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A challenge for solid organ transplantation in Germany is the shortage of organs. In an effort to increase donation rates, some federal states mandated hospitals to install transplantation officers to coordinate, evaluate, and enhance the donation and transplantation processes. In 2009 the German Foundation for Organ Transplantation (DSO) implemented the In-House Coordination Project, which includes retrospective, quarterly, information technology-based case analyses of all deceased patients with primary or secondary brain injury in regard to the organ donation process in maximum care hospitals. From 2006 to 2008 an analysis of potential organ donors was performed in our hospital using a time-consuming, complex method using questionnaires, hand-written patient files, and the hospital IT documentation system (standard method). Analyses in the In-House Coordination Project are instead carried out by a proprietary semiautomated IT tool called Transplant Check, which uses easily accessible standard data records of the hospital controlling and accounting unit. The aim of our study was to compare the results of the standard method and Transplant Check in detecting and evaluating potential donors. To do so, the same period of time (2006 to 2008) was re-evaluated using the IT tool. Transplant Check was able to record significantly more patients who fulfilled the criteria for inclusion than the standard method (641 vs 424). The methods displayed a wide overlap, apart from 22 patients who were only recorded by the standard method. In these cases, the accompanying brain injury diagnosis was not recorded in the controlling and accounting unit data records due to little relative clinical significance. None of the 22 patients fulfilled the criteria for brain death. In summary, Transplant Check is an easy-to-use, reliable, and valid tool for evaluating donor potential in a maximum care hospital. Therefore from 2010 on, analyses were performed exclusively with Transplant Check at our university hospital. [ABSTRACT FROM AUTHOR]

Purpose: The relevance of abdominal vascular injuries in polytraumatic patients within a large collective has not yet been thoroughly analyzed. This study aimed at assessing the prevalence of traumatic injuries in relation to outcome and currently established treatment options. Methods: 51,425 patients from the Trauma Registry of the German Society of Trauma Surgery (TR DGU) (1993-2009) were analyzed retrospectively. All patients who had an Injury Severity Score (ISS) of ≥16, were directly admitted to a trauma center and subsequently received treatment for at least three days, were ≥16 years old, and had an abdominal injury (AIS ≥2) were included. Patients with abdominal trauma (AIS ≥2) were compared with patients with additional vascular trauma (AIS 2-5). Results: 10,530 (20.5 %) of the 51,425 patients had documented abdominal injury. 760 (7.2 %) of the patients with abdominal injury additionally showed abdominal vascular injury (AIS ≥2, AIS 2-5) and were analyzed based on the classification of the American Association for the Surgery of Trauma (AAST) organ severity score (AAST vascular injury grade: II, 2.4 %; III, 2.7 %; IV, 1.8 %; V, 0.2 %. Patients with high-grade abdominal vascular injury (grades IV and V) showed a significant increase in mortality (IV, 44.6 %; V, 60 %) and consequently a decrease in the need for surgical intervention (IV, 67.4 %; V, 64 %). Conclusions: The results presented here show the prevalence and outcome of abdominal vascular injuries in a large collective within the TR DGU for the first time. Based on the current literature and these findings, a treatment algorithm has been developed. [ABSTRACT FROM AUTHOR]

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Introduction: The current organ donor shortage in Germany results in the death of 1000 patients on the transplant waiting list every year. In response, a recent amendment to the German Transplant Act aiming to increase donor rates was passed. Among a number of other measures, Germans are asked to decide whether they choose to donate organs or not in the event of a brain death or whether they would like to designate someone who should decide for them in this situation. The objective of this study was to collect and evaluate data on the public's attitude toward organ donation before the expected amendment. Methods: A survey on the subject of organ donation was conducted in 2011 among clients of a public pharmacy in a major city in the federal state North Rhine-Westphalia, Germany. Data regarding sex, age, health behavior, and attitude toward the amendment were collected and association organ donor card possession was analyzed. Results: A total of 1485 questionnaires were evaluated. Of those surveyed, only 14.1% had an organ donor card. No statistically significant associations between sex (P value .3045), age (P value .1453) and the possession of a donor card were observed. We found that 72.5% of respondents stated that they appreciated the expected amendment, and in the case of implementation, the majority would obtain an organ donor card. Discussion: The future success of transplantation medicine relies on an increase in the public's overall willingness to donate organs. Educating the public and ensuring transparency in transplantation medicine are vital to achieving higher donation rates. The new German transplantation act may be an important step to increase society's awareness and participation in organ donation. [ABSTRACT FROM AUTHOR]

