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Zur Entscheidung, ob bei einer medizinischen Behandlung ein Behandlungsfehler vorliegen konnte, haben die Arztekammern in Deutschland ab den 1970er-Jahren Gutachterkommissionen eingerichtet. Betroffene Patienten konnen sich zur Beurteilung ihrer Behandlung kostenfrei an diese Stellen wenden. Ihre Krankenunterlagen mussen hierzu von den behandelnden Arzten zur Verfugung gestellt werden und werden hinsichtlich der Frage, ob ein Behandlungsfehler vorliegt, von einem fachkundigen Arzt begutachtet. Willigt der betroffene Arzt nicht in das Verfahren ein, kann in Nordrhein das Gutachten auch aufgrund von den vom Patienten zur Verfugung gestellten Unterlagen erfolgen. Gegen die Einschatzung des Gutachtens konnen in Nordrhein beide Seiten Widerspruch einlegen. Es erfolgt dann ein von einem Juristen und einem fachkundigen Arzt der Kommission gemeinsam erstelltes abschliesendes Gutachten. Etwa jeder dritte Vorwurf wird von der Gutachterkommission anerkannt, was sich auch fur die Verfahren gegen Gefaschirurgen zeigte.

Lean management and related ideas have had a significant impact on organizations throughout North America and the world. Despite its popularity and impact, I-O psychologists have largely neglected Lean as a research topic and few I-O psychologists engage in applied practice in the area. In this focal article, we provide a working definition of Lean and present examples of Lean’s influence. Next, we outline possible reasons to explain I-O psychologists’ indifference to Lean. Finally, we provide some topic areas that I-O psychologists can use to contribute to the Lean literature. By using I-O psychologists’ skill in measurement and evaluation, along with our considerable organizational theory, we believe that I-O psychology can improve Lean and broaden their impact. We hope this focal article will inspire I-O psychologists to reconsider a research and practice area that they have previously ignored. In addition, we hope that this article causes I-O psychologists to reflect on their role to play in addressing popular management trends.

Objectives/hypothesis Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications. Study design Literature review and expert opinion. Methods Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM. Results Over the years, two models of monitoring have become well-established: 1) monitoring by the surgeon using a stand-alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set-up and provide a basis for context-appropriate interpretation and troubleshooting of recorded signals. Conclusions We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations. Level of evidence 4 Laryngoscope, 131:S1-S42, 2021.

Einleitung: Die Riesenzellarteriitis (RZA) und Takayasu – Arteriitis (TAK) sind Großgefäßvaskulitiden (GGV), die zu schweren Komplikationen wie Erblindung, Organ- und Extremitätenischämien und bei einem Teil der Erkrankten zum Tod führen können. Glukokortikoid-assoziierte[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Rheumatologiekongress 2020, 48. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 34. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh)

The American Society of Neurophysiological Monitoring (ASNM) was founded in 1989 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, Technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. It remains the largest worldwide organization dedicated solely to the scientifically-based advancement of intraoperative neurophysiology. The primary goal of the ASNM is to assure the quality of patient care during procedures monitoring the nervous system. This goal is accomplished primarily through programs in education, advocacy of basic and clinical research, and publication of guidelines, among other endeavors. The ASNM is committed to the development of medically sound and clinically relevant guidelines for the performance of intraoperative neurophysiology. Guidelines are formulated based on exhaustive literature review, recruitment of expert opinion, and broad consensus among ASNM membership. Input is likewise sought from sister societies and related constituencies. Adherence to a literature-based, formalized process characterizes the construction of all ASNM guidelines. The guidelines covering the Professional Practice of intraoperative neurophysiological monitoring were initially published January 24th, 2013, and subsequently that document has undergone review and revision to accommodate broad inter- and intra-societal feedback. This current version of the ASNM Professional Practice Guideline was fully approved for publication according to ASNM bylaws on February 22nd, 2018, and thus overwrites and supersedes the initial guideline.

