[Cross-sectional analysis of routine treatment for prostate cancer patients: CAPRIS - a healthcare research project of the IQUO]. / Querschnittsanalyse zur Routinebehandlung von Prostatakrebspatienten : CAPRIS - ein Versorgungsforschungsprojekt des IQUO.

BACKGROUND: Different practices for the treatment of prostate cancer patients exist in Germany. OBJECTIVES: The aim of this analysis was to investigate current practice for the treatment of patients with prostate cancer in urological IQUO partner practices (Interest Group for Quality Assurance in the Work of Office-based Uro-oncologists in Germany) dependent on tumor stage and risk factors. The analysis focused on T1/T2 and T3/T4 patients. In addition, applied therapies were analyzed based on risk group classification (CAPRIS, cancer of the prostate identification screening). MATERIALS AND METHODS: This retrospective cross-sectional analysis includes 1000 patients with prostate cancer with at least 12 months of documentation from the OnkoDataMed (ODM) database between February 2008 and May 2012. The 122 IQUO medical practices included were randomly selected; maximally 50 patients per practice were included in the analysis. The database was analyzed in terms of localized T1/T2 tumors and advanced T3/T4 tumors. Risk groups were formed according to parameters of the initial diagnosis including PSA value, tumor stage, and Gleason score. Descriptive statistics were performed to analyze all parameters. RESULTS AND CONCLUSIONS: As expected, PSA is the critical parameter for follow-up and therapy monitoring. Newer therapeutic options have only been initiated to a limited extent. Differentiated risk assessment has not been sufficiently used; however, it does provide a good opportunity for more individualized therapy in the future.

[Vascular ultrasonography]. / Gefäßsonographie.

Vascular ultrasound plays an important role in the visual depiction of arteries, veins, and changes of tissue in lymphatic diseases. In the case of arteries, this ranges from endothelial dysfunction over measuring the increase of intima media thickness to the detection of stenoses, occlusion, or aneurysm. Ultrasound helps to differentiate in functional arterial diseases such as primary and secondary Raynaud's syndrome as well as arterial compression syndromes like entrapment syndrome of different arterial regions or the chronic exceptional compartment syndrome of the lower leg. Ultrasound plays a central role in the diagnosis of rare arterial diseases like large vessel vasculitis, arterial dissection, cystic adventitial degeneration, and the differentiation of vascular malformation especially in children, thus, permitting ultrasound-guided intervention and follow-up controls. In venous thrombosis, sonography is the primary imaging method, while follow-up controls help in the prediction of recurrent venous thrombosis. Ultrasound is a tool to determine the cause and severity of chronic venous insufficiency and allows different therapeutic procedures for the treatment of varicose veins to be visually monitored.

[Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement]. / Ultraschallkriterien zur Graduierung von Stenosen der A. carotis interna - Revision der DEGUM-Kriterien und Transfer in NASCET-Stenosierungsgrade.

Since 1986, German ultrasound criteria for grading carotid stenosis have followed the local diameter reduction percentage consistent with the definition used in the European Carotid Surgery Trial (ECST) definition. To overcome the confusion caused by the coexisting grading method used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), a German interdisciplinary council on carotid artery stenosis has recommended the implementation of the NASCET grading system (distal diameter reduction percentage) as the standard. The multi-parametric German "DEGUM ultrasound criteria" consisting of combined Doppler and imaging criteria have consequently been revised and transferred to the NASCET definition. In addition, a novel differentiation between main (primary) and additional (secondary) criteria has been proposed. When these ultrasound criteria are combined, vascular sonography allows reliable grading of carotid disease.

[Chronic relapsing compartment syndrome]. / Das chronische rezidivierende Kompartmentsyndrom.

Chronic relapsing exertional compartment syndrome is not only found in young athletic subjects. Non-athletic patients can also suffer from exercise dependent pain in the lower limb. The syndrome is defined by increased tissue pressure in between a closed osteo-fibrous space resulting in disturbed microcirculation and finally irreversible neuroischemic damage. Pain increases during running and disappears gradually at rest. The diagnosis is based on the typical symptoms and so far on the pre-, 1 and 5 min post exercise intramuscular pressure measurement. We first describe sonographic criteria induced by increased compartment pressure, especially for the most frequent anterior compartment syndrome with compression of the deep veins, increased movement of arterial wall and finally enddiastolic closure of the anterior tibial artery. Duplex ultrasound also provides pathogenetic factors like popliteal and anterior entrapment, stenosis or hypoplasia of the anterior tibial artery or thrombosis of the deep muscle veins. Many patients are reporting a pain history over years, resulting in complete reduction of their sporting activity. The knowledge about pathogenesis, symptoms, diagnosis and therapy should help shorten the negative impact of the syndrome on their quality of life.

