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Background: Undergraduate medical students take the licensing exam (M3) as a two-day oral-practical examination. The main requirements are to demonstrate history taking skills and coherent case presentations. The aim of this project was to establish a training in which students can test their communication skills during history taking and their clinical reasoning skills in focused case presentations. Methods: In the newly developed training, final-year students took four telemedical histories in the role of physicians from simulated patients (SP). They received further findings for two SPs and presented these in a handover, in which they also received a handover of two SPs which they had not seen themselves. Each student presented one of the two received SPs in a case discussion with a senior physician. Feedback was given to the participants on their communication and interpersonal skills by the SPs with the ComCare questionnaire and on the case presentation by the senior physician. Sixty-two students from the universities of Hamburg and Freiburg in their final year participated in September 2022 and evaluated the training.Results: Participants felt that the training was very appropriate for exam preparation. The SPs' feedback on communication and the senior physician's feedback on clinical reasoning skills received the highest ratings in importance to the students. Participants highly valued the practice opportunity for structured history taking and case presentation and would like to have more such opportunities in the curriculum.Conclusion: Essential elements of the medical licensing exam can be represented, including feedback, in this telemedical training and it can be offered independent of location.

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Introduction: Respiratory syncytial virus (RSV) and influenza virus infections are a significant healthcare risk for immunocompromised patients. In addition to community onset, nosocomial acquisition and transmission may also occur. Detection of asymptomatic shedders (e.g., patients in the incubation period or immunosuppressed long term shedders) faitates control of nosocomial transmission.Methods: To strengthen the existing infection control concept, a PCR-based screening for RSV and influenza virus was implemented for all patients lacking respiratory symptoms (asymptomatic patients) who were hospitalized on an adult and a pediatric hemato-oncological ward. Laboratory results of this screening were analyzed retrospectively.Results: 665 respiratory specimens were obtained for screening from 251 patients (26% were 18 years and younger) from December 2016 to April 2017. In 23 patients without respiratory symptoms, either influenza virus or RSV infection was found, resulting in a detection rate of about 9%. In 6 patients, the infection was presumably detected during the incubation period, because an increase of viral load was observed in subsequent specimens. Positive screening results facilitated timely implementation of adequate infection control precautions. Nosocomial clusters of RSV or influenza were not detected during the screening period on the two wards.Conclusion: The seasonal screening program expanded our existing infection control concept in terms of patients lacking respiratory symptoms who shed influenza virus or RSV. It enabled us to identify 23 RSV or influenza infections in patients lacking respiratory symptoms in a period and thus to rapidly take isolation precautions.

Copyright of Zeitschrift Für Neurologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Many studies have analyzed the clinical significance of clonal hematopoiesis. The collected data lead to the conclusion that in defined clinical constellations a targeted diagnostic search for clonal hematopoiesis seems reasonable., Objective: A diagnostic algorithm and the selection of the right methods are required for use in everyday clinical practice., Methods: A search was carried out in PubMed for relevant literature using the terms clonal hematopoiesis, CHIP, and CCUS, which was evaluated and augmented with expert knowledge., Results: Clonal hematopoiesis is defined as the presence of clonality in hematopoietic cells and is detectable in 5-95% of the aged population depending on the method used. Clinical relevance was demonstrated for larger clones with mutations in specific genes and subsequently the terms clonal hematopoiesis of indeterminate potential (CHIP) and clonal cytopenia of undetermined significance (CCUS) were introduced. For both constellations the relevant gene spectrum as well as the relevant clone size were clearly defined. In CHIP a normal blood count and differential blood count are present by definition. CHIP is therefore currently an incidental finding. In CCUS, on the other hand, cytopenia is present. The clinical risks of the two constellations differ. CHIP is associated with a very low risk of progression to a hematologic neoplasm, whereas in CCUS the risk is significantly increased depending on clone size, number and spectrum of mutated genes., Conclusion: Screening for CHIP is currently not useful. In the presence of persistent cytopenia of unclear cause targeted diagnostic tests including bone marrow evaluation and genetic analyses should be performed., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

This article presents a case of pure red cell aplasia in a 35-year-old heart transplant recipient on chronic hemodialysis. Elevated parvovirus B19 immunoglobulin M blood levels were detected along with a high viral load of 80 billion IU/ml quantified by polymerase chain reaction. Bone marrow examination revealed giant proerythroblasts confirming parvovirus B19 infection. High-dose intravenous immunoglobulin was used for treatment. Anaemia had significantly improved 4 weeks later. Parvovirus B19 infection should be excluded in organ transplant recipients with anaemia due to ineffective erythropoiesis.

The Competence Network "Acute and Chronic Leukemias" was founded in 1997 by the consolidation of the leading leukemia study groups in Germany. Key results are the development of new trials and cooperative studies, the setup of patient registries and biobanking facilities, as well as the improvement of study infrastructure. In 2003, the concept of the competence network contributed to the foundation of the European LeukemiaNet (ELN). Synergy with the ELN resulted in cooperation on a European and international level, standardization of diagnostics and treatment, and recommendations for each leukemia and interdisciplinary specialty. The ultimate goal of the network is the cure of leukemia through cooperative research.

Genetic aberrations form the basis for diagnostic classification of patients with acute myeloid leukemia (AML) according to the World Health Organization (WHO) classification. Moreover, these aberrations predict response to induction chemotherapy, relapse-free survival, and overall survival of patients with AML. Understanding the pathogenetic role of cytogenetic and molecular changes has led to the development of targeted treatment strategies that require rapid diagnostic assessment of the genetic profile of each patient to select the best treatment available.