Purpose The purpose of this paper is to synthesize the accumulated body of research on Lean in higher education, draw conclusions to help guide successful Lean implementations and propose future research directions to establish a rich base of knowledge that informs both practice and research. Design/methodology/approach This literature review examines the academic literature regarding the use of Lean in higher education across 64 publications. EBSCO definitions were used to assess and present the synthesized results, which are detailed at the department/unit level and at the organizational level. Findings Overall, Lean appears to have significant and measurable value when used to improve academic and administrative operations in higher education. Such improvements are effective at the department/unit level or throughout the entire institution. However, implementing Lean within an institution is a serious undertaking that is most impactful if it involves long-term, strategic planning. Research limitations/implications The groundwork has been established for the development of conceptual frameworks to further guide Lean initiatives in higher education. Such frameworks, together with further integration of organizational development and change management literature will define best practices when implementing Lean locally and throughout the institution. Originality/value At the time of this writing, there has been no systematic review or integration of the published literature about Lean in higher education. This review provides a highly useful starting point for researchers interested in further developing theory about quality in academic institutions.

Purpose – The purpose of this paper is to discuss the importance of norms and inference, while providing national overall and subgroup norms for the updated Job Descriptive Index and Job in General measures of job satisfaction. Design/methodology/approach – A stratified random sample was drawn from an online panel to represent the US working population on key variables. Validity evidence is provided. Determination of subgroup norms was based on practical significance. Findings – The revised measures fit the theorized model and patterns of results are consistent with the literature. Practical subgroup differences were found for some stratification variables. Subgroup norms are made available; the first US overall norms are provided. Research limitations/implications – An updated job satisfaction measurement system is made available, complete with nationally representative overall and subgroup norms. A major limitation and direction for future research is the lack of norms for other nations. Practical implications – The revised measurement system is available for use in practice. National overall norms improve decision-makers’ ability to infer respondents’ relative standing and make comparisons across facets and employees. The JDI is useful for dimensional diagnostics and development efforts; the JIG is useful for evaluating overall job satisfaction levels. Social implications – By facilitating valid inferences of job satisfaction scores, the revised measurement system serves to enhance the quality of life at work. Originality/value – The authors provide the only publicly available job satisfaction measurement system that has US national overall norms.

Bergman and Jean (2016) compare published industrial and organizational (I-O) literature with labor statistics, demonstrating an underrepresentation of “workers” (i.e., “wage earners, laborers, first-line personnel, freelancers, contract workers”) relative to managerial, professional, and executive positions. They note that one of four ways in which worker underrepresentation undermines the utility of I-O psychology research is that we could miss the role of worker status as a main effect on important variables and/or a moderator of key relationships, which could hinder understanding of important phenomena as they relate to workers. We applaud the emphasis on workers and agree with this basic premise.

Bei der Planung von autologen distalen Rekonstruktionen wird eine Ultraschalluntersuchung der Stammvenen durchgefuhrt, um deren Eignung als Bypassmaterial zu bewerten. Ziel dieser Untersuchung war es, zu prufen, ob bei durchgefuhrter CT-Angiographie auf eine Ultraschalluntersuchung der V. saphena magna (VSM) zur Bestimmung als geeignetes autologes Transplantat verzichtet werden kann. An der Studie nahmen 33 Patienten mit arteriellen femoropoplitealen Verschlussen teil. Bei allen Patienten wurde eine CTA mit der Darstellung von arteriellem und venosem Blutstrom durchgefuhrt, hierbei wurden die morphologischen VSM-Veranderungen und deren Durchmesser auf drei Oberschenkelebenen gemessen. Die Ergebnisse der CTA wurden mit den Ergebnissen der Ultraschalluntersuchung verglichen. Nur an 36 (56,2 %) Beinen konnte die VSM als geeignet fur die autologe Rekonstruktion angesehen werden. Aufgrund einer Kombination von verschiedenen Veranderungen hatten 9 (27,3 %) Patienten keine geeigneten Venen an beiden Beinen. Zu beobachten war auch eine strenge Korrelation zwischen CTA und Ultraschalldaten hinsichtlich des VSM-Durchmessers auf drei Oberschenkelebenen (r [95 % CI] = 0,74065; [0,51–0,98]). Die Sensitivitat und Spezifitat der СTA bei der Messung des Durchmessers der VSM (groser als 3 mm) fur den gesamten Oberschenkel betrugen 97,8 und 40 %. Die ROC-Kurve bestatigte einen VSM-Durchmesser von 3,7 mm als geeigneten Schnittpunkt fur eine sichere Verwendung des autologen Transplantats zur arteriellen Rekonstruktion (AUC [95 % CI] = 0,805 (p

