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Background: The aim of this study was to evaluate the perioperative oncological and functional outcomes after robot-assisted radical prostatectomy (RALP) in older men.Patients and Methods: The records of n = 2,000 men who underwent RALP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients ≥ 75 years were indentified. Subsequently this subgroup was compared to the overall patient cohort with regard to perioperative results, pathological tumor stage, functional outcomes after 12 months and the prostate cancer-specific mortality and biochemical recurrence free survival.Results: The following results reflect the comparison of the cohort of patients who were ≥75 years of age versus the overall cohort of patients. A statistical difference of the parameters analyzed was observed only for minor complications 15.5 % versus 11.4 % (p<0.05), neurovascular bundle (NVB) preservation 51.1 % versus 65.7 % (p<0.05) and potency after 12 months 39.6 % versus 66.2 % (p<0.001). Major complications were noted in 2.2 % versus 1.3 % of cases. A Gleason score <7 was noted in 37.4 % versus 42.8 %, a Gleason score 7 in 51.1 % versus 47.7 % and a Gleason score >7 in 11.6 % versus 9.5 %. Tumor stages pT2 and pT3 were noted in 68.8 % versus 73.5 % and in 31.2 % versus 25.2 %, respectively. The positive surgical margin status was encountered in 11.1 % versus 8.9 % of cases, respectively. At 12 months 86.9 % versus 92.8 % of patients were continent and 39.6 % versus 66.2 % were potent, respectively. After a median follow-up of 17.2 months the prostate cancer-specific mortality in the subgroup of elderly patients was 0 % and the biochemical recurrence-free survival was 95.5%.Conclusions: The RALP approach in patients ≥75 years of age is a safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes as well as acceptable erectile function. Nevertheless, RALP should be limited to a selected cohort of patients with a good health status and an individual life expectancy of more than 10 years. For the assessment of the final oncological benefits of RALP in this patient population a longer follow-up is necessary. [ABSTRACT FROM AUTHOR]

Background: Objective cognitive assessment and subjective self-assessment do not sufficiently reflect actual daily routines and everyday functioning of patients with epilepsy. The study at hand examined whether a questionnaire assessing the activities of daily living provides additional diagnostic information., Methods: A total of 180 consecutive patients with epilepsy received a questionnaire addressing (i) mood, (ii) subjective cognitive performance as well as (iii) frequencies of subjective problems in everyday life and (iv) 36 activities of daily living (ADL-Track). Normative data were based on 536 healthy volunteers. Analysis focused on the interrelation among these subjective measures as well as their relation to objective neuropsychological performance., Results: Compared to the normative sample, social activities, home activities, and mobility were reduced in 25 - 34 % of the patients (OR = 2.07 - 2.79). Frequencies of activities of daily living reflect the results of subjective performance ratings ("attention", "praxia") and objective performance in attention, language, intelligence and memory. A negative mood showed highly significant correlations with subjective complaints and increased the risk of reduced activities by a factor of 2 - 3. Multiple regression analyses explained between 9 - 22 % of the variance of the ADL-Track scales., Conclusion: The ADL-Track, a questionnaire on frequencies of activities of daily living, appears more independent from mood than subjective complaints and it shows relevant correlations with subjective and even more with objective cognitive measures. Moreover, it indicates a behavioural domain in epilepsy which is not yet covered by standard diagnostics. When applied longitudinally, the ADL-Track may well turn out to be a valuable longer-term outcome parameter with regard to epilepsy and its treatment., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The aim of this study was to evaluate the perioperative oncological and functional outcomes after robot-assisted radical prostatectomy (RALP) in older men., Patients and Methods: The records of n = 2,000 men who underwent RALP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients ≥ 75 years were indentified. Subsequently this subgroup was compared to the overall patient cohort with regard to perioperative results, pathological tumor stage, functional outcomes after 12 months and the prostate cancer-specific mortality and biochemical recurrence free survival., Results: The following results reflect the comparison of the cohort of patients who were ≥75 years of age versus the overall cohort of patients. A statistical difference of the parameters analyzed was observed only for minor complications 15.5 % versus 11.4 % (p<0.05), neurovascular bundle (NVB) preservation 51.1 % versus 65.7 % (p<0.05) and potency after 12 months 39.6 % versus 66.2 % (p<0.001). Major complications were noted in 2.2 % versus 1.3 % of cases. A Gleason score <7 was noted in 37.4 % versus 42.8 %, a Gleason score 7 in 51.1 % versus 47.7 % and a Gleason score >7 in 11.6 % versus 9.5 %. Tumor stages pT2 and pT3 were noted in 68.8 % versus 73.5 % and in 31.2 % versus 25.2 %, respectively. The positive surgical margin status was encountered in 11.1 % versus 8.9 % of cases, respectively. At 12 months 86.9 % versus 92.8 % of patients were continent and 39.6 % versus 66.2 % were potent, respectively. After a median follow-up of 17.2 months the prostate cancer-specific mortality in the subgroup of elderly patients was 0 % and the biochemical recurrence-free survival was 95.5%., Conclusions: The RALP approach in patients ≥75 years of age is a safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes as well as acceptable erectile function. Nevertheless, RALP should be limited to a selected cohort of patients with a good health status and an individual life expectancy of more than 10 years. For the assessment of the final oncological benefits of RALP in this patient population a longer follow-up is necessary.