Objectives: Sedation has been established for GI endoscopic procedures in most countries, but it is also associated with an added risk of complications. Reported complication rates are variable due to different study methodologies and often limited sample size., Designs: Acute sedation-associated complications were prospectively recorded in an electronic endoscopy documentation in 39 study centres between December 2011 and August 2014 (median inclusion period 24 months). The sedation regimen was decided by each study centre., Results: A total of 368 206 endoscopies was recorded; 11% without sedation. Propofol was the dominant drug used (62% only, 22.5% in combination with midazolam). Of the sedated patients, 38 (0.01%) suffered a major complication, and overall mortality was 0.005% (n=15); minor complications occurred in 0.3%. Multivariate analysis showed the following independent risk factors for all complications: American Society of Anesthesiologists class >2 (OR 2.29) and type and duration of endoscopy. Of the sedation regimens, propofol monosedation had the lowest rate (OR 0.75) compared with midazolam (reference) and combinations (OR 1.0-1.5). Compared with primary care hospitals, tertiary referral centres had higher complication rates (OR 1.61). Notably, compared with sedation by a two-person endoscopy team (endoscopist/assistant; 53.5% of all procedures), adding another person for sedation (nurse, physician) was associated with higher complication rates (ORs 1.40-4.46), probably due to higher complexity of procedures not evident in the multivariate analysis., Conclusions: This large multicentre registry study confirmed that severe acute sedation-related complications are rare during GI endoscopy with a very low mortality. The data are useful for planning risk factor-adapted sedation management to further prevent sedation-associated complications in selected patients., Trial Registration Number: DRKS00007768; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: The overall increase in life expectancy causes a rapid increase in number of elderly patients needing colorectal surgery. It remains unclear if there is a significant risk factor in patients over 80 years of age for postoperative morbidity and mortality. For this reason we investigated the perioperative, outcome and long-term survival after surgery for colorectal cancer in our hospital., Materials and Methods: We retrospectively analysed a database containing information about patients who underwent surgery for colorectal cancer from January 2010 to December 2015 at the St. Bernhard Hospital in Kamp-Lintfort, Germany. The last follow-up date was 31th of December 2017., Results: A total of 232 patients were enrolled and analysed in this study. All patients were separated in tow groups depending in age. The first group was ≥80 years old (n=49). The second group was <80 years old (n=183). High ASA-Scores (≥3) were detectable more often in elderly patients (p<0,05). Elderly and young patients had a similar risk for postoperative anastomosic leakages (p=0,047). Likewise there were no significant differences regarding the Dindo-Clavien-Classification (p=0,13). The mortality within the first 30 days after surgery was significant elevated for elderly patients compared to younger patients (p=0,04). Also the overall 1-year survival was 90% for the younger and 73,5% for the older study group (p<0,05) Conclusion. Both the short-term outcome and long-term survival rate after colorectal surgery for cancer are worse for patients older than 80 years of age. After interpretation of all data it remains unclear if the age itself is still the biggest risk factor. When old patients have a good ASA-Score and no severe comorbidities, colorectal surgery remains safe even for patients older than 80 years.