An analysis was conducted of intermediate outcomes and possible influencing factors in patients with end-stage renal disease (ESRD) and critical limb ischemia after lower limb revascularization compared with patients with regular renal function (non-ESRD).Data collection was performed by inquiry of the German multicenter registry of First-Line Treatments in Patients with Critical Limb Ischemia (CRITISCH); 102 ESRD patients and 674 non-ESRD patients were included. Four different therapy modalities were analysed: bypass surgery, endovascular therapy (EVT), femoral artery endarterectomy, and no vascular intervention (conservative treatment or primary major amputation). Predefined end points were amputation-free survival (AFS), death, major amputation, and reintervention. Cox regression models were built to analyze independent risk factors for outcome parameters.ESRD patients showed inferior results at 2 years in the rate of AFS (ESRD, 35.4%; non-ESRD, 67.2%; P .001). Similarly, death rate (ESRD, 55.0%; non-ESRD, 20.7%; P .001) and major amputation rate (ESRD, 24.5%; non-ESRD, 15.8%; P = .029) were significantly elevated for ESRD patients. The choice of therapeutic approach in ESRD did not influence the incidence of the investigated end points (death or major amputation: EVT, 56.9% vs bypass, 76.9% [P = .225]; death: EVT, 46.2% vs bypass, 61.5% [P = .372]; amputation: EVT, 15.4% vs bypass, 15.4% [P = 1.000]; reintervention: EVT, 32.3% vs bypass, 15.4% [P = .324]). Cox regression analysis indicated that dialysis patients carry a twofold increased hazard of death or major amputation (hazard ratio, 2.27; 95% confidence interval, 1.67-3.10; P .001), and open surgical treatment (all patients combined) was associated with reduced risk of death compared with EVT (hazard ratio, 0.58; 95% confidence interval, 0.37-0.91; P = .017). Comorbidities were not found to have a noticeable impact on AFS, survival, reintervention, or major amputation.Two-year AFS, overall survival, and freedom from major amputation were decreased in ESRD patients compared with non-ESRD patients with critical limb ischemia. Cardiovascular comorbidities were without significant impact on outcome parameters, whereas choice of treatment modality within the ESRD group did not influence AFS. Decision-making in ESRD as to choice of therapeutic approach in dialysis patients should notably account for the individual's lesion characteristics and vascular disease; surgical revascularization and EVT may be used as complementary options.

Secondary prevention in patients with critical limb ischemia (CLI) is crucial for the reduction of cardiovascular morbidity and mortality. Nonetheless, current recommendations are extrapolated from other high-risk populations because of the lack of CLI-dedicated trials. The aim of this explorative study was to evaluate the association of statin therapy with the outcomes of CLI patients.The First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) registry is a prospective multicenter registry analyzing the effectiveness of all available treatment strategies in 1200 CLI patients. For the purposes of this analysis, patients were divided into two groups based on statin administration. Treatment crossovers and nonadherent patients were excluded from analysis. The primary composite end point of this study was the amputation-free survival (AFS). Major adverse cardiovascular and cerebral events (MACCEs), time to death, and time to major amputation were also analyzed.Statin therapy was applied in 445 individuals (37%), 371 (31%) patients received no statins, and 384 subjects were excluded from analysis (treatment crossovers). Patients receiving statins were more likely to be younger (P .001) and to have a history of coronary heart disease (P .001) or previous intervention at index limb (P .001). Patients receiving statin therapy had a lower hazard regarding AFS (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.34-0.63; P .001) and death (HR, 0.40; 95% CI, 0.24-0.66; P .001) as well as lower odds of MACCE (odds ratio, 0.41; 95% CI, 0.23-0.69; P = .001). However, statin therapy was not associated with reduced amputation rates (HR, 1.02; 95% CI, 0.67-1.56; P = .922). Statin effect on AFS was consistent among diabetics (HR, 0.47; 95% CI, 0.31-0.70; P .001), patients with chronic kidney disease (HR, 0.53; 95% CI, 0.32-0.87; P = .012), and patients older than 75 years (HR, 0.40; 95% CI, 0.26-0.60; P .001). Statin administration was also associated with an improved AFS in patients with antiplatelet medication (HR, 0.64; 95% CI, 0.41-0.99; P = .049) and without antiplatelet medication (HR, 0.26; 95% CI, 0.12-0.57; P = .001) and after both endovascular therapy (HR, 0.51; 95% CI, 0.34-0.76; P = .001) and bypass revascularization (HR, 0.38; 95% CI, 0.21-0.68; P = .001).Statin therapy in CLI patients is associated with an increased AFS and lower rates of mortality and MACCEs without improving, however, the salvage rates of the affected limb.