After cystectomy two principal types of urinary diversion are used for the surgical reconstruction of the urinary tract: incontinent and continent. In the continent type of urinary diversion, a differentiation must be made between those with and without catheterization for voiding. Besides urothelial cancer other reasons for urinary diversion include neurogenic bladder palsy (connatal or acquired) due to meningomyelocele or connatal diseases like bladder exstrophy. The main objective of the clinical urologist when selecting urinary diversion are to achieve continence and to preserve upper urinary tract function. Knowledge of the different forms of urinary diversion is critical for the exact interpretation of the images. This review presents the typical imaging techniques after a description of the basic surgical features of urinary diversion. CT urography and MR urography are becoming increasingly important as further imaging tools for controlling urinary diversions.

Purpose: To improve the image quality of magnetic resonance cholangiopancreatography (MRCP) by modification of examination conditions., Materials and Methods: MRCP of 72 patients was performed with a 1.5 T system (Magnetom Vision, Siemens, 25 mT/m) using two breath-hold techniques, half-fourier acquisition with multislice T2-WI HASTE in MIP technique, and single shot T2-WI turbo-spin-echo (RARE) with different slice thicknesses. The effects of n-butylscopolamine were assessed. Furthermore, oral contrast agents [barium sulfate, Fe(II)-gluconate, Fe(II,III)-oxide] in various concentrations were used. The slice thickness was varied for the RARE sequence (3-7 cm)., Results: N-butylscopolamine had no influence on image quality. Improvements could be attained by variation of the slice thickness. A significant reduction of disturbing background noise was obtained by oral application of iron gluconate, or iron oxide-containing contrast media. Similar improvements were achieved with barium sulfate., Conclusions: Variation of slice thickness allows an improvement of MRCP quality. Oral contrast media improve the image quality of MRCP. The expense of contrast media may be a determinant of choice.

With the use of intravital microscopy and computer-assisted image analysis systems the quantitative analysis of angiogenesis of freely transplanted islets of Langerhans shows that large islets compared with small islets become significantly better vascularized.

With the use of intravital fluorescence microscopy we demonstrate, that GRP in pharmacological doses reduces ischemia/reperfusion injury in the rat. As mechanism we discuss a precapillary vasodilation that has a protective effect on the capillary system downstream. A direct influence on leukocyte-endothelium interaction in post-capillary venules could not be shown. In addition, we show that even the GRP endogenously released plays an important role for the regulation of microvascular perfusion after ischemia/reperfusion injury.

In a 56 year old patient with zoster in the thoracic segments 10 and 11 an abdominal hernia developed. The hernia was caused by peripheral motorial paresis.

Ophthalmomimic is the interaction between the extraocular eye muscles and the mimic muscles. Beside their original phylogenetic assisting function in looking and hearing, the ophthalmomimic muscles now serve in psychological communication: The play with the white of the eye ball can be interpreted as devotion ("to turn a blind eye to"); attention ("to be all eyes"); caution ("to have small eyes and to prick up one's ears"). Further on are examined function and innervation of the involuntary M. retro-auricularis (M. transversus auriculae) of the external ear, so far neglected. Practical diagnostic use could be shown, among others, in early ocular forms of myasthenic syndromes and by the help of the oculoauricular phenomenon for the differentiation between nuclear and peripheral-distal pareses of the abducens nerve.

A scheme of neurological investigation is presented which combines anamnesis, clinical findings, electrophysiological data, course and postoperative documentation for the radicular processes of the lumbo-sacral region (ischias antica et postica).

Abducens nerve paresis may be of nuclear, of peripheral distal neurogenic origine, or is simulated by a myogenic weakness of abduction. Polygraphic emg analysis of the oculoauricularphenomenon (oap) permits a differentiation. In the emg, the oap proved to be a physiologic and constant automatic and always bilateral interaction between the hemolateral abducens nerve and both Nn. faciales with corresponding and obligatory coinnervation of the Mm. retroauricularis of the external ear. In case of medullary, nuclear or internuclear lesions, the oap is disturbed, instable, diminished or abolished, whereas in distal neurogenic or myogenic paresis, even in complete paralysis the oap is bilaterally well preserved.

The eletrodiagnosis of the muscles of the face and eyes are presented according to their historical development. Then the present-day technical possibilities in the different medical fields are explained with emphasis on neurology and psychiatry, illustrated by some clinical descriptions. Selective electromyelography of individual muscles, polygraphic analysis of synergistic or antagonistic reflex mechanismus and the combined biometric methods of psychophysiology are differentiated.

On forced lateral gaze the outer and upper part of both ears is turned backward (oculoauricular phenomenon). A new, as far as we know, skin muscle of the external ear is described and called "m. retroauricularis". The oculoauricular phenomenon is a reflex mechanism between the abducens (m. rectus externus) and facial (m. retroauricularis) nerves. The verification of the automatic and tonic coinnervation is made polygraphically (EMG, stimulodetection) and clinically (unilateral abolition in case of homolateral facial paralysis). The oculoauricular reflex is a physiological and bilateral phenomenon, often rudimentary in man. It serves in looking, hearing and miming. The bilateral mechanism of innervation in the brainstem via the medial longitudinal fasciculus corresponds to Bell's phenomenon as to the "anti Bell".