional arteriography. Thus the combination of both methods has been found to be very suitable.