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In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.

A 37-year-old man complained about a lack of strength, an unproductive cough and myalgia predominantly thigh-focused with subfebrile temperatures for days.Laboratory investigations indicated rhabdomyolysis with acute kidney injury (AKI). Drug misuse was denied. Exertion and trauma could be excluded as well as rheumatologic or other infectious causes often responsible for rhabdomyolysis. PCR of a nasopharyngeal swab was positive for influenza A virus subtype H1N1.Because of a progressive course of AKI haemodialysis was initiated. Levels of creatine kinase declined and urinary excretion rised. Hypocalcaemia due to secondary hyperparathyreoidism was substituted. During hospitalisation two seizures appeared. After performing a magnetic resonance imaging (MRI) the seizures could be attributed to a posterior reversible encephalopathy syndrome (PRES) secondary to influenza infection. A medication with valproic acid was initiated.Extrapulmonary manifestations of an influenza A (H1N1) virus infection are rare but have to be considered after exclusion of differential diagnosis in younger patients in particular. In addition to a therapy with neuraminidase inhibitors a symptomatic treatment is of paramount significance.

Fragestellung: Wellenreiten ist die Urform des Surfens und somit Vorläufer von Trendsportarten wie Windsurfen, Wakeboarden und Snowboarden. Die Beschreibung der ersten hawaiianischen Wellenreiter war ca. 400 Jahre vor Christus, jedoch erlangte Surfen erst Anfang des 20. Jahrhunderts weltweite Aufmerksamkeit.[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2012)

Pompe disease is a very rare disorder of glycogen metabolism. Due to a deficiency of the enzyme glucosidase glycogen accumulates inside the lysosomes. The clinical picture varies widely as a consequence of varying participation of skeletal and heart muscle. In adults respiratory insufficiency can occur which must be taken into consideration during anesthesiology procedures for affected patients. This case report describes a 60-year-old patient scheduled for punch biopsy of the prostate.

We report on an 80-year-old female patient with osteoporotic collapse of the L1 vertebra who developed absolute stenosis of the spinal canal. During preoperative vertebra augmentation with PMMA (polymethylmethacrylate), pulmonary embolism developed due to perivertebral leakage of acrylic cement. According to the literature, leakage of PMMA during (percutaneous) vertebroplasty is a more frequent complication than assumed so far. In view of the favorable prognosis of osteoporotic vertebral compression fractures with noninvasive management, we emphasize the need for clear and individual indications and adequate technical settings.

Prospective, multicenter study addressing late results after operative treatment of acute thoracolumbar spinal injuries.682 patients (T10-L2) were included and 372 (80%) were postoperatively followed for 2 1/4 years (4-61 months).Comparing the initially included patients (n = 682) with the study group (n = 372), no differences were observed and results were assumed to be representative. A C-type lesion or polytrauma significantly prolonged the hospital stay. The method of operative treatment did not affect the length of the rehabilitation period. Neurological improvement was observed in 3 out of 7 patients with complete, and in 44 out of 64 (69%) with incomplete lesion. The operative method did not affect the improvement rate. The physical capacity significantly decreased. After a mean of 1/2 year of disability only 71% returned to work. 48% returned to their preoperative physical level. The mean Hannover Spine Score was 68 points (preoperative 94, p0.001), indicating permanent impairment of function. The angle-stable internal fixator was superior in restoration of spinal alignment and best radiological results were noted after combined stabilization. Posterior stabilization lead to high re-kyphosing. No correlations between radiologic and clinical parameters were observed.All treatment methods under study were appropriate for achieving comparable clinical and functional outcome. The internal fixator is superior in restoration of the spinal alignment. Best radiological outcome is achieved by combined stabilization. Merely by direct reconstruction of the anterior column the postoperative re-kyphosing is prevented and a gain in segmental angle is achieved.

To reduce patient doses caused by selected interventional and angiographic procedures using the digital C-arm unit "Multiskop".After a patient study done previously, physical measurements with test phantoms were carried out, and physical-technical parameters such as distance between focus and image intensifier, additional filtration, and radiation dose per image were optimised. Then, the dose-area product (DAP) and the fluoroscopic time were measured for 130 percutaneous transluminal angioplasties (PTA), 40 PTA with stent implantation, 61 embolisations, and 302 digital subtraction angiographies (DSA). In the case of 16 PTA, 9 embolisations, and 38 DSA the number of radiographs was determined, and the DAP was divided into two parts, fluoroscopy and radiography. The measuring values were compared with data of the patient study done previously.The median values of the DAP and the fluoroscopic time amounted to 25 Gy cm2 and 9.7 min for PTA, 97 Gy cm2 and 8.5 min for PTA with stent implantation, 88 Gy cm2 and 17.2 min for embolisation as well as 54 Gy cm2 and 2.8 min for DSA. For the relation between DAP caused by fluoroscopy and radiography, and the number of radiographs, median values of 0.76 and 63 for PTA, 0.81 and 123 for embolisation as well as 1.85 and 134 for DSA were determined. In comparison to the patient study done previously the median values of the DAP were reduced by 31% for PTA, 26% for PTA with stent implantation, 55% for embolisation, and 38% for DSA.The comparison between the patient studies done previously and recently indicates the great potential of dose reduction for interventional and angiographic procedures. Although the X-ray equipment is ten years old the patient dose can be reduced by organizational and physical-technical modifications to such an extent that preliminary national reference dose values will not be exceeded. For further significant dose reductions while maintaining adequate image quality it will be necessary to purchase a modern X-ray equipment with pulsed fluoroscopy and automatic filter selection.

