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This study evaluates the implementation of clinical references in undergraduate medical education. For this purpose, images of typical diagnostic, intraoperative and clinical findings were integrated into two different teaching formats and adapted to the learning objectives of the Institute of Anatomy in Leipzig. Paper based questionnaires were used to evaluate the status quo (without clinical images) and the optimal time of implementation, as well as the benefit for the students of human medicine. Three test groups were drawn from two preclinical semesters (2014 and 2015). The first group in 2014 represents the control group, which did not have any image-supported clinical references but only defined learning objectives regarding the five exams in special anatomy. Primary implementation took place in the dissection course (second semester) as automatically running Power Point presentations while secondary implementation was during one of the five clinical seminars within the fourth semester. All groups were asked to evaluate the pros and cons through a self-developed paper-based questionnaire. The analysis was performed employing Microsoft Excel and SPSS. It has been demonstrated that most of the students welcome and appreciate the implementation of appropriate images as a valuable support in understanding clinical references. On the contrary, the dissection course did not seem to be the right time for this implementation. In keeping with previous studies, the important role of anatomy in medical education was outlined. A close collaboration between preclinical and clinical physicians concerning educational matters was presented. Considering these approaches, high-quality and sustainable education can be provided. Better patient care and education of young academics should be the motivation., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Median survival time of nonresectable hilar bile duct cancer is only 4 to 6 months owing to tumor spread in the biliary tree, refractory cholestasis, and sepsis or liver failure. We explored whether local photodynamic therapy of nonresectable bile duct cancer could improve survival. A sample size of 23 patients is required to detect an increase in 6-month survival rate from less than 50% to greater than 70% in a single-arm phase-II trial with a statistical power of 80% (Fleming's single step procedure; alpha = 0.05). Twenty-three consecutive patients (8 women, 15 men; 67 +/- 14 years) with nonresectable bile duct cancer (Bismuth type III n = 2, type IV n = 21) were treated with photodynamic therapy and biliary endoprosthesis. Photofrin (QLT Pharmaceuticals, Vancouver, Canada) (2 mg/kg body weight intravenously) was photoactivated after 1 to 4 days with laser light (630 nm; 242 J/cm(2)) via endoscopic retrograde access. The 6-month survival rate was 91% after diagnosis and 74% after start of photodynamic therapy (30-day mortality rate was 4%) at a median follow-up time of 10.3 months after diagnosis. Causes of death were tumor progression (n = 9) and bacterial infections (n = 4). The median rate of local tumor response was 74%, 54%, 29%, and 67% after the first, second, third, fourth, and fifth photodynamic therapy. Time to progression ranged from 3 to 8 months. All patients, except 1 with diffuse liver metastases, improved in cholestasis, performance, and quality of life. Photodynamic therapy can prevent tumor occlusion of hilar bile ducts. The apparent benefit in survival time should be confirmed in a controlled trial versus palliation by endoprosthesis only.