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Die Zahl der Verfahren und der Sterilisationen nach dem Gesetz zur Verhütung erbkranken Nachwuchses
(2015)
In dem Buch wird die Zahl der Verfahren nach dem Gesetz zur Verhütung erbkranken Nachwuchses von 1934 bis 1945 (nach Hochrechnung) im "Altreich" auf ca. 436.000 geschätzt. Durchgeführt wurden laut Schätzung im "Altreich" ca. 294.000 Sterilisationen. Dazu kommen noch ca. 10.000 bis 20.000 Sterilisationen in den "angeschlossenen" oder annektierten Gebieten bis 1945.
The pathophysiologic mechanisms behind urologic disease are increasingly being elucidated. The object of this investigation was to evaluate the publication policies of urologic journals during a period of progressively better understanding and management of urologic disease. Based on the ISI Web of Knowledge Journal Citation Reports and the PubMed database, the number and percentage of original experimental, original clinical, review or commentarial articles published between 2002–2010 in six leading urologic journals were analyzed. “British Journal of Urology International”, “European Urology”, “Urologic Oncology-Seminars and Original Investigations” (“Urologic Oncology”), “Urology”, “The Journal of Urology”, and “World Journal of Urology” were chosen, because these journals publish articles in all four categories. The publication policies of the six journals were very heterogeneous during the time period from 2002 to 2010. The percentage of original experimental and original clinical articles, related to all categories, remained the same in “British Journal of Urology International”, “Urologic Oncology”, “Urology” and “The Journal of Urology”. The percentage of experimental reports in “World Journal of Urology” between 2002–2010 significantly increased from 10 to 20%. A distinct elevation in the percentage of commentarial articles accompanied by a reduction of clinical articles became evident in “European Urology” which significantly correlated with a large increase in the journal’s impact factor. No clearly superior policy could be identified with regard to a general increase in the impact factors from all the journals. The publication policy of urologic journals does not expressly reflect the increase in scientific knowledge, which has occurred over the period 2002–2010. One way of increasing the exposure of urologists to research and expand the interface between experimental and clinical research, would be to enlarge the percentage of experimental articles published. There is no indication that such policy would be detrimental to a journal’s impact factor.
Introduction: For management of complicated retinal detachments, a pars plana vitrectomy with temporary silicone oil (SO) fill is the method of choice. According to literature, the retinal redetachment rate varies between <10% and >70% with around 36% in our own group (retrospective data analysis, n = 119 eyes).
Methods: The main goal was to reduce the retinal redetachment rate. Standard operating procedures (SOPs) and evaluation protocols (EVALPs) were developed to prospectively analyse risk factors. Lab analysis of SO was performed, and the role of surgical experience was evaluated and investigated with Eyesi®.
Results: We achieved a significant reduction of the retinal redetachment rate (to 6.80%, n = 101, p = 0.002). After surgery with SO injection, neither further membrane peeling (in 16.5%) nor retinal laser coagulation (in 100%) during revision surgery had a significant effect on the reattachment rate (p = 0.167, p = 0.23), while extensive additional laser coagulation reduced visual acuity (p = 0.01). A 3-port approach had to be set up to complete SO removal. A difference in success rate depending on surgical experience was confirmed, and the performance in Eyesi correlated with that in the patients' eye.
Conclusions: A SOP- and EVALP-based management and new strategies to secure the surgical performance seem to be essential for successful surgery.
Introduction: Potential health damage by environmental emission of tobacco smoke (environmental tobacco smoke, ETS) has been demonstrated convincingly in numerous studies. People, especially children, are still exposed to ETS in the small space of private cars. Although major amounts of toxic compounds from ETS are likely transported into the distal lung via particulate matter (PM), few studies have quantified the amount of PM in ETS. Study aim The aim of this study was to determine the ETS-dependent concentration of PM from both a 3R4F reference cigarette (RC) as well as a Marlboro Red brand cigarette (MRC) in a small enclosed space under different conditions of ventilation to model car exposure.
