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In terms of treatment planning, the radiologic phenomenon of vesicoureteric reflux has become less important than its inherent risk of further urinary tract infections and loss of renal function. Whilst radiologic and sonographic voiding cystourethrography continues to be the gold standard in the mere detection of vesicoureteric reflux, dimercaptosuccinic acid scanning is important for risk stratification. Also it serves to confirm renal involvement in uncertain situations with urinary tract infection and fever. In older children, it is the standard in primary diagnostics. Furthermore, it enables the diagnosis of occult reflux in many cases. Therefore, dimercaptosuccinic acid scanning is an indispensable tool in the diagnostic evaluation of vesicoureteric reflux., Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt vorliegt., (© Georg Thieme Verlag KG Stuttgart · New York.)

Enhanced recovery after surgery (ERAS) protocols are widely established in adult urology, especially for cystectomies and procedures involving the (small) bowel. However, data concerning pediatric surgery and pediatric urologic surgery are scarce. Individual items of ERAS protocols have been well-studied and significant benefits have also been shown for children without increased risk of complications. In a number of small series the safety and efficacy of implementing ERAS protocols have been reported recently. A broad consensus and a guideline for a common pediatric ERAS protocol is not yet available.

Background: Cryptorchidism is the most common genital malformation in male newborns. In recent years, guidelines concerning diagnosis and therapy have undergone considerable evolution with the implementation of recent knowledge in pathophysiology, diagnosis, and therapy., Objectives: The aim of this publication is to provide an overview of the current national and international guideline recommendations concerning diagnosis and treatment of cryptorchidism. Critical points are discussed in light of current scientific literature., Materials and Methods: The current guidelines of the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU), the American Association of Urology (AUA), the pediatric urologic task force of the Austrian Society of Urology (ÖGU), the international consultation on urological disease (ICUD) and the German Society of Urology (DGU)/German Association of Pediatric Surgery (DGKCh) have been analyzed concerning the most important aspects of treatment and diagnosis., Results: There is broad consensus concerning most steps and decisions for the treatment of cryptorchidism. However, some aspects of diagnostic imaging, the use of hormonal therapy, and surgical access in nonpalpable testis warrant further discussion and are the fields of considerable changes.

A case of periodic paralysis is reported that had to be treated by mechanical ventilation. Symptoms and course of this attack are demonstrated and it is shown how diagnosis was reached. Provocative factors of periodic hypokaliemic paralysis are discussed and their importance in anaesthesia is emphasised.

The serum level of the myocardial-specific isoenzyme of creatine phosphokinase, CK-MB was determined in 50 patients with severe multiple injuries or following extensive surgery. It is concluded that whenever the proportion of CK-MB exceeds 10% of the total creatine phosphokinase activity myocardial damage has occurred, especially since equivalent ECG changes were registered in this group of patients.

Tetanus is subdivided into 3 degrees of severity according to the course. When death occurs, we differentiate those cases due to the disease itself (16) and those resulting from late complications or avoidable technical defects (12). 82 of our 111 patients-79 men and women-had been neither passively nor actively immunized and none of the supposedly actively immunized had been inoculated properly. The horse serum available in earlier years was considered unsuitable while an intravenous human serum recently produced by Messrs Immuno of Vienna justified greater expectations. Sedation or prolonged sleep with and without relaxation, tube feeding and parenteral feeding, prolonged intubation or trachectomy, duration of the life-threatening phase of the disease, breaking off treatment ("stealing out"), mobilization and finally, the question of expense, bear no relation to the extremely small cost of a confirmed triple inoculation. An urgent consequence of this is obligatory active immunization in early childhood if an earlier inoculation has not been done, but also at any time afterwards.

The paper deals with a new aspect in patients with polytrauma using a method to distinguish between myocardial or skeletal muscle damage. The isoenzyme CKMB of kreatine kinase is found to be characteristic for myocardial damage when increasing to more than 10% of the whole enzyme activity. It should be mentioned that this elevation is also seen in other disorders. Therefore the correlation to ECG changes is important in considering the diagnosis.

The results of the first clinical trials of left ventricular assist devices are not encouraging. The only indication at present is in patients with cardiac failure after cardiac operations. The acute type of ellipsoid heart described in this paper-displays a canulation technique where the inflow canula inserted in the left ventricular cavity via the left atrium and the outflow canula is directly connected to the aortic canula of the cardiopulmonary bypass. The haemodynamic response shows the efficacy of this system. The circulation can be maintained in severe cardiac failure, as well as in ventricular fibrillation and cardiac arrest. On the basis of data obtained in experiments on 7 female calves this system is considered worthy of clinical trial.