During the premenstrual phase, psychological and physiological changes can occur, which are associated with different levels of disability. When they appear with Premenstrual Dysphoric Disorder (PMDD), different coping strategies may be used by women to deal with premenstrual changes. Currently no German measure exists for assessing premenstrual symptom-related coping strategies. Therefore, we developed the Premenstrual Change Coping Inventory (PMS-Cope). First, the 33-item questionnaire was tested with an exploratory factor analytic approach (EFA) in a sample of 150 women prospectively diagnosed with PMDD or severe Premenstrual Syndrome from August 2013 until March 2016. The EFA resulted in a 12-item scale with a two-factor structure: "seeking positive affect-inducing activities" and "seeking support"; Cronbach`s alpha of 0.73 and 0.71, respectively, demonstrated good reliability for both factors. Confirmatory factor analysis based on a second sample of 89 women conducted from May 2016 until June 2016 confirmed the two-factor structure. Additionally, a potential third factor "healthcare use behavior" was tested with an EFA. For the three-factor solution, satisfactory Cronbach's alpha values (0.70-0.72) were detected. The PMS-Cope was shown to be a valid, reliable, and economic measure. In future research, cross validations and confirmatory factor analyses with the three-factor solution should be conducted.

Background: Intrahepatic cholangiocarcinomas are the second most common malignant tumors of the liver with an unfavorable prognosis. The role of CA19-9 in terms of patient prognosis is still under debate in the literature., Objective: The aim of the present study was to investigate the prognostic value of preoperatively assessed CA19-9 levels in patients with intrahepatic cholangiocarcinoma after surgery., Material and Methods: A total of 63 patients suffering from intrahepatic cholangiocarcinoma underwent surgery between March 2001 and February 2013 at the West German Cancer Center in Essen, Germany. The follow-up ended in December 2017. The UICC stages, clinicopathological parameters and postoperative tumor-specific survival rates were analyzed with respect to preoperatively measured CA19-9 serum levels., Results: Increased CA19-9 serum levels correlated with higher UICC tumor stages and other unfavorable clinicopathological parameters. Moreover, patients with preoperative elevated CA19-9 serum levels displayed significantly reduced overall survival rates (especially >1000 U/ml vs. ≤1000 U/ml; median overall survival: 14.05 months vs. 42.40 months; p = 0.0003)., Conclusion: Preoperatively assessed CA19-9 levels >1000 U/ml are a strong negative prognostic factor of postoperative disease-specific survival in patients suffering from intrahepatic cholangiocarcinoma. Future studies are necessary to evaluate if patients with highly elevated CA19-9 serum levels should be considered for modified treatment strategies (e. g. neoadjuvant or adjuvant therapy).

Skin changes are common in patients on dialysis. This study focused on putative associations of specific skin findings with comorbidities and mortality.We performed a retrospective analysis of data from 508 patients on maintenance hemodialysis therapy in 7 centers in the German State of North Rhine Westphalia. Data had been collected by interview, from patient files, and from targeted physical examination in an earlier prospective study screening hemodialysis patients for the presence of nephrogenic systemic fibrosis. While on dialysis, patients' extremities had been examined for any of the following: edematous skin at the lower extremities, hyperpigmentation, induration, and xerosis cutis. Our present data analyses focused on associated mortality and comorbidities.Five hundred eight patients (median age 71 years, range 20.0-95.9; n = 292 men) had agreed to participate in the initial study: 48% (n = 243) were diabetics and 46% (n = 232) had been diagnosed with coronary heart disease. On examination, 86% of patients (n = 439) presented with at least 1 of the prespecified skin changes. Skin edema (n = 89; 18%), hyperpigmentation (n = 74; 15%), and induration (n = 9; 2%) were independently associated with increased mortality over 24 months (P < 0.002, P < 0.030, and P < 0.020, respectively).In our study, prespecified skin changes indicated an increased mortality risk in patients on chronic hemodialysis. Routinely assessing the skin of dialysis patients represents a simple, reliable, and cost effective means of identifying those at greatest risk., Competing Interests: The authors have no funding and conflicts of interest to disclose.