[DRG-based cost analysis of inpatient conservative treatment of stage III/IV peripheral arterial occlusive disease]. / DRG-basierte Kostenanalyse zur stationären konservativen Behandlung der PAVK Stadium III/IV.

UNLABELLED: DRG-based cost analysis of inpatient conservative treatment of PAD stage III/IV BACKGROUND: In a prospective study carried out by the German Society of Angiology and the DRG Competence Center, Munich, the question was investigated whether the costs of conservative treatment of patients with PAOD stage III/IV (DRG F65) are adequately represented within the current G-DRG system. METHODS UND PATIENTS: Between September 1 and December 16, 2002, a total of 704 patients with DRG F65 (peripheral vascular diseases) were evaluated at 8 angiologic centers in Germany. Apart from the length of hospital stay, the total costs (cost equivalents) were calculated using a method developed by the DRG Research Group at the University of Münster. Moreover, the study population was compared with a German calculation sample for the DRGs F65A/B, as published by InEK. RESULTS: As it turned out, conservatively treated patients with PAOD stage III or IV (DRGs F65A/B) cause significantly (p < 0.001) higher costs and have significantly (p < 0.001) greater lengths of hospital stay than patients who were also assigned to DRG F65 because of other vascular diseases. At the same time it became clear that angiologic centers treat twice as many patients with critical limb ischemia in comparison with the German average. The reimbursement hitherto estimated by InEK covers not even half the cost actually produced by conservative treatment of PAD stage III/IV. CONCLUSION: To ensure a performance-related reimbursement, a new basis DRG for patients with PAD stage III/IV has to be created, as has ben proposed by the German Society of Angiology. Otherwise, adequate conservative therapy in accordance with existing guidelines, of patients who cannot be treated surgically or interventionally will not be possible any more in the future.

[Ultrasound diagnostic techniques in dermatologic angiology and phlebology]. / Ultraschalldiagnostik in der angiologischen, phlebologischen Dermatologie.

The diagnostic uses of high-resolution ultrasonography (7.5-20 MHZ) have dramatically advanced in the past 20 years. We present representative examples of ultrasound diagnosis, based on our experience with over 15,000 examinations. For example, peripheral arterial disease was identified in 30% of older patients with venous diseases, while peripheral emboli and vasculitis can lead to widespread skin disease. Ultrasonographic diagnosis is required for appropriate interdisciplinary treatment. In addition, regular evaluation of the supra-aortic vessels and coronary arteries as well as arteries and veins of the limbs is needed in some forms of vasculitis. The causes of peripheral venous disease can be subdivided into four groups based on sonographic findings: Primary or secondary epi- and/or subfascial venous insufficiency, thrombotic venous occlusion, venous compression syndrome and arteriovenous-lymphatic malformations. The diagnosis and therapeutic approach to lymphedema and soft tissue diseases, with or without lymphadenopathy, requires careful sonographic evaluation. Ultrasonography is an essential part of dermatologic oncology, both for planning primary therapy and for follow-up. A sound command of ultrasonography is today an essential aspect of dermatologic diagnosis and therapy.

[Guidelines for the diagnostics of deep pelvic/lower limb vein thrombosis]. / Leitlinien zur Diagnostik der tiefen Becken-/Beinvenenthrombose - Empfehlungen des Arbeitskreises Vaskulärer Ultraschall in der DEGUM.

As a result of availability and failing invasiveness the technique of compression sonography led to a change in the indication of thrombosis examination - from the proof of thrombosis shown by phlebography to exclusion of thrombosis by ultrasound. Compression sonography showed the same sensitivity and specificity as phlebography for proximal limb thrombosis and reaches high safety due to actual treatment studies in the diagnosis of deep vein thrombosis. For the distal limb the compression sonography has provided > 90 % specificity, with an examinator dependent sensitivity of 50 to 95 %, and hence examination of the distal limb must be recommended. These guidelines for the diagnosis of deep vein thrombosis are recommendations by the Section of Vascular Ultrasound of DEGUM for examination technique and documentation. It also contains an algorithm of diagnosis for thrombosis as a result of the actual treatment studies.