Neuropsychological assessment has become an essential tool for the diagnosis and outcome control in the clinical management of epilepsy. However, only a few attempts have been made to formulate explicit guidelines about which cognitive domains should be addressed in epilepsy patients and which of the various coexisting neuropsychological tests would provide an appropriate and evidence-based assessment. The present survey among 14 epilepsy centres in German-speaking countries indicates that there is at least some consensus concerning the cognitive domains which need to be addressed. However, concerning test selection a large diversity of more than 200 applied psychometric tests among the different epilepsy centres becomes evident. Evidence-based test selection was only seen in 25 % of the applied instruments. One-third of the tests are conducted because of pragmatic reasons or due to subjective preferences, whereas for the majority of tests no justification is provided. Taking into consideration the bulk of publications on cognition and epilepsy, it is time to establish an evidence-based core test battery for the use in epilepsy patients. Therefore a closer communication between centres is needed to come to an agreement and to accumulate experience with already established and newly developed tests in order to promote evidence-based neuropsychology in the field of epilepsy., (Georg Thieme Verlag KG Stuttgart New York.)

In order to understand cognitive impairment associated with epilepsy, it is essential to appreciate that independent static and dynamic factors affect brain function in this disease. Whereas morphological lesions or structural changes are associated with more or less irreversible deficits, epileptic activity, seizures, and the treatment of epilepsy can cause dynamic and principally reversible impairment. The relative contribution of these factors differs depending on the type of epilepsy, the age at lesion/epilepsy onset, the localization and lateralization of epilepsy and individual demographic patient characteristics. Altered brain structure and function can result in epilepsy, but epilepsy can also alter the functional cerebral organization of the brain. Thus epilepsy-related cognitive impairment must be integrated within a developmental neuropsychological framework. The aetiology of epilepsy is strongly related to the age of onset. From a neuropsychological point of view, it makes a big difference for cognitive outcome as to whether epilepsy hits the maturing versus mature or aging brain. Dependent on this, epilepsy can result in retardation, loss of acquired functions, or accelerated mental decline. It will be demonstrated that cognitive impairments in epilepsy mostly exist from the beginning of epilepsy, that early onset lesions/epilepsy interfere with mental development, and that a progressive aetiology, severe seizures, and lesions secondary to epilepsy may accelerate mental decline. It will furthermore be discussed that uncontrolled epilepsy and epileptic activity may reversibly and irreversibly contribute to cognitive impairment. The same is demonstrated with regard to the pharmacological treatment of epilepsy. Finally, the cognitive risks and benefits of epilepsy surgery and the advantages of selective surgery will be addressed. The consequences for the neuropsychological assessment are discussed in part two of this review., (Georg Thieme Verlag KG Stuttgart, New York.)

Since first described in 1883 by Fournier only 420 cases of Fournier's gangrene have been published worldwide during the last 100 years. The anatomic association between the fascies of penis, scrotum, perineum, groin and gluteal favors the fast spread of tissue necrosis. We report two cases in which the penis, scrotum and a great part of the trunk and extremities were affected. Extensive débridement, including removal of the scrotum, and antibiotic treatment permitted us to get rid of the symptoms. Reconstruction of the skin defects was done in a second step by applying mesh grafts. The histological findings correspond to those found in cases of necrotizing fasciitis. The basic difference between these two illnesses is their localization. While Fournier's gangrene, as a special form, is localized primarily in the anogenital area, fasciitis may arise in all locations. For successful treatment of Fournier's gangrene speedy radical débridement and local application of antibiotics to cover the entire area are required.

41 patients (45 renal tumours) were examined by magnetic resonance imaging to assess the value of the method and its use to specify renal tumours. Histological findings were available in 38 cases. The results of MRI were compared with the CT and ultrasound diagnosis and the histological findings. In 92.1% (35/38) the CT-diagnosis agree with the histological findings, the ultrasound in 76.3% (29/38) and the MRI in 84.2% (32/38). To specify renal tumours the diagnosis by CT-scan and ultrasound is sufficient.

Four cases of intra- and extrahepatic aneurysms of the hepatic artery are discussed concerning the etiology, symptoms, therapy and complication rate. The diagnostic approach and problems in differential diagnosis are specified. Localization of the aneurysm and especially the relationship of the collateral circulation of the hepatic bed are essential to plan the therapy and are based on angiography. Interventional therapeutic techniques are favored for intrahepatic localization. Reconstructive or ablative surgery is indicated to treat the extrahepatic aneurysm.