Method: In order to create ETS reproducibly, an emitter (ETSE) was constructed and mounted on to an outdoor telephone booth with an inner volume of 1.75 m3. Cigarettes were smoked under open- and closed-door condition to imitate different ventilation scenarios. PM2.5 concentration was quantified by a laser aerosol spectrometer (Grimm; Model 1.109), and data were adjusted for baseline values. Simultaneously indoor and outdoor climate parameters were recorded. The time of smoking was divided into the ETS generation phase (subset "emission") and a declining phase of PM concentration (subset "elimination"); measurement was terminated after 10 min. For all three time periods the average concentration of PM2.5 (Cmean-PM2.5) and the area under the PM2.5 concentration curve (AUC-PM2.5) was calculated. The maximum concentration (Cmax-PM2.5) was taken from the total interval.
Results: For both cigarette types open-door ventilation reduced the AUC-PM2.5 (RC: from 59 400 +/- 14 600 to 5 550 +/- 3 900 mug*sec/m3; MRC: from 86 500 +/- 32 000 to 7 300 +/- 2 400 mug*sec/m3; p < 0.001) and Cmean-PM2.5 (RC: from 600 +/- 150 to 56 +/- 40 mug/m3, MRC from 870 +/- 320 to 75 +/- 25 mug/m3; p < 0.001) by about 90%. Cmax-PM2.5 was reduced by about 80% (RC: from 1 050 +/- 230 to 185 +/- 125 mug/m3; MRC: from 1 560 +/-500 mug/m3 to 250 +/- 85 mug/m3; p < 0.001). In the subset "emission" we identified a 78% decrease in AUC-PM2.5 (RC: from 18 600 +/- 4 600 to 4 000 +/- 2 600 mug*sec/m3; MRC: from 26 600 +/- 7 200 to 5 800 +/- 1 700 mug*sec/m3; p < 0.001) and Cmean-PM2.5 (RC: from 430 +/- 108 to 93 +/- 60 mug/m3; MRC: from 620 +/- 170 to 134 +/- 40 mug/m3; p < 0.001). In the subset "elimination" we found a reduction of about 96-98% for AUC-PM2.5 (RC: from 40 800 +/- 11 100 to 1 500 +/- 1 700 mug*sec/m3; MRC: from 58 500 +/- 25 200 to 1 400 +/- 800 mug*sec/m3; p < 0.001) and Cmean-PM2.5 (RC: from 730 +/- 200 to 27 +/- 29 mug/m3; MRC: from 1 000 +/- 450 to 26 +/- 15 mug/m3; p < 0.001). Throughout the total interval Cmax-PM2.5 of MRC was about 50% higher (1 550 +/- 500 mug/m3) compared to RC (1 050 +/- 230 mug/m3; p < 0.05). For the subset "emission" - but not for the other periods - AUC-PM2.5 for MRC was 43% higher (MRC: 26 600 +/- 7 200 mug*sec/m3; RC: 18 600 +/- 4 600 mug*sec/m3; p < 0.05) and 44% higher for Cmean-PM2.5 (MRC: 620 +/- 170 mug/m3; RC: 430 +/- 108 mug/m3; p < 0.05).
Conclusion: This method allows reliable quantification of PM2.5-ETS exposure under various conditions, and may be useful for ETS risk assessment in realistic exposure situations. The findings demonstrate that open-door condition does not completely remove ETS from a defined indoor space of 1.75 m3. Because there is no safe level of ETS exposure ventilation is not adequate enough to prevent ETS exposure in confined spaces, e.g. private cars. Additionally, differences in the characteristics of cigarettes affect the amount of ETS particle emission and need to be clarified by ongoing investigations.
