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Raumforderungen im Bereich des Skrotums stellen einen haufigen Grund fur einen ambulanten Besuch eines Patienten in der Praxis dar. Diese konnen schmerzlos oder schmerzhaft auftreten, extratestikular oder intratestikular liegen, zystisch oder solide erscheinen. Die Unterscheidung zwischen gutartigen und bosartigen Raumforderungen ist sehr wichtig, um den Patienten eine adaquate und differenzierte Therapie zu ermoglichen. In der Diagnostik spielt neben Anamnese, Untersuchung der inguinoskrotalen Region sowie Labordiagnostik insbesondere die Sonographie des Skrotums eine bedeutende Rolle. In den letzten Jahren ist der vermehrte Einsatz der kontrastmittelgestutzten Sonographie zur Differenzierung der verschiedenen Raumforderungen im Bereich des Skrotums zu beobachten. Von besonderer Bedeutung ist der maligne Hodentumor, da er die haufigste bosartige Erkrankung beim jungen Mann ist (nach Angaben des Robert Koch-Instituts ca. 3900 Neuerkrankungen pro Jahr in Deutschland).

Background: Immune checkpoint inhibitors (ICIs) are approved for first-line (cisplatin unfit, PD-L1+) and platinum-refractory urothelial carcinoma (UC). Still, most patients experience progressive disease (PD) as the best response. Although higher response rates to subsequent systemic treatment (SST) have been described, post-PD outcome data are scarce. Objective: To examine the outcome of UC patients who received SST and no SST after progressing to ICIs. Design, setting, and participants: A retrospective analysis of UC patients progressing to frontline or later-line anti-PD-1/PD-L1 therapy in 10 European institutions was conducted between March 2013 and September 2017. Intervention: Post-PD management as per standard practice. Outcome measurements and statistical analysis: Overall survival (OS) was analyzed with a Kaplan-Meier model. Cox regression was used for multivariate analysis (MV). Impact of SST on OS was examined with a time-varying covariate model. Results and limitations: A total of 270 UC patients with PD to ICIs (69 frontline, 201 later line) were analyzed. Of the patients, 57% of frontline-ICI-PD and 34% of later-line-ICI-PD patients received SST, and SST had an impact on OS in MV (frontline: hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.10-0.51, p< 0.001; later line: HR 0.22, 95% CI 0.13-0.36, p< 0.001). In the frontline-ICI-PD group, median OS with and without SST was 6.8 mo (95% CI 5.0-8.6) and 1.9 mo (95% CI 0.9-3.0), respectively. High disease burden (three or more metastatic sites: HR 2.49, p = 0.03; simultaneous liver/bone metastases: HR 3.93, p = 0.03) predicted worse survival. In later-line-ICI-PD group, response to ICIs (HR 0.37, p = 0.03), longer exposure to ICIs (HR 0.89, p = 0.002), and bonemetastasis (HR 2.42, p< 0.001) predicted survival. The retrospective nature of this study and a lack of certain parameters limit the interpretation of our analysis. Conclusions: Patients progressing to frontline ICIs are at risk of early death, excluding them from experiencing potential benefit from chemotherapy Patient summary: Our analysis suggests that outcomes after failing immunotherapy are poor, particularly in UC patients who received no prior chemotherapy. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

An investigation is conducted into the practical electric vehicle implementation of a high speed flywheel energy storage system that can supply and accept peak acceleration and braking power. Electric vehicle battery life cycle can be extended considerably by supplying peak energy requirements from a secondary source. Simulations are performed to determine the peak power and energy requirements over the SAE recommended electric vehicle test procedure. A scaled prototype secondary energy storage unit is built using flywheel energy storage. Tests are conducted to determine the energy transfer capabilities of a flywheel couples high speed permanent magnet synchronous machine through the proposed system's energy storage tank. Results are presented that indicate the necessity of the energy storage tank. A system evaluation is also included which indicates its near-term practically when compared to conventional regenerative control applications. Construction techniques are discussed for the development of high speed drive circuits used in electrically noisy environments. Shielding and electromagnetic interference reduction methods are proposed for application to an actual high efficiency sinusoidal phase current, microprocessor interfaced, vector controlled, high speed permanent magnet synchronous machine drive. A discussion on the theory and construction of such a drive is provided to demonstrate the implementation of a laboratory prototype high speed flywheel energy storage system. An experimental investigation is conducted using the developed high speed drive to determine permanent magnet synchronous machine parameter behaviour in the high speed flux weakening operating range. Special computer assisted measuring techniques are used to determine the realtime operating characteristics for two commercially available machines. The repeatable experimental results show a significant variation in the machine parameters as a function of the speed and torque angle. Implications of the newly identified dynamic parameters are discussed regarding their application to, and effect on, high performance permanent magnet synchronous machine torque control. Doctor of Philosophy (PhD)