Testosteronmangel – ein unterschätztes Risiko für Männer?

Background

Testosterone deficiency represents a significant health risk factor for men but the importance has so far been underestimated. Besides physiological and age-related reduction, acquired testosterone deficiency may also occur. Testosterone deficiency is a possible result of commonly occurring diseases or is itself the basis for development of different diseases. The scope of the present investigation was measurement of serum testosterone levels in different age groups.

Materials and methods

Serum testosterone levels were determined in samples from 5,735 healthy men at the LADR laboratory MVZ Dr. Kramer & colleagues, Geesthacht under routine conditions. The frequency of testosterone deficiency was calculated in different age groups and compared using SPSS 19.0 software.

Results

Pathologically low testosterone levels (<?2.5 ng/ml) were found in 15.2?% of subjects while 37.4?% had a testosterone level lower than 3.5 ng/ml. Decreased testosterone levels were not associated with age. In addition the proportion of men with decreased serum testosterone levels was comparable in all age groups. The average serum testosterone level decreased slightly in all age groups during the period before midday.

Conclusions

The data reveal high rates of testosterone deficiency in men independent of patient age. As decreased serum testosterone levels may be the consequence of several diseases and can be causally involved in the pathogenesis of further diseases, it is strongly recommended that serum testosterone measurement should be included in the diagnostic arsenal especially when symptoms, such as loss of libido, erectile dysfunction, lack of concentration, depression, lethargy, irritability and sleep disturbance are present.     

Thrombozytenfunktionsstörung bei Traumapatienten,ein unterschätztes Problem? Ergebnisse einer monozentrischen Untersuchung

Die Anaesthesiologie - Plasmatische Gerinnungsstörungen bei Schwerverletzten sind häufig; zu thrombozytären Funktionsstörungen existiert nur wenig Evidenz. Ein Monitoring der...     

Behandlungsfehler als Ursachen von Verkrüppelung Verletzter und Vorschläge zur Vermeidung

Ohne Zusammenfassung     

Sichere Anästhesie und Arbeitszeitgesetz: Wechsel von Personal erlaubt?

Die Anaesthesiologie - Arbeitszeitbeschränkungen in der Medizin nehmen im Hinblick auf die Patientensicherheit eine ambivalente Stellung ein. Sie erfordern eine Abwägung von...     

Zwei Fälle von gegengleicher Madelung's Deformität zugleich ein Beitrag zur Ätiologie derselben

Ohne Zusammenfassung Mit 6 Abbildungen im Text.     

Die endoskopisch-mikrochirurgische Dissektion der Speiseröhre: ein Beitrag zur Reduzierung pulmonaler Komplikationen nach Oesophagusresektion?

Zusammenfassung Zur Dissektion der Speiseröhre wurde eine neue endoskopisch-mikrochirurgische Technik entwickelt: über den cervicalen Zugang kann die Speiser6hre mit Hilfe eines neuentwickelten Operationsmediastinoskopes zirkulär freiprä-pariert und entfernt wurden. In einer randomisierten, tierexperimentellen Studie wurde die endoskopisch-mikrochirurgische Technik mit der stumpfen Dissektion and der abdominothorakalen Resektion verglichen. Die endoskopische Dissektion war mit deutlich geringerem Blutverlust durchführbar; ebenso wurden keine Pleuraverletzungen und keine Verletzungen des N. recurrens and des N. vagus beobachtet. In der Gruppe der stumpfen Dissektionen kam es zu, teilweise signifikanten, Änderungen von hämodynamischen and Gasaustausch-Parametern: Anstieg der Herzfrequenz, Blutdruckabfall and Abfall des paO₂. Diese Parameter wurden durch die endoskopisch-mikrochirurgische Dissektion nicht beeinflußt.

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Endoscopic microsurgical dissection of the sophagus —a contribution to the reduction of pulmonary complications after esophagectomy?