Prospective study of 36 patients with 46 popliteal artery aneurysms with non-surgical treatment.

BACKGROUND: There is a lack of prospective studies with popliteal aneurysms (PAA) < 2 cm and the very few information about the natural cause of the disease. PATIENTS AND METHODS: Between 1995 and 2000 46 patients having 65 popliteal artery aneurysms have been examined. The mean diameter was 1.9 cm (0.8-4 cm). In 41% of the cases PAA were bilateral, additional extrapopliteal aneurysms were found in 37%. The PAA was occluded in 8 patients at the initial examination (mean diameter 2.4 cm: 1.4-4 cm). One of these patients had to be amputated (long-term diabetes, dialysis and severe generalized peripheral arteriosclerosis). Since no information could be obtained from two patients, it was possible to prospectively monitor 36 patients with 46 PAA (30 m, 6 f) over a period of 2.5 years. 19 patients were treated with platelet inhibitors, 16 with coumarin and one refused any thromboembolic prophylaxis. The patients were examined every year by telephone interview and duplexsonography. RESULTS: During the monitoring period there occurred two complete occlusions and one distal arterial progression, while 2 patients died, but no amputation. The total complication rate was 6.5% with a higher incidence in PAA > 2 cm of diameter (14.2 vs. 3.1%). All complications were found in PAA with mural thromboses. Coumarin seems to be superior platelet aggregation inhibitors with a complication rate of 0% vs. 14.3%. The mean increase in diameter during follow-up was dependent on PAA size, 1.5 mm/year for PAA > 2 cm vs. 0.7 mm/year for PAA < 2 cm. CONCLUSION: This prospective study emphasises the necessity of a prophylactical surgery in patients with an aneurysm diameter > 2 cm. In view of the low rate of complications of the natural course of PAA (6.5% of all PAA or 14.2% for PAA > 2 cm/2.5 years), the bypass surgery should be performed by an experienced vascular department. Patients with PAA < 2 cm or patients with contraindication for peripheral bypass should receive anticoagulation.

[Heterophile antibodies, lack of communication and the diagnostic dilemma]. / Heterophile Antikörper, fehlende Kommunikation und das diagnostische Dilemma.

BACKGROUND: Heterophilic antibodies represent a great danger to clinical care by producing false-positive values for certain markers. Too large confidence in specificity of laboratory markers together with lack of communication between clinicians and clinical chemists may lead to unnecessary interventional diagnostic and therapeutic procedures. The prevalence of heterophilic antibodies is probably much higher than assumed up till now and several markers can be affected. AIM: In this review for clinicians, we explain formation of heterophilic antibodies, mechanisms of interference and present clinical data about affected markers and "side effects" from the literature. Furthermore we discuss possible alternatives and measures against this phenomenon. We consider broad awareness of this problem among clinicians the most important action to avoid further harm to patients.

[Cystic adventitial degeneration. An important differential diagnosis in intermittent claudication]. / Zystische Adventitiadegeneration. Eine wichtige Differentialdiagnose bei der Claudicatio intermittens.

The cystic adventitial degeneration is a rare disease, but an important differential diagnosis in patients with intermittent claudication. The amount of fluid in the cysts may vary and cause an intermittent compression of the artery. This explains the frequently intermittent symptomatology, leading to a critical ischemia if there is a complete obstruction of the artery. The histologic findings indicate that adventitial cysts are true ganglions. The intramural, uni- or multilocular cysts contain a gelatinous, muciform fluid. The diagnosis of a cystic adventitial degeneration should be considered in cases of isolated stenosis or occlusion of the popliteal artery. Realtime ultrasound helps to establish the diagnosis. The standard treatment has been surgical and has consisted a resectional and non-resectional technique. The ultrasound-directed percutaneous aspiration as a less invasive technique seems to be an effective treatment for this condition. The course, diagnostic and therapy of four patients is demonstrated.