Background: Organ shortage remains a major challenge in transplantation medicine. The aim of this study was to analyze the public's willingness to donate organs and to observe whether increased knowledge about organ donation has an effect on the attitude toward organ donation. The study in particular tested the efficacy of using electronic communication as a means to distribute information., Methods: In 2011, an Email invitation to participate in a survey was sent to the employees of the University Duisburg-Essen. The survey consisted of a two-piece questionnaire with an informational intervention on organ donation between the questionnaires. The technical design ensured that interviewees remained anonymous and could participate only once., Results: In total, 1,818 interviewees completed the questionnaire. Of the respondents, 42% were organ-donor card holders (which was consistent among genders and age groups), whereas 87% of the interviewees would support an organ donation for themselves. Of the interviewees who did not possess an organ-donor card, 67% were positively inclined toward holding one in future after reading the interventional information., Conclusions: The considerable improvement in attitude toward carrying an organ-donor card after reading the information illustrates the effectiveness of distributing concise information on organ donation. To increase the willingness to donate organs, it is of great importance to inform the public and facilitate the documentation of a decision to donate. The present study has proven the use of Email communication to be an important asset to this process.

Background: The relevance of hollow organ trauma in severely injured patients within a large collective has not been thoroughly reviewed as yet. This study aimed at assessing the prevalence of hollow organ trauma in relation to the outcome and the currently established method of treatment., Patients and Methods: Altogether data of all patients of the Trauma Register of the German Society of Trauma Surgery (DGU) (1993 - 2009) were interpreted retrospectively. All patients with an "Injury Severity Score" (ISS) ≥ 16, direct admission to a trauma centre and an age of ≥ 16 years were included. All patients with abdominal trauma (AISabdomen ≥ 2) were compared with patients with hollow organ trauma (AIShollow organ ≥ 2). The following organs were attributed to the hollow organs: stomach, small intestine (duodenum, jejunum / ileum), colon, gall bladder and urinary bladder., Results: From 9268 patients with abdominal injuries 1127 (12.2 %) additionally showed a hollow organ injury (AISabdomen ≥ 2, AIShollow organ 2 - 5) and were analysed in dependence on the classification of the "American Association for the Surgery of Trauma" (AAST) organ severity score. AAST-hollow organ: II°: 4.6 %, III°: 5.3 %, IV°: 2.1 %, V°: 0.2 %. Patients with leading hollow organ injury (grades IV and V) thereby showed a significant increase of lethality (IV°: 32.7 % and V°: 31.3 %). With an increasing grade of hollow organ injury, however, the ISS increased as well. Lethality was not increased over the expected lethality rate (RISC score) due to the additional hollow organ injury though., Conclusion: The results presented here show the prevalence and the outcome of hollow organ injury in a large collective within the Trauma Register of the DGU for the first time., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Due to the lack of donor organs many patients cannot be helped in time with the necessary transplantation in Germany. At the same time, there is an organ donor potential that is not being exploited. A high refusal rate with a low rate of organ donor card holders remains problematic. The objective of this study was to collect the rate of holders of organ donor cards in a collective and to evaluate the collective according to other attributes in the context of a targeted trial., Methods: In 2009, a three-part questionnaire including an educational text regarding the topic of "organ donation" was sent out to the employees of the Sparkasse Essen (a savings bank)., Results: Altogether, 974 out of 1480 (65.8 %) completely answered questionnaires were evaluated. 21.3 % of the respondents had an organ donor card at the time the survey was carried out. A statistically significant association between gender (p value, 0.0438), age (p value, 0.0267) and the possession of a donor card could be determined. 22.1 % of the respondents who participated in sports regularly or donated blood (p value, < 0.0049), were holding an organ donor card. 60 % of the respondents found the brief information to be sufficient, 22.6 % could imagine acquiring an organ donor card for them based on the presented information alone., Conclusion: The spread of information and transparency in transplant medicine are essential for the facilitation of "willingness to donate organs". In the framework of this trial, besides data analysis, also fundamental information on "organ donation" could be conveyed. After all, 95.3 % of the respondents have read the information material and hence document the success of the study., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: There is still a lack of organ donors in Germany