Youngsauer3709

This article presents a case of successful treatment of severe erosive esophagitis, which developed after total gastrectomy. The patient suffered from a poorly differentiated, diffuse gastric carcinoma with subtotal gastric outlet obstruction, accompanied by Helicobacter pylori-associated type b gastritis. A few weeks after Helicobacter eradication followed by successful surgery, swallowing of nutrition became impossible due to severe erosive esophagitis. Histologically there was no evidence of tumor infiltration in this organ. After numerous unsuccessful attempts using established conventional pharmacotherapy options, the problem could be solved by daily subcutaneous somatostatin-analogue (octreotide) injections. The patient started to eat again, and endoscopically/histologically the severe inflammation significantly improved. Attempts to reduce the daily injections, undertaken by the patient, resulted in relapses within a few days. Octreotide was well tolerated by the patient.A 66-year-old female patient with the initial diagnosis of acute myeloid leukemia is reported. Paraneoplastic syndrome manifested as hypernatremia due to central diabetes insipidus (CDI), which could be controlled with the administration of desmopressin. After initiation of the induction therapy, the required desmopressin administration could be reduced and terminated. In the further course, the early increasing polyuria and hypernatremia indicated the primary refractory acute myeloid leukemia.A 59-year-old male patient was admitted for possible reflex syncope following loss of consciousness during urination. During the visit, a malaise with unconsciousness occurred. Holter ECG at that time showed increasing sinus bradycardia with transition to a junctional escape rhythm (30/min); in addition, there were several sinus pauses > 2.0 s (the longest almost 10 s). This malaise occurred again during routine EEG, when a focal epileptic seizure on the right fronto-temporal with sinus bradycardia after 15 s was documented. Thus, the diagnosis of ictal asystole was made, anticonvulsant therapy was started, and a cardiac pacemaker was implanted.

Transthyretin(TTR)-amyloidosis (hereditary or wild-type) is characterized by deposition of misfold, insoluble amyloid fibrils in the interstitial space, leading to dysfunction of the involved organs. Cardiac involvement may vary, ranging from dyspnea, edema, and arrhythmia to overt heart failure and death.

A79-year-old Caucasian male presented with dyspnea, edema, and weight gain. Echocardiography revealed left ventricular wall thickening and restrictive cardiomyopathy. Bone scintigraphy revealed abnormal cardiac tracer uptake consistent with cardiac TTR-amyloidosis, which could be confirmed by endomyocardial biopsy.

The diagnosis of TTR-amyloidosis is challenging for the clinician and requires their heightened awareness. Definitive diagnosis needs astructured approach including laboratory and imaging findings combined with endomyocardial biopsy.

The diagnosis of TTR-amyloidosis is challenging for the clinician and requires their heightened awareness. Definitive diagnosis needs a structured approach including laboratory and imaging findings combined with endomyocardial biopsy.Nonpharmacological treatment is still an important supplement to the pharmacological treatment of hypertension. Thereby, either an elevated blood pressure can be lowered further or, alternatively, the use of antihypertensive drugs can be reduced. In the context of nonpharmacological treatment of hypertension, sodium restriction plays an important role. Sodium intake can either be reduced by lowering excessive dietary salt consumption or by the use of table salts with reduced sodium content. Lower dietary sodium consumption lowers blood pressure. This was controversial for a long time; however, now more and more observational and interventional studies have confirmed this fact. Nevertheless, some studies have shown an association of low salt consumption with increased mortality. This observation is explained by the so-called reverse epidemiology. This means that diseases with increased mortality, such as consuming diseases or severe heart diseases are associated with lowered food intake and as a consequence, with lower sodium intake. In addition to sodium restriction, the use of so-called salt substitutes with lower sodium content is also effective in lowering blood pressure. In most of the salt substitutes examined so far sodium chloride is partly replaced by potassium chloride. Numerous investigations show that these salt substitutes lower blood pressure. From a statistical point of view side effects such as hyperkalemia are very rare; however, hyperkalemia is potentially life-threatening. Therefore, the broader use of these salt substitutes is principally helpful but these salts should only be used after medical consultation. Especially renal insufficiency and the use of certain drugs, such as potassium-sparing diuretics and blockers of the renin-angiotensin system increase the risk of hyperkalemia.Acute rheumatic fever (ARF) results from an autoimmune reaction following Streptococcus pyogenes-induced tonsilitis. It is a disease that has become uncommon in Germany and is rare in adults. Treatment recommendations are controversial in this age group. The case of a 29-year-old male with ARF following tonsillitis due to S. pyogenes treated with penicillin and amoxicillin/clavulanic acid in the setting outpatient is reported. After 6 weeks, the patient presented to hospital with elevated body temperature, painless red-livid skin lesions, and polyarthritis. Laboratory results showed elevated inflammatory parameters and antistreptolysin O titers. The Jones criteria for ARF were met. Symptoms improved rapidly under therapy with nonsteroidal anti-inflammatory drugs. Antibiotic prophylaxis was not given, but regular echocardiographic controls remained non-pathologic over 12 months.Perioperative management of anticoagulation in patients receiving long-term anticoagulation or platelet aggregation inhibitors requires an individual consideration of competing risks. If the risk for bleeding is low, anticoagulation can often be continued. If it is necessary to pause anticoagulation, the necessity and dosage of bridging must be determined based on the individual risk of thromboembolism. Only patients with a high risk of thromboembolism should receive bridging in the full therapeutic dosage. The timing of pausing anticoagulation depends on the risk of bleeding from the urological intervention and the renal function of the patient. Platelet aggregation inhibitors should not be discontinued in the first month after coronary stent implantation, especially after acute coronary syndrome.