Hintergrund Das Wilkie-Syndrom, auch A.-mesenterica-superior-Syndrom oder Duodenumkompressionssyndrom genannt, ist selten. Charakteristisch ist eine Kompression des dritten Abschnitts des Duodenums durch den engen Abgangswinkel der A. mesenterica superior (AMS). Symptome sind Ubelkeit, Erbrechen, Vollegefuhl, Gewichtsverlust mit nachfolgender Kachexie und postprandiale Bauchschmerzen. Die gewohnliche chirurgische Therapie ist eine Gastro-/Duodenojejunostomie oder eine Y-Roux-Rekonstruktion, um die normale Darmpassage herzustellen.

Zur Verhinderung einer Lungenembolie bei tiefer Venenthrombose gilt die Antikoagulation als Verfahren der Wahl. Cava-Filter werden insbesondere in den USA vermehrt bei multiplen Indikationen eingesetzt. Die Evidenz, die einen solchen Einsatz rechtfertigen wurde, ist leider gering. In dieser Ubersicht wird die aktuelle Literatur bezuglich der moglichen Indikationen dargestellt.

Organizational diagnosis plays a critical role in organizational change initiatives in terms of both choosing appropriate interventions and contributing to readiness-to-change within an organization. Although numerous authors identify diagnosis as an integral component of the change process and many have recommended specific theories and models that should be used in diagnosis, little attention has been given to the diagnostic process itself. The lack of rigour in the diagnostic process and the misdiagnoses that follow are likely to be significant factors in the high failure rate of change initiatives reported in the literature. This article reviews evidence-based diagnosis in engineering and medicine, summarizes the basic steps found in those diagnostic processes, identifies three cause–effect relationships that underlie evidence-based diagnosis, and suggests four spheres of knowledge that must intersect to guide the diagnostic process. Based upon that review, an evidence-based approach is proposed for o...

Chirurgische und interventionelle Behandlungen von Karotisstenosen sind haufig. Die Risiken sind durch zahlreiche Studien gut definiert. Wie oft kommt es zu Fehlern bei der Behandlung? Behandlungsfehlervorwurfe bei Operationen und Interventionen an der A. carotis wurden anhand von Unterlagen der Jahre 2006 bis 2010 bundesweit ausgewertet. Als Grundlage dienten Verfahren vor der Gutachterkommission bei der Arztekammer Nordrhein, die mit allen Aktenunterlagen bewertet werden konnten. Hinzu kamen Verfahren bei Gutachterkommissionen und Schlichtungsstellen aller Arztekammern der Bundesrepublik sowie auch Falle, die den Autoren von Gerichten zur Begutachtung vorgelegt wurden. Erstaunlich ist die insgesamt geringe Zahl an vorgelegten Komplikationen bezogen auf die grose Zahl anzunehmender gefaschirurgischer oder interventioneller Eingriffe mit einem angenommenen Komplikationsdurchschnitt von 3%. Bei 25.000 Eingriffen pro Jahr (das sind mehr als 100.000 im ausgewerteten Zeitraum) wurde nur in etwa 100 Fallen ein Behandlungsfehlervorwurf vorgebracht. Die geringe Anzahl anerkannter Behandlungsfehler (nur in jedem 10. Fall) lasst zum einen den Schluss auf eine gute Qualitat der Eingriffe in Deutschland zu. Auch die Aufklarung wird besonders ernst genommen, wenn es um Eingriffe an der Halsschlagader geht. Dennoch darf in Kenntnis der umfangreichen Aktenlage kritisch hinterfragt werden, ob die Indikationsstellung stets den in Studien ermittelten und als Vorgabe fur einen Qualitatsstandard gultigen Kriterien entspricht, oder ob nicht manchmal eher groszugig mit der Indikationsstellung zur chirurgischen und interventionellen Therapie umgegangen wird.