Undislocated odontoid fractures may lead on the basis of conventional x-rays only to a wrong conclusion with regard to biomechanical aspect of stability. In this aspect the classification based on Anderson and D'Alonzo takes a high risk to misunderstand the fracture stability and can results in a secondary fracture dislocation. Therefore it is important to make the decision about operative versus nonoperative treatment on the base of the trauma mechanism. In this case report we elucidate this problem and the higher risk of anterior approach for correction. Furthermore a better classification of dens fractures will be recommended.

The diagnostic value of MRI in acute and chronic posttraumatic wrist pain will be demonstrated in several clinical cases. The integration of MRI in a diagnostic algorithm is discussed. The indication of MRI is given for suspected complex ligamentous lesions, occult fractures and soft tissue pathologies, in particular with disconcordant clinical and radiological signs. Pathology orientated study protocols are presented. Preoperatively, MRI will be helpful in planning definitive surgical treatment.

To determine and judge patient doses caused by selected interventional and angiographic procedures using the "Multiskip" digital C-arm unit.The dose-area product and the fluoroscopic time were measured for 71 percutaneous transluminal angioplasties (PTA), 33 PTA with stent implantation, and 37 embolizations; in addition, they were also measured for 285 digital subtraction angiographies (DSA). In the case of 13 PTA, 10 embolizations, and 33 DSA the number of radiographs was determined, and the dose-area product was divided into two parts, fluoroscopy and radiography, applying a computer programme.The median values of the dose-area product and the fluoroscopic time amounted to 36 Gy cm2 and 11.5 min for PTA, 131 Gy cm2 and 14.4 min for PTA with stent implantation, 197 Gy cm2 and 24.5 min for embolisation as well as 87 Gy cm2 and 3.7 min for DSA. For the relation between dose-area products caused by fluoroscopy and radiography and the number of radiographs, median values of 0.67 and 70 for PTA, 0.58 and 153 for embolisation as well as 1.35 and 135 for DSA were determined.To reduce the relatively high patient doses the modification of the C-arm unit is aspired to realize pulsed fluoroscopy and automatic filter selection. Also experimental investigations will be done related to additional filtration and reduction of the image intensifier input dose rate and dose per frame, respectively. Then, the effect of dose reduction caused by these measures will be confirmed in a comparable patient study.

The records of 24 patients with severe intractable non-traumatic epistaxis were reviewed to evaluate the efficacy of embolism therapy.The histories of 17 patients with idiopathic epistaxis, 6 patients with Osler-Rendu-Weber disease and 1 patient with a high-flow angioma were analyzed. All patients were treated by means of percutaneous embolization of the maxillary artery and its branches.In 5/17 patients with idiopathic epistaxis repeat embolization was necessary in 5 cases, while permanent hemostasis was achieved in 16/17 patients with embolism alone. Five of the 6 patients with Osler-Rendu-Weber disease labelled stage III before treatment were managed successfully with repeated embolizations, while all cases were reduced to stage I disease. The high-flow angioma was successfully ablated after embolization combined with direct injection of thrombosing material and laser resection.

The use of Anderson/D'Alonso or Aebi/Nazarian classification of dens fractures is the basis for exact selection of therapy. The ventral screw-fixation of Anderson type-II-Fracture is today the common standard of treatment, especially in the elderly. The stabilisation of the fracture with maintenance of atlanto-axial rotation-function, the minimal rate of pseudarthrosis compared with conservative therapy, the minimal operation trauma and the immediate mobilisation with high patient comfort are decisive benefits of this method. Reposition of the fracture, visualisation in two planes and the use of adequate instruments are important conditions to get optimal operation results. In-vitro-experiments have shown that there is no difference of stability in one- or two-screw-technique. Flexion injuries with oblique fracture plane, insufficient stability after anterior screw fixation and typ-III-fractures are indications for dorsal, atlanto-axial screw fixation. The conservative treatment(HALO-vest) is recommended only in otherwise inoperable patients.