The proportion of female urologists is steadily increasing, yet they continue to be underrepresented in academic leadership positions. Apostdoctoral lecture qualification (habilitation), which is mandatory for asuccessful scientific career, is achieved significantly less often by female urologists in Germany than by their male colleagues.

To identify factors to effectively promote female urologists into academic leadership positions, the current situation, as well as factors influencing successful habilitation of women who are members of the German Society of Urology (Deutsche Gesellschaft für Urologie [DGU]) were investigated.

An online questionnaire was distributed to 1343 female members of the DGU in Germany, Austria, and Switzerland. The responses of 521 women were statistically analyzed with respect to baseline characteristics and in relation to research funding. The primary endpoint of our study was the habilitation rate.

The average age of the 521 participating female urologists who completed teading academic positions. The results of the data analysis show that the promotion of research fellowships explicitly for women could be apromising approach.

Promoting habilitation among female urologists is required in order to increase the proportion of women in leading academic positions. The results of the data analysis show that the promotion of research fellowships explicitly for women could be a promising approach.In view of the growing demand for urological care and the simultaneous demographic change, the need for urologists in Germany is increasing. Therefore, young professionals are urgently needed to ensure urological care in the future. This objective can be achieved by fascinating medical students for urology and by implementing satisfactory residency programs in clinical departments and outpatient offices. GSK1265744 Perspectives and possible career paths should be shown to junior colleagues at an early stage. Structured research funding is needed to reconcile academic with clinical work. The German Society for Residents in Urology (GeSRU) offers young urologists a platform for networking, for representation of interests as well as for education and training.

Digitalization of patient documentation and introduction of the electronic patient record (ePA) pose challenges to everyday clinical practice.

We investigated the acceptance and status of the digitalization of patient data and the introduction of the ePA among German urologists.

Aquestionnaire with 30questions about the acceptance and status of digitalization of patient documentation and ePA was sent out via the newsletter of the German Society of Urology.

A total of 80urologists participated in the survey (response rate 2%). Digital platforms such as Urotube or Researchgate are used by 63% of participants. The complete implementation of digital patient documentation was reported by 72% of respondents working in medical practice and by 54% of those working in the hospital (p = 0.042). While 76% see the digitalization process as reasonable, 34% expressed partial or strong concerns about the complete digitalization of patient documentation. Only 14% of the participants offer video consultations. Advantages for ePA include better networking of the healthcare system (73%), improved diagnosis, indication (41%) and treatment quality (48%), and avoidance of medication errors (70%).

German urologists are open to the digitalization process and ePA. Especially younger urologists are using digital media. The advantages of digitalization are, in particular, an improvement in treatment processes. For asmooth introduction, across-departmental establishment and, if necessary, an adaptation of the treatment processes are necessary.

German urologists are open to the digitalization process and ePA. Especially younger urologists are using digital media. The advantages of digitalization are, in particular, an improvement in treatment processes. For a smooth introduction, a cross-departmental establishment and, if necessary, an adaptation of the treatment processes are necessary.

Urinary tract infections account for one of the most bacterial infectious diseases worldwide.

The primary aim of this pilot project was to identify the relative percentage of antibiotic use in comparison to all patients in auniversity medical center for the better establishment of antibiotic stewardship (ABS) programs.

This is an epidemiological pilot project. In the time period of three months it was evaluated which relative percentage of the patients was treated with antibiotics for bacterial urinary tract infection in comparison to all patients.

In summary, about 40% of all urological patients received an antibiotic treatment against urinary tract infections or as perioperative prophylaxis against bacterial infection in the operating room (OR). The antibiotic use at the urological ward is highest in comparison to ambulance or OR.

Infectious diseases, especially bacterial infections, account for asignificant part of urology. This knowledge is essential to establish ABS programs and to tackle the progression of antibiotic resistance.