to provide organs for everyone on the waiting list. Against this background, the project "inhouse coordination" was initiated in 112 German hospitals in order to promote organ donation. We report the first results and experiences with this project at three full-service university hospitals., Methods: From April 2010 to March 2011 data on all deceased patients with primary or secondary brain damage were collected retrospectively. The analysis of anonymised data was carried out by using the Software "Transplant-check" of the German Hospital Institute, as well as in-house databases., Results: In comparison to the year before, no increase in numbers of organ donation was achieved during the study period. A total of 544 patients were deceased with a primary or secondary brain damage as main or secondary diagnosis. In 40.3 % medical contraindications prevented organ donation. In 34.5 % treatment limitation was introduced. Brain death was diagnosed in 59 of 544 patients (10.8 %) and organ donation was possible in 5.5 %., Conclusion: In our analysis, a potential donor gap was noted which could not be clarified. Above all, it remains unclear in how many deceased patients with a fatal brain damage, the final diagnosis of brain death would have been possible. Even if these analyses did not lead to reliable results or conclusive evidence of organ donor potential, structural qualities were achieved in all hospitals. Ensuring the identification of potential organ donors and the accompanying support of the process should be of priority for future collaborative efforts of hospitals, transplant centers and the organ procurement organisation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: A chronic shortage of organs for transplantation has developed due to the disparity between the demand for solid organs and the current supply. Improved processes for identifying potential donors could expand the pool of available organs., Patients and Methods: All patients who died between January 1, 2006 and December 31, 2008 in the University hospital of Essen suffering from a primary or secondary cerebral injury were assessed retrospectively. Age, date of death, duration of stay in the intensive care unit, main and additional diagnoses and diagnostic test for assessing brain death as well as discussions with relatives were recorded anonymously., Results: 424 deaths with primary or secondary cerebral injury (group A) were identified during the study period. 267 deaths (62.9 %) (group B) were further evaluated for organ donation after excluding absolute medical contraindications, e. g. malignancies, multiple organ failure. In 68 cases (16.0 %), diagnostic test of brain death had been completed (group C). Despite a high refusal rate, 36 (8.5 %) organ procurements were realized (group D) resulting in 140 transplanted organs (3.9 per organ donor)., Conclusion: The first crucial step to improve the rate of organ donation is to identify any potential donor. In 8.5 % of intensive care unit deaths with primary or secondary cerebral damage, organ procurement was realized. In addition, education regarding transplant medicine and a positive attitude to organ donation among the general public as well as medical personnel is necessary to minimize the high refusal rates., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure., Methods: 13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score >16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I) and conservative managed patients (II))., Results: From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3%) of the patients with splenectomy and 102 (18.5%) without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2%) in both groups. After massive transfusion of red blood cells (>10) non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40%) and sepsis (38% vs. 25%)., Conclusions: Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3) and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.

Objective: Due to organ shortage, average waiting time for a kidney in Germany is about 4 years after start of dialysis. Number of kidney grafts recovered can only be maintained by accepting older and expanded criteria donors. The aim of this study was to analyse the impact of donor and recipient risk on kidney long-term function., Methods: All deceased kidney transplantations were considered. We retrospectively studied 332 patients between 2002 and 2006; divided in 4 groups reflecting donor and recipient risk., Results: Non-marginal recipients were less likely to receive a marginal organ (69 of 207, 33%) as compared to marginal recipients, of whom two-thirds received a marginal organ (p<0.0001). Graft function significantly differed between the groups, but detrimental effect of marginal recipient status on eGFR after 12 months (-6 ml/min/1.73qm, 95% CI -2 to -9) was clearly smaller than the effect of marginal donor status (-10 ml/min/1.73qm, 95% CI -7 to -14)., Conclusions: As we were able to show expanded criteria donor has a far bigger effect on long-term graft function than the "extra risk" recipient. Although there have been attempts to define groups of recipients who should be offered ECD kidneys primarily the discussion is still ongoing.