Summary A new endoscopic microsurgical technique for dissection of the esophagus has been developed and tried out in animals. With this technique the esophagus is dissected and removed via a cervical approach by means of a new operating endoscope. In a randomized animal study we compared endoscopic versus blunt dissection and versus abdominothoracic resection. During endoscopic dissection we saw significantly lower bleeding and no laceration of the pleural cavity or damage to the recurrent laryngeal or to the vagus nerve. Significant changes of hemodynamics or gas exchange were observed in the blunt dissection group: increase of heart frequency, decrease of arterial pressure and decrease of paO₂. In contrast these parameters did not change in the endoscopic group.

Die Arbeit wurde unterstützt von der Deutschen Forschungsund Versuchsanstalt fur Luft- and Raumfahrttechnik im Rahmen des Programms ,Forschung im Dienste der Gesundheit". Sie enthält wesentliche Anteile der Dissertationsarbeit von S. Kessler     

Infektionsinzidenz von Katheterverfahren zur Regionalanästhesie

Background

To analyze safety issues of regional anaesthesia and analgesia in Germany only a few single center studies are available. Therefore, the German Society for Anaesthesiology and Intensive Care Medicine (Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) and the Professional Association of German Anaesthetists (Berufsverband Deutscher Anästhesisten, BDA) initiated a network for safety in regional anaesthesia. From this the first results on infectious complications will be reported.

Materials and methods

In a Delphi process the documentation of the setup and maintenance of regional anaesthesia and analgesia was agreed with the participants in a working group from the DGAI. After approval by the officially authorized representative for patient data privacy protection a registry was programmed to collect anonymous data. Up to October 2008 data from 6 centers could be analyzed.

Results

After testing for plausibility 8,781 regional anaesthesia procedures (22,112 catheter days) could be analyzed. The 5,057 neuraxial and 3,724 peripheral catheter-based procedures were in place for a median of 2.48 days (range 1.0-3.0 days) and 4 severe, 15 moderate and 128 mild infections were recorded. Diabetics were not found to show a statistically significant increase in risk (2.6% compared to 1.9% for non-diabetics: n.s.). Neuraxial procedures seem to have a higher rate of infections than peripheral procedures (2.7% vs. 1.3%, p<0.0001). Multiple punctures of the skin also seem to be associated with a higher infection rate than single skin punctures (4.1% vs. 1.6%, p<0.0001).

Conclusions

Infectious complications of catheter-based regional anaesthesia are common. Strict hygienic standards must therefore be complied with. More data are necessary to calculate risk factors. The registry provided can also be used as a benchmark to reduce these rates further.     

Dreidimensionale Sonographie zur Volumenbestimmung von Lebertumoren – ein erster Erfahrungsbericht

In a clinical trial the accuracy of volumetry by use of three-dimensional ultrasound (3-D-US) in comparison to three-dimensional computer tomography (3-D-CT) was evaluated. Overall, 42 patients with focal hepatic lesions were investigated with 2-D- and 3-D ultrasound. In 11 patients additional computerized tomographic arterial portography using spiral technique was performed. The volumes of the lesions were calculated using the ellipsoid formula (for 2-D- and 3-D-US) as well as with a planimetric reconstruction for 3-D-US and 3-D-CT. In addition the intra- and inter-investigator variability of 3-D ultrasound was determined. The volume of the investigated liver lesions (planimetric reconstruction with 3-D ultrasound) ranged between 1.5 cm3 and 1231 cm3 with a mean volume of 155 cm3 and a median volume of 68 cm3. The deviation of 2-D-US vs 3-D-CT was -62% to +68%, in the case of 3-D-US (ellipsoid) vs 3-D-CT it was -28% to +9%, and for 3-D-US (planimetry) vs 3-D-CT it was -21% to +9%. The concordance index kappa was 0.886, showing very good agreement between the two investigators. The intra-investigator variability was 5%. Our data show that volume measurement by use of 3-D-US in independent of the investigator. With regard to accuracy of volume measurements 3-D-US is comparable to 3-D-CT but more precise than 2-D-US. These results indicate that 3-D-US may be applied in the follow-up of tumor patients as an alternative diagnostic procedure to computer tomography. In addition 3-D-US might be useful in planning liver resections by virtue of better evaluation of the volume of the liver tissue remaining after resection and better visualization of the topography of liver tumors and major hepatic vessels.     