Goal was to engineer biological, arterial grafts with antithrombotic, autologous endothelial luminal surface combined with extraluminal smooth vascular muscle layer (VSMC) and to test in vivo. (1) Different decellularisation methods described in literature were compared to identify the most suitable one with focus on the preservation of extracellular fibre matrix. (2) Endothelial precursor cells (EPC), isolated from bone marrow and VSMC from small venous segments of donor animals were cultivated. Cells were seeded sandwich-like on homologous decellularized venous scaffolds and conditioned under pulsatile circulation in a bioreactor. (3) The semiautologous grafts were implanted in carotidal position on both sides in five Beagle dogs (n = 10; group 2) as interposition. A group of five animals, receiving only acellular grafts in both carotid positions (n = 10; group 1) served as controls. Comparison of four in literature described decellularisation methods showed different preservation of elastic and collagen fibres compared with native veins, whereas decellularity was similar in all methods. This forced us to choose a decellularization protocol with the best preservation of the extracellular matrix. The in vivo experiments showed in group 1 (control) already after one week a complete thrombotic occlusion of the decellularized implants, whereas in group 2 9/10 semiautologous grafts were patent after 98 ± 4 days in ultrasound, angiography and histology (p = 0.0001). A complete incorporation of semiautologous grafts in the surrounding tissue could be shown. The seeding with two different cell types preserved an aneurysmatic degeneration under arterial conditions with patency without anticoagulation.

Objectifs Nous avons voulu etudier l'effet des comorbidites, de l'âge, et du sexe sur les resultats apres revascularisation chirurgicale au-dessous du genou pour ischemie chronique critique de membre. Methodes Il s’agit d’une etude retrospective de 624 patients consecutifs qui ont eu un pontage au-dessous du genou entre janvier 1996 et decembre 2005 pour maladie arterielle peripherique chronique (MAP). Les caracteristiques des patients etaient : diabete (D) n = 445 (71%), maladie coronarienne (MC) n = 310 (49%), insuffisance renale sous dialyse (IRd) n = 88 (14%), âge >70 ans n = 279 (44%), hommes n = 423 (68%), stade III de Fontaine de MAP n = 105 (17%), et stade 4 de MAP n = 519 (83%). Tous les patients avaient des lesions Trans Atlantic Inter-Society Consensus (TASC) C et D, tous ont ete traites avec un pontage veineux sur une artere crurale n = 354 (57%) et a une artere de jambe n = 270 (43%). Une analyse de Kaplan-Meier et une analyse multivariee ont ete faites. Resultats Les resultats precoces etaient comme suit. Le taux d'amputation majeure a 30 jours etait n = 43 (7%). La MC, l’IRd, l'âge, et le sexe n'influencaient pas le taux d'amputation majeure, alors que les patients ayant un diabete avaient un risque moindre d'amputation precoce que ceux sans diabete. (rapport de risque : 0,49, intervalle de confiance a 95% : 0,25-0,95, p n = 31 (5%) et n’etait pas influence par le D, la MC, et le sexe. Les patients ayant une IRd et les octogenaires avaient un haut risque de deces precoce (IRd : 13,6%, octogenaires 9,4%). Les resultats tardifs etaient comme suit. Les taux de suivi etaient : sauvetage de membre n = 596 (95,5%) et survie n = 622 (99,7%). Les taux de sauvetage de membre a 1, 3, et 5 ans etaient 79,1%, 72,1%, et 66,4%, respectivement, et n’etaient pas influences par le D, la MC, l’IRd, l'âge, et le sexe. Les taux de mortalite a 1, 3, et 5 ans etaient 79%, 63,4%, et 47,3%, respectivement. Les comorbidites telles que la MC, l’IRd, et l'âge >70 ans reduisaient de maniere significative l'esperance de vie. Le D n’influencait pas la survie a 1, 3 et 5 ans. Les taux de survie de cinq ans comme prevus par analyse de Kaplan-Meier apres revascularisation etaient : D, 46% ; MC, 38% ; IRd, 19% ; et âge >70 ans, 37%. Conclusion L'âge avance et les comorbidites reduisent l’esperance de vie mais pas la possibilite d'eviter une amputation majeure apres pontage au-dessous du genou pour ischemie critique de membre.