Hintergrund und Ziel der Arbeit: Aufgrund des demografischen Wandels ist mit einer Änderung des Altersspektrums bei den Obduktionen zu rechnen. Ziel der Arbeit war die Untersuchung der nichtnatürlichen Todesfälle, bei denen die Verstorbenen ein Mindestalter von 65 Jahren erreicht hatten, da dieser Populationsgruppe zukünftig eine wachsende Bedeutung zukommen wird. Material und Methoden: In dieser retrospektiven Mortalitätsstudie wurden alle nichtnatürlichen Todesfälle mit einem Sterbealter ≥ 65 Jahren analysiert, die in den Jahren 2000–2002 (Zeitraum I) und 2013–2015 (Zeitraum II) im Institut für Rechtsmedizin des Universitätsklinikums der Goethe-Universität in Frankfurt am Main obduziert wurden. Für die Analyse der suizidal Verstorbenen wurden zudem Daten nichtobduzierter Selbsttötungen (n = 100) aus Besichtigungen aufgenommen. Ergebnisse: Aus den 1206 Obduktionen resultierten 669 natürliche (55,5 %) und 404 nichtnatürliche (33,5 %) Todesfälle. Darunter ergaben sich 221 Unfälle (Zeitraum I n = 105; Zeitraum II n = 116), 82 Suizide (Zeitraum I n = 55; Zeitraum II n = 27), 41 Todesfälle im Zusammenhang mit medizinischen Interventionen (Zeitraum I n = 7; Zeitraum II n = 34) und 40 Tötungsdelikte (Zeitraum I n = 23; Zeitraum II n = 17). Verkehrsunfälle und Stürze bilden die größten Subgruppen bei den Unfällen. Erhängen und Erschießen sind die am meisten angewandten Suizidarten. Vergleicht man Zeitraum I mit II, so fällt die signifikante Zunahme von Todesfällen im Zusammenhang mit ärztlichen Maßnahmen auf. Eine signifikante Abnahme von Suizidenten ist durch die abnehmende Obduktionsrate in dieser Gruppe zu begründen. Die relative und absolute Fallzahl an Tötungsdelikten im Obduktionsgut weisen keine wesentliche Veränderung auf. Diskussion/Schlussfolgerung: Die Ergebnisse dieser Studie stimmen großteils mit der Literatur überein. Im Zeitvergleich zeigt sich eine relative Zunahme nichtnatürlicher Todesfälle im gerontologischen Obduktionsgut. Dies wird durch den Anstieg von Obduktionen nach iatrogenen Komplikationen wesentlich mitgeprägt.
Aims: Inadequate treatment is one of the factors interfering with a successful social and working life. Among students, it can impair their health and learning progress. In the field of medicine the problem of inadequate treatment seems widespread. This study examines wether inadequate treatment in internships differs between medicine and other academic disciplines.
Method: Using a questionnaire, the frequency, forms and severity of inadequate treatment among students were compared between the disciplines of medicine, civil engineering and teaching.
Results: 69,3% of medical students reported inadequate treatment during their internships, about twice as many as students of other disciplines. The ratios of verbal, non-verbal and organisational inadequate treatment were similar between the different academic disciplines. However, medical students executed tasks without receiving sufficient safety precautions or training significantly more often (sevenfold) than students of other disciplines. In total however, the experienced incidents of inadequate treatment were seen as similarly severe across the different academic fields.
Conclusion: Inadequate treatment of students during internships is a larger problem in medicine than in civil engineering or teaching, particularly concerning the performance of unsafe tasks. With regard to the health of students and patients, inadequate treatment in the medical education should be tackled. Previous studies suggest that this goal can be achieved only through longtime extensive measures on the level of students, lecturers, faculty and teaching hospitals.
Purpose: To evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons’ performance.
Methods: In a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9) or not (n = 12). Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room.
Results: Comparing each surgeon’s performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room.
Conclusions: Despite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance.
Background and Aims. Biliary complications are the most frequent complications after common liver surgeries. In this study, accuracy of hepatobiliary scintigraphy (HBS) and impact of hyperbilirubinemia were evaluated. Methods. Between November 2007 and February 2016, 131 patients underwent hepatobiliary scintigraphy after having liver surgery. 39 patients with 42 scans after LTX (n=13) or hepatic resection (n=26) were evaluated in the study; 27 were male, with mean age 60 years. The subjects underwent hepatobiliary scintigraphy with Tc-99m labeled Mebrofenin. The results were compared to ERCP as gold standard performed within one month after HBS. We calculated sensitivity, specificity, PPV, and NPV. We compared LTX patients to patients with other liver surgeries. Furthermore the influence of hyperbilirubinemia on HBS scans was evaluated. Results. HBS always provided the correct diagnosis in cases of bile leak in the liver-resected group (14/14). Overall diagnostic accuracy was 76% (19/25) in this group and 54% (7/13) in the LTX group. False negative (FN) diagnoses occurred more often among LTX patients (p=0.011). Hyperbilirubinemia (>5 mg/dL) significantly influenced the excretion function of the liver, prolonging HBS’s time-activity-curve (p=0.001). Conclusions. Hepatobiliary scintigraphy is a reliable tool to detect biliary complications, but reduced accuracy must be considered after LTX.