Objective: The purpose of the present study was to assess the needs of dementia patients using the German language version of the Camberwell Assessment of Need for the Elderly (CANE) and to investigate the internal consistency of German language., Methods: A sample of 45 dementia patients was investigated using the German CANE. Data were collected from family caregivers., Results: Most dementia patients showed a multitude of problems. In most cases, support was provided more frequently from informal caregivers than from social or medical services. Internal consistency ranged between 0.797 and 0.900 (Cronbach's Alpha)., Conclusions: The high frequency of problems indicates the importance of long-term planning of services for dementia patients. The internal consistency of the German CANE was sufficiently high.

The persistent shortage of organs for transplantation could be minimized by increasing the number of potential donors. The opinion of the staff of a university hospital toward organ donation is of special interest because they are directly involved in solid organ transplantation. In 2007, we conducted a first voluntary survey concerning organ donation among the staff of the university hospital of Essen. A short information campaign and further opinion poll among staff as well as visitors was performed in 2009 to compare professional and public attitudes toward organ donation. The first poll comprised 242 questionnaires showing 55% of the hospital staff carrying organ donor cards, particularly more women (60%) than men (46%). After this survey, an additional 19% of the hospital staff imagined they might carrying an organ donor card in the future. In the second survey, we analyzed 151 questionnaires, showing 66% of staff members carrying an organ donor card, an incidence significantly greater than among visitors (48%). The need for information regarding organ donation was greater among visitors (35%). However, 21% of the hospital staff still also need education concerning organ donation. More education and increased transparency of transplantation practice are necessary for hospital staff to act successfully as initiators. Hospital staff with positive attitudes toward organ donation may have a positive impact on the attitudes of the general public toward organ donation.

Introduction: Each year in Germany, the lack of donor organs results in more than 1000 patients dying while on the transplant waiting list. At the same time, there is an organ donor potential that is not being exploited. The objective of this study was to collect the rate of holders of organ donor cards among public officials in a major German city., Methods: In 2007, a survey was conducted among public officials in Essen, North Rhine-Westphalia, Germany, regarding the topic of organ donation. Gender, age, and the "indicator for organ donation willingness" were stratified and analyzed according to the holding of organ donor cards., Results: A total of 1582 completely answered questionnaires were evaluated; 20.92% of the respondents had an organ donor card. No statistically significant association between gender (P = .0691), age (P = .8513), or possession of a donor card could be determined. We observed a significant correlation (P < .0001) between the indicator for organ donation willingness and possession of an organ donor card., Discussion: Based on current research, we consider an up-to-date, broader-reaching, representative inquiry necessary for our society. Should this present similar results, then a special education campaign is necessary, which considers sociocultural backgrounds and responds to the indicator for organ donation willingness that we analyzed. In so doing, one individual goal is the promotion of health and body awareness and thus an increase in the associated potential organ donor willingness.

Background: Currently, organ transplantation is the treatment of choice for patients with chronic or acute organ failure. However, due to a lack of donor organs, every day three patients die on the waiting list for transplantation. At the same time there is a high potential of organ donors that is not utilized. Statements concerning the number of potential donors are possible only to a limited extent at present. Objective of this study was to collect the rate of holders of organ donor cards among the employees of the city of Essen before a targeted awareness raising campaign had been carried out., Patients and Methods: A questionnaire was sent out to the employees of the city of Essen in 2007. Gender, age and the "indicator for readiness for organ donation" were stratified and analyzed according to the holding of organ donor cards. The indicator reflects the evaluation of health awareness in the respondents., Results: Altogether, 1 814 questionnaires were evaluated. 20 % of the respondents were holding an organ donor card at the time of the survey. No association between gender (p-value 0.17) respectively age (p-value 0.79) and the possession of an organ donor card could be detected. 23 % of the respondents who regularly worked out or donated blood were identified as organ donor card holders. This is significantly more (p-value < 0.0001) than in respondents where this criterion did not apply., Conclusion: In order to optimize the potential of organ donors in the long term, it is necessary to reconsider and advance attitude towards the readiness for organ donation. Further spreading of information and education as well as transparency in the transplantation medicine are essential for this project.