Die Arteriosklerose manifestiert sich systemisch u. a. als periphere arterielle Verschlusskrankheit (PAVK). Bei einem PAVK-Patienten liegt daher sehr wahrscheinlich auch eine Arteriosklerose der Herzkranzgefase, der Karotiden, der Aorta und der Nierenarterien vor. Fur die Prognose des Patienten sind diese Manifestationen der Arteriosklerose entscheidend, denn PAVK-Patienten tragen hohe Risiken – einerseits dafur, an ihrer kardiovaskularen Komorbiditat zu versterben, und zum anderen fur eine notwendige Amputation der betroffenen Extremitat. Als traditionelle oder konventionelle Risikofaktoren gelten Rauchen, Diabetes mellitus, Dyslipidamie und Hypertonie. Ein evidenzbasiertes Konzept zur Sekundarprophylaxe nach peripheren Interventionen bzw. Operationen existiert nicht. Neben der optimalen Einstellung der Risikofaktoren muss fur jeden einzelnen Patienten das Risiko-Nutzen-Verhaltnis der Antiaggregation und Antikoagulation abgewogen werden. Initial ist nach Katheterinterventionen eine kurzfristige duale Antiaggregation vertretbar und wird weltweit nahezu regelhaft angewandt, obwohl eine Evidenz fur diese Masnahme fehlt. Bei Patienten, die langfristig einer oralen Antikoagulation mit Vitamin-K-Antagonisten (VKA) bedurfen, ist eine dauerhafte kombinierte Gabe von VKA und Antiaggreganzien wegen des erhohten Blutungsrisikos kritisch zu sehen. Hier ist im Einzelfall zugunsten der VKA auf die positiven Effekte der Antiaggregation zu verzichten. Die einzige Substanz, die zusatzlich zur Antiaggregation im peripheren Gefasgebiet einen positiven Effekt auf die Offenheitsrate hat, ist Cilostazol.

Ziel Ziel der Studie war die Untersuchung der Carboanhydrase IX (CA IX), somatosensorisch evozierter Potenziale (SSEP) und ihrer Kombination zur Erkennung und zum Verstandnis ungunstiger neurologischer Verlaufe nach Operation (Op.) eines thorakoabdominalen Aortenaneurysmas (TAAA). Im Blick standen insbesondere die verzogerte Paraplegie und eine mogliche Vorhersage mittels Untersuchung des zerebrospinalen Liquors.

BACKGROUND: Coral reef aorta (CRA) is described as rock-hard calcifications in the visceral part of the aorta. These heavily calcified plaques grow into the lumen and can cause significant stenoses, leading to malperfusion of the lower limbs, vis-ceral ischaemia or hypertension due to renal ischaemia. PATIENTS / METHODS: From 1 / 1984 to 11 / 2008, 80 patients (26 m, 54 f, mean age 61.6, range 14 to 86 years) underwent treatment in the Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine-University Hospital for CRA. The present study is based on a review of -patient records and prospective follow-up in our outpatient clinic. RESULTS: The most frequent finding was renovascular hypertension (n = 33, 41.3 %) causing head-ache, vertigo and visual symptoms. Intermittent claudication due to peripheral arterial occlusive disease was found in 35 cases (43.8 %). 15 patients (18.8 %) presented with chronic visceral ischaemia causing diarrhoea, weight loss and abdominal pain. 79 patients (98.7 %) underwent surgery; in 73 (93.7 %) aortic reconstruction was achieved with thromboendarterectomy, on an isolated suprarenal segment in 7 (9.3 %), an infrarenal segment in 21 (26.6 %), and the supra- and infrarenal aorta in 45 cases (60 %). Desobliteration of renal arteries was performed in 47 (one-sided n = 8, 10.1 %; both arteries n = 39, 49.4 %); the aortic -bifurcation was desobliterated in 37 (46.8 %), extension into iliac arteries was necessary in 29 cases (one-sided n = 4, 5.1 %; both arteries n = 25, 31.6 %). The coeliac trunk was desobliterated in 43 % (n = 34), the superior mesenteric artery in 44.3 % (n = 35) and the inferior mesenteric artery in 20.3 % (n = 16). In 15 cases additional revascu-lar-isation (bypass, transposition, graft interposi-tion) was necessary. Surgical access was via a left-sided thoracoabdominal incision in 56.4 % (n = 45) and via laparotomy in 41.8 % (n = 33). The 30-day lethality was 8.7 % (n = 7). Postoperative complications requiring correc-tive surgery occurred in 11 patients (13.9 %). Almost 1/3 of the -patients (n = 19, 27.5 %) returned for follow-up after a mean of 52.6 months (range 3 to 215 months). Of these, there was sig-nificant clinical and diagnostic improvement in 16 (84.2 %) and 3 (15.8 %) were unchanged. Impairment was not observed. CONCLUSION: In spite of the existing and improving surgical techniques for the treatment of CRA, procedures are challenging and should be performed in centres with expertise.