Erratum zu: Rechtsmedizin 2020. https://doi.org/10.1007/s00194-020-00447-4. Im o. g. Beitrag wurde im Abschnitt Material und Methoden auf S. 118 bei den Organindizes aufgrund eines Tippfehlers „mit p = 0,95“ statt „mit P = 0,95“ angegeben. Durch den Tippfehler könnte angenommen werden, es handle sich um eine Irrtumswahrscheinlichkeit, obwohl es sich um eine Konfidenz handelt. Zudem wurden in den Abschnitten Material und Methoden sowie Limitationen bezüglich der Erhebung von Organindizes versehentlich angeführt, es seien bei der linken und rechten Niere (♂, ♀) Ausreißer entfernt worden. Richtigerweise wurden Ausreißer bei der rechten Niere nur bei den Frauen entfernt. Die Überschrift in Tab. 6 muss richtigerweise „Tab. 6: Nichtparametrischer Toleranzbereich …“ und nicht „Tab. 6: Nichtparametrischer Normbereich …“ lauten. In Tab. 7, die sich auf den Kruskal-Wallis-Test bezieht, ist als Anmerkung „* Signifikante Korrelation“ angegeben. Aufgrund des Testverfahrens ist dies als „* Signifikanter Unterschied“ zu bezeichnen. Der Originalbeitrag wurde entsprechend korrigiert. Für diese Fehler möchten wir uns entschuldigen.
Einleitung: Die Obduktion nimmt einen wichtigen Stellenwert in der Medizin ein, da sie nicht nur der Klärung der Todesart und -ursache eines Verstorbenen dient, sondern auch zum Verständnis der Pathophysiologie von Erkrankungen beiträgt. In diesem zweiten Teil der Studie wurden aktuelle Normwerte für das Gewicht für die folgenden adulten Organe entwickelt: Leber, Lunge, Milz, Nieren. Zudem wurden Zusammenhänge zwischen Organgewichten und der Todesart untersucht. Material und Methoden: Die im Dreijahreszeitraum von 2011 bis 2013 im Institut für Rechtsmedizin in Frankfurt am Main durchgeführten Obduktionen wurden retrospektiv ausgewertet. Die statistischen Berechnungen erfolgten mithilfe des Programmes „BiAS. für Windows“ (epsilon-Verlag GbR, Hochheim-Darmstadt, Deutschland). Ergebnisse: Folgende Normwerte bzw. -bereiche wurden an der Studienpopulation erhoben: Leber 1047,0–2740,0 g (♂, n = 191) bzw. 749,0–2182,0 g (♀, n = 115), linke Lunge 230,0–840,0 g (♂, n = 119) bzw. 186,8–891,3 g (♀, n = 97), rechte Lunge 249,3–1005,8 g (♂, n = 116) bzw. 215,3–907,5 g (♀, n = 100), Milz 55,0–373,2 g (♂, n = 306) bzw. 50,0–355,0 g (♀, n = 204), linke Niere 110,0–255,0 g (♂, n = 258) bzw. 71,8–215,0 g (♀, n = 137), rechte Niere 100,0–270,0 g (♂, n = 266) bzw. 75,0–212,1 g (♀, n = 140). Für die am stärksten mit Organgewichten korrelierenden Körpermaße, nämlich Body-Mass-Index (BMI), Körperoberfläche („body surface area“, BSA) und Körpergewicht, wurden nach Subgruppen getrennte Normwerte ermittelt. Ein signifikanter Unterschied des Organgewichtes je nach Todesart lag bei Männern bei der Milz und bei den Nieren vor. Bei Frauen war bei keinem der Organe ein von der Todesart abhängiger signifikanter Gewichtsunterschied feststellbar. Außerdem wurden Organindizes entwickelt, mittels derer der Anwender berechnen kann, ob ein Organgewicht, Körpermaßen bzw. Alter entsprechend, im Normbereich liegt. Diskussion: Organgewichte unterliegen wie Körpermaße einem säkularen Trend, welcher jedoch nicht linear und für jedes Organ individuell verläuft. Für die Auswertung von Organgewichten im Rahmen der Obduktion werden deshalb aktuelle, an einer vergleichbaren Population erhobene Normtabellen benötigt. Bei deren Erstellung können sowohl Fälle mit natürlichem als auch mit nichtnatürlichem Tod unter weitestgehendem Ausschluss pathologisch veränderter Organe herangezogen werden.