This animal study was designed to assess the tolerance of the normal bile duct to a single intraluminal high-dose-rate afterloading irradiation. This information is essential for treatment recommendations in irradiation therapy of malignant bile duct stenoses. In 16 pigs bile duct catheters were inserted surgically. Over these devices single intraductal doses of 7.5 Gy and 15 Gy were applied using an iridium-192 source. After a period of two to three months the bile ducts and the surrounding structures were investigated by means of cholangiography, angiography, and macropathological and histological investigations. A single intraductal dose of 7.5 Gy leads to a slightly scarred shrinkage of the bile duct with sclerosis and obliteration of the capillary vessels. Vasculitis and necrosis of the bile duct wall are still evident three months after irradiation. A single dose of 15 Gy leads to severe lesions with widespread necroses of the bile duct wall which tend to bleed, and result in a high degree of shrinkage of the bile duct. The radiation damage is most prevalent near the papilla and in the narrow segments near the liver. Single intraluminal high-dose-rate afterloading doses of 7.5 and 15 Gy cause significant lesions and complications at the bile ducts. As the intact bile duct is the Achilles heel of intraductal therapy, considerably lower single doses are recommended for a fractioned treatment.

The aim of the study was to determine the proportion of high-risk patients who received appropriate antianginal therapy in the prodromal phase prior to a myocardial infarction, as an indicator of medical care seeking behavior. To this end, 606 male infarct patients aged 29-65 years were retrospectively interviewed 17-21 days after acute myocardial infarct. It was found that 77% of all patients (465/606) suffered from anginal pain, but only 32% of the patients with angina pectoris were receiving antianginal therapy in the prodromal period before acute myocardial infarction. Patients not taking medication were significantly younger than those with antianginal medication; they were more often smokers; they were less often suffering from high blood pressure; they expressed more pronounced nonacceptance of the risk; their history of anginal pain was significantly shorter; and they belonged more often to the patient group with a first myocardial infarction. In stepwise logistic regression analysis, high blood pressure, older age and exhaustion were found to be associated with medical treatment before infarction in the patient group with first myocardial infarction. In patients with recurrent infarction, continued smoking and denial of the risk remained predictive of nonmedication.

The long-term tolerance to and effectiveness of heparin-induced extracorporeal LDL precipitation (HELP) in combination with lipid reducing drugs and diet was tested in six patient (5 males, 1 female; mean age 48 +/- 4 years). Follow-up period was over 50 months, in one patient over 24 months, while one man had a sudden cardiac death 57 weeks after starting treatment. The study was divided into three phases. In phase I (24 months) treatment consisted of HELP and conventional lipid-reducing drugs; in phase II (12 months) of lovastatin (80 mg daily) and cholestyramine (12-24 g daily); and phase III (14 months) of HELP, lovastatin and cholestyramine. In phase I it was possible to lower the pre-treatment level of LDL-cholesterol from 306 +/- 18 mg/dl to 173 +/- 13 mg/dl (43.5%). A similar effect (from 307 +/- 21 mg/dl to 155 +/- 17 mg/dl [-49.5%]) was obtained in phase II. The resumption of HELP reduced the pre-treatment LDL concentration to 136 +/- 9 mg/dl (-55.7%). The various treatment regimens were well tolerated. Biochemical data remained unchanged except for iron loss requiring substitution. Thus combined HELP, lovastatin and ion exchange offer for the first time an effective and reliable means in familial hypercholesterolaemia of clearly reducing long-term the mean LDL cholesterol level below the atherosclerosis threshold of 120 mg/dl.

369 (63%) of 586 consecutive patients with confirmed myocardial infarction were admitted to hospital within 6 h of symptom onset. Patients' arrival to hospital followed a characteristic circadian distribution with a marked morning increase between 0600 and 1200 hours, and a corresponding decrease in the late night hours. There were no differences in the occurrence of late potentials and in ECG data between early and late arrival group. The early group (less than 5.9 h) was, however, characterized by significantly higher cardiac enzyme levels than the late group (greater than 6.0 h); they also experienced more arrhythmic events in the acute phase (16.0% vs. 9.7%; p less than 0.032). Catecholamines were significantly more often necessary (26.4% vs. 10.3%; p less than 0.0001). Six-month prognosis after AMI was markedly worse. The time between symptom onset and hospital arrival was not affected by age and risk factors. In univariate analysis, pain history and recurrent infarction also had no influence on delay of admission to hospital. The time interval was, however, significantly shorter when the acute event occurred during the night (18.4% vs. 8.3%; p less than 0.0001). Absence of prodromi in the prehospital phase (18.5% vs. 12.0%; p less than 0.04) and a higher socio-economic level (68.3% vs. 61.0%; p less than 0.077) also shortened the admission time, whereas a hyperactive behavioral pattern prolonged the delay time (21.1% vs. 28.9%; p less than 0.05).