BACKGROUND: Patients with inflammatory bowel diseases (IBD) experience various bodily and psychosocial impairments. We report data from a recent German questionnaire survey. METHODS: The cross-sectional study was conducted in 2005 as a postal survey in three regions in West (Kiel and Luebeck, Regensburg) and East (Halle/Saale) Germany. Patients with Crohn’s disease and ulcerative colitis (CD, UC) were recruited from specialized gastroenterological practices, university outpatient clinics, and the registry of a prominent patient organization (DCCV). The questionnaire followed the concept and distinctions of WHO’s ICF and incorporated (inter-)nationally established items and scales (i. a. HADS). RESULTS: Survey responders (n = 1083, CD: 58 %, 65 % female) had a mean age of 42 years with an average disease duration of 13 years. 25 % suffered severely or very severely from their disease in general, one third stated at least severe fatigue, and 52 % felt profoundly affected by stress. A clinically relevant anxiety was observed in 24 % with no relevant difference between males and females. Depression was more common in men (29 %) than in women (21 %). Restrictions in social participation (family life, work) were actually prominent in at least a quarter of the responders. CONCLUSIONS: Beside somatic ailments typical for the disease, patients also reported multiple psychosocial impairments and participation restrictions and should hence profit from a multi- and interdisciplinary team care.

The acceptance of a living donor kidney bearing cysts might implicate complications after the transplantation due to the natural history of renal cysts. We have presented our experience with transplantation of living donor kidneys containing cysts but not polycystic disease.We retrospectively reviewed donor and recipient records of all living kidney transplants performed between January 1997 and April 2008. We analyzed serum creatinine and urea levels, as well as ultrasound scans concerning cyst size and morphology at hospital discharge as well as at 12 and 24 months after transplantation.Among 268 living kidney transplantations, we noted 25 donors with renal cysts. In the computed tomography scan reports, 19 kidneys were described to show a single and six, multiple cysts. The size of 10 single cysts was5 mm; the other nine were a mean of 17.33 mm. Two of the multiple cyst kidneys had lesions5 mm; in four kidneys, the mean cyst size was 27.25 mm. The renal function of the recipients was normal or almost normal at discharge with a tendency to lower levels at 12 and 24 months after transplantation. Ultrasound revealed changes in cyst diameter among 6/23 kidneys; the mean diameter increased after 12 months, namely, 8.25 mm to 11.5 mm after 24 months. The subgroup of patients with enlarged cysts showed creatinine and urea levels slightly higher than in the entire group. No aspects of malignancy were found, according to the Bosniak and Israel classification system. One suspicious cyst was tomographically confirmed to be hemorrhagic without any need for treatment. None of the living donors had any problems related to the donor nephrectomy or a need for dialysis due to renal insufficiency in the long term. In addition, the living donors who had even beforehand cystic lesions in their contralateral nonremoved kidney at the time of transplantation did not show complications upon follow-up.In our study, 25 living donor kidneys carried cysts. Neither cyst-related complications nor dysfunction of the transplanted organs occurred. An unroofing or excision of the cyst was generally not necessary. Regular ultrasound scans and optional computed tomography scans are recommended for follow-up. Based on this experience, we concluded that kidneys presenting cystic diseases should be considered to be suitable for transplantation without a hazard to the recipients, thus extending the pool of organs.