Background: The present study reports a German survey addressing outcomes in nonselected historical series of liver transplantation (OLT) for hilar cholangiocarcinoma (HL)., Patients and Methods: We sent to all 25 German transplant centers performing OLT a survey that addressed (1) the number of OLTs for HL and the period during which they were performed; (2) the incidence of HL diagnosed prior to OLT/rate of incidental HL (for example, in primary sclerosing cholangitis); (3) tumor stages according to Union Internationale Centre le Cancer; (4) patient survival; and (5) tumor recurrence rate., Results: Eighty percent of centers responded, reporting 47 patients who were transplanted for HL. Tumors were classified as pT2 (25%), pT3 (73%), or pT4 (2%). HL was diagnosed incidentally in 10% of cases. A primary diagnosis of PSC was observed in 16% of patients. Overall median survival was 35.5 months. When in-hospital mortality (n = 12) was excluded, the median survival was 45.4 months, corresponding to 3- and 5-year survival rates of 42% and 31%, versus 31% and 22% when in-hospital mortality was included. HL recurred in 34% of cases. Three- and 5-year survivals for the 15 patients transplanted since 1998 was 57% and 48%, respectively. Median survival ranged from 20 to 42 months based on the time period (P = .014)., Conclusions: The acceptable overall survival, the improved results after careful patient selection since 1998, and the encouraging outcomes from recent studies all suggest that OLT may be a potential treatment for selected cases of HL. Prospective multicenter randomized studies with strict selection criteria and multimodal treatments seem necessary.

The MeduMobile project or Mobiler Campus Charité was started in the beginning of 2003 to evaluate new, multimedia supported teaching and learning scenarios. The project focuses especially on acute and rare diseases to which students usually have are very limited access. During the teaching sessions the MeduOnCall team and the academic teacher communicate with the students who are equipped with individual notebooks through a wireless net. In dermatology the MeduMobile project focused in summer 2003 and winter 2003/2004 on bedside teaching. Despite some technical difficulties in the beginning the project was well received by teachers and students. The possibility of simultaneous online searches by Internet as well as the possibility to include photographs depicting the course of the skin disease was felt to be one of the main advantages of this project. Based on these positive experiences an attempt will be made to integrate the project further into the regular teaching of the Charite.

Background: Intraoperative radiotherapy (IORT) represents an attractive method for local tumour control after surgical resection. IORT was introduced into multimodal treatment protocols in the 1980s. Aim of this study was to analyse the actual clinical and scientific activity of IORT in Germany., Methods: Questionnaires were sent to 102 centres in Germany. The analysis was focussed on indications in general surgery including bone tumours to evaluate the activity of IORT. The literature was analysed by a medline search for the years 1975 to 2001., Results: Questionnaires were answered by 92% of the centres. 24 departments are working with IORT in Germany (16 of them are university hospitals). Main Indications for IORT treatment are rectum carcinoma and soft tissue sarcoma. Furthermore, IORT is used in patients suffering from gastric, pancreatic and bile duct malignancies. Some IORT programs are also targeting on patients with head and neck malignancies and brain tumours. German institutions published within the last 5 years about 14% of all " Medline"-listed publications concerning IORT., Conclusion: There is an profound activity of IORT in Germany, which is concentrated on a few centres. A need for better national and international cooperation of centres performing IORT for clinical trials and to collect significant numbers of patients seems to be evident.