The risk profile and the macro-vascular complications of patients with type II diabetes mellitus (NIDDM) was investigated in general practice patients for the first time in the FRG. It was the aim of the study to evaluate the efficacy of the therapy and possible improvements after detailed instructions in a random sample of well defined NIDDM in the greater Munich area. 290 NIDDM (187 female, 103 male) out of a total of 1500 patients treated by 22 general practitioners were randomly recruited for the study. First results indicated an excess morbidity of the NIDDM, e.g. 43.5% with HbA1c greater than 8%, hypertension in 73.8%, hypertriglyceridemia in 75%, hypercholesterolemia in 36.3% adipositas in 78%, and a micro/macro-albuminuria in 44.5%. A similar risk profile could be determined in cases with recently diagnosed NIDDM. The remarkable risk profile documents itself in the incidence of macro-vascular complications: 40.8% of the male and 43.2% of the female showed a peripheral arterial disease (pAVD), in 8% of all patients a carotid artery stenoses could be detected by means of doppler ultrasound technique; 46.6% of the male and 59.3% of the female patients showed symptoms of CHD. With the exception of the incidence of CHD in patients less than 64 years the duration of NIDDM had no influence on the macro-vascular complications as demonstrated in previous studies. The age however always had a significant influence on all three vascular regions examined. Albuminuria correlated as such with a number of risk factors showed a significant correlation with the incidence of pAVD and occurred more often in males with carotid artery stenoses. Other correlations established were: Hypercholesterolemia and FVIII ass. Ag respectively, and the incidence of carotid artery stenoses; blood pressure, F VIII ass. Ag and pAVD. In the female a negative correlation could be seen between the pAVD and the HDL-level. In patients with CHD sex specific correlations could be determined to blood pressure, HbA1c, c-peptide and triglyceride levels.

The tolerance of sound esophageal mucosa to intracavitary high dose rate afterloading contact therapy with unique doses of 6 Gy and 12 Gy, respectively, was investigated in 15 pigs. Whereas no macroscopic or microscopic alterations of the mucosa are found after 6 Gy, a unique application of 12 Gy produces most severe side effects such as vascular occlusion due to fibrosis of the intima, formation of fistulas, and perforations of the esophagus wall. Future investigations will have to aim at the elaboration of schemes for dosage and fractionation.

A 42-year-old man of Croatian birth, with long-standing neurological symptoms, was found to have neurocysticercosis (a rare disease in Central Europe), as proven by positive antibody titres in serum and CSF and typical foci by computed tomography (CT). Ventriculo-cisternal drainage (after Torkildsen) controlled the acute symptoms of raised intracranial pressure. Postoperatively the CT revealed new low-density intracerebral foci, which responded to praziquantel.

Childhood or insulin-dependent diabetes is a life-long illness, placing complex and daily demands on the patient and the family. Some studies were carried out in order to investigate the relationship between health status, behavioral and psychological variables. The Hemoglobin A1 was used to index glycemic control. A newly developed diabetes knowledge test and a questionnaire on diabetic related beliefs were administered. The results indicate that diabetic control improves with age. General knowledge of diabetes increases with age, but relates not to diabetic control. But considering age and the particular subtests of knowledge as predictors 59.44% of the variance in diabetic control can be estimated. Perceived barriers to implementing self-care and feelings of disruptiveness culminate in the age of 12 to 13 years. Feelings of stigmatization and the affection by the disease loose weight as disturbing factors with increasing age and knowledge. Increased attention to the child's cognitive developmental level is suggested and methods for improving the effectiveness of patient intervention programs are discussed.

Lysozyme is absent from normal cerebrospinal fluid (C.S.F.) and in C.S.F. from children with viral meningitis. Appreciable amounts of lysozyme were noted in C.S.F. from children with bacterial meningitis (0.23 +/- 0.14 mg/100 ml) and cerebral convulsions (0-0.82 mg/100 ml). The C.S.F.-lysozyme content is a sensitive indicator for bacterial meningitis and important in the differential diagnosis between viral and bacterial meningitis. The beta2-microglobulin content of C.S.F. in healthy children was 0.11 +/- 0.05 mg/100 ml; in children with viral meningitis 0.20 +/- 0.06 mg/100 ml and in children with bacterial meningitis 0.44 +/- 0.17 mg/100 ml. Children with cerebral convulsions had also a rise in C.S.F. beta2-microglobulin.