Beitrag zur Behandlung von arteriellen Durchblutungsschäden

Zusammenfassung Es wurde über acht Fälle berichtet, in denen arterielle Durchblutungserkrankungen am Bein vorlagen. Es wurde versucht, durch die Ligatur derVene das Gleichgewicht zwischen Zufuhr und Abfluß zu verbessern. Das wenig einströmende Blut sollte, was seinen Sauerstoffgehalt anbetrifft, besser ausgenutzt werden. In fünf von acht Fällen wurde ein beachtlicher Erfolg erzielt.Herrn Prof. Dr. med., Dr. rer. nat. h. c.E. K. Frey zum 75. Geburtstag gewidmet.     

Beitrag zur Lehre von den Hämorrhoiden

Ohne Zusammenfassung (Mit 9 Abbildungen.)     

Präoperative portale Embolisation zur Induktion von Leberhypertrophie

Preoperative portal embolization (PVE) is now widely used to induce hypertrophy of the anticipated liver remnant. Here, pathophysiology, indications, technical procedures, and problems of PVE are reviewed and our experience of 105 PVEs is presented. The reported complication rate after PVE is low (0-10%) and the increment of the future remnant liver volume is 12% of total liver volume (range: 7-27%). The resection rate after PVE ranged from 58% to 100%. In our series of 105 PVEs, the morbidity rate was 3.8%, the future remnant liver increased by about 10% of total liver volume, and 34 patients (32.4%) did not undergo planned extended hepatectomy. After hepatectomy, hepatic failure occurred in one patient (< 1%). In conclusion, although PVE is a safe procedure for enlarging the future remnant liver, more appropriate indication criteria should be established.     

EbM-basierte Indikationen zur Radiotherapie von testikulären Keimzellmalignomen

The intensity of adjuvant radiotherapy for stage I seminoma could be reduced substantially in recent years, achieving cure with low side effects and a low probability of late complications. Today a dose of 20 Gy is applied to the para-aortic lymphatics. Valuable treatment alternatives to radiotherapy have emerged: surveillance strategy allows 80% of patients to avoid further treatment. However, the remaining 20% will be exposed to potentially more intensive salvage therapy. Adjuvant carboplatinum chemotherapy offers similar disease-free survival to adjuvant radiotherapy. Long-term experience with late toxicity is not available. In seminoma CS IIA/B curative irradiation remains the standard treatment. Brain metastases of testicular germ cell tumors are treated with a combination of chemotherapy and cranial irradiation. In intratubular germ cell neoplasia (TIN), radiotherapy with 20 Gy will safely eliminate all TIN loci, but will destroy potential residual fertility.     

Experimentelle Beiträge zur Lehre von den Wirbelluxationen

Ohne Zusammenfassung     

Beitrag zur Problematik von Amputationen bei Querschnittsgelähmten

Ohne ZusammenfassungMit 6 Textabbildungen     

Validität von Biomarkern zur Abschätzung des perioperativen Myokardischämierisikos

Background

Periprocedural myocardial ischemia is a common occurrence during vascular surgery and is of prognostic relevance. The determination of myocardial biomarkers in addition to established risk scores improves the perioperative risk stratification.

Methods

Based on a selective literature search in consideration of original publications and meta-analyses from the years 2000-2013 listed in PubMed on the causes, diagnostics and therapy of periprocedural myocardial ischemia and on guidelines of national and international specialist societies, this article gives a review of current articles on the validity of biomarkers for estimation of the perioperative risk of myocardial ischemia.

Results

The scientific literature on perioperative myocardial ischemia essentially consists of monocentric retrospective investigations. There are only a few prospective randomized studies or structured reviews. The incidence of myocardial ischemia lies between 11 % and 47 %. Over the last decades many different scores have been developed for individual risk stratification. Biomarkers, in particular cardiac troponins are, however, sometimes the only possibility for the diagnostics of periprocedural ischemia. The high sensitivity of new troponin assays allows the recognition of minimal amounts of myocardial cell destruction and subsequently a rapid diagnosis and treatment.

Conclusion

It is imperative that perioperative myocardial ischemia is recognized and treated in order to minimize the long-term accompanying morbidity and mortality. The highly sensitive determination of troponin can possibly play a key role in adequate patient treatment.